Aim. Evaluation of different methods of surgical treatment of patients with gastroduodenal ulcer, complicated by a combination of perforation and hemorrhage and the rationale for choosing optimal method of surgical treatment. Materials and methods. The article summarizes the experience of surgical treatment of combined complications of ulcer disease in the form of perforation and hemorrhage. This combination was found in 52 from 753 patients who underwent surgery for ulcer perforation. The hemorrhage arose from a perforated ulcer, and other. The hemorrhage was in the abdomen (5 cases or 0,66%) and in the lumen of the gastrointestinal tract (47 patients or 6,2%). Results. In the surgical treatment of combined complications of gastroduodenal ulcer disease the mortality rate was more than 19%. The most severe patients were those who had free perforated ulcer combined with hemorrhage. Gastric resection was applied at 31,9%. Simple stitching perforated hole ulcers is unacceptable because 2/3 patients with gastroduodenal ulcers have at least two ulcers, one of which is complicated by perforation and hemorrhage. Even at the minimum volume of surgical intervention it is appropriate to perform pyloroplasty according to Judd. Conclusion. The surgery of choice is pyloroplasty according to Judd. Approximately 1/3 of patients have to resort to resection of the stomach, which is dictated by the pathological changes in pyloroduodenal area.

 

Aim. Evaluation of different methods of surgical treatment of patients with general purulent peritonitis, and the rationale for choosing the optimal method of surgery. Materials and methods. Experience of surgical treatment of patients with general purulent peritonitis which required relaparotomy is summarized. A number of such patients was 504 (37,4%) of 1347 patients who undergone treatment of general peritonitis in the city clinical hospital of emergency medical care of Krasnodar from 2005 to 2014. Results. On the basis of experience in the treatment of 504 patients with general purulent peritonitis of various etiologies the use of programmed repeated sanitation of the abdominal cavity is justified. All patients were divided into two groups – the control group in which relaparotomy "on demand" was performed and the main group in which patients undergone programmed relaparotomy. In the control group which consisted of 189 patients 61 patient (31.7%) died, in the main group which included 315 patients 25 patients (7.9 %) died (p<0.01). Conclusion. Programmed relaparotomy is the stage of radical surgical treatment in the complex treatment and preventive measures in diffuse general peritonitis.

Aim. Characterization of histological indicators of myocardial damage in rejection of transplanted heart using computer morphometry to improve the quality of biopsy diagnostics. Materials and methods. Endomyocardial biopsies of 31 patients after cardiac transplantation were used. Histological sections were stained using the standard procedure with hematoxylin and eosin, and also with picro-fuchsin by van Gieson. The area of the biopsy sample, fibrosis, necrosis, lipomatosis and hemorrhages, as well as the number of cells in the infiltrate, was assessed using computer morphometry. Results. All biopsies are divided according to the degrees of rejection as follows: degree 0R – 16 samples, 1R – 14 samples, 2R – 10 samples, 3R – 4 samples. The severity of necrosis significantly increased along the increase in rejection severity, reaching 0% at 0R, 0.03% at 1R, 4.95% at 2R and 17.4% at 3R. The most massive hemorrhages were detected in samples attributed to 2R – 9.89% of the biopsy area. Lipomatosis was noted at all levels of rejection, reaching a maximum of 16.5% of the area in patients with 3R. The area of fibrosis increased with an increase in the severity of rejection: at zero degree it was 0.16% of the biopsy, at the first – 3.8%, at the second – 8.69%. Conclusion. The studied morphological indicators make possible a more detailed assessment of the degree, as well as the course of the rejection reaction, which will improve the quality of diagnosis with endomyocardial biopsy.

 

Aim. To improve the results of surgical treatment in patients with postsurgical ventral hernia, combined with peritoneal commissure of abdominal cavity is considered. Materials and methods. 79 patients aged 30-80 with ventral hernias, men/women parity 24:88 were examined. According to Toskin-Zhebrovsky classification hernias of the small sizes were observed in 16 (20,3%) patients, hernias of the average sizes – in 23 (29,1%) patients, hernias of the extensive sizes – in 27 (34,2%) patients and huge in the rest 13 (16,4%) patients. According to SWR-classification hernias of median localization were observed in 59 (74,7%) patients, lateral localization – in 12 (15,2%) patients, combined localizations – in 8 (10,1%) patients. According to the width of hernia gate: W1 – in 16 (20,3%) patients, W2 – in 23 (29,1%) patients, W3 – in 27 (34,2%) patients, W4 – in 13 (16,4%) patients. All patients undergone surgeries. The open surgeries including simultaneous stages were performed in 57 patients with postsurgical ventral hernias (PVH). Closed hernioplasty was performed in 22 patients. Results. At opened hernioplasty early complications were observed in 14 (24,5%) patients: in 1 patient (7,2%) it was a wound suppuration; in 10 (71,4%) patients – seromas; in 3 (21,4%) patients – early postsurgical intestinal obstruction. All patients who undergone closed video assisted surgeries have recovered. It was found, that in case of comorbidities the surgery is performed on the burdened background. Conclusion. It seems critically important to improve the immediate results of surgical treatment of patients with postsurgical ventral hernia and peritoneal commissures of the abdominal cavity by optimizing operational tactics and managing patients in the postoperative period.

