Purpose. To assess the effectiveness of various techniques of surgery of pulmonary metastases based on the outcomes of surgery interventions, frequency of postoperative complications and overall survival of patients.

Patients and methods. Ninety-seven patients with suspected lung metastases of known primary malignancies (47 men and 50 women, mean age of 46,5 years) were retrospectively included in two study groups between 1 January 2004 and 1 January 2016 and underwent pulmonary surgery with the Nd: YAG laser of the 1318 nm wavelength (Group A, n = 44) or with the electrocautery (Group B, n = 53).

Results. A total of 151 operations were performed: 75 in Group A, 76 in Group B. The mean number of resected pul­monary lesions was 8,2 (95% CI: 5,2–11,1) in group A and 4,9 (95% CI: 3,7–6,0, p = 0,047) in group B. Additionally 87 lesions were evaporated due to small sizes (1–2 mm) in Group A. The mean time of surgery was 146 minutes in Group A and 113 minutes in Group B (p < 0,01).

Post-surgery complications were diagnosed after 9 and 19 of interventions in Groups A and B, respectively. The most common complications were pneumonia, pneumothorax and subcutaneous emphysema. The number of Grade III com­plications according to Clavien-Dindo classification was 2 and3 inGroups A and B, respectively. The survival rates were computed for all patients: the one-year, three-year and five-year survival rates were 83,7%, 49,7% and 36,7%, respec­tively.

Conclusion. The Nd:YAG laser with wavelength of 1318 nm allow extensive parenchymal resections without an increase in post-surgery complications and may have advantages in pulmonary metastasectomy, especially in patients with mul­tiple pulmonary lesions.

Purpose. To analyze the efficacy of the YAG:Ho laser in laparoscopic treatment of large duodenal papilla (LPA) stenosis complicated by mechanical jaundice.

Patients and methods. The work is based on a prospective analysis of 31 patients undergoing treatment in the KhMAO-Ugra BU “NyaganDistrictHospital”. To perform antegrade laser papillotomy, a laser setup equipped with high-energy YAG: Ho laser, endovideosurgical complexes and a fibrocholedochoscope was used. During laparoscopic cholecystec­tomy, intraoperative choledochoscopy and antegrade laser papillotomy were performed.

Results. Laser papillotomy was successfully performed in 31 (100%) patients with benign stenosis of LDP, among them in 15 patients (48.4%) the stenosis of LDP was combined with choledocholithiasis, which was detected intraopera­tively in 9 (29.0%) cases. For optimal conduction of choledochoscopy, a guide device for a choledochoscope has been proposed (RF patent for utility model No. 149055 dated May 12, 2014).

All surgical interventions, including lithotripsy, were performed laparoscopically, there was no indication for conversion.

Conclusion. The received results show high efficiency of the applied technique, absence of complications and lethal outcomes. Antegrade laser papillotomy is effective even in those situations where endoscopic retrograde papillosphinc­terotomy is technically difficult or impracticable.

Purpose. Development and evaluation of the effectiveness of sound and safer methods of palliative surgery with obstructive jaundice advanced pancreatic head cancer.

Patients and methods. The study included 272 patients with advanced pancreatic head cancer and the complication of this process in the form of mechanical jaundice, which had various volumes of bile-excreting procedures. Minimally invasive (141 patients) and laparotomic interventions (131 patients) were used to perform biliary decompression.

Results. With mini-invasive techniques, there were significantly more postoperative complications than with open surgery. The number of early complications after open surgery for biliary excretion (9.2%) is less than after minimally invasive (37.6%), and this difference is determined by complications caused by the performed intervention (4.6% compared with 31.9%). Complications after surgical interventions in all cases were stopped conservatively, whereas after minimally invasive interventions, in order to eliminate complications, 1.4% of patients required repeated mini-invasive interventions.

