Трудности диагностики первичной меланомы уретры

This article touches upon topical problems of modern medicine, representing the difficulty of timely diagnosis of oncological diseases of arduous localization and management of patients with malignant neoplasms. As an example, a clinical case of primary urethral melanoma is presented, illustrating a complex of aspects associated with the rarity of detecting malignant neoplasms of a given localization. The creation of standardized tactics for managing patients with rare malignant tumors and the correct interpretation of research results at the diagnostic stage, play an important role in improving the quality and life expectancy of patients. A step-by-step analysis of difficult situations will increase the alertness of doctors of all specialties.В статье затронуты актуальные проблемы современной медицины, отражающие сложность своевременной диагностики онкологических заболеваний труднодоступной локализации и ведения таких пациентов. Представлен клинический случай первичной меланомы уретры, иллюстрирующий комплекс аспектов, связанных с редкостью выявления злокачественных новообразований данной локализации. Разработка стандартизированной тактики ведения пациентов с редко встречающимися злокачественными образованиями, а также правильная и своевременная интерпретация результатов исследований на диагностическом этапе играют важную роль в увеличении продолжительности жизни пациентов и повышении качества. Пошаговый разбор сложных ситуаций позволит повысить онконастороженность врачей всех специальностей.

ИСПОЛЬЗОВАНИЕ ТЕХНОЛОГИИ АВТОМАТИЗИРОВАННОЙ ОЦЕНКИ КАЧЕСТВА ЖИЗНИ БОЛЬНЫХ В КЛИНИЧЕСКОЙ ПРАКТИКЕ ОНКОУРОЛОГИЧЕСКОГО ОТДЕЛЕНИЯ

Objective. The developing and introduction the quality of life (QL) automatized assessment in oncourological patients in clinical practice.Subjects and methods. General questionnaire EORTC QLQ-C30 and modules (QLQ-PR25 and QLQ-BLM30) were selected for QL assessment. The software tools of hospital information system were used for development. There were surveyed 236 oncourological patients.Results. Forms of unitary and dynamic researches were developed for result visualization, interactive modules were developed for data complex analysis. The first results of QL assessment were received. The highest values were in role and social functions (medians were equal 100 points). Fatigue, pain and sleeplessness were disturbed patients most of all (medians — 33,3, 16,7 and 33,3 points respectively). The median of Global health status was not high, only 50 points. There were analyzed three nosological groups of patients: urinary bladder cancer, renal cancer, prostate cancer. And the lowest values of functioning scales were in patients with urinary bladder cancer; also these patients complained of dyspnea reliably more often.Conclusions. The developed technology of quality of life study can be used as a good methodological base for assessment of cure efficiency not only in early postoperational period, but during treatment, and in late time after termination of course of treatment.Цели исследования — разработка и внедрение автоматизированной оценки качества жизни (КЖ) больных онкоурологического профиля в клиническую практику.Материалы и методы. Для оценки КЖ был выбран общий опросник EORTC QLQ-C30 и дополнительные модули (QLQ-PR25 и QLQBLM30). Разработка проводилась с помощью программных средств госпитальной информационной системы. Было обследовано 236 пациентов онкоурологического профиля.Результаты. Для визуализации результатов были созданы бланки однократного и динамического исследований, а для комплексного анализа данных — интерактивные модули. Получены первые данные по оценке КЖ. Наиболее высокие значения отмечались по шкалам ролевой и социальной функций (медианы по 100 баллов). Больше всего пациентов беспокоили усталость, боль и бессонница (медианы — 33,3; 16,7 и 33,3 балла соответственно). Медиана шкалы общего статуса здоровья невысока — 50 баллов. При сравнении 3 нозологических групп пациентов (рак мочевого пузыря — РМП, рак почки и рак предстательной железы) выявлено, что самые низкие показатели по функциональным шкалам были у больных РМП, и достоверно чаще эти пациенты жаловались на диспноэ.Выводы. Разработанная технология исcледования КЖ может стать хорошей методологической основой для оценки эффективности лечения не только в раннем послеоперационном периоде, но и в ходе лечения, а также в поздние сроки после окончания лечения

Features of expression of immunohistochemical markers in local and generalized clear cell kidney cancer

