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The OBJECTIVE was to improve the quality of diagnosis and the effectiveness of treatment of refractory ulcers of the rectum. METHODS AND MATERIALS. We analyzed clinical and biochemical parameters in 39 patients with previously diagnosed solitary ulcers of the rectum. It was proved that in 18 patients, ulceration in the rectum was caused by an autoimmune process, according to the type of Crohn’s disease. The obtained data made it possible to substantiate and apply a new method of treating rectal ulcers – local bone marrow stem cell transplantation. RESULTS. All patients had pain, stool returned to normal, and ulcerative defects were noted to heal. CONCLUSION. Bone marrow stem cell transplantation differs fundamentally in its mechanism of action from known methods of treating rectal ulcers. The method has shown high efficiency and a good safety profile.

An outstanding surgeon and scientist, a talented teacher, one of the pioneers of world cardiac surgery, Honored Scientist of the RSFSR (1964), laureate of the USSR State Prize (1988), Colonel of the Medical Service, Doctor of Medical Sciences, Professor Vasily Ivanovich Kolesov was born on September 24, 1904 in the village Martyanovskaya (now Ust-Kubinsky district) Vologda province. In 1931, he graduated from the 2nd Leningrad Medical Institute and worked as a therapist in the village of Chusovoy, Perm Region. From 1934 to 1938, he taught at the Department of Faculty Surgery of the Perm Medical Institute, where he prepared his Ph.D. thesis, which he defended at the Leningrad State Institute for Advanced Medical Training in 1938 and moved to Leningrad. In 1953–1955, V. I. Kolesov headed the Department of General Surgery, and in 1955–1976 – Department and Clinic of Faculty Surgery of the 1st Leningrad Medical Institute named after Academician I. P. Pavlov. On February 25, 1964, for the first time in the world, Vasily Ivanovich sewed the distal end of the transected mammary artery into the end of the circumflex artery of the heart in a seriously ill man without coronary artery perfusion. At the end of the 1960s, V. I. Kolesov began performing anastomoses using the ASC-4 vascular stapling device, as well as devices designed by his son, E. V. Kolesov (ASC-UV and ASC-VAK), which significantly reduced the time of formation of a vascular anastomosis on a beating heart. On February 5, 1968, V. I. Kolesov for the first time operated on a patient 7 hours after her ECG registered myocardial infarction, and on May 17 of the same year, he restored the blood supply to the heart of a patient with unstable angina, proving for the first time in the world the possibility of surgically preventing the development of myocardial infarction. V. I. Kolesov published about 200 scientific papers, including 8 monographs on general, thoracic and cardiac surgery. Vasily Ivanovich and Evgeny Vasilyevich Kolesov were the authors of more than ten global and domestic priorities. V. I. Kolesov was awarded two Orders of the Patriotic War, I and II degrees, the Order of the Red Banner of Labor, medals «For the Defense of Leningrad», «For Military Merit», «For Victory over Germany», as well as many honorary insignia. Professor Vasily Ivanovich Kolesov died on August 2, 1992 and was buried at the Bogoslovskoye cemetery in Saint Petersburg.

Introduction. The article presents a comparison of simulation models for financing an inpatient emergency department and a therapeutic department using the example of an emergency therapeutic flow of patients.The objective was to analyze the economic aspects in an inpatient emergency department for the treatment of emergency therapeutic conditions such as hypertension.Methods and materials. Based on a retrospective analysis of the flow of incoming patients for emergency and urgent indications, a simulation model of the load and economic calculations of the work of the inpatient emergency department was developed.Results. According to the results of the study, it was revealed that with a three-fold increase in the flow of patients entering the department, the inpatient emergency department copes with this flow more effectively in comparison with the therapeutic one. Despite this funding, the medical institution receives significantly less.Conclusion. Based on the study, the need to create a special tariff plan for the work of such units as the inpatient emergency department was identified, because the capacity in this department is many times greater.

The objective was to evaluate the safety and effectiveness of endoscopic methods for removing cystic formations of the esophagus and mediastinum.Methods and materials. The study included 17 patients with esophageal and mediastinal cysts. All patients underwent gastroscopy, endoscopic ultrasonography and computed tomography at the diagnostic stage to determine the localization, sizes and topography of the formation.Results. In all cases, the formations were successfully removed. Submucosal tunnel endoscopic resection (STER) was successfully performed in 14 patients, the average operation time was 126 minutes. In 3 patients, the formations were removed by endoscopic submucosal dissection (ESD), the average operation time was 55 minutes. Two patients in the postoperative period had esophageal diverticulum in the area of previously removed formations.Conclusion. Submucosal tunnel endoscopic resection is safe and effective in the treatment of cystic formations of the esophagus and mediastinum. Long-term results of STER require further study.

