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Introduction. Currently thyroid nodules are a widespread problem in clinical oncology and head and neck cancer, malignant focal lesions constitute more than 15–20 %. Accurate diagnosis is very important and determines treatment, as well as the volume of surgical intervention.Objective – determination of the diagnostic value of the method of contrast-enhanced ultrasound in the diagnosis of thyroid cancer. Reference materials were the results of the histological study of surgical specimens.Method. Performed a retrospective analysis of medical records of 42 patients who underwent surgery at the surgical department of head and neck tumors on the verified thyroid cancer in the N.N. Petrov Research Institute of Oncology at the Ministry of Health of Russia. The number of female patients was 36 persons (85.5 %), the number of men was 6 people (14.5 %). The average age of patients among men was 55.5 years, women – 46 years. All patients underwent surgical treatment in the amount of extirpation of the thyroid gland – 16 patients (37.5 %), hemithyroidectomy – 26 patients (62.5 %).Results. The sensitivity of ultrasound with contrast in the diagnosis of cancer of the thyroid gland was 94.11 %, specificity was 87.5 %, diagnostic accuracy – 92.8 %.Conclusions. The technique of ultrasound nodules thyroid with intravenous contrast enhancement has an excellent diagnostic properties, allowing to identify and verify thyroid cancer is 8 % more accurately in comparison with standard ultrasound technique.

Despite the low incidence of nasopharyngeal tumors, the treatment of patients with this disease remains an important and intricate issue. Its risk factors include smoking and alcoholism. About 60% of nasopharyngeal cancer cases are detected at Stages III–IV due to the fact that the early disease stages are latent. The diagnosis of the disease is difficult because of the specific features of the anatomy of the nasopharynx and physicians’ errors. Chemotherapy can relieve pain in patients and considerably improve their quality of life. Chemoradiation therapy is a main treatment option for locally advanced forms. The now range of choice of chemopreparations is narrow so data on successful chemotherapy are particularly valuable. The effectiveness of therapy depends on a patient’s general health state and comorbid condition. The frequency of complications after chemotherapy is high. Some patients are at risk for febrile neutropenia. The risk factors include over 65 years of age; hyponutrition; previous aggressive chemotherapy; the presence of open wounds; chronic obstructive pulmonary disease; and low hemoglobin levels. It is necessary to thoroughly control clinical blood tests, to alleviate the manifestations of mucositis, to evaluate the effect of performed therapy after each even cycle, and to perform computed tomography of the chest and abdomen and spiral computed tomography of the head and neck. In the absence of contraindications to radiotherapy, this technique should be considered during treatment planning. In patients with nasopharyngeal cancer, the efficiency of performed chemoradiation treatment is higher than that of chemotherapy only.

Diagnostics of thyroid cancer (TC) remains a challenging issue due to the high incidence of asymptomatic thyroid nodular pathologies and absence of non-invasive methods of their assessment. Thyroid tumors are classified as benign and malignant with incidence ration approximated as 9:1. Correct and timely differential diagnosis is the basis for correctly choosing a treatment policy and hence determines treatment results. Methods for molecular genetic analysis are being recently developed and introduced into clinical practice, enabling the diagnostic process to be optimized. Analysis of the intracellular and secreted (exosomal) fractions of small regulatory RNAs (microRNAs) is one of the most promising methods for the diagnosis of cancers, including TC. The stability of extracellular microRNA is determined by bonds to proteins, lipoproteins, or its encapsulation into the membrane microvesicles – exosomes. There is reason for suggesting that exosomes with the specific composition of microRNA are a result of the process of active and biologically important secretion while release of other microRNA forms accompanies apoptotic or necrotic cell death. This determines the special diagnostic value of the exosomal fraction of circulating microRNAs, which may reflect the presence and clinically relevant properties of a tumor. This paper discusses the state of the problem and presents methods and preliminary results of the studies conducted by the authors to develop a novel method for diagnosing and monitoring TC. Thus, level of plasma exosomal miR-21 was shown to distinguish patients with benign tumor and follicular CT, while miR-31 can help to distinguish patients with benign tumor and papillary TC. Moreover, reciprocal character of miR-21 and miR-181a concentration in plasma exosomes was detected by comparison of patient with papillary and follicular TC.

The role of real-time elastography or sonoelastography has been widely discussed recently. However, there are practically no publications which showed the influence of endocrine status in the process for improving of diagnostic value of this method; this issue was the aim of our study. 128 patients (31 – benign adenomas and 97 – thyroid cancer: 13 – follicular and 84 – papillary) were evaluated prospectively. Mean age was 48.3 ± 15.9 years. It was confirmed that the blue colour or 4–5 elastotype of sonoelastography was mainly discovered in thyroid cancer vs adenoma (73.2 % vs 25.8 %, χ2 = 18.96, р = 0.0001). Parameters of the sensitivity, specificity and accuracy were equal 90.7 %, 54.8 % and 82.0 % for sonoelastography, and 95.9 %, 45.2 % and 83.6 % for fine-needle aspiration biopsy, respectively. The combination of sonoelastography with fine-needle aspiration biopsy or with body mass index, presurgical glucose or thyroid-stimulating hormone level increased specificity of sonoelastography by 65.0 %, 70.0 %, 64.7 % and 63.2 %, respectively. Thus, sonoelastography had the same diagnostic accuracy as fine-needle aspiration biopsy in predicting of thyroid cancer. The specificity of sonoelastography could be increased by combination with fine-needle aspiration biopsy as well as thyroid-stimulating hormone or glucose level and body mass index value.

