An analysis of the results of treatment of 149 patients was made. The revasculization of the myocardium and the endarterectomy using the left anterior descending artery were carried out in these patients at the period from 2003 to 2010. The middle age was 59,5±8,4 years. The exertional angina of the III-IV functional class was noted in 76% of the patients and 72% of patients had the myocardial infarction in anamneses. The follow-up study included 127 operated patients. The mean follow-up period was 43,3±23,9 months (maximal period - 8,5 years). The hospital lethality consisted of 2,7%. The survival rate was 89,3% in a long-term period. The cineangiography was performed on 52 patients in mean terms 50,2±22,9 months. A patency of arterial grafts was 51(98,1%), the patency of venous grafts - 77(93,9%). The signs of involution of the venous grafts were in 3(3,7%).

Aneurysms of extracranial arteries are sufficiently rare pathology in the extracranial arteries surgery. The authors aimed to research the frequency of occurrence of the extracranial arteries aneurysm, reasons of the onset, the localization, clinical manifestations and surgical treatment strategy. A retrospective study presents 10 cases of the extracranial arteries aneurysm for the last 5 years. A presence of aneurysmatic dilatation of extracranial arteries was detected according to the data of ultrasonic duplex scanning (UDS) and patients were directed to the hospital. The UDS was carried out as a routine procedure because of the presence of earlier acute stroke or the transitory ischemic attack. All the patients were carefully examined. A computed tomography and the recurring UDS were performed and the neurologic status of patients was estimated. An indication to surgical treatment was an increase of the internal carotid artery diameter and the common carotid artery more than 50% or equal to it. The presence of the local saccular aneurysm was one of the reasons. Surgical treatment strategy was determined by the anatomic position and possibilities for the reconstruction. The results of given operations showed, that the surgical treatment strategy should be recommended and could be fully justified in this pathology.

An analysis of treatment results was made in 226 patients with multiple isolated intrapulmonary metastases of solid tumors. It appears that surgical removal of metastases was possible in patients with satisfactory functional resources and accurate evaluation in order to validate the indications for surgery. The operation shouldn’t result in considerable reduction of quality of life and didn’t prevent using other methods of treatment such as medicamental and radiation therapy. The indications to surgical intervention have to be set as individual in consideration of the number of metastases and potential of the patient to undergo the surgery.

Percutaneous endoscopic gastrostomy was performed on 55 patients of anaesthesiology resuscitation clinic of Military Medical Academy during the last 5 years. A surgery duration was about 13,7±0,5 minutes. The following complications were observed: postoperative wound infections (3 cases), uncontrolled removals of the feeding tube (2 cases), bleeding was noted in 1 patient. The authors recommend the method of percutaneous endoscopic gastrostomy for widespread adoption in patient care institutions according to their experience. The enteral feeding could be used when patients would have the swallowing malfunction during more than 3 weeks.

Clinical and laboratory signs of abdominal sepsis and endotoxicosis were noted in 194 examined patients with diffuse peritonitis. It was stated that pathogenesis of visceral functions mainly expressed as a splanchnic blood circulation disturbance, massive translocation of gut organisms in portal bloodstream and the functional liver insufficiency particularly marked as form of macrophage liver insufficiency. The complex program of liver rehabilitation should be included in standards of treatment of the patients with diffuse peritonitis. It should be based on preventive measures of the enteral detoxication and microbial decontamination of small intestine and at the same time the intraportal transsubilical infusion correcting therapy has to be applied.

The article analyzed risk factors after operations for pancreatonecrosis in order to predict a course of the disease and carefully plan the treatment. It was revealed that the lethality level depended on different factors: the sex, age, a period of admission to the hospital, prevalence of necrotic suppurative process and severity of operative trauma. The authors made a conclusion of radical change to treatment approach. The open operations should be reduced at the expense of introduction of low-invasive methods of treatment in the case of pancreatonecrosis.

Transanal endoscopic microsurgery (TEM) is the method used in cases of benign tumors at the early stages of rectal cancer. The tumor localization in peritonized part of the rectum indicates a limiting level for removal of the neoplasm. TEM was performed on 137 patients. The mean age was 63,8±9,8 years and the number of women consisted of 65,7%. Neoplasms were located in the upper ampullar rectum and a potential possibility of connection with the peritoneal cavity was noted in 12 (8,7%) patients, but during TEM it was only in 5 cases. There wasn’t any conversion to a peritoneal surgery. The wound closures were carried out from the side of the rectum lumen and all the operations were finished with the control laparoscopy and formation of sigmostoma. The stomas were closed in 3 patients on fifth- sixth weeks. A connection with the peritoneal cavity during TEM isn’t critical event in the case of wound closure through surgical rectoscope and it doesn’t lead to the conversion to radical operation.

