objective. The aim of the study is to create the model for predicting the probability of the sternal wound infection in patients undergoing cardiac surgery after heart operations with the use of longitudinal median sternotomy. Material and methods. The results of treatment of 485 cardiosurgical patients were analyzed; these patients were divided into 2 groups. In the 1st group (265 patients), the prophylaxis of sternal infection was carried out according to a standard procedure, the method of «elimination of sternal infection» was applied in the 2nd group (220 patients). The rate of sternal infection was estimated depending on risk factors. The multiple logistic regression was used to create the model for predicting the risk of sternal wound infection. Results. The created model for predicting the risk of sternal wound infection includes the following factors: application of the method of «elimination of sternal infection» (OR=1871.9; p=0.036); diabetes mellitus type 2 (OR=0.207; p=0.022); the risk according to EuroScore Logistic (OR=1.04; p=0.04); the duration of stay in ICU (OR=1.15, p=0.006). Conclusion: The created model for predicting the risk of sternal wound infection in cardiosurgical patients is excellent effective (p=0.036). The proposed technique for the prevention of sternal infection allowed to reduce the incidence of its occurrence in patients from 7.9 to 0.45 %.

OBJECTIVE. The aim of the research was to compare the influence of the endovenous laser coagulation (EVLC) on the pulmonary system with the performing of the Troyanov–Trendelenburg operation and without it. MATERIAL AND METHODS. We performed 108 endovenous laser coagulation for 16 patients without great saphenous vein trunk dressing and for 92 patients with dressing. The Russian portable laser device «Diolan» was used for the endovenous laser coagulation, wavelength of 980 nm, capacity of 16–20 watts. An intraoperative transesophageal echocardiography was carried to 12 patients to visualize heart chambers in the moment of the laser exposure. RESULTS. The patients without Troyanov–Trendelenburg operation had massive inflow of gas bubbles and detritus into pulmonary system during the endovenous laser coagulation. CONCLUSION. The obtained results showed the qualitative and quantitative differences in the character of the substrate entering the heart and the pulmonary system.

OBJECTIVE. According to the analytical data, the acute non-occlusive mesenteric ischemia after infrarenal aortic aneurism repair occurs in 0.2–1 % of cases. This complication is difficult to diagnose and associated with unfavorable prognosis and high mortality. MATERIAL AND METHODS. The retrospective analysis included 112 case histories of patients with infrarenal aortic aneurism repair in the period from 2007 to 2017. RESULTS. During the early postoperative period, 2 patients (1.8 %) had an acute non-occlusive mesenteric ischemia with lethal outcome. In these cases, the complication developed with safety patency of main mesenteric arteries and was followed by developing early multiorgan failure and thrombocytopenia. The autopsy showed generalized atherosclerosis, infarctions of kidneys, spleen and liver, caused by cholesterol crystal embolism of microvascular bed, which was found after histological research. CONCLUSION. The clinical presentation of acute non-occlusive mesenteric ischemia after infrarenal aortic aneurism repair is low-specific. One of the etiological factors of this complication is cholesterol crystal embolism in microvascular bed of visceral arteries

OBJECIVE. The evaluation of predictive significance of DNA damage of mononuclear blood cells in patients with pancreatic necrosis. MATERIAL AND METHODS. The work is based on the analyzing the results of the complex treatment of 497 patients with pancreatic necrosis, and in whom DNA damage of mononuclear blood cells was studied by the method of the gel-electrophoresis («DNA-comet» method). RESULTS. In the course of the research, it was possible to introduce and effectively use the «DNA-comet» method in the early diagnostics of pancreatogenic infection. CONCLUSION. The introduction of the method allowed reducing the number of unreasonable surgical interventions in the sterile phase of pancreatic necrosis into 1.9 times, and along with complex therapeutic measures, to reduce the level of overall mortality from 11.1 to 3.9 %.

OBJECTIVe. The article is devoted to the study of the safety and the effectiveness of the arterial chemoembolization in patients with locally advanced pancreatic cancer. MATERIAL AND METHODS. Between 2000 and 2015, 52 patients with unresectable locally advanced cancer of the pancreatic head without remote meastases T3-4n0-1M0 were treated with chemoembolization of the gastroduodenal artery. 109 cycles of chemoembolization (from 1 to 7, average 2) were performed. RESULTS. Manifestations of postembolization syndrome were stopped within 24 hours with conservative therapy. chemotherapeutic toxicity of I degree was observed in 44 (85 %) patients, gastrointestinal toxicity of II–III degree – in 8 (15 %). clinical effect such as increased body mass and reduction of pain was achieved after performing two cycles in the majority of patients: 90 and 71 %, respectively. The average life expectancy of the entire group was 9.9, median of 6.7 months. however, these figures were higher in14 patients received three or more cycles: 14.4 and 9.6 months. oily chemoembolization of the arteries of the pancreas is a relatively safe method of treatment in patients with inoperable cancer of the pancreas head. Performing of the multiple cycles increases patient survival.

