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COMPARATIVE CHARACTERISTICS OF THE METHODS OF CHEMODRUGS ADMINISTRATION IN THE TREATMENT OF PATIENTS WITH LOCALLY-ADVANCED BREAST CANCER
Get PDFThe development of new methods of treating patients with breast cancer (BC) causes no doubts at anyone at present moment. The statistical data testify to steady growth of BC sickness rate during recent 20 years without tendency to stabilization The special attention is paid to the development of new methods of treating BC patients (regional forms of disease) with unfavorable factors for forecast of tumor growth. The presented methods of treatment of patients with locally-advanced breast cancer consist in giving complex treatment using two simultaneous ways of administration of chemodrugs - selective intra-arterial and endolymphatic in combination with a systemic one. The results obtained demonstrated greater efficacy of treatment with combinations of selective intra-arterial chemotherapy with a systemic one compared with endolymphatic chemotherapy in combination with the systemic one for the treatment of this disease.
Materials and methods. The present study was based on the data of 285 patients with locally-advanced forms of breast cancer HER/2-neu positive and basal-like biological subtypes, with the stages T4N0-2M0, the treatment was given in Donetsk regional antitumor center and Odessa University Clinic in 2000-2014.
During the research for an adequate analysis of the results of treatment by the technique under consideration there were formed two groups of patients. The first investigated group included 221 patients, in 168 patients were diagnosed HER/2-neu positive tumors in immunohistochemical conclusion and 53 patients had basal-like biological subtype of the tumor. The program of the comprehensive treatment of patients in this group included the internal thoracic artery catheterization through the upper epigastric artery, two or three cycles of SIAPCT in combination with intravenous one with an interval of 21 days, evaluation of the effect of radiation therapy (RT) on the breast and zone of the regional lymph outflow in the static mode SFD- 2-2.5 Gy, CFD- 40 Gy, the interval, estimation of the effect. Mastectomy in the patients of the investigated group was performed only when there was a complete or partial tumor response (136 surgeries in a radical scope). Courses of intraarterial PCT were given in continuous long-term infusion (4 hours) by the scheme CMF, CAF or CAMF. Taking into account the possibility of local complications against the background of administration of some chemotherapeutic agents (most often - doxorubicin), half of the drug dose was administered intravenously.
The total course doses of chemodrugs were calculated according to BSA criteria.
The control group included 64 patients, 45 were identified to have HER/2-neu positive and 19 basal-like subtypes of breast cancer.
The program of comprehensive treatment of the patients of this group includes endolymphatic chemotherapy according to the method developed by Donetsk regional antitumor center. As the main method of administration of chemodrugs in the lymphatic system there was used infusion introduction with the help of the system for intravenous drip, infusion rate was 0.3-0.5 ml/min that allowed us to exclude the possibility of extravasation of the chemodrug solution. The course dose of the drug was administered endolymphatically within 5-7 days. At the interval of 21 days two or three courses of ELPHT were given combined with the intravenous administration of anthracyclines (at the end of each cycle the catheter was removed, the catheterization was performed repeatedly). Then the effectiveness of the treatment by the criteria of RECIST was evaluated. Radiation therapy (RT) to the breast and area of the regional lymph outflow was given in a static mode SFD- 2-2.5 Gy, CFD- 40 Gy followed by evaluation of the effect. Mastectomy in the patients of the control group was performed only at the complete or partial tumor response (36 operations in a radical scope). Courses of endolymphatic PCT were given by the continuous long-term infusion (up to 8 hours) scheme of CMF, CAF or CAMF. Taking into account the possibility of local complications against the background of introduction of some chemotherapeutic agents, intercalator doxorubicin was administered intravenously, and antimetabolites and alkylating agents (methotrexate, 5-fluorouracil and cyclophosphamide) in all schemes were introduced endolymphatically.
Results. The average life expectancy of patients of the investigated group was 3.43 ± 0.18 years, while in the control group it was 2.82 ± 0.3 that significantly exceeded the statistical data of domestic and foreign authors. Indices of total 3-year survival rate of patients of the investigated group were 59.9 ±4.5% and 5-year- - 43.1 ±5.5 months.
In the control group indices of cumulative 3- and 5-year survival rates were significantly lower - 37.8% ± 6.6 and 25.2 ± 7.0%months respectively.
Conclusions.
