Purpose. To compare of the diagnostic accuracy of ultrasonography (US) with magnetic resonance imaging (MRI) as a reference in the assessment of pathological changes of the soft tissues at the X-ray negative stage of knee joint osteoarthritis (OA).

Materials and methods. Nineteen patients with X-ray negative stage of knee OA diagnosed in 2015 underwent US and MRI of the knee joints. We estimated the sensitivity and specicity, positive and negative predictive values for pathological changes in 7 distinct anatomical areas on US comparing to MRI.

Results. There were no false positive results. The ndings of US and MRI coincided for the presence of an excess amount of free uid in the joint cavity and suprapatellar bursa synovitis and the presence of Baker’s cyst, 15 (79%) and 4 (21%) patients, respectively. More o en, false-negative results on US have been seen in assessing changes in the lateral meniscus and osteophytes: 2 (11%) diagnosed cases vs 15 (79%) for MRI, respectively. The degenerative changes in the medial meniscus were found in 10 (52.6%) on US compared to 15 (79%) for MRI, respectively. Method of US showed the low sensitivity in the detection of early pathological changes of the knee ligaments: sensitivity and predictive value of negative results accounted for the cruciate were 47% and 18%, for collateral ones only 24% and 13%, respectively.

Conclusion. Ultrasound examination is highly eective in the diagnosis of synovitis, free uid in the joint cavity and suprapatellar bursa and Baker’s cysts in patients with X-ray negative stage of knee OA. It helps to identify the group of patients with the highest risk of progression of OA. The method of ultrasound is signicantly inferior to MRI in the diagnosis of early degenerative changes in ligaments, the menisci and cartilage of the joint.

Purpose. Evaluation of the effectiveness and safety of various pharmacotherapy options in patients with erectile dysfunction (ED) in combination with benign prostatic hyperplasia (BPH).

Materials and methods. In 127 men with BPH and ED, pharmacotherapy was performed for 3–12 months. Inclusion criteria: IPSS ≥8 points, IIEF-5 ≤21 points, prostate volume ≤40 cm³, prostatic specific antigen (PSA) level <1.5 ng/ml. In patients who are interested in improving erectile function, the following treatment options have been performed: monotherapy with tamsulosin 0.4 mg daily (n = 30), sildenafil monotherapy 25 mg daily (n = 31), tamsulosin 0.4 mg daily and sildenafil 25 mg daily (n = 34).

Results. With combined therapy, statistically significant and most pronounced improvement occurred at all time points for all 5 parameters: IPSS, QoL, IIEF-5, maximum urination rate (Q_max), residual urine volume. Monotherapy with α1-adrenoblocker at all times led to a significant improvement in 4 parameters (IPSS, QoL, Q_max, residual urine volume), but had no effect on erectile function. Monotherapy with a phosphodiesterase type 5 inhibitor (PDE-5) improved IIEF-5 from the very beginning, and the remaining parameters (IPSS, QoL, Q_max, residual urine volume) after 6 months.

Conclusions. The combination of α1-adrenoblocker and PDE-5 inhibitor can be considered as an optimal treatment option in patients with LUTS and ED with prostate volume <40 cm³ and PSA level <1.5 ng/ml.

The large proportion of postoperative infectious complications in urological hospitals makes extremely urgent the problem of its control. The high level of these complications in the postoperative period in patients with urolithiasis is caused by various endo- and exogenous factors.

Purpose. To determine the frequency, structure, and features of postoperative infectious complications in patients with urolithiasis in urological hospitals.

Materials and methods. As an object of research we used a medical card 232 of the operated patients with urolithiasis, which were copied out in individual registration card. Of 232 patients with urolithiasis 48.3% were men, their average age was 44.5 ± 9.4 years. Female patients were slightly larger (51.7%), respectively, the average age was 44.9 ± 8.1 years.

Results. The most common postoperative infectious complications in urolithiasis was infection in the area of surgical intervention (36,2%), acute urethritis (20,7%), acute pyelonephritis (14.7 per cent), paranephritis (9,5%), acute orhoepididimit (7,8%), acute cystitis (6%), pionephrosis (3,4%), urosepsis (1.7 percent). In the etiological structure of infectious agents associated with medical care with the highest frequency, microorganisms of genera Escherichia coli (43%), Proteus (9.5%), Staphilococcus spp were isolated. (8.3%) and Staphilococcus aureus (8.3%), and in 11.9% of cases, the Association of microorganisms. Analysis of the etiological structure of genera of the family Enterobacteriaceae resistant to β-lactam antibiotics showed that 63.2% of the amount to the genus strain of E. coli, 21% Proteus and 15.8% Klebsiella.

