Background. Myocardial infarction (MI) without obstructive lesion of coronary arteries (MINOCA) has incidence  to 14%. Despite its high prevalence,  MINOCA is paid not enough attention, therefore some patients can not receive appropriate treatment.

Aim. Evaluating the long-term results of clinical observation in patients with MINOCA  in comparison with patients with obstructive damage and the subsequent revascularization of myocardium.

Material and methods. On the basis of Scientific Research Institute RCH – 1 the multicenter cohort observation was organized. Patients from the register CROCS (the register of acute coronary syndrome in Krasnodar region) with the  diagnosis MI were divided into two groups: MINOCA including patients without obstructive damage of coronary arteries and MINOCA including patients with obstructive injury and the subsequent stenting a heart attack connected artery. All patients in 12 months would have control assessment during which they had objective survey; electrocardiography; daily monitoring; test of six-minute walking, echocardiography.

Results. In the MINOCA group in 12 months after the acute coronary event in 21.5% cases there were tension stenocardia, in 16.2% – a painless form of myocardial ischemia was revealed, in a group of patients with MINOCA stenocardia of tension was revealed at 12.5% and 8.4% – with painless ischemia. The group of patients with MINOCA is characterized  by more reliable decrease in both parameters of heart rate variability, and turbulence of heart rate. MINOCA is followed by statistically significant increase in risk of ACS development and death within 12 months. All indicators had reliable difference.

Conclusion. Patients with MINOCA are a special group, their differential characteristics demand definite diagnostic efforts.

Background. The most severe clinical cases following transpapillary endoscopic interventions are duodenal perforation with damage to the common bile duct and pancreatic duct, entrance into the abdominal cavity and retroperitoneum the aggressive contents of intestine and the infections. They usually lead to higher mortality.

Aim. Evaluation of the optimal management for duodenal perforation in patients who have undergone transpapillary endoscopic interventions.

Material and methods.A retrospective analysis of surgical treatment in thirty-two patients with duodenal perforation after transpapillary endoscopic interventions from the year 2007 to 2018 in one center was carried out. Nineteen cases (59.4%) were diagnosed less than 24 hours, 13 (40.6%) – more than 24 hours after injury. Twenty patients had the primary reconstruction of duodenum with various drainage options of injury area. In 19 cases there were a two-stage surgical procedure according the original method: 12 had a primary surgery, 7 were reoperated.

Results. After primary reconstruction of duodenum 11 patients (55.0%) had complications, seven (63.6%) – were re-operated, in four we have applied efferent treatments and symptomatic therapy. Three patients (15.8%) died. After two-stage surgery procedure 7 patients (36.8%) had surgical complications, five (26.3%) – were re-operated. Three patients (15.8%) – were died.

Conclusion. Primary duodenum reconstruction can be performed if the injury occurred less than 24 hours before surgery. Two-staged surgery is justified in cases with purulent inflammation in abdominum and reproperitoneal cavity because procedure allows reducing mortality from abdominal sepsis.

Background. Assessment of endovascular methods possibilities in the treatment for carotid-cavernous fistulas.

Material and methods. The results of endovascular treatment in 22 patients with carotid-cavernous fistulas in the period from 2008 to 2018 were evaluated. The number of male patients was 13 (59%), female patients – 9 (41%). Fifteen patients (68%) had traumatic damage, 7 patients developed a spontaneous disease. All patients had a specific clinical features of carotid-cavernous fistula, confirmed by anamnesis and angiographic study. After verification of the diagnosis, all patients underwent permanent transcatheter embolization of the pathological connection using detachable balloons, microspirals and adhesive composition.

Results. Twenty-one patients (95.5%) underwent one-stage embolization of carotid-cavernous fistulas. One patient (4.5%) required three procedures: two embolization with detachable balloons, final embolization with detachable spirals, due to deflation of the balloons in the early postoperative period. Destructive embolization of carotid-cavernous fistulas was performed in 2 cases (9%), reconstructive interventions were performed in 20 cases (91%). The angiographic success of the procedure was 100%. All treated patients had regression of symptoms during their hospital stay. During this period, one complication was identified in the form of post puncture hematoma, which required conservative treatment.

Conclusion. Endovascular treatment is a modern, effective and safe method for treating carotid-cavernous fistulas. Destructive occlusion (if there is no possibility of performing reconstructive intervention) is also a safe and clinically justified method for treating this pathology.

Background. Improvement of treatment results in patients with cicatrical deformations by means of new surgical techniques and vacuum dressings is the aim of this study.

Material and methods. We described clinical results after vacuum therapy application for reconstructive surgical treatment after facial and cervical cicatrical deformation caused by burns. Patients underwent dissection of cicatrical blocks, and then we performed layer-by-layer autodermoplasty with further vacuum dressing placement.

Results. Engraftment of tissue autotransplant took 507 days and we observed reliable clinical result.

Conclusions. Vacuum therapy favours optimal conditions for rapid engraftment and adaptation layer-by-layer tissue autotransplants.

