[Age-related changes of 6-sulphatoxymelatonin excretion in stomach and colorectal cancer patients].

Circadian rhythm of 6-sulphatoxymelatonin (aMT6s) excretion has been studied in stomach cancer (n = 89) and colorectal cancer (n = 86) patients. The excretion of aMT6s was decreased in cancer patients. The disturbances of the circadian rhythm of aMT6s excretion have been observed in the cancer patients as well. These changes were directly proportional to the extent of cancer process and to the extent of lymphogenic metastasis.

[Current principles and approaches to the treatment for patients with locally advanced rectal cancer].

The short-term treatment results of 91 patients with locally advanced rectal cancer are presented. All patients received surgical treatment and neoadjuvant chemotherapy. The chemoradiotherapy effect was evaluated by comparison of pre- and post-therapeutic MRI data. MRI data was also compared with post-operation tumor morphology data. In 23% of resected tumor samples complete tumor regression was evident, in 47.2% of cases partial regression was revealed. Lymph node metastases were found in 21.9% of cases. The discrepancy in MRI and morphology data can be explained by the limited ability of MRI in differentiation between viable tumor, fibronecrotic tissue and inflammatory reaction after chemoradiotherapy.

[Age-related and clinical-pathogenetic features of colorectal cancer associated with status of K-ras gene].

Activating mutation in K-ras gene is a key event in the pathogenesis of colon carcinoma. This study analyses frequency of this mutation in different age groups of colorectal cancer patients residing in North-Western Russia, and examines its relationship with essential clinical characteristics of tumor disease.

[Improvement in the diagnosis, therapy, and prevention of complications in patients with rectal cancer].

The goal of this study was to assess the informative yield of modem radiology diagnostic (endorectal and intraoperative sonography, spiral computed tomography and magnetic resonance imaging) and three-dimensional modeling methods in patients with rectal cancer. The effectiveness of postoperative immune-modulating therapy (Neovir and Betaleukin) was also evaluated. The aforementioned techniques contributed to an adequate preoperative selection of surgical treatment and allowed reducing the incidence of postoperative complications.

[Clinical aspects of hereditary nonpolyposis colorectal cancer: experience of genetic consultation].

Five-ten percent of early-onset (up to age of 50) colorectal cancers are regarded as being inherited. Positive results of a medical genetic examination call for microsatellite instability test. However, that method is not absolutely reliable because although all microsatellite instability tests for hereditary nonpolyposis colorectal cancer are positive, microsatellite instability of tumor DNA occurs in 15% of sporadic colorectal carcinoma. Moreover, Russian diagnostic practices are peculiar in that "familial history" is often missed due to premature demise of relatives and lack of data. Under the circumstances, research should be focused on issues of still earlier onset of cancer as well as multifocal nature of tumor growth although similar manifestations may occur in sporadic cancer.

[Assessment of effectiveness of gastroduodenal anastomosis in the surgery of gastric cancer].

An analysis of results of surgical treatment was made on the basis of experiences of performing 260 operations with gastroduodenal anastomosis for distal gastric cancer under conditions of the same hospital for 20 years. Postoperative lethality was 2.69%. Different complications after surgery were noted in 34.2% of the patients. Dumping syndrome after Billroth-1 operations developed in 12.3%. The 5 and 10 year survival after operations among 215 followed-up patients was 65.1% and 24.7% respectively. Original methods of operations were developed and introduced into practice for the improvement of immediate and long-term functional results of the surgery on the stomach.

[Testosterone production by tumor tissue in partial androgen deficiency in aged men (PADAM)].

