OBJECTIVE. The study aimed to raise an efficacy of motor functions after stenting of precerebral arteries in acute period of ischemic stroke in patients of elderly and senile age. MATERIAL AND METHODS. Treatment efficacy was assessed according to dynamics of neurological status, data of duplex scanning of brachiocephalic vessels, index of mobility «Rivermed», scale «Bartel» in 30 patients. RESULTS. Stenting of precerebral arteries in acute period of ischemic stroke facilitated to regress of motor disorders and normalized cerebral hemodynamics. CONCLUSIONS. Stenting is an alternative method to carotid endarterectomy. This approach should be applied in patients with expressed carotid stenosis in combination with accompanied diseases and high surgical risk.

OBJECTIVE. The authors developed methods and assessment of efficacy of infrared fluorescence imaging of pleural carcinomatosis using indocyanine green (ICG). MATERIAL AND METHODS. The prospective study included 14 patients with malignant pleural carcinomatosis. All patients underwent standard thoracoscopy with pleural biopsy, then pleural cavity was examined under fluorescence control using ICG solution. Comparison of accuracy of biopsy materials obtained in white light and fluorescence was made. RESULTS. Signs of malignancy had 21 biopsy specimens out of 28, which were obtained in white light (in 12 patients out of 14). Research of biopsy specimens using fluorescence allowed doctors to make the precise diagnosis in all 14 patients, with 33 out of 34 biopsy materials being informative. CONCLUSIONS. Intraoperative application of infrared ICG fluorescence developed accuracy of biopsy and histological verification of the diagnosis.

OBJECTIVE. The author designed an optimal treatment strategy in patients with opisthorchosis papillitis complicated by development of cholangitis. MATERIAL AND METHODS. Retrospective analysis of treatment results of 384 patients with opisthorchosis lesions of bile ducts was made. The patients were divided into randomized groups associated with applied surgical approaches. RESULTS. There was revealed an advantage of staged method of surgery performance. Practicability of application of minimally invasive and organ-saving methods was shown in initial stages of disease. Clinical version of classification of opisthorchosis papillitis were presented. СONCLUSIONS. Treatment management of patients with opisthorchosis papillitis should be based on the process stage and it should be maximally organ-saving.

OBJECTIVE. The study investigated the efficacy of minimally invasive interventions in patients with sterile form of pancreatonecrosis. MATERIAL AND METHODS. There were 202 patients with sterile form of pancreatonecrosis during 5 years. Local complications such as acute fluid clusters were revealed in 136 (67,3 %) and dense infiltrates were noted in 66 (32,7 %) patients. Minimally invasive surgeries were performed on 132 (65,3 %) patients. RESULTS. Pathological process was successfully treated in 97,2 % patients by using given methods and convertion to open surgery was performed in 2,8 % patients. CONCLUSIONS. The application of minimally invasive methods was final in 97,2 % patients with sterile form of pancreatonecrosis without lethal outcomes.

OBJECTIVE. The study substantiated the possibility of application of sodium hypochlorite for treatment of infected pancreatonecrosis. MATERIAL AND METHODS. The experimental study was conducted on 288 rats. Clinical research was carried out on 94 patients who were divided into two statistically homogenous groups. «Levomecol» ointment was used in the first group for sanation of omental bursae (lesser sac). The immobilized form of sodium hypochlorite was applied for the second group. RESULTS. Anti-inflammatory activity of immobilized form of sodium hypochlorite exceeded this activity in case of «Levomecol» application in 1,2-1,4 times. Anti-microbial activity was higher in 1,6-1,8 times at different terms of treatment of experimental animals. The proposed method of treatment of infected pancreatonecrosis allowed doctors to decrease the number of postoperative complications in patients on 11,2 % and lethality - on 9,2 %. CONCLUSIONS. It was stated that the application of immobilized forms of sodium hypochlorite for sanation of the omental bursae was pathogenically justified and efficient.

OBJECTIVE. The authors assessed an efficacy of correction of visceral blood flow and oxygen-carrying function of portal blood in patients with diffuse purulent peritonitis. The intraportal infusion therapy was applied using ozone-saturated solutions. MATERIAL AND METHODS. There were investigated the dynamics of index changes in blood flow of the portal vein, common hepatic artery, superior mesenteric artery and main parameters of oxygenation of system and portal blood. RESULTS. There was found that the application of intraportal infusion therapy facilitated to hepatic and mesenteric blood flow, oxygen-carrying function of portal blood and liver oxygenation. The method helped to restore liver function and eliminated enteral disfunction and it decreased severity of patients’ state that allowed doctors to improve treatment outcomes. CONCLUSIONS. The intraportal infusion therapy using ozone-saturated solutions is an important part of treatment management in severe forms of purulent peritonitis.

