Обоснование органосохраняющих операций при опухолях почек

Purpose of the study: to analyse the results of organ-preserving operations in patients with localized renal cell carcinoma.Materials and methods. The results of treatment of 458 patients who underwent organ-preserving treatment for renal cell carcinoma between 2009 and 2017 were analysed and evaluated. Of these, 286 were men (62.4 %) and 172 were women (37.6 %) with an average age of 54.7 ± 2.25 years (between 23 and 84 years).Results. The size of the tumours ranged between two to eight centimetres (average tumour size 4.6 cm). The duration of “open” operations ranged from 30 to 110 minutes (average of 62 minutes); those using laparoscopy lasted between 85 and 180 minutes (average of 146 minutes). The volume of blood loss during the operation was an average of 133.6 ml (from 80 ml to 500 ml). In most patients, the tumour was in the first stage of the disease (443 cases, or 96.7 %). In 17 of patients operated on morphologically, invasion of paranephric fibre at the third stage (3.7 %) was detected. A further 8 patients had a second stage tumour more than 7 cm in size but without germination beyond the kidney (1.7 %). There were no cases of intra- or post-operative mortality. Discussion. No significant differences during the postoperative period were observed in patients undergoing “open” and laparoscopic surgery; the frequency of postoperative complications was also approximately the same in both cases.Conclusion. Improvements in contemporary diagnostic methods have led to a sharp increase in the detection rate of small tumours. The results of studies comparing nephrectomy and kidney resection with a healthy contralateral kidney indicate the validity of the organ-preserving approach with small tumour sizes and localisation convenient for resection. In this regard, recently there has been a trend towards a wider use of kidney resection in renal cell carcinoma. Increased emphasis on the quality of life of cancer patients has led to an active study of the possibilities of using modern technologies in kidney cancer surgery.Цель исследования: изучение результатов органосохраняющих операций у пациентов с локализованным почечно-клеточным раком.Материалы и методы. Проанализированы и оценены результаты лечения 458 пациентов, перенесших органосохраняющее лечение с 2009 по 2017 г. по поводу почечно-клеточного рака. Из них 286 мужчин (62,4 %) и 172 женщины (37,6 %), средний возраст 54,7 ± 2,25 года (min 23 и max 84 года).Результаты. Размеры опухолей составили от двух до восьми сантиметров (средний размер опухоли 4,7 см). Время «открытых» операций колебалось от 30 до 110 минут (в среднем 62 минуты), лапароскопических — от 85 до 180  минут (в среднем 146 минут). Объем кровопотери при операции составил в среднем 133,6 мл (от 80 до 500  мл). У большинства пациентов констатирована первая стадия заболевания (443 случая, или 96,7  %). У 17 оперированных морфологически выявлена инвазия в паранефральную клетчатку — третья стадия (3,7 %). И 8 больных имели опухоль более 7 см без прорастания за пределы почки — вторую стадию (1,7 %). Случаев интра- и послеоперационной летальности не было. Обсуждение. Значительной разницы в течении послеоперационного периода, как и частоты послеоперационных осложнений, у пациентов, оперированных «открытым» и лапароскопическим доступом, отмечено не было.Заключение. Совершенствование современных методов диагностики привело к резкому повышению частоты выявления опухолей малого размера. Результаты исследований, сравнивающих нефрэктомию и резекцию почки при здоровой контралатеральной почке, говорят о правомочности органосохраняющего подхода при небольших размерах опухоли и удобной для резекции локализации. В связи с этим в последнее время отмечается тенденция к более широкому использованию резекции почки при почечно-клеточном раке. Повышение интереса к вопросам качества жизни онкологических больных привело к активному изучению возможностей использования современных технологий в хирургии рака почки.

Remote reef cryptobenthic diversity: Integrating autonomous reef monitoring structures and in situ environmental parameters

