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Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Introduction. Currently, traditional methods and minimally invasive surgical technologies are used in the treatment of celiac trunk compression syndrome. The choice of treatment method remains a subject of discussion. The drawback of the classical approach – laparotomy – is a significant trauma to the tissues of the abdominal wall, the risk of adhesions, wound infection and hernias. The disadvantage of videosurgical techniques is the risk of developing life-threatening bleeding requiring conversion of access. The main cause of this complication is damage to the wall of the aorta, celiac trunk and its branches during the intervention.Methods and materials. A set of tactical and technical principles was developed to reduce the risk of bleeding during laparoscopic decompression of the celiac trunk. The prerequisites were an assessment of the individual architectonics of the vessels according to 3D reconstruction data, the location of working instruments as parallel to the celiac trunk course, retrograde access to the compression zone, the use of an ultrasonic or bipolar dissector, contact with the vascular wall only with passive branches. With these principles surgical intervention was performed in 12 patients.Results. Complication (bleeding from the branch of the lower phrenic artery) – occurred in one (8.3 %) case – was eliminated laparoscopically. The average duration of the operation was 85 minutes, the average hospital day after the operation was 5 days. Treatment results within 3 to 12 months were evaluated in 8 out of 12 (66.7 %) patients. In 7 (87.5 % of patients with the studied results) cases, complete regression of symptoms and restoration of normal blood flow were noted. One (12.5 %) person had a slight abdominal pain syndrome against the background of normal hemodynamics in the celiac trunk.Conclusion. The presented data are comparable with the results of traditional surgical methods of treatment of celiac trunk compression syndrome and are the basis for further research.

Relevance. According to the data of the international register, the use of extracorporeal membrane oxygenation (ECMO) with mechanical circulatory support in the cardiopulmonary-cerebral resuscitation complex can save up to 30% among patients with sudden cardiac death.Intention. Analyze the main logistical and organizational problems of patient treatment identified over the two years of operation of the Center for the Treatment of Sudden Cardiac Death.Methods. A retrospective analysis of patients admitted in the period from October 2017 to January 2020 in a state of clinical death to the Center for the Treatment of Sudden Cardiac Death of a university clinic was carried out.Results and Discussion. In the course of the analysis, the criteria for connecting ECMO- cardiopulmonary resuscitation were developed. In most cases, the primary cause of death was cardiogenic factors (AMI, PE, fatal arrhythmias, etc.), while AMI was confirmed in 33 episodes. During the entire period of the Center’s operation, not a single patient has been admitted that fully meets the criteria for ECMO- cardiopulmonary resuscitation. However, the technology has been used as therapy for “despair” on six occasions. The main problem at present is long-term and multistage care outside the medical organization. The possibility of using ECMO posthumously was studied in order to preserve the organs of the corpse for subsequent transplantation. During two years of work, 11 effective donors were conditioned, thanks to which 22 kidney transplants and 2 liver transplants were successfully performed at the University.Conclusion. The experience gained has shown the need to revise the algorithms for providing care to patients with sudden circulatory arrest outside the medical organization, in order to expedite transportation to the ECMO center. In the case of ineffectiveness of extended resuscitation in the clinic, it is possible to consider the use of post mortem technology for conditioning a potential posthumous donor for the preservation of organs for the purpose of their subsequent transplantation.

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 107 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2020 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

The purpose of the study is to determine the professional competencies that are in demand among emergency medical personnel when they provide medical care in an inpatient department. Materials and research methods. We compared the impersonal reports on the work done by 20 doctors of specialized substations of the emergency medical service in St. Petersburg for 2015–2017 with the information about work in the mode of daily activities in 2017 of 10 doctors in the intensive care unit of the inpatient department of the Emergency Medical Service of the First St. Petersburg State Medical University named after academician I.I. Pavlov, stored in the qMS medical information system of the University. The volume of instrumental examination of patients who sought medical help, received it in the required volume and were discharged in a satisfactory condition within the first day, was assessed. We compared the results of ultrasound diagnostics performed by the emergency doctors in the screening mode using portable equipment with the results of the work of a consultant-specialist. 701 medical records of inpatients from among those admitted to the Medical University were analyzed. By studying 4573 medical records, possibility and effectiveness of independent primary triage of the incoming patients by the nursing staff was determined. In addition, with the help of the FlexSim HealthCare program, which allows to effectively predict and to simulate changes in work processes within medical institutions, computer simulation of the department’s work was carried out in the conditions of autonomous work of an emergency doctor. Statistical comparison was performed using the Mann-Whitney test, Student’s t-test for unrelated values, and analysis of four-field tables using the χ-square test. Research results and their analysis. Analysis of the research results showed: fundamental principles of work of the staff of inpatient department — multidisciplinarity, multitasking, autonomy. An ambulance doctor working in a stationary environment must be able to independently diagnose, to treat patients with various pathologies, and to simultaneously supervise several patients; having the level of practical and theoretical training specified in the professional standard, the emergency doctor can effectively provide resuscitation care in the volume of I – II levels, which is especially important, given the short time spent by patients in the department; professional standard of the emergency doctors requires to master ultrasound diagnostics to identify gross pathological conditions and to perform a number of manipulations; nursing staff working in the inpatient department must be able to work in an autonomous environment. Triage by nurses is effective and allows to identify patients who need an immediate examination by an EMS doctor. The use of a three-level sorting algorithm does not contradict basic principles of medical triage used in world practice.

