The article showed the results of ultrasonic assessment of topographic and functional diaphragm indices in patients with severe diffuse emphysema. They passed the selection for lung volume reduction surgery. The comparison of diaphragm indices was presented in patients with diffuse emphysema and control group of healthy volunteers. Dynamics of diaphragm condition was studied after surgical treatment. There wasn’t noted any statistical difference of diaphragm topographic indices as compared with the control group. There wasn’t shown a correlation between respiratory function indices and functional diaphragm indices, but it was noted a positive tendency in characteristics during quiet breathing.

The ascending gas and fluid stream method was applied in 12 patients with repeated purulent diffuse peritonitis. The number of leukocytes was determined in lavage fluid in order to estimate the efficacy of the method. Dynamics of general laboratory and clinical indices was compared with dynamics of leukocytes quantity. The research showed the adequacy of investigation results of lavage fluid to the course of inflammatory process in the abdominal cavity. The study presented an application possibility of given test for regulation usage correction of the ascending gas-fluid stream method.

The results of examination and treatment were analyzed in 51 patients with iatrogenic injuries of the bile-excreting ducts. Patients were divided into 5 groups according to international classification (EAES, 2013). It depended on the time of detection, the nature and scale of damage of the bile ducts, mechanism of injury, development of infectious and septic complications. Injuries of the main bile duct were detected intraoperatively (n=14). The complete intersection was in 10 patients (the first group) and the edge intersection - in 4 cases (the second group). Iatrogenic injuries of the bile-excreting ducts were revealed in 37 patients in postoperative period. There were the complete intersections in 28 cases (the third group) and the edge intersections - in 7 cases (the fifth group). Injuries of additional bile ducts were determined in 2 patients (the fifth group). An analysis of the main qualifying features of iatrogenic injuries of the bile-excreting ducts allowed defining indications to reconstructive-restorative surgery in 60,8% patients, restorative operations - in 29,4%, an external drainage - in 5,8% and reclipping of additional bile ducts in relaparoscopy - in 3,9%. The rational surgical approach allowed obtaining perfect results in 65,8% and good, satisfactory results in immediate and long-term period with low postoperative lethality of 1,95%. The study of diagnostics results and treatment of the patients with iatrogenic injuries of the bile-excreting ducts indicated about reasonability of assessment of main factors, which are based on iatrogenic injuries according to the EAES classification. An individual program of examination and more rational variant of surgery could be chosen due to this approach, which provides minimization of negative results and good quality of life.

The article analyzed an experience of treatment of 51 patients with follicular tumors. It was proved, that there weren’t any complications and recurrences in case of typically performed operation and adequate replacement therapy in postoperative period. It was noted a good quality of life from 2 to 5 years.

An introduction of blocking osteosynthesis was recently included into practice of treatment of forearm fractures. The forearm has a very difficult biomechanics and extremely important functional value. There are really high requirements to accuracy of reposition and stability of forearm fracture fixation. The blocking osteosynthesis successfully combines fixation stability with functionality, although its performance technique isn’t so simple, that forces experts to use other methods of fixation. It is possible successfully use advantages of the method by studying and keeping variety of operation nuances of blocking osteosynthesis on forearm in order to restore anatomy, biomechanics and obtain the stable fixation. The period of rehabilitation could be combined with period of union of bones in this case without postoperative complications such as nonunion of bones, construction fractures and instability of osteosynthesis. The method would be optimal provided that a surgeon masters the technique of construction implantation. There are maximum advantages in treatment of complicated fractures (nonunion of bones, false joint and defects) due to functionality of the method.

The retrospective research analyzed the data of 893 patients undergoing total hip arthroplasty. There were used the data about patients undergoing hip arthroplasty without complications (the first group - 808 cases) and patients with developed deep surgical site infection following total joint arthroplasty after 12 months (the second group - 85 patients). It was applied as the training matrix in creation of mathematical prognosis and algorithm of prophylaxis of deep infection in patients undergoing the primary total hip arthroplasty. There were revealed 21 prognostic significant criteria of deep infection development in surgical site. The program was tested in prospective investigation (293 clinical cases) with follow-up term of 12 months after operation. The rate of development of postoperative deep infection in surgical wound reduced as compared with the rate in group of retrospective research from 1,7% to 0,7%. The efficacy of proposed program was 80%.

