On the issue of interscapular-thoracic amputation in malignant neoplasms of the shoulder-scapular region

In view of the fact that the question of the use of one or another type of surgical intervention for malignant neoplasms of the shoulder of the scapular region has not yet been fully clarified (which is partly overtaken by the comparative rarity of this disease), and that each insufficiently radical operation leads in these cases to a serious outcome, while on the contrary, a timely radical operation gives good results, surgeons are forced to report the corresponding individual cases, so that in the future, on the basis of statistical data, they can build correct conclusions.

Effect of Prophylactic Radiotherapy on Patients with Stage II-III Esophageal Cancer after Esophageal Cancer Radical Operation and Influencing Factors in Its Recurrence

Objective. To explore the effect of prophylactic radiotherapy on patients with stage II-III esophageal cancer (EC) after esophageal cancer radical operation (ECRO) and influencing factors on EC recurrence. Methods. Totally, 65 patients with EC in our hospital were enrolled. Among them, 30 patients were treated by routine ECRO as a control group (Con group) and 35 patients by prophylactic radiotherapy as a research group (Res group). Then, the following measures were taken: record the efficacy on both groups, quantify their C-reactive protein (CRP) and white blood cell count (WBC) before and after therapy, evaluate their mental state through the revised piper fatigue scale (PFS-R) before and after therapy, determine their changes in Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) before and after therapy, compare them in terms of lymph-node metastatic rate (LNMR), hematogenous metastasis rate (HMR), anastomotic recurrence rate (ARR), and 3-year survival rate, compare them in terms of life quality after therapy via the Quality of Life-Core Questionnaire (QLQ-C30), and analyze influencing factors on their recurrence. Results. The Res group showed a notably higher total effective rate (TER) than the Con group ( P = 0.037 ). After therapy, CRP and WBC in both groups increased, but their levels were not considerably different in both ( P > 0.05 ). Additionally, after therapy, in contrast to the Con group, the Res group got notably lower PFS-R, SDS, and SAS scores, showed notably lower LNMR and ARR and notably higher 3-year survival rate, and experienced notably higher life quality (all P < 0.05 ), and the HMR results were not considerably different in both groups ( P > 0.05 ). Moreover, carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), esophageal inflammation history, family medical history, postoperative complications, and lymphatic and vascular infiltration were risk factors for the disease recurrence, and treatment method was the protective factor for it. Conclusion. For patients with stage II-III EC after ECRO, prophylactic radiotherapy is highly effective and safe and can lower the recurrence rate, so it is worth popularizing in clinical practice.

Delayed Diagnosis of Breast Cancer as a Cause of Crippling Radical Treatment of Elderly Patients

The volume of surgical treatment of breast cancer depends largely on the size of the primary hearth. Malignant neoplasms diagnosed at the initial stage of the disease make it possible to carry out organpreserving operational interventions, which is particularly important in the treatment of elderly patients with concomitant somatic diseases. Clinical observation is presented, which demonstrates the importance of the timely identified and consequences of the late diagnosis of breast cancer in the patient of the elderly, in the form of a crumpled radical operation that affects the quality of life of the patient.

Radical removal of advanced cancer of the oral cavity and oropharynx

Surgery for advanced cancer of the oral cavity and oropharynx are among the most difficult. This is due to the topographical and anatomical features that limit the operating field and the proximity of the internal carotid artery, which penetrates into the skull without branches. Her injury and bandaging are fraught with lethality. In the postoperative period, due to a violation of the function of swallowing, there is a stagnation of oral fluid in the oral cavity, which pro[1]motes healing by secondary tension. The functions of the oropharynx are impaired: swallowing, chewing, breathing and speech.Purpose of the study. To develop an operation in patients with advanced cancer of the oral cavity and oropharynx, allowing to visualize the area of the tumor with it’s radical removal and postoperative healing without suppuration.Patients and methods. We’ve operated a patient with advanced cancer of the oral cavity and oropharynx with me[1]tastases to the cervical lymph nodes (T4 N1 M0 – IV st.). Cervical lymphodessection and removal of the tumor from the oral cavity and oropharynx was performed according to the method developed at the National Medical Research Centre for Oncology of the Ministry of Health of Russia: the tumor was removed after a preliminary modified mandib-ulotomy. Good visualization allowed for a radical operation, after which a urostoma was formed, which promotes the free flow of oral fluid from the oral cavity, without its stagnation and without suppuration of the tissues. The jaw was restored with two titanium mini-plates.Results. The healing was carried out by primary tension. On the 7th day after the operation, breathing was restored[1]decanulated. On day 20, epithelialization of the wound surface of the oral cavity and oropharynx occurred. The nasoesophageal probe was removed. Plastic orostoma was produced. By this time, the functions of the oropharyngeal region were partially restored: chewing, swallowing, and speech. Discharged home. Remission for more than 2 years.Conclusions. Previously performed modifi ed mandibulotomy in patients with advanced cancer of the oral cavity and oropharynx, allows you to expand the view of the operating field and provide a radical operation. The formed orostoma, preventing suppuration in the oral cavity, accelerates healing with the restoration of functions: chewing, swallowing, breathing and speech.

Value of pulmonary annulus index in predicting transannular patch in tetralogy of Fallot repair

Objective: It is very important to accurately assess the transannular patch (TAP) in the surgical treatment of tetralogy of Fallot（TOF）. Methods: 130 patients who were diagnosed with TOF and underwent TOF repair. 112 cases were included in this study. They were divided into TAP group and no TAP group; the values of pulmonary annulus and aortic annulus were measured. GA ratio, PAI, PAAI, the pulmonary annulus Z-score and main pulmonary artery (MPA) Z-score were calculated to do statistically analyze. Results: A total of 112 patients were included in the study.62 cases (55.8%) did not transannular patch, 50 cases (44.2%) undergoing transannular patch. The pulmonary annulus Z-score, main pulmonary artery Z-score and PAI in TAP group were smaller than those in no TAP group (P < 0.05). ROC analysis showed that when the cutoff value of pulmonary annulus at -1.98 ,the area under curve (AUC) was 0.88, the sensitivity was 80%, the specificity was 71%; when the cut-off value of PAI at 0.53 ,AUC was 0.85, the sensitivity was 75%, the specificity was 80%; when the cutoff value of GA ratio at 0.55 ,AUC was 0.85, the sensitivity was 76%, and the specificity was 80%. The area under the PAAI curve (AUC) was 0.85, the sensitivity was 76%, and the specificity was 79%. Conclusion: The predictive effect of pulmonary annulus index as a simple and effective predictor of TAP in TOF radical operation is the same as that of pulmonary annulus Z-score.