Studying an opportunity to optimize the treatment of the patients with severe traumatic brain injuries is a topical issue in modern neurosurgery. Traumatic tension pneumocephalus is one of life-threatening conditions which accompanies severe TB1 and is often complicated with posttraumatic liquorrhea and mass effect. Materials and methods. We carried out systematic search in Russian and foreign medical databases (Medline, Russian Science Citation Index, EMedicine, UMKB) concerning our theme. We included the following words in our search request: tension pneumocephalus, mass effect, valve mechanism, treatment. The result of conducted review of literature was writing the clinic lecture, studying current status of the problem of etiopathogenesis, diagnostics and surveillance of the patients with tension pneumocephalus. The article presenas clinical case of successful surgical treatment of a patient with traumatic tension pneumocephalus. Conclusion. There are no uniform standards of urveillance of the patients with tension pneumocephalus. Based on our own experience, we determined that minimally invasive surgery is a method of choice among reconstructive craniofacial surgeries in the treatment of patients with traumatic tension pneumocephalus. It decreases the risks of intra- and postoperative complication. Compliance, using external ventricular drainage and repeated lumbar punctures with prevention of inflammatory complications helped stopping nasal liquorrhea and eliminating mass effect which caused absolute regression of neurological signs.

The article presents the analysis of effectiveness of laser vaporizationfor treatment of pain syndrome caused by lumbar disc herniation. We treated 149 patients (average age - 40 years). 62 (41.7 %) patients had lumbodynia, 67 (45.2 %) patients had lumbar ischialgia. Nerve root disorders (radiculopathy, radiculoneuritis) are found in 20 (13.1 %) patients. 86 (57.4 %) patients had median hernias of intervertebral disc (disc bulging for 0.6 ± 0.2 cm), 36 (24.3 %) patients had intervertebral disc protrusion and 27 (18.3 %) patients had lateral intervertebral hernia (disc bulging for 0.55 ± 0.15 cm). Satisfactory and good results of laser vaporization are registered in 140 (94 %) patients with circular protrusion and median hernias with disc bulging up to 7-8 mm. Also the decrease in VAS scores of pain syndrome by 2-5 points in comparison with initial condition is found. Unsatisfactory results are registered in 9 (6 %) patients with lateral hernias of more than 5 mm and with disease duration more than 6 months. Prospective (from 3 to 13 months) follow-up was conducted in 49 patients. 5 patients from the group with lateral hernias needed open surgeries.

The aim of the research was to develop a new technique for suturing the surgical incision in submammary area after subpectoral reconstructive breast surgery with good cosmetic result. Clinical observation group included 10 patients. It was found that the new technique of suturing the surgical incision, in comparison with the method offered by M.B. Calobrace et al. (2014), allows to decrease the duration of suturing from 6 min 10 ± 0.06 sec down to 5 min 29 ± 0.04 sec (р < 0.01), to reduce number of stitches from 24 down to 15, to shorten postoperative stitch from 4.24 ± 0.06 cm down to 3.71 ± 0.07 cm (р < 0.01), and to shorten cicatrix length in 1 year after the operation from 4.78 ± 0.19 cm down to 4.25 ± 0.22 cm (р < 0.05). Therefore, the developed technique of suturing the surgical wound provides the location of postoperative cicatrix in the area of submammary fold which makes it less noticeable. Moreover, it allows to shorten the length of postoperative cicatrix, decrease the duration of the surgery and to secure adequate stability of implant fixation.

Surgical treatment of secondary hyperparathyroidism (HPT) in patients having renal replacement therapy (RRT) is a current problem. The aim of our study was to optimize the treatment of secondary HPT based on the comparative analysis of effectiveness of the surgeries with different extents. We conducted a retrospective analysis of the results of surgical treatment of uremic HPT in 34 patients. 36 surgeries were performed including 34 primary (16 subtotal parathyroidecomies (PTE), 13 total parathyroidecomies (total PTE 1), 5 total parathyroidecomies with central neck dissection and resection of superior mediastinum and superior thymus horns (total PTE II)) and 2 repeated surgeries (total PTE 11 and parathyroidadenomectomy). Gross examination of 134 surgical specimens revealed dyssynchronous pathological changes in parathyroid glands (PTG), normal PTG structure was found in 2 cases. Recurrent HPT was found in 3 cases, persistent HPT - in 9 cases, hypoparathyroidism - in 5 cases after subtotal PTE and in 9 cases after total PTE with autotransplantation (p = 0,267). Target values of parathyroid hormone were registered in 8 patients, including 4 patients after subtotal PTE and 4 patients after total PTE (p > 0,95). Morbidity was similar in all types of surgeries (p > 0,5). Analysis of morbidity determined that simultaneous surgery of thyroid gland increased the risk of laryngeal paralysis (р = 0,028). The decrease in occurrence of secondary HPT persistence (with the source accessible for removal through cervical approach) at total PTE based on the removal of parathyroid glands of all localizations accessible through cervical approach (including thyroid gland lobes with diagnosed ectopia, central cervical fat pad, superior mediastinum and superior thymus horns) was registered (NNT = 4).

