Lumbar drainage is one of the methods used to prevent the occurrence of intracranial hypertension and treatment of nasal liquorrhea in patients after by endonasal transsphenoidal endoscopic removal of tumors of the chiasmosellar region. The application of this method intraoperatively is a standard procedure to facilitate manipulation of the brain surgeon, but prolonged post-operative drainage is used extremely selectively and depending on the approaches taken in the specific medical organization. The present paper describes different frequency and risks of lumbar drainage after the surgery. Our aim was to assess the efficacy and safety of postoperative drainage of liquor from the surveyed patients. We observed 80 patients in the postoperative period who were conducted passive lumbar drainage. The assessment was performed of the cell count and discharge of the liquor, depending on the size of the tumor. During the study, it was found that the optimal timing of drainage is: 3 days for patients with small and medium-sized pituitary adenomas and 5 days for patients with large and giant adenomas. In all cases, the maximum values of cell count were observed on the first day and they gradually reduced by the 3-5^th days due to reorganization of the liquor and reduced inflammatory response. Postoperative meningitis developed in 6 (5.8 %) cases and in 3 cases this complication led to death. It has been found, that prolonged liquor drainage meets the standards of safety and effectiveness for the correction of intracranial hypertension and accelerates the rehabilitation of the CSF.

The study involved the group of patients (n = 40) with psychotic disorders who used synthetic cannabinoids (spice). Among the psychotic disorders according to ICD-10 we allocated intoxication delirium (F12.03; 35 %), schizophreniform disorder (F12.50; 60 %), disorder with predominantly manic psychotic symptoms (F12.55; 5 %). The average age of patients was 25.2 ± 4.4 years. Hereditary aggravation in patients who consume synthetic cannabinoids was presented by alcoholism and substance abuse (20 %), affective disorders (7.5 %), schizophrenia (5 %); personality disorders (10 %); suicides (2.5 %). The group of patients with intoxication with delirium had significantly higher frequency of family history of alcoholism and addiction to psychoactive substances compared with patients with schizophreniform disorder (p < 0.02). Clinic intoxication delirium was characterized by disturbance of consciousness (delirium, twilight) lasting from several hours to 2-3 days, psychomotor agitation, aggression, shouting certain phrases and words, anxiety, fear, visual hallucinations. In patients with acute schizophreniform disorder (24 patients; 60 %) symptoms consisted of a dominant affect (depressive, or mixed), productive psychopathological symptoms within the list of F20 headings of ICD-10. Productive syndromes were limited to verbal hallucinosis (true or its limiting variants) in the form of voiced (which discuss the patient's behavior, threaten him/her with death, offer advice), reference of persecutory delusion. The coming out of a psychotic state was characterized by short-term postpsychotic depression. Patients received detoxification therapy and also combined psychopharmacotherapy with the use of antipsychotics, antidepressants, tranquilizers, normotymics, nootropics.

The shortening of a tooth arch is clinically shown by crowding. In the final period of a mixed bite, the place disadvantage for canines is often detected. The problem of elongation of a tooth arch due to distal movement of premolars, the first and second permanent molars on removable appliances is discussed. In practical orthodontia, this way of treatment of the shortened tooth arch traditionally solved only with use of the fixed equipment. The fixed equipment allows to control the made effort to each of the moved teeth. Power source in removable appliances are screws. When designing removable orthodontic appliances the area of the moved teeth and a possibility of force action of the used orthodontic screws on the moved group of teeth is considered. Maintenance of balance between the applied force and the area of roots of the moved teeth allows to reach optimization of process of reorganization of parodentium. The clinical case showing efficiency of removable appliances in a constant occlusion for elongation of a tooth arch is presented, their design is described.

The article is devoted to the definition of the psychological characteristics of oil and gas shift workers with high and low levels at meteoreaction in the Arctic. The oil and gas employees in conditions of the Far North and the Arctic are most likely to develop painful meteosensitivity. At the same time, the severity of it is caused by not only natural environmental factors, but also the person's psychological qualities and characteristics. The study was conducted as the scientific expedition, in which 70 oil and gas workers in the Nenets Autonomous Okrug participated from March to April 2015 (shift duration - 30 days), their age - from 24 to 60 years (mean age 38.46 ± 1.410). The study was conducted through questionnaires, psychological tests. Statistical analysis was performed using the methods of descriptive statistics and stepwise discriminant analysis. Processing was carried out using SPSS 22.00 software package. The study revealed that employees of oil and gas companies with a high level of situational meteoreaction had hyperthymic and excitable types of character accentuations, high level expression of constructive external self-limiting and constructive sexuality, as well as a low level of expression of the destructive and deficiency aggression, deficit anxiety, destructive inner self-limitation, destructive narcissism and sexuality.

