The constant expansion of treatment methods' range of cysts of kidneys - from the puncture to video and endoscopic resections - became a motivation to further improvement of low-invasive surgical techniques. The article presents the method of endovideotechnology treatment of solitary renal cysts. A laparoscopic resection of renal cysts with the treatment of the remaining lining of argon-plasma coagulation was performed in 32 children aged from 3 months to 17 years. Three trocars were used during the main stages of operation; they were set up depending on cyst's location. The sizes of cysts varied from 3 to 11 cm. Sometimes the fourth trocar was used for the retraction of liver and spleen and for the overviewing the remaining part of the cyst situated on the superior posterior part of kidneys. The operation lastedfor about26.6 ± 2.3 minutes in average, there weren't any conversions and intraoperative complications. One 7-years-old patient had a complication in the early postoperative period: disruption of the calyx. The article focuses on the features of operational equipment depending on the location of cysts in kidneys. The transperitoneal resection of prime renal cysts with an ablation of the internal wall of a cyst with argon-plasma coagulation gives high percent of effectiveness, rapid rehabilitation of children, excellentfunctional and cosmetic result and allows to avoid a disease recurrence.

The urgency of otogenic intracranial complications in modern otolaryngology is connected with difficulties of the early diagnostics, severe course of the disease and rather high percentage of fatalities. All of that defines practical value of the matters aimed to improve definition of an individual's liability to aggressive course of chronic suppurative otitis media, which can cause direct threat for a patient's life. The aim of the study was to increase accuracy of diagnostics of destructive course of chronic suppurative otitis media with forecasting of intracranial pathology at early stages of inflammation. Molecular genetic analysis was conducted of human DNA from 300 patients with chronic purulent otitis media and 100 healthy individuals for the presence of genotype variants of genes cytokines: IL-1b (511Т/С, 31 Т/C), IL-10 (1082 G/A, 819 С/Т). The SNP (single nucleotide polymorphism) distribution of gene cytokines in the studied groups corresponded Hardy-Weinberg equilibrium (HWE > 0.05). We found that a combination of genes IL-1b 511Т/С, IL-10 1082A/A, IL-10 819С/С, IL-1b 31C/C occurred correspondingly in 57.8,13.6 and 22 % of patients with attic disease, and were associated with expressed caries-destructive course of chronic suppurative otitis media complicated by intracranial pathology. The combination of gene polymorphisms of IL-1b 511 Т/Т, IL-10 1082 G/A, IL-10 819 С/T, IL-1b 31 T/C in 46 % of patients was clinically manifested by mucosal process in the middle ear.

According to the World Health Organization experts, the prevalence of diabetes is ahead of the most pessimistic forecasts and has already acquired the character of non-infectious epidemic in the world. Furthermore, today there is a tendency not only to the increase in the incidence of type 2 diabetes, but to the prevalence of comorbid conditions, including osteoporosis and osteopenia. In turn, in recent decades, osteoporosis is one of the most widespread and socially significant diseases, in all countries without exception its frequency in recent decades has been steadily increasing particularly among postmenopausal women. At the same time, a special state of bone metabolism in patients with type 2 diabetes is marked. The paper presents the study results of the content of the markers of bone metabolism in postmenopausal women with type 2 diabetes. Twenty-eight women, 15 of them with type 2 diabetes and 13 - in the control group were examined. The levels of ionized calcium, 25-OH vitamin D, osteocalcin, N-terminal propeptide of type 1 procollagen C-terminal telopeptides of type I collagen were determined. We also estimated the average daily calcium intake in women with type 2 diabetes. A substantial reduction in markers of bone metabolism, reflecting fixation processes, due to lower markers characterizing osteoresorption in patients with type 2 diabetes relative to the control group was determined. The findings raise the question of further studies of the mechanisms of formation of bone metabolism disorders in conditions of hyperglycemia.

Change in structural and functional properties of red cell membrane proteins in patients with the essential arterial hypertension (EAH) can promote development of significant dysfunction of these cells and can complicate the course of a system hypoxia in this category of patients. The aim of our research was to determine the interrelation between red cell sphericity and the level of proteins of their membrane in patients with EAH complicated and non-complicated with metabolic syndrome (MS). 51 male patients with EAH I and II (average age - 42 ± 1.5 years) were examined and divided into 2 groups: group 1 - 29 patients with EAH complicated with MS; group 2 - 22 patients with EAH non-complicated with MS. Protein spectrum was assessed by 10 red cell membrane proteins. Results. Patients with EAH complicated with MS had decrease in spectrin level and loss of correlations between the levels of red cell membrane proteins. Number of patients with diameter-thickness ratio < 3.4 (indicates the existence of cells prone to spherocytosis) in the group 1 was twice more than in the group 2 (29.4 % vs 13.7 %). Conclusion. We determined structural and functional disorders in interrelations of such membrane proteins as a-spektrin, ATP and GAPDH (in patients with EAH complicated with MS), and ATP, GAPDH and actin (in patients with EAH non-complicated with MS) which promote development of acquired spherocytosis and further impairments in microcirculation and gaseous metabolism in tissues.

Material and methods. The control group consisted of 166 children with acute purulent rhinosinusitis who underwent standard treatment: antibiotic therapy, on the strict condition - endonasal drainage of the maxillary sinuses, the treatment method around Proets, physiotherapy of the nose, vasoconstrictor nose drops. The main group consisted of 132 children with acute purulent rhinosinusitis, who, in addition to standard treatment, were prescribed topical corticosteroid - mometasone furoate. Results. The concentration of lactoferrin (in the main group) was normalized due to the action of the nasonex spray, which proves a high anti-inflammatory effect of the combined treatment. There was a statistically significant difference in the groups after 7 days and 1 month after treatment (t = 1.96; p = 0.05). Based on the data of Mac-Nimar criterion (X² = 11.204, with the probability of error p = 0.002) in the control group compared to the primary (x²=9.202, with the probability of error p < 0.0001), treatment was less effective. Conclusion. The use of inhalative topical glucocorticosteroid in treatment of children with acute purulent rhinosinusitis allows to achieve a positive clinical effect and the concentration of lactoferrin can serve as an important criterion of the effectiveness of treatment.

We compared the main group of patients (64 persons) underwent colon resection and liver resection, radiofrequency ablation of metastases in the liver and portal vein chemoembolization with the control group (62 persons) with the operation on the colon without intervention on the liver. The blood loss during surgery in the main group was 696.1 ± 226.3 ml and in the control group - 473.3 ± 245.9 ml (p = 0.000008). When performing hemihepatectomy blood loss during surgery was 802.9 ± 208.5 ml, and performing other liver resections - 575 ± 182.2 ml (p = 0.00005). Duration of hospital stay after the surgery in the study group was 16.8 ± 5.1 days and in the control group -14.0 ± 4.1 days (p = 0,001). Duration of hospital stay after the surgery was higher in the patients after hemihepatectomy, compared to the patients who received smaller volume liver resection -19.7 ± 3.9 versus 13.4 ± 3.8 days (p = 0,005). Postoperative complications were more frequent in the patients of the main group -18 (28.1 %) vs 10 (16.1 %). However, increasing the proportion of complications in the patients with simultaneous treatment of complications associated with the summation operations on the colon and liver operations. Performing liver resection is an independent factor contributing to the prolongation of operative time and blood loss, which increases the frequency of postoperative complications and increases duration of the patient's stay in the hospital.

There is more than 1 million people who have had a stroke in Russia; the third part of these people are of working age, and only every fourth patient returned to job. This article discusses one of the most effective methods of stroke prevention - the procedure of carotid endarterectomy. We performed 468 reconstructive operations in 448 patients. 65 % (305) of surgeries were open carotid endarterectomies. In other cases, operations of prosthetics or blood flow switching between extracerebral arteries (ECA) (163) were carried out. Short-term results of reconstructive operations showed that 96 % of outcomes were positive. Perioperative mortality at operations made 1.06 %. The general complications made 4.5 %, minor complications were observed in 21 patients (4.4 %). The five years survival rate of patients operated on ECA made 86 %, the main cause of death in recent follow-up period was a cardiac pathology (58 %), brain disorders made 15 %. Among dominating risk factors are coronary heart disease, previous transient ischemic attacks and residual neurologic impairment.