1. The results of complex treatment of locally-advanced breast cancer with unfavorable prognostic factors of tumor growth by the developed technique by using a combination of selective intra-arterial injection and intravenous chemotherapy in a pool of the internal thoracic artery in combination with radiation and hormonal therapy exceed the results of standard treatment programs for the patients with locally-advanced breast cancer with performing mastectomy and systemic chemotherapy.
2. The method developed by the authors can be recommended for widespread use in these patients
THE FEATURES OF ACUTE BRUCELLOSIS IN AZERBAIJAN REPUBLIC
Get PDFIt is well known, that the injury of organs and systems and also immunological rates considerably determine clinical course and the result of brucellosis. In the article are presented the results of examination of 120 patients with acute brucellosis. The control group included 30 practically healthy persons. Groups were representative by the age and sex. The diagnosis of brucellosis was set on the base of complaints, anamnesis, epidemiological and clinical data and the results of serological examination of the blood. All patients also underwent the fixation of interleukin -6, іinterleukin-4 and TLR-2 in the blood serum. The detailed epidemiological, clinical and immunological characteristic of patients with brucellosis was presented. Among examined persons prevailed men, persons of young able-bodied persons and rural dwellers. It was revealed, that the dominating way of transmission was the contact one. The highest level of infection was fixed among the workers of farm enterprises and veterinarians. The season features were also revealed, the highest level of morbidity was in summer-autumn period. The main clinical features were: fever, arthralgia, risen disposition to perspire, hepatosplenomegaly. It was revealed, that the level of pro-inflammatory interleukins considerably prevailed over the level of anti-inflammatory ones. Despite the high sensitivity of PCR diagnostics, the positive results in our research were received only in one third of patients
THE ROLE OF COMPLEX OF PROPHYLACTIC ARRANGEMENTS WITH THE USE OF REMINERALIZING PREPARATION AS TO ENAMEL RESISTANCE IN CHILDREN WITH DISORDERS OF TEETH FORMATION
Get PDFAim of research: To increase the resistance of teeth enamel in children with disorders of their formation by introduction of the complex of prophylactic arrangements using remineralizing preparation.
Materials and methods. The object of research is the zones of injured enamel (on the background of hypoplasia) of permanent teeth. The subject is the level of general calcium and orthophosphates in acid biopsy materials of injured teeth enamel. Methods of research: the vital coloration of enamel, transillumination, acid biopsy of enamel, photometric, statistic.
There was carried out the determination of level of calcium and orthophosphates in acid biopsy materials of injured enamel in 45 children, 6–12 years old with enamel hypoplasia. The group № 1 (21 persons) – children who underwent the complex of prophylactic arrangements that included recommendations as to the choice of means and subjects for oral cavity care and teaching the standard method of teeth brushing. The group № 2 (24 persons) – children, who additionally used remineralyzing cream on the water base with casein phosphopeptide – amorphous calcium phosphate (СРР-АСР) (Certificate on the state registration №10014/2010 of 03.12.2010).
Results. In children with chronologic enamel hypoplasia was established the low level of calcium and orthophosphates in acid biopsy materials of injured enamel. Calcium/phosphorus (Са/Р) coefficient in examined groups № 1 and № 2 was 1,26±1,14 and 1,19±0,56, respectively.
The high effectiveness of the offered complex of prophylactic arrangements (teaching the hygienic habits – group №1, additional use of remineralizing cream – group № 2) is proved by the growth of macroelements content in acid biopsy materials of injured enamel in examined children. The holding of prophylactic arrangements in children of the group № 2 using remineralizing cream, favored the more essential growth of level of calcium and orthophosphates in biopsy materials comparing with group of children № 1 (р=0,002 and р=0,03, respectively), and also reliably increased Са/Р coefficient (р=0,0005).
Conclusions. Introduction of complex of prophylactic arrangements using remineralizing preparation in children with disorders of teeth formation favored the rise of enamel resistance as a result of growth of the level of calcium and orthophosphates in its mineral component
CLINICAL FEATURES OF THE COURSE OF CHRONIC EPSTEIN-BARR VIRAL INFECTION DEPENDING ON THE TYPE OF IMMUNE REACTION OF ORGANISM
Get PDFThe results of the study of the main regulatory cytokines levels in patients with chronic forms of EBV-infection (CEBV) are presented the work.
Aim of research. To establish the types of immune reaction for prognostication of the clinical course of disease in patients with chronic forms of EBV-infection on the base of the analysis of multidirectional synthesis dynamics of anti-inflammatory cytokines (IL-1β, TNF-α, IL-6), regulatory IL-2 and anti-inflammatory cytokines (IL-4 and IL-10).
