Surgical Treatment of Gastric Malignancy in Chronic Kidney Disease Patient with Long-Term Haemodialysis

Background. Gastric cancer is the world 5th top malignancy, with treatment success largely conditioned by comorbidity. Patients with end-stage renal failure developed with chronic kidney disease could not expect a specialty cancer treatment before the advent of long-term haemodialysis.Aim. A case description of successful perioperative therapy and surgery in a long-term haemodialysis patient performed by a multi-specialty team of oncologists and transplantologists.Materials and methods. We case-illustrate surgical treatment options in a gastric cancer patient with long-term haemodialysis.Results and discussion. A specialty oncological treatment of end-stage renal failure patients requiring long-term haemodialysis is a complex multidisciplinary task feasible in hospitals equipped for different haemodialysis regimens. The treatment plan should be laid out by a multi-specialty team, as chronic kidney disease influences the choice of the drug class, dosage and administration mode. Moreover, such patients need laboratory (control of acid-base balance, haemoglobin, electrolytes, creatinine and urea) and clinical (body weight, liquid balance, etc.) monitoring.Conclusion. Perioperative management studies in gastric cancer and chronic kidney disease-comorbid patients under long-term haemodialysis is a promising area of combining eff ort in oncology and transplantation science. Further research is needed in this topic for data enrichment and analysis in complex comorbidity patients.

Alloplastic and Implant Materials for Bone Grafting: a Literature Review

Bone reconstruction aft er trauma, infection, tumour or congenital genetic disorder is an important subject of modern medicine usually relying on bone graft ing materials. Autologous bone or autograft is still considered the “gold standard” most eff ective in bone defect reconstruction and osseous regeneration. Having the advantages of autograft ing, a series of issues remain related to a limited donor material, painful graft taking and the risk of putative complications (nonunions, graft rejection, infection, iatrogenic fractures, post-microsurgery arteriovenous shunt thrombosis, etc.). Th erefore, improved biomaterials are demanded to adequately meet the autograft criteria. Choosing optimal graft materials becomes relevant, aside to the rationale of selecting new surgical techniques. Th e osteoconductive and osteoinductive property evaluation in modern osteoplastic materials comprises a research avenue into optimal graft development for osseous correction in maxillofacial surgery, neurosurgery, traumatology and orthopaedics. Such biomaterials can be combined with alloplastic graft s to attain the required properties of osteoconduction, osteoinduction and osteogenesis. Th is analytic literature review focuses on current state-of-the-art in alloplastic graft ing that, in our opinion, grounds the progress of auto- and allograft innovative development.

Laparoscopic Adrenalectomy: Preventive Principles in Intra- and Postoperative Complications

Background. Laparoscopic adrenalectomy is the current surgery of choice in most adrenal tumours, with a nearly 11 % complication rate and below 1 % mortality. Laparoscopy combines the advantages of minimally invasive surgery with well-known long-term prognosis of a traditional open surgery, at the same time requiring the surgeon’s skill of knowing the technique and avoiding complication.Aim. Concept definition of safe laparoscopic adrenalectomy.Materials and methods. A total of 28 patients with adrenal neoplasms were rendered laparoscopic adrenalectomy by same surgical team under benchmark recommendations during 2016–2019.Results. All patients have been discharged in satisfactory condition, with no intra-, postoperative complications or lethal outcomes.Discussion. Th e evidence presented displays feasibility of using the benchmark principles in laparoscopic adrenalectomy surgery. Laparoscopic adrenalectomy is superior in reducing the recovery time, surgical trauma, complication incidence, length of hospital stay, treatment cost, the improvement of overall wellbeing post-surgery and patients’ quality of life. Th ese principles proved effective to avoid intra- and postoperative complications of laparoscopic adrenalectomy and facilitated revamping of the operation technique in left -sided adrenalectomy.Conclusion. Th e benchmark principles of laparoscopic adrenalectomy enable the procedure higher efficacy and safety and require further implementation and long-term assessment of the outcome.

Overhaul of Radiological Mammography Check-ups for Early Malignancy Diagnosis during COVID-19 Pandemic