Relevance. Today, despite the development of medical technologies and the improvement of the logistical aspects of healthcare, the problem of unified treatment, diagnostic and routing algorithms for pregnant women and women in labor with urgent surgical pathology remains unresolved. The first step towards its solution is a detailed analysis of the current structure of incidence and routing paths.The objective was to analyze the incidence of urgent extragenital surgical pathology and routing paths in pregnant women and women in labor in St. Petersburg.Methods and materials. Based on the database of invoices issued by insurance organizations in St. Petersburg for completed cases of treatment, we performed a retrospective analysis of the data of pregnant patients with extragenital surgical pathology, hospitalized on an emergency basis in the period from 2019 to 2021. We assessed the structure of morbidity, terms of delivery to the hospital, indications and range of surgical interventions, treatment outcomes.Conclusions. In the structure of urgent and emergency hospitalizations in pregnant women, extragenital surgical pathology is 1 %. The total proportion of surgical interventions in patients with extragenital pathology is 35.1 %. Routing of a pregnant woman with suspected surgical pathology through the primary visit to the maternity hospital significantly increases (p

Background. Malignant tumors are one of the main causes of unfavorable outcomes in solid organ transplant recipients in the long term after transplantation. Localization of these tumors in a transplanted organ may cause loss of graft function. After chronic graft dysfunction and infections, malignant neoplasms come next as one of the leading causes of late kidney graft loss. The incidence of different types of malignancies varies according to the transplanted organ. Knowledge of etiology, pathogenesis, peculiarities of diagnosis and treatment of malignant tumors in solid organ transplant recipients is a significant part of screening at any stage of post-transplant period. Late diagnosis of malignancies in a transplanted kidney amidst disconnected stages of treatment and follow-up leads not only to graft loss, but also jeopardizes the life of recipients.Clinical case description. The patient is a 29-year-old female. History: IgA nephropathy with nephrosclerosis. Renal replacement therapy (RRT) with long-term hemodialysis since March 2019. Kidney transplantation from a deceased donor to the right external iliac vessels on March 13, 2019. Graft function is immediate. In October 2020, a tumor in the transplanted kidney was detected for the first time. In November 2021, an emergency graft nephrectomy was performed for health reasons. Antibacterial, antifungal therapy was carried out. Results of morphological study of the removed renal graft with immunohistochemistry (IHC) were obtained. The structure and phenotype of the tumor are consistent with myeloid sarcoma. Trephine biopsy: normocellular bone marrow.Conclusion. The 29-year-old patient was diagnosed with donor-derived myeloid sarcoma in her kidney transplant with the development of paraneoplastic syndrome and multi-organ failure. Currently, the patient is receiving RRT by long-term scheduled hemodialysis. Organ recipients need to be managed by a multidisciplinary team of specialized and highly specialized specialists, taking into account comorbid status and features of the course of the underlying disease.

The OBJECTIVE was to increase the safety of laparoscopic decompression of the abdominal trunk.METHODS AND MATERIALS. The results of treatment of 30 patients who underwent laparoscopic decompression of the celiac trunk were analyzed. Intraoperative bleeding requiring conversion to laparotomy occurred in two (6.7%) cases.RESULTS. To prevent such a complication, a method of preventive installation of a balloon catheter into the celiac trunk was introduced, which allows creating a temporary occlusion of the vessel in case of damage. A similar approach was used in 10 (33.3%) patients. The need to cover the lumen of the vessel with a balloon arose in one observation (3.3% of all patients and 10.0% using this technique). Bleeding from the inferior phrenic artery, which originated from the celiac trunk, was stopped by laparoscopic access.CONCLUSION. The experience presented in this paper allows us to consider the installation of a balloon boat in the celiac trunk as one of the possible ways to improve the safety of its laparoscopic decompression. Further research is needed to obtain a definitive picture of the effectiveness of this approach.

The OBJECTIVE was to study the efficacy and safety of laparoscopic decompression of the celiac trunk.METHODS AND MATERIALS. A comparative analysis of the results of laparoscopic (30 patients) and conventional decompression of the celiac trunk (50 patients) was carried out. All patients were operated on between September 2018 and July 2021.RESULTS. Intraoperative bleeding during laparoscopic decompression of the celiac trunk, which required conversion of access to laparotomy and vascular suture, was noted in 2 (6.7 %) cases. With conventional access, there were no such complications. The average duration of laparoscopic decompression of the celiac trunk was 107 minutes, from conventional access – 150 minutes. The average length of hospital stay after laparoscopic intervention was 4 days, after the traditional one – 7 days. Long-term results of treatment over a period of more than 6 months were evaluated in 28 patients who underwent laparoscopic decompression of the celiac trunk and 45 people who underwent conventional decompression. Ultrasound examination in all cases stated the return of linear and velocity parameters of blood flow in the celiac trunk to normal. complete relief of the clinical manifestations of the disease was achieved in 24 (85.7 %) patients after laparoscopic and in 39 (86.7 %) after traditional intervention.CONCLUSION. Laparoscopic decompression of the celiac trunk is an effective method of surgical treatment of the syndrome of compression of the celiac trunk, but there are risks of vascular damage. The long-term results of laparoscopic and open decompression of the celiac trunk are comparable.

