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Objective: To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (ASBO)., Material and Methods: A retrospective multiple-center study included 143 (85.6%) patients with ASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups., Results: ASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group ( n =36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group ( n =30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery ( p =0.287), early and late surgery in patients with strangulation ( p =0.940), early and late surgery in patients without strangulation ( p =0.76). Patients died ( n =10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours ( n =14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, p =0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, p =0.061), bowel resection (95% CI 33.3-14.0, p =0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613)., Conclusion: Delayed surgery may be advisable in patients with ASBO and no obvious signs of strangulation due to less mortality.

Aim: The study was aimed at comparing efficacy of conventional conservative therapy and comprehensive treatment including a plasmid VEGF-165-gene therapy drug in 'no-option' chronic limb-threatening ischaemia with different prevalence of trophic ulcers and infection during a 1-year follow-up period., Patients and Methods: A total of 101 patients (54% being men and 46% women, mean age 69 years) with 'no-option' chronic limb-threatening ischaemia underwent comprehensive conservative treatment. They were subdivided into 4 groups according to the WIFI classification: WIFI 130 (n=38), 131 (n=23), 230 (n=16), 231 (n=24). The control group patients (n=58) received standard treatment using a PGE1 analogue (Vasaprostan) and the study group patients (n=43) underwent standard conservative treatment (SCT) in combination with gene therapy. The end points of the study were as follows: major amputation rate, amputation-free survival, total mortality, and ulcer healing rate during a 1-year of follow up., Results: Major amputation rate in the control and study groups amounted to 35 and 28% (p=0.48), respectively, with amputation-free survival of 53 and 63% (p=0.35), total mortality of 21 and 12% (p=0.23), ulcer healing rate of 31 and 51% (p=0.04), respectively. The WIfI classification made it possible to single out a subgroup of patients (WIfI combination 130) yielding other statistically significant results: major amputation rate 27% and 0% (p=0.03), amputation-free survival 59 and 94% (p=0.025), ulcer healing rate 50 and 88% (p=0.016), respectively., Conclusion: Using plasmid-based VEGF-165 gene therapy in the subgroup with the WIfI combination 130 decreases the major amputation rate (p=0.03), increases amputation-free survival (p=0.025) and promotes ulcer healing (p=0.016) compared with the standard therapy during 1-year follow up. No significant differences in the compared groups were revealed by all endpoints of the study for other combinations analysed. The total mortality rate in patients with limb-threatening ischaemia does not depend on either the initial severity of ulcer or the selcted methods of conservative treatment.

The purpose of the study was to comparatively assess efficacy of using agents belonging to the group of prostaglandin E1 in comprehensive conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes by the frequency of major amputation, amputation-free survival, and total mortality by combinations of the WIfI classification during a 6-month follow up period. Our retrospective multicentre study enrolled a total of 109 patients, including 60 men and 49 women, with a mean age of 70±7.3 years. The patients were subdivided into 2 groups. Group 1 patients (n=58) received standard conservative therapy without prostaglandin E1 and group 2 patients (n=51) received similar treatment with the use of prostaglandin E1. The statistical analysis (chi-squared test, Fisher criterion, log-rank test) was carried out with regard to stratification of the patients in the groups by the WIfI component combinations. No statistically significant differences between the groups in the frequency of amputation and total mortality were revealed (p=0.094 and p=0.925, respectively). The use of the WIfI classification system made it possible to single out a cohort of patients (with a WIfI combination of 130) for whom the results of administering prostaglandin E1 statistically significantly differed by the frequency of amputation (p=0.042) and by amputation-free survival (p=0.017). No significant differences by these outcomes were obtained for other combinations analysed. A conclusion was drawn that using prostaglandin E1 in comprehensive conservative treatment decreased the frequency of amputation and increased amputation-free survival in patients presenting with unreconstructable critical limb ischaemia and referred to the category with a combination of 130 according to the WIfI classification.

In the present article, the authors substantiate the necessity of subdividing a heterogeneous cohort of patients presenting with Fontaine-Pokrovsky grade IV critical limb ischaemia into subgroups with the aim of making an appropriate therapeutic decision and predicting the outcome. We also translated into the Russian language the WIfI classification system developed by the Society for Vascular Surgery (2014) in order to predict limb loss and feasibility of performing revascularization. This is followed by comments on the classification, accompanied by examples of own clinical case studies. In order to check-up the ability of the SVS WIfI classification system to predict the one-year risk of major amputation in patients with decompensated ischaemia, we carried out a retrospective multicenter study, enrolling a total of 109 patients with unreconstructable stage IV chronic ischaemia. Our primary endpoint was the frequency of major amputation during the first year of follow up. The patients were divided into 4 subgroups based on a combination of the three WIfI domains, i. e., wound, ischaemia, and foot infection, respectively, as follows: 130 - 27% (n=29), 131 - 23% (n=25), 230 - 20% (n=22), and 231 - 30% (n=33). The frequency of amputation during the first year of follow-up with the natural course of the disease on the background of conventional therapy averagely amounted to 36%. By the WIfI component combinations, we revealed statistically significant differences between the subgroups (p=0.035): 130 - 21% (n=6), 131 - 28% (n=7), 230 - 36% (n=8), 231 - 55% (n=18). The WIfI classification makes it possible to predict the risk of major amputation in patients with limb-threatening ischaemia. The frequency of amputation during the first year of follow up in the natural course of the disease is associated not only with the WIfI clinical stage but also with the WIfI component combinations.

Aim: To standardize surgical care for malignant colonic obstruction., Material and Methods: There were 572 patients with malignant colonic obstruction: 247 of them were hospitalized in 2011-2013 (I group); 325 - in 2014-2017 (group II). Forty-six patients underwent medication; 302 - acute resection; 141 - stoma construction; 83 - stent deployment. Elective surgery and radiation or chemotherapy was performed after 0.5-6 months in 110 patients of group II. Acute resection was more common in I group, elective resection - in group II. Early and long-term results including Kaplan-Meier 3-year overall survival were compared in both groups., Results: Complications occurred in 46.69% (group I) and 21% (group II). Postoperative mortality was significantly higher in group I compared with II group: 26.11 and 10.33%, respectively. Three-year overall survival was higher in group I compared with group II: 0.82 and 0.69, respectively., Conclusion: Advisability of new two-stage surgical standard is confirmed for malignant colonic obstruction. Stoma formation and stenting may be a valid alternative in some patients with malignant colonic obstruction due to significantly lower postoperative mortality.

