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Aim To study the condition of coronary vasculature by data of coronarography (CG) in patients with chronic ischemic heart disease (IHD) and arterial hypertension (AH) associated with stage 2-4 chronic kidney disease (CKD) and to evaluate the effect of a 12-week complex treatment with perindopril or with a combination of perindopril/amlodipine on changes in vascular wall stiffness, endothelial function, and structure and function parameters in this patient category after coronary stenting.Material and methodsr This study included 87 patients with chronic IHD and AH associated with stage 2-3 CKD for whom CG was performed due to ineffectiveness of the antianginal therapy. The patients were divided into three subgroups: subgroup 1 included 28 patients who received a conservative treatment with perindopril 10 mg/day; subgroup 2 consisted of 25 patients who underwent coronary stenting and were prescribed perindopril; subgroup 3 consisted of 34 patients who underwent stenting and were prescribed the perindopril/amlodipine combination. The reference group included 47 patients with IHD and AH with preserved kidney function. Anatomic and functional parameters of the heart, arterial stiffness, pulse wave velocity, cardio-ankle vascular index, augmentation index, central aortic systolic and pulse pressure, endothelium-dependent vasodilation, plasma concentration of endothelin-1 (ET-1), and plasma concentration of nitric oxide metabolites were evaluated at baseline and after 12 weeks of treatment.Results In patients with IHD, AH, and stage 2-3 CKD, arterial stiffness was more pronounced than in patients with preserved kidney function. Concentrations of ET-1 were significantly higher and levels of nitric oxide were lower in CKD. Supplementing the complex therapy with perindopril resulted in a considerable hypotensive effect in all subgroups, improvement of the kidney function, and positive dynamics of arterial stiffness and endothelial function. Changes in these parameters were more pronounced in patients after coronary stenting than in patients receiving only a conservative treatment. The use of perindopril/amlodipine following stenting exerted the most significant angioprotective and cardioprotective effect.Conclusion Patients with IHD and AH in combination with early CKD have pronounced impairment of the condition of arterial blood vessels and the heart. Addition of perindopril to the treatment not only exerted a hypotensive effect but also beneficially influenced mechanisms of progression of this combined pathology.

Purpose: Analysis of infectious complications incidence in different types of percutaneous externalinternal biliary drainage in patients with obstructive jaundice of tumor genesis.Material and methods: The results of using antegrade external-internal drainage of the biliary tree in transpapillary and suprapapillary variants in 110 patients were analyzed. External-internal biliary drainage was performed in stages, after percutaneous transhepatic cholangiostomy or involuntarily primary with proximal obstruction of the biliary tree with bile duct segregation if it is impossible to form a fixing element of drainage proximal to the obstruction zone.Results: In the first group, transpapillary external-internal drainage was performed in 30 patients with peripapillary tumor obstruction. Of the 26 patients with proximal obstruction, suprapapillary external-internal drainage was performed in 8 patients, transpapillary — in 18 patients. Postmanipulation cholangitis in the first group occurred in 16 cases (28.6 %), liver abscesses developed 4 cases (7.1 %). In the second group, among 30 patients with transpapillary drainage on the background of peripapillary tumor obstruction, signs of acute cholangitis developed in 4 cases. Cholangitis was stopped by timely transfer of external-internal drainage to external. Among 24 patients with proximal obstruction of the biliary tree, suprapapillary external-internal drainage without complications was performed in 18 cases, transpapillary in 6 patients with the proximal block without disconnecting of the biliary tree. Acute cholangitis developed in 2 cases. Patients of the second group had no liver cholangigenic abscesses. There were no cases of hospital mortality in both groups.Conclusion: Factors in the development of postmanipulation cholangitis and liver abscesses during external-internal drainage of the biliary tree against the background of its tumor obstruction are the transpapillary position of endobiliary drainage with duodeno-biliary reflux in persistent biliary hypertension. In the case of suprapapillary location of the working end of external-internal drainage during antegrade drainage of the proximal tumor obstruction of the biliary tree with dissociation, the risk of postmanipulation cholangitis in non-drained liver segments is minimal. In the event of post-manipulation cholangitis in the case of transpapillary drainage of the biliary tree, a temporary transformation of external-internal drainage into external cholangiostomy is necessary.

