Objective. Assessment of the impact of National Program «Health» on a rectal cancer (RC) tumor-specific survival in the Arkhangelsk region (AR), Russia over the period 2000–2017 by the data of Arkhangelsk Regional Cancer Registry (ARCR)

Materials and methods. Anonymized data on all cases of RC (C19.0–C21.0) in the AR in 2000–2017 were extracted from the database of the ARCR. Over the study period, 4173 cases of the RC were selected. To assess the impact of the National Health Project in 2006 and All-national Dispensarization in 2013, the three time periods were chosen — 2000–2006, 2007–2012 and 2013–2017. Cancer-specific survival (CSS) was calculated. Separate influence of baseline factors on differences in CSS between periods was performed using Cox regression with consecutive input.

Results. One- and five year CSS were 62,6% (95% confidence interval (CI) 60,03–65,05%%) and 27,8% (95% CI 25,4–30,2%) in 2000–2006, 65,1% (95% CI 62,5–67,5%) and 32% (95% CI 29,5–34,5%) in 2007–2012, 67,7% (95% CI 65,2–70,1%) and 37,4% (95% CI 33,7–41,1%) in 2013–2017, respectively.

In univariate analysis the risk of death in the latest time periods was significantly lower: HR 0.86 (95% CI 0.79–0.95), p < 0.05 and 0.74 (95% CI 0.67–0.82), p<0.0001 for 2007–2012 and 2013–2017, respectively, comparing to 2000–2006. In a multivariate model only correction for treatment type has led to change of the coefficients between time periods: HR 0.94 (95% CI 0.86–1.03) and 0.84 (95% CI 0.75–0.93) for 2007–2012 and 2013–2017, respectively. The CSS was also in­dependently influenced by stage, age at diagnosis, place of residence and type of treatment.

Conclusion. Population-based five-year CSS of patients with RC increased by 8% during the analyzed period. Better CSS in the latest time period is associated rather with improvement of treatment than earlier detection of RC.

Purpose of the study. Evaluation of the results of surgical treatment of desmoid fibroids (DF) using reconstructive plastic surgery and determination of possible prognostic factors of relapses.

Patients and methods. The results of surgical treatment of 40 patients with desmoid fibroids of extra abdominal local­ization were analyzed. In 45% of patients, the tumor was located in soft tissues of the shoulder girdle and upper limb, in 35% — on the trunk, in 20% — in soft tissues of the lower limb and in 7% of patients on the neck. The tumor size varied from 2 to 20 cm, the median was 8 ± 4.38 cm. Surgical treatment for newly diagnosed DF was performed in 22 (55%) patients, and for recurrent tumors — in 18 (45%) patients.

Results. According to the planned histological study, negative resection boundaries were established in 24/40 patients (63%). In the remaining 16 cases (37%) positive resection margins were obtained: R1 in 14 patients and R2 in 2 patients. Adjuvant treatment is recommended for 14 patients with resection R1/R2. The duration of follow — up after treatment ranged from 6 to 107 months, median‑16.5 months. During follow-up, relapses were diagnosed in 14 patients (35%). No deaths have been reported.

Conclusion. Surgical treatment of DF of extraabdominal localization is accompanied by a sufficiently high frequency of relapses. According to the results of the study, an unfavorable factor in the development of relapses is the location of the tumor in soft tissues of the shoulder girdle and upper limb.

Objective. To evaluate 3‑year disease-free survival in patients with breast cancer who underwent radical subcutane­ous/skin-sparing mastectomy with simultaneous reconstruction.

Patients and methods. The article analyzes 472 patients diagnosed with breast cancer who underwent radical subcuta­neous/skin-sparing mastectomy in combined or complex treatment. In the Department of Oncology and reconstructive plastic surgery of the breast and skin radical skin mastectomy was performed in 255 (54.1%) and 217 (45.9%) patients with radical subcutaneous mastectomy. Reconstruction was carried out by autotissues, expanders, followed by replace­ment with endoprostheses, as well as a combination of flaps and endoprostheses. The mean age of patients was 43.8 ± 2.2 (18–73) years. In 32.3% of cases patients were in the age group up to 40 years.

Results. In 9 (1,7 ± 0,6%) of patients diagnosed with a recurrence of breast cancer, herewith in 5 cases of local and in 4 cases of regional recurrence (metastases in the infraclavicular lymph nodes).

