[Clinico-morphological properties and surgical treatment results in retroperitoneal liposarcomas].

The separate clinico-morphological features of nonorganic retroperitoneal liposarcoma (NRL) and their prognostic value were studied in 200 patients. The type of primary NRL is histologically erentiated in 65.5%, myxoid in 16.1%, dedifferentiated in 9.2%, pleomorphic in 4.6% and mixed in 2.3%. There is a positive elation between overall survival, lyposarcoma hystologic type < 0.007) and completeness of tumor resection (p < 0.0008). Differentiated and myxoid NRL with cell volume less than 5.0% are characterized by better prognosis. Myxoid NRL with cell volume more than 5.0%, dedifferentiated and pleomorphic NRL types are unfavorable prognostic factors. Radical surgical resectio leads to 5-year and 10-year overall survival of 57.5% and 7.8%. Palliative surgery lead to worse results with 3-year and 5-year overall survival of 50.0% and 31.8% respectively. Therefore, the most important prognostic factors in NRL are histological type and completeness of resection.

Prospects of using phytoadaptogen in the treatment of diffuse stomach cancer.

The efficiency of treatment of diffuse stomach cancer can be improved by using a complex phytoadaptogen. In groups receiving phytoadaptogen, the level of tumor marker CA 19-9 decreased and the mean life span of patients increased by 2.5 times. The drug exhibited immunomodulating (including interferonogenic and adhesiogenic), antioxidant, and hormone-modulating effects.

[Composite phytoadaptogens in oncology and gerontology].

The article describes results of research devoted to Phytomix-40, a mixture of plant adaptogens. It focuses on immunobiological criteria for its formulation, chemical composition and manufacture procedures, biological standartization tests, in vitro and in vivo preclinical studies, clinical trials in patients with non-malignant tumours (benign prostatic hyperplasia), precancer (oral leukoplakia), advanced cancer (malignant gastric cancer), and age-related neurodegenerative disease (parkinsonism). Prospects for the development of other plant preparations for non-toxic prevention and treatment of cancer and prolongation of life span of the affected subjects are discussed.

[Signet ring cancer of the stomach: clinico-morphological features, postsurgical results and prognosis].

Clinico-morphological features of signet ring cancer of the stomach were evaluated in 372 out of 2,308 gastric cancer patients undergoing gastroectomy or stomach resection. Signet ring tumor pathology occurs mostly in young females and younger patients generally. It features high incidence of early cancers, low frequency of metastatic spreading to lymph nodes (T1-T2), high frequency of immediate involvement of perigastric fatty tissues, peritoneum and ovaries and infrequent spreading to the liver. Post-surgical survival rates among patients with T1-T2 were relatively high, yet declining in cases of extension through the serous membrane of the stomach. D2-lymphdissection failure to improve the end-results of surgical treatment of signet ring cancer might be accounted for by the predominance of peritoneal metastases of this morphological pattern. Histochemical assay of mucines might be contribute additional data on prognosis.

[A theoretical model for assessing the relationship between "stage migration" and survival of gastric cancer patients after variable lymph node dissection].

Standard histological procedures identify metastatic gastric cancer in approximately 15% of cases of macroscopically unaltered lymph nodes. Such metastases evade detection after surgery due to inadequate lymph node dissection, thus increasing staging error. Consequently, about 15% of patients suffer from tumor which is actually more advanced than one diagnosed originally.

[Surgery for gastric carcinoma in patients with high risk of peritoneal metastases].

Survival in 242 cases of lymph dissection (D2) and 319 patients with (D1) operated on for gastric cancer was compared. D2 lymph dissection was not followed by higher survival rates in dealing with such gastric malignancies involving high risk of peritoneal metastases as signet ring cell, undifferentiated cell, diffuse-infiltrative, Borrmann type IV gastric cancer and complete involvement of the stomach. When D2 lymphoadenectomy was carried out for gastric adenocarcinoma, generally known to be rarely accompanied by peritoneal metastases, the end results were much better, even in cases of serosal invasion.

