[Modern endoscopic technologies for chronic calcifying pancreatitis]. / Sovremennye endoskopicheskie tekhnologii pri khronicheskom kal'tsinoznom pankreatite.

OBJECTIVE: To evaluate the effectiveness and safety of electrohydraulic lithotripsy of calculi of the main pancreatic duct using ultrathin SpyGlass DS endoscope. MATERIAL AND METHODS: The study included 29 patients with chronic calcifying pancreatitis and obstructive calculi of the main pancreatic duct. All surgeries were carried out between 2018 and 2023. RESULTS: Complete removal of calculi (≥5 mm) within one procedure was achieved in 25 (86%) patients. CONCLUSION: Pancreatoscopy with electrohydraulic lithotripsy using the digital SpyGlass DS system (BostonScientificCorp, Marlborough, MA) is the most effective method for calculi of the main pancreatic duct.

[Retrograde cholangioscopy in differential diagnosis of parasitic invasion]. / Retrogradnaya kholangioskopiya v differentsial'noi parazitarnoi invazii. Klinicheskii sluchai.

The authors present differential diagnosis of parasitic invasion of the common bile duct. A 52-year-old patient admitted with malignant bile duct obstruction, mechanical jaundice, cholestatic hepatitis and cholangitis. Bile duct tumor was preliminary diagnosed according to anamnesis, complaints, physical, laboratory and instrumental data. Retrograde cholangiopancreatography, endoscopic papillotomy and revision of the common bile duct were performed. There was occlusion at the level of the upper third of the common bile duct. Retrograde cholangioscopy was performed to clarify the nature of obstruction and tumor. Cholangioscopy revealed parasites in the common bile duct that required extraction. The patient was sent to the infectious disease hospital.

[Direct transfistulous ultrasound in minimally invasive surgical treatment of infected pancreatic necrosis]. / Pryamoe chresfistul'noe ul'trazvukovoe issledovanie pri minimal'no invazivnom khirurgicheskom lechenii patsientov s infitsirovannym pankreonekrozom.

OBJECTIVE: To develop a method for direct transfistulous ultrasound in minimally invasive treatment of infected pancreatic necrosis. MATERIAL AND METHODS: There were 148 patients with infected pancreatic necrosis between 2015 and 2019 at the Krasnodar City Clinical Hospital No. 2. Drainage with 28-32 Fr tubes was carried out at the first stage, endoscopic transfistulous sequestrectomy - at the second stage (19 (12.8%) patients). In 84 (56.8%) patients, we applied original diagnostic method (transfistulous ultrasonic assessment of inflammatory focus). RESULTS: There were 3 accesses to omental bursa in 93 (62.8%) patients and 2 in 43 (29.1%) patients. We also performed 2 access to retroperitoneal space in 63 (42.6%) patients and 1 access in 38 (25.8%) cases. Transfistulous ultrasound was used once in 19 (22.6%) patients, twice in 28 (33.3%) and 3 times in 37 (44.1%) patients. Examination was not performed in 18 (12.2%) patients due to the following reasons: migration of drainage catheters - 5, non-rectilinear fistulous tract - 13. No complications were observed. CONCLUSION: Transfistulous ultrasound makes it possible to diagnose pathological changes in the pancreas and parapancreatic tissue at various stages of surgical treatment.

[A modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis]. / Modifitsirovannyi metod chreskozhnogo drenirovaniya ostrykh nekroticheskikh skoplenii u patsientov s infitsirovannym pankreonekrozom.

OBJECTIVE: To develop a modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis. MATERIALS AND METHODS: Minimally invasive surgical technologies were used in 74 patients with infected acute necrotic collections at the Krasnodar Regional Clinical Hospital No. 2 between 2017 and 2019. Of these, 59 (79.7%) people underwent percutaneous drainage as a final treatment. In 11 (14.9%) patients, video sequestrectomy through the fistula was additionally used to increase efficiency of percutaneous drainage. RESULTS: PCD in our modification implies delivery of double-lumen drains 26-32 Fr in the same plane to zones of necrosis, their programmed replacement for prevention of obstruction and flexible endoscopy for control of pathological process. Local purulent-necrotic parapancreatitis occurred in 31 (41.9%) patients, widespread parapancreatitis - in 43 (58.1%) patients. There were 339 minimally invasive interventions. Laparotomy was required in 4 (5.4%) patients. Incidence of perioperative complications was 10.6%, mortality - 16.2%. CONCLUSION: A modified percutaneous drainage method may be used as final surgical treatment in 79.7% of patients with infected pancreatic necrosis.

