A retrospective analysis of the data of 188 patients with the infrarenal segment of the aortic aneurysm (ISAA) showed, that ischemic heart disease and arterial hypertension were diagnosed practically in all patients — 175 (93.0%) and 177 (94.1%) patients respectively. A decreased retractor function of the myocardium was noted in 88 (46.8%) of patients. According to the findings of echocardiography 134 (71.3%) patients had the arterial hypertension of third degree. For the assessment of the influence of the accompanying cardiac pathology on the results of planned surgical treatment and systematization of postoperative cardiac complications the classification, which was proposed by R. B. Rutherford et al. and modified by A. V. Pokrovsky et al. was used. The obtained data point at a direct proportional relationship between the degree of the initial cardiac status, frequency and severity of postoperative cardiac complications in patients after resection of ISAA in 1.6–2.3 times.

An analysis of results of the endovenous laser coagulation combined with crossectomy was made in 170 patients with varicose veins of lower extremities (C_VI, C_II–C_V). Clinical and ultrasonic data were investigated during a period of 3–5 days (45 lower extremities) and followed up in 1–3 years after operation (194 lower extremities). Three years later the absence of reflux was observed in 95.9% of cases. In 51.1% of cases, 1–2 zones of parietal and segmental hemodynamical insignificant bloodstream were detected. A recanalization of the great saphenous vein along the whole length was revealed in 8 cases out of 194 (4.1%) patients. The bloodstream was provided by affluxes in the area of a shin and a wellhead afflux of the stump of the great suphenous vein. The ultrasonic picture of recanalization was similar to that observed in post-thrombophlebitic occlusion.

The authors made a prospective randomized comparison of results of preoperative photodynamic therapy (PhT) with chemotherapy, preoperative chemotherapy in initial unresectable central non-small cell lung cancer in stage III. The efficiency and safety of preoperative therapy were estimated as well as the possibility of subsequent surgical treatment. The research included patients in stage IIIA and IIIB of central non-small cell lung cancer with lesions of primary bronchi and lower section of the trachea, which initially were unresectable, but potentially the patients could be operated on after preoperative treatment. The photodynamic therapy was performed using chlorine E6 and the light of wave length 662 nm. Since January 2008 till December 2011, 42 patients were included in the research, 21 patients were randomized in the group for photodynamic therapy and 21 — in group without PhT. These groups were compared according to their sex, age, stage of the disease and histological findings. After nonadjuvant treatment the remissions were reached in 19 (90%) patients of the group with PhT and in 16 (76%) patients without PhT and all the patients were operated on. The explorative operations were made on 3 patients out of 16 operated on in the group without PhT (19%). In the group PhT 14 pneumonectomies and 5 lobectomies were perfomed opposite 10 pneumonectomies and 3 lobectomies in group without PhT. The degree of radicalism of resection appears to be reliably higher in the group PhT (RO– 89%, R1–11% as against RO–54%, R1–46% in group without PhT), p=0,038. The preoperative endobronchial PhT conducted with chemotherapy was characterized by efficiency and safety, allowed the surgical treatment and elevated the degree of radicalism of this treatment in selected patients, initially assessed as unresectable.

The author analyzed the results of surgical treatment of 60 patients with generalized peritonitis (GP). The level of interleukin-6 in blood, serum, urine and peritoneal exudates were followed up and the diagnostic significance of interleukin was comparatively studied. All patients were treated by conventional intensive postoperative therapy, without immune correction. The severity of GP was determined by Mannheim peritoneal index (MPI): 17 patients had MPI, 20 patients had MPI II-23 and MPI III. The study revealed that the degree of the changes of IL-6 in blood, urine and peritoneal exudates depended on the severity of patients according to MPI. An analysis of the data suggests that the comparative study of IL-6 in peritoneal exudates, blood, urine during the postoperative period in patients with GP is one of the objective criteria for the assessment of the immune system. Increasing the rates of peritoneal exudates in the postoperative period shows a continuation of the systemic inflammatory response.

The data of 1740 patients (during 20 years) with rectal cancer were analyzed. Planned operations were performed in 95.8% of patients. The adenocarcinoma was verified in all patients. Accompanying pathology was detected in 84.9% of patients and the pathology of cardiovascular system was more frequent (76.6%). Complicated course of tumourous process was revealed in 4.5% of patients (cases of bowel obstruction, the perifocal inflammation). The majority of patients had the II, III stage of the oncologic process. All operations were performed by conventional (open) way. The number of anterior resection of the rectum increased and the number of abdominoanal resection with bringing down reduced. The specific weight of sphincter preserving operations, which were completed by forming a colostomy decreased. The quantity of performed abdominoperineal extirpation was constant.

