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CLINICAL CASES

    1. Herzen Moscow Cancer Research Institute, branch of National Medical Research Radiology Center (Moscow, Russian Federation)

    Abstract:Introduction. Melanoma as a specific kind if dermal malignant neoplasms had been first described by Laennec as far back as 1806. On statistical evidence, frequency of a primary skin melanoma in Russia is 1.2-1.9 % among all malignant tumors. In 1820 H. Norris was the first, who discovered “a fungiform stomach disease” in a patient with skin melanoma. According to data of recent papers, metastatic lesions in the gastrointestinal tract in patients with skin melanoma are detected more than in 60 % cases at autopsy, but never diagnosed at treatment stage. Metastatic stomach lesions in patients with skin melanoma are usually asymptomatic, or symptoms are of non-specific. Classification of these lesions at first proposed by Ji Yong Ahn in 2014, and it described three macroscopic forms of melanoma metastases in gastrointestinal tract: nodular, exophytic and flat pigmented. Most of them are usually pigmented, amelanotic metastases are very rare. Objectives. The primary objective of this clinical case descripton is to show the possibilites of multimodal endoscopy, including confocal laser endomicroscopy, in metastatic stomach lesions diagnostics. Methods. Patient K., male, 69 years old, had admitted to the P. A. Herzen Moscow Cancer Research Institute, due to a district oncologist’s referral with a diagnosis “Malignant tumor of hepatopancreatobiliary region with metastases in lungs and dextrocerebral hemisphere. Chronic gastric erosions». Patient had been comprehensively examined in our institution: MRI has confirmed presence of metastatic tumor in dextral temporal region; CT described solitary metastases in the left lung inferior lobe and pancreas cervix. Multimodal upper GI endoscopic examination had been performed, including white-light high-resolution endoscopy (WLI-HD), narrow-band imaging (NBI) with optical magnification 80x (NBI-ME), endoscopic ultrasonography (EUS) and confocal laser endomicroscopy (CLE), using Cellvizio system. Results. At upper GI endoscopic examination, four nodular, eroded on top, lesions sized from 0,5 to 2 cm had been detected in the in the subcardia and in upper, middle and lower thirds of the gastric corpus. Taking in mind, that lesions are multicentric, it was necessary to differentiate primary gastric B-cell lymphoma and metastatic stomach lesions. With NBI examination, it had been discovered, that pit pattern in lesions is regular and there were no signs of surrounding mucosa pathology. Also, no significant changes of intrapapillary capillary loops shape had been detected with NBI-ME. With EUS, it had been revealed, that lesions are hypoechoic, originating from deep part of mucosa, not invading submucosa. We have performed CLE and it had been detected, that in eroded lesions there was absence of glandular or pit structures and presence of chaotically (densely in some areas) located dark irregularly shaped, considerably enlarged, tumor cells nuclei. According to these findings, we have concluded, that lesions are poor-differentiated solid tumors, probably - multiple amelanotic metastatic melanoma. Precise biopsy was performed. Due to presence of considerable neurological disorders a microsurgical resection of the dextral temporal lobe tumor was performed, not waiting for routine pathology or immunohistochemical examination. One week later, pathologists confirmed amelanotic epithelial cell melanoma metastases in gastric mucosa and resected brain tumor mass. Conclusion. Thus, metastases to the stomach mucosa are not so rare events in patients with late stages of neoplastic process at skin melanoma. Multimodal endoscopic examination with CLE provides valuable diagnostic data of stomach tumor morphology, not only carcinoma, but a solid tumors too.

