[On the criteria for the forensic medical appraisal of harm to the human health from thermal injuries].

"Rules for forensic medical determination of the severity of bodily injures" currently used in practical expertise are at some variance with the Criminal Code and the Criminal Procedure Code of the Russian Federation. Their analysis taking into account the available clinical reports and the results of our original studies of archive materials made it possible to propose and substantiate additional criteria for the assessment of harm to the human health from thermal injuries.

[Complex diagnostic method of early forms of cancer of the uterine cervix]. / Kompleksnyi metod diagnostiki rannikh form raka sheiki matki.

A complex of diagnostic procedures including extended colposcopy, aiming biopsy, cytological examination and endocervical curettage was carried out in 110 patients for differential diagnosis between precancerous diseases and early forms of carcinoma of the uterine cervix. Application of the complex diagnostic method may be recommended for identification of early stages of malignancy in cervix uteri. Due to the findings obtained, it becomes possible to give a more accurate definition of pathologic process necessary for determination of therapy to be carried out in patients with cervical carcinoma in situ which has been detected without colposcopy. Cytological method appeared to provide much information on tissue specimens.

[Puncture of the posterior vault in the cytological diagnosis of malignant ovarian tumors]. / Opyt izucheniia punktatov zadnego svoda v tsitologicheskoi diagnostike zlokachestvennykh opukholei iaichnikov.

To confirm diagnosis, 4,614 punctures of the Douglas pouch through the posterior vault of the vagina have been performed in cases of suspected tumor located in the small pelvis since 1969. Further cytological examination established ovarian cancer in 871 cases, reactive changes in the mesothelium--186 and inflammatory lesions in the small pelvis--in 486 cases. Cytological data and the results of histological examination of resected tumors were compared: diagnosis was false-negative in 5.9% and false-positive--in 1.5% of cases. The said method was shown to be completely safe and highly instrumental both in cases of tumor in the small pelvis and detection of recurrences. Therefore, it may be recommended for application in out-patient service.

[Endolymphatic polychemotherapy of ovarian cancer]. / Endolimfaticheskaia polikhimioterapiia u bol'nykh rakom iaichnikov.

The results of treatment in 118 patients with ovarian cancer are presented. The sessional doses were as follows: thioTEPA--200--300 mg or cyclophosphamide--3200--4000 mg+5-fluorouracil--2000--3000 mg. Despite the fact that 116 patients had III--IV stages of the disease, the objective effect of the treatment was observed in 95 of them. Thus, the complete disappearance of tumor was gained in 3 cases, reduction of the tumor size more than by 50%--in 68 patients, more than by 25%--in 18, an insignificant diminishing of tumor, the appearance of its mobility--in 13. Surgical intervention has been performed in 96 patients, that makes 82% of the operability. Supravaginal amputation of the uterus with adnexa and extirpation of the greater omentum have been performed in 76 cases, that yields 67% of resectability. Sole tumors have been removed in 11 patients, the intervention being confined to laparotomy in 6 (5.1%). Pronounced degenerative and necrobiotic alterations in the tumor were revealed by its histochemical assay in 22 patients 40, 50 and 60 days after endolymphatic infusion of chemotherapeutic drugs.

[Endolymphatic polychemotherapy in treating cancer of the corpus uteri]. / Endolimfaticheskaia polikhimioterapiia v lechenii raka tela matki.

At the Rostov Research Oncological Institute 49 patients with uterine cancer were tested by endolymphatic infusion with the preliminary estimation of the tumor sensitivity to chemical drugs. To test the efficacy of the treatment applied was cytological control of the uterine aspirate every 5 days after the infusion prior to surgery, and also morphological changes in the removed tumors at different terms after endolymphatic polychemotherapy. After administration of the drugs at 2--5 day a cessation of the uterine bleeding, lessening or disappearance of pains were noted usually. Among 14 patients with an enlarged uterus as if in the 8--10 week pregnancy, its size was normalized in 11 patients following the treatment. In 5 of 8 patients with parametrial infiltrates the latter completely disappeared while in 3-separated from pelvic walls. Of 3 patients with vaginal metastases the latter disappeared in one case, in 2 cases these were 2/3--1/2 diminished. Total extirpation of the uterus with adnexa was performed in 41 patients, in three of them a histological assay showed no tumor in the removed specimens.

