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Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic inflammatory conditions of the gastrointestinal tract characterized by a relapsing and remitting course. Aim - to analyze clinical data and the most significant hematological and biochemical blood parameters used for diagnosis in patients with ulcerative colitis. Materials and methods. Between 2020 and 2021 examined 50 patients with the diagnosis "Ulcerative colitis" living in the Samara region. The diagnosis of ulcerative colitis was confirmed by a combination of clinical, radiological, endoscopic, and histopathological criteria generally accepted for inflammatory bowel diseases. A hematological blood test was performed on an automatic hematological analyzer Sysmex KX-21N, Japan, and a biochemical blood test was performed on an automatic biochemical analyzer Hitachi 902, Japan. Results. In the biochemical analysis of blood, an increase in the content of C-reactive protein in the blood is expected in 64% of patients. In 40% of patients, the concentration of total protein and electrolytes decreases. An increase in glucose levels was revealed in 44% of patients, in 10% of cases, a decrease in creatinine concentration, an increase in the activity of ALAT and ASAT was noted in 6 and 4% of cases, respectively. Reduced urea levels are noted in 6% of patients. Conclusion. As a result of the study, the data necessary for the diagnosis and monitoring of the effectiveness of the treatment of ulcerative colitis were obtained.

Introduction. In the treatment of patients with pararectal fistula, relapses of the disease are quite common, as well as postoperative complications in the form of suppression of a postoperative wound, anal incontinence, etc. The aim of the work is to improve the results of treatment of patients with pararectal fistula by reducing the number of purulent-septic complications in the postoperative period. Materials and methods. Analysis of 105 cases of treatment of patients was carried out. All patients were divided into 2 groups by random sampling: in group I, patients, in addition to standard preoperative training, underwent fistula sanitization with 1% dioxidin solution. In the postoperative period, patients underwent dressings with 5% dioxidin ointment, and also administered per rectum ointment from 1 postoperative day for 7 days. In the second group, standard preoperative training was carried out. All patients of the comparison groups were intraoperatively seeded on the flora from the fistula. Postoperative healing of postoperative wounds, subsidence of local and systemic inflammatory response were evaluated. Results. The results show a statistically significant improvement in treatment outcomes of patients in the major group. Conclusions. Application of two-stage prevention of postoperative complications makes it possible to improve results of treatment of patients with pararectal fistulas due to reduction of amount of pathogenic microflora in area of postoperative wound, faster stopping of local and systemic inflammatory reaction, and also due to increase of number of patients with primary healing postoperative wound.

Introduction. The prevalence of hemorrhoids in the adult population, according to various authors, ranges from 15 to 90%. In case of exacerbation of external hemorrhoids, conservative or surgical treatment can be applied. Of particular and important interest is homeopathic ointment, has an analgesic, antimicrobial, anti-inflammatory effect, and also affects the tone of the venous vessel. The purpose of our study was to study the effectiveness of Fleming’s ointment for the treatment and prevention of patients with acute hemorrhoids. Materials and methods. A prospective comparative study was conducted with the participation of 154 patients with acute hemorrhoids. In the main group (n = 76) of patients, treatment was carried out using diosmin and homeopathic ointment, which was applied 2 times a day for 7 days. In the control group (n = 78) patients, treatment was carried out using enteral administration of diosmin at a dosage of 1000 mg 1 time per day for 30 days and direct-acting anticoagulants in the form of an ointment 2 times a day for 7 days. Results. Within 3 months after the end of treatment, 4 (5.3%) patients of the main group and 12 (15.4%) patients of the control group had exacerbations of hemorrhoids. After 3 months, a statistically significant difference was revealed in the indicator of the subjective impact of hemorrhoidal disease on everyday life, which is associated with the development of exacerbations of hemorrhoids. Conclusions. Homeopathic ointment is an effective and pathogenetically justified remedy for the conservative treatment of patients with acute hemorrhoids. Its use leads to a significant decrease in the severity of clinical symptoms of the disease and an improvement in the indicators of objective research methods with good tolerability, the absence of undesirable effects and better long-term results compared to the standard treatment regimen.

