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Aim. To evaluate the effectiveness of the intrauterine levonorgestrel-releasing device (LNG-IUD) in the treatment of atypical hyperplasia and the use of LNG-IUD in combination with a gonadotropin-releasing hormone analog (3.6 mg goserelin depot) in the treatment of stage Ia highly differentiated endometrial adenocarcinoma in women wishing to preserve childbearing function, and to assess reproductive outcomes after treatment in these women. Materials and methods. A prospective and retrospective series of cases included all patients treated with LNG-IUD or LNG-IUD combined with goserelin 3.2 for atypical hyperplasia or early endometrial cancer (EC) treated in the Department of Innovative Oncology and Gynecology of the Institute of Oncogynecology and Mammology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology from January 2018 to March 2022. Response rates and the relationship of the response with clinical and pathological factors were calculated. Results. Fifty-six patients diagnosed with atypical hyperplasia or stage Ia highly differentiated endometrial adenocarcinoma were treated with LNG-IUD and LNG-IUD combined with 3.2 mg of goserelin. Of the 56 patients who completed a 6-month course of hormonal treatment, 42 (82%) showed a complete response: 22 (91.7%) with atypical endometrial hyperplasia (AEH) and 20 (74.1%) with EC. In 4 (7.8%) patients, a partial response was reported: 2 (8.3%) with AEH and 2 (7.4%) with EC. No response was noted in 5 (9.8%) patients in the EC group only. Childbirth was reported in 13 (23.2%) women: 8 (29.6%) with AEH and 5 (17.2%) with EC. Two (3.6%) women were in the second trimester of pregnancy, and 17 (30.4%) women had an early pregnancy loss; 7 (25.9%) of them had AEH, and 10 (34.5%) had EC. The positive response rate was 90.2% at 6 months: 24 (100%) patients with atypical hyperplasia and 22 (81.5%) with EC. Patients with EC in combination with polycystic ovary syndrome and obesity and patients with the non-obese EC phenotype had a lower therapy efficacy. Conclusion. LNG-IUD therapy for the conservative treatment of atypical hyperplasia and LNG-IUD therapy combined with goserelin 3.2 for early EC led to a morphological cure in most patients and can be considered for women planning pregnancy.

