[Surgical treatment of patients with chest wall metastases]. / Khirurgicheskoe lechenie patsientov s metastaticheskim porazheniem grudnoi stenki.

OBJECTIVE: To evaluate postoperative outcomes in patients with chest wall metastases. MATERIAL AND METHODS: We analyzed 40 patients who underwent surgery for chest wall metastatic lesions. Fourteen (35%) patients had sternal lesion, 26 (65%) ones - rib metastases. We used implants for chest wall defect closure in 15 (37.5%) patients. Chest wall repair with autologous tissues was performed in 19 (47.5%) patients. RESULTS: Median survival was 17 months. Most patients (n=30, 75%) showed improvement in the quality of life according to Karnofsky and EGOG scale after surgery. Continued tumor growth occurred in 4 (10%) patients within 8-16 months after surgery. There were 2 patients who suffered from tumor recurrence accompanied by other metastatic foci (progression). Complications were diagnosed in 5 (12.5%) patients. Tactical errors were identified in 4 (10%) patients and they were associated with progression of cancer in the form of new metastatic foci within 6 months after surgery. CONCLUSION: Active surgical approach for bone metastases in patients with favorable cancer-related prognosis can improve quality of life and survival at least in case of solitary lesions. New program for treatment strategy selection based on prognosis of life expectancy and algorithms of surgical treatment will reduce the risk of erroneous management and increase its effectiveness.

[Treatment of patients with metastatic lesions of the long bones]. / Lechenie patsientov s metastaticheskim porazheniem dlinnykh kostei.

OBJECTIVE: To optimize orthopedic care in patients with complicated course of metastatic lesions of the long bones. MATERIAL AND METHODS: There were 201 patients (72 men and 129 women) who underwent orthopedic care for metastatic lesions of the long bones for the period from 2006 to 2019. Breast cancer metastases were diagnosed in 71 (35%) cases, kidney cancer - 56 (28%) patients, prostate cancer - 19 (9%) cases, metastases without a primary identified focus - 15 (8%) patients. Other forms were observed in 40 (20%) patients. All patients were divided into two groups. The first group included 136 patients (68%) who underwent segmental resections with bone replacement. Of these, 100 (73%) patients had secondary lesions of the lower limb bones and 36 (27%) patients with metastatic lesions of the upper limb bones. A threat of pathologic fracture was in 63 (46%) cases, fracture - in 73 (54%) patients. The second group consisted of 65 (32%) patients who underwent immersion osteosynthesis. Of these, 47 (72%) patients had metastatic lesions of the lower limb bones and 18 (28%) patients had secondary lesions of the upper limb bones. A threat of pathologic fracture was in 24 (37%) patients, fracture - in 41 (63%) patients. RESULTS: In the first group, mean surgery time was 140 min, in the second group - 120 min. Mean blood loss in the first group was 600 ml, in the second group - 300 ml. Patients were activated on the 3rd postoperative day in both groups. We analyzed surgical, anatomical and functional results in both groups using MSTS, Watkins and Karnofsky's scales. CONCLUSION: Oncological replacement and osteosynthesis are the main methods of surgical treatment of secondary lesions of the long bones. However, our data emphasize advisability of bone replacement, since this method ensures the most adequate stabilization, pain syndrome relief and long-term improvement of the quality of life.

[Estimation of the efficacy of inertialess exercise machines used for the rehabilitation of adolescents presenting with pediatric cerebral palsy].

The objective of the present study was to estimate the role of the heyvus training machine as a tool for enhancing the effectiveness of combined rehabilitation of the adolescent patients suffering from spastic diplegia cerebral paralysis. The mechanisms of action of this treatment on the clinical manifestations of compromised statics and voluntary movements have been elucidated.

[Surgical treatment of malignant tumors of the thoracic wall].

23 patients with malignant tumors of the thoracic wall, invading bone structures, were operated in the period of 2005-2009 years. Thoracic wall reconstruction was performed in 20 (77%) of patients. The type of the reconstruction was defined by tumor localization, volume of resection, anatomic features of transplantational tissue flaps. Surgical method remains the mainstay in the treatment of the thoracic wall tumors. Although in cases of highly malignant bone or soft tissue sarcomas, only combined and complex methods allow the achievement of satisfactory results.

[Antibodies to the rhamnose determinants of the polysaccharide of streptococci group A in the sera of rheumatism patients and donors]. / Antitela k ramnoznym determinantam polisakharida streptokokkov gruppy A v syvorotkakh bol'nykh revmatizmom i donorov.

In the sera of patients with recurrent rheumocarditis, and especially in cases of primary rheumatism, the level of antibodies to group A streptococcal polysaccharide (A-PS) has been found, according to the results of the enzyme immunoassay, to be considerably higher than in the sera of healthy donors. The level of antibodies to rhamnose determinants (RD) of A-PS has been determined by the inhibition of the immunoenzyme reaction with A-PS under the influence of a variant of group A streptococcus and rhamnose disaccharides with the bonds alpha 1-2 and alpha 1-3. In patients with recurrent rheumocarditis the level of antibodies to A-PS has been shown to be considerably higher than in healthy donors having these antibodies. In acute primary rheumatism a high level of antibodies to A-PS has been detected only in a few cases, and at the same time the prevalence of antibodies to the specific RD of A-PS, bound with beta-N-acetylglucosamine, is observed. In the sera of patients with recurrent rheumocarditis and donors having a high content of antibodies to the rhamnose site of A-PS antibodies, seemingly active against at least two RD, have been detected. In acute primary rheumatism an insignificant amount of antibodies to the rhamnose site of A-PS may probably cause the autoimmune process accompanying rheumatism. This suggestion is substantiated by the previously established capacity of these antibodies for inducing the suppression of cytotoxic cell reactions to microbial antigens.

[Synthesis of the polysaccharide common antigen of Pseudomonas aeruginosa and its L-analog in the form of 6-aminohexyl glycosides]. / Sintez polisakharidnogo obshchego antigena Pseudomonas aeruginosa i ego L-analoga v forme (6-aminogeksil)glikozidov.

A synthesis of trisaccharide monomers built of D- or L-rhamnose residues is described. Their polycondensation in the presence of a 6-aminohexyl rhamnoside derivative afforded 6-aminohexyl glycosides of the natural common polysaccharide antigen of Pseudomonas aeruginosa and its L-analogue, respectively.

[Synthesis of 6-aminohexylglycosides of a polysaccharide from Streptococcus group A and its fragments]. / Sintez 6-aminogeksilglikozidov polisakharida streptokokkov gruppy A-variant i ego fragmentov.

Polycondensation of 4-O-benzoyl-1,2-O-(1-cyanoethylidene)-3-O-(3,4-di-O-benzoyl-2-O-tr ityl-alpha-L- rhamnopyranosyl)-beta-L-rhamnopyranose in the presence of 6-phthalimidohexyl-3,4-di-O-benzoyl-2-O-trityl-alpha-L- rhamnopyranoside affords, after deprotection, the polysaccharide built up of the repeating dissaccharide units----2) Rha (alpha 1----3) Rha (alpha 1----and containing 6-aminohexyl residue at the reducing end. This polysaccharide possesses the structure of the group A-variant streptococcal polysaccharide. Synthesis of 6-aminohexyl glycosides of 2- and 3-O-alpha-L-rhamnopyranosyl-alpha-L-rhamnopyranoses, which corresponds to the repeating units of the above polysaccharide, is described.