[Influence of diagnostic period on the outcomes in patients with Crohn's disease]. / Vliyanie dlitel'nosti diagnosticheskogo poiska na iskhod zabolevaniya pri bolezni Krona.

OBJECTIVE: To analyze archival data on emergency hospitalization of patients with Crohn's disease, indications for surgical treatment, structure of surgeries, localization of gastrointestinal lesions and relationship between diagnostic period and surgical treatment. MATERIAL AND METHODS: A retrospective analysis of medical records of patients with Crohn's disease in 3 large hospitals was performed over the past 6 years. We estimated cases of surgical treatment, localization of gastrointestinal lesions, clinical and laboratory parameters of patients, period between clinical manifestation and diagnosis, as well as outcomes of disease depending on duration of diagnostic searching. CONCLUSION: Duration of diagnostic searching in patients with Crohn's disease is a significant predictor of complications and surgical treatment.

[The place of ciclosporin A cationic emulsion 0.1% in the therapy of xerophthalmia]. / Mesto kationnoi emul'sii tsiklosporina A 0,1% v terapii kseroftal'mii.

Dry eye disease (DED) is pathogenetically based on inflammation of the ocular surface. A step-by-step approach to DED treatment involves early initiation of anti-inflammatory therapy, including instillation of cyclosporine A (CsA). However, recommendations for the use of topical CsA in clinical practice are limited. This article presents an expert consensus on practical recommendations for the management of patients with DED, including indications, time of initiation and duration of CsA therapy, comparison of CsA forms currently registered in the Russian Federation, as well as issues of patient education.

[Modern principles of safety in laparoscopic cholecystectomy]. / Sovremennye printsipy bezopasnosti pri vypolnenii laparoskopicheskoi kholetsistektomii.

Laparoscopic cholecystectomy has many advantages over open surgery. Nevertheless, incidence of intraoperative bile duct injury is consistently higher for laparoscopic technique. This review is devoted to modern principles of identifying the anatomical elements in hepatoduodenal ligament and rules for safe tissue dissection in this area. The last ones mainly consist in formation of «critical view of safety¼ before clipping and transection of tubular structures. The key for «critical view of safety¼ is mobilization of fatty and fibrous tissues of hepatocystic triangle starting from the lower third of the gallbladder.

[Severe pseudomembranous colitis in patients with previous coronavirus infection]. / Psevdomembranoznyi kolit na fone perenesennoi koronavirusnoi infektsii.

OBJECTIVE: To analyze treatment outcomes in patients with severe pseudomembranous colitis and previous coronavirus infection. MATERIAL AND METHODS: We retrospectively analyzed treatment outcomes, clinical, laboratory and histological data in convalescents of COVID-19 who admitted to the department of coloproctology for moderate-to-severe pseudomembranous colitis confirmed by endoscopic examination between 2020 and 2021. RESULTS: There were 13 patients with moderate pseudomembranous colitis and 6 ones with severe pseudomembranous colitis. Mean period after recovery from coronavirus infection was 19 days. Endoscopy revealed whitish-yellow or gray raised plaques on colonic mucosa in all cases. Four patients with signs of peritonitis underwent emergency surgery. Three patients had perforation of caecum; one patient had perforation of sigmoid colon and widespread peritonitis. Two patients underwent urgent surgery for progressive toxic megacolon and ineffective therapy. Subtotal colectomy and ileostomy were performed in all cases. Histological examination revealed necrosis of not only superficial layer of colon mucosa typical for clostridial colitis, but also the entire thickness of mucosa, as well as submucosal and partially muscular layers in some cases. Mucosal crypt atrophy, fibrinoid effusion in muscular layer, diffuse polymorphonuclear cell infiltration and necrosis of muscular and submucosal nerve plexuses, as well as necrosis of vascular walls with deposition of hyaline-like structures characterize microcirculatory ischemic processes in the colon wall. CONCLUSION: Severe pseudomembranous colitis associated with COVID-19 may not be associated with clostridial infection. Further analysis of possible ischemic etiology and pathogenesis of gastrointestinal lesions in COVID-19 is needed for preventive and therapeutic measures.