      1. Каприн А. Д., Старинский В. В., Петрова Е. В. (ред.) Злокачественные новообразования в России в 2012 году // М.: ФГБУ «МНИОИ им. П. А. Герцена» Минздрава России. 2014
      2. Dickson PV, Gershenwald JE. Staging and prognosis of cutaneous melanoma. SurgOncolClin N Am. 2011 Jan;20(1):1-17.
      3. Мерабишвили В. М. Злокачественные новообразования кожи (С43-44) // Oncology.ru, Онкологическая служба Краснодарского края, 2011
      4. Thomas NE., Kricker A., Waxweiler Wt. et al. Comparison of Clinicopathologic Features and Survival of HistopathologicallyAmelanotic and Pigmented Melanomas: A Population-Based Study // JAMA Dermatol. 2014 Aug 27. doi: 10.1001/jamadermatol.2014.1348
      5. Ihde JK, Coit DG. Melanoma metastatic to stomach, small bowel, or colon. // Am J Surg. 1991 Sep;162(3):208-11.
      6. Reintgen DS, Thompson W, Garbutt J. et al. Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract. // Surgery. 1984 Jun;95(6):635-9.
      7. Berger AC, Buell JF, Venzon D et al. Management of symptomatic malignant melanoma of the gastrointestinal tract. // Ann SurgOncol. 1999 Mar;6(2):155-60.
      8. Namikawa T, Hanazaki K. Clinicopathological features and treatment outcomes of metastatic tumors in the stomach // Surg Today. 2014 Aug;44(8):1392-9.
      9. Booth JB. Malignant melanoma of the stomach. Report of a case presenting as an acute perforation and review of the literature // Br J Surg. 1965 Apr;52:262-70.
      10. Wysocki WM, Komorowski AL, Darasz Z. Gastrointestinal metastases from malignant melanoma: report of a case // Surg Today. 2004;34(6):542-6.
      11. Agrawal S, Yao TJ, Coit DG. Surgery for melanoma metastatic to the gastrointestinal tract. // Ann SurgOncol. 1999 Jun;6(4):336-44.
      12. Otani S. Malignant melanoma. // Mt Sinai J Med. 1972 Jan-Feb;39(1):48-53.
      13. Vukmirovic F., Vukmirovic M., Vukmirovic I. Multiple Simultaneos Metastases of Malignant Melanoma in the Stomach, Small and Large Intestine // Macedonian Journal of Medical Sciences. 2013 Mar 15; 6(1):56-58.
      14. Oosting SF, Peters FT, Hospers GA et al. A patient with metastatic melanoma presenting with gastrointestinal perforation after dacarbazine infusion: a case report // J Med Case Rep. 2010 Jan 15;4:10
      15. Krausz MM, Ariel I, Behar AJ. Primary malignant melanoma of the small intestine and the APUD cell concept // J SurgOncol. 1978;10(4):283-8
      16. Tabaie HA, Citta RJ, Gallo L et al. Primary malignant melanoma of the small intestine: report of a case and discussion of the APUD cell concept. // J Am Osteopath Assoc. 1984 Jan;83(5):374-7
      17. Goral V, Ucmak F, Yildirim S et al. Malignant melanoma of the stomach presenting in a woman: a case report // J Med Case Rep. 2011 Mar 9;5:94
      18. Krishna Mohan MV, Rajappa SJ, Reddy TV et al. Malignant gastrointestinal melanoma with an unknown primary // Indian J Med PaediatrOncol. 2009 Apr;30(2):87-9.
      19. Liang KV, Sanderson SO, Nowakowski GS et al. Metastatic malignant melanoma of the gastrointestinal tract // Mayo Clin Proc. 2006 Apr;81(4):511-6.
      20. Davis GH, Zollinger RW. Metastatic melanoma of the stomach // Am J Surg. 1960 Jan;99:94-6.
      21. Bäckman H, Davidsson L. Metastases of malignant melanoma in the stomach and small intestine // Acta Med Scand. 1965 Sep;178(3):329-35.
