Objective: to determine whether liver computed tomography (CT) perfusion imaging can assess hemodynamics in patients with fibrosis and cirrhosis as a result of chronic viral hepatitis C (CVHC). Subjects and methods. The prospective study conducted at the Department of Radiation Diagnosis, M.F. Vladimirsky Moscow Regional Research and Clinical Institute, enrolled 61 patients with liver fibrosis and cirrhosis as a result of CVHC, of whom 26 patients had received antiviral therapy (AVT) and achieved a sustained virological response (SVR) at 24 weeks after the end of treatment. All the patients underwent liver CT perfusion imaging on a 256-slice Philips ICT computed tomography scanner (Netherlands). The parameters of arterial, portal, general perfusion and hepatic perfusion index were measured in each patient in his/her liver segments III, VII, and VIII, by calculating the slope of a curve. Results. The values of perfusion parameters in patients who had undergone AVT and attained SVR and who had received no specific treatment were compared with those in the fibrosis, compensated, subcompensated, and decompensated liver cirrhosis groups. In the liver fibrosis group, the patients who had achieved SVR after AVT had higher portal and total perfusion values than those who had received no specific treatment (p = 0.001 and p = 0.002; respectively). In the same group, the liver perfusion index was higher in the patients who had not undergone AVT than in the treated patients (p = 0.028). The values of total perfusion were statistically significantly higher in patients with compensated liver cirrhosis who had attained SVR after AVT than in the untreated patients (p = 0.008). In the decompensated liver cirrhosis group, portal perfusion after specific treatment was higher than in the non-AVT group (p = 0.012). The subcompensated liver cirrhosis group showed no statistically significant differences when comparing the values of liver perfusion parameters depending on the availability of treatment. Conclusion. Liver CT perfusion imaging cannot give an idea of how the hemodynamics of liver tissue changes in the presence of fibrosis and cirrhosis in patients with CVHC after AVT.

Portal vein thrombosis is one of the most common complications of liver cirrhosis, the risk factors for which are still not fully understood.Purpose: to develop a prognostic model to determine the likelihood of portal vein thrombosis based on anamnestic, etiological factors, the presence of hepatocellular carcinoma, as well as parameters of CT perfusion of liver tissue.Material and methods. 43 patients with compensated liver cirrhosis (58.1% of men) and 38 patients with subcompensated liver cirrhosis (50% of men) were included in the prospective study. The age of patients in the first group was 52.56 ± 9.62 years, in the second group - 50.95 ± 9.94 years. The number of patients with 1 etiological factor of liver cirrhosis in the study groups was 62.8% and 81.5%, respectively. Type 2 diabetes mellitus was exhibited in 23.3% of patients with compensated liver cirrhosis and in 15.8% of patients with subcompensated liver cirrhosis. The diagnosis of hepatocellular carcinoma was established in 27.9% of patients with compensated liver cirrhosis and in 18.4% of patients with subcompensated liver cirrhosis. All patients, after the native study, underwent CT perfusion of the liver using a 256-slice Philips ICT apparatus. As a result of postprocessing, the values of arterial, portal, total perfusion and perfusion index of liver tissue were determined. Statistical analysis of the data was carried out using the binary logistic regression method and the construction of ROC curves.Results. A logistic stepwise multivariate analysis showed that an increase in arterial perfusion (p = 0.002) and a decrease in portal perfusion (p = 0.004) were independently associated with portal vein thrombosis in patients with compensated liver cirrhosis, and a history of primary liver cancer (p < 0.001) was a dependent factor in this model. In patients with subcompensated liver cirrhosis, a history of hepatocellular carcinoma (p < 0.001) and a decrease in portal perfusion (p = 0.001) became independent predictors of portal vein thrombosis, male gender (p = 0.029) was a dependent factor in the developed model.Conclusion. CT-perfusion of the liver makes it possible to determine predictors that can be used together with such factors as the presence of hepatocellular carcinoma and gender in the construction of prognostic models to determine the likelihood of portal vein thrombosis in patients with compensated and subcompensated liver cirrhosis. Age, etiological factor and the presence of type 2 diabetes mellitus in the developed models were not statistically significant.