The results of endoscopic stomach drainage of fluid aggregates and post-necrotic pancreatic cysts have been investigated in 34 patients. All the patients were divided into two groups. The first group included early stage patients (from the onset of the disease up to 6 weeks duration), the second group covering the period post 6 weeks. According to the findings of the histological examination of pancreatic site tissue and peripancreatic fiber specific features of forming post-necrotic pancreatic cysts at early and late stages from the beginning of the disease have been studied by means of the endoscopic ultrasound technology. Besides, the stages of post-necrotic pancreatic cyst formation have been explored. The technology of through-the-stomach drainage has been developed, including the cyst puncture at the initial phase as well as subsequent dissection of the stomach wall and the cyst with the cystotome and its emptying. In the postoperative period balloon dilation of the cystogastroanastomosis and stage sanitations were carried out. If necessary, necrectomy with stent application was performed. Draining time parameters have been determined depending on the capsule formation, which consists of the early fibrinous layers and granulation tissue and subsequently turns into the fibrous membrane 3.4 mm thick. The study of the results of operations and the analysis of the causes of complications have been conducted, gastric bleeding being the most dangerous complication registered in 3 patients. To prevent intraoperative bleeding the method of post-necrotic cyst drainage has been changed.

We observed a group of 103 patients aged 18-30 years with pulmonary tuberculosis; each patient was observed for 12 months. 103 patients with pulmonary tuberculosis underwent a comprehensive clinical, radiological and microbiological examination. The carried out treatment was individualized basing on the presence and prevalence of cavities in the lungs, detection of Mycobacterium tuberculosis in sputum and determination of their drug sensitivity to anti-TB drugs. In 18.4 % of tuberculosis cases diagnosed with chest X-rays, intradermal Mantoux test with 2 TE PPD-L and Diaskintestom® was diagnostically irrelevant. 18.4 % of respiratory tuberculosis cases were detected during preventive chest X-ray and 81.6 % of patients were diagnosed in primary care facilities having referred with symptoms of inflammatory bronchopulmonary disease or concomitant diseases, combined with pulmonary involvement. We can conclude that without fluorography studies of the chest, intradermal Mantoux test with 2 TE PPD-L and Diaskintestom® is not a method for pulmonary tuberculosis timely diagnostics in people aged 18-30 years. The patients with pulmonary tuberculosis aged 18-30 years, diagnosed during preventive fluorography examination of the chest, after 12 months of treatment in 100 % managed to achieve clinical recovery. Same age patients with pulmonary tuberculosis, diagnosed when applying to primary care facilities with symptoms of inflammatory bronchopulmonary disease, after 12 months of treatment achieved clinical recovery only in 79.2 % and 20.8 % of them still had the lung cavities requiring further treatment and applying surgery to remove affected sections of the lungs.

Currently, most researchers define the term complete coronary revascularization (CCR) as coronary arterial bypass graft (CABG) of at least one branch of each of the three affected coronary basins: left anterior descending artery (LAD) left circumflex artery (LCA) and right coronary artery RCA. The rejection of bypass of one or more diseased coronary basin is estimated as an incomplete coronary revascularization (ICR). Material and methods. This retrospective study included patients, underwent isolated coronary bypass operations from 2001 to 2014 in the Irkutsk Regional Hospital. 1418 patients underwent isolated off-pump bypass operations. ICR occurred in 469 patients, the CCR - in 949. All patients were divided into 2 groups: ICR group and CCR group. These groups were compared by the late survival and by the frequency of the major cardiac events (MACE). The results of study were assessed after 1, 5 and 10 years from the date of CABG. Results. Survival of patients of ICR group after 1,5,10 years after surgery was 98.5 %, 75.4 % and 75.4 % respectively, of CCR group of patients - 98.7 %, 88.7 % and 81.3 % (p = 0.006). In ICR group "free" from MACE after 1, 5 and 10 years after surgery were respectively 98.2 %, 70.8 % and 61.0 % of patients, while in CCR group those made 98.3 %, 84.6 % and 72,6 % (p = 0,007). We can conclude that incomplete revascularization can be defined as a prediction factor of worst long-term outcome results of CABG.