Clinical results of wound healing dynamics were studied in 60 patients with soft-tissue infection against the background of diabetes mellitus type II. At the same time the study considered indices of intercellular contacts protein tissue expression such as connexin 43(Cx43) and basic fibroblast growth factor receptors (bFGFR). The basic therapy of biopsy material of wound borders was applied. The reduction of bFGFR expression and the minor growth of Cx43 expression were observed. The pain syndrome proceeded for a long time and there were signs of perifocal inflammation, retard wound healing with granulation tissue. The application of combined method of ozone therapy which included autohemotherapy with ozone and an external management of wound by ozone-oxygen mixture facilitated to considerable shortening of inflammatory phase and regeneration. It was associated with increased Cx43 expression (in 1,9 times) in comparison with initial level and bFGFR was enlarged in 1,7 times to eighth day of postoperative period.

The article presents results of 9 extracorporal renal resections for carcinoma with the following autotransplantation. The mean duration of operation was 297, 8 minutes and the mean period of hypothermic ischemia consisted of 112,6 minutes. A postoperative follow-up (max 4 years) revealed that there isn’t noted any dissemination of the tumor and functional condition of the transplanted kidney was satisfactory. The extracorporal renal resection with the following autotransplantation could be performed according to absolute indication of organ saving and technical impossibility of renal resection in situ. In the case, when experienced surgeons carry out the operation, the existing risk of postoperative complications is low in spite of large volume and traumatic character of surgery in interdisciplinary approach.

An analysis of complex examination of 110 patients with venous thromboembolism was made. The patients were separated into 2 groups. The first group included 60 patients, who had the start heparin therapy during 7 days with the following 6-month warfarin therapy. Warfarin was substituted by pradaxa (dabigatran) for 50 patients of the second group. The efficacy of pradaxa could be compared with warfarin. However, pradaxa had a number of advantages such as the predictable anticoagulant effect, standard dosages. This medicine is more predictable and doesn’t require a control of homeostasis and an adjustment of drug dosage.

The article presents the follow-up study of 254 onco-proctologic patients after reconstructive abdominoperitoneal resections. Patients were divided into 4 statistically homogeneous groups (2 main and 2 control groups). A comparative analysis of middle and lateral laparotomy wounds healing was made. Laparotomy wounds were stitched up using conventional method (in layers, tightly) and using other method of prolonged flow-aspiration drainage of hypodermic tissue. Postoperative wound infections were noted in 11,4% patients in case of conventional means. The prolonged flow-aspiration drainage in laparotomy wounds causes only 1,5% of complications.

Clinical manifestations and diagnostic methods of particular anatomical variants of intestinal rotation and fixation disorders were discussed by the authors in 208 children of different age groups. There was revealed the tendency to reduce rotation abnormalities diversity with the increase of age group. At the same time the frequency of occurrence of the colon fixation anomalies characterized by chronic recurrent process and progressing colostasis was enlarged.

The article presents the research based on data of 30 children with congenital heart disease. The mean age of the patients was 7 months. It was shown that open cardiac surgery caused an expressed but transitory expression of renal biomarkers, creatinine clearance and serum creatinine level. The frequency of occurrences of acute renal failure was 46,6%. Both biomarkers returned to normal values before discharge from the hospital.

The article analyzes the results of clinical observations and significance of small pneumothorax which displaces the mediastinum in polytrauma. On the basis of clinical data the author compiled a comparison table of tension and non-tension pneumothoraxes. For the first time it was stated the significance of small tension pneumothorax and validated the reason to consider small pneumothoraxes which shift the mediastinum as «tension» according to roentgenogram.

The article analyzes the experience of treatment of bullet penetrating wounds of the thorax accompanied by shock in 131 armed forces personnel of internal army and officers of the Ministry of Home Affairs of Russia during contra-terrorist operations on the North Caucasus at the period from 2000 to 2011. The postoperative lethality was reduced from 22,7% to 10,8% due to usage of the strategy which was directed to decrease of surgical aggression in 65 patients.

The article presents results of diagnostics and surgical treatment of diaphragmatic rupture in 32 victims with an estimation of diagnostic value of different instrumental methods of investigation and the efficacy of surgical approach. The correct interpretation of typical clinical and instrumental signs in consideration with trauma mechanogenesis allowed diagnostics of diaphragmatic rupture before the operation in 17 (53,1%) cases. It was observed that an undiagnosed rupture of the left hemidiaphragm caused a formation of posttraumatic diaphragmatic hernia in 2 (6,2%) patients. The laparotomy was applied in 28 patients as a surgical approach and thoracotomy - in 2patients. The laparotomy and after that thoracotomy were performed on one patient. The thoracotomy and laparotomy were carried out on the second patient in turn. The authors consider the laparotomy as optimal variant of surgical approach in acute period of trauma. The postoperative lethality was 15,6%.

An analysis of 658 medical records of inpatient treatment from 15 hospitals of St. Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52,9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1,0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1,0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma.