INTRODUCTION: Acute mesenteric ischemia (AMI) is one of the most dangerous complications of cardiac surgery using cardiopulmonary bypass (CPB). Several factors may contribute to the development of AMI, such as: age over 70 years, prolonged CBP, postoperative heart failure, cardiogenic shock, mechanical circulatory support and others. The mortality rate in AMI reaches 85 %. OBJECTIVE: To identify predictors of a negative clinical outcome in the development of acute mesenteric ischemia in patients after on-pump cardiac surgery. MATERIALS AND METHODS: A single-center retrospective observational cohort study included 53 patients in the intensive care unit who developed AMI after cardiac surgery performed using CPB. All patients with AMI included in the study were divided into two groups — survivors (n = 31) and non- survivors (n = 22) to identify predictors of negative clinical outcome. RESULTS: At the preoperative stage, the left ventricular ejection fraction (LVEF) was impaired in both groups, but in non-survived patients was significantly lower: 34.6 (25.4–52.4) in survivors and 28.7 (25.2–42.7) in non-survivors (p = 0.05). 12 hours after the surgery, the cardiac index (CI) (p = 0.01) and the index of left ventricular work (ILVW) were significantly (p = 0.03) lower in non-survivors. The average duration of CPB was 124 minutes (95–142) in survivors and 164 minutes in non-survivors (145–176) (p = 0.02). Also, 72.7 % of n0n-survivers received high doses of adrenomimetics in the postoperative period, in survivors — 41.9 % (p = 0.03). The rate of long-term mechanical respiratory support usage in non-survivors reached 86.3 %, in survivors — 35.4 % (p = 0.003). CONCLUSIONS: The key predictors of a negative outcome of OMI in cardiac surgery patients are: prolonged use of CBP, low CI, LVWI before and after surgery, high doses of adrenomimetics, prolonged mechanical respiratory support, as well as high concentrations of blood lactate 12 hours after the end of the surgery.

АКТУАЛЬНОСТЬ: Острая мезентериальная ишемия (ОМИ) является одним из самых опасных осложнений кардиохирургических вмешательств с использованием искусственного кровообращения (ИК). Формированию ОМИ может способствовать ряд факторов: возраст старше 70 лет, длительное ИК, послеоперационная сердечная недостаточность, кардиогенный шок, механическая поддержка кровообращения и другие. Летальность при ОМИ достигает 85 %. ЦЕЛЬ ИССЛЕДОВАНИЯ: Выявить предикторы неблагоприятного клинического исхода при развитии ОМИ у пациентов после кардиохирургических вмешательств в условиях ИК. МАТЕРИАЛЫ И МЕТОДЫ: В одноцентровое ретроспективное обсервационное когортное исследование было включено 53 пациента отделения реанимации и интенсивной терапии, у которых после кардиохирургического оперативного вмешательства, проведенного в условиях ИК, развилась ОМИ. Все включенные в исследование пациенты с ОМИ были разделены на две группы — выжившие (n = 31) и умершие (n = 22) — для выявления предикторов неблагоприятного клинического исхода. РЕЗУЛЬТАТЫ: На предоперационном этапе показатель фракции выброса левого желудочка (ЛЖ) был снижен в обеих группах, но в группе умерших был достоверно ниже: 34,6 (25,4–52,4) у выживших и 28,7 (25,2–42,7) у умерших (p = 0,05). Через 12 ч после операции сердечный индекс (p = 0,01) и индекс работы ЛЖ (p = 0,03) были значительно ниже в группе умерших. Средняя длительность ИК составила 124 (95–142) мин в группе выживших и 164 (145–176) мин — у умерших (p = 0,02). В группе умерших 72,7 % пациентов получали высокие дозы адреномиметиков в послеоперационном периоде, в группе выживших — 41,9 % (p = 0,03). Частота применения длительной механической респираторной поддержки в группе умерших пациентов достигла 86,3 %, в группе выживших — 35,4 % (p = 0,003). ВЫВОДЫ: Ключевыми предикторами неблагоприятного исхода ОМИ у кардиохирургических пациентов являются: длительное применение аппарата ИК, низкие показатели сердечного индекса, индекса работы ЛЖ до и после операции, применение высоких дозировок адреномиметиков, длительная механическая респираторная поддержка, а также высокие концентрации лактата крови через 12 ч после окончания операции, длительная механическая респираторная поддержка.

