Реконструкция молочной железы и лучевая терапия

In recent years there were significant advances in auto- and heterological breast reconstruction. Reconstruction with implants after mastectomy is being used more of ten. A recent study conducted by Albronoz et al, based on Nationwide Inpatient Sample data, found an increasing rate of immediate breast reconstruction with implants af ter mastectomy up to 11%, compared to autological methods of reconstruction [Barreau-Pouhaer L., 1992]. A possible reason for this increase is the growing number of young patients who need a mastectomy, but have not enough fat tissue for autological reconstruction. The purpose of reconstruction is to reach a long-term, oncologically safe and aesthetically pleasing result with reasonable operation expenses. Radiation therapy after mastectomy, as part of a complex treatment, is needed for an increasing amount of patients with breast cancer. Radiation therapy is a vital par t of cancer treatment, but often causes complications. Patients should be informed and consulted about potential complications so they can make reasonable decisions about their treatment.В последние годы отмечаются значительные продвижения в области ауто- и гетерологических реконструкций молочных желез. Реконструкция с помощью имплантатов при мастэктомии используется все чаще. Недавнее исследование, проведенное Albronoz с соавторами, на основе данных Nationwide Inpatient Sample с 1998 по 2008 год, выявило увеличение частоты одномоментных реконструкций имплантатами в среднем на 11% в год, по сравнению с аутологичными методами реконструкции [Barreau-Pouhaer L., 1992]. Возможной причиной для этого увеличения является растущее число молодых, нуждающихся в мастэктомии и не располагающих достаточной жировой клетчаткой для аутологичной реконструкции. Цель реконструкции – достичь долгосрочного, безопасного с онкологических позиций и эстетически удовлетворительного результата с рациональными затратами на операцию. Лучевая терапия после мастэктомии, как часть комплексного лечения, требуется все большему числу больных при раке молочной железы. Она, хотя и  является важнейшим  компонентом в лечении рака молочной железы, связана с высокой частотой возникновения осложнений. Следует надлежащим образом консультировать пациентово возможности этих потенциальных осложнений, с тем, чтобы они могли принимать обоснованные решения

БИОПСИЯ СИГНАЛЬНЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ ПРИ РАКЕ МОЛОЧНОЙ ЖЕЛЕЗЫ

За последние десятилетия в хирургическом лечении рака молочной железы появилась тенденция к органосохраняющему и все менее травматичному и калечащему этапу в многоступенчатой терапии этого заболевания. Выполнение подмышечной лимфодиссекции часто сопровождается такими осложнениями, как лимфостаз верхних конечностей, ограничение подвижности и болевые ощущения плечевого сустава, что, в ряде случаев, ведет к инвалидизации, при излечении от рака

Narrow-Beam Echo Sounding in Marine Geomorphology

The topography of the earth exists as a continuous spectrum in the scale of the features. Different scales require different methods of study. For deep-sea geomorphic studies, conventional echo sounding (wide-beam sounding) yields data from features on the scale of about one kilometre to features on the scale of the ocean basin. Deep-sea bottom photography yields data on the scale of millimetres to metres. This leaves a spectral gap of 1 - 1 000 metres about which, until recently, existed no satisfactory means of examination — yet this is the main scale on which terrestrial geomorphic interpretations are made. The information now available shows that this scale is equally as important to marine geomorphic interpretations. This paper will discuss the relationship of marine geomorphology and echo sounding. It will show how narrow-beam echo sounding yields unique data about the spectral gap of 1 - 1 000 metres necessary for geomorphic interpretation

The role of digital mammography, scintimammography with ^99mTc-methoxyisobutylisonitrile (MIBI) and ultrasound in the diagnosis of multicentric breast cancer

Background. The development of effective methods for diagnosing multicentric breast cancer patients (BC) is of great clinical importance, because it determines the tactics of surgical and radiation treatment.The aim of study: to compare diagnostic accuracy of scintimammography (SMG), digital mammography (MMG) and ultrasound (US) in the diagnosis of multicentric BC.Materials and methods. 410 women with histologically confirmed BC were included in this analysis. SMG was performed with dual detector SPECT unit Forte (Philips, Netherlands). Mammographic digital images were obtained on Senographe DS unit (GE Healthcare, USA). In 319 of 410 evaluated women we were able to determine results of preoperative US with high-frequency (7—18 MHz), high resolution linear array transducer. The pathological report was used as the gold standard. Multicentric BC was defined as 2 or more distinct invasive tumors occupying more than one quadrant. Detection of additional grouped calcifications of malignant type occupying a small portion of breast tissue (more than 15 pieces per 1 sq. cm) was considered as another mammographic sign of multicentric BC.Results. According to histopathological examinations multicentric BC was diagnosed in 51 of 410patients. SMG was more effective than MMG in detecting multicentric BC: sensitivity — 84.3 % vs 54.9 % (p <0.001), specificity — 98 % vs 95.8 % (p = 0.02), accuracy — 96.3 % vs 90.7 % (p = 0.04), positive and negative predictive values — 86 % vs 65.1 % (p = 0.004) and 97.8 % vs 93.7 % (p = 0.01), respectively. Histologically multicentric BC was revealed in 44 of 319 women that had US of the breasts. Sensitivity, specificity, accuracy, positive and negative predictive values for US were 52.3 %, 94.5 %, 88.7 %, 60.5 % and 92.5 %, respectively. SMG significantly (p <0.001) outperformed US for all diagnostic characteristics. Combination of MMG and SMG characterized by increased sensitivity (94.1 %), 94.2 % specificity, 94.1 % accuracy and positive predictive value of only 69,6 %.Conclusions. SMG is significantly more sensitive (84.3 %) than MMG (54.9 %) and US (52.3 %) in detection of multicentric BC. High (86 %) positive predictive value of SMG advocates it as a tool for surgery and radiotherapy planning