Determination of indications for performing reconstructive and plastic surgical interventions in stricture of UPS is a difficult task. When making an incorrect decision, the treatment can be ineffective. Functional and anatomical preservation of the kidney can significantly affect the outcome of the operation.

Purpose. Evaluation of the effectiveness of laparoscopic plastic surgery of stricture of UPS, depending on the anatomical and functional state of the ipsilateral kidney.

Material and method. The results of treatment of 134 patients, who underwent for the period from 2012 to 2015 the different types of reconstructive surgical interventions for stricture of the pelvic-ureteral segment (Calp de Virde scrappy plastic surgery, Andersen-Heinz ureteropyelanastomosis, and antineoplastic ureteropyeloanastomosis), were analyzed. To analyze the effectiveness of the treatment, in the preand postoperative period, the following parameters were evaluated: the presence of pain syndrome, the presence of pyeloectasia, the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPS stricture.

Result. The overall efficacy of laparoscopic UPS reconstruction was 94.7%. The results of treatment did not depend on the chosen technique of operative intervention. In this case, the effectiveness of the treatment was dependent on the initial deficiency of kidney function: the best results were seen in patients with kidney function deficiency of less than 25%, and the proportion of ineffective interventions was highest among patients with a deficit of more than 75%. The degree of dilatation of the pelvis in the postoperative period was also associated with preoperative indicators of kidney function deficiency, this may be due to the presence of cup-pelvis-plating system atony.

Conclusion. Thus, the results of our work demonstrated the high efficiency of laparoscopic plastics of UPS. The effective- ness of treatment is determined by the timeliness of the intervention. As a basic prognostic criterion for the effective- ness of the forthcoming intervention, the degree of deficiency of the kidney function should be considered.

Prevention and treatment of postoperative purulent-inflammatory complications in urological practice remains a subject for study and improvement in all medical centers. The principle of evidence must be taken as a basis of effectiveness of therapy. In this study the quality criteria of demonstrated therapy are immunological parameters.

The purpose of this study is to identify the effectiveness of using monooxidase (NO) containing a gas stream replenishing the deficiency of endogenous NO in a group of patients; and to investigate immunological reactivity in patients under complex therapy included nitrogen monoxide and immunomodulators.

Materials and methods. In this experimental study we determined the functioning of the main links of the patient’s immunological system. They were determined on the basis of the levels of general T-lymphocytes (T-total), T-helper (T-h), T-suppressor (T-s), natural killer (NK), B-lymphocyte and immunoglobulin G, M, A, circulating immune complexes (CIC).

Results. Based on the obtained data, we concluded that the traditional treatment of patients with postoperative complications was less effective than the one proposed in our study. Immunological picture of patient’s condition come back to normal almost from the first day of treatment, and under traditional treatment it was only on the 7th day. Under using complex treatment with nitrogen monoxide, parameters of humoral immunity corresponded to the norm already on the 7–14th day from the beginning of treatment.

Purpose. To identify risk factors for the development of acute cerebral circulatory impairments (ACCI) in pregnant women.

Materials and methods. The material for the study was the medical history of 31 pregnant women with diagnosis ACCI. The average age was 29,5 ± 5,1 years. The comparison group consisted of pregnant women with physiological pregnancy (n = 30) with different gestation periods, the mean age was 29,1 ± 6,7 years. In this study, a comparative analysis of risk factors for stroke was carried out: gynecological and allergic history, smoking and taking contraceptives, the presence of chronic diseases, indicators of the hemostasis and lipid spectrum, polymorphism of thrombophilia genes.

Results. The prevalence of ischemic stroke over hemorrhagic stroke was found, which was 77.4% and 22.6%, respectively. In 93.5% of cases, a stroke occurred during pregnancy, in 79.3% of them in the third trimester of gestation. The number of recuperated women was 67.7%. As a result of statistical treatment, a significant difference in study and comparison groups was obtained (p < 0.05) as a result of a burdened obstetric-gynecological history. Among the women taking contraceptives, 11 (35.5%) women were in the study group, and 3 (10%) women were found in the comparison group (p < 0.05). At the analysis of smoking in the history the number of women in the study group prevailed comparing to the comparison group (35.5–13.3%, p < 0.05). Changes in the lipid spectrum system and hemostasis were detected, but there were no significant differences between the study group and the comparison group (p> 0.05). Various forms of mutations were identified in the group with ischemic stroke in 14 (58.3%) women, in 2 (28.5%) women in the group with hemorrhagic stroke.

