The aim of the research. Development and implementation of new methods for pre-operative staging of advanced ovarian, gastric and colorectal cancer to improve patient selection for cytoreductive surgery and increase its radicality. Materials and methods. Data from 120 patients with advanced ovarian cancer, 28 with advanced gastric cancer and 119 with advanced colorectal cancer were analyzed. Preoperative detection of the incidence of peritoneal carcinoma and the possibility of surgery in radical or cytoreductive volume performed by CT with intravenous contrast (72 patients with ovarian cancer, 17 patients with gastric cancer, and 69 patients with colorectal cancer), and MR T1 and T2, contrast-enhanced T1, and diffuse-weighted sequences (48 patients with ovarian cancer, 11 patients with gastric cancer, and 50 patients with colorectal cancer). Subsequently, preoperative and intraoperative assessment of the prevalence of the tumour process with peritoneal carcinoma index (PCI) by Sugarbaker was performed. Results. A statistically significant increase in the informativeness of the preoperative assessment of the incidence of tumour process in peritoneum and the presence of distant metastases using DWI / MRI compared with CT with intravenous contrast was determined. Patients from all groups were categorized according to the completeness index of cytoreduction achieved by preoperative staging and patient selection using DWI / MRI and CT. The use of DWI / MRI allowed to significantly reduce the number of suboptimal and non-optimal cytoreductive interventions. Conclusions. DWI / MRI has made it possible to significantly improve the preoperative incidence of advanced ovarian, gastric, and colorectal cancer compared to CT, predict the radicality of future surgery, and detect inoperable cases.
Циторедуктивна хірургія при хіміорезистентній лейоміосаркомі матки
Colorectal cancer (CRC) is one of the most common malignancies. Susceptibility to malignant processes is mediated by genetically driven differences in the effectiveness of detoxification of potential carcinogens. One of the factors that may influence the risk of CRC is the glutathione-S-transferase (GST) gene family that encodes glutathione transferase enzymes. The GSTP1 gene is expressed both in normal and pathological conditions. Determining its specific alleles may be a marker of CRC. The aim of the research – to study GSTP1 gene polymorphism, which is likely to be more common among patients with primary metastatic colorectal cancer compared with healthy population. Materials and methods. The study involved 12 patients with primary metastatic colorectal cancer aged 43 to 72 years, the control group was represented by a sample of 31 people without cancer. Results. The incidence of advanced CRC in the presence of GSPT1 Val / Val (aa) polymorphism is statistically significantly higher than in the presence of Ile / Ile (AA) and Ile / Val (Aa) GSPT1 polymorphism. Conclusions. Among people with GSTP1 Val / Val (aa) polymorphism, primary CRC is 4.4 times more likely than among people with GSPT1 Ile / Ile (AA) and Ile / Val (Aa) polymorphisms, which are statistically significant (P < 0.05). The obtained results indicate the possibility of conducting a genetic study of GSTP1 polymorphism to form groups of potential risk of CRC.
Emergency conditions are very life-threatening situations and require fast actions and immediate intervention from medical stuff. For young doctors without extensive experience in the treatment of these important diseases, it is very crucial to know and timely apply modern treatment algorithms. Simulation medical scenarios are a good approach and can help to improve knowledge and practical skills. Authors provide frequent trainigs for students and interns for emergency medical conditions according to world standards and University syllabus. The main idea is to create new and improve old practical skills and competencies for students and interns.
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