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Year 2007 Vol. 15 No 1

HISTORY OF SURGERY

PAVLOV A.G.

SURGERY DEVELOPMENT IN MOGILEV REGION AT THE END OF THE 18TH – BEGINNING OF THE 20TH CENTURY

Surgery service in Mogilev region during one and a half centuries period has been gradually developing starting from the Rzhech Pospolita allotment and the Byelorussian Lands entry into Russia and till the Soviet period. Several historical and social factors, such as Patriotic War of 1812, a number of rebellions and the national culture repression in the middle of the 19th century have caused the prolonged delay of the surgical service formation in Mogilev region. Medical Society established by the Mogilev doctors has become the centre of the medical knowledge gaining since the middle of the 19th century. At the same time great discoveries in the field of medicine and the development of the international relations have enabled the enthusiastic surgeons of Mogilev to master more complicated surgical interventions and to provide skilled medical care despite the administrative delays.

Keywords: surgery, surgical aid organization, doctors’ society, governor and uyezd hospitals.
p. 2 - 7 of the original issue
References
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  7. Доклады Губернской земской управы по медицинскому отделу. – Могилев: Типолитография Я. Н. Подземского, 1915. .

ORIGINAL INVESTIGATIONS

LYZIKOV A.N., NADYROV E.A., BERESCHENKO V.V.

CYTOLOGICAL MARKERS OF THE INFECTED WOUNDS REGENERATION IN USING ANOLYTE NEUTRAL SOLUTION

Analysis of 98 patients’ treatment with the infected wounds in application of anolyte neutral solution (AN) which has been obtained on the second generation device «Aquamed» and 59 patients’ treatment in usage of traditional antiseptic therapy has been performed. Treatment methods of the infected wounds by means of AN solution with oxidizing-restoration potential from +890 to 925 mW and chlorine concentration 0.02-0.4% have been suggested. Statistically significant inverse correlation dependence of neutrophilic (p=0.001), phagocytosing (p=0.011) and degenerating (p=0.026) neutrophilic leucocytes in local AN solution application has been found out; that testifies to inflammatory processes decrease. In the experimental patients direct correlation links between cellular elements of regenerating wounds, duration of treatment and percentage of fibrocytes and fibroblasts (p=0.001) have been detected; that indicates to the regeneration process stimulation. Average duration of the experimental group treatment has comprised 9.47 days; the control group treatment – 13.65 days.

Keywords: surgery infection, cytology, anolyte neutral.
p. 8 - 13 of the original issue
References
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BATYUK V. I.

INCREASE OF ORGANISM RESISTANCE TO THE TRAUMATIC SHOCK

Studying of the traumatic shock is rather an actual aspect in modern medical science as shock is registered in 90-95% of patients with the associative trauma. Social significance of this problem is disputable as well, since the mortality rate in the result of a trauma takes the leading place among people at the capable of working age. Numerous experimental researches of native land and foreign scientists have allowed understanding of pathophysiological processes which take place in case of shock; it permits to reveal the ways of the given pathology intensive therapy. However, high lethality rate (20-30%) in case of the traumatic shock gives enough ground for further research in this field. Clinical, laboratory, morphologic changes that occurred in the laboratory animals in case of the traumatic shock stimulation according to Nobl-Kollip are shown in the article; and usage effectiveness of such preparations as mexidol and kreatinphosphat in the intensive shock therapy complex has been proved.

Keywords: traumatic shok, metabolic disturbance, morphologic changes, intensive therapy.
p. 14 - 19 of the original issue
References
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PETUKHOV V.I.

