Актуальность. Учитывая новые данные о повышенной выявляемости и более точные методы диагностики, требуется пересмотр классических представлений о клинике и критериях диагностики феохромоцитомы. Цель. Изучить и сравнить особенности клиники и результатов инструментальных исследований с устойчивыми представлениями о феохромоцитоме, а также выявить факторы, влияющие на эффективность лечения пациентов с подтвержденным диагнозом феохромоцитомы. Материалы и методы. Девяти пациентам с гистологически подтвержденным диагнозом "феохромоцитома" было выполнено обследование и лечение согласно современным клиническим рекомендациям (1 мужчина, возраст 56 лет; 8 женщин, средний возраст 37,6 ± 15,5 лет). Анализируемые параметры: наличие синдрома артериальной гипертензии и специфических симптомов феохромоцитомы, показания к скринингу, время от появления показаний к скринингу до постановки лабораторно подтвержденного диагноза, КТ-характеристики (нативная плотность, размер, процент вымывания контраста, специфические признаки), особенности предоперационной подготовки, наличие интраоперационных осложнений, эффективность проведенного оперативного вмешательства. Статис тическая обработка: описательные статистики -проценты, среднее M, стандартное отклонение SD и 95% доверительный интервал CI (программа StatCalc, версия 8.1.2). Результаты. Синдром артериальной гипертензии присутствовал у 6 из 9 пациентов, из которых у 4 имела место классическая триада феохромоцитомы (44%). Показания к проведению скрининга феохромоцитомы: 4 -при сутствие специфических симптомов, 5 -инциденталома надпочечника. Время от появления специфических симптомов феохромоцитомы до установки лабораторно подтвержденного диагноза -41 ± 14 мес (95% CI 18; 63),

Background. Despite the rapid oncology development, the problem of surgical treatment for locally advanced tumors of the paranasal sinus and nasal cavity is still relevant. The search and development of ways to improve the surgical approach, including modern endovascular methods, appears necessary. Aims development and evaluation of the effectiveness of an innovative approach to the surgical treatment of malignant tumors of the nasal cavity and paranasal sinus with superselective intra-arterial embolization as a preparatory stage. Materials and methods. The study is based on the treatment outcomes of 52 patients with cancer of the nasal cavity and paranasal sinus. The main group included 21 patients receiving treatment with our developed approach including preoperative superselective intra-arterial embolization as a preparatory stage for surgical treatment. The control group included 31 patients receiving standard surgical treatment with traditional ligation of the external carotid artery at the first stage. Estimation of the amount of intraoperative blood loss with gravimetric analysis was considered the primary endpoint of the study. Post-embolization syndrome manifestations were analyzed by evaluating the pain intensity with a visual analogue scale and thermometry. Results. Intraoperative blood loss in patients of the main group varied from 100 to 400 ml, being on average 231.9100.58 ml. In the control group, the blood loss varied from 300 ml to 1000 ml, on average 630.97190.23. The data analysis proved demonstratively the effectiveness of the developed approach to surgical treatment of locally advanced tumors of the nasal cavity and paranasal sinus, since it statistically significantly reduced the amount of intoperative blood loss (p 0.005). Conclusions. Our developed approach to the treatment for malignant tumors of the paranasal sinus and nasal cavity optimized the results of surgical treatment and statistically significantly reduced the amount of intoperative blood loss, compared to the traditional ligation of the external carotid artery, from 630.97190.23 to 231.9100.58 ml (p 0.005), with minimal manifestations of post-embolization syndrome.

Аберрантное метилирование промоторных участков генов-основное эпигенетическое изменение, характеризующее колоректальные неопластические образования. В настоящей работе был исследован количественный уровень метилирования 42 CpG-сайтов промоторных участков генов MGMT, APC и CDH13 в опухолях толстой кишки по отношению к уровню метилирования прилежащей условно нормальной ткани 25 пациентов. С помощью метода пиросеквенирования выявлено повышение уровня метилирования промоторных участков генов MGMT, APC и CDH13 в опухолевых образцах от 3 до 5 раз. В этих же образцах опухолей проведен скрининг активирующих SNP-мутаций в онкогенах KRAS (40 %), NRAS (0 %) и BRAF (0 %). Наличие SNP-мутаций в гене KRAS сопровождалось гиперметилированием одного или более промоторов исследованных генов. Доказана ассоциация этого эпигенетического показателя с метастазированием опухоли. Полученные данные об увеличении метилирования промоторных участков генов-онкосупрессоров могут быть использованы в качестве чувствительных прогностических маркеров прогрессирования и метастазирования колоректального рака.