Objective: Long-standing gastroesophageal reflux disease is the most common cause of a cicatricial stricture of the esophagus. The treatment of this pathology involves a wide range of methods including conservative and surgical options. Surgeons can encounter technical difficulties in case of concomitant neck and chest pathology. Clinical case: We report a case of a decompensated cicatricial stricture of the esophagus with concomitant paraesophageal hiatal hernia, refractory gastroesophageal reflux disease, and nontoxic multinodular goiter (166.9 cm 3 ). Selecting the optimal management for such patients is often a challenge. Staged treatment significantly improves postoperative quality of life, but the increased length of hospital stay can negatively impact patient compliance.

Background. Acute mesenteric thrombosis (AMT) is a condition that develops with thrombosis in the vessels of the mesenteric pool, which causes hypoperfusion of the intestinal wall and leads to secondary inflammatory changes. Mortality in OMT is 80–85 %. Early diagnosis of OMT is difficult due to the lack of specific clinical signs and laboratory markers.Objective. To identify preoperative risk factors for adverse clinical outcomes in OMT.Design and Methods. A single-center retrospective observational cohort study included 47 patients diagnosed with OMT. The following patient data were analyzed: age, gender, body mass index (BMI), assessment of the patients’ condition according to the SOFA, APACHE II, EuroSCORE scales. Various laboratory parameters in the preoperative and postoperative periods were analyzed.Results. The incidence of oncological diseases and history of acute cerebrovascular accident (ACV) were significantly higher in the group of lethal outcomes of OMT than in the group of surviving patients. The correlation of higher serum levels of lactate, D-dimer, creatinine, leukocytosis and procalcitonin in the preoperative period with the development of an unfavorable clinical outcome was revealed.Conclusion. The main risk factors for the development of an unfavorable clinical outcome of mesenteric thrombosis in patients are the presence of malignant neoplasms, a history of stroke, a high level of mixed venous blood lactate, creatinine, D-dimers, procalcitonin, leukocytosis in the preoperative period.

Amiodarone is a drug used in the treatment of life-threatening arrhythmias, which can lead to the development of amiodarone-induced thyrotoxicosis. In most cases this pathology can be treated by conservative methods; surgical treatment is resorted to in cases of thyrotoxicosis refractory to medical treatment. This case report describes surgical treatment of a patient with amiodarone-induced thyrotoxicosis, progressive heart failure, neurological pathology, bilateral pneumonia, functioning tracheostomy, systemic infectious process, multiple organ dysfunction syndrome, who was treated in the intensive care unit. Due to the lack of response to therapy with antithyroid drugs (thiamazole, lithium preparations and pulse therapy with prednisolone) and a progressive deterioration of the condition in a short period of time, according to vital indicators, the patient underwent thyroidectomy. In the postoperative period, there was a decrease in the occurrence of chronic heart failure symptoms. Medical control of cardiac arrhythmias was achieved. Surgical stage proceeded without complications in the period of 30-days. The patient was discharged for outpatient rehabilitation treatment.

Aim of the study. To evaluate the risk factors for the occurrence of intramuscular hematomas in patients with severe coronavirus infection receiving anticoagulant therapy.Materials and methods. Intramuscular hematomas in five patients with severe COVID-19 disease are reported in the paper. The criteria for selecting patients for the study included respiratory distress requiring oxygen, radiographic signs of severe pneumonia, anticoagulant therapy using low molecular weight heparin (LMWH), and spontaneous intramuscular hematoma. Clinical manifestations, blood coagulation results, conservative and surgical management were analyzed.Results. Standard regimen anticoagulation therapy in patients with coronavirus infection requires vigilance because of a risk of development of hemorrhagic complications.Сonclusion. When assessing a patient with hematomas, an emphasis should be given to examination of patients and changes in hemoglobin and hematocrit levels. Best strategy of anticoagulant therapy for patients with coronavirus infection and high risk of VTE, as well as optimal laboratory monitoring during LMWH administration are yet to be explored.