Methods. The research oт the study of the main cytokines levels by IEA method in the disease dynamics included patients with EBV-infection (n=80). The serum concentrations of studied cytokines: IL-lβ, TNF-α, IL-6, IL-2, IL-4, IL-10 were determined using test-systems by LTD “Protein outline” (Saint Petersburg, Russia), using the producer’s instruction, by sIEA.
Statistical analysis of the results of research was carried out using the program Statistika 6.0 for Windows (Stat Soft Inc, USA).
Results. The analysis of cytokine profile dynamics in patients with EBV-infection allowed reveal the multidirectional changes of synthesis of studied anti-inflammatory and proinflammatory cytokines that became a base for establishing of two types of immune reaction: dissociative and hyporeactive. Dissociative type was characterized with the low parameters of anti-inflammatory cytokines and regulatory IL-2 on the background of moderately increased values of anti-inflammatory cytokines, whereas the hyporeactive type was characterized with the low concentrations of all studied parameters.
Conclusions. The received results of researches prove the existence of cytokine imbalance at EBV-infection. The established types of immune reaction testify to the inadequate cellular-humoral reactivity of organism under conditions of EBV prolonged persistency that is manifested by inclination to suppression of cellular-mediated and intensification of humoral mechanisms of immune response and is reflected in clinical-biochemical manifestations of disease that results in prolonged wavy course.
Just the functional imbalance of immunity links to the priority of Тх2 type, which biological effects are directed on the limitation of intensity and prevalence of inflammatory process in different organs, favors the prolongation of viral persistency
THE FEATURES OF ARTERIAL THYMUSATNALBUPHINEACTION
Get PDFThe article presents and analyzes the results of the pilot study, at which opioid nalbuphine was daily administered in white rats-males of reproductive age (1,5–3,5 – month) for six weeks and one week after discontinuation of therapy. The drug “nalbuphine” was injected intraperitoneally daily 1 per day over 42 days. The data were compared with a control group of intact animals. The study was conducted on 52 animals, which were divided into eight groups.Morphometric study was performed using a system of visual analysis of histological preparations. Dynamics of changes in the external and internal diameters of medium caliber arteries thymus, media and lumen area, Vohenvorta ratio was studied.The increase of the external diameter and reduction of the internal diameter of the medium caliber arteries, increase of the area of media, increase of the area of the lumen, increase of the Vohenvortaratio.The blood vessels are dilated, gaps filled elements of the blood vessels around the swelling, the process of vascular sclerosis
THE ADVANTAGES OF DIFFERENTIATED TACTICS OF VIDEOTHORACOSCOPY IN PATIENTS WITH PLEURAL EFFUSION SYNDROME
Get PDFThe standard procedure of videothorascopic intervention has a series of disadvantages, connected with intubation narcosis, that limit the contingent of patients, who can undergo it.
Aim of the work is to raise the efficacy of diagnostic videothoracoscopy at pleural effusion syndrome on the base of its differentiated tactics.
Materials and methods. Differentiated tactics of the choice of method of diagnostic videothoracoscopy in patients with pleural effusion syndrome was introduced in the work of thoracic surgery department. Its essence is in fact that before operation after evacuation of effusion from the pleural cavity there was created an artificial pneumothorax, the state of hemithorax was radiologically assessed. According to the results of radiological examination, the patients, who underwent videothoracoscopy in simplified way, were selected. As opposite to the standard method, at simplified way the intravenous sedation was used instead of endotracheal, muscle rexalants were not used, the additional surgical manipulations were not carried out. For assessment of the efficacy of this tactics 124 cases of diagnostics and treatment of pleural effusion syndrome using videothoracoscopy we analyzed.
Results. In the result of introduction of differentiated tactics of videothorascopic diagnostic in patients with pleural effusion syndrome the number of postanesthetic side effects was reduced by 65,9 %, the frequency of anesthesia by narcotic analgetics – from 2,8 to 1,4 times/day, the term of recovery of independent stool – from 72,0 to 34,3 hours, the term of activation after surgery (independent movement) – from 23,8 to 10,3 hours, the duration of staying in the intensive care department was reduced from 24,8 to 9,7 hours, duration of postsurgical treatment was reduced from 16,0 to 10,1 days.