 

Aim. A comparative analysis of the horizontal parameters of mesognathic dental arches by the method of Pont and Linder-Harth. Materials and methods. The materials of the research were the results of measurements of diagnostic gypsum models of dental rows of 117 people aged 18-25 with a complete set of permanent teeth, physiological occlusion, mesognathic type of dental arches and various types of dental system. Measurement and calculation of the parameters of the dental arches in the transversal direction were carried out using the methods of Pont and Linder-Harth. Gnathic variants (mesognathy, dolichognathy, brachygnathy) of dental arches (Dmitrienko S.V., 2015) were determined taking into account the dental index calculated as the ratio of the half sum of the width of the crowns of 14 teeth to the width of the dental arch between the second molars. The types of the dental system (normodontia, macrodontia, microdontia) were determined from the summation of the width of the crowns of the upper teeth. Results. Biometric diagnostics of 117 pairs of gypsum models of dentition made it possible to establish that the methods of Pont and Linder-Harth are acceptable for the study of mesognathic dental arches as an estimate of transverse dimensions. There was no significant difference between the calculated indices and actual sizes in patients with mesognathic dental arches and various types of dental system, both in the premolar region and in the molar region. The size of the teeth is of decisive importance for the evaluation of the width of the dental arches of the mesognathic type. Conclusion. Optimization of medical and diagnostic measures in the clinic of orthodontics and orthopedic dentistry in the management of adult patients with dental-jaw pathology provides for the improvement of anthropometric studies, as well as the advisability of reviewing the conventional diagnostic regimens when studying the shape and size of dental arches to predict positive long-term results. Mathematically derived dependences of dental types of dental arches from their transversal parameters are informative, diagnostically significant values that can be used to predict the shape and size of dental arches in the treatment of patients with dentoalveolar anomalies in order to achieve an optimal functional and aesthetic result. The use of the Pont and Linder-Harth method in the analysis of the mesognathic dental arches has no significant errors, and can be used at the stages of diagnosis of shape and size anomalies in the transverse direction.

 

Aim. Clinical analysis of the efficacy of electroconvulsive therapy (ECT) in conditions of intensive care units (ICU) in psychiatric dispensary. Materials and methods. Within the two years of ICU functioning 150 patients (73 men and 77 women) aged 17 to 66 were treated with ECT in the Aksai branch of the "Psychoneurological Dispensary". For the course of therapy, the number of ECT sessions was from 2 to 24. The sessions were conducted both daily and at a frequency of 1-3 times a week, depending on the nosology. To assess the efficacy of ECT, a clinical global impression scale (CGI-I) was used. Results. A significant improvement in the state (1-2 on the CGI-I scale) after ECT sessions was observed in 108 patients (72%), slight improvement in 30 patients (20%), absence of changes in 9 patients (6%) and deterioration in 3 patients (2 %). High clinical efficacy of ECT prevailed in the spectrum of patient changes in the clinical group. Regardless the leading syndrome, a significant improvement in the state after the use of ECT prevailed in frequency. Taking into account the diagnostic category and the syndrome, the best effect was observed in the catatonic-oneiroid syndrome in paroxysmal (recurrent) schizophrenia, malignant neuroleptic syndrome, affective-delusional syndrome in schizoaffective disorder, catatonic paranoid and paranoid syndromes within the paranoid schizophrenia with episodic-progressive type of course with an increasing defect, as well as in paranoid schizophrenia with a follow-up period of up to 1 year. ECT was effective in overcoming psychopharmacotherapeutic resistance. Conclusion. Use of ECT in the "modified" version is a highly effective method of biological therapy, providing therapeutic results in catatonic paroxysmal (recurrent) schizophrenia, schizoaffective disorder, paranoid paroxysmal schizophrenia, paranoid schizophrenia with a follow-up period of up to 1 year, as well as in the treatment of malignant neuroleptic syndrome and psychopharmacotherapy resistant conditions.