[The Capsule Endoscopy Crohn's Disease Activity Index, clinical activity and fecal calprotectin level in patients with isolated small intestine lesions]. / Vzaimosvyaz' endoskopicheskoi aktivnosti, klinicheskoi aktivnosti bolezni Krona i urovnya fekal'nogo kal'protektina.

OBJECTIVE: To identify a correlation between diagnostic markers of Crohn's disease and endoscopic data using the Capsule Endoscopy Crohn's Disease Activity Index for isolated small intestine lesions. MATERIAL AND METHODS: We studied 127 patients over previous 19 years. All patients were divided into 2 groups: isolated Crohn's disease of small intestine (group 1) and lesion of small and large intestine or large intestine only (group 2). All patients underwent capsule enteroscopy (MiroCam system, South Korea). Clinical activity of Crohn's disease was determined using the Best's scale, endoscopic activity - using the the Capsule Endoscopy Crohn's Disease Activity Index. We also analyzed fecal calprotectin and other laboratory markers. RESULTS: We found moderate correlation between fecal calprotectin and clinical activity of Crohn's disease, as well as endoscopic activity, C-reactive protein and leukocytes in overall sample of patients. There was moderate correlation between endoscopic activity and clinical activity in overall sample of patients. We found no correlation between fecal calprotectin and endoscopic activity, endoscopic activity and clinical activity, endoscopic activity and C-reactive protein and leukocytes in patients with isolated small bowel disease. Isolated small intestine lesion is accompanied by significantly lower level of fecal calprotectin compared to lesion of small and large intestine. CONCLUSION: In isolated small intestine lesion, endoscopic data do not correlate with clinical symptoms and fecal calprotectin level. Thus, analysis of severity of disease using the Crohn's Disease Clinical Activity Scale alone and fecal calprotectin may not always be effective for isolated small bowel lesion.

[Isolated lesion of the optic nerve and retina as a relapse of MALT lymphoma transforming into diffuse B-large cell lymphoma]. / Izolirovannoe porazhenie zritel'nogo nerva i setchatki kak proyavlenie retsidiva MALT-limfomy s transformatsiei v diffuznuyu B-krupnokletochnuyu limfomu.

Neuroleukemia is a severe complication of hemoblastosis, which manifests as lymphoblastic lesions of the brain and cranial nerves. Isolated damage to one of the cranial nerves is rare. The diagnosis is based on the results of ophthalmoscopy, magnetic resonance imaging of the orbits, and lumbar puncture. Literature describes isolated cases of retinal and/or optic nerve damage in the absence of blast cells in the spinal fluid. These are the most difficult situations for timely diagnosis of neuroleukemia. The article describes a patient with MALT lymphoma transformed into diffuse B-large cell lymphoma manifesting as leukemic infiltration of the optic nerve and retina without brain damage and absence of blast cytosis in the spinal fluid. The diagnosis of neuroleukemia was established based on the results of cytological examination of the punctate of the infiltrated peripapillary retina and confirmed by regression of changes in the fundus against the background of antitumor treatment. The vital prognosis for patients with neuroleukemia is unfavorable. However, early diagnosis of leukemic infiltration of the optic nerve and/or retina can restore visual acuity of the affected eye and significantly improve the quality of life.

[Risk factors of local infection after cholecystectomy and criteria of smooth postoperative period]. / Faktory riska razvitiya infektsii oblasti khirurgicheskogo vmeshatel'stva posle kholetsistektomii i opredelenie kriteriev normal'nogo techeniya posleoperatsionnogo perioda.

OBJECTIVE: To identify the criteria of smooth postoperative period after cholecystectomy and risk factors of local surgical infection. MATERIAL AND METHODS: A prospective analysis included 680 patients after laparoscopic cholecystectomy. We assessed incidence and risk factors of infectious complications. Major markers of acute inflammation, ultrasonic features of surgical site in early postoperative period were analyzed. RESULTS: Postoperative infectious complications developed in 35 patients (5.1%). All studied risk factors except an age (obesity, cardiorespiratory diseases, surgery time over 150 min, violation of the principles of antibiotic therapy, intraoperative blood loss over 50 ml, drainage time over 5 days) significantly affected the development of infectious complications. Surgery time over 150 min and violation of the principles of antibiotic therapy were the most significant factors. Serum procalcitonin, erythrocyte sedimentation rate and C-reactive protein were characterized by the highest prognostic value on the 3rd postoperative day. Threshold values were defined. CONCLUSION: Surgery time and violation of the rules of antibiotic prophylaxis were the most significant risk factors of postoperative infectious complications. We determined the criteria of smooth postoperative period: procalcitonin <1.5 mg/l, C-reactive protein <50 mg/l, erythrocyte sedimentation rate <39 mm/h, ultrasonic pattern of hypoechoic accumulation within the bed of the bladder (dimension <10 mm) without signs of intestinal insufficiency, abdominal or subhepatic effusion on the 3rd day after surgery.