Introduction. Astrocytoma is the most commonly diagnosed type of glioma in children. Children’s astrocytomas can occur in different areas of the brain, but the most common localization for pilocytic astrocytomas is the cerebellum. The aim of our study was to evaluate the results of surgical treatment of children with pilocytic astrocytomas treated at our center. Materials and methods. The study included the results of treatment of 71 patients with a verified diagnosis of “Pilocytic astrocytoma” (PA) who received surgical treatment on the basis of JSC “National Center for Neurosurgery” from 2015 to 2020. Results. The average age of the children was 8.39 ± 4.08 years. In 64 patients, the first symptom presented was hypertensive-hydrocephalus syndrome, of which 46 (71.87%) patients underwent ventriculo-peritoneal shunting surgery. According to neuroimaging data and intraoperative picture, 45.07% of all tumors were located in the hemisphere of the cerebellum, and 35.21% in the cerebellar vermis, 15.49% of patients had the location of the PA in the cerebellopontine angle, and 3 in the brainstem. All 71 patients underwent surgical treatment in the volume of tumor resection. Total tumor resection was achieved in 73.23% of cases. The mortality rate within five years after diagnosis was 9.85%. In the group of patients who underwent subtotal resection and partial resection, mortality was 31.57%. Whereas in children who had achieved total tumor resection, mortality was 1.92% of cases within 5 years. Conclusion. Total PA resection of the posterior cranial fossa is associated with the least number of recurrence and lower mortality, which is why it can be called the “gold standard” in the treatment of PA. At the same time, partial PA resection is a predictor of tumor progression/recurrence. Close adherence of critical structures in the posterior cranial fossa makes it difficult and sometimes total resection is impossible, due to the high risks of severe complications. In view of this, the principle of “maximum safe resection” does not lose its relevance. In cases of partial resection, adjuvant therapy is recommended, which contributes to a more favorable outcome in these patients. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate prostate specifc antigen density (PSAD) as a predictor of overall (OS) and cancerspecifc survival (CSS) in patients with prostate cancer (PC) who have undergone combined hormonal-radiation therapy.Material and Methods. In order to assess the prognostic signifcance of PSAD we retrospectively analyzed outcomes of 714 PCa patients who received combined hormonal-radiation therapy at the A.M. Granov Russian Scientifc Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russia, between January 1996 and December 2016. Since the prognosis and management differ according to the extent of tumor involvement, patients were categorized into localized (n=272), locally advanced (n=231) and metastatic (n=211) PC groups. We equentially applied ROC-analysis, Kaplan-Meier product limit estimator and Cox proportional hazards model to assess the prognostic relevance and establish threshold values of PSAD that had a signifcant impact on survival rates.Results. In the localized PC group, PSAD threshold values of 0.34 ng/mL/cc and 0.36 ng/mL/cc were associated with a decrease in OS and CSS, respectively. Patients with “low” PSAD had signifcantly better OS and CSS survival rates in both uni- and multivariate analyses. In locally advanced PC group, PSAD threshold values were 0.28 ng/mL/cc and 0.63 ng/mL/cc for OS and CSS, respectively. However, exceeding the specifed values, in the locally advanced PC group, was not accompanied by a statistically signifcant decrease in survival rates. Finally, in the metastatic PC group, established PSAD threshold values were 2.25 ng/mL/cc and 2.30 ng/mL/ccfor OS and CSS, respectively. According to the results of univariate analysis, patients with “low” PSA tend to demonstrate statistically signifcant better OS and CSS rates. The results of multivariate analysis, however, failed to prove PSAD as an independent prognostic factor within the metastatic PC cohort. Conclusion. PSA density is a reliable tool for assessing survival rates in patients with localized PC who have undergone combined hormonal-radiation therapy.

Introduction. Nutritional support is an important component of multimodal cancer therapy. It is well known that proper nutrition supplemented by necessary nutrients can support muscles and their function, reduce the incidence and severity of complications associated with cancer therapy, and facilitate recovery. Proper nutritional support is planned according to patient’s need for energy (30 kcal / kg body weight per day), protein (1.5 g protein / kg body weight per day), and eicosapentaenoic acid (2 g per day).Materials and methods. We analyzed the dynamics of nutritional status of 632 cancer patients treated in P.A. Herzen Moscow Oncology Research Institute – a branch of the National Medical Radiology Research Center, Ministry of Health of Russia between 2019 and 2021. Study participants were divided into two groups: experimental (n = 316) and control (n = 316). Patients in the experimental group received proper nutritional support. This study included patients with confirmed gastrointestinal cancers (esophageal and gastric), colon cancer, head and neck cancer, and lung cancer.Results. Nutritional therapy in the process of drug antitumor treatment has improved the trophological status of patients with tumors of the head and neck, lungs, upper gastrointestinal tract. As a result of the work, there was a tendency to increase the body weight of patients in these subgroups, whereas in the control group there was a statistically significant decrease in body weight compared to the initial indicators by 9.4; 9.5; 5.3 and 9.6 kg, respectively. Also, full clinical nutrition contributed to an increase in the level of total protein in patients with cancer of the upper gastrointestinal tract and colon and rectum by 4.0 and 3.7 g/l, respectively, at the level of statistical trend. The level of albumin significantly increased (by 6.6 g/l) only in patients with lung cancer.Improved nutritional status of patients during their systemic therapy ensured a 6 % reduction in the frequency of intercycle periods, a 0.2–3.4 % reduction in the need for dosage correction, and a 2.9–11.1 % increase in the completeness of cancer therapy stages (trend).Conclusion. Our findings suggest that additional specialized (oral or enteral) nutritional support during chemotherapy stabilizes body weight and its index, resulting, first of all, in improved tolerability of treatment.

