Khurshed I. Khakimov

A surgical method is often used to treat a tumor lesion of the chest wall. Such procedures inevitably result in a defect that disrupts the skeletal framework and biomechanics of the thorax, leading to subsequent impairment of its organ function. Despite advancements in surgical techniques, including modern implants, the reconstruction of extensive chest wall defects, particularly in the aperture regions, remains a challenging task, regardless of etiology. This article discusses the principal challenges associated with the reconstruction of defects in the superior and inferior thoracic apertures in the context of oncological pathology. We present clinical cases involving extensive resection of the thoracic framework in the region of the superior and inferior apertures, with simultaneous reconstruction using super-elastic mesh implants made of nickel-titanium alloy (nitinol).

Introduction: Microbial biofilm formation on surgical implants significantly ex-acerbates implant-associated infections (IAIs) and often leads to implant failure. This study aimed to investigate the ex vivo effects of elevated temperature and antibiotics, or zinc in-corporation, on methicillin-resistant Staphylococcus aureus (MRSA) biofilm growth on ti-tanium (Ti)-based 3D plates fabricated by selective laser melting (SLM) and coated with a rough calcium phosphate (CaP) layer using the micro-arc oxidation technique. Materials and Methods: MRSA strain 43300 broth cultures were exposed to heating at 45°C for 60 min or 56°C for 30 min, with or without vancomycin (VMN). The control culture (250 microbial cells per 1 ml of isotonic sodium chloride) was maintained at 37°C. Ti-based discs (10 mm in diameter and 1 mm in thickness) with structured surfaces were coated with a CaP layer via micro-arc oxidation. The Ti-based samples were added to MRSA broth cul-tures for 2 hours, then transferred to fresh serum-free medium and incubated for 48 hours at 37 °C. Bacterial biofilm optical density on the CaP coating was quantified by computer mor-phometry after fixation and Gram staining. Results: A single ex vivo administration of VMN at its minimum inhibitory concentration (MIC, 2 μg/ml) was ineffective against MRSA biofilm growth. The therapeutic VMN con-centration (20 μg/ml) reduced the biofilm optical density by 17%. Heating of MRSA broth cultures showed no significant bacteriostatic effect, and combining hyperthermia with VMN did not enhance antimicrobial efficacy. In contrast, Zn-doped (~0.31 at.%) CaP coatings inhibited MRSA biofilm development at 37°C. The bacteriostatic effect (5%) exceeded that of VMN at MIC (0%) but was lower than that observed for the therapeutic VMN dose (17%). Discussion: The negatively charged CaP coating on titanium implants may promote MRSA biofilm formation through electrostatic interactions with bacterial cell surfaces. Hyperther-mia at 45°C or 56°C, either alone or in combination with vancomycin, showed limited effi-cacy, possibly due to bacterial thermotolerance and antibiotic resistance. Incorporation of zinc into CaP coatings demonstrated a modest bacteriostatic effect, suggesting potential as an adjunct strategy alongside conventional antibiotics such as vancomycin. Conclusion: Zn-doped rough CaP coatings on Ti-based implants show promise for use in bone tissue engineering, where there is a risk of implant-associated infection, owing to the bacteriostatic activity of zinc at low concentrations.

Bladder cancer occupies a significant place among all malignancies, accounting for approximately 3 % of all new cases of malignancy per year, with approximately 37 % of all bladder cancer cases being fatal (about 213,000 deaths annually). Despite advances in diagnosis and treatment, patients with muscle-invasive cancer remain at high risk for recurrence and metastases, especially delayed metastases that may occur years after completion of primary treatment. These delayed metastatic manifestations are often associated with poor prognosis and treatment difficulties. This article presents a clinical case of late progression of bladder cancer to the left pubic bone without regional metastases 12 years after combination treatment.