The article provides an overview of the frequency of distribution of pyometra in cats. Risk factors, clinical manifestations and clinical forms of the disease are analyzed. Current methods of pyometra diagnostics and clinical and laboratory criteria for early detection of signs of sepsis (systemic inflammatory response) in cats with pyometra are considered. The methods of pyometra therapy are analyzed. It was emphasized that the most effective and safest method of treating any form of pyometra is a total ovariohisterectomy in combination with broad-spectrum antibiotics. Encouraging results in the treatment of an open uncomplicated form of pyometers in cats were obtained using, along with antibiotics, preparations based on PgF2alfa and aglepristone.

Aim.To determine the role of antegrade X-ray surgical interventions in the treatment of benign postoperative biliary strictures.Material and methods.A retrospective analysis of treatment of 36 patients with benign biliary strictures was performed. Isolated stricture of biliodigestive anastomosis was diagnosed in 25 cases, partial clipping of common hepatic duct proximal to biliodigestive anastomosis – in 3 cases, partial clipping of bile duct – in 3 patients, isolated biliary strictures – in 5 patients including 4 of them with stricture within previously deployed T-shaped drainage. At the first stage, percutaneous transhepatic cholangiostomy was performed. According to antegrade cholangiography data, structure type “+1, +2” by H. Bismuth classification in modification of E. I. Galperin was diagnosed in 16 (55.2%) patients, proximal biliary strictures (“0”–“−2”) in 13 patients. Three patients with partial clipping of common bile duct and 4 patients with benign biliary stricture in the area of previously deployed T-shaped drainage were not classified. Recanalization of strictures by “catheter-guide” system was followed by antegrade dilatation of the stricture. Final stage was frame external-internal drainage for 6–12 months with stepwise redo balloon dilatation every 3 months (35 patients). The criterion for the end of minimally invasive treatment was the absence of balloon waist in the stricture zone observed during the next procedure but not earlier than in 6 months from primary balloon dilatation. Surgical correction was indicated for recurrent stricture.Results.Direct technical success was achieved in 35 patients. There was 1 case of recurrent strictures within 1 year among 3 cases of primary repair of biliary strictures in the area of previously installed T-shaped drainage. Resection of common bile duct stricture was followed by Roux-en-Y hepaticojejunostomy. Recurrence-free period among 36 patients ranged from 1 to 10 years, median – 56 months. There were no mortality and complications after X-ray surgery.Conclusion.Antegrade recanalization and balloon dilatation of the stricture followed by long-term external-internal biliodigestive frame drainage are effective for both stricture of biliodigestive anastomosis and partial clipping of bile duct. Conventional surgical procedures should be preferred for cicatricial strictures of extrahepatic bile ducts after previous T-shaped drainage deployment.

The beginning of 2020 was characterized by the development of a new coronavirus pandemic (COVID-19). Information about the epidemiology, etiology, pathogenesis, clinical and laboratory diagnostics, as well as prevention and therapy for this disease is constantly being expanded and reviewed. The COVID-19 pandemic creates the need for the emergence of new conditions of specialized care for patients with heart rhythm and conduction disorders [1]. These recommendations are intended for general practitioners, internists, cardiologists, electrophysiologists/arrhythmologists, cardiovascular surgeons, functional diagnostics doctors, anesthesiologists-resuscitators, laboratory diagnostics specialists, health care organizers in the system of organizations and healthcare institutions that provide specialized care to patients with heart rhythm and conduction disorders.

Introduction. A number of paraproteinemic polyneuropathy is directly linked to the monoclonal gammapathy of undetermined significance (MGUS). One of the first manifestations of MGUS in addition to the secretion of monoclonal immunoglobulin, and long before the manifestation of malignancy is polyneuropathy.Materials and Methods. Were examined in 16 patients with polyneuropathy associated with MGUS in age from 53 to 78 years. Patients underwent a course of infusion therapy with human immunoglobulin in the dose of 0.4 g/kg for 5 days.Results. After treatment revealed a reduction of the manifestations of the sensory component of the neuropathy, neuropathic pain and sensitive ataxia that was confirmed by electromyographic data of stabilography, and a rating on a scale Lovett, the scale of neuropathy disability score, the questionnaire «Pain detect». The motor component of polyneuropathy had more persistent symptoms.Conclusion. Treatment with human immunoglobulin is effective in reduction of neuropathic pain and sensory ataxia and in increase of superficial and deep sensation, while the motor component of polyneuropathy had more persistent symptoms.

