OBJECTIVE. The authors assessed an impact of the design of biological prosthesis on efficacy of aortic valve replacement in elderly patients. MATERIAL AND METHODS. Randomized parallel controlled prospective study was carried out. The patients were divided into groups with stented and stentless prostheses. A value of peak valve gradient was determined as a primary end point. RESULTS. The peak gradients were significantly higher in the first group than in the second group. There was noted a significant difference in value of miocardial hypertrophy of the left ventricular (mass index of the myocardium) during 30-day terms after operation. CONCLUSIONS. The final results would be possible to consider after the end of the study. The results of intermediate analysis supported the validity of the proposed hypothesis.

OBJECTIVE. The authors assessed possibilities of endoscopic methods for restoration and maintenance of trachea patency. MATERIAL AND METHODS. The article presents results of endoscopic treatment of 26 patients with trachea tumors. Tumor lesions of trachea was the main cause of contraction (primary tracheal cancer had 9 patients; esophageal cancer with invasion inside trachea - 5 patients; relapse of trachea cancer - 1case; relapse of larynx cancer - 1 case; lung cancer with invasion inside trachea - 3 cases; thyroid cancer - 2 patients). RESULTS. Endoscopic interventions were applied in order to restore the trachea patency such as tumor bougienage, electro-excision, tumor cutting, trachea stenting. There was observed bleeding in 3 patients, though it didn’t influence on operation approach. The patency of trachea was restored in all cases. Trachea stenting was performed in 19 patients as a preventive measure (silicone stents in 4 cases; self-expandable metal stent in 15 cases). Medical care remained actual in both restoration and trachea patency supporting. CONCLUSIONS. Endoscopic methods showed the high efficacy in treatment of patients with trachea tumors.

OBJECTIVE. Structural and functional properties of erythrocytes were researched in patients with benign obstructive jaundice of different degree of severity. MATERIAL AND METHODS. Patients (n =81) with obstructive jaundice of benign genesis were examined at the period from 2013 till 2016. The control group consisted of 29 healthy patients. The atomic-force microscopy of erythrocytes was applied in all patients in order to study structural and functional properties of erythrocytes. RESULTS. There was noted, that growth of bilirubin conсentration caused the increase of erythrocyte size. Binocave red blood cells acquired horizontal orientation in patients with B class of obstructive jaundice. Erythrocytes transformed to domed stomatocyte and their square increased, volume of red cells become twice more compared with normal state in patients with C class of obstructive jaundice. CONCLUSIONS. The degree of severity of obstructive jaundice caused red cell transformation. The binocave erythrocytes changed to the domed stomatocytes. This transformation significantly increased erythrocyte volume, the number of ruptures and their volume on bilipidic membrane layer.

OBJECTIVE. This work investigated an influence of high-temperature oscillation plasma flow on hypoderma and determined the degree of influence on lymphatic vessels. MATERIAL AND METHODS. The experiment was carried out on 15 guinea pigs, that were divided into 5 groups (3 species in each group). An incision of derma and hypoderma was performed in dorsal area. The control group was the first and their incised tissues were used for comparative morphological analysis. Hypoderma has been treated by high-temperature oscillation plasma flow using Plasma.Jet to achieve coagulation homeostasis in the second group. Excisional biopsy was made immediately after tissue processing by Plasma.Jet in this group. Biopsy was performed on the third day in the third group. It was on the fifth day in the fourth group and on the seventh day in the fifth group. RESULTS. According to histological and immunohistochemical study, it was stated that optimal hemostasis was achieved due to coagulation without necrotic changes and absence of lymphorrhea. CONCLUSIONS. The developed method of hemostasis allowed doctors to reduce complication rate in postoperative period.

OBJECTIVE. The article analyzed an efficacy and safety of application of neoadjuvant chemoradiotherapy (CRT) in elderly and senile patients with rectal cancer. MATERIAL AND METHODS. An analysis of treatment results was made in 267 patients, who were divided into two groups. The first group (n = 142) underwent combined treatment that included prolonged course of neoadjuvant CRT followed by surgery. The second group of 125 patients underwent surgery without application of CRT. The patients of both groups were subdivided according their age. The subgroup “A” consisted of young and middle age patients. The subgroup “B” included geriatric patients. Comparative analysis was made between the same age subgroups. RESULTS. The age factor didn’t significantly influence on the risk of complications of neoadjuvant CRT and its adverse effects on subsequent outcome of surgery. The application of preoperative CRT in geriatric patients accompanied by less significant growth of recurrence-free survival compared with young patients. CONCLUSIONS. The age factor shouldn’t restrict the application of neoadjuvant CRT in patients with satisfactory general health status and absence of tumor complication process.