The objective was to summarize the Center's experience in the treatment of sudden cardiac death and to assess the prospects of using venoarterial extracorporeal membrane oxygenation (VA ECMO) in the complex of extended cardiopulmonary resuscitation (CPR).Materials and methods. 109 patients aged 52.6±1.5 years, delivered to the hospital by emergency medical teams with a background of ongoing cardiopulmonary resuscitation.Results. In the majority of cases (78), extended resuscitation measures were ineffective, ECMO was not used due to inadequate technology connection criteria. In 15 cases, primary stabilization without ECMO was achieved, and these patients were transferred for further treatment to intensive care unit (ICU), 8 of them died later. Extracorporeal cardiopulmonary resuscitation (ECPR) was used in 16 cases, in 6 cases, patients were decannulated after cardiac recovery; also, ECMO was used postmortem 15 times to preserve donor organs. The overall survival rate among the delivered to the Center was 7.5%. We found out the correlation between the duration of the prehospital period and survival rate (time to hospital admission in survivors was 42.7±9.6 min versus 64.31±3.13 min in the deceased). The association between pH (AUC ROC 0.728) on admission and favorable outcome was found to be more reliable than EtCO2 (0.266) and blood lactate (0.387).Conclusion. The creation of centers for the treatment of patients with refractory circulatory arrest seems reasonable on the basis of level 3 hospitals with the possibility of using X-ray surgical methods of treatment. The widespread introduction of ECPR should be accompanied by the change of CPR algorithms in the prehospital period. The effectiveness of ECPR is determined by mandatory strict adherence to the connection criteria, which can be revised as experience accumulates.

Objective. The objective of this study is to develop a therapeutic strategy for protecting grafts in order to improve the efficiency of kidney transplantation (KT) using polyclonal antibodies (pAbs) through elimination of activated forms of neutrophils, chemo- and cytokines from the donor’s bloodstream, and a decrease in the level of expression of adhesion molecules on the renal vascular endothelium at the pre-transplant stage.Materials and methods. In 2017, we developed and for the first time applied a therapeutic strategy for ischemia-reperfusion injury (IRI) in a brain-dead donor (BDD). Given the limited time interval after brain death has been diagnosed, Timoglobulin (Sanofi Genzyme, France) was administered to the donor at a dose of 8 mg/kg intravenously for 6 hours. Before drug administration and immediately before the start of cold perfusion, a complete blood count and renal transplant biopsy were performed. The study group included 10 BDDs (mean age 39.3 ± 4.4 years) who received anti-thymocyte globulin (ATG). The comparison group included 10 BDDs (mean age 38.5 ± 4.3 years) who did not undergo the new strategy. Donor kidneys were transplanted to 40 recipients (average age 47.5 ± 4.3 years), who were also divided into 2 groups, depending on the graft received (with and without ATG). At the organ donation center, a biobank of specimens from donors of various categories, including those using the IRI therapeutic strategy and recipients for retrospective assessment of the effectiveness of pAbs, was formed.Results. Clinical blood test results show that in the ATG group, there was stable leukopenia (neutropenia and lymphopenia) of 1.46 ± 0.18x109/l. Fifteen (75%) recipients of kidneys obtained from donors with ATG had immediate graft function; in the control group – 10 (50%) recipients.Conclusion. Data obtained testify to the prospects of implementing the proposed strategy in clinical practice, which will improve the quality of the resulting grafts and their suitability for subsequent transplantation, prolong graft functioning due to elimination of leukocytes as a factor of IRI, prevention of early allograft nephropathy, increase in the donor pool by using expanded criteria donors (ECDs).

Introduction. This article presents the experience of five years of using simulation modeling to optimize work in the field of healthcare organization. Works are considered on the example of organizing the process of a three-level system for organizing emergency medical care in the regions, and examples of the practical application of computer modeling to improve the work of an inpatient emergency department are presented.The objective was to study various methods and approaches to the implementation of simulation modeling used in practice in the healthcare system. Consider the possibilities of simulation modeling on the FlexsimHC platform.Methods and materials. The analysis of methods and software used to create a simulation model in the healthcare sector was carried out. The main possibilities of using process modeling on the FlexsimHC platform were considered on the example of designing work inside and outside the hospital.Results. After a series of experiments in the virtual space, the data obtained were put into practice. On the example of the completed project of the simulation model of the region, a real way to optimize the emergency medical care in the region was proposed. Experiments were also carried out on models of an inpatient emergency department, the results of which revealed ways to optimize the workflow aimed at reducing the duration of stay inside the department, at an adequate distribution of patient flows, allowing timely implementation of all necessary medical and diagnostic measures without additional burden on medical personnel.Conclusion. Simulation modeling is the key to solving the logical problems of modern planning, allowing to reduce the risks of logistics errors in real time.

В статье отражена роль академика РАН Ю.Л. Шевченко в развитии отечественного здравоохранения.

