Surgical treatment of patients with gastric cancer with extended lymph node dissection often leads to the primary (intra-operative injury) and secondary (inflammatory processes in the postoperative period) damage to the parenchyma of the pancreas. The incidence of pancreatitis in the postoperative period, according to various authors, reaches 20% or more. Synthetic analogues of somatostatin occupy the special place among the pharmacological methods of prophylaxis. Earlier studies have shown a significantly lower rate of complications, including the formation of pancreatic fistula after operations on the pancreas when using somatostatin analogues. Usage of prolonged SST analogues for the prevention of postoperative pancreatitis remains a matter of research. The article presents a review of existing literature and own experience with prophylactic use of «Оctreotide depot » in patients with malignant tumors of the stomach, esophagus and the cardia

Purpose. Improvement of the results of treatment of patients with locally advanced and metastatic gastric cancer. Material and methods. From the 2010–2014 we performed 30 surgeries using techniques HICT. Among patients there were 17 men and 13 women. The median of age was 50 years. Locally advanced gastric cancer (T4a-T4b) was observed in 22 cases, including 4 patients in the emergency immunocytochemical study with peritoneal lavage detected cancer-free (Cyt +) cells in the abdominal cavity. The group of patients with metastatic gastric cancer accounted for 8 patients. Narrow carcinomatosis (P1) was 4 cases, carcinomatosis (P2-P3) — 4. Adjuvant systemic chemotherapy in the study group was not carried out. In the control group No 1 (n = 51) performed surgery alone, without additional anticancer therapy. In the control group No 2 (n = 66), a combined treatment (surgery + chemotherapy). Results. Follow-up median was 25 months. Overall 1-year survival rate for all three groups was 55%, 39% and 52%, respectively. Median survival in the intervention group versus 21.4 months in the 8 and 12 months, respectively. The most effective HICT is shown for patients with locally advanced gastric cancer. In the study group, median overall survival was 29 months. The survival rate of 1-, 2-, 3-year-old was equal to 68%, 61% and 42%. In the first control group, 1-year survival of 45%. None of the patients did not survive 2 years. In the second control group, one-year survival rate was 60%, 2-year survival is not. Results of treatment of metastatic gastric cancer proved to be more modest. In the main group the median survival was 10 months, compared with 6 and 7 months of the two control groups. There were no statistically significant differences.
Conclusions. 1. Availability of limited dissemination, free cancer cells in the abdominal cavity, as well as a massive defeat of serous membrane of the stomach can be seen as indications for HICT in gastric cancer.
2. In gastric cancer with carcinomatosis P2-P3 effectiveness of HICT is questionable, even with the full cytoreduction.

Bladder cancer (BC) is an important clinical and scientific challenge. In 2013, in Russia, the absolute number of patients with first-ever diagnosis of bladder cancer was 12 992 people. There is an increasing proportion of detection of bladder cancer stage I–II disease patterns: 2003–50.8% in 2013–69.6%, while the number of newly diagnosed patients in III and IV clinical stages remains at 30%. The proportion of individuals who completed the treatment of the number of newly diagnosed patients with bladder cancer in 2013, was as follows: only surgical method — 65.4%, 33.5% combined. 

Purpose. Improvement of the results of treatment of patients with locally advanced bladder cancer. 

Materials and methods. The main treatment for muscle-invasive bladder cancer is radical cystectomy. In the combined treatment of bladder cancer chemotherapy is the component that systemic exposure to the tumor, the way of regional and distant metastases. The study included 132 patients with locally advanced bladder cancer who were treated for 2005–2013, divided into four groups: NACT + CE — 27 people (20.5%), CE + ACT — 21 (15.9%), NACT + CE + ACT — 21 (15.9%) only CE — 63 (47.7%). An important component of treatment has been the use of platinum (cisplatin or carboplatin) in Schemes M–VAC and GP. An objective response is possible in 44.7%, and the stabilization process in 40.4% of patients.

Results. The clinical effect is evaluated in all patients. In the group of NACT 21% of patients survived for more than 4 years, but did not survive the 5‑year mark. In the group of CE + ACT the indicator achieved only 3‑year survival rate, which amounted to 43%. In the group of CE — none of the patients did not live up to 3 years, with 2‑year survival rate was 30%. In the group of ACT + NCT + CE 3 patients (15%) were alive at the time, passed the threshold of the 5‑year survival rate, there is no progression of cancer.

