Purpose of the study. Determination of pathogenetic substantiation and indication criteria for the inclusion of extracorporeal detoxification methods in preoperative preparation of patients with non-small cell lung cancer (NSCLC) complicated by inflammation.Patients and methods. This study included the data on 222 patients with newly diagnosed stage I–IV NSCLC referred for elective surgical treatment to the Department of Thoracic Oncology, National Medical Centre for Oncology, in 2017–2019. Endogenous intoxication was evaluated in all patients depending on the leukogram results: leukocytic intoxication index (LII), body resistance index (BRI), reactive neutrophil response (RNR), and neutrophil-lymphocyte ratio (NLR). Indicators of the inflammatory response, i. e. interleukin 6 and procalcitonin, were also studied.Results. 36.5 % of NSCLC patients developed inflammation. That over 70 % of the NSCLC patients showed pronounced clinical and laboratory signs of endogenous intoxication and inhibited protective systems of homeostasis. Initial sub- or decompensated endotoxicosis together with reduced overall reactivity of the body poses a high risk of systemic inflammatory response to antitumor surgical treatment. This justifies the inclusion of extracorporeal detoxification into preoperative preparation of this category of patients as an active preoperative therapy.Conclusions. Simultaneous elevation of LII, RNR and NLR characterizing the presence of endotoxicosis in sub- and decompensation of endogenous intoxication by own physiological detoxification systems requires an active preoperative preparation with extracorporeal detoxification.

This paper describes an example of radical surgical treatment of a patient with a giant retrosternal goiter complicated by compression of the organs of the neck and mediastinum. Considering all the risks and possible complications, we should take into account the fact that enlarged thyroid (T) body with retrosternal location can cause displacement and stenosis of the trachea and esophagus, and dislocation of large vessels and nerves of the mediastinum. This anatomical specificity is an imminent threat to successful treatment, and it also carries a certain risk of asphyxia and sudden death of the patient. In this clinical case, radical surgical treatment in this patient included sequential mobilization in two pleural cavities, and then the total removal of T through the traditional surgical access. The anesthetic complexity to support the surgical intervention involved both difficult intubation due to tracheal stenosis, and also the required separate ventilation of the lungs to visualize anatomical structures and mobilize a multinodular formation in two pleural cavities. Standard methods of artificial lung ventilation could be ineffective and even dangerous in this case due to the location and size of the tumor. We focused our attention on high-frequency ventilation (HFV), the best method of respiratory support during surgeries for tracheal and bronchial pathologies. The main task of the anesthetic team in this clinical case was to prevent the development of hypercapnia and hypoxia during intubation of the stenotic tracheal segment, and then adequate ventilation of the lungs with reduced area of proper gas exchange due to bilateral surgical pneumothorax. Thus, the full treatment was carried out due to the only safe method of compensating lung ventilation with anesthesia by HFV. The applied HFV method creates an adequate gas exchange in the lungs due to the small ventilation volume and high frequency of respiratory cycles per minute. HFV both prevented the development of threatening complications during intubation of the stenotic tracheal area and ensured an adequate gas exchange during successive thoracoscopic stages of thyroid tumor mobilization.

Purpose of the study. To analyse free radical oxidation and antioxidant defense in patients diagnosed with early cervical cancer (CC) before and after radical surgical treatment.Patients and methods. Levels of diene conjugates, malondialdehyde (MDA), superoxide dismutase (SOD), catalase, glutathione, glutathione- dependent enzymes, vitamins A and E were determined in 74 women under the age of 45 (48 patients those who were at the stage of surgical treatment with a diagnosis of CC at the National Medical Research Center of Oncology in the period 2017–2020 and 26 healthy women).Results. Patients with early CC showed significant changes in the intensity of lipid peroxidation processes and in antioxidant defense: elevate levels of MDA and diene conjugates, initial decline in the activity of SOD and catalase, low levels of vitamins A and E. These results complete the understanding of the processes occurring in the body of an oncological patient at the initial stage of tumor formation, which does not yet have an obvious clinical manifestation. After total removal of the ovaries, most of the indicators characterizing the enzymatic link of the antioxidant system tend to normalize, while the violation of the content of vitamins E and A (related to the non-enzymatic link of the antioxidant system) worsens.Conclusions. Desynchronization of free radical oxidation processes with multidirectional changes in oxidation and antioxidation in patients with early CC at the stage of radical surgical treatment should be considered from the position of hormone‑ reducing surgery and a resulting complex of changes in the organs and systems of women with cancer.

