ORIGINAL ARTICLES
The study of diagnostic efficiency of intraoperative fluorescence diagnosis (IOFD) of peritoneal dissemination in patients with gastric cancer comparing with standard laparoscopy was performed in P.A. Hertsen MCRI (the branch of NMRRC). The study included 114 patients with verified diagnosis of gastric cancer stage III–IV. For IOFD the domestic medication alasens (the active agent – 5-aminolevulinic acid) was used orally at dose of 30 mg/kg body weight 3 h prior to the study procedure. As the result of fluorescence diagnosis 10 (6.9%) patients had peritoneal tumor dissemination verified morphologically and undetected by standard laporoscopy. The sensitivity of peritoneal revision for standard laparoscopy in patients with gastric cancer stage III–IV was 60.8%, the specificity – 75.8%, the overall accuracy – 69.1%. The sensitivity for IOFD in patients with gastric cancer stage III–IV was 91.1%, the specificity – 93.9%, the overall accuracy – 92.7%. Thus, fluorescence study allowed improving the specificity, the sensitivity and the overall accuracy of diagnostic test. In the trial IOFD had the maximal diagnostic value in patients with visually undetectable microdissemination in «whight» light and with solitary visible peritoneal foci (the average number of additionally detected metastatic lesions in one patient – 1.22 and 1.4, respectively). Moreover, in the case of fluorescence diagnosis the number of detected microfoci of peritoneal dissemination was showed to increase with enlargement of area of tumor invasion to gastric serosa (at average of 2.29 additionally detected lesions in one patient with serosal invasion more than 2 cm2). The obtained results confirm the perspective of use of fluorescence diagnosis for detection of peritoneal dissemination, determination of true tumor extent, staging of the tumor and also for adjustment of following treatment tactics for this group of patients.
The results of a study on the effectiveness of photodynamic therapy with a photosensitizer fotoditazin and cryotherapy for actinic keratosis are represented in the article. The study included 80 patients with 215 lesions, among them erythematous form of actinic keratosis was diagnosed in 151 (70.2%) cases, hyperkeratotic form – in 46 (21.4%) cases, a pigmented form – in 12 (5.6%) and an atypical variant of the disease – in 6 (2.8%) cases. According to histological type the distribution of tumor was as follows: 19 (54.3%) cases were diagnosed as hypertrophic type, 6 (17.1%) – atrophic, 8 (22.9%) – bowenoid and 2 (5.7% ) – pigmented type. Patients from the study group received one session of photodynamic therapy using laser unit "LAMI" (662 nm) after 2 hours of application of fotoditazin 0.5% gel at dose of 0,2-0,3 ml per 1 cm2 of actinic keratosis focus with the following parameters: the energy density of the laser radiation – 200 J/cm2, power density – 0.14–0.48 W/cm2. In the control group patients underwent cryotherapy with liquid nitrogen with an exposure of 30-60 sec. The comparative analysis of the immediate results showed a tendency for the efficacy of photodynamic therapy to increase (the rate of complete regression was 92.5%) compared with cryotherapy (85.0%) (p>0,05). There were also a tendency for long-term results after photodynamic therapy to improve: three-year recurrence-free survival was 94.6% and 88.2%, respectively. For the photodynamic therapy there were significantly fewer adverse reactions, the epithelization time in lesions was significantly shorter. Compared with cryotherapy the photodynamic therapy provided significantly better cosmetic results (p <0.01), and can be used for out-patient treatment of patients with actinic keratosis.><0.01) and can be used for out-patient treatment of patients with actinic keratosis.
LITERATURE REVIEWS
In this review, based on more than 70 articles of Russian and foreign authors, methods of skin engraftment monitoring are discussed. Main processes occurring in skin on cellular and subcellular levels at different stages of engraftment are considered. Optical methods which allow performing non-invasive analysis of blood vessels, collagen concentration and form of cellular respiration (by NADH fluorescence) are described. Comparative analysis of nuclear and optical methods for engraftment monitoring highly developed and widespread nowadays is presented. The advantages of optical methods includes multifunctionality, usability and clarity of results, safety and low cost. In contrast to X-ray CT, MRI and ultrasound, optical methods can be used in monitoring mode. One of the promising directions for improving quality of engraftment due to antibacterial effect, photodynamic therapy, is described in details. The use of crystalline organic nanophotosensitizers (particularly aluminum phthalocyanine) is shown to be the most promising. The main distinctive feature of its application is that nanoparticles injected into wound surface or contact area of tissue graft are not photoactive until the moment the inflammation starts. The development of method for assessing skin condition by spectroscopic properties of tissue components (using fluorescent dyes and photosensitizers in molecular and nanoforms), which allows analyzing physiological state of skin (degree and rate of engraftment or rejection) and controlling certain biochemical and physiological parameters of a tissue graft or an entire area of affected skin is shown to be crucial.
CASE-REPORTS
The results of treatment of the patient with verrucous luekoplakia of mucous membrane of body of the tongue with photodynamic therapy are represented. In 2015 the patient underwent 4 courses of photodynamic therapy with photosensitizer photolon. Photolon was injected at dose of 2 mg/kg 3 h before irradiation (laser output power was 0.262 W, light dose – 50 and 100 J/cm2). The result of treatment was assessed as complete regression: 4 months after multiple-course photodynamic therapy there were no clinical and histological signs of luekoplakia.
