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Massive gastrointestinal bleeding (GIB) is a rare complication of Crohn’s disease (CD). For the recent decades a number of medical and surgical methods to control the GIB have been introduced. However, the unified algorithm and approach to this subset of patients is still lacking, mostly due to the absence of adequately powered and wellconducted RCTs. Determining the optimal treatment approach to inflammatory bowel disease (IBD) in patients who develop a GIB is still a valid research target.

Transabdominal preperitoneal (TAPP) inguinal hernia repair requires the surgeon to have good manual skills in laparoscopic surgery, as well as an understanding of the laparoscopic features of the groin anatomy. This is why TAPP is considered a more difficult surgical procedure compared to open techniques. Realistic training model for TAPP inguinal hernia repair would enhance surgeons’ skills before they enter in the operation room. Our aim was to create a realistic, inexpensive, and easily reproducible model for laparoscopic TAPP inguinal hernia repair and to assess its effectiveness. The applied TAPP inguinal hernia repair training simulator consists of a laparoscopic box and an inguinal region model placed in it. The model of the groin area is made of the porcine stomach and assembling materials. Uniaxial tensile and T-peel tests were performed to compare the mechanical properties of the porcine stomach and the human cadaver peritoneum. Thirty eight surgeons performed TAPP inguinal hernia repair using this model. Their opinions were scored on a five-point Likert scale. Close elastic modules of the porcine and human tissues (13.5 ± 4.2 kPa vs. 15.8 ± 6.7 kPa, p = 0.531) gave to trainees a realistic tissue feel and instrument usage. All participants strongly agreed that model was highly useful for TAPP inguinal hernia repair training. They also put the following points: the model as a whole 5 (3–5), simulation of anatomy 5 (3–5), simulation of dissection and mobilization 5 (3–5), and simulation of intracorporeal suture 5 (4–5). We successfully created a model for TAPP inguinal hernia repair training. The model is made of inexpensive synthetic and biological materials similar to the human tissue. The model is easy to reproduce and can be used in the training programs of surgical residents.

Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.Спонтанный хилезный перитонит во время беременности - редкое заболевание, которому посвящены единичные публикации. В статье описан успешный опыт лечения пациентки со спонтанным хилезным перитонитом в I триместре беременности, а также представлены современные взгляды на этиологию, эпидемиологию, патофизиологию, диагностику и лечение пациентов со спонтанным хилезным перитонитом и хилоперитонеумом. Авторы рассматривают лапароскопию как безопасный и эффективный метод лечения у пациентов со спонтанным хилезным перитонитом, в том числе и у беременных.

To analyze an efficacy of FT-protocol in patients with acute cholecystitis.Prospective randomized study included 102 patients (45 of main group (FT) and 57 of control groups). Patients did not differ by TG13 severity index. The protocol included information, antibiotic prophylaxis, restriction of drainage, intraperitoneal anesthesia with long-term anesthetics, low pressure pneumoperitoneum, antiemetics in the presence of risk factors, early activation and feeding of the patient. Pain was assessed by VAS immediately after surgery, and 2, 6 and 12-24 hours postoperatively.Surgery time was similar in both groups. Need for anesthesia and pain severity were significantly lower in the FT group. A total absence of pain (VAS 0-1) on the 1FT protocol in AC reduce postoperative pain, dyspepsia, shoulder pain and in-hospital stay with equal number of postoperative complications.Цель исследования - изучить результаты применения протокола раннего послеоперационного восстановления у пациентов с ОХ. Материал и методы. В проспективное рандомизированное мультицентровое исследование включены 102 пациента, 45 основной и 57 контрольной группы. Пациенты не отличались по возрасту, полу, давности заболевания, сопутствующей патологии. Протокол включал информирование, антибиотикопрофилактику, ограничение дренажей, инфильтрационную анестезию (ложе желчного пузыря, поддиафрагмальное пространство, троакарные раны), минипневмоперитонеум, электрохирургическое воздействие минимальной мощности, антиэметики при наличии 1 фактора риска и более, ранняя активизация (2 ч) и кормление больного (6 ч после операции). Боль оценивалась по ВАШ непосредственно после операции, через 2, 6 и 12-24 ч после операции. Критериями выписки были отсутствие осложнений на УЗИ, лейкоцитоза, лихорадки, боли, диспепсии и желание пациента. Осложнения оценивались по шкале Clavien-Dindo. Результаты. Продолжительность операции в группах не отличалась. Потребность в обезболивании и болевой синдром во всех временных интервалах были достоверно ниже в основной группе. Полное отсутствие боли (0-1 балл по ВАШ) отметили 8 (17,7%) пациентов основной и 2 (3,5%) контрольной группы (р=0,038). Френикус-симптом развился у 4 (8,9%) основной и 22 (38,6%) контрольной группы (р=0,001). Послеоперационная тошнота развилась в контрольной группе 40,5% против 13% основной (р=0,05). Время появления стула в группах не отличалось. Средний койко-день в основной группе составил 1,29±0,7 сут, в контрольной группе - 2,7±1,6 (р0,0001). Досуточное послеоперационное пребывание отмечено 24 (53,5%) в основной и 5 (8,9%) контрольной групп. Было 2 осложнения в основной группе IIIA степени (подпеченочный абсцесс и гематома послеоперационной раны) и 3 осложнения в контрольной группе (серома послеоперационной раны (IIIA), холедохолитиаз (IIIB) и инфаркт головного мозга (IV) - развившиеся в стационаре). Летальности и повторных госпитализаций не было. Выводы. Применение алгоритмов фаст-трек при остром холецистите позволило уменьшить послеоперационный болевой синдром, диспепсию, частоту развития френикус-симптома и сократить койко-день при равном количестве послеоперационных осложнений.