The constant mutation of the virus and the complicated epidemiological situation in other countries keep the probability of a third wave of the pandemic in the Russian Federation fairly high. It is important to summarize the gained experience as fast as possible to use it appropriately once it is needed.The objective: to analyze the specific parameters of care for critically ill patients with the novel coronavirus infection in Pavlov Multidisciplinary Medical Center.Subjects and methods. This is a result-based report on the work performed by the Infection Center, which was deployed twice in Pavlov Multidisciplinary Medical Center (from 28.04.2020 to 03.08.2020 and from 01.11.2020 to 15.03.2021). Totally, 3,830 patients with SARS-CoV-2 were managed (1,680 patients during the first deployment and 2,150 patients during the second one). In the preparatory period, the operation of the emergency department based on the inpatient emergency medical department (EMD) had been simulated to clarify its staff structure and the procedure for admission, examination, and treatment of patients. Here we compare the organizational approaches during the first and second waves of the pandemic and present the characteristics of the demographic data of the treated patients, the incidence of certain complications, and outcomes.Results. The overall lethality in the Center made 6.2%. Despite the experience gained in the first wave, the results of treatment during the second wave (autumn-winter) did not improve (5.7% died in the first wave and 6.7% in the second one). Lethality in ICU and EMD was 40.0% and 49.6%, in ICU only – 38.5% and 46.9% respectively. A moderate lethality increase in ICU was due to the concentration of critically ill and most critically ill patients. There were 51.4% of patients with comorbidities and 53.5% were above 65 years of age. Refinement and differentiation of tasks performed by departments, simulation of the operation of the Center before opening made it possible to increase the throughput of the medical unit avoiding rush during admission and deterioration the quality of treatment.Conclusion. Certain aspects of the organization of medical care affect the performance of a multidisciplinary medical institution transformed into an infectious diseases hospital. The experience gained under such circumstances can be useful in other emergencies with a large number of victims and patients.

This article presents the experience of the practical application of simulation modeling on the example of a model of an inpatient emergency department in working with a new coronavirus infection.

Currently, the age of primiparous women is increasing, but the risk of cancer, which is sometimes found during gestation, is also increasing. This article discusses the problems of diagnosis and treatment of cancer during pregnancy, which occurs under the guise of gestational complications. Two cases of malignant neoplasms first discovered during pregnancy are described. The first observation illustrates cholangiocarcinoma in a 37-year-old multiparous, and the second is a case of colorectal cancer in a 40-year-old primiparous. The timely identification of such women is an important challenge of the outpatient, which in the future can help maintain the quality of life of the mother and child.

The article is dedicated to the memory of the Russian surgeon, prominent scientist, public health organizer and the founder of the first Russian periodical surgical journal of N. A. Vel’jaminov in 1885, who was born 165 years ago and died 100 years ago.

Perioperative changes in microbiocenosis in patients with oncological diseases is the widely researched theme in colorectal surgery. In particular, the role of the colon microbiome in the development of purulent-inflammatory postoperative complications and possible significance in cancer disease recurrence have been actively investigated. Data on the colon microbiome tends to be divided on several groups. Part of the considered articles was focused on the condition of the colon microbiome during the perioperative period and its effect on the postoperative complications, in particular on the anastomotic leakage and the development of colitis in the postoperative period in dysbiosis statement. On the other hand, microbiome was evaluated to be a treatment option by the several studies. The effect of antibiotic therapy on the development of Clostridium Difficile infection was investigated as well. The most relevant and up-to-date scientific researches on the microbiocenosis in patients with colorectal cancer were analyzed. The collected data can be used successfully for practical medical using in Russia.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

To treat the patient with Achalasia and prevent the symptoms of gastroesophageal reflux the Peroral Endoscopic Myotomy with Simultaneous Endoscopic Fundoplication was done by the current authors. After performing a myotomy the endoloop was fixated to the stomach and was attached to the muscle of the esophagus by using the endoclips. The endoloop was tightened therefore shaping the cuff. This operation has been technically feasible and no immediate or delayed complications occurred.

