The objective is to assess the safety of motor mapping using navigated transcranial magnetic stimulation (nTMS) in patients with brain tumors based on the literature data and own observations.

Material and methods. The motor mapping with the help of navigated TMS was performed in 114 patients with supratentorial brain tumors. Side effects and complications, such as seizures, pain, hearing and cognitive changes during and after the procedure, were analyzed.

Results. 101 (90.4 %) patients did not notice any discomfort during the study. There was not any cases of seizures during and after the procedure. 11 (9.6 %) patients experienced discomfort, 8 (72.3 %) patients of them noticed a slight headache.

Conclusion. Navigated TMS is well tolerated in neurosurgical patients with tumors of the motor cortex.

The objective of the research is to optimize the method of transnasal endoscopic plasty of liquor fistulas in patients with prolactinomas, who got nasal liquorrhea against the background of treatment with dopamine agonists.

Material and methods. Transnasal endoscopic approach was performed in 7 cases with prolactinomas. There were 9 operations including 2 interventions caused by liquorrhea relapse. Plasty with Tachocomb and biological adhesives were used in 2 cases. The other 7 cases demanded additional use of an adipose tissue fragment.

Results. Complete arrest of liquorrhea was achieved in 5 cases. It resumed in 2 patients who had undergone plasty with Tachcomb and biological adhesives. They needed into the reoperations with use of autoadipose tissue.

Conclusion. Using of CTcisternography is necessary for revealing exact localization of liquor fistula. It is expedient to apply Tachocomb and a fragment of autoadipose tissue fixed with biological adhesives. Discontinuation of treatment with Cabergoline for a month is recommended after the operation.

The objective of the study is to substantiate the applying of broncho- and angioplasty lobectomy as an alternative to pneumonectomy in NSCLC.

Material and methods. The results of treatment of two comparable groups of patients with NSCLC were presented. In one group, patients underwent broncho- or angioplasty lobectomies (group A), in another – pneumonectomy (group B). The number of complications, overall and disease-free survival in both groups, as well as the factors affected the results were analyzed.

Results. The number of postoperative complications in group A and group B was 12.5 % and 15.6 %, respectively. The median of disease-free survival and overall survival in both groups did not differ meaningfully, consisting of 20 months and 48 months in group A, and 19 months and 25 months in group B (p=0.91) and (p=0.97). The results of treatment were meaningfully affected only by the stage of the disease (p=0.017) and multidisciplinary treatment (p=0.007), including chemotherapy and radiation therapy.

Conclusions. Performing of broncho- and angioplasty lobectomies can be justified as an alternative to lung removal in NSCLC within the multidisciplinary treatment.

The objective is to determine the optimal tactics in treatment of combined trauma using the objective assessment of the severity of injuries and the overall condition of the casualties.

Material and methods. The article presents the materials on biometric analysis of treatment of casualties with combined trauma in the program of multi-staged surgical treatment.

Results. In the process of multi-staged surgical treatment, we can determine the prognosis, the nature of the traumatic disease with the help of a biometric comprehensive study that will optimize comprehensive treatment program and rehabilitation of casualties in the trauma center of the 1st level.

Conclusion. The conditions for the application of the full spectrum of surgical interventions in the maxillofacial region in the acute period of traumatic disease are created in favorable prognosis. The choice of treatment in favorable or unfavorable prognosis is a multistaged surgical tactics of treatment – Damage control surgery.

The objective is to assess the efficacy of rivaroxabane and dabigatran etaxilate in treatment of the deep vein thrombosis with different extend.

Material and methods. The analysis of complex examination and treatment of 120 patients with venous thromboembolism was accomplished. All patients were randomized into two groups; each group consisted of 60 patients. The first group started the therapy with 5-days course of unfractionated heparin and followed the therapy with 6-month course of dabigatran etaxilate. Patients of the second group were treated only with rivaroxabane for 6 months.

Results. The treatment was over the full restoration of the lumen of thrombosed veins in 46.7 %. Venous stenosis was registered in 34.2 %, and venous occlusion detected in 19.1 %. The efficacy of dabigatran etexilat and rivaroxabane was similar in local and diffuse thrombosis. Whereas dabigatran etaxilate was more effective in treatment of total and subtotal thrombosis. Сhronic venous insufficiency was absent in 35 % of patients, was mild degree in 43.3 % of patients, moderate degree in 10,8 % of patients, and severe degree in 10,8 % of patients. Moderate and severe degrees of chronic venous insufficiency were less common in 7.7 % of patients treated with dabigatran etaxilate.

Conclusion. Anticoagulant therapy with rivaroxabane is advisable in local and diffuse thrombosis; treatment of total and subtotal thrombosis is advisable to start with 5-days course of unfractionated heparin.

The objective of the research is to study the efficacy and safety of using a minimally invasive endoscopic method in treatment of Zenker’s diverticulum.