Background: Growing glioblastoma is associated with an impairment of the blood brain barrier and increased hemodynamic parameters (CBV, CBF), which is related to advanced tumor angiogenesis. Arterial spin labeling (ASL) perfusion, an additional study to the routine intravenous contrast-enhanced magnetic resonance imaging (MRI), may be a technique for assessment of hemodynamics and identification of the residual tumor tissue.Aim: To study the potential of native ASL to assess hemodynamic parameters and detect residual tumor tissue in the patients who had undergone surgical resection of glioblastoma.Materials and methods: At 2 to 4 weeks after surgery for glioblastoma grade IV, brain MRI with native ASL perfusion and subsequent intravenous contrast enhancement was performed in 63 patients. Cerebral blood flow (CBF) values were measured in three areas of interest: in the presumptive tumor tissue (PTT) with maximal perfusion, in the postoperative scar tissue (PST) and in the deep white matter (DWM) of the contralateral hemisphere.Results: According to their CBF values, all patients were categorized into two groups. Group 1 included 43 patients (68.3%) with mean CBF in PTT of 135.4±41.3 ml/100 Gr/min (min 73.9, max 255.9). These values were 5 to 6-fold higher than the CBF values in the PST and 6 to 8-fold higher than those in DWM. Group 2 included 20 patients (31.7%) without any areas of abnormal CBF increase in PST, with its mean value of 22.1±5.6 ml/100 Gr/min (min 13.9, max 37.1), which was close to the CBF level in DWM (19.8±4.6 ml/100 Gr/min, p=0.06). There were no between-group differences for the CBF values in PST (p=0.6), and DWM (p=0.7).Conclusion: ASL MR perfusion technique has good potential for the identification of residual tumor tissue after surgical resection of glioblastoma and can be an alternative to contrast enhancement during long-term follow up.

Currently the relationship between liver diseases and glucose metabolism disorders is being studied. To characterize the negative impact of the mechanisms of insulin resistance on the liver parenchyma altered due to cirrhosis, we can use CT-perfusion of the liver — a method that allows us to assess hemodynamic disorders in the liver tissue. During the pilot study, it was found that the values of arterial perfusion and hepatic perfusion index in patients with compensated cirrhosis of the liver in the presence of type 2 diabetes mellitus were statistically significantly higher than in the absence of this pathology (p = 0,007 and p = 0,009 respectively). The values of portal and total perfusion in patients with compensated cirrhosis of the liver in the presence of type 2 diabetes mellitus were significantly lower than in the absence of this pathology (p < 0,001 and p = 0,007 respectively). CT-perfusion of the liver can be used in patients with compensated cirrhosis and the presence of type 2 diabetes mellitus in the anamnesis as a non-invasive method of instrumental diagnosis of hemodynamic changes, including in assessing the progression of portal hypertension and the subsequent detection of concomitant complications.