Results. The main advantages of introduction of differentiated tactics of videothorascopic diagnostics were: the reliable acceleration of activation after surgery, recovery of adequate peristalsis and independent stool, decrease of duration of staying in the intensive care department, decrease of the necessity in anesthesia with narcotic analgetics, reduction of the number of postanesthetic side effects and mean duration of postsurgical treatment. The received result is connected with the fact that two thirds of patients did not undergo the effect of preparations for intubation narcosis
THE INFLUENCE OF LEPTIN ON THE DEVELOPMENT OF IMMUNOLOGICAL DISORDERS IN PATIENTS WITH DIABETES MELLITUS TYPE 2 AND HYPOTHYROIDISM
Get PDFThe work deals with the determination of leptin and IL-6 influence on the development of immune disorders in patients with DM type 2 with hypothyroidism. There were examined 34 patients with diabetes mellitus type 2 and hypothyroidism and 27 patients with the primary hypothyroidism without DM. It was revealed that obesity is characterized with an increase of leptin and IL-6 levels that, in its turn, condition the development of system inflammation of the low intensity and result in the increase of risk of autoimmune changes. In patients with DM type 2 in combination with hypothyroidism on the background of obesity the indices of leptin, IL-6, CD4+, CD8+ and IRI reliably differed from the ones in the group of patients without obesity that testifies to the negative influence of obesity on the development of autoimmune immunological disorders in patients with DM type 2. There were established the correlations between BMI and leptin and IL-6 CD4+, CD8+, ІRI indices in patients with DM type 2 in combination with hypothyroidism
COMPARISON OF THE DYNAMIC CHANGES OF AMINO ACID BLOOD PLASMA SPECTRUM IN PATIENTS WITH THE PRIMARY CEREBRAL ISCHEMIC STROKE DEPENDING ON THE POSTAPOPLECTIC SPASTICITY DEVELOPMENT IN THE RECOVERY PERIOD
Get PDFThe aim of research was to reveal the dynamic changes of the level of excitatory and inhibitory neuroamino acids in patients with the primary cerebral ischemic stroke depending on postapoplectic spasticity presence at the end of the early recovery period.For this aim was studied the concentration of excitatory and inhibitory neuroamino acids in the blood plasma in first 72 hours in 97 patients with the primary ischemic cerebral stroke depending on postapoplectic spasticity on the sixth month after ischemic event. The control group included 15 patients with diagnosed chronic cerebral ischemia.In the result of research we revealed that the common sign for the two groups (with spasticity on the sixth month and without it) was the reliable rise of the level of excitatory amino acids comparing with the control. In patients without spasticity the heightened level of excitatory neurotransmitters in the most acute period of ischemic cerebral stroke was attended with the heightened level of inhibitory neuroamino acids. The distinctive feature of patients with postapoplectic spasticity was the decreased or stable level of transmitters of inhibitory action. During 6th moth after ischemic stroke was detected the rise of all studied neuroamino acids in patients with spasticity unlike to the ones without spasticity who were characterized only with the rise of taurine level and decrease of glycine and aspartate levels.So, the received results allow assume the insufficient activation of the inhibitory neuroamino acids system in the most acute period of the ischemic stroke in certain category of patients that in future are inclined to the spasticity development after stroke
THE MARKERS OF BONE METABOLISM AND SYSTEM INFLAMMATION IN PATIENTS WITH OSTEOARTHRITIS DEPENDING ON BODY MASS, THE INFLUENCE OF SYMPTOMATIC SLOW ACTING DRUGS
Get PDFAim. To assess the levels of markers of the bone synthesis and system inflammation in patients with osteoarthritis (OA) in combination with obesity and their dynamic under the influence of basic treatment.
Materials and methods. The research included 40 women with OA, 46–78 years old (mean age – 59,8±1,5 years). Duration of the disease varied from 3 to 36 years (mean duration – 10,0±1,1 years). Mean body mass index (BMI) among patients was 30,6±0,7 [22,3; 39,5]kg/m2, according to which patients were divided in 3 groups: patients with OA without obesity (n=17), patients with OA with 1 degree of obesity (n=14), patients with OA with 2 degree of obesity (n=9). The level of osteochondral metabolism was assessed using quantitative measuring of the levels of procollagen IC-terminal propeptide (РІСР), (Cloud-CloneCorp. “procollagen IC-Terminal Propeptide”, USA) and osteocalcin (Roche Diagnostics «N-MID Osteocalcin», Switzerland) on analyzer «ELECSYS 2010» by the method of immune-enzyme analysis; the level of the system inflammation was assessed by the level of C-reactive protein (CRP) by the method of immunoturbidimetry. The clinical efficacy was assessed by the dynamics of intensity levels of pain syndromes at physical load and at rest by the visual-analogue scale (VAS). The measuring of РІСР, osteocalcin and CRP levels and also the assessment of clinical efficacy as to the decrease of pain syndrome were carried out twice – at the beginning and at the end of observation. The period of observation is 2 months.
