The results of surgical treatment of 470 patients with acute pancreatitis of severe severity were studied. Out of 314 patients with infected pancreatonecrosis, 224 had retroperitoneal phlegmon and 90 - parapancreal abscesses. In this group of patients, early surgical treatment was used in the first 3-5 days from the time of admission. In all cases in the process of laparotomy open necrectomy and drainage were performed. In 156 patients of the second group, a savings technology was used for 4-8 weeks, aimed at distinguishing the purulent-necrotic process. Of these, 98 had local intra-arterial rheological therapy, 46 had early video laparoscopic drainage, and 12 had decompression retroperitoneal drainage. As soon as the delimitation (formation of the fluid cluster, parapancreatic cyst, abscess) was achieved, in 4-6 weeks in this group, minimally invasive transabdominal or transgastral drainage was performed and only open operations "on demand" were carried out with the progression of the purulent-necrotic process. The results of the treatment showed high mortality in the early extended operations in the first group of patients. With retroperitoneal phlegmon it reached 55.4 %. Savings tactics aimed at limiting the process in the retroperitoneal tissue and subsequent minimally invasive drainage, was characterized by a lower mortality - 31 (19.9 %) patient. Early video laparoscopic drainage of the abdominal cavity and retroperitoneal space (mortality - 10.9 %) and local rheological drug therapy (mortality - 21.4 %) were the most effective among the minimally invasive technologies of surgical treatment of pancreonecrosis, which facilitated the accelerated formation of the delimitation of the inflammatory process in the pancreas and retroperitoneal space.

The aim of the study was to investigate the frequency and nature of extraesophageal symptoms in patients with gastroesophageal reflux disease. 122 patients with GERD without comorbidity have been examined (58 males, 64 females). The anthropometrical survey has been performed; estimated age, duration of the disease and smoking have been taken into account. Extraesophageal symptoms were diagnosed with the rabeprazole test, the frequency and intensity of the symptoms were evaluated using a Likert scale. All patients underwent endoscopic examination and the assessment of quality of life by means of the SF-36 questionnaire. Extraesophageal symptoms of GERD were diagnosed in 38 (31.1 %) patients, reflux laryngitis - in 14 (9.8 %) patients, reflux-pharyngitis - in 7 (4.1 %) patients, reflux cough - in 11 (7.3 %) patients, heart pain - in 6 (3.2 %) patients. In patients with extraesophageal manifestations compared with the patients having only physical symptoms, body mass index and the severity of heartburn on the Likert scale were significantly higher. Other indicators, such as disease duration, smoking, presence of erosive changes in the mucous membrane of the esophagus, hernia hiatal didn't statistically reveal any difference between the groups. When comparing the quality of life it has been revealed that the indicators of physical health had no statistical difference in the two groups, when mental health indices were lower in those with extraesophageal symptoms of GERD.

Cardiac tumors are extremely rare pathologies with polymorphic clinical presentation, mainly founded in autopsy, and accidentally in cardiac surgery. Primary tumors of the heart are detected in 0.002-0.05 cases of autopsies, and 75 % of the tumors are the benign ones. Cardiac myxoma is the most frequent tumor of the heart. It can be localized in any chamber, but more often occurs in the left atrium. A pedunculated myxomas prolapse into mitral orifice, obstructing outflow from left atrium and inflow to left ventricle in diastole. Microscopically myxomas can have slimy, rigid, lobed or loose structure. Myxomas with loose consistency are most dangerous in occurrence of systemic embolism. Also, tumors can locate in ventricle or in several heart chambers. Most of tumors has a peduncle, a fibrous-vascular stalk from 4 to 8 cm in diameter. In 93 % cases myxomas are the single chamber tumors, but they can be biatrial, and grow in several chambers of the heart, thus, are the multiple primary tumors. The symptoms are of widely varied character and depend on the size and localization of the tumor. Now, because of advances in diagnostic, the frequency of myxoma detection is annually increasing, counting from 0.5 to 2.3 cases per 1 million people. The group of 70 patients aged from 19 to 77 with morphologically confirmed myxomas was analyzed. Surgical intervention is the only way to treat myxoma. The case described in the article presents a large myxoma, almost completely filling left atrium with mitral orifice occlusion. Routine echocardiography facilitated a timely diagnosis, and required treatment was performed.

Epidural fibrosis is formed around the dural sac and the neurovascular structures of the vertebral canal in the postoperative period. It is one of the common causes of Failed Back Surgery Syndrome (FBSS) syndrome. It occurs in 100 % with repeated surgical interventions, in connection with which the operational technique of working with the dural sac and on neurovascular structures of the vertebral canal becomes more complicated and sometimes leads to their damage. Despite the development of modern technologies, in medicine, there are no specific and sensitive methods for diagnosing epidural fibrosis, which would help to establish the correct diagnosis in 100 % of cases. The review summarizes and systematizes domestic and foreign literature data on etiology, pathogenesis and pathophysiology of cicatricial and epidural adhesion. The analysis includes 22 sources of Russian literature and 28 sources of foreign literature.

Manifestations of cervical osteochondrosis are largely predetermined by degenerative changes in the most mobile lower cervical spine (C_V-C_VI, C_VI-C_VII). Clinical picture of cervical osteochondrosis depends not so much on the presence of hernial protrusions as on the changes in bone structures with the formation of arthrosis with pain syndrome. In this regard, we found interesting to study relation of electroneuromyographic parameters and bone mineral density in patients with cervical osteochondrosis. A survey of 38 patients with cervical osteochondrosis localized predominantly in the segments C_III-C_IV, C_IV-C_V, C_V-C_VI C_VI-C_VII there were 20 men and 18 women. Subjective and objective examinations showed pronounced muscular-tonic syndrome (with cervicalgia, cervicocranygia, cervicobrachialgia) in all patients. We studied threshold values, M-response amplitude, nerve conduction in motor fibers of the axillary, radial, medial and ulnar nerves, as well as amplitude and frequency indices characterizing the functional state of the deltoid and trapezius muscles. When studying the state of bone tissue, we measured the speed of sound velocity (SV, m/sec) in the radial bones, determined the T-index - the number of standard deviations from mean for healthy young people, and the Z-index - the number of standard deviationsfrom mean for the age group. Comparative analysis of the results of studies by electroneuromyography and osteodensitometry in patients with cervical osteochondrosis of I-II periods, in the presence of neurotrophic disorders have not revealed changes in bone density. At the same time, in patients with cervical osteochondrosis of the III period in the presence of both protrusions and hernias of C_VI-C_VII C_VII-C_VIII discs, a reduction in threshold values of direct muscle response, an increase in the amplitude of evoked potentials, and a shortening of the latent period were recorded in the ENMG. Mineral density in patients with this pathology differed from the norm, indicating the presence of osteopenia.