Aim of the study : to provide a contemporary overview of the nomenclature and terminology of Recklinghausen– Engel syndrome (parathyroid osteodystrophy), its pathogenesis, and characteristic morphological and radiological manifestations. Special attention is paid to the differential diagnosis between brown tumor and skeletal giant cell tumor. The study aims to present the clinical and morphological criteria for distinguishing these conditions, systematized in a comparative table. Material and Methods . A literature search was conducted in the Medline, PubMed, Elibrary, and other databases. Of the 100 identified publications, 30 were included in this systematic review. We report a case of a resected brown tumor of the femur in a 58-year-old man with previously undiagnosed hyperparathyroidism, detailing the morphological diagnostic features and the disease course. Results. Recklinghausen-Engel syndrome (parathyroid osteodystrophy) is a rare but clinically significant metabolic skeletal disorder that develops in the setting of hyperparathyroidism. It is characterized by marked osteoclastic activity, the formation of cystic lesions, subperiosteal resorption, and so-called brown tumors. Despite its benign nature, this syndrome often mimics aggressive giant cell bone tumors, which complicates the interpretation of clinical, radiological, and morphological data and increases the risk of diagnostic errors. Conclusion. This article discusses the diagnostic challenges in the absence of overt clinical symptoms of hyperparathyroidism and emphasizes the key role of the pathomorphologist within a multidisciplinary team. Timely detection of parathyroid hormone hypersecretion and radical removal of the hyperplastic or neoplastic parathyroid gland lead to the regression of bone lesions and a favorable prognosis.

Introduction. Giant cell tumor (GCT) of bone is a relatively rare neoplasm. Its malignant transformation in the form of sarcomatous changes occurs in 8–10 % of cases. The literature lacks data on radiological signs and differential diagnostic criteria of primary malignant GCT of bone. Clear guidelines on the density range of the affected area for differential diagnosis are also absent. Aim. To analyze dynamics of tumor density changes in patients with malignant GCT of bone using computed tomography densitometry. Materials and methods. Ten patients (mean age 45.8 ± 4.2 years, range 28–58 years) with malignant GCT of bone were examined. All underwent treatment with denosumab with subsequent surgical intervention. Bone changes were assessed visually. Densitometric analysis was performed in accordance with a method developed by us involving determination of tumor density in Housefield units (HU) and relative tumor density index (k) (ratio between tumor density and density of the unaffected limb at the same level). Results. After 6 injections of denosumab, a clear sclerotic rim appeared at the tumor periphery containing thin lines of ossification. Analysis of densitometric parameters showed that tumor density after denosumab administration increased from 46.3 (median (Мe) 35.0; interquartile range (IQR) 51.4) HU to 88.8 (Мe 84.8; IQR 118.4) HU, while relative tumor density index increased from 0.33 (Me 0.22; IQR 0.45) to 0.68 (Me 0.62; IQR 0.89). Earlier we have published threshold values of these parameters (≥139.5 HU and ≥0.97, respectively) at which probability of residual tumor is lowered (sensitivity 81.8 %, specificity 96.6 %). Taking into account these values, 9 of 10 patients required continuation of therapy. Conclusion. Computed tomography densitometry allows to evaluate changes caused by denosumab therapy in patients with malignant GCT of bone. According to radiological data, progression of this disease has unique features. Taking into account histological types of malignant GCT, longer periods of observation and denosumab administration or changes in treatment tactics at the preoperative stage can be considered, as well as potential use of this drug in other primary bone tumors.

To restore extensive postresection chest defects remains an unsolved problem for surgeons over the world. To date, there are no regulatory oncological and surgical protocols that could be guided in choosing an implant and a procedure for its use to replace a chest defect. This communication describes a clinical case of successfully performed plastic replacement of an extensive postresection chest defect, through restoration of the costal arch with superelastic 3D titanium nickelide modules and through diaphragmopexia after a series of combined interventions, as a result of which the investigators resected 5 ribs, the left lower lobe, the diaphragmatic costal part, and the colonic splenic angle, the spleen was removed in the treatment of a multiple locally recurrent sarcoma. The stability of the position of the reinforcing artificial frame elements and their involvement in the breathing act could fully restore the respiratory biomechanics and create conditions for early activation of the female patient. The oncological and functional results show the effectiveness of the proposed technology, which expands the possibilities of treating patients with chest tumors, even in cases of simultaneous non-standard resections of the adjacent anatomical structures.