OBJECTIVE. The study determined the efficacy of endoscopic transpapillary methods in diagnostics and treatment of patients with obstructive jaundice of different etiology. MATERIAL AND METHODS. The efficacy of endoscopic methods of diagnostics and treatment was analyzed in 1508 patients with obstructive jaundice (obstruction of bile outflow and increased bilirubin level more than 20 mkmol/l) at the period from 2008 to 2015. There was applied all possible methods of diagnostic and treatment endoscopic transpapillar interventions. RESULTS. The surgeries were efficient in 1463 (97,02 %) patients and they were ineffective in 45 (2,98 %) patients. There weren’t any lethal outcomes. CONCLUSIONS. The application of endoscopic interventions is a compulsory condition of the work of gastroenterological center.

OBJECTIVE. The study aimed to develop diagnostics and treatment of urinary dysfunction in patients with unsatisfactory results of surgery of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS. The urodynamic studies were made for 93 (72,7 %) patients after transurethral resection of the prostate and 35 (27,3 %) patients after open adenomectomy. All the patients had urinary dysfunctions after surgery of BPH. RESULTS. Detrusor hyperactivity was revealed in 51 (39,9 %) patients. Detrusor hypoactivity was noted in 21 (16,4 %) patients. Combination of detrusor hyperactivity during storage phase and detrusor hypoactivity during emptying phase had 25 (19,5 %) patients. Infravesical obstruction was detected in 22 (17,2 %). Urgent incontinence was diagnosed in 10 cases. There were 9 patients with signs of stress and condition combined with predomination of stress component. Treatment depended on the causes of urination dysfunction. CONCLUSIONS. Results of urodynamic studies allowed doctors to implement pathogenically verified therapy of urinary dysfunction after surgery of benign prostatic hyperplasia and improve its efficacy.

OBJECTIVE. The authors researched the ways of improvement of treatment results in patients with complicated forms of erysipelas. MATERIAL AND METHODS. There were examined 68 patients with erysipelas complicated by abscess, phlegmon or necrosis of soft tissues. Basic treatment was used for the first group of patients. Combination of basic treatment and application of titanium glycerosolvate aquacomplex were carried out in the second group. Basic treatment and immunomodulator Derinat were applied in the third group. Combined therapy including titanium glycerosolvate aquacomplex and Derinat was used in the fourth group. RESULTS. Prescription of Derinat for patients with erysipelas allowed doctors to eliminate symptoms of general intoxication in more earlier terms compared with сonventional treatment. The application of Derinat stimulated T-and B-сomponents of immune system. The local application of Tizol facilitated to earlier decrease of inflammation and it stimulated regeneration processes in the wound. CONCLUSIONS. The therapy of destructive forms of erysipelas which included Derinat and Tizol shortened the terms of cleansing and repair of purulent wounds. This method increased the efficacy of treatment of given class of patients.

OBJECTIVE. The authors developed the integral criterion of prediction of endogenous intoxication in acute peritonitis based on evaluation of homeostatic disorders in blood plasma. MATERIAL AND METHODS. The patients (42) with peritonitis of moderate severity aged from 20 to 59 years old were examined. Calculation of prediction index of endogeneous intoxication using the proposed formula was made. RESULTS. Given clinical and laboratory data showed that the severity of peritonitis was caused by endogeneous intoxication, which was associated with intensification of lipid peroxidation process. The proposed index of prediction of endogenous intoxication allowed doctors to perform an accurate and adequate prevention of the possibility of endogeneous intoxication progress in acute pancreatitis. CONCLUSIONS. There was demonstrated the high efficacy of new integral criterion of prediction of endogeneous intoxication in acute peritonitis.

OBJECTIVE. The study assessed the efficacy of anatomic cruciate ligament reconstruction (ACL-R) with antegrade bone-tendon-bone (BTB) graft performance. MATERIAL AND METHODS. The arthroscopic reconstructions of ACL were analyzed in 91 patients. The antegrade ACL-R was carried out in the first group (33 %) patients. The antegrade isometric (non anatomical) ACL-R was made in the second group (26,4 %). The retrograde anatomical plasty of ACL was performed in the third group (40,6 %). RESULTS. The rates of front and rotary stability of the knee joint and quality of life were higher in the first and the third groups. There were rarely noted degenerative changes of joint. CONCLUSIONS. The antegrade anatomical plasty should be considered as a preferable version due to relative simplicity of the method and high anatomico-functional results and at the same time, this method had significant economic benefits.

OBJECTIVE. The authors compared results of changes in clinical and radial studies of vertebral arteries in case of trauma of cervical spine. MATERIAL AND METHODS. An analysis of data of complex examination and treatment was made in 157 victims aged 38,5 ± 1,5 years old. RESULTS. Pathology of vertebral arteries was detected in 68,8 % cases. The main ultrasound syndromes were deformations of speed with local hemodynamic significance, compression with systemic deficiency of blood flow, irritative effects, extravasal changes on the level of V-3 segment, thrombosis and dissection. CONCLUSIONS. The development of hemodynamically significant local effects on the vertebral artery depended on degree of stenosis and cross-section area of its canal.