1n 2015-2016 in Scientific-Clinical Department of Neurosurgery of 1rkutsk Scientific Center of Surgery and Traumatology, 22 patients (11 men and 11 women) were examined for osteochondrosis of the cervical spine and neck and upper extremity pain syndrome. Patients underwent clinical and neurological examination, radial methods of investigation (cervical survey radiography in the direct and lateral projections), functional tests (flexion and extension) and functional tests with weights, MSCT and MR1 of the cervical spine, radiographs of large joints of the upper extremities in two projections, stimulation electroneuromyography and osteodensitometry. The article presents the general clinical characteristics of the data of 22 patients with degenerative-dystrophic pathology of cervical spine and shoulder joint syndrome, and a moderate and severe neck and upper extremity pain syndrome. 1n the evaluation of clinical and neurological symptoms, unilateral cervicobrahialgia syndrome was detected in 19 (86 %) patients, cervicobrachialgia syndrome was noted on both sides in 3 patients, the syndrome of cervicocranialgia was noted in 4 patients. All radiographs showed deforming osteoarthritis of the clavicular-acromial joint (11 persons), shoulder (10 persons), elbow joint (4 persons). MR1 revealed a multilevel pathology of intervertebral discs. According to ENMG, there was a disturbance of the functional state of the peripheral nerves of the upper limbs, which manifested itself on both sides. The state of bone tissue of the limb with the pain syndrome was not significantly different from that of the healthy limb, and generally corresponded to the norm. Thus, the materials presented in the article represent the initial data of the examination of patients with the neck and upper extremity pain syndrome in the department of neurosurgery according to the algorithm developed in 1rkutsk Scientific Center of Surgery and Traumatology.

A number of tasks were set: how to develop a morphometric method for diagnosing stenosing processes that would allow us to specify the localization of the pathological process, its volume and extent; to develop a classification of stenosing processes depending on the stenosis coefficient Z_n; to develop a new method of latent instability of the vertebral-lumbar segment of the lumbar spine; to study the nature of multilevel lesions of intervertebral discs in osteochondrosis leading to stenosing processes of the spinal canal. Improvement of diagnostic methods in stenosing processes allowed the authors to develop new ways of diagnostics and surgical treatment of this pathology and to offer new medical technologies for practical health care. All of the above is the basis for the development of an algorithm for the surgical treatment of stenosing processes of the spinal canal and dural sac, which is the subject of this work. 416 patients underwent various surgical procedures depending on the severity of clinical and neurological disorders, the stenosis coefficient, the instability in the vertebral-motor segments, the magnitude of the extensional-flexion amplitude, the nature of the pathological process and the degree of its compensation. Of 416 patients, 179 patients underwent decompressive-stabilizing intervention with the installation of a dynamic system using a mini-invasive approach with a minimally invasive reconstruction of the spinal canal. Decompression-stabilizing intervention with rigid interspinous fixation, minimally invasive access to the vertebral canal with its minimally invasive reconstruction was performed in 96 patients. 141 patients underwent decompressive-stabilizing intervention with transpedicularfixation, with extended minimally invasive reconstruction of the spinal canal with its minimally invasive approach.

The article presents the analysis of diagnosis and treatment of 67 patients with gastrointestinal stromal tumors. The mostfrequent location was the stomach, the esophagus took the second place. Among the complications, gastrointestinal bleeding is leading, taking place in half of all cases. The tumor (GIST) develops from the interstitial cells of Cajal and is potentially malignant, the signs of which are established. The incidence of 1 million population is 10-20 cases. The expression of the proto-oncogene c-kit in GIST is detected by an immunohistochemical reaction with the CD117 marker. An erroneous diagnosis in a number of cases was a pseudocyst of the pancreas, found in a CT scan. Tumors bigger than 2 cm in diameter are subject to surgical treatment, smaller ones are recommended for dynamic observation. Organ-preservation operations without lymphodissection are considered acceptable in the course of surgical treatment. Target therapy with tyrosine kinase inhibitors (imatinib, sunitinib, etc.) is used. Two people received chemotherapy in the postoperative period. Histological examination of tumors in most cases detected spindle cell and epithelioid cell variants, in some cases there was a mixed version. GISTs remain the mostfrequent mesenchymal malignant neoplasms of the esophagus, stomach, small intestine, colon and rectum. The article demonstrates variants of GIST in 4 patients with localization of the process in the upper gastrointestinal tract, treatment options, when the final diagnosis was established during surgery with histological and histochemical studies.

The operation of total endoprosthesis replacement of large joints is associated with several anesthetic problems. Solving these problems ensures the safety of these highly traumatic operations and requires the solution of the following anesthetic tasks in the perioperative period: high degree of antinociceptive protection of patients with effective relaxation of the surgical intervention area; prevention of fatty hyperglobulinemia; decrease in the volume of perioperative hemorrhage and prophylaxis of thrombogenic complications. We developed our own program of anesthetic maintenance at major joints replacement. The components of the program are: the type of anesthesia - spinal anesthesia preservation of spontaneous respiration; our method of fat globulinemia prevention, based on maintaining the functional stability of the hepatocyte; our own method of replacement of peri-operative blood loss, based on the additional principle of "normalization of the oncotic blood pressure". Before the operation, patients receive a solution of tranexamic acid at a dose of 10 mg/kg of body mass to inhibit proteolysis (blood preservation technology). This method provides a "dry" operating field, reducing intraoperative hemorrhage. In the early postoperative period (5 hours after the surgery), under the control of whole blood clotting time, patients receive low molecular weight heparin Clexane at a therapeutic dosage of 1 mg/kg of body weight. This provides effective prevention of thrombogenic complications. The application of the developed technique shows its high clinical effectiveness. Over the past 5 years, 5,800 operations for large joint prosthetics have been performed, including 3,200 total hip replacement operations, 2,600 total knee replacement operations. There were no complications with a fatal outcome, in 5 cases fatty hyperglobulinemia was noted, which was stopped by the own method of treatment. There are no thrombogenic complications.

