Plasma cell leukemia (PCL) is a rare malignant plasma cell neoplasm with aggressive clinical progression, minimal response to therapy and unfavorable prognosis. Concomitant new coronavirus infection COVID-19 and its complications significantly worsen prognosis in patients with PCL. Currently, approaches to PCL therapy are not finalized, and regimens developed for multiple myeloma are used. In PCL, the most common clinical symptoms are renal failure and hypercalcinemia which are frequently observed in multiple myeloma. Therefore, use of proteasome inhibitor (bortezomib) with proven effectiveness in multiple myeloma, is justified. A clinical observation of a 64-year-old female patient who was hospitalized in poor physical condition with the new coronavirus infection COVID-19 is presented. During hospitalization, debut of PCL was suspected, and as soon as possible after diagnosis confirmation using vital indications, antitumor drug therapy was started with positive effect.

Двадцать одно клиническое наблюдение полостных онкологических операций у больных с сопутствующей myasthenia gravis объединяют использование «фармакологического дуэта» рокуроний-сугаммадекс и обязательный мониторный контроль нервно-мышечной прово-димости� Во всех случаях операции проходили в условиях сочетанной анестезии севофлураном на фоне эпидуральной анальгезии малыми дозами ропивакаина, фентанила и адреналина� Во всех наблюдениях, кроме одного, когда продленная искусственная вентиляция легких была запланирована и обусловлена тяжестью операции, кровопотерей и гипотермией, удавалась надежно восстановить самостоятельное дыхание сразу после окончания операции� Наглядно показана необходимость индивидуального подхода к пациентам, страдающим myasthenia gravis, обусловленного различием в ее тяжести и степени компенсации� Особо подчеркнуто, что при субкомпенсированном течении возможна неполная эффективность сугаммадекса и тогда требуется дополнительное внутривенное введение антихолинэстеразных препаратов (два случая)� Кроме того, у больных в тяжелом состоянии возможен диссонанс между «благополучным» TOF = 90% и клиническими проявлениями остаточной дыхательной недостаточности (один случай)�

In current conditions, increased life expectancy led to increased cancer morbidity. Presence of pain syndrome with significant intensity caused development of numerous guidelines on its treatment. Currently, pain management is based on the stepwise multimodal approach of the World Health Organization. In our opinion, wide application of narcotic analgesics is a disadvantage of this method. This pharmaceutical group has a significant number of adverse effects including addiction, development of hyperalgesia, and potential effect of increased rate of cancer recurrence.The study objective is to optimize the stepwise approach by addition of continuous multimodal analgesia. We aim to develop the principles of complex approach to pain management including new combinations of pharmaceuticals of different modalities and new techniques of continuous safe administration using innovative devices.The article presents a prospective description of a series of clinical cases in which new combinations of pharmaceuticals were administered in the context of complex treatment of pain syndrome of significant intensity. Objective evaluation of pain syndrome was performed using the Numeric Rating Scale.Multimodal intravenous pain management using mobile devices administering a mixture of pharmaceuticals in conjunction with basic peroral therapy and widely accepted discrete stepwise approach of the World Health Organization showed first positive results. In our opinion, further studies will allow to 1) decrease the rate of chronic pain syndrome in oncological patients; 2) treat pain syndrome of almost any intensity with preserved quality of life.The first results are encouraging; they show satisfactory effectiveness of the method and its safety. It is necessary to continue studies to develop and standardize the intravenous mixture composition for pain management in the context of the main clinical syndromes determining pain.

Endoscopic trachea stenting is a pressing issue in modern endoscopy. This method is applied in various diseases including benign stenoses associated with complications after long-term mechanical ventilation, malignant stenoses (oncological diseases of the trachea itself, compression from outside by esophageal or mediastinal tumors), post-injury stenoses and developmental defects.Currently, a certain contingent of patients exists for whom trachea prosthesis and its bifurcation remain the only possible option for stepwise or final treatment. If the lower third of the trachea, bifurcation zone or the main bronchi are affected, the optimal technique is stenting with Y-shaped stents which provide maximal patency of the airways.

Chronic pain syndrome developing in patients with oncological diseases significantly decreases their quality of life which makes effective integrative analgetic therapy a pressing issue. Currently, drugs of various pharmaceutical groups are used for pain management and administered subsequentially in accordance with the pain intensity visual analogue scale. For moderate and severe pain syndrome, opioid analgesics are used which have side effects limiting their use in some cases. Trials showed that new highly specific μ1-opioid receptor agonist tafalgin is characterized by high bioavailability, fast absorption, biotransformation, absence of accumulation which makes its safety profile favorable. Pronounced analgesic effect of tafalgin, as well as ease of administration and absence of significant adverse events, allow to significantly improve the quality of life of patients with chronic pain syndrome.