[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.

APPLICATION OF BIOLOGICAL TISSUE REPAIR STIMULATOR AND SEALANTS IN SURGICAL TREATMENT OF BRONCHOPLEURAL FISTULAS.

The aim of the study was to increase the effectiveness of surgical treatment of patients with pleural empyema complicated by the development of bronchopleural fistula due to the personification of the surgical approach to treatment. The cohort observation group consisted of 136 patients who were treated at the I. V. Davydovsky State Clinical Hospital No. 23 for pleural empyema complicated by bronchopleural fistula. The main group included patients in whom a biological stimulator of local tissue repair (BSRMT) was used to treat EP with BPS. The comparison group included patients who used the installation of a valvular broncho blocker for the treatment of EP with BPS. Results: the effectiveness of the use of fibrin glue ranged from 57.1% to 86.4%, depending on the etiology of the EP. The effectiveness of broncho location ranges from 80% to 84.2%. The greatest effectiveness was observed with the simultaneous use of fibrin glue and broncho blocking. The use of biological stimulants based on fibrinogen and growth factors may be effective in the treatment of various nosologies of the thoracic profile. Fibrin glue, obtained from its own blood plasma, has good adhesion indicators, is biologically inert, in addition, it has the property of stimulating repair, which is extremely important in the treatment of such pathology as bronchopleural fistulas. However, the issue of the use of fibrin glue and other sealants requires further study.

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.

[ARRHYTHMIAS IN PATIENTS OPERATED ON FOR HIATAL HERNIA].

The purpose of this publication is to identify the prevalence of arrhythmia as one of the manifestations of gastrocardial syndrome in patients with hernias of the esophageal orifice of the diaphragm and reflux esophagitis. To evaluate the results of antireflux surgery in the dynamics of arrhythmia regression. Materials and methods: the study included 101 patients with hiatal hernias who were undergoing inpatient examination and treatment. Arrhythmia was detected in 35 (34.6%) of 101 patients with hernias of the esophageal orifice of the diaphragm. Arrhythmias are characteristic of cardiofundal (40%), subtotal (66.6%) and total (100.0%) hernias of the esophageal orifice of the diaphragm, were recorded at a younger age, were dependent on the duration of the underlying disease. Clinical manifestations of arrhythmia depended on the degree of shortening of the esophagus, most often arrhythmias occurred with shortening of the esophagus of the II degree in cardiofundal hernias (68.7%), subtotal (60.0%) and total (100.0%). As a result of antireflux surgery, clinical manifestations of arrhythmia regressed in 19 (54.3%), in 26 (74.2%) patients, electrocardiogram and Holter monitoring indicators decreased or were absent altogether. In conclusion, it should be emphasized that arrhythmias on the background of hernia of the esophageal orifice of the diaphragm, associated with anatomotopographic and physiological features, are a frequent clinical situation characterized by the mutually aggravating effect of both diseases on each other. An instrumental study of the state of the cardiovascular system in the pathology of the upper gastrointestinal tract showed that there is an improvement in the indicators of cardiac arrhythmias associated with the underlying disease, the correction of which is possible only with surgical treatment of the underlying disease.

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.

[COMPLEX TREATMENT OF PATIENTS WITH VENOUS TROPHIC ULCER IN THE CONDITIONS OF COVID-19 HOSPITAL].