The first description of surgical treatment of anterior cruciate ligament injuries has become known about a hundred years ago. At the beginning, complete ruptures of the anterior cruciate ligament was treated by open restoration with arthrotomy. At present, open ACL plasty is practically out of use, except for single cases. In recent decades, worldwide, surgical treatment of knee ligament injuries has been performed with arthroscopic techniques. It has long been proven that arthroscopic operations are able to restore the primary anatomy of the damaged joint, combining anatomical validity and minimal traumaticity, pathogenetic justification and high functional efficiency. For more than 50 years, surgeons have been offered many different materials and methods for ACL reconstruction, but nevertheless there is currently no consensus on the choice of rational treatment tactics and the percentage of unsatisfactory results remains significant. Based on the data of modern authors, it can be concluded that the issue of knee joint ligaments damage not only does not lose its relevance, but, on the contrary, due to the increased interest in active lifestyle, it becomes more and more popular and studied. The article presents various views on the basic methods of arthroscopic restoration of the anterior cruciate ligament of the knee joint at the present stage of the development of surgery.

Treatment of valgus deformity of the first toe is today one of the intensively developing areas of modern orthopedics. The complexity of treatment of this pathology is predetermined, first of all, by its multicomponent nature. Forefoot deformities are often the main cause of a decreased quality of life, which makes the patient irritable, inactive, and also makes it impossible to use standard footwear, and sometimes even orthopedic one. The purpose of our study was the analysis of scientific literature devoted to the problems of diagnosis and surgical treatment of valgus deviation of the 1st toe (hallux valgus). The materials of the study were domestic and foreign articles, reviews and monographs on the surgical treatment of hallux valgus, with mandatory analysis of long-term treatment outcomes. The history of the development of treatment of this pathology is presented with the analysis of surgical treatment methods aimed at different links of pathogenesis, as well as complications arising from the use of different techniques. The article presents modern trends in development and ways to improve the methods of surgical treatment of valgus deviation of the first toe. The analysis of the literature data showed significant success in the surgical treatment of valgus deviation of the first toe. However the current percentage of relapses may be due to the lack of an accurate method for determining proximal articular set angle (PASA) in the preoperative period, as well as the lack of the hallux valgus treatment able to eliminate valgus deviation of the first toe and avoid recurrence of the disease due to a more accurate correction of PASA.

The research covered 83 patients with chronic osteomyelitis, 55 patients underwent the original operation of single stage sequestrectomy and grafting the residual bone cavity with fine-grain titanium nickelide. This method of treatment has demonstrated its effectiveness in the early rehabilitation period, as well as in the observation in a remote period of time. Clinical effects were characterized by the absence of relapses of chronic osteomyelitis in 94.6 % of patients during the follow-up period. The simulating effect of titanium nickelide in the formation of trabecular bone tissue was experimentally based on 20 animals (dogs). Thus, clinic-experimental research showed that porous titanium nickelide is a perspective material and can be used for different skeletal pathologies. Using it as bone cavity filling in the experiment resulted in an accelerated (3 months earlier) formation of bone organotypic regenerate. The use of bio-compatible fine-grain titanium nickelide contributes into rapid and efficient completion of inflammation process in bone tissue, simplifies the methodology, reduces the time of operation and the time of rehabilitation period and, as a result, increases the efficiency of treating patients with chronic osteomyelitis.

Abdominal tuberculosis is a rare form of the disease. The number of tubercular cases has been increasing everywhere since the mid-1980s, which has led to a general increase in the number of patients with abdominal tuberculosis. The Irkutsk region is one of the most disadvantaged regions of Russia in the incidence of tuberculosis and HIV infection. A retrospective analysis of 165 cases of abdominal tuberculosis was conducted. Among patients with abdominal tuberculosis 95.0 % of patients were 30-35 years old, 132 (80.0 %) patients used drugs, 80 % patients had HIV-infection and 79 (47.9 %) patients had hepatitis В. Overwhelming majority had an antisocial lifestyle. The leading manifestation of the disease was abdominal pain syndrome, which was noted in 88.3 %. Nausea and vomiting, hypotension and tachycardia were detected in 49 (29.7 %), 90 (54.5 %) and 118 (71.5 %) persons respectively. Perforations of tubercular gastrointestinal ulcers (75; 53.7 %) were the mostfrequent complications of abdominal tuberculosis. Gastrointestinal bleedings, tubercular mesenterial lymphadenopathy, tubercular lesions of the spleen, liver, and peritoneum were detected in 4 (2.8 %), 16 (11.4 %), 14 (14.0 %), 9 (6.4 %), 22 (15.7 %) patients respectively. The sings of peritonitis were the main indication to surgery. 140 (84.5 %) patients were operated. The total mortality made 57.6 %. Acute surgical pathology of abdominal cavity in tubercular and HIV-infected patients should arouse suspicion about presence abdominal tuberculosis. Unsuccessful outcomes of disease are caused by a combination tubercular process and HIV-infection.

Background. Acute pancreatitis is an important and unsolved problem of surgery. The most important subject of discussions in the treatment of acute pancreatitis is the choice of the timing of surgical intervention. Aim. To develop clinical and diagnostic criteria for early surgical interventions in patients with severe acute pancreatitis. Materials and methods. The study consisted of two stages: a retrospective study, including an analysis of the treatment of 20 patients, operated in early terms for 2-4 days and a prospective study, including analysis of human serum samples by HPLC method. Results. We determined that intra-abdominal pressure, indicators of APACHE 11 and B1SAP scores and CRP level correlate and their peak values are indicative for early surgical intervention. Using the HPLC method we isolated the group of 13 pathological and a group of 7 normal metabolites, characteristic of severe acute pancreatitis. These are specific markers of severe acute pancreatitis. Conclusions. Early surgical intervention with persistent and progressive 1AH significantly reduces the scores of the integral scales, the level of CRP which reflects the regression of MOF phenomena and reduces the risk of adverse outcome. Using the HPLC method we showed a principal possibility of predicting severe course of pancreatitis in early periods.

