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The purpose of the research is the study of the morphological structure of echinococcal cysts to assess the possibility of using organ-preserving methods of surgical treatment.Materials and methods. A clinical, instrumental, and morphological fundamental study was performed in the Surgical Clinic of the Botkin Hospital when radiation and morphological data in addition to clinical data were studied for 28 patients who underwent surgical treatment for liver echinococcosis. Excised gross specimens were examined to study the capsule structure, and the penetration of germinal elements of the cysts through membranes of the parasite (64 successively excised primary operated echinococcal cysts).Results and discussion. The fibrous capsule of the echinococcal cyst is a good barrier against Protoscolexes penetrating into the liver tissue. None of the 64 specimens studied in detail was found to have germinal elements of any echinococcal cyst penetrating through its fibrous capsule. The morphological justification of organ-preserving methods in the treatment of patients with liver echinococcosis allows a conclusion that these interventions are safe and radical.

Aim. To analyze multimodal treatment outcomes in patients with liver metastases from colorectal cancer, who were treated at multidisciplinary cancer clinic. Material and methods. From 2007 to 2021, 315 colorectal cancer patients with liver metastases underwent liver resections (201, 63.8 %), radiofrequency ablation (RFA) (29, 9.2 %), microwave ablation (MWA) (22, 6.9 %), transarterial chemoembolozation (TACE) in combination with RFA (22, 6.9 %), and TACE + RFA + TACE combination (41, 13.2 %) at the department of liver and pancreas surgery, Moscow Botkin Clinical Hospital. Results. A 90-day mortality rate was 1.9% in 6 patients who underwent liver resection. Postoperative complications after liver resection were observed in 49 patients (24.3 %). The overall 5- and 10-year survival rates after liver resection were 38.8 % and 23.2 %, respectively. The factors of poor prognosis after liver resection were: age over 70 years (p=0.03), localization of the primary tumor in the right half or rectum (p=0.037), three or more metastatic foci in the liver (p=0.01), maximum size of the tumor of more than 5 cm (p=0.021), synchronous colorectal liver metastases (p=0.039), and bilobar colorectal liver metastases (p=0.007). Postoperative complications after RFA, TACE + RFA, TACE + RFA + TACE WERE 5.8 %, 9.1 % and 7.3 %, respectively. In patients with a size of metastases of no more than 3 cm, the 3-year disease-free and overall survival rates after rfa were 45.8 % and 54.2 %, respectively. In patients with a size of metastases from 3 to 5 cm, the 3-year disease-free and overall survival rates after TACE + RFA + TACE were 56.1 % and 63.4 %, respectively. Conclusion. In colorectal cancer patients with liver metastases, multimodal treatment within a multi-disciplinary setting demonstrated significant improvements in their survival.

Aim. To determine statistically significant risk factors for delayed renal graft function. To assess the impact of delayed kidney graft function on the development of other complications, graft and recipient survival.Material and methods. In 237 consecutive kidney transplant recipients (from June 2018 to December 2021), we assessed its function in the early postoperative period. Delayed function was considered to be the need for hemodialysis in the first week after surgery. Among the donor factors, the type of donor, age, body mass index, the presence of vasopressor support, the time the donor was in intensive care, and the maximum level of creatinine during the follow-up were evaluated. Recipient risk factors include age, gender, body mass index, presence/absence and amount of urine, presence of preformed anti-HLA antibodies and/or repeated kidney transplantation, number of mismatches for six HLA antigens, number of mismatches for HLA-DR, presence and type of renal replacement therapy, etiology of end stage kidney disease. Among the perioperative risk factors are the duration of cold preservation, the time of second warm ischemia, the volume of intraoperative blood loss, the intraoperatively determined renal arterial resistive index of the renal graft, and the maximum concentration of tacrolimus in the first 4 days after kidney transplantation. After that the relationship between the presence of delayed kidney graft function and the development of early postoperative complications was assessed and its effect on the long-term survival of grafts and recipients was analyzed.Results. Out of 237 cases, 9 showed no function of the transplanted kidney, and therefore the grafts were removed. The incidence of delayed renal graft function was 24.5% (58/237). According to the results of a univariate analysis, a statistically significant relationship with the development of delayed kidney graft function had donor body mass index (p=0.019), male gender of the recipient (p=0.048), recipient body mass index (p=0.038), amount of urine (p=0.003), anuria (p=0.002), presence of preformed antibodies (p=0.025), repeated transplantation (p=0.002), time of second warm ischemia (p=0.036), intraoperative renal arterial resistive index (p=0.004) and maximum tacrolimus concentration in the first 4 days (p=0.022). In the multivariate model, donor body mass index >30 kg/m2 and peak tacrolimus concentration >23 ng/mL in the first 4 days were statistically significant (p=0.018 and p=0.025, respectively). A trend towards statistical significance was noted in the presence of oligoanuria before kidney transplantation (p=0.066) and resistance index >0.75 after surgery (p=0.056). One-year renal transplant survival in the absence and presence of delayed kidney graft function was 92.4% and 87.7%, two-year survival was 89.4% and 76.1%, respectively. The effect of delayed kidney graft function on graft survival was statistically significant (p=0.01), while overall recipient survival did not differ between the groups.Conclusion. During the univariate analysis, we identified 9 statistically significant factors, of which at least 3 are potentially modifiable. In the multivariate model, the most significant modifiable risk factor was an increased concentration of tacrolimus, which prompted the authors to reconsider the existing immunosuppressive protocol at the City Clinical Hospital n.a. S.P. Botkin. We consider the search for modifiable statistically significant risk factors for patients, their analysis and implementation of preventive measures to be an important task for each kidney transplant center.