The article is devoted to the history of gastric surgery in Saint Petersburg (Russia) in the XIX century. In the last decades of the 19th century, there was a breakthrough in surgery - surgeons from all over the world began to operate on the stomach. For the first time in Saint Petersburg and in Russia, Russian surgeons M.K. Kitaevsky, D.M. Monastyrsky and N.V. Ekk performed stomach resection for cancer by Billroth I method (M.K. Kitaevsky, 16.07.1881) and gastroenteroanastomosis for cicatrical pyloric stenosis (N.D. Monastyrsky, 13.03.1882), and at the meeting of the Society of Russian Doctors in Saint Petersburg in May 1882, V. Ekk proposed to overlap an anastomosis between the stump of the resected stomach and the loop of the small intestine that was realized by the Viennese surgeon T. Billroth only 3 years later in 1885, and got the name of the modification of gastric resection by the Billrot II method. It should be noted that M.K. Kitaevsky and N.D. Monastyrsky worked at Petropavlovsky Hospital - on the basis of which the Women's Medical Institute was established in 1897 (now the Pavlov First Saint Petersburg State Medical University).

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.

Surgical treatment of acute biliary pancreatitis over the past decades have been improved from realization of open traumatic surgical interventions to the use of minimally invasive technologies. However, despite the progress in the treatment of this pathology, the question of the timing of cholecystectomy after endoscopic papillosphincterotomy with lithoextraction remains unresolved. In some cases, after the endoscopic papillosphincterotomy, a recurrence of the disease occurs, as well as other various biliary complications, such as: acute calculous cholecystitis, choledocholithiasis, cholangitis, associated with the fact that the main etiological factor – the gallstone disease – has not been eliminated, specifically, cholecystectomy was not performed.The objective of this study was to analyze the evolution of surgical tactics in the treatment of acute biliary pancreatitis with combined cholecystocholedocholithiasis.

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 133 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2021 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

The OBJECTIVE was to show a potential and efficiency of endovascular methods in treatment of patient with portal vein stenosis after pancreatoduodenal resection complicated by the development of varices in the portomesenteric basin and recurrent gastrointestinal bleeding.METHODS AND MATERIALS. We presented the results of treatment of two patients who previously underwent pancreatoduodenal resection for pancreatic head cancer. 2 patients were admitted to the Clinic of the Research Institute of Surgery and Emergency Medicine of Pavlov University with a clinical picture of recurrent gastrointestinal bleeding.RESULTS. Both patients had no visible bleeding site with endoscopy, but had recurrent melena and hemoglobin loss. On radiological imaging we found a portal vein stenosis with a significant varicose transformation of the mesenteric basin. Endovascular stent placement for portal vein stenosis was performed in both cases with no recurrence of bleedings and no complications.CONCLUSION. Portal vein stenosis after pancreatoduodenal resection is a rare complication, which can manifest in recurrent gastrointestinal bleeding with no visible bleeding site on endoscopy. Endovascular methods are feasible and safe in treatment of portal vein stenosis with no relapse. Multidisciplinary approach in diagnostic and treatment of such patients allow to identify and remove the cause of recurrent bleeding.

A clinical case of surgical management of patient with biliodigestive anastomosis stricture complicated by multiple intrahepatic lithiasis is presented. The patient was 57 years old woman. Anamnesis of the disease: in 2016, biliodigestive anastomosis was performed due to iatrogenic damage of the biliary tract. She was admitted to the hospital with complaints of the right upper abdomen pain, accompanied by chills, jaundice, and fever up to 39°C. The examination revealed a stricture of a previously formed biliodigestive anastomosis complicated by multiple intrahepatic cholelithiasis. Surgical intervention was performed: at the first stage – percutaneous transhepatic cholangiostomy; at the second stage – laparotomy, separation of hepaticojejunoanastomosis, intraoperative cholangioscopy with lithoextraction, resection of a small bowel section with a Brownian anastomosis, post-colon hepaticojejunostomy on a disconnected loop and replaceable transhepatic drains (Smith-Praden-Saypol-Kurian).

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Introduction. Currently, traditional methods and minimally invasive surgical technologies are used in the treatment of celiac trunk compression syndrome. The choice of treatment method remains a subject of discussion. The drawback of the classical approach – laparotomy – is a significant trauma to the tissues of the abdominal wall, the risk of adhesions, wound infection and hernias. The disadvantage of videosurgical techniques is the risk of developing life-threatening bleeding requiring conversion of access. The main cause of this complication is damage to the wall of the aorta, celiac trunk and its branches during the intervention.Methods and materials. A set of tactical and technical principles was developed to reduce the risk of bleeding during laparoscopic decompression of the celiac trunk. The prerequisites were an assessment of the individual architectonics of the vessels according to 3D reconstruction data, the location of working instruments as parallel to the celiac trunk course, retrograde access to the compression zone, the use of an ultrasonic or bipolar dissector, contact with the vascular wall only with passive branches. With these principles surgical intervention was performed in 12 patients.Results. Complication (bleeding from the branch of the lower phrenic artery) – occurred in one (8.3 %) case – was eliminated laparoscopically. The average duration of the operation was 85 minutes, the average hospital day after the operation was 5 days. Treatment results within 3 to 12 months were evaluated in 8 out of 12 (66.7 %) patients. In 7 (87.5 % of patients with the studied results) cases, complete regression of symptoms and restoration of normal blood flow were noted. One (12.5 %) person had a slight abdominal pain syndrome against the background of normal hemodynamics in the celiac trunk.Conclusion. The presented data are comparable with the results of traditional surgical methods of treatment of celiac trunk compression syndrome and are the basis for further research.