Justification. The most methods of extensive skin and soft tissue defects are aimed at accelerating wound healing  and preventing infectious complications. To improve the effectiveness of such defects treatment, a method of dosed tissue distraction (MDTD) is used, consisting in the application of a continuously acting load to the area of healthy soft tissue in close proximity to the wound defect.

Purpose. It performed the evaluation of the medico-social  effectiveness of the introduction into clinical practice of developed methods and devices for implementing MDTD in  the treatment of skin and soft tissue defects of the extremities.

Methods. 407 patients were treated with wound defects of  the extremities, which were divided into two groups: the main group – 198 patients in whose treatment MDTD was applied using original methods and devices; comparison group – 209 patients, in whose treatment standard treatment methods were applied. Comparison of the long-term results of treatment according to the frequency of repeated operations, complications, indicators of quality of life, frequency of disability.

Results. The use of MDTD is characterized by better performance compared with the use of standard approaches. There is a decrease in the frequency of performing reconstructive plastic surgery after inpatient treatment (9–10 times), remote complications by 2.6 times, a reduced value of the Vancouver scale (by 28.8%), quality of life indicators higher levels. The use of the proposed approach is characterized by a shorter duration of treatment (by 26.0%), duration of disability (1.4 times), cases of disability (2.2 times).

Conclusion. The use of MDTD is characterized by high medical and social efficiency, allows to reduce the cost of treating extensive skin and soft tissue defects by reducing the length of hospitalization, the frequency of repeated rehabilitation and reconstructive operations, accelerated recovery of patients, improving the quality of life and reducing the incidence of disability.

Background. At present continuous growth of pathology after chemical burns of the esophagus (CBE) in children is observed. The lack of uniform statistical information about this pathology in domestic and foreign literature considerably complicates studying of that nosology.

The purpose of the present study is optimization of treatment techniques in children with chemical burns of the esophagus with various etiology and generalization of our own experience of treatment in this contingent of patients.

Material and methods. We have analyzed treatment techniques in 147 children with CBE with various etiology and severity for last decade. The general method of diagnosis was esophagogastroscopy performed within the first day of hospitalization. Endoscopic examination showed following stages of CBE: I stage in 36 patients, II stage in 67 cases and 44 patients had III stage.

Results. In children with I stage CBE erosive inflammatory process was controlled by conservative therapy in 10–14 days. This cohort of patients from 3–4 day of disease was considered outpatient. Patients with II stage CBE erosive inflammatory changes were treated by complex therapy on 21–23 day. There were surgical complications observed.    Patients with III stage CBE referred in most severe condition. Length of conservative treatment for erosive  inflammatory process was 1 month. In this group of patients we observed complications in 24 cases (16.3%) and bougienage was performed according to different techniques. Duration of bougienage varied from 3 to 24 months. Later on all children were observed out-patiently according to the place of residence.

Conclusions. Performed therapy should be complex and differentiated regarding the severity of trauma. Complex treatment technique designed in our hospital is quite efficient and could be recommended for clinical application. All children suffered from CBE are to be followed up refularly. Preventive medical check-up should include endoscopic examination, once every three months to avoid possible esophageal stenosis development. Preventive treatment for esophagitis is mandatory during the period of preventive medical check-up. 

Background. Kidney transplantation is the gold standard of treatment in patients with a terminal renal failure. Nevertheless, the main reason for death of recipients, loss of the renal allograft is cardiovascular disease, and disorder of lipid profile remains one of the most significant risk factors and progressing of cardiovascular pathology.

Aim. We estimated dyslipidemia dynamics before and at various terms after kidney transplantation and we tried to reveal interrelation of disorder of lipid metabolism with renal transplant functioning.

Material and methods.The retrospective observational research of the cohort in a uniform group of lipid profile dynamics observation in terms before kidney transplantation and in 6, 12 and 36 months of two hundred liver recipients at the age of 40.18 ± 10.33 years has been conducted. Among those there was 41.5% female patients and 58.5% male patients. The statistical analysis was carried out by means of STATISTICA 10.0 program. The critical significance value while checking statistical  hypotheses in this research was accepted equal 0.05. The method of multifactorial logistic regression was applied to search factors associated with a dyslipidemia.