The aim of the study was to study the effectiveness of complex treatment of decompensated chronic venous insufficiency (CVI) using innovative techniques and proteolysis inhibitors with a wide spectrum of activity in patients with SARS-CoV-2 (COVID-19) in COVID hospital. This study was performed in the surgical department of COVID hospital on the basis of the Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University). During the period from April 2020 to February 2021, 32 patients with confirmed SARS-CoV-2 (COVID-19) and the presence of venous trophic ulcers (VTU) of the lower extremities were treated. All patients underwent complex therapy for viral pneumonia in accordance with the order of the Ministry of Health of the Russian Federation. The protease inhibitor Aprotinin (Gordox ™) was used to improve microcirculation and prevent the development of a "cytokine storm". To accelerate the cleansing and epithelialization of venous trophic ulcers, the surface of the trophic ulcer was treated with an air plasma flow of NO and injections into the trophic ulcer of autoplasma. Against the background of complex treatment, all patients showed positive dynamics of the clinical picture: relief of hyperthermia, increase or stabilization of SpO2 values from 95% and above, significant decrease in CRP, LDH, D-dimer indices, increase in the number of lymphocytes, decrease in the VTU area by 1.5 times, active granulation and marginal epithelialization of the ulcer. In 14 patients (43.8%), complete epithelialization of the VTU defect was noted by the end of the third week. According to the CIVIQ-20 questionnaire, all 32 patients participating in the study showed positive dynamics. There were no lethal outcomes. Multicomponent therapy of decompensated forms of CVI of the lower extremities in the COVID hospital in patients with moderate severity of coronavirus infection with the use of proteolysis inhibitors leads to a rapid relief of symptoms of intoxication, prevents the progression of lung tissue and parenchymal organ damage and contributes to the positive dynamics of healing of ulcerative defects in the vast majority of patients.

[TELOMERASE ACTIVITY AS A POTENTIAL BIOMARKER FOR PREOPERATIVE DIFFERENTIAL DIAGNOSIS OF CYSTIC NEOPLASMS OF THE LIVER].

The goal of the study was to find ways to improve the quality of preoperative diagnosis of mucinous cystic liver neoplasms using such tumor markers as CA 19-9 and telomerase activity. We conducted a retrospective analysis and a prospective study that included the results of treatment of 80 patients with cystic neoplasm of the liver (31 with MCNL, 36 with multichamber non-parasitic cysts (NPC), 13 with stage II (WHO classification) echinococcus liver cysts. Our study showed the presence of telomerase activity in 29 (93.5%) patents with MCNL (in case of IMCNL, the TA was high both in the tumor itself and the CNL content).16 patients demonstrated high TA (+++) both in the tumor itself and the CNL content; 11 and 2 patients had moderate (++) and low (+) TA, respectively. 12 (38.7%) patients with MCNL had the CA 19-9 level above 1000 U/L, 14 (45.1%) - above 10,000 U/L, and 3 (9.6%) - above 100,000 U/L, while only 1 (6.5%) patient had the CA 19-9 level <1000 U/L. The analysis of data showed the absence of TA in the CNL content in 33 of 36 patients with NPC. However, three patients demonstrated a low activity of telomerase. CA 19-9 levels were below 1000 U/L in 27 (75%) of 36 patients with NPC. It was established that the determination of TA and the level CA 19-9 in the contents of the CNL is a valuable method, which makes it possible to carry out a preoperative differential diagnosis of CNL with a high probability.

[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.

[Simultaneous laparoscopic procedures in patients with synchronous multiple primary gastric and kidney cancer]. / Odnomomentnye laparoskopicheskie operatsii u bol'nykh s pervichno-mnozhestvennym sinkhronnym rakom zheludka i pochki.

OBJECTIVE: To evaluate an effectiveness of simultaneous laparoscopic procedures in patients with synchronous multiple primary cancer (SMPC). MATERIAL AND METHODS: We observed 3 patients (2 men and 1 woman) aged 61-78 years with synchronous multiple primary gastric and kidney cancer. Gastric tumors were localized in the lower third of the body (1) and the antrum (2), histological structure corresponded to adenocarcinoma G1 (1) and G2 (2). Kidney tumors were verified as light cell carcinoma and localized in the upper segment of the left kidney in 2 patient and right kidney in one patient. Mean dimension of tumor scheduled for resection was 4.65 cm, nephrectomy - 10.3 cm. Complexity of resection according to the RENAL scale was equal to 8 and 10. RESULTS: Three patients underwent laparoscopic Billroth-I distal gastrectomy, 2 - kidney resection and one patient - nephrectomy. Mean surgery time was 265±37 min, blood loss - 175±29 ml. There were no conversion and redo interventions within 30 days after surgery. Mean hospital-stay was 11±2 days. CONCLUSION: Minimally invasive technologies in patients with SMPC reduces blood loss, ICU- and hospital-stay. Earlier rehabilitation ensures the next stage of treatment in early postoperative period, while quality of life is better in comparison with traditional interventions.