Issues of tissue defects replacement after radical surgery for tumors of the head and neck do not lose their relevance. The article presents the results of plastics and replacement of the perforating combined defects of the floor of the mouth, portion of the upper and lower lips, the angle of the mouth, cheeks, neck lateral parts with simultaneous reduction of the configuration and function of the operated organs. Depending on the depth and nature of the existing tissue defect various methods of plastics were applied using arterialized flaps on the vascular pedicle in a free and non-free version. Satisfactory cosmetic and functional results were achieved in patients allowing to improve life quality and to adapt socially.

In the treatment of many unresolved issues, indicating the need for research aimed at finding more effective treatment approaches. The aim of the study is to analyze the results of combined treatment of patients with widespread forms of cancer of the cervical esophagus and hypopharynx with the application of surgical treatment in the amount of pharyngolaryngitis with single-step plastic of the defect. A retrospective analysis of results of combined treatment of 28 patients with a verified diagnosis of cancer of the cervical esophagus and hypopharynx. Combined treatment of patients with cancer of the cervical esophagus and hypopharynx included the following treatments: induction chemoradiotherapy according to the scheme cisplatin/5-fluorouracil, external beam radiation therapy 65 Gy, brachytherapy (7 Gy 1 time per week, 3 sessions), surgical treatment with one-stage plastic of the esophagus. In 7 patients (25 %) was achieved complete regression on the background of induction chemo-therapy, 21 patients (75 %) received the treatment in full. Postoperative mortality rate was of 9.52 %, post-operative complications such as anastomosis dehiscence – 19 %.

Introduction. Carpal tunnel syndrome (CTS) is a neurological disease associated with tunnel mononeuropathies. There are various proven treatment regimens for patients with the use of conservative and surgical methods of treatment. Studies devoted to a comparative analysis of the effectiveness of methods of conservative therapy in patients with CTS are not enough to choose a treatment strategy.Purpose of the study. To study the therapeutic efficacy of wearing a wrist orthosis with and without the use of NSAIDs in the treatment of patients with CTS.Materials and methods. The study involved 40 patients (the average age of the participants was 32.8 ± 4.3 years) with a primary diagnosis of CTS, who were admitted to the neurological department of of the St Petersburg State Budgetary Healthcare Institution “Elizavetinskaya Hospital”, the Department of Medical Rehabilitation of St. Petersburg State Budgetary Healthcare Institution “St. Luke’s Clinical Hospital” in the period from 2017 to 2021. Patients were randomized into two comparable groups for complex conservative treatment and observation for 2 months of the dynamics of neurological symptoms, pain scale, QuickDASH questionnaire and neurophysiological parameters. The first group of patients received NSAIDs (Nimesil), 1 sachet (100 mg of nimesulide) twice a day after meals for 4 weeks, and the second group – NSAIDs with the imposition of a wrist orthosis for 4 weeks.Results. The study involved 40 patients. The average age of the participants was 32.8 ± 4.3 years (range from 20 to 48 years). Neurophysiological indicators in the studied groups at the screening stage were comparable: distal latency of the M-response (DLMO), ms; the amplitude of the negative peak of the M-response, mV; sensory latency (SL), ms and sensory impulse conduction velocity (SSPI), m / s: 5.7, 5.3, 3.5 and 31.8 in the first group and 5.4, 5.5, 3.8 and 32.4 in the second group (p > 0.05 when comparing the corresponding parameters). After the course of treatment, significant changes in the analyzed parameters were revealed (p < 0.05).Conclusions. In patients who received nimesulide and wore a wrist brace, the effectiveness of treatment was higher.

In the treatment of many unresolved issues, indicating the need for research aimed at finding more effective treatment approaches. The aim of the study is to analyze the results of combined treatment of patients with widespread forms of cancer of the cervical esophagus and hypopharynx with the application of surgical treatment in the amount of pharyngolaryngitis with single-step plastic of the defect. A retrospective analysis of results of combined treatment of 28 patients with a verified diagnosis of cancer of the cervical esophagus and hypopharynx. Combined treatment of patients with cancer of the cervical esophagus and hypopharynx included the following treatments: induction chemoradiotherapy according to the scheme cisplatin/5-fluorouracil, external beam radiation therapy 65 Gy, brachytherapy (7 Gy 1 time per week, 3 sessions), surgical treatment with one-stage plastic of the esophagus. In 7 patients (25 %) was achieved complete regression on the background of induction chemotherapy, 21 patients (75 %) received the treatment in full. Postoperative mortality rate was of 9.52 %, post-operative complications such as anastomosis dehiscence – 19 %.