[Redo surgery after laparoscopic fundoplication]. / Povtornye operatsii posle laparoskopicheskikh fundoplikatsii.

OBJECTIVE: To analyze the results of redo surgeries after previous laparoscopic fundoplication. MATERIAL AND METHODS: A retrospective analysis included 37 repeated anti-reflux surgeries. Control group consisted of 38 patients after the first anti-reflux surgery performed on the same clinical base. The causes of unsatisfactory results of the first operations were studied. Intraoperative data, immediate and long-term results of surgical treatment were compared in both groups. Quality of life in both groups was studied before surgery and in long-term period using GIQLI questionnaire. RESULTS: The most common cause of recurrent reflux was a hernia recurrence combined with slipping or destruction of the fundoplication cuff. Dysphagia was usually a result of compression of the esophagus by tightly sutured diaphragmatic crura and recurrent paraesophageal hernia. The main group was characterized by significantly greater surgery time, hospital-stay, incidence of intraoperative and postoperative complications. However, a more significant improvement of quality of life (∆GIQLI) was observed in the main group due to the low QOL index before redo surgery. CONCLUSION: Redo surgeries are effective and safe procedures. These operations significantly improve QOL in long-term period despite certain technical difficulties. Repeated surgeries for dysphagia accounted for 2%, for recurrent reflux - 6%. Persistent postoperative dysphagia is usually associated with diaphragm repair rather fundoplication cuff. Reflux recurrence is often caused by cuff slippage and recurrent hernia.

[Combination therapy in patients with concomitant macular edema and proliferative diabetic retinopathy]. / Kombinirovannaia terapiia pri sochetanii makuliarnogo oteka i proliferativnoi diabeticheskoi angioretinopatii.

Diabetic macular edema (DME) is a serious complication of diabetic retinopathy. Numerous multicenter studies of the effectiveness of various treatment methods for DME do not give unambiguous recommendations for the treatment of refractory DME, and combinations of various forms of therapy continue to be actively studied. PURPOSE: To study the effectiveness of the combination of intravitreal administration of the drug Ozurdex with subsequent individually selected laser therapy in the treatment of the proliferative stage of diabetic retinopathy in patients with concomitant chronic DME, and its relationship with morphological changes in the retina observed with optical coherence tomography. MATERIAL AND METHODS: This retrospective study included 18 patients with insulin-requiring type II diabetes mellitus complicated by diabetic retinopathy in the proliferative stage and refractory DME. According to morphological changes observed with optical coherence tomography of the retina, the patients were divided into 3 groups: 6 patients with diffuse macular edema, 6 patients with cystic macular edema, and 6 patients with serous detachment of the retinal neuroepithelium. All patients underwent intravitreal injection of 0.7 mg Ozurdex followed by panretinal laser coagulation. The choice of laser applicates with the minimal parameters giving a therapeutic effect was carried out according to the procedure described previously (Patent No. RU2611887C1 d.d. 12/25/2015). RESULTS: The combination of intravitreal administration of Ozurdex followed by individually selected laser coagulation is effective against various morphological types of DME. However, the greatest visual acuity was achieved in patients with diffuse macular edema and retinal neuroepithelial detachment. CONCLUSION: The higher the initial visual acuity, the better the functional outcomes of the treatment. Baseline retinal thickness did not affect the effectiveness of the proposed method of treatment. Cystic macular edema was an unfavorable prognostic factor for improving visual acuity.

[Uveal schwannoma mimicking melanoma (case report)].

The article presents a rare clinical case of intraocular schwannoma localized in the pre-equatorial choroidea and the pars plana and complicated by secondary glaucoma. Prolonged course of the disease and the presence of scleral staphyloma allowed to assume benign nature of the tumor. Enucleation was performed due to painful secondary glaucoma. Histological examination of the enucleated eye revealed a choroidal schwannoma. Despite the absence of pathognomonic signs and rare occurence, the possibility of intraocular schwannoma must be kept in mind when examining patients for uveal melanoma.