OBJECTIVE. The authors developed the management strategy of emergency care for patients with acute spinal surgical pathology in conditions of megapolis. MATERIAL AND METHODS. A comparative statistical analysis was made in 2627 patients. The patients (n =777) underwent treatment in multicenter hospitals of emergency care of the spine (decentralized system). The other patients (n = 1850) were treated in Municipal Center of Emergency Surgery of the Spine (centralized system). RESULTS. It is appropriate to establish departments of emergency surgery of the spine on the base of separate multicenter hospitals in megapolis. These hospitals should be properly equipped and they should have specially trained doctors and nurses, stable financing, effective management on admission to hospital. CONCLUSIONS. The efficacy of proposed measures allowed authors to recommend them to wide practical application.

OBJECTIVE. Clinical efficacy of extraperitoneal pelvic packing for hemostasis was assessed in patients with unstable pelvic ring injuries and signs of unstable hemodynamics. MATERIAL AND METHODS. The results of treatment were analyzed in 19 patients with hemodynamically unstable pelvic ring injuries. Extraperitoneal pelvic packing was applied in order to stop bleeding after mechanical pelvic stabilization. The evaluation of hemostasis efficacy was performed by using computerized helical tomography with intravenous contrast. RESULTS. The extraperitoneal pelvic packing allowed doctors to achieve stop of bleeding in 14 (73,7 %) patients. CONCLUSIONS. Complex of mechanical stabilization and extraperitoneal pelvic packing of damaged pelvic ring could be actively used in cases of severe injuries for victims in critical conditions.

OBJECTIVE. Comparative analysis of transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) plastic surgeries was made in case of inguinal hernia repair. MATERIAL AND METHODS. Patients (n =236) underwent surgery at the period from 2012 till 2016. The TAPP was performed in 114 (48,3 %) patients and TEP was carried out in 122 (51,7 %). Clinical analysis of results was made in two groups. RESULTS. The research didn’t show any significant difference in the rate of intra- and postoperative complications and recurrences, but their structure varied. However, length of operation was less in case of one-sided hernia in TAPP group, although it was less in case of two-sided hernia in TEP group. An expression of pain syndrome was reliably lower in TEP group. CONCLUSIONS. Both methods demonstrated similar results and could be applied in treatment of inguinal hernias.

OBJECTIVE. Comparative assessment of results was made in application of synthetic and biological implants for rectocele repair. MATERIAL AND METHODS. The patients (n = 61, aged 34-61 years old) underwent operation concerning an isolated rectocele at the period from 2012 to 2015. Diamond-shaped plasty was performed using transvaginal approach. Synthetic composite mesh was used in 33 patients of the first group and biologic implant was applied in 28 women of the second group. RESULTS. Defecography showed reduction of middle size of rectocele in both groups in term of one year after surgery. However, the difference was insignificant in patients with biological implants. According to individual comparative analysis, the patients (n =9 (32,1 %) of the second group had the same size of rectocele as it was in preoperative period, but only 3 (9,1 %) patients of the first group had the same proportion. CONCLUSIONS. The anatomic results were significantly worse after application of biological implants, which appeared to be less reliable.

OBJECTIVE. The study investigated the role of stenosis of brachiocephalic arteries in development of postoperative complications in patients, who underwent the coronary bypass grafting (CABG) and operations concerning heart valve pathology in conditions of extracorporeal circulation. There were observed such complications as stroke (n = 4) and hypoxic ischemic encephalopathy with delirium in postoperative period. MATERIAL AND METHODS. The research was carried out in 21 patients on the base of Center of сardiosurgery and interventional cardiology of St. Petersburg Multifield Center. All the patients were male aged 64±6,9 years. RESULTS. The study showed that risk of cerebral complications, especially hypoxic ischemic encephalopathy with delirium, could increase in case of bilateral carotid stenosis combined with hemodynamically insignificant unilateral vertebral artery stenosis. The significant hemodynamic branchiocephalic arterial stenosis caused chronic and acute clinical signs of cerebrovascular insufficiency in anamnesis. CONCLUSIONS. The high risk of development of severe cerebral complications was associated with hemodynamically significant bilateral carotid stenosis accompanied by hemodynamically significant uni- and bilateral stenosis or one-sided occlusion of cerebral artery. Management of treatment should take into account risk factors of cardiosurgical patients.

OBJECTIVE. Modern data analysis of the rate of pulmonary embolism (PE) development was made. A comparative analysis of epidemiology dynamics of diseases was carried out and included of the past 40 years. MATERIAL AND METHODS. The retrospective analysis of 2042 autopsies was conducted in autopsy department of Municipal clinical hospital №1 named after N. I. Pirogov at the period from 2011 to 2013. According to results of necropsies, 440 samples of pulmonary embolism of different localization and their terms were found. RESULTS. Conducted study demonstrated a relative growth of the development rate of pulmonary embolism and fatal pulmonary embolism. Pulmonary embolism had been revealed by autopsy in 4,4 % patients in 1964-1973, but the rate of PE increased to 21,5 % in 2011-2013. The fatal PE was noted in 9,3 % of autopsies in 2011-2013, though it counted 2,5 % in 1964- 1973. CONCLUSIONS. The rate of pulmonary embolism development increased in 5 times. The growth of the PE rate was revealed in postoperative period and significant part of complications (18,5 %) were associated with fatal PE.