The purpose of the study was to analyse the remote results of bypass grafting for myocardial bridges. Our retrospective single-centre study included a total of 17 patients subjected to coronary bypass grafting of the anterior descending artery (ADA) in connection with a detected myocardial bridge (MB). All patients underwent assessment of the coronary bypass grafts (CBG) by means of intraoperative flowmetry - transit time flow measurement (TTFM), as well as angiographic control of the CBGs in the remote period. The duration of follow up amounted to 72 months. Six patients were found to have pronounced retrograde blood flow accompanied by an elevated index of peripheral resistance (Pi) and decreased mean volumetric blood flow velocity (Qmean) below the threshold values. Compression of the ADA proximal to the anastomosis appeared to be followed by improvement of blood flow parameters, in connection with which the shunted artery was ligated with monofilament polypropylene suture 4/0. According to the findings of coronary bypass angiography (CBA) the following results were obtained: 4 occluded grafts were revealed in the group of patients in whom ligation of the ADA was not performed. In patients subjected to ADA ligation in connection with pronounced retrograde blood flow, all bypass grafts were competent. The cumulative probability of freedom from graft occlusion was significantly higher in the group of patients subjected ADA ligation proximal to the anastomosis (Log Rank=0.032).

Objective: to assess the effect of lung hyperinflation (LHI) in patients with chronic obstructive pulmonary disease (COPD) on longterm outcomes of percutaneous coronary intervention (PCI)., Materials and Methods: Patients with COPD who suffered stable ischemic heart disease and underwent PCI (n=135) were included in a prospective cohort study. LHI was found in 60 patients, while 75 patients had no LHI. Evaluation included comparing the frequency of major adverse cardiac events (MACE) (cardiac death, myocardial infarcпункtion [MI], stroke, repeat revascularization) and Kaplan-Mayer curves between groups of patients with and without LHI. Associations of parameters of pulmonary function and plasma levels of high sensitivity C-reactive protein (hsCRP) with occurrence of MACE were also elucidated. Duration of follow-up was up to 3 years (median 20 months)., Results: Study groups did not differ significantly by main factors of cardiovascular risk, except plasma level of hsCRP. MACE occurred in 41.7 and 26.7 % of patients in groups with and without LHI, respectively (p=0.097). However, divergence of the Kaplan-Meier curves was statistically significant (p=0.04). The main contribution was made by cardiac death, MI and stroke (21.7 and 8.0 % among patients with and without LHI; p=0.027). No difference was found regarding repeat revascularization. The correlation between functional residual lung capacity and plasma level of hsCRP was closer than the correlation between forced expiratory volume in 1 second and hsCRP level (r=0.36 and r=0.19; p.

Objective: The study focuses on identifying predictors of treatment outcome in abdominal sepsis (AS) in humans., Subjects and Methods: 70 patients underwent determination of blood pressure, heart rate, SpO , the content of leu- kocytes, albumin, C-reactive protein, fibrinogen and TNF-a in arterial (femoral artery) and venous (subclavian vein) blood. Automatic biochemical analyzer Cobas-Integra 400 ('Roche", Switzerland), the test system Microlab STAR ELISA kit reagents "alpha TNF - ELISA - best" were used during the research. System statistical analysis included paired comparison of patients with favorable (n=27) and lethal (n=43) outcome, correlation, cluster; discriminating analysis, multidimensional scaling and plotting ROC curves with sensitivity and specificity indicators predictive value., Results: Identfied predictors of outcome inpatients,from which to form a predictive model of CRP fibrinogen, albumin, and TNF-a arterial blood. It is established that if the basic treatment of the patient CRP <9,8 g/l,fibrinogen >3,43 g/l, albumin <28,9 gl and TNF-a <499,3 ng/ml, the probability of death was statistically significantly higher thanfavorable., Conclusion: It is assumed that therapeutic measures should be aimed at correction of the above mentioned indicators.

Purpose: to assess effectiveness and safety of extended myectomy performed in patients with hypertrophic obstructive cardiomyopathy (HOCM) with midventricular obstruction., Material and Methods: Between 2010 and 2013 185 HOCM patients were operated for left ventricular outflow tract (LVOT) obstruction. Among these patients 32 had midventricular obstruction. Their age was 22-74 (mean 51.9+/-14.2) years. Mean peak gradient across LVOT was 89.1+/-20.4 mm Hg, thickness of interventricular septum was 26.9+/-4.3 mm. Operations were guided by intraoperative transesophageal echocardiography (TEE)., Results: There were no early deaths. Gradient at LVOT according to TEE decreased to 15.4+/-5.7 mm Hg. There were no complications specific for extended myectomy (such as ventricular septal defect, left ventricular wall rupture, or aortic regurgitation). In 2 (6.9%) patients permanent pacemaker was implanted because of complete atrio-ventricular block. Mean follow-up was 18.7 (95% confidence interval [CI] 17.2 to 20.3) months. Kaplan-Meier estimate of survival was 100% at 12 and 94.2% (95% CI 65.8-99.1%) at 22 months., Conclusion: Extended myectomy can be safely and effectively performed in HOCM patients with midventricular obstruction and should be considered individually in each patient.

Aim: To determine the efficiency of maintenance therapy with bortezomib in patients with multiple myeloma (MM) who have achieved complete remission (CR) after autologous hematopoietic stem cell (auto-HSCT), depending on the presence of minimal residual disease (MRD)., Subjects and Methods: In January 2014 to February 2016, fifty-two MM patients (19 men and 33 women) aged 24 to 66 years (median 54 years), who had achieved CR after auto-HSCT, were randomized to perform maintenance therapy with bortezomib during a year. On day 100 after auto-HSCT, all the patients underwent immunophenotyping of bone marrow plasma cells by 6-color flow cytometry to detect MRD. Relapse-free survival (RFS) was chosen as a criterion for evaluating the efficiency of maintenance therapy., Results: After auto-HSCT, MRD-negative patients had a statistically significantly higher 2-year RFS rate than MRD-positive patients: 52.9% (95% confidence interval (CI), 35.5 to 70.5%) versus 37.2% (95% CI, 25.4 to 49.3%) (p=0.05). The presence of MRD statistically significantly increased the risk of relapse (odds ratio 1.7; 95% CI, 1.2 to 3.4; p=0.05). Two-year cumulative risk of relapse (using the Kaplan-Meier) after auto-HSCT did not statistically significantly differ in MRD-negative patients receiving (n=15) and not receiving (n=10) maintenance therapy with bortezomib (p=0.58). After completion of maintenance treatment, 42% of the MRD-positive patients achieved a negative status. In the MRD-positive patients who had received maintenance therapy, the average time to recurrence was 5 months longer than that in the naïve patients: 17.3 versus 12.3 months., Conclusion: The MRD status determined in MM patients who have achieved CR after auto-HSCT is an important factor for deciding on the use of maintenance therapy.

