Parasternal mediastinotomy is a surgical method of morphological verification of mediastinal tumors, widely performed in oncological clinics. The article provides information about the method of implementation and the results of parasternal mediastinotomy for malignant tumors of the mediastinum.

Purpose of the study. Evaluation of the results of parasternal mediastinotomy for morphological verification of mediastinal tumors.

Patients and methods. The study included 77 patients who for the period from 2008 to 2018. 80 parasternal mediastinotomies were performed with a biopsy of a mediastinal tumor in the conditions of the Department of Thoracic Surgery of the P. Hertsen Moscow Oncology Research Institute. At the stage of preoperative examination, all patients underwent standard diagnostic studies: computed tomography of the chest, abdominal cavity, and a comprehensive ultrasound. In the case of the presence of the endobronchial component of the tumor, fibrobronchoscopy was performed. MRI of the brain was performed in patients with neurological symptoms. 12-lead ECG, echocardiography, and a study of the function of external respiration were performed to assess the functional status of patients.

Results. The final histological diagnosis was made in 76 of 77 (99%) patients. The clinical diagnosis of lymphoma was set in 66, thymoma — in 6 patients, lung cancer with affection of mediastinal lymph nodes — in 4 patients, mediastinal tumor — in 4 patients. In 24 patients (31%), operations were preceded by other attempts at morphological verification. In 12 patients — mediastinal tumor biopsy under ultrasound control, in 3 — parasternal mediastinotomy, in 2 — transthoracic mediastinal tumor biopsy combined with biopsy of supraclavicular lymph node under ultrasound control, 2 — biopsy of supraclavicular lymph node under ultrasound control, in 1 — mediastinum tumor biopsy under control. — chest wall biopsy, in 1 — open biopsy with thoracotomic access, in 1 — tonsil biopsy, in 1 — trachea biopsy. In all cases, the indication for performing a parasternal mediastinotomy was an insufficient amount of material for carrying out a complete immunohistochemical study.

Conclusion. Parasternal mediastinotomy is a safe and reliable method of morphological verification of the formations of the anterior mediastinum and para-aortic region. In case of the ineffectiveness of transthoracic biopsy under the control of ultrasound or CT navigation, the performing of parasternal mediastinotomy allows to establish a morphological diagnosis and to begin a specific treatment in the shortest possible time.

Surgical treatment of patients with tumoral defeat of pelvic bones, of preacetabular region, in particular, is one of the most challenging topics of modern oncorthopedics. Currently, one of the most modern methods of reconstruction of the pelvic bones is the use of modular endoprostheses based on the conical leg, the advantage of which is the ability to intraoperatively simulate an endoprosthesis that best meets the specific clinical situation.

Purpose of research. To assess the benefits of modular endoprosthesis of the acetabulum in patients with tumoral defeat periacetabular region.

Patients and methods. Within the period of 2011–2018 30 patients underwent surgical treatment in form of periacetabular resection with a modular endoprosthesis reconstruction in P.Hertsen Moscow Oncology Research Institute – Branch of National Medical Research Radiological Centre of Ministry of Health of Russian Federation. There were 13 men (43%) and 17 women (57%). The median age was 45 years (23–63 years). Primary bone cancers were in 19 (63%) patients, giant cell tumors in 5 (17%), locally advanced soft tissue sarcoma in 1 (3%), solitary metastases of kidney cancer in 2 (7%), and recurrent sarcomas after previous surgical treatment in 3 (10%) patients.

Results. The average duration of the operation was 310 min (145–520 min), the volume of intraoperative blood loss was 5520 ml (600–20 000 ml). The positive edge of resection according to the results of the planned morphological study was revealed in 3 (10%) patients. The average follow-up period was 36 months (4-73 months). Disease progression in terms of 6 to 40 months was revealed in 10 (33%) patients. 8 (27%) patients from disease progression. Complications of different types were diagnosed in 11 (37%) patients, among whom infectious complications prevailed 9 (30%). The average value of the functional results on a scale MSTS accounted for 59% (15 to 82%).

Conclusion. The use of modular systems of endoprosthesis replacement of the acetabulum and hip joint in tumor lesions is a promising surgical technique that allows to achieve adequate functional results with a comparable number of postoperative complications.

Purpose. To analyze the main medical and statistical parameters, allowing to evaluate the results of breast cancer treatment.

Patients and methods. Data on 4689 breast cancer (BC) patients were analyzed retrospectively. Inclusion criteria were: female, residence in St. Petersburg, diagnosis of BC established in 2011, 2012. The study also includes information on the options of BC surgical treatment, one-year mortality in breast cancer patients and index of the contingent accumulation in St. Petersburg in 2011–2017. For statistical data processing Statistica 12.0 for Windows, Population Cancer Register and MedInfo-4 were used. The differences in the groups of studies were considered statistically significant at p < 0.05.

