Introduction. Spontaneous nasal liquorrhea is a pathological condition associated with defect between nasal cavity and intracranial structures that lead to the expiration of the CSF from the nasal cavity.

The objective is to evaluate the effectiveness of endoscopic endonasal approach in the CSF leak treatment.

Material and methods. For the period from 2008 to 2018, 38 patients with spontaneous nasal liquorrhea were examined and treated in Pavlov First Saint Petersburg State Medical University, the clinic of neurosurgery of Kirov Medical Institute and Almazov National Medical Research Centre. All patients underwent plastic surgery of the CSF fistula by endoscopic endonasal aproach.

Results. Only in 4 cases, there was a large defect, the failure of the closure of which required repeated surgical intervention in 1–2 weeks after the initial operation.

Conclusion. The use of autologous tissues (muscle or fat autograft) is the method of choice for repeated surgical plastics of the cerebrospinal fluid fistula or in a large size defect (more than 5 mm).

The objective is to analyze own clinical observations with the purpose of optimization of diagnostics and application of the adequate medical grant to patients with wounds of heart.

Material and methods. The results of treatment of 268 patients with heart wounds operated in the clinic for the last 27 years were analyzed. The majority of patients 202 (75.4 %) had penetrating and through wounds to the heart, 66 (24.6 %) had non-penetrating injuries. The diagnosis was based on clinical symptoms, the results of electrocardiographic, echocardiographic and x-ray studies. The clinical picture depended on the nature of the wound – penetrating or non-penetrating. Videothoracoscopy helped to clarify the nature of the damage of the heart in vague diagnostic cases. In most patients, heart damage was recognized in a timely manner, a diagnostic error was committed in 18 (6.7 %) patients. In 59 (22.0 %) cases, myocardial wounds were stitched with P-shaped sutures, and in 209 (78.0 %) – with nodular sutures.

Results. 240 (89.6 %) patients were discharged in satisfactory condition, 11 (4.1%) patients were transferred to the cardiology department for the follow-up treatment, 17 patients died with penetrating or through cardiac injury. The mortality rate was 6.4 %.

Conclusion. Emergency surgery is the only effective method of treating heart injury. Long-term results of treatment were traced in 38 patients in terms of 1 year to 10 years. All patients had a clinical recovery.

Objective. To estimate the short-term results of modified variant of ALPPS (PRALPPS) in patients with perihilar and intrahepatic cholangiocarcinoma.

Material and methods. Procedure was indicated for future liver remnant <40%.

Results. PRALPPS was applied in 13 patients and completed in 10 patients. Degree of hypertrophy and kinetic growth rate were 48 and 4.3%/day respectively. Major morbidity (>II) after the stage 1 and 2 was presented in 3 (only IIIa) and 7 patients, respectively.

Conclusion. PRALPPS may be considered as an effective and safe procedure in patients with perihilar and intrahepatic cholangiocarcinoma.

Material and methods. The work is based on the results of retrospective analysis of data from the examination and treatment of 77 patients who were in the Center for Surgery of the Liver and Pancreas of the City Clinical Hospital of Emergency Medical Care in 2005–2017.

Results. The article presents our analysis of the results of surgical treatment of patients with chronic pancreatitis complicated by obstructive jaundice.

Conclusion. The obtained data allowed to substantiate the feasibility of preliminary minimally invasive decompression of the biliary tract, to determine its optimal method, as well as the choice of operational benefits in patients with subhepatic cholestasis.

The objective is to study acute perforated ulcers of the small bowel, which arise as a complication after operations on the abdominal and pelvic organs.

Material and methods. A retrospective analysis of patient’s cases whose postoperative period was complicated by the development of acute perforated ulcers of small bowel.

Results. Over the past 20 years, the frequency of this complication increased by 8 times. In the structure of primary nosology, various types of oncological diseases prevail (69.4 %), moreover most patients underwent emergency operations. Most often, this complication occurred on the 4–10th day of the postoperative period, and the ulcers were multiple. Among these patients, there was an extremely high mortality rate of 74.2 %.

Conclusion. Considering the significant increase in the number of this complication in recent years and the high level of mortality among patients, a detailed study of acute perforated ulcers of the small intestine of the postoperative period is necessary.

The objective is to improve the results of treatment of locally advanced colorectal cancer in patients of older age groups due to the personalized approach to choosing surgical tactics with a comprehensive assessment of the functional operability and molecular biological properties of the tumor.

Material and methods. A comparative evaluation of the results of surgical treatment of locally advanced colorectal cancer in patients of different age groups was conducted on representative clinical material. We studied the molecular profile of tumors, taking into account the age factor, and the clinical significance of specific markers in predicting the results of treatment.

Results. The most significant indicators of functional operability of patients that must be considered when choosing a surgical tactic were identified. . The features of the immunophenotype of tumors, taking into account the age factor, were determined; and the prognostic significance of specific immunohistochemical indicators was estimated.

Conclusion. The use of a personalized approach to choosing surgical tactics allows to achieve encouraging results of treatment in geriatric patients with locally advanced colorectal cancer.

The objective is to determine the optimal synthetic material for endoprosthetics of the abdominal wall.

Material and methods. The experiments were conducted on 50 rabbits of the Chinchilla breed, which were divided into 2 groups of 25 individuals in the each group. In the first group, a lightweight polypropylene endoprosthesis with filament diameter of 90 microns was implanted at the aponeurosis of the anterior abdominal wall, and in the second group – a super-lightweight polypropylene polyvinylidene fluoride endoprothesis with filament diameter of 70 microns. We performed morphometric and histological study of reactive changes in the tissue surrounding the implanted endoprosthesis.