Aim. To improvethe efficiency of X-ray treatment of postoperative complications (duodenal and biliary fistulae, intraabdominal iatrogenic bile collections). Material and Methods. Percutaneous transhepatic biliary drainage was carried out in 11 patients with nondilated intrahepatic bile ducts. Failure of duodenal stump after previous stomach resections in 5 patients, presence of external biliary fistulae after surgery on gall bladder and common biliary duct in 3 patients and severe pancreonecrosis in 3 cases led to need of antegrade transhepatic cholangiostomy. Results. Antegrade transhepatic cholangiostomy gives an ability to close duodenal fistulae in 5 patients and biliary fistulae in 3 patients with iatrogenic injury of common biliary duct. Percutaneous transhepatic biliary drainage was used in treatment of 3 patients with severe pancreonecrosis. There were 2 complications of antegrade transhepatic cholangiostomy such as hepatic subcapsular hematoma and porto-biliary fistula which were cured effectively using minimally invasive methods (percutaneous drainage of hematoma and disintegration of porto-biliary fistula by filling of intrahepatic canal). Conclusion. Antegradetranshepaticcholangiostomy in case of nondilated intrahepatic bile ducts differs from traditional technique. Often it assumes contrasting of biliary tree using any available way and demands strict compliance of manipulation technology

Purpose. To determine the indications for the supra - and transpapillary externally-internal drainaging of the biliary tree in case of jaundice syndrome. Material and methods. The results of minimally invasive treatment of 246 patients with external-internal drainage of the biliary tree were analyzed. Among patients with proximal tumor block the external-internal drainage is made in 92 cases, in 42 (45,7%) out of them in suprapapillary embodiment and in 50 (54,3%) - via transpapillary approach. In 154 cases with distal tumor (obstruction peripapillary cancer) transpapillary drainage was performed. Results. The technical success of the external-internal drainaging was achieved in 242 patients (98,4%). It was failed to pass the duodenum in 4 patients with the cancer of common bile duct (3) and cancer of papilla of Vater (1). There was no complications related to the technique of external-internal drainage. In 18 patients (8,8%) out of 204 with transpapillary location of the drainage, we were forced to temporarily return to full outer bile outflow because of acute cholangitis. The syndrome of an acute blockade of the papilla of Vater arising after transpapillary external-internal drainaging required endoscopic papillosphincterotomy in 42 (84%) out of 50 patients with proximal tumor block bile outflow and in 7 (4.5%) out of 154 patients with peripapillary cancer. Conclusion. Suprapapillary and transpapillary embodiment of the drainage are equivalent in terms of the efficacy of cholestasis elimination. Syndrome of an acute blockade of papilla of Vater is the most often complication of the transpapillary external-internal drainage requiring the carrying out of endoscopic papillotomy «on drainage». This syndrome arises very frequently in a case of transpapillary external-internal drainage due to the proximal tumor obstruction of the biliary tree. The risk of acute cholangitis due to regurgitation after manipulation is absent in the suprapapillary location of the external-internal drainage, and with its transpapillary position is realized only with a concomitant violation of the outflow of bile.

OBJECIVE. The authors would like to design an original device for aerosol laparoscopic chemotherapy and propose the most effective and safe mode. MATERIALS AND METHODS. The experimental and clinical studies were carried out and included 6 series. Male rabbits (n=71) were used for experimental part and the method was applied on 4 patients in clinical part. RESULTS. The original device and the effective mode of its application were developed for aerosol laparoscopic chemotherapy. The supposed method of chemotherapy appeared to be more effective than the standard method. There weren’t noted any complications or side effects. The method proved its safety. CONCLUSIONS. The aerosol laparoscopic intraperitoneal chemotherapy using the proposed regime is the effective and safe method of peritoneal carcinomatosis treatment.

