[Computed tomography for assessment of postoperative outcomes in patients with parastomal hernia]. / Primenenie mul'tispiral'noi komp'yuternoi tomografii dlya otsenki effektivnosti khirurgicheskogo lecheniya patsientov s parakolostomicheskoi gryzhei.

OBJECTIVE: To show the efficacy of innovative hybrid intraperitoneal alloplasty in patients with parastomal hernia. MATERIAL AND METHODS: Treatment outcomes were assessed in 60 patients with parastomal hernia using computed tomography. CONCLUSION: The innovative hybrid intraperitoneal alloplasty reduces the risk of recurrence by 7 times (p=0.01).

[Sclerotherapy as an alternative to surgery for recurrent nodular goiter]. / Skleroterapiya kak al'ternativa operatsii pri lechenii bol'nykh s retsidivnym uzlovym zobom.

OBJECTIVE: To evaluate the results of treatment of recurrent nodular goiter using sclerotherapy with polidocanol. MATERIAL AND METHODS: A comparative analysis of sclerotherapy (30 patients) and conventional surgical treatment (17 patients) of recurrent goiter was performed. RESULTS: Sclerotherapy ensures reduction of nodes (linear dimensions of nodes decreased by 14.2±1.1 mm after 3 courses), correction of endocrine imbalance in patients with functional autonomy and relief of initial signs of cervical organ compression in all patients with recurrent goiter. Sclerotherapy is associated with less pain syndrome and no need for inpatient treatment. However, the most significant advantage is reduced risk of complications. Hypoparathyroidism and laryngeal paresis developed in 53 and 24% of patients after conventional surgery while these events were not observed after sclerotherapy. CONCLUSION: Sclerotherapy with polidocanol is a perspective alternative to conventional surgery for recurrent nodular goiter.

[DIC-syndrome-related mortality in acute necrotic pancreatitis]. / DVS-sindrom pri pankreonekroze.

AIM: To improve the results of acute necrotic pancreatitis management via an analysis of changes in the main causes of mortality in patients with this disease over the last decade. MATERIAL AND METHODS: We have analyzed medical records of patients with acute necrotic pancreatitis followed by lethal outcome for the period 2015-2016. In all cases autopsy was performed in order to determine morbidity and mortality. Complications of pancreatic necrosis significant for tanatogenesis, treatment and prevention strategy were compared with those for 2005-2006. RESULTS: It was shown that not only significantly decreased mortality in acute necrotic pancreatitis but also important changes in its structure occurred for the last ten years. At present time DIC-syndrome and its organ complications are the most significant causes of death. CONCLUSION: Prevention of DIC-syndrome and its complications is necessary to improve the outcomes. Endothelial protectors' administration in early period, timely diagnosis and adequate treatment of DIC-syndrome are advisable.

Effect of Neoadjuvant Chemoradiation Therapy on Proteasome Pool in Rectal Cancer.

In untreated rectal cancer patients, the chymotrypsin-like activity of proteasomes in tumor tissue was 3-fold higher than that in conventionally normal tissue, which is explained by up-regulation of expression of immunoproteasomes and total pool of proteasomes. After neoadjuvant chemoradiation therapy, expressions of the total pool of proteasomes and immunoproteasomes in the tumor as well as the relative ratios of these indices to those in conventionally normal tissue were smaller by 1.4-3.3 times in comparison with the untreated patients. These changes were paralleled with pronounced (4.5-fold) down-regulation of proteasome activity in the tumor and a 3.7-fold decrease of activity ratio for the proteasomes in tumor and in conventionally normal tissue. The number of immunoproteasome subunits and the chymotrypsin-like activity of proteasomes can be viewed as potential markers to prognosticate effectiveness of neoadjuvant chemoradiation therapy in rectal cancer patients.

[Efficiency of combined methods of hemorroid treatment using hal-rar and laser destruction]. / Éffektivnost' kombinirovannoi metodiki lecheniia gemorroia s ispol'zovaniem HAL-RAR i lazernoi destruktsii uzlov.

