[Treatment of colorectal cancer complicated by intestinal bleeding in a patient with multivessel coronary artery disease and degenerative aortic valve disease]. / Lechenie kolorektal'nogo raka, oslozhnennogo kishechnym krovotecheniem u bol'nogo IBS i aortal'nym porokom serdtsa.

The aim of the presented clinical observation is to demonstrate a multidisciplinary approach in the treatment of a comorbid patient with complicated colorectal cancer, multivessel coronary artery disease, degenerative aortic valve disease and chronic heart failure. The authors presented a clinical case of treatment of a patient with ischemic heart disease, postinfarction cardiosclerosis (acute myocardial infarction from 1990), hemodynamically significant intestinal bleeding, the source of which was cancer of the descending colon. Comprehensive examination revealed moderately differentiated (G2) adenocarcinoma of the descending colon cT3N1M0, stage IIIB, in combination with multivessel coronary artery disease and degenerative aortic heart disease with a predominance of stenosis (pressure gradient: Pg max - 94 mm Hg, Pg mean - 68 mm Hg) and the development of aortic valve insufficiency. Taking into account the results of the examinations, the patient is indicated for myocardial revascularization and aortic valve replacement, which implied the subsequent long-term use of anticoagulants, but this increased the risk of recurrence of fatal colonic bleeding. At the same time, performing the operation to remove the source of recurrent bleeding according to all oncological principles had high risks of cardiovascular complications intraoperatively and in the immediate postoperative period. In this regard, after an objective assessment of all perioperative risks, it was decided to simultaneously perform direct myocardial revascularization, aortic valve replacement and extended left-sided hemicolectomy with extended lymphadenectomy. The patient is monitored at the Moscow State Clinical Hospital named after S.S. Yudin after the operation for 2 years, there is no data for the progression of the oncological process. Thus, a favorable outcome in this patient was determined by a multidisciplinary approach - performing a simultaneous operation on a comorbid patient.

Predictors of Chronic Thromboembolic Pulmonary Hypertension.

PURPOSE: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). MATERIAL AND METHODS: We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning.   Examination also included echocardiography. RESULTS: In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, post-infarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

[Evaluation of the effectiveness of various protocols of antibiotic prophylaxis and therapy in pancreatic necrosis]. / Otsenka éffektivnosti razlichnykh rezhimov antibakterial'noi profilaktiki i terapii pri pankreonekkroze.

The efficiency of various protocols of antibiotic prophylaxis and therapy (APT) used in 63 patients with pancreonecrosis is analyzed. Early treatment with carbapenemes is the most effective in disseminated infectious pancreonecrosis requiring obligatory surgical treatment. Drug efficiency is the key factor in choosing APT for intensive care of patients with destructive pancreatitis.