Background. The problem of early diagnosis of acute mesenteric ischemia is still relevant today. In this connection, it is of interest to search for a diagnostic marker of this pathological condition. Up to 80 % of all immunocompetent cells are localized in the intestinal mucosa. So, we can assume that the mesenteric channel occlusion can result in changes in the subpopulation structure of lymphocytes. The aim of the study is to analyse some parameters of the subpopulation structure of lymphocytes at various stages of acute mesenteric ischemia in the experiment. Materials and methods. The experiment was performed on 32 adult male rats - with an average mass of 200 g. The animals were divided into 4 equal groups. The first group was a control group. All other animals underwent laparotomy, blood sampling from the posterior vena cava, ligation of the mesenteric artery at the base of the mesentery root, suturing the wound. After 3, 6 and 8 hours, blood sampling, small bowel biopsy were performed in the second, third and fourth groups. The subpopulation structure of lymphocytes was assessed by direct immunofluorescence staining. Morphological material was stained with hematoxylin-eosin. Results. The complete occlusion of the cranial mesenteric artery was revealed to be accompanied by a decrease in the lymphocytes level, an increase in CD4/CD8 ratio. Conclusion. The data obtained were to develop a diagnostic method for acute mesenteric ischemia (Patent N 2552338, Russian Federation).

A retrospective analysis of 154 case histories of patients with adhesive disease of the abdominal cavity complicated by intestinal obstruction was carried out. The following data were taken into account in the analysis: age, sex, history of operations, availability of hospitalizations and operations for adhesions, their number, methods of treatment, intraoperative evaluation of the adhesion process, the outcome of the hospitalization. For an objective assessment of the severity of the adhesive process, we developed a scale for assessing the degree of adhesive process in the abdominal cavity, which takes into account not only the number and location of adhesions in the abdominal cavity, but also the structure of adhesions, the presence or absence of vascularization, and the presence of deformation of the intestinal tube. The degree of adhesion in the operated patients made 13 points, which corresponds to the pronounced adhesion of the abdominal cavity organs. Mortality rate was 10 %. In patients died from complications, the degree of adhesive process made 14 points. The first signs of adhesion of the abdominal organs appeared 3 years after the operation. And the number of operations for acute intestinal obstruction to the recurrence was 0.27. Spearman's correlation analysis revealed an average significant correspondence between the degree of adhesion and the outcome of treatment. A reliable correspondence between the likelihood of postoperative complications and the severity of the adhesion process was also revealed. A pronounced adhesion process in the abdominal cavity suggests a significant likelihood of repeated operations for adhesions. Thus, the proposed scale is an objective method for evaluating the adhesion process in the abdominal cavity and makes it possible to assume the probability of postoperative complications and relapse of adhesive intestinal obstruction.

Recently gastroesophageal reflux disease (GERD) was associated only with reflux-esophagitis and appeared to be a harmless disease with the most frequently noted symptom - heartburn. However, prolonged gastroesophageal reflux often provokes attacks of bronchial asthma, ischemic heart disease, is the cause of severe caries, repeated pneumonia and even cancer of the larynx. Terrible complications of GERD are ulcers of the esophagus with blood loss of various degrees, as well as stricture of the esophagus. It is with the widespread prevalence of GERD and its complications (in particular, Barrett's esophagus) that some authors associate an increase in the incidence of adenocarcinoma of the distal esophagus (up to 50 %) among all cases of esophageal cancer. In addition, according to some authors, GERD contributes to the occurrence of laryngeal cancer. Previously, GERD was understood as peptic or terminal esophagitis, but it is known that in more than 50 % of patients with reflux symptoms there is no visible lesion of the esophageal mucosa. It was found that with duodeno-gastral reflux, against a background of decreased acid formation in combination with anthropyloroduodenal dyskinesia, the alkaline contents of the duodenum affect the mucosa of the esophagus. Inflammatory-destructive changes in the mucous membrane of the esophagus may be more pronounced than caused by acid aggression. An important clinical fact is their resistance to conventional therapy. Part of patients with GERD have expressed motor disorders of the esophagus. Obviously, the existing motor disorders lead to the development of GERD, and subsequently, as a result of the direct effect of the inflammatory process on the nerve plexuses in the wall of the esophagus, motor dysfunction is aggravated.

A brief overview of the problem of the penis amputation, the consequences and possible methods for their resolution is presented. The article describes epidemiological situation and the main causes of the penis amputation. The modern existing ways of surgical treatment are illuminated, depending on the cause of amputation. Variants of phalloplasty are described. A rare clinical case of a patient undergoing amputation of the penis and adjuvant chemoradiotherapy for penile cancer in the third stage is presented. Subsequently, the patient underwent obliteration of the urethraperineostomy, as a result of which a cystostomy was performed. The patient complained of the impossibility of independent urination, a decrease in the quality of life. The presence of the crotch stoma did not suit the patient, he asked to restore the ability to upstanding urination. To eliminate these problems, fulfill the requirements, we reconstructed the patient's preserved and the formed the artificial part of the urethra. In the postoperative period, a complication occurred - urethral fistulas, which required a repeated corrective operation. Described are remote, yearly and biennial results with the presentation of objective methods of control - urethrograms and uroflowmetry. Conclusions are given on the presented material, it was suggested to use this technique in certain groups of patients, to re-evaluate after accumulating a significant experience of such interventions.

