Biomedical subjects
Publications and source records attributed to V B Matveev.
Correction of hormonal, immune, interferon, and antioxidant status and genetic abnormalities with a complex phytoadaptogen leads to positive clinical effects in elderly patients with benign prostatic hyperplasia.
Renal angiomyolipomas (AMLs) are benign renal tumors that may possess the features of a malignant neoplasm, such as local and vascular invasion. We describe the diagnosis and management of a rare case of AML associated with tumor thrombus extending into the right atrium.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Renal angiomyolipomas (AML) are the most common benign renal tumors. Although AML have a characteristic CT and ultrasound features, a differential diagnosis from other lipomatous tumors and renal cell carcinoma is not always possible. We present four cases of the most unusual radiological appearance of AML. Diagnostic difficulties arise in predominantly myocomponent lesions, in AML with haemorrhagic complications, in aggressive behavior of AML and coexisting renal cell carcinoma. When the diagnosis is equivocal, a fine needle aspiration biopsy is indicated. An accurate preoperative diagnosis of AML allows to avoid undesired nephrectomy and to perform preserving renal surgery in selected patients.
The postoperative outcome and survival were studied in patients operated for renal cancer with involvement of the liver. 9 patients have undergone radical nephrectomy and 12 patients--hepatic resections for direct hepatic involvement (2), synchronous (2) and metachronous (8) metastases of renal cell carcinoma. Right hemihepatectomy was performed in 2 and wedge resection in 10 cases. A complete resection was performed in 8 of 9 patients while one patient with direct hepatic invasion was found to have positive surgical margins. Postoperative lethality was absent but complications occurred in 6 patients: pancreatitis (1), pneumonia (3), hepatic abscess (1), hepatic and renal failure followed by GI bleeding (1). At follow-up, two patients died of progressive disease 4 and 68 months after the surgery and one was lost for follow-up. One patient with positive surgical margins is alive with pulmonary and liver metastases 16 months after surgery. Five patients are alive with no evidence of relapse 6, 10, 12, 19 and 56 months after the operation. Thus, the aggressive surgical approach is justified and should be considered in patients with renal cancer and hepatic involvement.
We analysed case records of 2507 patients with renal cell carcinoma treated in the department of onco-urology of Cancer Research Center (Moscow). 1939 of them underwent nephrectomy between 1971 and 1999. The overall incidence of adrenal metastases according to CT and histological findings was 4.7%. Synchronous metastases occurred in 90 and metachronous ones in 30 patients. Radical nephrectomy with adrenalectomy was performed in 18 out of 90 patients with synchronous metastases, palliative nephrectomy in 20 and 52 patients were not considered for surgery. Among 18 patients who underwent complete surgical resection, 12(66%) had either lymph node involvement or distant metastases. A microscopic metastasis was found on histological examination only in 1 patient with normal CT scan and macroscopically intact adrenal on intraoperative assessment. Mean survival after radical nephrectomy with adrenalectomy in 6 patients with solitary lesions was 57 months compared to the longest survival of 31 months in patients with widespread disease. Solitary metachronous ipsilateral and contralateral adrenal involvement was present in 7 patients. The average interval between nephrectomy and appearance of adrenal metastasis in this group was 73 months. One patient was lost for follow-up and one died of adrenal deficiency 4.3 months after adrenalectomy. One patient underwent a consecutive removal of brain and lung metastases 33 and 38 months following adrenalectomy while the remaining 4 were alive in 15, 16, 26 and 34 months with no evidence of the disease. Thus, ipsilateral adrenalectomy is obligatory only in patients with severe disease as shown by CT scan or at nephrectomy. About one-third of the patients will benefit from the surgery. Adrenalectomy should be performed in case of obvious adrenal involvement. The aggressive surgical approach is justified in solitary metachronous adrenal involvement because of long-term survival expected in some of such patients.
Whereas 25-57% of patients diagnosed with renal cell carcinoma (RCC) present with metastatic disease, about 50% of (RCC) patients develop metastases after potentially curative radical nephrectomy. Five-year survival at following surgical removal of solitary metastases is approximately 35-50%. Our experience demonstrate that a small cohort of patients benefit from aggressive surgical therapy for consequtively arising solitary distant metastases with long-term palliation.
