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in a consequence of that arises deficiency of essential saturated fat acids that activates an inflammation syndrome. Feature of enzyme of LpFLA2 is specificity concerning a vascular inflammation and is about the inflammatory enzyme, showing physiological activity in the relation of intims of arteries.
Apparently from the received results of research, indicators of studied enzyme (LpFLA2) at patients of ChGP combined by an atherosclerosis syndrome authentically raise and have exceeded values of an indicator of group of comparison in 2.6 times (P < 0.05) whereas concerning group of patients with ChGP it have exceeded reference values on 59 %. Hence, the elicited fact specifies in direct correction between indicators of studied enzyme with weight of disturbance of capillary of blood circulation not only in tissues of parodontitis, but also expressiveness of endothelial dysfunctions and display of an atherosclerotic syndrome.
The revealed changes in character of endothelies of vessels, their morphological and functional damage is one of the development reasons of atherogenesis at combined form of ChGP with an atherosclerosis syndrome. In the present condition research of markers of a chronic ischemia of a brain can reflect dysfunction degree of endothelial cells and neyrodegenerative processes in a brain.
Carried on by us immunepherment analysis of the maintenance of protein S-100 at patients of ChGP combined by a syndrome of atherosclerosis has shown to the high values of level of studied protein in blood serum on the average in 2.4 times concerning indicators of group of comparison that is in our opinion caused by disturbance of trophics of nervous cells in the conditions of a cerebral ischemia as astrocytes and microglies are the basic sources of synthesis of protein S-100. Along with disturbance of trophics of a nervous tissue at patients with ChGP an atherosclerosis syndrome disturbance of a carbohydrate exchange in nervous cells is noticed at an ischemia that results in to an exit of neyronalic enzyme of gly-colisis — enalases in blood where its concentration has exceeded reference values in 2.9 times (P < 0.05).
The considerable role in development of a chronic ischemia of a brain and microcirculatory frustration plays functional condition of thrombocytes which is a link of vascular-thrombocytaric, coagulation and fibronilitic rings of haemocoagulation systems. Adhesion and aggregation of thrombocytes against an exit in a blood channel ofbiologically active substances can promote occurrence of haemor-ragical syndrome.
Recently it is proved that one of factors stimulating synthetic activity of endothelium is activation of thrombocytes with discharging of serotaninum, ADF, thrombinum [2]. The endothelial dysfunction observed at combined form of disease promotes increase of aggregation activity of thrombocytes for the account of thrombomodulator of ADF. Apparently from results of research, at given groups.
At patients we observe the increase of the sum of active forms of thrombocytes in 2 times, an adhesiveness index of thrombocytes to % and the maximum aggregation at stimulation of ADF to 31 % (P < 0.05).
Activated thrombocytes substantially promote generirising of thrombinum, catalizing and providing factors for reactions of humoral coagulation cascade.
Conclusions
The generality of an inflammatory syndrome in tissues of parodontitis and an atherosclerosis syndrome (a chronic cerebral ischemia) is more full natural, as both syndromes form the same cells: endothelial, monocytes, thrombocytes, etc. in both situations at participation of sytacinum synthesis and secretion in blood of the protein acute phases and lypoproteins, proteases increase. Clinically both the inflammation syndrome, and process of atherogenesis can prolong long time, both syndromes are nonspecific and consist of the same functional reaction. In the present situation functional and structural damages of endothelia ofvessels are accompanied by disturbances in vascular — thrombocytic hemostasis link at ChGP combined by an atherosclerosis syndrome.
References:
1. Goloseev G. Microcirculatory link of system of a hemostasis at patients with ChGP in a combination with diseases of gastraduodental areas//Parodontology. - 2005. - № 1. - P. 21-25.
2. Gomazkova O. A. Molecular and physiological aspects of endothelial dysfunctions. A role of endogenic chemical regulators//Successes of physiological sciences. - 2000. - T. 31, № 4. - P. 48-59.
