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From the latest WHO classification of neuroendocrine neoplasms (NENs), the term MiNENs refers to mixed neuroendocrinenon-neuroendocrine tumors. A neuroendocrine component coexists with a non-neuroendocrine one in them. They are morphologically and/or immunohistochemically validated. The non-neuroendocrine component implicates adenocarcinoma, apart from other histological subtypes of carcinomas, such as squamous cell carcinoma. The neuroendocrine component can be represented by a high-grade tumour (HGNEC) in addition to neuroendocrine cancer. Gastric NENs also have subgroups of MiNENs such as mixed adenoneuroendocrine carcinoma (Mixed-adenocarcinoma-NEC), which includes both, small or large cell type, neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine tumor (Mixed-adenocarcinoma-NET). Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) is a rare disease. Based on the available data, neuroendocrine component has a highly aggressive biological behaviour represented by a low-differentiated neuroendocrine tumor in the majority of MiNENs cases. The treatment is based on the principles of neuroendocrine tumour therapy. The foregoing shows that it is not possible to provide precise epidemiological data, prognosis and approve treatment strategies.

Aim: to study the features of purine, lipid and carbohydrate metabolic disorders in patients with coronary artery disease over 90 years old (centenarians).Materials and methods. The study enrolled 225 patients over 90 years, hospitalized with coronary artery disease. The majority of patients (67.6%) were women. The mean age of the patients reached 92.5+2.2 years (from 90 to 106 years).The blood levels of uric acid, lipids, glucose and body mass index were determined.Results. Obesity was registered in 31.5% of patients, grade III obesity – in 1 patient. Overweight was observed in 39.1% of patients, normal body mass index (BMI) – in 28.9%. An increase in the blood concentration of triglycerides was determined in 11.2% of patients. A decrease in the level of high-density lipoprotein (HDL) cholesterol was registered in 12.7% of patients. The blood concentration of low-density lipoprotein cholesterol (LDL) less than 2.0 mmol/l was observed in 23.3% of cases. Dyslipidemia was registered more often in women (p=0.02). Hyperuricemia was found in 37.3% of patients – in 41.4% of women and 28.8% of men (p=0.04). Elevated fasting blood glucose levels were determined in 23.1% of patients, but only 0.9% of patients had glucose levels above 14 mmol/l.Conclusion. The study results indicate some features of metabolic disorders in centenarians with coronary artery disease. Most of the patients were obese or overweight. Frequent hyperuricemia was registered, but relatively low levels of atherogenic lipids and glucose.

Aim. To determine ultrasound, computed tomography and angiographic image characteristics for soft tissue hemorrhages/hematomas, the sequence of using imaging methods in patients infected with SARS-CoV-2, to study the morphology of changes in soft tissues, to determine the essence of the concept and to develop treatment tactics for this complication of COVID-19.Material and methods. During 4 months of treatment of elderly patients (+60) infected with SARS-CoV-2, 40 patients were identified with soft tissue hemorrhages/hematomas, of which 26 (65%) patients with large hematomas (>10 cm in size and > 1000 ml in volume). The analysis of clinical and laboratory parameters, methods of instrumental diagnostics (ultrasound – 26 patients, CT – 10 patients, angiography – 9 patients, punctures – 6 patients) was carried out; autopsy material was studied in 11 cases.Results. Image characteristics of hemorrhages/hematomas of soft tissue density were obtained using modern instrumental methods, and the sequence of application of visualization methods was determined. A tactic for managing a patient with stopped and ongoing bleeding has been developed. The morphological substrate of hemorrhagic complications in a new viral infection was studied. All patients were treated with conservative and minimally invasive procedures (embolization, puncture with pressure bandage). 15 patients (57.7%) recovered, 11 patients (42.3%) died from the progression of COVID-19 complications.Conclusion. Comprehensive clinical and laboratory sequential instrumental diagnosis of soft tissue hemorrhages in COVID-19. Treatment should be conservative and significantly invasive. The use of the term “soft tissue hematoma” in SARS-CoV-2 infected patients is not a natural quality of the normal pathological process and should not be observed from our point of view.