 

Aim. Evaluation of the features of functioning of the antioxidant system of blood and oral fluid in women suffering from chronic endometritis complicated by the bilateral salpingo-oophoritis. Materials and methods. 85 women participated in the study. The first group consisted of 30 practically healthy women. The second group included 29 patients with chronic endometritis in the exacerbation phase, the third group was represented by patients with a combined course of chronic endometritis and bilateral salpingo-oophoritis in the exacerbation phase (n=26). In the erythrocyte suspension and oral fluid, the activity of catalase and superoxide dismutase, glutathione peroxidase and glutathione reductase was assessed; in addition, the concentration of reduced glutathione was assessed in erythrocytes. Results. The obtained data reflect the development of an imbalance in the antioxidant system of blood and oral fluid that develops in patients with inflammatory diseases of the pelvic organs. Changes in the blood and oral fluid did not coincide completely, which was expressed by the relative insufficiency of superoxide dismutase activity in the blood (the ratio of activity of catalase and superoxide dismutase 1.3-1.8) and catalase in the oral fluid (the ratio of the activity of catalase and superoxide dismutase 0.5-0.8). It is also interesting to note that the studied indicators after the therapeutic measures characterized still more significant depletion of the antioxidant system, and for the most part it was characteristic of the oral fluid (the ratio of the activity of catalase and superoxide dismutase 0.05-0.1). This may be due to the intensive involvement of antioxidants in the recovery of the body. Conclusion. The results of the study suggest the prospect of additional metabolic correction of the antioxidant orientation to the standard therapy used for the treatment of pelvic inflammatory diseases. The pronounced changes in the biochemical parameters of the oral fluid make it possible to judge the possibility of using it for noninvasive laboratory evaluation of metabolic disorders in women with chronic endometritis and salpingo-oophoritis.

 

Aim.To evaluate the comparative frequency of various manifestations of myocardial ischemia depending on chronic obstructive pulmonary disease (COPD), its severity and pulmonary hyperinflation (PHI) in patients with stable effort angina having indications for planned endovascular myocardial revascularization. Materials and methods. Systematically selected 605 patients with stable effort angina with a history of long-term smoking, among which spirography identified 142 patients with COPD, were checked for the incidence of various manifestations of myocardial ischemia, as estimated by the classification of Diamond A.G. (1983). Results.Atypical angina occurred in patients with COPD 1.6 times more often (p=0.021), and dyspnea without other manifestations of myocardial ischemia – 1.8 times more often (p=0.025) than in the control group. There was an increase in the incidence of atypical angina and dyspnea in COPD patients from grade III, and also in case of PHI. Conclusion.COPD leads to a change in the manifestations of myocardial ischemia in patients with stable angina, which is accompanied by an increase in the incidence of atypical angina and dyspnea in patients with severe COPD and in case of PHI.

 

Aim. To estimate the frequency of hospital complications and the long-term (duration of observation to 3 years) results of percutaneous coronary interventions (PCI) performed for stable effort angina in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. Hospital complications were recorded after PCI in a series of 605 patients with stable effort angina with a history of long-term smoking, among which 142 patients with COPD were identified by spirography. For the prospective part of the study, 135 COPD patients and 216 patients in the control group were selected. During long-term follow-up (up to 3 years), the incidence of major cardiovascular events (MACCE) was recorded. Results. No effect of COPD on the incidence of hospital complications after PCI was found. The relative risk (RR) of major cardiovascular events in the long-term period was 1.36 (95% confidence interval 0.97-1.90). RR of revascularization was 1.77 (95% confidence interval 1.11-2.82). Conclusion. COPD does not affect the incidence of hospital complications after PCI, but increases the risk of MACCE in the long-term, mainly due to repeated myocardial revascularization.

 

Aim. To estimate prevalence of chronic endometritis among women with repeated implantation failures in vitro fertilization and embryo transfer (IVF and ET), as well as to assess the impact of timely diagnosis and comprehensive treatment of chronic endometritis on the success of implantation. Materials and methods. 55 women with two or more failed IVF and ET cycles comprised the study group. All patients underwent hysteroscopy and endometrial sampling for histology, immunohistochemistry and microbiological investigations. 3D ultrasound measurements of uterine cavity were applied. All women diagnosed with chronic endometritis underwent complex treatment and the effect of treatment was confirmed by hysteroscopy with biopsy. After treatment, all women had a further IVF attempt. The effectiveness of treatment was estimated using clinical pregnancy rate. Results. The diagnosis of chronic endometritis was confirmed be immunohistochemistry in 96,4% of women. In 16,9% of these cases hyperplastic endometrial polyps were also revealed. Those patients underwent another hysteroscopy and polypectomy. In 54,0% of cases intensity of chronic endometritis was estimated as high. Clinical pregnancy had been confirmed in 41,2% of women after complex treatment. Conclusion. Results of this research demonstrate that chronic endometritis is a state frequently associated with repeated implantation failures. The normalization of the hysteroscopic endometrial pattern was associated with a significant improvement of the reproductive outcome of the IVF and ET cycle performed after treatment.