3. Kamilov H. P. Radiological densitometric diagnostic methods of generalized parodontitis at elderly and senile age//Methodical recommendations. - Tashkent, 2012. - 26 p.
4. Hasanova L. E. Pathogenetic aspects of treatment of parodontitis at women at elderly and senile age//Mater. III International scient. pract. conf. The urgent aid in medicine. Stomatology - Almaty, 2014. - P. 28-31.
5. Tonetti M. S.,Van Dyke T. E. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP Work - shop on Periodontitis and Systemic Diseases//J Periodontal. - 2013. - 84 (4 sup.). - P. 24-29.
Khasanov Akbar Ibragimovich, D. m. s, Scientific leader Head and Neck tumors department National Research Center of Oncology, MH RUz E-mail: akbarkhasanov@mail.ru
Bekmirzayev Rahimjon Melikuziyevich, Senior Researcher, Department of tumors of the head and neck, E-mail: bekmirzaev_1980@mail.ru
Surgical treatment of non-epithelial tumors mandible
Abstract: In this article were studied surgical treatment of non-epithelial tumors mandible. In the period of2013-2015 the department head and neck tumors NRCO MH of R. Uzbekistan were treated 26 patients with non-epithelial tumors of the
mandible. The average age of patients was 27 years. Men were 8 (30.7 %), 18 women (69.3 %). Anatomically tumor damaged more than the horizontal part of the mandible in 20 (76.9 %) patients, followed by posterior segments — processes in 5 (19.2 %), and anterior segment (tuberculum mentale) in 1 (3.8 %) patients. Of the 26 patients in 14 were detected malignant tumors (sarcomas), and the remaining 12 benign tumors. Of the sarcomas most histologically detected osteosarcoma and fibrosarcoma, and benign tumors of the most detected osteoblastoklastoma — giant cell tumor. Patients with sarcomas before operation were performed chemo radiotherapy depending on histology. Patients with benign tumors was performed only surgical treatment.
Keywords: non-epithelial tumors of the mandible, surgical treatmentof the mandible.
Results
All 26 patients were performed surgical treatment of the mandible, with subtotal resection of the mandible was performed in 1 (3.8 %), gemimandibuloektomiya in 6 (23.0 %), segmental resection of the mandible in 14 (53.8 %), resection an edge in 3 (11.5 %) and the removal of the tumor was performed in of the mandible 2 (7.6 %) patients. In 3 (11.5 %) patients after removal of the tumor and at the same time-was performed reconstruction of the mandible with a titanium plate. Of the 14 patients with sarcoma in 12 patients at the same time performed a combined operation — the upper cervical lymph node dissection, and in 2 patients due trismus and the prevalence of tumors in the first stage performed a tracheostomy operation. Of the 5 patients in whom the tumor spread to the infratemporal and pterygopalatine fossa in 2 patients within 1 year after the operation was a recurrence of the tumor.
Conclusion
Surgical treatment in the combined, comprehensive or self-treatment is a leading method in the treatment of sarcomas of the mandible. Integrate consideration histological form of tumor dissemination and radical surgery are factors of improving survival.
Introduction
Despite the fact that the tumor of the mandible is the visual localization of the tumor and the available medical examination, the majority of patients to the moment of starting treatment has locally advanced form of the disease. In this situation, the only option to carry out radical treatment is combined or complex treatment, which is the main stage of the operation [1].
Anatomical topographical features of the area, proximity to vital organs complicate removal of the tumor within the healthy tissue or at a considerable distance from the tumor edge. This leads to the fact that the main reason of adverse outcomes for tumors of the jaws are relapses, which, according to various authors, occur in 33-69 % of cases.
This in turn has led to the search for additional methods of influence on the primary tumor, the nature of the application and that their effectiveness is largely depend on the type of tumor and its degree of differentiation. Regional metastases are found in 10-15 % of cases, mainly in poorly differentiated forms of tumors [2; 3; 4].
