Bone fracture in breast cancer patients with isolated bone metastasis.

AIM: To analyse the incidence of bone fracture of breast cancer patients with isolated bone metastasis and its effect on survival. We tried to find an answer to the question of "Can the development of bone fracture be predicted?" METHODS: Between 1993-2006, 139 breast cancer patients with isolated bone metastasis were examined. Patients were divided into two groups depending on the development of pathologic bone fracture. RESULTS: Fractures were developed in 41 patients (29.5%)within 41 months of follow-up. The locations of pathologic bone fracture were vertebral fracture in 26 patients (63.4%),femur fracture in 11 patients (26.8%), and hip fracture in four patients (9.8%). Fracture rates in hormone sensitive and resistant patients were 31.2% and 14.3%, respectively. The fracture rates in 13 triple negative and non triple negative patients were 7.7% and 31.4%, respectively (p=0.07). High CA 15-3 levels at the time of metastasis in patients with and without fractures were 68.4% and 61.1%, respectively. The risk for fracture was also high in Her2-neu positive patients (38.7% vs. 26.5%). While the incidence of fracture with the presence of one factor mentioned above was 22.2%, it was increased to 36.1% in the presence of two or three factors(p=0.13). Median survivals of the patients with and without fractures were 48 and 39 months, respectively (p= 0.65). CONCLUSION: Hormone sensitivity, high CA 15-3 levels and positive Her2-neu status are slight risk factors for bone fractures. Survival was not different in patients with or without bone fractures.

[Influence of the Mother on the Behavior of Young Rabbits during the Prepubertal Period].

In this study, we investigate the influence of a mother on the behavior of young rabbits during the prepubertal period. It is shown that the presence ofthe mother affects the ratio of types of activity in offspring and the mother can demonstrate behavioral patterns to suppress aggressive behavior in offspring. It was found that rabbits in the prepubertal period continue to have active contact with their mother and make successful attempts at sucking. It was noted that, in terms of percentage, both in the frequency and duration of different forms of activity among rabbits from one to three months of age, a neutral socially oriented and feeding behavior appear to be predominant. There were significant differences in the frequency of the socially oriented behavior and the duration of feeding behavior in young rabbits, who grew up with their mother and without her.

In which cases surgical gastrostomy and jejunostomy techniques are inevitable?

PURPOSE: This study investigated the surgical gastrostomy and jejunostomy procedures in cancer patients who needed nutritional support and endoscopy was unattainable. METHODS: Operation time and procedure, anesthesia and tube types, procedure-specific and surgical complications, and tube replacement at the follow up period were retrospectively analyzed. RESULTS: 109 patients (44 female, 65 male, mean age 50.9 years, range 14-87) were subjected to surgical gastrostomy/ jejunostomy. Ninety-three (85.4%) patients had head-neck and gastrointestinal cancers. In 94 (86.2%) patients endoscopy was impossible due to obstruction of the esophagus and stomach. Gastrostomy/jejunostomy was combined with other surgical procedures in 12 (11 %) patients. Procedure- related complications occurred in 22 (20.7%) patients. Early 30-day mortality occurred in 12 (11 %) cases. The median follow up period was 3.6 months (range 0-18). CONCLUSION: Obstructing cancer, obesity or previous laparotomy make the use of endoscopic techniques impossible. For these patients, surgical gastrostomy/jejunostomy is safe with acceptable complication rates and improves the treatment outcomes with nutritional support.

Characteristics and risk factors for colorectal cancer recurrence.