МАЛОИНВАЗИВНАЯ МОЛЕКУЛЯРНАЯ ДИАГНОСТИКА РЕЦИДИВА НЕМЫШЕЧНО-ИНВАЗИВНОГО РАКА МОЧЕВОГО ПУЗЫРЯ, АССОЦИИРОВАННОГО С ВПЧ-ИНФЕКЦИЕЙДимитриади С.Н

The presented clinical case demonstrates the potential of medical technologies with organ replacement in the treatment for kidney cancer (KC) with a tumor thrombus located in the retrohepatic inferior vena cava (IVC) complicated by thromboembolism of the medium and small branches of the pulmonary artery (PATE). The treatment outcomes in such patients are usually poor due to a great number of complications and high mortality. The literature data estimates operative mortality rate of 13 %, and the frequency of early postoperative complications reaches 60 %. Standard approaches to anesthesia in case of thromboembolism and the threat of massive PATE are ineffective. In this clinical case, we chose the therapeutic tactics with extracorporeal membrane oxygenation (ECMO) in the intra- and early postoperative period in order to avoid or minimize life-threatening complications in the KC patient with a tumor thrombus in IVC and PATE. The effective use of ECMO minimized the risk of fatal complications during nephrectomy with thrombectomy for a malignant kidney tumor in the patient with pulmonary embolism and subcompensated disorders of the oxygen transport function of the lungs. The main objective of medical care for this patient involved both the radical treatment of kidney cancer and the elimination of a potential cause of thromboembolism of the pulmonary artery branches, fragments of hematogenous and tumor microthrombi. The total duration of ECMO was 30 hours. No significant complications in organs and systems were recorded during the surgery and in the early postoperative period. The development and implementation of new technologies, including devices for oxygen blood saturation and carbon dioxide elimination, undoubtedly gives a chance for a cure for cancer patients with decompensated organ and functional capabilities.

Purpose of the study. The purpose of the study was to analyze parameters of molecular markers of structural and cellular renal damage in localized renal cell carcinoma (RCC) with determining the nature of the initial abnormalities in the kidney functional state before the treatment.Patients and methods. The study included 46 patients receiving elective surgical treatment for localized renal cancer in the Department of Oncourology, National Medical Research Centre for Oncology. The comparison group included the clinical and laboratory data of 13 healthy people comparable with the RCC patients in terms of age and gender. Cystatin C, IL‑18, KIM‑1, L-FABP, NGAL were determined in blood and urine in all patients.Results. Evaluation of the kidney functional state of RCC patients showed that the initial values of serum creatinine and the glomerular filtration rate were similar to the reference levels in healthy people, but statistically significant differences were found in the ratios of cystatin C concentrations in the blood and urine in all patients, compared with normal values. Determination of L-FABP indices in RCC patients showed that their levels were 2.5 times higher than normal values, and the urine concentration of IL‑18 was 1.7 times higher than normal values (p < 0.05). Blood and urine levels of NGAL and KIM‑1 did not differ significantly from the comparison group.Conclusions. The development of localized RCC is accompanied by the formation of tubulointerstitial dysfunction with impaired renal filtration capacity. All RCC patients showed elevated endogenous markers of structural and cellular renal damage – cystatin C, L-FABP, and IL‑18.

Introduction. Radical surgical treatment of cervical cancer (CC) involves the removal of the uterus with suspected metastatic foci in the regional lymphatic collectors and the ovaries. In this case, total ovarian suppression in patients of reproductive age is accompanied by polysystemic functional disorders in the form of postovariectomy syndrome (POES), which is manifested by changes in homeostasis, neuroendocrine and cardiovascular insufficiency, pronounced disorders in the psychoemotional sphere with the formation of a persistent stress situation and the development of psychological dysfunction.

