[Thoracoscopy in combined treatment of thymoma (in Russian only)]. / Videotorakoskopiia v kombinirovannom lechenii timom.

The experience of video-assisted thoracoscopic interventions for thymus tumors in the Research Institute of Oncology of Tomsk National Research Medical Center is presented. We also evaluate the features of postoperative management of these patients.

[Lieutaud's triangle lesion and urodynamic disorders in bladder cancer according to magnetic resonance imaging data].

OBJECTIVE: To estimate the capabilities of magnetic resonance imaging (MRI) in revealing bladder tumor in relation to its sizes and location and in diagnosing concomitant urodynamic disorders. MATERIAL AND METHODS: A total of 93 patients (78 men and 15 women; mean age, 62.1 ± 12.2 years) with bladder cancer were examined. Examinations were made using 1.5 T MRI according to an extended protocol with a mandatory inclusion of diffusion-weighted images; dynamic contrast-enhanced MRI was carried out in 86 patients. RESULTS: There were single nodules in 48.7% of the patients and multiple bladder wall lesions in 51.3%. Bladder wall injury involving the functional area of Lieutaud's triangle was revealed in 67.5% of the patients. Single and multiple tumors in Lieutaud' triangle were observed in 58.9 and 80.5% of cases. Ureteral orifice involvement led to secondary ureterectasia in 68.2%. CONCLUSION: As the number of tumors detected in the bladder increases, the risk of tumors in Lieutaud's triangle injury rises. The involvement of the triangle into the pathological process is accompanied by impaired urodynamics as uretere- ctasia in every four cases (26.8%; p < 0.008). It is shown that dynamic contrast-enhanced MRI must necessarily be performed to better visualize a tumor and to determine its relationships to the underlying wall and basic structures of the bladder.

[Specific features of mammographic visualization of "small" breast tumors developing on the background of fibrocystic disease].

All complications diagnosed at early stages of breast cancer were associated with small tumors, especially with those arising in the aftermath of fibrocystic disease. Hence, our task was to study the XR-semiotics of lesions of less than 15 mm in diameter and of the same origin. 100 mammograms of breast cancer patients with benign disease of the breast were studied. The presence of moderate-to-severe fibrocystic disease significantly affected the visualization of lesions of less than 10 mm in diameter. Since the XR-semiotics of small tumors failed to reveal malignancy features, all lesions visualized by mammography required additional diagnostic procedures using ultrasound and invasive radiology.

[Multi-media computer-based chart: modern tool of clinical record keeping]. / Komp'iuternaia multimediinaia istoriia bolezni--sovremennyi instrument vedeniia klinicheskikh protokolov.

AIM: To design the program of computer multimedia case history (MCH) for collection, storage and analysis of information about the patient including diagnostic images; to test MCH for application in telemedical consulting and control over valid conduction of the treatment protocol. MATERIAL AND METHODS: Brief representation of information is reached by integrated multilevel placement of the data on common time axis. Dynamics of the selected parameters is represented as normalized diagrams in the same system axes. Electron tables are filled either by hand or import of the data from individual electron file of all the information about the patient. Diagnostic images and conclusions are obtained from local computer bases of the diagnostic units. Inexpensive commonly used computers allows one to input digital micro- and macrophotos, x-ray images, etc. Monitor information is available from the universal computer net directly from the monitors Geolink-M. RESULTS: MCH was tested in the Hematological Research Center of RAMS. In cooperation with Bryansk diagnostic center N 1 telemedical consulting and some data bases were perfected. The MCH system joints routine activity of the clinic without any problems raising quality of the patients management, facilitating the access to therapeutic and diagnostic information and its analysis. On-line breaking the limits of the controlled parameters and protocols is detected automatically. These events are emphasized by "blocking questions" which must be worked out by the user. The information on the patient can be fully stored on CD-ROM in line with the MCH program providing organization of the data. CONCLUSION: The system is introduced which collects medical information from various sourses and builds up comprehensive representation of the data on the same time axis. The system provides control over implimintation of the protocols of the patients' management, gives a convenient access to medical information, ensures its reliable storage and availability in case of the patients transfer to other medical institutions, facilitates analysis of clinical cases, conduction of medical consulting.

[Investigation of mutations of BRCA1 and BRCA2 genes in 52 breast cancer patients]. / Testirovanie mutatsii genov BRCA1 i BRCA2 u 52 bol'nykh rakom molochnoi zhelezy.

The proportion of BRCA1/2 genes varies widely among populations. We investigated 52 cases of breast cancer: 24 cases of familial breast cancer, 22--early-onset (till 40 years) and 6--bilateral cancer. The frequency of carriers of mutations among familial cancer cases was 16%, among cases of disease till 40 years--9%. 538insC BRCA1 was the most common genetic mutation among hereditary cases of breast cancer.

[Transthoracic puncture in the diagnosis of peripheral lung cancer (methods, techniques)]. / Transtorakal'naia punktsiia v diagnostiki perifericheskogo raka legkogo (metodika, tekhnika vypolneniia).

The paper discusses how to perform transthoracic puncture of peripheral lung tumors of various sizes by using different controlling techniques (X-ray television and computed tomography). It also analyzes whether an adapter can be used to reduce the incidence of a puncture-induced complication, such as traumatic pneumothorax.

[Role of transthoracic fine-needle aspiration in the diagnosis of peripheral lung cancer]. / Rol' transtorakal'noi punktsii v diagnostike perifericheskogo raka lëgkogo.

The efficacy of transthoracic fine-needle aspiration guided by roentgenotelevision (86 cases) and computed tomography (106 cases) for peripheral lung cancer was studied. Special needles Nos. 18-20G (dia. 1-1.2 mm) and Nos. 22-25G (dia. 0.5-0.7 mm) were used depending on size and site of tumor. Roentgenotelevision imaging proved more informative for small-size tumors (less than 2 cm). Computed tomography offered more advantage in imaging medium- and large-size tumors because it allowed to avoid repeated aspiration and, therefore, reduce the risk of complications.

[Causes of exploratory thoracotomies in lung cancer]. / Prichiny probnykh torakotomii pri rake legkogo.

Exploratory thoracotomies were studied in 80 patients with inoperable lung cancer. The X-ray and computed tomography findings were analyzed retrospectively. The main causes of inoperability of lung cancer were determined. The authors consider that CT findings are of greater importance as compared with the routine X-ray examination and linear tomography for determining the lung cancer operability.

[Radiologic follow-up and prognosis of efficiency of systemic Sr-89 Cl-2 therapy of bone metastases in prostate cancer]. / Kompleksnaia luchevaia otsenka i prognozirovanie éffektivnosti sistemnoi radioterapii 89SrCl2 pri kostnykh metastazakhraka predstatel'noi zhelezy.

We evaluated possibilities of bone scintigraphy with 99mTc-methylendiphosphonate (99mTc-MDP) and magnetic resonance imaging (MRI) in follow-up and prediction of effect in patients with extensive bone metastatic disease treated with betha-emitter 89SrCl2. 24 patients with prostate cancer and extensive metastatic involvement of skeleton were referred for the study. 89SrCl2 was injected as single injection of 150 MBq (4 mCi), in eighteen from Amersham plc., England, as Metastron, in six--from Medradiopreparat, Russia). In all patients bone scintigraphy with 99mTc-MDP and MRI study of metastatic regions were performed before and in 3 months after 89SrCl2 injection. Patients treated with Metsatron were also studied in 6 months after injection. Quantitative analysis of data comprised count and anatomic dimensions of metastatic areas and calculation of indices [metastasis/intact bone] both for scintillation count of 99mTc-MDP bone scans and signal intensity of T1-weighted MRI scan. Henceforth, we conclude the data of bone scanning with 99mTc-MDP and of MRI give evidencies for significant regress of bone metastases in patients treated with 89SrCl2 besides symptomatic suppression of pain syndrome. 99mTc-MDP bone scanning is also of predictive value for the prognosis of therapeutic effect of systemic radiotherapy with 89SrCl2 in prostate cancer.

[Computed tomography in the evaluation of regional metastases of lung cancer]. / Komp'iuternaia tomografiia v otsenke regionarnogo metastazirovaniia raka legkogo.

The rate of metastatic spread of different groups of intrathoracic lymph nodes has been studied in depending on localization of the tumor by the nodes using CT method. 126 patients were examined with verified diagnosis of lung cancer. The central form was diagnosed in 55 (43.6%) patients, peripheral--in 71 (56.4%), a tumor was located in the upper lobe in 72 (57.1%), in the lower lobe--in 47 (37.4%), and in the middle lobe--in 7 (5.5%). CT-semiotic of metastatic lymph nodes was studied. The indices of the efficiency of diagnostic imaging when using CT were analyzed as well. The analysis of data obtained has shown that CT has great possibilities in evaluation of regional metastases of lung cancer.

[Radiologic diagnosis of bone metastases recurrence in patients with prostate cancer treated strontium-89]. / Luchevaia otsenka regressa kostnykh metastazov u patsientov s rakom prostaty pri sistemnoi radioterapii 89SrCl.