[Basic directions in studying cancer of the resected stomach]. / Osnovnye napravleniia v izuchenii problemy raka opeirovannogo zheludka.

The causes, incidence of, and the time of occurrence of cancer of the stomach resected for benign diseases are analyzed. The outcomes of 384 operations for recurrent gastric cancer, including 174 radical ones, are presented. The highest resectability was noted in late recurrence and following Bilroth-II gastrectomy with long-loop forward colonic anastomosis. The late outcomes depend on the time of recurrence, its location in the remaining part of the stomach, and the presence of lymphogenic metastases. Experience of 16 extirpations of esophagojejunal anastomosis was used to show whether recurrent gastric cancer after gastrectomy with satisfactory immediate and long-term outcomes can be surgically treated. The fate of 292 patients with gastric cancer in whom tumor cells were detected along the line of resection is traced. Preventive resurgery in this group of patients is not unjustifiable as in 80.8% of them recurrence fails to occur at all or is followed by late metastases.

[Molecular biological and clinical-morphological studies of gastric tumors associated with Epstein-Barr virus]. / Molekuliarno-biologicheskoe i kliniko-morfologicheskoe issledovaniia opukholei zheludka, assotsiirovannykh s virusom Epshteina-Barr.

The paper presents the results of the studies of gastric cancer (GC) associated with Epstein-Barr virus (EBV) among the patients residing in 4 geographical regions. In situ hybridization (ISH) techniques revealed that 49(11.4%) of the 430 examinees were EBV positive (EBV+), the virus-specific marker mRNA-1 of EBV, EBER-1) was found to be present in 80-100) of tumor cells. The proportion of EBV(+)-associated GC cases in different geographic regions ranged from 7.3 to 15%. These tumors were predominant in males (15%) as opposite to females (5.5%). Histological types most common among EBV+ tumors and their location in the stomach are also described. Serological findings indicated that the increased anti-EDV antibody response in 70% of GC cases coincided with the presence of the viral genetic information detected by ISH. In contrast to a humoral response to EBV, a humoral response to Helicobacter pylori was equal both in patients with EBV(+)- and EBV(-)-associated gastric tumors. Further molecular biological analysis of EBV isolates from virus positive and virus negative GC may answer the question whether there are really the so-called tumor and non-tumor variants of EBV.

[Non-sporulating anaerobic bacteria and anastomosis failure in patients with gastric carcinoma]. / Nesporoobrazuiushchie anaéroby pri razvitii nesostoiatel'nosti anastomozov u bol'nykh rakom zheludka.

Cases of anastomosis suture failure within the period from 1977 to 1987 and from 1988 to 1998 in 139 patients after various surgical operations for gastric carcinoma were analyzed. Infection in the cases of the anastomosis sUture failure at the early terms was mainly due to representatives of Enterobacteriaceae and at the later terms the failure was mainly due to non-sporulating anaerobes belonging to Bacteroidaceae. The data are indicative of the fact that the use of antimicrobials requires a differential approach.

[Detection and characterization of gastric carcinoma associated with epstein-barr herpes virus]. / Obnaruzhenie i kharakteristika opukholei zheludka, assotsiirovannykh s virusom gerpesa épstein-barr.

The present investigation was carried out to estimate the incidence of Epstein-Barr virus (EBV)-associated cases among gastric carcinoma (GC) patients in Russia. Carcinoma specimens from 184 patients with GC treated at the Cancer Research Center were investigated by EBV encoded RNA-1 (EBER-1) in situ hybridization. Seventeen (9.24%) cases showed uniform EBER-1 expression restricted to the carcinoma cells. Hybridized signals were not detected in the non-neoplastic gastric epithelium. EBV involvement was significantly more frequent among males, especially in the tumors belonging to less differentiated types (moderately differentiated tubular adenocarcinomas and poorly differentiated solid adenocarcinomas) and located in the upper stomach (cardia and middle part). Most EBV-positive GCs were characterized by great lymphoid compartment involvement. The findings of the distribution of EBV-positive. GCs by sex, site, and histology are similar to those in Japan; however, the detection rate of EBV-positive cases in Russia is higher than that in Japan (6.7%) and lower than that in the USA (16%).

