UJR 2005, vol XIII, # 2
THE CONTENTS
2005, vol 13, # 2, page 125
O.J. Chuvashova
Investigation of sensomotor brain cortex in malignant gliomas using functional MRI
Annotation
Objective: To visualize the zones of activation of sensomotor brain cortex in patients with malignant gliomas and to establish the factors influencing their early activation.
Material and Methods: The findings of the study of 16 patients (5 women and 11 men) aged 18—65 with stage III—IV gliomas were analyzed. The study of the zones of cortex activation and anatomical structures of the brain was done using functional MRI (fMRI) and MRI.
Results: Gliomas affect the zone of activation of sensomotor brain cortex. Involvement of the brain cortex and increased mass-effect reduce activation in the involved hemisphere when compared with the collateral one.
Conclusion: Functional MRI accompanied by MRI allow to obtain the information about the interrelation of glioma and the zone of sensomotor brain cortex activation as well as the influence of the tumor on this zone.
Key words: functional magnetic resonance imaging, sensomotor cortex, gliomas.
2005, vol 13, # 2, page 129
V.J. Kundin, М.О. Nikolov
Dynamic and static renoscintigraphy with 99mTC-DMSA in children. Interpretation of main parameters and examination protocol
Annotation
Objective: To evaluate the diagnostic significance of dynamic investigation with 99mTc-DMSA for the first 30 minutes from the moment of the injection; to compare the findings of dynamic and static investigations in evaluation of the function of the parenchyma; on the basis of the obtained findings to make standard protocol of DMSA scintigraphy in children.
Material and Methods: Dynamic and static kidney scan was made in two stages for 3 hours after injection of 99mTc-DMSA(1.85 MBg/kg). This method was used to investigate 102 patients, of them 12 children with dismetabolic nephropathy, 34 with glo-merulonephritis, 38 with pyelonephritis and 28 children with anomalies of kidneys. The findings were compared with dynamic kidney scan (DKS), which was done earlier at the stage of fulminant clinic signs of the diseases in 78 patients 99mTc-DTPA, MmTc-pyrophosphate and 99mTc-MAG3. The degree of kidney dysfunction was evaluated by the following criteria: absence of dysfunction moderate and pronounced deceleration.
Results: According to the findings of DKS the function of the kidneys was preserved in 17 children (21.8 %) and in 61 children (78.2 %) the function of the kidneys was damaged. The dysfunction of the kidneys was accompanied by moderate (36 children, 59.0%) or pronounced (25 children, 41.0 %) disfunction of the filtration-excretion and secretion-excretion abilities. These findings were based on a relative analysis of DKS and dynamic kidney scan with 99mTc-DMSA. The main features of the affected renal parenchyma were blood half-clearance time more than 30 minutes, early onset of to the third exponent, the percentage of radiopharmaceutical accumulation 0,5 % in the urinary bladder. Basing on the obtained findings, a protocol of DMSA kidney scan was made.
Conclusions: Dynamic kidney scan with 99mTc-DMSA allows evaluation of the functional condition of the kidneys during a 30 minute period, which can make the time of staying of the child in the diagnostic department shorter and reduces psychoemotional load. The protocol of DMSA kidney scan can be used in the work of radionuclide diagnosis departments.
Key words: dynamic kidney scan, static kidney scan, protocol of kidney scan, children, 99mTc-DMSA.
2005, vol 13, # 2, page 136
J.P. Ternickay
The experience of helical computed tomography application to investigation of changes in the cervical lymph nodes
Annotation
Objective: To study the capabilities of helical computed tomography (HCT) in assessment of the changes in the cervical nodes in tumors and inflammatory diseases.
Material and Methods: HCT of the head and neck was done with contrast enhancement. The obtained axial images were processes using 3D MPR reconstruction of work station Magic View. The study involved 190 patients with various diagnoses aged 1389(86 women and 104 men, of them 70 with malignant tumors of various histology in the area of paranasal sinuses and nasopharynx). Twenty patients had systemic nodal involvement (non-Hodgkin's lymphoma). The diagnosis of metastatic involvement and non-Hodgkin's lymphoma was confirmed with puncture biopsy and the study of post-operative material.
