[Indocyanine green angiography in assessment of parathyroid remnant perfusion after subtotal parathyroidectomy: a case report]. / Angiografiya s indotsianinom zelenym v otsenke perfuzii ostatka tkani parashchitovidnoi zhelezy pri subtotal'noi paratireoidektomii: klinicheskoe nablyudenie.

A 72-year-old female patient with chronic kidney disease stage presented with multiple parathyroid adenomas and tertiary hyperparathyroidism. SPECT/CT with 99mTc-MIBI revealed accumulation of radiopharmaceuticals in 2 out of 4 parathyroid glands. Ultrasound established localization of all parathyroid glands. Subtotal parathyroidectomy with excision of 3 glands and resection of half of the fourth gland was performed. Intraoperative indocyanine green angiography was performed to identify all parathyroid glands and remnant perfusion. There was normal parathyroid function after 6 months.

[Indocyanine green fluorescence angiography in transoral endoscopic thyroidectomy for papillary thyroid cancer]. / Primenenie fluorestsentnoi angiografii s indotsianinom zelenym v transoral'noi endoskopicheskoi tireoidektomii pri papillyarnom rake shchitovidnoi zhelezy.

OBJECTIVE: To evaluate the effectiveness of ICG angiography in patients with papillary thyroid cancer (PTC) undergoing transoral endoscopic thyroidectomy (TOETVA) and selective neck dissection (level VI). MATERIAL AND METHODS: A retrospective analysis included 20 patients with PTC who underwent TOETVA with selective neck dissection (level VI) between September and December 2022. ICG was administered intravenously (5 mg ´ 3 times). We analyzed parathyroid glands by visual examination and ICG angiography. Fluorescence of all glands was assessed. RESULTS: Twenty patients underwent ICG angiography during TOETVA. A total of 68 parathyroid glands were identified. Only 76.5% (52/68) of parathyroid glands were identified at initial visual examination. ICG angiography additionally localized 12 glands that improved detection to 94.1% (64/68). At least one well-vascularized parathyroid gland was demonstrated by ICG angiography in 16 patients. In all these patients, serum parathyroid hormone was normal in 1 and 10 days after surgery. Two out of four patients who failed to identify a well-vascularized parathyroid gland developed transient hypoparathyroidism. There were no intraoperative and postoperative complications associated with ICG angiography. CONCLUSION: ICG angiography was simple, safe and effective for better identification and preservation of parathyroid glands in patients with PTC undergoing TOETVA. This method was valuable for assessing the viability and function of parathyroid glands and predicting postoperative hypocalcemia.

[Isolated neurofibroma of the tongue]. / Izolirovannaya neirofibroma yazyka.

A clinical case of successful treatment of isolated tongue neurofibroma presented patient K., 64 years old, referred to the clinic complaining of a feeling of «discomfort¼ on swallowing. With a comprehensive examination, a diagnosis of an isolated tongue neurofibroma was established. Surgical treatment was performed. The diagnosis was confirmed morphologically. The presented clinical case of isolated tongue neurofibroma in an elderly patient is casuistic in nature, of scientific and practical interest due to the rarity and unusualness of the disease.

[Clinical, morphological, and prognostic features of papillary thyroid carcinoma with different BRAF mutational status assessed by immunohistochemistry]. / Klinicheskie, morfologicheskie i prognosticheskie osobennosti papilliarnogo raka shchitovidnoi zhelezy s razlichnym statusom BRAF, ustanovlennym immunogistokhimicheskim metodom.