The aim of the study was to examine the state of cognitive functions in patients with Parkinson's disease combined with the dyscirculatory encephalopathy and identify their risk factors for cognitive impairment. The results of the study showed that the frequency of cognitive impairment in patients with Parkinson's disease combined with the dyscirculatory encephalopathy was 90.3 %, Parkinson's disease without brain vascular disease - 28.6 %. Patients with concomitant cerebrovascular disease had more severe frontal deficit (mean score on the FAB in the main group -14.86 ± 2.18, in the control -16.93 ± 2.21; p < 0.0001), which manifested itself in the form of difficulty when performing tests for dynamic movements, simple and complicated reactions of choice, had the worst performance of speech and general mental activity, attention. In order to assess the relationship of certain clinical, social and biological factors with indicators of cognitive functions we conducted Spearman rank correlation analysis. Risk factors for the development of cognitive impairment of Parkinson's disease combined with vascular encephalopathy were age of patients, severity of motor impairment, duration and severity of hypertension, coronary heart disease, and the presence of acute cardiovascular events in history.

Chronic venous disease of lower extremities is a common vascular problem in the developed countries. The aim of our study was to explore a potency of ambulatory selective varicose vein ablation under local anesthesia (ASVAL) without vein stripping. ASVAL method was carried out in 12 patients. All patients had reflux of great saphenous vein verified by duplex ultrasound before surgical treatment. Exclusion criteria were reflux of small saphenous vein, reflux of perforator veins and clinical class 4-6 by classification CEAP. Design of the study was series cases. Follow-up time lasted one year. The surgery was performed by tumescent anesthesia of 0.01% Lidocain. All patients were given Diclofenac 100 mg for one postoperative day. In all patients we observed decrease of size or disappearance of great saphenous vein reflux verified by duplex ultrasound. No recurrence of varicose veins for one year was detected.

According to the data of the World Health Organization, osteoporosis takes the fourth place among non-infectious diseases after cardiovascular, oncologic disorders and diabetes mellitus. Clinical manifestations of osteoporosis with the root syndrome are not that different from those of radicular symptoms at degenerative-dystrophic processes in the spine. Our purpose was to study the state of upper extremities bone tissue in patients with clinical manifestations of cervical osteochondrosis. There were 40 patients under our observation diagnosed with cervical osteochondrosis, 26 of them - with stages 1 and 2 of osteochondrosis development, and 14 patients - with stage 3. Conducted densitometry examinations of upper extremities bone tissue revealed correlation between bone tissue state and both the time of the onset of the pathological process and its severity. In patients with stage 3 osteochondrosis, bone tissue mineral density on the affected extremity was lowered down to osteoporosis, and naturally, such cases require further treatment.

One of the major problems of modern oncology drug is liver damage, requiring additional costs for its treatment. The aim of our work was to study medical and economic efficiency of various schemes of hepatoprotective treatment of toxic liver damage. The paper presents the use of pharmacoeconomic studies in the treatment of hepatic drug-induced hepatitis, which occurs after chemotherapy in patients with Hodgkin's lymphoma. The study was conducted in the two comparison groups on a "cost - effectiveness". This method was chosen because it is in effect depending on the process (method), treatment was varied, as well as costs incurred. The unit of the effect of the number of days required for the relief of hepatic failure has been selected. Economic analysis of the work includes not only toxic hepatitis therapy, and treatment of any disease complications such as hepatic encephalopathy. The study revealed that the effectiveness of therapy increased 1.4 times and the economic costs were 51.8 % reduced with hepatoprotective drug "remaxol".

