[SURGICAL TREATMENT OF ULCERATIVE COLITIS. HISTORY].

The article describes the main achievements in the study of ulcerative colitis (UC) - a disease known since ancient times. «Bloody¼ non-epidemic diarrhea was described by Hippocrates. The first detailed description was made by K. Rokitansky in 1842. In 1875, S. Wilks and W. Mason first studied the pathomorphology of the colon in UC. The term «non-specific ulcerative colitis¼ was proposed by the Russian surgeon A. S. Kazachenko in 1913 at the 13th Congress of Russian surgeons. The historical excursion presents the main stages and achievements of surgical treatment of UC.

[Surgical treatment of pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion]. / Opyt uspeshnogo khirurgicheskogo lecheniya anevrizmy pankreatoduodenal'noi arterii v sochetanii s okklyuziei chrevnogo stvola.

We report successful surgical treatment of inferior pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion. Considering angioarchitectonics of the afferent and efferent arteries (significant tortuosity), possible liver ischemia during endovascular occlusion of pancreaticoduodenal artery and expected low efficiency of embolization, the patient underwent open surgery (celiac trunk replacement and resection of pancreaticoduodenal artery aneurysm). Postoperative period was uneventful. The first and subsequent postoperative controls showed an adequate function of the prosthesis and no contrast enhancement of the aneurysm. We concluded that rational surgical approach ensured optimal solution of the problem, i.e. surgical treatment of pancreaticoduodenal artery aneurysm was the most radical and functional.

[Comparative assesement of postoperative quality of life in patients with ulcerative colitis]. / Sravnitel'naya otsenka kachestva zhizni patsientov, operirovannykh po povodu yazvennogo kolita.

OBJECTIVE: To compare quality of life in patients undergoing proctocolectomy with ileal pouch procedure and ileostomy taking into account sexual function. MATERIAL AND METHODS: The comparative observational study included 138 patients with ulcerative colitis for the period 2013-2018. All patients underwent surgery with one- or two-stage formation of pelvic pouch (n=76) or ileostomy (n=62). Validated questionnaires SF-36, The International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI) were used in the study. RESULTS: Patients with pelvic pouch were significantly younger than patients with terminal ileostomy (33.7±10.9 and 44.6±14.9 years, respectively, p<0.0001). The majority of the parameters of SF-36 questionnaire were similar in both groups. Pain syndrome intensity was the only sign demonstrating the advantage of ileostomy over pelvic pouch. However, regression analysis did not confirm the effect of surgical technique on pain severity. Orgasmic function was significantly better in men with pelvic pouch compared to ileostomy. Other indicators of sexual function were similar. According to FSFI questionnaire, women with pelvic pouch also showed significantly better results than patients with permanent ileostomy. However, multivariate regression analysis revealed no significant effect of surgical technique on sexual function in men and women. At the same time, significant negative correlation between IIEF and FSFI scores and age was revealed. CONCLUSION: No significant influence of surgical technique on postoperative QOL was observed in patients with ulcerative colitis. Better sexual function in men and women with pelvic pouch are due to younger age rather type of surgery.

Evaluating the use of intra-articular injections as a treatment for painful hip osteoarthritis: a randomized, double-blind, multicenter, parallel-group study comparing a single 6-mL injection of hylan G-F 20 with saline.