      22. Ahn JY, Hwang HS, Park YS. Et al. Endoscopic and pathologic findings associated with clinical outcomes of melanoma in the upper gastrointestinal tract // Ann SurgOncol. 2014 Aug;21(8):2532-9
      23. Woollons A, Derrick EK, Price ML. Gastrointestinal malignant melanoma // Int J Dermatol. 1997 Feb;36(2):129-31.
      24. Barnhill RL, Gupta K. Unusual variants of malignant melanoma. // ClinDermatol. 2009 Nov-Dec;27(6):564-87.
      25. Iconomou TG., Tsoutsos D., Frangia K. et al. Malignant melanoma of the stomach presenting with an unknown primary lesion // Eur J PlastSurg (2003) 26:153-155
      26. Блохин Н. Н., Петерсон Б. Е. (Ред.). Клиническая онкология // Москва, 1979
      27. Toljamo KT, Niemelä SE, Karttunen TJ et al. Clinical significance and outcome of gastric mucosal erosions: a long-term follow-up study. // Dig Dis Sci. 2006 Mar;51(3):543-7.
      28. Пирогов С. С., Унгиадзе Г. В., Кувшинов Ю. П. и др. Первый опыт использования трехрежимного видеоэндоскопа для диагностики раннего рака желудка // Журнал «Клиническая эндоскопия» № 2 (24), 2010, стр 2-11
      29. Gheorghe K. Narrow-Band Imaging Endoscopy for Diagnosis of Malignant and Premalignant Gastrointestinal Lesions // J Gastrointest Liver Dis March 2006 Vol.15 No.1, 77-82
      30. Correa P., Piazuelo B. The gastric precancerous cascade // Journal of Digestive Diseases 2012; 13; 2-9
      31. Kaltsas G, Grozinsky-Glasberg S, Alexandraki KI et al. Current concepts in the diagnosis and management of type 1 gastric neuroendocrine neoplasms. // ClinEndocrinol (Oxf). 2014 Aug;81(2):
      32. Kato M., Kaise M., Yonezawa J. et al. Magnifying endoscopy with narrow-band imaging achieves superior accuracy in the differential diagnosis of superficial gastric lesions identified with white-light endoscopy: a prospective study // Gastrointestinal Endoscopy, Volume 72, No. 3: 2010 pp. 523-529
      33. Zhang J., Guo S., Duan Z. Application of magnifying narrow-band imaging endoscopy for diagnosis of early gastric cancer and precancerous lesion // BMC Gastroenterology 2011, 11:135
      34. Перфильев И. Б., Делекторская В. В., Кувшинов Ю. П. и др. Современные аспекты эндоскопической семиотики нейроэндокринных опухолей желудка // Российский журнал гастроэнтерологии, гепатологии и колопроктологии № 4, 2011 с. 27-36
      35. Kim GH., Kim KB., Lim EK. et al. Analysis of Endoscopic Electronic Image of Intramucosal Gastric Carcinoma Using a Software Program for Calculating Hemoglobin Index // J Korean Med Sci 2006; 21: 1041-7
      36. Tada K., Oda I., Yokoi C. et al. Pilot Study on Clinical Effectiveness of Autofluorescence Imaging for Early Gastric Cancer Diagnosis by Less Experienced Endoscopists // Diagnostic and Therapeutic Endoscopy Volume 2011, Article ID 419136, 7 pages
      37. Janssen J. The impact of EUS in primary gastric lymphoma // Best Practice & Research Clinical Gastroenterology 23 (2009) 671-678
      38. Kim GH., Kim KB., Lee SH. et al. Digital image analysis of endoscopic ultrasonography is helpful in diagnosing gastric mesenchymal tumors // BMC Gastroenterology 2014, 14:7
      39. Kim MN., Kang SJ., Kim SG et al. Prediction of Risk of Malignancy of Gastrointestinal Stromal Tumors by Endoscopic Ultrasonography // Gut and Liver, Vol. 7, No. 6, November 2013, pp. 642-647
      40. Attanoos R, Griffiths DF. Metastatic small cell melanoma to the stomach mimicking primary gastric lymphoma // Histopathology. 1992 Aug;21(2):173-5.
     