Results: Based on the study performed, the criteria of the changes in the cervical lymph nodes in tumors and inflammatory diseases were determined.
Conclusion: HCT allows differential diagnosis of tumors and inflammatory diseases in the cervical LN according to the changes in the shape, size in 100% of cases and changes in the densitometric indices in the LN structure in 96% of cases. HCT is a highly informative method, which should be a standard procedure in the patients with diagnosis of lymphadenopathy in the region of the neck, ENT tumors with the purpose to specify the presence and character of changes in cervical LN.
Key words: lymph node, metastasis, hyperplasia, helical computed tomography.
2005, vol 13, # 2, page 140
Y.Е. Vikman
Capabilities of ultrasound investigations in diagnosis of portal hypertension
Annotation
Objective: To define reliable diagnostic criteria for evaluation of portal hypertension (PH), its hemodynamic manifestations using ultrasound study (US).
Material and Methods: In total 214 patients with PH of various origin were examined: of them 150 men and 64 women aged from 31 to 73 years. Including patients with liver cirrhosis (LC) in compensative phase — 77, LC in decompensative phase — 42, chronic persistent hepatitis (CPH) — 34, hepatitises В and С — 21, tumoral lesion of liver — 26, chronic pancreatitis — 14 patients. All patients underwent two dimensional US, duplex US, and color
Doppler study.
Results: Normal architecture of the liver at echography in В mode means that the branches of portal and hepatic veins have a normal caliber, smooth walls, without «breakages» in the parenchyma. Under such circumstances liver cirrhosis is improbable. Definition of lumens of the portal and in splenic veins is expediently CPH and LC as their dilation allows to assume presence of diffuse pathology of the liver with a high confidence and to estimate an expressiveness of the changes. Vascular manifestations of PH were expressed in the changes of the size and structure of the vessels, architecture of the vascular bed. The diameter of the splenic vein more than 9 mm testifies for PH with accuracy of 87.5 % , and more than 10 mm (at simultaneous enlargement of diameter of the portal vein) reliably (p = 0.021) testifies for PH. Dilation of the portal vein at LC more than 15 mm was observed in
32 % of cases and more than 20 mm in 27 % of cases.
The suspicion of presence of PH can be based on the following US findings: vasodilatation of the portal system with decreasing of blood flow velocity, signs of stagnation in gallbladder wall and mucous membrane of the stomach, splenomegaly, and ascites. Inversion of blood flow in portal veins and/or portosystemic collaterals conferm PH.
Conclusions: US with application of color Doppler the greatest significance in diagnosis, differential diagnosis, and evaluation of PH degree. Echography has major advantage over CT in diagnosis of diseases which are accompanied by PH, due to ability to record the greater number of changes in real time. In most cases (97,5 %) of decompensative LC duplex US investigation allows to give complete information about the state of the liver, spleen, splenoportal bed, and direction and velocity of portal blood flow.
Key words: portal hypertension, liver cirrhosis, ultrasound.
2005, vol 13, # 2, page 144
О.S. Shevchenko
Duplex ultrasound scanning of the brachial artery in evaluation of arterial hypertension stage
Annotation
Objective: To study the peculiarities of vasomotor endothelial function at various degrees of severity of arterial hypertension (AH) complicated with chronic heart failure.
Material and Methods: Thirty-nine patients with stage I—III AH were examined, 9 developed FCII chronic heart failure; 23 % had a history of myocardial infarction. The controls were 9 healthy individuals. Brachial artery vasomotor endothelial function was studied using duplex ultrasound scanning with 7.5 MHz transducer at Ultramark 9 ATL (USA) in triplex mode (Celermajer et al., 1992).
Results: The obtained data give the evidence of preserved endothelial function at AH early stages. It changed stage II AH but was compensated due to humoral and nervous autoregulation. On progressing of the disease, especially in coronary artery disease, endothelial dysfunction grew and caused the loss of autoregulation capacities. The reactive hyperemia test demonstrated a paradoxical vasoconstriction at increased postocclusive blood flow and decellerated restoration or the initial blood circulation and vascular tone parameters.
