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There was studied the use of SPECT-CT for visualization of sentinel lymph nodes and lymph drainage pathways in 35 patients with localized prostate cancer (cT1-T2 N0 M0). Sentinel lymph nodes were imaged in 31 (89%) patients. There were advantageously detected drainage pathways to exterior (77%) and internal iliac (58%) lymph nodes. Visceral (29%) lymph nodes (paraprostatic, paravesical and mesorectal) were less determined. There was established high informative value of SPECT-CT for imaging sentinel lymph nodes, determining their location as well as identification of lymph drainage pathways in patients with prostate cancer.

The study included data on 168 patients with breast cancer, surgical treatment of whom was supplemented by axillary dissection (133 patients or 79.2%) or biopsy of sentinel lymph nodes (35 patients or 20.8%). The examination included ultrasound, planar scintigraphy of the breast and zones of regional lymph drainage. In 122 patients with primary breast cancer stage cT1-2N0M0 retrospective analysis of radionuclide imaging sentinel lymph node was performed. In 89 patients the introduction of colloidal radiopharmaceutical was carried out using a particle diameter of not more than 80-100 nm, in 33 patients study was conducted after administration of radiocolloid with a particle diameter of 200 to 1000 nm. Based on the data obtained by scintigraphy and ultrasonography of zones of regional lymph drainage there were offered two diagnostics models: the first, in which the presence of metastatic axillary lymph nodes was established when there were changes according to at least one of the diagnostic methods--scintigraphy or ultrasound; the second, in which the defeat of lymph nodes was determined only in the case of simultaneous detection of ultrasound and scintigraphic evidence of axillary lymph nodes. Sensitivity, specificity, and overall accuracy of the combination of ultrasound and planar scintigraphy axillary lymph nodes using the first model accounted for 82.7%, 67.7% and 74.4%, respectively. In the second model, the specificity was 94.6%, sensitivity--56%. Rapid transport of radiopharmaceuticals from the injection site, a high gradient of radiopharmaceuticals accumulation in sentinel lymph nodes, effective their visualization, approaching to 100%, were undoubted advantages of radiocolloids having a particle diameter up to 100 nm.

This study was performed in order to determine individual variability of axillary sentinel lymph nodes (SLN) localization in patient with breast cancer (BC). Individual topography of axillary SLN was determined in 182 patients with early BC. All women were candidates for conservative surgical treatment with postoperative radiotherapy. SPECT-CT visualization of SLN started 120-240 min after intratumoral injection of 74-150MBq of 99mTc-radiocolloids. Distribution of axillary SLN was allocated to following subregions: central (C), pectoral (P), apical (AP), lateral (L), subscapular (SSc). SLN visualization by SPECT-CT was successful in 153 cases (84%). AP nodes were detected in 7 patients (5%). SLN were localized on thoracic wall in 34 cases (22%), in the intrapectoral region--in 3 (2%) women. According to axillary levels they were detected on level I--in 149 (97%), level II--15 (10%), level III-- (7.5%) cases.

Single photon emission tomography (SPECT) with 99mTc-MIBI was performed after conventional staging in 83 operated non-small cell lung cancer (NSCLC) patients. Diagnostic results of SPECT and conventional computerized tomography (CT) staging were validated by histological examinations of operation material. According to histological verification 35 of 83 evaluated patients had lymph node (LN) invasion by NSCLC. SPECT detected LN involvement in 28 of these 35 patients and was false positive in additional 16 patients. Pneumonia or atelectasis were detected in 12 of 16 patients with false positive SPECT results. Sensitivity (Sen), specificity (Sp), accuracy (Ac), positive (PPV) and negative (NPV) predictive values of SPECT in diagnosis of LN invasion by NSCLC was as follows: 80%, 66%, 72%, 65%, 82%. Diagnostic accuracy of CT for detection of LN involvement was inferior to SPECT: Sen--71%, Sp--62%, Ac--66%, PPV--58%, NPV--75%. Combination of SPECT and CT data offer promising solutions with Sen reached 94% or high Sp which in patients without atelectasis or pneumonia can reach 96%.

