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The level of calcium in the blood serum, voice function, thyroid status and quality of life of patients up to 1 year after removal of the thyroid gland were studied. Thyroidectomy is an operation associated with a high risk of postoperative hypocalcemia with clinical manifestations (19.6%), which is transient in 15.5%, and permanent in 4.1%. After thyroidectomy transient voice disorders are observed that are not associated with paresis of the laryngeal nerves. These voice disorders spontaneously resolve in the period from 2 to 6 months after the operation. The effectiveness and safety of therapy for postoperative hypothyroidism, the correct selection of the dose of L-thyroxine depends not only on the level of TSH, but also on the genetic characteristics of the patient. Pharmacogenetic testing allows predicting the effectiveness of hypothyroidism correction. The quality of life after thyroidectomy is generally worse than after organ-preserving operations. To a large extent, it is determined by hypothyroidism. In the long term, the quality of life after thyroidectomy approaches the estimates of patients after organ-preserving operations. For an adequate assessment of the results of the operation, it is necessary to analyze the results no earlier than 1 year later.

The COVID-19 pandemia has shown that there is not enough knowledge today to fully control it. Along with severe respiratory syndrome, attention has recently been paid to extrapulmonary lesions, including endocrinopathies. The aim of the study was to summarize the current literature data about the effects of the SARS-CoV-2 coronavirus on the thyroid gland. One of the most striking manifestations of viral aggression is de Quervain's subacute thyroiditis. The analysis of works from the most authoritative international abstract bibliographic databases was carried out using methods of analysis and processing of scientific resources. Based on the analysis, it was concluded that subacute thyroiditis can be both a clinical manifestation and a complication of COVID-19. The SARS-CoV-2 coronavirus can also trigger other thyroid diseases. The causes of subacute thyroiditis are considered to be the direct effect of the SARS-CoV-2 coronavirus on thyroid cells due to the use of ACE2 receptors, the subsequent inflammatory reaction and apoptosis, as well as central hypothalamus-pituitary mechanisms. The clinical variants of subacute thyroiditis in COVID-19 are diverse and have not been fully evaluated. In this regard, it can be concluded that the true incidence of subacute thyroiditis in COVID-19 is much greater, since it is masked by severe lesions of other organs.

To develop a non-invasive method for differential diagnosis of thyroid nodes.Optical sonography was made in 623 patients with thyroid nodes including 374 women (60%) and 249 men (40%) aged 19-79 years (mean 64±15 years). All patients underwent ultrasound-assisted fine-needle aspiration biopsy. Cytological examination revealed cystic colloidal goiter (CCG) in 317 (51%) cases, follicular adenoma (FA) - in 197 (31.5%) cases, thyroid cancer - in 109 (17.5%) cases. All patients underwent surgery. Histological examination verified cystic colloidal goiter in 354 (56.8%) cases, follicular adenoma - 75 (12.0%) cases, thyroid cancer - 194 (31.2%) cases. Follicular cancer was diagnosed in 120 cases, papillary cancer - 70 cases, undifferentiated cancer - 4 cases.Sensitivity, specificity and accuracy of optical ultrasonography in differential diagnosis of thyroid nodules were estimated. Sensitivity of ultrasonography in the diagnosis of thyroid malignancies was 0.75, specificity 0.62, accuracy 0.67. Sensitivity of ultrasonography in the diagnosis of thyroid adenoma was 0.85, specificity 0.62, accuracy 0.73. Sensitivity of optical sonography in the diagnosis of CCH was 0.62, specificity 0.61, accuracy 0.7. Optical sonography ensures differentiation of CCH and follicular adenoma, CCH and thyroid cancer, follicular adenoma and thyroid cancer. Sensitivity, specificity and accuracy of ultrasonography in differential diagnosis of FA and thyroid cancer are 0.85, 0.62, 0.73 and 0.8, 0.71, 0.7, respectively.Разработка неинвазивного метода дифференциальной диагностики узловых образований щитовидной железы.Оптосонография выполнена 623 больным узловыми образованиями щитовидной железы, среди них 374 (60%) женщины и 249 (40%) мужчин в возрасте от 19 до 79 лет (средний возраст 64±15 лет). Всем выполнена тонкоигольная аспирационная биопсия под контролем УЗИ. При цитологическом исследовании в 317 (51%) наблюдениях верифицирован кистозно-коллоидный зоб (ККЗ), в 197 (31,5%) наблюдениях — фолликулярная аденома (ФА), в 109 (17,5%) наблюдениях — рак щитовидной железы (РЩЖ). Все 623 пациента прооперированы. При гистологическом исследовании в 354 (56,8%) наблюдениях верифицирован ККЗ, в 75 (12,0%) наблюдениях — ФА, в 194 (31,2%) наблюдениях — РЩЖ. Фолликулярный рак (ФР) диагностирован в 120 наблюдениях, папиллярный рак — в 70 наблюдениях, недифференцированный рак — в 4 наблюдениях.Рассчитаны чувствительность, специфичность и точность оптосонографии в дифференциальной диагностике узловых образований щитовидной железы. Чувствительность оптосонографии в диагностике злокачественных новообразований щитовидной железы составила 0,75, специфичность — 0,62, точность — 0,67, в диагностике аденомы щитовидной железы — соответственно 0,85, 0,62, 0,73, в диагностике ККЗ — 0,62, 0,61, 0,7. Оптосонография позволяет дифференцировать ККЗ и ФА, ККЗ и РЩЖ, ФА и РЩЖ. Чувствительность, специфичность и точность оптосонографии в дифференциальной диагностике ФА и ФР щитовидной железы составляют 0,85, 0,62, 0,73 и 0,8, 0,71, 0,7 соответственно.

