OBJECTIVE. The authors would like to reveal preoperative and intraoperative predictors of lethal outcome in patients with otogenic and rhinosinusogenic pyoinflammatory intracranial complications. The study assessed an efficacy of specialized medical care of this category of patients. MATERIAL AND METHODS. Тhis research included 303 patients (199 (65,68 %) men and 104 (34,32 %) women) aged from 39,3 ± 17,4 years on average who underwent operation concerning intracranial pyoinflammatory oto- and rinosinusogenic complications in multidisciplinary hospitals of different subjects of the Russian Federation at the period from 2000 to 2014. RESULTS. Multiple logit regression analysis of predictors of lethal outcome showed the presence of higher number of factors and errors which influenced on treatment during preoperative period. These factors and errors caused an extension of preoperative period and increase of unfavorable outcome. CONCLUSIONS. While planning the management of primary and specialized care, doctors should take into account the identified predictors for patients of this category.

OBJECTIVE. The authors evaluated the role of antibodies to striated muscle and acetylcholine receptors in diagnostics of myasthenia gravis and thymoma, as well as outcomes of thymectomy and prognosis of myasthenia course. MATERIAL AND METHODS. The study investigated correlations of antibody content to striated muscles and acetylcholine receptors from the presence and size of thymoma, myasthenia in 157 patients with various pathologies of the thymus. The dynamics of antibody concentrations was followed up after thymectomy. RESULTS. Antibody titer to striated muscle depended on the presence and size of thymoma, severity of myasthenia and changed after thymectomy. Concentration of antibodies was associated with the presence of thymoma and it didn’t change after surgical treatment. Thymoma wasn’t revealed in patients who were seronegative to both antibodies. CONCLUSIONS. Seropositivity according to one of antibody could indicate the presence of thymoma, but its absence to both antibodies allowed doctors to eliminate this diagnosis. Antibodies to acetylcholine receptors are important markers of myasthenia. Monitoring of antibody titer dynamics to striated muscles after thymectomy could be useful for assessment of response to surgical treatment and prognosis of course of myasthenia.

OBJECTIVE. The authors investigated pulmonary-pleural complications of pancreatitis and evaluated results of CT examination in diagnostics and possibility of low invasive surgery in treatment of pancreaticogenic pleurisy. MATERIAL AND METHODS. A retrospective analysis was made of 156 medical histories of patients with acute pancreatitis and their results. An ultrasound examinations of the chest and CT scan were applied in order to determine lung tissue condition and presence of fluid in pleural cavities. RESULTS. The application of CT in diagnostics of pulmonary-pleural complications allowed doctors to identify an effusion in pleural cavities in 3,5-50 % patients with acute pancreatitis. The number and localization of effusions were defined more precisely. CONCLUSIONS. Mini-invasive procedures (puncture, videothoracoscopy) with examination of exudate on amylase activity and biopsy of pleura determined the causes of pleuritis. This was effective in pleritis elimination against a background of different methods of treatment of pancreatitis.

OBJECTIVE. The aim of the study was to estimate the efficacy of new method of reinfusion of extracorporeal modified ascitic fluid in therapy of diuretic resistance ascites in patients with liver cirrhosis and portal hypertension syndrome. MATERIAL AND METHODS. An analysis of treatment was made in 83 patients, who underwent laparocentesis and ascitic fluid evacuation. The patients were divided into two groups. Laparocentesis and fractional evacuation of ascitic fluid were carried out for the patients of the first group (n=40). This procedure was followed by intravenous infusion of 25 % albumin (10 g of albumin on each 2 litres of removed fluid) in order to make up losses of protein. Laparocentesis and ascitic fluid evacuation with following extracorporal processing and reinfusion were performed for the second group of patients (n=43). RESULTS. There was noted an increase of day diuresis from (620,0 ± 110,0) ml to (2,2 ± 0,4) l compared with the first group from (780 ± 80) ml to (1,2 ± 0,5) l and rise of sodium excretion (132 ± 7) mmol/l compared with the first group - (120 ± 6) mmol/l. An average molecular peptide concentration was decreased in blood plasma to (0,254 ± 0,098) units in the second group and it counted (0,298 ± 0,045) units in the first group. CONCLUSIONS. Reinfusion of extracorporeal modified ascitic fluid was more effective than conventional correction of albumin level and electrolytes disturbances against a background of ascitic fluid evacuation.

