Malnutrition among surgical patients is rather common problem. The degree and severity of malnutrition after surgery significantly correlates with the length of stay in the intensive care unit and surgical hospital, rate of infectious complications development, unsatisfactory results of treatment and increased costs. The presented clinical recommendations clarifies key methods for the prevention of development, diagnosis and treatment of the protein-energy malnutrition (PEM) syndrome in the pre and postoperative period. The choice of methods for diagnosis and PEM correction during the perioperative period is based on studies evaluated from the endpoints of evidence-based medicine. In applications, key quality criteria for treatment, as well as algorithms of actions in the preoperative and postoperative period are presented.

The study was performed in 9 cancer patients with sepsis. A clinical blood test of patients with sepsis was accompanied by a neutrophilic leukemoid reaction, with the appearance in the differential count of white blood cells of young cells (myelocytes, metamyelocytes). According to the literature, it is shown that in severe sepsis, a local infection is accompanied by systemic of neutrophil activation (NF). Moreover, excessive activation and location of NF in the microvasculature, especially its young forms and the formation of extracellular trap networks (NETs), can contribute to pathological manifestations of multiple organ failure and thrombosis.

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Актуальность. Известно, что частота локального рецидива тимомы B3 после тимэктомии может достигать 8-30% случаев. Однако даже при необходимости в резекции смежных атомических структур средостения доля повторных радикальных операций, по данным литературы, составляет 45-71%, что обеспечивает общую 5-летнюю выживаемость на уровне 72%. Цель работы -представить клиническое наблюдение успешного удаления рецидивной тимомы B3 с экстирпацией и протезированием верхней полой вены. Материал и методы. Пациент, 59 лет, поступил в стационар с клиническим диагнозом: злокачественное новообразование вилочковой железы, тимома В3. Хирургическое лечение 2010 г. Рецидив 2018 г. Химиолучевая терапия декабрь 2018 г. (СОД 35 Гр + карбоплатин, 3 курса). Стабилизация. В плановом порядке выполнена стернотомия, удалена рецидивная опухоль, проведены экстирпация и протезирование верхней полой вены с помощью Y-образного протеза с резекцией обоих диафрагмальных нервов. Ранний послеоперационный период осложнился дыхательной недостаточностью в связи с двусторонним парезом диафрагмы, которая купирована длительной искусственной вентиляцией легких, восстановительным -реабилитационным лечением. Результаты. При контрольном осмотре через 12 мес состояние больного удовлетворительное, способен выполнять умеренный физический труд, данных за рецидив опухолевого процесса в средостении нет, наблюдается неполная реканализация левой брахиоцефальной ветви Y-образного протеза верхней полой вены. По данным спирометрии обнаружены умеренные рестриктивные нарушения легочной вентиляции. Заключение. Оперативное лечение рецидивных инвазивных тимом с экстирпацией и протезированием верхней полой вены позволяет надеяться на благоприятные непосредственные и отдаленные результаты.Финансирование. Исследование не имело спонсорской поддержки.Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

The history of the development of such a thing as the Internet of things in our country, as well as in the world, is gaining momentum. The communication of all devices that maintain communication and transmit data online are used constantly and around the clock. In order to accumulate data and combine it for the benefit of local residents, as well as advertising companies, in order to understand their needs and solve with the help of unobtrusive offers, all data obtained from gadgets and devices connected to the Internet are used.

Гемангиома сердца относится к редким доброкачественным опухолям, которые чаще локализуются в предсердии или в желудочке и гораздо реже в стволе легочной артерии. В статье представлено клиническое наблюдение успешного хирургического лечения больного с гемангиомой ствола легочной артерии с распространением на ее клапан и левую легочную артерию.Финансирование. Исследование не имело спонсорской поддержки.Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Purpose of review Metastatic breast cancer (MBC) was traditionally viewed as homogeneously progressive and incurable among all comers, but there is new evidence that MBC harbors a range of tumor molecular/immune subtypes and degrees of aggressiveness. Thus, MBC is not rapidly fatal in all affected patients. Recent findings A small subset of patients will attain long-term disease control, or undetectable disease, and will enjoy a prolonged survival with little disability from their disease or treatment. Though the term is controversial, some patients with long-term non-detectable disease may effectively be considered “cured”. To best advise treatment options in these patients, it is imperative to identify patients most likely to benefit from aggressive treatment. Summary In this review, we delineate the clinical, pathologic, and disease characteristics associated with long-term non-progression in MBC. We include a single institution case series of long-term non-progressive MBC patients and their characteristics as an example of the frequency of this sub-population of MBC. Future prospective trials are warranted to examine the utility of clinical characteristics as predictors of long-term survival in MBC.

Aim. Current clinical recommendations address the epidemiology, causes, clinical manifestations and pathogenesis of possible immediate and long-term complications, as well as the problematic issues related to treatment and rehabilitation of adult short bowel syndrome patients.Key points. Short bowel syndrome (SBS) is a symptom complex of impaired digestion caused by the reduction of small intestine absorptive surface and manifested by intestinal failure (IF) of various severity (maldigestion and malabsorption) developing into malnutrition and systemic somatogenic disorders. The vital strategic aspects of its treatment are the personalisation of liquid, macro- and micronutrients consumption as well as avoidance of intestinal failure- and parenteral nutrition-associated complications. Various nutritional support regimes and the indications for infusion therapy and maintenance parenteral nutrition are considered in this patient category, also in outpatient settings. To mitigate the dependence on intravenous fluid- and nutrient administration and attain enteral autonomy in SBS-IF patients, the use of recombinant glucagon-like peptide-2 (GLP-2) is justified as exerting a pronounced trophic effect on the epithelial regenerative potential as well as structural and functional adaptation of intestinal mucosa. The SBS-IF patients prescribed with home parenteral nutrition and/or their caregivers should be trained in a special programme that covers the catheter care, preparation of infusion solutions and nutrient mixture container, infusion pump operation as well as the prevention, recognition and management of complications. The main referral indications for small bowel transplantation (SBT) are: fast-progressing cholestatic liver disease-complicated irreversible intestinal failure; thrombosis of two or more central venous conduits used for parenteral nutrition; recurrent catheter-associated bloodstream infection.Conclusion. Current recommendations on diagnosis and treatment as well as the developed criteria of medical aid quality assessment are applicable at different levels of healthcare.