THE VENOUS WALL CHARACTER AND SCLEROSING PREPARATION CONCENTRATION IN CASE OF VARICOSE VEINS SCLEROTHERAPY

Phlebosclerosing therapy is an efficient, safe, mini-invasive, non-stationary method of the of the lower limbs varicosity treatment. At the same time phlebosclerosing therapy isn’t the universal way of treatment; its application should be strictly limited taking into account the character of the pathological process, the revealed peculiarities of the morphologic construction of the venous wall and the functional manifestations of the disease. While applying phlebosclerosing therapy of the lower limbs varicosity, a significant factor affecting its results is the character of the venous wall. The morphological investigations of the venous wall in case of various degrees of the venous wall affection have been performed. The presence of four types of the lower limbs varicosity according to the venous wall character («organdy», «soft», «dense», «groove») has been proved; it is rather essential for the choice of the concentration of phlebosclerosing medication in application of phlebosclerosing therapy and determination of the indications to other types of treatment of the lower limbs varicosity. The researches which have been carried out let distinguish the morphological types of the venous wall and their clinical signs, usage of which improves the results of phlebosclerosing therapy significantly.

Keywords: sclerotherapy of varicose veins, results.
p. 20 - 25 of the original issue
References
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  4. Флебология / В. С. Савельев - Гологорский.[ и др.]. – М.: Медицина, 2001. – 664 с.: ил.
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PROBLEMS OF SURGICAL HELP ARRANGEMENT

DEYKALO V.P., BOLOBOSHKO K.B.

THE STRUCTURE OF TRAUMA AND KNEE JOINT DISEASES

Frequency and structure evaluation of traumas and degenerative-dystrophic knee joint diseases has been performed by the authors on the basis of data analysis of the specialized trauma-orthopedic units of the in-patients departments during the period from 1996 till 2005. It has been found out that among the in-patients of the trauma-orthopedic type, the knee joint pathology patients make up a considerable part (15%); they are characterized by pathology variety and demand modern operative equipment application for highly-skilled medical aid. Predominance of the patients at the capable of working age has been detected. Meniscus ruptures prevail among the traumas and gonarthrosis – among the diseases. Significant number of the patients with degenerative-dystrophic pathologies of the joint cartilage (gonarthrosis, chondropathy, Konig disease) causes necessity of further studying of this problem aimed to improve the treatment methods and the program of individual medical rehabilitation optimization.

Keywords: knee joint, trauma, gonarthrosis, chondropathy, Konig disease.
p. 26 - 31 of the original issue
References
  1. Бахтиозин, Ф. Ш. Повреждение менисков коленного сустава / Ф. Ш. Бахтиозин. – Казань: изд-во Казанского университета, 1990. – 128 с.
  2. Дейкало, В. П. Использование МКБ-10 в травматологии: методические указания / В. П. Дейкало. – Минск, 2001. – 196 с.
  3. Жарко, В. И. Состояние здоровья населения Республики Беларусь и стратегия развития здравоохранения / В. И. Жарко, В. З. Черепков, А. К. Цыбин // Здравоохранение. – 2007. – №1. – С. 4-13.
  4. Bollen, S. Epidemiology of knee injuries: diagnosis and triage / S.Bollen // The British Journal of Sports Medicine. – 2000. – Vol.34. – P. 227-228.
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  6. Myasaka, K. C. The incidence of knee ligament injuries in the general population / K. C. Myasaka [et al.] // Am. J. Knee Surg. – 1991. – №4. – P. 3–7.
  7. Szabo, R. M. Principles of epidemiology for the orthopaedic surgeon. Current concepts review / R..M. Szabo // The Journal of Bone and Joint Surgery. – 1998. – Vol. 80-A, N 1. – P. 111-120.

SUSHKOV S.A., NEBYLITSIN YU. S.

IMPROVEMENT OF MEDICAL CARE POSSIBILITIES IN THE PATIENTS WITH LOWER LIMBS VEINS DISEASES

Questioning of 110 surgeons from all the republic regions has been carried out. Respondents have been suggested to answer the questions in order to get the idea about the tactic approaches used during the lower limb venous diseases treatment. Questionnaire includes the aspects of diagnostics, methods of operative and conservative treatment and patients’ rehabilitation. All the categories of surgeons who provide medical care to the patients with the lower limb venous system diseases have participated in this questioning. The obtained results have been subjected to analysis, on the basis of which some recommendations on the medical care improvement for this category of patients have been proposed. In addition to elaboration of rational, economically proved treatment plans for the patients with the lower limb varicose diseases and introduction of these plans into clinical practice, all-round activity aimed to increase the level of doctors’ training and modern equipment providing are really necessary in this field of surgery.