Background . Infectious complications are the most frequent and severe among all complications in cancer patients. The development of fungal-bacterial infections is particularly difficult. The aim was to develop an etiological description for the causative agents of infectious complications in oncological patients. Materials and methods . The study was conducted from January, 2020 to December (inclusive both dates), 2021. 3662 hospitalized patients (men and women) aged from 1 to 85 years with clinical manifestations of an infection were examined. The traditional microbiological method was used to clarify the etiology of the infectious process and to verify the pathogen. Phenotypic and real-time PCR methods were used for detection of carbapenemase and ESBL production. Results . The organs of the respiratory system, skin, soft tissues, and blood are most susceptible to infectious complications. In the etiology of infectious complications, the leading place is occupied by gram-negative bacteria. The conducted microbiological study made it possible to establish that resistance to cephalosporins and carbapenems in enterobacteria is realized through various resistance mechanisms. Extended-spectrum β-lactamases and carbapenemases are particularly relevant and concerning. Monitoring revealed the growth of carbapenemase-producing isolates of Klebsiella pneumoniae (34.9%), the spread of carbapenemase among Escherichia coli strains (5.1%), the increase in the spread of Acinetobacter baumannii strains with the production of NDM groups (32.6%). Conclusion . Prescription of antibacterial drugs should be based only on the results of microbiological diagnostics. The current situation requires modern methods of microbiological diagnostics: the use of only up-to-date (periodically updated) criteria for determining sensitivity to antimicrobial drugs, as well as the introduction of phenotypic tests that provide reliable information without molecular genetic methods.

Purpose of the study. Analysis of the possibility of using presepsin in the early diagnosis of sepsis in cancer patients after extensive surgical interventions for tumors of the thoraco-abdominal localization.Materials and methods. The study included 27 people: 10 healthy individuals (control) and 17 patients who received surgical treatment at the National Medical Research Center of Oncology for malignant neoplasms of thoraco-abdominal localization. In the blood of all patients, studies of sepsis markers were performed: presepsin (P-SEP), highly sensitive CRP (hsCRP) (PATHFAST, Japan), procalcitonin (PCT), interleukin 6 (IL6) (Cobas e 411, Germany), as well as lactate, total leukocyte count (WBC) with a leukocyte formula, a blood culture test for suspected septic complications included in a routine examination. The studies were carried out before and on the 2nd day after the operation. Data were assessed by comparing P-SEP levels with hsCRP, PCT, IL6, lactate, WBC, blood culture test results, and the clinical status of patients. Depending on the data obtained, 2 groups were distinguished: I – patients with confirmed sepsis (3 people), II – without sepsis (14 people). Statistical processing was performed using STATISTICA 13.0.Results. In the control group, the level of P-SEP was 182.7 ± 11.9 pg/ml. In patients before surgery, the marker values were 213.7 ± 47.7 pg/ml, which did not differ statistically from the control data and did not go beyond the reference values, as did the content of PCT, hsCRP, IL6. On the 2nd day after surgery, all patients showed unidirectional changes, characterized by an increase in the levels of the studied parameters, but with varying degrees of intensity. The most significant was the increase in the concentration of presepsin. At the same time, it was noted that the level of presepsin on the 2nd day after surgery in patients of group I patients with confirmed sepsis averaged 2577.5 ± 1762.5 pg/ml with a maximum level 4340.0 pg/ml, and in group II with In the absence of confirmed bacteremia, there was an increase in the level of presepsin 1205.0 pg/ml. The data obtained correlated with the dynamics of changes in the concentration of other sepsis markers – hsCRP, PCT, IL6. Thus, the study of the level of presepsin, along with widely used markers – hsCRP, PCT, IL6, allows diagnosing sepsis in the early postoperative period in cancer patients.Conclusion. In patients with malignant neoplasms of thoracoabdominal localization, changes in the levels of sepsis markers in the early postoperative period can be used as a basis for prescribing antibiotic therapy. Presepsin may be recommended for use as an early marker of sepsis in patients with oncological pathology.

