Surgical treatment of postoperative sternal mediastinitis using titanium nickelide implant

Postoperative sternal dehiscence is a severe complication of cardiac surgery. The aim of the study was to evaluate the outcomes of different surgical treatment tactics in patients with postoperative sternal mediastinitis. A total of 41 patients with postoperative sternal mediastinitis were studied from 2010 to 2014. Patients comprised 29 men (70,7%) and 12 women (29,3%) aged 61,12 ± 8,62 years. The first stage of surgical intervention included: secondary surgical debridement; surgical debridement with metal osteosynthesis (MOS) by metal suture (configurations: 1-1-1-1-1-1; 1-Х-1-1-1-1; 1-8-8-8) and longitudinal MOS of the left middle third of the sternum + transverse MOS (configurations: Z-Z-Z and 1-1-88-1-1 among others); sternal resynthesis with mesh titanium nickelide implant according to originally designed method (patent of the Russian Federation N 2489097). The study demonstrated that routine sternoraphy is not recommended in patients who underwent operations involving median sternotomy or if the re-thoracotomy is required due to infection complication in the sternum and anterior mediastinum. Indeed, this method did not result in recovery in 72,22% of cases and even worsened sternal fragmentation. In case of the absence of severe sternal fragmentation and when elimination of acute inflammation was achieved (surgical debridement, correct antibiotic therapy, and bandaging), sternal resynthesis with mesh titanium nickelide implant was preferable. Combination of this method with surgical debridement of the sternum and anterior mediastinum was acceptable in patients with chronic sternal osteomyelitis and mediastinitis. The method of sternal resynthesis with mesh titanium nickelide implant achieved good immediate results and secure fixation of the sternal fragments with recovery of sternal continuity. This method should be indicatedfor treatment of patients without severe sternal fragmentation

Physical therapy methods in the treatment and rehabilitation of cancer patients

The results of the effective use of magnetic laser therapy in the treatment and rehabilitation of cancer patients were presented. The effect of magnetic-laser therapy in the treatment of radiation-induced reactions in the patients with head and neck cancer and in the patients with breast cancer was analyzed. High efficiency of lymphedema and lymphorrhea treatment in the postoperative period in the patients with breast cancer was proved. The results of rehabilitation of the patients with gastric cancer after surgical treatment were presented. These data indicate a high effectiveness of different physical methods of treatment and rehabilitation of cancer patients

ОСОБЕННОСТИ ГУМОРАЛЬНЫХ ИММУННЫХ РЕАКЦИЙ К ВИРУСУ ЭПШТЕЙНА – БАРР У БОЛЬНЫХ С ПРЕДОПУХОЛЕВЫМИ ИЗМЕНЕНИЯМИ СЛИЗИСТОЙ ОБОЛОЧКИ И РАКОМ ЖЕЛУДКА РАЗНОЙ ЛОКАЛИЗАЦИИ И ГИСТОТИПА

The paper presents the results of determining the concentration of specific antiviral immunoglobulins to viral antigens in blood serum of patients with gastric dysplasia (n=56) and gastric cancer (n=54), as well as the incidence of their titers depending on tumor location and histotype. In patients with precancerous gastric lesions, the increase in the IgG titer to Epstein Barr Virus (EBV) capsid antigen (VCA) and IgG to EBV early antigen (EA) in blood serum was found to be associated with enhancement of inflammatory activity. In patients with gastric cancer, high titers of IgG to VCA and IgG to EA were observed more frequently than in patients with gastric dysplasia, and the decrease in differentiation grade was followed by the increase in the concentration of IgG to EBV VCA. High titers (≥1:320) of IgG to VCA were found of patients with tumors located in the gastric body and cardia. High IgG titers to EBV VCA were shown to be associated with the presence of exophytic and ulcerated exophytic tumor growth.Высокая распространенность, поздняя выявляемость рака желудка и широкая инфицированность населения вирусом Эпштейна – Барр (ВЭБ) ставят оценку роли вируса в опухолевой прогрессии и прогнозе заболевания на ведущие позиции. В статье представлены результаты определения концентрации специфических противовирусных иммуноглобулинов в сыворотке крови у пациентов с диспластическими процессами слизистой оболочки желудка (СОЖ) (n=56) и больных раком желудка (n=54), а также частоты встречаемости их титров в зависимости от локализации и гистотипа опухоли. Показано, что у больных с предопухолевыми изменениями в СОЖ нарастание титра IgG к вирусному капсидному антигену (ВКА) ВЭБ и IgG к ранним антигенам (РА) ВЭБ в сыворотке крови связано с усилением активности воспаления. У пациентов с раком желудка значительно чаще, чем при дисплазиях, встречались высокие титры IgG к ВКА и IgG к РА, а снижение степени дифференцировки опухоли сопровождалось повышением концентрации IgG к ВКА ВЭБ. При локализации опухоли в теле и кардиальном отделе отмечались высокие титры (≥1:320) IgG к ВКА и более высокие концентрации IgА к ВКА. Выявлена явная ассоциация высокихтитров IgG к ВКА ВЭБ с наличием экзофитной и экзофитно-изъязвленной форм роста опухоли