Cicatricial deformations of the neck occur in 4-30.5 % of children suffered from burn trauma, and are the most severe consequences. Early reconstructive surgery in this pathology provides free growth and development of the skull and upper body and promote psychological and social recovery of the child. The treatment of such patients presents great difficulties, and in each case requires an individual approach. The article presents the experience of treatment of two children with severe scar contracture of the neck, complicated by the lack of reserves in undamaged tissues of the neck and the surrounding areas. We used a combination of several methods of skin grafting, including axial flow and the prefabrication of flaps, divided in time into stages. In one case in a child with total neck contracture, we performed pre-surgical (3.5 weeks before the main stage surgical intervention) preparation of the two flaps - scapular and epaulet flaps. In the other case, 4-year old girl with subtotal flexion contracture, a month before the main surgery we prepared scapular flap and increased its area expander dermotension, with endoscopic implantation of endoexpander. In this paper, we describe in detail the technology of operative treatment of these two patients. In both cases, there were no postoperative complications. The use of modern medical technologies based on conventional techniques in surgical correction of severe flexion scar contractures of the neck of the presented patients decided both functional and aesthetic problems.

Materials and methods. The population-based cohort analysis was performed of the database of primary disabled in Irkutsk region due to the DDS for the period of 2013-2015. Morbidity rate of primary disablement was calculated for 10 000 of the population; nosology, age, gender specific structure of primary disablement was calculated in percentage. Results. The level of primary disablement due to DDs in the Irkutsk region was higher (2013, 2015 - 1.7; 2014 - 1.9) than in the Russian Federation (2013,2014 -1.2 per 10 000 of population). Working-age persons prevailed (in 2013, 2015 - 71.3 %, in 2014 - 73.9 %). The level was higher among the urban residents of the Irkutsk region (2015 - 1.8) than in rural areas (1.1 per 10 000 of people). In 2015, the share of men began to dominate (52.3 %, in 2013 - 45.4 %). Structure of primary disablement due to DDS deteriorated with increasing share of persons with the first and the second group disabilities - from 47.3 % in 2013 to 56.1 % in 2015. Liver cirrhosis is the most common cause for primary disability among DDS, its share increased from 66.8 % in 2013 to 75.2 % in 2015. The rate increased from 1.1 in 2013 to 1.3 per 10 000 people in 2015. Bowel disease has the second place with its share reduced from 23.0 % in 2013 to 12.3 % in 2015. The third place belongs to chronic pancreatitis.

The objective of this study was to compare the results of complex (medicinal and surgical), and only medicinal treatment of patients with rapidly progressive and dyskinesia associated forms of Parkinson's disease. Three atrophy indices (IA) of the brain matter were proposed to justify a differentiated approach to the treatment of each form. Multivariable regression analysis showed, that patients, who were treated with complex method and had IA-1 less than 0.16, IA-2 - less than 0.115, IA-3 - less than 0.06, had the best improvement of the clinical status during the follow-up period. There were also multiple correlation coefficients obtained in the range 0.911-0.943, which indicates a significant linear relationship between the factors of influence (IA) and response (clinical presentation). In groups with only conservative treatment, the coefficients were in the range of 0.331-0, 423, indicating low and medium dependence on clinical manifestations of atrophy indexes. The status of all patients was assessed after 3, 6, 12 and 18 months. It turned out that in case of the earlier mentioned indices values the result of the treatment was constant during the entire period of observation. It was statistically confirmed by the assessment of the squares of the Mahalanobis distance.

Forensic chemical examination is carried out in order to isolate, identify and quantify toxic, narcotic, psychotropic and potent substances in the organs and fluids of the human body. The present study we researched the process of extraction of 2,3-benzodiazepine - tofisopam. There have been cases of tofisopam poisoning. And there are no descriptions of tofisopam isolation from biological fluids in the literature. Liquid extraction, an effective and commonly used method of isolation in the chemical-toxicological analysis, is used when extracting substances from blood, lymph, saliva, urine and stomach washings. The process of isolation may be influenced by the nature of the organic solvent, pH, the presence of an electrolyte, time and frequency of extraction. We have studied the effect of each factor on tofisopam isolation from aqueous solutions. It has been found that the optimal organic solvent for the extraction of the solutions is dichloroethane, which extracts maximum amount of the analyte at pH = 5.0. Saturated sodium sulphate has a salting-in effect for tofisopam. The optimum conditions for tofisopam isolating are 7 minutes with double extraction. Based on the research method of tofisopam isolating the model mixture of urine was developed. We found that this model urine mixture isolates 66.51-67.9l % of tofisopam. We performed validation assessment of the developed method for evaluation of precision and accuracy. The assessment showed the suitability of techniques for the analysis.