Aim: Comparative evaluation of the effectiveness of various hemostatic methods in patients with colon and rectal cancer complicated by bleeding., Material and Methods: We examined 77 hospitalized patients with colon and rectal cancer complicated by bleeding. Conservative therapy was effective in 11 patients (group I), endoscopic hemostasis in 49 cases (group II), 17 patients underwent emergency surgery (bowel resection/ internal iliac arteries ligation) (group III). Vascular embolization was performed in 2 patients. 20 out of 77 patients in groups I-II underwent elective surgery and radiochemotherapy in 7-10 days after hemorrhage and normalization of hemoglobin. 3-year Kaplan-Meier survival was assessed after emergency (group III) and elective (I-II) interventions in 37 survivors., Results: The effectiveness of various methods of hemostasis was 14.3% in group I, 80.3% in group II and 100% in group III. Embolization was ineffective (patients underwent surgery). Complications were observed in 4.9% (II) and 29.4% (III), respectively. Mortality was significantly higher after conditionally radical surgery than after endoscopy: 17.6% vs. 0. 3-year survival was better after elective interventions compared with emergency surgery (0.79 vs. 0.64, respectively)., Conclusion: Endoscopy is the most effective method to stop colonic bleeding with minimal complications. It is a 'bridge to surgery' and alternative to conditionally radical operations in order to reduce mortality. Treatment of bleeding should be carried out in multi-field hospital by highly qualified specialists.

Craniopharyngiomas are benign epithelial tumors having a dysembryogenetic origin, which are usually located in the sellar/parasellar and/or third ventricle regions. Gross total resection is the modern standard of treatment for these tumors because of a low recurrence rate. However, this surgery in some patients with craniopharyngioma often leads to the development or worsening of diencephalic disorders poorly responding to treatment. Perhaps, in these cases, subtotal or partial tumor resection or implantation of an Ommaya reservoir into the tumor cyst followed by stereotactic radiotherapy/radiosurgery may provide better functional outcomes and higher life quality in patients, with tumor growth control being reasonable (according to the published data, the mean 10-year disease-free survival is 66.9% after total tumor resection and 79.6% after combined treatment). The paper presents a review of the literature on radiological treatment of craniopharyngiomas. We discuss the issues of indications, optimal timing of radiotherapy/radiosurgery, its efficacy, and treatment outcomes in terms of complications and quality of life. Particular attention is paid to enlargement of craniopharyngioma cysts during and after radiological treatment.

Aim: To evaluate an effectiveness of various hemostatic methods in patients with colon and rectal cancer., Material and Methods: 77 urgent patients with colon and rectal cancer complicated by bleeding were enrolled. Medication was effective in 11 patients (group 1), endoscopic hemostasis in 47 patients (group 2), vascular embolization in 2 cases (group 3), internal iliac arteries ligation in 2 patients (group 4), 15 patients underwent emergency resection (group 5). Twenty out of 62 patients in groups 1-4 underwent elective radical procedures and radio- or chemotherapy in 7-10 days after hemostasis and normalization of hemoglobin. 3-year Kaplan-Meier survival was assessed after emergency (group 5) and elective surgery (groups 1-4) in 31 patients., Results: Effectiveness of various hemostatic methods was 14.3% in group 1, 79.7% in group 2, 28.6% in group 3 and 100% in groups 4 and 5. Postoperative morbidity and mortality were higher after emergency (group 5) compared with elective (groups 1-4) procedures: 33.3 and 20%; 15 and 5% respectively. 3-year survival was better after elective than emergency operations - 0.78 and 0.57, respectively., Conclusion: Management of bleeding should be carried out by highly qualified specialist at multi-field emergency care hospital. Endoscopy and arterial embolization are the most effective methods of hemostasis with minimal risk of complications. In hemorrhage patients endoscopy and embolization ("bridge to surgery") are an alternative to conditionally radical operations, since they allow to reduce mortality.

The median overall survival of glioblastoma patients is about 15 months. Only a small number of patients survive 3 years. The factors of a favorable prognosis for the 'longevity phenomenon' in glioblastoma patients are not fully understood., Objective: to determine the occurrence rate of long-living patients with glioblastomas, identify clinical predictors of a favorable prognosis, and identify the presence and prognostic significance of an IDH1 mutation., Material and Methods: Among 1494 patients operated on for glioblastoma at the Burdenko Neurosurgical Institute from 2007 to 2012, there were 84 (5.6%) patients who lived more than 3 years after primary surgery. In all the cases, histological specimens were reviewed, and immunohistochemical detection of a mutant IDH1 protein was performed. Overall survival was calculated from the time of first surgery to the date of the last consultation or death, and the recurrence-free period was calculated from the time of first surgery to MRI-verified tumor progression., Results: The median age of long-living patients with glioblastoma was 45 years (19-65 years). All tumors were located supratentorially. The median Karnofsky performance status score at the time of surgery was 80 (range, 70-100). All patients underwent microsurgical resection of the tumor, followed by chemoradiotherapy. The median recurrence-free period was 36 months (5-98 months). Overall survival of 48, 60, and 84 months was achieved in 23, 15 and 6% of patients, respectively. Among 49 specimens available for the IDH1 analysis, 14 (28.6%) specimens had a mutant protein. There was no significant difference in survival rates in patients with positive and negative results for IDH1 (44.1 vs. 40.8 months; p>0.05)., Conclusion: The significance of various factors that may be predictors of a favorable course of the disease is discussed in the literature. This work is the first part of analysis of prognostically significant factors positively affecting overall survival of glioblastoma patients. In our series, the predictors of a favorable prognosis for long-living patients with the verified diagnosis of glioblastoma were as follows: young age, the supratentorial location of the tumor, a high Karnofsky score before surgery, and tumor resection. In our series, we used immunohistochemical tests and found no prognostic significance of the IDH1 gene mutation; further analysis will require application of direct sequencing. We plan to study other morphological and molecular genetic features of tumors, which explain prolonged survival of glioblastoma patients, as well as the role of various types of combined chemoradiation treatment.

Introduction: The RARa is a transcription factor playing important role in such processes as proliferation, differentiation and apoptosis of cells in norm and in tumor. At the same time, it is little known about significance of expression of two major products of transcription of gene RARa - isoforms RARa and RARa - in pathogenesis of solid and non-solid tumors, including multiple myeloma. The actual data testify ambiguity of input made by isoforms RARa and RARa into processes of tumor development and progression of malignant tumors., The Results: It was established that higher level of expression of isoform RARa in combination with increased expression of isoform RARβ (group 1) statistically reliable associated with lesser decreasing of concentration of Bence Jones protein in urine of patients in the result of applied treatment and, therefore, lesser effectiveness of response to standard treatment according protocol M-2 in comparison with group II which included patients with lesser levels of expression of RARa and RARβ (32.8% and 62.8% for groups I and II correspondingly; p=0.037). The analysis of indices of survival of examined patients in groups I and II demonstrated that median of total survival of patients from group I was reliably lower than in patients included into group II (30 and 84 correspondingly; p=0.046)., Conclusion: The results of study demonstrate that increased level of expression in the first instance of isoform RARa in combination with hyper-expression of isoform RARβ but not RARa can have unfavorable significance in case of evaluation of response to medicinal therapy and prognosis of total survival in patients with multiple melanoma.