AIM: To develop the combined method of treatment of hemorrhoids with arterial ligation under Doppler control and laser destruction of internal and external hemorrhoids. MATERIAL AND METHODS: The study included 100 patients with chronic hemorrhoids stage II and III. Combined method of HAL-laser was used in study group, HAL RAR-technique in control group 1 and closed hemorrhoidectomy with linear stapler in control group 2. Сomparative evaluation of results in both groups was performed. RESULTS: Combined method overcomes the drawbacks of traditional surgical treatment and limitations in external components elimination which are inherent for HAL-RAR. Moreover, it has a higher efficiency in treating of hemorrhoids stage II-III compared with HAL-RAR and is equally safe and well tolerable for patients. This method does not increase the risk of recurrence, reduces incidence of complications and time of disability.

[Systemic disorders management in patients with acute pancreatic necrosis]. / Vozmozhnosti korrektsii sistemnykh narushenii pri lechenii bol'nykh ostrym nekroticheskim pankreatitom.

AIM: To study the effectiveness of sulodexide for systemic disorders correction in patients with acute pancreatic necrosis. MATERIAL AND METHODS: The study included 60 patients with acute pancreatic necrosis who were divided into main and control groups by 30  patients. Their age varied from 27 to 79. Standard combined therapy with prevention of disseminated intravascular coagulation and thrombotic complications was recommended in all patients. In the control group enoxaparin therapy in prophylactic doses (4,000 IU (40 mg) per day) was used. Mean duration of treatment was 6±0.9 days. Sulodexide was used in the main group. Sulodexide was administered since the 1st hospital day 600 LE per day intravenously for 5-10 days. The duration of treatment was determined according to clinical course and «capillary leak¼ that was measured by serum proteins loss. Mean duration was 8.8±0.3 days. RESULTS: Hospital-stay was significantly lower in study group than in control group for about 5±2.2 days (p<0.03). Overall mortality was lower by 10%. In both groups unfavorable outcomes were caused by severe multiple organ failure. There were no deaths in case of SOFA score less than 6. In the main group mortality of patients with severe multiple organ failure was 2.4 times lower than in the control group (14% vs. 33%). CONCLUSION: Correction of microcirculation and tissue perfusion improves the severity of systemic manifestations of acute destructive pancreatitis. Mortality and hospital-stay were decreased due to reduced incidence, severity and duration of multiple organ failure and frequency of complications.

Clinical acceptability study of micronized purified flavonoid fraction 1000 mg tablets versus 500 mg tablets in patients suffering acute hemorrhoidal disease.

OBJECTIVE: To compare the clinical acceptability of micronized purified flavonoid fraction (MPFF) 1000 mg with MPFF 500 mg tablets, administered at the same daily dose in patients suffering non-complicated acute hemorrhoids. BACKGROUND: MPFF is an established treatment for hemorrhoidal disease. METHODS: This was a double-blind, multi-center, randomized study. Patients took either MPFF 1000 mg or 500 mg tablets for 7 days (daily dose; 3 g over 4 days followed by 2 g over 3 days). Adverse events were recorded in a patient diary. On day 7, anal pain and bleeding were assessed (visual analog scale [VAS] and Dimitroulopoulos scale, respectively). RESULTS: Patients (162) were randomized to MPFF 1000 mg (79) and MPFF 500 mg (83). No serious adverse events (AEs) occurred; 10 emergent AEs were considered treatment-related (6 for MPFF 1000 mg and 4 for 500 mg). Both regimens were associated with significant reduction in anal pain (VAS); -2.37 cm MPFF 1000 mg (P < 0.001) and -2.17 cm 500 mg (P < 0.001), with a slight trend in favor of MPFF 1000 mg (mean global reduction -2.27 cm, P < 0.001). Bleeding improved significantly in both groups of patients, 56% of patients on MPFF 1000 mg versus 61% on MPFF 500 mg. Bleeding ceased after treatment in 47% patients on MPFF 1000 mg versus 54% on 500 mg. CONCLUSION: After 7 days of treatment with MPFF at the same daily dose, both regimens reduced anal pain and bleeding. MPFF 1000 mg had a comparable safety profile to MPFF 500 mg, with the advantage of fewer tablets. Key limitations: Safety study.