Despite the evolution in modern surgery and in pharmaceutical industry, purulent pathology of the hand is occupying a leading position for many years among all diseases with which patients are admitted to hospitals. Over the years, medical care for such patients has been improving. A high social and economic significance of this problem makes surgeons to continue searches of new directions not only in surgical techniques, but also in postoperative wound management to improve outcomes in patients with purulent diseases of the hand.The purpose of this work is to assess results of care of patients with purulent finger and hand diseases treated with laser light necrectomy and photodynamic therapy. A comparative analysis of wound process dynamics and treatment outcomes in 198 patients with hand purulent diseases who had been admitted to Moscow City Hospital No. 4 was made by the authors. All patients were divided into four groups depending on the curative modality. In Group 1 (n = 53), a wound was sutured after surgery, and a drainage-lavage system (DLS) was installed; in Group 2 (n = 50), a wound was not sutured because of contraindications to suturing; in Group 3 (n = 46), patients had laser necrectomy after which a wound was sutured and DLS was installed; in Group 4 (n = 49), a wound was not sutured because of contraindications like in Group 2, but it was treated with antiseptic dressings and photodynamic therapy at an early postoperative period. Various aspects of the effectiveness of laser techniques have been analyzed: dynamics of wound healing, changes in wound defect size, level of pain syndrome assessed by VAS, changes in clinical blood tests, changes in wound exudate cytological picture as well as changes in wound microflora. Acceleration of wound healing was noted in all patients who were treated with laser light what, consequently, shortened their inpatient stay. Laser light also changed cytological and microbiological patterns of wound exudate, as evidenced by the decrease of wound detritus and by the decrease of microbial content in the wound. In patients, who were treated with laser light, less pain syndrome was registered immediately after laser technique application.The obtained findings demonstrate a positive effect of laser necrectomy with DLS at wound process as well. Photodynamic therapy significantly improved results in patients with open wound management on the hand and fingers. Laser techniques have good perspectives in purulent surgery of the hand.

The article presents a clinical observation of a patient with type 1 Multiple Endocrine Neoplasia syndrome (MEN 1). During the diagnostic search, a combination of primary hyperparathyroidism, parathyroid adenoma and hormonally inactive pancreatic head tumor was found. Simultaneous transoral parathyroidectomy and laparoscopic resection of the pancreatic head was performed. We haven`t found the literature data describing such kind of operations for MEN 1 syndrome. An original solution was applied to perform intraoperative ultrasonography monitoring. The results of 1-year postoperative follow-up are presented. This observation demonstrates the possibilities of endoscopic technologies in the treatment of MEN 1 syndrome.

Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.

To analyze own initial experience of transoral thyroid surgery.There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm.Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days.Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.Эволюция доступов в тиреоидной хирургии имеет богатую историю - от традиционного разреза на передней поверхности шеи к миниинвазивным и эндоскопическим вмешательствам. Собственный экспериментальный опыт и тщательный анализ мировых данных послужили основой для внедрения трансоральных операций на щитовидной железе в нашу клиническую практику. С марта 2018 г. по май 2019 г. после скрупулезного отбора, согласно критериям включения и оформления добровольного информированного согласия, оперированы 7 пациенток с узловыми образованиями щитовидной железы. Хирургический доступ осуществлен через 3 разреза в нижнем своде преддверия рта с установкой 10-миллиметрового эндоскопа и 25-миллиметровых инструментов. Рабочую полость поддерживали газовым способом. Средний возраст пациенток составил 43,3±11,8 года. Тиреоидэктомия выполнена у 2, гемитиреоидэктомия - у 5. Размеры узловых образований в удаленных препаратах варьировали от 10 до 42 мм. Время операции при гемитиреоидэктомии и тиреоидэктомии в среднем составило 206,4±63,8 и 232±37,5 мин соответственно. В 1 случае гистологически верифицирована папиллярная карцинома. Травм возвратного гортанного нерва и послеоперационной гипокальциемии не зафиксировано, как и местных осложнений. Дренирование раны не выполняли. Время нахождения в стационаре после операции 3,7±1,1 сут. Выводы. Выводы, полученные на экспериментальном этапе, их коррекция согласно мировому опыту позволили нам впервые реализовать в клинической практике трансоральную операцию на щитовидной железе. Трансоральный преднижнечелюстной доступ к щитовидной железе технически осуществим стандартными эндоскопическими инструментами, безопасен в отношении важных анатомических структур, более прецизионен благодаря оптическим возможностям видеоэндоскопа. Вмешательство на щитовидной железе возможно в любом объеме. И бесспорно, эстетический результат операции не вызывает сомнений.