The purpose of this study was to explore the long-term survival of patients after myocardial infarction (MI) and to elucidate main medical and social factors affecting survival., Material and Methods: In 2006 we included into this study 791 consecutive patients with MI. Duration of follow-up was 8.5 years. Survival was analyzed by construction of life tables and calculation of Kaplan-Meier estimates., Results: During follow-up 446 patients died. Leading was cardiovascular death (88.2%). Other causes were cancer (7.1%), internal diseases (4.1%), and external causes (0.6%). Risk of death was the highest during first year. One, three, and five-year survival was 74.9, 62.2 and 53.8%, respectively. Main medical and social factors that reduced long-term survival were: old age, lack of work, no percutaneous coronary intervention during initial hospitalization, recurrent myocardial infarction, and male sex among working age patients.

Aim: To evaluate the results of kidney transplantation from alive related donor in patients with Alport syndrome and to compare with those in patients with kidney hypoplasia., Material and Methods: We have analyzed 8 and 27 medical records of patients with Alport syndrome and kidney hypoplasia respectively. Following parameters were used - Kaplan-Meier survival analysis, Wilcox overall risk, percentage of transplants loss and mortality (Fisher's exact test calculation)., Results: It is concluded that percentage of transplants loss and mortality rate as well as overall survival and risk were similar in both groups., Conclusion: Despite risk of anti-GBM nephritis development in patients with Alport syndrome results are comparable with those after transplatation for chronic renal failure caused by other reasons.

The paper reports results of 6 year prospective observation of 7959 members of locomotive crews engaged at the Transbaikal Railways. The study aimed to estimate the probability and time of development of resistant arterial hypertension under effect of predictors of this disease. The data obtained are of value for diagnostic, prophylactic, and therapeutic practice.

The authors assessed the probability and terms of the development of chronic obliterating diseases of lower-limb arteries under the influence of the predictors studied. Using the Statistica 6.0 programme we carried out the analysis of the function of survival on a sample of 7,959 people. Based on the Kaplan-Mayer method and Cox regression model we determined the most significant predictors influencing the development of subclinical lesions of lower-extremity arteries. Also determined was the duration of the influence of each predictor prior to clinical manifestation and contribution of each predictor to the development of the examined outcomes.

Aim: To investigate the impact of the degree of coronary atherosclerosis evaluated by the SYNTAX scale on the early and late results of endovascular revascularization in elderly and middle-aged patients with ST-segment elevation myocardial infarction (STEMI)., Subjects and Methods: The investigation enrolled 327 consecutively admitted patients with STEMI and multivessel coronary bed disease, who had received revascularization within the first 12 hours after disease onset via primary percutaneous coronary interventions (PCI). The clinical, demographic, and angiographic characteristics of the patients, as well as the specific features of chosen revascularization strategies and treatment outcomes were compared in two groups of 103 elderly patients (≥65 years of age) and 224 middle-aged patients (≤64 years) in relation to the severity of coronary bed lesion according to the SYNTAX scale., Results: By and large, severe coronary atherosclerosis (≥23 SYNTAX scores) was related to reduced left ventricular ejection fraction and clinical manifestations of acute heart failure in all the analyzed patients regardless of their age and this was most markedly associated with the risk factors of cardiovascular events in the elderly patients. The elderly patients with severe coronary atherosclerosis (≥23 SYNTAX scores) were noted to have the lowest frequency of successful PCIs and higher 30-day mortality rates after primary PCI., Conclusion: The SYNTAX scale is of high prognostic value in the patients with STEMI, by determining the results of endovascular revascularization in elderly and middle-aged patients. The elderly patients with STEMI and severe coronary atherosclerosis are at very high risk for poor outcome within 30 days of follow-up after primary CPI, which necessitates a search for optimal revascularization strategies for this category of patients.

Aim: To define the effect of donor and recipient gender on the results of kidney transplantation from living related donor., Material and Methods: Group of 271 patients who underwent kidney transplantation from living related donor was analyzed. There were 115 women and 156 men. Age varied from 1 to 63 years (mean 21.30±12.32). There were 127 children aged 1-18 years (mean 11.28±4.63) and 144 adults aged 19-63 years (mean 29.81±11.24). Donors included 162 women and 109 men. Overall survival was calculated using Kaplan-Mayer. Mortality and incidence of transplants failure were determined using Fisher's exact test., Results: All patients were divided into 2 groups depending on recipients' gender and then into 4 subgroups depending on gender of donors and recipients. Comparative statistical analysis showed that transplants survival was higher in women vs. men (T=2.7, p=0.007). Survival of patients was similar in both groups. Moreover it was the best in subgroup of recipients-women with kidneys from donors-men. Difference was statistically significant (T=2.16, p=0.03). There was no significant difference in all other cases., Conclusion: The results of kidney transplantation are better in recipients-women than in men.

The peculiarities of a clinical course, results of pharmacological and interventional treatment in 447 patients with noncoronary cardiac arrhythmias were analyzed. A definition highly curable cardiac arrhythmia is introduced. The high efficiency and safety of the method of radiofrequency ablation in patients with highly curable cardiac arrhythmias that allows soldiers to leave the military service, as well as to enter military service under the contract. Proposed implementation of the control medical examination to conduct endocardial electrophysiological study and the subsequent medical examination to determine the category of fitness for military service not earlier than 6 months after surgery.

Sepsis is a disease with a high death-rate and is accompanied by profound metabolic disturbances. Interference of microbe metabolic products with biochemical processes in human organism is present in case of severe infection. But there is little information about integration of microbe and human metabolism in septic patients. We evaluated an indol level in healthy individuals and septic patients. It was revealed that septic patients have higher indol levels. Hemoperfusion through "Ovosorb" sorbing agent allows to decrease indol concentration to normal levels. Application of hemosorbtion in combination with magnetic blood processing allows achieving faster and more effective indol removal.

Using of radiochemotherapy improves short-term and long-term results of treatment in patients with primary Hodgkin's lymphoma (HL) comparing with treatment by chemotherapy alone. The rates of 5-year, 10-year OS and DFS are 88%, 83% and 90%, 86% in case of radiochemotherapy, versus 73%, 66% and 72%, 68% using chemotherapy alone. The 5-year and 10-year OS, DFS estimates in treatment with ABVD are 84% and 83%, 75% and 74%; BEACOPP-baseline--83% and 82%, 82% and 81% (p < 0.05). At the same time ABVD chemotherapy develops less toxicity (p < 0.001). The treatment with 6 cycles of ABVD is considered as the most appropriate in primary Hodgkin's lymphoma patients with extranodal lesions. Using more than 6 cycles doesn't seem to improve OS and DFS (the 5-year and 10-year DFS, OS estimates are 79% and 72%, 80% and 77% versus 88% and 87%, 90% and 89% (p < 0.05). Comparison of complications rate during chemotherapy with MOPP (919 cycles), ABVD (1300 cycles), BEACOPP-baseline (584 cycles), BEACOPP-escalated (140 cycles) reveals major hematologic toxicity and infectious complications rate in BEACOPP-escalated program (p < 0.05).