The aim of the research was to study electrophysiological values in patients with blade-humerus pain syndrome at cervical osteochondrosis and posttraumatic shoulder injuries. We managed 71 patients: 33 patients with cervical osteochondrosis and brachialgia getting conservative treatment in the neurosurgical unit of Irkutsk Scientific Center of Surgery and Traumatology (group 1) and 38 patients with injuries of shoulder joint capsules and ligaments getting treatment in the unit of traumatology and orthopedics (group 2). Comparison of electroneuromyographic values in patients of both groups showed unidirectional changes in the values and accentuated decrease in electroneuromyographic parameters on both affected and unaffected extremities. In both cases median nerve was affected most. We registered the decrease in conduction velocity of motor fibers of intact nerves in patients of both groups. Lack of clinical signs of lesion of these nerves can be indicative of functional changes in nerve conduction which reflect generalized reaction on the lesion of certain nerve stems.

We developed an algorithm for spinal diagnostics to optimize the diagnosis and treatment of patients with cervical osteochondrosis. This algorithm includes physical and neurological examination of a patient, radiological methods, multi-layer spiral CT (MRI) of cervical spine, densitometry and electroneuromyography (ENMG) and is used in practical work of neurosurgical unit of Irkutsk Scientific Center of Surgery and Traumatology. We managed 40 patients with cervical osteochondrosis in period I-III localized in C_III-C_IV, C_V-C_V C_V-C_W C_n-C_VIl segments and with severe muscular tonic syndrome (cervicalgia, cervical cranialgia, cervicobrachialgia). Patients with osteochondrosis in period I-II had medium decreased conduction of peripheral nerve motor fibers on both sides of spine, which indicates the lesion of some motor fibers. In patients with osteochondrosis in period III in case of protrusion and herniation of intervertebral discs the ENMG values corresponded to the increase in neurility and conduction velocity of motor nerve and muscle fibers in diseased segment. Conservative treatment was conducted up to the Standard approved by the Ministry of Health of the Russian Federation and was supplemented with acupuncture (9-10 sessions) based on the changes in ENMG values. Performed treatment caused significant decrease in pain syndrome, reduction of neurological manifestations and, as a consequence, positive dynamics of ENMG values. Proposed algorithmfor management of patients with osteochondrosis allowed to diagnose the localization of diseased functional spinal unit, to reveal problem peripheral nerves and, as a result, to choose adequate treatment tactics and to estimate its effectiveness.

The reduction of postoperative complication rate is a significant trend in modern surgery. One of the most important methods of intraoperative diagnostics is intraoperative neurophysiological monitoring (IONM). The aim of the research was to assess capabilities of intraoperative neurophysiological monitoring in neurosurgical practice considering literature data and experience of IONM application in the Center of Neurosurgery Railway Clinical Hospital at the Irkutsk-Passazhirskiy Railway Station of Russian Railways Ltd. We conducted 17 surgeries using IONM. We described the procedure, analyzed data of monitoring and patients' condition in early postoperative period. No deviations requiring modifications in surgical manipulations were found during neuromonitoring. No iatrogenic neurological disorders were registered in postoperative period. Intraoperative neurophysiological monitoring is an additional effective method which allows reducing the risk of postoperative complications and indirectly improving the results of surgical manipulations.