Conclusion: Doppler US study of post-occlusion blood flow and the changes in brachial artery diameters is a marker of AH stage.
Key words: duplex ultrasound scanning, reactive hyperemia, blood flow, autoregulation, arterial hypertension.
2005, vol 13, # 2, page 148
L.Y. Vasiljev, Y.Е. Vikman, О.М. Gladkova, І.М. Ponomarjov, E.B. Radzishevskay, О.М. Tarasova
Retrospective evaluation of stage I-II breast cancer consequences depending on radiation and chemotherapy administration
Annotation
Objective: Complex estimation of the course and consequences of breast cancer using history data with application of contemporary computer technologies.
Material and Methods: Patients with stage I-II breast cancer treated at Grigoriev Institute for Medical Radiology in 1993-1994. The analysis of the obtained information was done with Data Mining technology.
Results: It was shown that distant metastases developed less frequently in patients without radiation therapy (in patients without revealed primary metastases and with tumor size less than 1,5 cm) and in the patients with pre-operative and post-operative radiation therapy. The worst results were observed in the group with post-operative radiation therapy and in the group with pre-operative radiation therapy. Probability of positive treatment results in patients with postoperative radiation therapy increased in case of adjuvant CMF chemotherapy. The risk of distant metastases peaked by 1.1 year. Then it decreased and from 3.4 years reached its plateau for approximately one year. From 5.6 to 6.7 years the risk diminished and by year 10.0 a new outburst occurred, which was comparable with the first one.
Conclusion: Distant metastases develop less frequently in patients with small tumors and without primary metastases and in the patients with pre-operative and post-operative radiation therapy. The worst results were observed in the group with postoperative radiation therapy and in the group with pre-operative radiation therapy. Combination of post-operative RT and adjuvant CMF chemotherapy increases the probability of favorable outcome.
Time points 1.1, 4.5, and 10.0 years after the surgery are high-risk periods.
Key words: breast cancer, distant metastases, methods of mathematical processing.
2005, vol 13, # 2, page 153
О.М. Suhina, О.А. Nemalcova, N.А. Nikiforova, І.P. Moskalenko, G.V. Kulinich, P.P. Sorochan
Clinical course of inoperable cervical cancer during chronomodulated radiochemotherapy
Annotation
Objective: To study the efficacy of antitumor radiochemotherapy in patients with inoperable cervical cancer (CC) with the consideration of the time of the day when antitumor therapy was administered.
Material and Methods: The study involved 53 patients with stage Ilb-IV CC aged 24- 73, who were administered multimodality radical treatment including 5-FU. The patients were divided into 2 groups depending of the time of 5-FU administration. Group 1 (18 patients) was administered 5-FU in drops from 12 a.m. to 12 p.m. with small pelvis irradiation 8 hours later (SFD 4 Gy 2 times a week, MFD 32 Gy + 8 g 5-FU). In case of infiltration in the parametrium, a 10 Gy boost was added in small fractures. Group 2 (35 patients) were administered 5-FU from 6 p.m. to 6 a.m. with gamma-therapy 8 hours later (2 p.m.). Intracavitary irradiation was done using AGAT-B unit 2 times a week, SFD in A/B — 5/1.25 Gy, MFD in A/B 50-55/12.5-13.75 Gy.
Results: The incidence of radiation reactions (cystitis, entero-colitis, and rectitis) was 33.3 and 17.1 % , 33.3 and 14.3 % respectively in groups 1 and 2. Radiation reactions in group 1 (entero-colitis) required a pause in the treatment plan for 7-10 days in contrast to group 2 where the treatment was not interrupted. The values of complete tumor regression were similar in the both groups, 72.7 and 75 % .respectively. In stage III disease they were 100 and 88.5 %, respectively. In one patient from group 1 and in 2 patients from group 2, the process recurred within the period of 13 months.
