Purpose of the study. To represent the results of a two-stage surgical treatment in patients with extensive pelvic bone defects. Materials and methods. Data on 7 patients who underwent surgery for pelvic and sacrum tumors at the National Medical Research Centre for Oncology from 2016 up to 2020 are presented. The average age of the patients was 36 years. Patients with massive tumors that required a major resection of the posterior pelvis and the formation of an extensive bone defect requiring reconstruction with massive allografts and implants were selected for the study. 5 patients underwent different variations of sacrectomies with the resection of the iliac bones; 2 patients -interiliac-abdominal resections. For all these patients, surgical treatment was split into 2 stages. Results. At the first stage we performed: 5 surgical interventions (total or extended sacrectomy at L5-S1 with lumbar-iliac bilateral stabilization with an 8-screw pedicle system) in patients with sacral tumors. In 2 cases, an interilio-abdominal resection with the defect replacement with cement articulating spacer. Intraoperative blood loss on average was 1.8L. We used autohemotransfusion to compensate the intraoperative blood loss. The 2nd (reconstructive) stage was completed on average after 3 months. The reconstructive stage was not accompanied by major trauma in all patients. The average blood loss was approximately 800 ml. There were no complications after the reconstructive surgical stage. Conclusion. The described two-stage technique allowed to avoid severe infectious complications requiring removal of implants and grafts in all patients. Adequate spinal pelvic stabilization and/or spacing of the defect contributed to early functional rehabilitation of patients and the continuation of adequate adjuvant therapy in the interstage period. The delaying of the reconstruction allowed to reduce the duration and invasiveness of the main intervention without affecting the final result of treatment.
The objective was to evaluate the levels of neurotrophins in the brain of mice with urokinase (uPA) gene knockout, carriers of B16/F10 melanoma developing in presence of comorbid pathology – chronic neurogenic pain (CNP).Methods and materials. The study included female mice of two strains: С57ВL/6 (n=40) and C57BL/6-PlautmI.IBug-ThisPlau6FDhu/GFDhu (n=28). In the main groups, CNP was created by the bilateral sciatic nerve ligation, with В16/F10 melanoma transplanted under the skin of the back 2 weeks after. The comparison groups included sham operated animals with melanoma transplantation, the control groups – sham operated animals and animals with CNP. Mice were decapitated on day 21 of the tumor growth, and the brain levels of brain neurotrophic factor (BDNF); nerve growth factor (NGF), neurotrophins 3 (NT3) and 4 (NT4) were studied by ELISA.Results. The brain of mice with uPA gene knockout demonstrated higher levels of NT3 (by 1.3 times (p=0.0146)), NT4 (by 2.6 times) and NGF-β (by 1.9 times (p=0.0021)) and lower BDNF (by 1.7 times (p=0.0203)), compared to mice without knockout. Cerebral reduction of NGF-β was a nonspecific brain response to CNP and neoplastic growth in female mice, enhanced in the combination of the pathological factors. Greater stimulation of subcutaneous melanoma growth in female mice with uPA knockout under the influence of CNP combined with a 2-fold decrease in levels of NT3 and BDNF in the brain, along with 2.2 times higher cerebral levels of NGF-β, compared to female mice without knockout.Conclusions. In female mice with uPA gene knockout compared to mice without knockout, we revealed background differences and other dynamics of neurotrophin levels in the brain at melanoma growth both alone and in combination with comorbid pathology – CNP.
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