Introduction. Pancreatic resection is a common surgical treatment option for chronic pancreatic diseases. Diabetes mellitus, which develops as a result of surgical interventions on the pancreas, belongs to a specific type – pancreatogenic. To assess the state of carbohydrate metabolism in patients after surgery in the volume of pancreatoduodenal resection (PDR), a retrospective single-stage single-center study was performed.Aim. Assessment of the state of carbohydrate metabolism in patients after surgery in the volume of PDR.Materials and methods. In Botkin City Clinical Hospital 70 case histories of patients who underwent PDR were selected. The reason for the PDR was pancreatic head cancer (55 people), chronic pancreatitis (7 people), chronic calculous pancreatitis (8 people). Data on age, gender, date of surgery, glycemia levels before and after surgery, as well as C-peptide, insulin, and HbA1c were analyzed.Results. Out of 70 people in the initial group, diabetes mellitus was diagnosed before surgery in 8 people or in 11.5% of the entire sample. Indicators of carbohydrate metabolism did not differ significantly from each other. However, the level of C-peptide decreased in all patients, while in the group of patients with malignant tumors of the pancreas, despite the decrease in C-peptide, the level of fasting glycemia also decreased.Conclusion. If before the operation diabetes mellitus was diagnosed in 11.5% of patients, then after the operation the diagnosis of diabetes mellitus was established in 23.6%. Late detection of diabetes mellitus worsens not only the quality of life of patients, but also the overall prognosis, morbidity, and tolerability of chemotherapy. Obviously, the postoperative monitoring algorithm should include regular monitoring of glycemia, glycated hemoglobin at least once a year with normoglycemia in order to early diagnose carbohydrate metabolism disorders and prescribe therapy.

Aim: to present modern methods of diagnosis and treatment of chronic pancreatitis for gastroenterologists, general practitioners and physicians.Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, manifested by irreversible morphological changes in the parenchyma and pancreatic ducts, which cause pain and/or persistent impairment of function. Current concept on the etiology of CP is reflected by the TIGAR-O classification. The criteria for establishing the diagnosis of CP include typical attacks of abdominal pain and/or clinical and laboratory signs of exocrine, endocrine insufficiency with the mandatory detection of characteristic morphological changes (calcifications in the parenchyma and pancreatic ductal stones, dilatation of the main pancreatic duct and its branches). CT, MRCP, and pancreatobiliary endosonography are recommended as the methods of choice to verify the diagnosis of CP. Conservative treatment of patients with CP is provided for symptom relief and prevention of complications. Individual cases with severe non-interactable abdominal pain, as well as a complicated course of the disease (development of ductal hypertension due to main pancreatic duct stones or strictures, obstructive jaundice caused by compression of the common bile duct, symptomatic postnecrotic cysts, portal hypertension due to compression of the portal vein or thrombosis of the splenic vein, persistent duodenal obstruction, pseudoaneurysm of the celiac trunk basin and the superior mesenteric artery) serve as an indication for endoscopic or surgical treatment. The Guidelines set out modern approaches to the diagnosis, conservative, endoscopic and surgical treatment of CP, and the prevention of its complications.Conclusion. The implementation of clinical guidelines can contribute to the timely diagnosis and improve the quality of medical care for patients with chronic pancreatitis.