Successful Tigecycline Use in Combined Therapy of Ventilator-Associated Hospital-Acquired Pneumonia: a Clinical Case.

In patients under artificial lung ventilation (ALV) there is often observed development of severe ventilator-associated pneumonia (VAP) due to polyresistant hospital pathogens. It should be noted that in the patient described here with the initial diagnosis of community-acquired pneumonia rapidly subjected to prolonged ALV the previous antibacterial therapy by broad spectrum drugs significantly increased the risk of contamination just by multiresistant nosocomial strains, which hampered the starting therapy of nosocomial pneumonia either when there were not available or sometimes there were available microbial cultures. When the treatment of severe pneumonias caused by multiresistant hospital flora resistant to carbapenems is actual, in the alternative therapy it could be used tigecycline, a tetracycline from the group of glycylcyclines. A case of successful treatment of nosocomial VAP by tigecycline based on the results of the bronchoalveolar lavage (BAL) culture is described. The case is of interest because tigecycline was used as off label.

[Endovascular laser obliteration in treatment of patients with varicose veins with trophic disorders].

The authors studied efficacy and safety of endovasal laser obliteration (EVLO) in treatment for varicose veins in patients with trophic disorders, carrying out comparative analysis of the outcomes of treatment of 95 patients subjected to EVLO (Study Group) or combined phlebectomy (Control Group). It was shown that EVLO is accompanied by less traumatic lesion of tissues during interventions, thus leading to more rapid relief of oedemas of lower limbs and reduction of trophic skin disorders. In patients with open trophic ulcers with an area of more than 10 cm2 healing occurred averagely one month faster than in those after phlebectomy. Hence, EVLO may be recommended as a preferable technique in treatment of varicose veins in patients with trophic disorders. However, if the diameter of the venous trunk exceeds 1 cm there is a probability of its recanalization even in the remote period after the intervention.

[Diagnostics of thyroid cancer: limitations of the existing methods and perspectives for future developments].

A novel approach to the development of a precise method of intraoperative diagnostics of thyroid cancer has been proposed on the basis of fundamental study of proteasomes in malignant tumors of mammals and human. The method is based on estimation of proteasome activity in small fragments of the tumor and adjacent tissues.

Changes in proteasome chymotrypsin-like activity during the development of human mammary and thyroid carcinomas.

Changes in the proteasome chymotrypsin-like activity in mammary and thyroid carcinomas in comparison with the adjacent tissue were studied at stages T(1-4)N(0-3)M(0) and T(2-3)N(0-1)M(0), respectively. The activities changed in a wave-like manner over the course of mammary carcinoma growth in cases with and without metastases. The minimum increment of the activity in the tumor was recorded during the T(2)N(0) stage in the absence of local metastases. The increment of the activity reached the peak in N(1) tumors of the same size with metastases. The activities in the tumor and adjacent tissues virtually did not differ during the T(3-4)N(1-3) stages. The time course of proteasome activity changes in thyroid tumors of the studied stages was similar to that in mammary carcinoma. The results can be used for development of methods for evaluating the aggressiveness of mammary and thyroid tumors.

[Endoscopic retrograde cholangiopancreaticography for the treatment of necrotic pancreatitis].

40 patients with the acute necrotic pancreatitis and verified biliary hypertension were included in the study. During the endoscopic retrograde cholangiopancreaticography we avoided the main pancreatic duct contrast enhancement. The canulation during papillosphincterotomy (PST) was not used if the concrement was infringed in the ampulla. The use of these methods led to fast relief of the biliary hypertension and truthworthy positive dynamics of the disease course. The negative consequences were usually limited to transitory amilasemia and the pancreonecrosis progression was registered in only 4±4% cases. In comparison with cholecystostomy, the ERCP with PST showed better prognosis considering the frequency of septic complications and terms of hospital stay. The statistical analysis proved the the ERCP with PST are preferable to cholecystostomy in cases of pancreonecrosis with choledochlithiasis and biliary hypertension and the overall severity of pancreonecrosis is not higher than 11 by the physiological condition scale.