The results of work on identification and registration of complications of medicinal therapy in medical institutions of the Irkutsk region showed that that the frequency of undesirable medicinal reactions in patients made from 10 to 30 %. The standard scheme of antibacterial therapy results in resistance of pathogenetic flora. Hospital patients have great possibility of being infected with microorganisms, the so-called hospital strains (bacteria). The drug safety monitoring showed the necessity of the policing of prescribing of cardiovascular, antibacterial and antiglaucoma drugs.

After the epidemic in the middle of 1990-s, incidence of syphilis in Irkutsk region reduced from 432.4 in 1997 to 66.4 in 2013. At the same time incidence of gonorrhea reduced from 375.9 in 1993 to 75.8 in 2013 per 100,000 of population. About 10 000 cases of gonorrhea and 12 000 cases of syphilis are reported annually during the pick of the epidemic. We used cost-benefit analysis to estimate the economic efficiency of regional morbidity reduction. The costs were adjusted to 2013 year prices. Average direct and indirect costs per case were as follows: syphilis 23.2 and gonorrhea 7.1 thousand rubles. Reductions in syphilis and gonorrhea from maximum in the middle of 1990-s to 2013 have saved about 300 million rubles approximately. In 2005-3013 the costs reduction was estimated as 10 million rubles per year. This sum composed about 20 % of total subsidy from federal budget to Irkutsk region for struggle with sexually transmitted infections (STI). Per year correlation between sum of subsidy for struggle with STI and number of syphilis cases composed -0.54 and -0.55 of gonorrhea cases (p > 0.05). Social factors also were discussed among reasons of morbidity reduction. In 2005-2013 regional income and birth-rate in Irkutsk region were increasing in contrast with the middle of 1990-s.

The article describes the demographic situation, the status of neonatal, children cardiological and cardiosurgery cares in the Buryat Republic. The information gathered by main non-staff experts of appropriate specializations proves the necessity of cardiosurgical care to the children population, identifies the structure of heart defects, the volume of cardiosurgical care provided to patients with congenital heart diseases in the region and outside of the region during from 2013 to 2015, preoperative and postoperative mortality. In addition, the article represents diagnostic capabilities of one of the largest medical institutions of the Buryat Republic as a potential station for delivery of cardiosurgical care for patients with congenital anomalies of cardiovascular system and suggests ways to optimize the care of children with congenital heart disease.

The aim of our research is to study the features of complaints of joint syndrome among rural inhabitants of Mongolia aged 18 years and older. 564 people were examined at present (317 women and 247 men). The average age of the patients was 43.1 years, the average age of women - 45.6 years and men - 40.1 years. It was revealed that 55.5 % of respondents ever had pain in the knee and hip joints, 46.3 % of respondents reported about joint pain at the time of the survey. 43.4 % of respondents had arthroncus of large and small joints of arms and legs in anamnesis, 34 % of respondents informed about arthroncus at the time of the survey. Among women, 60 % of the respondents experienced pain in large joints of the legs in their lifetime, 51.4 % of women complained of pain in the knee and hip joints, continuing at this time. 48.4 % of men had pain in big joints of the legs ever in life, about 40 % of men reported joint pain while polling. About 44 % of women and men noted arthroncus of small and large joints in anamnesis, 34 % of both women and men had arthroncus at the time of the survey. Only one third of patients with joint complaints ever appealed to the doctor about that, and only 34 patients (6.2 %) were examined by a rheumatologist.

