The prognostic significance of the omental chemotherapy response score in hereditary ovarian tumors after neoadjuvant chemotherapy

The study was aimed to evaluate histopathological tumor response of omental metastases in BRCA1-associated and sporadic ovarian tumors after platinum-based neoadjuvant chemotherapy (nACT). We selected patients with histologically confirmed ovarian high-grade serous carcinoma who were treated with nACT followed by optimal debulking. Forty patients (14 BRCA1-associated cancers and 26 sporadic cases) meeting the criteria mentioned above were enrolled in the pathological examination. Clinical data (platinum-free interval, PFI) were collected through database review. Good regress [score 3] was observed in 4 out of 16 (25%) BRCA1-associated carcinomas and in one of 24 (4%) sporadic cancers (p = 0.14, Fisher's exact test). PFI was associated with the degree of response (minimal regress – median PFI 3.62 months, moderate regress – median 8.17 months, good regress - 21.28 months, p = 0.026, Kruskal-Wallis test). The omental response score predicted platinum-free interval in BRCA1-associated tumors (score 2+3 vs. 1; median PFI, 18.6 vs. 2.9 months; p = 0.04, Mann–Whitney U test). Histopathological tumor response of omental metastasis in BRCA1-associated and sporadic ovarian tumors after platinum-based neoadjuvant chemotherapy predicts PFI.Целью данного исследования стало сравнение выраженности патоморфологического регресса метастазов в большой сальник BRCA1-ассоциированных и спорадических опухолей яичника в ответ на платиносодержащую неоадъювантную химиотерапию (НАХТ). В исследование включены 40 пациенток (16 больных с мутацией BRCA1 и 24 «спорадических» случаев) в соответствии с следующими критериями: серозный гистотип опухоли высокой степени злокачественности, платиносодержащая НАХТ, оптимальная циторедуктивная операция (ОЦО), известная длительность бесплатинового интервала (БПИ). При оценке гистопатологического регресса метастазов в большой сальник в группе BRCA1-ассоциированного рака яичника РЯ частота выраженных регрессов [3 балла] составила 4/16 (25%), в группе спорадических опухолей – 1/24 (4%) (p = 0,14, точный критерий Фишера). Продолжительность БПИ достоверно зависела от степени регресса (при минимальном регрессе медиана составила 3,62 мес., при умеренном – 8,17 мес., при выраженном – 21,28 мес.; p = 0,026, тест краскела-Уоллиса). В группе носителей мутаций BRCA1 наблюдалось различие в продолжительности БПИ между случаями с умеренным и выраженным регрессом и случаями с минимальным регрессом (медианы 18,6 мес. vs. 2,9 мес., соответственно; p = 0,04, критерий Манна-Уитни). Степень выраженности патоморфологического регресса метастазов в большой сальник BRCA1-ассоциированных и спорадических опухолей яичника в ответ на НАХТ после ОЦО коррелирует с продолжительностью БПИ

Russian consensus on exoand endocrine pancreatic insufficiency after surgical treatment

The Russian consensus on exo - and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons

КЛИНИКО-МОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ НАСЛЕДСТВЕННОГО РАКА ЯИЧНИКА

Germ-line mutations in BRCA1 and BRCA2 genes are the most established risk factors for hereditary breast and ovarian cancers. The purpose of the study was to analyze BRCA1/2 testing in ovarian cancer patients. Materials and methods. We analyzed 222 patients with ovarian cancer (OC) who underwent genetic testing. Results. Recurrent Slavic mutations in these genes were detected in 60/222 (27%) patients.104 patients lacked any clinical signs of hereditary form of the disease, however BRCA1/2 genetic defects were identified among 11 (11%) of these women. BRCA1/2-associated carcinomas were characterized by more advanced stage at diagnosis and predominance of high-grade serous histological tumor subtype. Conclusion. These results emphasize the need for BRCA1/2 testing for all patients with OC. BRCA1/2-associated carcinomas have clinical and pathological cgaracteristics, which should be considered while planning therapy. Наследственные мутации в генах BRCA1 и BRCA2 являются наиболее известными и изученными факторами риска карцином молочной железы и яичника. Цель исследования – анализ опыта BRCA1/2- тестирования больных раком яичника. Материал и методы. Проанализированы данные 222 больных раком яичника (РЯ), направленных на генетическое тестирование. Результаты. Генетический дефект в генах BRCA1/2 был выявлен у 60 (27 %) из 222 пациенток. В группе женщин без клинических признаков наследственной формы заболевания генетические дефекты BRCA1/2 были обнаружены у 11 (11 %) из 104 пациенток. BRCA1/2-ассоциированные карциномы характеризовались более поздней стадией заболевания и преобладанием низкодифференцированного серозного гистологического типа опухоли. Заключение. BRCA1/2-ассоциированные опухоли составляют значимую часть злокачественных новообразований яичника, что обусловливает целесообразность генетического тестирования для всех пациенток с РЯ. BRCA1/2-ассоциированные карциномы имеют клинические и морфологические особенности, которые необходимо учитывать при планировании терапии.

Thoracoabdominal stab wounds: modern surgical tactics

The objective was to determine the optimal therapeutic and diagnostic algorithm for thoracoabdominal injury.Material and methods. The results of the examination and treatment of 389 injured patients with combined stab wounds of chest and abdomen were analyzed. The injuries were thoracoabdominal in 54 (13.9 %) cases.Results. We analyzed instrumental invasive and non-invasive diagnostic methods. The sequence of surgical interventions was determined.Conclusion. We revealed that the correct sequence and volume of surgical intervention ensured the success of treating the injured patients, while in cases of competing sources of bleeding, priority should be given in favor of performing thoracotomy

Treatment of massive pulmonary embolism with systemic thrombolysis in the nearest postoperative period

In the presented clinical observations, in one patient, acute massive pulmonary embolism developed on the 2nd day after the extended surgical intervention in the colon; in the second case, it developed on the 18th day after the extensive surgical aid against pancreatic necrosis. Clinical predictors of a high risk of death of thromboembolism and the technical impossibility of using another treatment method were the basis for systemic administration of tissue plasminogen activator. The direct result of systemic thrombolysis was the clinical recovery of patients. The hemorrhagic complication diagnosed in one of the observations was in the form of moderate bleeding from a vessel of the gastroenteroanastomosis region. Bleeding was stopped with the minimally invasive endoscopic clipping

CLINICAL AND MORPHOLOGICAL FEATURES OF HEREDITARY OVARIAN CANCER

Germ-line mutations in BRCA1 and BRCA2 genes are the most established risk factors for hereditary breast and ovarian cancers. The purpose of the study was to analyze BRCA1/2 testing in ovarian cancer patients. Materials and methods. We analyzed 222 patients with ovarian cancer (OC) who underwent genetic testing. Results. Recurrent Slavic mutations in these genes were detected in 60/222 (27%) patients.104 patients lacked any clinical signs of hereditary form of the disease, however BRCA1/2 genetic defects were identified among 11 (11%) of these women. BRCA1/2-associated carcinomas were characterized by more advanced stage at diagnosis and predominance of high-grade serous histological tumor subtype. Conclusion. These results emphasize the need for BRCA1/2 testing for all patients with OC. BRCA1/2-associated carcinomas have clinical and pathological cgaracteristics, which should be considered while planning therapy