Spontaneous pneumomediastinum, pneumothorax, pneumoperitoneum, and soft tissue emphysema have been recently described in several sources as possible complications in patients with severe COVID-19 and lung damage. This clinical case is dedicated to demonstrarte the development of these lesions in 3 male patients with comorbid conditions. The putative pathophysiological mechanism of these complications is air leakage due to extensive diffuse alveolar damage followed by rupture of the alveoli. All presented patients had a favorable outcome of the disease without lethal cases, their laboratory data and clinical dynamics were described.It should be noted that such conditions are not rare complications of COVID-19, and are observed mainly in male patients with severe form of the disease and the presence of comorbid conditions. Such complications are associated with long hospitalization and a severe prognosis. In some cases, with a mild course of the disease and positive dynamics in a decrease of the percentage of pulmonary lesions, the outcome is favorable, not requiring additional invasive interventions.

ActualityThe course of the novel coronavirus disease (COVID-19) is unpredictable. It manifests in some cases as increasing inflammation to even the onset of a cytokine storm and irreversible progression of acute respiratory syndrome, which is associated with the risk of death in patients. Thus, proactive anti-inflammatory therapy remains an open serious question in patients with COVID-19 and pneumonia, who still have signs of inflammation on days 7–9 of the disease: elevated C-reactive protein (CRP)>60 mg/dL and at least two of the four clinical signs: fever >37.5°C; persistent cough; dyspnea (RR >20 brpm) and/or reduced oxygen blood saturation <94% when breathing atmospheric air. We designed the randomized trial: COLchicine versus Ruxolitinib and Secukinumab in Open-label Prospective Randomized Trial in Patients with COVID-19 (COLORIT). We present here data comparing patients who received colchicine with those who did not receive specific anti-inflammatory therapy. Results of the comparison of colchicine, ruxolitinib, and secukinumab will be presented later.ObjectiveCompare efficacy and safety of colchicine compared to the management of patients with COVID-19 without specific anti-inflammatory therapy.Material and MethodsInitially, 20 people were expected to be randomized in the control group. However, enrollment to the control group was discontinued subsequently after the inclusion of 5 patients due to the risk of severe deterioration in the absence of anti-inflammatory treatment. Therefore, 17 patients, who had not received anti-inflammatory therapy when treated in the MSU Medical Research and Educational Center before the study, were also included in the control group. The effects were assessed on day 12 after the inclusion or at discharge if it occurred earlier than on day 12. The primary endpoint was the changes in the SHOCS-COVID score, which includes the assessment of the patient’s clinical condition, CT score of the lung tissue damage, the severity of systemic inflammation (CRP changes), and the risk of thrombotic complications (D-dimer) [1].ResultsThe median SHOCS score decreased from 8 to 2 (p = 0.017), i.e., from moderate to mild degree, in the colchicine group. The change in the SHOCS-COVID score was minimal and statistically insignificant in the control group. In patients with COVID-19 treated with colchicine, the CRP levels decreased rapidly and normalized (from 99.4 to 4.2 mg/dL, p<0.001). In the control group, the CRP levels decreased moderately and statistically insignificantly and achieved 22.8 mg/dL by the end of the follow-up period, which was still more than four times higher than normal. The most informative criterion for inflammation lymphocyte-to-C-reactive protein ratio (LCR) increased in the colchicine group by 393 versus 54 in the control group (p = 0.003). After treatment, it was 60.8 in the control group, which was less than 100 considered safe in terms of systemic inflammation progression. The difference from 427 in the colchicine group was highly significant (p = 0.003).The marked and rapid decrease in the inflammation factors was accompanied in the colchicine group by the reduced need for oxygen support from 14 (66.7%) to 2 (9.5%). In the control group, the number of patients without anti-inflammatory therapy requiring oxygen support remained unchanged at 50%. There was a trend to shorter hospital stays in the group of specific anti-inflammatory therapy up to 13 days compared to 17.5 days in the control group (p = 0.079). Moreover, two patients died in the control group, and there were no fatal cases in the colchicine group. In the colchicine group, one patient had deep vein thrombosis with D-dimer elevated to 5.99 µg/mL, which resolved before discharge.ConclusionsColchicine 1 mg for 1-3 days followed by 0.5 mg/day for 14 days is effective as a proactive anti-inflammatory therapy in hospitalized patients with COVID-19 and viral pneumonia. The management of such patients without proactive anti-inflammatory therapy is likely to be unreasonable and may worsen the course of COVID-19. However, the findings should be treated with caution, given the small size of the trial.

During the care of patients with novel coronavirus infection at the Lomonosov MSU Medical Research and Education Center from April 21 to June 13, 2020, we observed cases of spontaneous mediastinal emphysema (spontaneous pneumomediastinum) as a manifestation or a probable complication of COVID-19.The aim of the paper. To provide clinical case descriptions and approaches to the management of patients with spontaneous pneumomediastinum in COVID-19 associated pneumonia, as they are not addressed in the current clinical guidelines, and therefore are worthy of special attention.Among 224 patients with laboratory-confirmed diagnosis of the novel coronavirus infection COVID-19, five cases of pneumomediastinum without pneumothorax were identified. Of these, in two cases the pneumomediastinum developed during noninvasive lung ventilation (NLV) (one case) and invasive lung ventilation (one case). In three cases, spontaneous mediastinal emphysema was not associated with lung ventilation. By the time of publication, one case of pneumomediastinum was completed, and four patients remained hospitalized. All five patients were males aged from 52 to 84 years.This paper presents in depth the description of two cases of mediastinal and subcutaneous emphysema in patients with COVID-19.