The survey involved 130 anesthesiologists in the cities of Irkutsk and Ulan-Ude with the use of the MBI questionnaire - version for health professionals in adaptation of N.E. Vodopyanova allowed to study the prevalence and severity of various components of burnout syndrome (BOS). Sings of BOS were identified in doctors of young age; they most widely manifested as intense emotional exhaustion and depersonalization. Symptoms of emotional exhaustion begin to appear from the beginning of work and reach their maximum in the age group of 36-40 years, making 28 (24-32) score. Depersonalization as one of emotional burnout syndrome manifestations had a high level of 17 (15-19) points in 93 % of doctors aged from 35 to 45years. The most significant level of personal achievements reduction was noted in the age groups from 30 to 40 years (the average level - 32 (30-36) points). The resulting research data show that the daily work activity of anaesthesiologists causes significant professional harm and involves high responsibility, greater amount of work performed, working late shifts, which manifest themselves in the formation of personality deformation and development of the "stress associated with the difficulties of maintaining a normal lifestyle".

The object of the study was the aerial part of flowered violet (Viola uniflora L.), harvested at flowering time in the Irkutsk region. The herb contains flavonoids, phenolic acids, coumarins, tannins, polysaccharides, fatty acids and amino acids, as well as macro- and microelements. During the development of methods of quantitative determination of flavonoid compounds we experimentally established optimum conditions for their extraction from vegetable raw materials: the degree of grinding - 2 mm, extractant - 70% ethyl alcohol, the ratio of raw material - extractant 1:50 total extraction duration -1 hour (twice), time complexation reaction with a 5% ethanolic solution of aluminum chloride is 30 minutes. Stability of the complex was maintained for 1.5 hours. Quantitation of flavonoid compounds in the raw material were determined by differential spectrophotometry based on rutin. The optical density of the solution was measured on a recording spectrophotometer "Lambda 35 UV/VIS" Perkin Elmer instruments (USA) at a wavelength of 409 ± 2 nm in a cell with a working thickness of 10 mm. The content of flavonoids in terms of rutin in different samples ranged from 1.66 to 2.03 %. The developed method of quantitative spectrophotometric determination of the amount of flavonoids in Viola uniflora grass validated in terms of specificity, precision (convergence), linearity, accuracy and set its range of applications. According to the results of validation techniques quantification procedure of flavonoids Viola uniflora grass it has been found that the technique is reproducible and can be used in quantitative analysis.

Tick borne encephalitis (TBE) is a dangerous neurological disease that is transmitted to humans through the bite of Ixodid ticks. The disease exhibits an estimated 16 000 cases recorded annually over 30 European and Asian countries. The agent of TBE is the tick borne encephalitis virus (TBEV), belonging to the family Flaviviridae, genus Flavivirus. In spite the significant impact of TBE on human health, there is a serious lack of specific treatment against this disease. The only specific drug available is the human anti-TBEV immunoglobulin from vaccinated blood donors. The drug is produced and used in Russia only, both to prevent and to cure the TBE. In this work, we evaluated the ability of TBEV-specific DNA-aptamers and extracts of traditional medicine plants to neutralize the TBEV Selection of aptamers was performed using SELEX approach. Extracts of the seeds of Momordica cochinchinensis and Terminalia chebula were produced by boiling the ground seeds in water, clarified by centrifugation and filtration steps and filter sterilized. The SELEX had produced two aptamers - My13 and My38. Neither of two was capable to neutralize TBEV in vitro. The ability to shield the antibody binding sites on the surface of TBEV virions was also absent. The extract of M. cochinchinensis exhibited no neutralizing activity as well. Surprisingly, the T. chebula extract completely neutralized the TBEV after 30 min of incubation at 37 °C. The possible explanations and further development of the project are discussed.

Ixodid ticks are the vectors of many pathogens including tick-borne encephalitis virus and the Lyme disease agent Borrelia burgdorferi sensu lato. In Pribaikalye, Ixodes persulcatus, Dermacentor nuttalli, D. silvarum and Haemaphysalis concinna are regarded as main vectors of the diseases. Recently, significant changes in world tick fauna have been reported and this affects the spread of tick-borne pathogens. We studied the current species diversity, population structure and the number of attacks of hard ticks (Acari:Ixodidae) on humans in Irkutsk region and nearby territories during the season 2015. Long-term trends of changes in attack rate were analyzed as well. In total, 4268 individual ticks were identified and analyzed during the season 2015. The majority (86 %) of victims was bitten by I. persulcatus; 13.55 % of attacks on humans were caused by D. nuttalli and D. silvarum; whereas H. concinna was documented only in 2 cases (~0.05 %). No non-endemic or invasive tick species were documented in 2015. The seasonal activity and the age/gender structure of tick population that bite human hosts were described as well. The comparison of the results of 2015 with previously reported datasets on tick bite ratesfrom 1992-2001 andfrom 2007-2014 indicates that, after the burst of tick bites in 1992-2001, there are no significant increase of attack rate since 2007. Possible implications to human health and epidemiology of tick-borne infections are discussed.