Purpose. To discuss the possible causes of discrepancies in results of laboratory and X-ray methods of diagnostics of surgical cholestasis without a concomitant dilatation of the bile ducts, as well as features of X-ray-surgical tactics in such cases. Material and methods. In 2015-2016, 271 percutaneous transhepatic cholangiostomies were performed, including 23 cases - on unexpanded bile ducts, 7 these cancer patients with the laboratory evidence of cholestasis. The criteria for the absence of dilatation of the intrahepatic bile ducts were considered as not only an obvious non-visualized biliary tree on ultrasound, but also the diameter of the peripheral intrahepatic bile ducts less than 2 mm, which must be significantly less than similar peripheral branches of the portal vein. Results.Outside bile-outflow was effective, but only in two cases it provided the relief due to cholestasis performance. In 3 cases, blood bilirubin levels decreased by more than half of the initial ones. 5 out of 7 patients after external drainage of unexpanded bile ducts had evident signs of the liver failure. Two patients with malignant lesions of the biliary tree and baseline bilirubinemia over 450 umol/L died because of progressive liver failure. Conclusion. Mechanical jaundice corresponds to the concept of surgical cholestasis, which is associated with surgical diseases stipulating the violation of the outflow of bile and requires biliary decompression. By reducing the functional reserves of liver surgical cholestasis may not be accompanied by the significant expansion of the bile duct, which can be considered as a predictor of hepatic failure, which nevertheless requires cholangiostomy.

cardiovascular diseases, sudden cardiac death, risk, treatment, prevention Cardiovascular mortality in Russia is one of the highest in the world reaching 614 deaths per 100,000 annually. The main causes of death from cardiovascular diseases are the progression of congestive heart failure (about half of all cases) and sudden cardiac death (the other half). Thus, we can assume that the incidence of sudden cardiac death in 2016 was no less than 300,000. In the abbreviated version of the National Recommendations in English, the principles of decision-making algorithms in various clinical situations are used.

Show the possibility of an alternative use of interventional radiology techniques in complex treatment of patients with inflammatory complications of the diverticular disease of the colon.In 2012-2016, there were 87 patients under our supervision with complicated diverticular disease. In 57 (65.5%) cases were diagnosed infiltrate, in 24 (27.6%) cases - abscess of paracolon area (Ib-II type by Hinchey), in 6 (6.9%) cases (III-IV type according Hinchey) generalized peritonitis have been identified.Emergency laparotomy was performed in 13 patients. Abscesses of paracolon (Ib-II type by Hinchey) area were diagnosed sonographically during the initial examination in 17 patients. 26 percutaneous drainage of diverticulogenous abscesses of different localizations self-locking drainage #8Fr 'pig tail' was carried out under the combined ultrasonic and X-ray control in this group of patients. The technical success of percutaneous drainaging of the abscesses was achieved in all manipulations. 13 patients had a single drainaging, and for diverticular disease - disease-free during the observation period of 1 year to 5 years. Resection of the colon in a planned manner after percutaneous drainage of recurrent abscess of paracolon area was performed in 4 patients. Complications related with the technique of installing drainage were not reported, mortality in the group of drained patients was absent.Ultrasound examination of patients with suspected inflammatory complications of diverticular disease - a necessary and sufficient method for initial diagnosis of the disease. Percutaneous drainage of diverticulogenous abscesses (Hinchey Ib-II) is represented by the pragmatic 'first line' choice in patients with complicated diverticular disease, that allows to treat the pathology steadfastly in most of the cases.Цель - показать возможность альтернативного применения методик интервенционной радиологии в комплексном лечении пациентов с воспалительными осложнениями дивертикулярной болезни ободочной кишки. Материал и методы. В 2012-2016 гг. под нашим наблюдением находились 87 пациентов с осложненным течением дивертикулярной болезни. У 57 (65,5%) больных был диагностирован инфильтрат, у 24 (27,6%) - параколярный абсцесс (Ib-II тип по Hinchey), у 6 (6,9%) - распространенный перитонит (III-IV тип по Hinchey) [5, 9]. Результаты. По экстренным показаниям лапаротомия была выполнена в 13 наблюдениях. У 17 пациентов с параколярными абсцессами (Ib-II тип по Hinchey) диагноз был установлен сонографически при первичном обследовании. В этой группе больных было выполнено 26 перкутанных дренирований дивертикулогенных абсцессов разных локализаций самофиксирующимся дренажем pig tail 8Fr под сочетанным ультразвуковым и рентгенологическим контролем. У 13 пациентов дренирование было однократным, а течение дивертикулярной болезни - безрецидивным за время наблюдения от 1 года до 5 лет. Резекция толстой кишки в плановом порядке после перкутанного дренирования рецидивного параколярного абсцесса была выполнена у 4 пациентов. Осложнений, связанных с техникой установки дренажа отмечено не было, случаев летального исхода после дренирования не было. Технический успех перкутанного дренирования полости дивертикулогенного абсцесса был достигнут во всех манипуляциях. Вывод. Ультразвуковое обследование пациентов с подозрением на воспалительные осложнения дивертикулярной болезни - необходимый и достаточный метод первичной диагностики заболевания. Перкутанное дренирование дивертикулогенных абсцессов (Hinchey Ib-II) представляется прагматичным методом выбора первой линии у пациентов с осложненной дивертикулярной болезнью, позволяющим в большинстве наблюдений стойко купировать осложнение.