The aim of the research was to assess using biodegradable screws in treatment of hallux valgus. We managed 40 female patients (average age 50 ± 2.51) with hallux valgus who where admitted to the orthopedic unit of Irkutsk Scientific Center of Surgery and Traumatology for operative treatment. All patients had X-ray, MRI and intraoperational examination of affected foot before the surgery and in postoperative period. All patients were operated using own surgical technique. Patients were divided into two groups: group 1 (22 patients) - osteosynthesis using biodegradable (PLGA) screws; group 2 (18 patients) - osteosynthesis using metal cannulated screws. In group 1 postoperative values of M1P1 angle were within normal range (9.67 ± 0.78°). According to MRI, proximal articular set angle (PASA) was corrected from 21.5 ± 0.35 to 4.17 ± 0.09°. 6 patients of the group 1 were complaining of pain and discomfort in the area of screw-head contacting soft tissues. The result of operative treatment in the group 2 resulted in the correction of M1P1 angle from 34 ± 1.63 to 7.67 ± 0.75°. After the surgery intraoperative PASA was back to the normal range (4.33 ± 0.34°). The comparison of the results of treatment of patients of groups 1 and 2 didn't reveal any statistically significant differences in the values of М1Р1, М1М2, М1М5 angles and PASA. The advantage of using biodegradable screws, compared to the metal ones, in the treatment of hallux valgus is the possibility of postoperative MRI of the foot with calculation of PASA to evaluate treatment results. The disadvantage of using biodegradable screws is engineering deficiency preventing screw-head from dipping into bone tissue and causing soft tissue traumatizing. Biodegradable and metal screws allow to obtain similar results of hallux valgus treatment.

The aim of the study was to analyze the peculiarities of combined spinal and pelvic pathology in children living on the industrial area of the Irkutsk Region. To perform the analysis we carried out the clinical-roentgenological research, and when making orthopedic examination we took into consideration ecological factors and used the chart of multivariative analysis. It was found that in the structure of combined pathology, pelvis asymmetry ranks first, scoliosis ranks second, Legg - Calve - Perthes disease ranks third. According to the assessment of age structure of combined pathology we can conclude that at the equal manifestations of scoliosis, Spina bifida, retrospondylolisthesis, pelvis asymmetry, children of 11-15 y.o. more often have Legg - Calve - Perthes disease, children of 16-21 y.o. - coxarthrosis. In its turn relative share of Legg - Calve - Perthes disease cases in children living within a radius of 5 km from the industrial center is the largest (21 из 28 cases). It's important to mention that Legg - Calve - Perthes disease was registered in all examined boys and only in 35.5 % of girls. I and II degrees of manifestation of clinicoroentgenologic disorders of combined spine and pelvis pathology prevail (77 and 43 cases correspondingly) over the disorders of the III degree (15 cases).

We studied the effect of different levels of membrane-bound hemoglobin on the level of red-cell membrane proteins and also their interrelation in patients with essential hypertension with and without metabolic syndrome. It wasfound that high membrane-bound hemoglobin is closely related to the low level of high-density lipoproteins and high level of low-density lipoproteins in patients with essential hypertension complicated with metabolic syndrome. In patients with essential hypertension not complicated with metabolic syndrome high membrane-bound hemoglobin is related to the increased prothrombin time and decreased blood urea nitrogen. In patients with essential hypertension complicated with metabolic syndrome high membrane-bound hemoglobin significantly influences the level of membrane contractile proteins (actin, tropomiosine). In patients with essential hypertension without metabolic syndrome high membrane-bound hemoglobin is accompanied by the decrease of structural and integral membrane proteins levels (anion-transport protein and protein 4.1). As the result of quantitative changes in these proteins and change in their interrelations in patients with ssential hypertension complicated with metabolic syndrome more intensive disorders of structural and functional organization of red-cell membrane can appear.

Extraorgan complications of acute destructive pancreatitis are registered in 60-95 % of patients. Liver failure is registered in one of the four patients with pancreatic necrosis. We analyzed the results of surgical treatment of 122 patients with acute destructive pancreatitis. We studied clinical indicators of liver failure in 103 (84.4 %) patients with acute pancreatitis. The development of portal hypertension with decrease in hepatic volume perfusion is an important element in the pathogenesis of acute pancreatitis and associated liver function abnormalities. In patients with severe and moderate liver failure, the reduction of blood flow in portal vein was registered. It was caused by reduce of portal vein diameter and decrease in linear blood flow velocity. Destructive pancreatitis is accompanied by liver failure with hyperbilirubinemia, increased activity of cytolytic enzymes, incoordination in protein and carbohydrate metabolism as its common manifestations. An important factor in the pathogenesis of liver failure is a reduction of porto-hepatic hemodynamics and as a consequence - hepatic hypoperfusion.