Artemisia adamsii Bess. is a perennial herb. It belongs to the Compositae Giseke family. Artemisia adamsii grows in meadows, steppes, rocky hills, along roads and on solonetz. The plant grows in the Siberian region of Russia (Buryatia and Chita region), in Mongolia and China (Western Manchuria). Infusion, decoction of leaves, inflorescences, herbs are used in traditional Tibetan and folk medicine as antipyretic. We present the results of a comparative analysis of the chemical composition of essential oil of Artemisia adamsii of Russian (Buryatia) and Mongolian floras. Raw materials were collected during expeditions in 2014 in Ivolginsky district of the Republic of Buryatia (Russia) and in Khentei aimag (Mongolia). Samples of essential oil were obtained from the dried aerial parts of the plant by hydrodistillation. Essential oils are liquids with yellow-green to yellow colors. Oilyield was from 0.4 to 1.0 % in terms of the air-dry feed. Essential oils were investigated by chromatography-mass spectrometry on chromatograph Agilent Packard HP 6890 with detector quadrupole mass spectrometer MSD 5973N. More than 120 compounds were found in the composition of the essential oil of Artemisia adamsii and about 85 % was identified. 1,8-cineole (8.6-40.8 %), terpinene-4-ol (4.3-5.7 %), camphor (2.6-43.6 %) bicyclogermacrene (2.2-6.1 %), spatulenol (1.9-11.0 %) are the dominant components. Camphor, 1,8-cineole, terpineol-4, spatulenol possess antibacterial and anti-inflammatory activities.

The high exercise stress in sport causes decrease in immune cells reactivity. Changes of intensity of neutrophilic granulocytes «respiratory burst» due to the main operating factors of sports activity have not yet been investigated. The study included 96 male athletes (24.34 ± 3.54 y.o.), 59 female athletes (23.12 ± 2.3y.o.) and 53 healthy male non-athletes (23.17 ± 2.54 y.o.); 48 healthy female non-athletes (22.12 ± 3.01 y.o.) participated as control group. Two neural network predictor models for neutrophilic granulocytes functional activity were created. The average error of approximation was 2.77 % and 2.98 % for male and female respectively. In a series of virtual experiments, the effect of different approaches to the organization of training-competitive process was studied. We have found the conditions that should allow to avoid decompensation in the immune system in the end of the competition period.

Data of histological study of pathomorphological changes in liver of white mice with experimental plague are represented in the article. An important element in evaluation and prediction of the pathological process in the liver is the analysis of hepatocyte karyokinesis, the mitotic index calculation, the counting number of atypical mitosis and the degree of organ regeneration ability. Dynamics of these liver changes at infection process in experimental animals caused by Yersinia pestis plasmid variants was investigated in this work. The variability of liver injuries was shown depending on plasmid-associated virulence of the infection agent. It was proved that the Y. pestis strain carrying three basic pYP (6 mDa), pYV (45 mDa), pYT (61 mDa) plasmids caused the most severe systemic disease with lethal outcome as a rule. Lack of species-specific plasmids and especially virulence and pathogenicity plasmids reduced the rate of infection process generalization and the ability of the pathogen to initiate pathological changes incompatible with the microorganism life. Therefore, all morphological liver changes in experimental plague infection are directly dependent on plasmid profile of the pathogen. The mechanism of toxicity included the damaging effect of the toxin to the cellular structures and failure of the metabolic processes in the organism. Acuity of intoxication and the development of pathological process can be estimated by exploring changes in liver morphology.

Nowadays in chronic diseases structure mental derangement leading to disability and mortality of population comes to the front. As a result of illicit traffic of drugs extension, using psychoactive medicinal agents by drug abusers for intensification of intoxication and alleviation of abstinence syndrome has been fixed to increase. It results in occurrence of poisonings. The main goal of the work is a development of strategy of chemical-toxicological analysis of psychoactive medical agents useable for combined poisonings via thin-layer chromatography method. The research offers the results of studying the chromatographic behaviour of tofisopam and fluoxetine combined with psychoactive medicinal agents on chromatographic plates "Sorbfil UV-254" and "Armcorb UV-254" in general solvent systems. It is shown that separation of psychoactive substances does not occur accurate enough. Therefore, it is necessary to develop particular chromatographic systems. A system of composition of toluol - acetone - 25% solution of ammonia is revealed and can be recommended in screening while carrying out a nondirectional analysis of tofisopam and fluoxetine. In this system, all combinations under research are detected. A search of particular chromatographic systems was carried out by changing the quantity of toluol, acetone and ammonia. It is established that solvent systems of toluol - acetone - 25% solution of ammonia in a ratio 50:50:1 and 50:50:4 are optimal for identification of combinations with tofisopam and fluoxetine accordingly. The developed method allows detecting tofisopam and fluoxetine in urine on a preliminary step of research both individually and in combinations with psychoactive medicinal agents.