Objective: to present an analysis of the results of 100 cadaveric liver transplants performed at Botkin Hospital from July 2018 to October 2021. Materials and methods. From July 2018 to October 2021, 100 orthotopic liver transplantation (LTx) from a deceased donor were performed at the surgical clinic of Botkin Hospital. The recipients were 58 males (58%) and 42 females (42%). The mean age of the recipients was 48.73 ± 8.56 (24–66) years, while their mean MELD was 19.54 ± 4.35 (15–33). The main indications for LTx were cirrhosis resulting from chronic viral hepatitis (CVH) C (52%), nutritional-toxic cirrhosis (20%), autoimmune liver and bile duct disease (18%), CVH B (7%), and hepatocellular carcinoma (HCC) (3%). During the period under study, 119 potential liver transplant donors were evaluated. The mean age of the donors was 44.2 ± 11.12 (21–63) years. Median levels of sodium, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin were 141 (138–146) mmol/L, 27 (20.7–47.4) units/L, 25 (17–41.5) units/L, and 9.65 (6.42–13.7) μmol/L, respectively. The median graft hepatic steatosis was 10% (5–15). LTx was performed using the piggyback technique (99/100 cases) and classic technique with inferior vena cava resection (1/100). End-to-end porto-portal vein anastomosis was performed (99/100 cases). Anastomosis of the donor organ’s portal vein with the recipient’s left gastric vein due to occlusive thrombosis of the recipient’s portal vein was carried out (1/100). In all cases, a continuous end-to-end arterial anastomosis was formed. End-to-end choledochocholedochal anastomotic strictures (95/100) and end-to-side hepaticojejunostomy (5/100) were formed. Results. Median cold ischemia time was 312.5 minutes (280–380). Mean operative time was 488.91 ± 65.34 (95% CI: 475.9–501.9) minutes, median intraoperative blood loss was 1000 (600–1500) mL. Thirty-day mortality was 2% (Clavien–Dindo class V). Early postoperative complications (Clavien–Dindo class IIIa–IVa) developed in 12/100 patients (12%). Graft arterial thrombosis occurred in 3 cases (3%), biliary anastomotic strictures in 6 (6%), and subhepatic hematoma in 2 (2%). The average intensive care unit (ICU) bed day was 2.34 ± 1.67 (1–8). Total postoperative bed-day was 14.63 ± 5.35 (10–39). During case follow-up, a prolonged form of calcineurin inhibitor (CNI) was administered as immunosuppressive therapy in mono regimen (85 patients), in combination with mycophenolic acid derivatives (7), and in combination with everolimus (6). Of the 93 patients, 46 patients (49.46%) had the new coronavirus infection (COVID-19) before or after transplantation; in no case did COVID-19 lead to death. Six patients (13.04%) were hospitalized due to COVID-19. To date, 33/93 (25.48%) patients have been vaccinated, resulting in 75 (75%) liver transplant recipients immune to COVID-19. The overall 1-year survival rate was 95% and the 3-year survival rate was 91%. Conclusion. Introduction of LTx in multidisciplinary hospitals allows to, already at the start of the program, achieve immediate and long-term treatment outcomes (in decompensated diffuse liver disease) that are comparable to those of leading transplantation centers.

Objective: to demonstrate, using a clinical case, the first successful experience in a combined use of an automated chest compression device (ACCD) and hypothermic oxygenated machine perfusion (HOPE) for kidney transplantation from a donor with irreversible cardiopulmonary arrest. Materials and methods. In the presented clinical case, ACCD was successfully used in a donor who was pronounced dead following an irreversible cardiopulmonary arrest. This allowed to minimize the primary warm ischemia time. Kidney graft HOPE for 585 minutes reduced the static cold storage time to 165 minutes. Results. In the uneventful postoperative period, there was immediate kidney graft function. This allowed for rapid rehabilitation and discharge from hospital. Conclusion. Introduction of ACCD and HOPE will increase the number of donor organs, mainly kidneys intended for transplantation.

Objective: to evaluate the safety and efficacy of hypothermic oxygenated machine perfusion (HOPE) for kidney grafts obtained from expanded criteria donors (ECD).Materials and methods. From June 2018 to June 2021, 200 surgeries involving kidney transplants from deceased donors were performed at Botkin City Clinical Hospital. Of these, 123 were men (61.5%) and 77 were women (38.5%). The mean age was 47.62 ± 11.69 (20–73) years. In 102 cases, kidney grafts were procured from ECD. In 92 recipients (90.2%) of kidney transplants from an expanded criteria donor, static cold storage done according to the standard technique was used to preserve the organ; these patients constituted observation group 1. In 10 recipients (9.8%), hypothermic oxygenated perfusion was used in addition to static cold preservation; these patients formed observation group 2.Results. No 30-day mortality was recorded in both observation groups. The mean static cold storage time in group 1 patients was 612.33 ± 178.88 (133–1180) minutes. Overall incidence of delayed graft function was 26.5% (53/200). Incidence of delayed graft function was 19.3% (19/98) for organs from standard donors using static cold storage and 35.8% (33/92) for ECD organs. Twenty-five patients (12.5%) had postoperative complications. Postoperative complications with delayed graft function were diagnosed in 12 patients, which was 22.6% (12/53), with immediate function in 13 patients, which was 8.8% (13/147). Mean cold storage time in group 2 patients was 319.11 ± 110.24 (311–525) minutes. Mean HOPE time was 202.34 ± 21.48 (150–210) minutes. Delayed graft function was recorded in 1 group 2 patient (10%). No complications, including perfusion-related one, were recorded in this group.Conclusion. The unique technique used at Botkin City Clinical Hospital for HOPE in kidney transplant is safe. It provides a low risk of delayed graft function for ECD kidneys.

Aim. The study aim was to assess the negative dynamics of the hepatic artery resistive index as a reliable predictor of early thrombosis in liver transplant recipients from a postmortem donor, to determine risk factors and to identify a group of patients with an increased risk of this complication.Material and methods. From July 2018 to August 2021, 92 orthotopic liver transplants from a deceased donor were performed at the Surgical Clinic of the City Clinical Hospital n.a. S.P. Botkin. All liver grafts were taken from donors with brain death. Control Doppler ultrasound examination of hepatic blood flow in all patients was performed on days 1, 3, 5, 7, if necessary, daily. The hepatic arteries resistive index was considered normal at values from 0.55-0.79, high at 0.8-0.89, extremely high above 0.9. Depending on the resistive index value on the 1st postoperative day and its further dynamics, we divided the patients into 3 groups. In each group, we analyzed the incidence of hepatic artery thrombosis and assessed the impact of various risk factors on the resistive index elevation on the 1st day after surgery and on its growth during dynamic observation in the early postoperative period.Results. Of 92 liver transplants, in three cases, we recorded hepatic artery thrombosis (3.2%), which was not associated with technical difficulties of arterial reconstruction. No mortality was recorded in all three cases. In patients with a normal or high resistive index on the 1st day, without its increase during dynamic observation, the incidence of arterial thrombosis was 0%. In patients with a normal or high resistive index on the 1st day, and its increase during dynamic observation, as well as in patients with an extremely high resistive index on the 1st day, the incidence of arterial thrombosis was 18.1% and 11.1%, respectively. The risk factors of thrombosis were the age of the recipient over 50 years old in an extremely high resistive index on the 1st postoperative day (p=0.024), and the age of the donor over 50 years old in the growth of the resistive index during follow-up (p=0.04).Conclusion. The lack of positive dynamics in the hepatic artery resistive index reduction may be an additional predictor of arterial thrombosis after liver transplantation. This fact makes it possible to identify a high-risk group of arterial thrombosis, to take additional preventive measures in these patients and to improve the immediate results of treatment in this group of patients.

Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.

Objective: to evaluate the effectiveness of vacuum-assisted closure (VAC) therapy in comparison with standard treatments for infected and chronic non-healing wounds after kidney transplantation. Materials and methods. From June 2018 to November 2019, 75 kidney transplants from deceased donors were performed at the Transplantation Ward of Botkin City Clinical Hospital. There were 47 men (62.6%) and 28 women (37.4%). Standard surgical technique was used. Immunosuppressive therapy was carried out according to a three-component scheme with anti-CD25 monoclonal antibody induction (basiliximab) intraoperatively and on day 4. All patients received antibiotic therapy with protected third-generation cephalosporins for 7 days after surgery. Postoperative complications were evaluated according to the Clavien-Dindo classification. Standard methods, including daily dressings using modern dressing materials (group I) and VAC therapy (group II) were used for treating infected and chronic non-healing wounds. Results. 30-day mortality in the postoperative period was zero. Postoperative complications were recorded in 11 patients (14.6%), of which 7 had postoperative wound complications. Group I included 3 patients (1 with a Klebsiella pneumonia-infected wound and 2 with chronic non-healing wounds and no microflora growth). Group 2 had 4 patients (3 with infected wounds (Esherichia coli - 1, Klebsiella pneumonia - 2) and 1 with chronic non-healing wound). Complete cleansing of wound, absence of bacterial growth according to the microbiological examination, and maturation of granulations according to histological examination were considered as the criteria upon which a wound could be sutured in both groups of patients. The average time between the start of treatment and secondary suturing in group 1 patients was 33.11 ± 5.43 (28-37) and 15.01 ± 3.15 (13-17) days in group 1 and group 2 respectively. Conclusion. VAC therapy in patients with wound complications resulting from kidney transplantation, in comparison with standard treatment, can achieve rapid wound cleansing, acute inflammation relief and accelerated maturation of mature granulation tissue, thereby improving treatment outcomes in this category of patients.

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

Background. Urological complications are currently one of the main causes of the renal graft loss and the death of the recipient in the early and late periods after surgery. Objective. To reduce the risk of developing infectious complications after kidney transplantation by early removal of the internal ureteral stent. Material and methods. From June 2018 to March 2020, the Department of Organ and/or Tissue Transplantation of the City Clinical Hospital n.a. S.P. Botkin performed 89 deseased-donor kidney transplantations with the placement of an internal ureteral stent. Depending on the timing of stent removal, the patients were divided into 2 groups: the first group included 54 patients who had the stent removed on day 21, and the second group included 35 patients who had the stent removed on day 14. Results. No urological complications were recorded in both groups. Urinary tract infection was recorded in 8 patients (15%) in the first group, and in 1 patient (3%) in the second group (p = 0.01). Conclusion. Removal of the internal ureteral stent on the 14th day after kidney transplantation safely and reliably reduces the risk of a urinary tract infection development, improving the immediate results of the operation.

Background: Biliary anastomosis strictures after orthotopic liver transplantation (OLT) develop in 5–12% of patients. This complication significantly impairs the patients’ quality of life and can lead to graft loss.Aim: To analyze the first experience in the use of coated self-expanding nitinol stents in patients with biliary anastomosis strictures after OLT.Materials and methods: From December 2018 to January 2019, there were 5 patients with anastomotic strictures after OLT in the Department of Organ and/or Tissue Transplantation of the S.P. Botkin Municipal Clinical Hospital. All patients underwent endoscopic stenting of strictures with a self-expanding nitinol-coated stent. In all patients, the stent was removed at 3 months after its placement.Results: No complications and deaths were recorded in this patient group. The median duration of the follow-up after stent removal was 14.15 ± 2.35 (3–17) months, with no cases of restenosis identified.Conclusion: The use of coated nitinol stents in the management of patients with anastomotic strictures after liver transplantation is effective and safe. The possibility of their use in routine clinical practice requires confirmation in further studies.

Surgical wound infection is the most common complication after kidney transplantation. It is associated with a prolonged hospital stay, repeated surgical procedures, significant costs, which explains the constant search for optimized treatment for wound infections. We describe a clinical case of a patient with an infected lymphocele of the upper pole of the renal graft at Day 29 after kidney transplantation from a donor after brain death. The infected lymphocele was opened and VAC system was installed without the removal of the graft. With antibiotic therapy and modification of the immunosuppressive therapy, the graft function remained stable and no generalization of the infection occurred. The wound was completely clean at Day 28 of VAC therapy, with subsequent tight closure of the wound. The patient was discharged with a functioning graft.