ЦЕЛЬ ИССЛЕДОВАНИЯ Анализ влияния вариантов мультимодального анестезиологического обеспечения на функциональное состояние печени и уровень маркеров эндогенной интоксикации (ЭИ) у пациентов, оперированных по поводу онкогинекологических заболеваний после неоадъювантной химиотерапии (НАХТ). МАТЕРИАЛ И МЕТОДЫ Проведено проспективное рандомизированное исследование эффективности различных вариантов мультимодальной анестезии (ММА) у 122 пациентов в возрасте 36—76 лет после НАХТ. Больные разделены на 2 группы. Пациентам 1-й группы (n=59) выполняли анестезию севофлураном с эпидуральной аналгезией, пациентам 2-й группы (n=63) интраоперационно проводили ТАР-блок. Аналгезию поддерживали инфузией лидокаина, сернокислой магнезией, фентанилом, нестероидными противовоспалительными препаратами. Группы разделены на подгруппы — А и Б. У пациентов подгрупп А обеих групп в составе ММА с целью уменьшения проявлений ЭИ и гепатопатии использовали Ремаксол за 2 ч до хирургического вмешательства, интраоперационно и в первые трое суток. У пациентов подгрупп Б использование Ремаксола не предполагалось. Изучены биохимические показатели: общая (ОКА) и эффективная концентрация (ЭКА) альбумина, связывающая способность альбумина, содержание С-реактивного белка и ферментов печени. РЕЗУЛЬТАТЫ У всех пациентов преморбидный фон характеризовался ЭИ, интенсификацией системного воспалительного ответа, гепатопатией. На этапах исследования динамика изучаемых показателей зависела от вариантов ММА. У пациентов, получавших Ремаксол, наблюдалось повышение ЭКА и ОКА, свидетельствующее о значительном снижении ЭИ. Уменьшался расход опиоидных аналгетиков. ЗАКЛЮЧЕНИЕ Включение в состав мультимодальной анестезии препарата Ремаксол обеспечивает уменьшение выраженности проявлений гепатопатии и эндогенной интоксикации, снижение расхода опиоидсодержащих аналгетиков в интра- и послеоперационном периодах.

Introduction. The development of a malignant tumor naturally affects renal function. During tumor formation, the renal tissue is destructed either by direct invasion into the parenchyma, or by mechanical change in the renal architecture caused by compression of the renal parenchyma, collecting ducts, tubules, and nephrons. In addition, a tumor can secrete biologically active substances, which have an indirect negative influence the functional state of the organ. Currently, it has been established that kallikrein-kinin and renin-angiotensin-aldosterone systems play an important role in the development of nephropathy of various genesis. At the same time, these systems' role in the development of renal function disorders in the setting of tumor damage has not yet been studied.Purpose of the study. To study changes in the components of the kallikrein-kinin and renin-angiotensin-aldosterone systems in the case of localized kidney cancer.Materials and methods. Forty-five patients diagnosed with T1N0M0 kidney cancer and 13 relatively healthy patients without cancer were examined. The determination of the components of the systems under study was carried out by the kinetic method after chromatography of blood plasma and urine using DEAE-Sephadex A-50 (Amersham Biosciences Corp., Sweden). The indices of angiotensin-1, renin, aldosterone, and cortisol were studied by an indirect method of radioimmunoassay. Statistical processing was carried out using Statistica 8.0 software (StatSoft Inc., IBM Corp., USA) by means of the Student-Fisher test (p < 0.05).Results. The development of kidney cancer is accompanied by a 2.3-fold increase in the activity of kallikrein and other trypsin proteases with a significant deficiency of their inhibitors (p < 0,05). Against this background, there is a 1.3-fold decrease in the cortisol/renin ratio from a 2.9-fold and 2.3-fold increase in the values of the renin/angiotensin-I and cortisol/angiotensin-I interaction ratios, respectively, compared with the normal values of these indicators (p < 0,05).Conclusions. Renal cell carcinoma is accompanied by trespassing of local metabolism with the formation of tubulointerstitial dysfunction and a shift of the proteinase-inhibitory balance towards proteolytic activation.

