A retrospective analysis of diagnostics and surgical treatment was made in 440 patients with polytrauma, who were on the treatment in hospitals in Saint-Petersburg, Syktyvkar and Omsk during 2009–2012. The neurotrauma was the dominating damage. The patients were divided into two groups: the main and the control group, using the equal quantitative ratio according to the sex, age, circumstances of trauma and type of damages. The strategy of programmed multistage surgical treatment («damage control surgery») was used in the main group (220 patients, average age 31,7±5,2 years). The traditional strategy of treatment was applied in the control group (220 patients, average age 30,7±5,4 years). The damage control surgery allows the reduction of lethality in neurotrauma by 15,0% and improvement of social adaptation of patients by 12,7%.

The main method of elimination of stenosis of carotid arteries in atherosclerosis is the surgical operation. Meanwhile, there is no general opinion concerning the most efficient way of the performance of the operation. This research generalized an experience of performing the classic carotid endarterectomy with usage the temporary shunt and an autovenous patch in 167 patients. The most frequent complications were analyzed in standard groups. The advantages of the given method were determined, facilitating to the reduction of intraoperative risks and the increase of technical quality of performance of different stages of the operation. The work quotes 8 works.

The operations of coronary artery bypass surgery were performed in 52 patients over the period of time since June 2004 till November 2012. The age of the patients was from 46 till 77 years (on average 60,8±7,8 years). These patients were divided three groups on the basis of features of methods of coronary artery bypass surgery. The groups were matched between each other due to the initial clinic data. Acute cardiovascular insufficiency predominated in the structure of complications of the early postoperative period in 9 (17,3%) patients. These 6 (11,%) patients were operated under condition of the artificial circulation used. An average time of in-patient treatment was 13,6±5,6, 10,7±3,5 and 15,2±6,1 days of hospitalization respectively. The hospital lethality made up 3,8%. Reoperative myocardial revascularization is an effective method of treatment of recurrence of myocardial ischemia after coronary artery bypass surgery. The performance of coronary revascularization on the working heart facilitates to the reduction of the risk of the development of postoperative complications, including cardial ones and can lead to quick recovery.

Differential diagnostics of tumors of anterior mediastinum is one of the most difficult problems of thoracic surgery and oncology. The authors conducted a retrospective analysis of the results of transthoracal puncture biopsy under ultrasonic induction in 44 patients with the tumors of the anterior mediastinum. Transthoracal biopsy was carried out using the device for biopsy (Multiple Biopsy Device-MBD-23) and ultrasonic scanner (Voluson 730 Expert), the patients being under intravenous (38 patients) and under local (6 patients) anesthetization. The diagnosis was made as a result of morphological research in all 100% of patients, the biopsy being performed the second time in one patient. The general information value of puncture biopsy under ultrasonic induction was 98%. A complication (localized pneumothorax, cupping off by itself) took place only in one of the follow-up study (2%). The analysis of presented material let the authors make a conclusion that transthoracal puncture biopsy under ultrasonic induction is a safe and highly informative method of diagnostics of tumors of the anterior mediastinum in selected patients.

The treatment of cicatrical stenosis of the trachea was performed in 193 patients at the age 8–65 years (132 of men and 61 women). The length of cicatrical stenosis shaped mainly by growth of granulation tissue and its different combinations consisted of 0,5 to 2,5 cm, getting 3,0 cm and more in 74 cases. The peculiar features of such cicatrical changes were characterized differently depending on its dominating localization on the length of the trachea — in the area of the neck or in the range of the mediastinum. Respiratory distresses, which were the main clinical manifestation of the disease, depended on the degree of stenisis of the trachea opening with the cicatrical process in each case. The decrease of size of the trachea opening with respect to natural size on¹/₃ was considered as the first degree of stenosis, on²/₃ — II degree, more than on²/₃ — III degree. The efficiency of endoscopic methods of treatment was the most significant in cicatrical stenosis of trachea with the length not more than 0,5–1,5 сm and dramatically decreased with the increase of length. The cicatrical stenosis of trachea with the length more than 3,5–3,0 сm should be considered as the indication for radical surgical intervention such as resection and plasty of trachea with forming of intertracheal or laryngotracheal anastomosis.

