Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous immune-mediated peripheral neuropathy with progressive or relapse-remitting course. Incidence of CIDP ranged between 1 and 8.9/100 000. Recently, most frequent therapies for CIDP treatment was glucocorticosteroids, intravenous immunoglobulin and plasma exchange. In cases of ineffectiveness or lack of effectiveness, cytostatics, monoclonal antibodies and others could be used for CIDP treatment. In the article, authors presented an update data on the use of main methods for CIDP therapy, their mechanisms of action, indication for their use and advantages and disadvantages of each of them.

Over the last several decades, there has been breakthrough in cataract surgery. The rate of intraoperative complications was minimized. One of the most common complications remained the intraocular lens (IOL) dislocations due to inadequate capsular bag support. Thus, the search for an effective and safe method of the IOL fixation in the absence of adequate support of the lens capsule continued to be one of the major problems in anterior segment surgery. This review was devoted to the main methods of correction of intraocular lens dislocation and aphacia.

Introduction. The fundamental strategic objective of the national health care was to increase the life expectancy of Russians including the early detection and treatment of cancer, remaining in recent years the leading cause of mortality, and therefore ensuring the availability of diagnostic studies for patients conducted for early diagnosis and control of treatment was extremely urgent. The objective of the study was to assess the volume and economic indicators of the availability of studies by computer tomography and magnetic resonance imaging (CT, MRI) for patients.

Material and methods. The basis for the study – all cases of CT and MRI studies in patients under the program of state guarantees of free medical care for citizens in St. Petersburg in the dynamics of 5 years. The data were statistically processed using the methods of variation statistics.

Results. Over the last 5 years in St. Petersburg, the number of medical organizations conducting CT and MRI in patients under the program of state guarantees has been doubled (CT: 37 medical organizations in 2013, 63 – in 2018; MRI: 32 medical organizations in 2013, 65 – in 2018), and there was a significant increase in the number of studies by these methods. In 2017, the number of CT scans was 106028, MRI – 107503 that was more than 2 times higher the number of studies conducted in 2013: 44799 and 56090, respectively. The role of these studies for the diagnosis of tumor process was significant: 67.3 % of CT and 46.6 % of MRI were performed for this purpose. The increase in the number of studies was accompanied by the increase in tariffs and costs of the system of compulsory health insurance for their implementation.

Conclusion. In St. Petersburg, sufficient conditions was created to ensure the volume and financial indicators of access to medical care for patients with cancer (suspected cancer) in need of CT and MRI. At following planning for the development of this type of care, it was advisable to take into account the research needs of residents of certain districts in St. Petersburg.

Introduction. The incidence of cholangitis varied from 9 % to 33 % after the insertion of transpapillary external-internal endobiliary drainage. In case of proximal bile obstruction, the method of suprapapillary insertion of external-internal drainage were widely used for prevention of purulent complications. But it was impossible to use this method in case of distal bile obstruction. The choice of initial decompression method for distal bile duct obstruction (external only or transpapillary external-internal drainage) was unclear.

The objective was to improve results of primary percutaneous transhepatic biliary drainage in patients with jaundice and distal bile duct obstruction.

Material and methods. As a primary decompression method, percutaneous transhepatic endobiliary interventions under ultrasound and X-ray control were performed in 81 patients with distal bile duct obstruction. External-internal transpapillary drainage were performed in 30 patients, only external drainage – in 21 patients and in 31 patients we used original combined technique (compilation of external and external-internal transpapillary drainage).

Results. Intraoperative and early postoperative complications were noticed in 23 patient (28 %). Complications in the group of external endobiliary drainage were observed in 4 (19 %) patients. In the group of external-internal drainage, complication rate was 53.3 % (16 patients). At the same time, purulent complications were noted in 30 % of cases (9 people). In case of using combined external-internal drainage, no purulent complications was diagnosed. In the treatment of all complications, minimally invasive methods were successfully used.