Results. The prevalence of breast cancer among women in St. Petersburg varies from 532.6 per 100 000 population in 2011 to 545.00/0000 in 2012. In 2011 the incidence of BC in women in St. Petersburg was 46.210/0000 (standard deviation 1.05) and in 2012 – 49.50/0000 (standard deviation 1.05). The mean age of breast cancer patients is 64 years (standard deviation 12.25). Localization of a tumor in one of the glands was found in 4617 (98.5%) clinical observations. In 2,846 (60.7%) cases, the tumor sizes varied from 2 to 5 cm. Signs of infiltrative ductal carcinoma were histologically verified in 3689 (80%) cases. The proportion of single-stage breast reconstruction after mastectomy in the overall structure of surgeries in breast cancer patients increased in 2011–2017 more than 6.5 times. The 5-year survival rate in study groups was 64.4% and 63.3%.

Conclusions The main statistical parameters of medical care (MC) analysis in breast cancer patients in St. Petersburg in 2011–2017 allow to state generally positive trends in the anticancer fight organization. The increase of the breast cancer incidence rates is partly due to the improved quality of examination and treatment of patients through the creation in the city of a system of high-tech MC, as well as to the particularly wary of doctors in detecting breast tumors.

Purpose of the study. To study the patterns of forming an MRI picture of a complete pathological morphological response (pCR) of colorectal cancer a er neoadjuvant chemoradia on therapy (NHLT) based on comparisons with the pathomorphological picture.

 Patients and methods. Among 130 patients with locally advanced colorectal cancer who received a combined treatment with NHL at A. Tsyb MRRC clinic — a Branch of HMRRC of the Ministry of Health of the Russian Federation within the period 2012–2017 thirteen patients were selected for the study, in whom pCR was achieved, according to the pathological analysis of surgical specimen. MRI was performed on all patients before the NHLT and atier the end (atier 6–10 weeks) of treatment. We analyzed the MRI ndings from case histories (prospective assessment) on degree of tumor regression (mrTRG) using a ve-point grading scale. Ten of these patients had MRI examinations available for re-review (retrospective assessment), which allowed for a qualitate ve assessment of the signal intensity in T2 mode on a nominal scale, according to which low, medium, moderately elevated and high MR signals were discerned; signal localization was determined relative to the intestinal lumen with conditional selection of the inner and outer layer of the wall, and the outer contour was charactezied (smooth or uneven due to hypointense spicules). The obtained data on the localization of the MR signal of varying intensity were compared with the data of the pathological description of the operating drugs.

Results. A prospective MRI assessment of pCR in 77% of cases corresponded to TRG2 and in 92% — y N0. Macroscopically, the pCR in all patients had an appearance of an ulcerative defect of the intestinal wall, to which on T2-WI in 80% of cases corresponded to a moderately elevated MR signal from the inside of the wall, due to necroti c changes and granulations, and in 100% of cases — a low MR signal from the outer layer of the intestinal wall, caused by a more mature connective tissue, the outer contour in 50% of cases was tight due to the desmoplastic reaction; hypo-intensive inclusions corresponded to lime deposits, and “mucous lakes” — inclusions with high signal intensity and clear contours.

Conclusion The features of forming MRI picture of the pCR are due to a range of radiation pathomorphosis manifestations, including destructive, regenera ve and in ammatory processes in the tumor stroma.

Purpose of the study. To improve the quality of prostate transurethral resection by means of intraoperative ultrasound monitoring of the removed tissue volume.

Patients and methods. The study included 92 patients who, according to indications, underwent prostate transurethral resection. Patients were divided into 2 groups. The 1st group included patients (n = 50) operated on using the method of monitoring the removed tissue volume, proposed in the study. The average age of patients in this group was 67.4 ± 3.88 years, the average prostate volume before surgery was 59.5 ± 4.5 cm3 with a range of values from 42 cm3 to 94 cm3. The 2nd group (n = 42) included patients operated on according to the classical method of prostate transurethral resection. The average age of patients in this group was 68.1 ± 2.9 years, the average prostate volume before surgery was 53.5 ± 4.5 cm3.

Results. The average prostate volume atier surgery in patients of the 1st group was 23.2 ± 1.8 cm3. Thus, the average volume of the removed tissue was 63.2% of the prostate gland initial volume. The average prostate volume atier surgery in patients of the 2nd group was 25.6 ± 1.9 cm3 (p < 0.05). The average volume of the removed tissue was 52.1% of the prostate gland initial volume. The number of complications is comparable in groups of patients. When using the removed tissue control during surgery, it was possible to increase the resection radicality, which is refl ected by a smaller average residual volume of the prostate gland (by 9.4%) atier surgery.

Conclusion. The use of ultrasonic control of the prostate adenoma removed tissue volume during prostate transurethral resection does not increase the risks of possible postoperative complications, wherein increases radicality of the performed operation.