[Epiphrenic diverticulum of the lower third of the esophagus after previous antireflux surgery]. / Epifrenal'nyi divertikul nizhnei treti pishchevoda u patsientki posle provedennoi ranee antireflyuksnoi operatsii.

In this article is described a rare postoperative complication: epiphrenal diverticulum of the esophagus of the lower third of the esophagus in patient after antireflux surgery. Brief description of the main stages of surgical treatment. 96 patients with cardiofundal, subtotal or total hiatal hernias underwent operation. There were complications of I-II degree according to Clavien-Dindo in the early postoperative period in 11 patients (11.4%). Complications of IIIb degree were revealed in 2 patients (2.1%) in the early postoperative period and in 1 patient (1.0%) in the late postoperative period (2 months after hospitalization) - epiphrenal diverticulum of the esophagus. Laparotomy, the sagittal diafragmalnaya, diverticulectomy, valisesta pyloroplasty were performed. Postoperative period without complications. The patient's nutrition through the mouth is restored on the 5-th day. No dysphagia and reflux esophagitis were detected radiologically and endoscopically.

[Laparoscopic and robot-assisted procedures in patients with gastrointestinal stromal tumors (GIST) of stomach]. / Laparoskopicheskie i robot-assistirovannye operatsii u bol'nykh gastrointestinal'noi stromal'noi opukhol'iu zheludka.

OBJECTIVE: To analyze the results of minimally invasive surgical procedures in patients with gastric GIST. MATERIAL AND METHODS: The study included 30 patients aged 52.2±9.8 years. ASA grade II (44%), III (26%) and I (23%) were predominant. Lesion of stomach body was noted in 17 (56%) patients, antrum - in 8 (27%), fundus - in 2 (7%) and cardia - in 3 (10%) patients. GIST was located on the anterior wall of stomach in 56% of patients. Exophytic growth was observed in 16 (53%) patients, endophytic - in 12 (40%), transmural growth - in 2 (7%) cases. T2 grade of tumor was noted in 67% of cases (TNM 8). All patients underwent laparoscopic or robot-assisted ('daVinci Si') partial resection of the stomach. RESULTS: Radical resection (R0) without injury of pseudocapsule of tumor was made in all patients. Laparoscopic procedures were performed in 25 (83%) patients, robot-assisted - in 5 (17%). Early postoperative complications (Clavien-Dindo II) were observed in 3 patients. Spindle cell structure of tumors (93%) with low mitotic activity (63%) prevailed. Tumor stage I was observed in 56% of patients. Patients with high mitotic tumor index (44%) were directed to targeted therapy. Recurrence and/or metastasis in long-term period were absent in 26 (87%) patients. CONCLUSION: Laparoscopic surgery for gastric GIST is safe and characterized by the absence of significant postoperative complications and long-term recurrence-free period. The use of robotic surgical system is effective and justified for anatomically difficult localization of GIST.

[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.

[Treatment of reflux esophagitis in patients with cardiofundal, subtotal and total hiatal hernias]. / Lechenie refliuks-ézofagita u bol'nykh s kardiofundal'nymi, subtotal'nymi i total'nymi gryzhami pishchevogo otverstiia diafragmy.

