[Iron deficiency anemia in a patient with hereditary hemorrhagic telangiectasia. Case report].

Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease. It is characterized by vascular dysplasia with the formation of telangiectasias on the skin, mucous membranes of the respiratory and digestive tracts, arteriovenous malformations (AVMs) in the internal organs, which is manifested by bleeding. Diagnosis is based on Curacao criteria: recurrent and spontaneous nosebleeds, multiple telangiectases on the characteristic localizations, AVMs in one or more of the internal organs, a family history of HHT (i.e. first-degree relative who meets these same criteria for definite HHT). Therapy is aimed at preventing and stopping gastrointestinal, nosebleeds, correction of iron deficiency anemia. A promising method of therapy is the use of angiogenesis inhibitors, in particular bevacizumab. The article presents a description of a clinical case of HHT in a 49-year-old woman with telangiectisia on the mucous membrane of the tongue, gastrointestinal tract and liver AVMs.

[Complex surgical treatment of patients with necrotic soft tissue infections]. / Kompleksnoe khirurgicheskoe lechenie patsientov s nekroticheskimi infektsiyami myagkikh tkanei.

OBJECTIVE: To develop an optimal algorithm for complex treatment of patients with necrotic soft tissue infections (NSTI). MATERIAL AND METHODS: The study included 114 patients with NSTI who were treated between 2016 and 2021. We analyzed treatment outcomes in 2 groups: retrospective (n=43) with traditional approaches to purulent surgery (drainage of necrotic foci, local therapy with iodophores and water-soluble ointments, antibacterial and detoxification therapy, delayed skin grafting) and prospective (n=71) with active surgical treatment and modern algorithm based on a differentiated approach and high-tech methods (vacuum therapy, hydrosurgical treatment of wounds, early skin grafting and extracorporeal hemocorrection). RESULTS: The main group was characterized by shorter phase I of the wound process by 7.1±2.1 days, earlier relief of symptoms of systemic inflammatory response by 4.2±1.4 days, shorter hospital-stay by 7.7±2.2 days and lower mortality by 15%. CONCLUSION: Early surgery and integrated approach including active surgical strategy, early skin grafting and intensive care with extracorporeal detoxification are necessary to improve the outcomes in patients with NSTI. These measures are effective to eliminate purulent-necrotic process, reduce mortality and hospital-stay.

[Nasointestinal intubation in the treatment of acute adhesive small bowel obstruction]. / Nazointestinal'naya intubatsiya v lechenii ostroi spaechnoi tonkokishechnoi neprokhodimosti.

Proximal gastrointestinal decompression is essential in the treatment of acute adhesive small bowel obstruction. Improvement of endoscopic methods, surgical instruments and radiological methods of control makes it possible to timely assess lavage and intra-intestinal therapy. The review presents current views on upper gastrointestinal decompression and other options for the treatment of adhesive small bowel obstruction.

[New approaches in conservative treatment of acute adhesive small bowel obstruction]. / Novye podkhody v konservativnom lechenii ostroi spaechnoi tonkokishechnoi neprokhodimosti.

OBJECTIVE: To improve the outcomes of therapy of acute adhesive small bowel obstruction via development of a comprehensive management including CT, deep endoscopy-assisted nasointestinal drainage of small bowel with injection of a water-soluble contrast. MATERIAL AND METHODS: There were 128 patients with acute adhesive small bowel obstruction for the period from 2015 to 2018. The study included 2 groups of patients depending on therapeutic approach and duration of treatment. In the first group, conventional approach for acute adhesive small bowel obstruction was applied. Upon admission, all patients with confirmed acute adhesive small bowel obstruction underwent gastric intubation for decompression of the upper gastrointestinal tract. Barium sulfate injection followed by X-ray examination was performed to assess an effectiveness of therapy. In the second group, computed tomography was performed in addition to X-ray examination and ultrasound. Moreover, conservative treatment included deep endoscopy-assisted nasointestinal drainage and subsequent administration of a water-soluble contrast in addition to traditional approaches. RESULTS: Therapy was effective in 99 (71.2%) patients; 39 (28.8%) ones required surgery. Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast was effective in 45 (78.9%) patients. Overall mortality in traditional approach was 1.4%, postoperative mortality - 3.7%. There were no lethal outcomes in case of a new approach. CONCLUSION: Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast is the most effective therapeutic method for acute adhesive small bowel obstruction (78.9%). These findings can significantly improve treatment outcomes in these patients.

[Optimal time of surgery for acute adhesive small bowel obstruction]. / Vybor sroka operativnogo lecheniia pri ostroi spaechnoi tonkokishechnoi neprokhodimosti (mul'titsentrovoe prospektivnoe randomizirovannoe issledovanie).

AIM: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction. MATERIAL AND METHODS: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience. RESULTS: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.

[Laparoscopic diagnosis and treatment of acute early adhesive intestinal obstruction].

AIM: To estimate the role of emergency laparoscopic interventions in diagnosis and treatment of acute early adhesive intestinal obstruction. MATERIAL AND METHODS: It is presented the results of diagnostic and curative laparoscopic interventions in 58 patients with suspected acute early adhesive intestinal obstruction after abdominal surgery. Complex clinical-instrumental, non-invasive diagnosis does not always reveal this complication in early postoperative period. Diagnostic laparoscopy was the most informative method to assess state of abdominal cavity, to establish and characterize acute early adhesive intestinal obstruction, to determine following treatment and choice of surgery in all patients. RESULTS: Diagnosis of intestinal obstruction was not confirmed in 15 (25.9%) patients based laparoscopic checkup. Acute early adhesive intestinal obstruction was established in 43 (74.1%) patients. Small intestine injuries were observed in 2 (4.5%) cases during laparoscopy. Contraindications to laparoscopic treatment of obstruction were determined in 18 (41.9%) patients in whom conventional operations were performed with complications and death in 7 (38.8%) and 3 (16.6%) cases respectively. Curative laparoscopy was applied in 23 (53.4%) patients with successful resolving of intestinal obstruction and complications in 19 (82.7%) and 4 (17.4%) cases respectively.

[Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery].

It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient.