[Ascending aorta injury followed by cardiac tamponade after sternal puncture]. / Klinicheskoe nablyudenie punktsionnogo raneniya voskhodyashchei aorty s tamponadoi serdtsa kak oslozhneniya sternal'noi punktsii.

Heart or great outflow vessel injury followed by cardiac tamponade is an extremely rare event. However, it is the most dangerous complication of sternal puncture requiring urgent surgical intervention. The effectiveness of specialized care directly depends on its availability and timely diagnosis. Echocardiography is the simplest and informative method for objective diagnosis. We report successful surgical treatment of a 21-year-old patient with intrapericardial injury of the ascending aorta following sternal puncture.

[Hepatic leiomyosarcoma: a case report].

The authors present a review of pathogenesis, diagnosis and various approaches to treatment for an extremely rare tumor - primary hepatic leiomyosarcoma. This tumor is dif- ficult to be diagnosed by imaging examinations. The prevalent method of treatment is a radical resection (RO surgery). Ac- cording to literature the median survival of patients with LMSL is about one year with DFS after treatment about 10 months. Also the authors describe a case report of the successful cure of middle-aged female with primary hepatic leiomyosarcoma and Hodgkin's lymphoma in the anamnesis. She has undergone 6 cycles of neoadjuvant chemotherapy with Ifosfamide and Doxorubicin. The tumour response was estimated as partial. Then patient has undergone radical surgery in the volume of extended left hemihepatectomy with LND. Follow-up exami- nation 38 months after treatment revealed no progression of the disease.

[CURRENT STATE OF COMBINED TREATMENT FOR LOCALLY ADVANCED GASTRIC CANCER. ACHIEVEMENTS AND FAILURES: BASIC TRENDS IN CLINICAL ONCOLOGY].

Despite the modern achievements of different methods of treatment, primarily surgical, with recognized need of standardization of lymphadenectomy D2, gastric cancer still remains one of the most difficult malignant tumors characterized by high rates of one-year mortality and low rates of survival that are far from satisfactory. According to experts such unsatisfactory results are determined by a combination of factors: the characteristics of ill people, their functional status, age characteristics, the prevalence of the disease at diagnosis with the presence of systemic micrometastases, resistance to treatment, etc. Moreover, a factor of resistance to treatment i.e. to existing schemes and methods is mostly a key one that determines low levels of long-term survival.

[MODERN APPROACHES TO PERIOPERATIVE THERAPY FOR LUNG CANCER: "PRO" AND "CONTRA" FROM THE PERSPECTIVE OF EVIDENCE-BASED MEDICINE].

Patients with resectable non-small cell lung cancer have a chance to reach a 5-year survival rates ranging from 70% or more for stage IA and 20% for stage IIIA. These figures have remained stable for the past 20 years. Moreover, the inability to improve long-term outcomes is generally determined by a fatal disease progression due to the emergence of distant metastases or local recurrence often in combination with systemic progression process. Thus the use of chemotherapy both in neoadjuvant and adjuvant regimens has stimulated for a long time the search for the optimal scheme and treatment options. This article presents a critical analysis of the current state of the problem of neoadjuvant and adjuvant chemotherapy as well as chemoradiotherapy in order to optimize the tactics of combined treatment of these groups of patients.

[Bronchus sutures failure in lung cancer surgery].

Main methods of bronchus suturing after lung resection are presented in the article. The safest methods of bronchus closure are manual and mechanical suturing with use of UB apparatus. Use of UO or TL-TLH apparatus with longitudinal orientation of tantalic brackets significantly increases the frequent of bronchus suture failure. It is determined by deterioration of bronchus blood supply and poor trophic healing of bronchus wound.

[Concepts of adoptive immunotherapy in stomach cancer patients after radical surgery]. / Konteptsiia adoptivnoi immunoterapii bol'nykh rakom zheludka posle radikal'nogo khirurgicheskogo lecheniia.

Although there has been a sufficiently steady trend towards a decrease in the incidence of carcinoma of the stomach (CS), the problem related with treatment of this malignant tumor remains acute up to now in many countries. Presently, the surgical method, i.e. gastrectomy in the volume of D2 (with splenectomy being an element of it) remains the basic treatment for CS of stages I-III. A removal of an essential portion of the lymphoid tissues brings about a pronounced, prolonged and hard-to-correct immunodeficiency, which, in its turn, aggravates the risk of postoperative infectious complications and cuts the relapse-free life period. The method, offered by us, makes it possible to obtain the lymphocine-activated cells from the mononuclear cell population of the spleen, removed in operation, and to use them in the adoptive immunotherapy for the purpose of improving the life duration and quality for this category of patients. However, elaboration of methods combining the activation of both non-specific and specific anti-tumor immunity through designing the anti-tumor auto-vaccines based on dendrite cells is the most promising direction in the adoptive immunotherapy for a radically operated CS.

[Cancer of the proximal section of the stomach: the standards of surgical treatment based on 30 years of experience]. / Rak proksimal'nogo otdela zheludka: standart khirurgicheskogo lecheniia, osnovannyi na 30-letnem opyte.

Cancer of the GE-junction is a highly malignant tumor with early lymphatic metastasis to the lymph nodes both in the abdomen and mediastenum. At surgery, lymph nodal metastasis is revealed in nearly 80% of cases. At present, surgical treatment with extended lymph node dissection is the "golden standard". Over 30-year experience in surgically treating GE-junction tumors in 1209 patients at the Thoracoabdominal Department, Russian Cancer Research Center, Russian Academy of Medical Sciences, support the view that extended procedures are superior to standard procedures. Radical procedures were made in 956 of the 1209 patients. These included subtotal proximal gastrectomies in 54.2% of cases, transpleural gastrectomies with esophageal resection in 42.4%, and Ivor-Lewis type procedures in 3.4%. In cases with extended lymph nodal dissection, five-year survival was superior to the results of standard procedures: 32.8 +/- 6.0 and 22.6 +/- 2.8%, respectively (t = 1.8). These figures obviously testify that extended and combined procedures with extended lymph nodal dissection make it possible to stage of a primary tumor and to improve long-term survival.

[Main trends in the improvement of surgical treatment results in stomach cancer]. / Osnovnye puti uluchsheniia rezul'tatov khirurgicheskogo lecheniia raka zheludka.

According to the data on the treatment of 964 patients with cardioesophageal cancer, the local recurrence incidence fell dramatically (from 19.7 to 4.8%) in patients who had gone extensive surgery. The results of treatment of 1,209 cases operated on for tumor in the proximal part of the stomach are discussed. Extensive excision of lymph nodes without postoperative complications was found to assure better end results. Excision of lymph nodes should be regarded as an indispensable component of extensive surgery given for stomach cancer.