Keywords: varicose disease, varicose veins dilation, chronic venous insufficiency, acute thrombosis of deeply-seated veins.
p. 32 - 38 of the original issue
References
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MODERN DIAGNOSTICS AND THERAPY

GUREVICH N.A., LYZIKOV A.N., GUREVICH A.R.

NEW INFORMATION TECHNOLOGIES IN INTRA-OPERATIVE COMPLICATIONS PROPHYLAXIS OF LAPAROSCOPIC OPERATIONS IN THE ABDOMINAL ORGANS EMERGENT SURGERY

The paper presents the experience of the surgical operations with application of laparoscopic technology from November, 1993 till December 2005 in 3836 patients with an acute surgical pathology of the abdominal cavity organs. The first group includes 3604 patients who have undergone laparoscopy for diagnostic or medical purposes. Wide possibilities of laparoscopy in diagnosis and treatment of acute surgical diseases have been shown; at the same time the number of complications while performing emergent laparoscopy comprises from 2.2 to 9%; lethality rate – 0.1%.
Till now, the performed literature analysis of intra- and post-operative complications has been based only on the principles accepted in the open surgery. The given researches have been based on understanding the fact that maximally accurate reproduction of the operation process with its analysis has to become a new strategy to prevent and diagnose earlier the possible complications.
The second group is composed of 332 patients in whom laparoscopic operations have been performed by means of the hardware-software complex of remote control (HSC) connection. The given system is constructed on the basis of modern information technologies and unites the diagnostic and operational equipment which permits to receive efficiently the reliable information from the operating rooms; the registration devices and devices for data reflection; and also the computer technical devices. The authors consider the application of new information technologies in laparoscopic operations to be rather promising. The given method has allowed a significant decrease of intra-operative complications.

Keywords: laparoscopic operations, acute surgical pathology, hardware-software complex.
p. 39 - 52 of the original issue
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  15. Никитенко, А. И. Лапароскопическая аппендэктомия / А. И. Никитенко, А. М. Желаннов, А. А. Пузанков // Скорая медицинская помощь. – 2004. – Т. 5, №3. – С.43-44.
  16. Ничитайло, М. Е.. Хирургическая коррекция повреждений желчных протоков при лапароскопической холецистэктомии / М. Е. Ничитайло, А. Л. Скумс, И. П. Галочка // Анналы хирургической гепатологии. – 2003. – Т.8, №2. – С. 105 – 106.
  17. Руппель, Г. Г. Диагностическая лапароскопия при повреждениях живота / Г. Г. Руппель, А. М. Лазарь, С. А. Тарабарин // Хирургия. – 1997. – №6. – С.26-28.
  18. Совершенствование эндоскопических операций при остром аппендиците / В. П. Сажин [и др.] // Скорая медицинская помощь. – 2004. – Т. 5, №3. – С. 50-51.
  19. Сухопара, Ю. Н. Учебно-методические принципы подготовки по неотложной лапароскопической хирургии / Ю. Н. Сухопара // Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. – 1998. – Т.8, №5. – С. 211-212.
  20. Сухопара, Ю. Н. Основы неотложной лапароскопической хирургии / Ю. Н. Сухопара, Н. А. Майстренко, В. М. Тришин. – Санкт-Петербург, 2003.
  21. A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones. Lessons and limits from an initial experience of 92 patients / J. F. Gigot [et al.] // Surg.Endosc. – 1997. -Vol.11, N 7. – P .722-728.
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  23. Reiation between postoperative infections and gallbladder bile leakage during laparoscopic cholecystectomies / J. Diezy [et al.] // Surg. Endosc. – 1996. – Vol. 10, N 5. – P. 529-532.
  24. Katkhouda, N. Management of problems in laparoscopic surgery of the biliary tract / N. Katkhouda // Ann. Chir. Gynaecol. – 1994. – Vol. 83. – N 2. – P.93-99.
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SUSHKOV S.A., KUKHTENKOV P.A., KHMELNIKOV V.YA.