Introduction. The number of patients with chronic kidney disease has been steadily increasing throughout the world, which makes this pathology a pressing problem. The purpose. The analysis of heterotopic kidney transplantation results. Material and methods. The authors analyzed the experience of the clinical work arrangement, the results of operations, assessed the complication rate and the quality of life in 133 patients after heterotopic cadaveric kidney transplantation performed in the Grodno regional clinical hospital in the period from 2013 to mid August of 2018. Results. In the early postoperative period, complications occurred in 22 (13.5 %) patients, the postoperative mortality was 1.8% (3 patients). In the late postoperative period, the kidney explantation was performed in 4 (2.45%) patients, 6 patients died (3.7%) as a result of progressing comorbidities and complications (average at 15.6±9.8 months after transplantation). A 5-year predicted patient survival after heterotopic kidney transplantation calculated by using the Kaplan-Meier' method was 94.5%. Conclusions. Kidney transplantation in the Grodno Region, the results of operations, graft survival, quality of life and patient survival are comparable to international standards. A careful selection, examination, and preparation of patients for transplantation have a great effect on treatment outcomes.

Results of surgical treatment of 30 patients with combat-related gunshot traumatic brain injuries (GTBI) combined with paranasal sinuses injury (PNS) were analyzed. The injuries resulted from local armed conflict in the Eastern Ukraine. Object and methods. The patients were consistently enrolled in the prospective study in the period from May 25, 2014 to December 31, 2017. This group of patients made up 16.3% of all GTBI patients treated during that period. All patients underwent high-resolution cranial CT at admission. Frontal sinus injuries were observed in 25 (83%) cases; ethmoid bone injuries, in 13 (43) cases; sphenoidal sinus injuries, in 1 (3%) case. 26 (87%) patients had penetrating wounds; 4 (13%) patients, non-penetrating cerebral wounds. Fragment mine blast wounds were observed in 26 (87%) cases; 4 (13.3%) wounds were caused by bullets. Blunt wounds were diagnosed in 17 (57%) patients; bound shot wounds, in 7 (23%) patients; penetrating wounds, in 6 (20%) patients. GCS score after initial resuscitation ranged from 5 to 15 (average 10.6±3.5). Four non-penetrating brain wound patients were treated conservatively. Initially, 26 (87%) patients underwent surgery. Emergency intervention was performed to remove intracranial hematoma, close dura mater defects and restore skull base while simultaneously sealing ethmoid and frontal air sinuses. Well-vascularized frontal and lateral pericranial flaps on pedicle in various modifications were used to close frontal sinus and anterior cranial fossa defects. Outcomes. Nasal liquorrhea was observed in 12 (40%) patients at admission and in 2 (7%) patients after treatment. Purulent and septic complications were only detected in 1 (3%) patient. The complications had the form of combined meningoencephalitis, ventriculitis, and subdural empyema. Favourable treatment outcomes (good recovery or moderate disability) in 6 months after treatment were detected in 24 (80%) patients; unfavourable outcomes (severe disability or death), in 6 (20%) patients. Vegetative state was not observed in treated patients. Two lethal cases were not associated with paranasal sinus injury. In one case, there was a severe primary brain injury; in the other case, severe combined internal organ injuries with multiple organ failure.