Prospects of lectin systems of the human biotope symbiotic microorganisms are evaluated. Symbiotic lectins are described as metabolome-biotic imitators of probiotics, carriers, deliveries, depositors, and agents realizing glycoconju-gate metabiotics. Glycoconjugate metabiotics (adequate to symbiotic lectins) represent antagonistic factors against relatively pathogenic microorganisms. Such glycoconjugates include prebiotics, therapeutic agents, décor panels currently supporting normally functioning human cells, tissues and organs. Symbiotic lectins, interacting to synthetic glycoconjugate imitators of important substances for human interactome, serve as instruments for screening strains and their consortia possessing new potential for constructing multistrain pro- and symbiotics. Algorithms of such screening and constructing based on lectins-glycoconjugates interactions are developed. Proposed anaerobic (without oxidoreductase systems participating in oxidative stress) relatively high molecular mass synergistic symbiotic lectins (in contrast to low molecular mass acidic symbiotic effectors) are perspective as network multifunctional switching assistive recognition systems functioning in agreement to human protective systems (complement, lymphocytes, macrophages) in the absence of local availability of oxygen. Results support new technological prospects of the direct and indirect resulting protection involving human intestinal indigenous symbiotic (probiotic) lectin systems against surrounding pathogenic and/or relatively pathogenic exo- and endogenic microorganisms in biotopes of organism.

Problems of regulation of oxidative stress and the search for biologically active substances with antioxidant activity are the focus of researchers. Chicory (Cichorium intybus L.) is a plant containing various biologically active substances (hydroxycinnamic acid, flavonoids, coumarins, ascorbic acid, carotenoids, etc.), exhibiting antioxidant properties. The aim of our study was to evaluate the effect of aqueous and alcoholic extracts of chicory herbs on the processes of free radical oxidation in model systems in vitro using rapid method of determining antioxidant activity, based on the registration of chemiluminescence. A model system generating active oxygen species (ROS) was phosphate buffer with the addition of luminol solution and sodium citrate to initiate reactions involving the formation of ROS injected Fe²+ salt solution. Impact of extracts on lipid peroxidation was studied in chicken yolks homogenized in phosphate buffer. For initiation of oxidation reactions Fe²+ solution was used. Lipid peroxidation (LPO) processes were judged by the light intensity. The effect of aqueous and alcoholic extracts of common chicory herbs in various concentrations on the processes of free radical oxidation in the active forms of oxygen in the system (ROS) and LPO was researched. The study revealed the ability of the extracts of the chicory herb suppress the generation of ROS and LPO in model systems that characterizes their antioxidant properties, which are most pronounced when administered aqueous extracts of chicory herbs compared with alcohol in model systems at a concentration of 0.1 mg/ml.

The problem of regeneration of bone structure and joint cartilage is one of the priority programs of scientific research. Regulation of bone formation at the damage is carried out by complex set of factors. A reflection of the regeneration processes is the dynamics of blood parameters, among which are the indicators of inflammatory reaction of the organism, and condition of phagocytosis system. One way to control the severity of impaired reparative regeneration is the analysis of immunological tests of the first order. The aim of our study was to investigate nonspecific resistance of the organism for any breach of reparative regeneration of bone in the lower leg. The study was performed on rabbits "Chinchilla" which simulated the breach of the terms of reparative regeneration. We assessed leukocyte profile and indicators of phagocytosis in experimental animals. Status of the phagocytic activity of blood neutrophils was evaluated on the following parameters: phagocytic index, phagocytic number, nitroblue tetrazolium test, the concentration of circulating immune complexes. We found broken shin bone reparative regeneration of rabbit at fiftieth day of observations is accompanied by leukocytosis with increased segmented neutrophils and a decrease in lymphocytes, inhibition of phagocytosis, and violation of the elimination of circulating immune complexes.