АКТУАЛЬНОСТЬ Колоректальный рак (КРР) составляет значительную долю в общей структуре онкологических заболеваний, и смертность от него остается высокой. Пациенты с полипами толстой кишки имеют повышенный риск развития КРР и нуждаются в тщательном наблюдении. Тем не менее даже при выполнении всех критериев качественной колоноскопии распространенность интервального колоректального рака (ИКРР) остается высокой. ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка частоты выявления ИКРР в зависимости от количества и размера полипов толстой кишки, а также динамики повторных колоректальных полипов. МАТЕРИАЛ И МЕТОДЫ В ретроспективном многоцентровом когортном исследовании приняли участие 733 пациента с полипами толстой кишки в период с 2002 по 2020 г. Были оценены и статистически обработаны данные о закономерностях выявления повторных колоректальных полипов, а также ИКРР. РЕЗУЛЬТАТЫ В период с 2002 по 2020 г. у 733 пациентов проведено 3240 колоноскопий. У 86% пациентов обнаружены повторные полипы толстой кишки. У пациентов с первичными крупными полипами повторно крупные полипы выявлялись в 4,5 раза чаще, чем у пациентов с мелкими полипами. У 14% пациентов с ранее выявленными полипами менее 1 см встречались повторные полипы размером более 1 см. Выявлено 16 случаев колоректальной аденокарциномы, что составило 2,1% от общей выборки. У 13 (81%) пациентов интервал наблюдения соответствовал рекомендуемому. ЗАКЛЮЧЕНИЕ У большинства пациентов с полипами толстой кишки выявлены повторные полипы. Пациенты как с крупными, так и с мелкими полипами имеют риск развития ИКРР, однако у пациентов с крупными полипами ИКРР встречается в 6 раз чаще.

Amiodarone is an antiarrhythmic drug that is commonly used for treatment of various supraventricular and ventricu-lar arrhythmias. Amiodarone and its main active metabolite desethylamiodarone have a direct dose-dependent cytotoxic effect on thyroid follicular cells. Consequently, some patients receiving amiodarone may develop thyroid dysfunction: amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). The diagnosis, classification, and treatment of amiodarone-induced thyroid dysfunction remain to be a challenge to all clinicians deal with this problem. diagnosis of diffuse toxic goiter and, consequently, AIT1. Colour-flow Doppler sonography (CFDS) is proposed as the basic method of differential diagnosis of AIT 1 and AIT 2. CFDS «pattern 0», usually indicates AIT 2, the presence of «patterns I-III» mostly typical for AIT 1. The thyreostatics are recommended for AIT 1, oral glucocorticoids for AIT 2 and their combination for a mixed AIT. Emergency thyroidectomy should be applied to patients with deteriorating cardiovascular pathology and ineffective drug therapy. In the absence of clinical suspicion on thyroid dysfunction, thyroid hormones assessment should be done 3 months after the start of amiodarone treatment, thereafter every 6 months.

An overview of the clinical observation of a patient with the consequences of severe traumatic brain injury, with a tracheoesophageal fistula is presented. The article discusses a staged multidisciplinary approach to treatment.

