Background. Now there are heteropolar opinions on influence of postoperative purulent septic complications on rectal cancer patients on the long term oncological results.

Objective. Assess influence of these complications following laparotomy and perineal wounds after operations for rectal cancer on the long term oncological results.

Methods. We performed retrospective cohort research of 338 patients undergone scheduled radical operations for middle ampullar and lower ampullar rectal cancer T1-4N0-2M0 from January, 2003 to December, 2011. Patients were distributed in two groups: with suppuration of postoperative wounds and/or abscess of the abdominal cavity (n = 44–13%) and without purulent septic complications (n = 294).

Results. The logit regression analysis has shown that suppuration of laparotomy wounds and/or abscess of the abdominal cavity is one of the independent risk factors of a systemic recurrence. For development of a local recurrence purulent septic complications were not risk factors. The five-year overall and cancer specific survival in compared groups demonstrated statistically significant distinction. The overall survival in the main group – 47%, in the control one – 67.2% (Wilcoxon’s criterion р = 0.10, Cox-Mentela’s criterion р = 0.02, log rank criterion р = 0.03). Cancer specific survival was 43.5% and 70.1% respectively (Wilcoxon’s criterion p = 0.01, Cox-Mentela’s criterion p = 0.005, log rank criterion p = 0.009). The five-year recurrence free survival in the compared groups was similar 50.6 and 69% respectively (Wilcoxon’s criterion p = 0.25, Cox-Mentela’s criterion p= 0.12, log rank criterion p = 0.12).

Conclusion. Purulent septic complications of postoperative wounds in patients with rectal cancer have impact on long term results: they are independent risk factor for systemic recurrence development and decrease total and cancer specific survival rate.

Background Despite improvement of the equipment for polyfocal biopsy of the prostate gland (PBPG), a sufficient percent of data divergence in morphological characteristics of the prostate cancer (PC) at preoperative and postoperative stages is noted. Besides data of PBPG and clinical stage are quite important part of nomograms applied for indication detections for lymphadenectomy and neuro-sparing technique during radical prostatectomy (RPE). Regarding this fact error limits in clinical assessment of the primary tumor could influence surgical outcomes. Aim The aim of the present study was assessment of coincidence frequency of morphological characteristics of PC according to transrectal PBPG and clinical examination with morphological assessment of operational material after radical prostatectomy (RPE). Evaluation of errors influence on frequency of positive surgical margin (PSM) at clinical staging of PC was performed. Materials and methods Data of transrectal PBPG and operational material after RPE in 276 patients with PC were studied. Both biopsy and operative materials were exposed to preservation in 10% buffering solution of formalin, and after automatic conducting was painted by hematoxylin-eozinom. Each histologic conclusion was formed by at least two pathologists who estimated PBPG and samples after RPE in the same structure. The interrelation between staging errors and frequency of PSM was studied. Outcomes Analysis For patients with locally-advanced PC the adequate staging according to TPFB was noted only in 18,7% cases. Errors for clinical staging of the localized PC had no significant influence on PSM frequency: 3.7% in patients with correct staging and 6,5% in patients with poor staging with stage migration within pT2b - pT2c (p = 0,07). With down-staging of locally-advanced PC which was observed in 81,3% patients, significant increase in PSM frequency reached 23,1% in comparison with proper staging - 6.6% patients (p<0,01). Conclusions Down-staging of locally advanced prostate cancer at the preoperative stage is a frequent phenomenon which leads to essential increase in PSM after RPE.

In this article we describe possibilities of computer tomography in detailed assessment of surgical outcomes in patients following placement of metallic fixating systems for degenerative processes, traumatic injuries and other disturbances in the thoracic and lumbar spinal areas.

In 21.6–70.4% cases surgeons meet technical issues while forming duodenal stump when pathological process is closely located. We know about 200 kinds of duodenal stump closure, but with such a great variety of suturing methods there is no guarantee of safe suturing.

Objective. Improve outcomes in patients with pylorus and gastric outlet cancer.

Materials and Methods. Authors worked out a technique for duodenal stump formation (licence no. 2613940, dated 19.01.2016) that was evaluated in 315 patients in 2014–2017. Patients with gastric cancer diagnosis underwent extended (D2-3) gastrectomy 190 (60.5%) and subtotal distal gastric resection according to Balfour 125 (39.5%).

Results. While manipulating with duodenal stump in 45 (57.7%) patients we respected duodenal bulb to ensure radical surgical intervention. In 63 (80.8%) patients to adjust functional surgical results we performed cholecystectomy. Analysing immediate results we observed no suture insufficiency in duodenal stump, in 4 (5.2%) cases we noticed increased levels of alpha-amylase and mild enlargement of pancreas head while performing abdominal ultrasound examination. Postoperative complications were found in 5 (6.4%) cases: thromboembolism of small pulmonary artery branches – 2 (2.6%), lower lobe pneumonia – 3 (6.4%), postoperative pancreatitis – 1 (1.3%).

Conclusion. Application of monofilament for mechanic closure facilitated usage of this technique during laparoscopy with performing extra corporal knots; it secures anatomical, atraumatic adaptation of suturing tissues. This method for duodenal stump hermetic closure is characterised as a simple and reliable technique. Its usage allowed to achieve radical reduction of suture insufficiency and improve total outcomes in gastric cancer patients.

Background. Study long-term results following endoprosthesis and arthrodesis of an ankle joint.