    Full text is published :
    Pirogov S.S., Sokolov V.V., Kaprin A.D., Sokolov D.V. et al. METASTATIC LESION OF THE STOMACH WITH MELANOMA OF THE SKIN: POSSIBILITIES MULTIMODAL ENDOSCOPIC DIAGNOSIS. Experimental and Clinical Gastroenterology Journal. 2017;144(08):79-86
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    1. N.N. Blokhin Russian Cancer Research Center (Moscow, Russian Federation)
    2. N.I. Pirogov Russian National Research Medical University (Moscow, Russian Federation)
    3. Evrogen Lab LLC (Moscow, Russian Federation)

    Keywords:Cholangiocarcinoma,moleculartumortesting,BRAF V600E mutation,targeted therapy,dabrafenib,trametinib

    Abstract:We report a case of successful targeted treatment of a patient with metastatic cholangiocarcinoma refractory to chemotherapy and immunotherapy. After detection of BRAF V600Emutationinpatient’stumor, dabrafenib + trametinib combo was started which led to dramatic improvement in patient’s general condition and regression of most of the lesions. Effectisongoingafter6monthsoftargetedtherapy. This case demonstrates potential efficiency of a molecularly targeted approach to treatment of advanced cancers.

      1. Практические рекомендации по лекарственному лечению злокачественных опухолей (RUSSCO) // Злокачественные опухоли. - 2015. - № 4, спецвыпуск. - 456 стр.
      2. Charbel H., Al Kawas F. H. Cholangiocarcinoma: epidemiology, risk factors, pathogenesis, and diagnosis // Curr. GastroenterolRep. - 2011. - Vol.13. - P. 182-187.
      3. Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus Gemcitabine for biliary tract cancer // N Engl J Med. - 2010. - Vol. 362: 1273-1281.
      4. Putra J., de Abreu F. B., Peterson J. D. et al. Molecular profiling of intrahepatic and extrahepatic cholangiocarcinoma using next generation sequencing // Exp Mol Pathol. - 2015. - Vol.99(2). - P. 240-244.
      5. Javle M., Bekaii-SaabT., Jain A. et al. Biliary Cancer: Utility of Next-Generation Sequencing for Clinical Management // Cancer. - 2016. - Sep 13. -DOI: 10.1002/cncr.30254
      6. Hyman D., Puzanov I., Subbiah V. et al. Vemurafenib in Multiple Nonmelanoma Cancers with BRAF V600 Mutations // N Engl J Med. - 2015. - Vol.373 (8). - P. 726-736.
      7. Silkin S., Startsev S., Krasnova M. et al. Complete Clinical Response of BRAF-Mutated Cholangiocarcinoma to Vemurafenib, Panitumumab, and Irinotecan // J Gastrointest Cancer. -2015. - Dec 19. - DOI:10.1007/s12029-015-9792-2
      8. Loaiza-Bonilla A., Clayton E., Furth E. et al. Dramatic response to dabrafenib and trametinib combination in a BRAF V600E-mutated cholangiocarcinoma: implementation of a molecular tumour board and next-generation sequencing for personalized medicine // Ecancermedicalscience. - 2014. - Vol. 8. - P. 479.
      9. Hong D. S., Morris V. K., El Osta B. et al. Phase 1B Study of Vemurafenib in Combination with Irinotecan andCetuximabin Patients with Metastatic Colorectal Cancer with BRAF V600E Mutation // Cancer Discov. - 2016. - Oct 11. - DOI:10.1158/2159-8290.CD-16-0050.
     


    Full text is published :
    Peregudova M.V., Zaretsky A.R., Breder V.V., Romanova K.A. et al. THE EFF ECTIVENESS OF TARGETED THERAPY IN A PATIENT WITH BRAF-POSITIVE METASTATIC CHOLANGIOCARCINOMA. Experimental and Clinical Gastroenterology Journal. 2017;144(08):87-90
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    1. State funded medical institution “City clinical hospital № 15 named after O. M. Filatov” Department of healthcare of Moscow (Moscow, Russian Federation)
    2. State funded institution of higher professional education “Moscow State Medical and Dental University of A. I. Evdokimov” (Moscow, Russian Federation)

    Keywords:kidney damage,antiviral therapy,monoclonal antibodies to CD 20,rituximab (mabthera),mixed cryoglobulinemia,cryoglobulinemic vasculitis,chronic viral hepatitis C

    Abstract:As a clinical case we discuss cryoglobulinemic vasculitis of high activity with predominant kidney damage associated with chronic viral hepatitis C. The result of the treatment by monoclonal antibodies to CD 20 receptors - rituximab (mabthera) - confirms the efficiency of the drug in case of severe cryoglobulinemic vasculitis persistent to the standard treatment, with underlying chronic viral hepatitis C. After the therapy the hemodynamic indexes have stabilized, the hemorrhagic rash did not recur, cryoglobulinemia, proteinuria and hematuria decreased. Unfortunately the immunosuppressive therapy contributed to the increase of transaminase and cholestasis, which leaded to the need of the antiviral therapy for the elimination of the virus and relapse prevention. However, the ways of diagnostics and treatment of the patients with chronic viral hepatitis C with extrahepatic symptoms are not developed, represent serious problem and need to be further studied; the scheme of testing and antiviral therapy should be worked out.