ПРЕДОПУХОЛЕВЫЕ ИЗМЕНЕНИЯ И СИНХРОННЫЙ РАК ЖЕЛУДКА У БОЛЬНЫХ СО ЗЛОКАЧЕСТВЕННЫМИ НОВООБРАЗОВАНИЯМИ ЛЕГКИХ И ЛОР-ОРГАНОВ

The paper presents the analysis of the frequency of synchronous gastric and esophageal carcinomas in 176 patients with primary respiratory tract cancer, 122 (69.3%) of them with head and neck cancer and 54 (30.7%) with lung cancer.  The endoscopic examination revealed synchronous gastric cancer (n=4) and synchronous esophageal cancer (n=1) in 5 (2.8 %) cases (3 with primary lung cancer and 2 with primary laryngeal cancer). These patients received anticancer treatment for synchronous polyneoplasias. Ninety-one (51.7 %) patients had gastric mucosal atrophy, which in 25.7 % of cases was characterized as premalignant lesions: grade I-II dysplasia (20.2%) and grade III dysplasia (5.5%).  Considering the data obtained, patients with respiratory tract cancer have an increased risk for developing gastric and esophageal cancer. Endoscopic esophageal and gastric examination using advanced technologies should be included in the algorithm of management of these patients.Представлен анализ частоты синхронных опухолей желудка и пищевода у 176 больных с первичной злокачественной опухолью респираторного тракта, из них у 122 (69,3 %) пациентов – новообразования органов головы и шеи, у 54 (30,7 %) – рак легкого. При видеоэндоскопическом исследовании в 5 (2,8 %) случаях (первичный рак легкого – 3, первичный рак гортани – 2) были выявлены синхронный рак желудка (n=4) и синхронный рак пищевода (n=1). Этим пациентам проведено специальное противоопухолевое лечение по поводу обеих локализаций полинеоплазий. У 91 (51,7 %) пациента были выявлены атрофические изменения в слизистой оболочке желудка, которые в 25,7 % случаев носили характер предопухолевых процессов: дисплазия I–II степени – 20,2 %, дисплазия III степени (облигатный предрак) – 5,5 %. С учетом полученных данных больные с опухолевой патологией респираторного тракта составляют группу риска по раку желудка и пищевода. В алгоритм обследования этой категории больных необходимо включать эндоскопическое исследование пищевода и желудка с использованием современных уточняющих методик

ВОССТАНОВЛЕНИЕ ФУНКЦИЙ ВНЕШНЕГО ДЫХАНИЯ У ПОСЛЕОПЕРАЦИОННЫХ ПАЦИЕНТОВ С ПОМОЩЬЮ ТЕХНОЛОГИИ БИОУПРАВЛЕНИЯ, ОРГАНИЗОВАННОГО ПО КОНЦЕНТРАЦИИ УГЛЕКИСЛОГО ГАЗА В ВЫДЫХАЕМОМ ВОЗДУХЕ И ЧАСТОТЕ ДЫХАНИЯ

The methodical, technical and software realization of the biofeedback of expiration parameters are described. The biofeedback training method based on the breath frequency and CO2  concentration regulation is proposed. Preliminary study was conducted in the group of patients after abdominal surgical. It has been shown that the patients master their skills of CO2  concentration self-regulation. Using biofeedback for the postsurgical rehabilitation facilitates the rapid recovery of the expiration parameters.В статье рассматриваются методические, технические и программные аспекты адаптивного биоуправления, организованного по параметрам внешнего дыхания. Предложена методика БОС-тренинга, основанная на регуляции частоты дыхания и содержания углекислого газа в выдыхаемом воздухе. Проведены предварительные исследования в группе пациентов после абдоминальной хирургической операции. Показано, что пациенты осваивают навыки произвольной регуляции содержания углекислого газа в выдыхаемом воздухе. Был сделал вывод о том, что применение БОС-тренинга в послеоперационном периоде способствует быстрому восстановлению параметров внешнего дыхания

Stimulation of Liver Regeneration Using a Titanium Nickelide Implant (Experimental Study)