Relevance: Most diffuse liver diseases lead to fibrosis over time with the risk of cirrhosis. With progressive fibrosis and cirrhosis of the liver both physical properties of the hepatic parenchyma and its hemodynamics change. The only reliable method for determining the stage of the disease is puncture biopsy and subsequent histological examination, but this method is invasive and associated with complications. Currently, the determination of the severity of cirrhosis is based on clinical data (the Child-Pugh scale) and elastography is considered to be the main non-invasive instrumental method. It lets reliably differentiate the initial fibrosis and cirrhosis of the liver, while the F2 and F3 stages according to the conventional METAVIR scale remain a "gray zone", as well as the differentiation of degrees of the severity of cirrhosis. In addition elastography has a number of limitations. The main ones of which are operator dependence, apparatus dependence and the inability to determine functional changes in the liver. With the use of perfusion computed tomography (CT perfusion) it is possible to assess the functionality of the liver by quantifying changes in hemodynamics. The method applied measures the characteristics of blood flow in the tissue at a given scanning level by computed-tomographic data on the dynamics of the distribution of the contrast agent in the area of interest is collected, besides the type of liver perfusion is determined. This parameter is needed to assess the dynamics of treatment against the background of drug therapy.Objective: To identify statistically significant parameters of CT perfusion to determine the severity of hemodynamic disturbances in patients with various stages of liver fibrosis and cirrhosis and to compare the values of parameters of liver CT perfusion with fibrosis according to the METAVIR conditional scale determined using elastography.Materials and methods: 18 patients were included in this parallel pilot study. On the basis of clinical and laboratory data and the results of elastography, 10 of them were diagnosed with fibrosis and cirrhosis. The stages of fibrosis F1, F2 were determined in 3 patients; stages F3, F4 – in 7. In the group of patients with F3, F4, according to the METAVIR conditional scale, subgroups were distinguished depending on the severity of cirrhosis: compensated – 3 patients, subcompensated – 2, decompensated – 2. The control group consisted of 8 patients with organ diseases abdominal cavity not associated with liver damage. All patients underwent CT perfusion of the liver on a Philips iCT 256 using the following scan parameters: 80 KVp, 120 mAc, total scan time 56 s, and slice thickness 5.0 mm. Intravenously, bolus was administered to all patients with 50 ml of ioversol 350 mg/ml, the rate of administration was 3.8–4.0 ml/s, the time from the moment of administration of the contrast medium to the start of scanning was 6 s. After receiving a series of images, the data was processed on a Philips workstation. Quantitative analysis was carried out according to the following indicators: TTP (time to peak, s), BV (blood volume, ml/100 g), AP (arterial perfusion, ml/min/100 ml), PP (portal perfusion, ml/min/100 ml), TP (total perfusion, ml/min/100 ml) and HPI (hepatic perfusion index, %).Results: In the control group of 8 patients, the perfusion values were: TTP 37.4±5.2 s, BV 16.1±5.0 ml/100 g, AP 25.0±7.5 ml/min/100 ml, PP 44.5±14.5 ml/min/100 ml, TP 70.1±14.9 ml/min/100 ml, HPI 70.1±14.9%. In 3 patients with F1, F2, according to the METAVIR conditional scale, the following statistically significant values (p<0.039) of perfusion indices were determined: BV 27.2±8.6 ml/100 g, AP 20.0±3.8 ml/min/100 ml; with compensated liver cirrhosis (n=3): TTP 46.2±1.7 s, BV 12.4±1.9 ml/100 g, AP 10.7±2.8 ml/min/100 ml, PP 37.3±5.2 ml/min/100 ml, TP 48.1±3.5 ml/min/100 ml, HPI 22.4±5.5%; subcompensated (n=2): TTP 43.0±3.2 s, BV 8.9±2.6 ml/100 g, AP 12.8±3.0 ml/min/100 ml, PP 27.7±9.0 ml/min/100 ml, TP 40.5±7.3 ml/min/100 ml; decompensated (n=2): BV 30.5±1.8 ml/100 g, PP 8.5±1.5 ml/min/100 ml, HPI 81.3±1.8%.Conclusion: The preliminary results obtained confirm that CT perfusion can be used to predict and assess the severity of hemodynamic disturbances in patients with varying degrees of severity of cirrhosis and supplements clinical, laboratory and elastography data.

AIM The two-year study of the efficacy of Ifnb-1B (infibeta) in patients with relapsing-remitting (RRS) and secondary progressive multiple sclerosis (SPMS) in the Moscow region with the criteria NEDA-3. MATERIAL AND METHODS Three hundred patients, 81 men and 219 women, aged from 18 to 67 years, including 227 with RRS and 73 with SPMS, were studied. The duration of disease was from 0.5 to 39 years, the level of neurological deficit on EDSS scale was from 1 to 6.5 points. All patients received infibeta. RESULTS AND CONCLUSION During the treatment with infibeta, the chance of exacerbation decreased by an average of 39.4 times (OR 39.4 95% CI; 16.6-122.7) during the first year, by 35.3 times (OR 35.3; 95% CI 13.5-131,2) during the second year. A statistically significant decrease in the probability of exacerbation is also confirmed in the conditional logistic regression model (p<0.001). MRI revealed the signs of exacerbation and progression of the disease only in 11.5% of patients; 54.9% of the patients met the criteria NEDA-3. The highest efficacy of infibeta is noted in patients with RRS, more than 3/4 of them responded to therapy with the absence of both clinical and MRI signs of exacerbation and increase in neurodegeneration. Thus, a good clinical result is achieved in patients with RRS and SPMS treated with infibeta. When using the NEDA-3 criteria, a positive result is achieved in more than half of patients.

