[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.

[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.