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 107 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2020 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

The constant mutation of the virus and the complicated epidemiological situation in other countries keep the probability of a third wave of the pandemic in the Russian Federation fairly high. It is important to summarize the gained experience as fast as possible to use it appropriately once it is needed.The objective: to analyze the specific parameters of care for critically ill patients with the novel coronavirus infection in Pavlov Multidisciplinary Medical Center.Subjects and methods. This is a result-based report on the work performed by the Infection Center, which was deployed twice in Pavlov Multidisciplinary Medical Center (from 28.04.2020 to 03.08.2020 and from 01.11.2020 to 15.03.2021). Totally, 3,830 patients with SARS-CoV-2 were managed (1,680 patients during the first deployment and 2,150 patients during the second one). In the preparatory period, the operation of the emergency department based on the inpatient emergency medical department (EMD) had been simulated to clarify its staff structure and the procedure for admission, examination, and treatment of patients. Here we compare the organizational approaches during the first and second waves of the pandemic and present the characteristics of the demographic data of the treated patients, the incidence of certain complications, and outcomes.Results. The overall lethality in the Center made 6.2%. Despite the experience gained in the first wave, the results of treatment during the second wave (autumn-winter) did not improve (5.7% died in the first wave and 6.7% in the second one). Lethality in ICU and EMD was 40.0% and 49.6%, in ICU only – 38.5% and 46.9% respectively. A moderate lethality increase in ICU was due to the concentration of critically ill and most critically ill patients. There were 51.4% of patients with comorbidities and 53.5% were above 65 years of age. Refinement and differentiation of tasks performed by departments, simulation of the operation of the Center before opening made it possible to increase the throughput of the medical unit avoiding rush during admission and deterioration the quality of treatment.Conclusion. Certain aspects of the organization of medical care affect the performance of a multidisciplinary medical institution transformed into an infectious diseases hospital. The experience gained under such circumstances can be useful in other emergencies with a large number of victims and patients.

Currently, the age of primiparous women is increasing, but the risk of cancer, which is sometimes found during gestation, is also increasing. This article discusses the problems of diagnosis and treatment of cancer during pregnancy, which occurs under the guise of gestational complications. Two cases of malignant neoplasms first discovered during pregnancy are described. The first observation illustrates cholangiocarcinoma in a 37-year-old multiparous, and the second is a case of colorectal cancer in a 40-year-old primiparous. The timely identification of such women is an important challenge of the outpatient, which in the future can help maintain the quality of life of the mother and child.

The OBJECTIVE of the study was to evaluate the severity of submucosal fibrosis in patients with esophageal achalasia, its influence on technical and clinical success of peroral endoscopic myotomies (POEM), and their results.METHODS AND MATERIALS. The study included 116 patients with esophageal achalasia who underwent POEM in the Clinic of the Pavlov First Saint Petersburg State Medical University from June 2015 to March 2019. The mean age of patients was 50 years. It included 42 men and 74 women. This research was based on the retrospective analysis of video recordings of 116 POEM that were performed on patients with esophageal achalasia at the Endoscopy Department at the Pavlov First Saint Petersburg State Medical University.RESULTS. The mean operation time was 89.6 minutes. During the operation, changes in the esophageal mucosa were recorded in all patients, which were classified according to the esophageal mucosa in achalasia (EMIA), and during creating the tunnel, the severity of submucosal fibrosis (SMF) was evaluated according to the three-stage classification (SMF from 0 to 3 stage). We found out that SMF-1 occurred in 20 patients, SMF-2 occurred in 44 patients and SMF-3 occurred in 48 patients; we identified a new group of severe submucosal fibrosis – 3b that accompanied in our study by the highest 25 % frequency of mucosal perforation during surgery.CONCLUSION. The submucosal fibrosis of various SMF grades was determined intraoperatively in the majority of the patients and affected the POEM duration and complications.

The article is dedicated to the memory of the Russian surgeon, prominent scientist, public health organizer and the founder of the first Russian periodical surgical journal of N. A. Vel’jaminov in 1885, who was born 165 years ago and died 100 years ago.

