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This review is devoted to the relevance of the problem and the assessment of potential surgical indications, surgical methods and clinical results in the intestinal autotransplantation. Radical resection of theneoplasmisperformed. Currently, the main indications for performing intestinal autotransplantation are considered neoplasms of the pancreas, mesenteric and retroperitoneal space with the involvement of the superior mesenteric vessels in the process. Preliminary results demonstrate that radical resection can be effective in carefully selected patients. Although perioperative morbidity and mortality are relatively high, the literature describes some cases with long patient survival, especially when performing radical resection of a benign tumor or a tumor of potentiallow malignant. However, early tumor recurrence remains a serious problem in patients with a high-grade tumor, especially with pancreatic ductal adenocarcinoma (PDAC). It should be noted that when using intestinal autotransplantation, it is possible to perform a radical resection of the organ in patients with separate neoplasms in the abdominal cavity and the involvement of the main mesenteric vessels in the process. However, this aggressive method is associated with significant operational risk and should be only performed in specialized centers. The additional combination therapies have to be developed to optimize the clinical outcome and prolong the survival of patients with pancreatic cancer.

Immediacy of the problem of acute adhesive small bowel obstruction (AASBO) is due to its high prevalence and presence of certain difficulties in diagnosis, which affect the choice of the treatment method. In addition, the long-term results of treatment cannot be considered satisfactory due to the large number of AASBO recurrences. In 64-93% of cases, adhesions form on the abdominal organs after surgery. It should be noted that their recurrence after open surgery reaches 30% of cases, and after repeated operations this value increases to 78%. Determination of the main etiological factor is of great importance, which makes it possible to assess the feasibility surgery, since it is known that if adhesions do not develop, treatment can be conservative. In this regard, X-ray methods of investigation can be of great help. Surgical intervention is recommended in the presence of intestinal dysfunction symptoms that do not disappear after conservative treatment or when it worsens. Surgical intervention is recommended if symptoms of intestinal dysfunction do not disappear after conservative treatment or if they deteriorate. n recent decades, specialists in the field of abdominal surgery have been striving to expand the indications for laparoscopic interventions in order to reduce the invasiveness of surgery, which will also decrease the risk of adhesions. Keywords: Bowel obstruction, small intestine, surgery, adhesions, laparoscopic adhesiolysis.

Цель. Оценить результаты оказания помощи пациентам с панкреатогенными кровотечениями. Материал и методы. Проанализированы результаты лечения 84 пациентов с панкреатогенными кровотечениями (ПК). В 73 (86,9%) случаях кровотечения были после прямых вмешательств на поджелудочной железе (n=12) и гнойно-септических осложнений острого панкреатита (ОП) (n=61). В 11 (13,1%) наблюдениях кровотечения возникли при хроническом панкреатите (ХП), осложненном ложными кистами (ЛК) поджелудочной железы. В 42 (50%) наблюдениях имело место кровотечение типа А, в 26 (31%) – типа В и в 16 (19%) – типа С. Оценивались результаты оказания помощи в зависимости от типа и тяжести кровотечения. Результаты. Консервативная терапия в 31 наблюдении из 42 при кровотечениях типа А позволила добиться стойкого гемостаза. В 12 случаях при ПК, обусловленных пенетрирующими в поджелудочную железу язвами желудка и двенадцатиперстной кишки, для достижения гемостаза эффективно использовали методику комбинированного эндоскопического гемостаза с проведением антисекреторной терапии. При наличии внутрибрюшных послеоперационных профузных кровотечений типа В и С вследствие панкреонекроза в 38 наблюдениях выполняли релапаротомию, прошивание кровоточащего сосуда с тампонированием (n=7) поджелудочной железы, санацией и дренированием брюшной полости. Отмечено 18 летальных исходов. Резекция хвоста поджелудочной железы со спленэктомией выполнена в 4 наблюдениях, в 9 случаях для достижения гемостаза при кровотечениях из ЛК ПЖ производили прошивание кровоточащего сосуда с наружным дренированием и тампонированием ЛК ПЖ (n=6), а также продольный панкреатоеюноанастомоз (n=3). Летальные исходы были отмечены в 2 наблюдениях. В 2 случаях выполняли рентгеноэндоваскулярную эмболизацию желудочно-двенадцатиперстной артерии. Осложнений и летальных исходов не отмечено. Заключение. Кровотечения, сопровождающиеся выраженными гемодинамическими нарушениями, требуют выполнения открытых оперативных вмешательств. Рентгеноэндоваскулярные методы эффективны при кровотечениях, развивающихся при остром и хроническом панкреатите и в послеоперационном периоде. Научная новизна статьи Предложено выделять три типа панкреатогенных кровотечений. Использование предложенного варианта классификации наряду с учетом тяжести кровотечения позволяет выбрать наиболее патогенетически обоснованный способ гемостаза. Продемонстрировано, что тяжелые панкреатогенные кровотечения, сопровождающиеся выраженными гемодинамическими нарушениями, требуют выполнения неотложных открытых оперативных вмешательств. Рентгеноэндоваскулярные методы являются эффективными малоинвазивными методами гемостаза артериального кровотока при кровотечениях, развивающихся на фоне острого и хронического панкреатита, а также при кровотечениях в послеоперационном периоде.

Objective: To study the sepsis markers informativeness to assess the role of monocytes in the pathogenesis of generalized peritonitis (GP). Methods: The study included 160 patients with GP, who were divided into 3 groups, according to the stages of the disease. To establish the activity of monocytes was made a determination of the level of cytokine TNF-α and presepsin in the blood. Results: Studies showed that the level of TNF-α in patient with septic shock was reliably lower (24.5±13.3 pg/ml) than in patients with endogenous intoxication and abdominal sepsis. The value of TNF-α in deceased patients also was low – 4.8±0.9 pg/ml. This indicates a decrease in the ability of monocytes in GP at the stage of septic shock to exude a sufficient amount of pro-inflammatory cytokines in response to endotoxin aggression. The level of presepsin increased by stages and amounted to 355.6±8.6, 783.4±24.0 and 1587.7±70.5 pg/ml, respectively. This indicates the circulation in the blood of the CD14 receptor, which is able to express on monocytes, converting them into endothelial progenitor cells. Conclusions: Monocytes as endothelial progenitor cells contribute to the regeneration and restoration of endothelial function in its dysfunction that develops in GP and abdominal sepsis. In consequence of developing immunosuppression and suppression of monocyte function in the stage of septic shock, the process of renewal of endothelial cells is weakened, the secretion of pro-inflammatory cytokines, in particular TNF-α, decreases, which can contribute to an increase in mortality in septic shock. Keywords: Monocytes, abdominal sepsis, septic shock, endothelial dysfunction, progenitor cells.

Nowadays, telemedicine services are widely used throughout the world. Various types of telemedicine services, such as the storage and transmission of real-time information, remote monitoring or self-control can be applied in the fields of education, health and management, disease screening and disaster risk management worldwide. Telemedicine can play a big role in conducting medical research, as well as in the field of training scientific personnel, allowing remotely collaborate with scientific and clinical institutions and gain access to expensive remote equipment. In this context, it is considered appropriate to develop and apply such innovative ideas as online computing models in telehealth applications; simplified software and hardware interfaces, programs for modelling; portable telepresence systems; artificial intelligence applications that are especially relevant in cases where simulated patients cannot replace real ones; and development of a large number of application simulators. Keywords: Telemedicine, technology, telecommunications, innovation.