Material and Methods. During the period from 2006 to 2018, we arthrodesed 102 ankle joint and endoprosthesing with DePyu Mobility implants in patients with arthroses of various etiology. Of operated on patients,there were 16 female patients (61.5%) and 10 (38.5%) male patients, age range was from 19 to 78 years (mean age 50.6 years). The average operative time was 1.6 hours. Average blood loss was 200 ml. Of patients with arthrodesis procedures: 76 (75.5%) – female patients and 26 (25.5%) – male patients, age range varied from 32 to 68 years (mean age was 49 years). The average operative time was 2 hours, and average blood lost was 300 ml.

Results. To compare surgical results we applied AOFAS score defining treatment results according to functional criteria. Of 31 cases with endoprosthesing in 29 (93.5%) we observed sufficient long term results, and in 2 cases (6.5%) – satisfactory. Twenty-five patients (80.6%) were pleased with outcomes of surgery. In 20 patients (64.5%) volume of movement is less than usual, but more comparing to preoperative value. In 3 cases (9.3%) the pain syndrome was also stopped and volume of movements was unchanged and in 3 patients movements were normal (they had no significant ristrictions prior to the operation). In 1 case (3.2%) after endoprosthesing of ankle joint we observed varus deformity at the level of subtalar joint, so we performed correcting subtalar arthrodesis. In 2 patients (6.4%) achieved results were assessed as insufficient due to forming femoroacetabular impingement and pain syndrome. Cases of unstable endoprostheses were not seen. Following ankle joint arthrodesis we observed sufficient long-term results in 78 patients (76.4%), satisfactory results were in 24 (23.5%) patients. And in 24 cases (23.9%) patients required reoperation due to poor results of arthrodesis.

Conclusion. Ankle joint replacement with modern implants allows to achieve sufficient clinical results and it is a hi-tech alternative to arthrodesis procedures.

Anomalies of coronary arteries are very diverse. Due to angiography evolution, possibilities for their detection became more frequent, and it always attract attention of experts. In the present article, we describe a clinical case with a rare and insufficiently explored anomaly – presence of the single coronary artery.

Correction for post-traumatic kyphotic deformation and stabilization of the damaged segment has a defining value in surgical treatment and prevention of complications after traumatic compression and splintered fractures of the thoracic vertebral bodies. Possibilities for restoration of the sagittal balance of the spine and correction of kyphotic deformation while using mini-invasive fixation are studied insufficiently. In the present article we describe a clinical example of successful surgical treatment of a patient following сatatrauma with an uncomplicated unstable compression and splintered fracture of the vertebral body ThVII (AIII) and kyphotic deformation by a method of percutaneous transpedicular fixation by the u-Centum system. Percutaneous transpedicular fixation allows to considerably reduce vertebrogenic pain syndrome, effectively eliminate kyphotic deformation in an acute period of a vertebral trauma, carry out significant correction of kyphotic angle, early activization and can be an operation of choice in patients with uncomplicated AIII compression and splintered fractures of thoracic spine.

Pulmonary sequestration is a rare abnormality among all congenital defects of pulmonary development. We presented three clinical observations with various clinical manifestations. Possibilities of multispiral CT for the present pathology are described.

Intracardiac cysts are quite rare cardiac pathology in the adults. In this paper we describe a clinical observation for a mitral valve cyst in a male patient, 31 year. This patient had complaints on complicated swallowing, dizziness, nausea, episodes of consciousness loss and was indicated to have transthoracic echocardiography. During the echocardiographic research on a anterior leaf of the mitral valve we found a cavitary lesion with the size 27 x 38 mm which did not interfere with the blood supply in an output path of the left ventricle. The patient was successfully operated. Histologic research showed a true cyst of the mitral valve.

In the present article we described an interesting clinical case with multiple adenomas of parathyroid gland. We demonstrated proper combined application of visualising methods. Scintigraphy as a method of preoperative visualisation is defined as improving surgical results and reducing operative time.

The aim of the telehealth project is to study possible performance of remote analysis of Holter outcomes. We present experience of of our institution and remore Holter monitoring fulfillment. We studied diagnostic advantages of its remote performance. We used portable recorders and proprietary software. Analysis was performed by three physicians of the functional diagnosis department, Scientific Research Institute - Ochapovsky Regional Clinic Hospital #1. By present we performed more 2000 examinations. Clinical cases demonstrating advantages of remote Holter monitoring are described. We discussed perspective of this direction of telehealth. To this system 25 stations of registration devices were connected up in cities and territories of Krasnodar region. We apply 30 cardio-recorders of various producers. Thus, in Krasnodar region the full-scale system of remote Holter monitoring functions and advances now and this has been reached due to active introduction of modern innovative technologies in the field of communication, informatics and development of the software.

Today we observe increasing rates in diabetes prevalence of diabetes, especially in industrialized countries where about 5–6% of the population have this disease. Trophic ulcer changes of tissues for diabetic foot in 70% of cases lead to high amputations, despite all ongoing efforts on decreasing percent of high amputations, progress in this field remains rather low. For high economic and social importance of diabetic foot syndrome, approach to treatment of this pathology has to be multidisciplinary and unite experts of various areas. Timely diagnosis and then effective and predicted treatment in patients with the ischemia threatening to a limb with a diabetic foot syndrome, depend on more exact stratification of patients. Now there are a number of classifications for a diabetic foot syndrome which include basic ideas of the main pathogenetic mechanisms on development of this serious complication, and consider serious affection of the peripheral nervous system, the peripheral arterial bed, assessment of the wound defect extent and evidence of infectious process. The detailed description of SVS WlFI classification offered in 2014 by Society of vascular surgeons is presented in this article.