The aim of the study was examination of cause-effect relationships between PADAM, extragonadal production of androgens and high proliferative activity in aged men. The study group included 15 patients aged between 53 and 79 years with prostatic cancer (n = 5), urinary bladder cancer (n = 5) and cancer of the rectum (n = 5). Control samples of tissues of the prostatic gland, urinary bladder and rectum were obtained from dead bodies of men at the age between 18 and 29 years killed in the accidents at the age from 18 to 29 years. Testosterone levels in the tissues of peritumor zone of the prostate, in tumor tissue of patients with cancer of the prostate, urinary bladder and the rectum were higher than in blood serum. In prostatic cancer, testosterone in the tumor tissue was higher than in the tissues of prostatic peritumor zone. The values of Histochemical score AR of the peritumor zone in prostatic cancer patients were higher than those of the control group. It was detected that ER, PR, bcl-2, Ki-67 and p53 in prostatic tissue of young controls were absent while in patients with prostatic cancer these factors were expressed in the peritumor zone. In cancer of the urinary bladder, peritumor zone showed expression of PR, bcl-2, Ki-67 and p53, while no such expression was in the controls. ER, bcl-2, Ki-67 and p53 were registered in the peritumor zone of patients with cancer of the rectum but the controls had neither ER, bcl-2 nor p53 while Ki-67 expression in rectal cancer was higher than in the controls. The results of the study suggest that testosterone production by some tumors and tissues of the peritumor zone accompanied with high proliferative activity and dysregulation of the cell cycle is secondary to PADAM. These changes arise to compensate testicular deficiency and are manifestations of metabolic syndrome (X-syndrome). In this situation immune system fails to utilize all atypical cells.

[Changes in the expression of receptors of steroid hormones in the development of partial androgen deficiency of aging men (PADAM)].

This work is devoted to the vital topic of the influence of partial androgen deficiency of aging men (PADAM) on the development of cells with androgen receptors. The results obtained in this study suggest a conclusion that the production of testosterone by some tumors and tissues of the peritumorous zone, which is accompanied by increased proliferative activity and disturbance of the regulation of the cell cycle, is caused by PADAM. The given changes are directed at compensating for testicular deficiency (in particular at overcoming the androgen-dependent stage of development of androgen-sensitive cells). These changes are a partial manifestation of metabolic syndrome (X-syndrome). The atypical cells, which unavoidably develop during metabolic syndrome, are dealt with by means of the immune system, whose capabilities become less and less adequate in the given circumstances.

[Assessment of the intermediate and the late results of surgery for gastric stump cancer]. / Analiz neposredstvennykh i otdalënnykh rezul'tatov khirurgicheskogo lecheniia raka kyl'ti zheludka]

The data on the results of therapy for gastric stump cancer in 176 patients were evaluated. Reoperation was carried out in 81 (46.0%); postoperative lethality was 7.4%. Combined abdominothoracic or thoracic alone access was available in all cases. It is suggested that relatively high radicality is assured when combined surgery for gastric stump recurrence is used. Overall 5-year survival was reported in patients radically operated on for relapse.

[Clinical and cytogenetic investigation of a family with high predisposition for intestinal polyps]. / Mediko-geneticheskoe i tsitogeneticheskoe issledovanie sem'i s vysokoi predraspolozhennost'iu k polipozu kishechnika.

A medico-genetic investigation of a family, consisting of 25 members, revealed high predisposition to malignant pathology of the gastrointestinal tract: rectal cancer was diagnosed in 2, malignant polyposis of the large intestine--1, diffuse polyposis of the large intestine (DPLI)--3, and uterine fibromyoma--in 1 patient. Six members underwent a cytogenetic examination using the metaphase method for peripheral blood lymphocytes and G-banding of chromosomes. Two patients with DPLI carried 8.7 and 16.7% of hyperaneuploid cells and one--20% of cells with double minute chromosomes (DMS). It is suggested that formation and subsequent significant increase in hyperaneuploid and DMS cells could have been responsible for DPLI development in the family.

[Effectiveness of combined resection and exenteration of the pelvic organs as part of the comprehensive treatment of extensive malignancies of the rectum and female genitals]. / Effektivnost' kombinirovannykh rezektsii i ékzenteratsii organov malogo taza kak étapa kompleksnogo lecheniia rasprostranennykh opukholei priamoi kishki i zhenskikh genitalii.