The objective of the study: to compare the effectiveness of tuberculosis chemotherapy and treatment outcomes in the pregnant patients versus those nonpregnant.Subjects and methods. Medical records of 218 HIV negative women ill with tuberculosis were analyzed: TB + Pregnancy Group included 109 pregnant tuberculosis patients; and TB Group included 109 nonpregnant female tuberculosis patients. The patients from TB Group were enrolled in order to match patients from TB + Pregnancy Group regarding the age, social status, specific features of the disease, lung tissue destruction, bacillary excretion, and drug resistance profile.During treatment of tuberculosis, 72.5% (n = 79) of patients from the main group got pregnant. Pregnancy resulted in delivery in 67.0% (n = 73) of women, and in 23.0% (n = 25) of women, it was electively terminated before the 12th week of pregnancy.First line drugs were prescribed to 55.0 and 42.2% of patients from Groups 1 and 2 (pχ2 > 0.05); combinations of first line and reserve drugs (due to resistance to isoniazid) were used in 22.0 and 37.6% (pχ2 > 0.05) respectively; and reserve drugs (due to MDR/XDR TB) were used in 22.9 and 23.9% (pχ2 > 0,05) of patients. The main course of tuberculosis treatment lasted for 11.6 ± 4.7 months in the pregnant patients and 14.3 ± 3.8 months in those nonpregnant. And pregnant patients had one forth part of their chemotherapy coinciding with their pregnancy.Results: Only pregnant patients developed hepatotoxic reactions to anti-tuberculosis drugs. In HIV negative patients, treatment effectiveness was compatible in the pregnant and nonpregnant patients (58.7 ± 4.7 and 61.5 ± 4.7%, pχ2 > 0.05). Mortality due to progression of tuberculosis in the pregnant did not exceed the mortality in the nonpregnant ones (5.5 ± 2.2 and 7.4 ± 2.1%, pχ2 > 0.05). The frequency of relapses was the same in the pregnant women receiving anti-tuberculosis therapy and those nonpregnant (3.1 and 4.4%, pχ2 > 0.05).

The objective of the study: to characterize patients who developed tuberculosis in Chisinau in 2015.Subjects and methods. The retrospective descriptive study was conducted aimed to analyze data of 668 tuberculosis patients diagnosed in Chisinau in 2015.Results. The social characteristics demonstrated that in 2015 in Chisinau a tuberculosis patient was most often a young man belonging to socially marginalized population with no medical insurance. The analysis of tuberculosis detection methods showed that only 22.3% of patients were detected through regular screening in risk groups. Among tuberculosis patients, new cases made 60.3%, relapses – 21.7%, those after treatment interruption – 10.3%, and those after treatment failure – 5.7%. In 14 (2.0%) patients, tuberculosis was detected post-mortem.Out of 674 patients with life time diagnosed tuberculosis, pulmonary tuberculosis prevailed – 638 (94.7%), of them, 193 (30.3%) had a positive result of sputum microscopy for acid-fast bacilli, and 187 (29.3%) patients had a positive result of sputum culture by Lowenstein-Jensen or Bactec 960, and the result of Xpert MTB/Rif was positive in 259 (40.6%) patients. Multiple drug resistance was diagnosed in 118/187 (63.1%) patients.In 12 months, treatment outcomes were assessed in 647 patients: treatment was successful in 393 (60.7%) patients; 80 (12.4%) patients died, and 174 (26.9%) were still on treatment.

In 2015 the implementation of Edicts no. 951 by the Russian Ministry of Health On Guidelines on Improvement of Respiratory Tuberculosis Treatment and Diagnostics was started.Goal of the study: to analyze the characteristics of tuberculosis patients referred to treatment to Novosibirsk Tuberculosis Research Institute (NTRI) in 2014-2016 from the areas supervised by the Institute; to evaluate the clinical assessment of comprehensive chemotherapy efficiency after the introduction of the updated treatment regimens and express methods of microbiological diagnostics.Materials and methods: a prospective cohort study was conducted using the data of 481 patients referred for treatment to NTRI from the areas supervised by it, i.e. Siberian and Far Eastern Federal Districts.Results. Among the patients referred for treatment to NTRI in 2014-2016, new tuberculosis cases with multiple/extensive drug resistance (64.3-80.5%) and pulmonary destructions (67.9-82.7%) were very frequent. Among the patients already receiving treatment and referred to NTRI, the part of those with progressing course of the disease reduced from 35.0% in 2014 down to 9.7% in 2016 as well as the part of those with concurrent bronchial tuberculosis reduced from 41.3% in 2014 down to 27.9% in 2016.After introduction of the provisions of the Edict to NTRI, treatment efficiency of new patients improved assessed as per the cessation of bacillary excretion (by sputum smear microscopy: in 2016 – 91.7%, in 2014 – 75%; by culture: in 2016 – 90.9%, in 2014 г. – 77.3%).