The somatic mutation in BRAFT1799A (BRAFV600E), the data on the prognostic role of which are contradictory, is one of the most common molecular genetic abnormalities in the cells of papillary thyroid carcinoma (PTC). OBJECTIVE: To investigate the association of the immunoexpression of mutant BRAF in PTC with different morphological characteristics and long-term treatment results in patients. MATERIAL AND METHODS: Information on inpatients with PTC was obtained from the database of the Pathology Department, A.F. Tsyb Medical Radiology Research Center (a branch of the National Medical Radiology Research Center, Ministry of Health of the Russia). The paraffin-embedded blocks of surgically removed primary, metastatic, and recurrent PTC tissues were cut and stained with hematoxylin and eosin and anti-mutant BRAF monoclonal antibodies. The results of immunohistochemical tests were assessed and the frequency of BRAF immunoexpression was analyzed in relation to various clinical and morphological parameters of tumor growth, the pattern and volume of treatment in the patients, by taking into account its long-term results (the presence or absence of tumor recurrence and metastases in the postoperative period). RESULTS: The expression of mutant BRAF (BRAF+) was noted in 29 (39.3%) of the 74 cases of PTC. The BRAF+ group differed from the BRAF group by a higher proportion of male patients, older age, advanced clinical stage of carcinoma, a predominance of papillary structure of tumors, and a higher frequency of their recurrence and/or metastases in the postoperative period. CONCLUSION: The immunohistochemical assessment of BRAF status opens up a possibility to predict local recurrence and metastases in the postoperative period in patients treated for PTC.

TREATMENT OF LOCAL RADIATION LESIONS IN BREAST CANCER PATIENTS.

The purpose of this paper is the demonstration and analysis of the effectiveness of spinal cord stimulation in treatment of chronic drug-resistant neuropathy pain in a patient with radiation-induced plexopathy. She underwent radiation therapy for cancer of the right breast in 2000. Ten years later she complained with pain and weakness her right arm. After physical examination and investigation right-side brachial plexopathy was diagnosed. Antidepressant and anticonvulsant had positive effect during one year but then pain appeared again. That is why the patient has been implanted the system of epidural electrostimulation of thickening of the cervical spinal cord. During the post-operative period significant improvement of pain relief was noted. The doses of analgesics were decreased. Spinal cord stimulation efficacy for treatment of chronic pain was repeatedly proved in clinical investigation and meta-analyses. Nevertheless spinal cord stimulation effects on radiation-induced neurological disorders and possible pathophysiological mechanisms are not enough examined. All these facts require further investigation.

[Prognostic value of hemoglobin concentration in the course of chemoradiotherapy of patients with oropharyngeal squamous cell carcinoma].

There was performed a comparative analysis of the indicators of immediate and long-term results of chemoradiotherapy in 342 patients with squamous cell oropharyngeal carcinoma depending on hemoglobin level before and after treatment. In patients with normal level of hemoglobin a rate of response to treatment was almost two times higher than that of patients with anemia (75,3% vs. 23,5%) and complete regression of tumors was detected by more than three times often (65,4% vs. 17,6%). The overall five-year survival of patients with anemia was significantly worse than that of patients who had normal hemoglobin level (50,7% vs. 67,7%). Patients who had normal hemoglobin level at the time of discharge demonstrated a five-year overall survival of 75,7%, while those with a hemoglobin level below normal, but more than 80 g/l,--only 57,8%. Hemoglobin concentration was a significant prognostic factor for survival of patients with squamous cell carcinoma of the oral cavity and oropharynx. Low baseline of hemoglobin was also a negative prognostic factor for tumor response to treatment, especially to chemotherapy.

[Immediate and long-term results of simultaneous chemoradiotherapy in non-traditional modes of fractionation in the treatment of patients with oropharyngeal squamous cell carcinoma].

The analysis of the effectiveness of treatment was carried out in 257 patients with squamous cell carcinoma of the mucous membranes of the oral cavity and oropharynx. Two methods of irradiation were used in combination with concurrent polychemotherapy: standard radiotherapy (2 Gy 5 times a week) and radiotherapy in non-traditional modes of fractionation with uneven breaking of the daily dose into two fractions (1 Gy + 1.5 Gy or 1 Gy + 2 Gy with 4-hour intervals) to a focal dose of 60 Gy. Chemoradiotherapy with fractionated dose was more effective than standard chemoradiotherapy in frequency of objective tumor responses and regional metastases in the absence of increasing the number of early radiation reactions and late radiation damages. External beam radiotherapy in non-traditional modes of fractionation with simultaneous polychemotherapy exposure can significantly improve the results of the overall five-year survival compared with conventional fractionation technique--60.4 +/- 4.5%, 63.3 +/- 8.2% vs 27.6 +/- 10.2%, respectively.

