Aim. Develop a pre-operative planning algorithm to treat patients with lumbar spinal stenosis of degenerative etiology.

Material and Methods. The results of surgical treatment of 522 patients at the age of 23–78 years with degenerative lumbar stenosis were analyzed. Patients with osteoporosis, with a sagittal spinal profile disorder or deviations in the frontal plane of more than 20 degrees, with spondylolistesis of more than 1 Meyerding degree, with accompanying pathology aggravating the Charlson Commorbidity Index of more than 8 points, were not included in this group. All patients underwent decompressive-stabilizing operations using TPF for 1 to 8 vertebral-motor segments. Decompression and interbody stabilization were performed by the method PLIF, TLIF, or by the method of reconstruction of the lumbar vertebral-motor segment (patent no. 2527150), or the ventral fusion was performed.

Results. Immediate and distant results over a period of 24–36 months were studied by regression in major clinical manifestations. The VAS, McCulloch and Young scales, the Oswestry questionnaire, and the modified Macnab scale were applied. The quality of decompression, correction in operated PDS and intertose splicing were evaluated. The effect of the initial state of patients on the obtained results and the number of complications were studied as well. For this purpose, the correlation analysis was carried out between clinical parameters characterizing initial condition of patients (length of lumbar spinal stenosis, degree of functional maladaptation, duration of anamnesis and severity of premorbid background) and achieved results of treatment, as well as number of complications. A correlation analysis was also performed between the technique of performed operations and surgical tactics on the one hand and the achieved results and the number of complications on the other.

Discussion. Differences in results and number of complications depending on the applied technical and tactical treatment options and statistical treatment with determination of the correlation coefficient of Spirman and Fisher's criterion determined clinical and spondylometric signs in the pre-operative state of patients, that influenced the probability of complications when using the specified technical and tactical treatment options. It has been found that the state of the premorbid background reliably affects the probability of the most dangerous intraoperative and early complications. The length of decompressive stabilizing operations affects the probability of evidence for audits in the distant period. When performing TLIF, the spondylolistesis presence increases the likelihood of intraoperative liquvorea. The method of lumbar vertebral-motor segment reconstruction in lumbar lordosis deficiency improves the possibility of correction in operated vertebral-motor segments in comparison with TLIF technique.

Conclusion. Taking into account the revealed statistically confirmed effect of a number of clinical and spondylometric signs of the pre-operative condition in patients on the probability of complications using various technical and tactical versions of treatment, an algorithm of pre-operative planning of surgical intervention in patients with lumbar stenosis of degenerative etiology is presented.

The purpose of the study was to improve quality of surgical treatable of destructive pulmonary tuberculosis in patients with diabetes.

Materials and Methods. D.B. Giller and employees of the Department of Phthisiopulmonology and Thoracic Surgery of the First Moscow State Medical University M.I. Sechenov performed operations on 200 patients with diabetes due to tuberculosis. Group 1 was mustered from 78 patients from 2004 to 2009. Group 2 was mustered from 122 patients from 2011 to 2017.

Results. An analysis of the results showed that after 31 operations, 27 (13.5%) patients from both groups developed 33 complications. The second group (6.6%) had fewer complications after surgery than the first group (24.4%) 3.7 times. The first group had more vulnerary and bronchopleural complications than the second group. 12 patients (15.4%) of the first group and 6 patients (4.9%) of the second group had bronchopleural complications (empyema, residual cavity, delayed expansion of the lung and intrapleural bleeding). 2 patients died in the hospital (30-day mortality was 0.66%) after 303 surgical intervention in both groups. 1 patient (0.9%) died after 106 surgical interventions in the first group. 1 patient (0.5%) died after 197 surgical interventions in the second group. The full effect was achieved in 75 (96.2%) patients in the first group and 114 (93.4%) in the second group. The survival value of patients of the second group was 100% after 1 year, 98% after 2 years, 98.8% after 3 years, 96.9% after 4 years, 95.2% after 5 years. The surgical treatable affected the occupational rehabilitation of patients from group 2. 61.5% of patients from group 2 became able to work after 1 year. 64.5% of patients from group 2 became able to work after 5 years.