Conclusion. Our results showed advantages of the original combined technique due to the absence of the risk of purulent complications, and ensuring transpapillary access at the same time.

Relevance. The most severe component of acute destructive pancreatitis (ADP) is enzymatic parapancreatitis (EPP). Pathogenetic treatment methods are limited.

The objective was to evaluate the effectiveness of different treatment methods.

Material and methods. Group 1 included 86 patients with ADP, enzymatic peritonitis (EP), EPP; 44 patients with EPP of them were performed LD of the retroperitoneal tissue. Group 2 included 120 patients with EPP without EP, 48 – with PPD (percutaneous drainage of parapancreatic tissue).

Results. Mortality rate in patients with hemorrhagic EPP with LD was 16 %, without LD – 37 %, in patients with serous EPP with LD – 15 %, without LD –15 %. Mortality rate in patients with EPP without EP and with PPD was 6.2 %, without PPD – 8.3 %

Conclusion. LD and PPD should have been applied on the basis of the variant of EPP.

Introduction. The article described the methodology of the objective express diagnostics of cardiovascular and respiratory synchronism depending on manifestations of static spinal deformities. The approaches to simultaneous static and dynamic studies of postural balance with spiro-arterio-cardiorhythmography were discussed.

The objective of the work was to determine the mutual influence of static and dynamic postural balance on cardiovascular and respiratory synchronism.

Material and methods. We analyzed indicators of static and dynamic postural balance and indicators of cardiovascular and respiratory synchronism among the population without manifested signs of pathology from the studied body systems.

Results. The effect of static spinal deformities was observed only on the functional indicators of respiration. Statistically significant correlations of static spinal deformities were observed only with functional respiratory parameters. Indicators of cardiovascular and respiratory synchronism were not affected.

Conclusion. The lordotic variant of the static spinal deformity, in contrast to the kyphotic and scoliotic variant, reliably affected the functional indicators of the respiratory system, as well as the indicators of cardiovascular and respiratory synchronism. The balance of sagittal deformities correlated with functional indicators of cardiovascular and respiratory systems, as well as with indicators of cardiovascular and respiratory synchronism. It was important to emphasize that in order to maintain cardiovascular and respiratory compliance with the most commonly diagnosed variants of static deformity (kyphotic and scoliotic), significant modifications in cardiovascular and respiratory regulation were observed much less frequently than alongside with lordotic deformity.

Introduction. Each tenth tumor of skin is melanoma. Presence of tumor cells in sentinel lymph node influenced the medical tactics.

The objective of the research was to study the metastasis of skin melanoma into the clinically negative regional lymph nodes.

Material and methods. Histological, immunohistochemical, cytological and immunocytochemical methods were used to study biopsies of regional lymph nodes in 60 patients with skin melanoma.

Results. 5 % of patients were diagnosed with melanoma in situ, 15 % – Т1, 28.3 % – Т2, 23.3 % – Т3, 28.3 % – Т4. At outflow of the lymph through 1 collector, the metastases in sentinel lymph node (SLN) was defined in 51 %, through 2 collectors – in 81.8 % of cases. Tumor cells damaged single lymph node in 35.3 % of cases, two and more lymph nodes in 64.7 % of cases. Metastases in SLN with formation of secondary tumor at the T1 melanoma were observed at 11.1 %, T2 – 5.9 %, T3 – 21.4 %, T4 – 47.1 % of studies. Clusters of cells or isolated cells of melanoma in SLN at Т1 were noted in 22.2 %, at Т2 – in 41.2 %, at Т3 – in 42.9 %, at Т4 – in 35.3 % of cases. At outflow of lymph through 1 collector, metastasises of melanoma in non-sentinel lymph nodes (NSLN) were revealed in 24 %, through 2 collectors – in 44.4 % of cases. Secondary changes of NSLN were noted in 16.7 % of cases of defeat of single SLN, in 31.8 % of cases of defeat of two and more SLN. Metastases of melanoma were revealed in 69.2 % of cases of formation of secondary tumor and in 4.8 % of cases of presence of clusters in SLN in removed NSLN.