This article provides a literature review on the topic of hypoxic-ischemic encephalopathy (HIE). Hypoxic-ischemic brain damage of newborn belongs to one of the most important problems of anesthesiology and resuscitation of newborn babies. Despite progress, perinatal hypoxic-ischemic encephalopathy remains an important cause of child mortality and damage to the central nervous system resulting in a disability of children. HIE clinical signs are nonspecific, so the diagnosis is based on the combination of medical history, physical and neurological examination, laboratory data and neuroimaging techniques. Pathological stage runs when after undergoing asphyxia is the main purpose neuroprotective therapy. The first 6 hours of life of the child, born in asphyxia, is a therapeutic window for the stabilization of the vital functions of the body, during which therapeutic measures are most effective in reducing apoptosis of brain cells. The only method, relatively widely used and effective in infants with severe birth asphyxia, is controlled hypothermia. Published clinical studies show a statistically significant reduction in mortality and severe neuropsychiatric disability at 18 months of life in infants treated with hypothermia. The use of stem cells, the use of hypothermia in combination with xenon or erythropoietin improves neurological outcome: fewer deaths and serious damage to the nervous system. However, these techniques to date are in the experimental stage. Currently, the main task of neonatologists, anesthesiologists and intensive care specialists is not only saving newborn lives, but also creating conditions for proper growth and development of the child.

Presently, the expressed tendency to deterioration in parameters of semen is noted in the world, at the same time both the quantity of spermatozoa, and their functional properties decrease. The spermatogenesis is a difficult, extremely sensible process of cellular differentiation; the different systems of organism participate in its adjusting. Violations in any links affect the process of spermatogenesis, and finally, affects parameters of semen. This systematic review of the literature analyses recent publications concerning studies of oxidative stress influencing male fertility. The oxidative stress - the very widespread version of pathology, which accompanies and/or is one of key mechanisms in development of many types of reproductive disorders in men. There are three main mechanisms of impaired fertile function of men in the development of oxidative stress: reducing sperm motility, violation of ability of spermatozoa to penetrate into oocyte and spermatozoa DNA damage. The factors promoting its development are numerous: environmental pollution, life style, addictions, stress, diabetes, and varicocele; however, the most frequent reason of development of oxidative stress in reproductive system of men are infectious and inflammatory diseases and antispermal autoimmune processes in a man's urogenital tract. Considering possible participation of free-radical processes in patospermia development, it is worthwhile to use antioxidants in all cases of the man's infertility connected with oxidative stress.

The literature review provides basic information about cerebral stroke as one of the leading medical and socio-economic problems that caused high levels of mortality and morbidity from stroke, unfavorable disability index. This fact confirms the need for the introduction of efficient preventive measures among the healthy population and among patients with a stroke. The basic principles of secondary prevention, as well as the primary, are minimizing the risk factors and drug therapy. Antiplatelet therapy is a key point in the treatment and secondary prevention in patients with an ischemic stroke. On the basis of evidence-based data with the characteristics of antiplatelet agents, included in clinical guidelines and standards for the treatment of patients with ischemic stroke. Patients with ischemic stroke, if there are no contraindications for the appointment of antiplatelet agents, are prescribed antiplatelet agents from the first day (aspirin, clopidogrel and others). Patients usually have to take these drugs constantly (for life). The drug of choice in patients with intolerance, contraindications or complications of therapy with acetylsalicylic acid, as well as in patients with a stroke and diabetes, peripheral arterial disease, coronary syndrome, is clopidogrel. The literature review shows the basic principles of selection and prescription of antiplatelet agents tactics to ischemic stroke patients at different stages of the disease. A balanced, pharmacotherapeutically safe approach to the use of antiplatelet agents is very important. It raises the question of the need to apply the principles of personalized medicine in patients with a stroke, including the prescription of antiplatelet agents.

Despite the greater prevalence of chronic depression, there are controversial questions about the clinical and psycho-pathological structure of the course and determinants of chronic depressive disorder. There is an abundance of terms applicable to the long-term depressive disorders, and significant discrepancies in the assessment of these states. The allocation of chronic depression is not provided according to ICD-10 (1994). Chronic depression and dysthymia combine into one diagnosis "persistent depressive disorder (dysthymia)" according to DSM-V (2013). The possible determinants of chronic depression were analyzed: demographics (age and gender), social (education, socioeconomic and marital status) and psychobiological (children's experience, personal characteristics, previous mental and physical illness) vulnerability, stressful life events and social support, factors associated with the disease (severity of depression, comorbid conditions, number and duration of previous episodes).