[Epidemiology of venous thromboembolias among the high risk surgical patients and the role of sural sinus in initiation of thrombus formation].

The prospective study of postoperative venous thromboembolism after standard prophylactic measures among high risk patients was performed. The ultrasound lower limb veins investigation registered postoperative venous thrombosis in 32.7% of these patients, the proximal thrombosis was in 9.1%. Half of the cases demonstrated the isolated sural sinus thrombus and the overall sural sinus involvement was 83.3%. 50% of all thromboses were diagnosed within the first week after the operation. 86.1% of all cases were registered within 2 weeks after the surgery. Terms of anticoagulative drugs prescription showed no influence on the thrombosis incidence aiming the researched patients. The study demonstrated the high true incidence of postoperative venous thromboembolism after standard prophylactic measures among high risk patients and the leading role of the sural sinus in its initiation.

[Treatment of hepatic insufficiency in benign mechanical jaundice].

The aim of this work was to estimate hepatic dysfunction and improve treatment of benign mechanical jaundice using an injection hepatoprotector. The study included 124 patients of whom 74 were given remaxol. 50 control subjects received basal therapy. The patients were randomized by the random sampling method. Severity of cholestasis was evaluated from the total and fractional bilirubin content and γ-glutamyl transpeptidase (GGT) level; AST and ALT activities were used to detect cytolysis. Liver synthetic function was estimated from prothrombin index (PTI) and coagulation function from fibrinogen level, PTI and APTT. Endogenous intoxication during biliary tract decompression was assessed by calculating the leukocyte intoxication index from the Kalf-Kalif formula. It was shown that remaxol suppresses cytolysis, reduces total and fractional bilirubin levels, improves bilirubin excretion in bile and decreases activity of hepatocyte excretory enzymes.

[The application of topical negative pressure in the complex treatment of acute suppurative diseases of soft tissues].

Negative pressure wound treatment (NPWT) is one of the newest methods used in the treatment of wounds. It allows speeding up and optimizing the healing process and reducing the cost of treatment. Negative pressure stimulates proliferation of granulation tissue, provides a continuous evacuation of fluid and effectively cleans wound surface. The authors present to the reader the results of treatment of acute suppurative diseases of soft tissues with the method of topical negative pressure.

[The miniinvasive treatment of the aseptic fluid collections by the acute necrotizing pancreatitis].

The study aimed to state the indications to punctures and draining of the aseptic fluid collections by the acute necrotizing pancreatitis. Data of 82 patients were analyzed. The miniinvasive treatment proved to be preferable to the conservative treatment only in cases of the internal organs compression. Punctures and draining didn't provide the decrease of septic complications and pseudocyst formation. Poor result of miniinvasive procedures predict the high risk of pseudocyst formation.

[Sclerotherapy for the treatment of thyroid functional anatomy].

Comparative efficacy of ethanol and ethoxysclerol in sclerotherapy was studied among 37 patients with thyroid functional autonomy. It is shown that ethoxysclerol exceeds ethanol in efficiency of treatment, doesn't lead to depressed function of treated thyroid lobe and is better tolerated. Thereby ethoxysclerol should be always used as a sclerosant in patients with hormonal disturbances and multiple "hot" nodules.

[Laparoscopic abdominal drainage by sterile destructive pancreatitis].

90 patients with acute pancreatitis were observed, in 60 of them laparoscopic drainage was performed. The procedure by sterile pancreatonecrosis is indicated only in presence of extent amount of exudate in abdominal cavity. Duration of draining the abdominal cavity should be strictly limited because of the high risk of septic complications. Contraindications for the abdominal drainage by acute necrotic pancreatitis are not only adhesions in the abdomen and shock state of the patient at the moment of procedure necessity, but also unstable hemodynamics in anamnesis and even by the arterial pressure downtrend.