Introduction. The use of intravascular imaging techniques, in particular intravascular ultrasound, makes it possible to reduce the number of subsequent revascularisations. The method of optical coherence tomography (ОСТ), due to its high resolution accuracy, makes it possible to establish and assess the edge dissection, stent thrombosis, tissue prolapse, and strut fracture and malposition. This paper aims to assess the impact of routine use of OCT on long term outcomes in patients with scaffolds implanted.

Materials and methods. 32 stenting procedures with the use of bioresorbable coronary intravascular scaffolds (Absorb, Abbot Vascular) were performed in 2014-2015 with subsequent visualisation and assessment with optical coherence tomography. In the control group (n=16) scaffolds were implanted without the use of OCT under traditional contrast enhanced X-ray imaging. The analysis of the combination of outcomes that included subsequent emergency revascularisation in the target artery, cardiac death, myocardial infarction and 12 months post-op OCT imaging data, served as the end.

Results. The total of 55 BVS were implanted, 22 in the OCT group and 23 in control. Suboptimal results were registered in eight cases out of 16 in the OCT group (50%). These included: one dissection and atherosclerotic plaque prolapse — implantation of a second BVS and postdilatation, one eccentric stent expansion — a model for acute thrombosis, resolved with postdilatation, and stent underexpansion in the remaining six. Once the OCT revealed the intima dissection following predilatation; this was stabilised with the implantation of a second scaffold. The examination results at 12 months follow up established that there were 3.215 more scaffold restenoses in the control group.

Conclusion. The cutting edge technique of intravascular revascularisation with bioresorbable coronary scaffolds requires careful preparation and intraoperative control. The results of our study support the use of intravascular imaging techniques as methods of choice for the assessment of the expansion, areas of dissection, thrombosis and scaffold eccentricity.

Introduction. Acute appendicitis (OA) developing in patients during pregnancy presents a complex problem in emergency medicine. Clinical practice proves that acute appendicitis may complicate pregnancy at any gestation. Appendicitis developing in late pregnancy poses serious difficulties in terms of diagnostics and the selection of optimal obstetric and surgical management strategy due to limited options for the use of state of the art endoscopic imaging examination methods.

Materials and methods. The authors have analysed the treatment and diagnosis results of 159 pregnant women admitted to surgical and maternity departments of the City Teaching Hospital №8 in 2006–2015. Of these, 73 (45.9%) women were treated surgically for acute appendicitis; 13 (17.8%) women were in the first, 34 (46.6%) — second and 26 (35.6 %) — third trimester of pregnancy. In 86 (54.1%) women the diagnosis of acute appendicitis was ruled out at the diagnostic stage. Of these, 26 (31.4%) women were in the third trimester of pregnancy. The control group included women with acute appendicitis in the first and second trimesters of pregnancy.

Results and discussion. For all the pregnant women admitted in the third trimester, the diagnosis of acute appendicitis was extremely difficult as evidenced by the length of the pre-op observation period. For instance, for 14 (53.8%) women the length of pre-op observation amounted to over 12 hours, for six (23.1%) women — up to 12 hours, for four (15.4%) women — up to six hours. The average pre-op observation time amounted to 12.7±3.1 hours. In the control group in women in the second trimester this indicator was 10.9±2.3 hours and statistically insignificant (p>0.05). The pre-op observation time for women in the first trimester of pregnancy amounted to 5.4±1.2 hours (p<0.05).

Conclusion. In cases of uncomplicated acute appendicitis in pregnant women up to 34 weeks gestation it is advisable to perform the surgery via the Volkovich-Dyakonov extended access and bring the pregnancy to term. In patients with acute appendicitis with complications and/or when the gestation is 35 weeks and over it is justifiable to perform both the caesarean and appendectomy through the midline laparotomy access.

Introduction. Aneurysms of visceral arteries in the abdominal cavity are very rare. Often aneurysms of branches of the abdominal aorta are an incidental finding as patients seldom present obvious clinical signs or pathological changes in the organ supplied by the artery involved. The incidence of aneurysms of branches connecting the celiac trunk and the upper mesenteric artery amounts to 3.5% of all the cases of aneurysms of abdominal aorta arteries, mostly the gastroduodenal artery. This paper presents a case of minimally invasive treatment of gastroduodenal artery pseudoaneurysm at the BSMU Clinic.

Materials and methods. Patient K, a 47-year-old female, was admitted for emergency treatment at the Bashkir State Medical University Clinic in May 2019. The patient’s complaints included feeling weak, black stool for seven days prior, faintness and epigastric pain.

Results and discussions. Instrumental examination and angiography data demonstrated that the size of the pseudoaneurysm has increased 2.5 times and reached 65×45 mm; the clinical picture led to the conclusion that the aneurysm was ready to rupture and that there was an immediate need to stop the blood flow to the gastroduodenal artery pseudoaneurysm.

Conclusion. The range of currently available image-guided surgical procedures makes it possible to perform adequate embolization of pathological structures such as artery aneurysms.

Introduction. Acute limb ischemia is a severe disorder caused by a sharp drop in the arterial perfusion of the limb. It carries a threat to the limb’s function and viability. The issue of early recognition of acute limb ischemia in surgery is both important and difficult. The current guidelines recommend that patients with acute limb ischemia when the limb is viable should be urgently examined and treated. Restoring the blood flow in patients with acute limb ischemia is a priority, since a significant reduction in arterial perfusion can lead to limb amputation and life-threatening complications. In acute limb ischemia different treatment methods can be used, both open surgery and endovascular procedures. The treatment strategy depends on the localisation, duration of ischemia, neurological deficit, concomitant diseases and risks associated with treatment and its results. Endovascular procedures on the arteries of the lower leg are most often indicated to save a limb. Endovascular procedures on the arteries of the lower leg are indicated more often in patients with critical limb ischemia. Endovascular procedures when the condition is primary demonstrate good outcomes and high efficiency on the arteries of the lower extremities at all levels of the lesion.

Materials and methods. This paper presents a clinical case of a successful endovascular procedure performed for the treatment of acute thrombosis of the arteries of the lower leg. Three stents were implanted, with a good angiographically confirmed outcome.

Conclusion. Endovascular balloon angioplasty with stenting of the tibioperoneal trunk can result in good outcomes in patients with acute thrombosis of the arteries of the lower leg.

Introduction. Refeeding syndrome is a condition underpinned by metabolic disorders emerging as a result of the resumption of feeding in patients after a protracted period of starvation. The real figures of the potentially life threatening refeeding syndrome incidence are unknown. This paper aims to demonstrate the clinical picture and methods of resolving of the refeeding syndrome by presenting a clinical case.

Materials and methods. The clinical presentation of the refeeding syndrome with pronounced neurological and cardiological symptoms is demonstrated on the example of a female patient with acute pancreatitis of medium severity at the resumption of enteral feeding. A review of available literature on the subject is also presented.

Results and discussion. The range of diagnostic considerations was rather broad as the authors had to eliminate acute coronary and neurological disorders. The auxiliary laboratory examination methods helped form the hypothesis of a developing refeeding syndrome and correct the treatment. Parenteral phosphate-containing preparations and enteral feeding with phosphates were administered. The patient was transferred to the neurology department for further treatment. The patient was discharged home on day 53 with total regression of neurological symptoms.

Conclusion. Hypophosphataemia — a very low level of phosphorus in blood — is a key clinical marker of the syndrome. However, low blood levels of potassium, calcium, magnesium and vitamin В1 may also play a role. Chronically undernourished patients and those not having any enteral feed for over 10 days are fall in the high risk group. The feeding should be resumed at a low level energy intake. Vitamins should be prescribed at the resumption and continued for at least 10 days. The electrolyte and fluid balance does not have to be corrected prior to the resumption of feeding; it can be done simultaneously with feeding.

Introduction. Chronic lymphocytic leukaemia (CLL) is a malignant clonal lymphoproliferative disorder characterised by the accumulation of atypical mature CD5/CD19/CD23-positive B lymphocytes, predominantly in blood, bone marrow, lymph glands, liver and spleen. Chemotherapy protocols with the inclusion of nucleotide analogues, alkylating drugs and monoclonal antibodies are currently the standard of treatment. FCR (fludarabine, cyclophosphamide, rituximab) is one of the most effective protocols. CLL may lead to various immunologic disorders resulting in an increased risk of a malignant neoplasm. This paper aims to present a demonstration of a case of the combination of chronic lymphocytic leukaemia and stomach cancer, and an attempt to establish — based on literature data — a link between the diagnosed stomach adenocarcinoma and the main disease.

Materials and methods. Authors have analysed the case history, laboratory and instrumental data and the treatment of a patient with chronic lymphocytic leukaemia and stomach adenocarcinoma.

Results and discussion. The patient E., 63 yo, was diagnosed with chronic lymphocytic leukaemia in 2016. The patient was started on FCR chemotherapy protocol (Fludarabine, 70 mg days 2-4 of CT, Endoxan 500 mg days 2-4 of the cycle, Rituximab 700 mg day 1 od CT) in June 2018. When the patient came to the BSMU hospital for a chemotherapy cycle in August 2018, gastric endoscopy was performed; tissue pathology examination resulted in the diagnosis of stomach adenocarcinoma. A concilium of surgeons, oncologists and haematologists made a decision to perform a gastrectomy with the oesophageal resection and Roux anastomosis.

Conclusion. Having used a clinical case as an example and reviewed available literature, the authors have demonstrated that either CLL or the immunosuppressed status served as the causal factors for the development of the adenocarcinoma. The development of stomach adenocarcinoma in patients with chronic lymphocytic leukaemia makes the course and outcome of the main disease much more severe. A decision regarding the management strategy for such patients has to make individually every time, taking into account the severity of the oncological disease; this impacts on the choice of the treatment protocol. All the cases of spontaneous remissions in patients with lymphocytic leukaemia must be screened extensively in order to facilitate early diagnosis of malignant neoplasms.

In the SFHI (State Funded Healthcare Institution) Republic’s Centre for Cardiology the method of alcohol septal ablation has been introduced in 2015. The paper presents one case of a successful treatment of a patient with hypertrophic cardiomyopathy with left ventricular outflow tract obstruction treated with the use of the method of alcohol septal ablation under control of contrast enhanced echocardiography of the ablation area in the interventricular septum.

Micro RNAs (miRNAs) are short non-coding RNAs (ncRNAs) of ~22 nucleotides in length involved in the post-transcriptional regulation of gene expression. They were discovered over 15 years ago and their functions are becoming clearer. They play an important role in all biological processes. MiRNAs are important modulators of the expression of eukaryotic genes. Focusing on transcripts encoding proteins they impact on the cellular transcriptome thus helping to determine the destiny of a cell. More and more data emerge to indicate an important functional role of miRNAs in the brain development. Since their discovery many miRNAs have been described as key factors in the development and function of the central nervous system. Some play a significant role in the genesis and differentiation of nerve cells (neurons and glial cells). Notably, it has recently been established that miRNAs play a vital role in the mechanisms underpinning the infantile increase of the gonadotropin-releasing hormone (GnRH) production by neurons in the hypothalamus. This phenomenon is necessary for the onset of puberty in mammals. In this review offers our attempt to describe miRNAs as new players in the control of hypothalamic functions, namely the onset of puberty.

Introduction. The incidence of ovarian cyst amounts to 5–17 % in postmenopausal women. Currently monitoring of or screening for ovarian cysts in menopausal patients is not regimented in the Russian Federation at all. This situation warrants a review.