Aim. Assessment of the impact of independent ultrasound screening by the emergency physician on the daily activities of the emergency department. Methods. The effectiveness of the use of ultrasound screening by the emergency physician was assessed using computer-based simulation modeling and the subsequent implementation of the data obtained into the practical work of the emergency department. The results were analyzed using descriptive statistical methods. Results. In the course of the study, a simulated model of emergency department was built, similar to the actually functioning department in the Pavlov First St. Petersburg State Medical University. The new professional emergency physician’s standard, requiring knowing the basics of ultrasound-based diagnosis, were implemented first in the model and then in everyday practice. Independent ultrasound screening by the emergency physician allows reducing the length of stay of patients in the emergency department and the workload on medical personnel at the same time increasing the capacity of the department which is confirmed both by computer simulation and by actual implementation in the daily activities of the department. Conclusion. The data received are indicative of a positive impact of independent ultrasound screening on the hospital stay of patients in the department and workload on the medical staff; emergency residency program should be complemented by teaching the basics of ultrasound diagnosis.

Organs’ shortage remains the main limiting problem for accessibility of organ transplantation. There is the growing interest among transplant society for use organs obtained from «uncontrolled» donors after cardiac death (uDCDs), or, asystolic donors. But the warm ischemic time is critical factor for wide accepting of practice of transplantation such kind of organs. The article presents the first case of successful clinical organ transplants from the donor with out-of-hospital irreversible cardiac arrest obtained with help of life support devices.

This article discusses the issue of routing, diagnosis and treatment of patients with intestinal bleeding, in order to more rapid and accurate diagnosis.

Emergency medical education is becoming increasingly challenging as a result of shifting the workplace of emergency physician from ambulance to Emergency Department. Prehospital specialist rarely uses infusion therapy, instrumental methods of treatment and diagnostic independently. Comparison shows the need of longer education for hospital practices, because additional ultrasound and reanimatology trainings are required.

Laboratory tests are one of the most commonly ordered tests in the ED and often the rate-limiting factor in the workup of a patient. The pneumatic tube system (PTS) can use to provide quick specimen delivery. First aim of this study was to assess PTS by comparing routine chemistry, hematology, coagulation blood test results and sample integrity indices between duplicate samples transported either manually or automatically. Also we tried to assess the contribution of PTS to reduction in lab turnaround times.

The article presents modern diagnostic criteria and treatment tactics in patients with cholangitis and biliary sepsis on the background of cholecysto-choledocholithiasis. The analysis of one-stage combined methods of surgical treatment was performed.

There are a few cases of applying of extracorporeal membrane oxygenation in emergency situations in Russian Federation. This article is about of first experience of using VA-ECMO for the treating patients, which were admitted with cardiac arrest in our ED. We are faced with the problem of long transportation from out-of-hospital to hospital treatment. There is necessity for harmonization algorithms of CPR for amblulances while creating ECMO-centers for the patients with cardiac arrest in Russia.

Описан исторический путь с момента формирования журнала «ВИЧ-инфекция и имуносупрессии» с 2009 года по настоящее время. Миссия журнала — освещение последних научных достижений в области медицины, эпидемиологии, фармации и биологии ВИЧ-медицины; стимулирование интереса отечественных специалистов в проведение исследовательской деятельности; поддержка молодых ученых и помощь в обработке материалов и оформлении статей; систематическая работа по расширению рамок исследований и публикаций по смежным вопросам, включая коморбидные состояния; консолидация и компенсирование исследований учеными из различных регионов; проведение научных форумов; подготовка крупных публикаций в виде руководств и монографий и формирование библиотеки журнала; участие в обосновании и проведении дополнительного профессионального образования. Приведены перечисления библиотеки журнала в виде руководств, монографий, информационных бюллетеней, тематической подборки статей.

