[In searching for perfect blood substitute. Creation and application of perftorane]. / V poiskakh ideal'nogo krovezamenitelya. Sozdanie i primenenie perftorana.

The article is devoted to historiography of perfluorocarbons, as well as discoverers of perftorane and their discoveries. There would be no national priority in transfusiology without these discoveries. Perftorane is the only one of the world series of perfluorocarbon emulsion drugs that has passed all phases of clinical trials. Perftorane has been used in clinical medicine for 30 years.

[The Russian priority of development of intravenous anesthesia (Report I).]

The article analyses research activities of the discoverers of "Russian narcosis" from the Military Medical Academy of St. Petersburg: the head of the Department of Pharmacology N. P. Kravkov, the head of the Department of Hospital Surgery S. P. Fedorov and his resident A. P. Eremich. They for the first time in the world developed ideas of comprehensive experimental substantiation and then safe clinical administration of preparation "hedonal" to achieve stage of safe general anesthesia and implementation of long-term and traumatic operations. The scientific works of Russian discoverers indicated fundamentally new direction in formation of anesthesiology in the Russian Empire and in the world. A. P. Eremich at stage of preparatory tests, working out technique of intravenous infusion, determination of range of safe therapeutic doses and creation of special installation facilitating work with hedonal during operations of Professor S. P. Fedorov, can be recognized as the first Russian anesthesiologist and also as the first National resuscitator.

[Hemorrhoidal artery ligation without Doppler navigation in surgical treatment of hemorrhoidal disease]. / Ligirovanie gemorroidal'nykh arterii bez ul'trazvukovoi doplernoi navigatsii v khirurgicheskom lechenii gemorroidal'noi bolezni.

OBJECTIVE: To compare the immediate and long-term results of surgical treatment of hemorrhoidal disease (GD) stage II-III using two methods of identification of hemorrhoidal arteries (HA) with their subsequent ligation and mucopexy. MATERIAL AND METHODS: A prospective, randomized, controlled, single-center study was conducted to evaluate the effectiveness of HA ligation with and without Doppler navigation. The study included 120 patients: group A - Doppler-guided ligation (n=60) and group B - ligation without ultrasound (n=60). RESULTS: GD stage II was found in 27 patients of the group A and 30 patients of the group B (p=0.4). Mean number of ligated HA in the group A was 3.36, in the group B - 2.83 (p=0.062). Mean number of mucopexy was 3.2 and 3.5, respectively (p=0.8). Mean follow-up period was 8.3±2.1 and 8.1±1.9 months, respectively (p=0.96). Relapse of all preoperative symptoms was registered in 1 patient (1.6%) in the group A. Intermittent bleeding was observed in 5 (8.3%) and 3 (5%) patients, respectively (p=0.71). Periodic hemorrhoid prolapse (GP) occurred in 6 (10%) and 4 (6.6%) respondents, respectively (p=0.74). VAS score of pain syndrome after 2 months and later was 0 - 1 points (p=1.0). Most of patients in both groups (group A - 89%, group B - 94%; p=0.7) noted that surgery did not disrupt their usual lifestyle and relieved from symptoms of GD. CONCLUSION: There are no significant advantages of Doppler-guided HA ligation compared to palpation regarding incidence of hemorrhoid prolapse (p=0.74) and hemorrhoidal bleeding (p=0.71). Pain syndrome (p=0.24), incidence of postoperative complications (p=0.51) and relapses (p=0.31) showed comparable safety of both techniques.

[Morphometry of adipose tissue for prediction of the outcomes of total pancreatectomy with pancreatic islets autotransplantation in patients with chronic pancreatitis]. / Morfometriya zhirovoi kletchatki dlya prognoza rezul'tatov total'noi pankreatektomii s autotransplantatsiei ostrovkov podzheludochnoi zhelezy u bol'nykh khronicheskim pankreatitom.