The purpose of the study was to comparatively assess the endoscopic plastic or nitinol stenting in patients with unresectable adenocarcinoma of the pancreatic head, who subsequently received systemic chemotherapy.Material and Methods. Between 2014 and 2018, 64 patients underwent retrograde stenting followed by chemotherapy. All patients were divided into 2 groups. Group I consisted of 21 patients, who underwent nitinol stent implantation. Group II comprised 43 patients, who underwent plastic stent implantation.Results. The technical success was 91.3 % in group I and 93.5 % in group II (р=0.324); clinical success was 95.2 % in group I and 90.6 % in group II (р=0.218). Complications according to the Clavien–Dindo classification in group I patients: Grade II in 2 (9.5 %), Grade III in 1 (4.5 %), and Grade IV 2 in (9.5 %). In group II patients, these complications were as follows: Grade II in 4 (9.3 %), Grade III in 4 (9.3 %), and Grade IV in 1 (2.3 %). The median duration of chemotherapy was 127.3 days. Stent dysfunction was observed in 5 (23.8 %) patients of group I and in 24 (55.8 %) patients of group II (р=0.026). The median time of stent patency was 108 ± 5.2 days in group I and 64 ± 4.3 days in group II (р=0.034). In group I patients, the median survival time was 100 days in 5 patients, 120 days in 9 patients, and 150 days in 5 patients. Two patients are alive. In group II patients, the median survival time was 100 days in 10, 120 days in 16, and 150 days in 13. Five patients are alive.Conclusion. Based on the results obtained, it is advisable to recommend the use of nitinol stents for resolving obstructive jaundice in patients with unresectable ductal adenocarcinoma of the pancreatic head, who are scheduled to undergo chemotherapy.

Objective: to evaluate the first results of the Botkin Hospital transplant program. Materials and methods. From June 2018 to October 2019, 100 solid organ transplants were performed at the Botkin City Clinical Hospital. Out of the 100 transplantations, 72 were kidney transplants (average age of recipients was 45.65 ± 11.35 years, HLA match averaged 2.09 ± 1.03) and 28 were liver transplants (average age of recipients was 50.14 ± 7.62 years, average MELD was 17.78 ± 3.28 (14–34). Results. After transplantation, there was no 30-day mortality. Postoperative complications following kidney transplantation were established in 11 patients (15.2%). In 3 patients (4.3%) – suppuration of postoperative wound, in 2 patients (2.8%) – hematomas in the area of the postoperative suture during hemodialysis, in 5 patients (6.9%) – retroperitoneal lymphocele, in 1 patient (1.4%) – urosepsis. There were 4 cases (5.5%) of acute rejection, 3 cases (4.2%) of humoral rejection, and 1 case (1.3%) of cellular rejection. Early postoperative complications following liver transplantation were detected in 2 patients (7.2%). In one patient – hematoma under the right lobe of the liver on the 1st day after surgery, the diaphragm was the source of bleeding, in one patient – ascites leakage through postoperative sutures, which required relaparotomy. In 2 patients (7.2%), postoperative complications were found in the separated postoperative period. In one case, of choledochocholedochal anastomotic stricture – stricture stenting was performed with coated nitinol stent. In another case, acute adhesive intestinal obstruction, which required laparotomy, adhesiolysis. Conclusion. Implementation of the transplantation program in multidisciplinary hospitals can boost transplant care in a district and improve the treatment results of patients with terminal organ damage.

Background. Solid pseudopapillary tumor of the pancreas is a rare neoplasm, accounting for only 1–2 % of all pancreatic neoplasms and having a tendency to affect mainly young women.Material and methods. We report a case of a solid pseudopapillary tumor of the pancreas in a 28-year-old man treated with laparoscopic distal pancreatectomy in Moscow Botkin Hospital.Results. The tumor was discovered incidentally by routine survey ultrasound or computed tomography of the abdomen. The patient underwent distal pancreatectomy with splenectomy. The immunohistochemical study showed a pronounced positive nuclear staining for β-catenin and progesterone and a negative staining for chromogranin A and synaptophysin, thus confirming the presence of solid pseudopapillary tumor of the pancreas.Conclusion. In case of pancreatic tumor, even in male patients, a solid pseudopapillary tumor must be considered in the differential diagnosis. Surgical strategies should be based on the location, size of the tumor and the involvement of adjacent organs, because R0-resection with a solid pseudopapillary tumor leads to a good 5-year survival.

