[Surgical treatment of COVID-19 patients during the pandemic]. / Opyt khirurgicheskogo lecheniya patsientov s COVID-19 v period pandemii.

OBJECTIVE: To analyze the results of emergency surgery in COVID-19 patients with viral pneumonia. MATERIAL AND METHODS: A retrospective study included 75 COVID-19 patients who underwent emergency surgical interventions. Comorbidities included cardiac diseases, nonspecific lung diseases, type 2 diabetes, kidney diseases, overweight, and cancer. Various combinations of these diseases were also noted. RESULTS: We carried out emergency surgeries for abdominal, thoracic, soft tissue and venous diseases. Postoperative mortality was 42.6%. The best results were obtained after minimally invasive interventions without mechanical ventilation. Extended surgery with mechanical ventilation was followed by fast progression of pneumonia according to clinical and CT data. CONCLUSION: Surgical interventions undoubtedly worsen prognosis of treatment in patients with COVID-19. Emergency minimally invasive surgery without mechanical ventilation can reduce the risk of unfavorable outcomes in patients with viral pneumonia, especially in case of concomitant cancer and other severe comorbidities.

[Topographic and anatomical landmarks for endoscopic navigation in surgery for complicated gastric cancer]. / Topografo-anatomicheskie orientiry endovideokhirurgicheskoi navigatsii pri vypolnenii operatsii po povodu oslozhnennykh form raka zheludka.

OBJECTIVE: To develop an algorithm for sequential visual navigation and imaging of the most permanent topographic and anatomical landmarks for safe laparoscopic surgery of complicated gastric cancer. MATERIAL AND METHODS: We analyzed 42 laparoscopic surgeries for complicated locally advanced gastric cancer. RESULTS: Anatomical navigational landmarks and technical aspects of their safe isolation during laparoscopic surgery for gastric cancer are recommended. CONCLUSION: The topographic-anatomical navigation system based on the most constant anatomical landmarks ensures safe laparoscopic interventions for complicated locally advanced gastric cancer.

SURGICAL TREATMENT OF COMPLICATED GASTRIC CANCER IN YOUNG AND MIDDLE-AGED PATIENTS.

The high frequency of complicated forms of gastric cancer in young and middle-aged patients is associated with faster and more biologically aggressive tumor growth, as well as with a delay in diagnosis. The study aimed to evaluate the efficacy, safety, and technical feasibility of surgical interventions for complicated forms of gastric cancer in young and middle-aged patients. We studied 98 patients with complicated forms of gastric cancer from IIB to stage IV according to the TNM8 classification with a predominant lesion of the antrum and body of the stomach. We performed open, laparoscopic, or robot-assisted surgeries of various scopes (R0 or R1), mostly gastrectomy and subtotal distal resection of the stomach. We compared the clinical manifestations of the disease, the time of surgery, intraoperative blood loss, postoperative complications, survival, and quality of life in 2 groups of patients divided by age: 19 young patients (mean age 39.4±4.4 years) and 79 middle-aged patients (mean age 53.9±5.8 years). Clinical manifestations of gastric cancer were more pronounced in young patients. The number of postoperative complications in patients of Group 2 was significantly higher (7.8% to 5.26%) compared to Group 1 (p<0.05). Rehabilitation in patients who underwent laparoscopic surgery was significantly (p<0.05) faster than with the traditional method. The overall survival of young patients with IIB-IV stages of gastric cancer was 0.8 months less, and among patients with III-IV stages it was 2.4 months less than in the group of middle-aged patients and did not depend on the surgery scope. There were no statistically significant differences between the groups in terms of intraoperative blood loss, duration of surgery and hospital stay. Increased surgery duration of in middle-aged patients significantly correlated with the number of postoperative complications. Extended surgeries do not significantly increase the number of lethal, life-threatening complications. Combined surgeries in the R0 scope in patients with advanced gastric cancer (including with carcinomatosis) improved the quality of life of patients yet did not increase in overall survival, which determines the reasonable limits of surgical aggression.

ROLE OF THROMBODYNAMICS GLOBAL COAGULATION TEST IN IMPROVING TREATMENT RESULTS IN PATIENTS WITH CORONAVIRUS INFECTION AT A COVID-19 HOSPITAL.