The aim of the research was to develop an algorithm of complex conservative treatment of patients with cervical osteochondrosis. We examined and provided conservative treatment to 40 patients with cervical osteochondrosis in periods 1-11 with severe pain syndrome. The treatment was mainly aimed at pain management. For this purpose, we assigned non-steroidal anti-inflammatory drugs (NSA1D) to the patients. NSA1D are the most effective medicinal agents, first of all due to their analgesic effect. Also, the treatment included physiotherapy and acupuncture. As a result of the treatment, neurological manifestations were reduced. Number of cervicalgia cases decreased from 12 (before the treatment) to 6 (after the treatment), number of cervical cranialgia cases - from 12 to 7, number of cervicobrachialgia cases - from 16 to 8 correspondingly. Developed complex of conservative treatment measures allows to obtain successful treatment results in most cases. 1t is important to note that proposed treatment regimen is available, simple and can be applied in all neurological and neurosurgical units and hospitals.

We studied the use of Ortho-SUV hexapod in the treatment of 15 patients with lower limb false joints. All patients were at active working age - from 22 to 50 years. 1n 12 patients, the period from the moment of trauma was 1 to 3 years, in 3 patients - 3 to 6 years. 5 patients had femoral false joints, 10 patients - shin false joints. 1n 98 % of cases, the formation of false joints was caused by inadequate treatment of initial trauma. 1n 100 % of cases, false joint localized at diaphyseal level and was accompanied with shortening of injured segment for 2.5 ± 1.0 cm in 13 patients, and for 0.5 and 0.8 cm in 2 cases. We also registered recurvatum and valgus deformity in 5 patients, recurvatum and varus deformity in 8 patients, and antecurvatum and varus deformity in 2 patients. Combined contracture in knee and ankle joint was found in 90 % of patients. Using combined transosseous osteosynthesis along with Ortho-SUV hexapod allowed us to correct hip deformity for 35 ± 10 days and ankle deformity - for 20 ± 5 days on the average. When shortening of femoral bone for more than 5.0 cm, the deformity was corrected in two stages. At the first stage, we reconstructed the length of a segment using methods of transosseous osteosynthesis at discrete-continuum distraction. At the second stage, we corrected deformity using Ortho-SUV hexapod within specified time limits. Duration of femoral and shin false joint consolidation was 194 ± 16 days. We registered inflammatory complications in the areas of transosseous elements contacting soft tissues in 3 (0.2 %) patients. These complications didn't have an effect on the treatment results.

The concept of "tandem stenosis" comprises combination of degenerative stenosis in both cervical and lumbar spine. At the moment, there is no consistent approach to the surgical procedures in this group of patients, as well as the researchers do not pay much attention in their papers to the sequence and stage-by-stage approach to the procedures and to the analysis of combined surgical procedures. The aim of the research was to analyze the results of staging decompression/ stabilization interventions in the treatment of patients with tandem stenosis of cervical and lumbar spine. We performed a retrospective analysis of prospectively collected results of treatment of 46 patients with combined (tandem) stenosis of cervical and lumbar spine. The patients were operated in four neurosurgical clinical units of Vladivostok, Irkutsk and Novosibirsk. We assessed clinical data: level of pain syndrome - using visual analog scale (VAS), neck disability index (NDI), Oswestry disability index (ODI), MacNab and Nurick clinical outcomes, as well as the results of plain spine radiography and neuroimaging studies (MRI, MSCT). Multicenter study of the results of staging surgical procedures with the use of specialized microsurgical instruments in the treatment of patients with tandem stenosis of cervical and lumbar spine allowed us to confirm their high clinical and radiological effectiveness.