OBJECTIVE. The research demonstrated possibilities of low invasive methods in treatment of retroduodenal perforations in patients with choledolithiasis complicated by obstructive jaundice. MATERIAL AND METHODS. Methods of treatment management were described in patients with retroduodenal perforation after endoscopic papillosphicterotomy and lithoextraction. RESULTS. The low invasive methods, which were described in this article, allowed doctors to cope with retroduodenal perforation without open surgical interventions. CONCLUSIONS. The choice of management strategy of patients with retroduodenal perforation depended on the time period, when it was revealed. Combined endoscopic and percutaneous methods could be successfully applied in treatment management of patients with retroduodenal perforation.

OBJECTIVE. The research showed the possibility of operative treatment of patients with terminal stage of respiratory failure who underwent long-term oxygen therapy. MATERIAL AND METHODS. Surgical correction of respiratory failure was performed for two patients after clinical, functional and radio studies. RESULTS. The degree of arterial hypoxemia significantly decreased after operation due to improved ventilation of maximally saved pulmonary tissue areas. This allowed doctors to apply a situational oxygen therapy. Tolerance of physical activity reliably improved and value of BODE-index decreased. CONCLUSIONS. The terminal stage of respiratory failure couldn’t be a contraindication to surgical treatment.

OBJECTIVE. The authors evaluated the first European experience of fluorescence thoracoscopy with indocyanine green (ICG) in light spectrum which was approximated to near-infrared (NIR) in thoracoscopic segmentectomy (VATS segmentectomy). MATERIALS AND METHODS. The study covered 21 patients who underwent thoracoscopic segmentectomy during 2016. The ICG (0,15 mg/kg of body weight) was injected intravenously after dominant pulmonary artery ligation during operation. The boundary line between areas was marked by electrocautery at the border of fluorescence. RESULTS. The well-defined fluorescence borders were observed in 18 out of 21 patients (85,7 %). The median duration of intensive ICG staining was 95 sec and that was enough to mark intersegmental plane. The intraoperative verification was unsuccessful in 2 patients due to technical reasons. The first attempt of identification for the patient with severe COPD had unconvincing results and an additional ICG injection was used to achieve the precise fluorescence. There wasn’t revealed any complications associated with ICG injection. CONCLUSIONS. The ICG fluorescence is safe and effective method of segmental plane location. The implementation of this method significantly facilitates in thoracoscopic segmentectomy. The NIR fluorescence imaging systems allow clinicians to work with lower doses of ICG.

OBJECTIVE. The authors investigated the ways of improvement the results of treatment and diagnostics of patients with strangulated inguinal hernias. MATERIAL AND METHODS. An analysis of diagnostic and treatment results was made in 136 patients. The main group included 52 patients who underwent treatment at the period from 2015 till 2016. An individual treatment and diagnostic strategy was applied for these patients, where diagnostic and therapeutic laparoscopy was actively used. The control group consisted of 84 patients who were treated at the period from 2011 till 2014. There was a common diagnostic and treatment strategy. That management led to late diagnostics and unsatisfactory treatment results. RESULTS. The research showed that the rate of common complications decreased from 25 to 1,9 % and the rate of local complications reduced from 29,8 to 5,7 % (p < 0,05). The lethality dropped from 8,3 to 0 %. CONCLUSIONS. The application of individual diagnostic and treatment approach allowed doctors to reduce levels of common and local complications and morbidity rate in patients with strangulated inguinal hernias.

OBJECTIVE. The authors studied the rate of bleeding from cystic cavity of the pancreas and analyzed the completed treatment. MATERIAL AND METHODS. The article presented an experience of treatment of 155 patients with chronic cystic pancreatitis. Pseudocysts complicated by hemorrhage into their cavity in 8 patients. The signs of gastroduodenal and intraabdominal bleeding had 5 patients. RESULTS. Suturing of bleeding vessels, extirpation of the stomach, external drainage of pancreatic cysts and gastrocystoanastomosis were immediately performed in 5 patients. Diagnostic angiography was conducted in order to localize a source of bleeding with subsequent attempt of endovascular occlusion of this vessel in 3 patients. Endovascular occlusion stopped bleeding in 2 cases, though it caused a spiral migration and lethal outcome in one case. CONCLUSIONS. Bleeding from the pancreatic cysts was difficult to diagnose. This pathology left the only surgical method of saving patient in most cases.

OBJECTIVE. The study determined an optimal method of surgical treatment of Zenker-diverticulum. MATERIALS AND METHODS. The patients (12 men) were examined using X-ray contrasting of the esophagus and fibroesophagoscopy. The planned diverticulectomy from cervical access was performed on all patients. RESULTS. The treatment was without complications and the patients had favorable outcomes and good long-term results. CONCLUSIONS. The open diverticulectomy using cervical access is the operation of choice.