      1. Meltzer M., Franklin E. C., Elias K. et al. Cryoglobulinemia- clinical and laboratory study. II. Cryoglobulins with rheumatorid factor activity. Am I Md. 1966. 40. 837
      2. Милованова С. Ю., Игнатова Т. М., Козловская Л. В. Особенности течения хронического гепатита С с криоглобулинемией // Клиническая гепатология. - 2006.-2(1).-С. 15-18.
      3. Козловская Л. В., Гордовская Н. Б., Малышко Е. Ю., Тегай С. В., Коротчаева Ю. В. Варшавский В. А., Мирошниченко Н. Г., Милованова С. Ю. и др. Криоглобулинемическое поражение почек: особенности течения и лечение // Нефрология и диализ. - Т4. - № 1.-2002. - С. 4-8.
      4. Мухин Н. А. Нефрология // Национальное руководство краткое издание. -Москва.-2015 г.-с 597
      5. Charles E. D., Dustin L. B. Hepatitis C virus induced cryoglobulinemia. Kidney Int/ 2009; 76 (8): 818-824
      6. Ferri C. Mixed cryoglobulinemia. Orphanet J Rare. 2008: 3:25
      7. Мухин Н. А., Козловская Л. В., Малышко Е. Ю. Криоглобулинемический нефрит, ассоциированный с хронический инфекцией вируса гепатита С // Тер архив. - 2000. - 6: 1-5
      8. Agnello V., Romain P. L. Mixed cryoglobulinemia secondary to hepatitis C virus infection. Reum. Dis. Clin. of North Am. 1996; 22: (1)
      9. Giannico G., Manno C., Scbena F. P. Treatmen of glomerulonephitides associated with hepatitis C virus infection. Nephrol Dial Transplant 2000; 15: 34-38
      10. Тегай С. В., Лопаткина Т. Н., Косминкова Е. Н. и др. Поражение почек, ассоциированное с вирусами гепатита В и С. Consilium Med. 2002. Т. 4. № 7: 337-341
      11. Козловская Л, Б., Мухин Н. А., Гордовская Н. Б. и др. Факторы риска прогрессирования криоглобулинемического гломерулонефрита, связанного с вирусом гепатита С // Клиническая медицина. - 2001.-№ 4. - С.32-35.
      12. Милованова С. Ю., Игнатова М. Т., Некрасова Т. П. и др. Особенности течения хронического гепатита С с криоглобулинемией // Российский журнал гастроэнтерологии, гепатологии и проктологи, колопроктологии. - 2005. -Т. XV- № 5. - С. 48-51.
      13. Cacoud P., Poynard T., Ghillani P. et al. Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group.Mulridepartment Virus C. Arthritis Rheum. 1999; 42:2204-2212.
      14. Ferri C. Mixed cryoglobulinemia. Orphanet J Rare. 2008: 3:25.
      15. Trejo O., Romos-Casalis M., Garcia-Carrasco M. Cryoglobulinemia: study of etiologic factors and clinical immunologic in 443 patients from a simple center. Medicine. 2001:8:252-262
      16. Дюйшеева Г. М., Гурская С. В., Каневская М. З. Криоглобулинемический васкулит тяжелого течения, ассоциированный с инфекцией вирусом гепатита С // Клиническая медицина. № 6. 2015. С. 5661. 9-11.
      17. Galossi A., Guarisco R., Bellis L., Puoti C. Extrahepatic manifestation of chronic HCV infection. J. Gastrointestin. Liver Dis. 2007; 16(1): 65-73. 20.
      18. Weidensaul D., Imam T., Holyst M. et al. Polymyositis, pulmonary fibrosis and hepatitis C. Arthr. Rheumat. 1995; 38: 437-439.29.
      19. Meliconi R., Andreoni P., Fasano L. et al. Incidence hepatitis C virus infection in Italian penitents with idiopathic pulmonary fibroris. Thorax 1996; 51:315-317.32.
      20. Matsumori F. Hepatitis C virus and cardiomyopathy. Herz 2000; 25:249254.36.
      21. Чернецова О. В., Лопаткина Т. Н., Попова И. В. и др. Синдром Шегрена при хроническом гепатите С: клинические особенности и диагностика // Тер архив. 2003; 4: 33-37.38.
      22. Галян Е. В., Кравец Е. Б., Латыпова В. Н., Дамдиндорж Д. Структурно функциональные особенности щитовидной железы у пациентов с хроническими гепатитами В и С // Бюллетень сибирской медицины. 2009; 2: 96-100. 40.
      23. Vezali E., Elefsiniotis I., Konstantinou E., Saroglou G. Thyroid dysfunction in patients with chronic hepatitis C: virus - or therapy -related? J Gastroenterol Hepatol. 2009; 24(6): 1024-9.41.
      24. Козловская Л. В., Тегай С. В., Малышко Е.Ю, Лопаткина Т. Н., Косминкова Е. Н. Поражение почек, ассоциированное с вирусами гепатитов В и С // Нефрология. Том 04/N 7/2002. -С 67-78
      25. Козловская Л. В., Тегай С. В., Малышко Е.Ю, Лопаткина Т. Н., Косминкова Е. Н. Поражение почек, ассоциированное с вирусами гепатитов В и С // Нефрология. Том 04/N 7/2002. -С 67-78
      26. Saadoun D., Rigon M. R., Sene D. et al. Rituximab plus Peg-interferon -alfa/ribavirin compared with Peginterferon-alfa/ribavirin in hepatitis C-related mixed cryoglobulinemia. Blood.2010; 116:326-334.
      27. Cacoub P., Saadoun D., Limal N. et al. PEGylated interferon alfa 2b and ribavirin treatment in patients with hepatitis C virus-related systemic vasculitis. Arthritis Rheum 2005;52: 911-915.
      28. Saadoun D., Reache-Rigon M., Thibault V. et al. Antiviral therapy for hepatitis C virus-associated mixed cryoglobulinemia vasculitis. A long-term follow up study. Arthritis Rheumatism 2006;54 (11): 3696-3706.
      29. EASL Recommendation on Treatment of Hepatitis C 2015. European Association for the Study of the Liver. J. of Hepatology. 2015 Jul; 63(1): 199-236.
      30. Дунаева Н. В., Караев В. Е., Воробьева О. А., Мазинг А. В., Лапин С. В., Смирнов А. В. Противовирусная терапия хронического гепатита С, осложненного системным криоглобулинемическим васкулитом // Журнал Инфектологии. Оригинальное исследование. - Том 8.-№ 2.-2016. -С.40-47.
      31. Saadoun D., Landau D. A., Calabrese L. H., et.al. Hepatitis C - associated mixed cryoglobulinemia: a crossroad between autoimmunity and lymphoproliferation. Rheumatology. 2007; 46: 1234-1242.
     