The objective of the research is to study the efficacy and safety of using a minimally invasive endoscopic method in treatment of Zenker’s diverticulum. Material and methods ., 42 patients with a pharyngo-esophageal diverticulum at the age of 59 to 80 years were examined and treated over the two-year period of work. The indication for the operation in all patients was the presence of dysphagia II–IV degree. The method of tunnel dissection in the submucosal layer of esophagus with dissection of the array of cryopharyngeal muscle and endoscopic esophagodiverticulostomy was used. Regardless of the version of endoscopic intervention, the key moment of the operation is the dissection of the cryopharyngeal muscle, which allows to eliminate the fold between diverticulum and esophagus, thus creating a fistula between diverticulum and esophagus. Results. Results of treatment were evaluated clinically, taking into account patients’ complaints and according to the control of X-ray fluoroscopy of esophagus. The patency of esophagus was objectively restored in all cases. Delays of the passage of contrast medium through the esophagus did not occur. Patients did not experience the difficulty in swallowing. Significant complications during the postoperative period were not noted. Conclusions. Endoscopic esophagodiverticulostomy in the treatment of Zenker’s diverticulum is the effective method of treatment. The operational injury is minimal, what reduces the length of stay in hospital. The peculiarity of the method of treatment allows using the early enteral nutrition. The minimally traumatic nature of endoscopic operation and the quickness of its performance allow applying this technique in weak patients, as well as in patients with concomitant pathology.

The objective is to analyze the results of rendering medical assistance to pregnant women delivered to the University clinic with suspicion of complications of cholelithiasis.Material and methods. The authors conducted the retrospective analysis of the case histories of pregnant women for 2 years, who applied urgently with suspicion of complications of cholelithiasis. In total, 69 patients at different stages of gestation, from 22 to 39 weeks of pregnancy, appealed with suspension of complication of cholelithiasis for this period. The average age of enrolled patients was 29.20±0.8 years. 48.98 % of the enrolled patients were pregnant at first time.Results. The presence of cholelithiasis was confirmed in 82.61 % of pregnant women. 43.86 % of these patients were diagnosed with hepatic colic, which was stopped by spasmolytic therapy. 52.63 % of pregnant women were diagnosed with acute cholecystitis. The surgical intervention – laparoscopic cholecystectomy - was required in 5.26 %. Acute biliary pancreatitis was in 8.77 % of pregnant women with cholelithiasis; delivery and revision of the abdominal cavity were required in 1 case. In addition, 3.51 % had choledocholithiasis with mechanical jaundice. All patients with this diagnosis were performed endoscopic papillosphincterotomy with lithoextraction.Conclusion. Complications of cholelithiasis rank the second place in the frequency of occurrence among urgent surgical diseases in pregnant women. The ultrasound examination is the starting point for determining the further treatment tactics for this category of patients. Pregnant women with complications of cholelithiasis should be examined in inpatient department of ambulance by surgeons and obstetrician-gynecologists collaboratively.

The main effective method of treatment for implantation metastases remains the regional treatment strategy. Systemic chemotherapy is ineffective. The standard treatment of peritoneal carcinomatosis is cytoreductive surgery with intraperitoneal chemo-hyperthermal perfusion (HIPEC), which is performed in an open, closed or laparoscopic way. In recent years a new method of intraperitoneal chemotherapy has been developed: laparoscopic aerosol intraperitoneal chemotherapy (PIPAC). An experimental study is made to compare the efficacy and safety of various methods of intraperitoneal chemotherapy.

OBJECTIVE. The aim of the study is to demonstrate the effective surgical technique in the treatment of cicatricial strictures of the bile ducts. MATERIAL AND METHODS. The authors analyzed the surgical treatment of 18 patients with iatrogenic cicatricial damages of the bile ducts. The development of cicatricial strictures of the bile ducts was diagnosed in all 18 patients with iatrogenic damages of bile ducts after previously performed reconstructive operations. RESULTS. biliodigestive anastomoses on the exchangeable transhepatic drains were applied for 17 patients; Y-anastomosis were applied for 1 patient. biliodigestive anastomoses on the exchangeable transhepatic drains were applied for 2 patients of the 17 on the second stage in 3 months after external drainage of the hepatic ducts. Repeated scarring of the bile ducts and anastomosis had not been observing for the 5 years of observation. CONCLUSION. The choice of surgical tactics in treatment of cicatricial strictures of the bile ducts depends on the type of stricture. high strictures appears more often. The effective treatment of them is biliodigestive anastomoses on exchangeable transhepatic drains.