Aim: to reveal the Khabarovsk region territories that are under high risk of spread of dysentery in the period of large-scale flood fallout liquidation. Materials and methods. There was the analysis conducted of dysentery incidence during the period of 2003-2012 including distribution of annual and long-term annual average indicators per 100 000 inhabitants throughout administrative entities of Khabarovsk territory. We used methods that reveal tendencies and evaluated dynamic rates of dysentery epidemic process in time. Results and discussion. Khabarovsk region shows uneven levels of manifestations of epidemic process of dysentery not only during evaluation of annual incidence but also among certain administrative territories. During ten years preceding the flood in the Amur River region, long-term annual average level of incidence equaled to 42.7 ± 1.74⁰/₀₀₀₀ The epidemic process was most intense in the Nanayi region, in other six administrative regions long-term annual average levels of incidence were exceeding similar averaged levels in Khabarovsk region. An intense epidemiologic situation on dysentery in several territories of the region was associated with registration of foci of clustered incidence caused by dysentery Sonne of alimentary and water-borne origin including atypical variants of Shigella Sonne. Conclusion. A year before the flood the elevation of dysentery incidence was registered in most of the territories of Khabarovsk Kray, and there was the evidence of outlined tendency of activation of epidemic process. This served as a basis for required adequate emergency measures for prophylaxis of dysentery.

In recent years, the growth in the number of diabetic patients has been registered in the most countries. In turn, the diseases of the cardiovascular system are still the leading cause of death in many countries. Against the background of rapid growth in the incidence of diabetes mellitus, the number of patients with combined pathology including coronary heart disease and type 2 diabetes mellitus increases. Oxidation of LDL with the subsequent generation of cytokines and other biologically active molecules is considered one of the major pathogenic mechanisms of atherosclerosis. Hyperglycemia contributes to the processes of lipid peroxidation with activation of atherogenesis with increased risk of vascular lesions. The modern views on commonality of the mechanisms of the development of diabetes and coronary heart disease are studied. Attention is paid to the generation of free radicals, which being highly reactive unstable chemical compounds damage the endothelium. However, activation of free radical processes in the conditions of hyperglycemia stimulate the increased synthesis of pro-inflammatory cytokines, including necrosisfactor-a tumor, interleukins, which are a reflection of local and systemic inflammation. This review presents detailed description of the main pro-inflammatory cytokines (interleukin-1ß, interleukin-6, interleukin-8, TNF-a) and C-reactive protein. The value of insulin resistance and hyperfibrinogenemia in diabetes mellitus combined with coronary heart disease and the factors, which increase the risk for adverse outcomes of coronary heart disease, is presented in the article.

This article presents the literature data on existing methods of postoperative pain relief. The technique of extended micro-catheter postoperative analgesia is discussed, as well as advantages and disadvantages of the method. Described method of microencapsulation is used to prolong the action of drugs, in particular local anesthetics. The effectiveness of encapsulated 2% lidocaine and bupivacaine was experimentally proven. The research showed that structural components of liposomes, liposomes themselves and liposomal drugs have clear pharmacological effects, which is superior to their conventional forms. Liposomal membranes protect drugs from preterm metabolism, alter pharmacokinetics and pharmacodynamics that allow to greatly reduce the applicable doses, enhance the action and to reduce high toxicity of administered drugs. Liposomal forms of directed drug transport cross the blood-brain barrier, cell membrane and subcellular structures, which allows to recommend them for anesthesiological purposes, for treatment of cancer, infectious diseases, cardiac, neurological diseases, gene therapy, and many diseases that were previously resistant to classical pharmacotherapy. The study of epidural anesthesia with the use of liposomal bupivacaine for postoperative analgesia in cancer patients demonstrated that duration of drug action increased 2-3 times in comparison with conventional bupivacaine. There are on-going studies of liposomal drugs, filled with local anesthetics as a possible method of adequate postoperative analgesia and control of pain in the postoperative period.