AIM: To analyze treatment of patients with reflux esophagitis and large hiatal hernia. MATERIAL AND METHODS: There were 85 patients with reflux esophagitis and large hiatal hernia. Laparoscopic repair was performed in 33 patients, laparotomy - in 52 cases. All patients underwent fundo- or gastroplication by A.F. Chernousov, correction of large defect of hiatal orifice by cruroraphy was applied in 55 (64.7%) patients. RESULTS: Postoperative morbidity was near 10% after laparoscopic and conventional surgery despite more difficult video-assisted endoscopic technique. Complications Clavien-Dindo grade I-II were noted in 4 (12.1%) patients after laparoscopic treatment and in 6 (11.5%) patients after laparotomy. Medication was effective in all cases. Two patients with subtotal hernias had complications Clavien-Dindo grade IIIB after endoscopic surgery: recurrent hiatal hernia followed by severe reflux esophagitis and dysphagia. These complications required redo surgery. Repair of hiatal orifice is always possible without mesh reinforcement. Posterior cruroraphy is feasible and effective in all patients. Incidence of intraoperative and postoperative complications is comparable in both approaches (p<0.05). Mean hospital-stay after laparotomy was 7.3 days, after laparoscopy - 5.8 days. CONCLUSION: Endoscopic formation of antireflux cuff by A.F. Chernousov is appropriate and effective in patients with reflux esophagitis and large/giant hiatal hernias.

[Quality of life of patients with complicated reflux-esophagitis followed antireflux surgery]. / Kachestvo zhizni bol'nykh, operirovannykh po povodu refliuks-ézofagita i ego oslozhnenii.

AIM: To analyze quality of life of patients with complicated reflux-esophagitis followed antireflux surgery. MATERIAL AND METHODS: The trial enrolled 200 patients who underwent surgical treatment at the Burdenko Faculty Surgery Clinic of Sechenov First Moscow State Medical University for complicated reflux esophagitis from 2008 to 2015. Inclusion criteria were long-standing reflux esophagitis irresistible to conservative treatment, hiatal hernia with shortening of the esophagus and/or peptic stricture and/or Barrett's esophagus. Patients were divided into 2 groups according to the degree of esophagus shortening: group I - 98 patients with esophagus shortening degree I; group II - 102 patients with shortening grade II. Men/women ratio was 87(43.5%)/113(56.5%). Mean age was 56.0±13.9 years (16-83 years). We performed fundoplication in A.F. Chernousov modification in the first group and modified valvular gastroplication in the second group. All patients underwent survey within 6 months - 10 years after surgery to assess long-term outcomes. X-ray examination, upper GI endoscopy, standard laboratory tests were performed with pH-impedance and computed tomography if it was necessary. Quality of life was estimated by RAND SF-36 and GSRS (Gastrointestinal Symptom Rating Scale) questionnaires. RESULTS: SF-36 questionnaire revealed postoperative changes of physical, psychological and social values and was able to compare them with those in general population. Postoperative overall health was significantly higher in both groups compared with preoperative level and comparable with general population. GSRS questionnaire have also revealed positive changes. Overall postoperative GSRS score was 1.6±0.5 and 1.6±0.6 points in groups I and II respectively that corresponds to minor concern after surgery.

[Laparoscopic and robot-assisted surgery for locally advanced and generalized stomach cancer]. / Laparoskopicheskie i robot-assistirovannye operatsii pri mestno-rasprostranennom i generalizovannom rake zheludka.

AIM: To analyze the first experience of laparoscopic and robot-assisted surgery for locally advanced and generalized stomach cancer at the Burdenko Clinic of Faculty Surgery. MATERIAL AND METHODS: Since 2011 27 laparoscopic and 2 robot-assisted operations for locally advanced and generalized stomach cancer have been performed in our hospital. Mean age of patients was 62.1±10 years. There were 19 men and 10 women. RESULTS: There were 11 gastrectomies with abdominal esophageal resection and 18 Billroth I subtotal resections. Advanced surgery was made in 4 (13.7%) patients including 1 case of transverse colon resection and 3 cases of liver resection. Mean time of surgery was 260 min (180-380 min) in gastrectomy, 210 min (175-310 min) in subtotal resection. Mean intraoperative blood loss was 120 ml (50-220 ml). CONCLUSION: Minimally invasive technologies reliably reduce blood loss, rehabilitation, ICU- and hospital-stay. The quality of life after minimally invasive interventions is significantly higher compared with conventional surgery while reduced rehabilitation allows to start chemotherapy already in early postoperative period.