Aim.To describe a clinical case of pregnancy and healthy labour in a young female patient with uncomplicated diverticular disease (DD).Key points.In recent years, DD is more frequently observed in younger patients. A 37-yo woman manifested the symptoms of periodic intense abdominal pain and constant abdominal discomfort. Colonic DD was diagnosed with irrigoscopy. A high-fibre diet, rifaximin-α at 400 mg twice a day for one week, once a month for six months, and topical anti-inflammatory therapy were prescribed. Clinical symptoms were eradicated upon the treatment. Unaware of pregnancy, the patient had another course of rifaximin-α at the second week of gestation, after which the therapy was stopped. Rifaximin-α, which has a poor intestinal absorption, did not affect the foetal development. A caesarean childbirth was healthy, the newborn was delivered on term with no complications (Apgar score 8).Conclusion.DD should be included in differential diagnosis for patients with non-specific symptoms (abdominal pain, bloating and discomfort), regardless of young age. No protocols are currently accepted for the DD management during gestation. In the clinical case reported, a patient having diverticular disease and a rifaximin-α therapy at an early term of gestation proceeded without complications for herself and the foetus.

Aim. This observational (non-interventional) study was aimed at obtaining data on practitioners’ commitment to prescribing rifaximin- α therapy to patients with uncomplicated diverticular disease (UDD), to assess patients’ adherence to such prescriptions, as well as to assess physicians’ and patients’ satisfaction with this drug under the conditions of outpatient practice. Materials and methods . 27 research physicians in 22 research centres located in 15 Russian cities and 250 patients participated in an open, prospective multicentre observational study. The observation lasted for 6 months with an interim assessment after 3 months. Physicians’ prescription of rifaximin- α (dose, duration of administration, number of prescribed courses) was evaluated, as well as patients’ compliance expressed as the ratio of the actual number of taken pills to the number of prescribed pills during each course according to the MMAS-4 scale. Such symptoms, as abdominal pain, constipation, diarrhea, flatulence and tenesmus were evaluated using a 4-score scale. At the end of the study, physicians’ and patients’ satisfaction with the treatment was evaluated using a 5-score scale. Results . One fifth — 52 patients (20.8%)—had received rifaximin- α therapy prior to inclusion in the study. Most frequently, rifaximin- α therapy was prescribed monthly at a dose of 400 mg 2 times a day for 7 days. 67.6% of patients received 6 courses of treatment during the study period. The proportion of patients who received more than one course of treatment over 6 months was 97.6%. During almost all treatment courses (97.5%), patients’ compliance was more than 80%. The total score of symptom intensity decreased from 5.6 at the inclusion visit, to 2.2 points at the second visit and to 0.9 points at the end of the observation. A statistically significant (p

Meckel’s diverticulum is an important issue of modern surgery due to challenges in the diagnosis of its complications. Among them, intestinal bleeding is estimated at 5%. A man with gastrointestinal bleeding of unknown cause was urgently admitted to the surgical department of the Samara State Medical University. Previously, the patient was diagnosed with chronic hepatitis C and decompensated hepatic cirrhosis. Blood tests revealed reduced hemoglobin and RBC, increased WBC, ALAT, and ASAT, and abnormal coagulation. Abdominal ultrasound revealed enlarged liver and intraperitoneal fluid. Esophagogastroduodenoscopy and colonoscopy failed to identify any source of bleeding. Medical therapy was ineffective. Considering recurrent intestinal bleeding, the patient underwent laparotomy. After the dissection of the ileum, a vein of the submucosal layer of Meckel’s diverticulum with fresh blood coming from a defect was detected. Resection of the ileum with diverticulum was performed, intestinal anastomosis was constructed. The postoperative outcome was good. The patient was discharged with relevant recommendations. This observation is rather uncommon. Published papers describe only single cases of intestinal bleedings in patients with decompensated hepatic cirrhosis. KEYWORDS: Meckel’s diverticulum, hepatic cirrhosis, profuse intestinal bleeding, resection of the ileum. FOR CITATION: Katorkin S.E., Bystrov S.A., Andreev P.S. et al. Successful surgery for profuse bleeding from Meckel’s diverticulum in a patient decompensated hepatic cirrhosis. Russian Medical Inquiry. 2021;5(3):162–164. DOI: 10.32364/2587-6821-2021-5-3-162-164.