Aim - to improve the results of treatment of pressure sores using low-energy laser technology. The authors performed a comparative analysis of the effectiveness of the use of low-energy laser irradiation in the complex treatment of pressure ulcers of 2-3 degrees in 35 patients with severe brain damage for the period from 2017-2019. The contact laser was used with the following parameters: wave length - 904 nm, frequency - 5000 Hz, irradiation mode - pulsed, power - 13.5mWt/cm2, exposure - on average 2 minutes per zone. The results were compared with those in 41 people treated according to the traditional methodology. The demographic criteria, localization and length of the process did not have significant intergroup differences. The use of low-energy laser technology in combination with other conservative methods made it possible to accelerate the healing of pressure sores by 1.3-1.4 times, and to reduce the degree of microbial contamination of the focus in earlier periods (p0.05). At the same time, both the duration of the inpatient rehabilitation phase and the overall treatment costs are reduced. An integrated approach using low-energy laser technology as an additional physical factor can significantly improve the results of the treatment of pressure sores in people with severe brain damage.

Small bowel tumor causes gastrointestinal bleeding in 1-4% of cases. Gastrointestinal bleeding from metastases of renal cell carcinoma is a rare and little-known manifestation of this disease. We report a rare clinical case of a solitary metastasis of clear cell renal cell carcinoma into small bowel in 5 years after nephrectomy. The first symptom was intestinal bleeding. This example emphasizes the need for more thorough examination of patients with symptoms of latent and anamnestic blood loss.В 1—4% случаев желудочно-кишечных кровотечений причиной является опухоль тонкой кишки. Желудочно-кишечные кровотечения из метастазов почечно-клеточного рака являются редким и малоизвестным проявлением этого заболевания. Описан редкий клинический случай солитарного метастаза светлоклеточного почечно-клеточного рака в подвздошную кишку через 5 лет после нефрэктомии, дебютировавшего кишечным кровотечением. Представленное клиническое наблюдение подчеркивает необходимость более тщательного обследования пациентов с симптомами скрытой и анамнестической кровопотери.

Two unusual cases of anastomotic ulcer complicated by bleeding after gastric resection are reported. There were retained antrum in one patient and long 'dry' intestinal loop after laparoscopic Roux resection in another one. Emergency gastric stump resection with Haberer procedure were successfully performed in both cases.Описаны 2 случая кровотечения из пептической язвы анастомоза после резекции желудка. В одном случае причиной осложнения явилась оставленная часть препилорического отдела, в другом — длинная «сухая» петля кишки после лапароскопической резекции по Ру. В обоих случаях в срочном порядке успешно выполнена резекция культи желудка с редуоденизацией по Haberer.

