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The pandemic of the new coronavirus infection COVID‑19, according to recent studies, has a significant effect on vascular platelet hemostasis in its pathogenesis. The article examines the tactics of managing patients with COVID‑19 from the standpoint of assessing hemostasis disorders, the risks of thrombus formation and the correction of detected disorders.

Introduction. Morphological diagnosis of inflammatory bowel diseases (IBDs) based on endoscopic biopsies remains a rather challenging task and does not always allow the pathologist to make the final conclusion. Difficulties arise due to the absence of a classical morphological picture in biopsy specimens as well as the lack of clinical and laboratory data. These issues may lead to an incorrect interpretation of the detected pathological changes and an erroneous conclusion. The aim of the study was to assess the quality of biopsy diagnosis of IBDs using Internet diagnostic tools, namely, the digitalized histological slides. Materials and methods. We created an Internet platform, which contained 100 scanned images of histologi-cal slides from 70 patients with suspected IBD. Based on our own practical experience and guidelines of international European and British societies of pathology, we arranged a survey. The diagnosis was made on the combined clinical and morphological approach, considering also a complex of clinical, laboratory, endoscopic, and morphological data. The first stage of the survey was anonymous and included a list of 25 questions. Ten pathologists, who agreed to take part in the study, completed the questionnaire. After statistical processing, the results were assessed using a Fleiss' kappa criterion. Results. The comparative analysis of morphological study showed that the participants were able to diagnose accurately only 71% of ulcerative colitis cases and 63% of Crohn’s disease cases. At the same time, the agreement coefficient demonstrated satisfactory values: the Fleiss' kappa was 0.34 and 0.25, respectively. In some cases, the participants found it difficult to perform a differential diagnosis between IBD and other forms of colitis and were not always capable of distinguishing ulcerative colitis from Crohn’s disease. A few of the individual criteria, on which the diagnosis is based, rarely reached agreement above a kappa of 0.5. The participants’ agreement was considered more often as “weak” and “satisfactory”. This is largely due to the fact that we did not discuss the exact criteria for the proposed parameters and that these parameters were divided into four degrees of severity from 0 to 3. Conclusion. The results showed the current discrepancies in the assessment of biopsies in patients with suspected IBD. The developed Internet platform provides additional significant opportunities to improve the quality of morphological diagnosis in ileal and colon biopsies by means of refining the criteria and their assessment in the final diagnosis statement. Keywords: inflammatory bowel disease, colitis, digital pathology

Severe Acute Respiratory Syndrome (SARS-CoV-2) has spread rapidly throughout the world, causing high morbidity and mortality Analysis of clinical and autopsy data may allow to understand this disease The results of pulmonary and renal autopsies in 37 deceased patients from COVID-19 are presented Materials and methods An autopsy was performed in Moscow in 37 deceased patients aged from 28 to 94 years The microscopic features of the lungs and kidneys were examined using hematoxylin and eosin staining Results Important findings include diffuse alveolar injury, pulmonary thrombosis and microangiopathy, as well as acute kidney injury in all cases, varying in severity Conclusions We report the presence of acute kidney injury in all cases, which requires correction of renal function in patients with SARS-CoV-2, with control of serum creatinine levels, urine volume, proteinuria and hematuria Тяжелый острый респираторный синдром (SARS-CoV-2) быстро распространился по всему миру, вызвав высокую заболеваемость и смертность Анализ клинических данных и данных аутопсии может помочь нам разобраться в данной болезни Мы представляем результаты легочной и почечной аутопсии у 37 умерших от COVID-19 пациентов Материалы и методы В Москве произведена аутопсия 37 умершим пациентам в возрасте от 28 до 94 лет Были исследованы микроскопические особенности легких и почек с помощью окрашивания гематоксилином и эозином Результаты Важные результаты включают диффузное альвеолярное повреждение, тромбоз и микроангиопатию в легких, а также острое повреждение почек во всех случаях различной степени тяжести Выводы Мы сообщаем о наличии острого повреждения почек во всех исследуемых случаях, что требует коррекции функции почек у больных SARS-CоV-2 с контролем уровня креатинина в плазме крови, объема мочи, наличия протеинурии и гематурии

Background: Pathological anatomy, patogenesis and the morphogenesis of manifestations and complications of COVID-19 remain insufficiently studied. The fullest information on structural bases of organs and tissues alterations by new coronavirus disease can be obtained as a result of autopsies. Aims: The aim of the study was to study the morphological changes of lungs and other organs of the autopsies of COVID-19 deceased persons. Results of 2000 autopsies of people who died of a severe form of COVID-19 in Moscow, consisting of 1212 men and 788 women, from March 20 to May 22, 2020 (a ratio 1.54:1) aged from 20 to 99 years (on average 68.515.63 years) were presented. This experience was previously generalized in the Atlas COVID-19 pathology. Autopsies were made in the converted interstationary pathoanatomical offices at strict observance of rules of biosafety according to standard and legal documents of WHO, Russian Ministry of Health and Rospotrebnadzor. Results: Morphological changes of lungs with varying severity and extent were detected in all examined cases; however, damage to other organs was also common, which in some cases prevailed over pulmonary changes and was the cause of death. The main morphological changes in lungs were diffuse alveolar damage and microangiopathy, alveolar hemorrhage syndrome, thrombosis, and thromboembolism. Conclusion: The involvement of the lungs, other organs, and vascular system in the pathological process is a result of multiple factors. It is advisable to implement clinical and morphological masks of COVID-19.

The research aim is to study the morphological features of COVID-19 in the lungs of patients who died in Moscow from March 20 to June 6, 2020. Methods . Autopsy material of the lungs from 123 deceased (54 women, 69 men) with COVID-19 coronavirus infection (confirmed by PCR) was analyzed, the median age was 71 (30 – 94) years, and the duration of the disease was 14 (3 – 65) days. In all cases, the patient’s medical records and autopsy reports were analyzed. Macro- and microscopic changes in the lungs were evaluated in all the observations. Results . The pathology of the lungs in COVID-19 corresponds to various phases of diffuse alveolar damage (DAD). The exudative phase of DAD was detected in 54 (43.9%), the proliferative phase – in 21 (14.63%), and their combination – in 51 (41.46%) of the deceased. Histological features of different phases of DAD are described. Conclusion . An analysis of autopsy material revealed a mismatch between the duration of the course of the disease and the phase of diffuse alveolar damage. A significant portion of the dead found a combination of exudative and proliferative phases of the disease. Histological signs that indirectly indicate a violation of the coagulation system during COVID-19 are described.

Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation.As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin).According to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%).Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.Цель. Определить первичную антибиотикорезистентность штаммов Helicobacter pylori (H. pylori), изолированных от пациентов, проживающих в европейской части Российской Федерации. Материалы и методы. В рамках клинико-лабораторного исследования в период с 2015 по 2018 г. проанализировано 27 гастробиопсийных образцов, полученных от H. pylori-инфицированных пациентов. Верификация инфицированности H. pylori проводилась с помощью быстрого уреазного теста, а также 13С-уреазного дыхательного теста. Значения минимальной подавляющей концентрации антибиотиков определяли диффузионным методом с применением полосок Е-тест (BioMerieux, Франция) согласно рекомендациям фирмы-производителя. Чувствительность изолятов определяли к 6 антибактериальным препаратам (амоксициллин, кларитромицин, метронидазол, левофлоксацин, тетрациклин, рифампицин). Результаты. Согласно полученным данным, резистентность к амоксициллину составила 0%, кларитромицину 11,1%, метронидазолу 59,3%, левофлоксацину 3,7%, тетрациклину 0%, а рифампицину 14,8%. Двойная резистентность к кларитромицину и метронидазолу зарегистрирована у 2 (7,4%) изолятов. Заключение. Первые результаты оценки антибиотикорезистентности H. pylori в европейской части РФ свидетельствуют о низкой резистентности микроорганизма к кларитромицину и достаточно высокой к метронидазолу.

The objective: to predict lethal outcomes in patients with COVID-19 based on the result of chest computed tomography (chest CT) using a semi-quantitative visual scale of the pulmonary parenchyma lesion.Subjects and methods. Inclusion criteria: patients who underwent chest CT from March 2 to May 1, 2020, inclusively, upon referral of a general practitioner due to suspected community-acquired pneumonia caused by COVID-19. Chest CT was performed in 48 medical organizations providing primary medical care to the adult population in Moscow. Exclusion criteria: patients whose chest CT was not assessed by CT 0-4 score; patients who were not confirmed as COVID-19 positive.In the Russian Federation, CT 0-4 score is recommended to be used for assessment of the extent of lung parenchyma lesion in cases with suspected COVID-19.Data on fatal outcomes were received on May 4, 2020 inclusive.Results: data of 13,003 patients from the Unified Radiological Information Service were retrospectively included in the study according to inclusion and exclusion criteria. The test aimed to detect a trend of directional changes in the proportion of deceased patients among various categories using CT 0-4 score demonstrated a statistically significant result (p < 0.0001). The chance of a lethal outcome increases directionally from CT-0 to CT-4. The test for deviations from the linear trend also provided p < 0.0001, i.e. when moving to higher scores (CT-3 and CT-4), there was an accelerated increase in the risk of death. Analysis of overall survival using the Cox regression model showed that the assessed factors (age and CT 0-4 score) were statistically significantly associated with the time to death from COVID-19 (p < 0.05). The risk of death increased with age, on average, 8.6% for every 5 years (95% CI 0.8-17.0%). When transferring from one category of CT to the next one, the risk increased by 38% on the average (95% CI 17.1-62.6%). There was no statistically significant association of gender factor with overall survival (p = 0.408).The visual score of CT 0-4 recommended for use in the Russian Federation to assess lung parenchyma lesions according to chest CT data, is a predictor of a lethal outcome in patients with COVID-19. CT 0-4 score is convenient for practical use.

Relevance. Facial paralysis is a common neurological illnesses of the maxillofacial region. Gold standard of dynamic correction of permanent facial paralysis is gracilis muscle transfer. However, using this flap is impractical or impossible in some cases. There are few domestic and international publications about extensor digitorum brevis muscle for facial reanimation surgery.Purpose. Assessment of muscle variability on the dorsum of the foot; analysis of blood supply and innervation of the extensor digitorum brevis muscle.Materials and methods. Operations performed on 10 unclaimed corpses: dissection of the extensor digitorum brevis muscle, as well as the blood vessels and nerves of the dorsum of the foot. The legal and ethical requirements for such studies were observed planning the design of the study and during work.Results. As a result, in 80% of cases, was found a typical anatomy of muscles, blood vessels, and nerves in the dorsum of the foot. In 10% was found a typical anatomy of muscles and nerves, but there was no lateral tarsal artery – the branch of the dorsal artery of the foot. Blood supply to the extensor digitorum brevis muscle performed by perforating branches of the peroneal artery. In 10% was found subtotal atrophy and fibrous degeneration of the extensor digitorum brevis muscle.Conclusions. The use of the extensor digitorum brevis muscle is a perspective method for the treatment of facial paralysis. Harvesting of this flap is complicated.

To revise the existing criteria to improve the definition of chronic colitis stages in inflammatory bowel diseases (IBDs).A total of 100 cases of IBDs (ulcerative colitis (The sequence of chronic colitis stages was defined from Stage 1 (early changes) to Stage 3, which are characterized by progressive mucosal structural rearrangement. Mainly at Stage 3 that characterizes the final stage of structural rearrangement in the mucous membrane, where dysplastic changes (the onset of tumor transformation) are detected.For the diagnosis of chronic colitis in IBD, it is mandatory to detect mucosal structural rearrangement. Stages 1 and 2 are characterized by early structural changes in the mucous membrane, whereas the process becomes irreversible at Stage 3. The identification of colitis stages is of diagnostic and, undoubtedly, prognostic value.Пересмотр существующих критериев для усовершенствования определения стадий развития хронического колита при воспалительных заболеваниях кишечника (ВЗК).Изучены 100 случаев ВЗК, диагностированных за период с 2017 по 2019 г. (язвенный колит 70 случаев и болезнь Крона 30 случаев). В качестве группы сравнения были отобраны 30 случаев заболевания колитом, которые при окончательной постановке диагноза были отнесены к колитам инфекционной и лекарственной природы.Выделены последовательные стадии развития хронического колита от 1-й (начальные изменения) до 3-й, для которых характерно прогрессирование структурной перестройки слизистой оболочки. Преимущественно на 3-й стадии, которая характеризует финальную стадию структурной перестройки слизистой оболочки, в ней обнаруживаются диспластические изменения — начало опухолевой трансформации.Для постановки диагноза хронического колита при ВЗК обнаружение структурной перестройки слизистой оболочки является обязательным. 1—2 стадия характеризуется начальными структурными изменениями слизистой оболочки, а на 3-й стадии процесс становится необратимым. Выделение стадий развития колита имеет важное диагностическое и, несомненно, прогностическое значение.

