COMPLEX TREATMENT OF RESECTABLE GASTRIC CANCER BY USING INTRAOPERATIVE CHEMOTHERAPY WITH OZONIZED MEDIA

O.I. KITH, S.A. ILCHENKO, N.V. SOLDATKINA, A.V. DASHKOV

Rostov Scientific and Research Oncology Institute, Rostov-on-Don , RUSSIA

Introduction. The main method of treatment of gastric cancer is surgical (Davidov M.I, et al., 2001), but efficacy is approximately 30-40% (Gantsev Sh.Kh., 2006). To improve the results of treatment, methods of comprehensive treatment, limited by the resistance of the tumor, are developed (Skoropad V.Y., 2009). Therefore, the method injection and delivery of chemical drugs to the tumor (Tryakin A.A., 2009), the application of such various modulators (Tyulyandin S.A., 2001), as ozone therapy, become more important. The action of ozone therapy is associated with the development of free radical processes, the formation of active forms of oxygen (Ryabov S.V., Boyarinov G.A., 2000).

Purpose. To improve results of treatment of patients with resectable gastric cancer by the application of intraoperative chemotherapy with ozonized media.

Materials and methods. Information about 40 patients with gastric cancer T3-4N0-2M0 was analyed. 20% of patients were at the age under 50 years, 80% - over 50 years. Adenocarcinoma of various degrees of differentiation was morphologically found in all patients. 20 patients (the main group) were conducted complex treatment, including gastrectomy and chemotherapy with ozonized media. 20 patients (control group) were conducted courses of standard intravenous chemotherapy. For the conduct of complex treatment with the application of chemotherapy with ozonized media,

100 ml of ozonated (400 mg / l) autoblood, 1000 mg/m2 of 5-fluorouracil, 100 mg/m2 of leucovorin, 100 mg/m2 of oxaliplatin dose with 50 ml of ozonized (1000 mg / l) of physiologic saline were intravenously injected intraoperatively into the left gastric artery, after 30 min of exposure of the chemical drug there was performed gastrectomy in the ffected organ.

Results and discussions. Patients of the both groups are observed within 1-12 months. Within th follow-up in patients of the primary group no cases of recurrence and distant metastases were revealed. In the control group of patients - progression of the disease (metastases into liver, peritoneum, ascites) was revealed.

Conclusions. Complex treatment with the application of intra-operative chemotherapy with ozonized media improves the results of treatment of patients with resectable gastric cancer.

THE USEFULNESS OF ULCER SIZE AND LOCATION IN THE DIFFERENTIAL DIAGNOSIS OF BENIGN AND MALIGNANT GASTRIC ULCER

E. KOCHAK, F. KILICH, E. AKBAL, A. TASH, S. KOKLU, L. FILIK, İ.BIYIKOĞLU

Ankara Education and Research Hospital, Ankara, TURKEY

Background: Gastric cancer can present as a gastric ulcer, which can mimic a benign gastric ulcer. There has been some evidence that gastric ulcer is associated with an increased risk of gastric cancer. Up to now, the important period for endoscopic follow-up of gastric ulcers has not been clear. For some patients with gastric ulcer, histopathological examination can sometimes give inaccurate results and they should undergo repeat gastroscopy to assess ulcer healing. In this study we aimed to investigate the value of gastric ulcer size and location in the differential diagnosis of benign and malignant gastric ulcers.

Materials and Methods: We reviewed retrospectively the upper endoscopic findings of 14,400 patients between April 2008 and March 2010. 276 patients with gastric ulcers were divided into two groups according to histopathological examination. The benign gastric ulcer group consisted of 178 patients and the malignant gastric ulcer group consisted of 78 patients. Ulcer location, size, age and gender were compared between the two groups. The diameter of the ulcer was measured by placing the opened biopsy forceps (7 mm) beside the ulcer.

Results: The study included 137 female and 139 male patients, with a mean age of 58.1±15.5 years. The malignant ulcer group was significantly older than the benign ulcer group (p< 0.005). While the male gender was predominant in the malignant ulcer group, the female gender was predominant in the benign ulcer group. The predominant region of ulcer location was the corpus for the malignant ulcer group and the antrum for the benign ulcer group. The malignant ulcer ratios according to region in the whole group were, respectively, cardia 19 ulcers with 14 malignant (73.68 %), corpus 70 ulcers with 38 malignant (54.2 %), angulus 45 ulcers with 6 malignant (13.3 %) and antrum 142 ulcers with 20 malignant (14.8 %). The median size of ulcers was significantly higher in the malignant ulcer group compared with the benign ulcer group (60 mm and 10 mm, p < 0.001, respectively). The median sizes of benign and malignant gastric ulcers were antrum 7 mm and 60 mm (p<0.001), angulus 10 mm and 50 mm (p<0.003), corpus 10 mm and 60 mm (p<0.001), and cardia 15 mm and 60 mm (p<0.005), respectively.

Conclusion: These results suggest that the location and diameter of gastric ulcers may be used as a marker of risk factors for developing gastric cancer. Therefore, the endoscopist should evaluate the gastric ulcer very carefully, especially in the cardia and corpus and when greater than 1 cm in diameter. On the other hand, repeat endoscopic examination may not be necessary to evaluate benign gastric ulcers under 1 cm in diameter in the distal part of the stomach.

FREQUENCY OF DETECTION OF H. PYLORI IN PATIENTS WITH DISEASES OF GASTROENTEROLOGICAL PROFILE

V.Y. KOVAL, E.Y. ARKHIY

Uzhgorod National University, Medical Faculty, Uzhgorod, UKRAINE

Introduction According to data of epidemiological studies, helicobacteriosis is one of the most spread chronic infections, the carrier of which is almost every other person. About 80-90% of gastritises and gastric ulcers and duodenal ulcers are caused by Helicobacter pylori. If the role of Helicobacter pylori in the etiology and pathogenesis of gastric and duodenal diseases is sufficiently studied, then in pancreatic diseases these data is ambiguous.

The aim of this study was to analyze H. pylori contamination in patients with gastric, duodenal and pancreatic diseases.

Materials and methods of the study We examined 287 patients (149 women, 138 men) who were treated at the Regional Clinical Hospital of Uzhgorod named after A. Novak. Among the examined - 61 patients for chronic erosive gastroduodenitis, of which 17 patients with rheumatological profile, 76 patients for chronic gastroduodenitis with symptoms of atrophic gastropathy, 18 patients with duodenal ulcer disease, 9 patients with gastric ulcer and 124 patients with chronic pancreatitis. The diagnosis was set according to clinical criteria, data of biochemical blood tests, esophagogastroduodenoscopy with target biopsy, pH - metry and ultrasound examination the organs of abdominal cavity. Presence of Ag Helicobacter pylori in faeces by means of Cer Test Biotec SL test0systems (Spain) was determined in all patients by immunochromatographic method.

Results of the study The presence of Helicobacter pylori was determined in 70.45% of patients with chronic erosive gastroduodenitis, 76.47% of patients with rheumatological profile with presence of gastric anamnesis. In patients with gastric ulcer and duodenal ulcer, 100% presence of Helicobacter pylori was found. During the study of 124 patients with chronic pancreatitis helicobacterial infection with the presence of erosive and erythematous gastropathy was revealed in 66.12% of patients.

Conclusion In case of gastric anamnesis Helicobacter pylori shall be determined not only in gastric ulcer and duodenal ulcer, but also in patients with rheumatological profile, as well as chronic pancreatitis, as it allows adequate treatment of patients and reduction of the probability of possible complications.

Date: 2014-12-28; view: 1004