Conclusion. Of all the data analyzed in pregnant women with stroke, statistically significant risk factors are: smoking, taking contraceptives, the presence of chronic diseases, including an obstructed obstetric-gynecological anamnesis. Primary and secondary preventive measures will depend on the availability of a particular risk factor.

Purpose. We present the experience of treatment of patients with cerebral vascular accident by the ischemic type, the cause of which was non-atherosclerotic lesion of brachiocephalic arteries.

Materials and methods. During 2011–2015 years 4118 patients with acute ischemic stroke were observed. Of these, 589 patients (14.3%) were operated in the acute period of stroke in the period from 4–6 hours to 14 days. The cause of the stroke was various types of pathology of the extracranial divisions of the brachiocephalic arteries (EDBA). Of this number, with atherosclerotic carotid artery stenoses, 336 patients (57.1%) were operated on, with non-atherosclerotic pathology of carotid arteries — 253 patients (42.9%). Of these 253 patients, dissection of the intima of the carotid arteries was detected in 10 (3.9%) patients, aneurysms in the extracranial segment of the ECA and ICA were detected in 14 (5.5%), and 229 (90.6%) revealed various types of tortuosity and kinks carotid arteries and fibrous dysplasia. All patients are operated on. Various types of reconstructions of carotid arteries with a good clinical effect have been performed. There were no lethal outcomes.

Concusions. The data obtained in the study confirm the opinion that not only atherosclerotic lesions of the ICA are an indication for surgical treatment at an early date. This stage is an important part of the comprehensive rehabilitation of patients with acute ischemic stroke.

Purpose. To study the effectiveness of various schemes of correction of repolarization disorder syndrome, including with the use of beta-blockers, in young athletes of the initial training group.

Materials and methods. At the first stage, 410 children involved in sports sections were examined. The average age of the examined was 12.22 ± 3.11 years. At the second stage, the athletes (boys) of the initial training group were selected from the surveyed contingent, engaged in martial arts. The groups were formed: A – people with violation of myocardial repolarization processes (72 patients, the average age 10,50 ± 0,35 years), the control group – people without changes in an electrocardiogram (33 people, the average age 10.36 ± 0, 62 years old). All underwent an electrocardiographic study at rest and after physical activity on the Innomed HS80GL apparatus with analysis of the main indicators. The vegetative status and the state of adaptation were estimated by Kerdo index and adaptive potential by Baevsky. After the examination, the subgroup A1 (40 people) was prescribed metabolic and antioxidant drugs. Additionally, in the subgroup A2 (32 people), a non-selective beta-blocker was included in the treatment regimen. The course of treatment is 10 days. The analysis of indicators was carried out in 10 days and in a month after the initiation treatment. Statistical processing was carried out in the program Statistica.

Results. An earlier disappearance of cardialgia was determined in the subgroup A2 (p < 0.05), whereas in the subgroup A1, 5% of patients had complaints not only at the end of the course, but also a month later after the initiation treatment. The more rapid positive dynamics of the electrocardiographic pattern with a more stable result was observed with the prescription of a beta-blocker.

Purpose. A comparative analysis of the efficiency of different procedures of exercise therapy is carried out: hydrokinesitherapy and therapeutic gymnastics with the use of exercise on an unstable support (stabiloplatform) depending on the sex of patients.

Materials and methods. Under our observation there were 72 patients undergoing rehabilitation on the basis of SBOH CC No. 201 DHM Zelenograd, an equal number of women and men and 36 people with back pain of vertebrogenic genesis. All patients repeatedly received standard medical therapy, physiotherapy (magnetotherapy, laser therapy) and a massage therapist. At the end of the physiotherapy treatment was assigned a set of physical therapy: group 1 included men and women, 36 — classes on stabiloplatform, a course of 10 treatments; Group 2 consisted of men and women, 36 — hydrokinesitherapy in the pool, a course of 10 treatments. The effectiveness of therapy was assessed: on a scale (VAS, mm), Schober’s test, test Tomiura test Ott summary index of health status (Oswestry questionnaire).

