[Surgery for complicated accessory lobe of the azygos vein]. / Khirurgiya oslozhnennoi dobavochnoi doli neparnoi veny.

Congenital anomalies of respiratory system are quite diverse and not all of them are subject to surgical treatment. One example is accessory lobe of the azygos vein. This anomaly usually has no clinical manifestations and requires only follow-up, as well as attention in surgery on the right half of the chest for some other disease. This situation changes when complications occur, for example, purulent-inflammatory process. Therapy is not always effective, and lung tissue destruction requires surgical treatment. Progressive destruction complicates diagnosis and choosing surgical tactics. We present a rare case of severe purulent-inflammatory complication with abscess in accessory lobe of v. azygos. Anatomical abnormalities following this congenital pulmonary anomaly can cause difficulties in surgeries for other intra-thoracic diseases. The situation is especially relevant for thoracoscopic access. This report will be useful for radiologists, pulmonologists and thoracic surgeons.

[Hemodynamics in the right gastroepiploic artery and its practical application]. / Formula gemodinamiki pravoi zheludochno-sal'nikovoi arterii i ee prakticheskoe primenenie.

OBJECTIVE: To study functional anatomy of the right gastroepiploic artery (RGEA), its gastric and omental branches and practical significance of these anatomical features. MATERIAL AND METHODS: We analyzed 20 cadaveric organ complexes (11 men and 9 women, aged 49-85 years) between 2018 and 2019. The organ complexes consisted of the stomach, proximal duodenum and large omentum. RGEA catheterization at the level of pylorus was followed by selective real time angiography. We assessed the following parameters of RGEA: total length, diameter at the level of pylorus, number and diameter of gastric and omental branches. To objectify the study, we visually divided RGEA into 5 equal segments between pylorus and the last branch arising from this artery. RESULTS: The RGEA looks like a gradually and evenly narrowing tube. Mean diameter of the artery at the level of pylorus was 2.2±0.68 mm, mean length - 23.6±3.7 cm. Mean number of gastric and omental branches was 16.2±4.8 and 8.6±2.6, respectively. The number of gastric branches in the distal part of the RGEA increased, while the diameters of the gastric branches did not significantly differ. The number of gastric branches in distal RGEA increased, while diameters of gastric branches were similar. The greatest number of omental branches with the largest diameter was observed in the 2nd and 3rd segments of the artery. Considering these data, we formulated the equation for RGEA hemodynamics and developed the technique for optimal blood supply to proximal part of the gastric transplant during esophagogastroplasty. CONCLUSION: Anatomical features of the right gastroepiploic artery can be used in reconstructive surgery of abdominal cavity and chest.

[Platelet variation coefficient and its prognostic value in acute pancreatitis]. / Koeffitsient variatsii trombotsitov i ego prognosticheskoe znachenie pri ostrom pankreatite.

OBJECTIVE: To evaluate the role of platelet variation coefficient in prediction of severity of acute pancreatitis (AP). MATERIAL AND METHODS: The study included 90 patients with AP who admitted to the Tula City Emergency Hospital between 2018 and 2019. Patients had no signs of renal and hepatic insufficiency, cancer, blood diseases, inherited platelet disorders, previous splenectomy, antiplatelet and anticoagulant therapy. Mortality of patients with mild-to-moderate AP was 0%, severe pancreatic necrosis - 5.26%, extremely severe pancreatic necrosis - 92.3%. We analyzed the number and volume of platelets, thrombocytocrit and volume-adjusted distribution of platelets. All parameters were assessed after 1, 3, 7, 14, 21, 28 and 35 days. RESULT: There was a significant correlation between AP severity and the number, volume and volume-adjusted distribution of platelets. Reduced platelet count, enlarged cells and heterogeneous volumes of platelets indicate severe course of pancreatitis. Identification of these changes as early as 3 days of disease is of great clinical importance. Platelet variation coefficient (PVC) is proposed to predict severity of AP. We found a direct correlation between IL-6 and PVC (correlation coefficient 0.78). CONCLUSION: The proposed PVC is available and easy to use for prediction of AP severity. It allows you to assess the course of acute destructive pancreatitis and effectiveness of treatment after the first three days of therapy. You can improve prediction of AP using this value.

[Current state of elective surgery for peptic ulcer]. / Analiz sovremennogo sostoianiia planovoi khirurgii iazvennoi bolezni.

AIM: To analyze the current state of elective surgery for peptic ulcer and to assess its significance for improving the results of treatment of this disease. MATERIAL AND METHODS: The analysis included elective procedures for peptic ulcer performed in the surgical department of Tula Regional Clinical Hospital in the period from 2011 to 2015. These data were compared with those for the period 1996-2000 in order to objectively identify current changes in surgery for peptic ulcer. The interval between both periods was 10 years. The main group consisted of 47 patients with peptic ulcer who underwent surgery in 2011-2015. The control group included 254 patients who underwent similar procedures in 1996-2000. RESULTS: Annual number of elective procedures for peptic ulcer decreased 5 times. There was advanced mean age in the main group, 29.8% of patients in the main group were older than 60 years, in the control group - 23%. Male/female ratio in the main group was 1:1, in the control group - 5:1. Prolonged ulcer history was observed in 10.6% of patients of the main group and 3.2% - in the control group. At the end of the last century, the greatest number of scheduled operations was performed for duodenal ulcer, now - for stomach ulcer. There was increased incidence of surgery for post-resection gastric syndrome (17 and 4.8% in both groups, respectively). We noted similar indications for elective surgical treatment of peptic ulcer in both groups. However, the negative feature of current period is significant augmentation of patients with decompensated pyloroduodenal stenosis. The structure of elective operations in 2011-2015 was characterized by significant proportion of decompensated complications of peptic ulcer as a result of prolonged medication. Prolonged postoperative hospital-stay and increased postoperative mortality were noted in the main group. CONCLUSION: Reduced number of elective procedures for peptic ulcer is associated with changed structure of patients undergoing surgery. Unreasonable prolonged medication aggravates patient state and adversely affects the results of surgical treatment. The current state of elective surgery for peptic ulcer does not correspond to the objective to improve the results of treatment of this disease.