Opioid receptor antagonists are widely used for the treatment of alcohol dependence. Currently, original drug Odelepran (INN: ondelopran) with a unique binding profi le to all three types of human opioid receptors (μ, κ, δ) is being developed by R-Pharm.

Aim of the study. To investigate a cancerogenic potential of the new opioid receptor antagonist ondelopran in a twoyear study in rats

Materials and methods. The study cancerogenic potencial was performed in male and female Wistar rats at the age of 8–10 weeks at the start of experiment. All animals were allocated to 8 groups. Each group consisted of 50 animals of each sex. Test item (ondelopran fi lm-coated tablets, 125 mg), was administered to the animals intragastrically as a tablets suspension in 1% starch solution daily, 5 days a week for 24 months in two doses: 10 mg/kg (equivalent therapeutic dose for humans) and 100 mg/kg. Animals of control groups were administered with placebo and vehicle (1% starch solution). Clinical observation and examination of animals were conducted weekly to detect any signs of intoxication; dynamics of the body weight and registration of animal deaths were also assessed. To assess the rate of the pathological changes, the macro- and microscopic examination of inner organs and neoplasms was conducted.

Results. During the study the mortality rates did not diff er between the groups. Clinical signs ts.and symptoms of intoxication upon administration of the tested item and placebo were not observed. Neoplasms were found in the organs of all groups of animals. More than 30 variants of neoplasms were identifi ed upon pathomorphological examination. The identifi ed tumors are typical for rats and considered as spontaneous age-related pathology. There was no statistically signifi cant diff erences between groups in the total incidence of tumors.

Conclusion. To conclude the above said, the test item of the ondelopran fi lm-coated tablets, 125 mg have no carcinogenic properties.

Common bile duct cancer is a rare malignant disease with a poor prognosis. Five-year overall survival is 18-48%, and more than half of the patients relapse within five years.

Metastases in the regional lymph nodes and the presence of tumor cells in the margin of the resection are independent factors of a negative prognosis and are associated with a high risk of recurrence.

The clinical significance of other prognostic factors, such as renal invasion, low degree of differentiation, tumor size, pancreatic invasion and the need for resection of adjacent organs, require further study.

A brief review of current data on the generality of the epidemiology and molecular pathogenesis of breast cancer and benign breast diseases is presented. Currently, a type of mastopathy, fibrosclerosis/sclerosing adenosis, ac­companied by the formation of microcalcifications, is considered as a benign pathological condition with a high risk of malignancy, and also as a pre-start condition of a possible transition of mastopathy to cancer. In the review is discussed the fundamental biological process of the epithelial-mesenchymal transition (EMT) as a molecular pathogenetic basis of this phenomenon. Identification of the above mentioned pathological changes using mam­mography and refined diagnostics using a vacuum aspiration biopsy allow timely treatment of fibrosclerosis and sclerosing adenosis with Indinol® Forto, a drug of pathogenetic action based on indole-3-carbinol, due to its mul­tiple anticancer and oncoprophylactic activity, including ability to reverse at the epigenetic level the EMT process abnormally proceeding in these benign breast diseases.

The review examined and analyzed scientific publications on the effect of electromagnetic fields (EMF) on various sys­tems of the human body and animals with tumors, as well as on pain in the experiment and the clinic. The theoretical foundations and practical results of the use of EMF in various modulations and modes in the goals and objectives of oncology, including how to optimize the process of anesthesia and correct the vital activity of the body's functional systems with a tumor, are consecrated. Information is given on possible physicochemical effects, features, and mecha­nisms of therapeutic influence at various levels of a living organism. The ability of electromagnetic waves to transfer in­formation both within a single biosystem and at the level of a whole living organism with a tumor is shown. Studies of combined action of EMF and chemotherapy were analyzed. It has been established that there are experimental prerequisites for using this factor in order to induce changes in the permeability of the membranes of tumor cells by in­creasing the internalization of chemotherapeutic agents and, thus, enhance the antitumor effect. The role of EMF in the induction of apoptosis in tumor cells is shown. It has been shown that chemotherapy together with electromagnetic fields induces apoptosis and has an inhibitory effect on DNA synthesis in osteosarcoma cells, breast cancer, colon cancer, melanoma and other tumors. The role of magnetic fields in order to enhance the analgesic effect was investigated. The analgesic effect is due to the cessation or weakening of nerve impulses from the painful focus due to the elimination of hypoxia, the improvement of microcirculation, and the reduction of edema, it has been shown. Transcranial magnetic therapy is used as an analgesic tool in onconurology. The therapeutic anti-pain effect is associated with the stimulation of the antinociceptive system, an increase in the synthesis of natural analgesics — endorphins with their subsequent release into the cerebrospinal fluid and blood. As it has already been shown, with the increase in the intensity of pain and its duration, all indicators of the quality of life and the results of treatment of the patient deteriorate, so the search for ways to improve the antitumor effectiveness of specialized treatment and eliminate the causes that prevent their im­plementation continue to be relevant and in demand.