The authors present immediate and five-year results of complex endovascular and surgical treatment of 8 patients with loco-regional rectal cancer. The immediate positive result was achieved by using the single-stage selective oily chemoembolization of the upper, middle and low rectal arteries. This leads to the resolution of colonic obstruction, decreased tumor size and made a positive effect on the mesorectum. In all cases radical surgeries were performed 48–72 hours after endovascular treatment. The general 5-year survival was 87.5% and the survival without relapse was 75% respectively after such variant of complex treatment. In all cases distant metastases were not detected.

An analysis of effectiveness of diagnostic noninvasive and invasive measures for obstructive jaundice was made using clinical findings of 383 patients. The efficacy of these measures was assessed and limits were determined in relation to etiology of obstructive jaundice and the condition of extrahepatic bile ducts. The criteria of selection of diagnostic methods were detected on preoperative and intraoperative stages. The rational report of diagnostic strategy was formulated.

The most frequent causes of leg ulcers (90–95%) are chronic venous insufficiency (45–60%), obliterating atherosclerosis of the lower extremity arteries (10–20%), diabetes mellitus (15– 25%) and their combinations (10–15%).The leg ulcers, specified as pyoderma gangrenosum, are the rare and severe pathology, which is very often misdiagnosed. The case history of a 58-year old female patient with vast leg ulcers of the both shanks is analyzed. The leg ulcers were caused by pyoderma gangrenosum and chronic venous insufficiency due to the varicose disease. Complete epithelization of both ulcers was achieved by means of dermoplasty combined using the dermal equivalent against the background of system immunosuppressive therapy.

A 10-year experience and results of combined methods of surgical treatment of arterio-venous fistulas of peripheral vessels in 50 patients were analyzed. The patients were systematized on the basis of existing classifications, clinical manifestations of the disease, methods of invasive (ultrasound dopplerography and duplex scanning) and invasive (angiography) examinations. According to many authors no one of conventional methods of surgical treatment of arterio-venous fistulas which are used singly can be effective and must not be recommended as the most optimal. Stepwise employing of traditional operations and endovascular techniques are the main conditions for preventive measures of ischemic disorders in the limbs.

The author considers results of inestigation for studying an efficiency of permanent intramesenteric (retroperitoneal) blockade and applying lymphotropic therapy for prevention of incompetence of sutures of intestinal anastomosis against the background of diffuse peritonitis and acute intestinal obstruction. An infusion was carried out 4–6 times a day with a special solution (novocain 0.5% (7 ml/kg/day); heparin (150 units/kg/days); proserin (0.03 mg/kg/day) and seftriakson (15 mg/kg/days)) in order to obtain the effect of permanent intramesenteric blockade and lymphotropic therapy. The solution is administered by droplet injection with the rate 100–120 drops a minute (80–120 ml per each infusion). Due to the application of the given method the frequency of cases of the incompetent sutures of intestinal anastomoses in patients of the main group decreased from 15.5% to 3.4% (X²=16,2; p<0,001) as compared with the other patients.

The authors analyzed results of the free flap transfer in surgery of head and neck. 60 operations were performed since October 2006 till May 2012. Indications for using them were reconstruction of the mucosa of the oral cavity and the pharynx in 48 cases, the extensive defects of skin and soft tissues of the head and neck in 12 cases. All cases except 2 had the initial reconstruction. First 18 operations were performed with the binocular loupes, followed by using operating microscope. During the operations 42 radial skin-fascia flaps, 10 anterolateral femoral flaps, 5 thoracodorsal flaps, 1 anteromedial femoral flap, 1 scapular skin bone flap and 1 jejunal flap were used. During the early postoperative period one of the patients died (postoperative lethality 1.7%). Necrosis of flaps took place in 6 cases (5 radial skin-fascia flaps, 1 thoracodorsal flap). The causes of failures were assessed as arterial thrombosis (1 case), venous thrombosis (2 cases), postoperative infection (1 case). The exact cause in 2 cases couldn’t be determined. Thus, the total success in the given series of surgery was 88.9%.

This article presents the results of anatomic researches of the innervations of the inguinal area, performed for studying an arrangement of the main nerves of the inguinal area in relation to the operation access and the area of plasty of the posterior wall of the inguinal canal. The method of temporary translocation of inguinal nerves is developed for their preservation at radical operations of inguinal hernias. Long-term experience of surgical treatment of inguinal hernias with the temporary translocation of inguinal nerves is summarized.

The therapeutic approach should be defined more exactly in proximity of residual retroperitoneal metastases of germ cell testicular tumor and main vessels (left after chemotherapy). The data of 29 (24%) patients were analyzed over a period of time since 2003 till 2011. The general survival was 82% in the group without lymph node dissection (17 patients) in median observation of 27.5 months. The proximity with main vessels was registered in half of the cases in the group of operated patients (12 people), a single vascular reconstruction was required. The general survival was 97% in median observation for 35 months. The involvement of main vessels of retroperitoneal space significantly complicated the retroperitoneal lymph node dissection, but didn’t have negative prognostic value.