Perioperative changes in microbiocenosis in patients with oncological diseases is the widely researched theme in colorectal surgery. In particular, the role of the colon microbiome in the development of purulent-inflammatory postoperative complications and possible significance in cancer disease recurrence have been actively investigated. Data on the colon microbiome tends to be divided on several groups. Part of the considered articles was focused on the condition of the colon microbiome during the perioperative period and its effect on the postoperative complications, in particular on the anastomotic leakage and the development of colitis in the postoperative period in dysbiosis statement. On the other hand, microbiome was evaluated to be a treatment option by the several studies. The effect of antibiotic therapy on the development of Clostridium Difficile infection was investigated as well. The most relevant and up-to-date scientific researches on the microbiocenosis in patients with colorectal cancer were analyzed. The collected data can be used successfully for practical medical using in Russia.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

To treat the patient with Achalasia and prevent the symptoms of gastroesophageal reflux the Peroral Endoscopic Myotomy with Simultaneous Endoscopic Fundoplication was done by the current authors. After performing a myotomy the endoloop was fixated to the stomach and was attached to the muscle of the esophagus by using the endoclips. The endoloop was tightened therefore shaping the cuff. This operation has been technically feasible and no immediate or delayed complications occurred.

Organs’ shortage remains the main limiting problem for accessibility of organ transplantation. There is the growing interest among transplant society for use organs obtained from «uncontrolled» donors after cardiac death (uDCDs), or, asystolic donors. But the warm ischemic time is critical factor for wide accepting of practice of transplantation such kind of organs. The article presents the first case of successful clinical organ transplants from the donor with out-of-hospital irreversible cardiac arrest obtained with help of life support devices.

Emergency medical education is becoming increasingly challenging as a result of shifting the workplace of emergency physician from ambulance to Emergency Department. Prehospital specialist rarely uses infusion therapy, instrumental methods of treatment and diagnostic independently. Comparison shows the need of longer education for hospital practices, because additional ultrasound and reanimatology trainings are required.

Utilization of kidneys donated from uncontrolled donors after cardiac death (UDCD) became an additional source of organs for transplantation worldwide in the light of ongoing global organ shortage. Machine perfusion proven to be a promising perspective for selection, rehabilitation and treatment of kidneys from expanded criteria donors, however, exact mechanisms of these effects remains unclear. On presented clinical case we are trying to clarify the essence of them. In 2006-2007 a pilot study was carried out by our team for use of machine perfusion to perform selection of kidney obtained from UDCD and improve their quality. According to study design each couple of grafts were divided and transplanted to different recipients. During ordinary procedure a staff mistake occurred, which, fortunately, helped us to understand one of the treatment mechanisms of hypothermic machine perfusion.

Deficit of donor organs is main critical factor limiting of organ transplantation. In article highlighted the organ donation practice in SaintPetersburg with accent on unsuccessful attempts of the increasing of number deceased organ donors. Given by analyses of neurosurgical and neurological rates of mortality last three years, the authors tried to ground the urgency of the putting in clinical practice the optimization of the transplant algorithms, organ donor’s audit, and the implementation of new approach to define organ donor’s process stages. In article are presented the results worked out of the metrics coefficients for estimating donation potential of emergency hospitals. There was done the study of involvement and education in organ donation practice, legislative issues among critical care professionals, neurologists and critical care nurses. In articles is presented the first attempt of estimate of economical aspects of donation process in donor’s hospitals. There was done the recommendation for national organ donation network creating.

The objective is to analyze the results of rendering medical assistance to pregnant women delivered to the University clinic with suspicion of complications of cholelithiasis.Material and methods. The authors conducted the retrospective analysis of the case histories of pregnant women for 2 years, who applied urgently with suspicion of complications of cholelithiasis. In total, 69 patients at different stages of gestation, from 22 to 39 weeks of pregnancy, appealed with suspension of complication of cholelithiasis for this period. The average age of enrolled patients was 29.20±0.8 years. 48.98 % of the enrolled patients were pregnant at first time.Results. The presence of cholelithiasis was confirmed in 82.61 % of pregnant women. 43.86 % of these patients were diagnosed with hepatic colic, which was stopped by spasmolytic therapy. 52.63 % of pregnant women were diagnosed with acute cholecystitis. The surgical intervention – laparoscopic cholecystectomy - was required in 5.26 %. Acute biliary pancreatitis was in 8.77 % of pregnant women with cholelithiasis; delivery and revision of the abdominal cavity were required in 1 case. In addition, 3.51 % had choledocholithiasis with mechanical jaundice. All patients with this diagnosis were performed endoscopic papillosphincterotomy with lithoextraction.Conclusion. Complications of cholelithiasis rank the second place in the frequency of occurrence among urgent surgical diseases in pregnant women. The ultrasound examination is the starting point for determining the further treatment tactics for this category of patients. Pregnant women with complications of cholelithiasis should be examined in inpatient department of ambulance by surgeons and obstetrician-gynecologists collaboratively.