Conclusion. Combined treatment mode NACT + CE + ACT can achieve significantly longer time to tumor progression and better overall survival; the reverse side is to increase the frequency of postoperative complications.

Erectile dysfunction (ED) requires a comprehensive, advanced diagnostics, as the judge the state of the microvasculature of the corpora cavernosa by ultrasound may indirectly.

Purpose. To improve the diagnostic results of erectile dysfunction using falloscintigraphy.

Materials and methods. We examined 56 men. All patients fulfilled the ultrasound study of penis itself and stimulated erections with pharmacological agents (prostaglandin E, 20 mg). We spent falloscintigraphy to identify the microcirculatory disturbances in the tissues of the penis.

Results. Analysis of the questionnaire of erectile function demonstrated that in the group there were 4 (7.1%) patients with severe ED, 29 (51.7%) — with moderate ED, 23 (41.2%) — with mild erectile dysfunction. According to the ultrasound of the penis we registered signs of ED in 38 (67.9%): arterial — 24 (63.1%) patients, venous ED — 11 (28.9%) patients, mixed ED — 3 (8%). In 18 (32.1%) patients by ultrasound, we detected no structural pathology tissue of the penis, so we conducted additional tests — falloscintigraphy. Falloscintigraphy results showed that the two men (11.2%), we have not identified any pathology. Therefore we have regarded their erectile dysfunction as psychogenic. In 16 (88.8%) patients were detected during falloscintigraphy impaired microcirculation of the corpora cavernosa. The results of our study show that falloscintigraphy has a high sensitivity (91%) and specificity (94%) compared to the US (78% and 60%, respectively) in the diagnosis of disorders of the microcirculation of the corpora cavernosa of the penis.

Conclusions. Falloscintigraphy may be used for the diagnosis of vasculogenic erectile dysfunction, if the ultrasound is not effective to detect microcirculatory disturbances of the corpora cavernosa.

Purpose. Conducting computational studies of dosimetric characteristics of microsources with the radionuclide I‑125, pilot production of which is established in the research and production complex of isotope and radiopharmaceuticals, JSC “State Scientific Centre of the Russian Federation — Institute for Physics and Power Engineering named after A. I. Leypunsky” (SSC RF IPPE). Sources of production IPPE are similar to the model 6711 of the company Nicomed Amersham, dosimetric characteristics of which are standardized in accordance with the TG43 AAPM formalism.

Materials and methods. Microsourse «SEED No. 6711» (model of the company Nicomed Amersham) is hermetically sealed in a titanium capsule silver rod covered with a thin layer of radioactive I‑125. The half-life of iodine‑125 is 59,43 days. In the process of decay of I‑125 is converted into the Te‑125.

Calculation of parameters of microsources and their comparison with the standard model 6711 is carried out with use of the computer code MCNP.

Results. The method of calculation of the basic dosimetric characteristics of the microsourse SSC RF-IPPE in accordance with the TG43 formalism is developed. A comparative analysis of experimental data and calculated results by MCNP code, which allowed to identify possible reasons for differences, is performed. The estimated dose characteristics and recommended standard data for dose characteristics of micro «SEED No. 6711» are compared.

Conclusions. There are two possible reasons for the differences between experimental and calculated results. The first one may be the roughness of the surface of a silver rod or diffusion of radioactive iodine in silver. The second reason might be the difference of the cross sections of the characteristic radiation of silver used in MCNP code. In the comparison of calculated dose characteristics and recommended standard the role of the application activity is very important. In compliance with the standard conditions on the composition of the environment, water phantom and air with 40% humidity, the results obtained are outside the acceptable difference of 3% from the recommended data. While the variation of only the thickness of the deposition of radioactive material in the 0–10 mkm change dosimetric characteristics in the range of 15–20%.

Effective complex treatment of patients with pathology of the oral mucosa (OM) includes drug effects on pathogenic bacteria as a possible etiological factor in the development of these diseases.

Purpose. Study of characteristics of oral microflora of patients with diseases of the OM, the efficiency of the national preventive agent for topical application "Fagodent" in the form of a gel based on bacteriophages in the treatment of chronic recurrent aphthous stomatitis and lichen planus.