INITIAL EXPERIENCE OF LAYER DERMATOLIPECTOMY (SHAVE-THERAPY) IN CASE OF CHRONIC VENOUS INSUFFICIENCY TREATMENT

Till now treatment of the lower limbs chronic venous insufficiency with the marked trophic disturbances has remained rather problematic. It is not always possible to achieve trophic ulcer healing by means of the conservative methods, and the venous system intervention alone doesn’t permit to reach desirable results. In number of cases performing of plastic surgery is required. However, generally accepted methods of ulcer defect plastic removal appear to be ineffective. Taking into account this fact, possibility of layer dermatolipectomy (shave-therapy) application with the splitted graft autodermaplasty for this category of patients is of great interest.
25 patients who have undergone this surgery are included into the present research. The operation has always been combined with intervention on the superficial, perforated and deeply-seated veins.
The initial experience of layer dermatolipectomy application with the splitted graft autodermaplasty has shown that this method of treatment is rather effective in case of chronic venous insufficiency accompanied by the marked trophic disturbances. Application of this method permits to obtain positive results in the most complicated clinical situations.

Keywords: dermatolipectomy, chronic venous insufficiency, varicose vein dilation, post-thrombophlebitic disease, trophic ulcer.
p. 53 - 57 of the original issue
References
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  3. 3.Послойная дерматолипэктомия (shave¬-therapy) при длительно незаживающих венозных трофических язвах / В. Ю. Богачев [и др.] // Ангиология и сосудистая хирургия. – 2003. – Т. 9, N 4. – С. 65-70.
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  5. 5. Савельев, В. С. Венозные трофические язвы. Мифы и реальность / В. С. Савельев, А. И. Кириенко, В. Ю. Богачев // Флеболимфология. – 2000. – № 11. – С. 5-10.

GHABISHA SAIF ALI

COMBINED TREATMENT OF THE INTESTINAL ASCARIASIS AND THE LIVER HYDATID CYSTS SURGICAL COMPLICATIONS

Ascariasis and Hydatid disease (Echinococcus granulosus) are severe parasitogenic diseases. One-fourth of the whole world population is infected with ascariasis. Ascariasis and echinococcosis are widely spread in the Middle East, India, Africa, Northern America, New Zealand, Australia, Turkey and Northern Europe. The comparative analysis of the surgical complications of the abdominal organs parasitogenic diseases treatment in case of the intestinal ascariasis and the liver echinococcosis has been carried out in 166 patients being operated on during the time period from 2002 till 2005 at the surgical department of Al-Nasr Hospital, the town of Ibb, Yemen. According to the helminthiasis type, the patients were divided into 2 groups – 131 patients with various forms of the intestinal ascariasis, the biliary ducts ascariasis and the abdominal ascariasis; 34 patients with the liver echinococcosis cysts. In some patients the course of general Albendazol (in the Republic of Belarus it is certificated as mebendazol) chemotherapy was used together with surgical intervention.

Keywords: echinococcosis, ascariasis, surgical treatment, albendazol.
p. 58 - 63 of the original issue
References
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  14. Treatment of surgical complications of worms infection in humenbeings / Saif Ali Ahmed Ghabisha: рatent / Unimark Tarde&Intellectaul Property.

ZENKOV A.A., PUSHKOV I.E., SHUMEYKO I.A., LOYKO N.G., MYSHLENOK D.F., MIKHNEVICH A.V., VORONYAEV V.E.

SURGICAL TREATMENT OF THE PATIENTS WITH MULTIPLE ARTERY LESIONS OF AORTA-FEMORAL AND FEMORAL-POPLITEAL SEGMENTS

70 patients with multiple artery lesions of the lower limbs were operated on from 2004 till 2006 years at the department of thoracic and vascular surgery of Vitebsk regional hospital. Proximal reconstruction with revascularization of the deep femoral artery has only been performed in 32 cases (45,7%). One stage reconstruction of aorta-femoral and femoral-popliteal segmentshas been carried out in 38 cases (54,3%). The indications for the «two-floor» reconstructions of the lower limbs arteries were multiple lesions of aorta-femoral and femoral-popliteal segments with contra-indications for angioplasty and stent procedures. In the immediate postoperative period better results were achieved after one-stage «two-floor» reconstructions. Significant decreasing of functional ischemia class was achieved after «two-floor» reconstructions in comparison with revascularisation of DFA. In the immediate postoperative period the thrombosis rate of the proximal bypasses and limb loss rate were lower after «two-floor» operations (thrombosis rate comprises 9,38% and 2,63%, limb loss rate - 6,25% and 0%).

