The experience of surgical treatment of high risk group patients with ischemic mitral regurgitation of different degree of manifestations was analyzed. The basic approaches to the management and the choice of treatment strategy are reported in this article. The authors suggested the priority strategy on the background of completed investigation: 1) the performance of the annuloplasty on pressure ring in combination with coronary bypass surgery in surgical treatment of ischemic mitral regurgitation of III degree, as most effective kind of intervention; 2) the performance of operation of isolated coronary bypass surgery on working heart for high risk patients with the presence of moderate ischemic mitral regurgitation, that allows the significant improvement of indices of postoperative period and the decrease of evidence of mitral regurgitation at the expense of a salvage of myocardial contractility.

An analysis of efficacy of 1.5% reamberin solution usage was made in 80 patients for correction of blood rheological properties disorder in the case of peritonitis and bowel obstruction. It was established, that reamberin, which was administered in the dose of 500 ml after 12 hours of the beginning of intensive care during 48 hours, efficiently corrected the rheological disorders. It was because the erythron and reticulocyte production were activated, the hyposmolarity was removed, the intensity of free radical oxidation and peroxide oxidation of lipids was decreased and the antioxidant status was restored. This facilitated the hydrophily and erythrocyte volume decrease, the haemolysis reduction and qualitative gas exchange at the level of tissues.

An analysis of complex examination and treatment of 123 patients with diffuse purulent peritonitis was made. The patients were divided into two groups. The first group consists of 68 patients, whom conservative surgical intervention was performed at the first stage and videoimage endoscopic sanation of the abdominal cavity with the administration of sodium hypochlorite water solution was made at the second stage. The main group consists of 55 patients, who had the same treatment except that the abdominal cavity was processed with pulsating stream of antiseptic with immobilized forms of sodium hypochlorite at the second stage. It is established, that the application of developed technology allows decreasing of the frequency of postoperative complications on 8.3% and postoperative lethality — 4.8%.

The results of examination and surgical treatment of 298 patients with chronic pancreatitis and the original morphological investigations of material of the pancreas were studied. The data allowed the detection of additional criteria features of inclusion of the patients with chronic pancreatitis to be made in groups according to foreign Marseilles-Roman classification (1988). It is shown, that the basis of study of morphogenesis of chronic pancreatitis is immunohistochemical method, which let the authors diagnose not only the pathological changes of exo- and endocrine sections of pancreas, but at the same time the structural features of nervous apparatus and vessels of microcircular bed. The revealed morphological features of different forms of chronic pancreatitis vs clinical finding characteristics and the data of instrumental and laboratory methods of research allow the substantiation of surgical treatment version to be made.

On the basis of the results of treatment of 105 patients with locally advanced ductal adenocarcinoma of the pancreatic head the authors present the results of work over a period of time since 1999 to 2009. In the main group the combined treatment was used for 51 patients: the non-adjuvant selective chemoembolization of the pancreatic head adenocarcinoma was performed, than standard gastropancreatoduodenal resection with lymphodesection and 6 cycles of adjuvant chemoinfusion in celiac trunk were completed. In control group standard gastropancreatoduodenal resection was performed. In the group of combined treatment the 1-, 2-, 3-year survival rates consist of 80.4%, 58.8% and 43.1%, respectively. The average life span was 22.3±2.1 months. The average life span of 54 patient of control group was 8.4±2.1 months and a common 3-year survival consists of 13%. There was no lethality after the performance of X-ray endovascular procedures and gastropancreatoduodenal resection. Postoperative complications reliably didn’t differ in both groups.

On the basis of examination of 35 dialytic patients, who had clinical findings of progressed chronic cardiac insufficiency against the background of the large arteriovenous shunt through existing vascular access, the authors show the complications. The volume of blood circulation along the arteriovenous fistula, which was more than 30% of cardiac output, caused dilatation of heart cavities with cardiac decompensation. If the largest potency to volume remodeling of native proximal arteriovenous fistulas is taken into account, this kind of access could cause hemodynamic abnormalities more often than others (in 22 (62.9%) of patients). The best primary survival was demonstrated by arteriovenous shunts (87.1%) during 2 years. However, long-term survival of native arteriovenous fistulas dramatically outperformed the other kinds of accesses. The choice of constant vascular access for hemodialysis is an important and difficult task in chronic renal disease of V degree patients.

An analysis of complex laboratory, ultrasonic investigations and following treatment of 120 patients with acute surface varicothrombophlebitis was made. The patients were divided into two groups, each being 60 people. In the first control group the treatment was conducted in one step: standard venectomy was performed at high point of inflammatory process. In the main group, the development of thrombotic process was prevented by sclerosurgical technology at the first stage. Radical treatment was carried out at the second stage after 4–6 weeks. The number of complications in near-term postoperative period decreased in 5% and in long-term in 13.3%, the quality of life increased in 13.3% in second group patients.

The development of postoperative ventral hernia was observed in 8 patients from 114, who undergone the liver transplantation operation. The patients were followed in terms up to 14.5 years. The authors consider the indications and features of surgical treatment of such postoperative hernias.