In the course of this study 651 patients with morphologically confirmed soft tissue tumors of different localizations underwent gray-scale sonography, Doppler sonography and energetic Doppler carting. Hitachi HI Vision 900, Logiq-400, Aloka-650, Aloka-2000 scanners wih 5-13 MHz sensors were used. Lipomas, fibrolipomas, benign angioneoplasms and some of the desmoids were shown to have a characteristic sonographical picture. The potential sonographic symptom complexes were determined. Among the malignant tumors the distinct sonographic features were observed in liposarcoma and peripheral nerve sheath tumors. The other soft tissue sarcomas have no characteristic sonographic pattern. In this cases the differential diagnosis could be assisted by clinical signs and medical history analysis.

Tumor regression was reported in 20-30% of patients with inoperable non-small-cell lung cancer (NSLC) following standard first-line chemotherapy. Clinical trials with second-line gefitinib (Iressa) showed a strikingly high response in patients with mutated EGFR. However, clinical experience with gefitinib as first-line therapy had been limited to small-scale trials mostly among subjects of Asian origin. Our study was not associated with the drug manufacturer and included 25 chemotherapy-naive patients with mutated EGFR inoperable lung adenocarcinoma. Standard dose was 250 mg/day. Complete response was observed in 1 patient (4%), partial--11 (44%), sustained stabilization--13 (52%); median time until tumor progression--186 days. Median overall survival failed to be registered within the duration of the study. Among most frequent side-effects were skin rash (19; 76%) and diarrhea (14; 56%): marked side-effect -toxicity grade III (4; 16%). Gefitinib appeared highly efficient and tolerable and may be recommended as first-line treatment of mutated EGFR inoperable NSLC.

For comparison of physical status and quality of life of patients we analyzed 2 clinical groups: patients with ischemic heart disease (IHD) and aortic valve disease. Using original methodology of bringing results of questionnaire " Nottingham Health Profile " to functional classification we had a possibility to compare quality of life of patients with functional classes of physical working capacity and NYHA classification. Subjective component inserted into NYHA classification and quality of life questionnaire leads to substantial discrepancy with objective data on physical working capacity. In most cases patients of both clinical groups subjectively overestimate functional capacity of their organism. In patients with IHD most significant limitations manifest in psychic sphere of life, while in patients with aortic valve disease - in physical sphere of life, what demonstrates great effect of psychosomatic factor in development of IHD.

We examined 194 men (mean age 40 +/- 1.4 years) with acquired aortic valve disease. Basing on the data of estimation of physical working capacity and reserve of cardiorespiratory system we assessed staging of development of compensatory mechanisms of circulation in patients with acquired aortic stenosis and aortic insufficiency. According to working capacity all patients were divided into 4 groups with different hemodynamic response of the organism to physical work. Staged development of mechanisms of compensation of the circulation was found to be related to pronounced left ventricular remodeling: concentric myocardial hypertrophy developed in aortic stenosis while aortic insufficiency was associated with eccentric hypertrophy of the myocardium. These differences in geometry were observed already at stage II. Parameters of systemic hemodynamics and energy expenditures of the heart during exercise practically did not differ between aortic stenosis and insufficiency of aortic valve and were characterized by progressive lowering of efficacy of circulation from stage II to stage IV despite pronounced tension of myocardial reserve. As a result significant lowering of tolerance to physical effort took place in patients of the given group.

Ultrasound examination using color Doppler imaging was used in 70 patients with non-epithelial ovarian carcinoma and 23 patients with subserous nodes of uterine myoma. Diagnosis was confirmed by histological assay of resected material. The procedure can be used for differentiated diagnosis between non-epithelial ovarian carcinoma and subserous nodes of uterine myoma, as well as for appraisal of individual features of tumor so that adequate treatment might be selected.