Conclusion. The data obtained indicate the need for research on the prevalence of resistant strains of microorganisms, the introduction of more specifi c, sensitive methods and monitoring. This will increase the effectiveness of treatment, reduce the risk of the spread of resistant strains and increase nosocomial infections.

Purpose. The purpose is to study the state of immunological reactivity in children with chronic glomerulonephritis.

Patients and methods. 288 children with chronic glomerulonephritis were examined, of which boys accounted for 64.6%, girls — 35.4%. The mean age was 10.63 ± 3.88 years. Children are divided into 3 groups: Group I — 104 children with nephrotic form, Group II — 96 children with hematuric form, Group III — 88 children with mixed form. In the serum are identifi ed: CD3 ⁺, CD4 ⁺, CD8 ⁺, CD16/56 ⁺, CD19 ⁺, CD95 ⁺ -subpopulations of lymphocytes; IgA, M, G; cytokines — IL-1β, IL-8, TNF-α, IFN-α, IL-4 and IL-10; the level of circulating immune complexes, the test for the reduction of nitrous tetrazolium (HST test), the phagocytic index and the phagocytic activity of neutrophils.

Results. Immunological reactivity in children with chronic glomerulonephritis is characterized by a statistically significant increase in T-helpers (by 36.2% and 41.9% in nephrotic and mixed forms), apoptosis marker (by 50.5%, 51.7% and 65.4% respectively, in children with nephrotic, hematuric and mixed forms), parameters of humoral immunity, the level of circulating immune complexes (2.4, 2.2 and 2.6 times, respectively, in nephrotic, hematuric and mixed forms, p < 0.05), pro-inflammatory cytokines and decreased T-killers, B cells and phagocytic activity. At the same time, the degree of expression of immunoglobulin changes was higher with nephrotic (IgA 2.1 times, IgM 2.2 times, IgG 1.7 times, p < 0.05) and mixed forms (IgA 2.0 times, IgM 1.8 times, IgG 1.6 times, p < 0.05) with chronic glomerulonephritis. The level of TNF-α in children with a hematuric form exceeded the control ones by 3.9 times (p < 0.01), with the nephrotic and mixed form in 4.2 (p < 0.01) and 4.3 times (p < 0.01) respectively. The level of IL-1β and IL-8 was higher in nephrotic form in 2.0 and 1.5 times (p < 0.05), with hematuric — in 1.8 and 1.4 times (p < 0.05), at mixed — in 2.0 and 1.5 times (р < 0.05) accordingly. The average level of IFN-γ, regardless of the form of CGN, exceeded the control level by 1.8 times (p < 0.05).

Conclusion. Children with chronic glomerulonephritis have an imbalance in the immune system. It should be noted that the very presence of chronic inflammation is accompanied by a violation of immunological reactivity. In children with chronic glomerulonephritis, hyperreactivity of immunity is noted.

The basis for the development of atopic dermatitis (AtD) is a complex interaction between genetic disorders, environmental factors, lack of the skin barrier and immunological disorders. In view of the importance of immunological disorders in the etiopathogenesis of atopic dermatitis, the study of these parameters in patients with AtD is a necessary aspect to assess the severity of the course, prognosis of complications and recurrence.

Purpose. Comprehensive assessment of clinical and immunological parameters in adolescents with atopic dermatitis.

Materials and methods. The study included examination of 28 patients with atopic dermatitis aged from 12 to 16 years, with disease duration from 10 to 15 years, which included analysis of complaints and anamnesis data, evaluation of disease severity on the SCORAD scale, General clinical and immunological studies. The peculiarities of cellular and humoral immunity in the relapse stage were determined. The main indicators of phagocytic activity of blood neutrophils were also investigated.