The work is devoted to the hernioplasty method, which provides the strengthening of back wall of the inguinal canal by autogenous tissues, which were the walls of the hernial sac. After dissection of hernial sac, two muscle flaps were formed and fixed to transverse fascia on the whole perimeter of the inguinal canal. The control group consists of 64 patients and main group — 66 (90.4%). The Liechtenstein operation was performed in control group. In contrast, the method, suggested by the authors, was used in the main group. The patients with hernioplasty were carefully and sufficiently examined in order to make an objective comparative analysis of the results. The results of the review allow the authors to confirm, that the suggested hernioplasty method provides stable local homeostasis of tissues and high quality of life.

An absence of breast is the irreversible cosmetic and physical defect, which reduces the self-assessment and psyco-emotional status of women. Nowadays the necessity of reconstruction after mastectomy will gain more popularity and plays a fundamental role in psychological and social rehabilitation of breast cancer patients. The article analyzes the experience of reconstructive plasty of 26 patients with I–III stages of breast cancer.

An analysis of 135 transplant surgeries of vascularised bone grafts in treatment of pseudoarthroses and defects of the clavicle, humerous, ulnar, radial, metacarpal,wrist and fingers bones was made. The fusion was noticed in 130 operated patients. The earlier removal of immobilization (in 2), the repeated trauma (in 2) and osteomyelitis of the transplanted graft, which required its removal in 1 patient, were the causes of failure in 5 (3.7%) patients.

The blocking osteosynthesis is preferable in the case of open forearm fractures of the I degree. The treatment of patients with open comminuted complicated forearm fractures should be reasonable to perform in two stages: at the first stage, healing of soft tissues with fixation in the apparatus of external fixation should be obtained. At the second stage, the conversion of external fixator on interlocking nail with single-stage performance of osteoplasty as needed should be carried out. The presented experience of treatment of healing failure, pseudoarthroses and forearm bone defects by developed method allows the practical application of the method to be recommended.

Abstract Background: The writing of surgical and hospitalization reports is time-consuming and does not necessarily enable the increment of a statistical database, tool that is indispensable nowadays to evaluate unit activity or to carry out scientific studies. In order to prevent this double data capture, a computer tool, named CordaBase, has been developed by surgeons and set up in a cardiac surgery unit. Materials and Methods: CordaBase is an interactive software that stores medical data. Thanks to its intuitive interface, CordaBase stores data which is classified chronologically in the following categories: past medical history, preoperative assessment, operating gesture, stay in intensive care unit, stay in wards and evolution/monitoring after discharge. This date, stored in an Access base, are then used in the creation of personalized surgical and hospitalization reports. All the data is permanently available and can be used for the carrying out of scientific works or for the evaluation of the unit activity. Results: From March 2009 to December 2010, 2617 consecutive patients operated on in a Cardiac Surgery Unit were recorded prospectively in the software. All of this stored data assisted the surgeon in his or her administrative tasks, thanks to personalized surgical and hospitalization reports, immediately at the secretariat’s disposal. The database, which is requisitely filled by administrative work, enables the carrying out of any statistical study on all unit activity. Conclusion: With a hindsight of almost 2 years, CordaBase has proven its usefulness in an active cardiac surgery unit, both on an administrative and scientific level. The computerized reports have lightened the medical secretariat’s workload and statistical studies have now become possible without having to take the paper medical files out again. In the years to come, the accumulation of medical data prospectively or retrospectively stored will surely confirm the potential of the use of such a software.

The aim of this work is to reflect on different teaching methods can be used in a surgical teaching and its assessment methods. Two sessions of Multiple Choice Questions (MCQ) have been proposed, the first before all education, the second after education in order to assess its impact on knowledge. Script Concordance Test (SCT) will replace the traditional interactive case report. Eighteen participants (Group 1) completed both sessions of MCQ: 9 residents (R), 2 equivalent resident (ER), 4 Clinical Fellow (CF), 1 Professor (Pr) and 2 senior surgeons (SS). Sixteen participants (group 2) were present at the first session of MCQ: 6 R, 1 ER, 4 CF, 2 Pr, 2 SS and 1 indeterminate status. Finally, 12 participants (group 3) were present at the second session: 6 R, 1 ER, 1 CF, 1 SS and 3 indeterminate status. The results of “seniors” in Group 1 were higher than those of “juniors” at the first session. MCQ results for the second session were higher in the subgroup CF. A more marked progression in knowledge was observed in resident and Clinical Fellow. Finally, the score obtained by the group 3 was lower than in group 1. The format of the MCQ was particularly heterogeneous. The SCT will help to assess the capacity of decision making in a context of uncertainty (as unexpected surgery requiring quick decisions with immediate effect, surgical strategy in an unusual clinical situation). The different tools available would allow the establishment of an evaluation of teaching, but also to assess the development of thinking skills in situations of uncertainty. Their implementation will take place with the participation and support of the largest number of teachers in our specialty.