Conclusion. If doctors use our tactics in patients with destructive pulmonary tuberculosis and diabetes, the risk of complications after surgery will drop and reactivation of tuberculosis will not occur.

Objective. Estimate baseline coagulation profile values in patients scheduled for cardiosurgical intervention in age groups of pediatric population.

Material and Methods. The coagulation profile was analyzed in a complete selection of patients admitted to the intensive care department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 for the period from January to December 2018. The study includes 842 patients planned for cardiac surgery.

Results. This study demonstrates the dependence of the basic parameters of the hemostasis system on age characteristics, mainly during the period of the first year of life. APPT values were similar in all age groups, whereas extended PV was recorded in patients less than one year.

Conclusion. Evaluation of coagulation system parameters should be based on age-specific reference values. Understanding the concept of developing hemostasis is extremely important in conditions of optimal prevention, diagnosis and treatment of hemorrhagic and thrombotic conditions in the pediatric population.

Background. Laparoscopic surgery becomes a standard treatment for many surgical diseases. Defects of a stapler laparoscopic mechanical suture during the formation of an anastomosis after hemicolectomy are detected in 18% of observed cases.

Objective. Development, substantiate reproducibility and safety of a manual intracorporeal term-terminal invagination ileotransverse anastomosis method after performing the right laparoscopic hemicolectomy.

Material and Methods. Authors presented a description of the technique and their own experience of performing laparoscopic hemicolectomy on the right with the formation of a manual original anastomosis in 10 patients with pathology of the right half of the colon. Eight patients (80.0%) had a malignant tumor of the right half of the colon, 1 patient (10.0%) showed multiple polyps of the cecum and the ascending part of the colon, 1 patient (10.0%) developed a cystic-solid submucosa tumor of the ileocecal angle. One patient had metastatic lung disease at the time of establishing diagnosis. The postoperative follow-up period was 7–18 months.

Results. There were no conversions to open surgery. All operations (n = 10) were ended completely laparoscopically – right hemicolectomy with standard D2 lymph node dissection. In one patient, we revealed intraoperatively the spread of the tumor to the gallbladder, which required additional cholecystectomy. The duration of the operation was 122.5 ± 10.7 min.; median blood loss was 107 ± 5.2 ml. At the time of follow-up all patients are alive.

Conclusion. The technique is universal in the surgical treatment of patients with various pathologies of the right half of the colon.

Aim. To develop and improve new ways of surgical treatment for deep burn injuries and their consequences with use of vacuum therapy and cell technologies.

Material and Methods. In the present article clinical examples of vacuum therapy application for two groups of patients are given. In the first group there were patients with total deep burn injuries of the body, the second group included patients with multiple scarry deformations of hands. In both groups during surgical treatment patients underwent autodermoplasty of wound defects with the subsequent imposing of vacuum dressings, in the first group the cell cultures of the frozen dermal allofibroblasts were also used.

Results. We achieved sufficient clinical outcomes in both groups.

Conclusion. Vacuum therapy creates optimal conditions for engraftment of autodermotransplantats and reduces terms of wound preparation for autoplasty.

Background. The present article studies a possible role of parathyroid hormone-related protein (PTHrP) in urolithiasis pathogenesis.

Aim. To consider PTHrP level as a predictor of the urolithiasis development.

Material and Methods. We presented an analysis of treatment in 79 patients with primary and recurrent nephrolithiasis that had underwent surgical treatment in the Uronephrological Center of Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1, Krasnodar from 2017 to 2019. All observed patients were divided in two groups: patients with primary and recurrent nephrolithiasis. A group of 10 relatively healthy people was included in the study as well. All patients and conditionally healthy people had a test for blood parameters; in particular, the level of parathyroid hormone-related protein was assessed in order to compare the indicators in all three groups.

Conclusions. The PTHrP level was showed to be statistically significantly different in patients with urolithiasis from the group with relatively healthy people. Groups with primary and recurrent nephrolithiasis show not difference in the level of PTHrP. Further studies are necessary to consider this protein as one of the predictors of urolithiasis and study its role in the pathogenesis of nephrolithiasis.

