Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants.

The purpose of the research was to establish main causes of development and outcomes of adhesive obstruction.We analyzed the outcomes of treatment of 154 patients with acute intestinal obstruction. The following data were taken into consideration: age, gender, surgeries in past medical history, terms of adhesions manifestations, clinical symptoms, findings of additional examinations, methods of treatment, outcome. It has been established, that the most frequent causes of adhesions were appendectomy (23%), stomach operations (21 %) and gynecological interventions (14 %). After surgeries performed in conditions of regional hospitals, adhesions developed after appendectomy, gynecological operations and interventions on the intestine. In patients operated in city hospitals intestinal obstruction more often occurred after extensive operations on the stomach, appendix, and after gynecological interventions. Urgent surgical interventions more often led to adhesive process in the abdominal cavity (63 %). Mortality made 5.8 %. Causes of death were intestinal fistulas and abdominal sepsis.Thus, acute adhesive intestinal obstruction as an extreme form of abdominal adhesions continues to be an urgent medical issue.

The purpose of the study was to develop and evaluate the technique for volumetric tumor segmentation based on diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting and assessing the response to chemotherapy in patients with bladder cancer (BC). Material and Methods. We examined 26 patients with morphologically verified transitional cell carcinoma of the bladder. The group was characterized by the presence of one or several tumors with a size of 17 to 46 mm. Before planning chemotherapy according to the M-VAC scheme, a study and post-processing of DW-MRI with volumetric segmentation of lesions, assessment of the volume and apparent diffusion coefficient (ADC) in the entire tumor mass were performed. According to the ADC data, shape of the tumor and its relation to the bladder wall, the coefficient (C) for predicting the response to chemotherapy was calculated. Results. In the cases with a coefficient value below 0.51, a high risk of treatment failure was predicted, at C≥0.74, a positive effect of treatment was predicted. With a value of 0.51≤C<0.74, the prognosis was uncertain, stabilization was more likely. The sensitivity and specificity of the method were 92.3 % and 92.4 %, respectively. Conclusion. The method of volumetric segmentation makes it possible to predict and evaluate bladder cancer response to chemotherapy with a sufficiently high accuracy. The advantages of the method are the possibility of assessing the tumor regardless of the degree of filling of the bladder, with non-contrast MRI, and with large lesions.

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ВВЕДЕНИЕРубцовый стеноз трахеи является одним из наиболее тяжёлых осложнений, возникающих в ре-зультате продлённых оротрахеальных интубаций, трахеостомий, травм шеи с повреждением трахеи [3, 5, 6,8]. Пациенты, страдающие рубцовыми стенозами трахеи, наблюдаются в течение длительного времени, неоднократно госпитализируются в лечебные учреж-дения, им выполняются сложные реконструктивные операции, не всегда заканчивающиеся выздоровле-нием пациентов. По данным ряда авторов, до 25 % пациентов остаются инвалидами после перенесённых хирургических вмешательств вследствие хондрома-ляций, обширных рубцов и фиброза ткани [3, 5, 6]. Из-вестно, что до 28 % хирургических вмешательств на трахее сопровождаются различными осложнениями, в результате которых 10 % пациентов погибают [7].Большинство пациентов, получавших лечение по поводу рубцовых стенозов трахеи, являются трудо-способной частью населения, наиболее подверженной риску травматизма; в том числе до 75 % пациентов -в возрасте до 50 лет [3,4, 5,7]. Одним из основных факто-ров развития рубцового стеноза трахеи и хронизации воспаления является присоединение бактериальной инфекции. При проведении бактериологического ис-следования наиболее часто высевается госпитальная микрофлора, аэробные и анаэробные микроорганиз-мы в ассоциации [1,4,8]. Своевременное назначение адекватной антибиотикотерапии улучшает течение заболевания, приводит к более эффективным резуль-татам лечения рубцового стеноза трахеи. ЦЕЛЬ ИССЛЕДОВАНИЯОценка микробного статуса и эффективности антибиотикотерапии у пациентов с рубцовыми сте-нозами трахеи. МАТЕРИАЛЫ И МЕТОДЫРабота выполнена на основании анализа меди-цинских карт пациентов с рубцовыми стенозами трахеи (n = 33), находившихся на лечении в отделении торакальной хирургии ГБУЗ ИОКБ в период с 2011 по