Aim of the study: the use of the valvular bronchial blocking technique in the treatment of bronchopleural fistulas in patients with thoracic pathology. Material and methods. During the period from 2012 to 2017, the valvular bronchial blocking technique was used in the treatment of 76 patients with bronchopleural fistulae (men 68, women 8). The age of patients is 16 to 82 years. In 24 patients, the indication for bronchial blocking was complications of thoracoscopic operations with bullous pulmonary emphysema. In a smaller number of cases (21), pneumothorax occurred in patients with COPD. Purulent diseases of the lungs and pleura caused a blockage in 24 patients. Results. Medlung blockers were used to treat patients. The blocker was placed in the "targeted" bronchus under local anesthesia while performing fibroblochoscopy. In all cases, the blocker was established. Reduction or cessation of air leakage through drainage from the pleural cavity occurred within a period of 5 hours to 1.5 days. In patients with poorly positive dynamics, correction of the blocker standing and additional blocking were performed, which resulted in good outcomes in 4 patients. A positive result was obtained in more than 85 % of patients. In 10 cases, no effect was obtained, which required surgical intervention. The duration of the blocker in the bronchus was from 4 days to 4 months. When removing the blocker, there were no complications. Conclusion. The technique of valvular bronchial blocking allowed to improve the results of treatment of patients with thoracic profile with various diseases complicated by the appearance of bronchopleural fistula, including complications of the postoperative period.

Background. Autovein is considered as the best prosthesis in the infrainguinal bypass surgery. However, in 30 % of individuals great saphenous vein is inappropriate for grafting because it is too small or due to phlebitis, varicosity and prior surgery. From this point of view, decellularized vascular grafts, which retain most of the properties of living tissues, seem quite interesting. Due to the high frequency of development of prosthetic aneurysm in the postoperative period xenografts does not gain high popularity. This complication occurs in an average of 6 % of cases, but modern technological advances in manufacture of xenografts have reduced the percentage of aneurysms to 4.1 %, which is still high. To solve this problem, we decided to use external support of nitinol mesh. Aim: assessment of efficiency of bioprosthesis with external support by knitted nitinol mesh as a conduit in infrainguinal bypass surgery. Materials and methods. It was a single-center randomized controlled trial in two groups, 36 patients in each group. There were no statistically significant differences between the groups. Patients of the control group underwent a standard femoropopliteal bypass surgery. In experimental group we used bioprosthesis with external support by knitted nitinol mesh. Results. Aneurysms development was observed in 6 patients (16.67 %) of the control group (4 patients - anastomotic aneurysms; 2 patients - true shunt aneurysms). There were no aneurysms in the experimental group (p < 0.05). Conclusion. The use of a nitinol-based mesh effectively prevents the development of an aneurysm of the xenograft in the postoperative period.

Background. In our country some aspects of thyroid and parathyroid surgery are still discussed. Aim. To present our experience in surgical treatment of benign diseases of the thyroid and parathyroid glands. Materials and methods. A retrospective analysis of the results of surgical treatment of 1511 patients with thyroid and parathyroid disease was performed. Results. Thyroidectomy was performed in 73.6 % of cases with thyroid diseases. The frequency of postoperative complications: laryngeal paresis - 1.37 %, hypoparathyroidism - 0.84 %, hemorrhagic complications - 1.2 %. Selective parathyroidectomy was performed in 99 % of cases with primary hyperparathyroidism. Persistent hypoparathyroidism and laryngeal paresis have not been identified. Total parathyroidectomy with central neck dissection, upper mediastinum and upper horn of the thymus gland was performed in 66.3 % of cases with secondary hyperparathyroidism. Persistent laryngeal paresis was established in 3.3 % of cases, hemorrhagic complications - in 3.3 %. Conclusions. Constant analysis of our own results gives us reasons for our own attitude to the controversial issues of thyroid and parathyroid surgery. Presently, we prefer thyroidectomy in the treatment of diffuse toxic goiter and multinodular goiter, hemithyroidectomy - for the single-node goiter. In the surgical treatment of primary and uremic hyperparathyroidism, we consider mandatory the use of intraoperative monitoring of intact parathyroid hormone. When performing total parathyroidectomy, we perform the autotransplantation of the fragment of the parathyroid gland.

The choice of an optimum method of surgical treatment in case of esophageal achalasia of III-IV stage is still a pressing problem. Geller's operation, balloon dilatation and other minimally invasive methods do not allow to achieve the desired effect of smoothing dysphagia. On the other hand, a number of surgeons in case of III-IV stage consider esophageal resection to be more preferable. Due to the attempt to find an optimum method of conservation of the esophagus in case of esophageal achalasia a laparoscopic esophagocardiofundoplasty operation with partial Hill fundoplication was developed. The aim of the research is to assess the long term results of the operation in terms of the quality of life and effectiveness of treatment. The cases of 51 patients suffering from esophageal achalasia of III-IV stage during the period from 2002 to 2016 were included in the research and these cases received special methods developed by the author. The quality of life was assessed with the help of specific questionnaires GERD-HRQL, GIQLI, the dynamics of changes in the weight of the body and the Eckardt scale of indicating the effectiveness of treatment. The results of the research show decrease of indicators on the Eckardt scale from 9.2 ± 0.5 to 1.9 ± 0.2 points, the GERD questionnaire from 17.3 ± 0.8 to 5.9 ± 0.7 points and increase of indicators according to the GIQLI questionnaire from 92.3 ± 1.2 to 122.9 ± 1.5 points and increase in the weight of the body from 22.9 ± 0.6 to 24.7 ± 0.6 kg.

The article analyzes the surgical treatment of 78 patients with deep neck total necrotic phlegmon. It was revealed that in 95 % of cases in the early period are complicated by descending mediastinitis. The pre-examination stage included: X-ray of the neck by Zemtsov and chest X-ray, ultrasound examination of pleural cavities, thoracic and mediastinal MSCT The surgical stage included opening and draining of the abscess, revision of the deep cellular spaces of the neck and upper mediastinum. In 65 (83.3 %) case thoracomediastinoscopy and decompressive mediastinotomy were performed. In 58 patients, "programmed" bilateral thoracoscopic sanations were performed, with drainage of the mediastinum. Anaerobic microflora made 84.6 % of the infection. The total necrotic phlegmon of the deep cell spaces of the neck in 95 % is complicated by descending necrotizing mediastinitis. Local signs of inflammation, with necrotic phlegmons of the neck, do not allow to determine involvement in the inflammatory-destructive process of mediastinum. The absence of early findings from radiological exam does not exclude the presence of descending necrotizing mediastinitis. Autopsy and revision of the deep cellular spaces of the neck in 87.8 % does not eliminate the spread of the necrotic process along the mediastinal fiber. Active surgical tactics in the total phlegmon of the deep cellular spaces of the neck is justified and allows us to recommend one-stage drainage on the neck and thoracic-mediastinal sanation.