Aiming to evaluate efficiency of 89SrCl (Metastron) in patients with metastatic lesion of the skeleton in prostate cancer we have performed a follow-up scintigraphy of the skeleton with 99mTc-methylendiphosphonate (MDP) and MRI with quantitative study of metastatic foci. 12 patients with prostate cancer (on the average 11 +/- 6 bone metastases were examined using scintigraphy of the skeleton with 99mTc-MDP and MRI study in T1, T2 and proton density modes. Investigations were performed before injected as a single dose of 150 MBq (4 mCi). At all the stages there was made a quantitative study of foci of pathological uptake of 99mTc-MDP compromising numbers of foci, focus parameters, intensity of 99mTc-MDP accumulation in the pathological part relatively the contralateral region as well as quantification of MRI signals from metastatic areas in signal intensity units. In 3 month 4 patients with extensive metastatic skeletal lesion (> 12) showed a considerable decrease of number of foci of pathological 99mTc-MDP uptake (on average to 6 +/- 3). In the remained metastatic foci there was noted a decrease of dimensions and 99mTc-MDP uptake intensity at an average by 29.8 +/- 15%, improvement in T1 intensity by 113 +/- 55.6 units. In 2 patients who initially presented a "superscan" pattern on 99mTc-MDP bone scintigraphy the 89SrCl treatment converted this of low intensity had demonstrated their complete regression. Results of radiologic follow-up of bone metastases in prostate cancer using MRI and bone scintigraphy with 99mTc-MDP argue that systemic radiotherapy with 89SrCl induces significant regress of metastatic process that involves all volume of the metastases.

Quantification of breast cancer blood flow in absolute units using Gjedde-Rutland-Patlak analysis of 99mTc-MIBI uptake.

BACKGROUND: Scintimammography with 99mTc-MIBI has been proven as efficient technique of diagnosis of breast cancer. Nevertheless, quantification of breast carcinoma blood flow (BCBF) in absolute units is not yet developed. To compensate this, we analysed kinetics of 99mTc-MIBI uptake in breast cancer using Gjedde-Rutland-Patlak (GRP) approach. METHODS: If BC is radioactivity in breast cancer quantified by dynamic scintigraphy, C(h)-blood concentration of 99mTc-MIBI and K-transport constant, then, assuming 99mTc-MIBI uptake to breast carcinoma unidirectional for early minutes after injection and subjected to equation d(BC)/dt = K; C(h), classic GRP plot can be obtained from this by integration as BC/C(h)=K x (integral of C(h)(dt))/C(h) + V0 and placing [(integral of C(h)(dt))/C(h)] as X, and (A/Ch) as Y. The K can be then obtained as slope. K is breast cancer clearance equal to product (retention fraction); (blood flow) : K = E; BCBF. K can be calculated from A(t) and Ch(t) as asymptote of 99mTc-MIBI retention function h(t) = F-1[F[A(t)]/F[Ch(t)]], where F depicts Fourier transforms. The BCBF can be then obtained as ratio K/E. We employed the technique in 33 patients with breast carcinoma of stages T(1-3)N(0-3)M(0-1) injecting 99mTc-MIBI (370-510 MBq) as i.v. bolus. In 12 scintigraphy with 99mTc-MAA (370 MBq) injected via catheter intraaortically was performed as validation study. RESULTS: E values were essentially uniform over the population with overall mean 0.58 sd 0.06. Blood clearance curves did not differ between various stages also and were subjected to biexponential approximation. K was in all cases obtained from the slope of initial 3 min part of GRP plot, strongly linear (r > 0.95, p < 0.001) in all cases. 99mTc-MAA validation study revealed significant correlation with 99mTc-MIBI blood flow values (r = 0.94, p < 0.01). The BCBF(as ml/min/100 cm3) was in T1 12.85 sd. 4.76, in T2 15.87 sd. 1.78, in T3 17.35 sd. 2.45, and in T4 23.07 sd. 2.21, expressing tendency to increase with stage. Higher BCBF was significantly associated with metastatic spread and in patients with BCBF over 17 ml/min/100 cm3 distant mets were revealed in all cases. CONCLUSION: Hence, analysis of early kinetics of 99mTc-MIBI in breast carcinoma provides correct estimates of blood flow in the neoplasm and can be applied in clinical studies and for calculation of cytostatic delivery to BC.

[99m-Tc-Technetryle mammascintigraphy: clinical protocol and first experience in clinical diagnosis of breast cancer]. / Mammastsintigrafiia s 99mTc-Tekhnitrilom: tekhnika vypolneniia i pervyí opyt klinicheskogo primeneiia pri rake molochoí zhelezy.