Primary multiple malignancies are rarely observed in clinical practice. Literature data indicate the existence of potential risk factors, primarily genetic ones (Li-Fraumeni or Beckwith–Wiedemann syndromes) for the development of such diseases. Most of the tumors found in various organs are metachronous. This paper presents a variant of managing a patient with primary multiple neoplasia of the kidney, prostate, and colon. The patient (61 years old) was admitted to clinic with diagnosis: primary multiple metachronous cancer: left kidney cancer cT3aN0M0, prostate cancer cT1bN0M0, neoplasm of the right colon (tubular adenoma with high-grade dysplasia). Comorbidities: coronary heart disease, paroxysmal form of atrial fibrillation, arterial hypertension. The clinic held a multidisciplinary consultation involving an oncologist, a coloproctologist, an urologist, a radiologist, a chemotherapist, an anesthesiologist, a cardiologist, and a rehabilitation specialist. Simultaneous laparoscopic prostatectomy, nephrectomy, and right hemicolectomy were performed. The patient was managed according to the standard protocols of the rapid recovery program. Distinctive feature of the patient we observed was that the kidney tumor was detected 8 years ago during an outpatient examination, although we could not confirm this fact documented. Since the association between renal cell carcinoma and the risk of developing other malignant tumors has been shown in the literature, we can assume with high probability that patients with renal cell carcinoma have an increased risk of developing a subsequent primary malignancy.

: traditionally, evisceration is performed only through a complete median laparotomy, however, the rapid development of modern medical technologies, especially in the last ten years, allows for a fundamentally new level of surgical intervention. The aim of research : evaluation of the effectiveness of laparoscopic pelvic evisceration in women. Materials and methods : in the period 2011 to 2018, 19 laparoscopic eviscerations were performed in women aged 50-78 years due to locally advanced cancers of the pelvic organs. After the compulsory examinations - computed tomography (CT), magnetic resonance imaging (MRI), ultrasound of pelvic organs and abdominal cavity, colonoscopy, cystoscopy, excretory urography, rectal examination, oncomarkers, laboratory study (hemoglobin, residual nitrogen Blood serum), scintigraphy, positron emission tomography (PET CT), the presence of locally advanced lesions was confirmed, and the patients were sent for surgery. Results : 6 of total, 7 front and 6 rear evisceration was performed. For the purpose of urine diversion was performed a Bricker operation, for the derivation of feces was formed a primary anastomosis with a circular stapler with an additional preventive stoma, or a terminal colostomy. Perioperative results of pelvic excretion are given. Conclusion : When compared with the results of other works on open traditional pelvis exenteration, we can judge that with laparoscopic access there is significantly less blood loss, patients spend less time in intensive care, separation, and less the frequency of early postoperative complications. Such operations should be carried out by competent specialists and in specialized centers, which will reduce the number of complications, relapses, and also will allow to accumulate experience of multi-organizational interventions, for their subsequent introduction into general practice.

The article is devoted to the treatment of the new coronavirus infection (COVID-19) in the advanced stages of the disease. The types of response of the immune system to the viral load of SARS-CoV-2 with the start of the inflammation process are considered. The situation is analyzed in detail in which the growing autoimmune inflammation (up to the development of a "cytokine storm") affects not only the pulmonary parenchyma, but also the endothelium of the small vessels of the lungs. Simultaneous damage to the alveoli and microthrombosis of the pulmonary vessels are accompanied by a progressive impairment of gas exchange, the development of acute respiratory distress syndrome, the treatment of which, even with the use of invasive ventilation, is ineffective and does not really change the prognosis of patients with COVID-19. In order to interrupt the pathological process at the earliest stages of the disease, the necessity of proactive anti-inflammatory therapy in combination with active anticoagulation treatment is substantiated. The results of the first randomized studies on the use of inhibitors of pro-inflammatory cytokines and chemokines (interleukin-6 (tocilizumab), interleukin-17 (secukinumab), Janus kinase blockers, through which the signal is transmitted to cells (ruxolitinib)), which have potential in the early treatment of COVID- 19. The use of a well-known anti-inflammatory drug colchicine (which is used for gout treatment) in patients with COVID-19 is considered. The design of the original COLORIT comparative study on the use of colchicine, ruxolitinib and secukinumab in the treatment of COVID-19 is presented. Clinical series presented, illustrated early anti-inflammatory therapy together with anticoagulants in patients with COVID-19 and the dangers associated with refusing to initiate such therapy on time.

: the trigger pathogenetic mechanism of local and systemic inflammatory changes in acute pancreatitis is the production of inflammatory mediators and, in particular, cytokines. It determines the positioning of the systemic inflammatory response as a target for therapeutic action. The aim of research: evaluation of the analgesic effect of lornoxicam therapy, as well as studying the effect of the drug on the systemic inflammatory response in patients with acute pancreatitis. Materials and methods : the randomized prospective study included 334 patients with acute pancreatitis aged 25 to 68 years. The patients were divided into two groups. Patients in group 1 (n = 246) were treated only with standard conservative OP therapy; 88 patients in group 2 were additionally treated with lornoxicam. The severity of the pain syndrome and the frequency of postoperative complications were evaluated. Results : In the second group of patients, systemic complications developed statistically significantly less frequently (p = 0.00034), and mortality was also statistically significantly less (p = 0.006). In group 1 patients, on the third day of the inpatient period, there is an increase in the level of proinflammatory cytokine production, while in group 2 patients, cytokine secretion decreases statistically significantly. Conclusion : the inclusion of lornoxicam therapy to the complex of conservative measures in patients with acute pancreatitis allowed to reduce not only the intensity of the pain syndrome, but also the frequency of complications of pancreatogenic toxemia and to reduce mortality in this category of patients.