Vol 3, No 3 (2003)

Apoptosis is a physiological, actively regulated cell death. Its biological role is outstandingly important, since it serves as defense mechanism aimed to eliminate from the body useless or potentially dangerous cells, and functions in tight balance with proliferation and differentiation processes. Research on programmed cell death has become a very active area in modern biology. Besides a visible fundamental impact into the understanding of mechanisms of cellular homeostasis, studies on apoptosis are gaining an increasing significance for the applied medical science.

The morphology of region umbilical vein, umbilical sinus and ductus venosus of 26 human fetuses between 20 and 40 weeks’ gestation have been investigated. The angle between DV and left branches of portal vein in dominate cases was sharp and right that reflects the general regularity an architectonic of vascular riverbed. The specific anatomical finding of the ductal isthmus had been an accumulation of vascular muscle-elastic cells of intimal hyperplasia (intimal «pillow»), probably, executes the role of the fortification of resistant behaviours of vessel wall in connection with DV and portal sinus with high hemodynamics load in this area.

Cases of opportunistic mycotic infections without inflammatory reaction have been studied. Invasive mycotic processes in patient with neutropenic and impediment leucocytosis have been investigated. In this cases infections process characterized by severe morfologic manifestation, polyorganic lesions and reversion of infections process.

The main trends of modern medicine lead to understanding the necessity of a wide employment of biotechnology for all kinds of medical treatment. Different methods of cell and tissue therapeutics are actively introduced into clinical practice of orthopaedic surgery. Explantation of bone cell precursors, induction of directed differentiation of bone cells in vitro, followed by their transplantation to patients with fractures and fracture complications for repair optimization, - all this has its definite pathogenetic basis. The first positive results obained by clinicians provide evidence on the availability of these methods, their acceptable cost, and their promise for treatment of bone and articular cartilage defects.

The treatment results of more than 800 patients with primary and metastatic liver malignancies including 120 with hepatic resections are analyzed in comparison with the literature data. Modern tendencies in the tactics of management for liver tumors are reviewed. It is noted that curable liver resection is still the main surgical procedure in liver malignancies. Re-resection has become a routine intervention but is possible in less than 20 per cent of patients. In the last years, liver transplantation appears as an alternative curable treatment of hepatocellular carcinoma. There is improvement of results of «debulking» surgical procedures combined with locoregional chemotherapy. No positive effects of preoperative arterial infusion or chemoembolization for resectable liver tumors were found. On the other hand, preoperative portal vein embolization is widely used for decreased risk of postoperative hepatic failure. The efficacy of adjuvant arterial and portal vein chemotherapy is not fully proven. Periodical hepatic artery and portal vein chemoembolizations appear to be effective for this purpose. Combination of regional chemotherapy and local ablation (ethanol injection, radiofrequency, laser, cryosurgery) are reasonable for the management of unresectable recurrent liver cancer. It is concluded that multimodality approach including methods of surgery and interventional radiology should be preferred for hepatic malignancies. Use of this approach improves treatment results.

This article presents the comparative analysis of perspectives in the field of molecular-genetic research of gap junction intercellular communications (GJIC) in colorectal cancer and other malignant tumors. The current investigations are characterized by profound theoretical studies and experimental research of GJIC antitumor properties. Special interest is rewarding to in vitro and in vivo experiments showed that different cancer cells transfected with GJIC-connexin genes reduced their tumorigenicity significantly. Some somatic connexin gene mutations were recently been revealed at the late stage of sporadic human colorectal cancer. This fact let us suggest that more detail molecular-genetic investigations of connexin genes in malignant tumors further could be a perspective line of cancer research. The results of the investigations could be demanded for the development of early diagnosis and gene therapy of malignant diseases.

In the recent years, after the new Los-Angeles classification of chronic hepatitis was accepted, there has been an increase in the role of morphological methods in the diagnostics of etiology, degree of activity and stage of this disease. Several semi-quantitative methods were suggested by some well-known hepatologists-morphologists (Knodell R. G. et al., 1981; Desmet J. V. et al., 1994; Ishak K. et al., 1995; Serov V. V., Severgina L. O., 1996; and others) to assess the degree of activity and the chronisation stage of hepatitis. These methods have found a wide clinical application and recognition, but they are not perfect and require further development and improvement. There are characteristic features of viral and alcohol liver lesion as well as their combinations. Morphological signs of HBV, HCV and HDV-infection in the liver are distinguished. With the help of PCR and hibridisation in situ, it became possible to determine the viral genome directly in the liver tissue, and the role of repeat biopsies in the assessment of antiviral therapy efficacy has increased. With the help of immunophenotyping of the inflammatory infiltrate cells the peculiarities of immune-mediated liver lesion are studied. Morphological methods allow observing apoptosis and clarifying its significance in chronic hepatitis pathogenesis and in cancerogenesis. Computer analysis of the histological picture videoimage provides an exact quantitative evaluation of morphological changes in the liver. Everything mentioned above proves the inestimable role of the «golden standard» of chronic hepatitis diagnostics - the morphological examination of the liver biopsies.

The proposed methods let classify territories in accordance with the values of different measures of medical service accessibility. The topologies are built through three phases. At the first phase a preliminary statistical analysis of public health and medical service data is being performed, groups of measures are being selected. At the second phase the dimensionality of measures is being reduced via factor analysis. At the third phase the territories typology is being formed through cluster analysis. The proposed methods were applied to territories of Komi Republic. Considered approaches can be used in other regions, first of all northern regions of Russia.

New chronophysiologic approach to the problem of bowel regularity is proposed. Chronoenterography as a new diagnostic procedure is suggested for studying the circadian defecation rhythm. Intestinal bradyarrhythmia was discovered in about 40% of persons claimed to be healthy. The availability of the «optimal» and «pessimal» phases in the temporal structure of the circadian defecation rhythm was detected. The constipation risk was proved to depend on the defecation phase. It was shown that the «optimal» defecation phase is the main determinant of the circadian bowel regularity, as its physiological significance in this regularity is as important as 3 other factors taken together: the diet, the regimen and physical activity. The quality of life of the patients with intestinal bradyarrhythmia became almost 20 % higher after treatment. The existence of some connection between intestinal bradyarrythmia and colorectal cancer was detected. Urgent need of total screening of intestinal bradyarrhythmia is indicated, as it is a risk factor of colorectal cancer, which is leader in cancer incidence and in cancer female mortality in St. Petersburg.

Медик В. А., профессор, член-кор. РАМН, директор Новгородского научного медицинского Центра СЗО РАМН, заведующий кафедрой социальной медицины, экономики и управления здравоохранения института медицинского образования Новгородского государственного университета им. Ярослава Мудрого.