Results. Level of the general cholesterol before transplantation was 4.34 ± 1.21 mmol/l, in comparison with an initial indicator of the general cholesterol increase in dynamics in 12 and 36 months was 17.5% (р = 0.02), 22.9% (р = 0.03), respectively. The LDL level in the studied cohort of recipients was around 2.36 ± 1.21 mmol, and in 6 months it increased by 12.3% (р = 0.02), in a year for 5.9% (р = 0.21) and 36 months later differed from initial on 14.8 (р = 0.01). In three years after transplantation period LPVP decreased by 12.3% (р = 0.01). In comparison with initial level before transplantation  they increased on 8.9% (р = 0.03) и 16.7% (р = 0.01) in 12 and 36 months, respectively. The factors associated with dyslipidemia is the age – 1.21–1.7 (р < 0.02), diabetes – 1.1–1.5 (р < 0.03), the speed of glomerular filtration (kg/sq.m) – 1.23–1.32 (р < 0.02), proteinuria (g/l) – 1.55–2.1 (р < 0.001), the left ventricle myocardium mass index (kg/sq.m) – 1.23–1.55  (р < 0.03), hemoglobin (g/l) – 1.1–1.23 (р < 0.04), systolic arterial blood pressure – 1.2–2.1 (р < 0.001), diastolic arterial blood pressure – 1.1–2.2 (р < 0.002). The negative correlational interrelation between the level of cholesterol and survival of the renal allograft, estimated on the speed of glomerular filtration was revealed (р = 0.003). Level of the general cholesterol was a significant independent predictor for survival and functioning of the renal allotransplantat in 3 years after transplantation.

Conclusion. Тhe progressing disorder of a lipid profile in the long-term post-transplantation period was revealed, dyslipidemia is a significant modified predictor of successful kidney transplantation.

Rationale. Injuries and diseases of large joints occupy a leading place in the list of urgent problems in orthopedics. Various methods of treatment for this pathology are regularly offered in the literature, but most of them do not allow restoring a full-fledged hyaline cartilage.

Background. To improve the results of organ-preserving treatment in patients with osteo-chondral defects of large joints.

Material and methods. А prospective study was conducted on 30 large animals (60 knee joints) aged 1.5 to 3 years. We divided the animals into 3 groups of 10 individuals (20 joints) in each, based on the method of replacement of the osteo-chondral defect. In all cases, a full-layer defect formed from the hyaline cartilage by a mill with a diameter of 4.5 mm, depth of 7 mm with the capture of the subchondral bone in the medial condyle of the right thigh. Artificial defects were restored by one of the following methods. The left joint was considered a control joint and the defect formed by the same technique was not filled.

Results. The result was evaluated in 1 month, 3 months and 6 months viewing the nature and degree of defect filling. Specific volumes of such tissues as chondrocytes, cartilage matrix and the average depth of the defect from the thickness of the native cartilage were better in group 3, and connective tissue was less in group 3.

Conclusion. In the group without defect replacement, the  obtained data are comparable with the studies of other authors, according to which bone and cartilaginous defects practically do not regenerate on their own. Our proposed method with the use of extracellular collagen matrix, autocartilage and plate rich plasma is less aggressive in comparison with autochondroplasty and the result can be more stable compared to microfracturing or tunnelization.

According to the results of systematic reviews of WHO, maternal mortality associated with massive bleeding almost reached 30% and has no tendency to decrease. Among the causes of massive obstetric hemorrhage, the most challenging ones are uterine hypotension and morbidity adherence placenta. Most severe complication for placentation is placenta increta in the uterine wall. Over the past 50 years, the number of cases with morbidity adherence placenta has increased tenfold. By all indications, this pathology has taken on the character of an epidemic and is one of the main causes for massive blood loss and blood transfusion, as well as peripartum hysterectomy. For surgical hemostasis in this pathology we apply X-ray vascular methods (temporary balloon occlusion of large vessels, vascular embolization), ligation of the iliac, uterine, ovarian arteries, various versions of distal hemostasis, including the use of uterine turnstiles, intrauterine and vaginal cylinders, compression sutures. However, data confirming the advantage of any specified methods are not enough. The risk of massive bleeding is high while using any of these methods. The article analyzes the blood saving methods existing at the present stage and possibility of these methods usage in obstetrics. Besides, we describe efficacy and safety of their use in massive blood loss, including the surgical treatment of morbidity adherence placenta.

Long non-coding RNAs (lncRNAs) are a large group of non-coding RNAs (ncRNAs) which are more than 200 nucleotides in length. LncRNAs, as regulation factors, show an important role in complex cellular processes, such as apoptosis, growth, differentiation, proliferation, etc. Recently, the results of many studies have also shown their significant role in carcinogenesis. Endogenous lncRNAs are known to be secreted by tumor cells in human biological fluids in the form of microvesicles, exosomes, or protein complexes, thereby forming circulating lncRNAs that do not degrade under the influence of RNases and are in a stable state. Compared with traditional biomarkers, as proteins circulating lncRNA have several advantages that will allow to consider circulating  lncRNA as a new potential  biomarker for various diseases. Aberrant expression of lncRNAs was observed in cancer patients. In this context, endogenous lncRNAs can regulate the main characteristics  of cancer cells, controlling the expression of oncogenes associated with their suppressive and oncogenic functions. Consequently, circulating lncRNAs can be excellent biomarkers for cancer. Knowledge of the molecular mechanisms by which lncRNAs contribute to the development of cancer will improve our understanding of etiology, and open up horizons for the development of new biomarkers. In this paper, we will analyze current knowledge about the change in the expression profile of circulating lncRNAs in cancer, as well as methods for their detection.