Nowadays hospitals use a large number of methods of radiological diagnostics that are able not only to evaluate morphological changes of hepatobiliary zone, but also to assess functional state of the liver, and the state organ hemodynamics. Despite that, differential diagnostics of biliary tract occlusive lesions is still a challenge that requires a combination of various modern techniques. Misdiagnosis, delay in surgical treatment lead to serious complications, sometimes with fatal consequences. In this category of patients, each method of instrumental diagnostics has its advantages and disadvantages. To determine the nature of the pathological process in the majority of cases it is necessary to consistently use a wide range of diagnostic procedures. The issue of selection of optimal diagnostic algorithm for assessment of the state of hepatobiliary organs with application of new high-tech methods of radial diagnostics remains urgent. Early identification of biliary hypertension causes and the nature of the block helps to reduce the risk of serious complications, promotes the development of optimal management of patients, as well as allows to plan the type and volume of surgery.

The Buryat Republic has a diverse and rich flora which includes many valuable ornamental, medicinal and food plants. These plants include the representatives of the division of ferns (Polypodiophyta) related to one of the most ancient groups of higher plants. Ferns are used in Tibetan, Chinese and Indian medicine, as well as by the inhabitant of the Caucasus, Eastern Himalayas, North America and others. On the territory of the Buryat Republic 25 species of medicinal ferns are identified. The data on the medicinal ferns of the Buryat Republic and their biological activity is systematized in this review. The results of experimental studies of various dosage forms and the extracts from the individual components isolated from different parts of the ferns (roots and rhizomes, fronds, stalks, gametophytes, disputes) are presented in detail. The generalization of literature data shows that rather small number of medicinal ferns of the Buryat Republic has broad spectrum of biological activity.

Non-organ retroperitoneal liposarcoma is the most frequent initial malignant tumor in retroperitoneal space and it comprises 40 % of all non-organ retroperitoneal tumors. Difficulty of early diagnostics and complex antitumor treatment of patients with non-organ retroperitoneal tumors is one of the most actual and complicated issues in oncosurgery. Nonorgan retroperitoneal liposarcoma is a problematic issue because of complicated topographic and anatomic position, adjacency to retroperitoneal organs and great vessels and frequent loco-regional recurring. The most effective treatment mode of non-organ retroperitoneal tumors is surgical. Traumatic multivisceral resections are needed in 50 % of observations, including nephrectomy in 35-39 % of cases. Morphological invasion of the tumor into organs is confirmed in 35.7 % of cases. According to the most observations (70 %), there are no signs of invasion into kidney. Today, the treatment of tumors is being reconsidered. Nowadays, the enhancement of professional knowledge and technological advancement provides an opportunity to implement kidney-preserving surgeries, which improve life quality of the patients. In our opinion, using renal autotransplantation is very promising. It is widely used in pathology, in non-urgent and urgent urology, oncourology, vascular surgery. Our clinical case has demonstrated the technique of extracorporal resection of giant liposarcoma from involved kidney. Further steps include temporary kidney conservation, precise dissection from tumor and replantation of iliac vessel under emergency morphological control. Follow-up period is 18 months. According to the instrumental examination, no indices of backset and of tumor growth were revealed and the kidney's integrity was saved.

The aim of the article is to demonstrate the possibilities of minimally invasive surgery in the treatment of spontaneous rupture of the esophagus (Boerhaave syndrome). Within the last 10 years endoscopic treatment has changed the approach to the esophageal rupture treatment. Implantation of fully-covered self-expanding metal or plastic stents is the most extensively studied endoscopic method, and it has proven to be effective in 67-100 % of cases. The successful closure of esophageal rupture by endoscopic placement of a vacuum sponge (endoscopic vacuum assisted closure (E-VAC)) has recently been reported. Vacuum-assisted closure (VAC) is an established treatment modality for extensive cutaneous infected wounds. This principle has been adapted to the treatment of endoscopically accessible upper gastrointestinal leakages by endoscopic placing of sponges connected with a drainage tube in the necrotic cavities (E-VAC).