The issues of medical statistics on mortality from cancer, especially the correctness of such indicators, attract general interest. In a comparative aspect, mortality rates in different countries are given and the possible influence of various factors on the distortion of these indicators is described. The death rates in the Russian Federation, the Republic of Bashkortostan and Ufa are considered in detail. Comparison of the number of doctors and oncologists in the republics of Bashkortostan and Dagestan revealed some differences in the territories by the availability of doctors, especially oncologists. At the same time, the ratio of morbidity and mortality in these territories are in similar and correct parameters. A detailed analysis of the letters of the Ministry of Health of Russia with recommendations relating to the principles of coding for cancer in combination with another pathology. The statistical incident was the change in the coding rules for a post-mortem diagnosis in 2011 and the peculiarities of the translation of the text from ICD-10. According to the results of the analysis, proposals were developed aimed at the objectification of mortality rates and 5-year survival of cancer patients.

Purpose of research: To study methodological, organizational and normative problems of comparison of final clinical and pathological-anatomical diagnoses in the Russian Federation on the basis of a review of domestic and foreign publications.Abstract: Clinical and anatomical comparisons remain the most important function of quality control of medical and diagnostic work. Cases of divergence of diagnoses should be the subject of professional discussion in the medical community with the adoption of appropriate administrative measures to address deficiencies in the provision of medical care. Currently, there is no adequate regulatory regulation of the issue of comparison of clinical and pathological-anatomical diagnoses. This gives rise to many problems, including the subjectivism of the pathologist in the interpretation of the actions of the clinician, the permanent threat of criminal liability of medical workers for misdiagnosis. Penalties for discrepancies in diagnoses imposed by the Сompulsory Health Insurance Fund lead to an artificial underestimation of the divergence of diagnoses in medical organizations and to incorrect statistical accounting. The underestimation of the role of comorbid diseases and the lack of clear norms of their use in the diagnosis create difficulties in the correct assessment of the disease tanatogenesis, limits the analysis of morbidity and mortality for multiple reasons and entails the loss of some of the available information.

Background: Autopsies on COVID-19 deceased patients have many limitations due to necessary epidemiologic and preventative measures. The ongoing pandemic has caused a significant strain on healthcare systems and is being extensively studied around the world. Clinical data does not always corelate with post-mortem findings. The goal of our study was to find pathognomonic factors associated with COVID-19 mortality in 100 post-mortem full body autopsies.Materials and Methods: Following necessary safety protocol, we performed 100 autopsies on patients who were diagnosed with COVID-19 related death. The macroscopic and microscopic pathologies were evaluated along with clinical and laboratory findings.Results: Extensive coagulopathic changes are seen throughout the bodies of diseased patients. Diffuse alveolar damage is pathognomonic of COVID-19 viral pneumonia, and is the leading cause of lethal outcome in younger patients. Extrapulmonary pathology is predominantly seen in the liver and spleen. Intravascular thrombosis is often widespread and signs of septic shock are often present.Conclusion: The described pathological manifestations of COVID-19 in deceased patients are an insight into the main mechanisms of SARS-CoV-2 associated lethal outcome. The disease bears no obvious bias in severity, but seems to be more severe in some patients, hinting at genetic or epigenetic factors at play.

Currently, there are only scarce data on pulmonary COVID-19 lesions in pregnant women in the literature although the disease hasn't spared any country. This study aimed to provide insight into this issue. We carried out a retrospective analysis of the clinical data, autopsy, and microscopic findings in 4 pregnant women with severe COVID-19. Patients were admitted 4-5 days after COVID-19 onset with fever, dry cough, and reduced saturation. Positive SARSCoV2 nasopharyngeal swab PCRs were obtained. Chest CT revealed bilateral 'ground glass' pneumonia, CT 3-4. The women were diagnosed with severe COVID-19 requiring ALV and ECMO. They underwent emergent C-section with subsequent therapy. Patient 1, 37 y.o., 28-29 gestation weeks (GW), had comorbid conditions-obesity and arterial hypertension, died on the 11th bed-day (BD) due to pulmonary embolism. Patient 2, 31 y.o., 27 GW, developed bacterial pneumonia and acute pansinusitis with multiple organ failure resulting in death on 15th BD. Patient 3, 22 y.o., 35 GW, had ventilatorassociated pneumonia, lymphopenia, thrombocytopenia, anemia, and phlebothrombosis as COVID-19 complications. Later, she developed sepsis, which resulted in a lethal outcome (on 26th BD). Patient 4, 38 y.o., 32 GW, was diagnosed with pneumothorax on the 10th BD requiring pleural cavity drainage. The disease was complicated by bacterial pneumonia leading to respiratory failure and death (on the 30th BD). At autopsy, all four women had 'shock lungs' and diffuse alveolar damage at microscopy. Microscopic evaluation of the 1st patient's lung specimens revealed hyaline membranes corresponding to exudative DAD phase combined with proliferative DAD signs. In the 2nd case, we observed a pronounced cytopathic effect resulting in 'ugly' multinucleated cell formation, and multiple hemosiderophages in the alveolar lumens, as well as alveolar and bronchial metaplasia, confirmed by positive CK5-6 IHC staining. Third patient lung specimens demonstrated organizing viral pneumonia (with interalveolar granulation tissue, numerous interalveolar siderophages, indicating an alveolar-hemorrhagic syndrome) combined with massive bacterial pneumonia. Organizing viral pneumonia with mature interalveolar granulation tissue and sarcoid-like granulomas was diagnosed in 4 patient. Clinical and morphological analysis demonstrated that COVID-19 pneumonia features are similar for pregnant and non-pregnant patients of the same age group. The proliferative DAD phase was detected in three of 4 cases. However, of special interest is the first case, in which a combination of DAD phases was determined. At the same time, no severe obstetric complications were identified, which we associate with the timely diagnosis and prevention measures.