Conclusion. Survival analysis according to the particular bile decompression method showed the best indicators of overall 6, 9-month and one-year survival rate for all types of open surgical methods eliminate jaundice compared with minimally invasive techniques.

The purpose of the study was to evaluate the prognostic significance of carcinoerembryonic antigen in patients with rectal cancer and correlate its baseline with the degree of therapeutic pathomorphosis after neoadjuvant chemoradiotherapy.

Materials and methods. An estimate of the informative value of carcinoerembryonic antigen (CEA) indices in 179 patients with colorectal cancer determined before and after preoperative chemoradiotherapy (CRT) in SOD 50 Gy.

Results. Analysis of the results presented in the study showed that in all patients, CRT caused a significant decrease in the level of CEA (–71%) 10 weeks after its end (p < 0.001). In the course of the pathomorphological study, after the neoadjuvant treatment, the first degree of tumor pathomorphism was recorded in 4.5% of patients, II – 38.5%, III – 45%, IV – 12% (the degree of pathomorphosis is not related to the clinical stage and the degree of differentiation of colorectal cancer). It was revealed that patients with III and IV degrees of therapeutic pathomorphosis initially had a CEA level lower, in comparison with patients with grade I-II. Clinical progression of the disease is diagnosed in 24% of cases (43/179). It was noted that in patients with the IV degree of therapeutic pathomorphism of the tumor, no recurrence of the rectal cancer was detected in either case.

Conclusion. The results of the study showed that the problem of individual prediction of the effectiveness of combined treatment of the rectal cancer remains very relevant, rather complicated and yet not completely solved. However, it can be assumed that the use of such an indicator as CEA in monitoring patients after the treatment, can serve as a criterion for the sensitivity of colorectal cancer to CRT. Initially low antigen level can be considered as a positive factor of tumor response to ongoing treatment and disease-free survival of patients with locally advanced rectal cancer.

To date, there have been single studies showing a decrease in testosterone levels in patients as a result of urologic surgeries. It was found that a low level of testosterone has a negative impact on the physical and mental state of men. It was also found that a low level of testosterone increases the likelihood of postoperative complications.

Purpose. Study the changes in testosterone levels in prostate plasma ablation.

Patients and methods. 47 patients with benign prostatic hyperplasia who underwent plasma ablation of the prostate were examined. All patients were divided into 3 groups: Group I (14 patients) – patients with a normal preoperative level of testosterone (above 12 nmol/L), IIA group (17 patients) – patients with preoperative testosterone deficiency receiving HRT 2 weeks before surgery and during the entire period of postoperative follow-up and IIB group (16 patients) – patients with preoperative testosterone deficiency who did not receive therapy. In addition to standard general clinical examinations, all patients had a blood test for total testosterone, luteinizing hormone, sex hormone binding globulin. The level of free testosterone was calculated from the nomogram of Vermeulen, also testing was carried out using questionnaires AMS and IIEF-5.

Results. The decrease in the level of testosterone as a result of the operation was noted in all patients. A month after the operation, none of the groups recorded a return of testosterone values to the original level. However, in the group of patients undergoing HRT, normalization of the testosterone level (12.1 nmol/L and more) was noted by 30 days. Also, early and late postoperative complications were assessed in all three groups. In the group of patients with testosterone deficiency who did not receive HRT, the number of complications was significantly higher. In the group of patients receiving HRT, there was an improvement in the general condition and erectile function, confirmed by the results of the AMS and IIEF-5 questionnaires.

Conclusion. Performing plasma ablation of the prostate gland on a par with other methods of endoscopic surgery of the prostate gland leads to a significant decrease in the level of testosterone in the blood. Performing such operations against a background of testosterone deficiency adversely affects the clinical course of the early postoperative period, the development of complications and the general condition of the patient. Preoperative diagnosis and correction of testosterone deficiency is an important component that allows minimizing the number of risks and complications resulting from surgical interventions, as well as improving the quality of life and accelerating post-operative rehabilitation of patients.