To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction.The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience.It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.Цель - установить оптимальный срок оперативного лечения острой спаечной нестрангуляционной тонкокишечной непроходимости. Материал и методы. Проведен анализ 703 публикаций из баз данных е-LIBRARI.RU (342 работы), NCBI (361 работа) по острой спаечной тонкокишечной непроходимости (ОСТКН), в большинстве которых представлен ретроспективный анализ работы одного медицинского центра. Результаты. Установлено, что при лечении ОСТКН в РФ используется преимущественно короткий курс консервативного лечения. По данным международных исследований, срок консервативного лечения при ОСТКН составляет 2-5 сут. Проведен анализ преимуществ и недостатков короткого и длительного курсов консервативного лечения. На основании полученных данных спланировано и зарегистрировано (Unique Protocol ID: 14121729) мультицентровое проспективное рандомизированное исследование 'Сравнительные результаты раннего оперативного лечения (12-часовой консервативный этап) и длительного консервативного лечения (48 ч) при острой спаечной тонкокишечной непроходимости' (COTACSO). Протокол исследования предусматривает клиническое, лабораторное и инструментальное исключение странгуляции, рандомизацию и консервативное лечение двух групп пациентов в течение 12 и 48 ч. При сохранении непроходимости к указанному сроку будут выполнены оперативные вмешательства. Главная конечная точка исследования - сравнение летальности в группах. Срок завершения исследования - декабрь 2020 г.

The kinetics of lignosulfonic acid nitrosation in the presence of acetic and nitric acids used for generation of nitrous acid in combination with sodium nitrite was studied as applied to colorimetric determination of lignosulfonic acids.

This review presents data on frequency of second tumors that develop after therapy for malignant tumors in children as well as correlation links between their development and morphological variants of primary tumor, risk factors and methods of initial treatment. There are shown tumors, which therapy more often induces development of second malignancies.

Between 1968 and 1987, 356 previously untreated consecutive children with Hodgkin's disease (HD), aged under 14, were treated at the Pediatric Department of N.N. Petrov Research Institute of Oncology (St. Petersburg, Russia). Prevailing among histologic subtypes were lymphocytic predominance and mixed cellularity (34 and 31.7%, respectively). Two-thirds of the patients (67.7%) were with Stages III-IV and one-third (32.3%) with Stages I-II. Radiation therapy (RT) as a primary method of treatment was used in 72 patients (20.2%), chemotherapy (CT) in 76 (21.4%), and combined (RT + CT) therapy (CMT) in 208 cases (58.4%). The patients were followed from 6.3 to 26 years (median follow-up was 13.7 years). For the whole group 5-, 10-, 15-, 20-, and 25-year actuarial survival (S) rates were 90, 80, 74, 73, and 73%, respectively. The corresponding event-free survival (EFS) rates were 63, 56, 56, 55, and 55%. The amelioration of the results was noted beginning with the 1973-1977 period, and for those treated in the last period (1983-1987) 5-year S and EFS rates were 93 and 68%, respectively. We conclude, that the modern treatment is also effective for our children suffering from HD.