[Effect of Mn(II) on the error-prone DNA polymerase iota activity in extracts from human normal and tumor cells].

The DNA polymerase iota (Pol iota), which has some peculiar features and is characterized by an extremely error-prone DNA synthesis, belongs to the group of enzymes preferentially activated by Mn2+ instead of Mg2+. In this work, the effect of Mn2+ on DNA synthesis in cell extracts from a) normal human and murine tissues, b) human tumor (uveal melanoma), and c) cultured human tumor cell lines SKOV-3 and HL-60 was tested. Each group displayed characteristic features of Mn-dependent DNA synthesis. The changes in the Mn-dependent DNA synthesis caused by malignant transformation of normal tissues are described. It was also shown that the error-prone DNA synthesis catalyzed by Pol iota in extracts of all cell types was efficiently suppressed by an RNA aptamer (IKL5) against Pol iota obtained in our work earlier. The obtained results suggest that IKL5 might be used to suppress the enhanced activity of Pol iota in tumor cells.

[Initial experience of treatment of primary intraocular lymphomas associated with primary CNS lymphomas].

Methods of diagnostics of primary intraocular lymphomas associated with primary CNS lymphomas are described. This article demonstrates the value of neurophtalmological assessment before surgery in patients with intracranial space occupying lesions. Three cases with bilateral primary intraocular lymphomas are presented. Authors analyzed initial results of intraocular lymphomas treatment with intravitreal methotrexate injections.

[Enucleations in uveal melanoma (analysis of archival records)].

The paper analyzes outpatient cards of 415 patients who underwent enucleation for uveal melanoma (UM) in 1962-2008 and who have been registered in the Moscow City Ophthalmology Center since 1990. The patients' mean age was 58.94 +/-1.29 years. During the follow-up, 56 patients died 5.24 +/- 1.84 years postoperatively. The distribution of UM by the histological types was as follows: spindle cell (n = 275; 66.27%); mixed cell (n = 100; 24.09%), and epithelioid cell (n = 26; 6.27%) UM. Eleven (2.65%) patients were diagnosed as having necrotic melanoma. Poor (preequatorial and juxtapapillary) position was observed in 35.4% of the patients. Mortality in patients with UM after enucleation was 14.44% with a life expectancy of 5.24 +/- 1.84 years. The findings make it possible to recommend that an enucleation procedure should be developed, by concurrently forming a locomotor stump, which promotes the improvement of the results of individual cosmetic prosthetics in patients with UM that is not to undergo organ-saving treatment.

Effect of human cell malignancy on activity of DNA polymerase iota.

An increased level of mutagenesis, partially caused by imbalanced activities of error prone DNA polymerases, is a key symptom of cell malignancy. To clarify the possible role of incorrect DNA polymerase iota (Pol iota) function in increased frequency of mutations in mammalian cells, the activity of this enzyme in extracts of cells of different mouse organs and human eye (melanoma) and eyelid (basal-cell skin carcinoma) tumor cells was studied. Both Mg2+, considered as the main activator of the enzyme reaction of in vivo DNA replication, and Mn2+, that activates homogeneous Pol iota preparations in experiments in vitro more efficiently compared to all other bivalent cations, were used as cofactors of the DNA polymerase reaction in these experiments. In the presence of Mg2+, the enzyme was active only in cell extracts of mouse testicles and brain, whereas in the presence of Mn2+ the activity of Pol iota was found in all studied normal mouse organs. It was found that in cell extracts of both types of malignant tumors (basal-cell carcinoma and melanoma) Pol iota activity was observed in the presence of either Mn2+ or Mg2+. Manganese ions activated Pol iota in both cases, though to a different extent. In the presence of Mn2+ the Pol iota activity in the basal-cell carcinoma exceeded 2.5-fold that in control cells (benign tumors from the same eyelid region). In extracts of melanoma cells in the presence of either cation, the level of the enzyme activity was approximately equal to that in extracts of cells of surrounding tumor-free tissues as well as in eyes removed after traumas. The distinctive feature of tissue malignancy (in basal-cell carcinoma and in melanoma) was the change in DNA synthesis revealed as Mn2+-activated continuation of DNA synthesis after incorrect incorporation of dG opposite dT in the template by Pol iota. Among cell extracts of different normal mouse organs, only those of testicles exhibited a similar feature. This similarity can be explained by cell division blocking that occurs in all normal cells except in testicles and in malignant cells.

