Vol 16, No 3 (2023)

Introduction. Pancreatic enteroanastomosis formation is a decisive stage of the entire operation, as the frequency of complications leading to death remains high.
The aim of the study was to improve the clinical outcomes of surgical interventions on pancreas by choosing the proper technique for pancreatic enteroanastomosis formation.
Materials and methods. A retrospective-prospective study was performed in the Center for Surgery of the Liver, Pancreas and Biliary Tracts, Ryazan State Medical University.
The retrospective stage included the analysis of 270 operation protocols and case histories of patients undergone pancreatic resection. Based on the analysis, the academic staff of the Department of Hospital Surgery, Ryazan State Medical University, developed a technique for pancreatic jejunoanastomosis via through U-shaped sutures (the modified Blumgart-style pancreaticojejunostomy).
The prospective stage included analysis of 98 case histories and operation protocols of patients undergone pancreatic resection. There were 73 patients with chronic pancreatitis and 25 patients with the head of the pancreas cancer. Groups were formed uniformly depending on the etiology.
Statistical analysis methods included: multivariate correlation analysis using the contingency coefficient (φ); Shapiro-Wilk test; Pearson's chi-squared test; one-way ANOVA test and multiple comparison method with Bonferroni correction for Student's t-test.
Results. Correlation between the infiltrated pancreas and the frequency of complications - φ was 0.517.
The frequency of anastomosis failure with the PD diameter >3 - φ was 0.167, with PG≤3mm - φ = 0.358.
The infiltrated parenchyma of the pancreas and the PD diameter ≤3 mm affected the incidence of postoperative complications - φ = 0.387 (PG > 3 mm, the incidence of postoperative complications - φ = 0.254).
At the reconstructive stage, patients of group 1 were exposed to pouch-invagination pancreatic enteroanastomosis end-to-side, patients of group 2 were exposed to pancreatic enteroanastomosis using nodular sutures, patients of group 3 were exposed to pancreatic jejunoanastomosis using through U-shaped sutures, the modified Blumgart-style pancreaticojejunostomy. In patients from group 1 complications were observed in 58% of cases, in patients from group 2 complications were observed in 45.4% of cases, in patients from group 3 complications were observed in 20.5% of cases (p=0.010). Pancreatic enteroanastomosis failed in 29% of patients from group 1, and in 21.2% of patients from group 2; in patients from group 3 no pancreatic enteroanastamosis failure was observed (p = 0.003). There were 9.7% of gastrostasis cases in patients from group 1, 9.1% of gastrostasis cases in patients from group 2, 8.8% of gastrostasis cases in patients from group 3 (p = 0.1). Postoperative pancreatitis was observed in 12.9% of patients from group 1, in 9.1% of patients from group 2, in 5.9% of patients from group 3 (p=0.015). Twenty-nine percent of patients from group 1, 18.1% of patients from group 2, 2.9% of patients from group 3 required repeated surgical interventions.
Conclusions. In case of through U-shaped sutures application, repeated surgical interventions for pancreatic jejunoanastomosis were performed in 2.9% of cases, the rate of postoperative complications was 20.5%, no anastomosis failure was observed.
Pancreatic jejunoanastomosis using through U-shaped sutures has proven to be more effective compared to other pancreatic enteroanastomosis techniques applied in clinical practice. It can be used in educational and pedagogical and research activities in medical universities.

Introduction. Diseases accompanied by a violation of the blood supply to the intestinal wall occupy one of the main places in urgent surgery of the abdominal organs. Intraoperative assessment of intestinal viability is one of the most difficult tasks and plays a leading role in determining the volume of surgical aid, predicting the course of the postoperative period.
Aim. To study the possibility of using contrast imaging using a controlled polychrome LED light source to assess the viability of the intestinal wall of a model animal in conditions of acute ischemia.
Materials and methods. The work is based on the results of experimental studies conducted on 15 clinically healthy sexually mature laboratory rats. The simulation of acute small intestine ischemia lasting from 15 minutes to 12 hours was performed by ligation of the major vessels. Each animal underwent a relaparotomy after a corresponding time interval. The intestine was extracted from the abdominal cavity and visual parameters of wall necrosis were assessed using the Kerte method and using a polychrome LED light source for contrast imaging of biological tissues during surgery. After determining the visual signs of necrosis, intestinal fragments were submitted for pathomorphologic examination. The study was ended by removing the animal from the experiment according to the protocol approved by the Ethics Committee.
Results. The spectral composition of the light source providing the most reliable detection of necrosis of the intestinal wall is represented by two spectral bands with maximum wavelengths of λpeak = 503 nm, λpeak = 594 nm and an approximate ratio of band intensities of 2:1. By morphological study, the following intervals were found to be significant when simulating small intestinal ischemia in the experiment: 1 hour after ligation - time of onset of ischemia, 6 hours - time when ischemia is reversible, and 12 hours - time when small intestine necrosis is recorded.
Conclusions. The use of a controlled shadowless semiconductor light source for contrast imaging of biological tissues during surgery in the selected mode improves the definition of visual parameters of intestinal viability.

The aim of the study was to present a clinical case of generalized sarcoidosis without involvement of the lungs and intrathoracic lymph nodes.
Materials and methods. The literature and data of clinical observation, surgical treatment and results of autopsy of a patient with generalized sarcoidosis were analyzed.
Results. In this study, the authors draw attention to the case of generalized sarcoidosis without lesions of the lungs and intrathoracic lymph nodes, accounting for 5% in the structure of morbidity. A clinical case of patient A., who was hospitalized in the surgical department of the Emergency Hospital, is presented. The patient was admitted with suspicion of urgent surgical pathology with extrapulmonary manifestations of the disease (polyserositis) and granulomatous lesions of the parietal and visceral peritoneum, extrapulmonary pleura typical of sarcoidosis, and peritonitis, progression and development of a rare clinical form of the disease, neurosarcoidosis, which amounts to as much as 10 % of all cases of this disease.
Conclusions. The clinical case demonstrates specificity of this multisystemic disease and the need for a multidisciplinary approach to treatment and diagnosis, which may be challenging due to the absence of typical manifestations of this pathology, as in the presented clinical case. The authors share their experience to help medical professionals avoid diagnostic and tactical errors in the management of such patients, since they encountered a truly untypical and rare manifestation and complication of sarcoidosis in a patient, who was admitted not in a specialized therapeutic or pulmonological department, but in surgical department of a multidisciplinary hospital.

The paper describes a case of endovascular treatment of a patient with Paget Schroetter syndrome (PSS), who had verified thrombosis of the brachial, axillary and subclavian veins. The main etiological factor of venous thrombosis was hyperabduction syndrome – compression of the subclavian vein by the pectoralis minor muscle during arm movement. The indication for endovascular treatment was acute venous insufficiency of the upper limb with the developing threat of phlegmasia cerulea dolens. Regional catheter thrombolysis was performed using alteplase. There was a lysis of thrombotic masses with beneficial long-term clinical outcomes of the patient's treatment.

The paper analyzes the literature data and authors’ proper experience in the study of immunopathogenesis and immunodiagnosis of burn sepsis. It argues the issues of effective use of immunocorrection in the complex treatment of severely burned patients.
Diagnosis of sepsis after severe burn injury is challenging due to the overlap of signs and clinical manifestations of the hypermetabolic reaction of thermal injury and sepsis. The systemic inflammatory response caused by burns can mimic manifestations of sepsis and complicate its early diagnosis. Considering this, modern immunodiagnostics can serve as an effective tool in identifying damaged key immune markers in burns, determining the severity of immune status disorders in burn disease and the risk of developing septic complications for timely immunocorrection and providing appropriate complex therapy for patients with extensive burns.
However, the problem of immunocorrective therapy in severely burned patients remains extremely relevant, debatable and not fully resolved. It is a personalized approach based on immune analysis and clinical recommendations for the complex treatment of burn injury that should be applied in the immunotherapy of burn sepsis to improve the clinical outcomes and, possibly, prevent the development of sepsis in patients with severe burn injury.