Results of 163 thoracoscopic examinations for thoracic trauma are presented. In all cases, the the cause of the injury was stabbing. Among the patients, there were 147 men (90.2 %) and 17 women (9.8 %). Thoracoscopy was performed under local anesthesia or endotracheal anesthesia (predominantly), in a semi-lateral position on the healthy side with a reliable fixation of the patient, which is necessary, since it sometimes there is need to change the position of the table. The first thoracoport was usually introduced into the 5th intercostal space. After the revision of the pleural cavity, according to the indications, places of additional punctures and the introduction of appropriate instruments were determined. For evacuation of blood from the pleural cavity an electric pump was used. For hemostasis, electrocoagulation was commonly applied, and in a number of cases we used the haemostatic sponge. To stop bleeding from the lung tissue, as well as for aerostasis, the Roeder loop was used. After thoracoscopy, the question of further tactics was resolved. With ineffective thoracoscopy, thoracotomy was required. In case of successful thoracoscopy, the operation was finished with draining the pleural cavity through the most adequately located punctures. Thoracoscopy is an effective method of determining further tactics in this pathology. With a trauma in the "danger zone", 41 of 62 patients managed to avoid conversion. In many cases thoracoscopy allows to perform hemostasis, aerostasis and other curative measures. It also can reduce the amount of thoracotomy by 2-2.5 times

Diagnosis and treatment of patients with obstructive jaundice syndrome is one of the actual problems of abdominal surgery. The aim of our study was to determine criteria for the development of adverse outcomes in patients with obstructive jaundice, according to CT perfusion. We have analyzed the results of perfusion CT of 47 patients with mechanical jaundice syndrome. All patients were divided into two groups according to severity of the process. The first group (mild) included 29 patients with jaundice duration up to 7 days and the level of total bilirubin up to 150.0 mmol/L. The second group (moderate) included 18 patients with a duration of the disease of more than 7 days and the level of bilirubin more 150.0 mmol/L. Analysis of perfusion CT results showed that in the group of patients with mild jaundice, significant changes in arterial and portal hemodynamics do not occur. In patients in the second group, we revealed expressed reduction of portal hemodynamics up to 50.0 % (p < 0.003). ALP and HPI were increased twofold (p < 0.01). Despite increased arterial fraction, TLP reduced to 25.5 % (p < 0.05). When analyzing the postoperative complications, we observed the development of adverse outcomes only in patients with moderate degree of the pathology. When assessing the perfusion of the liver in patients with adverse outcomes compared with the control group there is a more pronounced decrease in PVP to 68.0% and TLP - up to 40.0% (p < 0.05).

This article shows many years of surgical experience of treatment of unformed duodenal and high jejunal fistulas using specific combined methods in main treatment group. The review covers the period from 2000 to 2016 years, which includes treatment of 132 patients who suffered from unformed duodenal and high jejunal fistulas. The research was conducted on the basis of the Republic Clinical hospital of G.G. Kuvatov in Bashkortostan. We followed the purpose of analysis and evaluation of the structure and quantity of early postoperative complications, including purulent-septic complications, as well as postoperative lethality, by comparing the main and control groups of treated patients, who received different kinds of therapy of unformed duodenal and jejunal fistulas. The treatment complex (main treatment group) consists of local use of collagen to strengthen intestinal sutures; selective injections of angioprotectors to blood vessels to improve microcirculation and trophic tissues; laser and antibiotic therapy for better eradication of microorganisms. The obtained results showed that the technique developed by us allowed to reduce the frequency of inconsistency of intestinal sutures, the number of newly formed intestinal fistula and purulent-septic complications in the treatment of patients with unformed duodenal and high jejunal fistulas.

The article contains the results of the first clinical experience of application of original method of surgical treatment of stomach cancer by performing a gastrectomy and formation of artificial jejunum reservoir. The relevance of the study consists in the imposition of a submerged organ of the esophageal-jejunal anastomosis hanging down the lumen of the organ, anastomosing the stump of the pancreas with the jejunum by "end-to-side" type, with a mucosal mucosa seam with a sleeve-shaped anastomosis peritoneisation and a lean jejunum loop at the level of the choledochus stump - creating anti-reflux "end-to-side" choledochojejunoanastomosis, followed by the formation of Braun anastomosis with 20 cm reservoir, by Hoffman's stomach type, performing a function of the removed stomach. The method proposed by the authors of the present study is based on more than 15years of practice in the use of refluxing anastomoses in trans-abdominal surgery and 70-year-old practice of applying diaphragm crurotomy by A.G. Savinykh, as the only method of access to the esophagus. The treatment results were assessed using X-ray contrast techniques, endoscopic and ultrasound equipment, as well as traditional laboratory, radiographic and clinical tests. The results of treatment of 6 patients in terms from 6 months to 5years were estimated. Successful outcome of the surgery was achieved in all cases. The effectiveness of the intervention is confirmed throughout the range of clinical and instrumental criteria used. The authors conclude that the method shows a good clinical perspective.

With the use of vacuum therapy in the treatment of purulent wounds, it is not possible to actively localize the microflora in the wound, since the last is for a long time covered by an insulating sealed bandage. In addition, unlike with traditional methods of treating wounds with daily dressings, there is no effect of "washing away" detritus, necrotic masses, accumulations of leukocytes. The aim of the work was to develop a technique for vacuum-instillation therapy of wounds using dimexidum and betadine and to evaluate its effectiveness in comparison with the isolated application of controlled negative pressure in patients with purulent wounds of various origins. 58 patients with chronic purulent wounds, trophic ulcers with atherosclerotic lesions of the vessels of the extremities and diabetic angiopathy were examined. The first group of patients received isolated vacuum therapy, the second group was managed with vacuum-instillation therapy with dimexidum and betadine, the control group received traditional treatment with water-soluble ointments. Evaluation of the results of treatment was based on growth of granulation tissue, reduction of defect size, and level of cytokines in traumatic discharge. Vacuum therapy significantly improves the course of the wound process, which leads to faster cleaning, granulation of the defect and a decrease in its size. When added to NPWT instillations of antiseptics, anti-inflammatory, antioxidant and anabolic effects are enhanced, which facilitates more pronounced regenerative response and, accordingly, a reduction in the duration of treatment.