Treatment of recurrences of breast cancer was as follows: in two cases polychemotherapy courses were conducted, in 6 cases operations were performed — excision of relapse in the breast (3) and subclavian lymphadenectomy (1), remov­al of the reconstructed gland (2), in 1 case — radiation therapy.

In 13% relapses of breast cancer were diagnosed at stage III of breast cancer, the lowest percentage of relapse 0.7% at stage III. In luminal type A recurrence of breast cancer was diagnosed in 1.8%, in luminal B in 2.4%, in triple negative type — 2.5%, in luminal B Her2 positive — 2.7%. Metastases of breast cancer in our group of patients were diagnosed in 22 (4.7 ± 0.9%) patients. The highest percentage of long-term metastasis in our study revealed — 12.5% at stage III, the lowest percentage of 2.8 at stage I breast cancer. 3‑year overall survival of breast cancer patients in our group was 97.8% (n = 269).

Conclusion. Radical subcutaneous/skin-sparing mastectomies with simultaneous reconstruction are radical in the onco­logical plan of treatment and improve the quality of life in patients with breast cancer.

Morphological manifestations of prostate cancer (PCa) in 15–20% of cases are similar to those with benign hyperplastic processes in prostate tissue and/or with a histological pattern of atypical small acinar proliferation (ASAP).

The purpose of this study is a comparative study of the detection of prostate cancer in biopsy material using a review morphological analysis and immunohistochemistry with the use of monoclonal antibodies to the nuclear p63 protein, high molecular weight cytokeratins of clone 34βE12 and α-methylacyl-CoA-racemase.

Materials and methods. The method of the study was a retrospective analysis of the findings on the review morpholog­ical and immunohistochemical (IHC) analyzes of biopsy material of 428 patients who were examined and treated in the urological hospital for the period from 2013 to 2017.

Results. Almost half of the cases of ASAP, determined by routine histological examination of biopsy specimens with hematoxylin-eosin staining, in the process of IHC analysis using monoclonal antibodies to the nuclear protein p63, cyto­keratins of clone 34βE12 and α-methylacyl-CoA racemase were verified for prostate cancer. The number of histological findings on benign prostatic hyperplasia detected in routinely stained preparations decreased by 12.38% in favor of the histological diagnosis of prostate cancer after the IHC study.

Conclusion. Immunohistochemical analysis of biopsy material using monoclonal antibodies to nuclear p63, high-molec­ular cytokeratins of clone 34βE12 and α-methylacyl-CoA racemase for suspected prostate cancer: firstly, specifies the micromorphological picture and demasks prostate cancer; secondly, it increases the detectability of prostate cancer; thirdly, it reduces the occurrence of false-negative results.

Purpose. To evaluate the effectiveness of intraoperative ultrasonography (IOUS) in the surgical treatment of kidney tumors.

Patients and methods. Possibilities of IOUS application in the surgical treatment of kidney tumor according to the results of examination and surgical treatment of 145 patients (95 men and 50 women) diagnosed with kidney cancer were evaluated. The patients were divided into 2 groups: group 1 (comparisons) — 76 patients; during the examination and treatment, the IOUS method was not used, group 2 (basic) — 69 patients, who during the surgical treatment used the IOUS method to further clarify the localization, the size and boundaries of the tumor formation.

Results. The use of IOUS helped to reduce the frequency of nephrectomy (11.9% in the comparison group and 8.7% in the main group), and reduce the frequency of intraoperative complications, which amounted to (8.7% against 13.2%). The frequency of damage to the spleen and the transition to open surgery did not differ. The use of IOUS allowed to characterize in detail the anatomical features of the tumor, its vascularization and to implement the RENAL prognosis: favorable — in 50.7% of patients, unfavorable — in 15.9%.

Conclusion.When performing kidney tumor surgery, it is recommended to perform IOUS of the affected kidney in order to further clarify the boundaries of the tumor lesion to improve the effectiveness of the operation.

Purpose of the study. To provide prevention of early and treatment of late postoperative lymphorrhea in patients with oncolog­ical profile using fluorescent lymphography, photodynamic, radiation and endolymphatic lymphostatic therapy.

Patients and methods. In the process, the results of treatment of 2 groups of patients were evaluated. Group I (main group) — 310 people — were patients with localized malignant tumors, who underwent elective surgical treatment and to whom were applied developed measures for the prevention of early and treatment of late postoperative lym­phorrhea using fluorescent lymphography (168 people), photodynamic (68 people), radiation (48 people) and endo­lymphatic lymphostatic therapy (26 people). Group II (control group) — 310 people — who underwent elective surgical treatment of tumor diseases of similar localization using standard measures for the treatment of postoperative lym­phorrhea (punctures, pressure dressings, etc.). The groups were comparable by sex, age, nosology and the volume of surgical interventions.

Results. We estimated the volume and duration of lymphorrhea by the amount of allocated to the drainage and evacuated puncture lymph. In the control group, the average lympho-loss in the hospital was 59.6 ml, at the outpatient stage — 15.8 ml. Of the 310 patients in the control group, postoperative complications were identified in 29 (9.4%) patients: wound suppuration (11), abscesses (4), pleural empyema (2), thromboembolism (3), adhesive disease (6), pyelonephritis (2) and myocardial infarc­tion (1). Initial lymphorrhea, more than 100 ml per day, was present in 27 (93%) of these patients.

Lymphorrhea in the main group in the hospital was 32.7 ml, and at the outpatient stage — 8.1 ml. Complications in the main group were detected in 13 (4.2%) patients: wound suppuration, anastomotic failure and fistula — 3, abscesses — 1, thrombo­embolism — 1, bleeding from duodenal ulcer — 1, adhesive disease — 7.

After the application of the proposed measures for the prevention and treatment of lymphorrhea in the main group, the dura­tion and volume of lymphorrhea decreased almost twice, as did the frequency of postoperative complications.

Conclusion. Prolonged lymphorrhea leads to an increase in the incidence of postoperative complications. Fluorescent lymphog­raphy, photodynamic therapy, radiation therapy and endolymphatic lymphostatic therapy, taking into account indications and contraindications to each of these methods, can be used for the diagnosis, prevention and treatment of postoperative lymphatic lesions. An individual approach to the prevention of postoperative lymphorrhea leads to a decrease in its volume and duration, a decrease in the frequency of postoperative complications, a reduction in the patient’s stay in hospital and at the outpatient stage and allows for the timely start of special treatment in cancer patients.

Extrahepatic bile duct cancer is one of those pathologies in which about 70% of patients due to the prevalence of the tumor process can not receive radical treatment, which determines the need for active implementation of methods that allow, while maintaining a satisfactory quality of life of patients, to increase survival rates.

Due to the peculiarities of localization and development of malignant tumors of the extrahepatic bile ducts, as well as the nature of the disease, special importance in the treatment of these patients is given to various methods of external or internal bile removal and on the second stage of treatment can be considered local or systemic methods of exposure.

Currently, as a method of local therapy in patients with unresectable extrahepatic bile duct cancer, various options of radiation therapy, radiofrequency and microwave ablation, photodynamic therapy are used.

This article presents a literature review covering the feasibility, safety and efficacy of photodynamic therapy in patients with Klatskin tumor.

Objectives. To make analysis of main types of surgeries performed at various neck wounds in civil medical institution in the conditions of the local military conflict.

Patients and methods. The work is based on a retrospective analysis of the treatment of 241 patients with various neck wounds who were admitted in an urgent order to the surgical department of a city hospital in Chechen Republic from 1991 to 2000. All the wounded were divided into two groups: 129 with gunshot wounds (main group) and 112 with stab wounds of the neck (comparison group). The average age was 35 ± 5 years, dominated by males — 78%.

Results. It was established that in 25 (19.3%) cases the operation was started under local anesthesia, in 45% of cases anesthesia was given to continue the surgery, in 84% intubation was made, in 16% — intravenous operations. As a result of the analysis, it was revealed that for neck gunshot wounds the following operations were most often performed: a typical tracheostomy without a laryngeal and tracheal suture in 26.3% cases; atypical tracheostomy without suture of larynx and trachea — 16.2% cases; the laryngeal or tracheal suture with tracheostomy was performed in 13.1% cases, in 12.4% of cases was performed operative exploration of neck organs.

In cases of concomitant chest wounds, in 10.8% of cases, in addition to operative exploration of neck organs, thoracot­omy was performed, in most cases for suturing wounds of the esophagus.

Conclusion. The study confirmed that in the wounded with neck gunshot wounds, the amount of aid consisted primar­ily in restoring airway patency, stopping bleeding and anti-shock actions.