In recent years there has been rapid growth in the incidence of melanoma. Due to the large number of patients with various pigmented lesions, suspicious for melanoma, requiring differential diagnosis there is an actual problem of excisional biopsy in this group of patients. This review extensively covered approaches to radical surgical treatment of patients with skin melanoma. There are described in detail results of the studies of foreign experts regarding the influence of excisional and incisional biopsy on overall and disease-free survival rates of patients. On a large representative material (1126 patients) there are widely reflected the results of our studies to assess the effect of different surgical approaches to treatment of patients with skin melanoma. At present the authors can not recommend to perform excisional biopsy of patients with primary skin melanoma in oncological practice. Obviously for a final resolution of this problem it is necessary to conduct a multicenter randomized trial.

The study includes data on 54 patients with pleural malignant lesions (39 with metastatic pleural malignant tumors and 15 with pleural malignant mesothelioma) received treatment using a multimodal approach: maximum cytoreduction, intraoperative photodynamic therapy and hyperthermic chemoperfusion of pleural cavity. A control group of patients with malignant pleural mesothelioma consisted of 21 patients who had undergone only conservative treatment. It was found out that the use two-thoracotomy surgical approach had advantages over standard thoracotomy across IV intercostal space. The use of multimodal treatment was accompanied by relatively low (1.85%) postoperative mortality on the background of a relatively high number (79.6%) of postoperative complications, easily cured in the early postoperative period. The use of multimodal therapy in treatment for metastatic pleural malignant lesions was accompanied by a median of disease-free survival of 11 months and a median of overall survival of 23 months. The proposed multimodal treatment compared with conservative methods of therapy improved disease-free (12 months vs. 7.5 months) and overall (18.8 months vs. 10.2 months) survival. Thus the use of a multimodal approach in treatment for pleural malignant lesions is relatively safe but requires further study.

Drug therapy for symptomatic multiple myeloma is comparable for both sexes in its effectiveness and safety. A 3-year event-free survival is comparable in men and women; overall survival in men is lower than in women.

Compared with surgical treatment the combined treatment of patients with non-small cell lung cancer accompanied by post-operative radiotherapy in the mode of hypofractionation from 3 Gy to SOD-36-39 Gy (EQD2 = 43,2-46,8 Gy) allowed statistically significant increasing a 5- and 10-year overall and disease-specific survival in patients with metastases to regional lymph nodes (pN1-2). The increase of overall and disease-specific survival was also observed in patients older than 60 years with the worst initial status (70-80 by the Karnofsky scale), II stage of disease, peripheral cancer and adenocarcinoma however for these groups survival differences did not reach a statistically significant level. The presented method of postoperative irradiation did not have severe toxicity and did not lead to a decrease in survival of elderly and functionally debilitated patients.

Aim: To analyze the influence of pharmacogenetic factors on the risk of clopidogrel resistance and cardiovascular events during 18-months follow-up., Subjects and Methods: Two hundred and fifty patients taking clopidogrel were examined. Platelet function was determined by optical aggregometry. Thromboxane A synthase 1 (TBS1) gene polymorphism was investigated in all the patients. The impact of TBS1 gene polymorphism on the risk of clopidogrel resistance and cardiovascular events was analyzed during 18 months of follow-up., Results: The carriage of TBS1 gene polymorphism AA was shown to affect the risk of clopidogrel resistance. Cardiovascular complications significantly less frequently occurred in TBSI gene polymorphism AA carriers during 18 months., Conclusion: The carriage of a slow AA allele of the'TBS1 gene is suggested to be a clinically significant protective factor in the secondary prevention of coronary heart disease

A total of 40 patients (median age 6 years, range 1-28 years) with high-risk malignant brain tumors received a single (n = 35) or tandem (n = 5) high-dose chemotherapy (HDCT) with autologous hemopoietic stem cell transplantation (auto-HSCT). The 2-year OS and DFS are 52% and 47%, accordingly, with median follow-up of 24 (range 2-96) months. The patients without complete response at the time of auto-HSCT had worst prognosis with 53% DFS in patients with partial remission and 25% in patients with disease stabilization (p = 0.001). Patients with relapsed tumor had worse prognosis, than high-risk patients in the first remission with DFS 26% and 62%, accordingly (p=0.02). The relapse rate also correlated with patient's age (38% DFS in patients younger, than 4 years and 60% in older patients, p = 0.005) and tumor morphology (63% DFS in patients with medulloblastoma, 60% in patients with germ-cell tumors, 45% in other embryonal CNS tumors, p = 0.05). The 4th-grade transplant-related toxicity and mortality rates were observed in 13% and 18% of patients, accordingly. Therefore, HDCT with auto-HSCT in young patients with high-risk CNS tumors is characterized by acceptable toxicity and allows improving overall therapy results.

Eribulin is a novel antimicrotubule drug, which is approved in the second line treatment of advanced breast cancer in patients who received anthracyclines and taxanes. The article presents the results of two huge phase III clinical trials (301, 305) and their pooled analysis. Eribulin monotherapy demonstates staistically significant improved overall survival compared to standart treatments (15.2 mnths vs 12.8 mnths, p = 0.03 in pooled analysis). Certain subgroups of patients--Her2-negative and triple-negative have the most survival benefit. According to own experience with Eribulin inside the clinical trials, presented in the article, the drug is effective and well tolerated even by older patients.

The purpose of this study was to examine the incidence of breast cancer with triple-negative phenotype (TN BC) in the Russian population as well as to compare the clinical and morphological features and outcomes for women with TN BC with other types of breast cancer. We studied a cohort of 499 patients with breast cancer without distant metastases, diagnosed between 2002 and 2011 at N.N.Blokhin Russian Cancer Research Center in Moscow. Triple-negative breast cancers were defined as those that had "negative" level of estrogens and progesteron receptors and were HER2neu negative. 330 (66.2%) of patients has triple negative tumors, 81 (16.2%)--ER and PR negative and HER-2 positive tumors, and 88 (17.6%)--ER and/or ER positive and HER-2 negative tumors. Further was evaluated disease-free and overall survival. 18.5 % of all analyzed patients had triple negative phenotype. Median follow-up was 40.5 months. Characteristic features of the TN BC were: TN breast cancer, compared with other subtypes, characterized by a higher incidence of clinical and morphological features associated with an aggressive course of the disease: the age less than 35 years, grade 3, non- specified invasive histology, high level of Ki-67, the rapid development of the disease, which manifests itself in small terms of the first complaints before the diagnosis. TN BC patients has poorer 5-year overall survival (73.6 + 3.6%) and the 5-year disease-free survival (70.6 + 3.5%), which is significantly lower than the comparable survival of patients with other subtypes of breast cancer (p < 0.001). The results of our study confirm the similarity of majority of clinical and morphological characteristics, course and prognosis of the disease of the Russian population of TN BC patients with those in Europe and the United States.