Keywords: numerous lesions of the lower limbs arteries, artery, aorta-femur segment, femur-subgenus segment.
p. 64 - 72 of the original issue
References
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KUBRAKOV K.M., VYKHRISTENKO K.S., PROTAS R.N.

DIFFERENTIAL DIAGNOSTIC CRITERIA OF THE BRAIN ABSCESSES AND INTRACRANIAL EMPYEMAS

Despite highly informative modern methods of investigation (magneto resonant tomography, x-ray computer tomography, cerebral angiography, etc.) as well as wide application of antibacterial drugs of the latest generation in neurosurgery practice, the problem of diagnosing and treatment of intracranial abscesses is still one of the most complicated problems in modern medicine [1,2,3,6,11]. Neurotraumatism increase and appearance of antibiotic-resistant microorganism which have been cultivated in the stationeries hamper significantly the solution of the strategic and tactical problems in supervising the patients with pyo-inflammatory diseases of the brain and membranes. Clinical manifestations and course have also changed.
The overview of up-to-date literature as well as own materials have been presented in the article. The attempt is made to distinguish the differential-diagnostic verge between the brain abscess and intracranial empyemas.

Keywords: brain abscess, intracranial empyemas, differential diagnostics.
p. 73 - 79 of the original issue
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AL-SHARIF D.M., MORKHAT V.I.

FLAP EXTRACTION PECULIARITIES IN THE YEMEN REPUBLIC POPULATION TAKING INTO ACCOUNT GEOGRAPHICALLY CAUSED LENS CHANGES

In torrid countries cataract is one of the prevailing ophthalmologic pathologies which are caused by geographical peculiarities of these territories. Cataracts which occur in various geographical conditions have essential differences. In mountain regions cataract develops at earlier age and mainly in males; it develops faster, the nucleus of the lens more often has dense brown composition, it’s larger in size and has less common phospholipids. Detected during surgical operations territorial peculiarities were not unexpected for the surgeons and permitted to avoid sudden complications during flap extraction (average visual acuity was 0, 51±0, 1). Clinical research of the postponed implantation on its transsclertal fixation in iridociliary area through the self-adapted cornea incision has been performed with transscleral fixating suture application provisionally on the adapted eye. The surgery hasn’t been followed by serious operative and post-operative complications; it permits to obtain rather good results. Visual acuity of 0.5 and higher after 6 months of observation has been achieved in 11 patients, from 0.3 to 0.4 – in 3 patients.

Keywords: cataract, geographical conditions, size of the lens nucleus, operative complications.
p. 80 - 86 of the original issue
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ZHEBENTYAEV A.A, SINITSKAYA E.V.

THE RESULTS OF DISTANT LITHOTRIPSY (ESWL) IN TREATING UROLITHIASIS WITH LITHOSCOP APPARATUS

ESWL and contact (percutaneous, transurethral access) destruction of stones with the help of X-ray, ultrasonic and endoscope methods of investigations are the alternative methods to the traditional open operations in modern urology in case of urolithiasis. The universal introduction of ESWL has changed treatment tactics but has not changed urolithiasis incidence rate. ESWL is a highly effective, non-invasive method, with minimum of serious complications, comfortable for a patient and for a doctor.
In the article the first experience of ESWL application is analyzed performed in Vitebsk urological clinic in 2006. 119 patients were treated with the help of LITHOSCOP (III-generation device, made by Siemens). The amount of open and endoscope operations in case of urolithiasis has 1.5 times decreased; the amount of less-invasive methods in the treatment of urolithiasis has 2.2 times increased. Anesthesia isn’t required during LITHOSCOP-associated treatment. The ratio of the open operation to ESWL has decreased from 1.6 in 2005 up to 0.48 in 2006. ESWL as the mono therapy was effective in 96.6 % of all cases; it considerably exceeds efficacy of treatment with the help of «URAT-P The treatment with the help of LITHOSCOP was accompanied by minimum of complications. 80% of the patients have left the hospital after ESWL with a capacity to work.

