[The enigma of desmoid fibroma].
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Biomedical subjects
Publications and source records attributed to A V Boĭko.
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The 30-year experience of P.A. Herzen Moscou Cancer Research Institute in the treatment of soft tissue desmoid fibromas (DF) is summarized. A comparative study of effectiveness of surgical, combined, radiation and medicamentous methods was carried out. Frequency of recurrences after surgical treatment made up 94%, after combined treatment with preoperative radiation it decreased 3-fold (27.5%), in cases of postoperative radiation it made up 53%, and after radiation therapy--15.7%. However radiation therapy may have limitations due to necessity for irradiation of large tumour masses and usage of high-dose ionized irradiation which results in development of postradiation tissue damages. Further research brought about an original chemohormonal therapy (tamoxiphen, vinblastin, methotrexate), which provides stable recovery in 81.3% of patients. Principal positions for management of DF are formulated.
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The authors have observed 218 patients with nonparasitogenic cyst of the liver. Of them 94 were operated on. The cyst enucleation, partial excision of its wall, external cyst drainage, cystodigestive anastomosis formation, combined liver and the cyst resection were done. Preference to the cyst enucleation (in 22.5% of observations), its partial excision (in 33.8%) and combined resection of liver with the cyst (in 19.4%) was given. In polycystosis the partial excision of large cysts were the alternative operations as well as omento-hepatopexy. One (1.06%) patient have died. Postoperative complication occurred in 23 (24.2%) of patients.
Bacterial contamination of water and fish in the Volga delta region was studied. Water near large enterprises contained more bacteria than at 75 km a distance of downstream. All organs and tissues of sturgeon contained opportunistic bacteria. Bacterial contamination of water is responsible incidences for acute intestinal diseases of the population.
Samples of black caviar in 47.7% of cases are contaminated by opportunistic bacteria Aeromonas, Proteus, Vibrio, V. parahaemolyticus. Standardization of these micro-organisms content in black caviar is recommended.
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A tumor response to chemoradiotherapy was studied in 260 patients with small-cell lung carcinoma in situ on the basis of clinical parameters using different regimens of dose fractionation and various levels of total focal doses. Nonclassical irradiation regimens were found superior to routine dose fractionation. At present it seems improbable routine dose fractionation. At present it seems improbable to predict a response of small-cell lung carcinoma to irradiation and polychemotherapy on the basis of clinical parameters in each individual case. A varied response of small-cell cancer to conservative antitumor therapy is likely to be determined by its morphological, biological and genetic heterogeneity.
New potentialities of radiotherapy of cancer patients are associated with three scientific directions: investigations in clinical radiology, the use of advantages of radiation advanced technology and guarantees of therapeutic quality. The first direction includes scientifically substantiated regimens of non-classic dose fractionation, various radiomodifiers and their combinations, and individual prognosis of a tumor response to ionizing radiation. This direction based on 3000 cases, holds promise. The second direction is associated with the advantages of modern technology used for diagnosis, topometry and radiotherapy design. The third direction is intended to reduce differences in radiotherapy quality between research institutes and cancer hospitals.
It is believed that new anticancer potential of radiotherapy lies in further research efforts in the fields of: clinical radiobiology, utilization of the last developments in radiological equipment, overall high quality of radiological service. Research in radiobiology should be aimed at the design of nonstandard dose fractionation, introduction of various modifiers and their combinations, prediction of individual responses of the tumor to ionizing radiation. First-hand clinical data on 3000 cases support the promise of such approach. The advantages of modern equipment could be successfully realized at the stage of confirming the diagnosis and topography++, design of the treatment schedule and in the process of radiotherapy. To warrant the same quality of radiological service rendered in large cancer research centers and provincial hospitals, the latter should be provided with relevant equipment, methodological instructions, participate in current cooperative programs.
The purpose of this paper is to consider a number of biological and clinicomorphological signs of human tumors which influence the prediction of a course of disease as well as prognosis of a tumor response to radiation exposure. Analysis of the literature has shown that some factors of quite a favourable course of a tumor process are likely to be the signs of clinical radioresistance of the tumor. A strong possibility of individual prognosis of a tumor response to radiation therapy was shown for oropharyngeal and stomach tumors even at its onset, guided by change in the level of their proliferative activity, determined with an indirect immunofluorescent rapid method. The probability of detecting tumors, which are clinically radioresistant to proposed therapy, is 82.4-95%.
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A method for isolation of parahemolytic vibrios is suggested, based on their high mobility in semiliquid agar gel. A special semiliquid medium was designed and tried, containing agar-agar, peptone, sodium chloride, mannose, gelatin, indicator, Progress agent. The material is inoculated into the center of a petri dish. After incubation at 37 degrees C parahemolytic vibrios form macrocolonies on the surface of the medium, colored black against the red background of the medium. This method permits ruling out preliminary enrichment of the inoculation material in liquid medium, is more effective and rapid.
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General principles of management of localized small-cell lung cancer were developed using the experience of treatment of 300 cases of the disease. Tumor extent should be assessed according to the TNM classification. The effectiveness of surgery + radiation as a first component of complex treatment was evaluated in a randomized study which included 71 patients. Patients with T1-3 primary tumor and metastatic involvement of bronchopulmonary lymph nodes, those of the lung root and a group of tracheobronchial lymph nodes (NI-2) should be radically treated with either surgery or radiation. Unless contraindicated, surgery should be preferred at the first stage. However, treatment should start with irradiation in cases of lymph node involvement. The second stage should include combination chemotherapy.
Various types of non-routine dose fractionation were used in 2062 patients with malignant tumors of different sites. The conclusion was that superfractionation was more preferable for tumors with a high proliferative pool, with fast growth rates, marked radiosensitivity. It ensures the protection of normal tissues without a decrease or even with an increase in an antitumor effect. Such fractionation can be recommended when large tissue areas are to be irradiated. Dynamic dose fractionation regimens proved to be more effective than the use of large fractions not only in squamous cell carcinoma but also in sarcoma both before operation and as therapy after a radical program.