OBJECTIVE: To compare different clinical and morphometric features of patients undergoing TPAIT for prediction of postoperative outcomes. MATERIAL AND METHODS: A retrospective review enrolled patients who underwent TPAIT for the period from January 2007 to October 2017. Morphometric parameters were analyzed using preoperative CT scans and patients were grouped to examine association of these characteristics with postoperative morbidity. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on pancreatic islet features, perioperative blood transfusion, ICU- and hospital-stay, complications, repeated admission within 90 days and islet function was assessed. RESULTS: A total of 34 patients were included in this study (12 males and 24 females). At the time of diagnosis, mean age of patients was 43.1 years. Mean body mass index (BMI) in sarcopenic patients was 24.9 kg/m2, mean BMI in those without sarcopenia - 24.8 kg/m2 (p=1.00). Various surgical complications were observed in 11 patients (32.3%). Patients with sarcopenia experienced more complications (83.3%) compared with patients without sarcopenia (50%). However, differences were not significant (p=0.31). Islet characteristics (islet numbers, purity), readmission, ICU- and hospital-stay, incidence of blood transfusion and islet function were also similar in both groups. CONCLUSION: Sarcopenia is not a predictor of postoperative complications and islet cell function in chronic pancreatitis patients following TPAIT.

[Gastric neuroendocrine tumors]. / Neiroéndokrinnye opukholi zheludka.

Gastrointestinal neuroendocrine tumors are rare neoplasms. Currently, incidence of gastric neuroendocrine tumors (gNETs) is being significantly increased. There are 3 groups of gNETs: types I, II and III. Each type has important features regarding clinical picture, prognosis and treatment strategy. Type I is the most common (70-80%) and associated with chronic atrophic gastritis including autoimmune gastritis and Helicobacter associated atrophic gastritis. Type II (5-6%) is associated with multiple endocrine neoplasia type I and Zollinger-Ellison syndrome (MEN I - ZES). Both types are characterized by hypergastrinemia and small tumor dimension. These neoplasms are multiple and mostly benign. On the contrary, NETs type III (10-15%) is not associated with hypergastrinemia and represented by single large neoplasms. Tumors are malignant as a rule. Therefore, surgical resection and chemotherapy are preferred for these tumors. Endoscopic surgery followed by observation is acceptable for almost all NETS type I and II. At the same time, this approach is advisable only for small and highly differentiated neoplasms type III.

[Duodenal neuroendocrine tumors]. / Neiroéndokrinnye opukholi dvenadtsatiperstnoi kishki.

Significant augmentation of the incidence of duodenal neuroendocrine tumors duodenum has been observed in recent decades. There are 5 histological types of these tumors: gastrinoma (50-60%), somatostatin-producing tumor (15%), inactive serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinoma (<3%) and gangliocytic paraganglioma (<2%). The majority of tumors are localized within the bulb and postbulbar part of duodenum, 20% are found in periampular area. Treatment strategy depends on dimensions, localization, histological class, stage and type of tumor. It is believed that endoscopic resection is permissible for small inactive tumors (G1) located above major duodenal papilla. The majority of other neoplasms requires surgical resection. Personal experience of various surgeons is limited by small group of patients. Therefore, it is necessary to summarize results for selection of optimal treatment.

[Problem of decision-making in surgery]. / Problema priniatiia reshenii v khirurgii.

Decision-making process is often complex, responsible and not always reflected in surgical protocol. Some surgeons usually prefer standard finishing of procedure; others talk about individual approach but they have some preferences; the third ones analyze all possible perioperative factors (pre- and intraoperative data) and seek to justify differentiated approach. Some aspects of these processes are discussed in this report.

[Pancreatic tuberculosis]. / Tuberkulez podzheludochnoi zhelezy.

Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.

[Current state of the problem of allotransplantation of Langerhans cells (achievements and prospects)]. / Sovremennoe sostoianie problemy allotransplantatsii kletok Langergansa (dostizheniia i perspektivy).

Literature data devoted to transplantation of Langerhans cells have been analyzed. The main stages, indications, dissection of islets, immunosuppressive therapy, complications and data of the latest clinical trials were discussed.

