Vol 15, No 2 (2010)

The paper describes the procedure for mini-invasive lateral-access video-assisted resection of the thyroid in its tumors, which has been tested in cadaver experiments. The length of skin incision varied between 2.0 and 3.0 cm, depending on the length and thickness of the neck. There were no problems in imaging the recurrent laryngeal nerve and in exposing the superior and inferior thyroid arteries. The parathyroids were difficult to visualize in some cases. With lateral access, the distance to cervical structures averaged 3.0 and 3.0 cm to the superior and inferior thyroid arteries, respectively; it did 3.5 cm to the recurrent laryngeal nerve. The pretracheal and paratracheal fats, the nearest regional metastasizing areas, could be adequately revised in all cases. Video-assisted resection of the thyroid was clinically used in 135 patients in the treatment of benign and low-grade malignant thyroid tumors (T1-2NxM0). Surgery was performed in 120 women and 15 men; their age was 40.9 years. Preoperative cytological studies revealed papillary/follicular adenoma and low-grade adenocarcinoma (T1-2N0M0) in 92 and 52 patients, respectively. The surgical interventions were hemithyroidectomy with isthmusectomy and subtotal thyroid resection, sentinel lymph node biopsy was made in 18 patients. On the basis of topographic and anatomic studies, the authors have proven the principal possibility of adequate thyroid resection through the mini-invasive lateral access; the latter allows biopsy of the sentinel lymph node of thyroid cancer; hemithyroidectomy with the determination of the sentinel lymph node through a mini-invasive lateral approach reduces operative time and blood loss and does not increase the frequency of postoperative complications, decreases postoperative hospital bed/days to 2-3 days, results in a good cosmetic scar, and does not impair cervical organ function. The indications for mini-invasive lateral-access hemithyroidectomy are adenoma of the thyroid and its low-grade cancer (T1NxM0); the relative indications are female gender and under 60 years of age.

The authors studied the sensitivity and specificity of 3 new tests detecting human hemoglobin (hHb), the hemoglobin-haptoglobin (hHb/Hp) complex, and tumor pyruvate kinase (fTu M2-PK) in feces to diagnose colorectal cancer (CRC). The investigation included patients with CRC (n = 78), ulcerative colitis (UC) (n = 21), enteric polyps (n = 12), and apparently healthy donors (n = 47). The sensitivity of the hHb test system was highest (88.5%) in diagnosing CRC while the hHB/Hp and fTu M2-PK tests were slightly lower (76.9 and 77.9%, respectively). These tests revealed UC with a slightly lower sensitivity in the same order: 76.2, 57.1, and 66.7%, respectively. The feces from the patients with enteric polyps were marker positive in some cases. In donors, the specificity of the hHb and hHb/Hp tests was high (93.6 and 100%, respectively) and that of the fTu M2-PK test system was slightly lower (81.1%).

The authors show it possible to define the site of a tumorous process in difficult diagnostic cases by an immunocytochemical (ICC) study of serous exudates. The ICC profile of tumor cells in the exudates was detectable at various sites of a primary tumorous process. Based on the study performed it may be concluded that in most cases the tumor cells in the exudates preserve the ICC profile that is inherent in primary tumor. Relying on the ICC reactions, the site of a tumorous process may be supposed in serous tunic metastasizing lesions without a detected primary focus.

The risk factors of pyoinflammatory complications of postoperative wounds during elective surgery were studied in gynecological and gynecological cancer patients. An algorithm was developed and described for measures to prevent infectious postoperative wound complications and their treatment. The above algorithm makes it possible to reduce the frequency of infectious complications, wound and abdominal abscesses, peritonitis by 2.5-fold and the length of stay in bed. The results of magnetic laser therapy used to prevent pyoinflammatory complications of wounds are given.

Benign metastasizing leiomyoma is an extrauterine metastasizing leiomyomatous lesion of distant organs and systems, without histological and immunohistochemical signs of malignization. At present, there are about 80 such clinical cases in the literature. This paper describes the authors' rare clinical case that shows a problem in the diagnosis of benign uterine leiomyoma metastasizing to the lung and how to choose adequate treatment policy for these patients.

The authors give the current data available in the Russian and foreign literature on marker recurrence in ovarian cancer. Special criteria for unifying the assessment of a treatment response and for determining the progression of solid tumors (Response Evaluation Criteria in Solid Tumors - RECIST) and criteria for determining marker recurrences, by measuring the level of CA125 (Gynecologic Cancer Intergroup - GCIG), are considered. The results of the studies comparing the standard RECIST criteria with the GCIG classification are analyzed.