The incidence of pancreatitis in the last ten years has been steadily growing — the age of patients with the first diagnosis of acute / chronic pancreatitis has decreased from 50 to 39 years, the percentage of patients with disability has increased to 15 %. One of the most common manifestations of chronic pancreatitis is the development of postnecrotic pancreatic cysts of various localization with a corresponding clinical picture. Currently, the main types of surgical treatment for postnecrotic pancreatic cysts are: drainage and resection methods of treatment. Topographic and anatomical features and the presence of concomitant pathology in the anamnesis necessitate the development of new minimally invasive, safe and effective methods of surgical treatment of postnecrotic pancreatic cysts.

The article presents an analysis of the results of puncture drainage of pancreatic pseudocysts. The medical records of patients who were hospitalized in the past four years to the surgical departments were analyzed. In all the cases, the cause of the formation of pancreatic pseudocysts was biliary destructive pancreatitis. There were 86 such patients in total; all were female, their age ranged from 42 to 78 years. The procedure for draining pancreas cysts was performed under ultrasound guidance, using a GE Logik P 5 ultrasound scanner with attachments for color Doppler mapping with convex sensor 3.5–5 MHz. With formed postnecrotic cysts, patients underwent cystogastroanastomosis (CGA) under the control of ultrasound and EGD. The duration of the stay of patients in the hospital was 7–14 days. In 14 cases, patients were discharged from the hospital with drains under the supervision of a surgeon at the place of residence. Such complications of drainage of pancreas pseudocysts as bleeding, peritonitis and suppuration, were not observed. Cyst recurrence was registered in 2 cases after primary external drainage of the cyst cavity.

At the moment, there is no consensus on such important issues for the practicing physician as the choice of the type of abdominoperineal resection and the optimal way to close the perineal defect. The review presents the data on the incidence of perineal wound complications after the use of various types of rectal extirpation and various types of perineal defect closure. The inconsistency of the data makes it necessary to conduct further randomized studies.

Pulmonary embolism (PE) occupies one of the leading positions in the structure of postoperative complications, while determining an extremely high mortality rate. Despite the advances in medicine in the prevention, diagnosis and treatment of this disease, the PE epidemiological thresholds have not changed significantly over the past twenty years. Today, despite the routine use of mechanical and pharmacological thromboprophylaxis, the 30-day mortality rate after major surgeries ranges from 16.9 % to 31 %. Considering that more than 300 million surgical interventions are performed in the world, and more than 10 million operations per year in the Russian Federation, the scale of the problem can be easily imagined. The results of numerous studies confirm that at present, the problem of postoperative PE remains extremely urgent and requires further study. This manuscript provides a review of modern literature highlighting the key issues of the studied pathology.

The aim of the study was to evaluate the efficacy and safety of increased doses of anticoagulants in comparison with standard doses in inpatients with COVID-19. Material and methods. A systematic review was carried out in October 2021 using the Pubmed database. The analysis included only randomized clinical trials with ≥200 participants that reported the death rate as the total number of cases or the percentage of patients. The primary outcome was all-cause mortality within the observation period. Additionally, the risk of arterial and venous thrombotic events, major and clinically relevant non-major bleeding was assessed. Results. Searching of Pubmed identified 8,903 references, of which the results of 6 randomized clinical trials (INSPIRATION, 3 platforms study in REMAP-CAP, ACTIV-4a, and ATTACC including stable and unstable patients, RAPID, ACTION and HEP-COVID) with the total of 5,228 patients were included in the final qualitative analysis and quantitative synthesis. Among all the patients, 2,660 received increased doses and 2,568 — standard doses of anticoagulants. The follow-up period varied from 21 to 30 days. The administration of increased doses did not affect the risk of death (OR, 0.95; 95 % CI, 0.73–1.24; I² = 59.14 %), but was associated with a reduced risk of thrombotic events (OR, 0.56; 95 % CI, 0.43–0.73; I² = 24.90 %), and an increased risk of major bleeding (OR, 1.86; 95 % CI, 1.23–2.80; I² = 0.00 %) or clinically relevant non-major bleeding (OR, 3.66; 95 % CI, 1.65–8.10; I² = 0.00 %). Within the sensitivity analysis, similar results were obtained in the subgroups of critically ill or stable patients and individuals with increased D-dimer. The maximal reduction in the risk of thrombotic events was found for the subgroup of patients with increased D-dimer (OR, 0.48; 95 % CI, 0.34–0.70; I² = 36.38 %). Conclusions. The use of increased doses of anticoagulants in inpatients with COVID-19 does not reduce the risk of death. Still, it is associated with a decrease in the risk of arterial and venous thrombosis and an increased risk of major bleeding.

Currently, the use of anticoagulants is a mandatory component of the complex therapy of COVID-19. Regarding the choice of drugs and their dosages, there is no consensus yet. Increasing doses reduces the risk of thrombosis, but at the same time increases the risk of bleeding, which is a common event in severe COVID-19. This makes it relevant to study alternative options for thromboprophylaxis. The aim of this study was to compare the efficacy and safety of oral sulodexide and dabigatran etexilate in patients with COVID-19. Sulodexide demonstrated the same clinical efficacy as dabigatran in the treatment of patients with a degree of lung damage not higher than CT-2, while the relief of the initially existing coagulopathy occurred significantly faster, and there was no excessive increase in thrombin time, characteristic of dabigatran.