The objective of the research is to study the efficacy and safety of using a minimally invasive endoscopic method in treatment of Zenker’s diverticulum.Material and methods., 42 patients with a pharyngo-esophageal diverticulum at the age of 59 to 80 years were examined and treated over the two-year period of work. The indication for the operation in all patients was the presence of dysphagia II–IV degree. The method of tunnel dissection in the submucosal layer of esophagus with dissection of the array of cryopharyngeal muscle and endoscopic esophagodiverticulostomy was used. Regardless of the version of endoscopic intervention, the key moment of the operation is the dissection of the cryopharyngeal muscle, which allows to eliminate the fold between diverticulum and esophagus, thus creating a fistula between diverticulum and esophagus.Results. Results of treatment were evaluated clinically, taking into account patients’ complaints and according to the control of X-ray fluoroscopy of esophagus. The patency of esophagus was objectively restored in all cases. Delays of the passage of contrast medium through the esophagus did not occur. Patients did not experience the difficulty in swallowing. Significant complications during the postoperative period were not noted.Conclusions. Endoscopic esophagodiverticulostomy in the treatment of Zenker’s diverticulum is the effective method of treatment. The operational injury is minimal, what reduces the length of stay in hospital. The peculiarity of the method of treatment allows using the early enteral nutrition. The minimally traumatic nature of endoscopic operation and the quickness of its performance allow applying this technique in weak patients, as well as in patients with concomitant pathology.

OBJECTIVE. The aim of the study is to demonstrate the effective surgical technique in the treatment of cicatricial strictures of the bile ducts. MATERIAL AND METHODS. The authors analyzed the surgical treatment of 18 patients with iatrogenic cicatricial damages of the bile ducts. The development of cicatricial strictures of the bile ducts was diagnosed in all 18 patients with iatrogenic damages of bile ducts after previously performed reconstructive operations. RESULTS. biliodigestive anastomoses on the exchangeable transhepatic drains were applied for 17 patients; Y-anastomosis were applied for 1 patient. biliodigestive anastomoses on the exchangeable transhepatic drains were applied for 2 patients of the 17 on the second stage in 3 months after external drainage of the hepatic ducts. Repeated scarring of the bile ducts and anastomosis had not been observing for the 5 years of observation. CONCLUSION. The choice of surgical tactics in treatment of cicatricial strictures of the bile ducts depends on the type of stricture. high strictures appears more often. The effective treatment of them is biliodigestive anastomoses on exchangeable transhepatic drains.

In-patient emergency department is a new division, being organized in medical units providing emergency care. In this country, its role and place within medical care system are not fully definite. Goal: to compare work of intensive care departments in hospitals providing care for emergency patients depending if an in-patient emergency department with the intensive care ward is available or absent. Materials. Summarized data on the patients admitted for emergency care to Dzhanilidze St. Petersburg Research Institute of Emergency Care (2010–2012) and Pavlov First Saint Petersburg State Medical University (2014–2016) where the in-patient emergency department is available. Results. Establishment of the in-patient emergency department with the intensive care ward results in the 2-fold reduction of patients' admission to the hospital intensive care department thus reducing the admission of patients with diseases beyond the hospital's specialization. Thus the excessive workload of the intensive care department personnel is reduced and care options are expanded since the duration of the patients' stay is increased while the number of beds remains the same. Conclusion: Adding the in-patient emergency department to the structure of a multi-specialty hospital allows changing the system of medical care, concentrating the efforts and funds on the treatment of patients with absolute indications for admission to the intensive care wards.

The article is devoted to the choice of antireflux procedure in surgery of gastroesophageal reflux disease. The mechanisms of the most popular antireflux operations are described. The criteria for selecting options of reconstructions gastroesophageal junction are presented in the article. The theoretical propositions are supported by the results of clinical observations.

The article presents an analysis of 34.903 esophagoscopy results performed for population of Leningrad region at the period from 2007 to 2013. A prevalence of erosive esophagitis was 4,9%, peptic strictures - 0,18%, columnar-celled metaplasias - 1,43% and esophageal adenocarcinoma - 0,645%. The data obtained showed a high prevalence of GERD-associated syndromes with injury of mucous coat of esophagus in the local population of Russians.

The article presents an analysis of results of 24 384 endoscopic examinations of the upper gastrointestinal tract in population of the Leningrad oblast with symptoms of gastric dyspepsia during the period from 2007 to 2011. The detection of the columnar-celled metaplasia was 1.1%, adenocarcinoma of the esophagus — 0.045%. Esophageal adenocarcinoma occurred in 3.95% of cases of the column-celled esophagus. Barrett’s esophagus was revealed in males more often than in women (56.5% and 54.5% respectively). The peak incidence of esophageal adenocarcinoma in males was at the age from 46 to 60 years (36.4% of patients), in females — from 61 to 75 years (27.3% of patients). Intestinal metaplasia was detected in 72.7% of cases with esophageal adenocarcinoma. The diagnosis of long and short segment of column-celled esophagus revealed no significant difference in the development of esophageal adenocarcinoma.