Results. The intensity of the pain syndrome according to the VAS score in the compared groups before the rehabilitation did not differ (on average 5.8 in men and 6.15 in women), after the completion of the course of treatment it statistically significantly decreased in both groups. Significantly, the best indicators were determined in the group of men when practicing on the stable platform (1.4 vs. 3.8 in women), and in women with physical therapy in the pool (1.6 vs. 2.9 in men). Effectiveness of changes in the test values of the mobility assessment of different parts of the spine, depending on the method of rehabilitation performed: men were more efficiently restored on the stabiloblatform, women in the pool classes. The indicators of the Tomayer test (inclination forward) significantly changed in both groups: in men on the stabiloplatform from 28.3 ± 0.05 to 13.8 ± 0.1 (p <0.05); for those engaged in the basin from 28.5 ± 0.2 to 16.2 ± 0.5 (p < 0.05). Women in the stable platform — from 28.5 ± 0.05 to 16.2 ± 0.03 (p < 0.05); for those engaged in the basin from 28.5 ± 0.1 to 12.7 ± 0.2 (p < 0.05). Before treatment, the overall health index (according to the results of the Oswestry questionnaire) differed significantly in both groups. After the end of treatment, there was a significant decrease in the indices in all the patients examined. At the same time, in men, the indices were significantly better when exercising on the stabiloplatform (index decrease from 39 ± 0.2 to 12 ± 0.1, p < 0.01), and in women — in the second group with hydrokinetic therapy (index decrease from 36 ± 0.6 to 12 ± 0.2, p < 0.05).

Conclusion. The results of the study of the psychoemotional state, the vertebroneurological status and the assessment of the pain of patients with dorsopathies suggest that men and women respond differently to rehabilitation methods, in particular: static and dynamic methods of exercise therapy, which, apparently, is related to gender differences and/or individual characteristics of the individual.

Purpose. To develop an artificial neural network for diagnosing and predicting the development of cholecystitis based on an analysis of data on risk factors, and to explore the possibilities of its application in real clinical practice.

Materials and methods. The collection of materials was held in at the hospitals of the city of Kursk and included a survey of 488 patients with hepatopancreatoduodenal diseases. 203 patients were suffering from cholecystitis, in 285 patients the diagnosis of cholecystitis was excluded. Analysis of risk factors’ data (such as sex, age, bad habits, profession, family relationships, etc.) was carried out using an internally developed artificial neural network (multilayer perceptron with hyperbolic tangent as the activation function). The computer program “System of Intellectual Analysis and Diagnosis of Diseases” was registered in accordance with established procedure (Certificate No. 2017613090).

Results. The use of neural network analysis of data on risk factors in comparison with the processing of information that forms a clinical picture allows the diagnosis of a potential disease with cholecystitis before the onset of symptoms. The training of the artificial neural network with a quantitative output coding the age of probable hospitalization made it possible to generate an array of values, signifficantly (α ≤ 0.001) not differing from the empirical data. The difference between the mean calculated and mean empirical values was 0.45 for the training set and 1.75 for the clinical approbation group. The mean absolute error was within the range of 1.87–2.07 years.

Conclusion. 1. The proposed new approach to the diagnosis and prognosis of cholecystitis has demonstrated its effectiveness, which is confirmed in clinical approbation by the levels of sensitivity (94.44%, m = 2.26) and specificity (80.6%, m = 3.9).

2. The error in predicting the age of probable hospitalization of patients with cholecystitis did not exceed 2.29 and 2.38 years for p = 0.95 and p = 0.99, respectively.

Extracellular matrix (ECM) proteins are a major component of the tumor stroma. Laminins emerge as one of the main families of ECM proteins with signaling properties. Apart from the structural function, laminins and products of their degradation affect survival and differentiation of cancer cells, motility of cancer and stromal cells, angiogenesis, invasion into distant organs, and other aspects of cancer development. Here, we discus expression of laminins in colorectal cancer (CRC), studying of laminin functions in in vitro and in vivo models of CRC, and using laminins as prognostic markers of CRC. Recently, we have reported a new approach to assessing prognostic power using classifiers constructed from sets of laminin genes. The method allows for accurate prognosis of CRC and provides additional information that may suggest possible molecular mechanisms of laminin function in CRC progression.