Currently, morbidity and mortality from chronic diffuse diseases of the liver and cirrhosis continue to increase worldwide. The difficulty of stabilizing the process with pharmacological agents, lots of restrictions for liver transplantation, the palliative character of the surgical correction of complications determine the urgency of finding various ways to stimulate liver regeneration, including surgical ones. Most of the known methods of surgical stimulation of regeneration are quite traumatic, and their stimulating effect is short-lived. The methods associated with cellular technologies are mostly expensive, ineffective, or poorly understood. In the experimental study, the effect on the parenchyma of a healthy and cirrhotic liver clips for clamping parenchymal organs exerting different unit pressure on the tissue was studied. The object of the study was laboratory rats with a healthy liver and animals with simulated cirrhosis. The animals were operated on with the imposition of titanium nickelide clips on the liver. Changes in the liver were studied 3, 7, 14, and 28 days after the surgery by histological examination of various parts of the liver. It was established that the clip with a lower specific pressure did not cause tissue necrosis, led to atrophy of the marginal part of the liver, also increased hepatocytes and binuclear hepatocytes were observed in the bulk of the liver. A decrease in the proportion of connective tissue was also observed in groups with liver cirrhosis. Thus, we consider it possible to use clips with a certain specific pressure on the tissue as a method of stimulating the reparative properties of the liver in chronic diffuse diseases and cirrhosis of the live

ЭПИДЕМИОЛОГИЯ КОЛОРЕКТАЛЬНОГО РАКА В ТОМСКОЙ ОБЛАСТИ

Background. Colorectal cancer is the third most common cancer worldwide. The tendency towards increased incidence of colorectal cancer in Tomsk region correlates with World and Russian tendencies. The purpose of the study was to analyze the incidence rate of colorectal cancer in Tomsk region. Material and methods. The study was based on cancer register data collected at the Cancer Research Institute and Regional Cancer Center (Tomsk) and covered the period 2005 по 2015. Demographic data were obtained from local authorities and government statistics. Results. In Tomsk region, colorectal cancer is the second most common cancer. During the study period (2005–15), the incidence rate of colorectal cancer increased by 39.9 %. The highest incidence rates were observed in patients aged 55 years and older. The median age of patients diagnosed with colorectal cancer in 2015 was 56.3 years. The female and male median age showed a decreasing tendency. In 2015, the colorectal cancer incidence rate in both females and males was the highest among the territories included into the Siberian Federal Region, being 30.9 per 100,000. The rate then stabilized in females, but tended to increase in males. The cumulative risk of developing cancer among the population of Tomsk region had increased, being 7.9 in 2015 compared to 6.5 % in 2005. The cumulative risk of developing cancer was higher in males than in females (10.1 % versus 6.9 %). A specialized care to patients with colorectal cancer over a 10-year period has improved, however one-year mortality rate remains high. The study has shown that screening programs based on the detection of occult blood in the stool are not specific enough. Colonoscopy using high-resolution endoscopy and narrow beam imaging (NBI) are recommended to use as a screening method for the detection of precancerous diseases of the colon.Введение. Колоректальный рак (КРР) является одним из самых распространенных злокачественных новообразований. В России наблюдается рост заболеваемости при неудовлетворительной ранней диагностике. Актуальна проблема колоректального рака и для Томской области, входящей в состав Сибирского федерального округа. Цель исследования – оценить эпидемиологическую ситуацию по колоректальному раку в Томской области, предложить мероприятия по ее улучшению. Материал и методы. Показатели заболеваемости и состояния онкологической помощи рассчитывались за период с 2005 по 2015 г. с использованием официально-отчетной документации областного онкологического диспансера, данных государственной статистики о годовой численности населения и программы «ОНКОСТАТ». Проанализированы результаты обследования 170 пациентов неорганизованного населения, направленных на видеоколоноскопию за 2013–2016 гг. Результаты. В течение исследуемого периода число больных колоректальным раком в Томской области увеличилось на 39,9 %. В структуре заболеваемости злокачественными новообразованиями населения области (без учета рака кожи) колоректальный рак занимает второе место. Наибольшие показатели заболеваемости регистрируются в возрасте старше 55 лет. Средний возраст заболевших в 2015 г. составил 56,3 года. Различие среднего возраста между заболевшими мужчинами и женщинами – 2,6 года. В динамике наблюдается уменьшение среднего возраста заболевших как у мужчин, так и у женщин. В 2015 г. Заболеваемость колоректальным раком (оба пола 30,9 на 100 тыс. населения) была одной из самых высоких среди административных территорий, входящих в состав Сибирского федерального округа. В течение времени показатель варьировался с тенденцией к росту у мужчин и стабилизацией у женщин. Кумулятивный риск развития КРР у жителей области составил 7,9 %, этот показатель увеличился по сравнению с 2005 г. (6,5 %). У мужчин (10,1 %) он выше, чем у женщин (6,9 %). Показатели специализированной помощи больным колоректальным раком за 10-летний период улучшились. Но осталась низкой выявляемость заболевания на профилактических осмотрах, запущенность снизилась незначительно, высока одногодичная летальность, менее половины заболевших находятся на учете 5 лет и более. Исследование показало, что скрининговые программы, основанные на определении скрытой крови в кале, недостаточно специфичны. Предлагается использовать как метод скрининга для выявления предопухолевых заболеваний толстой кишки колоноскопию с применением видеоэндоскопов высокого разрешения и узкоспектральной эндоскопии (NBI)