Severe Acute Respiratory Syndrome (SARS-CoV-2) has spread rapidly throughout the world, causing high morbidity and mortality. Analysis of clinical and autopsy data may allow to understand this disease. The results of pulmonary and renal autopsies in 37 deceased patients from COVID-19 are presented.An autopsy was performed in Moscow in 37 deceased patients aged from 28 to 94 years. The microscopic features of the lungs and kidneys were examined using hematoxylin and eosin staining.Important findings include diffuse alveolar injury, pulmonary thrombosis and microangiopathy, as well as acute kidney injury in all cases, varying in severity.We report the presence of acute kidney injury in all cases, which requires correction of renal function in patients with SARS-CoV-2, with control of serum creatinine levels, urine volume, proteinuria and hematuria.

To elucidate the prevalence of hepatitis B and C viral infection among the people who died in Moscow in 2015-2017, by studying the primary medical records of a representative sample of fatal outcomes, followed by the mathematical extrapolation of the data obtained to the total number of all deaths.The 2015-2017 primary medical documentations from 8 therapeutic-and-preventive establishments with morbid anatomy units in the administrative districts and from 2 infectious diseases hospitals of the Moscow Healthcare Department were studied. The sample of those who died was 11.8-12.1% of the total number of all-cause deaths in Moscow during these years and was representative at a 0.95 confidence probability and a ±5% confidence interval. The Bernoulli theorem and the Laplace function for the 95% confidence probability were used to extrapolate the obtained data to the number of all those who died in these years.The mortality rates associated with acute viral hepatitis B and C were 0.04-0.07 and 0-0.008, respectively, per 100,000 population, which corresponds to the official statistical data. The mortality rates for chronic viral hepatitis and liver cirrhosis in their outcomes, including hepatocellular carcinomas in their presence, exceeded the official statistical data by many times, accounting for 0.5-1.6 and 10.4-12.1 persons with viral hepatitis B and C, respectively, per 100,000 population and rose by 22.5% over 3 years. The rates obtained for hepatitis B virus were 1.7-5.6 lower, and those for hepatitis C virus were, on the contrary, 1.3-1.5 times higher than average in the European Union countries. There was a manifold (7.4-24-fold) prevalence of hepatitis C virus in the etiology of chronic liver damage. The mortality from liver cirrhosis of alcoholic and unknown etiology was 14.4-19.5 persons per 100,000 population and declined by 21% over 3 years. The percentage of deaths caused by acute viral hepatitis was 0.5% per 100,000 population in Moscow in 2017; that caused by chronic viral hepatitis, including liver cirrhosis in the outcome and hepatocellular carcinoma, which had developed in their presence, was 46.3%; and that of liver cirrhosis of alcoholic and unspecified etiology was 48.7% of the total number of all liver lesions.The study of primary medical records of a representative sample of fatal outcomes, followed by the mathematical extrapolation of the data obtained to the number of all deaths, makes it possible to objectively estimate the burden of mortality from hepatitis B and C viral infection.Цель исследования - выяснить распространенность инфекции, вызванной вирусами гепатита В и С, у умерших в Москве в 2015-2017 гг. с помощью изучения первичной медицинской документации репрезентативной выборки летальных исходов с последующей математической экстраполяцией полученных данных на общее число всех умерших. Материал и методы. Изучена первичная медицинская документация 8 лечебно-профилактических учреждений с патолого-анатомическими отделениями административных округов и 2 инфекционных клинических больниц Департамента здравоохранения Москвы за 2015-2017 гг. Выборка умерших составила 11,8-12,1% от общего числа умерших от всех причин в эти годы в Москве и была репрезентативной при доверительной вероятности 0,95 и доверительном интервале ± 5%. Для экстраполяции полученных данных на число всех умерших в эти годы в Москве применяли теорему Бернулли и функцию Лапласа для доверительной вероятности 95%. Результаты. Смертность от острого вирусного гепатита B составила 0,04-0,07, а С - 0-0,008 человека на 100 000 населения, что соответствует данным официальной статистики. Показатель смертности от хронического вирусного гепатита и цирроза печени в их исходе, включая развившиеся на их фоне гепатоцеллюлярные карциномы, многократно превысил данные официальной статистики, составив для вируса гепатита B 0,5-1,6, а С 10,4-12,1 человека на 100 000 населения, и увеличился за 3 года на 22,5%. Полученные показатели для вируса гепатита В в 1,7-5,6 раза ниже, а С, напротив, в 1,3-1,5 раза выше, чем в среднем в странах Евросоюза. Отмечено многократное (в 7,4-24 раза) преобладание вируса гепатита C в этиологии хронического поражения печени. Показатель смертности от цирроза печени алкогольной и неустановленной этиологии оказался равным 14,4-19,5 человека на 100 000 населения и снизился за 3 года на 21%. В процентном соотношении показателей причин смерти на 100 000 населения в Москве в 2017 г. острый вирусный гепатит составил 0,5%, хронический, включая цирроз в исходе и гепатоцеллюлярную карциному, развившиеся на их фоне, - 46,3%, цирроз печени алкогольной и неустановленной этиологии - 48,7% от общего числа всех поражений печени. Заключение. Изучение первичной медицинской документации репрезентативной выборки летальных исходов с последующей математической экстраполяцией полученных данных на число всех умерших позволяет объективно оценить бремя смертности от инфекции, вызванной вирусами гепатита B и С.

