RESUMO
AIM: To assess safety of rectum removal with distal sacral resection. MATERIAL AND METHODS: The short-term results of surgical treatment of primary and recurrent locally advanced rectal and anal cancer with sacral fixation have been analyzed. 32 patients underwent combined operations with sacral resection at the level of S2-S5. In 12 patients only one point of tumor fixation (F1) was revealed, 10 patients had two points of fixation (F2), three patients had three fixation points (F3) and in 7 cases the tumor was fixed to four points (F4) of fixation to different pelvic structures. RESULTS AND DISCUSSION: Mean intraoperative blood loss and surgery time was 551±81 ml and 320±20 min in cases of sacral fixation only that was significantly lower compared with F2 cases - 1278±551 ml and 433±45 min, F3 cases - 2200±600 ml and 620±88 min, F4 cases - 2157±512.5 ml and 519±52,3 min, respectively (Ñ<0.05). Complications requiring surgical intervention occurred in 9% patients (n=3). Among 23 patients with intact bladder and ureters urinary disorders occurred in 42% (n=10). Resection margin was negative along posterior surface of the specimen in all cases. CONCLUSION: Advanced surgery with distal sacral resection is advisable for radical removal of locally advanced and recurrent rectal and anal canal cancer fixed to the sacrum with negative resection margin. These operations are feasible in specialized centers and should be performed by specially trained oncological or colorectal surgeon.
Assuntos
Adenocarcinoma , Neoplasias do Ânus , Procedimentos Cirúrgicos do Sistema Digestório , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Neoplasias Retais , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias do Ânus/patologia , Neoplasias do Ânus/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Federação Russa , Sacro/patologia , Sacro/cirurgiaAssuntos
Vírus da Influenza A/imunologia , Vírus da Influenza B/imunologia , Vacinas contra Influenza/efeitos adversos , Administração Intranasal , Adolescente , Adulto , Anticorpos Antivirais/sangue , Especificidade de Anticorpos , Humanos , Imunoglobulina A Secretora/sangue , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/imunologia , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/efeitos adversos , Vacinas Combinadas/imunologia , Vacinas de Produtos Inativados/administração & dosagem , Vacinas de Produtos Inativados/efeitos adversos , Vacinas de Produtos Inativados/imunologiaRESUMO
Vaccination activity and safety of inactivated influenza centrifugal divaccine have been studied in groups of subjects aged 18 to 22, 15 to 16, and 9 to 14 years. The vaccine tested contained either a standard dose (6-8 micrograms) or double a dose (12-16 micrograms) of the haemagglutinin (HA) of influenza viruses A(H1N1) and A(H3N2). The double antigenic load of the vaccine did not enhance its reactogenicity for adults or adolescents aged 15 to 16 years. It enhanced, however, the production of antihaemagglutinine antibodies to the vaccine strains. The range of the antibodies formed and their persistence were independent on the virus dose. The increased dose (12-16 micrograms) of HA decreased the humoral immune response in school children aged from 11 to 14 years. Neither standard nor double dose of the vaccine caused any changes in the biochemical or haematological parameters of blood and urine. No allergic response was registered by the indirect mast cell degranulation (IMCD) test in rats.