The number of patients with severe liver failure awaiting transplantation is increasing steadily. The shortage of donor organs, in turn, leads to long waiting time for liver transplants and increases the likelihood of decompensation and progression of the disease, significantly increasing the proportion of urgent patients on the waiting list for liver transplantation. This article presents a clinical case report of a successful multistage surgical and therapeutic treatment of complications in a patient before and after liver transplantation. In the early postoperative period, the recipient of the liver from a deceased donor underwent the debridement of the aortic root and the aortic valve replacement for the treatment of acute infective endocarditis, with the immunosuppressive therapy being discontinued for 3 weeks without a deterioration of the graft function.

The article presented here as a Program lecture of the Rector of the First Saint-Petersburg State Medical University n.a. acad. I.P. Pavlov highlights the key problems of modern organ transplantation, and explores the main challenges for medical professional education in this context.

OBJECTIVE. The authors aimed to develop complex perfusion medical device in order to successfully maintain viability of donor liver until transplantation. MATERIAL AND METHODS. Experimental perfusion device for normothermic perfusion donor’s liver was developed and tested in the Central Research and Experimental-design Institute of Robotics and Technical Cybernetics. RESULTS. The pre-clinical tests were performed on porcine liver. It was demonstrated that normothermic machine perfusion could restore liver function after 30 minutes of warm ischemia time and provide normalization of biochemical parameters of organ functioning.

OBJECIVE. The authors would like to design an original device for aerosol laparoscopic chemotherapy and propose the most effective and safe mode. MATERIALS AND METHODS. The experimental and clinical studies were carried out and included 6 series. Male rabbits (n=71) were used for experimental part and the method was applied on 4 patients in clinical part. RESULTS. The original device and the effective mode of its application were developed for aerosol laparoscopic chemotherapy. The supposed method of chemotherapy appeared to be more effective than the standard method. There weren’t noted any complications or side effects. The method proved its safety. CONCLUSIONS. The aerosol laparoscopic intraperitoneal chemotherapy using the proposed regime is the effective and safe method of peritoneal carcinomatosis treatment.

The colon microflora was investigated by PCR method in real time before and after planned operation in 38 patients with colon cancer. A multifactor analysis showed absence of statistically significant dependence of revealed changes in microflora from sex, age of patients, volume and method of surgery, presence of tumor stenosis and infiltrate. An anaerobic imbalance was often registrated in postoperative period, especially after antibiotic prophylaxis and therapy. Clostridium difficile and Clostridium perfringens were often detected in patients with tumor of the right part of colon (p

The article is dedicated to the issue of intoxication in children. Acute accidental intoxication appears to be especially relevant for pediatric practice. Drugs, various chemicals frequently used in everyday life and in farming, as well as animal poisons, including snake poisons, may have a toxic effect on children. Specialists of professional associations of physicians “Russian Society of Emergency Medicine” and pediatricians “Union of Pediatricians of Russia” formulated and briefly described the main causes of acute intoxication in children, clinical manifestations and the most significant laboratory indicators of toxic manifestations for various substances, as well as therapy principles and algorithms for such conditions in compliance with principles of the evidence-based medicine. The article presents pathognomonic symptoms and peculiarities of drug intoxication, provides a description of mediator symptoms of intoxication with various substances, as well as the symptoms that may indicate toxic effect. The article contains a description of principles of correction of vital body functions, measures for removing toxic substances from the body and information on the main antidotes. Special attention is given to the most frequent types of intoxication (with organic acids, lye, naphazoline, paracetamol, snake poisons [viper bite]). The article lists stage of medical care rendering to children suffering from acute intoxication and presents prognosis and further management of pediatric patients suffering from such conditions.

The article presents the assessment results of efficacy of modern bariatric laparoscopic operation during 10 years of practice. This work analyzed the treatment results of 1018 operated patients at the period from 2007 to 2014. The laparoscopic regulated gastric bandage operation was performed in 275 (28, 8%) cases. The lapa roscopic longitudinal gastric resection (LLGR) was applied in 411 (43,1%) (231 operation used the developed modification and 180 used standard method). The laparoscopic gastric bypass surgery (LGBS) was carried out in 253 (26,5%) cases (56 used the developed modification and 197 used the Lontron modification). The laparoscopic biliopancreatic bypass surgery (LBBS) was made in 14 (1,4%) cases (11 used Hess Marceau Baltasar modifications and 2 - Fobi modification, 1 - Scopinaro operation). BIB was implanted in 65 (6,3%) cases. The diagnosis of metabolic syndrome had initially been established for 321 (31,5%) patients. The rest of the patients 697 (68,4%) have been operated for obesity of different degree. An initial body mass index (BMI)

The article analyzes the experience of application of polymeric (mesh) implants for hiatal closure in patients with gastroesophageal reflux disease (GERD). The authors showed the main principles of the choice of mesh implants and recommendations to their usage. Principal technical stages of surgery are described. It is noted, that the application of prostheses had the high efficiency and safety in antireflux surgery.