 

Aim. A comprehensive assessment of the various links of immunity in women of reproductive age with genital infectious-inflammatory processes. Materials and methods. The study used peripheral blood of 30 patients with inflammatory diseases of the pelvic organs (IDPO), 30 patients with a viral infection of the urogenital tract (IUT), and peripheral blood of 20 apparently healthy women of reproductive age (Control). The cell immunity was evaluated by the contents of CD3 (+), CD4(+)-, CD8(+)-, CD19(+)-, CD56(+)CD16 (+) lymphocytes, the humoral level – by the concentration of serum immunoglobulins of major classes (IgA, IgM, IgG), the functions of neutrophils – in terms of their phagocytic and oxygen-dependent microbicidal functions. Results. The study of population composition of peripheral blood lymphocytes showed that the absolute and relative levels of lymphocytes in peripheral blood, CD3 (+)-, СD8 (+) lymphocytes, as well as the relative level of CD4 (+) and СD19 (+) lymphocytes, is increased in women with IDPO and IUT relatively to the age reference. Along with this, a strong tendency to decrease in the serum concentration of immunoglobulins A and M and predominant depressive changes in the neutrophilic granulocyte system were revealed in patients suffering from infectious and inflammatory diseases of the genital tract. Conclusion. The revealed immunity disorders in women of reproductive age suffering from IDPO and IUT are pathogenetically significant, and a complex pregravid immunocorrection of defects of phagocytic and microbicidal function of phagocytic cells, as well as certain parameters of cellular (quantitative deficiency of NK- and B-lymphocytes) and humoral (inadequate level of serum IgA, IgM, IgG) immunity are important for maintenance of reproductive potential.

 

Aim. To study the oxygen transport function in red blood cells and energy balance in patients suffering from epistaxis of various progress severities. In case of epistaxis a single blood loss is insignificant, yet in case of recurrent epistaxis there is a threat of a tissue hypoxia development. However no indicator blood values demanding transfusion therapy exist these days. This is a study of the blood oxygen transport function and energy balance in the red blood cells in those suffering from single epistaxis, recurrent moderate epistaxis and recurrent severe epistaxis. Materials and methods. In patients’ red blood cells a contents of 2.3-diphosphoglyceric acid (2.3-DFG) and hemoglobin oxygen affinity (Р50) were estimated; energy balance was assessed by the activity of glucose-6-phosphate-dehydrogenase (G-6-FDG), lactate-dehydrogenase (LDG), as well as by the lactate and pyruvate contents in the red blood cells and plasma. Tissue hypoxia severity was assessed by the lactate/pyruvate ratio in blood plasma. Results. It has been determined that in case of single epistaxis the studied parameters do not differ from normal ranges. In case of recurrent epistaxis the level of hemoglobin and P50 goes down, plasma LDG activity goes up, the pyruvate content goes down, while plasma lactate retains within the normal ranges. Conclusion. The stated changes in the carbohydrate metabolism in the red blood cells and blood plasma of patients suffering from severe recurrent epistaxis suggest a breakdown of compensatory mechanisms, which manifests itself in the reduced cell energy reserve and disturbed red blood cell membranes. The obtained data testify that the severity of the state of patients suffering from epistaxis is not only defined by a quantitative loss of red blood cells and hemoglobin, but also by the adaptive capacities of the body, which determine its resistance to hypoxia. The guide link in the pathogenesis of disturbed gas transport function of blood in patients suffering from epistaxis is metabolic acidosis developing as a consequence of tissue hypoxia.

 

Aim. The study of the dynamics of the syndrome of intraperitoneal hypertension and ischemic reperfusion syndrome, which cause abdominal sepsis in patients with diffuse peritonitis. Materials and methods. The course of the disease was studied in 136 patients suffering from diffuse purulent peritonitis. Four groups of patients were identified according to the level of intra-abdominal hypertension (WSACS). A retrospective assessment of the severity of the infection was carried out in accordance with the basic positions of “Sepsis-3”. The intraabdominal pressure was monitored by the Uno Meter Abdo Pressure® Kit. The level of lactate in peripheral blood was evaluated by chromatographic method. Results. In groups 3 and 4 (n=74), abdominal sepsis was in 47 patients, in 27 patients there was a septic shock. Intra-abdominal hypertension was reduced in 29 patients by naso-intestinal intubation, in 45 patients – by decompression laparostomy. Ischemic reperfusion syndrome developed in 58.6% and in 48.9% of cases, respectively. The dynamics of blood lactate and organ failure was more productive in patients with laparostomy. Mortality rate was 17.2% and 15.6%, respectively. Conclusions. The severity of reperfusion disorders in peritonitis depends on the severity of intra-peritoneal hypertension and intra-intestinal hypertension, the timing of their existence, the way and speed of decompression of the abdominal cavity and intestines. Progression of abdominal sepsis and negative dynamics of the reperfusional disorders syndrome in the postoperative period in patients with diffuse peritonitis increases lethality.