Paratesticular rabdomyosarcoma (PR), the most frequently occurring paratesticular tumor, is encountered mostly in young and middle-aged men. PR metastasizes early and is characterized by lymphogenic dissemination of the tumor with affection of the retroperitoneal lymph nodes. Orchofuniculectomy is the first-line treatment in all the patients. If the patient is metastases-free it is followed by preventive retroperitoneal lymphadenectomy with subsequent adjuvant chemoradiotherapy. In disseminated PR, combined treatment is indicated including surgical removal of metastatic foci and adjuvant chemo- or chemoradiotherapy. If surgical removal of all the tumor foci is infeasible, patients with disseminated PR undergo chemotherapy. Radiation of metastatic retroperitoneal lymph nodes is uneffective. Prognosis of PR depends on the age, stage of the disease and treatment.
Conservative penis-salvage treatment provides a complete local effect in 55% cases, preservation of the penis in 51.4% patients without a fall in long-term specific and recurrence-free survival compared to penectomy and can be recommended as an alternative to penis amputation in patients with stages Tis-T2. Removal of a penile tumor raises efficacy of salvage treatment and insignificantly increases survival. Application of surgical treatment only is associated with a high rate of local recurrences. Chemoradiotherapy in penile cancer is significantly more effective vs each method alone. Radiation in a total focal dose more than 60 Gy improves local control over the tumor. Most effective are schemes of chemotherapy based on bleomycin. Polychemotherapy has no advantages over monochemotherapy with bleomycine.
Emergence of regional penile cancer (PC) metastases reduces late survival of PC patients from 94.4 to 83.9%. PC stage can hardly be diagnosed by clinical data significantly. Bilateral inguinal lymphadenectomy is indicated for all PC patients with enlarged and clinically negative regional lymph nodes in poorly differentiated primary tumor (G3) and stages T2-3. Follow-up can be recommended for patients with stage Tis-T1, low and moderate anaplasia (G1-2) of the primary tumor. Metastases to the iliac lymph nodes are an indication to pelvic lymphadenectomy. Preventive removal of the iliac lymph nodes in intact inguinal ones is not justified. Unremovable fixed regional lymph nodes should be exposed to radiotherapy.
10 normal prostates and 100 prostates with tumour were studied immunohistochemically. ACT was found mainly in the cells lining the ducts. Synthesis of ACT is significantly increased in carcinoma due to mainly two parallel processes: ACT production by carcinoma cells and intensification of its production by normal cells mainly at the tumour periphery. Hyperplastic structures showed not very high ACT content, adenomatous structures revealed a higher response. On the whole, there is a parallelism between the content of ACT and prostatic specific antigen (PSA) in both normal and carcinomatous prostate, however PSA is being found in a much more wider spectrum of cells. Content of ACT in seminal fluid may be used as a parameter for diagnosis and monitoring of prostate cancer.
Cystectomy in the treatment of invasive cancer of the urinary bladder is not the only therapeutic modality in this pathology. In selected patients an alternative exists--transurethral resection of the urinary bladder followed by adjuvant concurrent chemotherapy and radiotherapy. The preserving therapy can be recommended to patients over 60 years of age in the presence of a low-grade solitary tumor of a mobile wall of the urinary bladder respectable with preservation of the organ capacity.
29 cases of angiomyolipoma (AML) reported in the paper illustrate clinical pictures and difficulties in this disease diagnosis. It is shown that when AML overgrows 5 cm in size it often provokes pain (13 cases), which ranks the first among AML symptoms. Ultrasonic differential diagnosis is not easy in large bleeding AML, in extrarenal AML location, whereas well and poorly vascularized tumors, the absence in them of clear-cut spiral arteries or aneurysm-like cavities cause much trouble for AML angiographic diagnosis. For the above causes computed tomography is also likely to provide misdiagnosis. A comprehensive approach to AML preoperative diagnosis brings about satisfactory results in 80% of the cases.
Renal oncocytoma clinical manifestations, diagnosis and treatment results are illustrated on 8 patients treated within 1988-1993. Two patients with the tumor diameter exceeding 10 cm had oncocytoma-specific angiographic and CT pictures featuring a wheel with spokes. Seven and one patients underwent nephrectomy and renal resection, respectively. At 8-84-month follow-up all the patients were alive. The absence of the recurrences and metastases confirms benign nature of renal oncocytoma. However, malignant potential of this tumor and difficulties in its preoperative diagnosis dictate preference of surgical approach to treatment of oncocytoma.
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