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The main objective of this review is to present various types of treatment which are available for patients with bladder cancer. Some treatments are standard and some are being tested in clinical trials. Nowadays we have a lot of new treatment approaches and can use them for bladder cancer treatment. For superficial bladder cancer the main treatment method is operation. Adjuvant chemotherapy is indicated only for high-risk patients and the tumor recurrence rate is decreased to about 20%. Surgery and radiotherapy is used for muscle-invasive bladder cancer. There are no clear indications for neoadjuvant treatment administration. Radiotherapy and chemotherapy are suitable after no radical operation. Administration of palliative chemotherapy for metastatic disease might improve survival. We have to use different methods of treatment (operation, chemotherapy, radiotherapy, biology therapy) as multimodality treatment option for bladder cancer.

Cervical cancer is one of the most common cancers in women. The purpose of this article is to analyze the main diagnostic and treatment strategies for all stages and recurrences of cervical cancer. The article reviews the epidemiological situation, clinical features, diagnostic procedures for detection of this tumor and for evaluation of the dissemination of the disease, staging criteria, TNM (Tumor, Nodes, Metastases) and FIGO (Federation Internationale de Gynecologie et d'Obstetrique) classification, as well as treatment and prognosis. Surgical treatment (radical type II or III hysterectomy and lymphonodectomy) for early stage I and IIA cervical cancer is the main treatment method. Delivery of adjuvant postoperative radiation therapy or concomitant chemoradiation depends on the prognostic factors (tumor penetration to cervical tissues, lymphovascular invasion, tumor invasion to paracervical tissues, and surgical margins). For treatment of more advanced stages of cervical cancer (IIB, IIIA, IIIB, IVA) concomitant chemoradiation: external beam radiotherapy with chemotherapy and brachytherapy is used. Description of the treatment guidelines for each stage of cervical cancer is given in this article. These guidelines are useful for good treatment practice.

Primary cytoreductive surgery remains the standard care in advanced ovarian cancer. Optimal cytoreductive surgery is defined as a residual tumor load less than 1 cm. after operation. The randomized clinical trials showed that interval debulking surgery improved survival in patients who did not undergo optimal primary debulking surgery. The retrospective trials have suggested that the outcome for patients treated with neoadjuvant chemotherapy followed by interval debulking surgery is the same as for patients treated with primary debulking surgery followed by adjuvant chemotherapy. The neoadjuvant chemotherapy should not to be used for clinical practice until the randomized clinical trial carried out by Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer and National Cancer Institute of Canada answers this question. There are no data from randomized trials to show the survival advantage in patients who received second-look operation as compared to those who did not.

In the world five-year overall survival of patients with pancreatic cancer is low, i.e. about 5-6%. Patients without treatment live few months. Patients with pancreatic cancer are treated with combined treatment modalities. Chemotherapy is one of the three treatment methods. In the article we review chemotherapeutic agents that are used in everyday practice like fluorouracil and it's use in combination with other chemotherapeutic agents, and also, new drugs like gemcitabine, taxanes, capecitabine and other. Effectivity of the treatment with these agents, results of survival, toxicity and particularities of intraarterial chemotherapy are discussed. New perspectives in the treatment of patients with pancreatic cancer and methods of new chemotherapeutic strategies are analyzed.

Horseshoe kidney is a challenge for vascular surgeon performing abdominal aortic aneurysm repair. First case of successful surgical treatment and positive remote result is described in Lithuanian medical press. Literature review of world surgical treatment experience is given. Operative technique depends upon anomalous kidney vascularization. Three types of vascularization are described. Rational operative approach and necessity of isthmotomy are discussed, investigation methods and treatment algorithm is presented.

This study presents the results of analysis of 134 lung cancer patients treated with radiotherapy in 1999-2002. The objective of the paper was to evaluate the importance of some prognostic factors on survival of lung cancer patients. We have analyzed influence of patient's age, stage of the disease, tumor size, lymphnodes status, histological type and radiotherapy dose to the survival of lung cancer patients. Among analyzed patients 87% were males and 73.9% were more than 60 years old. Locally advanced lung cancer was diagnosed in 65.6% of cases. The non-small cell lung cancer was diagnosed in 83.8% of cases. During the study period 58.2% of patients died. Statistically significant prognostic factors in our study were: stage, locally advanced lung cancer, involvement of the lymphnodes, III B and IV of the disease. The survival of the patients depends on the radiotherapy dose in our study. The better survival was associated with the bigger than 50 Gy dose (p0.001).

The aim of this study was to analyze survival dependence on 3-D conformal radiotherapy dose applied to non-small cell lung cancer patients treated in Kaunas University of Medicine Hospital from year 1999 to 2001. One hundred fifteen patients with median age 67.3 years were analyzed. There were 101 men and 14 women. Squamous cell carcinoma was the most common type of histology (80.86% patients). Most patients (61.7%) had locally advanced lung cancer (stage III). Radiotherapy doses applied ranged from 30 Gy (3.0 Gy/10 fractions) to 70 Gy (2.0 Gy/35 fractions). After analysis of radiotherapy dose influence on survival statistically significant improvement in median survival with higher doses was found (p=0.0001 Breslow). The group of patients irradiated with higher than 50 Gy dose demonstrated better survival than patients treated with smaller doses. (Log rank p=0.0061, Breslow p=0.0013). There was a correlation between dose and conformity of dose distribution.

Animal models are widely used in preclinical studies in order to explain the mechanisms of action of chemotherapy, radiotherapy and concomitant chemoradiation, to analyze pathophysiology of tumors and to evaluate the treatment of choice for malignant tumors. The choice of murine tumor or human tumor xenograft system is still debated. Xenografted human tumors have two main advantages: their human origin and wanted pathological type, which is necessary for future clinical studies. There are a lot of disadvantages of xenografted tumors: the stroma and vascular network of transplanted tumors have murine origin, the graft is mostly ectopic, the volume of transplanted tumors at the time of chemoradiotherapy is much smaller than that of the tumor in man; due to residual immunity it is difficult to determine response to cytotoxic treatment. It is still impossible to extrapolate the results obtained in a tumor model in animal to man. These investigations are usefull for interpretation of clinical results and for proposing the less empirical method of chemoradiation for phase II clinical trials.

Patients with coronary artery disease associated with peripheral vascular disease often raise problems of operative strategy. Particularly the sequence of procedures in which lesions must be treated is a frequent source of controversy. The aim of this study was to research surgical strategy, early and late clinical outcomes for patients undergoing one-stage coronary and abdominal aortic or magistral artery surgical interventions.From 1999 through 2002 twenty eight patients underwent combined major vascular reconstruction with coronary artery bypass grafting.In group with abdominal aortic aneurysm 2 patients died. One patient died from intraoperative acute abdominal aortic aneurysm and bifemoral artery thrombosis with continuous bleeding from the vascular prosthesis in association with disseminated intravascular coagulation. Another patient died from bleeding from the sudden multiple gastroduodenal ulcers on post-operative day eight. In groups with peripheral vascular occlusive disease and carotid artery disease there were no deaths.The data show that combined coronary artery bypass grafting and vascular operations are feasible on patients with concomitant carotid artery or peripheral vascular occlusive disease. Management of CAD associated with abdominal aortic aneurysm remains controversial.

Concomitant radio-chemotherapy is widely used in the treatment of various localisations of cancer. Numerous interactions are known between ionizing radiation and cytotoxic agents, which in vitro may modify the dose-response relationships. The main interactions are spatial cooperation, independent cell kill, cell synchronization, inhibition of repair of radiation damage, reoxygenation, reduction of the hypoxic fraction and increased apoptosis. Exposure of irradiated cells to cytotoxic agent lead to increase the number of unrepaired double-strand breaks. By this mechanism the action of DNA repair of both therapeutic modalities enhance therapeutic efficiency. The main effects of chemoradiotherapeutic combination in the laboratory are inhibition or antagonism, sub-additive, additive and supra-additive effects. The most important for clinical practice are supra-additive effects, when the cytotoxic effect of the combination is greater than the sum of the effects of radiotherapy alone and that of chemotherapy alone. It is however difficult to extrapolate laboratory and experimental results to clinical practice because the conditions for interaction of chemo- and radiotherapy in vitro are different. Clinical conditions usually are more compatible for additive and sub-additive interactions. The main role of laboratory and experimental investigations is to propose new drug--radiotherapy combination to phase II trials.

Patients with coronary disease associated with abdominal aortic aneurysm or aortoiliac occlusive disease often raise problems of operative strategy. In particular, the order in which these lesions should be treated is a frequent source of controversy. Our approach for the past two years has been a combined myocardial revascularization with abdominal aortic reconstruction in patients with both lesions. From 1999 through 2001 seven patients underwent combined abdominal aortic reconstruction with coronary artery bypass grafting. We report here the fatal case of combined coronary artery bypass grafting and abdominal aortic aneurysm repair. Partial heparinization and operation without extracorporeal circulation caused acute thrombosis of abdominal aortic aneurysm and femoral arteries. Our first experience advocates using total heparinisation and cardiopulmonary bypass for combined cardiac-aortic procedures.