The characteristics and principles of surgical treatment of giant presacral neurogenic tumors are analyzed on the example of authors’ own series of cases and based on the literature review. Three clinical cases of surgical treatment of patients with giant presacral neuromas are presented. Besides routine preoperative clinical examination, 3D-printed models of pelvic bones, tumors and blood vessels were made based on CT-angiography data. In two cases, giant L5 root neuromas with presacral extension were removed through retroperitoneal approach, and in one case, two-stage removal of the giant presacral neurofibroma through the median laparotomic and dorsal approaches was performed. Giant presacral neurogenic tumors are the rare pathology in the practice of spinal surgeons. Surgical treatment should be carried out by a multidisciplinary surgical team. It should be borne in mind that life-threatening complications are common in the early postoperative period. Application of customized 3D-printed models is an additional useful tool of perioperative planning.

Objective : to evaluate the effectiveness of endosonography guided fine needle aspiration (EUS-FNA) of focal lesions of the pancreas. Assessment of the impact of age, gender, size of the lesion and its localization on informativity of the puncture. Material and methods : the retrospective study included 244 patients between 2012 and 2020 who underwent EUS-FNA for pancreatic lesions. The factors influencing the information content were determined and their statistical processing was carried out. Results : 454 morphological studies were performed in 244 patients. Of these, 211 are cytological, 149 are histological, and 94 are immunohistochemical (IHC). The frequency of informative conclusions was higher in the IHC group compared to cytological (p=1.611×10-6) and histological studies (p=3.617×10-5). The information content in the puncture of solid formations was 75.5%, cystic-solid — 80.4%, and cystic — 28.9%. (p=9.393×10-7). Informativity is significantly reduced when EUS signs of background pancreatitis are detected (p=0.0026). Conclusion : EUS-FNA is an effective and safe method for obtaining material for morphological diagnostics. EUS-FNA of cystic formations is the least informative and is associated with the greatest cases of complications. Age, gender, size of the lesion, and its localization has no effect on informativity of the puncture. Background chronic pancreatitis significantly reduces the informativity of EUS-TAP.

Type 2 diabetes prevalence is increasing dramatically worldwide. Conservative therapy doesn’t bring stable effect and is often insufficient, not to mention the lack of prospects to cure the disease. Fortunately, accumulating evidence points towards the notion that a complete remission of type 2 diabetes is feasible following a choice of surgical interventions. The efficacy of bariatric surgery in particular for achieving glycemic control has highlighted surgery as a candidate curative intervention for type 2 diabetes. When compared to intensive medical therapy and lifestyle intervention, metabolic surgery has shown superiority in achieving reducing number of medications and metabolic factors improvement, which translates in long-term benefits on diabetes progression and complications. Understanding factors that predict diabetes remission can help to select patients who will benefit most from bariatric surgery and to choose the most effective type of operation. This literature review analyzes studies of the most significant clinical and biochemical predictors of remission of type 2 diabetes mellitus after bariatric interventions, as well as highlights well-known mathematical prediction models.

Ultrasound examination of the neck followed by fine needle aspiration (FNA) biopsy is one of the methods for detecting and diagnosing parathyroid gland lesions. Among parathyroid lesions, there are solitary adenomas, multiple gland hyperplasia decease, double adenomas, carcinomas, etc.[1] However, traditional FNA is not always possible because of difficulties in visualization and access (the location of the lesion behind the thyroid gland, large vessels, cartilage, and bone structures together with such conditions as multinodular goiter, lymph nodes, fibrosis, and other tumors of the neck).[2,3]

The OBJECTIVE of the study was to analyze the experience of performing thyroidectomy (TE) in patients with amiodarone-induced thyrotoxicosis (AmIT) at our centre.METHODS AND MATERIALS. The study included 12 patients with AmIT who underwent TE. Medical records were analyzed to assess the features of the AmIT and indications for TE. We also studied the operation protocols and postoperative follow-up data. Intraoperative, early and long-term postoperative complications were recorded. The long-term TE results were evaluated by the dynamics of the left ventricular ejection fraction (LVEF) based on the echocardiography data.RESULTS. The main indications for TE included the resistance of thyrotoxicosis to medication and worsening of the cardiac pathology. No cases of thyrotoxicosis progression or thyrotoxic crisis were registered during the operation. The vocal cord paresis developed in one case, completely restored in a year. Blood loss was minimal in all cases. Other intraoperative complications were absent. Not a single death was registered in the early postoperative period. At this period, a short paroxysm of atrial fibrillation resolved on its own was registered in patient with arrhythmogenic right ventricular dysplasia. A patient with biventricular chronic heart failure of a high functional class died 39 days after the operation due to a massive pulmonary thromboembolism. The long-term results of TE were evaluated in eight patients. In four out of five patients with initially reduced LVEF, it increased. In three patients with initially normal LVEF, it did not change.CONCLUSION. Thyroidectomy is an effective and safe treatment in patients with AmIT, including those with the persistent thyrotoxicosis and severe cardiac pathology. The success is possible when the preparation of patients for the intervention is carried out by a team of specialists experienced in treating of such patients.