Aim. Evaluation of treatment options and efficacy in patients with hepatocellular carcinoma based on data from the FSBI Rostov Cancer Research Institute using a multidisciplinary approach to the problem. Materials and methods. 124 cases of hepatocellular carcinoma were analyzed. In 79.8% of patients (average age of 61.4 years) the disease was diagnosed at advanced stages (IIIIV). Antibodies to viral hepatitis B were detected in 18 (14.5%) patients, and antibodies to viral hepatitis C in 35 (28.2%) patients. Liver cirrhosis occurred in 38 (30.6%) cases, and ChildPugh class A in 20 (16.1%) cases. In the FSBI RCRI, a multidisciplinary approach has been introduced into clinical practice; decision on treatment tactics is made with a close cooperation of several specialists. The use of special treatment methods was available in 67 (54%) patients. 32 patients with Barcelona Clinic Liver Cancer (BCLC) stage A (early) or stage B (intermediate), had surgical treatment or hepatic arterial chemoembolization (HACE) with lipiodol or microspheres using various cytostatics (18 and 14 patients, respectively). 35 patients with advanced stage C were given a systemic therapy with various cytostatics (gemcitabine, oxaliplatin, doxorubicin) or targeted therapy with sorafenib. The treatment efficacy was assessed according to mRECIST. Results. The best median overall survival (OS) up to 21 months was in the group of patients (n=18) who underwent volume resection surgery. In this group, sorafenib was prescribed to 2 patients after surgery. When performing HACE, the median OS was 14.2 months. In 6 patients, HACE was performed 2 or more times. Among the 14 patients who had HACE, sorafenib was prescribed in 8 cases, and the median OS in this group was 16.3 months. 20 patients were given targeted therapy with sorafenib. Following 3 months of taking the drug, 16 patients achieved stabilization of the disease according to the mRECIST, in 1 patient a partial response, in 3 patients disease progression. Median OS was 9.1 months; progression-free survival among patients treated with sorafenib was 5.4 months. Conclusions. The use of a multidisciplinary approach in clinical practice makes it possible to choose the optimal treatment option for hepatocellular carcinoma and contributes to the improvement in OS. The combination of local treatment methods (surgical treatment, HACE) with effective drug therapy is the most optimal approach to treating patients with advanced stages of hepatocellular carcinoma.

Aim. To evaluate results of venous resections in tumor infiltration of venous wall in pancreatic cancer (PC). Materials and Methods. The study included 74 patients with PC and tumor invasion of the wall of the mesenteric-portal system (T3 N0-1 M0). The control group included patients (n=53), receiving palliative chemotherapy. The average age of patients in the group of surgical treatment was 61.89.8 years, in the control group 63.210.1 years (р0.05), the average diameter of the tumor was 39 mm and 43 mm, respectively (р0.05). In 62 cases of the group of surgical treatment the tumor was located in the head of pancreas (P), the patients were conducted pancreaticoduodenal resection with venous resection. In the rest of cases (n=12) the tumor was located in the body of P, corporocaudal resection of P was conducted with venous resection. Results. In the early postoperative period 2.7% of patients developed thrombosis of the reconstruction zone, 1.4% developed bleeding. 30-Day postoperative lethality was 4.1%. Median survival in surgical treatment of PC with venous resection was higher in comparison with palliative chemotherapy: 19 months vs 13 months, р0.05. In the group of venous resection the lowest annual survival (46.2%) was noted in patients with marginal resection of the vein. No significant differences were found in the parameters of survival with use of direct venous anastomose and venous prosthetics (66.7% vs 63.2%, p0.05). Conclusions. Angioplastic interventions permitting to achieve microscopically complete resection of the tumor in PC with tumor infiltration of mesenteric-portal system, permit to improve survival of patients in comparison with palliative chemotherapy.