Materials and methods. In a pilot study (up to 3 months follow-up) they included 27 patients aged 19 to 80 years old with chronic recurrent aphthous stomatitis (CRAS) and lichen planus (LP). To monitor the efficiency of in vitro we carried out spot-testing for bacterial lawn.

Results. Results showed the frequent detection of bacteria of the staphylococci and streptococci in smears obtained from the elements of defeat in the CRAS and LP, while the PCRdiagnostics detect the presence of rare parodontopatogenov on aftah and papules. The study of the effectiveness of products based on bacteriophages "Fagodent» in vitro showed a high sensitivity of the pathogens to bacteriophages gel "Fagodent" when exposed to cultures derived from patients with CRAS. The use of prophylactic agents based on bacteriophages in the treatment of chronic recurrent aphthous stomatitis significantly reduced pain, accelerated the relief of the inflammatory process to reduce the time of repair. Application means "Fagodent" in the complex treatment of lichen planus is not significantly affected the course of the disease.

Conclusion. The laboratory research and clinical observations confirm the effectiveness and appropriateness of products based on bacteriophages "Fagodent" in the treatment of chronic aphthosous stomatitis.

The purpose. Analysis of statistical data of oncological departmental polyclinics, serving a permanent attached contingent of patients in cases of the most common cancer sites: basal cell skin cancer, breast cancer, prostate cancer.
Materials and methods. Analisis of medical history patients of polyclinics. There were registered 1054 patients with malignant tumors. Of these 128 (12.14%) and had the PMN, of that number, 8 patients had triple the localization of cancer. BCC: skin diagnosis was 132 patients, of which 52 (39.9%) of had the PMN. With the diagnosis: breast cancer was registered 179 patients, including 30 patients had the PMN of the 8 patients had bilateral breast cancer. Diagnosed with FPW to outpatients included 139 patients, of whom 20 people (14.4%). On each localization of cancer presented with second and third cancer localizations. Conclusion. Patients with BCC skin were the in group of high risk for the development of PMN. The second location was in case of every third patient. Most commonly BCC combined with breast cancer, prostate cancer, cancer of the colon.

Diagnostics of psycho-emotional disorders of patients with malignant diseases of the prostate is not doubt, because timely correction contributes to the shortening of rehabilitation period and restoration of the quality of life of patients after treatment. Detection and diagnosis of prostate cancer for many patients is stressful and causes changes in the affective sphere, and manifests itself in increased levels of anxiety and depression in men. To cope with stress is possible due to the used coping strategies.
Purpose. Studying the coping mechanisms in prostate cancer patients.
Materials and methods. 56 men treated in FGBU "LRTS" Russian Ministry of Health. The average age was 65.7 ± 6.1 years. The average duration of the disease prostate cancer is 3 ± 2 months. All men were subjected to the standard algorithm for the evaluation of hormonal status, the PSA, taking a history, inspection and physical examination, magnetic resonance imaging and scintigraphy of bones of a skeleton. All the patients underwent laparoscopic radical prostatectomy. Psychological testing with the use of the method of "Coping test" the scale of reactive and personal anxiety for the differentiated evaluation of anxiety. 
Results. The most common for prostate cancer revealed constructive coping strategies are "planning solve", "selfcontrol" and "search of social support". According to the scale Spielberg–Hanin a high level of situational anxiety was revealed.
Conclusion. According to the results of the research, patients with prostate cancer are likely to use constructive coping strategies, that leads to stabilization of psycho-emotional state of men and promotes more effective adaptation in the terms of stress, that is caused by treatment of prostate cancer.

Reconstruction of large defects of the anterior abdominal wall in patients operated for cancer diseases is mainly performed in the presence of concomitant ventral hernia or by direct ingrowth of the tumor in the tissue of the anterior abdominal wall. Currently in the treatment of this category of patients, the method of choice is the use of alloplastics with reticular endoprosthesis, performed in a variety of ways. In this article, we present clinical cases that perform the alloplastics of extensive defects of the anterior abdominal wall in two cancer patients with extensive defects of the abdominal wall.