Patients with castration-refractory prostate cancer (PC) are a complicated group of patients for treatment. At the time of diagnosis, 85% of patients have a localized tumor process, however, in 40% of patients, generalization of the tumor process is observed. The most common localization of prostate cancer metastasis is the skeletal bone, which affects up to 90% of cases.

At the same time, taking into account the increase in the morbidity of prostate cancer pathology, it dictates the need to search for new, more effective methods of treatment for this group of patients. Currently, there are six effective methods of treatment of metastatic castration-refractory prostate cancer (mCRPC): effects on androgenic stimulation (abiraterone acetate, enzalutamide); chemotherapy with drugs from the taxane group (docetaxel, cabazitaxel); immunotherapy (Sipuleucel-T), radionuclide therapy with Radium-223 chloride (Ksofigo®). 223Ra is a tropic to bone tissue alpha emitter, which, due to its high linear energy transfer and short transmission distance, provides an enhanced localized antitumor effect due to higher energy delivery. The article presents a literature review highlighting the mechanisms of development of castration refractoriness, the characteristic and efficacy of Radium-223 in the treatment of patients with metastatic castration-refractory prostate cancer.

The problem of infertility in women with internal genital endometriosis is one of the main reasons among the reasons for this infertility problem. The review presents modern literature data of recent years, in which endometriosis is considered as one of the main causes of infertility. Despite the existing methods of diagnosis and treatment of infertility associated with endometriosis, today there is no single algorithm for conducting such a category of patients. The need to define survey tactics is an important component in the effectiveness of treatment. When developing a plan for managing patients with infertility associated with endometriosis, the age of the woman, duration of infertility, the presence of pain and the stage of the disease should be taken into account. Treatment of infertility associated with endometriosis includes surgical methods, hormone treatment and the use of ART.

According to some authors, the development of adenomyosis occurs during menstruation against the backdrop of regeneration, healing and re-epithelialization of the uterine mucosa. At this point, the introduction of endometrial cells into the “weakened” transition zone, which has structural and functional differences compared to the rest of the myometrium, can occur. The JZ “transition zone” is the region in the inner layer of the myometrium, which has received many definitions: an intermediate zone, an archiometry, an internal myometrium, a subendometric myometrium. This zone is a basal layer of myometrium and consists of longitudinally placed smooth muscle fibers, usually its thickness in women of reproductive age does not exceed 2–8 mm. Many researchers consider mechanical damage to the transition zone as the key pathogenetic link in adenomyosis. The main method of screening and the “gold standard” of primary instrumental diagnostics in gynecology remains transvaginal ultrasound examination of pelvic organs. Magnetic resonance imaging can also be used, the advantage of which in comparison with ultrasound is the possibility of obtaining an image in any plane and the absence of “invisible” zones, has a high resolution. A systematic review and meta-analysis of data obtained with transvaginal ultrasound and MRI in women with histologically confirmed adenomyosis showed a similarly high level of accuracy of diagnosis, but an important advantage of MRI was the standardization of images. However, not always with the deviations of the transitional zone of the uterus revealed with the help of MRI, histologically confirmed adenomyosis is subsequently diagnosed. There is a significant need to develop a common terminology and classification of violations of the transition zone of the myometrium, as well as systematization of ideas about instrumental criteria for diagnosis of adenomyosis.

The article analyzes information on prevalence, etiology, peculiarities of differential diagnosis, as well as indications and methods of surgical treatment of non-ischemic (arterial) priapism. The literature data are supplemented by the results of our own observations.

The disease is characterized by a rarity and significant differences in therapeutic tactics in comparison with ischemic (venous) priapism. Arterial priapism occurs about 50 times less often than venous and in most cases is secondary to trauma of the penis, perineum or congenital abnormalities of the vessels of the penis. Primary, that is, unclear etiology, arterial priapism is described as a casuistic rarity.

Laboratory-confirmed arterial priapism is a planned situation, not requiring immediate measures to stop the pathological erection, while the outcome of venous priapism directly depends on the duration of the disease and the success of emergency urological care.