Objective : to improve the results of preoperative diagnosis of Mirizzi syndrome. Material and methods . Under our supervision for 2006–2015 we had 23 patients with the Mirizzi syndrome. Verification of cholecystolithiasis, condition of gallbladder’s wall and biliary tract dilatation degree was evaluated sonographically. Biliary decompression was realised by percutaneous transhepatic cholangiostomy that was implemented under the combined ultrasonic and X-ray control by the Seldinger technique for self-locking pigtail drainages 8 F. As a method for direct visualization of the bile ducts was used antegrade cholangiography. Results . Preoperative diagnosis was verified in 18 (78.3%) patients, based on the results of ultrasound and data of antegrade cholangiography. In I type of Mirizzi syndrome (prefistule form) was revealed a combination of non-standard ultrasonic symptoms: if there were signs of "high" extrahepatic block of bile ducts (area of liver gate and confluence of hepatic ducts) there was recorded actual intravesical bile hypertension. Lack of lymphadenopathy near the choledoch and focal lesions of liver parenchyma in the goal area confirmed the benign character of the "high" bile ducts block. II type of Mirizzi syndrome (fistula form) was characterized by the presence of megacholelitiasis combined with a lack of intravesical bile hypertension. Antegrade cholangiography in combination with intra-ductal diagnostic catheters and manipulation wires and in some cases with cholecystography allowed to differentiate types of Mirizzi syndrome. In 5 cases Mirizzi syndrome was an intraoperative finding. Antegrade minimal-invasive access to the biliary tree was used in patients with high risk of surgery for subsequent X-ray interventions (lithotripsy, balloon dilatation of major duodenal papilla, dislocation of stones to the duodenum). Conclusions . Effective preoperative diagnosis of Mirizzi syndrome can be successful more than in half cases of the combined use of ultrasonography of the biliary tract and the results of antegrade dynamic cholangiography. That was carried out through percutaneous transhepatic cholangiostomy in conjunction with additional diagnostic intraluminal manipulations (wires and catheter inspection and palpation).

Nowadays, treatment of paraproteinemic polyneuropathy is a fairly complex interdisciplinary process. The main method of therapy is still the use of chemotherapeutic drugs as means of pathogenetic treatment of the underlying disease. However, the use of chemotherapy with neurotoxicity can cause development of toxic polyneuropathy which increases neurological deficit. Any comprehensive neurorehabilitation program for patients with these forms of polyneuropathies have not been developed to date. The article presents data of clinical observations of 26 patients with paraproteinemic polyneuropathy which had undergone a course of neurorehabilitation treatment, both medical and nondrug technologies, including the methods of kinesiotherapy and physiotherapy.

Endobiliary antegrade stenting by self-expanding stents was performed in 32 patients with unresectable tumors of pancreatobiliary area. Uncoated stents were used in 15 patients with the proximal obstruction of the biliary tree. Uncoated stents prevent the blockade of lobar, segmental and cystic duct. Covered self-expanding stents were used in 17 cases of distal occlusion and obstruction of the peripapillary area. Antegrade stenting drainages of 8Fr were performed in a stepwise manner, consistently performing outside, then outward-internal drainage of the biliary tree, which was transformed into endobiliary stenting. Hybrid endobiliary antegrade stenting, which involves maintaining outward-internal drainage in lumen installed endobiliary stent, was performed in 14 patients. Hybrid antegrade stenting endobiliary allowed to keep endobiliary access to palliative care for all the time, monitor and correct the patency of the stent, by releasing from intraluminal sludge, to carry out a successful reparative stenting “stent to stent” in case of the invasion of tumor or scar tissue in to the lumen of the stent or around of its proximal end.