Purpose. Prospective analysis of the efficacy of the original protocol SPbHL-05 was performed.Patients and Methods. Sixty patients with Hodgkin's lymphoma (HL) aged less than 18 years old were treated in accordance with SPbHL-05 from January 2000, to July 2009. In induction chemotherapy we used VBVP and ABVD schedules followed by involved-field radiotherapy. Fourteen patients (23,3%) with 0–2 adverse factors (the favourable group) received two cycles of chemotherapy (VBVP), 25 children (41,7%) with 3-4 unfavorable signs (the intermediate group) received two cycles of VBVP alternating with two cycles of ABVD, 21 patient (35%) who had 5 or more adverse prognostic factors (the unfavourable group) received three cycles of VBVP alternating with three cycles of ABVD.Results. With a median follow-up of 68 months, overall survival (OS) at 5 years is 91.3%, event-free survival (EFS) is 82.8%. OS in the favourable and intermediate risk group were 100%, EFS were 92,9% and 90,7%, respectively, OS and EFS in unfavourable risk group—77,1% and 55,6%, respectively.Conclusion. The identification of prognostic risk factors and using medicines with less prominent side effects would be of major importance in the development of new strategies of treatment for childhood HL.

The paper discusses the advantages offered by two regimens of therapy of Hodgkin's disease in children and adolescents (139)--DAL-HD (versions 87 and 90) (83) and SPbHD-05 (56). Survival rates were fairly high (OS--94.3%; DFS-- 90.0% and EFS--81.2%); they differed depending on risk group. Both the potential of a largen choice of prognostic criteria used in risk grading and the hazards from akylating drugs and anthracyclines were demonstrated.

A prognostic score was developed in the course of treatment of 551 pediatric patients with Hodgkin's disease stage I-IV (1967-2001). It took care of such significant factors of uni-and multivariate analysis as age (11 years or more), peripheral lymph node involvement (5cm or more), systemic symptoms (B), histological pattern for lymphocytic depletion, IVB stage and/or extranodal disease (E) and biological rate of tumor process ("b"). As a result, three groups at risk were identified: favorable prognosis (65.8%: overall survival - 92%, relapse-free - 67%), medium risk (17.8%: overall survival - 67%, relapse-free 48%) and high risk (16.4%: overall survival - 38%, relapse-free 25%). Our data may be used to estimate the scope of risk-adapted therapy for Hodgkin's disease.

143 cytological studies of the material obtained from 98 children aged from 2 to 18 years with tentative diagnosis of Ewing's sarcoma were made. Histocytological correlations showed 96.2% cases to be of informative value, 87% of them with precise cytological diagnosis of the above sarcoma. The analysis of images specified mean values of square (S) and ploidity (P) of tumor cell nuclei in 21 children with a good (10), and bad (11) outcome of the disease. It was established that if ploidy is higher than expected one (p = 0.0357 S), bad prognosis can be supposed and a good prognosis in the opposite case. In case of good prognosis differentiated tumor cells with large clear nuclei are seen in the smears, and poorly differentiated cells with hyperchromic nuclei are observed in cases with bad prognosis.

A clinico-radiological evaluation of chemotherapy received by 20 patients with osteosarcoma at the Institute's Clinic (1999-2003) was conducted. Morhological confirmation of the findings on course dynamics agreed upon by clinicians and roentgenologists was obtained in 78%. X-ray examinations provided more information. The clinico-radiological evidence on tumor regression failed morphological test in one-third of cases.

A retrospective evaluation of the clinical features, cytological, biological (DNA) and histological data on 29 children with Wilms' tumor. Two prognosis-related groups were identified: (1) good outcome (17)--all children, aged 4-15, had survived by end of follow-up; (2) bad outcome (12)--all children died within 4 months--4 years. Cytological examination by fine-needle biopsy of smears was carried out prior to preoperative neoadjuvant therapy in all 29 patients; in addition, print smears from resected tumor were taken from 21. Blastemal, stromal, epithelial and anaplastic cells levels were estimated by the semi-quantitative procedure (0, 1+, 2+, 3+). DNA ploidy was determined by image cytometry after destaining slides and re-staining them according to Feulgen. It was shown that favorable outcome could be expected when fine-needle biopsy of print smears identified DNA diploidy and marked drug-related pathomorphosis involving fewer blastemal cells and signs of cell dystrophy and tumor necrosis. When anaplastic and aneuploid cells were detected, matched by the absence of therapeutic pathomorphosis, outcome was poor.