OBJECTIVE: Hip osteoarthritis (OA) is difficult to treat. Steroid injections reduce pain with short duration. With widespread adoption of office-based, image-guided injections, hyaluronic acid is a potentially relevant therapy. In the largest clinical trial to-date, we compared safety/efficacy of a single, 6-mL image-guided injection of hylan G-F 20 to saline in painful hip OA. METHOD: 357 patients were enrolled in a multicenter, double-blind, randomized saline placebo- controlled trial. Subjects were ≥35 years of age, with painful (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]-A1:5.0-8.0; numeric rating scale [NRS]: 0-10) mild-to-moderate hip OA (Kellgren-Lawrence grade II/III) and minimal contralateral hip pain (WOMAC-A1 < 4). Outcome measures included "pain on walking" (WOMAC-A1 and -A), Patient Global Self-Assessment (PTGA), WOMAC-A1 responder rate (+≥2 points on NRS), and adverse events (AEs) over 26 weeks. RESULTS: 357 patients (hylan G-F 20 single:182; saline:175) were enrolled. Both groups demonstrated significant pain improvement from baseline over 26 weeks (P < 0.0001); saline-induced pain reduction was a remarkable 35%. WOMAC-A and PTGA scores also significantly improved (P < 0.0001). No statistically significant difference was observed between groups in WOMAC-A1 scores (hylan G-F 20 single:-2.19 ± 0.16; saline:-2.26 ± 0.17) or WOMAC-A1 responders (41-52%). Treatment-related AE rates at target hip were similar (hylan G-F 20 single:23 patients [12.8%]; saline:12 [7.0%]). Posthoc analysis found, despite protocol requirements, many patients had psychological (31%) or potential neuropathic pain (27.5%) conditions. CONCLUSION: A single 6-mL hylan G-F 20 injection or saline for painful hip OA resulted in similar, statistically significant/clinically relevant pain and function improvements up to 6 months following injection; no differences between hylan G-F 20 and saline placebo were observed.

[Prevention of venous thromboembolic complications in firearm injury]. / Profilaktika venoznykh tromboémbolicheskikh oslozhnenii pri boevoi ognestrel'noi travme.

Prevention of venous thromboembolic complications in wounded is a complex problem which has not yet been fully resolved throughout the world. Current state of venous thrombosis prevention in wounded in different countries and certain ways of its improvement are analyzed in the article.

Certolizumab pegol in treatment of Crohn's disease with perianal lesions.

AIM: To assess the effectiveness of conservative treatment of Crohn's disease (CD) with perianal lesions. MATERIALS AND METHODS: The study included 20 patients with CD with perianal fistulae. Prior to the start of conservative therapy, 7 patients underwent fistulae drainage with setton placement. During the study, all patients received therapy with certolizumab pegol (CP) for a year. At the time of treatment initiation and after 12 months, the CD activity index, the quality of life according to IBDQ questionnaires and the perianal Crohn's disease activity index (PCDAI) were assessed. RESULTS: After a year of CP therapy, clinical remission was achieved in 8 (40%) patients, endoscopic remission in 7 (35%) patients, fistula closure in 6 (30%) patients. There was also a decrease in the PCDAI with the average score 3.6 points compared to 9.3 points (p˂0.05) prior to the treatment. An improvement in the quality of life of patients was also established, the average quality of life index was 182,2 points compared to 156,0 points (p˂0.05) prior to the treatment. CONCLUSION: This study showed that CP therapy is effective in treatment of CD with perianal lesions.

[Clinico-Pharmacological and Clinical Basis of Multiplicity of Intake of Novel Oral Anticoagulants].

In this review we present comparison of pharmacokinetics of novel oral anticoagulants (NOAC) dabigatran, rivaroxaban, apixaban, and edoxaban, principles of selection of a regimen of their dosing for phase III clinical trials in patients with atrial fibrillation. Multiplicity of administration of NOAC depends on required level of anticoagulation, ability to maintain anticoagulation for 24 hours, relationship between minimal and maximal levels of equilibrium concentrations, efficacy and safety. Once a day administration of some drugs of this group is reasonable from positions of clinical pharmacology. It can provide not only better adherence to treatment but greater safety relative to development of bleeding.

[Managerial and methodological aspects of emergency surgery for malignant colonic obstruction]. / Organizatsionnye i metodologicheskie aspekty okazaniia neotlozhnoi khirurgicheskoi pomoshchi pri obstruktsionnoi kishechnoi neprokhodimosti opukholevogo geneza.

AIM: To determine the most feasible treatment strategy for malignant colonic obstruction. MATERIAL AND METHODS: There were 427 patients with malignant colonic obstruction who were hospitalized for emergency indications. 30 of them were treated with medical therapy; 286 - underwent acute resection; 43 - stoma construction; 68 - stents deployment. 64 out of 427 patients underwent elective restorative/radical surgery and radio- or chemotherapy in 1-8 months. 3-year Kaplan-Meier survival was assessed. RESULTS: Complications occurred in 58% after acute resection and in 32.6% and 8.8% after stoma and stent deployment, respectively. Postoperative mortality was significantly lower after palliative surgery (stent or stoma) compared with acute resection: 2.9%, 18.6%, 29.37%, respectively. 3-year survival was higher after elective resections compared with emergency resection group: 0,81 и 0,68 respectively. CONCLUSION: Bridging strategy (stoma/stents) may be a valid alternative in some patients with malignant colonic obstruction due to significantly reduced postoperative mortality. Acute surgery for malignant colonic obstruction should only be carried out by appropriately trained surgeons at multi-field hospital.