[Perforated peptic ulcer closure: laparoscopic or open?] / Ushivanie perforativnoi pepticheskoi yazvy: laparoskopicheskoe ili otkrytoe? (s kommentariem A.S. Ermolova).

AIM: To compare laparoscopic and open closure of perforated peptic ulcer (PPU). MATERIAL AND METHODS: The study included 153 patients who underwent PPU suturing. 78 patients underwent laparoscopic closure (laparoscopic group) and open suturing via upper midline laparotomy was performed in 75 cases (open group). Surgery time, postoperative pain severity, time of analgesics intake, postoperative complications, hospital-stay and and cosmetic effect were compared. RESULTS: Laparoscopic PPU closure may be effective and accessible in experienced endoscopic surgeon. It significantly reduces postoperative pain severity, need for analgesics, incidence of postoperative complications and provides excellent cosmetic effect. However, there is greater time of surgery compared with open intervention. There were no significant differences in hspital-stay between groups. CONCLUSION: Laparoscopic PPU suturing can be considered a good alternative to open surgery. Further researches are needed for standardization, assessment of safety, real advantages and disadvantages of laparoscopic technique.

[Intersphincteric resection for stage I-III low rectal cancer is an oncologically safe alternative to extralevator abdomino-perineal rectal resection]. / Intersfinkternaia rezektsiia pri nizhneampuliarnom rake priamoi kishki I-III stadii iavliaetsia onkologicheski bezopasnoi al'ternativoi ékstralevatornoi ékstirpatsii priamoi kishki.

AIM: To compare oncologic efficiency of intersphincteric resections and extralevator abdominoperineal excisions in surgical treatment of low rectal cancer. METHODS: Between 2006 and 2015 in Department of colorectal and pelvic floor surgery (Russian scientific center of surgery n.a. acad. B.V. Petrovsky) and in Clinic of Colorectal and Minimally invasive surgery (Sechenov First Moscow State Medical University) 40 consecutive patients underwent intersphincteric resection (ISR) and 31 underwent extralevator abdominoperineal excision (EAPE). All patients had low rectal cancer staged I-III within 5 cm from the anal verge. RESULTS: Circular resection margin >1 mm was achieved in 95% and 84% of patients after ISR and EAPR correspondingly (p=0.002), negative distal resection margin was achieved in 95% of ISR patients. In ISR group mean distance from the lower tumor edge to the distal resection margin was 1,17±0,78 cm. Colo-anal anastomosis leak rate was 17%. The 3-year disease-free survival in ISR group was 97%, 5-year disease-free survival was 93%. The 5-year disease-free survival in stage III for ISR group was 71,4%. In 98% of ISR patients complete restoration of bowel continuity was performed.

[Mannheim peritonitis index as a surgical criterion for perforative duodenal ulcer]. / Mangeimskii indeks peritonita - kriterii vybora operativnogo vmeshatel'stva pri perforativnoi duodenal'noi yazve.

AIM: to define the correlation between Mannheim peritonitis index scores and outcomes of different radical and palliative interventions for perforative duodenal ulcer. MATERIAL AND METHODS: Treatment of 386 patients with perforative duodenal ulcer is presented. Different surgical techniques were analyzed including stomach resection, various methods of vagotomy with/without drainage, ulcer suturing and ulcerative edges excision with suturing in patients with Mannheim index scores <21, 21-29 and over 29. Clavien-Dindo classification was used to analyze postoperative complications. RESULTS: In 64.3% of cases mortality was caused by peritonitis and peritonitis-associated complications. Surgical features resulted unfavorable outcome only in 35.7% of cases. Severe complications requiring re-operation were predominantly observed after stomach resection. CONCLUSION: Mannheim peritonitis index is sensitive method allowing prognosis the outcomes in patients with perforative duodenal ulcer. Radical interventions are advisable in Mannheim index scores <21, in other cases palliative surgery for example suturing or edges excision with suturing is preferred. If radical surgery is performed with strict indications (Mannheim index scores <21) volume and type of surgery do not significantly influence on mortality rate.