Goal of the study: to study specific features of detection, diagnostics, clinical, morphological manifestations and treatment efficiency of tuberculous exudative pleurisy in those with alcohol addiction.Materials and methods. 62 medical cases of those suffering from exudative tuberculous pleurisy were retrospectively studied, in whom alcohol addiction was diagnosed basing on the patient's history and examination by the substance abuse doctor. Tuberculous pleurisy was verified in 80.65% of cases. Results: Alcohol addiction was diagnosed in 15% of those suffering from tuberculous pleurisy. Among patients with alcohol addiction 47% were 30 years old and older, and they were single, 11% lived alone, 76% were the unemployed but within employable age, 27% had previous convictions, and 10% were homeless. More than 27% of patients had not have fluorography screening for 2 years and more. In 53% of cases pleurisy was combined with concurrent pulmonary lesions and in 27% of cases respiratory lesions were bilateral. Destruction of lung tissue was observed in 42% of cases, and in 35.5% tuberculosis mycobacteria were found in sputum. Caseous necrosis was found in 7.5% of cases, epithelioid giant-cell granulomas were found in 64% of cases, and caseous necrosis in granulemas was found in 44% of cases when examining the needle biopsy specimens. Poor treatment adherence and low treatment efficiency had been observed among those patients.

It has been hypothesized and investigated that seasonal factors provide impact on the treatment interruptions. Treatment outcomes of 19 923 new pulmonary tuberculosis cases with the positive result of sputum tests have been studied. Patients registered for treatment during the cold seasons (Quarters I, IV) interrupt treatment, including interruption of the intensive phase, rarer compared to the warm seasons (Quarters II, III). The least relative risk of treatment interruption is observed in the patients registered during Quarter IV compared to the other Quarters. Also chemotherapy was interrupted more often and patients migrated less when registered in Quarter III compared to the patients registered in Quarter II. The observed consistent pattern should be taken into account when planning measures aimed to increase patients' motivation for treatment adherence.

The paper presents an analysis of rectal cancer incidence in the Republic of Belarus over the 30-year time period, assessing earliness of the diagnosis and treatment outcomes. From 1980 through 2010, rectal cancer incidence in Belarus increased 2.4-fold (from 8.9 to 21.0 per 100 000 population). The proportion of rectal cancer patients undergoing radical surgery grew from 32.4 % in 1985 to 57.2 % in 2010. One-year mortality rates decreased and were 37.6 % in 1994 and 27.2 % in 2010. The share of rectal cancer patients followed up for 5 years and more after establishing the diagnosis was 34.5 % in 1990 and 51.7 % in 2010.

Objective. The purpose of the study is to analyze the errors, complications and outcomes of the operative treatment of patients with femoral neck fracture in the 1st group with application of wires bundle and fixation in the llizarov frame (64 cases) and in the 2nd group with application of developed monolateral wire- and half-pin device (23 cases). Material and Methods. The observation of 87 patients with fractures of the femoral neck. Operations performed using spokes kit for transosseous osteosynthesis by GA llizarov and develop devices for the treatment of patients with fractures of the proximal femur. Two groups of patients were studied: duration of surgery, duration of osteosynthesis, complications, and outcomes (in terms of one year after the dismantling clips) using the modified scale Luboshyce — Mattis — Schwartzberg. Results. Fracture repair was achieved in 40 patients (62,5%) of the 1st group. The following complications were observed in this group: non-union and pseudarthrosis — in 21 (32,8%) case; aseptic necrosis of the femoral head in 3 (4,7%) cases; hip ankyloses — in one (1,6%) case, breakage and migration of wires into the joint cavity and smaller pelvis — 3 (4,7%) patients and cutting out of wires from the femoral head was observed in 3 (4,7%) cases. Totally 61 complication were revealed. In the second group of the patients non-union was found in one patient (64 years old). Complications were observed in 6 patients of this group — pint-tract infection, moderate secondary displacement of the fragments (the patient fell down on the operated limb) and wire breakage. Conclusion. The efficiency of the femoral neck osteosynthesis with application of elaborated monolateral wire- and half-pin fixator made up 95,7% of the positive outcomes (in osteosynthesis using bunch of wires with llizarov frame fixation the same 60,9% of the positive outcomes).