Background. The article reports the number of examinations with stationary mammography systems, in outpatient screenings, as well as in a mobile mammography survey across the Sverdlovsk Region.Aim. A study of expedience and design of radiological breast check-ups (exemplified by mammography) for early cancer diagnosis under the COVID-19 pandemic situation.Materials and methods. A survey based at the Sverdlovsk Regional Oncology Dispensary’s Department of Diagnostic Radiology analysed the expedience and design of non-invasive diagnostic procedures in a case study of breast X-ray checkups (mammography) in the Sverdlovsk Region during 2019—2020. Th e survey used the Sverdlovsk Region population statistics on breast malignancy incidence for 2019—2020.Results. According to reports, the number of outpatient screening surveys significantly decreased in 2020 vs. 2019 due to the coronavirus pandemic and effective ban on screenings and medical check-ups. Th e mobile mammography screening numbers increased more than twice in 2020 vs. 2019.Discussion. Screening measures continued during the COVID-19 pandemic. Clinicians adhered to local guidelines, while fully complying with the recommendations to contain SARS-CoV-2 infection. Th e growth of mobile mammography screenings enabled completion of the annual check-up plan, however, the breast malignancy detection rate slightly dropped in 2020 compared to 2019.Conclusion. Mammography screenings at the Sverdlovsk Regional Oncology Dispensary in 2019--2020 demonstrate the expedience and good organisation of breast radiological check-ups (mammography) in Sverdlovsk Region. Accounting for the epidemiological state of coronavirus infection, a positive trend is evident towards growing examinations and improved breast malignancy detection, which lowers mortality accordingly among the female population of Sverdlovsk Region.

Geneti c Traits of Brachiocephalic Atherosclerosis

Background. According to the World Health Organization, the atherosclerosis development depends on the quality of life and lifestyle (60 %), genetic (20 %), environmental factors (10 %) and quality of medical aid (5 %). The routes to defeat atherosclerosis generally and certain systemic enzyme disorders in particular pertain in research into the population genetic predispositions to this pathology.Materials and methods. A comparative study of genetic predispositions to malignant brachiocephalic atherosclerosis analysed the renin—angiotensin system gene association in 60 patients. Th e renin—angiotensin system allelic and polymorphic loci haplotype frequencies have been determined.Results and discussion. Patients with atherosclerotic brachiocephalic vascular lesions revealed a statistically significant frequency of the AGT gene’s allele C involved in coronary heart disease development.Conclusion. Th e study suggests a putative involvement of the angiotensinogen system genes in mediating the development of brachiocephalic atherosclerosis and coronary heart disease

Role of Microenvironment in Ovarian Tumourisation

Background. Metastasis is a formidable complication of malignant neoplasms, with therapy not always effective in advanced malignancy. Metastasis is a multistep process involving the cancer cell detachment from primary tumour, intravasation, extravasation and invasion into the target organ. Early metastasis stages are well understood, whilst the impact of tumour microenvironment on the disease progression and advancement remains a matter of debate.Aim. An immunohistochemical study of the adaptive and reactive properties of greater omentum with metastatic involvement in ovarian cancer.Materials and methods. We examined greater omentum tissue samples from 40 patients with verifi ed stage 3a and b ovarian cancers. For light microscopy, samples were fi xed in 10 % formalin, dehydrated, paraffi n-embedded and stained with Mayer’s haematoxylin and eosin. Immunohistochemical assays used monoclonal antibodies against CD7, CD4, CD8, CD 68, VEGF, D2-40 and CD44 proteins. Statistical data analysis was performed with Statistica v. 7.0 soft ware.Results and discussion. Analyses of the greater omentum tissues revealed cases of leucocyte-bank encapsulation of metastatic foci. Higher CD7+ and CD8+ cell counts were observed in encapsulation, possibly influencing the greater omentum reactive and adaptive properties. Higher CD44-expressing cell counts were also detected in greater omentum samples lacking encapsulation. Angiogenesis marker-expressing cells (e.g., VEGF and CD34) predominated in greater omentum tissues lacking leucocyte-bank encapsulation of metastatic foci.Conclusion. Events in tumour microenvironment may be indicative of a preserved or reduced organ adaptivity, the latter facilitating disease progression.

Organ-Preserving Surgery in Urethral Cancer (a Clinical Case)

Background. Despite low incidence, malignant urethral neoplasms are among the most aggressive tumours. Prevalence of muscle-invasive and metastatic cancer at diagnosis, as well as a high relapse rate compel adherence to the most radical treatment. At the same time, the high incidence of urethral tumours in elderly and senile patients and high postoperative complication rates warrant the development of organ-preserving treatment.Aim. A case description to verify the organ-preserving treatment applicability in urethral cancer.Materials and methods. We report the treatment experience in a senile patient with concomitant chronic kidney disease at the Volgograd Regional Clinical Oncology Dispensary’s Oncourology Unit. Accounting for the age, concomitant pathology and tumour histology factors, a minimally invasive organ-preserving surgical intervention was performed as laparoscopic urethral resection with ureterocystoneostomy.Results and discussion. Renal function was assessed in postoperative period with dynamic nephroscintigraphy and blood creatinine monitoring. Control cysto-, ureteroscopy and contrast-enhanced CT scanning in areas of interest were performed to rule out relapse and progression.Conclusion. No report of disease relapse or progression at follow-up indicates the oncological safety of organ-preserving surgery in this patient category. Th is approach also gains support from immediate and long-term outcomes of the patient’s improved renal function and sustained good quality of life.