Breast cancer course may be influenced by a profile of steroids and peptides produced by mammary fat. The study was concerned with assessment of hormonal (leptin and adiponectin production, adipocyte diameter and aromatase level) and progenotoxic factors which characterize DNA damage (8-OHdG) and such cancer promoters as tumor necrosis (TNF-alpha), interleukin-6 (IL-6), nitric oxide (NO), thiobarbiturate reactive products (TRP), macrophage/histiocyte infiltration, estrogen 4-hydroxylase expression (CYP1B1) in mammary fat located 1.5-2 cm or not less than 5 cm away from tumor edge. Thirty-three pairs of mammary fat samples from 23 menopausal and 10 cycling patients were used. Closer proximity of mammary fat involved intensified biosynthesis of estrogens (as shown by aromatase level) and their conversion to catechol derivatives (as shown by CYP1B1 concentration) as well as accumulation of 8-OH-dG. Smoking and hyperglycemic patients and those with considerable mammary fat volume revealed accumulations of anti-inflammatory and progenotoxic cytokines (IL-6 or TNF-alpha). Hence, hormonal/progenotoxic ratio in mammary fat can be identified both by topographic, systemic and environmental factors.

The efficiency of plasmapheresis in the treatment of infectious complications and multiple organ dysfunctions was evaluated in 66 patients after heart surgery. Early plasmapheresis attenuated the cytokine-related systemic inflammatory response and organ damage. The optimal use of plasmapheresis modifications (membrane plasma filtration, plasma carboperfusion, cryoapheresis) improved the clinical outcomes.

Pulmonary and pleural involvement was identified in 17% (42.2% at the debut of the disease, while 57.8%--in the course of tumor progression) out of 264 children with Hodgkin's disease. Basing on X-ray evidence, pulmonary lesions were classified as perinodal, focal-infiltrative, disseminated, nodular, mixed infiltration and lobitis, while those of the pleura--exudative pleurisy and tumor masses involving the pleura. Focal-infiltrative pattern was most common (53%). The best results were reported in the treatment of perinodal infiltration, whereas the worst--disseminated and mixed infiltration as well as pleural lesions.

125 suspects for endometrial pathology were examined to evaluate clinical significance of color Doppler sonography for comprehensive diagnosis of endometrial carcinoma. This pathology was identified in 114; atypical hyperplasia--11. The data on combined application of traditional ultrasound and color Doppler sonography were compared with those on clinical and postoperative histological examinations. The combined method proved the most informative both in primary diagnosis of endometrial carcinoma and assessment of invasion into the myometrium. The specific features of blood supply to carcinoma are discussed.

The feasibility of application of indirect lower lymphoscintigraphy (ILLSG) was assessed in 202 patients with Hodgkin's disease. Its high diagnostic potential was demonstrated by comparison with direct X-ray contrast lymphography: ILLSG's sensitivity was 91.5%, specificity--76.1% and overall accuracy--88.4%. The procedure used for topometric preparation prior to exposure of paraaortal and ileaco-inguinal lymph nodes proved instrumental in designing individual irradiation fields: their boundaries were altered in 21.6% on the basis of ILLSG data.

Bacteriological examination of angiocardiac system, biocenosis of the intestine and upper respiratory tracts was made in 3473 patients who were to be operated or reoperated for congenital or acquired valvular defects in the presence of chroniosepsis and chronic septic endocarditis, complicated IHD. 375 patients with other diseases served control. 74 of them have undergone surgery for varicose veins of the legs. Preoperative contamination with opportunistic microflora was found in the heart, major vessels, veins of the majority of the patients. There was also dysbiosis of natural biotops. Patients with valvular defects to be reoperated 2-20 years after the initial operation on the heart had infection in the angiocardiac structures, severe dysbiosis of natural biotops, i.e. advanced dysbiosis--severe persistent condition with permanent source of endogenic infection complicated the underlying disease and bringing postoperative septic complications.

A clinico-ultrasound description of presentation of melanoma metastases to the gallbladder in 8 patients is discussed. Secondary lesions to the bladder presented as exophytic outgrowths extending from the bladder wall into the lumen. Echo generated by the lesions was of medium intensity and low intensity around the edge of the elastic wall. They revealed dopplergaphic signs of blood flow. Complex application of echo- and dopplergraphy offered a means of differential diagnosis of metastatic lesions and other pathologies of the gallbladder presenting as exophytic outgrowths in the bladder wall in melanoma patients.