Coral reef sessile organisms inhabiting cryptic spaces and cavities of the reef matrix perform vital and varied functional roles but are often understudied in comparison to those on exposed surfaces. Here, we assess the composition of cryptobenthic taxa from three remote tropical reef sites (Central Indian Ocean) alongside a suite of in situ environmental parameters to determine if, or how, significant patterns of diversity are shaped by local abiotic factors. To achieve this, we carried out a point-count analysis of autonomous reef monitoring structure (ARMS) plate images and employed in situ instrumentation to recover long-term (12 months) profiles of flow velocity, wave heights, temperature, dissolved oxygen, and salinity, and short-term (3 weeks) profiles of light and pH. We recovered distinct environmental profiles between sampling sites and observed that ocean-facing reefs experienced frequent but short-lived cooling internal wave events and that these were key in shaping in situ temperature variability. By comparing temperature and wave height profiles recovered using in situ loggers with ex situ models, we discovered that global satellite products either failed to recover site-specific profiles or both over- and underestimated actual in situ conditions. We found that site choice and recruitment plate face (top or bottom) significantly impacted the percentage cover of bryozoans, gastropods, soft and calcified tube worms, as well as crustose coralline algae (CCA) and fleshy red, brown, and green encrusting macroalgae on ARMS. We observed significant correlations between the abundance of bryozoans, CCA, and colonial tunicates with lower mean temperature and higher mean dissolved oxygen profiles observed across sites. Red and brown encrusting macroalgae abundance correlated significantly with medium-to-high flow velocities and wave height profiles, as well as higher pH and dissolved oxygen. This study provides the first insight into cryptobenthic communities in the Chagos Archipelago marine-protected area and adds to our limited understanding of tropical reef sessile communities and their associations with environmental parameters in this region. With climate change accelerating the decline of reef ecosystems, integrating analyses of cryptobenthic organisms and in situ physicochemical factors are needed to understand how reef communities, if any, may withstand the impacts of climate change

ОПЫТ ЛАПАРОСКОПИЧЕСКОЙ ХИРУРГИИ ПРИ ЛЕЧЕНИИ ПОЧЕЧНО-КЛЕТОЧНОГО РАКА НА БАЗЕ РЕСПУБЛИКАНСКОГО КЛИНИЧЕСКОГО ОНКОЛОГИЧЕСКОГО ДИСПАНСЕРА

Purpose of the study. Study of the nearest results of laparoscopic operations in patients with localized renal cell carcinoma.Materials and methods. The results of treatment of 92 patients who underwent operative treatment in the period from 2015 to 2017 with the help of laparoscopic technique for kidney carcinoma were analyzed and evaluated. Of these, 57 men (62%) and 35 women (38%), the average age is 50.5 ± 2.25 years (min. 26 and not more than 75 years). Results. The duration of the operation was influenced by various factors, such as the features of the vascular anatomy of the kidneys, the presence of the adhesive process of the abdominal cavity, the state of paranephalic fat. When improving the technique of performing laparoscopic interventions, the operation time was reduced. In the period of mastering the technique of laparoscopic interventions on the kidney, the operation time averaged 210.0 ± 20.2 min (min 120 and max 300 min); subsequently it decreased on average to 130.00 ± 10.5 min (min 70 and max 190 min). After accumulation of experience, the technique of laparoscopic resection of the kidney without total ischemia with selective clamping of segmental arteries, or without compression of the renal artery was mastered.The conclusion. An analysis of the immediate results of laparoscopic interventions in patients with renal cell carcinoma showed their high efficacy and safety. The results of laparoscopic nephrectomies and kidney resections significantly improve with the improvement of technology and the accumulation of surgical experience. Введение. Цель исследования - изучение ближайших результатов лапароскопических операций у пациентов с локализованным почечно-клеточным раком.Материалы и методы. Проанализированы и оценены результаты лечения 92 пациентов, прооперированных с 2015 по 2017 гг. с помощью лапароскопической техники по поводу почечно-клеточного рака. Из них 57 мужчин (62%) и 35 женщин (38%), средний возраст 50,5±2,25 года (min 26 и max 75 лет).Результаты. На продолжительность операции влияли различные факторы, такие как особенности сосудистой анатомии почек, наличие спаечного процесса брюшной полости, состояние паранефральной жировой клетчатки. При совершенствовании техники выполнения лапароскопических вмешательств время операции значительно сократилось. В период освоения методики лапароскопических вмешательств на почке время операции в среднем составляло 210,0±20,2 мин (min 120 и max 300 мин), в последующем оно уменьшалось в среднем до 130,00±10,5 мин (min 70 и max 190 мин). После накопления опыта была освоена методика лапароскопической резекции почки без тотальной ишемии с селективным пережатием сегментарных артерий или без компрессии почечной артерии.Заключение. Анализ ближайших результатов лапароскопических вмешательств у пациентов с почечно-клеточным раком показал их высокую эффективность и безопасность. Результаты лапароскопических нефрэктомий и резекций почки существенно улучшаются с совершенствованием технологий и накоплением хирургического опыта.