Conclusion: 5-FU administration to inoperable patients with CC during multimodality radiochemotherapy is more effective late in the evening and at night, it reduces toxicity of the antitumor treatment and the degree of its severity.
Key words: cervical cancer, radiochemotherapy, chronomo-dulation.
2005, vol 13, # 2, page 157
V.P. Starenkiy, О.М. Tarasova, О.М. Suhina, N.А. Mitrjaeva, V.М. Gorbenko, V.I. Goncharov
Chemomodification of radiotherapy for non-small-cell lung cancer
Annotation
Objective: To study the methods of non-small-cell lung cancer (NSCLC) radiochemomodif ication on the basis of Taxotere and accelerated irradiation mode.
Material and Methods: Complex evaluation of radiochemomodif ication efficacy in 45 patients with NSCLC (group 1) who were administered accelerated radiotherapy (stage 1:1.6 + 1.6 Gy per day with 6-hour intervals between fractions in 10 treatments up to total dose of 32 Gy, isoef fective 40 Gy; stage 2: 2 weeks later 2 Gy x 5 fractions per week to the primary focus up to TED 60-65 Gy) with IV administration of 40 mg of Taxotere 24 hours before the treatment. Comparative analysis was done with the groups of similar age and disease stage: 50 patients who were administered accelerated radiotherapy without Taxotere (group 2) and 25 patients who were administered traditional radiation therapy. Immediate and long-term results as well as radiation reactions during the treatment were assessed.
Results: The planned volume of treatment was administered to all patients. The analysis of tolerance showed that moderate (52 % and 53.3 % , respectively), and severe (18% and 22 %) radiation reactions were more frequent in the groups with accelerated mode, including that with chemomodification, when compared with the traditional treatment (32.4%). The most frequent local radiation reactions were pulmonitis, which were more severe in groups 1 and 2 when compared with group 3. More frequent primary focus regression was observed in groups 1 and 2 when compared with group 3 (87% and 72% vs 48%). The study of the primary tumor regression depending on the microstructure demonstrated that in patients with adenocarcinoma from group 1, radiochemomodif i-cation was more effective then in RT without chemomodification (79 % in group 1 vs 36% in group 2 and 25 % in group 3). The analysis of long-term results revealed significant advantages of radiochemomodicication in NSCLC patients with stage IIIA and IIIB disease (N1-0): 1 and 2-year survival was 65.4 ± 8.8% and 4.1 ±9% vs30± 7.4% and 15.3 ±5.9% in group 2, 24.4 ± 7.4% and 12.4 ± 5.9% in group 3 with survival median 16.3, 8.3, 6.5 months, respectively.
Conclusion: Better immediate and long-term results of NSCLC treatment allow to recommend accelerated mode with chemomodification for practical use if adequate accompanying therapy is used. Taxotere administration significantly increases RT efficacy in patients with morphological variant of adenocarcinoma.
Key words: non-small-cell lung cancer, radiochemomodifi-cation.
2005, vol 13, # 2, page 162
N.А. Nikiforova, P.P. Sorochan, S.І. Revenkova, І.P. Moskalenko, О.М. Suhina, О.V. Kuzmenko, О.А. Nemalcova
Hematoimmunological state of patients with inoperable cervical cancer undergoing multimodality treatment
Annotation
Objective: To study the influence of multimodality radiochemo-therapy depending on the time of day on the parameters of hemo-and immunopoiesis in patients with local cervical cancer.
Material and Methods: Hematological parameters and immunity state were studied in 53 patients with inoperable cervical cancer (T2b-4a N0-1 M0) undergoing radiochemotherapy. The patients were administered multimodality treatment (5-fluoro-uracil) with 12-hour infusions from 12 a.m. to 12 p.m. (group 1) or from 6 p.m. to 6 a.m. (group 2) followed by distant gamma-irradiation of the small pelvis 8 hours later (single focal dose of 4 Gy 2 times a week, mean focal dose of 32 Gy + 8 g 5-fluorouracil). Intracavitary irradiation was delivered using AGAT-B unit 2 times a week, (single focal dose in A/B 5/1.25 Gy, mean focal dose in A/B 50-55/12.50-13.75 Gy). Hematological and immunological studies were done before and at the end of the course of treatment.