Risk stratification of ventricular tachyarrhythmia in patients without structural heart disease is still one of the most important question that requires the answer. We now demonstrate our attempt of risk stratification for this group of patients, taking into account their anamnestic and history data and instrumental research results.

to analyze the efficacy of interventional methods in treatment of Klatskin tumor patients.Treatment of 133 patients with Klatskin tumor for the period 2000-2015 was analyzed. Bismuth I type was revealed in 28 (21.1%) cases, type II - in 45 (33.8%) cases, type III - in 51 (38.3%) cases, type IV - in 9 (6.8%) cases. All patients underwent sonofluoroscopy-assisted percutaneous transhepatic cholangiostomy using self-fixing Pig tail 8Fr drains at the first stage followed by externointernal drainage or antegrade biliary stenting. We deployed 1-6 drains simultaneously or step by step depending on severity of biliary occlusion.Technical success was achieved in all patients. Major postoperative complication such as drain dislocation followed by advanced biliary peritonitis was observed in 1 (0.8%) case. Minor complications occurred in 22 (16.5%) patients. In-hospital mortality was 7.5% (10 patients). The cause of death was severe liver-renal failure. Liver abscesses occurred in 13 patients after transpapillary externointernal drainage on background of temporary occlusion of biliary drain. This required interventional surgery.Obstructive jaundice management should be performed using interventional techniques simultaneously or step by step if unresectable tumor or inoperable patient are present. Herewith it is advisable to restore bile flow in maximal volume of liver parenchyma. Use of uncovered self-expanding biliary stents for palliative treatment of Klatskin tumor may be realized in «hybrid» variant to control stent patency as well as for neoadjuvant therapy of tumor.Материал и методы. Проведен анализ эффективности методов интервенционной радиологии с использованием антеградного чреспеченочного доступа в лечении 133 пациентов с опухолью Клацкина за период с 2000-2015 гг. Тип опухоли Bismuth I был выявлен в 28 (21,1%) наблюдениях, II - в 45 (33,8%), III - в 51 (38,3%) и IV - в 9 (6,8%) наблюдениях. Всем больным выполняли чрескожную чреспеченочную холангиостомию под сочетанным соно-флуороскопическим контролем с использованием на первом этапе самофиксирующихся дренажей Pig tail 8Fr с последующим наружновнутренним дренированием или антеградным эндобилиарным стентированием. Одномоментно и этапно в зависимости от распространенности билиарной окклюзии мы устанавливали от 1 до 6 дренажей. Результаты. Технический успех достигнут у всех пациентов. 'Большое' постманипуляционное осложнение - миграция холангиостомического дренажа с распространенным желчным перитонитом - встретилось в 1 (0,8%) наблюдении. 'Малые' осложнения развились у 22 (16,5%) пациентов. В стационаре умерли 10 (7,5%) пациентов. Причинами смерти стало прогрессирование печеночно-почечной недостаточности. У 13 пациентов, которым выполнено транспапиллярное наружновнутреннее дренирование, на фоне транзиторной блокады билиарного дренажа развились абсцессы печени, что потребовало дополнительных рентгенохирургических вмешательств для их санации. Выводы. При наличии очевидных признаков нерезектабельности опухоли и (или) неоперабельности пациента ликвидацию синдрома механической желтухи при опухолевом билиарном разобщении половин печени следует проводить чрескожно чреспеченочно одномоментно либо последовательно с двух сторон, стараясь восстановить желчединамику в максимально возможном объеме печеночной паренхимы. Использование непокрытых саморасширяющихся эндобилиарных стентов в паллиативном лечении опухоли Клацкина при билиарном разобщении половин печени может быть реализовано в 'гибридном' варианте как для текущего контроля за проходимостью стента, так и для проведения неоадъювантной терапии опухоли.Материал и методы. Проведен анализ эффективности методов интервенционной радиологии с использованием антеградного чреспеченочного доступа в лечении 133 пациентов с опухолью Клацкина за период с 2000—2015 гг. Тип опухоли Bismuth I был выявлен в 28 (21,1%) наблюдениях, II — в 45 (33,8%), III — в 51 (38,3%) и IV — в 9 (6,8%) наблюдениях. Всем больным выполняли чрескожную чреспеченочную холангиостомию под сочетанным соно-флуороскопическим контролем с использованием на первом этапе самофиксирующихся дренажей Pig tail 8Fr с последующим наружновнутренним дренированием или антеградным эндобилиарным стентированием. Одномоментно и этапно в зависимости от распространенности билиарной окклюзии мы устанавливали от 1 до 6 дренажей. Результаты. Технический успех достигнут у всех пациентов. «Большое» постманипуляционное осложнение — миграция холангиостомического дренажа с распространенным желчным перитонитом — встретилось в 1 (0,8%) наблюдении. «Малые» осложнения развились у 22 (16,5%) пациентов. В стационаре умерли 10 (7,5%) пациентов. Причинами смерти стало прогрессирование печеночно-почечной недостаточности. У 13 пациентов, которым выполнено транспапиллярное наружновнутреннее дренирование, на фоне транзиторной блокады билиарного дренажа развились абсцессы печени, что потребовало дополнительных рентгенохирургических вмешательств для их санации. Выводы. При наличии очевидных признаков нерезектабельности опухоли и (или) неоперабельности пациента ликвидацию синдрома механической желтухи при опухолевом билиарном разобщении половин печени следует проводить чрескожно чреспеченочно одномоментно либо последовательно с двух сторон, стараясь восстановить желчединамику в максимально возможном объеме печеночной паренхимы. Использование непокрытых саморасширяющихся эндобилиарных стентов в паллиативном лечении опухоли Клацкина при билиарном разобщении половин печени может быть реализовано в «гибридном» варианте как для текущего контроля за проходимостью стента, так и для проведения неоадъювантной терапии опухоли.