The results of treatment of gastric cancer with peritoneal dissemination are not very comforting. The average life expectancy of patients after diagnosis is less than 6 months. Methods of systemic treatment are ineffective. The most effective strategy is regional treatment, a special place in recent years has taken intraperitoneal chemotherapy with low-dose Cisplatin and Doxorubicin administered as a pressurized aerosol (PIPAC). This article presents the analysis of the first results of treatment of patients with gastric cancer with peritoneal carcinomatosis, which was used PIPAC at conventional regimens (standard for this technique, low-dose cytostatics, exposure time and intraperitoneal pressure) and in the experimentally developed effective regimen. The developed PIPAC regimen proposed by the authors proved its safety and objectively more effective than the standard for such parameters as objective tumor response, histological response and overall survival of patients. The study will be continued to obtain statistically reliable results.

OBJECTIVE. The authors aimed to develop complex perfusion medical device in order to successfully maintain viability of donor liver until transplantation. MATERIAL AND METHODS. Experimental perfusion device for normothermic perfusion donor’s liver was developed and tested in the Central Research and Experimental-design Institute of Robotics and Technical Cybernetics. RESULTS. The pre-clinical tests were performed on porcine liver. It was demonstrated that normothermic machine perfusion could restore liver function after 30 minutes of warm ischemia time and provide normalization of biochemical parameters of organ functioning.

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.

Peritoneal carcinomatosis (PC) is one of metastatic spread variant of malignant tumors, which shows significantly poor prognosis in patients. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) - is a modern regional therapy method for implantation metastases. Currently there are still unresolved issues in native equipment, optimal chemotherapy drugs doses for PIPAC, ability in adjuvant and neoadjuvant application of method and a combination with surgical treatment. Concerning this we carried out series of experimental studies on animal model (rabbits, n=71), which resulted in development of the device for laparoscopy aerosol chemotherapy also with selection of effective and safe PIPAC mode.

2012 through 2016 patient capacity in the bed space in hospitals of Saint-Petersburg is increased in number of 40 to 144 or 0,12% to 0,41% in share (among them the rate of hospital beds of short stay units is increased to 47,1%, rate of daily beds is increased to 52,9%). Ratio of number of patients referred from emergency unit to specialized units is reduced by 26,1% to 14,5%. Average annual bed occupancy rate is increased by 435,8 to 167,7. Hospital bed turnover is increased by 64,4 to 201,6. The death rate is reduced by 0,41% to 0. Bed population ratio in Saint-Petersburg (27,3 per 1 million of population) is below the recommended level (111 beds for 1 million of population).

The article is about experience of using handheld ultrasound tool by emergency physicians for screening examination of patients, hospitalized in Emergency Department

The colon microflora was investigated by PCR method in real time before and after planned operation in 38 patients with colon cancer. A multifactor analysis showed absence of statistically significant dependence of revealed changes in microflora from sex, age of patients, volume and method of surgery, presence of tumor stenosis and infiltrate. An anaerobic imbalance was often registrated in postoperative period, especially after antibiotic prophylaxis and therapy. Clostridium difficile and Clostridium perfringens were often detected in patients with tumor of the right part of colon (p

The article presents the assessment results of efficacy of modern bariatric laparoscopic operation during 10 years of practice. This work analyzed the treatment results of 1018 operated patients at the period from 2007 to 2014. The laparoscopic regulated gastric bandage operation was performed in 275 (28, 8%) cases. The lapa roscopic longitudinal gastric resection (LLGR) was applied in 411 (43,1%) (231 operation used the developed modification and 180 used standard method). The laparoscopic gastric bypass surgery (LGBS) was carried out in 253 (26,5%) cases (56 used the developed modification and 197 used the Lontron modification). The laparoscopic biliopancreatic bypass surgery (LBBS) was made in 14 (1,4%) cases (11 used Hess Marceau Baltasar modifications and 2 - Fobi modification, 1 - Scopinaro operation). BIB was implanted in 65 (6,3%) cases. The diagnosis of metabolic syndrome had initially been established for 321 (31,5%) patients. The rest of the patients 697 (68,4%) have been operated for obesity of different degree. An initial body mass index (BMI)

The article is dedicated to the issue of intoxication in children. Acute accidental intoxication appears to be especially relevant for pediatric practice. Drugs, various chemicals frequently used in everyday life and in farming, as well as animal poisons, including snake poisons, may have a toxic effect on children. Specialists of professional associations of physicians “Russian Society of Emergency Medicine” and pediatricians “Union of Pediatricians of Russia” formulated and briefly described the main causes of acute intoxication in children, clinical manifestations and the most significant laboratory indicators of toxic manifestations for various substances, as well as therapy principles and algorithms for such conditions in compliance with principles of the evidence-based medicine. The article presents pathognomonic symptoms and peculiarities of drug intoxication, provides a description of mediator symptoms of intoxication with various substances, as well as the symptoms that may indicate toxic effect. The article contains a description of principles of correction of vital body functions, measures for removing toxic substances from the body and information on the main antidotes. Special attention is given to the most frequent types of intoxication (with organic acids, lye, naphazoline, paracetamol, snake poisons [viper bite]). The article lists stage of medical care rendering to children suffering from acute intoxication and presents prognosis and further management of pediatric patients suffering from such conditions.