The article presents the experience of using sodium phosphate in patients, who were treated at the Clinic of Hospital Surgery of the Samara State Medical University Clinics in 2019.Purpose of the study: evaluate the quality of patient preparation for colonoscopy with sodium phosphate in surgical hospital environment. Material and methods. A total of 50 patients who were admitted for emergency indications to the Clinic of Hospital Surgery in 2019 were enrolled in the study. All patients were divided into two groups.The study included patients aged 24 to 69 years. The median age was 55.1 years in the treatment group and 56.2 years in the control group (p = 0.06). Men predominated in both groups: 16 (64%) in group 1 and 18 (72%) in group 2 (p = 0.08). The average time for submitting complaints about intestinal bleeding before seeking medical aid was 1.0 ± 0.70 days in the treatment group and 1.0 ± 0.35 days in the control group (p = 0.92). Group 1 included 25 patients, who were preparing for colonoscopy with sodium phosphate, Group 2 included 25 patients who were preparing for the examination with Macrogol.Results: the preparation quality was evaluated using the Boston Bowel Preparation Scale. Initially, the treatment and control groups did not have any statistically significant differences in all studied parameters. The colonoscopy identified the following nosologies. In Group 1, 9 patients had a diverticular disease of the colon; 4 – colon cancer; 12 patients continued treatment of grade 2–3 chronic internal hemorrhoids. In Group 2, the patients were distributed as follows: 10 patients were diagnosed with diverticular disease of the colon; 4 – colon cancer; 1 – an adenomatous polyp of the transverse colon and 10 patients had grade 2–3 chronic internal hemorrhoids. In addition, all patients filled out the questionnaire, which showed that the use of sodium phosphate is more convenient for the patient not only in terms of the dosage, but also due to relatively pleasant organoleptic properties. After examination of the colon, 45 patients received conservative treatment, five were operated following the colonoscopy and preoperative preparation.Conclusion: we believe that the quality of preparation of patients with intestinal bleeding with sodium sulphate and Macrogol does not differ, however, sodium sulfate is preferable because of its more pleasant organoleptic properties and the smaller volume of solution used.

Ulcerative colitis (UC) is a common disease with the evident tendency to annual increase in incidence. The disease mostly affects young individuals of active working age. The peak of incidence of the disease is observed at the age of 20-29 and 50-55 years. The aim of study was optimization of diagnostics and management of patients with ulcerative colitis by correction of antibacterial therapy on the basis of the data of microbiological examination of the microflora of the wall of colon. Materials and Methods. 35 Patients with ulcerative colitis from 28 to 61 years of age with the average age 37.6 years who underwent outpatient and stationary treatment in colonoproctology and gastroenterology departments of SamSMU clinics in the period from January to May 2017 were examined. Of them, 18 were males (48.6%) and 17 females (51.4%). Results. Significant species diversity of microflora was identified that requires exact species identification and development of standard procedures for isolation of microorganisms from bioptates of patients with ulcerative colitis with the aim of administration of antibacterial treatment. In analysis of sensitivity of the isolated strains to antibiotics 45% of the isolated microorganisms were found to have signs of resistance to 1-2 groups of medical drugs, and 33% showed signs of resistance to 3 and more groups. Only 22% of strains were found to be sensitive to all tested preparations. Eradication of such flora presents certain difficulties, and in our opinion, requires administration of combined therapy after examination of bioptate. Conclusions. All patients with ulcerative colitis require examination of the microbial composition of the intestinal wall for optimization of diagnostics and treatment. 105-106 titer of microorganisms, their wide species diversity may support inflammation in the colon and prevent relief. It is necessary to continue study of microbiological composition of the colonic wall in the comparative aspect for optimization of diagnostics and management of patients with ulcerative colitis.