[Metal self-expanding stents for malignant obstruction of stomach outlet and duodenum]. / Opyt primeneniia metallicheskikh samorasshiriaiushchikhsia stentov pri zlokachestvennoi obstruktsii vykhodnogo otdela zheludka i dvenadtsatiperstnoi kishki.

AIM: To compare different types of self-expanding stents (partially coated or uncovered) for malignant pyloroduodenal obstruction (MPDO). MATERIAL AND METHODS: 89 MPDO patients underwent stenting at the Botkin City Hospital (Moscow) for the period 2008-2016. The causes of malignant obstruction were: stomach cancer - 53 (59.5%), pancreatic cancer - 31 (34.8%), compression by retroperitoneal lymph nodes - 3 (3.4%), duodenal cancer - 2 (2.2%). Patients were divided into two homogeneous groups. In group 1 (32 patients) partially coated stents were used, in group 2 (57 patients) - uncovered stents. Mean age was 68.3±6.2 and 64.3±5.7 years in both groups respectively; male/female ratio 18/14 in group 1, 32/25 in group 2. Length of stricture was 51±5.1 mm in group 1, 48±4.8 mm in group 2. GOOSS score in group 1: 0-8, 1-13, 2-11, 3-0, in group 2 0-14, 1-25, 2-18, 3-0 (p=0.03). RESULTS AND DISCUSSION: Technical success was achieved in 32 patients of group 1 (100%) and in 57 patients of group 2 (100%). There were no procedure-associated complications and mortality. Clinical success was observed in 29 (90.6%) patients of group 1 and in 50 (87.7%) patients of group 2. GOOSS score of group 1: 0-8, 1-8, 2-10, 3-12, group 2: 0-3, 1-15, 2-19, 3-20. There were 3 distal dislocations of the stent within 1 - days in group 1, in group 2 dislocations were absent. Postoperative chemotherapy was prescribed in 20 (62.5%) patients of group 1 and 38 (66.7%) patients of group 2 (p=0.08). 27 patients of group 1 and 49 patients of group 2 died due to progression of the disease, others are under observation. Mean life expectancy: group 1 (18 patients - 50 days, 9 patients - 100 days, 5 patients were alive by the moment of study); group 2 (32 patients - 50 days, 100 days - 17 patients, 8 patients were alive by the moment of study). 3 patients (9.4%) in group 1 and 7 (12.3%) patients in group 2 had stent dysfunction (p=0.02). Mean period of partially covered stent function was 138±3.9 days, uncovered stent - 96±4.8 days (р=0.003). CONCLUSION: Our study showed that time of stent function corresponds to median survival. Greater number of stent migration in group 1 is due to stent coverage, higher incidence of stent dysfunction in group 2 - due to malignant invasion.

[Efficiency of tacrolimus therapy for perianal Crohn's disease].

AIM: To determine the efficacy of 0.1% tacrolimus ointment in patients with perianal Crohn's disease (CD). SUBJECTS AND METHODS: This prospective randomized trial enrolled 20 patients with perianal CD as anal fissures and rectal fistulas. The inclusion criteria were rectovaginal or extrasphincteric fistulas and purulent leakages. A study group comprised 11 patients, including 9 with anal fissures and 2 with fistulas. A control group included 9 patients, including 8 with fissures and 1 with fistulas. The study group received systemic therapy with azathioprine 2 mg/kg/day and tacrolimus ointment 2 mg/day; the control group had systemic therapy with azathioprine 2 mg/kg/day, hormone ointment 1 mg/day, and metronidazole suppositories 250 mg/day. Control examination and perianal CD activity index (PCDAI) determination were done 6 and 12 weeks after therapy initiation. RESULTS: At 6 weeks after beginning the study, local examination revealed the signs of anal fissure epithelialization in 5 (45.5%) of the 11 patients in the study group and in 3 (33.3%) of the 9 patients in the control one. At 12 weeks, fissure epithelialization and fistula obliteration were stated in 6 (54%) patients in the study group and in 3 (33%) of the 9 patients in the control group. At 12 weeks, PCDAI in the study and control groups was 2.00 and 4.44 scores (p = 0.01). CONCLUSION: The findings suggest that topical 0.1% tacrolimus ointment versus antibacterial suppositories and hormone ointments is effective in treating patients with perianal CD. Topical 0.1% tacrolimus ointment therapy caused a reduction in PCDAI.