To analyze efficacy of interventional methods via antegrade transhepatic approach in treatment of patients with strictures of biliodigestive anastomoses.24 patients aged 47.2 years were treated for the period 2002-2015. Average time from extrahepatic biliary reconstruction using transhepatic stented tubes to strictures appearance varied from 9 months to 12 years. One- and double-sided percutaneous transhepatic cholangiostomy was performed to abort biliary hypertension. Stricture recanalization was achieved using «catheter-wire» system. Antegrade dilatation of stricture was made using balloon catheter 8 mm and pressure up to 6 atm and stage exposition up to 10 minutes. Balloon repair of anastomosis was supplemented by stented outer-inner drainage of the area of stricture.Restoration of patency of stricture area using antegrade interventional methods was effective in 22 patients. Recurrent stricture occurred in 2 cases within 1.5 years that required repeated biliary reconstruction including antegrade extraction of blocked uncovered stent in 1 patient. There were no major postoperative complications and deaths. Maximal recurrence-free follow-up after stent installation was 11 years.Цель исследования. Анализ эффективности методов интервенционной радиологии с использованием антеградного чреспеченочного доступа в лечении пациентов со стриктурами билиодигестивных анастомозов (БДА). Материал и методы. За период 2002-2015 гг. на лечении находились 24 пациента. Средний возраст больных 47,2 года. Срок образования стриктур после реконструктивных операций на внепеченочном желчном дереве с использованием транспеченочных каркасных дренажей составил от 9 мес до 12 лет. С целью купирования билиарной гипертензии выполняли одно- или двустороннюю чрескожную чреспеченочную холангиостомию. Реканализацию стриктуры осуществляли с помощью системы катетер-проводник. Антеградную дилатацию стриктуры выполняли баллонным катетером диаметром 8 мм при рабочем давлении в баллоне до 6 атм и этапной экспозиции до 10 мин. Баллонную пластику анастомоза завершали каркасным наружновнутренним дренированием зоны стриктуры. Результаты. Восстановление проходимости зоны стриктуры БДА антеградными рентгенохирургическими методами было эффективно у 22 пациентов. В 2 наблюдениях в сроки до 1,5 года возник рецидив стриктуры, потребовавший повторной эндобилиарной реконструкции, в том числе c антеградным извлечением блокированного непокрытого стента у одного пациента. 'Больших' постманипуляционных осложнений и летальных исходов не было. Максимальный срок безрецидивного наблюдения пациента после установки непокрытого баллонорасширяемого стента в зоне гепатикоеюноанастомоза составил 11 лет.

This study was carried out to investigate the effect of a new microbiological preparation Vetom 21.77 containing spore-mycelial biomass of Duddingtonia flagrans on hematological and biochemical parameters of broilers. The drug was administered for 3 months. A total number of 105 five-day-old broilers (Hubbard F15) were allocated to four test groups, where birds received the preparation in doses of 2, 5, 50 and 300 µl/kg bodyweight, and a control group with no treatment. Blood samples were collected 1.5 and 3 months after the beginning of the experiment for biochemical and hematological analysis. According to the results obtained, administration of the microbiological drug was followed by positive changes in the immunity of treated broilers. The preparation seems to have stimulating effect on their metabolic processes. There was no negative effect of the drug on the physiological state of the birds. In the course of the experiment, neither disease indications, nor mortality were detected in the birds, excluding deaths caused by the required slaughter. There were no treatment-related allergic reactions, even at the highest daily dose, as exemplified by almost borderline low eosinophil levels observed in treated broilers over the study period. No clinically relevant results were detected in serum biochemical profile.