It should be noted that in some cases, the number of tumors of the jaws — angiosarcoma, malignant fibrous histiocytoma, leiomyosarcoma, unclassified sarcoma — using of chemoradiotherapy leads to a complete clinical and morphological effects.
Bone marrow malignant sarcomas are highly sensitive to radiation and drug therapy tumors with early development of regional and distant metastases. In this regard, for the treatment use chemo-radiotherapy treatment and only when residual tumor relapse or conduct surgery [1].
In recent years, are developed a variety of methods and techniques of regional intra-arterial chemotherapy for locally advanced cancers of the maxillofacial region. They help reduce the toxic effect of chemotherapy and to increase their concentration in the tumor, resulting in enhanced their therapeutic effect and subsequently reduces the amount of surgical intervention [5; 6; 7; 8; 9; 10; 11]. As
seen in the treatment of tumors of the mandible it depends on many factors and therefore the aim of our work is to improve the treatment of non-epithelial tumors of the mandible.
Materials and methods
In the period 2013-2015,. in the department of head and neck tumors RORC MoH Uzbekistan. We treated 26 patients with non-epithelial tumors of the mandible. The average age of patients was 27 years. Men were 8 (30.7 %), 18 women (69.3 %). Anatomically tumor affects more than just the horizontal part of the mandible in 20 (76.9 %) patients, followed by posterior segments — processes in 5 (19.2 %), and anterior segment tuberculum mentale in 1 (3.8 %) patients. Of the 26 patients from the 14 detected malignant tumors (sarcomas), and the remaining 12 benign tumors.
The most frequently diagnosed osteosarcoma 3 (21.4 %) and fibrosarcoma in 3 (21.4 %) patients, then — chondrosarcoma in 2 (14.3 %), angiosarcoma in 2 (14.3 %) in 2 reticulosarco-ma (14.3 %), malignant ameloblastoma in 1 (7.1 %) and miksosar-koma in 1 (7.1 %) patients.
Of the benign tumors found most Osteoblastoklastoma — giant cell tumor in 6 (50 %) patients. Patients with sarcoma were performed preoperatively chemo radiotherapy depending on histology. One patient was performed intraarterial regional chemotherapy. Patients with benign tumors was performed only surgical treatment.
Results and discussion
Evaluation of the effectiveness of neoadjuvant chemo radiation therapy was performed in all 14 patients. The results of treatment were evaluated by objective data in dynamics, according to X-ray examination, ultrasound, MDCT, MRI and morphology. Neoadjuvant chemotherapy and radiation therapy is used to increase resectability and improve the anti-tumor effect. All patients after neoadjuvant therapy showed a significant decrease in pain in the tumor lesions, headaches, lockjaw reduction associated with reduction in tumor size. Example — Fig. 1 and 2.
All 26 patients underwent surgical treatment of the mandible, and the subtotal resection of the mandible was performed in 1 (3.8 %), gemimandibuloektomiya 6 (23.0 %), segmental resection of the mandible in 14 (53.8 %), the edge resection 3 (11.5 %) and the removal of the tumor was performed in of the mandible 2 (7.6 %) patients. In 3 (11.5 %) patients after removal stage reconstruction performed mandible titanium plate.
Using titanium reconstructive plates of various designs for of the mandible defect compensation on the one hand, is the easiest method, and on the other — by using to strict indications enables to achieve high aesthetic and functional performance. In this case the surgeon will have to perform two tasks at once, the first radical removal of the tumor and the second at the same time performed reconstruction of the mandible.
Of the 14 patients with sarcoma in 12 patients at the same time performed a combined operation — the upper cervical lim-fodisektsiya, and in 2 patients due lockjaw and the prevalence of tumor intubation started with a tracheostomy. In these cases, the tumor had locally advanced form. Example — Fig. 3 and 4.