The aim of the study - to identify the causes and develop methods of treatment and prevention of septic phlegmons of the lower extremities after combined phlebectomy. The article presents the experience of treating 6 patients between the ages of 21 and 69 years with severe pyo-inflammatory complications (septic phlegmons) of the lower extremities after combined phlebectomy between 2012 and 2019. All patients had signs of a expressed systemic inflammatory response (SIRS3 and SIRS4) when they received admission. Against the background of intensive detoxification therapy in intensive care department, all patients were operated on emergency indications. Under anesthesia, they were performed an opening the subcutaneous phlegmons of the lower extremities using wide stripes incisions. Comprehensive therapy included the prescribing of antibiotics, anti-inflammatory drugs, stage necrectomy, the treatment of purulent wounds with various variants of surgical energy (plasma flows and NO-therapy) in various modes. The results of the treatment were estimated in the near and distant periods. Timely diagnosis, surgical treatment with the opening of purulent cavities with a wide excision of necrotized subcutaneous fat and fascia, as well as the subsequent plasmadynamic stage wound purification in therapeutic mode allowed in all cases to stop systemic inflammatory syndrome, to achieve rapid cleansing and healing of wounds. All patients were discharged for outpatient treatment. There were no fatalities. The long-term results of treatment were found to be satisfactory, and no patients were found to be disabled. The careful compliance to the main stages of the combined phlebectomy, especially the quality control of postoperative hemostasis, can minimize the development of septic complications. The comprehensive treatment with active surgical tactics and the use of air-plasma technologies allow to achieve a rapid cleansing of wounds and a speedy recovery of patients.

Among various methods of thermal energy them a special place is occupied by plasma surgical technology. The article details the historical aspects of the formation and development of plasma technology - in Russia and in Western countries. Types of plasma surgical installations of domestic production, the history of their creation are described. Separately presented air-plasma technology, received in recent years, widespread in general and military surgery. It should be noted that this technology has been successfully tested in abdominal and thoracic surgery, operative gynecology, dentistry and oncology. However, as time has shown, it is most in demand in the treatment of various kinds of purulent-inflammatory diseases. Based on the literature data, the areas of practical application of the technique, the features of the plasma-physical effect in various regimes, the possibility of its combined use together with other physico-chemical methods are described. The authors used foreign databases Web of Science, MedLine, as well as the Russian resource of RINTS.

Nowadays, the various techniques of thermal energy are applied for dissection and coagulation of biological tissues in surgery. The plasma surgery technology is on of the leading one among them. Multiple publications concerning application of plasma flows testify the following advantages: bloodless dissection of tissues, hemostasis and sterilization of wound surface, making of optimal conditions for subsequent regeneration of tissue substrate, especially due to stimulating effect of molecules of exogenous nitrogen oxide (II) of air plasma jet. On the basis of publication data, the analysis is applied to efficiency of the given technology, features of plasma physical effect in various regimen, possibilities of combined application of this technology with other physical chemical methods. The article presents in details historical aspects of development of plasma technology in Russia, types of plasma installations, specific thermal alterations of organs and tissues after plasma processing in surgical regimen. The method was successfully approved in abdominal and thoracic surgery, operative gynecology, stomatology and oncology. However, plasma technology is mostly called-for in contaminated surgery. This technology, in combination with surgical processing, provides efficient elimination of necrotizing masses and pathogenic flora; thorough hemostasis with formation of mechanically isolating scab as a barrier for in-hospital infection. The fast settlement of inflammatory occurrences in the very wound and in tissues of para-vulnar zone and also stimulating effect on regeneration processes testify positive effect of sanation with various plasma flows in treatment regimen.