Purpose of the study. To conduct a comparative analysis of the expression of the following markers: Ki‑67, cyclin D1, E‑cadherin, CD44, MMP‑9, VEGF, P53, vimentin in renal tumor tissue in clear cell kidney cancer depending on the prevalence of the tumor process.Materials and methods. The material for the study was the operating material of 100 patients with light cell kidney cancer who were treated at the National Medical Reseaгch Centгe fог Oncology of the Russian Federation Health Ministry from 2015 to 2018. 50 patients were diagnosed with local cancer (T1–3an0m0), 50 – generalized cancer (T1–4N0M1). For the immunohistochemical (IHC) study, the material was fixed in 10% neutral formalin for 24 hours and encased in paraffin. Dewaxing and restoration of antigenic activity of the material was carried out in the RT module (Thermo Fisher Scientific) using Tris buffer pH=9, for 20 minutes at 98 °C. the Formulation of the IGC reaction was carried out in the immunohistostainer «Autostainer 480S» (Thermo Fisher Scientific). Used system detection UltraVision Quanto Detection System (Thermo Fisher Scientific), and the Chromogen DAB. Antibodies used: E‑cadherin (EP700Y) Cell Marque, 1: 100; CD 44 (EPR1013Y) Cell Marque 1:150; Ki‑67 (SP6) Spring Bio, 1:200; P53 (DO‑7) Cell Marque, 1:200; cyclin D1 (EP12) Dako, 1:200; VEGF Termo Fisher, 1:100; Vimentin (V9) Dako, 1:150; MMP‑9 (EP100902) Epitomics, 1:100. The results of the reactions with markers were evaluated by counting the number of colored cells in each 3rd field of view of the entire drug at magnification of the X200 lens in the AXIO Scope microscope. A1 (Carl Zeiss). The results were expressed as a percentage-the proportion of stained cells in relation to all tumor cells in the field of vision. Parametric methods of statistics were used for statistical processing of the results. The reliability of the difference between the two averages was determined by the student's t‑test for unrelated populations.Results. In clear cell kidney cancer, a low level of proliferative activity was observed in General, but in generalized, compared with local, it was significantly higher (P<0.05) (8±0.5% and 5±0.6%, respectively), and in generalized cancer, there was an overexpression of Cyclin D1–70±3.9%, compared to 14.4±2.3% in local stages, P<0.05. In generalized kidney cancer, epithelial-mesenchymal transformation processes are more pronounced in comparison with local cancer (a significant increase in Vimentin expression by 28% and CD44 by 16.6% (P<0.05), a decrease in E‑cadherin expression by 24% (P<0.05), and activation of neoangiogenesis processes (a significant increase in VEGF expression by 32%, P<0.05). The P53 protein was absent in local kidney cancer cells and was extremely low when generalized – 3.8±0.7%. One of the main markers of extracellular matrix degradation MMP‑9 was approximately at the same level at both stages: at local‑50±6% and 49.6±7.2% at generalized, the difference in indicators is not reliable (P<0.05).Conclusion. Progression of clear cell kidney cancer from local to generalized forms is accompanied by hyperexpression of cyclin D1, a decreased e‑cadherin expression while increasing vimentin expression (increasing signs of epithelial-mesenchymal transformation), an increase in CD44 and VEGF expression

THE USE OF QUALITY OF LIFE AUTOMATIZED ASSESSMENT TECHNOLOGY IN PATIENTS IN CLINICAL PRACTICE OF THE ONCOUROLOGICAL DEPARTMENT

<p><strong>Objective. </strong>The developing and introduction the quality of life (QL) automatized assessment in oncourological patients in clinical practice.</p><p><strong>Subjects and methods. </strong>General questionnaire EORTC QLQ-C30 and modules (QLQ-PR25 and QLQ-BLM30) were selected for QL assessment. The software tools of hospital information system were used for development. There were surveyed 236 oncourological patients.</p><p><strong>Results. </strong>Forms of unitary and dynamic researches were developed for result visualization, interactive modules were developed for data complex analysis. The first results of QL assessment were received. The highest values were in role and social functions (medians were equal 100 points). Fatigue, pain and sleeplessness were disturbed patients most of all (medians — 33,3, 16,7 and 33,3 points respectively). The median of Global health status was not high, only 50 points. There were analyzed three nosological groups of patients: urinary bladder cancer, renal cancer, prostate cancer. And the lowest values of functioning scales were in patients with urinary bladder cancer; also these patients complained of dyspnea reliably more often.</p><p><strong>Conclusions. </strong>The developed technology of quality of life study can be used as a good methodological base for assessment of cure efficiency not only in early postoperational period, but during treatment, and in late time after termination of course of treatment.<strong></strong></p

Cutaneous lupus erythematosus: pathogenesis, clinical pattern, diagnostics, therapy

This article contains the latest information about the mechanisms of development of lupus erythematosus based on the literature review. The modern classification of specific and non-specific skin lesions in lupus erythematosus is shown.The authors described the clinical pattern of cutaneous forms of lupus erythematosus very detailed. the data about pathological and immunological criteria for the disease diagnostics, modern methods of pharmacotherapy lupus erythematosus was classified