Analyzing the results of 99mTc-Technetryle mammascintigraphy in 41 females with breast cancer indicated that polypositional planar mammascintigraphy ensures a high sensitivity (over 88%) in revealing a primary nodule in T1, (more than 95%) in large tumors at above 95% specificity. No nodal accumulation of 99mTc-Technetryle was observed in controls (with fibrocystic mastopathy and suspected coronary heart disease. Mammascintigraphy showed a 85% sensitivity in recognizing axillary lymph nodal metastases too and ascertained that 14 patients had suptaclavicular and subclavian lymph nodal metastases. Therefore, 99mTc-technetryle mammascintigraphy is the method of choice in early detecting a tumorous process, primarily lymphogenic metastasis in breast cancer, and in evaluating its extent.

[Meckel's diverticulum in children]. / Divertikul Mekkelia u detei.

In 1978-1988 operations were performed on 92 children: 35 with diverticulitis, 7 with intestinal intussusception, 5 with hemorrhage from an ulcer of the diverticulum, 13 with strangulation or mechanical ileus, 2 with strangulated Littre's hernia, one with torsion of the omentum, 22 with secondary diverticulitis, and in 7 children Meckel's diverticulum was a chance finding during other operations in the cavities. Boys accounted for 60.9' (56) of cases. There were 12 children under one year of age, nine from 1 to 3 years, 17 from 3 to 5 years, 17 from 5 to 7 years, and 12 children aged from 7 to 10 years. The clinical manifestations depended on the pathological changes developing in Meckel's diverticulum. A clinical picture of acute appendicitis developed in diverticulitis, six children had a typical picture of intussusception, and one child had a picture of acute abdomen. Anemia and a stool with dark blood were encountered in hemorrhage from a diverticular ulcer. Seven out of 13 children with ileus had a pronounced clinical picture, in the remaining 5 it was unclear and resembled that of acute appendicitis. Meckel's diverticulum was suspected before the operation in 17 (9.95%) patients. The Volkovich-Dyakonov laparotomy approach was used in 64 children, a pararectal incision in 9, a transrectal incision in 15, a median incision in one patient, hernio-laparotomy was conducted in one and Shpizi's operation in 2 children. Diverticulectomy was accomplished by the oblique-transverse method in 79 children, by the wedge techniques in 5, by the purse-string method in 2 patients, and resection of the intestine with the diverticulum was conducted in 5 children.(ABSTRACT TRUNCATED AT 250 WORDS)

[The dynamics of the hormonal and tumor marker levels in response to adrenaline administration in lung cancer patients]. / Dinamika urovnia nekotorykh gormonov i opukholevykh markerov v otvet na vvedenie adrenalina u bol'nykh rakom legkogo.

CIA, ferritin, ACTH, cortisol, TTH, T3, T4, insulin, CT and PTH levels were assayed radioimmunologically in the blood serum of 227 patients with lung cancer, stages I-IV, 134 cases of chronic nonspecific diseases of the lung, 28 patients with benign tumors of the lung and 30 healthy subjects. Adrenaline tests were carried out in 160 of them. Similar shifts were observed in hormone profile in both cancer and non-cancer patients. The predictive value of the hormone tests for stage I-II cancer appeared higher than in those for CIA and ferritin. However, the diagnostic value of a single test of marker proved insufficient for its practical use. Adrenaline tests identify fine disturbances in endocrine regulation and considerably raise the predictive value of such indicators as ACTH, insulin, TTH, T3, T4 and calcitonin. To assure high effectiveness of the use of basic radioimmunological data, a combination of indexes should be prepared for each case, and it should include, apart from basic levels of markers, their post-test values and indexes of reactivity.

[The potentials of computed tomography in assessing the spread of lung cancer]. / Vozmozhnosti komp'iuternoi tomografii v otsenke rasprostranennosti raka legkogo.

The paper presents the results of a complex examination of 198 cases of lung cancer, using computed tomography, which provided additional data in 52.3% of cases. These data were used to assess the tumor spreading to the mediastinum, pleura and thoracic wall. The computed tomography-related features of lymphatic nodes of the mediastinum, both normal and metastatically involved, are discussed.

[Long-term radiation injuries following neutron therapy]. / Pozdnie luchevye povrezhdeniia posle neitronnoi terapii.

The paper is concerned with the data on late radiation injuries of normal tissues and critical organs in a group of 35 patients after fast neutron therapy in a period of 12 mos.-3.5 yrs. The value of radiation exposure of critical organs and tissues was considered for patients with head and neck tumors in relation to methods of fast neutron therapy and photon radiation with 60Co after a radical program.