The purpose of the study was to improve treatment outcomes for patients with inoperable colorectal liver metastases using the combination of chemoembilization of the hepatic artery and radiofrequency ablation.Material and methods. Treatment outcomes of 60 patients with methachronic unresectable liver metastases from colorectal cancer were analyzed. Eligibility criteria were as follows: absence of extrahepatic metastases, size of metastases from 3 to 5 cm, and inability to perform resection. All patients were divided into two groups. Group I included 30 patients who received combination of regional chemotherapy and radiofrequency ablation. Group II (the control group) consisted of 30 patients who received radiofrequency ablation only.Results. Post-embolization and post-ablation syndromes were observed in both groups of patients. Rightsided hydrothorax (Clavien-Dindo grade II) was found in 4 out of 60 patients (2 patients in Group I and 2 patients in Group II). One-, two- and three-year disease-free survival rates in Group I patients were 96.6 %, 76.6 % and 53.3 %, respectively. The corresponding rates in the control group patients were 90.0 %, 53.6 % and 30.0 %, respectively (p=0.049). The overall one-, two-and three-year survival rates in Group I patients were 100 %, 90 % and 63.3 %, respectively. The corresponding rates in the control group patients were 100 %, 70 % and 50.0 %, respectively (p=0.202).Conclusion. The combination of regional chemotherapy and radiofrequency ablation led to the improvement in overall and disease-free survival rates.

Case report. We present the case of a 50-year-old female patient with inherited type 1 neurofibromatosis, who was found to have a tumor in the major duodenal papilla. She underwent endoscopic ultrasound-guided resection of the major duodenal papilla with subsequent histological and immunohistochemical examination. Discussion. Somatostatinomas are rare neuroendocrine tumors of the gastrointestinal tract with an annual incidence of 1 case per 40 million people. The combination of type 1neurofibromatosis and somatostatinoma of the ampulla of the major duodenal papilla occurs extremely rarely. Endoscopic ultrasound provides visualization of tumor spread in all layers of the intestinal wall and in the major duodenal papilla, thus giving opportunity to perform radical surgery by minimally invasive method. Conclusions. Minimally invasive endoscopic surgery in patients with a combination of type 1 neurofibromatosis and somatostatinoma is a good alternative to pancreatic resection in this rare category of patients. Further follow-up studies are needed.

523 patients with necrotizing pancreatitis (2006-2013) were retrospectively analyzed. We compared results of the CT data, intraoperative locat-dock, the results of histological examination of biopsy material of 77 cases of necrotizing pacreatitis. Revealed their fair match. The main criteria (providing the ability to model) characterizing pancreatic necrosis were volume and localization of pancreatic necrosis, the prevalence of extrapancreatic disease process. To improve the results of treatment patients with necrotizing pacreatitis. Four clinical and morphological models of pancreatic necrosis were created: «Model-1» - 191 patients, «Model-2» - 159, «Model-3» - 95, «Model-4» - 78. Depending on the results of modeling used various methods of treatment of percutaneus drainage (PCD), open surgery (OS) and combined step-up approach. Specific complications in cases managed with PCD (n=117) - 8 (6,8%), OS (n=58) - 16 (27,5%); Combined step-up approach - 200 (17,5%) of all (n = 375) - 59 (15,7%). The greatest number of complications observed in cases with «Model 3» and «Model-4». Mortality: «Model-1» - 3 (6,9%), «Model-2» - 23 (14,4%), «Model-3» - 21 (22,1%), «Model-4» - 22 (28,2%) of (n=523) - 69 (18,4%). Clinical management of patients with necrotizing pancreatitis is defined by the location and extent of pathological changes in retroperitoneum, depending on the amount, location of pancreatic necrosis. Modeling of pancreatic and peripancreatic necrosis allows in selection of the optimal method of surgery and reduce the incidence of complications, morbidity and mortality.

In order to identify and correct concomitant diseases all patients undergo a comprehensive examination before surgical treatment. Rare concomitant diseases include primary chronic adrenal insufficiency. This clinical case presents the total duodenopancreatectomy in a patient with primary chronic adrenal insufficiency. Available algorithms are not always suitable in the treatment of such patients after surgical interventions, especially long-term and extensive. It is necessary to focus on laboratory parameters and the clinical picture. An individual and multidisciplinary approach to the treatment of patients with comorbid pathologies is important.

Based on the analysis of the references given in the Russian and foreign periodicals, the present paper states the current notions of the etiology, epidemiology, and pathogenesis of and the methods for the diagnosis, prevention, and treatment of acute lung injury developing with the use of blood preparations. It shows the difficulties arising in the diagnosis of this complication and presents the algorithms of differential diagnosis and treatment of acute posttransfusion lung injury. The authors describe their own observation of a case of evolving acute posttransfusion lung injury, the used methods of diagnosis, and the results of treatment in detail.

IntroductionPancreatic necrosis is one of the most severe acute abdominal conditions, accounting for 15%–20% of all patients with acute pancreatitis and characterized by significant rates of postoperative complications and mortality. Patients with pancreatic necrosis, in which pathological changes are localized in the proximal pancreas and retroperitoneal space, deserve special attention. This form of the disease includes patients with disconnected main pancreatic duct (MPD) syndrome who have a difficult prognosis.AimThe aim of the study was an improvement of treatment results in patients with necrotizing pancreatitis and signs of the dissociation of the pancreas duct system using the endoscopic transpapillary stent placement method.Material and methodsThis study was a retrospective cohort study. There were 32 patients with acute necrotizing pancreatitis who were managed using the endoscopic transpapillary stent placement method between 2019 and 2021. Disconnected MPD syndrome was diagnosed in all 32 patients. In total, 26 patients were admitted to hospital in the first 72 h, while 6 patients were admitted after 72 h. We diagnosed the necrotizing process located in the proximal and central areas of the pancreas and peripancreatic space in all these patients (“model III”).ResultsPositive results related to transpapillary stent placement were noted in 24 (75%) patients (first cohort). A total of 20 patients from this group were admitted to hospital in the first 48 h, and 4 patients were admitted later than 72 h from the onset of disease. Moreover, 8 patients (25%; second cohort) failed to succeed in transpapillary stent placement. Complications in the first cohort occurred in 3 (12.5%) patients: dislocation of the stent into the duodenum occurred in 1 patient, and bleeding after papillosphincterotomy took place in 2 patients. Meanwhile, infected necrotized pancreatitis developed in 5 patients, and 1 patient (5%) died. Complications among the second cohort occurred in 2 (25%) patients: erosive bleeding (after debridement). Infected necrotized pancreatitis developed in 4 patients, and 2 patients (25%) died.ConclusionsEndoscopic transpapillary stent placement is an effective minimally invasive approach in the management of patients with necrotizing pancreatitis.