Purpose. To study the frequency of general surgical diseases development snd their features in patients after heart transplantation (HTx). Methods. From January 2010 to December 2018 it was performed 112 HTx (mean age - 46.7 +/- 14.0 years old; 82 - male, 30 - female). During 30 days after HTx 9 patients died. After discharge all recipients (n=98) were included in dispensary observation list. We retrospectively analyzed patients (n=35) who underwent general surgery manipulations in more than 30 days after HTx. All surgical interventions have been done under the reduction of immunosuppression therapy. Results. During 9 years of post-heart transplant follow-up 45 surgical interventions were performed, 7 % (n=3) of them due to infectious complications, 31 % (n=14) oncology and others (62%, n=28). Most of manipulations were planned (39 from 45, 87 %), the following general surgery interventions prevailed: laparoscopic cholecystectomy (n=13) and those to remove inguinal and umbilical hernia (n=12). During the 1st year the frequency of diseases required surgical treatment was 26 % (n=11), infectious causes took place in 5 patients, non-infectious - in 6. Subsequently the incidence of infectious complications decreased that could be associated with the minimization of immunosuppressive therapy. Oncology was more frequent long-term after HTx - more than 3 years: among them the development of colon polyps prevailed and all recipients underwent polypectomy. There was no impact of age, gender, causes of chronic heart failure, obesity, immunosuppressive regimen (including the induction) on the frequency of general surgery diseases development (p>0.05). Conclusion. Based on our experience, we proposed an algorithm of examination, the features of surgical tactics and preparation for it in heart transplanted recipients are described. The important role of post-heart transplant follow-up in the timely detection of diseases requiring general surgical care is given.

Recovery of intestinal continuity is remaining a complex issue in abdominal surgery. Previous operations, such as Hartmann's procedure, are usually done in the emergent setting, often in frail and septic patients. As a result, severe adhesions occur, and recognition of various anatomical structures becomes more difficult.The article describes a clinical case of EUS-guided recovery of rectum's continuity after complete anastomotic stenosis. The operation “EUS-guided formation of rectosigmoid anastomosis using Lumen-Apposing Metal Stent” was performed.In order to obtain a stable anastomosis within 6 months, a session of bougienage and 4 sessions of balloon dilatation were performed. Currently, the diameter of the colon at the stricture level is about 14 mm, clinically stricture is not significant.EUS-guided enterostomy can be used to form an intestinal anastomosis in patients with benign diseases. However, this method alone is not the final method of treatment and requires further supervision of patients.

The last 10 years have seen an exponential increase in the number of obese patients. In most countries, over 30% of the population is overweight and obese. Bariatric surgery is the most effective treatment for morbid obesity today. The number of bariatric interventions performed annually is growing and today exceeds 760 thousand per year. Over the past 7 years, the most commonly performed bariatric surgery has been laparoscopic sleeve gastrectomy. Despite the huge experience in bariatric surgery and the continuous improvement of staplers and dissections tissue technologies the complications still exists. The most serious complication after performing a laparoscopic sleeve gastrectomy is a leak of staple line. The article presents current view on the causes, diagnosis, prevention and treatment tactics for patients with the leak after sleeve gastrectomy.