Materials and methods. In this paper the authors review retrospective and prospective studies concerning outcomes in patients with ovarian cysts in menopause published in the last 5 years. Results. The retrospective and prospective studies analysed show that the risk of malignancy of this type of benign neoplasm is low, on average 0.7%. The results of a large prospective study prove that there is no need for surgical treatment in 80% of patients.

Discussion. There is now doubt that patients with this disorder should be followed up in accordance with an algorithm that clearly defines the criteria for surgical treatment and the follow up length. Surgical treatment should be indicated when there is at least one of the signs of an ovarian cyst: symptomatic, texture not smooth, over 50 mm in diameter, multilocular, bilateral. A positive CA-125 in combination with ultrasound, MRI and CT imaging make it possible to calculate the risk index with the use of a particular formula and determine the indications for a risk-reducing bilateral salpingo-oophorectomy. The follow up of BRCA1/2 mutation-free patients with a benign ovarian neoplasm should include a close step-by-step monitoring and all the necessary examinations performed in a timely manner.

Conclusion. The risk of a malignant transformation of an ovarian cyst in menopause is rather low (about 0.7%); following up patients with simple ovarian cysts in menopause is possible and should be carried out in strict compliance with the algorithm; the preventive bilateral salpingo-oophorectomy in patients presenting no signs of ovarian pathology is indicated only for the high risk group (BRCA1/2 mutations confirmed or there is family history).

Introduction. In the Russian Federation there is a constantly updated register of infections associated with surgery and the treatment of oncological diseases reporting which is mandatory. Massive expenses and detriment to patients’ health caused by these infections prompted the authors to run a retrospective epidemiological analysis of the morbidity registered in the population of the city of Kazan during the period under review. This paper presents a study of patterns of the emergence and spread of nosocomial infections.

This study aims to examine the clinical and epidemiological characteristics of infections associated with surgery and the treatment of oncological diseases registered in the population of the city of Kazan.

Materials and methods. Authors analysed the Emergency Notifications for an Infectious Disease (form 058/u) as well as the data from the Rospotrebnadzor Federal Statistical Record Form №2. The paper presents the morbidity annual dynamics, structure and spatial characteristics and describes key pathogens of HAIs.

Results and discussion. On the basis of the data obtained the authors give clinical and epidemiological characteristics of the annual dynamics of the morbidity characterised by recurrent rises during the year with the top incidence in the autumn. Neonatal PSI infections dominate the HAIs incidence structure (52.8%). St. aureus is the priority HAI pathogen (26.5% of cases) in the city of Kazan.

Conclusion. Microbiological monitoring of emerging HAIs is an efficient tool for managerial decision making and the development of an algorithm for anti-epidemic measures in the departments and the hospital as a whole for the reduction of risk of infection.

Introduction. Closing the wound cavity after the coccyx resection in patients with posttraumatic coccygodynia remains an issue unresolved. Closing the wound cavity with local tissues often leads to the wound dehiscence due to excessive tension which in turn leads to suppuration and prolonged healing.

This paper aims to assess experimentally the effectiveness of using ground autograft bone of the coccyx removed for the closure of the surgical wound.

Materials and methods. In the animal experiment the coccyx resection was performed under a combined anaesthesia in six pigs (three in the study group and three in control). In the control group the wound edges were sutured to its floor. In the study group after the coccyx resection the ground bone mass made of the coccyx resected was implanted into the wound cavity.

Results and discussion. In the control group the wound dehiscence was registered in all the animals. After the animals were taken out of the experiment it was established that in the study group a new consolidated bony conglomerate was formed without any pronounced inflammatory changes around the wound. In control the wound cavity healed with secondary intention.

Conclusions. The study confirms the effectiveness of using ground autograft bone for the closure of the wound cavity.

Comments to letter by Prof. Sh. Kh. Gantsev ‘Oncology specialist training: Is a reform overdue?’ (Creative Surgery and Oncology, 2018, № 3).