Purpose. To investigate the effect of the development of erectile dysfunction (ED) in patients with prostate cancer after radical prostatectomy (RPE) on the assessment of these patients’ quality of life and their psychological state and the influence on these parameters of ED treatment by implantation of the prosthesis of the penis.

Materials and methods. The material of the study was analysis of the questionnaire data of 30 patients with PC with the postoperative ED before the postoperative period and after the falloprosthesis. In the long-term postoperative period (2–3 years) patients (n = 30) with an ED stand, who wanted to restore sexual function, were installed a 3-component prosthesis of the penis. The comparison group consisted of 38 patients, examined 3 years after RPE. The second comparison group consisted of 28 patients who were examined prior to surgical treatment. The questioning of patients was carried out using the questionnaire MIEF-5, which characterizes the state of sexual function, and the psychological test of Spielberger-Khanin for assessing anxiety.

Results. Itwasshownthatthesumofthepointsofsituationalanxietyafterprostheticsofthepenisdecreasedfrom 32.4 ± 3.6 to 17.4 ± 1.5 points (p = 3.74-5), and personal anxiety – from 43.7 ± 2.2 to 33.0 ± 1.2 points (p = 1.71-5); and, these differences are statistically highly reliable. Accordingly, the evaluation of sexual function shifted in a positive direction (all patients confirmed satisfaction with the restored sexual function).

Сonclusion. The results attest to the high rehabilitation efficiency of correction of ED, which developed after RP, by installing a falloprosthesis.

About 30 million men in the world are infertile. Genetic factors are the cause of 15-30% of cases of pathospermia.

Purpose. To study the influence of polymorphism G-105A (rs28665122) of SEPS1 gene on the development of pathospermia among men with infertility inMoscow region.

Patients and methods. There were examined 138 men. All patients were divided on 2 groups: the first (n = 70) – patients with pathospermia, the second (control) – fertile men (n = 68). All patients underwent clinical examination: analysis of spermograms, determination of hormonal profile, ultrasound of scrotum organs. We performed a genetic analysis of peripheral blood leukocyte DNA in patients of both groups. All DNA samples were studied for the presence of polymorphism G-105A (rs28665122) SEPS1 gene using polymerase chain reaction methods and the analysis of restriction fragments length polymorphism (PCR-RFLP).

Results. All patients of the first group suffered from severe infertility. Of these, 26 (37.14%) men had asthenozoospermia, 23 (32.85%) men with teratozoospermia, 21 (30.0%) azoospermia. A clinical study of patients of the first group did not reveal any serious deviations from the norm, so we were installed they idiopathic infertility. Our study of gene polymorphism SEPS1 showed that patients with pathospermia have allele -105А (genotypes GA+AA) a twice as often as in the control group of fertile men (48.57% и 27.94%, respectively, p < 0.001). 

Conclusion. Polymorphism G*-105A SEPS1* gene may be
used for screening of infertility in men.

Purpose. To identify possible effects of systemic dysmorphogenesis of connective tissue on the formation and characteristics of the course of nontraumatic subarachnoid hemorrhage at a young age, with further development of an algorithm for screening physical examination of patients with an increased risk of aneurysmal hemorrhage.

Patients and methods. A group of examined patients who underwent SAH under the age of 45 years were 78 people. Methods: neurological examination according to a conventional scheme using traditional methods with assessment of the main functional systems and determining the depth of their damage, determination of constitutional types, assessment of the degree of phenotypic manifestation of DCT by the sum of scores, general clinical laboratory, neuroimaging, and statistical.