[Radiation therapy for medullary thyroid carcinoma].

The paper analyzes the effectiveness of external beam radiation therapy of medullary thyroid cancer in 38 patients. The radiation therapy of the first phase combined therapy was performed in 9 (24 %) patients: after treatment, 5 patients had a partial response, 4--stabilization. The radiation therapy of the second phase combined therapy was performed in 27 (71%) patients: after treatment, 2 patients had a complete response (booster method), 5--partial response, 4--stabilization. External beam therapy has been performed in 2 (5 %) patients with palliative and symptomatic goals. Additionally has been estimated level of calcitonin in patients after combined treatment. The calcitonin level becomes normal without radiation therapy. Therefore, exposure for medullary thyroid carcinoma is questionable (exception for cases gain exposure to the rest of the tumor).

[Concurrent radiochemotherapy in the treatment of squamous cell oral and oropharyngeal cancer].

The aim of this study was to evaluate the end results of the radiochemotherapy of 237 patients with squamous cell carcinoma of oral mucosa (locally advanced, stage III-IV, - 134; 56.4%, and metastases to regional lymph nodes of the neck - 91; 38.4%) carried out at the Center's Clinic. Interstitial neutron (252 californium) plus polychemotherapy was given to 26 (11%) (group 1); neutron + distant radio + polychemotherapy - 34 (14 %) (group 2); distant fractionated radiotherapy + polychemotherapy - 177 (75%) (group 3). Complete response was reported in 190 (80.2%); partial - 44 (18.6%) and stabilization - 3 (1.3%). Overall response was 98.8%; 5-year survival - 64.5 +/- 3.3%, irrespective of tumor site, grade and method of treatment. Concomitant modality proved highly effective, free from toxic and functional or cosmetic harm.

[Early-onset radiation complications and tissue damage in the treatment of head and neck tumors].

The report discusses the results of an evaluation of the effectiveness of combined radiotherapy in 1,192 cases of head and neck tumors divided into 4 groups: distant radiotherapy in standard fractions of 1.8-2.3 Gy, 5 times a week, TTD of 60 Gy (group 1 - 486 40.8%); radiotherapy + local UHF hyperthermia + regional intraarterial chemotherapy + hyper glycemia + administrations of regional intraarterial chemotherapy + hyperglycemia + local UHF hyperthermia (group 2 - 244 20.5%); accelerated superfractition radiotherapy with variable STD of 1 and 1.5/2 Gy, TTD of 60 Gy, plus neoadjuvant polychemotherapy with cisplatin 100 mg/lm2 + 5-fluorouracil, continuous intravenous infusion of 3,000 mg for 72 h (group 3 - 204 17%1); combined photon-neutron therapy (group 4 - 258 21.6%): neutron beam therapy - 36 (3%); interstitial neutron brachytherapy with 252 Cf sources in combination with external beam gamma-therapy and chemotherapy. Overall radiation injury incidence was 1,087 (91.2%); oral mucositis grade I (WHO) - 110 (9.2%), grade II - 166(13.9%), grade III - 811 (68%), radiation dermatitis - 279 (23.4%), grade I/II - 196 (16.4%), grade III/IV - 83 (7%). Grade III/IV side effects developed in 26.7% after gamma therapy and in 72.2% - in the photon-neutron group (p < or = 0.0001). Skin damage was rare, as expected, in the photon-brachytherapy group (1.8%) (p < or = 0.0001). Hence, Cf252 neutron brachytherapy and radiotherapy with concomitant chemotherapy appeared to produce the most sparing effects.

[Neck skin-muscular flap use in cases of expanded operations on the occasion of malignant neoplasms of maxillo-facial region].

