[DIAGNOSIS OF VASCULAR INVASION BY PANCREATIC TUMORS].

Basing on analysis of own material (84 patients) and data of literature there was established, that vascular invasion by pancreatic tumors constitutes the main obstacle for conduction of the patients' radical treatment. Early diagnosis permits radical resectability of the patients, what constitutes the only one effective method of treatment. In vascular invasion by tumor a surgeon experience and professional preparation determines possibility of the extended operation performance with intervention on affected main vessel, enhancing the treatment radicalism.

[SURGICAL TREATMENT OF FOCAL HEPATIC AFFECTION: ANALYSIS OF THE RESULTS AND PERSPECTIVES].

Basing on own material analysis (386 observations) and the literature date there was established, that hepatic resection occupies the first place in treatment of the organ focal affection, together--nontumoral and a tumoral one. The treatment of all kinds of focal hepatic affection must be expanded in a specialized clinic in the Ukraine. The main task of the investigation was to determine a permissible volume of hepatic resection, depending on functional state of the organ parenchyma, improvement of existing and elaboration of a new methods of operative intervention, directed on the complications prophylaxis and the hepatic function preservation.

[REMOTE RESULTS OF SURGICAL TREATMENT IN PATIENTS, SUFFERING LOCALLY SPREAD FORMS OF MALIGNANT PANCREATIC TUMORS].

Remote results of surgical treatment of patients, suffering locally spread forms of pancreatic malignancies (PM), using different approaches, were analyzed. In retrospective investigation were included 84 patients with PM and invasion of the main vessels. In the group І patients palliative operations were performed, including in a subgroup Іа­ cryoablation of PM, in a subgroup Іb ­ palliative pancreatic resection with leaving the tumor on the main vessels intact; and in patients of group ІІ the tumor was resected radically, including in a sub* group ІІа­pancreatic resection or total pancreatectomy with resection of the main vessels, and in subgroup ІІb ­ pancreatic resection or total pancreatectomy with cryoablation of tumor, which was left on the main vessel. The one­year, three­years and five­years survival indices have constituted in a subgroup Іа, accordingly 74, 17 and 0% (survival median 16 mo); in a subgroup Іb ­ 70, 20 and 0% (survival median 20 mo); in a subgroup ІІа ­ 83, 49 and 21% (survival median 29 mo); in a subgroup ІІb ­ 73, 41 and 18% (survival median 26 mo). Difference between the general survival indices in subgroups Іа and ІІа, Іb and ІІа is statistically significant. Application of aggressive surgical tactics have permitted to improve the general survival indices of the patients.

PERFORMANCE OF TOTAL PANCREATECTOMY FOR PANCREATIC MALIGNANCIES.

Lethality, morbidity, survival indices and metabolic consequences of total pancreatec' tomy (TP), performed in patients, suffering pancreatic tumors, were analyzed. There were retrospectively analyzed 35 TP оperations, including 5­ urgent, 30 ­ elective, performed in a single center. General lethality have constituted 20% (7 patients died), and after elective ТP ­ 6.7% (2 died). Complications rate after elective TP have consti' tuted 40%; survival mediana­18 mo; indices of a 3­year survival ­ 40%, and a 5­ year one ­ 13.3%. Most frequently revealed metabolic changes after ТP ­ pancreatic exocrine insufficiency, pancreatogenic diabetes, changes in a lipid metabolism in hepatocytes. Our experience witnesses expediency of ТP introduction into surgical practice in specialized centers of Ukraine with results, which are matching a worldwide.

[Clinical significance of K-RAS and cytokeratine 20 markers in diagnosis of lymphogenic metastasis of pancreatic cancer].

Aim of the work is to estimate the role of the metastases molecular signs (MMS) in paraaortal lymphatic nodes, revealed using combined molecular-biological method with application of K-RAS markers and cytokeratine 20 (CK20) for the survival prognostication in the pancreatic head cancer patients after performing pancreatoduodenal resection. Actuarial index of general survival of the patients with MMS in paraaortal lymphatic nodes was trustworthy lower than in patients without such a signs. The two-year survival index in patients without MMS was 60%, the survival mediana--32 mo. Any of the patients with MMS did not survive two years, the survival mediana was 13 mo.

Ukrain (NSC-631570) in the treatment of pancreas cancer.