 

Aim. To perform the efficacy analysis of abdominal birth in maternity hospitals in Krasnodar Krai based on the ratio of efficiency of caesarean section (RECS). Materials and methods. A multicenter retrospective study was conducted, which included 47 maternity hospitals of Krasnodar Krai in 2016 (number of births, the percentage of surgical activity, perinatal mortality). Calculation of the ratio of efficiency of cesarean section in each of these health institutions was made. Results. Comparative analysis of the ratio of efficiency of caesarean section has revealed the high RECS in Krasnodar Krai (an average of 8,5±0,9, p>0.05). “Bad” ratio (RECS below 1.0) met 9 health establishments of Krasnodar Krai (19,1%), “satisfactory” (RECS 1.0-1.5) - 12 hospitals and “excellent” (RECS 2,0 and above) - 26 maternity hospitals. Conclusion. The effectiveness of abdominal delivery in Krasnodar Krai is high. A detailed individualized analysis of the indications for the operative births is necessary. The most effective is the creation of diagnostic coefficients of risk factors for abdominal delivery, optimization of the routing of pregnant women with complications of gestation, extragenital pathology, premature births in hospitals of the III level, and the transition of all obstetrical institutions of the region to a unified classification of M.S. Robson, which will allow not only to give a more complete analysis of the indications for cesarean section, but also to identify ways to reduce this indicator at each obstetric hospital.

 

Aim. To study the features of the diagnosis of ovarian cancer in the territory of a large agro-industrial region of Russia – Krasnodar Krai. Materials and methods. Materials for the study were data from the Population Cancer Registry of Krasnodar Krai, as well as the statistical registration form No. 1090/y "Notification of a patient with a first-time diagnosis of cancer or other malignant neoplasm". Based on data on 5 583 newly diagnosed patients with ovarian cancer for the period 2005-2014, in Krasnodar Krai, the analysis of the dynamics of the main indicators of diagnostic quality (morphological verification, stepwise diagnosis, advanced stage of disease, one-year mortality, preventive detection, etc.) taking into consideration the particular qualities of territorial location in the large agro-industrial region of Russia. The analysis of methods of treatment for the patients with ovarian cancer which are subject to special treatment was carried out for the ten-year period. Results. Analysis of the dynamics of the main indicators of the diagnosis of ovarian cancer in Krasnodar Krai for 2005- 2014 showed that the specific gravity of the morphological verification of the diagnosis in 2014 was 88.7% that is 3.1% lower than the average Russian indicator (91.5%). The level of diagnosis of ovarian cancer in the I-II stage increased by 1.5 times and amounted to 33.3% in 2014, with an average Russian indicator of 37.1%. The level of late diagnosis (III-IV stage) was higher than the Russian average by 8.9%. A low level of active diagnosis of ovarian cancer was registered, which was 15.7%, which is 13.2% lower than the Russian average (18.1%). Conclusion. Recommendations are given to practical public health services to improve the quality of medical care for patients with ovarian cancer in Krasnodar Krai.

Aim. The purpose of the study is testing and evaluation of aerocryothermal training for the restoration and expansion of the functional potential of human body. Materials and methods. The studies were conducted with the participation of 34 men of working age, divided into 2 groups: those with relatively low (group 1, 16 persons) and normal (2 group, 18 people) level of the functional potential of human body. Level of the functional potential of human body was determined using exercise tolerance test, postural change, and by the level of serum fibronectin. The subjects underwent a cycle of aerocryothermic training in the regime: 10 procedures of 2-5 minute stay in the cryocamera at a gas temperature of -150 ± 2 ° C. The procedures were performed once a day or every other day. The duration of exposure was increased in parallel with the increase in cryotherapy tolerance. Results. It was found that as a result of aerocryothermal training by the examined persons had improved hypothermia tolerance (approximately 40 % compared to the initial level), increased anaerobic physical endurance (12-20 %), orthostatic sustainability (5-10%), non-specific resistance mechanisms (18-46 %). Listed changes were more significant in subjects with low levels of the functional potential of human body. Заключение. Метод аэрокриотермических тренировок в разработанном режиме является эффективным и без- опасным средством восстановления и расширения функционального потенциала организма лиц трудоспособного возраста, повышения устойчивости к внешним воздействиям, активности защитных механизмов от внешних и вну- тренних повреждающих факторов, что позволяет рекомендовать широкое применение метода в экстремальной, профессиональной, военной, спортивной медицине. Conclusion. The method of aerocryothermic training in the developed mode is an effective and safe means of restoring and expanding the functional potential of the body of persons of working age, increasing resistance to external influences, the activity of protective mechanisms against external and internal damaging factors, which allows us to recommend the wide application of the method in extreme, military and sports medicine.

 

Aim. To study the dynamics of changes in the field of vision against the background of the treatment of glaucomous opticopathy in patients with the primary open-angle II "A" stabilized glaucoma stage by a combined method involving the use of intranasal nootropic "Semax 0.1%" and percutaneous neuroelectrostimulation using the ESOM apparatus. Materials and methods. One group of patients included 38 patients treated with the proposed method, the second group included 29 patients receiving trophic treatment. The field of vision was studied using the automatic static perimeter "Perigraph Perikom"; the data were expressed in terms of sum of degrees of computer perimetry for 8 meridians. Results. Assessment of indicators was made after the end of the course of treatment, after 1, 3 and 6 months. The improvement of the studied indicator in the first group immediately after the course of treatment was observed at 9.65%, the result remained significantly higher throughout the study period, in the 2nd group the index increased by 4.5% and after 6 months was back to the initial value. Conclusion. The combined method of treatment of glaucomous opticopathy in patients with POAG II A of the stabilized stage allows toachieve an improvement in the sum of degrees of computer perimetry for a period of up to six months. High efficiency was noted in comparison with traditional therapy.