The aim of our research was to analyze the results of bacteriologic examination in patients with local and disseminated chronic osteomyelitis. We performed retrospective analysis of the results of bacteriologic examination of wound exudate in 80 patients who were admitted to the clinic of Irkutsk Scientific Center of Surgery and Traumatology for operative treatment of shinbone shaft fractures complicated with local and disseminated chronic osteomyelitis. We used common methods of mono- and bilocal osteosynthesis which resulted in different terms of fracture union and bone defect replacement. Bacteriologic examination of exudate from bone and soft-tissue wounds was performed in all patients at their admission to the clinic. In patients with local chronic osteomyelitis and with usual terms of fracture union, the most common were pure cultures (93. %) with dominant S. aureus (60 %). In patients with delayed fracture union, the most common were microorganism associations (55.5 ± 11.7 %). In patients with disseminated chronic osteomyelitis with usual terms of defect replacement, pure cultures were registered in 90 % of cases. In patients with delayed defect replacement pure cultures were found in 57,2 % of cases. Comparative analysis showed that in patients with delayed fracture union and defect replacement, bacterial associations were more common than in patients with usual terms of defect replacement. Preoperative bacteriologic examination showed that S. aureus was the dominant flora of wound exudate in patients with local and disseminated chronic osteomyelitis. Bacterial associations in wound exudate of patients with delayed fracture union and defect replacement is associated with significant circulation failure in affected extremity and is an unfavorable factor for reparative process disorder at chronic osteomyelitis.

The aim of the work was to establish the significance of complex bacteriological research in the diagnostics of acute appendicitis and to determine an optimal material for the research based on the findings. We examined 19 patients with acute phlegmonous or acute gangrenous appendicitis (males, aged 18-60 years). We performed bacteriological research of abdominal exudate (n = 19) and biopsy specimen (n = l9) of appendix wall taken before opening the lumen of the intestine. Both abdominal exudate and appendix wall specimen were taken at the same time. Aerobic and anaerobic microorganisms were detected and identified, antimicrobial susceptibility was tested. In total, we detected 25 strains of aerobic and 13 strains of anaerobic microorganisms. It has been established that a bioptate was most informative for testing (68.4 %); the parallel study of an abdominal exudate gave positive results in 21.1 % of cases. In the structure of clinically significant microflora dominated E. coli (43.3 %), then went nonfermentative gram-negative bacteria (13.3 %) and Bacteroides spp. (16.7 %). We marked growing resistance of detected strains of gram-negative bacteria to some antibiotics. For instance, 62 % of detected E. coli strains were resistant to ampicillin, 25 % - to ciprofloxacin. 92 % of strains were resistant to cefepime, 93 % -to ceftriaxone, 77 % - to Amoxiclav, 67 % - to gentamicin, 90 % - to tobramycin. From one bioptate a strain of E. coli ESBL was separated. The study of intraoperative bioptate of appendix wall increases effectiveness of microbiological diagnostics in comparison with the abdominal exudate research.

Modern therapeutic strategies for intervertebral disc repair mainly focus on targeting molecular pathways of extracellular matrix degeneration. Anabolic strategies for regeneration are aimed to increase production of major extracellular molecules. Members of TGF-b superfamily proteins, particularly the bone morphogenetic proteins (BMP) have a high regenerative potential regarding the mesenchymal cells. The goal of this study is to study production of proteoglycans by the intervertebral disc cells under the influence of bone morphogenetic protein 2. Material and methods. The experiment was carried out on the cell cultures derived from the annulus fibrosis cells and nucleus pulposus cells of the human intervertebral disc. We studied cell livability, metabolic activity and proteoglycan expression. Cell livability was assessed using the trypan blue staining. Alamar blue test was used for the estimation of metabolic activity. Amount of sulfated glycosaminoglycans was assessed using the assay based on the reaction with 1,9-Dimethylmethylene Blue. Results. Cultivation with bone morphogenetic protein 2 in different concentrations did not decrease livability of the cells. Study cell cultures with application of bone morphogenetic protein 2 in different concentrations showed significant increase in metabolic activity and proteoglycan synthesis by the annulus fibrosis cells. Despite the relative increase in the number of the nucleus pulposus cells treated with the bone morphogenetic protein 2, the differences in metabolic and synthetic activity compared with control group was not significant. Conclusion. The bone morphogenetic protein 2 has an anabolic effect towards the intervertebral disc cells, particularly in the production of proteoglycans by the annulus fibrosis cells.