Based on the results of the retrospective analysis of 12 094 medical histories available from five large otorhinolaryngological clinics of the city of Moscow the authors arrived at the conclusion that the surgical treatment of maxillary sinus patholologies including the resection of retentional cysts accounts for 4.1% of the total number of surgical interventions on the ENT organs. The endonasal and extranasal approaches were used in 28.5% and 68.9% of the cases respectively. The combined approach to the maxillary sinus was applied in 2.6% of all the cases. The vector studies of the anatomical features of the ostiomeatal complex in 102 patients presenting with cystic lesions of the maxillary sinus with the use of computed tomography have demonstrated that the lumen of the complicated system communicating the maxillary sinus and the nasal cavity remains patent along its entire length; its part in the ethmoidal infundibulum region is as long as 1.31±0.03 mm and amounts to 2.09±0.02 mm in the region of natural anastomosis of the maxillary sinus (p0,01). The results of the histological study of 81 histological preparations give evidence that the lesions of the mucous membrane in the regions of ethmoidal infundibulum and natural anastomosis of the maxillary sinus have a chronic character and manifest themselves as sclerosis of lamina propria and hyperplasia of mucous glands. The authors nave come to the conclusion that the surgical approach to the maxillary sinus through the middle meatus is not sufficiently well substantiated and therefore can not be recommended for the resection of the cysts from this air cavity in the body of the maxilla.На основании ретроспективного анализа 12 094 историй болезней 5 крупных ЛОР-клиник Москвы авторами было установлено, что хирургические вмешательства на верхнечелюстной пазухе, связанные с удалением ретенционных кист, составляют 4,1% от общего числа хирургических вмешательств, проведенных на ЛОР-органах. В 28,5% операций оториноларингологи применяют эндоназальный, в 68,9% - экстраназальный и в 2,6% - комбинированный доступ к верхнечелюстному синусу. На основании векторного исследования КТ-анатомии остиомеатального комплекса 102 пациентов с кистозным поражением верхнечелюстной пазухи было установлено, что просвет сложной системы сообщения пазухи с полостью носа сохраняется на всем протяжении и составляет 1,31±0,03 мм в области решетчатой воронки, 2,09±0,02 мм - в области естественного соустья (p0,01). В результате гистологического исследования 81 гистологического препарата было установлено, что поражение слизистой оболочки в области решетчатой воронки и естественного соустья верхнечелюстной пазухи носит хронический характер и проявляется склерозом собственной пластинки и гиперплазией слизистых желез. Авторы приходят к заключению о необоснованности хирургического доступа к верхнечелюстной пазухе через средний носовой ход при удалении кист верхнечелюстной пазухи.

The Crohn’s disease is a multisystem chronic idiopathic disease from inflammatory bowel disease group, which is characterized by the development of immune granulomatous inflammation with the formation of non-necrotizing epithelioid cell sarcoid granulomas as in the wall of the intestine, and extra-intestinal. Granulomas are found, on average, in half of patients with Crohn’s disease, and is twice more often at children, and also in operational material, in comparison with biopsy. Communication of development of granulomas with the autophagy-related genes is revealed and possibility of existence of two phenotypes or genotypes of a disease, depending on existence of a granulematous inflammation though it is impossible to exclude that in some cases granulomas remained not found. Further researches will allow to specify the frequency of development and pathogenesis of granulomas, and also their clinical and predictive value.

The paper describes a case of primordial odontogenic tumor of the mandible, a rare neoplasm that has been recently included into the WHO classification. It presents its clinical, radiological, morphological, and immunohistochemical characteristics.Представлено наблюдение первичной одонтогенной опухоли нижней челюсти, редкого новообразования, недавно включенного в классификацию ВОЗ. Приведена ее клиническая, рентгенологическая, морфологическая и иммуногистохимическая характеристика.

To identify filiform papillary lesions, localization changes, and the composition of the microflora of the dorsal lingual surface in patients with gastroesophageal reflux disease (GERD).Dorsal lingual surface biopsy specimens were investigated in 7 patients with GERD (3 men, 4 women) and in 6 individuals without digestive diseases (3 men, 3 women). The diagnosis of GERD was based on a set of clinical data, daily pH-metry, EGDS, and the specialized GerdQ questionnaire. Scanning electron microscopy and fluorescence confocal microscopy were used.Intact filiform lingual papillae had a complex structure and consisted of primary and secondary papillae. Foci of increased epithelial desquamation with partial or complete loss of secondary papillae were detected in patients with GERD. There was a microflora biofilm only on the epithelium of the secondary papillae in the intact areas and in the areas with preserved secondary papillae in patients with GERD. On the contrary, the foci of lesion and those with completely lost secondary papillae in GERD patients exhibited the microflora (more diverse in its morphological characteristics) on the surface of the epithelial cells of primary papillae, except for their cup-shaped hollows in the area of the lost secondary processes. These cup-shaped hollows preserved dense intercellular contacts of epithelial cells.The lingual mucosal filiform papillae in GERD patients are characterized by the appearance of areas with partial or complete loss of secondary papillae and with increased desquamation of epithelial cells. There is microflora biofilm translocation to the primary papillae, except for their cup-shaped hollows (an area of the lost secondary papillae). Translocation of the microflora increased its morphological diversity.Цель исследования - выявить повреждения нитевидных сосочков, изменения локализации и состав микрофлоры дорсальной поверхности языка у пациентов с гастроэзофагеальной рефлюксной болезнью (ГЭРБ). Материал и методы. Изучены биоптаты дорсальной поверхности языка у 7 больных ГЭРБ (3 мужчины, 4 женщины) и 6 человек без патологии органов пищеварения (3 мужчины, 3 женщины). Диагноз ГЭРБ базировался на совокупности клинических данных, суточной рН-метрии, ЭГДС и специализированного опросника GerdQ. Использовали методы сканирующей электронной микроскопии и флюоресцентной конфокальной микроскопии. Результаты. Нитевидные сосочки языка в норме имеют сложное строение и состоят из первичных и вторичных сосочков. У пациентов с ГЭРБ определяют очаги повышенной десквамации эпителия с частичной или полной утратой вторичных сосочков. В норме и в участках с сохранными вторичными сосочками у больных ГЭРБ биопленку микрофлоры выявляют только на эпителии вторичных сосочков. Напротив, в очагах повреждения и полностью утративших вторичные сосочки у больных ГЭРБ микрофлору (более разнообразную по своим морфологическим признакам) выявляют на поверхности эпителиальных клеток первичных сосочков, за исключением их чашеобразных углублений в области утраченных вторичных отростков. В таких чашеобразных углублениях сохраняются плотные межклеточные контакты эпителиальных клеток. Заключение. Для нитевидных сосочков слизистой оболочки языка при ГЭРБ характерно появление участков с частичной или полной утратой вторичных сосочков и повышенной десквамацией эпителиальных клеток. Происходит транслокация биопленки микрофлоры на первичные сосочки, за исключением их чашеобразных углублений (зоны утраченных вторичных сосочков). При транслокации микрофлоры нарастает ее морфологическое разнообразие.