Results: Simultaneous administration of prolonged 5FU infusions from 6 p.m. to 6 a.m. and multimodality treatment were shown to promote preservation of the physiological level of peripheral blood leukocytes and to be characterized by less pronounced degree of T-cell immunity inhibition.
Conclusion: As to the findings of hematoimmunological investigations of inoperable cervical cancer patients, it is reasonable to use prolonged 5-FU infusions during chemoradiation treatment from 6 p.m. to 6 a.m. with the purpose to minimize the complications in the homeostasis system.
Key words: cervical cancer, chemoradiation therapy, immune system, chronotherapy.
2005, vol 13, # 2, page 168
Т.P. Yakimova
Immunomorphological characteristics of breast cancer at radiotherapy
Annotation
Objective: To compare the morphological characteristics of the tumors depending on expression of blood lymphocyte apoptosis receptors, which are responsible for anti-tumor immunity.
Material and Methods: Comparative morphological study involved 71 patients with stage I-III breast cancer (ВС) before and after radiation therapy with large fractions. In addition, the data of radiation pathomorphism were compared with the presence or absence of apoptosis receptors on the blood lymphocytes revealed using immunoenzyme method.
Results: Inhibition of prolif erative properties of the tumor and activation of histiocyte reactivity of sinuses of the lymph nodes under the influence of radiation therapy with large fractions was established. The presence of apoptosis receptors on the blood lymphocytes reduced the effect of radiation therapy and affected the degree of tumor dissemination.
Conclusion: Pre-operative radiation therapy with large fractions is an effective anti-tumor remedy, which reduced biological properties of the tumor. Apoptosis in ВС regression is inconsiderable but the presence of apoptosis receptors on the peripheral blood lymphocytes considerably reduces radioresistance of the tumor and inhibits the organism resistance, with is responsible for more frequent tumor metastasizing to the regional nodes.
Key words: breast cancer, apoptosis, radiation pathomorphism, CD95 receptors of blood lymphocytes.
2005, vol 13, # 2, page 172
О.М. Kovalenko, В.А. Tuguchov
The changes in hormonal regulation of bone tissue formation and resorption in those who survived acute radiation sicKness. Communication 1
Annotation
Objective: To analyze the changes in hormonal regulation of formation and resorption of the bone tissue in men who survived acute radiation sickness (ARS) due to Chornobyl accident immediately after the accident (1987-1992).
Material and Methods: The study involved the participants of the Chornobyl accident clean-up aged 21-49 at the time of the accident. The absorbed dose ranged within 0.5—7.1 Gy. The subjects were divided into three groups: 1) persons with absorbed dose of 0.5-1 Gy; 2) those who survived grade 1 ARS; 3) grade 2-3 ARS. Basal blood concentration of testosterone, somatotropin, C-peptide, cortisol, thyroxin, triiodothyronine were studied in 1987,1988-1989,1991-1992; those of parathyrin and calcitonin (CT) were studied in 1988-1989 in the participants of the clean up with doses 0.5-1 Gy.
Results: Among the hormonal shifts delaying bone formation, reduction of basal blood concentration of testosterone and stable increase of cortisol level were noted, while basal secretion of parathyrin, moderate reduction of thyroxin, triiodothyronine and significant increase of basal concentration of calcitonin were noted, which can be considered a compensation reaction of hormone regulation system aimed at preservation of mineral bone density, inhibition of its resorption and collagen decomposition. Basal concentrations of somatotropin and C-peptide did not differ from those in healthy subjects.
Conclusion: Systemic hormonal shifts, which can influence the processes of formation and resorption of the bone tissue in the direction of osteopenic syndrome development, were observed in the participants of the Chornobyl accident clean-up with a high absorbed dose in 1987-1992.
Key words: participants of Chornobyl accident clean-up, acute radiation sickness, hormonal regulation, osteopenic syndrome.