The article is devoted to the comparative analysis of sutural materials and search of ways of their improvement. Advantages and disadvantages of the products which are used in surgical practice are shown. The surgical sutures applied nowadays have such important advantages as knot strength, torpidity, lack of "shape memory". Their main disadvantages are provocation of pyoinflammatory complications, allergic reactions, difficult to predict terms of a resorption, high rigidity, and insufficient elasticity. Considering impossible and unnecessary the creation of universal sutural material, authors make mention about the most widespread technologies of modification of traditional surgical sutures such as introduction of admixture to their structure, various coating applications, chemical modification of fibers. Results of experimental assessment of influence of traditional materials and prototypes on wound process are given. They consider that the development and deployment in surgical practice of new types of sutural materials with the improved characteristics are the priority direction in acceleration of processes of operational wound healing. One of such materials is titanium nickelide. Having biological torpidity and corrosion resistance, it stimulates processes of regeneration of tissues, when swordcut is formed. Titanium nickelide provides implants with a new set of properties: shape memory with temperature change, superelasticity at body temperature. The encouraging results obtained in the experiments indicate the prospects of its use as a suture material. However, the literature contains only fragmentary data on the interaction of suture materials based on interaction of titanium nickelide with biological tissue. This is not enough for the wide use of new medical devices in surgical practice. A number of additional medical and biological studies are required, including those relating to the interaction of implants with the tissues of the body.

The aim of the study: analysis of the results of treatment of patients with post-traumatic diaphragmatic hernia. Material and methods. For the period from January 1995 to September 2016, 6 patients with post-traumatic diaphragmatic hernia were treated in the clinic. Among the patients there were 5 men and 1 woman. The age of patients was from 18 to 52 years. All patients were admitted to the hospital when complications appeared. In one case the diagnosis of hernia was established at the hospital at the place of residence during a survey. The remaining patients were hospitalized with a diagnosis: pleural empyema on the left, bronchopleural fistula (1), pathology of the abdominal cavity (2), intercostal neuralgia (1), and spontaneous pneumothorax (1). All patients had a chest injury or a blunt abdominal trauma: 4 were treated for this diagnosis (blunt abdominal trauma - 3, non-penetrating stab-cut wound of thorax -1), one patient was treated outpatiently, in 1 case there was no hospitalization. Results. Surgical intervention was performed after shortterm preoperative preparation. The purpose of the operation: elimination of the defect of the diaphragm and correction of complications. Operative access was upper-median laparotomy and revision of abdominal organs. We consider it optimal for adequate revision of the abdominal cavity organs, evaluation of the pleural cavity state, and suturing the diaphragm. The defect of the left dome of the diaphragm was found in all cases. Repeated intervention was performed in one patient 3 days after the first operation. One patient died. Conclusion. It is necessary to develop a protocol for the diagnosis and treatment of patients with post-traumatic diaphragmatic hernias to improve treatment outcomes.

Diabetes mellitus remains one of the most pressing problems in the 21st century. The research objective was to study the level of glycotoxins and oxidation-reduction potential of a serum/cell at the complicated and uncomplicated course of diabetes mellitus type 2 was and find the ways to correct the disorder. Materials and methods. There were three groups of patients aged from 55 up to 70 years, a total of 80 people. The main group (group No. 3) was presented by 40 men suffering from a diabetes mellitus type 2 with a macrovascular disease of the lower extremities. Depending on the chosen remedy and the carried-out therapy, patients of the first group were sectioned into subgroups on 20 people, in the 2nd subgroup additionally N-acetylcysteine solution was introduced in a daily dose of 600 mg once, intravenously, within 7 days. Definition of the studied indicators was made by HPLS methods, prior to therapy, for the third and seventh day. Results. Obtained data confirm activation of polyol pathway of glucose disintegration. Antioxidant potential of the serum and cells decreases. Using N-acetylcysteini in complex therapy reduces implications of carbonyl and oxidative stresses, due to multiple decrease of the final products of glycation. Conclusions. When identifying the presented indicators in patients with diabetic macroangiopathy of the lower extremities, the administration of N-acetylcysteine, intravenously in a daily dose of 600 mg (7 days course) is recommended.

Background. Postoperative adhesions are a serious problem in surgery. However, at the present time molecular mechanisms of the adhesion process are insufficiently studied. Aim. To study the dynamics of expression of genes encoding the synthesis of collagen in case of damage to the serosa on the example of the peritoneum in conditions of aseptic inflammation. Materials and methods. Aseptic inflammatory process in the abdominal cavity was modeled (Wistar rats, n = 40). A micro- and macroscopic picture of the damage area was studied. Immunofluorescent staining for Type I collagen (Col 1A1) was performed. The expression of genes encoding collagen of different types was evaluated using the RT²-Profiler PCR kit Array Rat Wound Healing. Results. It has been established that the adhesion process with peritoneal damage in aseptic conditions reaches its maximum by the 30^th day of observation. The same period coincides with the maximum of collagen synthesis in fibroblasts in the repair area, revealed by immunofluorescence study. The interrelation of synthesis of type I and III collagens went as expected - the onset of expression of type III collagen (from day 3) is ahead of the expression of collagen type I (from day 7). Peak gene expression of collagens type I, Alpha-1 and -2; type III Alpha-1, type IV Alpha-1 and -3, type V Alpha-1, -2 and -3; type XIV Alpha-1 (Col14a1) falls on the 14th day. For the first time, active involvement of type V alpha-3 collagen in the adhesion process was noted - we detected both early (from day 1) and maximum intensive (up to 166.96 times increase in comparison with intact animals). Conclusion. Perhaps, the hyperexpression of collagen V alpha-3 that we revealed is an important link in the pathogenesis of adhesion in the abdominal cavity.

