Gastric cancer keeps its position among the top five leaders of oncological mortality. Extended lymph node dissection D2 allows to achieve good long-term results after surgical treatment, however process extension and specific features of a tumor have significant impact on the result.

Background. Study influence of various tumor characteristics, volume of LN dissection and operation on recurrence probability in patients with locally-advanced gastric cancer.

Material and methods.We performed analysis of long-term results of treatment in 662 patients with gastric cancer with application of minimum admissible lymph node dissection D1 and extended lymphodissection D2 operated by one group of surgeons and also 10 various characteristics of tumor process which had an impact on survival rate.

Results. Improved survival in patients with extended LN dissection was observed beginning from stage II disease and was the best in cases with stage III. Main group of patients treated with extended LN dissection showed better results compring to the control group with minimally accepted lymphodissection regarding overall and recurrence-free lifespan. Own effect of an extended LN dissection is shown against the background of any other factor of variability. Effects of tumor characteristics (first of all, its prevalence, i.e. stage of disease, metastatic invasion of regional lymph nodes and histologic structure of tumor) and combined surgical volume have always more effect than extended LN dissection.

Conclusions.The observed additional effect of an extended lymph node dissection is universal, that is shown on any clinical background of the disease – histologic structure, gastric localization, form of tumor growth, invasion depth in a gastric wall, invasion of regional lymph nodes and stage of cancer (except stage I). The most significant negative impact on life expectancy in patients after treatment had low differentiated tumors, metastatic invasion of regional lymph nodes, stages of disease, on duration of recurrence-free period – stage of cancer and the combined nature of surgical intervention.

Background. Degenerative diseases of zygapophysial joints of the lumbar spine are the main reason of a resistant facet syndrome in 70–85% of the population older 40 years. This research was aimed to carry out an analysis of results after facetoplasty used for treating patients with degenerative diseases of zygapophysial joints of the lumbar spine.

Material and methods. The research included 128 patients at the age of 41 (35.5; 46) years with degenerative diseases of zygapophysial joints of the lumbar spine and clinical manifestations in the form of an isolated facet syndrome. They have had puncture of zygapophysial joints with intra articulate introduction of joint fluid prosthesis (facetoplasty) within the period from 2015 to 2017. We used a visual analogue scale of pain and the Osvestri questionnaire for patients with problems in the back to assess clinical efficiency. Dynamic assessment was made in average in 24 months after the operation.

Results. As a result it is found out that the facetoplasty is an effective mini-invasive method for facet syndrome treatment, caused by degenerative diseases of zygapophysial joints of the lumbar spine.

Conclusion. Usage of facetoplasty in patients with isolated FS caused by degenerative disease of zygapophysial joints of the lumbar spine allows to observe sufficient clinical outcomes within immediate and long-term postoperative periods.

Objectives. To estimate the relationship of proprotein convertase subtilisin/kexin type 9 (PCSK9) level with blood pressure (BP) and smoking in a population of young males in Novosibirsk.

Material and methods. The group was formed by the method of random numbers from the population sample of  Novosibirsk that underwent a one-time survey as part of the screening «Monitoring of health status and prevalence of risk factors of therapeutic diseases, their prediction and prevention in Siberia». The study included 492 males, the average age was 36.0 ± 5.86 years. Levels of PCSK9 were determined with ELISA using a test system «Human PCSK9 ELISA» (BioVendor, Czech Republic).

Results. The average level of the PCSK9 protein was 325.9 ± 141.97 ng/ml, median (interquartile range) was 300.19 (240.20; 361.80). Mean systolic BP was 126.13 ± 13.40 mm Hg, mean diastolic BP was 82.91 ± 9.93 mm Hg. Fifety-six percent (277 males) was non-smokers, 44% (214 males) smoked. PCSK9 levels were higher in sample of smokers (339.49 ± 139.86; 311.82 (251.04; 369.78)) than in sample of non-smokers (315.17 ± 143.16; 286.16 (229.91; 351.71)) (p = 0.011), samples were independent. There was no difference in the level of PCSK9 protein in a pair of samples contrasting in BP. A weak statistically significant correlation between the level of PCSK9 and smoking (rs = 0.115, p = 0.01) was shown, it was indirectly confirmed by the result of multiple regression analysis. Hypertension was an independent predictor of higher levels of PCSK9 protein according to multivariate linear regression analysis using a stepwise method (B = 32.593; SE = 14.624; p = 0.026). Also hypertension was an independent predictor of a higher level of PCSK9 protein according to multivariate linear regression analysis using the backward method in the same model (B = 30.457; SE = 14.649; p = 0.038).

Conclusion. The presence of hypertension indicates an increased level of PCSK9. The obtained data support the role of PCSK9 in the pathogenesis of cardiovascular diseases and the prospect of its use as a biological marker. Present study was the first one of such category in Russia.

Background. We discussed main issues regarding pathogenesis of burn disease and development of multi-organ failure and identified basic methods for prevention and improvement.

Objectives. We studied possible prevention of multi-organ failure syndrome.

Material and methods. We presented analysis of treatment in hard-burnt patients for 10 years. This analysis included 643 compromised patients with deep burns. They were treated in Samarkand Branch of RNTEMP from 2008 to 2018, age range was 18–74 years. All patients were divided into 2 groups regarding their treatment method. Control group included 313 (48.67%) patients treated in Burn Department of Samarkand Branch of RNTEMP for the period 2008–2012.