A total of 115 children (median age 10.5 years, range 2-17) with Ewing sarcoma family tumors (ESFT) received therapy in N.N. Petrov Institute of Oncology pediatric department from April 1985 till August 2013. These patients were divided into two groups depending on treatment tactics used: patients treated according to modified T9 protocol (n = 64) and patients treated according to EICESS-92 or Euro-Ewing 99 regimens (n = 51). Twenty four patients from the second group with adverse prognostic factors received high-dose chemotherapy with autologous stem cell transplantation. All patients received surgical treatment and/or irradiation for primary tumor local control. Five-year overall and disease-free survival was 39% and 37,9% in the first group. In the second group these values were significantly higher; 55% and 39.5%, accordingly (p = 0.03 and 0.25). All patients from the first group with primary metastatic ESFT died of disease progression, while in the second group OS and DFS reached 45.8% and 28.9%, accordingly. There was a statistically significant correlation between local relapse rate and irradiation dose biological equivalent (in TDF units). The local relapse cumulative rate was minimal (12,6%) in patients receiving 80 TDF.

In our study the analysis of significant predictors affecting the results of treatment of anaplastic astrocytoma brain (grade III) is showed. According to our data to assess the effectiveness of special treatment of these patients is possible with such clearly defined predictors such as age, volume of surgery, initial tumor size and functional status (the Karnofsky index). The study demonstrates that in patients who underwent radiotherapy using single focal dose of 3 Gy overall survivals was comparable with the group of patients who underwent radiation therapy using small dose fractionation. The use of adjuvant chemoradiotherapy in patients with grade III glioma does not increase overall survival rate compared with patients who received only adjuvant radiotherapy.

The outcomes of Gamma Knife radiosurgery for 95 patients with melanoma brain metastases were studied. The majority of the patients (82%) presented multiple metastatic brain lesions. Local control was achieved in 94% of cases. The Kaplan-Maier analyses of life expectancy revealed that median survival after radiosurgical treatment was 6.9 months. The median survival by RTOG RPA class was 18,3 months for class I; 6.9 months for class II and 3.9 months for class III. These results demonstrate that Gamma Knife radiosurgery provides a high level of local control for melanoma brain metastases and may increase the life expectancy.

Objective: To evaluate the efficiency of chemoembolization using irinotecan-loaded DC Bead microspheres in the second-line chemotherapy for colorectal liver metastases., Material and Methods: In 2008 to 2013, thirty-two patients with unresectable colorectal liver metastases underwent 78 chemoembolizations (mean 2.44 per patient). The results of embolization were assessed by computed tomography using the Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Survival rates were analyzed applying the Kaplan-Meier method., Results: According to the RECIST criteria, a partial response at 3, 6, and 12 months of treatment was found in 4, 2, and 0%, respectively. Stabilization was noted in 67, 53, and 12%. There were no complete responses. The median time to disease progression was 225 days; median survival was 420 days. By the study analysis, all the patients included in the study died., Conclusion: Chemoembolization with drug-eluting microspheres may be successfully used in the second-line chemotherapy of colorectal liver metastases.

In 14 patients with cirrhosis and portal hypertention autologous mesenclyme multipotential stem cells (AMMSC) transplanation was performed in portal vein (I group, n=7) and common trunk of the hepatic artery (II group, n=6). Duration of pathological processes since diagnosis is 1-8 years (3,7±2,4 years). The initial severity was evaluated by a set of child-Pugh score: Class A - 6 (42,9%), Class B - 8 (57,1%). Cell cultures indentication and characteristics consistent with International Society of cell technology guidanes (ISCT) since 2006.   The treatment results and patients survival were determined in period 2 month - 5 years according Kaplan-Meir survival curve analysis. Morphology of liver bioptats also was performed.   It was shown that AMMSC transplantation generally positivly affects on the morpho-functional dynamics and basic hepatic syndromes. Aterial perivascular zone is the most optimal for transplantation in terms of migration, engraftment and differentiation of cells in comparison with portal field, as evidenced by the transition of some patients from class B to class A by child-Pugh score.

Objective: To study the effects of cytotoxic and targeted anti-VEGF drugs on some mechanisms of apoptosis., Material and Methods: The effects of cytotoxic and targeted anti-VEGF drugs on the expression of the apoptosis activators Bax and PML and the apoptosis inhibitor Bcl-2 were studied in the colorectal cancer (CRC) liver metastases; a comparison group comprised patients receiving no chemotherapy., Results: Immunohistochemical examination revealed lower Bax and PML expressions and higher Bcl-2 expression in the majority of untreated patients, suggesting the suppressed mechanisms triggering tumor cell apoptosis. Cytotoxic therapy resulted in a statistically significant rise in the expression of the apoptosis activator Bax (p = 0.01), a reduction in the level of the apoptosis inhibitor Bcl-2 (p = 0.04) and a slight increase in PML that controlled the induction of apoptosis. Adding an anti-VEGF agent to cytotoxic therapy exerted no statistically significant impact on Bax and Bcl-2, but caused more frequent positive PML expression than in the control and cytotoxic chemotherapy groups., Conclusion: Our study showed that cytotoxic and targeted anti-VEGF agents activate the apoptosis of tumor cells in the CRC liver metastases.

Unlabelled: Choosing the treatment method for patients with large choroidal melanomas remains a subject of debate. No literature data can be found on survival of such patients after either eye-preserving surgery or enucleation that takes into account the initial tumor size. The purpose of the study was to analyze the five-year survival rates for large choroidal melanomas (by J.A. Shields) in respect of the provided treatment., Material and Methods: Medical records of 103 patients who had undergone treatment for choroidal melanoma (initial prominence 5.0-10.2 mm, initial diameter 7.3-20 mm) were studied. Eye-preserving surgery was performed on 60 patients, of whom 46 patients received brachytherapy (single session in 37 cases) and the other 14 patients--brachytherapy in combination with transpupillary thermotherapy (with subsequent endoresection of the tumor in one case). A total of 16 patients from this group required secondary enucleation. Primary enucleation was performed on 63 patients. Histopathological results confirming choroidal melanoma were analyzed in all 79 cases., Results and Discussion: The 5-year melanoma-specific cumulative survival rate in the group of eye-preserving surgery was 0.8146, while in the group of primary enucleation it reached 0.8951. The 8-year rate was 0.6921 and 0.7558 correspondingly. However, according to Gehan-Wilcoxon test, the differences were statistically insignificant (p = 0.11). The five-year survival of large choroidal melanoma patients who underwent eye-preserving surgery and no enucleation was 0.7708, 9-year - 0.6175., Conclusion: Since the five-year melanoma-specific survival rate after primary enucleation is higher than that after eye-preserving surgery and secondary enucleation (though the difference is statistically insignificant), treatment options for large choroidal melanomas have to be chosen individually, taking into account the age and attitude of the patient as well as the size of the tumor.