[Possibilities of surgical treatment of gastric cancer recurrences depending on the type of previous resection]. / Vozmozhnosti khirurgicheskogo lecheniia retsidiva raka zheludka v zavisimosti ot tipa predshestvuiushchei rezektsii.

The study deals with the end results of 375 surgeries performed for recurrent cancer of the stomach. Radical surgery was carried out in 168 cases (extirpation of the remaining part of stomach--140; repeated resection of stomach--12; extirpation of esophagoenterostomy--16). Stomach resection after Billroth-II with anterior long-loop colostomy created the best conditions for radical extirpation of the remaining stomach, while Billroth-I resection--the worst. The end results were worse when tumor relapsed earlier than three years after primary resection of the stomach and on sites in gastroenterostomy area, as compared to relapse at later stage and outside anastomosis area.

[Current principles of diagnosis and surgical treatment of non-organ retroperitoneal tumors]. / Sovremennye printsipy diagnostiki i khirurgicheskogo lecheniia neorgannykh zabriushinnykh opukholei.

The data on surgical treatment of 455 patients operated on for primary and recurrent non-organ retroperitoneal tumors (NRT) are discussed. 64.2% of tumors were resected; postoperative lethality was 8.2%. Particular emphasis is placed on the complex nature of diagnosis and an algorithm of examination is suggested. The sequence of main procedures and stages are described; 43% of radical procedures were performed in combination with one another. NRTs tended to relapse and malignant tumors recurred most frequently within the first 18 months. In the course of 182 operations, 54.4% of NRTs were resected: postoperative lethality was 11.1%. The end results were determined by a number of factors, primarily, nature of tumor (benign or malignant), tumor process (primary or recurrent), tumor size and histological pattern. Because of the poor end results, surgical procedures should be improved and their range should be extended.

[Surgical treatment of adrenal gland tumors]. / K voprosu o khirurgicheskom lechenii opukholei nadpochechnikov.

The data on surgical treatment of 146 patients with adrenal gland malignancies as well as literature on the problem are discussed.

[Submerged esophago-intestinal anastomosis in surgical treatment of gastric cancer]. / Pogruzhnye pishchevodno-kishechnye anastomozy v khirurgicheskom lechenii raka zheludka.

The short-term results of 1,605 gastrectomies performed for stomach cancer, using different types of esophagoenterostomy, are discussed. Anastomotic leakage is the main criterion for a choice of the most optimal procedure of forming an anastomosis. The contribution of the first and second rows of sutures to leakage is evaluated. An analysis of data on anastomotic leakage incidence points to the advantages offered by application of submerged esophagus-related anastomosis. A new modification of procedure of formation of muffle-type of esophagoenterostomy is presented. Leakage was registered in 1.3% which was due to technical errors during surgery. The non-reflux properties of the anastomosis are emphasized, with particular emphasis on its reliability, good functional characteristics, simplicity and wide range of application. The clinical applications are described.

[Proteolytic enzyme activity in stomach cancer patients with various prognoses]. / Aktivnost' proteoliticheskikh fermentov v opukholiakh bol'nykh rakom zheludka s razlichnym prognozom zabolevaniia.

Activity of lysosomal proteinases cathepsin B, L and D was studied in tissues of malignant tumors, cancer and normal lymph nodes and mucosal membrane obtained from 18 patients with gastric cancer. The enzymatic activity was distinctly higher in cancer tissues as compared with controls. Activity of cathepsin D was increased in tissues with diminished rate of the tumor differentiation, with pronounced cancer invasion and metastases to regional lymph nodes--the group of highly negative prognosis. At the same time, activity of cathepsin B was increased in tissues of patients with positive prognosis of gastric cancer; negative correlation of cathepsin B activity was observed in both groups of patients. This correlation may be considered as an additional prognostic factor.