 

Aim. In our article, we studied the possibility of remodeling of stress-induced c-fos expression damages in rat peripheral blood mononuclear cells (PBMNC) by cranial electrotherapy stimulation (CES-therapy). Materials and methods. As a model of combined stress, the present study used a forced swimming test and orthostatic stress. For the assessment of individual stress resistance, a forced swimming test was used. Evaluation of the c-fos gene expression level in PBMNC was carried out by real-time polymerase chain reaction. Leukocyte expression of c-fos is a recognized and unique peripheral biomarker of the psychogenic and somatic stress. Results. The use of CES-therapy was followed by a decrease (p=0,04) in the expression of the c-fos gene in PBMNC (0,6 as the median of treatment group vs 1,8 as median of control group). Conclusion. These results reflect the stress-limiting effect of this treatment method and correlate with the findings of previous experimental and clinical studies.

 

Aim. Identify the most informative ultrasound criteria for the pathology of the embryo and extraembryonic structures from the 8th to the 11th weeks of gestational age in order to predict the course and outcome of pregnancy for the fetus. Materials and methods. 215 pregnant women were examined during gestation from 8 to 11 weeks. Results. By calculation of sensitivity and specificity, the most informative parameters of unfavorable development of pregnancy were revealed. Parameters of adverse course and outcome of pregnancy for the fetus are the following highly specific signs: absence of yolk sac, inadequate development of yolk sac, inadequate vascularization of the chorion. Lowspecific signs are: tone of myometrium, inadequate vascularization of the yellow body. Conclusion. Ultrasound evaluation of the embryo and extraembryonic structures during gestation from 8 to 11 weeks makes possible predicting the features of the course and the unfavorable outcome of pregnancy for the fetus.

 

Aim. Study of the effectiveness of pharmacological management of experimental osteoporosis with rosuvastatin, L-norvaline and their combination in comparison with strontium ranelate. Materials and methods. Simulation of hypoestrogenic osteoporosis was performed by bilateral oophorectomy in female Wistar rats. Four weeks after the surgery, the animals were administered study drugs during 4 weeks. After 12 weeks in the experimental animals, the parameters of intraosseous microcirculation of the proximal metaphysis of the femur were analyzed and the coefficient of endothelial dysfunction was calculated on the basis of laser Doppler flowmetry data. Calculation and registration of parameters of microcirculation were performed using the Biopac systems MP-150 laser doppler flowmeter and the TSD-144 needle sensor, and the results were processed using the AcqKnowledge version 4.1-4.2 software. For a comprehensive assessment of the formation of osteoporotic shifts and the effectiveness of therapy with the drugs studied, histomorphometry of the proximal metaphysis of the femurs was performed. When calculating the width of the bone trabecula, ImageJ version 1.39 was used. Results. It was found that L-norvaline and rosuvastatin in the doses under study in monotherapy and in combination significantly increase the parameters of regional intraosseous microcirculation of the vertex femur region. The investigated drugs and their combination, in comparison with the reference preparation, have an endothelial protective activity. This circumstance favorably affects intraosseous microcirculation, which contributes to the stable course of bone remodeling and prevents progression of osteoporotic disorders. In a morphometric study, it was established that L-norvaline, rosuvastatin, and their combination in these dosages prevented a decrease in the average width of bone trabeculae to the level of animals with experimental osteoporosis. Conclusion. L-norvaline, rosuvastatin and their combination in these dosages have a significant osteoprotective effect.

 

Aim. To identify specific neurohumoral response to stress in patients with thoracoabdominal injuries and alcohol intoxication. Materials and methods. 244 patients with thoracoabdominal injuries were examined. 183 injured had the signs of alcohol intoxication, when they were admitted at the hospital. Blood pressure and heart rate were measured. Kerdo index was calculated and then evaluated over time. Venous blood samples were taken from 24 male patients before and after induction of anesthesia, during surgery, after 1, 6, 12, 24 hours. Cortisol, insulin, TTH, STH and prolactin were determined in the samples. Results. Kerdo index decreases during the time of the treatment. Kerdo index changes equally in patients with alcohol intoxication and without it. Cortisol level for the injured with alcohol intoxication increased moderately, but for longer time. The concentration of insulin, STH and TTH do not go beyond the reference values. In patients without signs of alcohol intoxication all of these biological substances have a tendency to a short-term (up to 12 hours after surgery) increase. The ratio of cortisol/insulin was significantly higher, in case the injured had signs of alcohol intoxication, indicating the predominance of catabolism and efficient use of lipids. Conclusion. An alcohol intoxication is a factor influencing the development of stress-induced response and reducing its severity in patients with thoracoabdominal injuries.