Results. In the analysis of anamnestic data of patients, a history of diseases associated with atopia in 16 (57.1%) of 28 adolescents (AtD, bronchial asthma in relatives of the first and second line of kinship) was revealed. When assessing the disease severity on a scale of SCORAD, prevailed patients with moderate to severe atopic dermatitis over — 19 (67,9%) patients, the average score of the assessment of the severity of AtD amounted to 29.3 ± 1,25. The conducted immunological examination with assessment of cellular and humoral immunity showed significant changes in immunological reactivity in patients with AtD. On the part of the cellular immunity level it is necessary to note a clear decrease in CD3+ and CD8⁺, as well as an increase in the subpopulation of T-lymphocytes — CD4⁺ and b-lymphocytes — CD20⁺ in most patients compared to normal indicators characteristic of this age group. Compared to healthy adolescents, there were high rates of IRA and NK cells (CD16⁺). In all patients there was an increase in immunoglobulin M and G, a high content of immunoglobulin E. The formation of secondary immunodeficiency, manifested by a decrease in phagocytic activity of leukocytes and incomplete phagocytosis, which is a factor predisposing to the development of pyoderma.

Conclusion. Changes in immune status in patients with AtD are expressed by imbalance of population Of T-lymphocytes, increase of various classes of immunoglobulins and considerable oppression of practically all indicators of functional activity of neutrophils of blood.

Purpose. Evaluation of the effectiveness of the method of palliative pancreatoduodenal resection for complications of advanced pancreatic head cancer.

Patients  and methods. The article analyzes the results of treatment of 32 patients with advanced pancreatic head cancer in the Department of Radiosurgery of the FSBO «N. Blokhin National Medical Research Center of Oncology” of Ministry of Health of Russia. All patients underwent palliative pancreatoduodenal resection. In terms of the prevalence of the process, the patients were distributed as follows: 17 (53.1%) patients with the locally advanced process and 15 (46.9%) patients with distant metastases.

Results. The average time of the operative intervention was 5.2 ± 0.3 hours, the average blood loss was 543.1 ± 1.3 ml, the average bed-day was 22.1 ± 0.6 days. In total, in the shortest postoperative period, complications were noted in 5 patients (15.6%). The total postoperative lethality after the PDR was 6.3%. In general, the results were divided into 4 groups: good results were recognized in 16.7% of cases, satisfactory enough — in 26.7%, less satisfactory, but a positive effect — in 50%, non-satisfactory results of treatment were found in 6.6% cases. Quality of life using the MOS-SF-36 questionnaire — if the average indicator on the scale of physical health was 41.2 ± 0.5 before the operation, then after a month of surgery it was significantly higher — 68.1 ± 0.9, according to the scale the average figure increased from 30.6 ± 0.9 to 71.5 ± 0.7. However, the differences between the values before and after surgery are statistically significant (p<0.01). The long-term survival rate for 1 year after the operation was 39.2%, 2 years after the surgery, 7.1%.

Conclusions. Palliative pancreatoduodenal resection with a common pancreatic cancer in some cases can be an operation of choice that effectively eliminates the underlying pathological process and its complications in the form of mechanical jaundice, duodenal obstruction and pain syndrome and significantly improve the quality of life of patients.

Inter-ileal abdominal dissection (IIAD) is one of the most traumatic maiming operations, which implies removal of the lower limb with a single block with an adjacent half of the pelvic ring. Taking into account the low overall incidence of locally advanced bony and soft tissue sarcomas localized in the projection of the pelvic bone and hip joints, and a small number of clinics with sufficient experience in performing such operations, modern specialized literature has a limited number of publications on the IIAD.

Purpose. Presentation of the experience in the implementation of the IIAD in patients with locally advanced sarcomas of bones and soft tissues.

Patients and methods. The analysis of results of treatment of 26 patients with locally advanced sarcomas of bones and soft tissues is presented. There were 14 men (54%), women 12 (46%). Patients with primary malignant tumors of bones 23 (88%) prevailed among patients. Depending on the morphological structure, 16 (61%) had chondrosarcoma, 4 (15%) had osteosarcoma and 3 (11%) had a malignant fibrous histiocytoma. Three (11%) patients had locally advanced softtissue sarcomas. In 2 (7.5%) synovial sarcoma and in one (3.5%) malignant tumor from the shells of peripheral nerves. The primary tumor process was in 21 (81%) patients. The clinical stage was established as IIb in 14 (54%), Ib in 3 (11%), IVa 1 (3.5%) and IVb in 3 (11%) patients, respectively.

Results. The average duration of the operation was 4.1 hours (2.7–6 hours). The volume of intraoperative blood loss is 3400 ml (500–9000 ml). The margin of resection was evaluated as positive in 4 (15%) patients. The recurrence of the tumor after  the IIAD performed by us was in 4 (15%) patients with a negative edge of R0 resection.