The main method of differential diagnosis of hemodynamic forms of priapism is the gasometry of blood obtained by puncture of cavernous bodies. The absence of hypoxia is a pathognomonic symptom of arterial priapism and serves as a rationale for angiography, the task of which is the topical diagnosis of vascular disorders.

The revealed pathological vascular joints undergo superselective embolization. The effectiveness of the technique in terms of stopping the pathological erection is close to 100%.

Surgical tactics do not depend on the etiology of arterial priapism: posttraumatic and “non-traumatic” variants of the disease imply an absolutely identical approach.

Expectant  tactics  regarding  arterial  priapism  are  the  subject  of  scientific  discussion.  Despite  the  possibility  of an independent cessation of pathological erection with arterial priapism, due to the risk of developing cavernous fibrosis, expectant management is appropriate only in children with undisputed posttraumatic etiology of the disease. The observation period should not exceed 3–4 weeks.

The prognosis of arterial priapism is much better than venous. Arterial priapism, as well as endovascular methods of its treatment are not accompanied by the risk of acute cavernitis. Erectile function, provided the timeliness of the intervention is preserved in virtually all patients.

Diabetes therapy in elderly patients is a complex task due to their heterogeneous population, high risk of hypoglycemic conditions, the development of life-threatening arrhythmias and cardiovascular diseases, dementia, and the presence of a large number of comorbid diseases. The number of elderly patients in the world is growing rapidly, however, the algorithm for the treatment of elderly patients has not yet been developed and preference is given to an individual approach to the therapy of violations of carbohydrate metabolism. There are no therapeutic goals in elderly patients depending on their clinical and functional characteristics, the recommended level of glycated hemoglobin varies in a wide range from 7 to 9%. Priority is the problem of preventing hypoglycemia, which can lead to fatal consequences. The requirements for the use of oral hypoglycemic drugs in elderly patients with diabetes mellitus are also reduced to the absence of nephro-, hepatoand cardiotoxicity, as well as their lack of interaction with other drugs and ease of use. Such conditions are answered by incretin therapy represented by agonists of glucagon-like peptide-1 and inhibitors of dipeptidyl peptidase-4. It is also possible to use ultra-long-acting insulin. It is undesirable to use sulfonylureas and intensive insulin therapy in elderly patients. In the absence of contraindications, the use of metformin and pioglitazone is permissible, with the caution the use of SGLT-2 inhibitors is recommended. Treatment with any medicinal hypoglycemic drugs is possible in elderly patients who lead an active lifestyle and are capable of self-monitoring of carbohydrate metabolism, but in patients with low social adaptation it is desirable to limit the incretin therapy.

For today it is difficult to imagine medical practice without modern visualization methods of instrumental diagnostics. At the same time, according to the estimates of the World Health Organization, two-thirds of the world population is deprived of such opportunities. Ultrasound diagnostics with intravenous contrasting (CEUS), which requires minimal financial costs and technical equipment, has a great potential to remedy this situation. At present, there is a growing interest in the use of echography with contrast enhancement in order to improve the efficiency of detecting focal pathology and the accuracy of differential diagnosis, incl. in surgical hepatology.

Difficulties in planning the surgical tactics in patients with metastatic colorectal liver cancer are well known (discrepancy in the data of preoperative methods of radiation diagnosis about the number and segmental location of foci in the liver, the probability of additional foci). The “gold standard” of the diagnostic evaluation, which combines palpation of the liver and the performance of intraoperative ultrasound (IOUS), is now supplemented by the possibility of contrast enhancement during intraoperative echography.

In this article, we present a description of the method of ultrasound diagnostics with intravenous (IV) contrasting, illustrating the possibilities of investigation by clinical cases of intraoperative ultrasound diagnostics with contrast enhancement in patients with metastatic liver cancer.

Our impressions about the possibilities of ultrasound with intravenous contrast in the intraoperative diagnosis of tumor foci in patients with metastatic liver cancer we build on this little experience.