[Malignant (non-Hodgkin's) lymphoma of the organ of vision].

Based of their experience and analysis of the papers available in the medical literature, the authors describe the clinical picture of malignant lymphomas of the organ of vision. They give a concept of the current classification of lymphomas and information on the specific features of their course, by taking into account the site of the process (eyelids, conjunctiva, intraocular and orbital regions) and present recommendations on their treatment.

[Association between high activity of DNA polymerase iota and the development of human uveal melanoma].

Enzymatic activity of DNA polymerase iota (Pol t) was analyzed in human uveal melanoma cell extracts, using an earlier elaborated approach. The Pol t activity was observed in seven out of eight malignant tumors, while it was absent in the normal uveal tract cells of the same patients. These findings serve as an additional confirmation of the Pol t oncogenic potential.

[Histiocytic lesions of the orbit and eye appendages]. / Gistiotsitarnye porazheniia orbity i pridatkov glaza.

2 cases of sinus histiocytosis with massive lymphadenopathy are reported. The disease belongs to non-neoplastic lesions associated with proliferation of histiocytes with antigen-treating function. A case of sarcoma is also described. It consisted of follicular dendritic cells related to histiocytes with the antigen-representing function.

[Lymphoproliferative diseases of the orbit and appendages of the eye]. / Limfoproliferativnye zabolevaniia orbity i pridatochnogo apparata glaza.

The results are available of clinical, morphological, cytological and immunological investigations of orbital lymphomas and lymphomas of appendages of the eye. Malignant lymphoma was detected in 17 patients and reactive lymphoid hyperplasia in 3 patients. All the malignant lymphomas had B-cell phenotype. By cell composition, MALT-lymphoma is more polymorphic than lymphoma from mantle zone cells and lymphoma from small lymphocytes and centro follicular lymphoma. The conjunctive is affected primarily with lymphoma from marginal zone cells or mantle zone cells. As a rule, this is a primary local lesion. Other variants of orbital lymphoma and lymphoma of the eye appendages develop more often as secondary lesions in systemic disease and are characterized by more aggressive course. The key in differential diagnosis of reactive lymphoid hyperplasia and small cells lymphomas is immunophenotyping, especially at initial stages of the tumor process.

[The characteristics of the clinical picture of lymphosarcoma and of a metastatic tumor of the orbit of another origin]. / Osobennosti klinicheskoi kartiny limfosarkomy i metastaticheskoi opukholi orbity drugogo geneza.

Clinical symptoms in patients with primary orbital lymphosarcoma, generalized lymphosarcoma involving the orbital tissues, and metastatic tumors of the orbit of another origin are analyzed. The orbital process has bee studied in 158 patients. The most frequent symptoms were ptosis and exophthalmos. Decreased visual acuity, pain, sensation of swelling in the orbit caused by rapid tumor growth were characteristic of metastases to the tumor and orbital lymphosarcoma in total system's involvement. In case of an isolated involvement of the orbit, lymphosarcoma ran a more swift course than metastases to the orbit and orbital lymphomas in systemic involvement which ran an aggressive course. These data cannot serve as differential diagnostic signs. The decisive information is provided by morphological examination of a biopsy specimen.

[Possibilities of ultrasound biometry in the differential diagnosis of early melanomas and nevi of the choroid]. / Vozmozhnosti ul'trazvukovoi biometrii v differentsial'noi diagnostike nachal'nykh melanom i nevusov khorioidei.

The authors analyse the results of echobiometry carried out in 21 patients with choroid nevi and in 8 patients with primary melanomas of the choroid, administered no treatment for this or that reason. Nevi with a prominence of less than 1 mm were found to be the most incident, and their elevation did not increase over the course of the follow-up. Only in two patients with nevi these formations were found elevating, this corresponding with the manifestation of clinical signs of primary melanoma. The tumor progress was clearly seen in the patients with primary melanoma of the choroid, it was permanently elevating.