Conclusion. At increase of Тmelanoma of the skin, the quantity of sentinel lymph nodes with reactive changes decreased, and their number with metastases increased. Metastatic defeat of sentinel lymph nodes at outflow of lymph through 2 lymph collectors in two and more SLN and NSLN exceeded the defeat of SLN at outflow of lymph through 1 lymph collector in single lymph nodes. The use of immunocytochemical method of research allowed to expand pathomorphological verification of metastatic defeat of sentinel lymph nodes by 66.7%.

The article described the rare clinical case of the patient with probable transmissible encephalopathy (Creutzfeldt–Jakob disease) in whom rapidly forming primary progressive aphasia was the herald clinical feature, and motor and sensory functions were preserved. Creutzfeldt–Jakob disease was diagnosed, and it was confirmed by clinical picture with fast progression of the disease, together with neurovisualization (brain magnetic resonance imaging, FLAIR and DWI options) and electroencephalography pattern. Other possible causes of primary progressive aphasia were excluded.

Acute cerebellitis is a common inflammatory syndrome typically occurring in children and only on very rare occasions in adults. Thus, there was no description of acute cerebellitis, associated with Crohn’s disease, found in Russian sources of literature. We reported a case of acute cerebellitis in 45-year-old woman with a long history of Crohn’s disease treated with Mesalazine as a basic therapy and a resection of ileotransversoanastomosis together with small intestine two months before the onset of neurological symptoms. She first presented with severe headache and left-sided cerebellar dysfunction. The MRI showed signs of pronounced edema of the left hemisphere of the cerebellum, pial Gd-enhancement along the cerebellar folia, difficulty of CSF- flow. The application of lumbar puncture was impeded by the possibility of complications, such as brain herniation. Treatment with high-dose intravenous Methylprednisolone resulted in clinical and radiological improvement. Over the following year, her clinical status remained unchanged, except for one case of epileptic seizures as a result of switching of basic therapy of Crohn’s disease on Adalimumab. In this case, hemicerebellitis most likely has an immune-mediated nature. The temporal relationship with increased activity of Crohn’s disease and a significant positive response to corticosteroid therapy favored this hypothesis. It was known that inflammatory bowel diseases (IBD) had many extra-intestinal manifestations including neurological ones. With regard to that, the alterations in gut microbiota could be a possible common base for systemic inflammatory and autoimmune diseases, such as Crohn’s disease or autoimmune cerebellitis, described in this study.

The basic method of myocardial revascularization in acute coronary syndrome is coronary stenting. Due to the high risk of later coronary events such as restenosis and late coronary thrombosis, studies on the different types of stents are currently underway.

The objective was to evaluate the degree of neointimal coverage of stents with a permanent and biodegradable polymer in one patient.

The patient with unstable angina was implanted 2 everolimus-containing stents with a constant polymer (Promus Premier) and a biodegradable polymer (Synergy). After 9 months, optical coherence tomography (OCT) was performed with the calculation of indicators.

774 struts of the Synergy and 701 struts of the Promus Premier were analyzed. When evaluating the thickness of the formed neointima, no significant differences was obtained (p=0.47). At the same time, a greater number of uncovered struts were detected in the Promus Premier stent compared with Synergy stent (1.14 vs. 0 %, p = 0.002). The number of malposed uncovered struts was not statistically different (0.14 versus 0.13, p = 1.00), the difference in the number of malposed struts covered approaches statistically significant (1.14 versus 0.26, p = 0.0545).

According to the results of optical coherence tomography, no significant differences between the studied platforms was obtained when assessing the late lumen loss. A greater number of uncovered struts in the stent with permanent polymer was detected, which could be considered as a risk factor for the development of late coronary thrombosis.