PURPOSE: To evaluate the characteristics of recurrence and examine the clinicopathological factors related to disease- free (DFS) and overall survival (OS) of patients with colorectal cancer (CRC) recurrence. METHODS: One hundred and sixteen CRC patients with stage II and III disease that had been resected curatively in our clinic between 1999 and 2006 were retrospectively evaluated. The parameters evaluated were gender, age, preoperative CEA levels, tumor localisation, duration of surgery, the units of perioperative blood transfusion, tumor differentiation, TNM stages and adjuvant therapies. The presence of preoperative intestinal obstruction, radical abdominopelvic lymph node (RAPL) dissection and lymphatic, vascular and perineural invasion were also evaluated. RESULTS: With 36.6+/-2 months follow-up, 49 (42%) patients developed local recurrence and/or distant metastases. Twenty-three (19.8%) patients presented with isolated local recurrence. Thirteen of 49 patients with local recurrence were successfully operated with R0 curative resection. The OS survival rates for those with curatively and palliatively resected recurrences were 29 and 19 months, respectively. In multivariate analysis, the factors related to DFS were tumor localisation and differentiation, neurovascular invasion, blood transfusion and RAPL dissection. Among these factors, only RAPL dissection was not statistically significant for OS. CONCLUSION: The factors increasing local recurrence rates of CRC should be clearly described. Local and systemic treatment modalities, like preoperative chemoradiotherapy should be planned for patients carrying these risk factors.

[Suppressive effect of recombinant immunomodulator ronkoleukin on the blood level of antiinflammatory cytokines, anticardiolipin autoantibodies and heart failure].

AIM: To elucidate clinical efficacy and immunocorrecting properties of recombinant immunomodulator ronkoleukin in patients with postinfarction cardiac dysfunction with NYHA FC II-III CHF. MATERIAL AND METHODS: In a 6-months prospective comparative clinically controlled study we observed 33 survivors of myocardial infarction divided into 2 groups according to FC of chronic heart failure (CHF): group I (n=17) with FC II CHF with LVEF > 45% (mean age 52 +/- 2.9 years) and group II (n=16) with FC III CHF and lowered ( 40%) LVEF (mean age 53.7 +/- 3.3 years). Comparison group comprised practically healthy subjects. Clinico-laboratory and functional assessment of state of patients was carried out before initiation of therapy with ronkoleukin and in 2 - 3 days after completion of 2 courses of therapy with 3 months interval. Immunological study included determination of subpopulation content of peripheral blood lymphocytes, blood plasma immunoglobulins, antiinflammatory cytokines Il-1a, Il-1b, Il-2, Il-6, Il-8, TNFa and AB to Cl. RESULTS: It was found that ronkoleukin is an effective immunocorrector producing no adverse effects in patients with FC II-III CHF. Most pronounced effect ronkoleukin manifested in relation to humoral immunity lowering dysimmunoglobulinemia, blood levels of IgA, IgG, CIC and antibodies to cardiolipin, inhibiting excessive cytokine activation in dependence on degree of severity of CHF. CONCLUSION: Administration of ronkoleukin to patients with postinfarction dysfunction of the heart with FC II-III CHF for correction of secondary immunodeficient state in addition to basic therapy provides positive changes of hematological, immunological parameters, intracardiac hemodynamics, facilitates regression of symptoms of CHF and improves quality of life.

[Clinicoimmunological disorders in patients with postinfarction left ventricular remodeling and chronic cardiac failure].

AIM: To characterize clinical and immune disorders in patients with ischemic heart disease (IHD), postinfarction left ventricular remodeling (PLVR), clinical manifestations of chronic cardiac failure (CCF). MATERIAL AND METHODS: A comparative clinical controlled trial of immune system was made. The immune system was assessed by diagnostic and prognostic significance of changes in population composition of T- and B-lymphocytes, by activation of proinflammatory cytokines (IL-1alpha, IL-2, IL-6, IL-8, Inf-alpha, TNF-alpha); high expression of circulating immune complexes (CIC), autoimmune complexes to cardiolipin (CL) in 94 CCF patients with PLVR. The patients were divided into 3 groups according to severity of CCF. Group 1 consisted of 32 patients with CCF (FCII by NYHA) and normal ejection fraction (EF) of the left ventricle (52.0 +/- 2.8%). Group 2--31 CCF (FCIII) patients with decreased EF (by 43.8%) (36 +/- 4.3%). Group 3--31 CCF (FCIV) patients with low (25 +/- 3.8%) EF of the left ventricle. The protocol required conduction of echocardiographic parameters, paired bicycle exercise tests, 6-min walk tests, 24-h ECG monitoring, population cell composition of T- and B-lymphocytes, concentrations of cytokines, IgG and IgG autoantibodies to CL. RESULTS: A dominating hyperactivation of cytokines TNFalpha, IL-1alpha, IL-2, IL-6 with high expression of CIC and autoAB to CL was associated with moderate or severe CCF (FCII-IV by NYHA), declined inotropic function of the left ventricle (EF 38-23%), low exercise tolerance and remodeling of the left ventricle. CONCLUSION: Immune disorders in the form of hyperactivation of proinflammatory cytokines (most of all TNFalpha, IL-1alpha, IL-2, IL-6), enhanced expression of CIC and autoAB to CL growing with severity of CCF and abnormal heart pump function play an important role in CCF pathogenesis in IHD patients with LCPR and can be markers of the disease progression.