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

The article presents the results of surgical treatment of 58 patients with pancreatic cysts. An analysis of efficiency of various current miniinvasive surgical methods of treatment is given. Criteria of differential approach to the choice of the kind of miniinvasive intervention in pancreatic and parapancreatic cysts were formulated.

The results of examination and treatment of 152 patients with perforated duodenal ulcer were analyzed with the aim to make the ground of systemic approach to their surgical treatment in consideration of contemporary achievements of laboratorial and instrumental diagnostics and the opportunities of minimally invasive surgery. The results of conducted clinical study showed that in order to establish the correct preoperative diagnosis and the choice of rational treatment of patients with perforated duodenal ulcer it is necessary to conduct a purposeful complex investigation, including an assessment of general somatic state and the operative-anaesthetic risk of patients and changes of pyloroduodenal zone and the severity of peritonitis and prediction of lethality. The diagnostic algorithm let the authors make a diagnosis of perforated duodenal ulcer before the operation and decide on an adequate volume of surgical intervention. It is established, that the integral assessment of the examination results and surgery, the evaluation of the titres of antibody to ulcerogenic strains Helicobacter pylori, studying of psychophysiological profile of patient can justify the complex program of medicamentous therapy in postoperative period, providing the remission of peptic ulcer.

The changes of intra-abdominal pressure (IAP) were followed up in 244 patients with abdominal sepsis after operation. The influence of liquid «resuscitation» with different types of plasma substitutes on the rates of IAP was studied and the dependence of changes IAP from filling of vascular bed was investigated. The impedance technique was used to determine the circulating blood volume and its percentage from proper index was estimated according to the sex, age and constitution. The percentage of interstitial liquid in organism was calculated by analogy. The severity of manifestations of abdominal compartment syndrome (ACS) increases with the assessment of severity of the general condition to APACHE-II scale. The most severe ACS course was while using the crystalloid solutions in the complex of infusion therapy. The inclusion of colloids in the infusion therapy facilitated more full volume filling of vascular bed with the liquid, reduced the capillary leakage, accelerated the process of reduction of ACS. The advantage was shown by using the derivatives of hydroxyethylstarch, which promoted the elimination of deficiency of intravascular liquid in the best way.

The results of study of quantitative functional characteristics of platelets are shown in patients with acute pancreatitis. The patients (57 people) with acute pancreatitis were examined: 40 patients had a mild clinical course of acute pancreatitis and 40 patients had a severe clinical course of acute pancreatitis. The circular functional mass of platelets and the level of TGF-β₁ were determined in dynamics in patients with acute destructive pancreatitis. A correlated analysis was made among the results obtained by means of laboratory and instrumental examinations and clinical course of acute pancreatitis. It was found, that the increase of TGF-β₁ and circular functional mass of platelets in the course of several days was really a good prognostic factor of clinical course of acute pancreatitis. The data obtained showed that the changes of indices of quantitative and functional characteristics of platelets are the important pathogenetic criterion of prognosis for severity of clinical course of acute pancreatitis.

The article is devoted to the substantiation of strategy changes in acute cholecystitis and the bilirubinemia of obscure etiology. At the first stage the treatment was started from RCG in 120 patients and RCG with EPG in 232 patients. The results obtained were not very good, there being many organizational problems. At the second stage the laparoscopic cholecystectomy with drainage of the common bile duct (228 patients) were performed in 248 patients with acute cholecystitis and increased bilirubin from 29,54 till 167,16 millimole/l. Futhermore, the postoperative transdrainage cholangiography was made in 184 (74,2%) patients, the stones or the obstruction of bile secretion weren’t found. The classical intervention on common bile duct was required only to 4 patients, for the rest EPG was performed according to the indications. EPG was the most effective and the results were the best.

Criteria of pancreatonecrosis are described in the article. Clinical and ultrasonic signs, the applied ways of treatment of acute pancreatitis are considered in 715 patients. The methods of treatment of complications of pancreatonecrosis are described. The lethality of the patients with pancreatonecrosis was 13,2% and between operated patients — 16,4%. The lethality was 2,8% in the group of patients with pancreatitis.