The research was carried out on 9 rabbits (males) of Chinchilla breed with modeling of standard perforating fracture of femoral bone. We performed intraosseous introduction of nanocomposite elemental selenium and heteropolysaccharide arabinogalactan 50 mg Se/kg to individuals of experimental group (n = 3) and NaCl 0,9 % to individuals of control group (n = 6). It was established that local intraosseous introduction of the nanocomposite with perforated fracture model did not affect basal metabolic indicators (body temperature, oxygen consumption, carbon dioxide production), but boosted the metabolic processes in the area of the surgical wound from the 9th to 21st days. It proves the bioavailability of the drug and the possibility of creating a local depot of selenium using a nanocomposite.

Managing bone tissue regeneration is a key problem in traumatology and orthopedics. The researches proved that thyroid hormones affect hemostasis and reparative regeneration of bone tissue favorably and promote osteogenesis and bone consolidation. The aim of this research is to study the influence of disturbed reparative regeneration on the concentration of thyroid hormones in blood in the dynamics. Experimental research on rabbits (n = 12) with modelling of disturbed reparative regeneration revealed disorder in thyroid hormones synthesis and different directions of T3 and unbound T3 production on the 35^th day when the maximum decrease of T3 (2 times) and unbound T3 (1.5 times) compared to normal values was registered. The analysis of production of T4 and unbound T4 revealed suppression of the values from the 1^st to 50^th day and gradual increase in unbound T4 from the 50^th day. The most significant manifestation of thyroid gland reaction on the disturbed reparative regeneration of shin bones was the decrease in T3 and peripheral conversion of thyroid hormones up to 50^th day with formation of false joint in these terms.

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.

Actuality. At the moment, one of the current trends in medicine and sociology is the study of life quality in population. The motivation for this study was the lack of population-based studies on life quality assessment for adult population conducted in Irkutsk, taking into account the individual characteristics of all age groups with questionnaire SF-36. Purpose. To evaluate standard criteria for Irkutsk adult population's life standard in terms of the age and gender by means of the standard questionnaire SF-36. Materials and methods. The article represents the interview results received from 579 Irkutsk dwellers at the age of 18-85. The Russian version of SF-36 Questionnaire has been used for the present research. The criteria were estimated according to 8 scales. The levels of the respondents' physical well-being, socio-environmental adaptation, psycho-emotional changes and viability were specified. Moreover, the respondents' clinical-anamnestic status including complaints, anamnestic evidences for somatic pathology and earlier surgical interventions were evaluated as well. The received data were processed by Statistica 6.0 software with the use of nonparametric and multiple factor analysis. Results. The results determine the levels of physical functioning, social adaptation, psycho-emotional changes and the viability of Irkutsk residents of different age, gender and socio-professional groups. Conclusions. The presence of comorbidity in varying degrees affected the quality of life.

The conducted research relates to the structure of anal canal and distal rectum of Wistar rats. This structure is of interest in terms of comparative anatomy and as an object of experimental model in pathology. We studies female rats aged 6-10 months, weighing 200-300 g. Light microscopy of specimens was performed with the system microscope LEICA DM2000 (Germany). The study findings revealed that the anal canal is lined with multilayered epithelium on the connective tissue, in distal part ofwhich are buried hairfollicles, adipose glands and rudiments of perspiratory glands. Passage of anal canal into the skin with high density of hairfollicles with adipose glands is a white line. Intrinsic sphincter is identified by thickening of circular layer of the intestine. External sphincter is presented by separate complexes of skeletal muscles fibers, placed exteriorly and inferiorly from the anal canal muscle layer under the hypoderma. We did not detect the Parks' ligament as a separate structure. This means that the function of this part of the intestine in rats and that one of a human are not completely consistent.

Clinical drug trials in Irkutsk Scientific Center of Surgery and Traumatology began in 2005. In 2013, the laboratory of clinical trials was established in the science department of clinical surgery. We analyzed the experience of Irkutsk Scientific Center of Surgery and Traumatology in international multicentre trials. Participation in international multicentre trials allows the Irkutsk Scientific Center of Surgery and Traumatology to get affiliated with the publications in first quartile scientific journals. The experience of the laboratory in clinical trials is projected into practical work of other institutes - Hospital of Irkutsk Scientific Center SB RAS and Irkutsk Regional Clinical Hospital. The important objectives of the laboratory of clinical trials are developing the protocols, performing drug clinical trials and medical device clinical trials. The laboratory carries out admission of patients for observational trial PROTOCOL. One of the fields of work of the laboratory is the prospect of clinical testing of developed clinical technologies.