In order to determine the signs of connective tissue pathology in all patients with SAH, the general examination included determining the constitution, height, weight with the definition of the Ketle index. Attention was also paid to the presence of visible small vessels on the face, chest and other parts of the body, telangiectasias, angiomas, thoracic cell deformities, scoliosis, flat feet, arachnodactyly, diastase of the rectus abdominis muscles, hernia of the anterior abdominal wall. Among the many undifferentiated phenotypic signs of DCT, external (changes in the skin and its derivatives, changes in bones, joints, spine, features of the structure of the hands and feet, peculiarities of the structure of the auricle, eyes, oral cavity, craniocephalic features) and internal (the presence of additional chords, heart valve prolapses, nephroptosis and kidney development abnormalities).

Results. When examining 78 patients with subarachnoid hemorrhage at a young age, the risk factors for its development were revealed (non-closed Willisian circle (86.6%), pathological tortuosity of the cerebral vessels (81.6%), dysplastic changes in the heart (68.3%) and kidneys (63.3%), which significantly differed from the comparison group (arterial hypertension – 97.8%, heart disease (IHD, atrial fibrillation) – 53.2%, hypercholesterolemia – 97.8%.) The value of systemic dysplastic change in connective tissue in the formation and flow of SAC at young age is shown. The constitutional-anatomical and functional features, characteristic for external and internal phenotypic signs of connective tissue dysplasia in different age groups, are revealed, and the role of additional vascular risk factors in the course of SAH are found. Conclusion. The complex study of connective tissue dysplasia as a risk factor for the development of aneurysms with a clinical manifestation in the form of SAH at a young age can be used in clinical practice for the timely detection and surgical treatment of aneurysms without signs of SAH. The obtained data can become a basis for developing an algorithm for screening physical examination of patients with an increased risk of aneurysmal hemorrhage.

Purpose. To study the influence of bioacoustic stimulation of the respiratory system in athletes on the value of vital capacity of the lungs.

Materials and methods. For technical realization of bioacoustics stimulation of the respiratory system, a biotechnical system, containing a block of an acoustic interferometer, an interferometer control system, and a system for recording sound field parameters, was used. The study involved nine athletes test volunteers: men aged 19 to 31 years, a sport – skiing, a sports category – the first adult, who underwent a training using bioacoustics stimulation in the following way: three times for three minutes each exposure, with an interval between exposures equal to one minute. Before the beginning of each exposure, the medical staff conducted a survey of the athlete’s well-being, measurement of the heart rate and blood saturation with oxygen, and determination of the vital capacity of the lungs. During the exposure, a constant control of health, heart rate and blood saturation with oxygen was conducted, and measurements of the vital capacity of the lungs were carried out after each stimulating effect.

Results. Eight of the nine volunteers increased the vital capacity of the lungs, according to subjective sensations, all volunteers noted a feeling of deeper breaths after exposure, a feeling of lightness of breath and absence of shortness of breath after training afterwards. Athletes who participated in earlier stages of the study noted that the effect of stimulation is pronounced in terms of subjective assessments of a feeling of lightness of breath, a greater depth of inspiration, a greater volume of breathing at once, and within 3 days after three-fold exposure during one session. Conclusion. The results of the study testify to the significant potential possibilities of bioacoustics stimulation of the respiratory system of athletes to increase the functional reserves of the body, determined by the increase in the vital capacity of the lungs. Important for the practice of sports medicine is that the increase in vital capacity of the lungs occurs after a one-day course of bioacoustics stimulation of the respiratory system, persists for 3 or more days after stimulation and is accompanied by subjective estimates of easier breathing.

T

Today, pancreatic cancer is one of the most acute medical and social problems that is connected with features of clinical course of the disease, late manifestation, complexity of diagnostics and rather low efficiency of treatment. More often, this pathology is revealed at late stages, when the radical surgical benefit is not advisable. Until recently, treatment options for patients with metastatic and unresectable locally advanced pancreatic cancer were very limited, the prognosis remained very unfavorable. At the end of the twentieth century, in many countries of the world began to develop new methods of local destruction of unresectable tumors intraabdominal localization, contributing to the relief of symptoms of the tumor process, increase the quality of life and its duration. These include radiofrequency and microwave ablation, high-intensity focused ultrasound therapy, cryoablation, irreversible electroporation and photodynamic therapy. Today, these methods of treatment are actively introduced into practical health care, allow to increase the life expectancy of patients with unresectable tumor processes, along with maintaining or improving its quality. This article presents a literature review of different methods of local treatment in patients unresectable locally advanced pancreatic cancer.