[Technological features of open and minimally invasive surgical treatment of local complications of purulent-necrotic pancreatitis]. / Sravnenie tekhnologicheskikh osobennostei primeneniya otkrytykh i minimal'no invazivnykh sposobov khirurgicheskogo lecheniya mestnykh oslozhnenii gnoino-nekroticheskogo pankreatita.

There are various options for surgical treatment of purulent-necrotic pancreatitis with significant technological differences. Combining surgical methods other than traditional ones into a group of minimally invasive ones based on the principle of the absence of standard laparotomy is not entirely correct. The review presents modern methods of surgical treatment of acute pancreatitis, comparison of their technology regarding classical stages of surgical intervention and their classification.

[Transfistulous endoscopic sequestrectomy in the treatment of infected pancreatic necrosis]. / Sposob chresfistul'noi videoskopicheskoi nekrsekvestrektomii v lechenii infitsirovannogo pankreonekroza.

OBJECTIVE: To develop an effective minimally invasive method for the treatment of infected pancreatic necrosis. MATERIAL AND METHODS: There were 168 patients with infected pancreatic necrosis who were treated at the Regional Clinical Hospital No. 2 between 2011 and 2018. Eighty-seven (51.8%) patients underwent primary drainage with large-diameter double-lumen drains 28-32 Fr, and original technique of transfistulous endoscopic sequestrectomy was used. Puncture-drainage interventions with transfistulous endoscopic sequestrectomy were used in 23 (26.4%) patients with local and 64 (73.6%) patients with widespread purulent-necrotic parapancreatitis. RESULTS: Percutaneous channels are accesses to purulent-necrotic cavity and used for transfistulous endoscopic sequestrectomy. This procedure was performed 98 times. Time of primary sanitation in patients with 3 accesses in omental bursa was significantly less compared to 2 accesses (62±4.3 vs. 89±8.2 min, p<0.05). In case of repeated sanitation, time of intervention did not depend on the number of accesses. Incidence of local complications was 9.1%, extra-abdominal complications - 19.4%. Mortality rate was 12.6%. CONCLUSION: Original technique of transfistulous endoscopic sequestrectomy increases efficiency of sanitation of infected parapancreatitis, improves treatment outcomes and reduces mortality to 12.3%.

[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Minimally invasive treatment of post-burn esophageal perforation]. / Miniinvazivnoe lechenie posleozhogovoi perforatsii pishchevoda.

Perforation of the esophagus is a serious and dangerous condition due to progressive development of mediastinitis and sepsis. This disease is often fatal. In the last decade, endoscopic stenting of the esophagus became more common in these patients as an alternative to traditional surgery. We report successful minimally invasive endoscopic treatment of esophageal perforation with post-burn necrosis of its wall.

Increasing the known biodiversity of cnidarian parasites of bryconid fishes from South America: two novel Myxobolus species with ultrastructure and ssrDNA-based phylogeny.

This study increases the known biodiversity of cnidarian parasites in neotropical bryconid fishes. Two novel Myxobolus species are described based on morphology, ultrastructure and small subunit ribosomal DNA (ssrDNA) sequencing: Myxobolus vetuschicanus n. sp. infecting fins of Salminus franciscanus and Myxobolus mineirus n. sp. infecting the mesentery of Brycon orthotaenia from the São Francisco River basin, Minas Gerais State, Brazil. Ultrastructural analysis of the two species revealed an asynchronous sporogenesis process, with germinative cells and young developmental stages of myxospores in the periphery of the plasmodia. In M. vetuschicanus n. sp., the plasmodia were surrounded by a layer of fibroblasts and in M. mineirus n. sp., the plasmodial membrane had direct contact with the host tissue. The phylogenetic analysis based on the ssrDNA of Henneguya/Myxobolus species showed that the two novel Myxobolus species grouped in subclades together with other parasite species of bryconid fishes.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[Minimally invasive surgical interventions in the treatment of severe acute pancreatitis]. / Mini-invazivnye khirurgicheskie vmeshatel'stva v lechenii patsientov s ostrym pankreatitom tyazheloi stepeni.