Results. In the animals of the second group, the inflammatory response to the implanted prosthesis was on the 3rd day of the experiment lower by 1.3 times, on the 7th day – 1.2 times, on the 10th – 1.1 times; fibroblastic response on the contrary increased 1.2, 1.12, 1.16 times on the same days.

Conclusion. When choosing a lightweight synthetic material for hernioplasty, the preference should be given to the super-lightweight polypropylenepolyvinylidene fluoride endoprosthesis.

This article is about the successful treatment of the patient with such heavy complications of a perforative duodenal ulcer as heavy abdominal sepsis, with the subsequent formation of fistulas of gastrointestinal tract. Application of the technique of «open abdomen» using vacuum assisted closure, allowed in this case to realize the principle of «sourcecontrol» and to achieve stabilization of the condition in multiple organ failure and septic shock. It is worth noting the advantage of stage reconstructive surgical interventions to this category of patients that allows to gradually improve quality of life of the patient without high operational risks of big simultaneous reconstructive operations.

We presents the rare clinical observation from our own practice, which demonstrates the effectiveness of surgical treatment of the patient with angiodysplasia of the small intestine complicated by bleeding. A clinically based algorithm for the diagnosis of this disease is described in detail.The possibility of achieving encouraging results of surgical treatment in this difficult category of patients with a reasonable choice of surgical tactics has been demonstrated.

Taking into consideration the results of our clinical observation, we can argue that the technique of endoscopic submucosal dissection of large leiomyoma of the esophagus with subsequent closure of the defect with a mucosal flap is applicable in clinical practice. This method is relatively safe, allows to achieve complete, quality results of morphological study, helps to reduce the number of postoperative complications, compared to more invasive surgical interventions. Also it reduces the time of social recovery and contributes to preserving the quality of life after the treatment.

The objectve of the study is to present a rare observation of thyrotoxic hypokalemic periodic paralysis in a Caucasian male. The article presents a clinical observation of 44-year-old man suffering from diffuse toxic goiter. The course of the disease was complicated by the development of attacks of periodic hypokalemic paralysis. The patient was repeatedly hospitalized to the neurological departments of different city hospitals with diagnosis of cerebrovascular disorders. Thyrotoxicosis as the cause of periodic paralysis was diagnosed in five months after the disease onset. Due to the risk of progression of thyrotoxic complications and worsening of neurological pathology, the patient underwent thyroidectomy. There were no complications. Working capacity restored on the 12^thday. Attacks of muscle weakness were not observed. Replacement therapy with 100 mg of levothyroxine per day was prescribed. Parameters of potassium, total calcium were normal.

Conclusion. A rare observation of genetically determined manifestations of diffuse toxic goiter – a thyrotoxic hypokalemic periodic paralysis is presented. Surgical treatment allowed to radically cure thyrotoxicosis and to eliminate episodes of paralysis, to return the patient’s workability.

The clinical case of successful cure of the victim with severe closed chest injury is presented, as a result of which the life-threatening acute respiratory failure could not be compensated by artificial lung ventilation and, in connection with which the use of extracorporeal membrane oxygenation as a «life-saving technology» was required.

The article describes the clinical experience of treatment of life-threatening pathology by minimally invasive methods. There is a long-term stable positive result after the operation. The introduction of new technologies in medicine minimizes the risk of postoperative complications, contributing to a favorable outcome of the disease.

Normal pressure hydrocephalus is a pathological condition characterized by ventricular expansion in combination with normal intracranial pressure and manifested by a specific triad of symptoms, including gait disorders, cognitive disorders and urinary incontinence. The prevalence of the disease has not been fully studied and according to various population epidemiological researches reaches 0.3–3 % among  patients older than 61 years. A feature that differs normal pressure hydrocephalus from other neurodegenerative diseases is the possibility of full or partial regression of neurological symptoms after surgical treatment. The most common surgical intervention for normal pressure hydrocephalus is ventriculoperitoneal shunting. It is an implantation of a system of catheters connected by pump-valve into the patient’s body, that drainage cerebrospinal fluid from ventricles to abdomen cavity. Correct and timely surgical treatment of normal pressure hydrocephalus allows increasing the quality of life of patients with normal pressure hydrocephalus and, as a result, the quality of life of their relatives and friends.

Despite a thousand-year history of anal fistula treatment, long-term outcomes have not been optimal, which encourages us to explore new surgical approaches. One of the methods of surgical treatment of anal fistulas is the use of ligature (Seton) in its different modifications. This review analyzes the literature data on the use of different modifications of seton treatment of anal fistulas. The analysis of publications showed the great interest in the use of the method, yet there is neither clear scheme nor systematic approach to applying it in clinical practice. Further study, as well as randomized researches, are required to find the optimal treatment and improve surgery results of using seton when dealing with anal fistula.

Hand injury holds one of the first places among injuries of the musculoskeletal system in children. The share of fractures of metacarpal bones account for 10 to 35 % of all fractures, while for 1/5 of pediatric patients they are accompanied by injury to the growth plate. The existing classification of pediatric metacarpal fractures does not accurately reflect the nature and extent of damage to the growth plate; it underestimates or overestimates the nature of the fracture, the degree of displacement of fragments of metacarpal bones with the traditional approach to treatment, without taking into account the age-related anatomical and physiological characteristics of the traumatized child. Further scientific research on the diagnosis and treatment of traumatic injuries of metacarpal bones in children, the introduction of the results of these studies into clinical practice will contribute to improving the quality of care for patients with hand injuries and to preventing disability of the children.