 

Aim. A comparative cytokine profile assessment of the lacrimal fluid of the eyes of patients in the clinic of traditional treatment of demodectic blepharitis, and using the course of cryotherapy of the eyelids by an autonomous cryoapplicator made of titanium nickelide. Materials and methods. Clinical studies were conducted in 65 patients with demodectic blepharoconjunctivitis (DBC). A tear of the eye was taken on the 3rd, 7th and 30th days after the traditional treatment, and using cryotherapy of the eyelids by an autonomous cryoapplicator made of porous permeable titanium nickelide cooled in liquid nitrogen. In the studied biological fluid (tear) of patients with DBC, the content of cytokines (IL1β, IL8, IFNα, IL2, IL10) was evaluated by an enzyme immunoassay. Results. The opposite nature of the changes in the balance of cytokines and the ratio of its pro and anti-inflammatory links in the time of observation was revealed. A significant dynamic increase of IFNa and IL2 content in the lacrimal fluid of the examined after cryostimulation can evidence for an adequate activation of cellular immune link under its interaction with Demodex mite antigens, as well as for reinforcing the regeneration mechanisms. Conclusion. The analysis of obtained data evidences for the high efficiency of clinical and immunological effect of lid cryotherapy method for DBC treatment.

 

Aim. To improve the results of treatment of severe chronic venous insufficiency (CEAP 4-6) using the methods of minimally invasive phlebology. Materials and methods. The study included 158 patients aged 26-72 (mean age 49,5±1,2) suffering from chronic venous insufficiency (CEAP 4-6). All patients underwent the following examination methods: assessment of subjective and objective symptoms, duplex ultrasound scan and laboratory examinations. Results. Comparative study of endovenous laser hemadostenosis of great and small saphenous veins in combination with subfascial endoscopic perforator vein surgery (SEPS) in the control group and the combined use of endovenous laser coagulation and microfoam echo-sclerotherapy in the main group showed significant benefits in the primary group in the form of a significant reduction of pain syndrome, decrease of postoperative complications, a significant reduction of terms of rehabilitation. The study demonstrated the absence of significant differences between main and control groups of respondents according to the criteria of recurrence of the disease in the late postoperative period (difference in frequency of the detected unsatisfactory effects of the studied medical interventions in the late postoperative period was not statistically significant (p=0,67). Conclusions. Positive dynamics of the combined use of endovenous laser coagulation and microfoam echosclerotherapy of the main group in the immediate postoperative period demonstrate the effectiveness of this method in patients with chronic venous insufficiency (CEAP 4-6).

 

Aim. Conducting a market analysis of the Russian and regional pharmaceutical market of phlebotropic drugs applied in complex therapy and prevention of lower extremity varicose vein disease without ulceration and inflammation. Materials and Methods. Content analysis, sociological survey/questionnaire; grouping method; segmentation and assortment analyses. Results. A content analysis of the range of phlebotropic drugs registered in the territory of the Russian Federation, a content analysis of the range of phlebotropic drugs of regional commercial wholesale and retail level, an expert assessment of the range of phlebotropic drugs. Conclusion. The outlines of the Russian commercial market sector, the regional commercial wholesale and retail sectors of the phlebotropic drugs market were formed. Based on the results of the expert evaluation, a priority assortment of phlebotropic drugs was obtained.

 

Aim. To explore the possibility for a temporary compression of the perforation hole by endobiliary stenting in close proximity of papillotomy anastomosis. Materials and methods. On the basis of clinical observations, two stenting technologies were compared experimentally in case of retro-duodenal perforation development through the pockets of hepaticopancreatic ampulla and in trial cannulation after the pre-scattering: self-expanding endoprosthesis and tight frame stenting with several plastic stents. Results. Closure of the perforation is provided due to a self-expanding stent, when it occurs in 2mm from papillotomy anastomosis. In case of perforation through the pockets of the ampoule of the major duodenal papilla both tight stenting and self-expanding stenting provide a tight closure. Conclusion. In case of retro-duodenal perforation during trial cannulation after the pre-dissection of hepaticopancreatic ampulla, the tight closure of the perforation at a distance of no more than 2 mm. from papillotomy anastomosis is provided by stenting self-expanding endoprosthesis. In case retro-duodenal perforation through the pockets of the ampulla of the Major duodenal papilla occurs, both methods (tight stenting and stenting by a self-expanding stent) ensure tight closure of the perforation.