The delayed reconstruction of the mammary gland after radical mastectomies is a surgical method for the rehabilitation of patients. Breast reconstruction using an expander is used in women with a small breast size, as well as in patients who refuse to use the patchwork methods for restoring the mammary gland. The article describes expansions, which were applied from the moment of their creation and those that are currently in use. Indications and contraindications to the delayed reconstruction of the mammary gland with the use of an expander are determined.

The article presents the mammary gland marking and stages of delayed reconstructions performed in the department of oncology and reconstructive-plastic surgery of the breast and skin of the P. Hertsen MORI. In the case of a small size of the breast and the consent of patients for the use of implants, this reconstruction is the main surgical intervention. Rehabilitation of patients after radical mastectomies is a series of surgical interventions using expander techniques. At the 1st stage – the use of the expander, at the 2nd stage – the replacement of the expander for the implant, at the third stage – tatooing of areola and / or reconstruction of the nipple-areolar complex from its own tissues.

Due to consistent surgical interventions, as well as the correction of the second breast, it is possible to achieve symmetry of the mammary glands, and, of course, to recreate the removed mammary gland.

Purpose. To study the medical and social characteristi of pati nts with parti secondary adentiti complicated and uncomplicated dentofacial anomalies.

Materials and methods. The study group consisted of 206 pati nts aged 19 to 62 years. The average age of respondents was 40.5 years. The respondents were divided into the main and control groups of the study. The main group of the study consisted of 179 pati nts with parti secondary adenti complicated and uncomplicated dentofacial anomalies, 27 pati ts with dentofacial anomalies were included in the control group of the study.

Results. The frequency of requests for dental care of respondents in the main group of the study was revealed: 34% – 2–3 ti s a year, 38.5% – 1 ti a year, 12.3% – 1 ti in several years, 15.1% – very rarely. In control group of the study: 40.7% – 2–3 ti a year, 44.5% – 1 ti a year, 7.4% – 1 ti in several years, 7.4% – very rarely.

The main reasons for seeking dental care in the main group of the study: 54,2% – the toothache, bleeding gums, bad breath; 25.1% – the preventi e examinati 27.9% – the decision of the respondent on prostheti for extracted or damaged teeth (of which 6% of respondents have problems with chewing); 15.6% – the decision to correct the bite; 5% the problems with chewing.

The main reasons for seeking dental care in the control group of the study: 11% – the toothache, bleeding gums, bad breath, 37% – the preventi e examinati 7.4% – the decision of the Respondent on prostheti of destroyed teeth, 51.9% – the decision to correct the bite.

The result of clinical examinati of pati ts: 96.7% of the study group – the presence of signs of overloading of teeth; 81.5% of pati ts of the control group – the presence of signs of overloading of teeth. In the main group of the study revealed a change in the positi of teeth in the dentiti as a result of loss of teeth, occlusion plane violati of 83.2%, 16,8% – were pati ts with removed teeth up to three years ago.

