[The problems of older people and directions of medical, social and psychological support during the COVID-19 pandemic.]

The review article examines the medical, psychological and social problems that older people face due to the pandemic. The article contains the analysis of the mortality rate in the older age group in different countries. It also demonstrates the negative impact of the pandemic stress on the formation of psychopathological disorders (anxiety, asthenia, panic, cognitive dysfunction). The authors carried out an analysis of psychological support methods for various psychopathological disorders among the elderly, based on both the results of their own clinical experience in the treatment and psychological correction of the disorders of older people experiencing the pandemic, and similar results of other researches in other countries. The results of the presented research during the pandemic suggest that the frequency of asthenia and psychosomatic disorders in patients was increased. The paper presents algorithms for the differential diagnosis and treatment of asthenia as part of the post-covid syndrome. The article contains an objective scientific and practical assessment of the experience of self-isolation for the elderly, as well as the analysis of the reasons for mental maladjustment and the formation of addictions. The algorithm and the results of psychological support, provided to older people by a psychosocial support organization, are demonstrated.

[TREATMENT OF NON-SMALL CELL CARCINOMA OF LUNG IN SENILE PATIENTS].

A comparative analysis of surgical treatment of non-small cell carcinoma of lung was made in 64 patients of senile age and more young patients. It was stated, that preference should be given to the partial lung resections (lob- and segmentectomies). The authors recommended to avoid pneumoectomy and typical resection of the lung as non-radical operations accompanied by high rate of local recurrences. The comorbidity background of patients should be thoroughly investigated before planning of surgery. If necessary, a surgical treatment of accompanied vascular pathology should be fulfilled as the first stage before oncology surgery.

[Surgical treatment of multiple isolated intrapulmonary metastases].

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.

[The assessment of surgical treatment of patients with malignant pleural effusion].

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

[Possibilities of palliative operations in patients with intrapulmonary metastases of renal cancer].

Results of treatment of 51 patients with intrapulmonary metastases of renal cancer were analyzed. Surgical interventions in volume of complete cytoreduction were made in 31 of them. All the patients were followed-up after operations at the period from 3 through 68 months. A multi-factor analysis has shown that surgical metastasectomy gives reliably better results of treatment of patients with disseminated renal cancer. Regressive analysis in the group of operated patients has shown that involvement of the lymph nodes of the bronchopulmonary group and mediastinum gave reliably worse results of treatment of this group of patients.

[Cytoreductive operations in complex treatment of patients with intrapulmonary metastases of colorectal carcinoma].

An analysis of results of treatment of 112 patients with metastases of intrapulmonary colorectal carcinoma (CRC) for the period from 1990 to 2006 has shown that cytoreductive opera tions for excision of the metastases are an effective method of treatment of this category of patients which allows a two times increased survival median as compared with analogous index in the group of patients exposed to palliative chemotherapy. Palliative chemotherapy fails to have statistically significant influence to survival of patients who have ablated intrapulmonary CRC metastases in the volume of complete cytoreduction.

[Surgical prophylactics of bronchopleural fistulas after pneumonectomy].

The authors made an analysis of the results of treatment of 924 patients with non-small cell lung cancer, operated in the volume of pneumonectomy during 1990-2007 years and developed a method of complete suturing the mediastinum wound in order to isolate the bronchus stump from the free pleural cavity and prevention of the development of a bronchopleural fistula.

[Role of biological tumor markers CEA, Cyfra-21, NSE, TU M2-PK in diagnosis and treatment of lung cancer].

The authors investigated the dependence of increasing serum oncomarkers CEA, Cyfra-21, NSE, TU M2-PK on survival in 739 patients with nonsmall cell lung cancer. The tests for the determination of the content of CEA, Cyfra-21, NSE in blood serum have low sensitivity and are of little use for the diagnosis of lung cancer. The tests because of their simplicity and low cost can be used for the detection of groups of patients with preliminarily diagnosed nonsmall cell lung cancer needing additional methods of examination for more exact staging of the disease and exclusion of remote metastases and more active using adjuvant method of treatment. The use of tumor pyruvate kinase can be perspective for clinical oncopulmonology. However, due to its low specificity, further experiences are required for using this oncomarker in the group of patients with nonsmall cell lung cancer.

[Use of determination of the serum carcinoembryonic antigen in oncopulmonology].

The test for the determination of the serum carcinoembryonic antigen was found to possess low specificity and to be of little use for the diagnosis of lung cancer. The test can be used for the detection of patients with diagnosed non-small-cell cancer of the lung for more exact staging of the disease and exclusion of distant metastases as well as for more active using adjuvant methods of treatment and for the dynamic observation of the course of the disease.

[The possibility and prognostic value of secondary lymphatic cancer spread in intrapulmonic metastases of solid tumors].

In the period from 1996 to 2007 operations were fulfilled in 120 patients with isolated pulmonary metastases of solid tumors (68 men and 52 women aged from 22 through 77 years): 46 patients with metastases of colorectal cancer, 28 - with cancer of the kidney, 23 - with non-small cell carcinoma of lung, 7 - with breast cancer, 9 - with endometrium cancer, 7 - with melanoma. Altogether there were 128 operations. The operations have revealed lesion of intrathoracic lymph nodes in 29 patients (24%). In most cases (21 patients) they were lesions of lymph nodes of the lung root and intrapulmonary lymph nodes. In 93% of cases (27 patients) localization of the lesion coincided with anatomical pathways of lymph outflow from the affected part of the lung. The survival rate median of the operated patients who had alterations in the lymph nodes was 21 months, in cases with intact lymphatic system it was 37 months. A conclusion is made of possible secondary lymphatic cancer spread from intrapulmonary metastases of solid tumors and its negative influence on results of treatment that allows recommendation of revision of the lymphatic system of the lungs and mediastinum in all cases of surgical treatment of intrapulmonary metastases, and in a number of cases recommendation of anatomical resections of the lung tissue as operation of choice.

[Role of cytoreductive surgery in complex treatment for lung metastases from solid tumors].

The report evaluates prognostic factors derived from the data on survival of 123 patients with isolated lung metastases from solid tumors after performing full-scale cytoreductive surgery. Colorectal carcinoma was diagnosed in 43 patients (35%), renal carcinoma--26 (21%), non small cell lung cancer--25 (20%), melanoma--11 (9%), endometrial carcinoma--9 (7.5%) and breast cancer--9 (7.5 a%). All patients were followed up for 3--150 months (median--16 months). Fifty-eight patients (48%) had died by the time the study started. Median of survival for colorectal carcinoma was 29 mos, renal carcinoma--23 mos, non small cell lung cancer--18 mos, melanoma--13 mos, endometrial carcinoma--70 mos and breast cancer--38 mos. According to the findings on regression results, of prognostic value for such patients are both intraoperative and histologically confirmed evidence of secondary metastases to the lymph nodes as well as relapse-free survival. Median of survival for secondary metastases to the lymph nodes was 21 mos and 67 mos without them (p = 0.04). Three cohorts were identified relating to relapse-free survival: 0-12, 12-24 and more than 24 mos. Median of survival for those groups was 19, 23 and 38 mos, respectively (p = 0.03). Such parameters as tumor site, gender, age or postoperative antitumor pharmaceutical therapy appeared irrelevant as far as survival was concerned.

[Surgery in the treatment of metastatic lesions of the lung and pleura]. / Khirurgiia v lechenii metastaticheskikh porazhenii legkikh i plevry.

An experience with treatment of 53 patients with intrapulmonary metastases of malignant tumors of different nature included 65 surgical interventions, among them there were bilateral operations and reoperations. During the postoperative period complications took place in 5 cases (9.1%). After the operations there were no lethal outcomes. Long-term results of the surgical treatment of intrapulmonary metastases insignificantly differed from those of surgical treatment of primary lung cancer. The surgical treatment is thought to be an expedient method of treatment of intrapulmonary metastases in patients without recurrent tumors, late metastasis of another localization, satisfactory condition of the patient. High effectiveness of thoracoscopic methods for treatment of metastatic lesions of pleura is also noted.

[Diagnosis and surgical treatment of mediastinal neoplasms]. / Diagnostika i khirurgicheskoe lechenie pri novoobrazovaniiakh sredosteniia.

The authors share their experiences with examination and surgical treatment of 163 patients with various neoplasms of the mediastinum. The first place among the neoplasms is occupied by tumors of the lymphatic apparatus (33%), the second--by tumors of the thymus (21%). The video-thoracoscopic technique was used in 17 of 131 operations performed. Complications after the operations took place in 6 patients (4.5%), two patients died (1.5%). A conclusion is made that the patients of this category must be treated not only by thoracic surgeons but also by hematologists, neurologists, neurosurgeons and specialists in radiation therapy.

[Surgical treatment of synchronous bilateral lung tumors]. / Khirurgicheskoe lechenie dvustoronnikh sinkhronnykh opukholevykh porazhenii legkikh.

An experience with treatment of 29 patients with bilateral malignant tumors includes primary tumors and those of metastatic origin. When large bilateral lung resections are necessary, the consecutive operations are considered to be expedient with intervals of 4-6 weeks. When the operation volume is not more than lobectomy in one side and an atypical or segmental resection in the other side, it is possible to fulfill a one-step intervention from the transsternal access. The surgical treatment for bilateral tumors should be supplemented by radio- and chemotherapy. Surgical treatment for bilateral tumors of the lungs is permissible but in the side of the maximal lesion followed by treatment of the rest of the tumor by nonsurgical methods.

[Surgical treatment in intrapulmonary metastases]. / Khirurgicheskoe lechenie pri vnutrilegochnykh metastazakh.

An experience with treatment of 35 patients with pulmonary metastases from different tumors is described. In all, 45 surgical interventions were performed which included bilateral operations and reoperations. At the postoperative period complications were observed in 5 cases (14.7%). There were no lethal outcomes after operations. Long-term results of the surgical treatment of patients with pulmonary metastases considerably differed from those observed in patients with primary lung cancer. If there is no recurrent tumor, no distant metastases of another localization and the patient's condition is estimated as satisfactory, the surgical intervention is thought to be a valuable method of treatment for pulmonary metastases.