Purpose. The purpose of the article is to access possibilities of blood flow mathematical analysis in aortic aneurysm before and after bare metal stent implantation.

Materials and methods. Mathematical models of aortic blood flow were based on data received at studying 15 CT-scans of patients with abdominal aorta aneurysms (12) and dissections (3) and their duplex ultra-sound hemodynamic data. At constructing mathematical model the program SolidWorks was used. Working with the program consisted of two stages: establishment of conditions for geometric objects; forming of abdominal aorta model from these objects. In the study hemodinamic aneurysm indexes was evaluated on rectilinear and curvilinear segments. Some of characteristics were variable: diameter, aneurysm wall thickness, its length, elasticity.

Results. Correlation of extreme tension into aneurysm wall on rectilinear and curvilinear segments according to aneu­rysm wall thickness was assessed. Possibilities of pathological blood flow changes correction at bare metal stent im­plantation into aortic aneurysm were estimated: if presence of bare metal stent were introduced into mathematical parameters blood flow characteristics became almost as standard characteristics. Received data can enhance successful endovascular treatment of aortic diseases with using of bare metal stents.

Conclusion. Mathematical models of aortic and vascular aneurysms before and after surgery can be an effective tool in bettering quality of medical help for vascular patients.

Purpose. Comparative analysis of the diagnostic value of traditional cytology (TC) and liquid cytology (LC) in the identi­fication of cervical intraepithelial neoplasia (CIN) and cervical cancer (CC).

Patients and methots. The study included 87 women aged 18 to 80 years. All women were referred with suspicion of CIN, or underwent a control cytological examination after treatment for CIN and cervical cancer. Smears were taken sep­arately from ecto-, endocervix and mixed. Various tools were used (trowel, brushes type D, F and Cervex-Brush Combi). Each patient was sampled at the same time by different types of instruments. All surveyed women were performed at the same time traditional and fluid cytology. Liquid preparations were prepared using SurePath™ technology (BD and Company, Netherlands, USA) and E‑Prep (Biodyne, South Korea). Traditional cytological preparations were stained ac­cording to the Pappenheim method, liquid preparations — by Papanicolaou. A comparative analysis of cytological and histological findings was carried out.

Results. According to our data, the number of non-informative material practically coincides in the shopping center and in the LC, from the instruments used the best results were obtained when using a cytobrush of type D and a wood­en spatula. The frequency of detection of CIN squamous epithelium in the LC is somewhat less than in the shopping center (60% vs. 62%). This is due to the lack of experience in evaluating the life cycle drugs. Despite the fact that the overall frequency of CIN detection is somewhat lower in the LC than in the TC, the frequency of detection of high grade squamous intraepithelial lesion (HSIL) is higher in the LC (51% versus 46%). This is due to the fact that cellular elements are concentrated in a limited area and single small HSIL complexes that are missed in the shopping center are better detected in the LC. The sensitivity of the TC smear from the cervix was 96.2%, life cycle — 92.4%. The accuracy of the shopping center is 92%, the life cycle is 89.6%.

Conclusion. LC is an alternative to traditional cytological examination in order to detect pretumor diseases and cervical cancer. For an objective assessment of liquid preparations, additional training of cytologists is necessary.

Purpose of the study. Identification of the main causes of ischemic stroke in patients with aortic dissection, features of the clinical picture, the choice of optimal tactics for the management of such patients.

Patients and methods. During 2017, 11 patients with aortic dissection were hospitalized for emergency indications and underwent complex, surgical interventions. In 4 patients, the reason for hospitalization was ischemic stroke, in 7 patients, the onset of the disease was manifested by chest pain. Subsequently, in all cases, ischemic stroke developed within 48 hours from the onset of pain symptoms. Fatal outcomes occurred in 5 (45.45%).

Results. All patients were operated on for aortic dissection. Various types of surgery were performed. The best results were achieved with a hybrid operation — prosthetics of the aortic arch with endoprosthetic replacement of the de­scending aorta. The main reason for the development of ischemic stroke with aortic dissection and surgery for its elimi­nation is the development of brain malfunction. The cause of death was the dissemination of the dissection into the vis­ceral arteries with the development of multiple organ failure or aortic rupture of the aorta with hemo tamponade.