HUMORAL IMMUNE RESPONSES TO EPSTEIN-BARR VIRUS IN PATIENTS WITH PRECANCEROUS GASTRIC LESIONS AND GASTRIC CANCER OF DIFFERENT HISTOTYPES

The paper presents the results of determining the concentration of specific antiviral immunoglobulins to viral antigens in blood serum of patients with gastric dysplasia (n=56) and gastric cancer (n=54), as well as the incidence of their titers depending on tumor location and histotype. In patients with precancerous gastric lesions, the increase in the IgG titer to Epstein Barr Virus (EBV) capsid antigen (VCA) and IgG to EBV early antigen (EA) in blood serum was found to be associated with enhancement of inflammatory activity. In patients with gastric cancer, high titers of IgG to VCA and IgG to EA were observed more frequently than in patients with gastric dysplasia, and the decrease in differentiation grade was followed by the increase in the concentration of IgG to EBV VCA. High titers (≥1:320) of IgG to VCA were found of patients with tumors located in the gastric body and cardia. High IgG titers to EBV VCA were shown to be associated with the presence of exophytic and ulcerated exophytic tumor growth

PREMALIGNANT LESIONS AND SYNCHRONOUS GASTRIC CANCER IN PATIENTS WITH LUNG AND HEAD AND NECK CANCER

The paper presents the analysis of the frequency of synchronous gastric and esophageal carcinomas in 176 patients with primary respiratory tract cancer, 122 (69.3%) of them with head and neck cancer and 54 (30.7%) with lung cancer.  The endoscopic examination revealed synchronous gastric cancer (n=4) and synchronous esophageal cancer (n=1) in 5 (2.8 %) cases (3 with primary lung cancer and 2 with primary laryngeal cancer). These patients received anticancer treatment for synchronous polyneoplasias. Ninety-one (51.7 %) patients had gastric mucosal atrophy, which in 25.7 % of cases was characterized as premalignant lesions: grade I-II dysplasia (20.2%) and grade III dysplasia (5.5%).  Considering the data obtained, patients with respiratory tract cancer have an increased risk for developing gastric and esophageal cancer. Endoscopic esophageal and gastric examination using advanced technologies should be included in the algorithm of management of these patients

EPIDEMIOLOGY OF COLORECTAL CANCER IN TOMSK REGION

Background. Colorectal cancer is the third most common cancer worldwide. The tendency towards increased incidence of colorectal cancer in Tomsk region correlates with World and Russian tendencies. The purpose of the study was to analyze the incidence rate of colorectal cancer in Tomsk region. Material and methods. The study was based on cancer register data collected at the Cancer Research Institute and Regional Cancer Center (Tomsk) and covered the period 2005 по 2015. Demographic data were obtained from local authorities and government statistics. Results. In Tomsk region, colorectal cancer is the second most common cancer. During the study period (2005–15), the incidence rate of colorectal cancer increased by 39.9 %. The highest incidence rates were observed in patients aged 55 years and older. The median age of patients diagnosed with colorectal cancer in 2015 was 56.3 years. The female and male median age showed a decreasing tendency. In 2015, the colorectal cancer incidence rate in both females and males was the highest among the territories included into the Siberian Federal Region, being 30.9 per 100,000. The rate then stabilized in females, but tended to increase in males. The cumulative risk of developing cancer among the population of Tomsk region had increased, being 7.9 in 2015 compared to 6.5 % in 2005. The cumulative risk of developing cancer was higher in males than in females (10.1 % versus 6.9 %). A specialized care to patients with colorectal cancer over a 10-year period has improved, however one-year mortality rate remains high. The study has shown that screening programs based on the detection of occult blood in the stool are not specific enough. Colonoscopy using high-resolution endoscopy and narrow beam imaging (NBI) are recommended to use as a screening method for the detection of precancerous diseases of the colon