Balo's concentric sclerosis (BCS) is a rare demyelinating disease, first described by Hungarian neurologist Josef Balo in 1928. BCS occurs predominantly in young adults, the average age of onset of the disease - 34 years (range from 3 to 62 years). Our case report describes a 27-year woman with acute onset progressive right-side pyramidal weakness, MRI results showed a variant of demyelination as Balo's concentric sclerosis.

Objective. To evaluate the efficiency of ASL-perfusion as a method of estimating of hemodynamics and detection of residual tumor tissue after surgical treatment of glioblastoma.Material and methods. 56 patients after brain tumor’s surgical resection of glioblastoma (GRADE IV). CBF values were determined in 3 different areas - in the presumed tumor tissue with maximum perfusion, in the postoperative scar tissue and in the deep white matter of the opposite hemisphere. All patients were divided into 2 groups according to CBF value.Results. 1st group: 38 (67.9%) patients - the average CBF in suspected tumor was 137.6±35.2 (79.6-227.6) ml/100 g/min. It was 6-8 times higher than CBF in the deep white matter of the opposite hemisphere, and 5-6 times higher than in the postoperative scars.2nd group: 18 (32.1%) patients with no pathological elevation of CBF in postoperative scar tissue. CBF there was 22.3±5.9 (13.9-37.1) ml/100 g/min. CBF in white matter in the contralateral hemisphere was similar.There was no significant differences in CBF of scar tissue (p=0,52) and in white matter of contralateral hemisphere (p=0,96) in both groups.Conclusion. The possibilities of ASL-perfusion are enough to estimating of hemodynamics and detection of residual tumor tissue after surgical removed glioblastoma.

The primary appendiceal cancer is one of the rarest malignancies. Its counts for 0.5% of all colon cancer and does not exceed few bips in all surgically removed appendices. The disease does not have specific signs. It can imitate acute appendicitis, its complications, or a disease of uterine appendages. The appendiceal cancer is commonly diagnosed during pathomorphological investigation after surgery. A clinical case of a 58-yearold female patient with a tumor of the appendix is presented in the paper. Initially the tumor was thought to be an appendicular infiltrate. During the patient's second hospitalization a differential diagnosis between a uterine appendages tumor and appendicular mucocele was performed. The histological examination identified mucosal adenocarcinoma (G1) of the appendix with invasion into the ileum wall. With the full range of radiation diagnostics that provides additional information to clinical assessment and laboratory work-up it is challenging even for practicians to diagnose the disease. Despite the rare frequency of appendiceal cancer, it should be included into the list for differential diagnosis. The paper presents the basics of the differential diagnosis with special emphasis on the awareness of this disease. The knowledge of specifics of its pre-operative diagnosis could be useful to practitioners.

Rectal cancer occupies one of the leading places in the structure of mortality in both sexes, with the only radical method of treatment is surgery. For the planning of surgical treatment, it is important to assess the metastatic lesion of the locoregional lymph nodes, the presence of extramural lymphovascular invasion, which is an important predictor of recurrence of the disease, as well as an indicator of the early appearance of distant metastases. The effectiveness and reliability of preoperative staging of the low rectal cancer has increased significantly after the introduction into clinical practice of magnetic resonance imaging, as well as a comprehensive preoperative radiation examination of patients. The article is devoted to the problems of preoperative staging and determination of statistically significant relationships between the presence of extramural vascular invasion in cancer of the low rectal cancer and the presence of distant metastases, the identification of the correlation between T and N - stages of the tumor, their morphological types with diagnosed extramural vascular invasion.