Aim. Creating a mathematically based scale of risk stratification of thromboembolic complications in patients with acute abdominal organs pathology requiring urgent surgical treatment.

Material and Methods. This work is based on data from 185 case reports of patients with acute surgical diseases of the abdominal organs that had undergone emergency operations. Clinical and statistical analyses were carried out and the most significant risk factors for venous thromboembolic complications were identified. By digitally estimating the specific gravity of each of the factors, the method of sequential probability ratio criterion was applied to the obtained data.

Results and Discussion. Based on a retrospective analysis of clinical records, 13 most informative prognostic criteria for thromboembolic complications formed in the prognostic table were identified. Each sign, depending on its value, had a specific gravity. For the convenient using of the prognostic scale in practice, the indicators of natural logarithms are translated into arbitrary units (points). The results are checked on available archival records. The overall forecast reliability was 97%.

Conclusion. The proposed prognostic scale made it possible to optimize the likelihood of a feasibility study in patients with acute diseases of the abdominal organs.

In Regional Clinical Hospital no. 2 POEM was performed in 47 of these patients: 24 men, 23 women aged 18 to 80 years (average age = 54.4 ± 13.8 years) for 2017–2019. According to the severity of achalasia, the patients were divided as follows: with I–II degree – 12 patients (25.5%), with II–III degree – 20 patients (42.5%), with III–IV degree – 10 patients (21.3%), with IV degree – 5 patients (10.6%). POEM results: 42 (88.4%) patients had a positive result, and 5 (11.6%) patients had a negative result.

Amyloidosis is a unique group of disorders caused by the insoluble protein fibers accumulation known as amyloid fibrils in extracellular tissue and organ spaces. The involvement of different organs and tissues in amyloidosis is often the cause of missed or delayed diagnosis, and amyloidosis remains a major clinical problem as it is associated with 1/1,000 deaths in developed countries. We present a case of a 59-year-old female patient with complaints of breath shortness while talking, a sense of air lack in the horizontal position, swelling of the lower limbs, reduction of blood pressure to a minimum of 70/50 mm Hg, weight reduction by 7 kg in 6 months, dizziness. The patient was hospitalized to the Cardiology Department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 with heart failure. The electrocardiogram revealed left ventricular hypertrophy. Echocardiography showed biventricular myocardial hypertrophy with a maximum interventricular septum thickness of 16 mm, nonuniform ventricular myocardial structure and reduction of global left ventricular comparability to 38%. Computer tomography of chest organs demostrated interstitial swelling of parenchyma of both lungs. The infection during the further examination. For the final morphological verification of the diagnosis, it was necessary to perform peripheral transbronchial biopsy S 3, 4, 5 of the left lung and myocardial biopsy with specific staining on amyloid using congo red. In the lung and myocardial biopsy, the colour of the congo red is positive. An immunohistochemical study of the lung tissue and myocardial sample revealed Amyloid AA expression. This case represents a rare cause of heart failure in a woman. A feature of this observation is the rare involvement in the pathological process of both pulmonary tissue and myocardium with AA-amyloid deposition.

During the postoperative period, cardiological complications occupy the first position regarding morbidity and mortality rates. They depend on various factors such as compromised cardiovascular history and type of surgical intervention, features and type of anesthesia, water balance and postoperative care of the patient. To prevent complications, one should reply two questions: is there a risk of cardiovascular complications in the perioperative period and how to avoid them. The article presents a review of the literature on current views on the perioperative assessment of cardiac risks in patients undergoing noncardiac surgery.

Coronary artery perforation is a rare (0.1–3.0%) but rather severe complication that occurs during the coronary interventions. Treating the perforation caused by the coronary conductor is extremely complicated, as it could be caused quite unexpectedly and may be accompanied by catastrophic consequences if misdirected. Choosing effective treatment techniques is not easy, as evidenced by hospital and remote clinical outcomes with high mortality rates.

This article presents a literature review of modern methods of diagnosis and treatment for urethral strictures. In addition, the own results of a pilot study on the use of synthetic tissue-engineering structures as a material for urethroplasty substitution are presented as well.