The aim of the study was to evaluate the effectiveness of the global coagulation test of thrombodynamics for monitoring and correcting the hemostatic system and improving the results of complex treatment in patients with SARS-CoV-2 in the COVID hospital. From April 2020 to December 2020 on the basis of the University Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University) of the Ministry of Health of the Russian Federation 245 patients between the ages of 27 and 89 with SARS-CoV-2 associated pneumonia were treated. The mean age of the patients was 56.7 ± 4.2 years. All patients participating in the study were divided by simple randomization into two groups. The volume of lesion of the lung parenchyma was assessed according to the data of computed tomography. All patients were treated for SARS-CoV-2 in a comprehensive manner in accordance with the temporary guidelines of the Ministry of Health of the Russian Federation with the mandatory prescription of low molecular weight heparins (LMWH). Assessment and correction of the hemostasis system in 177 patients (47.7%) of group 1 was carried out daily using local coagulation tests (LCT), including APTT, PT, TT, PTI, INR, Fibrinogen and D-dimer level. The second group included 128 patients (52.3%), who, in addition to local coagulation tests, used the integral coagulation test - the thrombodynamics test- to assess and correct the state of the hemostatic system. Assessment and correction of hemostasis were performed at the control points (1, 7, 14 days) of the study. Compared to LCT, the thrombodynamics test reliably more often revealed the state of hypercoagulability, which was promptly corrected by increased doses of LMWH in group 2. Positive dynamics of clinical symptoms were detected in patients of group 2 1.8 times more often than in group 1 (p<0.05): fever and shortness of breath in group 2 decreased faster, the SpO2 index recovered more rapidly, especially in patients with severe hypoxia (with SpO2<90), the number of patients with moderate and severe severity by the third point of the study in group 2 was 1.8 times less than in group 1 (p<0.05). Severe forms of lung damage (CT-3 and CT-4) were detected in group 2 3.2 times less frequently (p <0.01) compared with group 1, and the number of deaths was 3.3 times less frequent (p<0.01) by the end of the study. The average bed-day in group 2 of patients (15±1.6 days) was 1.6 times shorter than in group 1 (24±7.2 days). Hemorrhagic complications were not recorded, despite the therapeutic doses of LMWH in patients of group 2. The severity of the condition of patients with SARS-CoV-2 and the dynamics of their symptoms depend on the state of microcirculation in the lungs and in the periphery and on the volume of thrombotic lesions. Anticoagulant therapy prescribed as early as possible in adequate therapeutic doses in patients with SARS-CoV-2 associated viral pneumonia made it possible to achieve positive treatment results. The use of the global coagulation thrombodynamics test has shown high efficiency for the timely assessment and correction of the state of the hemostasis system.

[Multiple primary synchronous colon cancers in patients with advance gastric cancer]. / Pervichno-mnozhestvennyi sinkhronnyi rak zheludka i pravoi poloviny tolstoi kishki u bol'nykh s oslozhnennym mestno-rasprostranennym rakom zheludka.

Two patients with locally advanced gastric cancer are reported. Both patients underwent colonoscopy in preoperative period. Preoperative examination revealed synchronous colorectal cancer. Preoperative colonoscopy in patients with gastric cancer ensured timely diagnosis of synchronous colorectal cancer and adequate minimally invasive treatment with favorable results.

[Metastasis of clear cell renal cell carcinoma into small bowel in 5 years after nephrectomy]. / Metastaz svetlokletochnogo pochechnokletochnogo raka v podvzdoshnuyu kishku spustya 5 let posle nefrektomii.

Small bowel tumor causes gastrointestinal bleeding in 1-4% of cases. Gastrointestinal bleeding from metastases of renal cell carcinoma is a rare and little-known manifestation of this disease. We report a rare clinical case of a solitary metastasis of clear cell renal cell carcinoma into small bowel in 5 years after nephrectomy. The first symptom was intestinal bleeding. This example emphasizes the need for more thorough examination of patients with symptoms of latent and anamnestic blood loss.

[Administration of the immunomodulatory drug aminodihydrophthalazinedione sodium for prevention of progression pneumonia induced COVID-19].