The article reviews main stages of establishment and development of the Department of Hospital Surgery in different periods. We showed the role of heads and stuff of the department in the development of multipartial complex which aims at the unity of three components – to teach, to treat and to study. The first head of the department and of the clinic of hospital surgery (1921–1931) was N.A. Sinakevich. It was a pe- riod of establishment of the department, its staffing, formation of clinical site and training calendar. V.G. Shipachyov was the head of the department from 1931 to 1952. During the Great Patriotic War, the work of the department was aimed at the needs of war time related to the problems of reconstruction surgery and treatment of traumatic injuries. After the war, the work of the department was dedicated to the problems of hypothyroidism, obliterating endarteritis, gastrointestinal and urgent surgery. In 1953, Z.T. Senchillo-Yaverbaum became the head of the department. The work of the department was dedicated to gastrointestinal and pancreatic surgery, herniology, thyrophymas. Also the department included course of traumatology. In 1972, V.I. Astafiev became the head of the department. In this period, many young hopefuls started to work on the department. Also the research, treatment and educational complex was created on the base of the department, Re- gional Clinical Hospital and Siberian Branch of Academy of Medical Sciences USSR. While keeping the traditions of the department, V.I. Astafiev created new research and practice directions and special referral units – of cardiac, vascular, thoracic, purulent and urgent surgery, operative coloproctology, plastic surgery, diagnostic picture and X-ray surgery. Also the system of individual and collective training of surgical clerk. In 1988–1993 Y.I. Morozov was the head of the department. The new direction of the work was the development of complex treatment of purulent soft tissue involvement in patients with diabetes. From 1993, E.G. Grigoryev is the head of the department of hospital surgery and the Institute of Surgery.

The article summarizes experience and achievements of Irkutsk Scientific Research Institute of Traumatology and Orthopedics (now - Irkutsk Scientific Center of Surgery and Traumatology) over a 70-year period. The development of new methods of diagnostics and treatment and organization of health care for patients with traumatological and orthopedic pathology are highly influenced by the Institute. The team of Irkutsk Scientific Center of Surgery and Traumatology developed a new promising direction of combined tension-band osteosynthesis, substantiated organ-sparing endoprosthesis replacement, created new technologies of treatment of chronic osteomyelitis, developed concept of treatment of spinal trauma and spinal cord injuries, determined regularities of cross-system organization of physiological functions at the musculoskeletal system pathology, created original technologies and instruments for the treatment of musculoskeletal system traumas and disorders. Innovations created in ISCST include 330 patents. Irkutsk Scientific Center of Surgery and Traumatology was awarded Governor's Award in Science and Technics for the development and introduction in clinical medicine of new diagnostic and treatment methods and of candidate medicines in 2012 and 2013.

Analysis of the literature and our research showed that an imbalance of the intestinal microbiota is associated with many diseases. We present some of the mechanisms of disease. Using non-invasive, simple, affordable method of determination of fecal calprotectin reveals the presence and progression of chronic non-specific inflammatory bowel disease, and can be widely used in clinical practice

The primary interventions for trachea in the thoracic surgery units are performed for the treatment of cicatricial stenosis of the trachea. Circular resection of the trachea is one of the treatment procedures in this pathology. The benefit of this method as compared to the others is that the resection with tracheo-tracheal anastomosis allows a one-stage recovery of patient with this pathology. The first successful resection of the trachea was performed in the late 19th century, and since then this surgery technique is constantly being improved. Several methods of suture placing in anastomosis surgery are proposed, different suture materials are used, special devices are developed to facilitate the anastomosis performing. There are several tactics depending on the presence or absence of tracheostome in the patient. Different methods are worked out to approximate the trachea ends with different diameters. Prevention of anastomosis leakage is achieved by strengthening the anastomosis area to reduce the suture tension. In addition, there are studies dealing with the improvement of trachea regeneration by physiotherapy impact on the anastomosis area. Laser therapy and hyperbaric oxygenation are also put forward for use. Nevertheless, a number of items remain to be solved: indications for circular resection of the trachea are not clearly formulated, the size of trachea fragment to be resect is the subject of active discussion.