ObjectiveThis review article summarises the latest evidence for preventive central lymph node dissection in patients with papillary thyroid cancer taking into account the possible complications and risk of recurrence.BackgroundPapillary thyroid cancer is the most frequent histological variant of malignant neoplasms of the thyroid gland. It accounts for about 80-85% of all cases of thyroid cancer. Despite good postoperative results and an excellent survival rate in comparison with many other malignant diseases, tumor metastases to the cervical lymph nodes are frequent. Most researchers agree that the presence of obvious metastases in the lymph nodes requires careful lymph node dissection. It was suggested to perform preventive routine lymphadenectomy in all patients with malignant thyroid diseases referred to surgery.MethodsIt was performed the literature review using the “papillary thyroid cancer”, “central lymph node dissection”, “hypocalcemia”, “recurrent laryngeal nerve paresis”, “metastasis”, “cancer recurrence” along with the MESH terms. The reference list of the articles was carefully reviewed as a potential source of information. The search was based on Medline, Scopus, Google Scholar, eLibrary engines. Selected publications were analyzed and their synthesis was used to write the review and analyse the role of preventive central lymph node dissection in patients with papillary thyroid cancer.ConclusionsThe necessity of preventive central lymph node dissection in patients with differentiated papillary thyroid carcinoma is still controversial. There is much evidence that it increases the frequency of transient hypocalcemia. Due to the fact that this complication is temporary, its significance in clinical practice is debatable. It can also be assumed that an extant of surgery in the neck area is associated with an increased risk of recurrent laryngeal nerve injury. However, most studies indicate that this injury is associated more with thyroidectomy itself than with lymph node dissection. Recurrent laryngeal nerve dysfunction is also a temporary complication in the vast majority of cases. At the same time, a large amount of data shows that central lymph node dissection reduces the risk of thyroid cancer recurrence in two times.

Reconstruction of critical-sized bone defects remains a tremendous challenge for surgeons worldwide. Despite the variety of surgical techniques, current clinical strategies for bone defect repair demonstrate significant limitations and drawbacks, including donor-site morbidity, poor anatomical match, insufficient bone volume, bone graft resorption, and rejection. Bone tissue engineering (BTE) has emerged as a novel approach to guided bone tissue regeneration. BTE focuses on in vitro manipulations with seed cells, growth factors and bioactive scaffolds using bioreactors. The successful clinical translation of BTE requires overcoming a number of significant challenges. Currently, insufficient vascularization is the critical limitation for viability of the bone tissue-engineered construct. Furthermore, efficacy and safety of the scaffolds cell-seeding and exogenous growth factors administration are still controversial. The in vivo bioreactor principle (IVB) is an exceptionally promising concept for the in vivo bone tissue regeneration in a predictable patient-specific manner. This concept is based on the self-regenerative capacity of the human body, and combines flap prefabrication and axial vascularization strategies. Multiple experimental studies on in vivo BTE strategies presented in this review demonstrate the efficacy of this approach. Routine clinical application of the in vivo bioreactor principle is the future direction of BTE; however, it requires further investigation for overcoming some significant limitations.

Study results of cellular immunity and cytokine profile of commercial pre-farrow and lactating sows are shown. Before farrow, the animals demonstrated physiological immunodeficiency characterized by relative leukopenia and lymphopenia, decreased T-cell number, higher helper/suppressor ratio providing immunological tolerance in dam/fetus system. Their cytokine profile was specified by relatively deficient interleukin-1β and tumor necrosis factor-α indicative of immune system suppression and high level of γ-interferon involved in parturition and activation of suppressor cells. Post-farrow sows demonstrated higher cellular immunity involving higher levels of leukocytes, lymphocytes and T-cells as well as tendency of T-lymphocyte helper/suppressor ratio reduction being indicative of T-cells’ suppressor activity. The cytokine profile of the sows was specified by the recovered numbers of interleukin-1β, tumor necrosis factor-α and γ-interferon, decreased level of interleukin-2 and interleukin-4 that regulate cellular and humoral immunity, respectively as well as their subsequent increase (in particular, interleukin-2) following animal immunization against parvoviral infection and erysipelas on day 7 post farrowing (Parvoruvax vaccine, Merial, France) and against classical swine fever on day 14 post farrowing (culture dry virus-vaccine LK-VNIVIPFIT). This is due to the formation of the cellular and humoral immunity.