[Single-port laparoscopic cholecystectomy: advantages and disadvantages]. / Odnoportovaya laparoskopicheskaya kholetsistektomiya: preimushchestva i nedostatki.

AIM: To analyze the outcomes of single-port laparoscopic cholecystectomy. MATERIAL AND METHODS: Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect. RESULTS: It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development. CONCLUSION: Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.

Chapitre 5. L'impact de la pandémie de COVID-19 sur l'évolution du paradigme éthique de la médecine clinique en Russie (« à la guerre comme à la guerre ¼).

The CОVID-19 pandemic became a catalyst for the transformation of the ideas of the existence of global ethics in favor of real moral pluralism, exposed the problem of abandoning the principles of personalized medicine in favor of public health ethics (collective ethics of civil society). The authors sequentially analyze the objective factors that influenced the change in the moral paradigm of the clinical medicine in Russia: the peculiarities of the course of infection, the lack of resources in the health-care sector, the inability to use advanced treatment methods in different groups of patients, the protection of medical workers, the provision of emergency and planned surgical interventions, and the prevention of further spread of infection. In addition, the moral consequences of the use of administrative measures to limit the spread of the pandemic are given: restriction of social contacts, the use of personal protective equipment, retraining of specialists, re-profiling of the bed fund, leveling problems of communication with colleagues, patients and students. Special attention is paid to the problem of “anti-vaxxers”, representing a significant part of society and hindering the implementation of the vaccination program of the population. We believe that active and passive protest against vaccinations lie not in a rational plane, but in an emotional one, in an immanent distrust of the state and its institutions. Thus arises a secondary ethical problem of the state’s responsibility for the life and health of every citizen, regardless of their beliefs. Contradictions in the moral principles of individual strata of the population (including groups like those who agree to get vaccinated, those who doubt, the indifferent ones, “active anti-vaccinators”) currently seem irreconcilable due to the state’s detachment from solving moral problems.Ethic divergence in the context of the pandemic has become real, stable and difficult to overcome, while the claims of a single, global, global bioethics are being questioned. The COVID-19 pandemic has formulated the ethical task of the 21st century, which will have to be the development of public policy and practice of clinical medicine in the context of serious moral contradictions and significant bioethical differences.

[The cause of acute abdominal pain].

The authors analyze the structure of acute abdominal pain in the general surgeon "s practice. The article contains the results of an analysis of the frequency of various causes of pain, as well as a description of the most frequent causes of death in acute pancreatitis, cholecystitis, appendicitis, bleeding and perforative ulcer, ileus, strangulated hernia, and acute mesenterial ischemia.

[Estimation of stomach surgery results]. / K metodike otsenki rezul'tatov operatsii na zheludke.

Operations on the stomach make up about 2-5% of all operations performed in clinics of general surgery. In evaluation of the efficacy and quality of treatment the quantitative indices are used: intraoperative and postoperative complications, frequency of relapses of the basic disease, frequency and degree of severity of developing functional manifestations of the diseases of postoperative stomach and metabolic disturbances. However, contemporary trends to standardization of surgical technique and to high rank of technological equipment of the operation unit predetermine related or identical results after various operations on the stomach. Differences in outcomes of surgical treatment are best of all revealed in the study of qualitative results. The qualitative evaluation of various operative procedures with the use of integrale scales of Johnston and Visick has some substantial disadvantages. WHO recommends to use "adequacy of treatment", i.e. achievement of the adequate quality of life for each patient as a criteria for evaluation of the efficacy of treatment. The authors suggest that, until the influence of particular operation on the level of the quality of life of patients in postoperative period (in comparison with the initial ones before the operation and in healthy people) is not studied, it is impossible to judge about its advantages and shortcomings. The quality of surgical operation--the choice of the procedure and its technical realisation--predetermines quality of life of patients in postoperative period.