Of the 5 patients in whom the tumor spread to the infratemporal and pterygopalatine fossa in 2 patients within 1 year after the operation indicated tumor recurrence. Thus, in the treatment of tumors of the mandible using an integrated approach. Preoperative
chemo radiotherapy, especially intra-arterial chemotherapy significantly reduces the volume of the tumor, the transition by providing unresectable tumors resectable. Conducting combined operations, in many cases provides a radicality of surgery.
Fig. 1. MSCT of the patient R. before chemotherapy
Fig. 2. MSCT patient R. after chemotherapy
Fig. 3. Patient R. affected part of of the mandible when the local prevalence of sarcoma
Conclusion
Surgical treatment in the combined, complex or self-treatment is a leading method in the treatment of sarcomas of the
Fig. 4. Patient R. remote macropreparations
mandible. Integrate consideration histological form of tumor incidence, preoperative chemoradiotherapy and providing radical surgery are factors improving survival.
9.
10.
References:
Kropotov M. A., Sobolewski V. A. Primari tumors of the mandible, treatment, rehabilitation and prognosis//Bone and soft tissue sarcomas and tumors of the skin. - 2010. - № 2. - P. 10-16.
Mudunov A. M., Matyakin E. G., Kropotov M. A., Aleshin V. A. Sarcomas of the skull base. The principles of treatment, long-term results and prognostic factors//Bone sarcomas, soft tissue tumors and skin. - 2010. - № 3. - P. 16-29.
McMains K. Christopher. Patology: Sarcomas of th Head and Neck. E.//Medicine. - 16.10.2007//[Electronic resource]. - Available from: http://www.emedicine. Com/ent/topic675.htm (date of the application: 09.01.2008).
Protsyk V. S., Trembach A. M., Box E. V., Garbar L. I. Combined treatment of patients with jaw. Mat. V Congress of CIS Oncologists and Radiologists: Tez. rep. - Tashkent, 2008, 14-16 May. - P. 166.
Patel S. G., Shaha A. R., Shah J. P. Soft tissue Sarcomas of th Head and Neck: an update//Am. J. Otolaryngol. - 2001. - 22(1): 2-18. Homma Akihiro. Superselective Arterial Cisplatin Infusion with Concomitant Radiation Therapy for Advanced Nasal Cavity and Paranasal Sinus Carcinomainoma//Austral-Asian Journal of Cancer. - ISSN-0972-2556. - January 2012. - Vol. 11, №. 1. - P. 33-43. Rasch C. R., Hauptmann M., Schornagel J., Wijers O., Buter J., Gregor T., Wiggenraad R. et al. Intra-arterial versus intravenous chemo-radiation for advanced head and neck cancer: Results of a randomized phase 3. trial//Cancer. - 2010. - 116. - P. 2159-2165. Sakashita T., Homma A., Hatakeyama H. and other authors. Salvage operations for patients with persistent or recurrent cancer of the maxillary sinus after superselective intra-arterial infusion of cisplatin with concurrent radiotherapy//British Journal of oral and maxillofacial surgery. - April 2014. - Volume 52, Issue 4. - P. 323-328.
Chizh G. I. Malignant tumors of the nasal cavity and paranasal sinuses. - Rostov-on-Don: Izdat Growth, 2002. - 89 p. Ferrari V. D., Maroldi R., Ferrari L. et al. Intra arterial locoregional chemotherapy with high dose cisplatin (IHCT) in locally advanced or relapced H&N cancer//Annals of Oncology. Abstracts book of the 33rd ESMO Congress. - Italy, September 2008. - Volume 19, Supplement 8. - viii 223. - 710 p.
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11. Isobe Koichi, Uno Takashi, Hanazawa Toyoyuki, Kawakami Hiroyuki, Yamamoto Seiji, Suzuki Homare et al. Preoperative Chemotherapy and Radiation Therapy for Squamous Cell Carcinoma of the Maxillary Sinus//Japan J. Clinical Oncology. - 2005. -V. 35, № 11. - P. 633-638.