OBJECTIVE. The study identified predictors of endocrine detection of sperm in case of open testicular biopsy in patients with non-obstructive azoospermia. MATERIAL AND METHODS. The research was based on the results of examination and testicular biopsy of 76 patients with secretory azoospermia aged from 20 to 55 years old. The instrumental, laboratory, physical methods of research were carried out for all the patients before performing of the open biopsy for testicular sperm extraction. Hormone levels were determined in blood plasma such as luteinizing hormone, follicle stimulating hormone, prolactin, total and free testosterone, estradiol and sex steroid binding globulin. Patients were divided into two groups. The first group consisted of patients (n =43) whom sperms were found in testicular biopsies. The second group included patients (n = 33) whom sperms weren’t detected. RESULTS. Сonсentration of follicle stimulating hormone in blood plasma was the most significant hormone predictor. It was found that follicle stimulating hormone level between 12 and 16 IU/L indicated to the low probability of sperm presence in testicular biopsies and in case it was less than 17 IU/L the probability was extremely low. There was also established that elevated follicle stimulating hormone levels in patients older than 26 years pointed to the low probability of finding sperm using open testicular sperm extraction. CONCLUSIONS. Increase of luteinizing hormone, follicle stimulating hormone or their correlation in blood plasma indicates to a low probability of finding sperm by open testicular sperm extraction. The concentrations of testosterone, sex steroid binding globulin, prolactin and estradiol in the blood plasma weren’t reliable predictors of finding sperm in testicular biopsies.

OBJECTIVE. Тhе article considered the various modern techniques of panсreatoenteroanastomosis formation and their results from critical positions. MATERIAL AND METHODS. The authors suggested to apply a new method of panсreatoenteroanastomosis formation in order to decrease the rate of lethality, postoperative complications and traumatic conditions after operation. RESULTS. The developed method of panсreatoenteroanastomosis formation was used in 25 patients with chronic pancreatitis at the period from 2015 to 2016. CONCLUSIONS. The satisfactory results were obtained and that confirmed the efficacy and significance of the method.

OBJECTIVE. The article analyzed the results of application of combined dyslipoproteinemia treatment including partial ileoshunting operation in combination with statins. MATERIAL AND METHODS. The dynamics of blood lipid levels during combined treatment of dyslipoproteinemia was studied in 56 patients with different clinical manifestations of atherosclerosis. RESULTS. Combined hypolipidemic therapy reduced total cholesterol levels by 42,3 % and LDL-cholesterol by 54,7 %, increased HDL-cholesterol by 24 % and decreased atherogenic index of plasma by 61,8 %. CONCLUSIONS. The application of atorvastatin therapy using10 mg/day allowed doctors to decrease the preoperative concentration of LDL-cholesterol levels twice in majority of cases (81,3 %). This method was used for patients who underwent partial ileoshunting operation because of acquired dyslipoproteinemia.

OBJECTIVE. The authors analyzed the efficacy of bleomycin application as sclerosing agent in patients with transudative pleural effusion in consequence of hepatic failure. MATERIAL AND METHODS. The research included 7 patients with right side hepatic transudative pleural effusion who didn’t respond to conservative medical treatment. Drainage of the right pleural cavity with following injection of bleomycin were performed for all the patients. RESULTS. This procedure was effective in 6 out of 7 patients (86 %). There was a single case of recurrence and lethal outcome (14 %) due to hepatic coma. There weren’t noted any severe side effects during 6 months after induction of bleomycin. CONCLUSIONS. Pleurodesis using bleomycin appeared to be effective and safe method of treatment for patients with hepatic transudative pleural effusions.

OBJECTIVE. The article analyzed the experience of treatment of endometriosis-related pneumothorax (ERP). MATERIAL AND METHODS. The diagnosis of ERP was detected in 30 women at the period from 2004 to 2015. A control group consisted of 149 women. RESULTS. Statistically significant differences associated with presence of ERP were the elder age, right-side localization and recurrence course of disease. Diaphragmatic fenestrations and endometriotic ectopy and their combinations were specific findings in ERP-group. This group of patients characterized by frequent recurrences and higher rate of complications. The most effective method of treatment of ERP was diaphragm resection with pleurectomy and hormone therapy from 3 to 6 months after surgery. CONCLUSIONS. Endometriosis-related pneumothorax could cause up to 34 % cases of spontaneous pneumothorax in women of reproductive age. Diaphragmatic fenestrations and endometriotic lesions were specific signs of EAP. Direct visual examination of the pleural cavity was inevitable for reliable diagnostics of the disease. Surgical treatment of ERP was determined by higher rates of complication and recurrence. Postoperative hormone therapy could significantly improve the results of surgical treatment of ERP.