[The molecular genetic alterations in mucosa of intestines as markers of oncologic progression and estimate of effectiveness of anti-reflux operations in patients with Barrett's esophagus].

The development of disease of Barrett's esophagus is based on processes of metaplasia of epithelium of esophagus when as a result of reflux of gastric juice and bile acids the normal planocellular epithelium of esophagus is replaced by cylindrical epithelium of intestinal type. Thereupon, Barrett's esophagus is progressing up to dysplasia and adenocarcinoma of esophagus. The progression from precancerous states up to tumor is related to development of genome disorders in cells associated with malignant transformation. The genetic and epigenetic alterations conditioning tumor growth can be used as markers of prognosis of clinical course of disease. To receive possible markers of progression of Barrett's esophagus the study was organized concerning methylation of such genes-suppressors of tumor growth as MGMT, CDH1, p16/CDKN2A, DAPK, RAR-ß and RUNX3 in patients with Barrett's esophagus and adenocarcinoma of esophagus. The effectiveness of applied anti-reflux surgical treatment was evaluated too. The abnormal methylation of studied genetic panel in patients with Barrett's esophagus prior to surgical treatment was observed reliably more frequently in altered epithelium as compared with unaltered epithelium (p<0.0001), under dysplasia as compared with metaplasia (p<0.0358) and in the presence of long (>3 cm) segments of altered epithelium as compared with short (<3 cm) segments (p=0.0068). In normal epithelium, prior to operation, abnormal methylation of panel of genes was detected in 7/60 (12%) of patients. Against the background of surgical treatment number of long and short segments of altered epithelium of esophagus reliably decreased (p<0.05). At that, in short segments after operation rate of methylation increased significantly (p=0.0068). Though after operation number of patients with Barrett's esophagus and dysplasia and metaplasia decreased, the rate of abnormal methylation in the other patients increased. It is demonstrated that anti-reflux operation ameliorates condition of mucous membrane of esophagus under Barrett's esophagus. However, in cases without regression significant increasing of rate of abnormal methylation of studied panel of genes is occurred. This is a proof that abnormal methylation of system of genes is related to worse response to application of anti-reflux surgical treatment.

[Liver tissue regeneration under the influence of cryoprecipitate and alloplant].

AIM: To study the effectiveness and impact of cryoprecipitate and alloplant on regeneration of liver tissue in patients with cirrhosis. MATERIAL AND METHODS: 114 patients with liver cirrhosis have been treated at the Department of Faculty Surgery of I.M. Sechenov First Moscow State Medical University from 2007 to 2014. Cryoprecipitate and alloplant were injected into cirrhotic liver tissue in the first (72 patients) and second (42 patients) groups under ultrasound control respectively. Patients' age was 48.9±12.14 years (range 18-75). There were 66 men (58%) and 48 (42%) women. Mixed (toxic and viral) etiology of cirrhosis was observed in 40.3% of patients, viral--in 25.8%, toxic--in 34.2%. RESULTS: Minimally invasive treatment under ultrasound showed significant (p>0.05) positive dynamics of hepatocellular failure, cytolytic and cholestatic syndromes, hypersplenism in 3, 6 and 12 months after cryoprecipitate administration in most patients with cirrhosis Child-Pugh class A, B and C (group 1). Alloplant injected into hepatic tissue causes less regeneration of liver tissue. It improves clinical and laboratory parameters in patients with cirrhosis Child-Pugh classes A and B. In case of class C allopolant is not effective.

[Gastrectomy with spleen preservation in patients with stomach cancer].

It was analyzed the results of surgical treatment of 118 patients with stomach cancer. Lymphadenectomy and gastrectomy were done in all cases. All patients were divided into two groups. Gastrectomy and splenectomy were performed in the first group, gastrectomy with preservation of spleen was done in the second group. It was revealed that splenectomy is not an independent prognostic factor influencing on prolonged survival of patients with stomach cancer. Preservation of spleen permits to reduce the number of early postoperative complications.