[Hormonal balance in ovarian tumors]. / Gormonal'nyi balans u bol'nykh opukholiami iaichnikov.

As a result of examining the urine excretion of 17-OCS, 17-KS, estrogens and the concentration of protein bound iodine and butanolextractable iodine in blood of patients with benign and malignant ovarian tumors, there were found some deviations from the normal hormonal balance in all these patients. These deviations were manifested in a delayed transformation of cortisol to cortisone, in a shifted androgeno-estrogenic balance toward estrogen active fractions, and in the reduced production of thyroid hormones. In ovarian cancer, however, these changes were manifested to a greater extent.

[Metastasis to the lymph nodes as an index of the effectiveness of preoperative endolymphatic polychemotherapy of cervix cancer]. / Metastazirovanie v limfouzly kak pokazatel' éffektivnosti predoperatsionnoi éndolimfaticheskoi polikhimioterapii raka sheiki matki.

Ninety eight patients with cervical cancer were subjected to endolymphatic chemotherapy with multiple cytostatic drugs to affect metastatic lymph nodes. A comcentrated mixture of chemotherapeutic drugs (total amount about 20 ml) was injected into plantar lymph vessels, an interval being 10-14 days. The combinations and dosage of the drugs were as follows: thio-TEPA (100-150 mg) or cyclophosphamid (1000-2000 mg)+methotrexate (100 mg)+5-fluorouracil (1000-1500 mg). Subsequently, 76 patients underwent an extended extirpation of the uterus with adnexa, and their lymph-nodes were studied morphologically. It was found that the number of metastases into the lymphnodes was considerably less than it had been expected. Of 45 patients with the disease stage II metastases have been found only in 3 cases (7%). Of 24 patients with cancer stage III the lymphnodes were involved in 4 cases (16.6%). According to the literature data metastatic involvement of the lymphnodes is on an average encountered in 36% for stage II and in 51% - for stage III.

[Use of olivomycin in the treatment of cancer of the uterine cervix]. / Primenenie olivomitsina v lechenii raka sheiki matki

Olivomycin was used locally as 0.2% ointment (20-40 tampons) in 39 cervical cancer cases (I stage--27 patients, II--8, III--1 and IV--2 patients) and in 2 vaginal cancer cases (II stage). There was noted a visual disappearance of the neoplasm in 24 cases, the decrease up to 1/3 of initial tumor dimensions in 11 cases, up to 1/2-2/3--in 5 cases. There was no effect in one case of cervix adenocarcinoma. An extended extirpation of the uterus with its adnexa was carried out after the treatment in 36 cases, in 13 of which no histological signs of tumor were found. Two patients are being under observation, because they refused the operation in view of the complete disappearance of the tumor.

[Endolymphatic chemotherapy of cervix neoplasms]. / Ob endolimfaticheskoi khimioterapii raka sheiki matki

In the gynecological department of Rostov Oncological Institute endolymphatic polychemotherapy with a preliminary determination of tumor sensitivity to chemotherapy was employed in 54 patients with cervical cancer, 3 of them in stage III and IV having contraindications to radiotherapy. A combination of chemical substances and the dosage of single administration were as follows: thio-TEPA--100--150 mg + methotrexate 75--100 mg; thio-TEPA--100--150 mg + 5-fluoruracil--1000 mg; cyclophosphane--2000 mg + methotrexate--75--100 mg; cyclophosphane--1600 mg + methotrexate--75--100 mg + 5-fluoruracil--750 mg. Lymphoinfusion was made in the lower extremity, and after 7--10 days it was repeated in the second one. Visual disappearance of the tumor was noted in 17 patients, lessening of the tumor size by two-thirds--in 16, a 1/2 decrease--in 20. Among 23 patients in stage III after the treatment parametrial infiltrations disappeared entirely in 11 cases and only in pelvic walls--in 12. In 40 cases an extensive extirpation of the uterus with adnexa was performed. In all cases degenerative changes in tumor tissues were observed, whereas in 7 cases no tumor cells were found.