The aim of this study was to investigate the effects of Ukrain in the treatment of pancreatic cancer. Most patients with advanced pancreas cancer experience pain and have to limit their daily activities because of tumor-related symptoms. Currently, there is no satisfactory treatment for pancreas cancer. The 12-month survival rate is approximately 18% for patients treated with gemcitabine and only around 2% for those treated with 5-fluorouracil. Between January 1, 1996 and December 31, 1999 42 patients with advanced symptomatic pancreas cancer were randomly assigned to receive either vitamin C (5.4 g every second day, repeated 10 times) and Ukrain (10 mg every second day, repeated 10 times) (21 patients), or vitamin C (5.4 g every second day x 10) and normal saline (10 ml) (control group, 21 patients). The primary measure of efficacy was overall survival. Other evaluation criteria included change in body weight, pain intensity (measured by analgesic consumption) and Kamofsky performance status. The one-year survival was 81% in the Ukrain group compared with 14% in the control group. The 2-year survival was 43% in the Ukrain group compared with 5% in the control group. In a recent study of 126 patients treated with gemcitabine or 5-fluorouracil, none of the patients survived beyond 19 months. The longest survival in the Ukrain group was 54 months after the start of therapy (from March 1996 to date). The last follow-up of other patients was on September 6, 2000. Median survival was 17.17 months for Ukrain-treated patients and 6.97 months for the control group and mean survival was 21.86 and 8.92 months for the Ukrain and control groups, respectively (p = 0.001). Ukrain treatment was well tolerated. We conclude that Ukrain prolongs survival of pancreas cancer patients. To determine whether and to what extent this drug can be used as standard therapy in pancreas cancer, a phase III study should be carried out.

Ukrain treatment in a patient with breast carcinoma. Case report.

A 50-year-old female patient with breast cancer (stage IV) was treated with Ukrain because of the impossibility of radiotherapy and chemotherapy. The first course led to a subjective improvement in her general condition, objective changes such as the appearance of border between the tumor and healthy tissues and a decrease in tumor size. Ukrain facilitated the surgeon in performing an operation to remove the primary tumor as well as the metastatic lymph nodes. After the second and third courses of Ukrain, the patient demonstrated clinical remission.

Ukrain treatment of a patient with retroperitoneal synovial sarcoma. Case report.

A 23-year-old woman, diagnosed with a synovial sarcoma of the peritoneum, underwent an operation for tumor extraction. In the postoperative period, Ukrain was injected i.v. at a dose of 10 mg on alternate days, for a total of 10 injections. After a 2-month break, this schedule was repeated. Ukrain treatment was well tolerated by the patient and there were no complications in the postoperative period. The following changes in immunohematological parameters were observed: increased total leucocytes, T lymphocytes and T helpers. Nearly 4 years after Ukrain therapy, the patient is in complete remission.

Ukrain treatment in a patient with metastatic renal cell carcinoma extending to the vena cava inferior. Case report.

A 52-year-old man with renal cell carcinoma was treated with surgery and chemotherapy (vinblastine). Ukrain was administered after tumor progression to the vena cava inferior and appearance of liver metastasis. The drug induced a complete remission, which has lasted 32 months since the first therapy course.

[Transcutaneous electric stimulation of the liver and bile ducts during active enterosorption in combined surgical treatment of obstructive jaundice of nontumorous etiology]. / Cherezshkirna elektrostymuliatsiia pechinky ta zhovchovyvidnykh shliakhiv na foni aktyvnoï enterosorbtsiï v kompleksnomu khirurhichnomu likuvanni obturatsiinoï zhovtianytsi nepukhlynnoho henezu.

The influence of transcutaneous electrostimulation of liver and biliferous ducts while conduction of desintoxication using chitinous enterosorbent "Mikoton" on the result of treatment of hepatargy in patients with obstructive jaundice of nontumoral genesis in the early postoperative period was studied.

The influence of glucose, succinate, pH of the medium and higher temperature on the cytotoxic activity of the preparation Ukrain.

Cells of ascitic forms of Ehrlich's carcinoma and sarcoma 37 transplanted into C57BI/6 mice were used to study the influence of glucose, succinate, and pH of the medium on the cytotoxic activity of the preparation Ukrain. Viability of cells was estimated by the method of intravital staining with tripan blue after the incubation of cell suspension in the presence of the preparation (1.05 x 10(-5) mol and 1.69 x 10(-4) mol). It was established that glucose (5 mmol) reduces the cytotoxic activity of Ukrain, while succinate (5 mmol) increases it. The activity of the preparation was practically absent at pH 6.1-6.7 of the incubation medium and was at a maximum at pH 7.3-8.0. A temperature of 41.5 degrees C has no influence on the effectiveness of Ukrain.

Certain biophysical properties of Ukrain.

Ukrain was found to be relatively resistant in vitro to mean intensity radiation over the whole UV range. Of the seven peaks in the absorption spectrum of Ukraine those at 210 and 230 nm are conspicuous in the spectrum of the plasma of colorectal patients injected the previous day with this drug.

Influence of Ukrain on the redox processes of hepatocytes.

In our in-vitro experiments on the addition of Ukrain into an incubation solution of intact rat liver-cell homogenate, it was indicated that the effect of Ukrain depends on the metabolic redox chain. The endogenous respiration rate which is supported by ionic solution of incubation only, with Ukrain addition submits to a 25% decline. At the same time Ukrain stimulates NADP-dependent oxidation. Since the oxygen consumption increase under Ukrain's influence is characteristic of the metabolic state 4 of Chance (1956), it could be explained as a protonophoric effect (6). The data obtained indicate a complex mechanism of Ukrain's influence on the processes basic for the living organism, the breakage of which always leads to the pathological changes.