In the period from 2011 till 2012 the Otcreotide-depot was used by the authors in treatment of 34 patients. The patients were divided into two groups: the first group — the prevention of development and the second group — the treatment of external pancreatic fistulas. Ocreotide-depot was applied in 17 patient of the first group: as part of the complex therapy of severe pancreatitis in 4 patients and after pacreaticoduodenectomy in 13 patients. Ocreotide-depot was used in 17 patients of the second group: 7 cases of patients after different types of pancreatic resections and after external drainage of pancreatic cysts in 10 patients. The positive effect of using the drug was obtained in 30 patients (88,25%): the cases of preventive application of drug in 17 patients and during the treatment of external pancreatic fistulas in 13 patients. The preventive and therapeutic usage of Ocreotide-depot facilitated an uncomplicated postoperative period in 13 cases and the healing of the external pancreatic fistulas in terms from 5 till 7 days in 13 patients. The application of Ocreotide-depot could be recommended as a preventive measure against the incompetence of pancreaticojejunoanastomosis after pancreaticoduodenectomy in complex therapy of severe pancreatitis and also in treatment of external pancreatic fistulas after pancreaticoduodenectomy and percutaneous drainage of postnecrotic pseudocysts.

The oncological breast surgeries with single-stage replacement of the lost volume by means of autogeneous tissue using distant flaps grafting (particularly by skin — muscular flaps of the latissimus dorsi ) allow obtaining satisfactory and stable aesthetic results without the decrease of indices of relapse-free and general survival. The early results of the application of the skin-muscular flaps of the latissimus dorsi for single-stage breast reconstruction after radical breast resection are presented in this work in 3 patients with breast cancer. The technique allows performance of the extensive radical resection with single-stage grafting in patients with breast cancer and obtaining an objective clinical response against the background of neoadjuvant therapy with subsequent applying radiation therapy and systemic treatment.

An analysis of complex clinical and ultrasonic investigations of the abdominal wall and the following surgery in 42 women with ventral hernia of big size accompanied by the ptosis of the abdomen was made. The patients were divided into two groups, each consisting of 21 patients. The endoprosthesis replacement of defect of the abdominal wall was made with standard polypropylene implant in the first group. The endoprosthesis replacement was complemented by lifting of muscular aponeurotic tissues of the hypogastrium using the implant of the original construction in the second group. The polypropylene endoprosthesis includes the main flap (15×15 cm) with rounded corners and the additional flap (5×40 cm) as a broad band situated at the lower edge of main flap in across-track direction. The increase of physical component of health was noted in 1,8 times in the second group patients and psychological component raised in 2,5 times.

A meta-analysis of extensive statistical data of «acute scrotal» syndrome in children was made. The two databases were considered. The first consisted of 1342 observations and described the nosologic structure of «acute scrotal» syndrome in children. The second included 440 patients and showed the long-term results of conservative treatment in children with acute scrotal problems. When a mathematical analysis of initial data was carried out, the authors determined, that the possibility of atrophy of stricken gonad in conservative treatment of acute hydatid problems belonged to the segment from 0,303 till 0,684.

The blocking intramedullary osteosynthesis (BIO) of the forearm bones possesses quite a number of advantages in comparison with the bone and transosseous methods. The BIO allows the restoration of the anatomy and biomechanics of the forearm, it shortens the term of disability and restores the function of the extremity in proximate terms. The BIO of the forearm bones consists of great number of nuances, each of them is really important. It is necessary to have the X-ray unit with electron-optical image for the intraoperative monitoring of operation stages and to follow the well-defined algorithm of technology of performing BIO of the forearm bones with special reference to all possible features of anatomy.

The research of efficiency of operative and conservative methods of treatment was conducted in 426 patients with damage of the hip joint, brought to the Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg with severe mechanical shockogeneous trauma, resulted in shock since 1997 till 2008. The operative interventions were performed using the methods suggested by the authors. The results were estimated by Harris scale and showed significant advantages of operative methods over conservative ones.

The algorithm of special study in patients with severe chronic constipations includes the chronometry of passage of sulphate barium along the gastric tract with the assessment of evacuation function of each part of the large intestine, the irrigoscopy, the fibrocolonoscopy, the investigation of motor function of sigmoid colon. The proposed diagnostic algorithm allows the determination of part or parts of the large intestine with incompetent motor and evacuation functions and decision on the necessary extent of resection of the colon.