Their complex treatment included routine anti-shock infusion-transfusion therapy and conventional management regarding burn disease stages. Main group consisted of 330 (51.33%) patients with the same pathology referred to Samarkand Branch of RNTEMP during the period 2013–2018. They were treated with improved procedure of anti-shock infusion-transfusion therapy with inotropic and organo-saving support according to disorders of vital functions and early active surgical technique.

Results. It is shown that implementation of advanced complex intensive infusion-transfusion therapy, application of organ-saving therapy, correction of the compromised premorbid background, and nutritional support as well facilitate shock manifestation, reduce number of patients with multi-organ insufficiency and mortality in hard-burnt cohort.

We present a case of successful combined treatment for dendritic stone (K-IY according to classification of Scientific Research Institute of Urology) in the left kidney of a patient with comorbid pathology (diabetes mellitus II type, CHI risk I, lumbar osteochondrosis). Feature of this case is that during operative transcutaneous endoscopic intervention we removed ≈80% of an easily available pelvic part of a stone, and to avoid excessive trauma of parenchymatous tissue for the purpose of the maximum preservation of renal function, we left intact hard to reach calyceal fragments of a concrement. Considering data of рН metric 3-day monitoring which revealed constantly sharp sour reaction of urine (<5.8–6.0), within the 5-month postoperative follow-up, the patient accepted health supplement ‘OMS-citrate’ according to the administered scheme which provides implementation of the maximum scope рН urine and individual dosage selection depending on the personified extent of metabolism disorder.

The offered approach in citrate ‘mixtures’ administration deprives of a possibility for salts settling out, interfaced to the corresponding enzymes, as there are no conditions for incrustation of an external layer of a stone, as with a normal amplitude рН urine from 5.0 to 8.0 (>0 U), activity of all enzymes are reduced as their activation requires long (10–15 day) stay of рН urine in narrow limits (<0.8–1.2 units an isoaciduria). Citrate therapy in the setting of the stent of internal drainage, had been carried out, within 4 months the remained stone fragments completely released all renal collecting system, and on the stent after its extraction in 5 months there were no signs of salt incrustation. X-ray-radiological examinations in 1.5 years after the operation showed no signs of lithiasis recurrence, at the same time function of kidneys did not worsen (remained), and the urodynamics was restored. Besides, on the background of the carried-out treatment fornephrolithiasis, positive dynamics of the accompanying comorbid pathology (diabetes and atherosclerotic disease) was observed.

Background. To define efficiency of decreased microbial dissemination in burn wounds after low-temperature argon plasma of the arc discharge of atmospheric pressure.

Materials and methods. In the present article we described results of efficiency analysis after usage of low-temperature argon plasma of the arc discharge of atmospheric pressure for skin burn treatment Degree II–III (ICD-10). Burns had various etiology (flame, boiled water, contact) and area. We defined change in microflora of burn wounds after single administration of the PLAZMORAN installation in three groups of patients, depending on a surgical treatment type (dermabrasion, early necrotomy with plasty and plasty on the granulating wounds).

Results. We noticed that treatment of burn wounds with Plasmoran showed results confirming decreased bacterial dissemination or complete wound sanitation after plasma effect and it reduced risk of possible purulent inflammation and speeded up terms of wound epithelialization.

Conclusion. Basing on the bacteriological researches analysis it was determined that use of low-temperature air plasma of the arc discharge of atmospheric pressure reduces dissemination of wounds by pathogenic microflora.

Arterio-venous malformations are rather rare findings but sometimes they result in neurologic complications and lethality. These diseases quite often manifest with hemorrhages, cerebral seizures (in cases with intracranial locations).

Modern diagnostic methods allow to diagnose cases with AVM of the central nervous system at pre-clinical stage. Last years we tried to improve methods of surgical treatment in AVM patients, intravascular occlusion and possibility of radiosurgery.

Coronary surgery and endovascular coronary interventions allowed significantly reduce mortality and an invalidization caused by sharp and chronic forms of coronary heart disease in Krasnodar Region. Searching ways for further improvement of these indicators we start paying more attention to problems of timely identification of risk factors in cases with atherosclerotic cardiovascular diseases (ACD) and their primary prevention, especially among the efficient labor pool.

From this point of view family hypercholesterolemia (SGHS) as a disease connected with a very high risk of ACD and frequently at young age, is one of the significant points of effort application for prevention of incidence and mortality from ACD. In recent years on the basis of the executed epidemiological and register researches there was a significant revision of ideas on possible prevalence of SGHS, as a result this disease is considered not to be so rare: ~ 1:200–1:250 in a general population. Low awareness among the population and physicians on SGHS in Russia and Krasnodar Region, its extremely low detection frequency, lack of information about real prevalence of this pathology lead to the fact that the correct diagnosis is very seldom verified, and modern treatment which is capable to change the course of a disease is carried out.

Modern approaches of diagnosis and treatment for SGHS are presented in this article, clinical cases from own clinical practice are described and also, we discuss possible steps on the organization of timely identification and treatment of SGHS.

The history of cardiovascular surgery development strikes with courage of the ideas. Takeoff and falling, success and defeats — all these were on the way of formation of cardiac surgery, but without mistakes and failures dynamic development of medicine is generally impossible.

One of the outstanding cardiac surgeons, whose name will remain in the history forever is Walton Lillehei, the person whose keynote was «work to exhaustion, and play up to the end». Despite vicissitudes of life, he was not afraid to take the risk, understanding that in case of success, hundreds of lives would be saved. But at the same time his activity was not thoughtless passion, and on the contrary, each step of his, attempt of improvement or development of something new, whether it was surgical technique or introduction of a new device, had the soil of long researches and clinical observations.