Background Heparin therapy and prophylaxis may be accompanied by bleeding and thrombotic complications due to individual responses to treatment. Dosage control based on standard laboratory assays poorly reflects the effect of the therapy. The aim of our work was to compare the heparin sensitivity of new thrombodynamics (TD) assay with sensitivity of other standard and global coagulation tests available to date. Study population and methods A total of 296 patients with high risk of venous thromboembolism (deep vein thrombosis (DVT), early postoperative period, hemoblastosis) were enrolled in the study. We used a case-crossover design to evaluate the sensitivity of new thrombodynamics assay (TD) to the hemostatic state before and after unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) therapy/prophylaxis and to compare it with the activated partial thromboplastin time (APTT), anti-Xa activity test, thrombin generation test (TGT) and thromboelastography (TEG). A receiver operating characteristic (ROC) curve analysis was used to evaluate changes before and after heparin prophylaxis and therapy. Blood was sampled before heparin injection, at the time of maximal blood heparin concentration and before the next injection. Results Hypercoagulation before the start of heparin treatment was detected by TD, TGT and TEG but not by APTT. The area under the ROC curve (AUC) was maximal for TD and anti-Xa, intermediate for TGT and TEG and minimal for APTT. Conclusions These results indicate that TD has a high sensitivity to the effects of UFH and LMWH after both prophylactic and therapeutic regimes and may be used for heparin monitoring.

Background Laparoscopic distal pancreatectomy (LDP) is a safe procedure, but its role in resection of large pancreatic lesions has been questioned. Methods Patients who underwent LDP for pancreatic solitary tumors in 1997–2017 were included in this study. The patients were divided into three groups in accordance with tumor size

To analyze vocal cords function after thyroid surgery by using of ultrasound examination.Assessment of voice quality according to GRBAS scale, ultrasound examination of vocal cords and indirect laryngoscopy were performed in 57 patients after thyroid surgery.Postoperative indirect laryngoscopy and ultrasound revealed normal mobility of vocal cords in all patients. However, 98.3% of patients subjectively noted deterioration of voice quality due to hoarseness and fatiguein early and long-term period, respectively. Complete restoration of vocal function occurred after 6 months postoperatively. Impaired voice quality is probably due to edema of vocal cords after intubation that is manifested by unclear contours during ultrasound. Ultrasound is useful to diagnose shortening and displacement of paretic vocal cords.Ultrasound of vocal cords could be alternative to indirect laryngoscopy for postoperative assessment of vocal cords function in patients after thyroid surgery.Цель исследования - определение частоты нарушения голосовой функции после операций на щитовидной железе и оценка возможностей метода УЗИ в визуализации голосовых связок. Материал и методы. У 57 пациентов, перенесших операцию на щитовидной железе, выполнены оценка качества голоса по шкале GRBAS, УЗИ голосовых связок и непрямая ларингоскопия для оценки функции голосовых связок. Результаты. При полной подвижности голосовых связок, определяемой методами непрямой ларингоскопии и УЗИ после операции, у 98,3% больных субъективно отмечается ухудшение качества голоса, причем на ранних стадиях из-за хрипоты, а на более поздних из-за усталости. Через 6 мес после операции предоперационные показатели в отношении голоса восстановились. Ухудшение качества голоса обусловлено, вероятно, постинтубационной травмой голосовых связок, которые на УЗИ определялись с размытыми и нечеткими контурами. В случае, если ларингоскопия выявляла парез голосовых связок, УЗИ позволяло установить их укорочение и околосрединную позицию. Выводы. УЗИ голосовых связок может быть альтернативой непрямой ларингоскопии при оценке функции голосовых связок у пациентов после операций на щитовидной железе.