The intraoperative radiation therapy (IORT) in combined therapy of soft tissue sarcoma in a single dose 10–20 Gy is the method, which can optimize the role of radiation therapy in treatment of this nosology. This method allows exact localization of the irradiation zone in the frames of «tumor bed», thereby minimizing the damage of normal tissues and critical organs. The aim of the study was the influence of IORT on the rate and structure of postoperative complications and long-term results of treatment in the group under study (n=49) in comparison with the group of combined treatment without IORT (n=57) and the group of surgical treatment. No statistically reliable difference in the rate of postoperative complications in groups (p=0.57) was obtained and there was no influence on the structure of postoperative complications. At the same time the statistically reliable increase of general survival rates (p=0.025) and the survival without relapse in the main group (p<0.025) were obtained. Thus, the application of IORT in combined treatment of soft tissue sarcomas showed the satisfactory profile of «surgical safety», provided the reliable increase of general survival rates and rates without relapse.

Sixty children (age 3–15 years) with hydatid disease of the liver were treated. The patients were divided into 2 equal groups (control and main groups).The hydatid disease of the liver was revealed in 22 (33,6%) patients, combined hydatid disease of the liver and lung were noted in 38 (66,4%) patients. The «capitonnage» of the residual cavity was applied in the control group and omentoplasty — in the main group. Chemotherapy with Nemazol (dose 10–15 mg/kg/day) was carried out. In order to reduce the negative influence of Nemazol on patients and to accelerate reparation processes of liver parenchyma Vobenzyme (2–3 pills/ 3 times/day) was applied. The number of complications was 23.2 % in the control group. The adhesive bowel obstruction was noted in 6.6% of patients, bleeding and jaundice in 3.3%, the residual cavity suppuration in 10%. Complications were registered in the main group in 6.6% of children (the adhesive bowel obstruction in 3.3%, preservation of the residual cavity after a year in 3.3%). The number of relapses in the control group was 6 (12%), there were no relapses in the main group. Thus the procedure of preoperative and postoperative chemotherapy allowed avoidance of the development of relapses of hydatid disease of the liver. Omentoplasty is the most rational method of treatment of residual cavity in surgery of hydatid disease of the liver in children.

The authors consider one of possible variants of surgical treatment of shoulder girdle trauma, which is accompanied by an injury of the main artery. It is based on the application of the principle of staged surgical treatment (damage control orthopedic). The well-timed sufficient diagnostics and treatment of bone-arterial trauma, coordinated work of several surgical teams, the appropriate postoperative management of patients with the using of postponed high-technology intervention allowed obtaining an optimal functional result for extremely severe multitrauma of the chest and limb.

The work presents an analysis of condition severity of 139 casualties with isolated and combined spleen injuries on admission to a surgical hospital. The assessment of condition severity was made using the traditional gradation and score scale VPHSP. The degree of the severity of combined trauma of the spleen was determined by the scales ISS. The investigation showed that the scale ISS and VPH-SP allowed objective measurement of the condition severity of patients with spleen trauma. The score assessment facilitated early detection of the severe category of the patients, determined the diagnostic algorithm and the well-timed medical aid.

An experience of treatment of 133 patients with severe burns was analyzed. Bleedings from the upper parts of the gastrointestinal tract were diagnosed in 16 patients in different terms since their admission to the hospital. At the moment of carrying out of the endoscopic research all bleedings were considered as taking place. Statistically significant risk factors of the development of gastroduodenal bleedings were considered to be an alcoholic intoxication at the moment of injury and insufficient fluid therapy during the pre-admission stage and young age of the patients. The antisecretory therapy showed that the detection of risk factors in question should be regarded as an indication to the reinforced regime of preventive measures for gastroduodenal injuries.

The indices of Doppler laser flowmetery are proposed to be used for determination of the readiness of a granulating wound for free autoplasty. An analysis of capillary blood flow in the groups under test showed the information value of indicators of microcirculation obtained by Doppler laser flowmetery for determination of the granulating wound condition before autotransplantation and prediction of the results of skin engraftment. It is stated, that the disorder of microcirculation has been developed against the background of progression of wound invasive infection. The obtained data can allow the development of an algorithm of treatment and the preparation of the patients to surgery, determination of the terms of operation, the development the strategy of postoperative management of the patients, which can reduce unfavorable results of operations.

A retrospective analysis of diagnostics and surgery in 240 patients was made. The vertebral spinal trauma took place in 168 patients (average age 31±5 years), degenerative dystrophic diseases of spine were in 72 patients (average age 52±7 years). The clinicodiagnostic complex included survey and functional radiography of the spine, magnetic resonance image and helical computer tomography of the spine with spondylometric measurements and color duplex scanning of the vertebral artery. Stabilization of the spine was performed in 137 (57%) cases. The variants were determined on the basis of predominate injury of 1 out of 3 supporting complexes. The rigid and dynamic methods and their combination were used for fixation of the spine. More favorable results were registered using dynamic fixation and the arthroplasty of intervertebral disks with nitinol constructions. An algorithm of radiodiagnostics and surgery methods were proposed.