Comparative analysis of the results of different flaps, cut out on side surface of the neck for plastic cover of extensive defects of maxillo-facial region (MFR) formed after malignant tumors ablation, use was carried out. Reconstructive plastic operations were performed in 84 patients: displacement of neck skin-facial flap on the stem in 54 (64.1%) patients, use of neck skin-muscle flap (SMF) in 20 (23.8%) patients, use of improved method of skin-muscle transplant forming from only medial part of nodding muscle in 10 (12.1%) patients. Good cosmetic and functional results were received in 62 (73.8%) observations. Use of complex SMF after surgical interventions in cases of malignant tumors in MFR let reduce the number of postoperative complications and provide earlier rehabilitation of this heavy group of patients.

[RET and GFRA1 germline polymorphisms in medullary thyroid cancer patients].

The role of RET and GFRA1 germline polymorphisms in predisposition to sporadic medullary thyroid cancer (MTC) and polymorphisms' modulation effect on clinical features of inherited and sporadic MTC were investigated. Blood samples from 67 MTC patients (22 hereditary and 45 sporadic), 3 asymptomatic mutant RET gene carriers and 178 ethnically matched healthy control individuals were tested. Screening of RET exons and portion of introns 1, 8, 10, 13, 14, 15, 16 and GFRA1 5'-UTR was performed by means of direct sequencing and PCR-RFLP. 8 polymorphic variants of RET gene (exons 11, 13, 14, 15 and introns 1, 8, 13, 14) and 4 GFRA1 polymorphisms in GFRA1 were detected. Linkage disequilibrium was found between RET variants G691S and S904S, L769L and IVS8, S836S and IVS13. In sporadic MTCs, allelic frequency of only one polymorphic RET variant, L769L, was significantly decreased versus control group. In hereditary MTCs, a significant over-representation of S836S and under-representation of S904S sequence variants were observed as compared to sporadic MTCs and controls. No co-segregation was found between individual polymorphisms and phenotype of sporadic MTC. In patients with inherited MTC whose genotype was presented with polymorphic L769L and wild-type S836S, disease onset occurred 20 years later than in individuals with polymorphic L769L and S836S or wild-type L769L (p = 0.01) suggestive of a possible protective role of L769L in MTC development and modulating effect of a combination of L769L with wild-type S836S on clinical outcome of inherited MTC.

[Immediate and long-term results of plastic reconstruction of soft tissues of the head and neck in areas previously treated with surgery for tumor and radiation injury].

The efficiency was studied of vascularized tissue complexes in 346 cancer patients with extensive facial injuries to the head and neck who had undergone combined treatment. Free microsurgical autotransplantation was carried out in 7 (2%) patients, deltapectoral graft--151 (44%), sternocleidomastoid myocutaneous flap--39 (11%), pectoralis major flap--10 (3%), bi- and tri-lobed flap--55 (16%), temporal musculoperiosteal flap--25 (7%), cheek flap--24 (6.9%), thoraco-dorsal axillary flap--24 (6.9%), frontal flap--6 (1.7%), free-flap transfer--5 (1.5%). Although most vascularized tissue complexes were placed in previously irradiated areas, primary engraftment was reported in 249 (72%) patients, while peripheral or partial necrosis in distal part of flap- in 97 (28%). Good cosmetic and functional results were obtained in 298 (86%) patients who considered themselves cured.

[Assay of thyrocalcitonin in cervical lymph node using fine-needle washings for the diagnosis of disseminated medullary thyroid carcinoma]. / Opredelenie soderzhaniia tireokal'tsitonina v punktate limfaticheskikh uzlov shei dlia diagnostiki metastazov medulliarnogo raka shchitovidnoi zhelezy.

Fine-needle aspiration biopsy of cervical lymph nodes was carried out in 22 patients with suspected metastatic involvement with medullary thyroid carcinoma (MTS). It was followed by cytopathological examination of aspirates and assay of of thyrocalcitonin (TCT) in fine-needle washings. TCT determinations proved highly informative as well as significantly high in all seven cases of MTS involvement (26-8,484.87 pg/ml, mean 2,208 +/- 1,722 pg/ml).