Determining the taxonomic composition of microbial consortia of the piglet intestine is of great importance for pig production. However, knowledge on the variety of the intestinal microbiome in newborn piglets is limited. Piglet diarrhea is a serious gastrointestinal disease with a high morbidity and mortality that causes great economic damage to the pig industry. In this study, we investigated the microbiome of various sections of the piglet intestine and compared the microbiome composition of healthy and diarrheal piglets using high-throughput sequencing of the 16S rRNA gene. The results showed that bacteria of the Lactobacillus genus were the most common in the ileum, while Fusobacterium and Bacteroides dominated in the rectum. Comparing the microbiome composition of healthy and diarrheal piglets revealed a reduced number of Lactobacillus bacteria as a hallmark of diarrhea, as did an increased content of representatives of the Escherichia-Shigella genus and a reduced number of Bacteroides, which indicates the contribution of these bacteria to the development of diarrhea in piglets. The relative abundance of Enterococcus bacteria was higher in the diarrhea group. Although some bacteria of this genus are commensals, a small number of species may be associated with the development of diarrhea in piglets. Therefore, our results indicate that the gut microbiome may be an important factor in the development of diarrhea in piglets.

The carried out research revealed negative impact of chronic T-2 toxin intoxication on immune status of white rats vaccinated against Salmonellosis. This is illustrated by erythropoiesis inhibition and amenia development. The immunized animals and animals chronically exposed to T-2 toxin typically demonstrate a decrease in the number of erythrocytes by 13% and in the level of hemoglobin by 9.6% due to reduced hemolotic action of xenobiotics and hematopoiesis depression. The use of aminoseleton in the vaccination scheme enhances adaptive immunity and natural resistance of the organism under these conditions. On day 30 post vaccination the vaccinated rats demonstrated an increase (in comparison to the control animals) in the number of erythrocytes - by 14.1%; hemoglobin - by 11.7%, number of leukocytes - by 6.5%, absolute number of segmentonuclear neutrophils - by 23%, immature neutrophils - by 11.1%. It is related to active formation of neutrophils in the marrow and their further migration to the blood circulation system for phagocytosis. The detected morphological changes in blood of the vaccinated and exposed animals suggest hematological disorder associated with T-2 toxicosis demonstrated as erythropoiesis inhibition and leucopenia. Decrease in specific humoral immunity and natural resistance caused by chronic T-2 toxicosis following experimental infection with Salmonella cholerae suis had a negative effect on the animal lifetime and safety.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children’s Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

Peer-review of monograph of V. V. Makarov, N. Ya. Makhamat, A. M. Gulyukin, M. I. Gulyukin “Anthrax: Modern Knowledge and Global Occurrence”. М.: Agentstvo tvorcheskikh tekhnologiy, 2019. 145 p.: il. ISBN 978-5-6042239-6-3.

Background. According to World Health Organization thyroid cancer (TC) is the most common endocrine malignancy. The frequency of regional lymph node (LN) lesions in this disease may be up to 80%, which requires advanced operations. In cases when metastasis develop in the II-V group cervical LN, should be perfomed thyroidectomy with functional neck dissection. Life expectancy and life quality of this severe category of patients depends on perfomed intervention. Extent and operation technique tend to move to functionally sparing methods, which aimed to preserve oncological principles with anatomical structures damage prevention and to promote better cosmetic effects. However, existing nowadays interventions do not always combine these requirements. The foregoing calls for further improvement of the operation - thyroidectomy with lateral modified radical neck dissection with the achievement of the maximum radicalism, optimal safety and the desired cosmetic result of intervention. Aim. Improving the results of surgical treatment of patients with TC with metastases in the LN group II-V operation areas by improving methodology, with a decrease in the number of complications and achieving the desired cosmetic effect without prejudice radical intervention. Materials and methods. Study based on results of treatment of 46 patients with different forms of cancer which were examined and operated in department of endocrine surgery of S.P.Botkin City Clinical Hospital of the Department of Health of Moscow. Patients were divided on 2 groups. In first group were included 22 (47.8%) patients operated in the period from 2008 to 2011 and in second group 24 (52.2%) patients who received treatment with 2012 by 2015. Here with cancer forms in first group were distributed as follows: papillary cancer - 18 (81.8%) cases, follicular - 3 (13.6%) and medullary - 1 (4.5%) follow up. In second group papillary cancer has been identified in 18 (75.0%) patients, follicular in 3 (12.5%) and medullary - in 2 (8.3%). Extent of process was assessed and in first group: T1bN1bM0 - in 2 (9.1%) cases, and in second group - in 3 (12.5%) cases, T2N1bM0 - in 7 (31.8%) and 9 (37.5%), a T3N1bM0 - in 13 (59.1%) and 12 (50.0%) surveillances respectively. Age ratio ranged from 35 to 65 years. Mean age in first group was 50 years for men and 52 for women, while in the second group - 45 years for men and 48 years. Sex ratio in both groups - 1:9; 21 (95.5%) and 22 (91.7%) patients with differentiated cancer forms underwent radioiodine therapy. Conclusion. Proposed improved method of thyroidectomy with functional neck dissection using in patients with TC allows to perform a radical operation achieving required safety of intervention and preserve patients life quality.