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Treatment of аnal fistulas as perianal manifestations of Crohn’s disease is an important task, the solution of which has not yet been found. First of all, this is due to debilitating symptoms that reduce the quality of life. Incorrect tactics in the treatment of this disease can lead to the development of anal incontinence, and in some cases to the removal of the rectum. The purpose of this review was to study the effectiveness of various surgical methods for the treatment of perianal fistulas, the features of their use in various types of fistulas, as well as to assess the impact of surgical treatment on the function of the anal sphincter. It was found that most of the described methods were used in a strictly selected limited group of patients and allowed only temporary elimination of the clinical manifestations of Crohn’s disease. Unsatisfactory results of treatment, especially in the late postoperative period, a small number of clinical observations in published scientific papers on the treatment of perianal manifestations of Crohn’s disease, as well as low reliability of the results, dictate the need for further studies involving more patients.

AIM: to evaluate the effect of intestinal anastomosis type on risk of Crohn’s disease (CD) recurrence.PATIENTS AND METHODS: the retrospective cohort study included 130 patients with CD who underwent surgery for a complicated CD in 2012–2017. Ileocecal resection with anastomosis was performed in 112/130 (86.2%) patients. Resection of the terminal ileum with resection of the right side of the colon with the formation of an ileo-transverse anastomosis. In 18/130 (13.2%) cases. Stapled “side-to-side” anastomosis was formed in 57/130 (43.8%) patients, while hand sewn “end-to-end” — in 73/130 (56.2%) patients. Post-op complications occurred in 21/130 (16.2%) cases. After surgery, most patients were treated by azathioprine as an anti-recurrence therapy — 112/130 (86.2%) patients, while in 31/112 (23.8%) cases, additional biological therapy was done. In 14/130 (10.7%) patients, anti-recurrence therapy was carried out in mono mode with a biological drug.RESULTS: mean follow-up was 28.5 (1.9–95.4) months. Recurrence occurred in 54/130 (41.5%) patients on average 18 ± 5 (12–41) months after surgery. Thus, the operative time exceeding 200 minutes was significantly associated with an increase in the recurrence rate (p = 0.03). It was found that the type of anastomosis does not affect the recurrence risk. Moreover, among the significant factors was the operative time. It increases the chance of recurrence by 2.9 times in the univariate model (p < 0.05), and in the multivariate model — by 6.3 times, when exceeding 155 minutes.CONCLUSION: the type of anastomosis does not affect the recurrence risk. The operation time exceeding 155 minutes increases the chance of recurrence by 6 times (p < 0.01).

This work addresses the question of primary school age children`s blood microcirculation in dependence on their individual typical features. We examined some 120 healthy children of 6-9 years, which were the students of secondary schools of the city of Melitopol. Anthropometric survey was conducted by the standard measurement scheme of longitudinal chest and weight parameters of the bodies of children. Diagnosis of body type (somatotype) was conducted by the method of M. Chernorutskiy. According to the index of physical development - Pine index (PI), the children were divided into three somatic type: asthenic with IP> 30 gipersteni at PI

The analysis of the reports made by 77 local medical administrations in the Russian Federation indicates unsatisfactory employment of sanatorium facilities for improving health of radiation-exposed population. Health resorts and sanatoria of the Russian Middle Zone should extend care for those who suffer from the Chernobyl accident aftereffects.

By means of biomicroscopy, histological methods and scanning electron microscopy topological relationships between the white rat m. cremaster microvessels and changes of their spatial organization have been studied in the postnatal development beginning from the 3d to the 14th week. In the terminal link of the microcirculatory bed zonal functional complexes of microvessels--myoangions are revealed. They represent rather autonomic and regularly repeating constructions of microvessels, having spatial regularity in respect to muscle fibers. With age the myoangion increases its stretchness from 303 +/- 14 in 3-week-old up to (70 +/- 3) X 10 mcm in 14-week-old animals. Capillary density in the m. cremaster during the development decreases from 354 +/- 12 up to 210 +/- 4 mcm, respectively. Distance between the longitudinal capillaries increases from 16.1 +/- 1.3 up to 31.2 +/- 1.8 mcm. Increase of transversal connections takes place in the capillary network, increasing number of the branching knots; this demonstrates certain complication of the nutritive link of the muscle microcirculatory bed. By the time of sexual maturation (6 weeks) there is a sharp decrease of the inflow and outflow coefficients. Higher meanings of the coefficient (0.70-0.74) are noted before sexual maturation period in comparison to that in mature animals (0.53-0.55).

After the per os administration of 1Dlm/ml of botulin, type B. there were observed at the period of development of the limb paralysis and myasthenia morphological changes in the locus coeruleus cells expressed in the development of a more pronounced than normal perinuclear clarification and some nuclear basophilia. Histochemical study of succinic dehydrogenase, acid phosphatase, cholinesterase, and catecholamines pointed to the intensified neuron metabolism of the locus coeruleus; this could serve as an indication of enhanced energopacemaker function of this nucleus in hypoxia which occurred.

On the appearance in the animals (guinea pigs) of paralysis of the limbs and myasthenia after the administration of Cl. botulinum, type B, toxin, there was seen a considerable vascular hyperemia of the spinal cord, and in the neurons of the phrenic nerve nucleus there developed dystrophic-necrotic processes coursing with a marked swelling, hyperchromasia and tigrolysis. As revealed histochemically, at this stage of the botulin intoxication the neurons of the phrenic nerve nucleus displayed metabolic changes expressed in the altered activity of succinic dehydrogenase, acid phosphatase and cholinesterase.

After the administration to guinea pigs per os of 1 Dlm of botulin toxin, type B, a change of the RNA synthesis in the nucleoli and DNA depolymerization in the nuclei was observed in some of the cells of the mesencephalic nucleus of the trigeminal nerve. An increase in the activity of succinic dehydrogenase and of acid phosphatase coursed without any necrotic processes in the cells. Basing upon the changes in the activity of succinic dehydrogenase in the neurons of the mesencephalic nucleus a conclusion was drawn that hypoxia began to develop at the period of appearance of paralyses of the limbs and reached its maximum in myasthenia.

Pathomorphological and histochemical study carried out in guinea pigs at the stage of paralysis of the limbs after the oral administration of C. botulinum toxin has revealed the presence of morpho-metabolic changes pertaining to phase 2 of the development of dystrophic processes in the neurons of the nucleus of the abducent nerve and Darkshevich's nucleus. At the myasthenic stage the development of dystrophic processes in the neurons of Darkshevich's nucleus has been found to reach phase 3. The study indicates that C. botulinum toxin possesses different tropism in respect of the neurons of the oculomotor nuclei; this fact correlates with the clinical picture of botulism.