[WAYS TO SOLVE THE PROBLEM OF HOME PARENTERAL NUTRITION IN PATIENTS WITH SHORT BOWEL SYNDROME].

The purpose of the work is to identify the most optimal ways to solve the problem of home parenteral nutrition for patients with short bowel syndrome.Basics. Discussion of the current situation will help optimize the work of the Orphan Diseases Center, lead to a greater introduction of online technology, and aim at the search and implementation of new methods of treating patients in this category.Conclusion. The most optimal strategy has been proposed to improve the interaction between various specialists and patients in need of long-term parenteral nutrition.

[Chronic intestinal pseudoobstruction: difficulties in diagnosis and treatment. Case report].

The article presents a clinical case of a 23-year-old patient with an extremely severe congenital form of chronic intestinal pseudoobstruction coupled with a neuromyopathy,colon malrotation, malabsorption, bacterial overgrowth syndrome, cholelithiasis and gastrostasis, which excluded bowel transplantation. Long-term treatment in the intensive care unit with combined, mainly parenteral nutrition for 6 months, using antibiotics, prokinetics, intestinal decompression allowed to achieve partial stabilization of the patients condition and transfer to home treatment with the continuation of adequate complex therapy.

[The characteristics of health condition of students of medical university].

One of the priority areas of socio-economic development of Russia is concern about health status of young generation, as young people provide the near future and determine demographic economic and social potential of society. The purpose of the study is to implement comparative assessment of health status of students of Medical University and to identify risk factors of development of chronic non-communicable diseases. The article presents data of sociological survey and medical examination (indicators of systolic blood pressure, diastolic blood pressure, heart rate, capillary blood for glucose and cholesterol). The risk factors were determined by 7 parameters: high blood pressure (systolic and diastolic), tachycardia, hyperglycemia, hypercholesterolemia, smoking, lack of exercise. The comparative evaluation of the average functional and biochemical parameters of medical students made it possible to identify statistically significant increasing of systolic blood pressure and total cholesterol in female students in 2018. The evaluation of the structure of risk factors demonstrated that tachycardia is the most frequently detected functional deviation. It was observed in 61% of boys and 27% of girls in 2015 and of boys and 33% of girls in 2018. The evaluation of state of health and identification of risk factors of development of chronic non-infectious diseases of student youth in the learning process involves differentiated focus on the development of preventive measures to strengthen and maintain health with the formation of healthy lifestyle. The effective solution of this problem is possible with the interaction of health care, system of higher professional education and other interested structures.

[Resected bowel syndrome: clinical course and treatment options].

The current concepts of the short bowel syndrome and malabsorption after intestinal surgery are generally accepted, but do not fully reflect the patients condition, making it difficult to diagnose and treat it. AIM: The purpose of the study is to analyze the clinical course of the patients after bowel resection, to create a classification based on the variants identified to allow for a differentiated treatment and to introduce the concept of the resected bowel syndrome. MATERIALS AND METHODS: We observed 239 patients (96 men and 143 women) aged 18 to 80 who underwent intestinal resection for 1 month to 16 years (from 2002 to 2018). The 1st group included 96 patients with small bowel resection (40 men and 56 women). The 2nd group included 39 men and 58 women with small bowel resection, including the resection of the ileocecal valve and the right-hand side of the colon (n=97). The 3rd group included 17 men and 29 women with the resection of the right-hand side of the colon or colectomy (n=46). The survey included the NRS-2002 (Nutritional Risk Screening 2002) screening test to identify nutritional risk, a clinical assessment of the symptoms that occurred after the surgery, instrumental methods (esophagogastroduodenoscopy, colonoscopy with biopsy, ultrasound of the abdominal cavity organs and the kidneys, a plain radiography of the abdominal cavity organs, an X-ray examination of the small intestine and the intestinal passage), serum citrulline and short-chain fatty acids in faeces. RESULTS: Based on the analysis of the clinical symptoms and the nutritional status of the patients, a new concept is proposed the resected bowel syndrome with two variants of its progression: either with or without the development of nutritional insufficiency of three types: the dehydration type, the protein-energy insufficiency type and a mixed type. Type 1 requires the use of antimicrobials with the control of SCFA concentrations in faeces. Type 2 requires the introduction of an optimal amount of easily digestible protein to correct protein-energy deficit. The 3rd (most severe) mixed type requires prescription of a parenteral nutrition component with the control of citrulline concentration in the blood serum. CONCLUSION: The proposed concept the resected bowel syndrome makes it possible to improve its diagnosis, take into account the variants of its progression and allow for a differentiated treatment.

[Iron deficiency syndromes and their correction with nutritional support in elderly patients with colo-rectal cancer.]

51 patients with operated colorectal cancer T1N0M0, T3N1M0 and T4N0M1 at the age of 67±2,3 years receiving adjuvant chemotherapy and nutritional support (NS) were examined. Nutritional status was assessed using alimentazione-volume diagnosis to the points on L.N.Kostyuchenko, nutritional risk - with NRI, body composition - with bioimpedance method, the iron metabolism - with basic markers (serum ferritin, transferrin saturation with iron, erythrocyte indices: erythrocyte saturation of iron, the average concentration of hemoglobin in the erythrocyte, mean corpuscular volume, hemoglobin, etc.), traditional settings, the staging of tumors - according to TNM. Iron deficiency before the development of anemia can be corrected with NS. Upon the occurrence of anemia requires additional pharmacological treatment iron supplementation, preferable with iron III hydroxide olygoisomaltazat 1000 + NS) for the prevention of toxic-metabolic complications.

[Short bowel syndrome]. / Sindrom korotkoi kishki.

The paper gives information on the classification, pathogenesis, and clinical manifestations of short bowel syndrome following after intestinal resection. It discusses the treatment and rehabilitation of patients with this condition.

[THE CLINICAL COURSE OF THE ISOLATED EFFECTS OF EXTENSIVE SMALL INTESTINE RESECTION IN THE LATE POSTOPERATIVE PERIOD].

UNLABELLED: The purpose is the postoperative period study of clinical and functional status of patients after small intestine resection, which was performed in different volume MATERIAL AND METHODS: 91 patients with sequelae of small intestine resection in different terms after the operation were surveyed. Patients were assessed for clinical symptoms on a scale "Method of evaluating intestinal failure after gastric resection", in our own modifications, clinical-laboratory and biochemical blood examination, ultrasound examination of abdominal cavity and kidneys, x-ray examination of the gastrointestinal tract, esophagogastroduodenoscopy with histological examination of the mucosa. We determined the scatology, the consistency of the feces on the Bristol scale, concentration and profile of short chain fatty acids in coprofiltrates. Blood serum Citrulline was determined using high performance liquid chromatography on the chromatograph "Stayer". The degree of nutritional risk was assessed using screen questionnaire NRS-2002 RESULTS: Analysis of clinical, anthropometric and laboratory data showed that patients with residual stumps of the small intestine more than 2 meters have a distinct tendency to stabilize their condition, confirmed by the level of citrulline in the serum. At the same time complete adaptation does not occur, because the main reason of the operation is adhesive intestinal obstruction with chronic relapsing course. Patients with stumps of the small intestine less than 2 m have highly individual adaptation, which may be due to a small sample of patients in this group. The detected changes in the concentration and profile of coprofiltrat short-chain fatty acids allow differentiated approach to therapy of diarrhea syndrome as the main clinical manifestations of the effects of isolated small intestine resection.