Material and methods., 42 patients with a pharyngo-esophageal diverticulum at the age of 59 to 80 years were examined and treated over the two-year period of work. The indication for the operation in all patients was the presence of dysphagia II–IV degree. The method of tunnel dissection in the submucosal layer of esophagus with dissection of the array of cryopharyngeal muscle and endoscopic esophagodiverticulostomy was used. Regardless of the version of endoscopic intervention, the key moment of the operation is the dissection of the cryopharyngeal muscle, which allows to eliminate the fold between diverticulum and esophagus, thus creating a fistula between diverticulum and esophagus.

Results. Results of treatment were evaluated clinically, taking into account patients’ complaints and according to the control of X-ray fluoroscopy of esophagus. The patency of esophagus was objectively restored in all cases. Delays of the passage of contrast medium through the esophagus did not occur. Patients did not experience the difficulty in swallowing. Significant complications during the postoperative period were not noted.

Conclusions. Endoscopic esophagodiverticulostomy in the treatment of Zenker’s diverticulum is the effective method of treatment. The operational injury is minimal, what reduces the length of stay in hospital. The peculiarity of the method of treatment allows using the early enteral nutrition. The minimally traumatic nature of endoscopic operation and the quickness of its performance allow applying this technique in weak patients, as well as in patients with concomitant pathology.

The objective is to define the place of the operation of simple closure for perforated duodenal ulcers in the modern stage of the treatment of these patients.

Material and methods. Comparative analysis of 2 groups of patients with perforated duodenal ulcer was made. The 1st group consisted of 40 patients who performed simple closure of perforated ulcers. The 2nd group consisted of 130 patients who fulfilled the excision of the edges of perforated ulcers and Judd pyloroplasty.

Results. It is shown, that the simple closure of perforated ulcer (group 1) leads to statistically significant deterioration of results according to the increasing time from the moment of perforation. Fisher criterion = 0.01784 (p<0.05). The increase of mortality among the patients of the 2nd group also dependent on the duration of the disease and severity of developed peritonitis, but this increase of mortality is not statistically significant. Fisher criterion = 0.11974 (p>0.05).

Conclusion. The operation of the simple closure of perforated duodenal ulcer in the present stage of development of medicine should not be the operation of choice among the most of patients with this pathology.

The objective is to analyze the results of rendering medical assistance to pregnant women delivered to the University clinic with suspicion of complications of cholelithiasis.

Material and methods. The authors conducted the retrospective analysis of the case histories of pregnant women for 2 years, who applied urgently with suspicion of complications of cholelithiasis. In total, 69 patients at different stages of gestation, from 22 to 39 weeks of pregnancy, appealed with suspension of complication of cholelithiasis for this period. The average age of enrolled patients was 29.20±0.8 years. 48.98 % of the enrolled patients were pregnant at first time.

Results. The presence of cholelithiasis was confirmed in 82.61 % of pregnant women. 43.86 % of these patients were diagnosed with hepatic colic, which was stopped by spasmolytic therapy. 52.63 % of pregnant women were diagnosed with acute cholecystitis. The surgical intervention – laparoscopic cholecystectomy - was required in 5.26 %. Acute biliary pancreatitis was in 8.77 % of pregnant women with cholelithiasis; delivery and revision of the abdominal cavity were required in 1 case. In addition, 3.51 % had choledocholithiasis with mechanical jaundice. All patients with this diagnosis were performed endoscopic papillosphincterotomy with lithoextraction.

Conclusion. Complications of cholelithiasis rank the second place in the frequency of occurrence among urgent surgical diseases in pregnant women. The ultrasound examination is the starting point for determining the further treatment tactics for this category of patients. Pregnant women with complications of cholelithiasis should be examined in inpatient department of ambulance by surgeons and obstetrician-gynecologists collaboratively.

The proven data on the dangerous using of drugs from the group of monoclonal antibodies to TNF-alpha in patients with Crohn’s disease, as well as methods of correction of the revealed homeostasis disorders are pre- sented.

The presented clinical case demonstrates the identification of rare pathology – inflammation of the urachus cyst with complicated course, and is a valuable for medical practice.

This article represented the clinical case of small intestinal mesentery inversion, caused by the enterolith fragments formed in the jejunal diverticulum.

The possibility of implementing active surgical tactics in patients with locally advanced tumoral process in the small pelvis is demonstrated, despite the invasion of the main iliac vessels. It has been established that the use of a personified approach to the planning of surgical treatment, along with the use of a wide range of reconstructive-plastic techniques, allows achieving good long-term results even in such complex clinical situations.

The article presents a brief overview of local and foreign literature sources and reflects some of the issues of the etiology and pathogenesis of bleeding from the upper gastrointestinal tract in patients with acute vascular pathology of CNS and modern minimally invasive methods of hemostasis.