OBJECTIVE. The aim of the study is to analyze the results of practical application of endovideosurgical transaxillary access in thyroid surgery. MATERIAL AND METHODS. We performed the retrospective comparative analysis of the results of surgical treatment of thyroid diseases using traditional, Miccoli’s endovideo-assisted access, endovideosurgical transaxillary access. RESULTS. With the use of endovideosurgical transaxillary access, the best cosmetic result is achieved – the absence of a scar on the neck. The number of specific complications in the samples is not significantly different, nonspecific complications are not accompanied with functional disorders. CONCLUSION. The expediency of improving the endovideosurgical thyroid surgery from remote accesses showed demand ability and safety of the technique. The important condition for their application is the possibility of performing an operative intervention in a proper manner.

OBJECTIVE. The aim of this study was to improve the results of the complex treatment of early periprosthetic infection in hip replacement by using a vacuum therapy. MATERIAL AND METHODS. The study included 82 patients with periprosthetic infection who had been hospitalized to the department of traumatology and orthopedics federal state budgetary educational Institution of higher education «north-Western state Medical University named after I. I. Mechnikov» from 2008 to 2016. We compared the results of the treatment in the retrospective group (without vacuum therapy) and in the prospective panel (using the local negative pressure method). RESULTS. The studies demonstrated the efficacy of the method of vacuum therapy in combination with standard methods of periprosthetic infection treatment. The clinical effects were: decrease of tissue edema, good reduction of wound exudate, decreasing the concentration of the microflora in the surgical wound area, granulation growth, stimulation of epithelialization, reducing of the time spent in the hospital. CONCLUSION. All these effects lead to the fact that the number of cases where we were able to maintain the implant increased from 52,9 % in retrospective groups to 78,8 % in prospective groups.

OBJECTIVE. The aim of the study was to substantiate the criteria for predicting of the acute phase course of traumatic disease and transportability in polytrauma patients. MATERIAL AND METHODS. The course of traumatic disease was studied in 233 patients. The prognostic value of the ISS, RTS, TRISS scores and Russian VPH-P, VPH-SP and Tsybin scores was studied using the method of binary logistic regression, Roc analysis and correlation analysis. RESULTS. RTS (AUC=0.93), TRISS (AUC=0.86) and Russian VPH-P (AUC=0.74) scores have the highest prognostic value. There is a strong correlation between the RTS and TRISS scores (r =+0.90). CONCLUSION. It is advisable to use the RTS score and Russian VPH-P score to predict the acute phase course of traumatic disease and transportability in polytrauma patients.

OBJECTIVE. systematization of the electrophysiological phenomena observed during the intraoperative neuro-monitoring with subsequent development of the grading system for results of neuro-physiological testing of pyramidal tract, convenient for surgeon. MATERIAL AND METHODS. 288 patients, at the age of 1–27, under intraoperative neurophysiological monitoring underwent instrumental correction of deformity of the thoracic/thoracolumbar spine. RESULTS. We evaluated in points the changes of motor evoked potentials, observed during the surgical intervention. It was observed that the frequency of changes of their parameters, indicating the danger of iatrogenic lesions, depended on the age of the patient and did not exceed 10 % of the total amount of observations. CONCLUSION. Intraoperative neurophysiological monitoring allows the surgeon and anesthesiologist to correct their actions in a timely fashion; and it minimizes the danger of iatrogenic neurological disorders.