To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital.The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT).Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy.The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.Показать практическую эффективность разработанного алгоритма комплексного лечения больных с хирургическими осложнениями пролонгированной варфаринотерапии (ПВ) в условиях общехирургического стационара.В исследование включили 138 больных с хирургическими осложнениями ПВ. Все больные принимали варфарин не менее 6 мес (49,5% больных — более 5 лет). 54 пациента принимали варфарин по поводу тромбоза глубоких вен и 84 пациента — по поводу различной кардиальной патологии. Обследование включало: клинические и инструментальные методы, а также стандартные лабораторные показатели (СЛП) и глобальные коагулогические тесты (ГТ) — тромбоэластографию (ТЭГ) и тест тромбодинамики (ТТ).Из 138 больных у 24 диагностировали повторные ВТЭО, у 114 — различные по локализации и интенсивности геморрагические осложнения. 111 больных пролечили консервативно, 27 — оперировали (25 — в экстренном порядке, 2 пациента — через двое суток), 10 пациентам выполнили эндоскопический гемостаз, двоим пациентам — пункцию гематомы под УЗ-контролем. Причинами развития повторных ВТЭО явились неадекватный лабораторный контроль и нарушения режима приема варфарина. Большинство этих больных лечили консервативно (оперировали только 3 больных с развитием жизнеугрожающей флотации в магистральных венах). Лечение 114 больных с геморрагическими осложнениями ПВ зависело от клинической картины кровотечения и степени выраженности варфаринассоциированной коагулопатии (WAC). В зависимости от этих факторов отменяли варфарин и сочетали в/в введение витамина К/СЗП/КПК в различных комбинациях. Разработанная тактика позволила ограничиться консервативными мероприятиями у 90 больных этой группы, а 24 больным выполнить хирургическое вмешательство на фоне коррекции гемостаза. Высокую эффективность при определении состояния тромботической готовности и прогнозировании риска развития ВТЭО показал тест тромбодинамики (ТТ). При определении степени WAC и коррекции лечения больных с геморрагическими осложнениями ПВ высокую эффективность показала тромбоэластография (ТЭГ).Применение разработанного клинико-диагностического алгоритма при лечении осложнений ПВ позволяет добиться положительных клинических результатов даже в условиях общехирургического стационара.

Background: Liver resection or ablation remains the only curative treatment for patients with colorectal metastases. Simultaneous resection of tumors in the liver with invasion to the diaphragm is challenging and controversial. Therefore, we wanted to assess the safety of simultaneous laparoscopic liver and diaphragm resection (SLLDR) in a large single center. Methods: Patients who underwent primary laparoscopic liver resection (LLR) for colorectal liver metastases at Oslo University Hospital between 2008 and 2019 were included in this study. Patients who underwent SLLDR (group 1) were compared to patients who underwent LLR only (group 2). Perioperative and oncologic outcomes were analyzed. Results: A total of 467 patients were identified, of whom 12 patients needed a simultaneous diaphragm resection (group 1) while 455 underwent laparoscopic liver surgery alone (group 2). The conversion rate was 16.7% in group 1 and 2.4% in group 2 (P=0.040). In 10 of 12 (83.3%) cases the diaphragm resection was performed en bloc with the liver tumor. There was no significant difference in operative time, blood loss, resection margins, hospital stay or postoperative complications. One patient died within 30 postoperative days (0.2%) in group 2 and none in group 1. Overall survival was not statistically different between the groups. Conclusions: In selected patients, SLLDR can be performed safely with good surgical and oncological outcomes. Keywords: Laparoscopic hepatectomy; diaphragm resection; combined procedures; colorectal metastases

The article presents the outcome in patient with duodenal congenital abnormality caused by defective intrauterine rotation of the intestinal tube with premature turn of back intestine.Представлен результат лечения пациентки с врожденной аномалией двенадцатиперстной кишки, причиной которой является дефектная внутриутробная ротация кишечной трубки с преждевременным поворотом задней кишки.

optimization of the results of treatment of wound infection. The authors analyze the results of treatment of 589 patients with wound infection for the period from 2004 to 2017. During the surgical treatment and further local therapy, air-plasma technology was used. The results were compared with those in 280 people, treated according to the standard method (control group). It was found, that air-plasma treatment of the suppurative inflammation of soft tissue in the cutting-coagulation regime significantly accelerates the necrolysis of the wound surface and the subsequent repair of postnecretomic wounds (in 1.5-1.8 times), regardless of the level and extent of the lesion of the integumentary tissues. Plasmodynamic sanation in the NO-therapy regimen stimulates the growth of granulation tissue and processes of epithelialization, allows to significantly reduce the degree of microbial contamination of the focus, and also to shorten the period of inpatient treatment. Similar trends relate to other important indicators. In patients with wound infection of soft tissue, air-plasma technology must be included in the complex of local therapeutic measures.