Pilonidal sinus is a disease which occupies an important place in Coloproctology profile and constituting 15% of all purulent diseases of the anus. The aim of this work is the analysis of the results of surgical treatment of patients with pilonidal sinus: by closing the wound with a continuous suture with the catch of the bottom of the wound (modified method) in comparison with excision of Pilonidal sinus and suturing wounds seams Moshkovich. All patients (n=82) were divided into 2 groups (30 and 52 patients), respectively completed the operational manual. We performed the analysis of the results of treatment according to operative time, early postoperative complications, disease relapses, the severity of pain, timing of rehabilitation, and identified the differences between the groups for the development of early postoperative complications (χ2=21.72; p=0.05). Thus, the obtained statistically significant data on the advantage of the method of wound closure with a continuous suture with the catch of the bottom of the wound over the method of suturing wounds seams Moshkovich.

One of the most advanced directions in the development of the hip joint surgery and its complications is shown to be the use of external fixation apparatuses. The operative interventions system combining the classic elements, using the external fixation apparatuses, is developed taking into account the form of degenerative and dystrophic lesion of joints, the patient age and accompanying complications. Among all the destruction forms of proximal part of the femur in children the partial defect of epiphysis is most favourable in the subsequent prediction. The use of Elizarovs apparatus not only makes easier the nursing and excludes the contracture in adjacent joints but fits the aims of the joint decompression, affected epiphysis unloading.

New developments in surgery of displastic processes of cotyloid cavity tectum are presenj ted. Based on the progressive correction of pelvic component of the joint by the external fixation apparatus, these methods are sufficiently efficient and appropriate in children of school age. The variations of the correction of cotyloid cavity tectum are tested in the infantile department of the research center The recovery traumatology and orthopedics of Tatarstan and are found to be good. This paper is concerned with the detailed description of the operative interventions.

A distingishing feature of the newly developed method of the treatment of destructive dislocation of the femur in children is a possibility to use autotransplant on the feeding muscular limb for the plasty of proximal part of the femur with the recovery of cartilaginous integument of the joint surface of femoral component. The method shows the high efficacy. The positive result is obtained in 8 cases out of 9. The use of Ilizarovs apparatus significantly promotes the realization of the method and provides a possibility to make the patient more active in the process of the treatment.

In the practice of surgeons there are two difficulties in the correction of proximal part of femur: the true interorientation of bone fragments and their fixation in osteosynthesis. The authors have developed a device for the determination of coordinates of proximal part of femur and a device for the fixation of bone fragments. The principal diagrams of devices and their application methods are presented in this paper. The use of these devices allowed to perform the operative correction of proximal part of femur in 54 patients.

External rotatory contracture in hip joint appears in some cases in the process of correction of the proximal part of femur. Incomplete and low dislocations of femur are stated to be characterized by absolute shortening of short external rotators and high forms of dislocations by shortening of middle gluteal muscle. The methods of correction of the length of these muscles in the process of treatment of the dislocation of femur are suggested. The comparative analysis of treatment results of the congenital dislocation of femur in 159 persons by the methods, developed by the authors and traditional methods is presented. The positive result of the treatment is received in 95,4% patients.

The problem of the treatment of congenital dislocation of the femur is actual currently. The main attention of the orthopedists is paid to the correction of deformation elements of proximal part of the femur and cotyloid cavity tectum. The paper is concerned with the tactics of operative treatment of children with congenital dislocation of the femur depending on the form of the disease and age of patients. Some methods of the treatment are developed on the basis of the recovery of right biomechanics of paraarticular muscles and joint elements. These methods are the basis of the suggested approach to the treatment of pathology. The efficacy of the treatment is confirmed by a large number of observations and twenty years of the treatment of congenital dislocation of the femur in children.

Children's injuries, according to various authors [1-3], account for 12 to 30% of all types of non-occupational injuries. In the structure of child mortality from accidents, up to 70% is accounted for by traumas received in everyday life, up to 17.7% - in road traffic accidents [4].

The aim of the present study was to identify the main errors in diagnosis, peculiarities of localization of injuries, and causes of death of victims with combined craniocerebral trauma depending on their age.

An original design for taking cylindrical bone grafts from allograft has been developed. Cylindrical grafts can be made from both cortical and cancellous bone. Cortical grafts in traumatology are used to connect bone fragments in the treatment of fractures. A spongy cylindrical bone graft in the form of a column is widely used for biostimulation of the femoral head during its aseptic necrosis, as well as for filling bone cavities after resection of benign tumors.