to comparatively analyze standardized mortality ratios (SMR) from stroke in the populations aged over 30 years in the Russian Federation and in the USA over a 15-year period.The analysis included nontraumatic subarachnoid hemorrhage (NTSH) (a group of ICD-10 codes I60), nontraumatic intracerebral hemorrhage (NTIH) (I61), cerebral infarction (CI) (I63), and stroke, not specified as hemorrhage or infarction (SNSHI) (I64). The new European standard (European Standard Population.2013) was used for standardization. The data of the Federal State Statistics Service of the Russian Federation, those of the World Health Organization Mortality Database (WHO MD) and Human Mortality Database (HMD) for the USA were applied.During the considered period, 30-49-year-old Russian men showed a reduction in SMRs from NTSH (I61) by 9.0% (from 18.9 to 17.2 per 100,000 population), from SNSHI (I64) by 10 times (from 12.5 to 1.3); SMRs from CI (I63) increased by 4.3% (from 6.9 to 7.2). In men aged 50 years and older, SMRs from NTIH and SNSHI decreased by 32.3% (from 143.2 to 97.0) and by 10 times (from 580.8 to 60.6), respectively; those from CI increased by 13.8% (from 229.8 to 261.4). In the USA, 30-49-year-old men displayed 26.1% and 2-fold decreases in SMRs from NTIH (from 2.5 per 100,000 population in 1999 to 1.7 in 2013) and CI (from 1.8 to 0.9), respectively; those from SNSHI remained unchanged (1.3). In men aged 50 years and older, SMRs from NTIH, CI, and SNSHI reduced by 39.7% (from 29.0 to 17.5), by 2 times (from 1.8 to 0.9), and by 2 times (143.0 to 72.5), respectively. 30-49-year-old Russian women exhibited a 22.2% reduction in SMRs from NTIH (from 9.0 to 7.0), a 4.3% increase in those from CI (from 2.7 to 2.8), and an 11-fold decrease in those from SNSHI (from 5.5 to 0.5). Women aged 50 years and older showed changes in SMRs from the codes in the same sequence from 105.6 to 60.5, from 172.8 to 189.6, and from 466.5 to 43.7, respectively. In the USA, 30-49-year-old women displayed reductions in SMRs from NTIH by 10.0% (from 1.5 to 0.9), from CI by 33.3% (from 0.3 to 0.2), and from SNSHI by 10% (from 1.0 to 0.9). Women aged 50 years and older exhibited changes in SMRs from the codes in the same sequence from 24.0 to 14.8), n those from CI (from 20.6 to 6.7) and from SNSHI (from 6.5 to 10.3).In Russia, the reduction in mortality rates from the above causes (which is most significant from that in NTSH may be associated with both medical and socioeconomic factors, including with the improved prevention and organization of medical care. The differences in SMRs between the two countries may be related to the principles in the organization and control of coding of the causes of death.Цель - провести сравнительный анализ стандартизованных коэффициентов смертности (СКС) от острого нарушения мозгового кровообращения (ОНМК) населения старше 30 лет в РФ и США за 15-летний период. Материал и методы. В анализ включены нетравматическое субарахноидальное кровоизлияние (группа кодов МКБ-10 I60), нетравматическое внутримозговое кровоизлияние (HBK) (I61), инфаркт мозга (ИМ) (I63) и инсульт (ИН), не уточненный как кровоизлияние или инфаркт (I64). Для стандартизации применяли новый Европейский стандарт (European Standard Population.2013). Использовали данные Федеральной службы государственной статистики РФ, данные World Health Organization Mortality Database (WHO MD) и Human Mortality Database (HMD) для США. Результаты. В России среди мужчин 30-49 лет за рассматриваемый период СКС от НВК (I61) снизился на 9% (с 18,9 до 17,2 на 100 тыс. населения), от ИН (I64) - в 10 раз (с 12,5 до 1,3), от ИМ (I63) увеличился на 4,3% (с 6,9 до 7,2). В возрасте 50 лет и старше от НВК снизился на 32,3% (с 143,2 до 97,0), от ИН - в 10 раз (с 580,8 до 60,6), от ИМ увеличился на 13,8% (с 229,8 до 261,4). В США среди мужчин 30-49 лет СКС от НВК снизился на 26,1% (с 2,5 в 1999 г. до 1,7 в 2013 г. на 100 тыс. населения), от ИМ - в 2 раза (с 1,8 до 0,9) от ИН остался без изменений (1,3). В возрасте 50 лет и старше от НВК снизился на 39,7% (с 29,0 до 17,5), от ИМ - в 2 раза (с 1,8 до 0,9), от ИН - в 2 раза (с 143,0 до 72,5). Среди женщин в России СКС в возрасте 30-49 лет от НВК снизился на 22,2% (с 9,0 до 7,0), от ИМ увеличился на 4,3% (с 2,7 до 2,8), от ИН снизился в 11 раз (с 5,5 до 0,5). В возрасте 50 лет и старше СКС от НВК изменился с 105,6 до 60,5; от ИМ - с 172,8 до 189,6, от ИН - с 466,5 до 43,7. В США СКС среди женщин 30-49 лет от НВК уменьшился на 10% (с 1,5 до 0,9), от ИМ - на 33,3% (с 0,3 до 0,2) от ИН - на 10% (с 1,0 до 0,9). В возрасте 50 лет и старше СКС от НВК изменился с 24,0 до 14,8, от ИМ - с 20,6 до 6,7, от ИН - с 6,5 до 10,3. Заключение. Снижение смертности от указанных причин в России (наиболее существенное от инсульта, не уточненного как кровоизлияние или инфаркт) может быть связано как с медицинскими, так и социально-экономическими факторами, в том числе с улучшением профилактики и организации медицинской помощи. Различия в СКС между двумя странами могут быть связаны с принципами организации и контроля кодирования причин смерти.