A treatment of fractures of distal metadiaphysis of the humeral bone remains an actual problem of modern traumatology at present time. This is associated with immediate proximity of the radial nerve and risk of iatrogenic injury in external fixation, presence of short distal fragment, comminuted nature of fracture, complexity of treatment method selection, need of extensible approach. Biomechanical features of different fixators were analyzed in consideration of presence of short distal fragment, traumatic of external fixation and risk of iatrogenic injury of the nerve. The authors suggested the method of osteosynthesis of the humerus by using blocking osteosynthesis with preliminary extension of intra-medullary canal of distal fragment for obtaining stable osteosynthesis (priority № 2014105323 from 14.02.2014). The proposed method allowed avoiding the iatrogenic neuropathy of the radial nerve, providing the stability of fixation higher, than in case of external fixation. It excludes the need of external immobilization and combines the period of bony union with the period of rehabilitation and socially integrates the patient in minimal terms.

The temporary pacing is provided as a key principle of maintenance and correction of hemodynamics after weaning the patient from cardiopulmonary bypass. There are conventional algorithms of temporary pacing, but the substantiation of electrode fixation areas is variable. The authors experimentally investigated the efficacy of temporary epicardial pacing in DDD and DDDBV using 18 laboratory animals after cardiac surgery with application of cardiopulmonary bypass. The hemodynamic parameters were compared in given groups. It was noted that in case of temporary epicardial pacing in DDDBV conditions was the best hemodynamic effect. The authors recommended more optimal areas for electrode fixation in temporary pacing: bachmans bunble (closest to the artrial septum), proximal part of the crista terminalis for the right atrium electrodes; the front-side free wall of the right ventricle at the distance of 3-4 cm from the apex of the heart, diaphragmatic surface of the right ventricle proximal to artioventricular groove for the right ventricle electrodes; obtuse margin (side wall of the left ventricle), diaphragmatic surface of the left ventricle proximal to artioventricular groove for the left ventricle electrodes.

The article described the developed and patented method of removal of trancheal-lung complex from dead body and its transplantation to the recipient-corps.

A retrospective analysis of cases of sternal infection development was made in 388 cardiovascular patients from 2006 to 2012. The standard preventive measures of wound infection development were applied in the first period from 2006 to 2009. The method of «elimination of sternal infection» was used in the second period from 2009 to 2012. The application of the method of «elimination of sternal infection» allowed reducing the rate of sternal infection from 7,7 to 0,5% (odds ratio 0,099,95% CI: 0,013-0,747; p=0,025). According to results of statistical analysis the most significant factors were: body mass index (p=0,002), resternotomy in early postoperative period (p<0,001), risk according EuroSCORE Logistics (p<0,001) and usage of the method of «elimination of sternal infection» (p=0,006). The prevention of postoperative infectious complications shorthens the terms of hospital stay no less than 3 weeks, improves the quality of life for the patients and decreases treatment costs on 2,5 times.

The article presents the results of treatment of 201 patients with neuroischemic form of diabetic foot syndrome. The research included 158 women and 43 men of the middle age of 62,5±11,2 years. The complex approach was applied in treatment includ ing medicamentous treatment, revasculization of extremity, an application of modern combined collagenous coating and foot relieving using silicone insoles and orthopedic footwear. The endovascular and open reconstructive operations were performed in order to obtain the revasculization of extremity. Given complex approach allowed reducing the terms of hospital stay, the rate of ulcerous defects recurrences and relapses of ischemia of lower extremities during one year after endovascular interventions.