The results of the surgical treatment of 865 patients with extended malignancies of the rectum and female genitals are presented. Combined resection and exenteration of organs of the small pelvis (both radical and palliative to ensure cytoreduction of tumor) were carried out in 695 cases (palliative surgery for symptoms--170). The number of resections and sphincter-saving operations has increased while the lethality rates have dropped in recent years. Three-year survival after combined radical surgery for rectal cancer was 59.1%; five-year survival--49% (palliation with removal of distant metastases--26.0 and 14.8%; without removal--24.2 and 0%, respectively; palliative surgery for symptoms--2.3 and 0%, respectively). In cases of palliative surgery for cytoreduction of tumor of the female genitals, 3- and 5-year survival after removal of all distant foci was 66.2 and 54.1%; partial cytoreduction--42.2 and 28.8%, and surgery for symptoms--13.8 and 13.8%, respectively. Cytoreduction improved both the chances and efficacy of adjuvant radio- and chemotherapy. It is suggested that surgery be included as a component of complex treatment of malignancies; combined cytoreduction is fully justified even if its effect is merely palliative.

[Current principles and methods of radical therapy for locally extensive esophageal and gastroesophageal cancer]. / Sovremennye printsipy i metody radikal'nogo lecheniia mectorasprostranennogo raka pishchevoda i kardioèzofageal'noi zony.

The results of radical surgical and combined treatment of 124 cases of esophageal and cardioesphageal tumors are presented. Extensive local disease (stage III, T2-4N0-2M0) was diagnosed in 113 patients (91.1%). Esophagoectomy with transmediastinal esophagogastroplasty and cervical esophagostomy proved most useful for esophageal tumor, while extensive surgery after Lewis in combination with extirpation or proximal resection of the stomach--for proximal gastric disease involving the esophagus. Combined surgery with resection of adjacent organs was carried out in 50%. Post-operative mortality rates were reduced to 7.1% due to application of effective surgical, anesthetic and intensive care procedures. The 3-year survival rate was 26.5%. Prognosis improved significantly when radiation was used prior to dissection of lymph nodes.

[Cloning of amplified nucleotide sequences of DNA in a patient from a high-risk stomach cancer family]. / Klonirovanie amplifitsirovannykh nukleotidnykh posledovatel'nostei DNK chlena sem'i s vysokim riskom vozniknoveniia raka zheludka.

An abnormally long shorter shoulder of chromosome 21 was identified in 3 out of 4 members of a family at high risk for gastric cancer. We attempted to clone the amplified fragments of DNA of one of the family members who had the same chromosomal marker. This was done after the amplified sequences were enriched by re-association in phenolic emulsion, and 52 clones were obtained. All inserts were separated and each was hybridized on filters containing Hind III DNA of patient O.L. and that of a healthy donor. Hybridization with the genome DNAs of patient O.L. and the donor failed to go through in 9 inserts. Hybridization with all genomic DNAs went through in 34 inserts. Hybrids with one or several Hind III fragments of DNAs of O.L. and the donor were formed in 9 inserts. The size of fragments with varying molecular weight in inserts 6, 9, 11, 30, 39, 43 and 44 identified in the DNA of patient O.L. was 3-10 times that in the DNA of the donor. The differences in the molecular weight and size of the detected bends seem to indicate that we succeeded in cloning at least several different amplified fragments of the genome of the patient.

[Current approaches to radical surgical and combined treatment of rectal cancer]. / Sovremennye podkhody k radikal'nomu khirurgicheskomu i kombinirovannomu lecheniiu raka priamoi kishki.

The article gives an analysis of the 30 years experiences with treatment of more than 3200 patients with rectum cancer at a specialized oncological department. Postoperative lethality was 7.3%. In recent years this figure has been decreased (5.2%). The individual programs of treatment were associated with the degree of growing the tumor through the bowel wall and with the metastatic damage of the regional lymph nodes. These factors show that careful as well as extended and combined operations are justified. The advantages of combined methods of treatment and functionally saving surgical interventions have been revealed.

[Current trends in the diagnosis and therapy of colorectal cancer]. / Sovremennye napravleniia v diagnostike i lechenii kolorektal'nogo raka.

The report deals with the 30-year experience gained by the Department in the treatment of nearly 5,500 cases of tumors of large bowel. Radical surgery for colonic tumor was followed by lethality in 3.0 and 5-year survival-80.8%; rectal tumor resection-5.3 and 58.2%, respectively. Individually-tailored modalities have been devised for a spectrum of cases of colonic wall invasion and metastatic lesions in regional lymph nodes. A choice of sparing, extended and combined surgical procedures vis-a-vis these factors has been developed, the latter offering most advantage. Therapeutic strategies for hepatic metastasis have been worked out on individual basis.