Multivariate approach for selecting sets of differentially expressed genes.

An important problem addressed using cDNA microarray data is the detection of genes differentially expressed in two tissues of interest. Currently used approaches ignore the multidimensional structure of the data. However it is well known that correlation among covariates can enhance the ability to detect less pronounced differences. We use the Mahalanobis distance between vectors of gene expressions as a criterion for simultaneously comparing a set of genes and develop an algorithm for maximizing it. To overcome the problem of instability of covariance matrices we propose a new method of combining data from small-scale random search experiments. We show that by utilizing the correlation structure the multivariate method, in addition to the genes found by the one-dimensional criteria, finds genes whose differential expression is not detectable marginally.

Results of surgical treatment of retinal detachments complicated with proliferative vitreoretinopathies with the use of perfluropropane (C3F8) gas.

The aim of the current study is the efficiency assessment of C3F8 gas usage in posterior vitrectomies in patients having retinal detachment of different etiologies with presence of proliferative vitreoretinopathies and retinal tears. 34 patients have undergone posterior vitrectomy with the usage of perfluoropropane C3F8 gas for providing internal tamponade. Total attachment of retina has been attached in all 34 cases and C3F8 gas has been injected in each eye. The most frequent complications that have been revealed after the usage of C3F8 gas and their management are reflected in the article. Thus, we came to a conclusion that vitrectomy in combination with episcleral buckling, transvitreal drainage of subretinal liquid, diode endolaser coagulation of retina and internal tamponade with C3F8 gas is effective and pathogenetikally proved method for treatment of rhegmatogenous retinal detachments complicated with severe vitreoretinopathies. The achievement of perfect anatomical results depends on manifestation degree of proliferative vitreoretinopathy. This study was supported by grant of the Ministry of Health of Armenia.

Laser picosecond microspectrofluorometry of haematoporphyrin in cells and liposomes.

The results of a laser picosecond microspectrofluorometric study of the spectral and kinetic characteristics of haematoporphyrin (Hp) fluorescence at various sites in cultured SPEV cells and phosphatidylcholine liposomes are presented. The computer-controlled detection system is based on the single-photon counting method with picosecond time resolution. In aqueous medium, the Hp fluorescence spectrum is characterized by two bands at 615 and 675 nm. In living cells and liposomes, Hp fluorescence is red shifted to 630 and 690 nm. In addition a new band at 665 nm is detected. The dependence of this band on the incubation time and Hp concentration was investigated. The fluorescence decay kinetics of Hp in a culture medium, liposome and a cell nuclear membrane were measured. Possible Hp aggregate formation in the lipid bilayer and its implications are discussed.

The movement of melanosomes in melanophore fragments obtained by laser microbeam irradiation.

The melanophores of the teleost Gymnocorymbus ternetzi are filled with pigment granules, melanosomes, which in response to appropriate treatments, can disperse throughout the cytoplasm or form an aggregate in the cell center. Melanophores with the dispersed pigment were irradiated by a laser microbeam, focused on the cell center by the microscope objective. If the average energy of the microbeam was 6-7 microJ, either the center of the melanophore was damaged and a single ring-shaped fragment was formed, or the cell was broken into several fragments of smaller size. The fragments retained their ability to move the pigment granules. In ring-shaped fragments, after adrenaline treatment, the melanosomes formed a ring-shaped aggregate moving away from both outer and inner (irradiation-produced) margins of the fragment. The smaller fragments treated with adrenaline moved the pigment to their centers. Both small and ring-shaped fragments could aggregate melanosomes as soon as 5 minutes after irradiation.