Conclusion. As a rule, several pools of blood supply to the brain, episodes of psychomotor excitement are involved in the dissection of the aorta and branches of the aortic arch, cognitive impairments are progressing, since cortical branch­es of the brain are usually involved. With the timely assignment of neuroprotective therapy, revascularization, early complex rehabilitation, there is a significant positive dynamics of neurological status, restoration of cognitive functions.

Teratoma is a tumor consisting of several types of tissues derived from one, two or three germ leaves, the presence of which is not peculiar to those organs and anatomical areas of the body in which the tumor develops. According to the WHO classification definition, immature teratomas are those containing embryonic tissues along with definitive, mature tissue structures. In histological WHO classification immature teratomas belong to germ cell ovarian tumors and are in­cluded into the group of teracomas. The prognosis is determined by the variant of the histological structure, the primary localization of the tumor, timely and adequate treatment.

This article presents a clinical case of treatment of a young female patient with persistently recurrent pelvic teratoma.

The presented observation demonstrates, on the one hand, the unpredictability of the course of the tumor process in embryonic tumors. On the other hand, there were demonstrated the possibilities of surgical treatment of another re­lapse of teratoma in a young patient with a massive tumor of the pelvic cavity in a situation where the hopes for a radical operation according to previous abdominal revisions seemed vague.

The article pertains the main problems faced by manufacturers and consumers of paid medical services. The increase in the volume of paid medical care prevails in the fields of dentistry, diagnostics and cosmetology. Of course, the expansion of voluntary medical insurance in almost all areas of medicine, further digitalization and gradual development of commercial outpatient care will be promising areas in the domestic health care. After all, currently every fourth outpatient medical organization is private owned. In this regard, taking into account the foreign and domestic experience of modernization of the medical services market, the paper comprehensively analyzes the trends in the development of commercial medicine within the legal, organizational and socio-economic regulation of the health care industry. Marketing tools to optimize the system of paid services are presented. The key role of mechanisms of public-private interaction in health care management is proved. Integrative approaches to the problems of introduction and development of paid medical services, considered in this study, will allow to systematize and to adjust the extra-budgetary activities of medical organizations while simultaneously increasing the availability and quality of medical care in Russia.

Purpose. Population assessment of the quality and effectiveness of medical services, as well as the activities of medical organizations working with the child population in comparison with 2016–2017.

Materials and methods. Sociological research in polyclinics of four large health care institutions of Yakutsk of the com­pared groups is carried out: Polyclinic No. 1–100 respondents, City hospital No. 2–60 respondents, City hospital No. 3–80 respondents, medical center of Yakutsk — 100 respondents. The study was conducted in 2016–2017. during the study, 340 respondents were interviewed, including 87% of women and 13% of men (the survey was conducted among parents and other legal representatives of minor patients).

Results. The article deals with the issues related to the implementation in the activities of public health institutions of the Republic of Sakha (Yakutia) quality standards and evaluation of the results of their implementation in terms of pa­tient awareness of the service (availability, openness of information), comfort conditions of service, waiting time for the service, the attitude of staff to patients (courtesy, goodwill), competence of staff and the overall level of satisfaction with the service provided. Despite the fact that more than 60% of respondents are aware of the functioning of the official websites of medical institutions, only 15.8% of respondents used information about the services and how to get them posted on them. At the same time, three-quarters of respondents are aware of the possibility of remote appointment by phone or Internet. However, only 18.6% of them took advantage of these opportunities, and 56% did not resort to them. The greatest criticism is caused by the lack of medical report on the patients’ state of health –60.8% of dissatisfied surveyed parents chose this criterion. More than 40% of complaints are due to the fact that pediatricians have not given recommendations for diagnosis and treatment. More than half of the survived participants (54.5%) at the recent visit to a medical institution, received a medical service on the day of making an appointment. The average waiting time to visit a paediatrician is 76 minutes. Two-thirds of respondents complain about the lack of available sitting chairs. Almost half of the respondents indicate the lack of drinking water in medical institutions, Almost 80% of respondents are generally satisfied with the medical services received in the clinics of Yakutsk. More than 70% of respondents are ready to recom­mend their clinic to friends, acquaintances and colleagues.

Conclusion. According to the results of the study, it was concluded that the organizers of health care need to readjust appropriately some management procedures of the organizations, in particular: patients’ attendance by specialists, public relations, personnel management, facilities and resources, in connection with the visitor’s basic rebukes.