In recentyears, the interest in the significance of Helicobacter pylori in various pathological processes is growing. The most studied is the role of Helicobacter pylori in gastroduodenal pathology. Gallstone disease is one of the most common diseases of the digestive system. Inflammatory changes in the biliary tract aggravate the clinical course of gallstone disease both in the preoperative and in the postoperative period and cause strictures, deformations of the extra hepatic bile ducts in the long term. One of the most threatening complications of gallstone disease is acute cholecystitis. Determination of IgG to Helicobacter pylori in complex diagnosis is important in patients with calculous cholecystitis. We conducted a prospective study of patients (n = 105) aged 30 to 50 years, suffering from different variants of calculous cholecystitis, in the preoperative and postoperative period by enzyme immunoassay. Enzyme-linked immunosorbent assay is reliable, affordable, least invasive method for diagnosing H. pylori infection. In patients with calculous cholecystitis, we marked a significant increase in IgG antibodies to Helicobacter pylori before surgical intervention and a subsequent reduction 10 days after it. Diagnosis of Helicobacter pylori infection of the gallbladder increases therapeutic efficiency and helps to develop preventive measures for complications of gallstone disease.

Background. In our country some aspects of thyroid and parathyroid surgery are still discussed. Aim. To present our experience in surgical treatment of benign diseases of the thyroid and parathyroid glands. Materials and methods. A retrospective analysis of the results of surgical treatment of 1511 patients with thyroid and parathyroid disease was performed. Results. Thyroidectomy was performed in 73.6 % of cases with thyroid diseases. The frequency of postoperative complications: laryngeal paresis -1.37 %, hypoparathyroidism - 0.84 %, hemorrhagic complications -1.2 %. Selective parathyroidectomy was performed in 99 % of cases with primary hyperparathyroidism. Persistent hypoparathyroidism and laryngeal paresis have not been identified. Total parathyroidectomy with central neck dissection, upper mediastinum and upper horn of the thymus gland was performed in 66.3 % of cases with secondary hyperparathyroidism. Persistent laryngeal paresis was established in 3.3 % of cases, hemorrhagic complications - in 3.3 %. Conclusions. Constant analysis of our own results gives us reasons for our own attitude to the controversial issues of thyroid and parathyroid surgery. Presently, we prefer thyroidectomy in the treatment of diffuse toxic goiter and multinodular goiter, hemithyroidectomy - for the single-node goiter. In the surgical treatment of primary and uremic hyperparathyroidism, we consider mandatory the use of intraoperative monitoring of intact parathyroid hormone. When performing total parathyroidectomy, we perform the autotransplantation of the fragment of the parathyroid gland.

Background. Postoperative adhesions are a serious problem in surgery. However, at the present time molecular mechanisms of the adhesion process are insufficiently studied. Aim. To study the dynamics of expression of genes encoding the synthesis of collagen in case of damage to the serosa on the example of the peritoneum in conditions of aseptic inflammation. Materials and methods. Aseptic inflammatory process in the abdominal cavity was modeled (Wistar rats, n = 40). A micro- and macroscopic picture of the damage area was studied. Immunofluorescent staining for Type I collagen (Col 1A1) was performed. The expression of genes encoding collagen of different types was evaluated using the RT²-Profiler PCR kit Array Rat Wound Healing. Results. It has been established that the adhesion process with peritoneal damage in aseptic conditions reaches its maximum by the 30^th day of observation. The same period coincides with the maximum of collagen synthesis in fibroblasts in the repair area, revealed by immunofluorescence study. The interrelation of synthesis of type I and III collagens went as expected - the onset of expression of type III collagen (from day 3) is ahead of the expression of collagen type I (from day 7). Peak gene expression of collagens type I, Alpha-1 and -2; type III Alpha-1, type IV Alpha-1 and -3, type V Alpha-1, -2 and -3; type XIV Alpha-1 (Col14a1) falls on the 14th day. For the first time, active involvement of type V alpha-3 collagen in the adhesion process was noted - we detected both early (from day 1) and maximum intensive (up to 166.96 times increase in comparison with intact animals). Conclusion. Perhaps, the hyperexpression of collagen V alpha-3 that we revealed is an important link in the pathogenesis of adhesion in the abdominal cavity.

According to the research of several authors, titanium nickelide thread has unique properties, which allows it to be considered as a possible basis for suture material. However, for extensive use of titanium nickelide thread in surgical practice, a deeper investigation of its interaction with living tissues is required. In experiments on white rats, we studied the influence of implantation of three types of threads (polypropylene, polyvinylidene fluoride and titanium nickelide) on soft tissues. After 14 days from the moment of implantation, blocks of soft tissue samples with suture material were obtained from animals. The blocks were subjected to microscopic examination, during which the area of the vessels was measured, the degree of fibrosis in the tissue was assessed, and structural changes of the same type were detected. Statistical processing of the received data was carried out with the help of the applied software Statistica 6.0. As a result, it has been established that the implantation of a thread from titanium nickelide, in comparison with other investigated materials, causes less pronounced inflammatory reaction, less edema, less pronounced manifestations of destruction and lymphostasis. This promotes regional angiogenesis, which accelerates the process of restoring soft tissues. The obtained data testify to the prospects of the use of titanium nickelide for the development of a new suture material.

Background. The problem of development of postoperative complications after operations on the organs of the gastrointestinal tact is extremely important. Failure of intestinal suture, formed in the presence of peritonitis develops from 2.8 to 32 % of patients. Aim. To improve immediate outcomes in the formation of a small intestine anastomosis in conditions of purulent peritonitis. Materials and methods. We conducted immunohistochemical examination of biopsy specimens of the small intestine of 20 patients died of peritonitis and compared the area of the vascular bed in different types of intestinal wall section. The experimental operations were performed in 100 Wistar rats. On the background of established models of peritonitis we performed different variants of small bowel anastomosis, including one with the use of photodynamic therapy. On the 6th day after the surgery, animals were sacrificed, and histological examination of the anastomoses was conducted. Results. Suture strip in the section of the small intestine made at the angle of 60° is supplied substantially better than in the section made at the angle of 90°. The experiment confirmed that the suggested method of anastomosis showed the best results. Conclusion. When one forms the "end-to-end" anastomosis in the small intestine in conditions of purulent peritonitis, it is reasonable to cross the intestinal wall at the angle of 60° and to perform photodynamic therapy on the formed anastomosis.