Rectal cancer is one of the leaders in the structure of mortality in both sexes, with the only radical method of treatment is surgery. For the planning of surgical treatment, it is important to assess the metastatic lesion of the locoregional lymph nodes, which is an important predictor of the recurrence of the disease. The efficiency and accuracy of the preoperative determination of metastatic regional lymph nodes in low-ampullar rectal cancer increased significantly after the introduction into clinical practice of magnetic resonance imaging with the use of diffusion-weighted image and a non-ionic paramagnetic. The article is devoted to the problems of preoperative staging and determination of metastases in regional pararectal lymph nodes by comparing the results of MRI studies with contrast enhancement and MRI with diffusion-weighted images (DWI) in the diagnosis of metastases -positive locoregional lymph nodes, comparison with the data of histological studies of intraoperative material.

Rectal cancer is one of the leaders in the structure of mortality in both sexes, with the only radical method of treatment is surgery. For the planning of surgical treatment, it is important to assess the metastatic lesion of the locoregional lymph nodes, which is an important predictor of the recurrence of the disease. The efficiency and accuracy of the preoperative determination of metastatic regional lymph nodes in low-ampullar rectal cancer increased significantly after the introduction into clinical practice of magnetic resonance imaging with the use of diffusion-weighted image and a non-ionic paramagnetic. The article is devoted to the problems of preoperative staging and determination of metastases in regional pararectal lymph nodes by comparing the results of MRI studies with contrast enhancement and MRI with diffusion-weighted images (DWI) in the diagnosis of metastases -positive locoregional lymph nodes, comparison with the data of histological studies of intraoperative material.

The primary appendiceal cancer is one of the rarest malignancies. Its counts for 0.5% of all colon cancer and does not exceed few bips in all surgically removed appendices. The disease does not have specific signs. It can imitate acute appendicitis, its complications, or a disease of uterine appendages. The appendiceal cancer is commonly diagnosed during pathomorphological investigation after surgery. A clinical case of a 58-yearold female patient with a tumor of the appendix is presented in the paper. Initially the tumor was thought to be an appendicular infiltrate. During the patient's second hospitalization a differential diagnosis between a uterine appendages tumor and appendicular mucocele was performed. The histological examination identified mucosal adenocarcinoma (G1) of the appendix with invasion into the ileum wall. With the full range of radiation diagnostics that provides additional information to clinical assessment and laboratory work-up it is challenging even for practicians to diagnose the disease. Despite the rare frequency of appendiceal cancer, it should be included into the list for differential diagnosis. The paper presents the basics of the differential diagnosis with special emphasis on the awareness of this disease. The knowledge of specifics of its pre-operative diagnosis could be useful to practitioners.

INTRODUCTION:Neurodegeneration (ND) is the basis of the gradual increase in neurological deficit and cognitive impairment in patients with multiple sclerosis (MS). Morphometry of the brain is the method for monitoring of ND. The possibility of using neuropsychological tests for this purpose is being actively discussed.AIM:To examine the effect of treatment with interferon beta-1b (IFNb-1b) on the development of the neurodegenerative process according to morphometry and cognitive testing.MATERIAL AND METHODS:Twenty-three patients with relapsing-remitting MS were examined. The control group included 10 healthy people. All patients received IFNb-1b in a dose of 9.6 million IU. EDSS, MSFC, depression and anxiety Beck test, Wechsler test, magnetic resonance imaging (MRI) of the brain, voxel morphometry with FreeSurfer 5.3 were used. The EDSS score was 4.0 before treatment.RESULTS:In MS patients, MSFC and Wechsler scores were worse in comparison with similar indicators of the control group. Deterioration of neurological status, motor function test and PASAT during exacerbation was identified in 7 patients. Morphometry revealed the increase in hypointense white matter lesions (HWML) (p<0.05) in patients with MS. There was a downward trend in the cortical and subcortical gray matter volume and the increase in ventricular volume. A direct correlation between the amount of HWML and the degree of disability on EDSS scale (p=0.018), the inverse correlation between HWML and Wechsler test, PASAT (p<0.05) were identified. After a year of therapy, there were no statistically significant changes in motor and cognitive functions and no signs of 'pseudoatrophy'.CONCLUSION:Morphometric data in MS were changed compared to healthy controls. There were correlations between morphometry results, disability and cognitive dysfunction. After a year of IFNb-1b therapy, there were no significant changes in cognitive function and EDSS.