Khojitoev Sanjar Valirakhimovich, Republic Specialized center of phtisiology, Researcher, assistant of faculty urology department, Master's degree E-mail: sanjarkh@gmail.com
Tillyashaykhov Mirzagolib Nigmatovich, Director of National Cancer Research center, D. M., Professor, Urooncology department E-mail: tmirza58@mail.ru
Abdurakhmonov Doniyor Komiljonovich, Republic Specialized center of phtisiology, D. M., head of department of urology E-mail: sanjarkh@gmail.com
Comparison of modified radical cystectomy with traditional in bladder cancer patients with comorbidities
Abstract: The paper analyzed 65 cases of bladder cancer who undergone traditional and extraperitoneal radical cystectomy with ureterocutaneostomy. Patients included the study had a number of complications and comorbidities that limited volume of surgery. Radical cystectomy with extraperitoneal access objectively shorter. Postoperative rehabilitation faster, it decrease the risks associated with surgical interventions in the peritoneal cavity. Keywords: bladder cancer, radical cystectomy, comorbidity.
Introduction
In the structure of cancer pathology bladder cancer (BC) takes the 9th place. The global death rate from bladder cancer in 2008 was 4.4: 100 000 in men and 1.1: 100 000 — women. BC takes third place among urological and 2nd place among oncouro-logical pathology [1; 2; 3].
In Uzbekistan, according to Cancer Registry, in 2014 the incidence of bladder cancer has reached 1.3 : 100 000 and the mortality rate of 0.6 : 100 000.
In the world of 80 % of diagnosed cases of bladder cancer are non-invasive or T1 [1; 3]. In Uzbekistan, according to the Cancer Registry, nearly 70 % of bladder cancers are diagnosed muscular invasive. Thus 41 % of patients with stage III and 13 % identified in stage IV. According to the above-mentioned reports, at least 30 % of patients, from newly diagnosed with bladder cancer, we can perform organ-preserving treatment.
According to the literature, the incidence of postoperative complications after radical cystectomy varies very widely — from 19 % to 64 % [5].
Compared with failure of intestinal and urinary anastomoses, paresis (obstruction) of the intestine more common complication after radical cystectomy, which was observed in 23 % of patients in recent studies [6].
Ureterocutaneostomy (UCS) after radical cystectomy remains the main method of urinary diversion in our region, as in most cases of bladder cancer are diagnosed at later stages T3-T4, and somatic status of patients does not allow performing the operation. Surgical treatment takes many hours, traumatic, requires highly skilled operator and a special post-operative care.
UCS remains in the EAU guidelines and recommended a certain contingent of patients in whom it is impossible to perform a more complex and difficult operation [4; 7].
Materials and methods
We conducted analysis of 65 cases of BC in the male patients T2-4aN0-2M0 stage, treated in the department of urology of Tashkent city oncology dispensary 2010 to 2014.
1 — group of patients undergoing traditional radical cystectomy with bilateral ureterocutaneostomy (30 patients).
II — group of patients who underwent extraperitoneal radical cystectomy with bilateral ureterocutaneostomy (35 patients).
The average age of the patients was in the group I — 63 years, in the group II — 65. All patients included in the study were older than 50 years. In 50-59 in both groups of 8 patients. 60-69: I group —11 patients, II —13; 70-79: I — 10, II —12 group;
I patient in the I and 2 patients in group II were older than 80 years.
In both compared groups patients had invasion depth T2-16 in group I (53.3 %) and in II — 17 (56.6 %) patients, respectively. 9 (30 %) patients in the first and 11 (33.4 %) patients from the second group diagnosed T3 invasion. From I group 5 (16.6 %) and
II group 7 (20 %) patients had signs of germination in prostate and ureterohydronephrosis. In all cases Histological analysis showed transitional cell carcinoma.
13 % of patients in the first and 23 % in the second group had histologically proven metastases in the lymph nodes.
2 patients in group I and 4 in the II diagnosed one side ureterohydronephrosis due to the invasion to the ureter.
Patients included in the study had a number of complications and co-morbidities, which limited the long time traumatic surgery (Tab. 1).