OBJECTIVE. The aim of the study is to evaluate the clinical efficacy of isolated hyperthermic liver chemoperfusion with melphalan and tumor necrosis factor alpha when it is isolated bilobate metastatic lesion and the ineffectiveness of systemic chemotherapy in patients with colorectal cancer. MATERIAL AND METHODS. The patient K, 67 y. o., with colorectal adenocarcinoma T3N0M1 (hep, 3 type). liver metastases were detected synchronously with the detection of the primary tumor. Resection of the primary tumor was performed at first, then there was systemic chemotherapy (6 FOLFOX and 3 FOLFIRI). The was tumor progression in liver after second-line chemotherapy. Isolated hyperthermic liver chemoperfusion was perfomed after complete vascular exclusion of the liver with parallel circulation to return blood to the system of the superior vena cava from the inferior vena cava and portal vein. hepatic perfusion in heart-lung machine with the chemotherapy drugs (melphalan and tumor necrosis factor alpha) carried out through the gastro-duodenal artery and back flow to the circulation circuit from the retro-hepatic vena cava. RESULTS. Using of the isolated hyperthermic liver chemoperfusion allowed reaching full necrosis of liver metastases that confirmed by histopathology results and CT data of the abdominal cavity in a month after the procedure. CONCLUSION. Isolated hyperthermic liver chemoperfusion with melphalan and tumor necrosis factor alpha is the effective method of regional chemotherapy, which is advisable in patients with unresectable isolated metastatic lesion of the liver and resistible to systemic chemotherapy.

OBJECTIVE. This paper reviews literature and provides results of original trial data on early diagnostics of lung cancer (LC) with primary and work-up diagnostic procedures. MATERIAL AND METHODS. The pospective diagnostic data of 537 patients divided into 2 groups was analyzed: 1) panel study in early diagnostics of LC using low-dose computed tomography (369 patients) and 2) transthoracic core biopsy (168 patients). RESULTS. The pathological lesions in lung parenchyma, suspicious for early peripheral lung cancer, were detected in 24 % of study participants. The effectiveness of transthoracic core biopsy as diagnostic work-up method was 87.5 % and it correlated with nodule size and location in lungs parenchyma. CONCLUSION. The modern lung cancer diagnostics allows detecting the disease on the early stage and collecting the morphologic materials sufficiently enough for personalization of management algorithms.

OBJECTIVE. The aim of the study is to demonstrate the effective surgical technique in the treatment of cicatricial strictures of the bile ducts. MATERIAL AND METHODS. The authors analyzed the surgical treatment of 18 patients with iatrogenic cicatricial damages of the bile ducts. The development of cicatricial strictures of the bile ducts was diagnosed in all 18 patients with iatrogenic damages of bile ducts after previously performed reconstructive operations. RESULTS. biliodigestive anastomoses on the exchangeable transhepatic drains were applied for 17 patients; Y-anastomosis were applied for 1 patient. biliodigestive anastomoses on the exchangeable transhepatic drains were applied for 2 patients of the 17 on the second stage in 3 months after external drainage of the hepatic ducts. Repeated scarring of the bile ducts and anastomosis had not been observing for the 5 years of observation. CONCLUSION. The choice of surgical tactics in treatment of cicatricial strictures of the bile ducts depends on the type of stricture. high strictures appears more often. The effective treatment of them is biliodigestive anastomoses on exchangeable transhepatic drains.

OBJECTIVE. The aim of the study is to improve the results of treatment in patients with complications after percutaneous endobiliary operations for obstructive jaundice. MATERIAL AND METHODS. The percutaneous endobiliary interventions for obstructive jaundice were performed in 208 patients. Intraoperative and early postoperative complications were diagnosed in 38 patient (18.2 %). operative and endovideosurgical interventions were used in the treatment of complications. RESULTS. hemorrhagic complications were 4.3 % of cases. Bile outflow in the postoperative period were observed in 14 patients (6.7 %). Infection complication were identified in 15 patients (7.2 %). The treatment of complications with minimally invasive methods was successful in all cases. CONCLUSION. In most cases, the complications of percutaneous endobiliary operations can be resolved minimally invasive ways.

OBJECTIVE. The aim of the study is to improve the results of treatment of patients with mechanical jaundice. MATERIAL AND METHODS. The results of treatment of 350 patients with mechanical jaundice of benign genesis were analyzed. The causes of this disease in 230 (68.6 %) cases were choledocholithiasis, in 75 (21.4 %) cases were cicatrical narrowing of the large papilla of the duodenum (n = 50), in 45 cases were the formed biliodigestive anastomoses (n=25) and chronic pancreatitis (12.8 %). RESULTS. To eliminate mechanical jaundice, 154 (44 %) patients underwent various percutaneous decompressive echo-controlled interventions under the ultrasound control in terms of their nature and volume. In addition, endoscopic transpapillary interventions were performed in 196 (56 %) observations. various postoperative complications were noted after performing percutaneous decompressive echo-control interventions under ultrasound in 14 (4 %) observations, and after endoscopic transpapillary interventions in 21 (6 %) cases. CONCLUSION. Minimally invasive endoscopic and echo-controlled interventions as the first stage of surgical treatment are effective methods of treatment of patients with mechanical jaundice.