The article describes two cases of quite rare genetic disease, tuberous sclerosis, one of which was diagnosed as early as in adulthood in a patient with a history of episindrom, the other was diagnosed at the age of eleven in a patient with newly diagnosed seizures, having a history of heart rhabdomyoma. Complex use of radiological methods in the conditions of our clinic allowed to establish in short terms the diagnosis, to estimate a condition of internal organs and also to decide on further tactics of treatment and supervision of patients.

Benign pituitary tumors are the most common sellar neoplasms. Lesions larger than 39 mm in the maximum dimension are called giant. They are rare, and, therefore, there are few data on the clinical and morphological features of giant pituitary tumors with different hormonal activity.AIMThe aim of this study was to identify the clinical and functional features of giant pituitary tumors with different hormonal activity.MATERIAL AND METHODSWe analyzed data of clinical, laboratory, and instrumental examinations of 351 patients diagnosed with pituitary macroadenomas at the Moscow Regional Research Clinical Institute in the period between 2008 and 2017: there were 144 hormonally inactive pituitary adenomas and 207 hormonally active pituitary adenomas (65 prolactinomas and 142 somatotropinomas).RESULTS AND DISCUSSIONAmong 351 patients with pituitary macroadenomas, there were 32 (9.1%) giant adenoma cases: 18 (12.5%) 144 patients with hormonally inactive pituitary adenomas and 14 (6.8%) 207 patients with hormonally active pituitary adenomas 6 (3.9%) 65 prolactinomas and 6 (2.9%) 142 somatotropinomas. The volume of giant adenomas was somewhat larger among somatotropinomas 48 926 [35 067; 97 650] mm3 and prolactinomas 36 872 [15 281; 75 102] mm3 compared to that of hormonally inactive pituitary adenomas 26 933 [21 910; 42 895] mm3. Tumors had predominant suprasellar and posterosellar growth (31 (97.8%) and 29 (90.6%) cases, respectively). The most common first patient complaints were visual impairments (59.4%) and headache and/or dizziness (43.8%). Correspondingly, due to these complaints, 16 (50%) patients first consulted an ophthalmologist. Hypopituitarism detected before any treatment was present in 16 (50%) patients.CONCLUSIONIn most cases, visual impairments and headaches/dizziness were the first manifestations of giant pituitary adenomas; therefore, ophthalmologists and neurologists should always refer patients with these complaints to MRI. Patients with identified giant pituitary tumors should be referred to an endocrinologist for exclusion of hypopituitarism and, if necessary, timely prescription of hormonal therapy.

Rationale: Crohn's disease is characterized by continuous severe course, and in a half of the patients is associated with formation of strictures that are difcult to treat and signifcantly decrease quality of life. Difculties during the differentiation between inflammation-related and fbrostenotic strictures and divergent approaches to their treatment in patients with Crohn's disease indicate the need in precise diagnostics and systematization of the radiological semiotics of strictures.Aim: To propose radiological semiotics of the small and large intestine strictures based on the results of multiaxial computed tomography (MACT) and magnetic resonance imaging (MRI).Materials and methods: MACT and MRI visualization was performed in 40 patients with a stenotic type of Crohn's disease.Results: The radiological signs of the strictures were classifed into two main groups: intestinal and extra-intestinal. They were systematized according to nine criteria, such as character of formation, etiology, number, inflammation grade, extension, shape, and location, presence of ileus and presence of other complications. The inflammation activity in the intestinal wall was evaluated during the postcontrast assessment: active inflammation in the arterial phase (at 25 seconds after administration of the contrast agent), chronic inflammation in the delayed phase (at 10 minutes). The MRI results were cross-checked with those of MACT. At the precontrast stage, MRI was more informative as per the width of the intestinal lumen, whereas MACT was preferential in the diagnosis of fat infltration of the intestinal wall. Post-contrast MACT and MRI were diagnostically equivalent. The most indicative for active inflammation were diffuse weighed MRI images, arterial phase MACT and MRI, whereas chronic inflammation and wall fbrosis were better diagnosed at the delayed phase (at 10 minutes) of MACT and MRI. Both methods (MACT and MRI) could not differentiate between the submucous and muscular layers of the intestinal wall. Mixed type of inflammation was seen in the walls of intestinal strictures: chronic inflammation dominated in the intermediate, most extensive part of a stricture and remained stable during the dynamic follow-up, whereas active inflammation was found in the marginal parts of the strictures, which were most susceptible to changes during the follow-up.Conclusion: Based on a set of certain signs obtained by radiological visualization, we propose a registry for stricture assessment based on evaluation of the inflammation activity.