We described a case of an endogenous hypercorticism in 18-years old patient with Itsenko - Cushing syndrome which was caused by a hormonally active adrenal tumor of the left adrenal gland. In a clinical picture of a disease the following symptoms dominated: arterial hypertension, increase in body weight, adiposity of the trunk, hands, neck, face, strips of extensions of skin on femurs. We found multiple nevus pigmentosus of black, yellowy-brown color from 1.5 to 10 mm on lips and mucous of a mouth, skin of a face and a trunk. The hormonal research established violations of a circadian rhythm of a hydrocortisone, increase in the free hydrocortisone of blood to 749.0 nmol/24 h (reference range 123.0-626.0), urine to 1314.0 nmol/24 h (reference range 60.0-413.0). The ACTH level decreased to 1.7 pg/ml (reference range 7.0-66.0). The negative result of the night overwhelming test with Dexamethazonum is received. Muitislice CT of adrenal glands revealed signs of a nodular hyperplasia of the left-hand adrenal gland. The laparoscopic adrenalectomy is made at the left. Pathoanathomical conclusion: a nodular pigmental hyperplasia of a glomerular and fascicular zone of bark of an adrenal gland with inclusion of a miyelolipomatoz. In the nodular corticocytes inclusions of lipofuscin granules were found. In the postoperative period symptoms of a hypercorticoidism regressed, throughout two years of observation there is no recurrence. Monitoring of hormones of blood in six months: hydrocortisone 359.5 nmol/l, ACTH 7.02 pg/ml. Retrospectively, the patient displays an infrequent heritable disease - Carney complex. The patient's mother at the age of 32 years underwent left-side adrenalectomy concerning Itsenko - Cushing disease with morphological confirmation of a nodular pigmental hyperplasia in adrenal gland. In both cases clinical convalescence occurred. Interest of the presented observation consists in its exclusive rarity. The unilateral adrenalectomy was efficient, but the probability of a recurrence of a hypercorticoidism and other manifestations of Carney complex remains.

The article presents the analysis of treatment of posttraumatic tracheoesophageal fistula caused by long staying of a flat battery in the esophagus lumen. The analysis cover treatment of two children at the age of 8 months and 1 year 3 months with a severe chemical burn of the esophagus because of long staying of a flat battery in the esophagus lumen. A principal clinical symptom of a disease was a dysphagia. The call for medical help was delayed - from 1 to 3 days. During the first esophagoscopy the excision of battery was done. A total necrosis of a front and lateral side of the esophagus in a cervical esophagus and a backside of trachea caused by the growth of atracheoesophageal fistula. A gastric fistula was performed for food supply. An emerged tracheoesophageal fistula led to the disturbance of breathing, which is why tracheostomy was urgently performed. The first child had a one-stage plastic operation of backside of trachea defect, the second child had a cycling off fragment of the esophagus, this had made it possible to pack off the trachea and stabilize the children's condition. In three months, the children had undergone a reconstructive plastic operation - retrosternal coloesophagoplasty with an extirpation of an esophagus stump. In this case, a backside of trachea was formed from the diverticulum of trachea (a segment of the esophagus after its disconnection).

The article is devoted to problem of syncope with cardiac arrhythmias in children. In pediatric patients, arrhythmogenic syncope represent the greatest threat to life and health. Arrhythmogenic syncope may be associated with weakness of sinus node, impaired atrioventricular conduction, paroxysmal tachycardia, syndrome of Wolff - Parkinson - White, long QT syndrome, Brugad's syndrome. Arrhythmogenic syncope are divided into 2 groups - bradiarrhythmical and tahiarrhythmical. The most common cause of arrhythmogenic syncope are ventricular tachyarrhythmia. Ventricular tachyarrhythmias occur in severe organic disease of the myocardium. Ventricular tachycardia with the transition to ventricular fibrillation is often the cause of sudden cardiac death. Syncope associated with bradycardia often occur in children with complete atrioventricular block, atrioventricular block of 2^nd degree (2:1, 3:1 etc.). Weakness of sinus node causes syncope much less frequently. During sharp slowing of sinus rhythm the underlying atrium sinus nodes switch on which can provide a rate of 30-40 per minute. Syncope with weakness of sinus node occurs more often with bradycardia less than 30 per minute, and the presence of asystole periods of up to 2 seconds or more. The article presents clinical case of our own observation of a child with syncope. The cause of syncope was the syndrome of sinus node weakness with rhythm pauses to 9-14 seconds. It is not always possible to register syncope during daily Holter ECG monitoring. In this case, it is impossible to identify arrhythmogenic causes of syncope.