The aim of the study was to compare the effectiveness of laser singlet phototherapy and traditional photodynamic therapy the treatment of periodontal diseases in an animal model. The experimental model involved 70 male rats Wistar in which periodontitis was modeled and treated: in group I (30 animals) a nanosecond laser device for medical use with a wavelength of 1270 nm was used for 7 sessions in a 400 ns pulse mode, an average radiation power of 2 W, and a radiation density of 200 J/cm2, group II (30 animals) received photodynamic therapy with the administration of a photosensitizer, followed by irradiation with a laser wavelength of 660 nm for 7 sessions 2 Wt average radiation power, group III (controls, 10 animals) - traditional drug therapy. Morphological studies were performed on 7, 14 and 21 day after treatment. On day 7th and 14th the study revealed In group I the presence of full blood vessels and diffuse expressed leukocyte infiltration with an admixture of macrophages, in group II - pronounced edema of the tissue and vasoconstriction. On day 21 the picture included in group I regenerated periodontal ligament with dilated full blood vessels on the border with the bone beams of the alveolar bone, in group II a moderately pronounced edema of the periodontal ligament with single dilated vessels, in controls significantly destroyed periodontal ligament substituted with granulation tissue and periodontal ligament. Thus, the treatment of periodontitis with the methods of singlet phototherapy leads to the development of reactive inflammation and significant vascularization of periodontal tissues which contributes to the rapid regeneration and stability of remission.

to analyze the generally accepted histological criteria for diagnosing the activity of inflammatory bowel disease (IBD) in patients with therapy-induced endoscopic remission.Colon biopsy specimens from 57 patients aged from 19 to 52 years (mean age 31±2.5 years), including 41 patients with ulcerative colitis (UC) and 16 with Crohn's disease (CD) affecting the colon, were examined. All the patients had no clinical signs of disease activity; endoscopic examination diagnosed remission (none or minimal changes). The biopsy specimens were taken from all colon segments during colonoscopy and processed by conventional methods.Persistence in chronic inflammation with signs of its activity (neutrophils in an infiltrate and cryptitis) and mucosal structural changes (no histological remission) were found in 29.3% of the patients with UC and 37.5% of those with CD (only in 31.6% of the patients). Persistence in chronic inflammation without signs of its activity and/or mucosal structural changes (incomplete histological remission) were detected in 80.5, 81.25, and 80.7% of the patients, respectively. Complete histological remission without mucosal inflammatory and structural changes was observed only in 19.5, 18.75, and 19.3% of the patients, respectively.The investigation shows that histological remission is still difficult to achieve to date, despite the use of the present-day treatment protocols for IBD. On the other hand, the conventional morphological criteria for the diagnosis of histological remission in IBD are quite subjective and need further discussion and agreement. Whether there may be a complete structural and functional recovery of the colon mucosa remains open.Цель исследования - анализ общепринятых гистологических критериев диагностики активности воспалительных заболеваний кишечника (ВЗК) у больных с терапевтически индуцированной эндоскопической ремиссией. Материал и методы. Исследованы колонобиоптаты от 57 больных в возрасте от 19 до 52 лет (средний возраст 31±2,5 года): у 41 больного был язвенный колит (ЯК) и у 16 - болезнь Крона (БК) с поражением толстой кишки. У всех больных отсутствовали клинические признаки активности заболевания, при эндоскопическом исследовании диагностирована эндоскопическая ремиссия (изменения отсутствовали или были минимальными). Биоптаты брали во время проведения колоноскопии из всех отделов толстой кишки и обрабатывали по общепринятой методике. Результаты. Персистенция хронического воспаления с признаками активности (наличие нейтрофилов в инфильтрате и криптит) и структурными изменениями слизистой оболочки (отсутствие гистологической ремиссии) выявлена у 29,3% больных ЯК и 37,5% БК (всего у 31,6% больных). Сохранение хронического воспаления без признаков активности и/или структурные изменения слизистой оболочки (неполная гистологическая ремиссия) обнаружены соответственно у 80,5, 81,25 и 80,7% больных. Полная гистологическая ремиссия при отсутствии воспалительных и структурных изменений слизистой оболочки отмечена только у 19,5, 18,75 и 19,3% больных соответственно. Заключение. Результаты исследования показали, что на сегодняшний день гистологическая ремиссия является пока еще трудно достижимым результатом, несмотря на применение современных протоколов лечения ВЗК. С другой стороны, общепринятые морфологические критерии диагностики гистологической ремиссии ВЗК достаточно субъективны и нуждаются в дальнейшем обсуждении и согласовании. Остается открытым вопрос о возможности полного структурно-функционального восстановления слизистой оболочки толстой кишки.

The article describes diagnostics and surgical treatment of a rare benign tumor (lipoblastoma) of four anatomical areas of the head and neck in an 8-months child. Diagnostic data, surgical procedure performed using microsurgical techniques and intraoperative neuromonitoring and the patient's condition in the long-term postoperative period are presented. The histological conclusion about the removal of the tumor with negative resection margins suggests favorable prognosis of the disease.В настоящей работе описана диагностика и хирургическое лечение редкого доброкачественного новообразования — липобластомы — четырех анатомических областей головы и шеи у ребенка в возрасте 8 месяцев. Представлены данные диагностики, ход операции, выполненной с применением микрохирургической техники и интраоперационного нейромониторинга, а также состояние пациента в отдаленном послеоперационном периоде. Гистологическое заключение об удалении опухоли в пределах здоровых тканей позволяет говорить о благоприятном прогнозе основного заболевания.

To investigate the expression of moesin, p21-activated kinase 4 (PAK 4), matrix metalloproteinases (MMP 2, MMP 9), and CD34 in the eutopic and ectopic endometrium in different forms of adenomyosis.Fifty uteri removed for diffuse adenomyosis and for adenomyomas were examined in reproductive-aged (n=25) and premenopausal (n=25) women. A comparison group included 20 uteri removed for intramural and subserosal fibroids in reproductive-aged and premenopausal women. The investigators performed histological and immunohistochemical (using antibodies to moesin, PAK 4, MMP 2, MMP 9, and CD34) examinations of the eutopic and ectopic endometrium.Different forms of adenomyosis were characterized by the irregular border of the endometrium and myometrium due to that there were multiple foci of ingrowth of the basal layer of the endometrium through the terminal plate into the myometrium. In both diffuse adenomyosis and adenomyomas, the basal layer of the eutopic and ectopic endometrium differed many (3-8.5) times, showing the higher expression of the enzymes in the epithelial and stromal cells, which affected their invasive activity (moesin, PAK 4, MMP 2 and MMP 9), and the increased number of CD34 cells in its stroma. At the same time, there were no statistically significant differences in their expression in the basal layer of the eutopic and ectopic endometrium in diffuse adenomyosis and adenomyomas.The findings favor the theory of the pathogenesis of adenomyosis due to the invasion of the eutopic endometrium into the myometrium.Цель исследования - изучить экспрессию моэзина, PAK 4, MMP 2, MMP 9 и CD34 в эутопическом и эктопическом эндометрии при различных формах аденомиоза. Материал и методы. Изучено 50 удаленных маток по поводу диффузной формы аденомиоза и аденомиом (по 25 случаев) у женщин репродуктивного и предменопаузального возраста. В группу сравнения вошли 20 наблюдений удаленных маток по поводу интрамуральных и субсерозных миом у женщин репродуктивного и предменопаузального возраста. Проводили гистологическое и иммуногистохимическое (с антителами к моэзину, РАК 4, ММР 2, MMP 9 и CD34) исследование эутопического и эктопического эндометрия. Результаты. Для разных форм аденомиоза характерны неровная граница эндометрия и миометрия за счет множественных очагов врастания базального слоя эндометрия через пограничную пластинку в миометрий. Базальный слой эутопического и эктопического эндометрия как при диффузной форме аденомиоза, так и при аденомиомах отличается многократно, в 3-8,5 раза, повышенной в эпителиальных и стромальных клетках экспрессией ферментов, влияющих на их инвазивную активность - моэзина, РАК 4, ММР 2 и ММР 9, а также увеличением в его строме числа клеток с рецептором CD34. При этом отсутствуют статистически достоверные различия показателей их экспрессии в базальном слое эутопического и эктопического эндометрия при диффузном аденомиозе и аденомиомах. Заключение. Полученные данные свидетельствуют в пользу теории патогенеза аденомиоза вследствие инвазии эутопического эндометрия в миометрий.