OBJECTIVE: To improve the outcomes in patients with severe destructive pancreatitis undergoing minimally invasive surgery. MATERIAL AND METHODS: There were 482 patients with acute destructive pancreatitis for the period from 2007 to 2016. Non-infected acute destructive pancreatitis was diagnosed in 58% (n=280) of patients, infected pancreatic necrosis - in 42% (n=202) of patients. Minimally invasive technologies were used in the treatment of purulent complications of destructive pancreatitis: endoscopic papillotomy, percutaneous puncture of fluid accumulations, ultrasound- and X-ray-assisted drainage of abscesses and retroperitoneal phlegmon. RESULTS: There were 688 drainage surgeries in 92 patients with infected pancreatic necrosis: US-assisted Seldinger drainage - 599 (87%), single-stage drainage - 89 (13%) cases. Percutaneous transfistular retroperitoneal interventions were made in 72 patients (one intervention - 29 patients, redo procedures - 43 patients). Complications associated with minimally invasive procedures developed in 2.7% (19) of cases. Six patients required laparotomy. Mean length of hospital-stay was 36.5 days. Mean rate of restitution of post-necrotic areas was 37.7 days. CONCLUSION: Minimally invasive procedures reduce overall mortality up to 6% in patients with acute pancreatitis and up to 14% in those with destructive forms of inflammation.

Characterization and gene expression analysis of pacu (Piaractus mesopotamicus) inducible nitric oxide synthase (iNOS) following Aeromonas dhakensis infection.

Nitric oxide (NO) is an important effector molecule which is involved in a myriad of biological processes, including immune responses against pathogens such as parasites, virus and bacteria. During the inflammatory processes in vertebrates, NO is produced by the inducible nitric oxide synthase (iNOS) enzyme in practically all nucleated cells to suppress or kill intracellular pathogens. The aim of the present study was to characterize the full coding region of the iNOS gene of pacu (Piaractus mesopotamicus), an economically and ecologically important South American fish species, and to analyze mRNA expression levels following intraperitoneal infection with the pathogenic bacterium Aeromonas dhakensis by means of quantitative real time PCR (qPCR). The results showed that the pacu iNOS transcript is 3237 bp in length, encoding a putative protein composed of 1078 amino acid residues. The amino acid sequence showed similarities ranging from 69.03% to 94.34% with other teleost fish and 57.70% with the human iNOS, with all characteristic domains and cofactor binding sites of the enzyme detected. Phylogenetic analysis showed that the iNOS from the red-bellied piranha, another South American characiform, was the closest related sequence to the pacu iNOS. iNOS transcripts were constitutively detected in the liver, spleen and head kidney, and there was a significant upregulation in the liver and spleen at 12, 24 and 48 h after infection with A. dhakensis. No significant variations were observed in the head kidney during the periods analyzed. These results show that iNOS expression was induced by A. dhakensis infection and suggest that this enzyme may be involved in the response to this bacterium in pacu.

Expression of immune genes in systemic and mucosal immune tissues of channel catfish vaccinated with live theronts of Ichthyophthirius multifiliis.

Ichthyophthiriasis caused by Ichthyophthirius multifiliis (Ich) has a worldwide distribution and affects most freshwater fishes. Fish surviving natural infection and/or immunized with Ich develop strong innate and adaptive immune responses. However, there is a lack of the knowledge regarding immune gene expression patterns in systemic and mucosal immune tissues, and how immune genes interact and lead to innate and adaptive immune protection against Ich infection in fish. The objective of this study was to investigate the expression of innate and adaptive immune-related genes in systemic (liver, spleen) and mucosal (gill, intestine) tissues of channel catfish over time following vaccination with live Ich theronts. The vaccinated fish showed significantly higher antibody titers and survival (95%) than those of mock immunized fish. Expression of IgM and IgD heavy chain genes exhibited a rapid increase from 4 h (h4) to 2 days (d2) post-vaccination in systemic immune tissues. Immune cell receptor genes (CD4, CD8-α, MHC I, MHC II ß, TcR-α, and TcR-ß) were more highly upregulated and remained upregulated for longer duration in systemic tissues than in mucosal tissues of the vaccinated fish. The cytokine genes IL-1ßa and IFN-γ were rapidly upregulated in both systemic and mucosal tissues of vaccinated fish, with peak expression from h4 to d1 post-vaccination. Toll-like receptor genes TLR-1 and TLR-9 showed relatively stable upregulation in the gill of immunized fish following vaccination. Results of this study revealed the molecular immune responses in mucosal and systemic tissues of vaccinated fish and demonstrated that Ich vaccination resulted in innate and adaptive immune responses against Ich infection.

[Endoscopic ligation in treatment and prevention of bleeding from esophageal varices]. / Endoskopicheskoe ligirovanie kak metod lecheniya i profilaktiki krovotechenii iz varikozno-rasshirennykh ven pishchevoda.