Locally advanced breast carcinoma treated with neoadjuvant chemotherapy: are the changes in serum levels of YKL-40, MMP-2 and MMP-9 correlated with tumor response?

Serum levels of YKL-40, MMP-2 and MMP-9 in 27 patients with locally advanced breast carcinoma received neoadjuvant chemotherapy were measured. All patients underwent neoadjuvant chemotherapy named as FAC protocol (5-Fluorouracil, Doxorubicin and Cyclophosphamide) with 21 days interval. There was 26,7% decrease in mean serum YKL-40 levels (from 146,4 microg/ml to 107,3 microg/ml) in clinically responsive group. This level was almost unchanged in non-responsive group (P>0, 05). There was 42, 1% decrease in mean serum YKL-40 levels (from 173,1 microg/ml to 98, 8 microg/ml) in pathologically responsive group. This decrease was more dramatic in patients with complete pathological response (70, 2%). However, this level was slightly increased in non-responsive group. Changes in serum levels of MMP-2 and MMP-9 were not found to be associated with tumor response. Serum measurement of YKL-40 can be a helpful tool to predict pathological tumor response in breast cancer patients with neoadjuvant chemotherapy but not MMP-2 and MMP-9.

[Effect of carvedilol on blood levels of cytokines and symptoms of heart failure in patients with postinfarction cardiac dysfunction.]. / Moduliruiushchee vliianie karvedilola na aktivatsiiu tsitokinov i regress serdechnoi nedostatochnosti u bol'nykh s postinfarktnoi disfunktsiei serdtsa.

Effect of 6 months treatment with carvedilol (25 mg/day) on blood levels of cytokines (interleukins 1alpha, 2, 6, 8, tumor necrosis factor alpha) and clinical symptoms of heart failure was studied in patients with cardiac dysfunction after myocardial infarction. Patients with NYHA class II heart failure, ejection fraction 50% and moderately lowered tolerance to physical exercise (n=21) initially had enhanced cytokine expression: blood content of interleukin (IL) 2 was 2.8 times, tumor necrosis factor (TNFalpha) 78%, IL-1alpha 60% above normal level. Therapy with carvedilol in this group was associated with decreases of Il-2 (-23.8%), TNFalpha (-16.7%), IL-1alpha (-12.5%) (p<0.05-0.01). This was accompanied by alleviation of clinical symptoms and improved exercise tolerance. Patients with NYHA class III heart failure (n=16) with low left ventricular ejection fraction (30+/-2.7%) and low exercise tolerance had high levels of all studied cytokines. Levels of IL-2, TNFalpha and IL-1alpha were most elevated (3.1, 2.8 and 2 times higher than normal values, respectively). Therapy with carvedilol was associated with improvement of clinical symptoms and exercise tolerance (+35%, p<0.05)), increase of ejection fraction (+15%, p<0.05), decrease of left ventricular end systolic volume (-17.5%, p<0.05), and lowering of blood levels of TNFalpha (-31%), IL-2 (-17.4%), IL-1alpha (-15.6%). However cytokine levels remained substantially elevated compared with normal values. Carvedilol was well tolerated, and did not cause negative metabolic effects or other complications.