Aim to determine the efficacy of drug aminodihydrophthalazinedione sodium (Galavit) for prevention of progression of the coronavirus infection pulmonary complications: acceleration of regression of pulmonary infiltrates and resolution of COVID-induced pneumonia. 22 patients with medium and severe COVID-induced pneumonia were included in the study. The study included 8 men and 14 women, the average age was 62.17.4 years. Patients with more than one adverse prognostic factor made 82%. Average volume of pulmonary tissue affection (computer tomography CT-2, 2550% of lung volume) was registered in 13 (59.1%) patients, significant volume (CT-3, 5075% of lung volume), in 9 (40.9%) patients. All patients had progressive respiratory failure manifestations due to hypoxemia and related diseases. Aminodihydrophthalazinedione sodium was administered for 714 days from the beginning of disease, at the end of the course of standard complex therapy, in case of preservation of signs of intoxication, negative dynamics according to computer tomography data. Administration of aminodihydrophthalazinedione sodium had a positive effect on the dynamics of clinical scores. The progression of respiratory failure was halted and there was an increase in SpO2 values. According to the control computer tomography data the stabilization of the pulmonary parenchyma affection degree was noted, as well as reduction of the size of the compacted areas in the pulmonary tissue and formation of the picture of organising pneumonia that contributed to reduction of respiratory failure grade. The use of aminodihydrophthalazinedione sodium in complex therapy of COVID-induced pneumonia has a modulating effect on the immune system, prevents the progression of pulmonary tissue affection, promotes regression of infiltration foci, preventing the development of excessive pneumofibrosis and the progression of respiratory failure.

Minilaparotomy for treatment of choledocholithiasis.

BACKGROUND: Minilaparotomy has been reported to be an alternative minimally invasive option to laparoscopy. However, the quality of available data on the effectiveness of minilaparotomy to treat choledocholithiasis is poor. MATERIALS AND METHODS: Two hundred and twenty-eight patients with choledocholithiasis underwent surgical exploration of the common bile duct via minilaparotomy from 1995 to 2010. Of these, 193 patients had choledocho/cholecystolithiasis with previous ineffective attempts at endoscopic clearance and 29 patients had choledocho/cholecystolithiasis without previous attempts at endoscopic clearance. Six other patients had recurrent/residual choledocholithiasis despite ineffective attempts at endoscopic clearance. Peri-operative adverse events were analyzed in accordance with the revised Satava classification for intra-operative events while post-operative complications were graded according to the Accordion classification. RESULTS: Conversion was needed in 3.9% of procedures. The mean operative time was 86 min. Post-operative complications occurred in 6.1%, 2.2% of which were major (Accordion grade 4-6). Mortality was 0.9%. CONCLUSION: Minilaparotomy is an effective minimally invasive approach for the surgical treatment of choledocholithiasis. This approach could be considered as an alternative to the laparoscopic approach for surgical exploration of the common bile duct in patients with choledocholithiasis.

[Evaluation of subjective experience of cognitive deficit in patients with schizophrenia using the Eppendorf Schizophrenia Inventory].

Presented is a new questionnaire--Eppendorf Schizophrenia Inventory (ESI)--for evaluation of subjective experience of cognitive dysfunction characteristic of schizophrenia and data that confirmed reliability and diagnostic validity of the ESI. The ESI is suggested to be an additional method of psychopathological diagnosis of schizophrenic disorders.

[Changes in the functional state of the central nervous system during physical work using individual protective means at different environmental temperatures]. / Ob izmenenii funktsional'nogo sostoiania TsNS pri vypolnenii fizicheskoi raboty v sredstvakh individual'noi zashchity pri razlichnykh temperaturnykh usloviiakh okruzhaiushchei sredy.

Integral parameters were applied to studies of functional status of the central nervous system (CNS) in humans exposed to physical work using individual protective means in heating (30 degrees C) and cooling (10 degrees C) microclimate. Peculiarities of changes in CNS functional status were proved to depend on the origin of factors and their combinations. Factors appeared to compete with each other and final results can depend on domination of the certain factor.

[Changes of functional state of the human body and the dynamics of its recovery in hard physical work in protective devices in various air temperatures]. / Izmenenie funktsionalnogo sostoianiia organizma cheloveka pri vypolnenii tiazheloi fizicheskoi raboty v sredstvakh individualnoi zashchity pri razlichnoi temperature vozdukha i dinamika ego vosstanovleniia.

Effect of the hard manual work on humans using the individual protective means in temperature conditions from 17 to 30 degrees C was studied. The investigation revealed the altered thermoregulatory, circulatory, central nervous systems and the acid-base status. The changes were found depending on the environmental temperature. The recovery period (one-hour rest and shower) did not normalize the disordered functions, so further correction of the functional status is necessary.