Conclusion. Unti treatment of pati ts for dental care in the event of symptoms is among the most important components of a high-level dental morbidity. The main causes and frequency of applicati for dental care, the nature of pati nt complaints, the presence of bad habits, the criteria for selecti treatment and preventi faciliti and other factors have been revealed. In this arti , the medical and social characteristi of pati ts with dentiti defects. Determinati of the medical and social characteristi of pati nts during dental treatment makes it possible for the denti t and orthopedic denti t to assess the main expectati of pati nts, in additi to local dental problems, which allows to achieve positi e stable results of treatment with changes in the positi of teeth and restorati of the integrity of the dentiti

The clinical observation of a successful treatment of a young patient with intima dissection of the internal carotid artery and thrombosis of the lumen of the internal carotid artery and the middle cerebral artery of traumatic genesis is presented. Injury of the internal carotid artery occurred with a large physical load of a rotational nature. Fracture of the styloid process caused a dissection of the internal carotid artery with its thrombosis on the extracranial level and the development of ischemic stroke in the basin of this artery. In an emergency order, a complex of diagnostics was performed-CT CT, CT angiography. The first stage was performed thrombextracion from the internal carotid artery and the middle cerebral artery by the X-ray endovascular method. To fix the intima in the internal carotid artery in the area of her injury we stented her. Complete revascularization was achieved in the basin of the internal carotid artery with almost complete regression of neurologic symptoms. The patient returned to work. The use of x-ray endovascular mini-invasive technologies, thrombus extraction and stenting in the next few hours after the development of AVCC allowed to achieve a good near and distant clinical result.

The incidence and mortality of skin melanoma in the world and in Russia is growing every year. It should be noted that the proportion of patients with melanoma of late stages remains high. Until recently, only ineffective chemotherapy regimens were available for such patients. That is why the possibility of using modern drugs in real clinical practice for the treatment of this cohort of patients is an urgent issue of modern clinical oncology. The appearance in a real clinical practice of a new group of immunological drugs (anti-CTLA4 and anti-PD-1) for the treatment of patients with metastatic melanoma allows to increase both the time to progression and the life span of this cohort of patients.

In this article, we present the experience of St. Petersburg Regional Clinical Hospital “City Clinical Oncology Clinic” in the treatment of patients with metastatic melanoma under the conditions of real clinical practice with the preparation of ipilimumab as part of the expanded access program from February 2014 to March 2017. In total, 31 patients with disseminated melanoma (12 men and 19 women) were treated with ipilimumab during this period. The average age was 57 years (from 39 to 81 years), in 8 patients there were metastases to the brain. Patients with ECOG status 1 at the time of initiation of treatment were the majority 28 patients (90%), three patients (10%) had ECOG status 2. All patients had previously received 1 to 4 lines of systemic chemotherapy. The median of the observation period is currently 12 (3-35) months. The median time to progression was 6 months. At 5 of 31 patients at the time of analysis, signs of progression were not identified. The median overall survival (OB) was 12 months 9 of 31 patients were alive at the time of the analysis. The annual OM was 56.5%, the 2-year period was 29.4%.

The article presents a clinical case of treatment of a patient with metastatic melanoma, which will have an effect against the progression of the disease after four lines of therapy, including ipilimumab. The patient was included in the program of expanded access to the PD-1 inhibitor, nivolumab. In all, the patient received 65 nivolumab injections. The life expectancy of the patient from the moment of diagnosing the metastatic stage of the disease is 3.5 years, while 2.5 years on the background of nivolumab therapy. Patient monitoring continues.

Retroperitoneal fibrosis (Ormond’s disease) is a rare disease, it is characterized by the development of a nonspecific inflammatory process in the retroperitoneal tissue with the formation of a fibrous tissue that gradually leads to compression by a number of located structures. Although the final diagnosis can be made only on the basis of biopsy, computed tomography is of great importance for the evaluation of the pathological process, it allows diagnosing the disease, assessing its prevalence and observing the dynamics during treatment. This article presents clinical observations of two patients diagnosed with retroperitoneal fibrosis using conservative and surgical methods of treatment. Patients were under dynamic control, they underwent ultrasound, CT and MRI examination during treatment. These diagnostic procedures made it possible to identify Ormond’s disease and prescribe the necessary treatment. The article contains the protocols of CT studies, the conclusions of ultrasound and MRI examinations, the data of laboratory analyzes, the description of surgical interventions