AIM: To demonstrate the efficacy of endoscopic ligation in treatment and prevention of bleeding from esophageal varices in patients with liver cirrhosis and portal hypertension. MATERIAL AND METHODS: We performed a retrospective analysis of 338 patients with liver cirrhosis who underwent ligation for the period 2009 - May 2016. There were 209 (61.8%) men and 129 (38.2%) women. In this group 511 ligations were performed. The total number of ligated nodes was 4086. RESULTS AND DISCUSSION: Ligation was effective in 502 (98.2%) cases. In 9 (1.8%) cases endoscopic ligation was ineffective and Blackmore tube was required. The main cause of failed procedure was pre- or intraoperative active bleeding from esophageal varices. Complications in this group can be considered 3 cases of bleeding during ligation. CONCLUSION: Endoscopic ligation is highly effective (from an economic and medical points of view) treatment and prevention of bleeding from esophageal varices in patients with liver cirrhosis.

Complete and Sustained Response with a Doublet Chemotherapy Protocol in an 81-Year-Old Patient with Metastatic Breast Cancer.

Metastatic breast cancer (MBC) entails an overall 5-year survival of approximately 25%. The choice of therapy is influenced by expression of the HER2 gene and hormone receptors, by a disease-free interval, and by age. The use of paclitaxel combined with gemcitabine (doublet protocol) has shown efficacy as first-line treatment for MBC in either initial or maintenance therapy when compared to monotherapy with paclitaxel. There is evidence showing that the doublet protocol is a good alternative to maintenance therapy in women under 50 years old. Nevertheless, there is a lack of information concerning individuals above that age. We report the case of an 81-year-old patient presenting with recurrence of MBC, with lung and skin metastases both positive for hormone receptor and negative for HER2. We implemented a therapy based on the combination of gemcitabine and paclitaxel for 12 cycles, when complete response was achieved. Currently, 16 months after this achievement, the patient is receiving maintenance treatment under the doublet protocol, presenting acceptable parameters of toxicity since the beginning of treatment, which shows satisfactory tolerability and management of chemotherapy in an elderly patient. We suggest that the maintenance treatment protocol with a doublet might be an alternative with a satisfactory response in patients with MBC.

Detection and quantification of virulent Aeromonas hydrophila in channel catfish tissues following waterborne challenge.

The aim of this study was to understand the pathogenesis of motile aeromonas septicemia caused by an emergent, high virulent Aeromonas hydrophila (vAh) in channel catfish, Ictalurus punctatus Adipose fin clipped catfish were challenged with vAh using a waterborne challenge method, and the distribution of vAh over a time course was detected and quantified using real-time polymerase chain reaction. The results showed that 77.8% of fish died within 48 h post challenge with mean day to death of 1.5 days. At 2 h post challenge, vAh (inferred from genomic DNA copies or genome equivalents) was detected in all external and internal tissues sampled. Gill had the highest vAh cells at 1 h post challenge. Spleen harbored the most vAh cells among internal organs at 4 h post challenge. The tissues/organs with most vAh cells detected at 8 h post challenge were adipose fin, blood, intestine, kidney and skin, while liver showed the highest vAh cells at 24 h post challenge. These results suggest that vAh was able to rapidly proliferate and spread, following wound infection, through the fish blood circulation system and cause mortality within 8-24 h.

Molecular immune response of channel catfish immunized with live theronts of Ichthyophthirius multifiliis.

The parasite Ichthyophthirius multifiliis (Ich) has been reported in various freshwater fishes worldwide and results in severe losses to both food and aquarium fish production. The fish surviving natural infections or immunized with live theronts develop strong specific and non-specific immune responses. Little is known about how these immune genes are induced or how they interact and lead to specific immunity against Ichthyophthirius multifiliis in channel catfish Ictalurus punctatus. This study evaluated the differential expression of immune-related genes, including immunoglobulin, immune cell receptor, cytokine, complement factor and toll-like receptors in head kidney from channel catfish at different time points after immunization with live theronts of I. multifiliis. The immunized fish showed significantly higher anti-Ich antibody expressed as immobilization titer and ELISA titer than those of control fish. The vast majority of immunized fish (95%) survived theront challenge. Expression of IgM and IgD heavy chain genes exhibited a rapid increase from 4 hour (h4) to 2 days (d2) post immunization. Expression of immune cell receptor genes (CD4, CD8-α, MHC I, MHC II ß, TcR-α, and TcR-ß) showed up-regulation from h4 to d6 post immunization, indicating that different immune cells were actively involved in cellular immune response. Cytokine gene expression (IL-1ßa, IL-1ßb, IFN-γ and TNF-α) increased rapidly at h4 post immunization and were at an up-regulated level until d2 compared to the bovine serum albumin control. Expression of complement factor and toll-like receptor genes exhibited a rapid increase from h4 to d2 post immunization. Results of this study demonstrated differential expression of genes involved in the specific or non-specific immune response post immunization and that the vaccination against Ich resulted in protection against infection by I. multifiliis.