    Full text is published :
    Sagynbaeva V.E., Golovanova E.V. CRYOGLOBULINEMIC VASCULITIS WITH KIDNEY DAMAGE ASSOCIATED WITH CHRONIC VIRAL HEPATITIS C: ANTI-CD 20 MONOCLONAL ANTIBODIES TREATMENT. Experimental and Clinical Gastroenterology Journal. 2017;144(08):91-96
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    1. "Polyclinic № 3" of Affairs Management of the President of the Russian Federation (Moscow, Russian Federation)

    Abstract:Provides data for the treatment of constipation in 37 women in various stages of pregnancy. Highlighted that in addition to dietary measures requires taking laxatives, in particular Forlaks, has a mild laxative effect, long persistent effect and aftereffect, not causing side effects.

      1. Бурков С. Г. Заболевания органов пищеварения у беременных. - М.: КРОН-ПРЕСС, 1996. - 224 с.
      2. Гребенев А. Л., Мягкова Л. П. Болезни кишечника (современные достижения в диагностике и терапии). - М.: Медицина, 1994. - 400 с.
      3. Connell A. M. Hilton C., Irvine G. Variation of bowel habit in two population samples // Br Med J, 1965; 2: 1095-1099.
      4. Lacy B. E., Mearin F., Chang L. et al. Bowel disorders // Gastroenterology 2016; 150: 1393-1407.
      5. Ивашкин В. Т., Абдулхаков Р. А., Баранская Е. К. и соавт. Клинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению взрослых пациентов с хроническим запором // Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2014; 5: 69-75.
      6. Suares N. C., Ford A. C. Prevalance of, and risk factors for chronic idiopathic constipation in the community: systematic review and meta-analysis // Am J Gastroenterology 2011; 106: 1582-1591.
      7. Heaton K. W., Radvan Z., Cripps H. Defecatio frequency and timing, and stool form in the general population: a prospective study // Gut, 1992; 33: 818-824.
      8. Wald A. Constipation, diarrhea and symptomatic hemorrhoidis during pregnancy //Gastroent Clinics North Am 2003; 32:309-22.
      9. O’Donnell L.J.D. Bristol stool form scale // Brit Med J, 1990; 300: 439-440.
     


    Full text is published :
    Burkov S.G. CONSTIPATION IN PREGNANT WOMEN: A MODERN VIEW ON THE PROBLEM. Experimental and Clinical Gastroenterology Journal. 2017;144(08):97-100
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