Conclusions. Postoperative complications were noted in 5 (19%) patients. Four (80%) had wound purulent-septic com-plications: partial flap necrosis — 2, total necrosis of the flap — 1, edge necrosis of the wound — 1 patient. The overall 5-year survival rate of patients treated in the clinic by the treatment was 40%. The results of the functional status of patients after  the operation were 45% on the MSTS scale, which correlates with the data of other authors.

Purpose. Evaluati on of the effectiveness of complex restorati ve treatment with the inclusion of galvanic mud procedures in patients with pain in the lower back.

Patients and methods. There were 30 patients (18 men and 12 women) with a diagnosis: lumbulgia or lumboeishalgia under observation. Patients underwent a course of rehabilitation on the basis of the Republican Hospital of Rehabilitation, Makhachkala. Against the background of standard therapy, galvanic mud procedures were included in the therapy.  The effectiveness of the treatment was assessed by the control of pain assessment according to the VAS scale, the body mass index, the psychoemoti onal state of the HAM test, the tests of Schober and Thomayer were carried out.

Results. After the complex treatment in patients, clinical and functional indices of the state of the neuromuscular apparatus Were noted, varying depending on gender. The results of the study showed that the intensity of the pain syndrome according to the VAS score in the compared groups before the rehabilitation differed significantly (5.4 ± 0.1 points in men and 6.16 ± 0.3 in women, (p <0.05), after completion of the course of treatment, the VAS score decreased statistically in both groups: in men 2.0 ± 0.4 points and in women 1.8 ± 0.1 points (p <0.05), but between groups of significant differences in the quantitative assessment of pain the syndrome was not revealed. In determining the mobility of the lumbar spine, the results of the Schober test with lumbargia as in men, and women were unreliably reduced, after treatment restored within the norm: in men before treatment, 3.46 ± 1.47 cm, after 5.3 ± 0.73 cm (p < 0.05), in women before treatment 3.95 ± 0.5 cm, after 5.35 ± 0.55 cm (p < 0.05).The analysis of the dynamics of the test results of Tomayer revealed unreliably significant differences before treatment in men = 24.8 ± 2.4 cm, in women = 21,6 ± 6,2 cm. After the course of treatment in both groups there was a significant improvement in the indices: in men = 5.23 ± 1.44 cm (p <0.05), in women 1.45 ± 0.87 cm (p < 0,05), but at the same time a reliable difference in the indices (p < 0.01).

Conclusion. The conducted research has shown that carrying out galvanic mud procedures in a complex of treatment in patients with lower back pain positively influences the restoration of lumbar vertebral segment motor activity, as well as the psychoemotional state of the patient. In this case, women are more actively reduced pain and increased motor activity, but less significant indicators of the change in the psychological test.

For a long time, chemotherapy remained the main treatment option for metastatic urothelial carcinoma (mUC). Over the past year, there have been revolutionary changes associated with the approval of five new drugs aimed at blocking the interaction between the surface protein of T-lymphocytes PD-1 and its ligands PD-L1 and PD-L2, resulting in the activation of the immune response. It is noteworthy that the anti-PD-1 antibody pembrolizumab demonstrated an increase in overall survival relative to chemotherapy in a randomized phase III trial in the second line with mUC. Based on this level 1 evidence pembrolizumab was approved by the US Food and Drug Administration (FDA). Nivolumab (antibody PD-1) also demonstrated an increase in overall survival compared to historical control and was approved by FDA. Likewise, antibodies targeting PD-L1, including atezolizumab, durvalumab and avelumab, received accelerated approval from the FDA as the second line of treatment for mUC. Some of these agents are approved in the first line by the results of phase II study (atezolizumab and pembolizumab received accelerated approval for first-line treatment in patients not receiving cisplatin). Despite these many endorsements, clinical development of new biomarkers for selection of patients, who can get maximum advantages of immunotherapy and also for development the optimal therapy sequencing still are biggest and critical question for future investigation. The clinical introduction of biomarkers to determine optimal treatment of patients remains extremely important.