Intratumoural Effector Cell Subpopulations in Breast Cancer: a Literature Review and Own Data Report

Breast cancer (BC) is most prevalent female malignancy worldwide. Despite advances in BC diagnosis and progress in drug therapy, a series of challenges associated with emergent tumour resistance causing the disease escalation still remain. Immune evasion is among the driving forces of tumour resistance against modern treatments, which promotes world-active research into the mechanisms of tumour—immune interaction.Tumour microenvironment is known to contribute greatly to the nature of this interaction. Immune cells are constitutive of tumour microenvironment as tumour-associated macrophages, myeloid-derived suppressor cells and tumour-infi ltrating lymphocytes. Tumour-infi ltrating lymphocytes are represented by B-, T- and NK-cells, which localisation and subpopulation structure in tumour may possess a prognostic and clinical significance. Th e infi ltration density by certain effector cell types prior to chemotherapy is an important predictor of patient survival. Putting otherwise, the presence of effector lymphocyte subpopulations in tumour defi nes the strength of antitumour immunity and may establish the success of drug treatment.This study analysed the infiltration levels of CD3, CD4, CD20 and CD38 lymphocytes in several molecular BC subtypes. Tumour immunophenotyping was performed in cryosectioning and immunofl uorescence assays with a ZEISS AXIOSKOP microscope, Germany. We analysed 96 luminal BC (37 subtype A (38.5 %), 52 B-Her2-negative subtype (54.2 %), 7 B-Her2-positive subtype (7.3 %)) and non-luminal BC samples (3 HER2+ subtype (14.3 %), 18 triple-negative subtype (85.7 %)). The infiltration and antigen expression patterns have been assessed. Analyses of tumour-infi ltrating subpopulations revealed lower infiltration in luminal BC vs. other subtypes, albeit at no significance.

Comparative Assessment of Original vs. Standard Surgery Techniques in Treatment for Purulent Pyelonephritis

Background. Modern minimally invasive surgical techniques reduce traumatism of operative interventions and aggressive anaesthesia, which accordingly shortens the patient’s hospital stay and rehabilitation period.Aim. An improvement of surgical outcomes in patients with purulent pyelonephritis via introduction of laparoscopic techniques.Materials and methods. Th e study included 80 purulent pyelonephritis patients operated at the Territorial Clinical Hospital during 2006—2018. Th e patients were divided between two cohorts. Cohort 1 included 40 (50 %) patients operated with standard techniques (ST), cohort 2 — 40 (50 %) patients having surgery by an original minimally invasive technique (OT). Kidney decapsulation was found to outcome in parenchymal decompression and blood circulation restore in cortical layer. Intraarterial infusion of alprostadil prevents further spread of purulent-destructive processes in kidney.Results and discussion. In patients with the minimally invasive technique, postoperative period proceeded at no complications. On day 1, the patients reported reduced pain syndrome in the surgical area. Contrasted renal MSCT before and aft er surgery showed the recovery of renal blood flow and significant diminishing of destruction foci in short term. Nephrectomy was not performed as no-indication.Conclusion. The treatment outcomes in 40 patients having the new surgical technique demonstrate its efficacy and applicability in clinical practice.

Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer

Background. Prostate cancer (PC) is subdivided into risk categories according to patient prognosis. High-risk disease was previously typified by a higher risk of metastasis and mortality, which implied comprehensive treatment. Manifold studies have concluded that surgery is a key measure in such cases, even as monotherapy. Open radical prostatectomy (RP) was routinely performed in most high-risk PC patients until robot-assisted radical prostatectomy (RARP) had become a reasonable choice as improving outcomes in low- and intermediate-risk PC patients. Reliable RARP assessments in high-risk PC are still lacking. Th e review summarises published data on functional and oncological RARP outcomes in high-risk PC patients and analyses surgical inpatient cases at the BSMU Clinic for 2018—2021.Materials and methods. The surgical outcomes in high-risk PC inpatients were analysed retrospectively at the BSMU Clinic for 2018—June 2021. Among 540 RARPs performed, 199 PC patients were identified as high-risk in the D’Amico criteria.Results and discussion. Mean operation time was 100 min, blood transfusion rate — 3.5 %. Bladder catheterisation time was 5 days, average hospital stay — 7.1 days.Conclusion. RARP may facilitate optimal therapeutic efficacy and favour postoperative recovery as monotherapy or the first step in a multimodal treatment of high-risk PC patients.