[Endoscopic transpapillary interventions in diagnostics and treatment of patients with diseases of the pancreatobiliary area].

It was performed analysis of efficiency of endoscopic retrograde transpapillary interventions in diagnostics and treatment of 1513 patients with diseases of the pancreatobiliary area for the period 2008--2012. About half of patients had choledocholithiasis. There were tumors in 9.5% of patients. Associated diseases confirmed or first identified during transpapillary intervention (stricture + choledocholithiasis, cancer + choledocholithiasis, etc.) were revealed in 6.8% of patients. We used almost all types of endoscopic transpapillary techniques which are applies for biliary hypertension including retrograde cholangiopancreatography, endoscopic papillotomy, endoscopic mechanical lithoextraction and lithotripsy, nasobiliary drainage, bougienage, balloon dilatation, stenting and endoscopic contact electrohydraulic lithotripsy of calculus of common bile duct. Efficiency of endoscopic transpapillary interventions was 96.5%. Complications were observed in 4.3% of patients. Mortality rate was 0.06%.

The morphological and molecular characterization of Henneguya rotunda n. sp., a parasite of the gill arch and fins of Salminus brasiliensis from the Mogi Guaçu River, Brazil.

A new species of myxosporea (Henneguya rotunda n. sp.) was found in the membrane of the gill arch and the fins of Salminus brasiliensis in the Mogi Guaçu River, municipality of Pirassununga, São Paulo state, Brazil. Morphological and morphometric analyses using light microscopy revealed parasites with similar characteristics at both infection sites. The mature spores found infecting the fins had oval spore body with 7.1 ± 0.2 µm in length, 5.6 ± 0.2 µm in width, 3.7 ± 0.1 µm in thickness, 16.4 ± 1.2 µm in length of the caudal process, and 23.6 ± 1.1 µm in total length of the spore. In a frontal view, the polar capsule was observed to be symmetrical with 3.4 ± 0.2 µm in length and 1.8 ± 0.1 µm in width. Mature spores contain six to seven turns of the polar filaments. The morphometric data concerning the spores obtained from plasmodia from the membrane of the gill arch were similar to those from the fins. Ultrastructure analysis revealed that the plasmodial wall was formed by a single membrane and had numerous pinocytotic canals connecting the outside of the plasmodia to the ectoplasm zone. Beyond that, various electron-translucent vesicles also were observed at the periphery of the plasmodium. The molecular analyses of the 18S rDNA gene from the spores obtained from the gill arch membrane and fin membrane showed that these sequences shared 100% similarity. Phylogenetic studies using maximum parsimony and maximum likelihood methods demonstrated the polyphyletic clustering of the myxosporean parasites of characiform fishes. H. rotunda n. sp. clustered as a sister species of Myxobolus pantanalis, also a parasite of S. brasiliensis.

Morphology and 18S rDNA sequencing identifies Henneguya visibilis n. sp., a parasite of Leporinus obtusidens from Mogi Guaçu River, Brazil.

During a survey of myxozoan parasites of freshwater fish from the Mogi Guaçu River in São Paulo State, Brazil, plasmodia of Henneguya visibilis n. sp. were found on the fins of Leporinus obtusidens (Characiformes: Anostomidae). The plasmodia, which were observed on five out of eight (62.5%) L. obtusidens examined, were 400-1,000 µm long. Mature spores were elongated with a spore body 10.8 ± 0.6 µm long and 3.9 ± 0.2 µm wide, a caudal process 18 ± 1.2 µm long, and a total spore length of 26.8 ± 1.1 µm. Polar capsules were elongated 4.9 ± 0.3 µm long and 1.4 ± 0.1 µm wide. Histological examination indicated that the plasmodia developed in the connective tissue, and no inflammatory infiltrate was observed at the infection site. Ultrastructural analysis showed a plasmodium wall with a single membrane and several pinocytotic canals. Sporogenesis occurred from the periphery to the center of the plasmodia. Phylogenetic analysis of the 18S rDNA sequence using maximum likelihood and maximum parsimony methods showed H. visibilis n. sp. positioned in a sub-clade composed of Henneguya/Myxobolus parasites of several freshwater fish families.