The most common causes of diabetes insipidus are neurosurgical operations on the pituitary gland due to its defeat by benign and malignant tumors, the neoplasms themselves, lymphocytic hypophysitis. Much less is known about the development of metastatic lesions of the pituitary gland by primary tumors of the lung, breast and kidneys. Even less common is diabetes insipidus caused by leukemia, lymphoma, xanthogranulomas, germinomas, HIV infection, pituitary hemorrhage, drug-induced, combined with neurofibromatosis, as well as diabetes insipidus during pregnancy. The review describes the predictors of the development of diabetes insipidus during surgical interventions, the frequency of development and prognosis in various neurosurgical operations. The article focuses doctors of various specialties on timely diagnosis, prevention and treatment of diabetes insipidus, including its atypical forms.

Purpose of the study. To assess the women's quality of life when using in the surgical component of the treatment in reconstructive surgeries, and their effect on survival and the period of a relapse-free period.

Patients and methods. Within the period 2012-2017, we analyzed the results of surgical treatment of 192 patients diagnosed with breast cancer. Stages of breast cancer were mainly I-IIB (78%). Histologically, in 89% of cases the tumor was represented by invasive non-specific cancer, in most patients the treatment was complex (84%). With it 192 radical Madden mastectomies with and without the reconstruction of the gland were performed.

Results. Six months after surgery, the patients were surveyed by a psychologist, 127 (66%) patients evaluated cosmetic surgery results as good, 50 (26%) patients — as satisfactory and 15 (8%) — as unsatisfactory. The unsatisfactory results were primarily attributed to the operation after which there were various postoperative complications, in the form of suppuration of postoperative wounds, lymphorrhea, etc. the Type of surgery does not affect the frequency of complications such as infectious complications, early postoperative bleeding, lymphorrhea.

Conclusion. In case of identical early postoperative complications, we obtain better cosmetic long-term results during reconstructive operations. In reconstructive breast surgery, there are several methods of restoring the lost form of the breast, while oncosurgical patients should be treated individually in each case. Technically, the use of expanders and silicone implants is easier and more convenient for the surgeon and the patient. Women with severe ptosis during the reconstructive stage of treatment with allografts are better to carry out a two-stage reconstruction. The presence of the implant does not affect the course of the postoperative period, the prognosis of survival and the period of recurrence-free period.

Presently primary-multiple malignancies are still poorly studied and represent a complex problem in clinical Oncology. The frequency of occurrence of primary-multiple metachronous or synchronous tumors remains at a high level. It is worth noting that about 1.5% of patients with primary multiple tumors had a malignant neoplasm of the prostate. Performing simultaneous laparoscopic operations allow to achieve rapid postoperative rehabilitation of the patient, to avoid the risk of re-operation and anesthesia, in addition, there is a clear economic benefit, there is no need for re-ex­amination and preoperative preparation. This article demonstrates two clinical cases of simultaneous surgical treatment of patients with primary multiple tumors of the kidney and prostate.

Purpose of the stydy. To study the Features of the technological component of the Ivanovo region health system policy in malignant tumors early diagnosis

Materials and methods. The base of the research is the Ivanovo Regional Oncology Dispensery, Department of Health of the Ivanovo Region. Methods: sociological, expert assessment, analytical, documentary. The assessment of the technological component of oncological service policy was carried out in the three areas: a) an assessment of the quality of oncological assistance using the method of correspondence examination of completed cases of assistance with filling out expert assessment cards (600 cases of assistance); b) an assessment of patients' satisfaction with the help provided by the method of a sociological questionnaire survey (600 patients); c) an assessment of the apparent patients' dissatisfaction with the help provided based on the analysis of justified complaints (30 people).

Results. The expertize of oncological medical services provided showed that there is a decrease in a number of its properties in modern conditions. The first ranking places in terms of the frequency of violations belong to the following properties of medical services quality: timeliness; adequacy; continuity; performance, availability. In the structure of medical and organizational defects in the quality of care, according to the results of expert evaluation, the leading part of them- 70.5% — is occupied by diagnostic defects (non-compliance by the medical personnel with the oncological screening standard, non-use of instrumental and laboratory research methods).

Conclusion. The policy of oncological care quality has signs of decrease (the number of diagnostic and medical-organi­zational defects averages 1.7 for each case of diagnosed cancer), which leads to advanced cases of oncopathology. The results of the study showed that the current system of oncological care in modern conditions is not sufficiently effective and requires improvement, including by increasing the doctors' level of cancer alertness, increasing the efficiency of the regional cancer pathology commissions.