This clinical observation demonstrates a method of a motivated use of a transdermal therapeutic system (TTS) based on fentanyl for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer. The most common complication after elective lung resections is an alveolar-pleural fistula or prolonged air leakage. This clinical phenomenon occurs as a result of communication between the alveoli of the lung parenchyma distal to the segmental bronchus and the pleural cavity. In most cases, air leakage through the drains is eliminated spontaneously, but the frequency of prolonged pneumostasis absence in the postoperative period can reach 25 %, which has a negative effect on the outcomes of surgical interventions due to the development of pneumonia and empyema. Long-term drainage of the pleural cavity does not always end with aerostasis and requires repeated invasive interventions. One of the ways to achieve the tightness of the lung tissue involves various methods of chemical pleurodesis, which is a surgical manipulation – the introduction of a sclerosing chemical substance into the pleural cavity by spraying medical talc through a trocar or a injecting tetracycline solution into the pleural drains. The chemical causes aseptic inflammation and adhesions between the visceral and parietal pleura, followed by obliteration of the pleural cavity. The sclerosant introduction is accompanied by severe pain that can provoke respiratory and/or hemodynamic deficits, up to apnea and life-threatening heart rhythm disturbances. Pain relief during chemical pleurodesis is obviously an important factor in the prevention of a number of complications in patients undergoing surgery for lung cancer. Bolus intravenous injections of narcotic analgesics lead to an analgesic effect, but a short-term one due to the absence of a depot in the body and a sharp drop in the drug concentration in the blood serum. Unfortunately, this method of introducing narcotic drugs can cause various complications in weakened and elderly cancer patients, such as respiratory depression and cardiac arrest. The TTS action is characterized with continuous dosing and the creation of a constant concentration of the narcotic drug over a certain period of time. This method provides a multilevel and systematic approach to pain relief, reduces toxicity and minimizes the inhibition of the central mechanisms of external respiration regulation without causing respiratory and cardiac disorders in patients who underwent lung resection.

Purpose of the study. To study functional changes in the neuropsychological status of reproductive age patients with newly diagnosed breast cancer and to assess the possibility of using xenon-oxygen therapy to correct disorders.Patients and methods. This study included 60 reproductive age patients with newly diagnosed breast cancer who were undergoing surgical treatment at the Department of Bone, Skin, Soft Tissue and Breast Tumors of the National Medical Research Centre for Oncology of the Ministry of Health of Russia from 2018 to 2020. The main group included 30 patients with breast cancer diagnosed at the surgical stage of combined treatment, who underwent a rehabilitation course of xenon-oxygen therapy in the early postoperative period. The control group was formed from patients with the same diagnosis, without the use of this therapy. The functional state of the central nervous system in all patients was assessed by the parameters of the electroencephalography (EEG) bioelectrical activity. For the final assessment of the physiological and psychological state of the patients, a standardized questionnaires of the quality of life – ESAS, MOS-SF‑36, were used. Statistical data processing was performed using the Statistica 10 software package. Results. During the study, statistically significant differences were found in the assessment of subjective indicators, so in the group of patients using xenon-oxygen therapy, there was an improvement in well-being by 2.6 times, a decrease in depression by 2.3 times, a decrease in symptoms of nausea by 3 times, anxiety 1.9 times (p < 0.05). Against the background of an improvement in the psychophysiological state, the EEG showed a significant increase in the power of slow delta and theta rhythms, an increase in the power of the alpha rhythm and a decrease in the power of the beta rhythm, while in the patients of the control group only a decrease in the power of the beta rhythm was noted.Conclusion. The early postoperative period in patients with newly diagnosed breast cancer is characterized by the formation of a depressive symptom complex. The use of a course of xenon-oxygen therapy contributes to the normalization of the subjective feeling of physical and psychological health, increasing vital and social activity. Changes in the indicators of brain bioelectric activity and an improvement in psychophysiological state occur against the background of changes in brain activity caused by the normalizing effect of xenon.

Purpose of the study. Studying possible management of postoperative pain and normalization of adaptation status in patients with reproductive system onychopathology using xenon- oxygen therapy.Patients and methods. The study included 97 patients receiving surgical treatment for reproductive cancer at National Medical Research Centre for Oncology in 2016–2020. All patients were divided into the main and control groups depending on the performed corrective therapy with xenon- oxygen mixture. Inclusion criteria were: established diagnosis — endometrial cancer, cervical cancer or ovarian cancer at the surgical stage of antitumor treatment, absence of decompensated concomitant pathology. In addition to general clinical tests, the intensity of symptoms in patients was assessed using a standardized Edmonton questionnaire, adaptation status and data of a numerical rating scale of pain were recorded, the severity of endogenous intoxication was measured using calculated lymphocytic, leukocyte, nuclear and leukocyte shift index. Stages of the study included functional assessment of the patient's condition before surgical treatment and on the 1st and 5th days of the postoperative period.Results. An analysis showed statistically significant differences between the groups: in the group of patients receiving xenon- oxygen therapy, 12.9% of patients complained of pain, while in the control group — 34.2%, on mild exertion 17.1% and 39.9%, respectively (p<0.05). The therapy with xenon- oxygen mixture demonstrated its high significance in the adaptive status regulation and regression of negative clinical manifestations in patients after oncogynecological surgeries.Conclusion. The effectiveness of the chosen therapy with xenon- oxygen mixture demonstrates the possibility of anesthesia and normalization of the adaptive status of oncogynecological patients who underwent surgical treatment for reproductive cancers.