This article describes a rare clinical case of prostate cancer with a high baseline PSA level of 1407 hg/ml. In the course of diagnosis, hormonal and surgical treatment there was a successive dynamics of PSA decline: 07.08.2015–1407 ng/ ml, 14.09.2015–43,61ng/ml; 17.11.2015–0,326 ng/ml; 13.02.2016 (end of hormone therapy) — 0,084 ng/ml. After the operation of radical prostatectomy with enlarged lymphadenectomy, on 20.04.2016 (with prolonged hormone therapy up to 9 monthes) gradual decrease of PSA level continued: 05.05.2016–0,008 ng/ml; 17.06.2016–0,008 ng/ml; 08.09.2016–0,039 ng/ml; 30.11.2016–0,002 ng/ml; 07.09.2017 (total PSA) — 0,008 ng/ml. In parallel, there was a consistent improvement in the clinical picture, up to the MRI data of 19.10.2017, when there were no significant neoplastic changes at the level of the study (in the projection of the prostatic bed).

A gold standard for the treatment of metastases of colorectal cancer in the liver is combined treatment with postoperative or perioperative chemotherapy. Despite the improvement of antitumor drugs, the main condition for the successful treatment of patients with metastatic colorectal cancer is the operation in a radical volume, implying a macroscopic and microscopic absence of a residual tumor. The main contraindications to anatomic resections of the liver include a marked decrease in liver function, insufficient volume of the remaining parenchyma of the liver, and for a long time, bilobar liver damage was considered, which excludes the possibility of simultaneous removal of all foci.

The traditional variant of the surgical solution of the problem of bilobar metastatic liver injury is the implementation of two-stage anatomical resections. It has been proved that the reduction of liver and FLR functional reserves of less than 20% at normal and 40% in the case of compromised liver parenchyma, the implementation of surgical interventions is associated with a high risk of hepatic insufficiency. One of the promising ways to overcome this obstacle is to perform various modifications of ALPPS liver resections.

In the present work, we present a clinical case of performing a two-stage liver resection according to the type of ALPPS in a patient with metastatic colorectal liver cancer who had previously undergone PVL with unrealized vicar hypertrophy. The described observation testifies to the justification of performing repeated liver resections in patients with metastatic colorectal cancer and demonstrates the possibilities of ALPPS technique.

The objective. The study of the views of patients, dentists and medical students to the application of information and telecommunication technologies in dentistry.

Materials and methods. The method of sociological research. Interviewed 450 patients, 102 of a dentist and 152 students of the dental faculty of the Belgorod state University.

Results. The survey demonstrated that patients are ill-informed about the use of information and telecommunication technologies in dentistry (48,6% of the respondents noted that the term “telemedicine” is unfamiliar to them). Among students and patients in the priority position occupied by teleconsultations (73.8–83,8%), among physicians and educational activities (90,2%). While 75 to 90% of doctors and students wanted to obtain more knowledge about telemedicine technology, about half of physicians and more than 60% of the students are willing to participate in telemedicine programs.

Conclusion. Based on the obtained results, we can conclude that the introduction of telemedicine in educational and medical-diagnostic processes in dentistry is advisable.

Purpose. To consider the relationship between the concepts of “medical service” and “medical care” in the work of public medical institutions, based on the analysis of normative legal documents of the modern period.

Materials and methods. In the course of the research, more than 18 legal and regulatory documents that were published during the period from 1990 to 2017 were analyzed, an analysis of judicial practice and related literature sources (periodicals) was carried out.

Results. The analysis made it possible to distinguish the stages in the development of the organizational and legal framework for the provision of paid medical services in the Russian Federation and the dynamics of the relationship between the terms “medical care” and “medical service”. It was revealed that the concept of “medical services” appeared much later and was associated with the development of paid medical services and the need to establish legal aspects of health care. The provision of medical assistance is regulated mainly by public law, and the provision of medical services is governed by private law. The term “medical care” is broader than the “medical service” from the standpoint of the social aspect. At the same time, the concept of “medical service” can be considered more widely than medical care in cases when it is not only about measures aimed at treating the patient, but also about providing additional services to the patient in the process of receiving medical care.

Conclusion. Thus, we concluded that the categories of medical care and medical services should not be identified, but also not completely different concepts, but rather enter into a partial intersection relationship. The need to distinguish between the concepts of “medical care” and “medical service” is dictated not only by the category relations or opinion of the population and the medical community, but also by the need for legal support for the process of providing paid medical services with state-owned establishments.