Antireflux resection of mucous membrane of esophagogastric anastomosis (ARMS) was performed on 6 patients with typical symptoms of gastroesophageal reflux disease (GERD). The patients had a short segment of сolumnar-celled metaplasia (1-2 cm) without radiological and endoscopic signs of hiatal hernia. All the patients received medicamentous therapy by antisecretory agents more than 3 years. The operation included the endoscopic resection of2/3 circle of mucous membrane of esophagogastric anastomosis and resection of the area of columnar-celled metaplasia. The results of treatment were assessed during 3-7 months after ARMS. There was noted an absence of clinical manifestations of GERD, regression of inflammatory signs of mucous coat of esophagus in 4 out of 6 patients. Symptoms of GERD remained in 2 patients, although the intensity of signs significantly decreased.

Введение. Совершенствование хирургической деятельности в амбулаторных условиях актуально. Цель. На основе изучения характера и объемов оперативных вмешательств, проводимых в амбулаторных условиях, разработать рекомендации по улучшению этой работы. Материалы и методы. Статистическая отчетность за 5 лет, операционные журналы центра амбулаторной хирургии и травматологического центра (21479 операций), методики параметрической статистики. Результаты. Выявлена структура оперативных вмешательств при различных формах организации амбулаторной помощи, обеспеченность населения этим видом медицинской помощи, проанализирована ресурсная база амбулаторной хирургии. Заключение. Целесообразно пересмотреть порядки оказания амбулаторной хирургической помощи, привести ресурсную базу в соответствие с современными требованиями и возможностями, ввести дифференцированную подготовку врачей по амбулаторной травматологии и ортопедии. Ключевые слова: амбулаторно-поликлиническая помощь, хирургия, структура оперативных вмешательств, организация.

The incidence of esophageal adenocarcinoma among the population in economically developed countries has been increasing significantly for last three decades. Columnar-lining esophagus (Barrett's esophagus) is one of the proven factors of developing esophagus cancer. The prevalence of Barrett's esophagus and esophageal adenocarcinoma in Russia is not investigated enough. The analysis of the results of 34903 endoscopic examinations of the upper gastrointestinal tract in population of Leningrad region with symptoms of gastric dyspepsia during the period from 2007 to 2013 is presented in this article.

Gastroesophageal reflux disease is a widespread among population in economically developed countries including Russia. It was analyzed the results of 34 903 endoscopic examinations of upper gastrointestinal tract in ethnically and socially homogeneous population of Leningrad region with symptoms of gastric dispepsia. Procedures were performed for the period 2007-2013. Prevalence of erosive esophagitis was 4.9%. Peptic esophageal strictures due to chronic reflux-associated inflammation were revealed in 0.2% of examined patients (3.7% of patients with erosive esophagitis). Obtained data allow to considergastroesophageal reflux disease as a socially significant problem in Russia requiring close attention and further study.Гастроэзофагеальная рефлюксная болезнь широко распространена среди населения экономически развитых стран, включая Россию. Цель - представить анализ результатов 34 903 эндоскопических исследований верхних отделов пищеварительного тракта у представителей относительно однородной по этническому и социальному составу популяции (жителей Ленинградской области) с симптомами желудочной диспепсии. Материал и методы. Процедуры выполняли в период с 2007 по 2013 г. Распространенность эрозивного эзофагита составила 4,9%. Пептические стриктуры пищевода как исход хронического рефлюкс-ассоциированного воспалительного процесса были выявлены у 0,2% обследованных (3,7% страдающих эрозивным эзофагитом). Результаты. Полученные данные заставляют рассматривать гастроэзофагеальную рефлюксную болезнь как социально значимую для России проблему, требующую пристального внимания и дальнейшего изучения.

The authors judge, that use of the offered criteria under conditions of highly skilled and specialized hospital makes possible the performance, of mainly less invasive organ-saving operations in women of reproductive age at purulent - inflammatory diseases of uterus and adnex.