The overall structure of the diagnosis should be presented underlying disease; complications of underlying disease and coexistent disease. If patient has other significant conditions contributing to the death (comorbidity), they should be included in the diagnosis after underlying disease as concurrent disease, polypathia or background diseases (condition). The category «underlying disease» should include only the disease (condition), which by itself or through the complications can lead to death and should be recorded in Part I of the medical certificate of cause of death. Other significant conditions contributing to the death (comorbidity) and defined as concurrent disease, polypathia or background diseases (condition), should be recorded in Part II of the medical certificate of cause of death. Coexistent diseases shall not be taken into account of the statistics of causes of death, and therefore they should not stand in a medical certificate of cause of death.Структура диагноза должна включать рубрики: основное заболевание, осложнения основного заболевания и сопутствующие заболевания. При наличии других заболеваний (состояний), которые способствовали летальному исходу (коморбидность), после рубрики основное заболевание добавляется рубрика коморбидные заболевания (состояния): конкурирующие, сочетанные и/или фоновые. Основное заболевание, которое само или через свои осложнения могло привести к смерти, указывается в части I медицинского свидетельства о смерти. Прочие важные заболевания (состояния), способствовавшие смерти (при коморбидности), определенные как конкурирующие, сочетанные и/или фоновые, вносятся в часть II свидетельства о смерти. Сопутствующие заболевания (состояния), не имеющие причинно-следственной связи с основным заболеванием и не являющиеся причиной смерти, в свидетельство о смерти не выносятся.

to investigate the specific features of somatostatin receptor expression in the ileal mucosa of patients with inflammatory bowel disease (IBD).Ileal biopsy specimens from 42 patients aged 22 to 55 years, including 16 patients with Crohn's disease (CD), 14 with indeterminate colitis of IBD unclassified (IBDU), and 12 with the unchanged ileal mucosa (a comparison group). Immunohistochemical examination was performed using anti-somatostatin receptor type 2 (SSTR-2) antibodies (Epitomics, USA). SSTR2-positively stained cells were counted per 100 epitheliocytes.There were three receptor expression types: predominantly membranous, cytoplasmic, and mixed (membranous-cytoplasmic). Calculation of cells with membranous expression indicated that the median was 1 in the patients with Crohn's disease (interquartile range (IQR) 0.5), 3 in those with IBDU (IQR 2.5), and 2 (IQR 2) in the comparison group. These indicators were 1 (IQR 2), 3 (IQR 2), and 2 (IQR 1) for cytoplasmic expression and 5 (IQR 4), 2 (IQR 3), and 3 (IQR 2) for membranous-cytoplasmic one.The number of SSTR-2-expressing cells was significantly smaller in the patients with Crohn's disease than that in those with the unchanged mucosa and in those with indeterminate (unclassified) colitis. There were three SSTR2 staining types: predominantly membranous, cytoplasmic, and mixed (membranous-cytoplasmic). The cells with membranous staining appeared to be neuroendocrine, those with cytoplasmic expression were intraepithelial T lymphocytes, and those with membranous-cytoplasmic expression were both neuroendocrine and epithelial.Цель исследования - изучить особенности экспрессии рецепторов соматостатина в слизистой оболочке подвздошной кишки при воспалительных заболеваниях кишечника. Материал и методы. Исследованы илеобиоптаты от 42 больных в возрасте от 22 до 55 лет: 16 - с болезнью Крона, 14 - с неопределенным (неклассифицируемым) колитом и 12 - с неизмененной слизистой оболочкой подвздошной кишки (группа сравнения). Иммуногистохимическое исследование проведено с антителами SSTR-2 к рецепторам соматостатина 2-го типа ('Epitomics', США). Подсчет позитивно окрашенных клеток проводили на 100 эпителиоцитов. Результаты. Выявлено три варианта экспрессии рецепторов: преимущественно мембранный, цитоплазматический и смешанный (мембранно-цитоплазматический). Подсчет клеток с мембранной экспрессией показал, что медиана при болезни Крона составила 1 [интерквартильный размах (ИК) =0,5], при неклассифицируемом колите - 3 (ИК=2,5), в группе сравнения - 2 (ИК=2). Для цитоплазматического варианта экспрессии эти показатели были равны соответственно 1 (ИК=2), 3 (ИК=2) и 2 (ИК=1), а мембранно-цитоплазматического варианта - 5 (ИК=4), 2 (ИК=3) и 3 (ИК=2). Заключение. Число клеток, экспрессирующих рецепторы соматостатина 2-го типа, уменьшено в большей степени у больных с болезнью Крона по сравнению с больными с неизмененной слизистой оболочкой и пациентами с неопределенным (неклассифицируемым) колитом. Выявлено три варианта экспрессии рецепторов соматостатина 2-го типа - преимущественно мембранный, цитоплазматический и смешанный (мембранно-цитоплазматический). Клетки с мембранным вариантом экспрессии этих рецепторов являются, по-видимому, нейроэндокринными, с цитоплазматическим - интраэпителиальными Т-лимфоцитами, а с мембранно-цитоплазматическим - как нейроэндокринными, так и эпителиальными.