Objective: To make an integrated assessment of the proliferative activity of gastric cancer (GC) (Ki-67 and mitotic index - MI) and the degree of tumor cell apoptosis (apoptotic index - AI), by calculating the cell regeneration coefficient (CRC) in relation to the histological variant and functional immunophenotype (IPT) of a tumor and to determine if there is a possible association of the above indicators with adjusted 4-year relapse-free survival rates., Subjects and Methods: Surgical specimens obtained from 55 patients with CC were examined. The tumors were divided into histological variants in accordance with the International histological classification criteria (WHO, 2010) and into IPT by a set of the produced mucins MUC1, MUC2, MUC5AC, MUC6, and the glycoprotein CD10. MI and AI were estimated from the number of mitoses and apoptotic bodies in the 5-microm-thick hematoxylin- and eosin-stained tumor histological sections; Ki-67 was determined by scoring the number of its immunopositive nuclei per 1000 counted tumor cells at x1000 magnification., Results: The values of Ki-67, MI, AI, and CRC in GC were found to be significantly related to the tumor histological variant and IPT; and MI, AI and CRC were also associated with adjusted 4-year relapse-free survival rates. The Ki-67 index in the gastric carcinomas is of no prognostic value, which is most likely to be attributable to the inadequacy of this indicator for the estimation of the biological potential of tumors growing in the tissues with constantly regenerative cell populations, which is peculiar to the epithelium of the gastric mucosa, particularly to that of the necks of the glands, which most GCs are histogenetically related to., Conclusion: Thus, the values of MI, AI, and CRC are best used as additional prognostic factors in patients with GC. At the same time, the prognostic value of Ki-67 in GC has been overestimated, as shown by the authors' data.

We included into this study 112 patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM) subjected to percutaneous coronary interventions with stenting. Everolimus and sirolimus eluting stents (EES and SES) were implanted in 54 (group 1) and 58 (group 2) patients, respectively. After 12 months in groups 1 and 2 rates of repeat target lesion revascularizations (TLR) were 5.5 and 8.6% (odds ratio - OR - 0.62, 95% confidence interval - CI - 0.14- 2.74, p = 0.72); acute myocardial infarctions (MI) - 3.7 and 5.2% (OR 0.71, 95% CI 0.11- 4.4, p = 0.94); deaths - 1.85 and 1.7% (OR 1.1, 95% CI 0.1- 17.6, p = 1.0), respectively. There was no significant difference between groups by rate of unfavorable cardiac events (composite of cardiac death, nonfatal MI, and clinically indicated TLR) - 11.1 and 15.5% in groups 1 and 2, respectively (OR 0.68, 95% CI 0.225- 2.059, p = 0.69). Rates of stent thrombosis also did not differ (1.85 and 3.4% in groups 1 and 2, respectively; OR 0.53, 95% CI 0.05- 6.0; p = 0.94). Thus the use of EES and SES in patients with IHD and type-2 DM was equally effective.

Aim: To compare the results of semiclosed retrograde loop endarterectomy from the superficial femoral artery (SFA) and proximal femoropopliteal bypass grafting (FPBG) with a synthetic prosthesis., Material and Methods: From 2007 to 2011, at the Department of Vascular Surgery of Municipal Clinical Hospital No 15 named after O.M. Filatov we operated on a total of 97 patients with occlusive and stenotic lesions of the femoropopliteal segment, with 83 (86%) of them being men. The mean age of the patients was 62.7 ± 8.9 years. By the degree of chronic ischaemia the patients were subdivided according to the Fontain-Pokrovsky classification as follows: 52 (53.6%) patients had stage 2B ischaemia, 22 (22.7%) patients presented with stage 3, and 14 (14.4%) patients had stage 4. Nine (9.3%) patients were diagnosed with symptoms of acute ischaemia. Depending on the operative treatment performed, the patients were subdivided into two groups: Group I (n=56) comprising patients subjected to FPBG above the knee-joint fissure and Group II (n=41) consisting of those who underwent loop endarterectomy from the SFA., Results: Technical success was obtained in 97 (100%) patients. After the operation the average ankle-brachial index (ABI) amounted to 0.87 ± 0.22 in Group I and 0.83 ± 0.22 in Group II. One (1.8%) patient from Group I developed shunt thrombosis successfully treated by thrombectomy. In Group II after surgery we also observed 1 thrombosis (2.4%) of the desobliterated superficial femoral artery, treated by thrombectomy from the SFA. The remote results were followed up during 4-7 years. Primary patency in the group of patients undergoing FPBG amounted after 1 and 2 years to 73.1% and 63.2% (p<0.005), and after 3 and 4 years to 34.1% and 30.7% (p>0.05). In the group of patients after loop EAE from the SFA 1-, 2-, 3- and 4-year primary patency amounted to 92.1%, 74.6% (p<0.05) and 63.1%, 58.9% (p>0.05), respectively., Conclusion: Semiclosed retrograde loop endarterectomy (EAE) demonstrated better results both in the immediate and remote postoperative periods as compared with femoropopliteal proximal bypass grafting using a synthetic prosthesis.

Surgery as being a preferential method of treatment of patients with cholangiocarcinoma is associated with high complications and mortality levels while demonstrating poor long-term outcomes. Optimization of preoperative management and improvement of the results of surgical treatment for patients with proximal extrahepatic bile duct carcinoma. From January 1998 to December 2013 surgical treatment was performed in 36 patients (19 males, 17 females) with Klatzkin's tumor, from whom 10 patients obtained postoperative chemotherapy. Bismuth-Corlette type III-IV tumor stage was determined in 30 (83.3%) patients. Portal vein resection was performed in 13 (36.1%) patients. 27 (75.5%) patients underwent R0 resection. Postoperative mortality rate consisted 16.7%, complications were revealed in 87.1% of cases. 6 (16.7%) patients required additional surgery and interventional procedures were performed in other 20 (55.5%) patients to fix postoperative complications. Overall 5-year survival rate in R0-resection group was 40.1%, median - 29 months. In postoperative chemotherapy group overall 3-year survival rate was 66.7% which was twice higher than in surgery group but the difference was not statistically significant (p=0.35). The improvement of short-term outcomes of surgical treatment for patients with Klatzkin's tumor requires optimization of preoperative management and detailed adherence of surgical techniques. Combination of surgery with postoperative chemotherapy showed the trend to improvement of overall survival.

The study included 62 patients with morphologically verified squamous cell carcinoma of laryngopharynx, stages T2-4N0-2M0. As a result of the treatment complete regression was recorded in 28.1 ± 7.9% of cases, partial regression--in 50.0 ± 8.8% of patients, and stabilization--in 21.9 ± 7.3% of cases. The total efficiency of therapy made up 78.1 ± 7.3%. Chemotherapy complications and radiation injuries did not exceed I-II grade by CTC-NCIC criteria and PTOG/EORTC scale, were easily stopped, did not affect the time periods of further treatment and had no considerable influence on the postoperative period. Conservative surgery was performed in 26% of cases. The total 5-year survival rate made up 65.4 ± 8.4%, relapse-free 5-year survival rate--60.6 ± 8.9%. The efficiency of the vocal function rehabilitation made up 73.9 ± 9.1%. Rehabilitation time was 21 ± 8.2 days.