[A role of activation of proinflammatory cytokines and production of autoimmune complexes in the pathogenesis of chronic heart failure in patients with postinfarct cardiac dysfunction]. / Rol' aktivatsii provospalitel'nykh tsitokinov i produktsii autoimmunnykh kompleksov v patogeneze serdechnoi nedostatochnosti u bol'nykh s postinfarktnoi disfunktsiei serdtsa.

A comparative randomized clinical study was conducted to evaluate the diagnostic and prognostic value of the activation of proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1alpha, IL-2, IL-6, IL-8)] and the increased production of autoimmune complexes in the pathogenesis of chronic heart failure (CHF) in patients with coronary heart disease (CHD). The study included 47 patients with CHD who had a more than 6-month history of Q-forming myocardial infarction. The patients were randomized into 3 groups: 1) 21 patients with NYHA Functional Class (FC) II heart failure (HF); 2) 16 patients with FC III HF; and 3) 10 with FC IV HF. Basic therapy involved angiotensin-converting enzyme (ACE) inhibitors, nitrates, diuretics, beta-adrenoblockers; 27.6% received digoxin, disaggregatory agents. A study protocol involved the estimation of the parameters of EchCG, paired bicycle ergometric tests, 6-min walking test, ECG daily monitoring, the levels of proinflammatory cytokines in the serum and IgG autoantibodies to cardiolipin. The findings suggest that with the higher expression of autoimmune complexes, the activation of cytokines (primarily TNF-alpha, IL-1alpha, IL-2) plays an important role in the pathogenesis of CHF in patients with postinfarct cardiac dysfunction: the high activation of cytokines and the elevated level of autoimmune complexes are associated with moderate or severe NYHA FC II-IV HF, depressed left ventricular contractility (ejection fraction, 23-38%), low exercise tolerance, and cardiac remodeling.

[Effect of different types of anesthesia on hemodynamics and certain indicators of metabolism in obesity]. / Vliianie razlichnykh vidov obezbolivaniia na gemodinamiku i nekotorye pokazateli metabolizma u bol'nykh ozhireniem

The authors have studied the response of the cardiovascular system and kinetics of some indices of fat and carbohydrate metabolism during the operation under different kinds of anesthesia in 175 patients with obesity. A comparative estimation of local anesthesia and narcosis with ether, fluothane, ntirogen monoxide during operative procedures in obese patients is given. It is believed that in patients with obesity for short-time operative procedures it is rational to use fluothane-nitrogen monoxide-oxygen anesthesia.

[Humoral factors of nonspecific reactivity of the body in peritonitis]. / Gumoral'nye faktory nespetsificheskoi reaktivnosti organizma pri peritonite.

Humoral factors of inflammation such as histamin, heparin and others are known to play an important role in pathogenesis of peritonitis. Their intimate interrelations in the metabolism are responsible for the degree of the nonspecific defense reaction of the organism with this disease. The recovery of the humoral-tissue regulation of homeostasis goes on slowly against the background of inhibition of the nonspecific reactivity of the organism despite a liquidation of the source of peritonitis.

[Diagnosis and treatment of pylephlebitis of appendicular origin]. / Diagnostika i lechenie pileflebita appendikuliarnogo geneza.

Under observation there were 11 patients with destructive appendicitis complicated by pylephlebitis. Early antibiotic treatment using antibiotics of reserve under control of antibioticogram, introduction of metronidazole++, heparin and adequate desintoxicating therapy allows to anticipate successful results. The best results in shorter terms can be achieved by the intraportal administration of antibiotics, heparin and other drugs after recanalization and catheterization of the umbilical vein.

[Causes of mortality in acute appendicitis]. / O prichinakh letal'nosti pri ostrom appenditsite.

Cause of lethal outcomes of acute appendicitis were studied. Operations were performed in 11162 cases. Fourty eight patients (0,43%) died. In addition, 7 patients died without an operation. In 65% of dead patients diagnostic, technical and tactical errors were stated. Among their causes were the following: late admission to the hospital resulting in the appearance of complications which masked the main disease, groundless extension of indications for the operation, absence of individual operative measures and methods depending on the specific features of the pathological state.