The presence of additional fully formed accessory breast (polymastia), accessory nipples (polythelia) or other options ectopically positioned breast tissue is fairly rare developmental anomalies. Its occurrence frequency is approximately 1% of the general population. This article describes a rare case of localization of additional mammary glands and their surgical correction.

The problem of early diagnosis of a breast cancer is extremely actual. Growth of incidence at women from 19 to 39 years increased for 34% over the last 10 years. It defines need of acceleration of development and deployment of the latest technologies of identification of the earliest symptoms of diseases. The x-ray mammography is the conducting method among of all radiological methods of diagnostics. Nevertheless a number of restrictions of method reduces its efficiency. The technologies increasing informational content of x-ray mammography – the leading method of screening – due to use of artificial contrasting and advantages of digital technologies are constantly developed. In this review it is described works, in which the authors having clinical experience of application of CESM – contrastenhanced spectral mammography on representative group of women. Positive sides and restrictions of new technology in comparison with mammography, ultrasonography and MRT are shown in this article.

Osteoporosis is one of the most significant bone complications of cancer. About 1.5 million cancer patients worldwide have bone metastases. Patients with myeloma, breast cancer, prostate, thyroid, bladder and lung have very high risk of development of bone lesions and related complications. Currently, osteodensitometry is the gold standard for the diagnosis of osteoporosis. In recent years we frequently use the innovative imaging techniques for bone metastases, such as CT, MRI, PET/CT. Unfortunately, the diagnostic value of these methods is that it is not always possible to identify abnormalities of bone metabolism in cancer, especially in the early stages. This review shows the world experience of usage of biochemical markers of bone resorption (calcium, hydroxyproline, NTX, CTX, PYD, DPD, TRAP-5b, bone sialoprotein - BSP) and markers of bone synthesis (osteocalcin, CSF, ACF, Karlovy vary IFF), their advantages and disadvantages. The level of these markers is increased in most patients with osteoporosis and bone metastases, it is suggesting a potential role in early diagnosis of bone metastases.

In this paper, it has been tasked to demonstrate progress is Russian scientists who are pioneers in the application of clinical photodynamic therapy (PDT) in Europe. In this review current understanding of the mechanisms of action PDT on the tumor and the body, the technical aspects of the application of the laser radiation of varying intensity, particularly its effect on biological tissues. The results of studies on the use of PDT with different photosensitizers in the complex therapeutic measures in patients with cancer. The data on the efficacy and safety of PDT. Given the effectiveness of PDT and ease of use, no adverse reactions, this medical technology can be attributed to one of the most promising trends in oncology. Accumulated a large experience of PDT in oncology testifies to high efficiency of this method in the treatment of various tumors. However, despite the positive results obtained in clinical practice, PDT in oncology is not widely used.

It is proposed to implement this knowledge into the educational process at universities. Researchers of the А. Tsyb MRRC and Obninsk Institute for Nuclear Power Engineering (MEPhI) are working under development of educational complex program «Medical physics». This cooperation is expected to improve professional training and education in health physics.

Modern-day drug therapy has significantly increased the life expectancy of patients with breast cancer, therefore now this is the quality if the therapy itself which is of major importance. Cardiac toxicity of some cytostatics may come out in years after the therapy. Anthracycline antibiotics are considered to be the main factor leading to cardiotoxicity. In case of recurrent use of anthracycline antibiotics, the overall dose of these should have to be limited. The combination of anthracyclines with trastuzumab increases essentially the risk of cardiotoxicity. To reduce the risk of developing such severe epiphenomenon it is recommended to use pegylated liposomal forms of anthracyclines, to detect background diseases in due time, as well as to generally take preventive actions.

The article presents the results of a retrospective analysis of the provision of urological care 352 HIV-infected patients in the Urological City Clinical Hospital №47 of Moscow Health Department for the period 1996–2012. We estimated of income dynamics of HIV-infected patients in urological hospital, studied the distribution of these patients for urological nosology and stage of HIV infection. We noted the predominance of acute infectious and inflammatory diseases of the genitourinary system, that require immediate initiation of antibiotic therapy in the empirical mode, and in some cases, emergency surgery. We detected the predisposition to acute infectious and inflammatory diseases of the scrotum is a feature of HIV-infected patients.