[Cathepsin D activity in gastric cancer]. / Izuchenie aktivnosti katepsina D pri rake zheludka.

The levels of activity of cathepsin D were compared in neoplastic and normal gastric mucosa in 42 patients, aged 39-78, at different stages of the disease. A relationship was established between cathepsin D activity and main clinico-morphological characteristics of stomach tumor: cathepsin D activity was found to increase with decreasing differentiation and increasing depth of invasion and metastatic spreading of tumor tissue. Possible involvement of proteolytic enzymes and, in particular, an aspartyl proteinase--cathepsin D--in the mechanisms of invasion and metastatic spreading of neoplasms is discussed.

[Prostaglandins E in malignant stomach neoplasms]. / Prostaglandiny serii E v zlokachestvennykh novoobrazovaniiakh zheludka.

Prostaglandins E (PGE) levels in gastric neoplasme have been studied radioimmunologically in 84 patients (aged 31-77) with tumors of different stages. A relationship between PGE level and main clinico-morphological features of tumor has been established. PGE concentration was shown to correlate with age, stage, histological pattern of tumor, cell differentiation and tumor infiltration. The highest PGE concentrations were observed in young patients, low-differentiated adenocarcino, a and pronounced tumor infiltration to adjacent tissues. No correlation has been found between PGE level and sex and tumor localization and size. The PGE level in the intact gastric mucosa was significantly lower in the body of the stomach than in its proximal and upper parts. The results of the investigation suggest a possible use of PGE antagonists for stomach cancer treatment.

Alterations of (CA)n DNA repeats and tumor suppressor genes in human gastric cancer.

We have examined whether alterations of simple (CA)n DNA repeats, as observed in human colon cancers, occur during human gastric carcinogenesis and whether such alterations reflect genomic instability that could lead to other genetic changes. A total of 22 gastric cancer samples were analyzed: 15 well or moderately differentiated adenocarcinomas, 6 signet-ring cell carcinomas, and 1 poorly differentiated adenocarcinoma. When (CA)n repeat sequences were examined at 10 loci, one adenocarcinoma showed a loss of repeat sequences at five loci, three adenocarcinomas gained a repeat at one locus, and one adenocarcinoma had new, repeated sequences at five loci. Three samples showed mutations in the p53 gene, two in exon 5 (both GC to AT transition at a CpG dinucleotide) and one in exon 7 (AT to GC transition). Only one sample with a p53 mutation also showed altered (CA)n repeats. A putative tumor suppressor gene, connexin 32, was not altered as assessed by single-strand conformation polymorphism analysis. These results suggest that genomic instability revealed by (CA)n repeat changes does not seem to contribute to induction of point mutations in p53 or connexin 32 genes but may participate in loss of heterozygosity at APC/MCC loci. The results are consistent with the hypothesis that different mechanisms are involved in the gain and loss of (CA)n repeats.

[Prolonged antibacterial action of synthetic suture materials containing gentamicin]. / Prolongirovannoe antibakterial'noe deistvie sinteticheskikh shovnykh materialov, soderzhashchikh gentamitsin.

A new sutural material in the form of polyacrylamide threads containing gentamicin in an amount of 10 per cent by the thread weight was studied. After storage for a year under refrigerator conditions the threads preserved their antibacterial activity when studied in vitro. Since gentamicin was included within the threads by means of the ionic links its release from the threads to the environment either in vitro or in vivo was gradual and uniform within at least 10 days. The quantity of the released antibiotic depended on its content per unit of thread length. The marked antibacterial effect within the prolonged period is a basis for the use of the threads in surgical practice for the prevention of infections in the early postoperative period.