Objective: To analyse safety and expediency of cardiac surgical technologies including cardiopulmonary bypass (CPB) in patients with locally advanced lung cancer and invasive tumors of the mediastinum., Material and Methods: Cardiac surgical techniques and CPB were used in 23 patients (group 1) with locally advanced thoracic tumors between 2005 and 2015. For the same period, there were 22 patients (group 2) who underwent combined surgeries and could have had similar techniques. However, these techniques were not used for various reasons. Mediastinal malignancies and non-small cell lung cancer were diagnosed in 26 (57.8%) and 19 (42.2%) patients, respectively. Invasion of superior vena cava ( n =15), aorta ( n =13) and pulmonary artery ( n =12) was the most common. Lesion of innominate vein ( n =8), left atrium ( n =6) and innominate artery ( n =4) was less common. A total of 21 pneumonectomies were performed (14 in the first group and 7 in the second group). Lobectomy was less common (one patient in each group). Sublobar lung resection was performed in 10 patients (2 patients in the first group and 8 ones in the second group). All resections were total in the first group (R0) that was confirmed by routine morphological examination of resection margins of different organs and vessels. The situation was worse in the second group (R1 in 19 (86.4%) patients, R2 in 3 (13.6%) patients)., Results: Total postoperative morbidity was 53.3%, mortality - 8.2%. These values are higher compared to patients undergoing surgical treatment for thoracic malignancies. Incidence of postoperative complications was higher in the first group (16 (69.6%) and 8 (36.4%), respectively). Four patients died in the first group. Sepsis ( n =2), acute right ventricular failure ( n =1) and acute myocardial infarction ( n =1) caused death. There were no lethal outcomes in the second group. Various postoperative complications were diagnosed only in 8 (36.4%) patients. The long-term results were followed-up in 80% of patients. In the first group, 3- and 5-year survival rates were 30.5% and 25%, respectively (median 43.8 months). In the second group, these values were 25% and 2%, respectively (median 24.9 months). Long-term mortality in the second group was caused by progression of malignant process, including local recurrence, after palliative surgery (R1, R2 resection)., Conclusion: Higher risk of postoperative complications and mortality in patients undergoing on-pump surgery is compensated by significantly better long-term results. Further progress is associated with higher safety of CPB, as well as solving some organizational and educational problems.

Focal cortical dysplasias are known to be the most frequent and furtive lesions leading to intractable epilepsy in children. Epilepsy surgery in central gyri, been effective in 60-70% of cases, is still significantly challenging due to the high risk of postoperative permanent neurological impairment., Study Aims: Assessment of the outcome after epilepsy surgery in children with FCD in central lobules., Material and Methods: Nine patients, median age 3.7 ys, IQR=5.7 ys (min 1.8- max 15.7 ys) with FCD in central gyri and DR-epilepsy underwent surgery. Standard preoperative evaluation included MRI and video-EEG. Invasive recordings were used in 2 cases, coupled by fMRI in 2. An ECOG and neuronavigation, as well as stimulation and mapping of primary motor cortex were used routinely during the procedure. Gross total resection was achieved in 7 patients according to postoperative MRI., Results and Conclusions: Six patients with new or worsening of already existing hemiparesis recovered within a year after surgery. At the last FU (med 5 ys) favorable outcome (Engel class IA) has been achieved in 6 cases (66.7%), while two patients with persisting seizures reported seizing less frequently (Engel II-III). Three patients were able to discontinue AED-treatment and four children resumed development with improvement in cognition and behavior.