Keywords: distant lithotripsy (ESWL), urolithiasis, LITHOSCOP.
p. 87 - 92 of the original issue
References
  1. Вощула, В. И. Мочекаменная болезнь: этиотропное и патогенетическое лечение, профилактика: Монография / В. И. Вощула. – Мн.: ВЭВЭВР, 2006. – 268 с.
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  8. Moody, J. A. xtracorporeal shock-wave lithotripsy / J. A. Moody, A. P. Evans, J. E. Lingeman; ed. R. M. Weiss, N. J. R. George, P. H. O’Reilly // Comprehensive Urology. – Mosby International Limited, 2001. – P. 623-636.

REVIEWS

GIDRANOVICH A.V.

LIPID METABOLISM AND BREAST CANCER: INFLUENCE OF THE VITAMIN THERAPY

The lipid metabolism plays a considerable role in the pathogenesis of many diseases. Though the greatest scientific material has been obtained by different investigators, there isn’t the ultimate opinion concerning the degree of lipid metabolism mechanisms involvement in the carcinogenesis including the origin and progression of breast cancer. Breast cancer affects women at pre-menopausal age and women at postmenopausal age, who are characterized by the increased levels of LDL cholesterol and the reduced levels of HDL cholesterol. Some investigators draw parallels between metabolic syndrome in the postmenopausal women (obesity, low glucose tolerance, low serum HDL cholesterol, and high serum triglycerides hypertension) and breast cancer. Development of breast cancer results in the changes of metabolic indexes. In the breast cancer patients, dyslipidemia develops and becomes worse, and it leads to high levels of total cholesterol, triglycerides, LDL cholesterol, low HDL cholesterol. Vitamins directly or indirectly participate in lipid metabolism, resulting in lipid metabolism changes during their consumption. One must take this fact into account in individual rehabilitation program development.

Keywords: breast cancer, lipid metabolism, vitamins.
p. 93 - 102 of the original issue
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SPIRIDONOV S.V.

MODERN POSSIBILITIES OF OPERABLE NON SMALL-CELLED III DEGREE LUNG CANCER TREATMENT

By the beginning of the 21st century in the majority of the developed countries the tendency in performing oncology surgeries in case of lung cancer had begun to appear in large regional multi-profile centers on the basis of cardio-thoracic departments. It permits to extend lung cancer surgical treatment possibilities and possibilities for accompanying cardiac diseases treatment (coronary artery shunting, aneurism resection) using the latest cardio-surgery achievements such as performing operations with the artificial blood circulation or even with the lung transplantation. But the results of the surgical intervention alone in case of IIIA or IIIB degree of non small-celled lung cancer are not very satisfactory. If the patient isn’t refused surgery, the treatment of this patient should be planned with the compulsory additional usage of chemotherapy and radiotherapy. The recent researches haven’t shown the positive effect of the post-operative radiotherapy on the life length increase. Some researches have established that in 80% of cases, the main cause of death after radical operation in case of non small-celled III degree lung cancer is the progressing process with distant metastasis. That’s why the interest of oncologists to systemic influence on the tumor is rather clear. During the last 3 years five researches have been conducted which testify to adjuvant chemotherapy positive effect and its everyday wider application expediency. However, there are many unsolved problems concerning practical application of adjuvant chemotherapy. What chemotherapy is optimal according to its toxicity and effectiveness? What patients are to undergo adjuvant chemotherapy?

Keywords: non small-celled lung cancer, adjuvant radiotherapy, adjuvant chemotherapy.
p. 103 - 109 of the original issue
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