Aim: To elucidate whether and how tacrolimus affects the cumulative survival of patients after living related kidney donor transplantation., Subjects and Methods: The clinical materials of 246 related kidney transplant recipients, including 108 patients in whom tacrolimus (Prograf and Advagraf) Astellas Pharma US, Inc) was included in the immunodepression protocol (Group 1) and 138 patients who did not receive the agent (Group 2), were analyzed. Comparative analysis used the following tests: the Kaplan Meier test estimating the cumulative survival of recipients and transplants; the Cox test assessing the cumulative risk; and the log-rank test. Allorenal graft losses and mortality rates were also calculated., Results: Mathematical analysis of the above indicators demonstrated that the allograft and survival rates were far higher (p < 0.05) and the cumulative risk was much less in Group 1 (p < 0.02). Graft losses and the recipients' deaths were higher in Group 2., Conclusion: The analysis suggests that the incorporation of tacrolimus into the immunodepression therapy protocol positively impacts the results of lung related kidney donor transplantation.

An analysis of treatment results was made in 226 patients with multiple isolated intrapulmonary metastases of solid tumors. It appears that surgical removal of metastases was possible in patients with satisfactory functional resources and accurate evaluation in order to validate the indications for surgery. The operation shouldn't result in considerable reduction of quality of life and didn't prevent using other methods of treatment such as medicamental and radiation therapy. The indications to surgical intervention have to be set as individual in consideration of the number of metastases and potential of the patient to undergo the surgery.

Unlabelled: Adjuvant chemotherapy is a debatable question in patients with early stages of non-small cell lung cancer (NSCLC). Prognostic/predictive markers should be used for individualizing prescription of adjuvant chemotherapy. The aim of our study was to investigation effectiveness adjuvant chemotherapy in patients with early stages of NSCLC due to proliferation index of tumor. We included in study 254 patients with I-II stages of NSCLC that conducted treatment in department of thoracic surgery Zaporozhye regional clinical oncology center since June 2008 to December 2012. Expression Ki-67, proliferation marker, measured in 95 patients that used adjuvant chemotherapy and in 122 patients with out additional treatment. Measuring of proliferation index was don by next method: 0-5% immunopositive cells--0 point, 6-25%--1 point, 26-50%--2 point, 51-75%-- 3 point, 76-100%--4 point. High expression was > or = 2 points., Results: Mean of proliferation index in patients with early stages of NSCLC was 37.6% (95% CI, 33.8-41.5%). Median of survival in patients with II stage of NSCLC was 39.7 month if patients conducted adjuvant chemotherapy and 21.4 month with out treatment. It was tendencies increasing survival in patients with II stage of NSCLC after adjuvant chemotherapy, but it was not statistically significant (P = 0.16). Survival patients with high proliferation index was 10.5 month--75 percentile, 18 month--median, 29.9 month--25 percentile. In patients after adjuvant chemotherapy 75 percentile of survival was 34.4 month, median of survival not complete. Survival differences of two group were statistically significant (P < 0.0001). Thus individualization of prescription adjuvant chemotherapy in patient with early stages of NSCLC helps improves results of treatment and avoid unreasonable toxic therapy.

Aim: The study was aimed at comparative analysis of efficacy of endovascular and surgical revascularization in patients presenting with lower limb critical ischaemia (LLCI) due to lesions of infrainguinal arteries., Material and Methods: The retrospective study included a total of 236 patients with LLCI undergoing revascularization of lower extremities performed at our Institute from 2007 to 2011. The patients were subdivided into two groups. Group One consisted of 135 patients subjected to transcutaneous endovascular interventions. Group Two comprised a total of 101 patients having endured bypass grafting operations. Limb salvage and survival of patients during five years were assessed by means of the Kaplan-Meyer method., Results: Technical success and clinical improvement in the both groups did not differ significantly, amounting to 90%. The complication rate and the number of major amputations turned out considerably higher in the group of surgical treatment as compared with that in the group of endovascular treatment. After 1, 3 and 5 years the indices of limb salvage and survival (LSS) in the both groups did not differ significantly amounting respectively to 94.4, 72.7, and 52.2% in the surgical group and 89.7, 67.2 and 46.3% in the endovascular group (p=0.196). The number or re-do operations in the remote period due to relapses of LLCI was considerably higher in the group of endovascular treatment., Conclusion: Endovascular and surgical methods demonstrate similar immediate and remote outcomes in patients with LLCI induced by lesions of infrainguinal arteries, but the choice of the method of revascularization should obligatorily take into consideration the localization and extension of arterial lesions, the presence of an appropriate autovein for the bypass graft, the level of perioperative risk, and life expectancy.

It was shown that parameters of metabolic syndrome as predictors of lethal vascular outcomes of arterial hypertension (AH) in Belarus are significantly different fiom those proposed in WHO recommendations (1999). The glucose level of informative value in WHO recommendations is 6.1 mmol/l versus 5.6 mmol/l in Belarus, total cholesterol 5.0 and 5.9 mmol/l respectively. A more detailed verification of the value of both parameters is needed for the patients in Belarus and Russia depending on age and sex using non-linear models. We used a comprehensive approach to prognosis of the risk of vascular lethal outcomes of AH as a component of metabolic syndrome with the evaluation of results of clinical and laboratory examination as well as orthostatic reactions in patients of different age groups. Construction of the prognostic algorithm "Classification tree" taking account of orthostatic reactions enhances the correctness of lethal outcome prognosis up to 81.8%. The study revealed the prognostic value of systolic and diastolic arterial pressure in the supine position (15 min of active aortostatic sample) for prognostication of vascular lethal outcomes. Further studies are needed on the role of orthostatic reactions in AH patients of old age together with clinical and laboratory parameters in the prognostication of outcomes of various cardiovascular diseases.

The purpose of the study was to evaluate the prognostic value of the detection of tumor cells in the bone marrow (BM) in children with neuroblastoma (NB) by flow cytometry. The detection of tumor cells was performed in BM of 51 patients with NB (24 boys and 27 girls) aged from 6 days to 15 years (median--1 year 3 months). Flow cytometry allowed determining NB cells in BM in a much larger number of cases than cytomorphology (49.0% and 29.4% of patients, respectively). Patients, in whom NB cells were not detected in BM by flow cytometry, had significantly better event-free and overall survival rates as well as progression free survival (83.5%, 87.7% and 86,8%, respectively) compared with those in whom immunophenotyping revealed the tumor cells (28.0%, 35.87% and 34,3%, respectively). The prognostic value of the detection of BM lesion by flow cytometry was also confirmed in selected groups of patients with other criteria of stratification. Therefore the detection of tumor cells in BM by flow cytometry could potentially be considered in conjunction with other factors in choosing treatment strategy in patients with NB.