Introduction. Difficult diagnosis, aggressive progression, and absence of an increase in treatment effectiveness (especially in patients with osteosarcoma and Ewing sarcoma) make malignant tumors of the bones a significant medical problem. Use of traditional therapy methods is often associated with development of drug resistance and frequent recurrences. Therefore, there is a need for new treatment strategies and overcoming of the limitations of traditional methods through their improvement, combination or substitution to achieve higher survival, lower recurrence rate, and wider availability for patients with bone tumors.Aim. To present a clinical observation of the use of a new method of radical intraoperative thermal ablation for bone tumors, assess exposure tolerance, long-term oncological and functional results.Clinical observation. This article presents a clinical case of the use of a new radical treatment method for a patient with tibial osteosarcoma who underwent intraoperative thermal ablation using a new domestic complex of local hyperthermia “Phoenix-2”.Results. A session of intraoperative thermal ablation was performed in the operating room under anesthesia directly in the wound for 48 minutes. Access to the tumor-affected bone was performed with the standard oncological approach (en-block), the bone was not transected or removed. A constant heating mode of 90 °С was used, assuming a gradual increase in temperature. Thus, 60 °С reached 20 minutes, and the temperature at the end of high-temperature exposure was 78 °С (inside the medullary canal). The operation time was 2 hours 30 minutes. The postoperative period proceeded without complications. After 38 months of follow-up, examinations did not reveal any recurrence or progression in the patient.Conclusion. The technique of radical intraoperative thermal ablation using a local hyperthermia complex Phoenix-2 is effective and allows to widen the toolkit of treatment methods for patients with bone tumors. It can serve as an alternative or addition to organ-preserving surgical treatment without costly reconstruction stages.

Introduction. An additional or the only way to treat tumors of the chest wall is often a surgical method, which inevitably results in a post-resection defect. Reconstruction of extensive chest wall defects remains an unsolved problem for surgeons around the world.The study objective – to present the long-term oncological and functional results of treatment of a patient with multiple locally recurrent leiomyosarcoma after reconstruction of an extensive post-resection chest wall defect using superelastic 3D frame modules made of titanium nickelide. Reconstruction of the chest wall with 3D modules after extensive block resection showed the possibility of not only restoring the anatomy in the area of the post-resection defect, but also maintaining the biomechanics of breathing in the postoperative period.Clinical observation. This study presents a clinical case of extensive resection and successful one-stage reconstruction of the chest wall skeleton with 3D superelastic titanium nickelide modules in a patient with recurrent leiomyoma with locally recurrent leiomyosarcoma.Results. The superelastic modules did not limit the width of the resection during the operation and ensured long-term stability of the position of the reinforcing elements of the artificial framework. Control examinations showed no tumor recurrence after 12 months and maintaining patient performance.Conclusion. The effectiveness of the proposed reconstruction expands the possibilities of treating patients with tumors of the chest wall.

To present the results of reconstruction of post-resection chest wall defects with nickel-titanium (TiNi) implants in patients with invasive NSCLC and to analyze the features of perioperative management. We enrolled 9 patients with NSCLC involving the ribs after lobectomy or pneumonectomy with chest wall reconstruction. Defects were closed used TiNi mesh and rib prostheses. We selected the shape and dimensions of artificial ribs individually before surgery according to CT data and 3D models of reinforcing elements. There were male smokers aged 64.6±4.6 years among patients (range 58-73). T3N0M0 was diagnosed in 6 patients, T3N1M0 - 2, T3N2M0 - 1. Squamous cell carcinoma was verified in 4 (44.4%) patients, adenocarcinoma - in 5 (55.6%) patients. All patients had comorbidities. Mean Charlson's comorbidity index was 6.56±4.6. Dimension of chest wall defect varied from 78 to 100 cm². Postoperative period was uneventful without signs of respiratory failure. There were no lethal outcomes. Complications occurred in 33.3% of patients (prolonged air discharge through the drains, pleuritis and atrial fibrillation). Surgical treatment of NSCLC spreading to the chest wall is a complex task requiring further improvement. Bioadaptive TiNi implants are a promising reinforcing material that allows successful reconstruction of post-resection chest wall defects with good anatomical, functional and cosmetic results. «Sandwich» technology is advisable for extensive defects. This approach includes 2 layers of knitted mesh and rib prostheses between these layers.