Cancer of the vulva: modern methods of diagnostics and surgical treatment.

Over the last 15 years in the Novgorod Region the incidence of cancer of the vulva, with some fluctuations, increased almost 3 times and had a definite tendency to increase including HRV positive variants in younger persons. It was found that the use of new technologies in particular cryoapplication and expanded surgery with subsequent reconstructive plastic for cancer of the vulva, allowed reducing blood loss and the death rate to 0.58 per lOO thousand of female population.

[Are we ready for the growing threat of virus dependent cervical cancer and the initiation of screening in conditions of insurance medicine?].

The dynamics is presented of the rates of virus dependent diseases, in particular cervical cancer (CC), which are directly connected with the level of organization of screening and subsequent treatment of cancer. It is shown that in conditions of insurance medicine a reduction of examination rooms and female enrollment in cytology screening is observed. As a result, over the past 5 years, CC incidence in the Novgorod region increased 1.2 times, and in Russia as a whole, the proportion of such cases in female population under 29 years since 2000 increased 4.5 times (from 2.0% to 9%). The urgent task of cancer control is to restore examination rooms, to overcome disagreements between government institutions and medical departments, to increase coverage of women by cytology screening by means of formation of the program of individual accounting of women.

[Possibilities of remaxol in prevention of toxic hepatitis during chemotherapy for cancer patients].

The effectiveness of planning polychemotherapy (PCT) for cancer patients depends on the functional state of the liver. The use of remaxol was studied in 100 patients with advanced forms of cancer (including breast cancer) in a preventive mode in comparison with the control group (100 patients, essentiale group of 40 patients) and in the process of PCT. Remaxol, compared with the control group, allowed reducing the frequency of drug hepatotoxicity by 30 +/- 3.7% and by 6.5 +/- 2.9% in comparison with the group of patients who received essentiale.

[Diagnosis and morphologic verification of tumors detected by mammography screening].

Pre-operative morphological verification of tumors of the breast is a necessary phase of diagnosis. The primary method of obtaining material is a fine needle aspiration biopsy, which in some cases is provides poor information. The use of histological methods of biopsy of non-palpable breast lesions extends possibilities of accurate diagnosis and combined treatment of patients with breast cancer, determines the choice and extent of treatment for benign tumors. The latter, after removing them by means of cryomammotom with urgent histological examination, allow limiting of this manipulation and avoiding segmental resection.

[Use of Reamberin for the prevention of adverse effects of combined antineoplastic agents in stage III-IV ovarian cancer during induction treatment].

Ovary cancer treatment often presents clinical promlems due to frequent occurence of late diagnostics (III-IV stages), severe treatment complications in patients with ascitis and tumor intoxication. Reamberin can be used as supportive therapy aimed at decrease of intoxication, which is one of the main hindrances for antitumor therapy. In the current study reamberin was used in 89 stage III-IV (FIGO) ovary cancer patients with ascitis, age 42 to 79, CP or CAP chemotherapy recipients after prior cytoreductive surgery. The occurrence of hematological complications (grade 1-2 anemia and neutropenia) and cardiac dysfunctions in the study group was much lower, than in the control group. This difference is statistically valid (p < 0.01 and p < 0.05). The patients receiving reamberin prior to chemotherapy or during chemotherapy rarely (in 3.7% of cases) displayed raised creatinine values. In the control group grade 1-3 renal impairment was observed in 41.4% cases, in 12 cases the therapy had to be ceased. This difference between the groups is statistically valid (p < 0.001). Patients receiving reamberin displayed more rapid rate of CA-125 tumor marker serum concentration decrease. Therefore, reamberin is an effective drug for prevention of chemotherapy side effects and alleviation of intoxication allowing the more rigid chemotherapy schedule without an increase in toxicity.

[Potential endovascular prophylaxis for pulmonary thromboembolism in the combined treatment of cancer patients].