The article describes a clinical case of surgical treatment of a patient with multiple primary malignant lesions of the lungs (cancer of the left lung, central peribronchial nodular tumor with involvement of the upper lobe and distal parts of the main bronchus; cancer of the right lung, central tumor with involvement of the upper lobar bronchus). Radical treatment became possible due to using the potential of artifi cial gas exchange of both lungs with two devices with fundamentally different ventilation mechanics. The choice of an optimal tactics for the functional correction of the supposed hypoxemia by volumetric and high-frequency pulmonary ventilation allowed avoiding an imbalance in the ventilation/perfusion ratio and preventing the development of life-threatening complications, as well as ensured an adequate gas exchange for the patient during surgical treatment.

Lung surgeries following pneumonectomy using veno-venous extracorporeal membrane oxygenation (V-V ECMO) are described in the literature. The authors report a 62-year-old man with bilateral metachronous primary multiple lung cancer after previous extended lower lobectomy combined with sublobar resection of the upper lobe for squamous cell carcinoma of the left lung. Despite satisfactory functional status and heart function, the patient had poor lung function. Therefore, we decided to increase safety of resection using extracorporeal respiratory support. Extended right lower lobectomy was carried out under V-V ECMO. Surgery was followed by intrapleural bleeding that required urgent surgical hemostasis with completion of perioperative V-V ECMO. Postoperative ventilation lasted for 33 days but the patient was discharged later in a satisfactory condition.

Objective. To evaluate resistance rates to carbapenems and III–IV generation cephalosporins among gramnegative bacteria, including production of carbapenemases and extended-spectrum beta-lactamases (ESBL). Materials and Methods. A total of 460 gram-negative bacteria isolated from hospitalized patients aged 1 to 85 years from 8 medical institutions of Rostov-on-Don and the region from April 2018 to December 2019 were tested by conventional microbiological methods. The most common acquired carbapenemases genes were determined by real-time PCR using commercial kits (Central Research Institute of Epidemiology, Russia). Results. The tested isolates included 180 (39.1%) isolates of K. pneumoniae, 87 (18.9%) – E. coli, 101 (22.0%) – A. baumannii and 92 (20.0%) – P. aeruginosa. K. pneumoniae and E. coli isolates exhibited the high resistance rates to cefotaxime – 96.7% and 71.2%, to ceftazidime – 95.5% and 54.0%, and to cefepime – 95.5% and 54.0%, respectively. ESBL production was detected in 35.0% and 78.2% of K. pneumoniae and E.coli isolates, respectively. K. pneumoniae and E. coli isolates were resistant to imipenem, meropenem, and ertapenem: 57.8% and 3.4%; 55.0% and 2.3%; 60.0% and 4.6%, respectively. Carbapenemase production was detected in 27.8% of K. pneumoniae and 4.6% of E. coli isolates. The most common beta-lactamases were metallo-beta-lactamases (NDM) and serine carbapenemases (OXA-48). A. baumannii isolates showed the high resistance rates to imipenem and meropenem (87.1% and 85.1%). The most common beta-lactamases were metallo-beta-lactamases (NDM) and serine carbapenemases (OXA-24⁄40 and OXA-23). P. aeruginosa isolates also showed the high resistance to carbapenems – imipenem (61.9%) and meropenem (58.7%). The most common betalactamases were metallo-beta-lactamases (VIM) and GES-5. Conclusions. The results of this microbiological study indicate the extremely high prevalence of aerobic gram-negative bacteria in different infections. A. baumannii, P. aeruginosa, K. pneumoniae and E. coli isolates being resistant to third- and fourth-generation cephalosporins and carbapenems are particularly dangerous, especially due to production of ESBL and carbapenemases. The most clinically important are OXA and NDM beta-lactamases.