An analysis of treatment was made of 265 patients with strangulated hernia of the anterior abdominal wall. The patients were divided into main group (n=138) and control group (n=127). Nonstrain and conventional methods of hernioplasty and low-intensive laser radiation (LILR) were used for the patients of the first group. LILR wasn’t applied in the control group. The studied groups were statistically comparable on the basis of main disease, sex and age. Computed thermography was used in addition to standard methods of diagnostics in order to identify the wound complications in postoperative period. The application of low-intensive laser radiation for patients of main group allowed reducing the rate of development of local infectious complications in the area of plasty as compared with control group from 15,7 and 53,4% to 8,9 and 32,8% (p<0,05); terms of drainage of postoperative wound decreasing from 8,1±1,0 to 4,2±1,0 days and hospital stay shortening from 11,6±1,0 to 6,2±1,0 days (p<0,05). The intensity of pain syndrome and rate of complications declined from 38,1 to 17% in control group. There wasn’t any recurrence in the main group. Prosthetic methods of plasty and application of LILR significantly improve the immediate and long-term results in case of strangulated hernia of anterior abdominal wall. This rate would approach the results of treatment in planned surgery. Computed thermography allowed well-timed revealing of wound complications and forecasting the course of postoperative period.

Melatonin is neurohormone, which is involved in regulation of many functions of an organism, including the digestive system. Therefore the authors offered to include this hormone as a preconditioner factor in surgical treatment of colon tumors using laparotomy and laparoscopy. Preoperative application of melatonin allowed shortening the terms of postoperative period and hospital stay.

Prostate biopsy guided by transrectal ultrasonography (TRUS) is largely used in prostate cancer diagnostics. This procedure is usually quite painful and fear of pain could scare patients from this important research. The aim of the study was to compare methods of anesthesia for prostate biopsy. The patients were divided into 4 groups (40 patients in each group). TRUS-guided periprostatic anesthesia with 1% solution of lidocaine (10 ml) was carried out in the first group. An intrarectal introduction of 5 g EMLA cream (lidocaine 2,5% and prilocaine 2,5%) was applied in the second group. The intrarectal introduction of 10% lidocaine spray (3 doses) was used in the third group. Placebo as ultrasonic gel was utilized for the fourth group. The authors used the 100- score linear visual analog scale (LVS 1-100) and 5-score numeric visual scale (NVS-4). Minimal scores of pain were obtained in patients using TRUS-guided periprostatic anesthesia with 1% solution of lidocaine (10 ml). This type of anesthesia didn’t lead to increase of the number of complications.

The results of treatment of acute surgical diseases are worse in pregnant women, than in ordinary people, because of changes in patient’s organism. However, these patients would be treated the same way as ordinary patient according to conventional standards. The authors launched the special centre for treatment of acute surgical diseases of abdominal cavity for pregnant women and puerperas in order to provide the adequacy of treatment to the changes of patient’s organism. There was suggested a new standard of diagnostics, based on limited term (4-5 hours) with the following diagnostic laparoscopy or laparotomy in obscure cases. The experience of treatment of 171 patients with acute pancreatitis proved the high efficacy of the new strategy and developed standard of diagnostics. The main part of the patients were operated at the first 2-4 hours (105 patients - 61,4%) after hospitalization and 43 (25,1%) patients - within 4-6 hours. The cattaral form (92 patients - 53,8%) and phlegmonous (74 patients - 43,3%) form of the appendix changes were revealed in majority of patients. The gangrenous appendicitis was detected in 5 cases (2%). All the patients recovered. There wasn’t maternal or perinatal mortality.

The article presents a retrospective analysis of the results of surgical treatment of postoperative intraabdominal complications in 42 patients with colon cancer complicated by bowel obstruction and perforation of the tumor. The pyoinflammatory processes such as peritonitis and abscesses of abdominal cavity took a leading place in the structure of postoperative complications according to the authors. Method of «closed» decompression and intraluminal irrigation of the large intestine without wide opening of organ lumen was developed and applied into practice as perioperative prophylaxis of pyoinflammatory processes. These measures allowed reducing the rate of postoperative intraabdominal complications from 19,2 to 7,7%.