Зомета в терапии рака предстательной железы с метастатическим поражением костей на фоне андрогенной депривации (результаты Российского многоцентрового исследования)

Introduction: Hormonal therapy is the method of choice in treating disseminated prostate cancer. Chronic androgenic suppression causes a reduction in bone mineral density. The most common complications of bone metastases are pathological fractures, spinal cord compression, pain, etc.Methods: A multicenter study (11 clinics of Russia) assessing the efficacy of Zometa in preventing skeletal complications of bone metastases was conducted in 2004—2005. Zometa was administered intravenously at a dose of 4 mg every 3Р4 weeks with androgenic deprivation. Its objective effect was evaluated in 70 patients. Changes in bone mineral density were evaluated by densitometry.Results: Complete pain relief was achieved in 73% of the patients; after therapy 86% of the patients had 0—1 WHO activity status score, 97% of the patients had no bone complications. The level of bone resorption marker β-Cross-Laps decreased to the normal values in 51% of the patients.Conclusion: The study has provided an evidence of the efficacy of Zometa and the necessity of using this drug in complex therapy for bone metastases of prostate cancer.Introduction: Hormonal therapy is the method of choice in treating disseminated prostate cancer. Chronic androgenic suppression causes a reduction in bone mineral density. The most common complications of bone metastases are pathological fractures, spinal cord compression, pain, etc.Methods: A multicenter study (11 clinics of Russia) assessing the efficacy of Zometa in preventing skeletal complications of bone metastases was conducted in 2004—2005. Zometa was administered intravenously at a dose of 4 mg every 3Р4 weeks with androgenic deprivation. Its objective effect was evaluated in 70 patients. Changes in bone mineral density were evaluated by densitometry.Results: Complete pain relief was achieved in 73% of the patients; after therapy 86% of the patients had 0—1 WHO activity status score, 97% of the patients had no bone complications. The level of bone resorption marker β-Cross-Laps decreased to the normal values in 51% of the patients.Conclusion: The study has provided an evidence of the efficacy of Zometa and the necessity of using this drug in complex therapy for bone metastases of prostate cancer

Substantiation of Organ-Saving Operations in Renal Tumours

Purpose of the study: to analyse the results of organ-preserving operations in patients with localized renal cell carcinoma.Materials and methods. The results of treatment of 458 patients who underwent organ-preserving treatment for renal cell carcinoma between 2009 and 2017 were analysed and evaluated. Of these, 286 were men (62.4 %) and 172 were women (37.6 %) with an average age of 54.7 ± 2.25 years (between 23 and 84 years).Results. The size of the tumours ranged between two to eight centimetres (average tumour size 4.6 cm). The duration of “open” operations ranged from 30 to 110 minutes (average of 62 minutes); those using laparoscopy lasted between 85 and 180 minutes (average of 146 minutes). The volume of blood loss during the operation was an average of 133.6 ml (from 80 ml to 500 ml). In most patients, the tumour was in the first stage of the disease (443 cases, or 96.7 %). In 17 of patients operated on morphologically, invasion of paranephric fibre at the third stage (3.7 %) was detected. A further 8 patients had a second stage tumour more than 7 cm in size but without germination beyond the kidney (1.7 %). There were no cases of intra- or post-operative mortality. Discussion. No significant differences during the postoperative period were observed in patients undergoing “open” and laparoscopic surgery; the frequency of postoperative complications was also approximately the same in both cases.Conclusion. Improvements in contemporary diagnostic methods have led to a sharp increase in the detection rate of small tumours. The results of studies comparing nephrectomy and kidney resection with a healthy contralateral kidney indicate the validity of the organ-preserving approach with small tumour sizes and localisation convenient for resection. In this regard, recently there has been a trend towards a wider use of kidney resection in renal cell carcinoma. Increased emphasis on the quality of life of cancer patients has led to an active study of the possibilities of using modern technologies in kidney cancer surgery

EXPERIENCE OF LAPAROSCOPIC SURGERY IN THE TREATMENT OF RENAL CELL CANCER ON THE BASIS OF THE REPUBLICAN CLINICAL ONCOLOGICAL DISPENSARY

Purpose of the study. Study of the nearest results of laparoscopic operations in patients with localized renal cell carcinoma.Materials and methods. The results of treatment of 92 patients who underwent operative treatment in the period from 2015 to 2017 with the help of laparoscopic technique for kidney carcinoma were analyzed and evaluated. Of these, 57 men (62%) and 35 women (38%), the average age is 50.5 ± 2.25 years (min. 26 and not more than 75 years). Results. The duration of the operation was influenced by various factors, such as the features of the vascular anatomy of the kidneys, the presence of the adhesive process of the abdominal cavity, the state of paranephalic fat. When improving the technique of performing laparoscopic interventions, the operation time was reduced. In the period of mastering the technique of laparoscopic interventions on the kidney, the operation time averaged 210.0 ± 20.2 min (min 120 and max 300 min); subsequently it decreased on average to 130.00 ± 10.5 min (min 70 and max 190 min). After accumulation of experience, the technique of laparoscopic resection of the kidney without total ischemia with selective clamping of segmental arteries, or without compression of the renal artery was mastered.The conclusion. An analysis of the immediate results of laparoscopic interventions in patients with renal cell carcinoma showed their high efficacy and safety. The results of laparoscopic nephrectomies and kidney resections significantly improve with the improvement of technology and the accumulation of surgical experience