The data on clinico-sonographic examination of 603 patients with Hodgkin's disease and non Hodgkin is disease are presented. Involvement of abdominal lymph nodes was recorded in 186 (30.8%) cases. The diagnostic procedure specificity and sensitivity in Hodgkin's and non-Hodgkin's disease were 98.5; 64.5 and 99.6; 86.1%, respectively. The results of sonography application in detecting malignant lymphomas in the liver and spleen proved uninspiring because only foci could be identified which accounted for not more than 6-10% of all lesions of different organs. Diffuse lesions were detected in a few cases only.

The clinico-echographic data on 91 cases of angiomyolipoma of the kidney are presented. This pathology appears to be the most frequent renal tumor in women. It usually has no clinical signs. Echographic examination typically produces images of formations having distinct contours; image quality is basically determined by fat level. More often than not, the image densitometric characteristics are rather low. The signs of a spontaneous rupture of tumor are discussed. Angiomyolipoma grows slowly--0-5 mm within 3 years. Check-ups (chiefly, echography) should be carried out every 12 or 24 months.

Since 1992, there has been a rise in tuberculosis mortality and morbidity among adults and children in the Kaliningrad region. By 1995, tuberculosis morbidity and mortality have increased by 88 and 92%, respectively. Mortality among children has shown a 2.2-fold increases. The pattern of clinical pulmonary tuberculosis types has become worse.

The study group included 104 patients with soft-tissue sarcoma and metastases into the lung, treated at the Institute Clinic in 1960-1992. Surgery for lung metastasis was given to 10 and chemotherapy-to 48 patients; the remaining 48 cases received treatment for symptoms only. Overall 5-year survival was 13.5% (after surgery-30.0%; chemotherapy-19.1%). All the 46 patients treated for symptoms died within two years after detection of lung metastasis. Chemotherapy proved effective in the treatment of multiple metastasis when detected shortly after removal of the first lesion.

Basing on the experience of the surgical treatment of 15 patients with catheteric embolism of the heart and vessels the authors concluded that septic occurrence in given patient category requires urgent operative intervention. In catheteric heart embolism in patients with heart defects surgical interventions may be performed in nonperfusing deep (28-25 degrees C) hypothermal protection, permitting simultaneous removal of heart foreign body and to correlate heart defects not requiring continuous circulation control.

Data of examinations of 1176 patients with different diseases of soft tissues have shown that the arsenal of diagnostic methods which can be used under laboratory conditions has become wider. Of special value is the method of aspiration biopsy which must be introduced into medical practice. In obscure and doubtful cases the examination must be complex, including soft-tissue roentgenography, echography, thermography and radionuclide examination. Angioscintigraphy of soft tissues is an important method in differential diagnostics when the tumor is localized on extremities. Fairly promising is the method of magnetic resonance computed tomography.

The paper deals with results of complex diagnosis of intrathoracic lymph node involvement in 194 patients with malignant lymphoma (85 cases), cancer (11), sarcoidosis (95) or lymphadenitis (3 cases). All the patients underwent complex roentgenologic and radionuclide examination. Tumor tissue sampling aimed at morphologic verification was carried out by transthoracic puncture, mediastinoscopy, parasternal mediastinotomy or diagnostic thoracotomy. The following diagnostic algorithm was suggested: in patients with involvement of the anterior mediastinum, diagnosis should start with transthoracic puncture (efficacy--71%) which should be followed, if it fails, by parasternal mediastinotomy (100%). Mediastinoscopy proved the best procedure for diagnosing central mediastinal lymph node involvement (efficacy--96%). Patients with lymphadenopathy in the anterior central mediastinum should undergo mediastinoscopy (efficacy--67%) or parasternal mediastinotomy (90%). Diagnostic thoracotomy was performed in 7 (3.6%) patients in whom the other methods had failed.