Results. The presence of direct correlation between РІСР and BMI (r=0,62; р=0,008) among patients with OA in combination with the normal body weight was established at the research, whereas among patients with OA in combination with obesity the analogous correlation was demonstrated between SRP and BMI (r=0,43; р=0,04) on the background of correlation of PICP and OC levels (r=0,46; р=0,03).
Obesity in patients with OA was associated with the reliably higher levels of pain at both rest and physical load from the side of knee joints, with maximal intensity of the pain syndrome among patients with OA and 1 degree of obesity.
Statistical analysis did not reveal the reliable dependence of РІСР and OC in patients with OA from the initial CRP level on the background of tendency to the higher РІСР level and lower OC level among patients with initially increased CRP level comparing with ones with normal CRP level. The therapy with basic preparations at OA during 2 months among patients with OA with increased CRP level led to the reliable decrease of РІСР level (р=0,0076) and the tendency to increase of OC level (р˃0,05), without the reliably significant difference between the initial and final РІСР and OC levels among patients with OA and normal CRP level.
At the end of observation period the maximal analgesic effect was demonstrated as to the articulate pain at rest from the side of knee joints (р˂0,001) among patients with OA, who received diacerein, with clinically comparable effect from the side of other aticulate zones (р˂0,05), that was associated with reliable decrease of CRP level (р=0,013).
Discussion. The received results testify that the control of the system inflammation level at OA is a target not only relative to the decrease of pain syndrome but also conditions the stable state of subchondral bone (SCB), providing the compensation of processes of destruction and synthesis in bone tissue. The significance of procollagen IC-terminal propeptide (РІСР) and osteocalcin (OC) as the markers of bone synthesis that are able to reflect metabolic processes in SCB at OA, and also the discordant influence of CRP level on PICP level at the relative stability of OC level were demonstrated at the research.
The received results allow consider the inflammatory process at OA as a target for preservance of the bone tissue, conditioning the expedience of taking into account the ability of OA basic preparations to realize the control influence on the level of system inflammation. Diacerein that in ESCEO recommendations (2014) is related to the preparations of the 1 step of treatment of patients with OA provides the control on inflammation and stability of osteocalcin level that testifies to the balance of catabolic processes in SCB.
Conclusions. At OA the levels of procollagen IC-terminal propeptide (РІСР) and osteocalcin (OC) were not associated with obesity and did not depend on the initial CRP level at the presence of correlation between РІСР level and BMI among patients with OA with the normal body weight and BMI and CRP level among patients with OA in combination with obesity.
The absence of reliable dynamics from РІСР side and maintenance of the stable OC level on the background of the reliable anti-inflammatory effect at using diacerein in patients with OA can testify to the compensatory adequacy of reparation processes in SCB
DENTAL STATUS OF CHILDREN WITH THE TEETH FORMATION DISORDERS
Get PDFAim of research: to analyze the dental status of children with the teeth formation disorders on the background of the digestive diseases (DD).Object of research – the change of the teeth hard tissues and periodontal tissues, subject of research – clinical characteristics of the status of teeth hard tissues and periodontal ones.Results of research: in children with chronological enamel hypoplasia (CEH) and molar-incisor hypomineralization (MIH) on the background of digestive diseases (Class ICD-10, К00-К93: “Gastritis and duodenitis” (К29), “Cholecystitis” (К81), “Other bile-excreting diseases” (К83)) was fixed the high and very high intensity of the dental caries, respectively. Caries as CEH and MIH complication was diagnosed in 55,81 % and 42,85 % of examined, respectively. In children with CEH and MIH on the background of digestive organ diseases was diagnosed the middle severity of gingivitis РМА, Papillary, Marginal, Alveolar Indices): 29,13±8,87 % and 25,24±8,97 %, respectively. The rate of persons with the healthy periodontal tissues according to CPI (Community Periodontal Index) was 21,42±21,91 % in children with CEH and 7,14±13,11 % in examined with MIH.In examined with CEH and MIH was fixed the satisfactory hygiene of the oral cavity according to Green-Vermillion index (OHI – Oral Hygiene Index).Conclusion: children with teeth hard tissues formation disorders on the background of digestive diseases need the dispensary observation and course of the therapeutic and prophylactic arrangements for preventing the possible complications (caries, gingivitis, periodontitis)