Remote reef cryptobenthic diversity: integrating autonomous reef monitoring structures and in situ environmental parameters

Coral reef sessile organisms inhabiting cryptic spaces and cavities of the reef matrix perform vital and varied functional roles but are often understudied in comparison to those on exposed surfaces. Here, we assess the composition of cryptobenthic taxa from three remote tropical reef sites (Central Indian Ocean) alongside a suite of&nbsp;in situ&nbsp;environmental parameters to determine if, or how, significant patterns of diversity are shaped by local abiotic factors. To achieve this, we carried out a point-count analysis of autonomous reef monitoring structure (ARMS) plate images and employed&nbsp;in situ&nbsp;instrumentation to recover long-term (12 months) profiles of flow velocity, wave heights, temperature, dissolved oxygen, and salinity, and short-term (3 weeks) profiles of light and pH. We recovered distinct environmental profiles between sampling sites and observed that ocean-facing reefs experienced frequent but short-lived cooling internal wave events and that these were key in shaping&nbsp;in situ&nbsp;temperature variability. By comparing temperature and wave height profiles recovered using&nbsp;in situ&nbsp;loggers with&nbsp;ex situ&nbsp;models, we discovered that global satellite products either failed to recover site-specific profiles or both over- and underestimated actual&nbsp;in situ&nbsp;conditions. We found that site choice and recruitment plate face (top or bottom) significantly impacted the percentage cover of bryozoans, gastropods, soft and calcified tube worms, as well as crustose coralline algae (CCA) and fleshy red, brown, and green encrusting macroalgae on ARMS. We observed significant correlations between the abundance of bryozoans, CCA, and colonial tunicates with lower mean temperature and higher mean dissolved oxygen profiles observed across sites. Red and brown encrusting macroalgae abundance correlated significantly with medium-to-high flow velocities and wave height profiles, as well as higher pH and dissolved oxygen. This study provides the first insight into cryptobenthic communities in the Chagos Archipelago marine-protected area and adds to our limited understanding of tropical reef sessile communities and their associations with environmental parameters in this region. With climate change accelerating the decline of reef ecosystems, integrating analyses of cryptobenthic organisms and&nbsp;in situ&nbsp;physicochemical factors are needed to understand how reef communities, if any, may withstand the impacts of climate change.</p

DataSheet_1_Remote reef cryptobenthic diversity: Integrating autonomous reef monitoring structures and in situ environmental parameters.zip

Coral reef sessile organisms inhabiting cryptic spaces and cavities of the reef matrix perform vital and varied functional roles but are often understudied in comparison to those on exposed surfaces. Here, we assess the composition of cryptobenthic taxa from three remote tropical reef sites (Central Indian Ocean) alongside a suite of in situ environmental parameters to determine if, or how, significant patterns of diversity are shaped by local abiotic factors. To achieve this, we carried out a point-count analysis of autonomous reef monitoring structure (ARMS) plate images and employed in situ instrumentation to recover long-term (12 months) profiles of flow velocity, wave heights, temperature, dissolved oxygen, and salinity, and short-term (3 weeks) profiles of light and pH. We recovered distinct environmental profiles between sampling sites and observed that ocean-facing reefs experienced frequent but short-lived cooling internal wave events and that these were key in shaping in situ temperature variability. By comparing temperature and wave height profiles recovered using in situ loggers with ex situ models, we discovered that global satellite products either failed to recover site-specific profiles or both over- and underestimated actual in situ conditions. We found that site choice and recruitment plate face (top or bottom) significantly impacted the percentage cover of bryozoans, gastropods, soft and calcified tube worms, as well as crustose coralline algae (CCA) and fleshy red, brown, and green encrusting macroalgae on ARMS. We observed significant correlations between the abundance of bryozoans, CCA, and colonial tunicates with lower mean temperature and higher mean dissolved oxygen profiles observed across sites. Red and brown encrusting macroalgae abundance correlated significantly with medium-to-high flow velocities and wave height profiles, as well as higher pH and dissolved oxygen. This study provides the first insight into cryptobenthic communities in the Chagos Archipelago marine-protected area and adds to our limited understanding of tropical reef sessile communities and their associations with environmental parameters in this region. With climate change accelerating the decline of reef ecosystems, integrating analyses of cryptobenthic organisms and in situ physicochemical factors are needed to understand how reef communities, if any, may withstand the impacts of climate change.</p