The treatment of colitis of the “switched-off” colon is becoming increasingly important, both medically and socially and economically, in patients with abdominal gunshot trauma, significantly delaying the possibility of performing reconstructive surgeries aimed at eliminating the stoma and restoring colonic continuity with fecal passage. Materials and Methods: to determine the predictors of the development of diversion colitis and its severity in 42 patients with stomas following abdominal gunshot trauma, a retrospective and prospective comparative controlled study of the diagnostic and surgical treatment outcomes during the rehabilitation phase was conducted in a multidisciplinary hospital. Patients in the study (n = 20) and control (n = 22) groups underwent clinical and endoscopic examinations, computed tomography, and morphological examination of mucosal biopsies from the switched-off colonic areas, including bacterial analysis. Results : Clinical manifestations of diversion colitis were detected in 64.2% of patients. It was established that predictors of its occurrence were pathomorphological processes in the intestine and zones of gunshot injury alteration in the phase of purulent-septic complications of the course of traumatic disease in the wounded. Three degrees of colitis severity in stoma patients were distinguished: minimal (19.1%), moderate (38.2%), significant (42.7%), objectified by morphological and bacteriological results, which are the basis for the diagnostic algorithm of instrumental studies. Patients of the main group underwent preoperative preparation for 10-14 days to correct the disturbed microbiocenosis. The terms of reconstructive and restorative surgeries aimed at eliminating stomas and restoring gastrointestinal continuity ranged from 2 to 12 months. The total number of complications in the study group was 11.7%, in the control group 29.3%. The average hospital stay in the study group was up to 25 days, while in the control group it was over 90 days, taking into account the treatment of purulent-septic complications. Conclusion : the pathogenesis of diversion colitis in patients with gunshot abdominal trauma is ischemic in nature and is associated with a disruption of the microflora in the dysfunctional colon. Its diagnosis should be based on the results of MSCT, FCS, morphological and bacteriological studies. Surgical rehabilitation of wounded patients with a functional stoma for more than 6 months requires specific preparation, including correction of the microbiome and intestinal motility.
The biography of an outstanding Russian therapist, hematologist, and creator of sternal puncture and lymph node aspiration biopsy techniques is presented. His contribution to the development of medicine, science, and education is highlighted.
In modern military conflicts, limb injuries prevail in the structure of sanitary losses, which constitute the absolute majority of combat surgical pathology. Gunshot wounds inflicted by modern high-energy wounding projectiles are characterized by a large amount of damage to the tissues of the extremities, which determines the occurrence of severe purulent-septic complications, leading to long treatment periods, severe disability of the wounded and a significant decrease in their quality of life. Objective : to analyze the cause and frequency of purulent-septic complications and the effectiveness of the treatment of gunshot injuries of the extremities by negative pressure in victims with mine-explosion injury in a military conflict. Materials and methods : the results of complex treatment of 148 wounded men with combat injuries of the limbs, accompanied by extensive tissue defects from 50 cm2 to 140 cm2, complicated by a progressive inflammatory process (phlegmons, abscesses, osteomyelitis), were analyzed. Specialized medical care was performed in a multidisciplinary hospital and included secondary surgical treatment of wounds, staged osteosynthesis and PST amputations, VAC therapy, and the use of epidermal growth factor preparations. Results : purulent-septic complications were diagnosed in 82.4% of cases. Soft tissue injuries were noted in 44.7%, of which 67.8% of the injured were the main group, 32.2% – the control group. Gunshot fractures of bones were diagnosed in 55.3% of the victims. The treatment of the subjects of the main group was carried out in compliance with the principles of “damage control” and traumatological gradation of stage-by-stage osteosynthesis. The treatment results of the victims of both groups were characterized by an increase in the average duration of fracture consolidation. The healing time of extensive gunshot wounds of the extremities in the main group was 17.9% faster than in the control group. The average duration of inpatient treatment for the wounded in the main group was 2.7 times less than in the control group, and amounted to 21.7±14.3 and 84.5±29.7 days, respectively. Conclusion : multi-stage surgical and traumatological tactics for extensive wound defects of the soft tissues of the limb and gunshot fractures of long tubular bones should include: full surgical treatment, drainage, extra-focal osteosynthesis with rod devices. Medical care for victims with explosive and gunshot injuries should be based on the principles of multi-stage surgical treatment (damage control and medical resources).
The article discusses clinical observations of the treatment of two patients using ICG navigation to remove the residual stump of the cystic duct with remaining calculi after a previous laparoscopic cholecystectomy (LCE). These clinical observations represent successful outcomes of surgical treatment of the residual stump of the cystic duct with calculi using modern techniques for imaging the biliary tract, which help to avoid anatomical damage in the surgical area.
Under real-world clinical practice together with indices for assessing disease activity and the effectiveness of therapy, drug retention provides critical information on efficacy, safety, compliance and convenience of use.The aim – to obtain data on the safety of netakimab (NTK) in a population of patients with ankylosing spondylitis (AS), including various somatic diseases, as well as to assess retention on therapy during 2 years of observation in real word clinical practice.Materials and methods. Patients were recruited for the study from August 2020 to December 2021 at 23 centers in the Russian Federation. The study included 137 patients who were prescribed netakimab therapy before enrollment. Clinical and medical history data for the first visit were entered retrospectively, and following visits at 12, 24, 52, 76, 104 weeks of therapy were collected within the study. The average age of the patients 42,3 y. O., 34.3% of them with previous biologics therapy.Results. Median observation period was 104 weeks (range 1–137 weeks). At the end of the analyzed period (104 weeks of therapy), 85,5% [95% confidence interval (95% CI): 79.7–91.8] of patients continued treatment with Netakimab. Retention on NTK therapy was slightly better in “bio-naïve” vs patients who received biologics earlier: 88.7% (95% CI: 82.3–95.5) and 78.9% (95% CI: 67.5–92.2), respectively, without significant differences between groups (p=0.16). 21 (15.3%) patients withdrew from study before visit 6. The main end of study reasons was lost to follow-up – 7 (5.1%) patients, and treatment inefficacy – 6 (4.4%) patients. The BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score with C-reactive protein) showed statistically significant decreases from baseline: by three times during the first 3 months of therapy and two times decrease during the first year of treatment. This trend continued in the second year of treatment, although with a lower rate of reduction. By week 104 of therapy, 52.9% (95% CI: 47.3–58.4) reached low disease activity (1.3≤ASDAS<2.1), 21.3% (95% CI: 12.8–29.8) had inactive disease (ASDAS<1.3). Netakimab was well tolerated by patients: AEs, related to therapy according to the investigator’s opinion, were reported in 8 (6.0%) patients.Conclusions. In real-world clinical practice, 85.5% of patients continued treatment with Netakimab at the end of 104 weeks. By 104 weeks 74% patients had low disease activity or inactive disease. Netakimab was well tolerated by most of patients.