 

Aim. To carry out literature analysis devoted to pathological mechanisms of delayed union and nonunion of limb fractures and the influence of various osteosynthesis strategies on bone healing in polytrauma. The risk of bone fractures nonunion in polytrauma increases with high-energy complex comminuted and open fractures with severe injuries of soft tissues and bones, bruised lung, shock and severe massive blood loss. The development of a systemic inflammatory response affects local immune responses in the fracture zone to the early inflammatory phase of bone healing and disrupts subsequent osteogenesis and angiogenesis processes. Early stable-functional osteosynthesis using minimally invasive techniques creates optimal conditions for bone healing. When following the tactics of the stepwise treatment of Damage Control Orthopedics, the risk of infectious complications and fracture nonunion increases with the duration of treatment in the apparatus of external fixation. Conclusion. In polytrauma a violation of consolidation of bone fractures of the extremities occurs more often than in isolated trauma. Risk factors of fracture nonunion in polytrauma are the severity of bone and soft tissue damage, shock, acute blood loss and systemic inflammatory response, as well as unjustified delay in the final stable fixation of long bones fragments or using traumatic methods of their early osteosynthesis without taking into account the severity of the condition of the injured.

 

Aim. Systemization and analysis of published data to define terminology, risk factors, diagnostic methods and treatment strategy for ectopic mural pregnancy. Materials and methods. Keyword search of information published on electronic bibliographic databases PubMed and Cochrane Library. Limitations: English language, period till October 31, 2017 inclusive. For analysis we curated studies containing information about risk factors, diagnostic methods and criteria and treatment methods or prospective observation of ectopic mural pregnancy. The studies were divided in following categories: case report, review, clinical trial, randomized clinical investigation, systematic reviews and meta-analyses; abstracts and articles were calculated separately. Results. We found 1425 sources corresponding to the keywords. Among 1006 studies included in the review according to inclusion criteria there were 236 articles and 770 abstracts of which there were 863 case reports, 129 reviews, 5 clinical trials, 4 randomized clinical investigations, 5 systematic reviews. Ectopic mural pregnancy includes different forms with specific risk factors; in some cases pregnancy prolongation till fetus livability is possible. The main diagnostic method is ultrasound. Diagnostic terms and treatment methods are not standardized. Conclusion. Due to the rarity of this pathology and high risk of dangerous complications including fertility loss and lethal outcomes there is a need for a national audit of mural ectopic pregnancies with a database establishment for possible outcomes analysis and an individual prognosis assessment. It is necessary to develop clinical guidelines to raise the level of doctors’ awareness about the rare forms of ectopic pregnancies and improve standards of medical treatments.

 

Aim. The article reflects modern representations of the influence of the traumatic occlusal factor in the pathogenesis of the dynamics of dysfunction of the masticatory musculature, TMJ and inflammatory processes in the periodontium. The main attention is paid to the influence of occlusal factors in the dynamics of the pathological process on the function of the masticatory muscles and the TMJ, and the role of traumatic occlusion on the state of the morphological formations of the periodontium. The enzymatic systems of neutrophil granulocytes and oxidoreductase are important in the disturbance of oxidation-reduction processes, which, in turn, contributes to the growth of intracellular hypoxia with the intensification of destructive processes in the alveolar part of the jaws. To develop a harmonious occlusion, further complex studies of the dentofacial system are needed. Conclusion. The dentofacial system functions on the basis of the complex interaction of the masticatory apparatus which is coordinated by the system of a trigeminal nerve with all its structural components. The complexity of diagnosis and therapy of neuromuscular and articulatory-occlusive syndromes is associated with various concepts about the etiology and pathogenesis of these disorders against the background of a similar clinical picture of their various forms and inadequate methods of treatment.

 

Aim. To demostrate the complexity of the diagnosis and the consequences of the effect of insufficient hormone replacement therapy on the prognosis of the patient with the viril form of congenital adrenal cortical hyperplasia. Materials and methods. A retrospective analysis of anamnestic data, the course of the disease, laboratory and instrumental data and ongoing treatment throughout the life of the patient from birth to 23 years was carried out. Results. Since the diagnosis was established, frequent changes in periods of decompensation and compensation were observed, which led to the development of central and peripheral adenomatosis – adrenal hyperplasia, pituitary microadenoma, development of the polycystic ovary syndrome. Сonclusion. This case shows the importance of compensation for congenital adrenal cortical hyperplasia at all stages of ontogenesis to prevent the development of complications.

 

A department of cardiovascular surgery was created, which performed the functions of the cardiosurgical center of the Kuban. Surgical treatment of congenital and acquired heart diseases began in Krasnodar in 1959. The surgeries were performed under endotracheal inhalation anesthesia without an artificial circulatory system under hypothermia. Over the first 16 years, more than 600 surgeries were performed. Right-sided thoracotomy access to the mitral valve was used through a stratified interatrial septum. Finger and instrumental commissurotomy through the heart’s auricle were introduced into clinical practice. In 1969, V. V. Kopteltsev summarized the experience of surgical work in his doctoral dissertation "Surgical treatment of patients with mitral stenosis".