Article is supplemented with analysis of the effectiveness of the main pharmacological groups of antibacterial drugs for the treatment of nonspecific infectious and inflammatory diseases of the urogenital system in patients with HIV infection.

This review summarizes the published data on the therapeutic properties of the mud "Tinakskaya". In addition, data on the use of natural factors lake "Therapeutic" in medicine is performed.

Over the last decade there have been significant changes in the approaches to the drug treatment of renal cell carcinoma. In clinical practice, there was a group of targeted drugs, the purpose of which has increased the life expectancy of patients with advanced kidney cancer. The studies devoted to the study of the sequence of destination targeted agents, combinations, studies of new drugs and to identify prognostic factors, are held.

Comparison of the efficacy and safety of drugs "Avegra®" and "Avastin®" used in combination with paclitaxel and carboplatin as first-line therapy in patients with locally inoperable or metastatic NSCLC. 

The study included 138 patients, male and female aged 18 to 75 years with newly diagnosed inoperable or widespread metastatic NSCLC (except squamous cell NSCLC), relevant eligibility criteria. After passing screening, patients were centrally randomized in one of the study groups in a 1:1 ratio. Treatment was carried out according to the following scheme: "Avegra®" or "Avastin®", 15 mg/kg intravenously over 90 minutes immediately after carboplatin on day 1 of each 3‑week cycle + paclitaxel 175 mg/m² intravenously over 3 hours on day 1 of each 3‑week cycle + carboplatin dose required to achieve AUC 6 mg/ml×min, intravenously over 15–30 minutes, immediately following paclitaxel, on the first day of each three-week cycle. The treatment lasted for six cycles of three weeks or until progression or until the development of intolerable toxic effects. 

Based on CT scan assessment performed by an independent specialist, the overall response rate (ORR, partial response rate + complete response rate) defined as a primary endpoint was 42.59% (95% CI 30.33–55.83%) in "Avegra®" arm and 39.29% (95% CI 27.58–52.27%) in "Avastin®" arm, respectively. The difference in ORR between study drug and comparator was 3.30% with 95% CI –14.96–21.40% (р =0.874, the Pearson x² test with Yates correction). The lower limit of calculated 95% CI (-14.96%) exceeds the specified non-inferiority margin and it is indicating the non-inferiority of "Avegra®" efficacy compared to "Avastin®". 

During the study period the incidence of adverse events, including severe adverse events (grade 3–4 according to CTCAE) related with the investigational drugs, did not have statistically significant differences in both study arms.

The drug "Avegra®" in direct comparison to "Avastin®" demonstrated equal efficacy, similar safety and immunogenicity profile, equal pharmacokinetic characteristics. Based on the results of the clinical study the first biosimilar of bevacizumab — drug "Avegra®" was successfully registered in Russian Federation in November 2015 and can be recommended for use in clinical practice.

The article considers actual issues of psychosocial rehabilitation at the present stage of psychiatric care to the population of the Oryol region.

The purpose. Study and generalize the experience of the use of methods of psychosocial rehabilitation in several psychiatric institutions of the Oryol region.

Materials and methods. 1. The analysis of activity of out-patient departments, where we developed a new "development Program of sociorehabilitation service in regional psychoneurologic dispensary". 2. Analysis of the activity of hospital services, where the main role is played by psycho-social rehabilitation. 3. The analysis of new forms of psychosocial rehabilitation: in terms of the specifics of Oryol oblast psychiatric hospital of specialized type with intensive supervision (OPHSTIO).

Results. As a result of the analysis we identified the most effective methods of sociorehabilitation: outpatient: "Social card of the outpatient" is intended for persons in need of social, psychological, legal and other professional assistance, that allows to plan and control the types of assistance provided. The organization of a hostel for patients at the outpatient stage, which allowed to introduce a "full" recovery cycle. In OPHSTIO — implementation of multiprofessional teams and "sick tips" and the opening of an Orthodox chapel of the Mother of God icon "All grieving pleasures".

Conclusions. Methods of psychosocial rehabilitation allowed to optimize the work of the main stages of treatment and rehabilitation processes, to provide in a timely manner the necessary comprehensive care to patients based on individual needs of the mentally ill in the outpatient and inpatient therapy in the Oryol region.