Inflammatory bowel diseases (IBD) are commonly associated with extraintestinal manifestations, hematological disorders being the most special among them. In some cases, they dominate the clinical picture masking the intestinal manifestations of the underlying disease. Aplastic anemia is an extremely rare extraintestinal IBD manifestation. There are only two clinical cases of aplastic anemia associated with ulcerative colitis and non with Crohn's disease reported in the literature. Combination of Crohn's disease and В₁₂-deficient anemia is more prevalent, but is seen usually only after more than 20 cm of the ileus has been resected. The first clinical case presented in this paper is a combination of severe fistula-forming Crohn's disease with a constriction in the terminal part of the ileus and profound pancytopenia as an outcome of aplastic anemia. This profound pancytopenia is associated with an extremely high risk of life-threatening complications both of surgical treatment, as well as of several chemotherapeutic agents, which made the management of this patient difficult. The second clinical case demonstrates the manifestation of Crohn's disease as ileocolitis starting from the symptoms of cobalamin deficiency: severe В₁₂-deficient anemia, funicular myelosis and sensory ataxia, with blunted intestinal symptoms. This made the initial diagnosis and timely treatment difficult. Replacement therapy with cobalamin injections and treatment with glucocorticoids and antibacterials led to endoscopically confirmed remission of Crohn's disease and normalization of hematological parameters, with persistent polyneuropathy. Thus, management of patients with Crohn's disease should be multidisciplinary. In the case of anemia, leucopenia and/or thrombocytopenia in IBD patients it is necessary to exclude potential myelodysplasia and bone marrow aplasia. In the event of megaloblastic anemia and/or progressive polyneuropathy one should bear in mind potential cobalamin deficiency. However, in severe anemia it is important to perform diagnostic assessment for IBD, first of all, for Crohn's disease, especially, if any intestinal symptoms are present.

Objective. To study the characteristics of the diagnosis and treatment of non-alcoholic-related Wernicke–Korsakov syndrome (WKS). Materials and methods. Eight patients (five men and three women) with mean age 38.9 ± 1.4 years with WKS were observed; WKS in three patients developed on the background of acute and two on the background of exacerbations of chronic gastrointestinal tract diseases with malabsorption, and in three after surgery to the upper segments of the gastrointestinal tract Results. Illness debuted with impaired consciousness. Symptoms of ataxia, oculomotor disorders, and bulbar syndrome started after 24–48 h. One patient developed a treatment-resistant state of tonic-clonic seizures. The brain MRI picture was characterized by the presence of hyperintense foci on T2-weighted images in the areas of the hypothalamus, mammillary bodies, brainstem, and cerebellum, with accumulation of contrast in the mammillary bodies. Patients received treatment with a complex of group B vitamins (Neurobion) and thiamine, with positive results Conclusions. Patients with gastrointestinal tract diseases accompanied by malabsorption are at risk of developing WKS. The appearance of changes in consciousness, ataxia, and oculomotor disorders in these patients is an indication to start thiamine therapy, thus preventing the development of stable cognitive deficit.