Our study was concerned with the role of ultrasound examination of the lower extremity veins to detect deep venous thrombosis and to evaluate complex prophylaxis of thromboembolism of pulmonary arteries (TEPA). The procedure involved vena cava filter placement in patients with neoplasia and high risk of TEPA as compared with controls receiving conservative therapy alone. A positive correlation was established between surgery and/or polychemotherapy, on the one hand, and higher stage and high risk of TEPA, on the other. Patients with deep venous thrombosis and neoplasia were referred to groups of extremely high risk of that pathology. Angiological history, physical examination and ultrasound check-ups of the lower vein must be carried out in cancer patients. Vena cava filter placement proved to be an effective and safe measure of TEPA prophylaxis. It lowered the risk of lethal outcome in 24 during surgery and polychemotherapy. Lethality rate among controls was 43.5 +/- 0.51%.

[Quality of life, social and psychological rehabilitation of surgical patients with vulvar cancer].

A questionnaire was used to evaluate quality of life of surgical patients with vulvar cancer (stages Ia-Iva). Overall and 5-year survival after combined and surgical treatment (combination of epidermato-fascial plasty unrestricted by closure of wound defects with adjacent tissues) was 86.05 +/- 3.2%, relapse-free--97.3% and 45.08 +/- 3.5% 57.1 +/- 4.1%, respectively, (p < or = 0.05) in group 1. Screening showed that surgical patients need more as far as quality of life and social rehabilitation are concerned.

[Evolution and perspectives in the surgical treatment of ovarian cancer].

Owing to its anatomo-topographic features, ovarian carcinoma starts to disseminate at early stages. Views on surgical treatment are divided between radical removal of all metastatic tissues, and operation "within reasonable limits of safety". Volume of surgery is discussed on the basis of the available literature and our own data with due consideration of patterns of tumor dissemination and recurrence and a complex of intraperitoneal factors. Potential of nanotechnologies and, in particular, photodynamic therapy of relapsing canceromatosis of the peritoneum is discussed.

[Mammographic screening: results and perspectives in evaluation of reproductive health and prevention of cancer].

8542 local women, aged over 40, were screened using digital high-sensitivity equipment. High incidence of hormonal dysfunction of the breast and other breast diseases in healthy subjects were reported (60.1% +/- 9.3) (diffuse hormonal dysfunction--33.8% +/- 14.6). Early breast tumors (up to 1 cm), which generally remain undetectable, amounted to 0.19%. It was shown that mammographic data may be used in forming groups of risk for pre-morbid or morbid pathology among those requiring etiotropic therapy. In this connection, the role of timely medical advice can hardly be overestimated.

[Test checking in the oncological training of the general practitioner]. / Testovyi kontrol' v onkologicheskoi podgotovke vracha obshchei praktiki.

The paper discusses the need to develop an effective system of proficiency tests to be used in teaching oncology to general practitioners. Consideration should be made of both the state of the art of oncology teaching method and limited time assigned to it in medical college curricula.

[Laparoscopic methods of creating fistulas in cancer of the digestive organs]. / Laparoskopicheskie metody nalozheniia svishchei pri rake organov pishchevareniia.

Modified methods of making external fistulas for laparoscopy in 72 patients with tumors of digestion organs are described. An assessment of such fistulas with respect to their functional role, localization of the tumor process and other conditions is given.

[Extension of the borders of the examination area in laparoscopy]. / Rasshirenie granits osmotra pri laparoskopii.

In order to extend the limits of the examination zone in laparoscopy the authors have proposed a method of rolling the greater omentum in a "rouleu" with the help of a special manipulator. The efficiency of the examination becomes greater due to a greater access to the "blind" zone, in particular, for the examination and investigation of the small pelvis organs, small intestine loops, colon mesenterium, formation from the retroperitoneal space and pancreas. In 26 out of 31 patients the method described helped substantially extend the laparoscopic examination.