This article is the review of literature concerning use of proton beam therapy in treatment of oncology. The staticized data on comparison of effi ciency of this method at an eye melanoma are lit. Advantages of proton therapy on the level of local control and depression of frequency of development of the radio induced cataract are refl ected in the provided data. In evident material the technology of preparation and carrying out radiation of an eye is shortly covered with a fascicle of protons. The experience of use of proton therapy of tumors of a skull base got for the last several decades, showed good results. Physical properties of a fascicle of protons allow to achieve the maximum dose conformality, having lowered, thereby, a radial load on the next crucial anatomical structures. The presented material on an oncopediatrics shows insuffi cient knowledge of scientists concerning advantage of a fascicle of protons over modern methods of photon radiation. There are only preliminary clinical results concerning generally of treatment of cranyopharyngiomas. At cancer therapy of a mammary gland, proton therapy showed the best local control of postoperative recurrent tumors, and also depression of a dose load on the contralateral party. The available results of the retrospective analysis of clinical data in the University medical center of Lome Linda, testify to advantages of proton therapy of the localized prostate cancer. The lack of a biochemical recurrence and a local tumoral progression within 5 years after radiation was shown. The data obtained from experience of use of proton radiation therapy with passively scattered fascicle for cancer therapy of a prostate at an early stage showed the admixed results in comparison with modern methods of radiation therapy with the modulated intensity. In treatment of non-small cell cancer of mild advantage of proton therapy aren’t absolutely proved yet. There are data on extreme toxicity of a combination of a chemotherapy and photon radiation. It is supposed that physical properties of protons will allow to reduce toxicity of such technique, however clinical trials in comparison of protons and RTMI aren’t fi nished yet. The main directions of development of a method of proton therapy are shortly lit.

Hyperparathyroidism is one of the most common endocrinopathies. This disease leads to a violation of phosphorus-calcium metabolism and the washing out of calcium from bone tissue. Breach of the skeleton’s structure in hyperparathyroidism is often mistaken for metastatic bone damage, which leads to incorrect treatment tactics. In this work we present the clinical observation of a patient with an adenoma of the parathyroid gland and a severe bone form of hyperparathyroidism. Multiple lesions of bones with destruction of the cortical layer and the presence of the softtissue component were initially regarded as metastases in the bone. However, the morphological pattern of bone foci, as well as an elevated level of calcium and parathyroid hormone, made it possible to diagnose the bony form of hyperparathyroidism. The search for the cause of hyperparathyroidism revealed a tumor in the projection of the right lower parathyroid gland. Surgical removal of parathyroid adenoma led to the normalization of the level of calcium and parathyroid hormone. The article presents data of laboratory-instrumental methods of research and the results of surgical treatment of a patient.

Breast cancer (BC) takes the first place in the structure of morbidity and mortality among the female population. One of the main methods of treating the disease is surgical one, it can lead to both complete removal of the breast and partial tissue damage. In most cases, the further socially active behavior of the patient depends on the quality of the performed operation.

In this article, two clinical cases of corrective lipofilling at the final stage of reconstructive and plastic surgeries in patients with breast cancer after complex treatment are presented. Specifi c examples showed a positive effect after a single lipofilling session of the formed breast using both syringe and water jet techniques. This procedure is carried out to improve the cosmetic results in patients after comprehensive treatment for breast cancer.

It is proved that mesenchymal stromal cells, or messenger cells present in all fatty tissues, promote its regeneration by forming new blood vessels or directly affect damaged or susceptible structures — restore and rejuvenate the areas of lipofilling. Therefore, adipose tissue is a natural source of regeneration of the human body. On these clinical examples, after a successful one lipophilic session, improvement of the quality of the skin in the reconstructed breast area was noted and, as a result, a good cosmetic result after reconstructive plastic surgery, both in the patient with the use of a silicone endoprosthesis and without it.

This article presents a clinical observation of the treatment of recurrent invasive urothelial cancer of the upper urinary tract using surgical and chemotherapy treatments. During the treatment, surgical treatment and 2 chemotherapy lines were performed. The patient was under strict dynamic control, during which diagnostic procedures were carried out, which allowed time to identify the progression of the underlying disease and prescribe timely treatment of identifi ed relapses.

At the first stage, the patient underwent surgical radical treatment to remove the primary tumor focus localized in the lower third of the right ureter. At the control examination a local relapse was revealed. The 1st line of chemotherapy was prescribed and performed, against which the full effect of the treatment was noted. But in the future, the progression of the disease was revealed, which required the 2nd line of chemotherapy with preliminary surgical removal of a local relapse.