Currently, the world is marked rise in the number of patients with liver disease. Approximately 100,000 patients hepatitis complicated by acute liver failure, with mortality in this disease reaches 70-90 % despite the use of modern methods of treatment Currently, there are more than 20 concepts of this disease. In 15-20 % of cases the cause of acute liver failure can not be established. Most clinicians believe that the pathogenesis of liver failure is a strong humoral and hyperimmune response, resulting in massive necrosis of liver cells. Diagnosis of liver failure based on anamnesis, clinical, biochemical and electroencephalographic changes. Traditional conservative therapy of acute liver failure in the first place based on the measures taken to address the etiological factor. Transplantation is an effective measure in acute liver failure. In the world there are a sufficient number of prognostic scales, criteria and risk factors of acute liver failure. Each of them has its own characteristics, but a unified system of prognostic estimation of arrester.

The article presents a literature review on the VATS treatment of spontaneous pneumothorax as a complication of bullous lung emphysema. The review considers questions of etiology, diagnostics and therapeutic tactics in VATS treatment of spontaneous pneumothorax with bullous emphysema. The main target of surgeons is not only elimination of spontaneous pneumothorax, but quick exposure of lung parenchyma pathology in order to predict possible reoccurrence of spontaneous pneumothorax. Video-assisted thoracoscopy in this case is a mini-invasive, less traumatic and highly efficient method of treatment of spontaneous pneumothorax. Anti-relapsing surgical interventions with pleurodesis are unanimously considered to be necessary. An integrated and differentiated approach to the treatment of spontaneous pneumothorax as a result of bullous emphysema helps to determine diagnostic and therapeutic tactics of VATS treatment and choice of pleurodesis induction leading to improved treatment outcomes in this category of patients.

The article describes the modern literature data on the incidence of acute, chronic pancreatitis and its complications. The current classification of complications of acute and chronic pancreatitis. The possibilities of digital diagnostic methods (ultrasonography, computer tomography, endosonography) this pathology. Considered the advantages and disadvantages of these methods of diagnosis. Describes the types of minimally invasive interventions under the control of the means of medical imaging, the indications and contraindications to them, deals with the complications. The selection criteria method of digital diagnosis of complications of acute and chronic pancreatitis and type minimally invasive treatment

We analyzed present-day data in Russian and foreign literature on development of cytokine cascade in diffuse bacterial peritonitis having studied the role of cytokines in forming systemic inflammation response syndrome. It has been showed that cytokines primary regulate local protective response by forming typical inflammatory reaction with its classic local manifestations and natural anti-microbial resistance mechanisms. The main stage in the development of diffuse bacterial peritonitis is a disbalance in the system of proinflammatory cytokines and anti-inflammatory mediators; and this disbalance defines the severity of extraabdominal complications and multisystem organ failure. In the article, the markers of inflammation severity are described assisting in evaluation of the course of inflammation process and postoperative survival rate. Due to changes in immune system of the patients, it is necessary to assess complexly their immune status including cytokine profile, which in this group of patients is of diagnostic and prognostic value and needs to be further studied

The article presents the present-day data on the phenomenon of ischemic myocardial postconditioning. It has been shown, that this phenomenon consists in protection of the heart from reperfusion damage by the means of short episodes of ischemia/reperfusion performed at the early stage after prolonged ischemia. It is presented that postconditioning effect manifests in limiting the size of infarction and preserving endothelial function in the region exposed to ischemic injury. The article reports on the modern concept of role of various intracellular signal cascades in providing survival of the cell after the episode of ischemia/reperfusion. Much attention is given to changing in the state of pores localized in internal mitochondrial membrane as end links of realization of postconditioning effect. Prospects of clinical use of postconditioning are very optimistic due to the fact that application of different variants of preconditioning is limited because in most cases it is impossible to predict the time of occurrence of ischemic injury, whereas postconditioning may be used after prolonged ischemia.

Meningiomas are among the most common primary intracranial tumors. They arise from meningothelial cells of the arachnoid layer that forms the external lining of the brain and occur primarily at the base of the skull in the parasellar regions as well as over the cerebral convexities. Of particular difficulty are anaplastic meningiomas, having similarities with malignant soft tissue tumors. Immunostaining allows to define not only the source of cytogenetic, tumor grade, but detect abnormal proteins - transcription products damaged DNA regions and make recommendations for the appointment of targeted therapy. Targeted effect on the meningioma will allow to achieve a significant increase in patient survival.