OBJECTIVE. The authors defined the risk factors of cerebral complications after cadiosurgical operations. MATERIAL AND METHODS. The patients with ischemic heart disease who underwent coronary artery bypass grafting (CABG) were included in the first group (n=189) 132 (69,8 %) men and 57 (30,2 %) women aged 62,5 ± 8,3 years old. The patients who underwent reconstructive surgery of the heart valves were in the second group (n=50) and numbered 34 (68 %) men and 16 (32 %) women aged 63,1 ± 7,7 years old. The operations on valves were performed under conditions of extracorporeal circulation in the Center of Cardiosurgery and Interventional Cardiology of St. Petersburg Multidisciplinary Center. RESULTS. The research showed that the proportion of severe cerebral complications such as acute stroke and delirium was equal to 7,4 % in patients with coronary artery bypass grafting, while in group of patients with valvular pathology it numbered 14,0 %. The proportion of patients with delirium was 5,8 % in the first group and it consisted of 12 % in the second group. The number of patients with stroke was 1,58 % in the first group and it counted 2,0 % in the second group. Chronic cerebrovascular failure, stroke in the anamnesis, fibrillations of auricles and post-infarction cardiosclerosis were the leading risk factors of acute stroke development in early postoperative period. CONCLUSIONS. There was noted that such risk factors as postinfarction cardiosclerosis, stroke in the anamnesis and also the constrictive atherosclerosis of brachiocephalic trunk were associated with the group of patients who had cerebral complications after CABG operation. The proportion of patients with fibrillations of auricles (paroxysmal form) and a low left ventricular ejection fraction was higher in group of patients who underwent reconstructive surgery of the heart valves. The frequency of tobacco smoking was high among patients in both subgroups (77 % and 57,1 %).

OBJECTIVE. The authors analyzed the personal treatment management, which was focused on the priority application of low invasive surgical methods in patients with destructive and complicated appendicitis. MATERIAL AND METHODS. The results of treatment of 803 patients with acute appendicitis were investigated in prospective study. Patients were stratified according to the presence of complicated forms of acute appendicitis and the method of treatment. RESULTS. Laparoscopic appendectomy was performed in 93 % cases and conversion of access was carried out in 6 % cases. The rates of postsurgical complications and wound infection were 1,6 % and 0,7 %, respectively. The indices were lower than in case of open appendectomy 8,4 % and 6,3 % (р < 0,05), respectively. The level of complications was 6 % in application of percutaneous drainage in periappendiceal abscess. Nonsurgical treatment of circumscribed appendiceal mass was effective in 91,9 %. CONCLUSIONS. Realization of given personal approach allowed doctors to use the whole range of minimally invasive techniques in more adequate way. The results of treatment indicated its validity.

OBJECTIVE. This article analyzed the results of surgical treatment of patients who underwent laparoscopic hernioplasty. MATERIAL AND METHODS. The results of surgery of 1303 patients with inguinal hernia were assessed. All the patients were operated on in City Centre of Innovative Medical Technologies at the period from March 2013 to December 2016. Laparoscopic prosthetic hernioplasty using mesh prosthesis was carried out on 1199 patients. Traditional Liechtenstein hernia repair had 104 patients. RESULTS. The research showed that laparoscopic hernia repair had greater clinical efficacy as compared with traditional hernia repair. It appeared to be preferable choice of surgical treatment of inguinal hernias of any complexity.

OBJECTIVE. The authors investigated different methods of hernioplasty. MATERIAL AND METHODS. Endovideosur gical inguinal hernioplasty was performed in 3900 patients at the period from 1994 to 2016. The article described the developed and implemented techniques, strategy of surgical treatment, the choice of the type and size of prostheses in patients with different variants and complex forms of inguinal hernias. RESULTS. Specific postoperative complications were analyzed and suggested the methods of their prevention. CONCLUSIONS. The analysis of results was made. The authors gave recommendations concerning the technique of operative intervention.

OBJECTIVE. The article detected risk factors of supravesial hernia formation and its recurrence in patients with bilateral inguinal hernias after laparoscopic herniaplasty. The authors would like to develop strategy in order to solve this problem. MATERIAL AND METHODS. An analysis of treatment results was made in 84 patients. The research was based on ultrasound clinical data at the period of 3-5 years after operation. RESULTS. Factors of high recurrence rate and supravesial herhia formation were identified as combination of features of work activity and increased physical exertion accompanied by chronic diseases and regular intra-abdominal rise of pressure. The algorithm of choice among various laparoscopic methods of surgery was designed. Total prosthesis of supravesial and inguinal regions using developed original technique is recommended for application in cases of high risk group. Standard separate hernioplasty could be used in an absence of high risk. CONCLUSIONS. The proposed algorithm allowed doctors to reduce the rate of recurrence and formation of supravesial hernias.

OBJECTIVE. The authors aimed to develop complex perfusion medical device in order to successfully maintain viability of donor liver until transplantation. MATERIAL AND METHODS. Experimental perfusion device for normothermic perfusion donor’s liver was developed and tested in the Central Research and Experimental-design Institute of Robotics and Technical Cybernetics. RESULTS. The pre-clinical tests were performed on porcine liver. It was demonstrated that normothermic machine perfusion could restore liver function after 30 minutes of warm ischemia time and provide normalization of biochemical parameters of organ functioning.