Effective, safe and convenient inhalation therapy of asthma is of particular importance in pediatric practice. We performed open randomized comparative trial to evaluate efficacy of ultra-fine Beclazone ECO Ease Breathe (BEEB) vs fluticasone in equal doses in children with asthma. The study involved 40 children (26 males, 14 females) of 6-17 years of age with moderate asthma. They were treated with fluticasone followed by BEEB 250 μg b.i.d. We analyzed clinical findings, frequency and severity of asthma symptoms, peak expiratory flow rate (PEFR), medications used for asthma, lung function parameters. After 2 months of treatment with BEEB, the full control of asthma has been achieved in 11 patients (27.5 %) vs 9 patients treated with fluticasone (22.5 %). The good control was achieved in 27 (67.5 %) and 28 (70 %) patients, respectively. The asthma control was poor in 2 patients with BEEB (5 %) and 3 patients with fluticasone (7.5 %). Moderate improvement in mean FEV 1 and PEFR and reduction of their postbronchodilator growth were noted. All the children easily acquired the proper inhalation technique for BEEB. After 2 months of treatment, 39 of 40 patients have wished to continue therapy with this inhaler. There were no adverse events of the drug. There were no additional expenses for asthma and need of hospitalization or other medical care during the study. Therefore, BEEB as the basic therapy of childhood moderate asthma improves asthma control and compliance of the patient and the physician, and significantly decreases the cost of treatment.

The role of the kidneys in endotoxin aggression (EA) and the involvement of EA in disturbance of hemostasis were shown in 33 children with congenital urological pathology. With a progressive decrease in the accumulative-excretory function of the kidneys, compensated chronic EA became subcompensated or noncompensated with a pronounced clinical manifestation: fever, exacerbation of chronic pyelonephritis, an expanded form of the disseminated intravascular coagulation (DIC) III syndrome, and macrohematuria. Preoperative correction of antiendotoxin immunity and hemostasis and improvement of urine passage prevented bleeding and other postoperative complications.

The authors examined students of specialized secondary education institutions of Syktyvkar during a three-year-long period. Some morphofunctional indices are worse in them than in similar cohorts in Central Russia. The unfavorable environmental situation impaired tolerance to hypoxemia, cardiac rhythm regulation, central hemodynamics, and balance of autonomic processes and affected dynamics of the physiological status of the body during social adaptation to learning.

Currently the differential diagnosis of anaplastic meningiomas often is quite complex. An interpretation of the data of radiological studies does not allow the exclusion of diseases with similar clinical course and character of a lesion, such as primary lymphoma and tuberculosis of the central nervous system, neurosarcoidosis and others. The article presents a clinical case, representing a rare and difficult to diagnose variant of anaplastic meningioma with extremely aggressive nature of the current and widespread involvement of the brain and spinal cord.Дифференциальный диагноз анапластических менингиом зачастую довольно сложен. Интерпретации данных радиологических исследований не всегда позволяют исключить схожие по клиническому течению и характеру поражения заболевания, такие как первичная лимфома и туберкулез ЦНС, нейросаркоидоз и др. В статье представлен клинический случай редкого и сложного для диагностики варианта анапластической менингиомы с крайне агрессивным характером течения и распространенным поражением головного и спинного мозга.

In acute and chronic experiments staged on cats and rabbits a study was made of the role played by various portions of the brain in the reaction of respiration to aminazine. In administration of this preparation in a dose of 2–3 mg/kg to cats and in a dose of 8–10 mg/kg to rabbits no significant shifts occurred in the frequency and nature of respiratory movements. The use of hypnotics, acting as a depressive agent on the brain cortex, did not change the reaction of respiration to aminazine. In decerabrated anaimals, aminazine injection led to marked respiratory disturbances. Such animals often perish, the cause of death being repsiratory arrest. Evidently, weakly pronounced respiratory reactions following aminazine administration in intact animals were the result of considerable compensatory capacities of the higher portions of the brain in respiratory regulation.