Surgical procedures such as mediastinoscopy (101 cases) and parasternal mediastinotomy (6 cases) were used for improvement of diagnosis of lesions in mediastinal organs. As a result of complex examination including histological methods, malignant lymphoma was diagnosed in 12 cases, Boeck's sarcoidosis--75, mediastinal form of lung cancer--8, tuberculosis of mediastinal lymph nodes--6 and other lesions of organs of the mediastinum--in 6 cases.

The frequency of aseptic necrosis of femoral head was evaluated on the basis of 1066 case histories of Hodgkin's disease of all stages in patients aged 15 and more. The lesions were found in 14 patients (1.3%). Nine of them had received combined treatment for tumor, four--combination chemotherapy alone, and one--radiation alone. All had been given prednisolone. No significant correlation between treatment modality and osteonecrosis development was established. It is suggested that the effect of synergism of such damaging factors as ionizing irradiation, cytostatic drugs and glucocorticoids may be responsible for aseptic necrosis in cases of Hodgkin's disease.

The study using clinico-roentgenological data on 62 patients was concerned with the effectiveness of mammography in evaluating radiation response. Tumor regression was registered in 58 cases. Changes in the X-ray picture in the course and after treatment as well as X-ray signs of radiation injury are described. Mammography proved more reliable than clinical examination in evaluating the degree of tumor regression.

The results of therapy of 152 patients with stage III Hodgkin's disease (106--IIIA, 46--IIIB) were studied. The administration of 2-4 cycles of polychemotherapy (MOPP scheme including embichin, vincristine, procarbazine and prednisolone) followed by large field irradiation after a radical program in 2-4 weeks was envisaged in the therapeutic plan. Cox's multifactor regression analysis made it possible to determine the values of some indices for the outcome of disease. The main prognostic factors in chemo- and radiotherapy were a histological type and mediastinal lymph node involvement. The fact of the involvement of the mediastinal lymph nodes in a tumor process rather than a degree of their enlargement played a decisive role. Such prognostic factors as male sex and the age over 40 were regarded as unfavorable, however their role was not as important as that of a histological type and mediastinal lymph node involvement. The above program of chemo- and radiotherapy made it possible to reduce the effect of general symptoms and signs of "biological activity" of a process.

The rationale and opportunities of x-ray investigation in skin melanoblastoma are analysed. Roentgenography was employed in 51 patients. In 7 cases the tumor was found to proliferate subcutaneous fat. In 11 cases roentgenological investigation has aided in detailed determination of the form of tumor growth in the obscure clinical picture. The roentgenological investigation made it possible to reliably determine the extent of melanoblastoma spread in underlying tissues, that enabled a more precise planning of the extent of the operation and a more reliable prognostication of the disease.

Clinico-roentgenologic and thermographic signs of bone involvement were studied in 53 cases of Hodgkin's disease. Although radionuclide and X-ray procedures were found to be diagnostically superior over thermography, the latter is complication-free, time-saving and can be used repeatedly. It, therefore, may be recommended as the first diagnostic procedure when bone involvement is suspected. As a result of the treatment, regression was observed in 50% and stabilisation--in 30.6% of pathologic foci. Radiation-induced hyperthermia accounts for low reliability of thermography in evaluating response.

Aseptic necrosis of femoral head was observed in 12 cases of Hodgkin's disease. The available data suggest that aseptic necrosis was induced by the treatment of Hodgkin's disease. Patients who have received a course of combined therapy (polychemotherapy including glucocorticoids+radiation of hip joints) should be referred to the group at risk for development of this complication.

Clinico-roentgenological manifestations of specific destructive lesions in the lung in cases of Hodgkin's disease are described. The authors' findings suggest that disintegration focus formation is determined by duration of diseases, rapid regression of specific lesion of the lung as a result of therapy and suppression of reparative regeneration of lung tissue by corticosteroids and possibly, cytostatic drugs. However, a course of cytostatic therapy eventually resulted in the regression of lung tissue alterations and dissolution of disintegration cavities in most cases.