2005, vol 13, # 2, page 176
L.V. Bilogurova, S.М. Pushkar
The state of hemostasis system coagulation NnK in breast cancer at application of two protocols of multimodality treatment
Annotation
Objective: To study the character of the changes in hemostasis system coagulation link in patients with breast cancer (ВС) depending on application of two protocols of multimodality treatment.
Material and Methods: The study involved 48 women with ВС aged 38-65, who were divided into two groups depending on the used protocols of multimodality treatment. The study was performed before, at the end of radiation therapy, after radical mastectomy as well as after the course of post-operative radiation therapy.
The state of hemostasis system was studied using electrocoa-gulography with the consideration of most important structural chronometric parameters of electrocoagulogram. Total f ibrinolytic activity of the blood and presence of paracoagulation processes were determined using biochemical methods.
Statistical processing of the findings was done using Statistica software.
Results: The analysis of the obtained findings showed that before the multimodality antitumor treatment all patients had marked disorders in hemostasis system. In 68.75% of the patients, hypercoagulation phenomena were present, they consisted in 2-fold reduction of the time of fibrin clot formation, high frequency of soluble fibrin-monomer complexes (SFMC), 77.8% , which suggested presence of paracoagulation and danger of DIC syndrome. In the rest, hypocoagulation against a background of increased f ibrinolytic activity at high (up to 42.8%) occurrence of SFMC was noted. Preoperative RT promoted normalization of coagulation homeostasis both in patients with increased and decreased hemo-static potential. But the signs of DIC syndrome development persisted. Radical mastectomy in group 1 did not produce any considerable changes in the state of homeostasis system. In group 2 radical removal of the tumor did not influence the initial hypercoagulation tendency of hemostatic potential of the blood. Second RT course in group 1 promoted further normalizing of coagulation link in homeostasis system. Reduction of hypercoagulation degree was observed after post-operative RT in group 2 but SFMC and fibrin degradation products (FDP) were detected in the blood of the patients of the both groups.
Conclusion: The obtained findings suggest that the protocol including pre- and post-operative RT produces more positive effect on the state of homeostasis system. But the conditions for throm-boembolytic complication persist during the whole period, which requires correcting therapy with the drugs preventing and restoring coagulation and vascular-thrombocyte links disorders.
Key words: breast cancer, coagulation hemostasis, fibrinolytic activity, hypercoagulation, hypocoagulation, DIC syndrome, pre-and post-operative radiation therapy.
2005, vol 13, # 2, page 184
N.A. Klimenko, M.I. Onyshchenko
p-53 expression in cells of chronic inflammatory focus at total low dose-rate y-irradiation
Annotation
Purpose: To study dose dependence of p53 expression in various types of inflammatory cells at total low-dose y-irradiation.
Material and Methods: The study was performed on 96 male Wistar rats. Chronic inflammation was induced by injection of carrageenan solution into previously prepared subcutaneous air pouch. Irradiation was performed by day 3 and 7 of inflammation at doses of 0.1,0.5,1.0 Gy, dose-rate 20mGy/h. p53 expression was estimated with immunohistochemical assay in macrophages, lymphocytes, and fibroblasts.
Results: p53 is expressed in the inflammatory cells even without irradiation, probably, as a response to the DNA damage by mediators of inflammation or for cleansing of the inflammatory focus from cells, which completed their function, by apoptosis; p53 expression increased with the dose of y-radiation in all investigated types of inflammatory cells at all used terms of inflammation; the dose 0.1 Gy did not lead to statistically significant changes of p53 expression intensity in comparison to controls for all cell types at all terms of inflammation.
Conclusion: The low value of p53 expression at dose 0.1 Gy shows obtained in this study low level of oncogen suppression activity in respect of high proliferation and peroxidation activity in the inflammatory focus at the same dose. Thus, it can be supposed, that oncogenous potential of chronic inflammation can be realized to the most at irradiation with dose 0.1 Gy.
Key words: chronic inflammation, low-dose y-radiation, p53 expression.
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