2018, volume 14

Purpose: to improve the results of treatment of the obstructive complications (an urethra stenosis, a bladder neck sclerosis) caused by application of the high-intensity focused ultrasonic ablation (HIFU) concerning treatment of the localized prostate cancer. Material and Methods. An object of the research included 41 patients, with the infravesical obstruction (IVO) which has arisen in the postoperative period to which elimination the holmium laser is used. Results. The bladder neck was the most frequent place of obstruction. Average time before emergence of the first episode of IVO: 8.2±1.3 months. Distinctions on time before development of an episode of IVO depending on the fact of carrying out TURP before HIFU not confirmed (p=0.440). More advanced age for a moment HIFU-ablation has been associated with much higher frequency of IVO (p=0.021). Considerably smaller frequency repeated was observed by IVO at a larger ratio transurethral resection to the initial volume of a prostate (p=0.031). Duration of a laser endoscopic ure-throtomy was 27 [10-70] minutes, serious perioperative or postoperative complications were not determined. Average term before removal of a catheter of Foley: 3 [1-5] days, hospitalization duration included 4 [3-6] days. After treatment considerable improvement on indicators of the maximum speed of a stream of urine (Qmax) and volume of residual urine was observed. The total score according to the questionnaires of IPSS and QoL has considerably improved, significant changes on symptoms of accumulation are noted. After the first holmium laser urethrotomy of 80.4% of patients have noted satisfactory results without recurrence of IVO; 19.6% of patients were required a repeated laser endoscopic urethrotomy. Recurrence term after the first laser urethrotomy is on average equal to 2.5 months. Conclusion. The endoscopic urethrotomy by means of the holmium laser is safe, effective and minimum invasive type of treatment of a stenosis of a neck of the bladder / urethra after ablative cancer therapy of prostate. The advantages are the minimum of traumas of surrounding tissues and preservation of the mechanism of deduction of urine.

Purpose: assessment of the diagnostic value of Vascular Endothelial Growth Factor (VEGF) in predicting the outcome treatment of patients with muscle-invasive bladder cancer. Material and Methods. The study involved 264 people: 204 patients with RMP; 60 people aged 21 to 60 years were the comparison group. Patients with RMP are divided into stages of the disease. With non-muscle-invasive ВС (NIRMP) under TA-1NxMo there were 75 patients. Out of 129 patients with muscle-invasive ВС (MIRE) within the body (pT2aN0M0-T2bN0M0) was diagnosed in 69 of people. In 60 patients, the tumor sprouted paravesical tissue and surrounding organs (rt3a-bn0m0-41; pT36N1M0-11; pT4N1M0-5; T4N1M1-3); 19 patients had metastases to the iliac lymph nodes are installed only after the operation. Metastases were found in three patients out of 19 in addition to the lymphonoduses in the lungs. Tumors had the following gradations: G1-97; G2-37; G3-58. All patients NMIN (n=75) completed a TUR of the bladder wall with the tumor. MERE patients underwent radical cystectomy (n=117), open resection of the bladder (n=12), palliative surgery (n=3). The period of follow-up after surgical treatment was 3.5±0.5years. Quantitative determination of VEGF in blood serum was performed by solid-phase ELISA. Results. Despite the fact that the increase in VEGF level of blood serum in groups of patients with NIMRE and MIRE has significant differences both before and in the postoperative period, it is associated with the aggressiveness of tumor growth, development of metastases and recurrences of the disease. Conclusion. The increase in the content of VEGF serum suitable for use as an indicator: the risk of relapse within the first year after TUR in patients NMIN; development of relapses and metastases in pre and postoperative periods in MERE patients.

Objective: to study the efficacy of surgical treatment of primary hyperparathyroidism in risk of uronephrolithiasis progression. Material and Methods. The research involved 55 patients, the biochemical and clinical parameters before and after treatment with retrospective-prospective method of analysis were studied and analyzed. Results. It is established that the surgical treatment of patients with uronephrolithiasis is proved to be effective in 96,4% of the cases, as it allows to eliminate the classic symptoms of primary hyperparathyroidism, and urolithiasis. Improvement of laboratory hormonal and biochemical indices of mineral metabolism, and, consequently, reducing the severity of risk factors of urolithiasis is marked. Conclusion. Surgical treatment of renal forms of primary hyperparathyroidism is a pathogeneti-cally reasonable method. Parathyroidectomy performed in an adequate amount prevents relapses and progression of diseases that are the consequence of primary hyperparathyroidism.

The Aim: to study the effect of different pancreatic stump closure techniques, including depending on the diameter of the main pancreatic duct to frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomies were performed in 126 patients with neoplasms of the body and/or tail of the pancreas. Patients were divided into 4 groups depending on the pancreatic stump closure techniques. Group 1 (control): isolated suturing of the main pancreatic duct of the pancreatic stump with its sealing by gastrocolic omentum or hemostatic sponge; group 2: isolated suturing of the main pancreatic duct of the pancreatic stump with its sealing by biological glue 2-octylcyanoacrylate; group 3: pancreatic stump closure were performed by Endoscopic Linear Cutter; group 4: after distal pancreatectomy were performed external transduodenal transnasal drainage of the enlarged main pancreatic duct of pancreatic stump. Results. The frequency of acute postoperative pancreatitis in the control group of patients was 45.8%, in the group 2 of patients — 44.4%, in the group 3 of patients — 9.7%, in the group 4 of patients — 15.0%. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy resulted in a decrease of the frequency of moderate form of acute postoperative pancreatitis. The use of Endoscopic Linear Cutter and external transduodenal transnasal drainage of the enlarged main pancreatic duct resulted in decrease of frequency of acute postoperative pancreatitis in patients with a diameter of the main pancreatic duct of the pancreatic stump up to 5 mm. Conclusion. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy resulted in the decrease of frequency and severity of acute postoperative pancreatitis.

The aim is to carry out the analysis of outcomes of anterior cruciate ligament arthroplasty undertaken by various methods in patients with complete ligament rupture. Material and Methods. 104 patients diagnosed with complete rupture of anterior cruciate ligament (ACL) in knee joint who underwent knee joint arthroplasty fulfilled by various methods were the object of the present study. Clinical outcomes of the treatment were estimated by clinical signs of ACL failure, the degree of functional impairment of knee joint (IKDC 2000) and motor pathology assessed instrumentally. Results. Significantly better function restoration in knee joint occurring as early as 3 months postoperatively has been stated in the group of patients with two-bundle ACL arthroplasty by synthetic implant "DONA-M" on the basis of IKDC subjective knee indices. Negative Lachman test and Pivot shift test were demonstrated as early as 3 months postoperatively by all patients after two-bundle ACL arthroplasty with synthetic implant "DONA-M", reduced support asymmetry 6 months postoperatively was stated in all patient groups as well as run path and surface area in patients with single-bundle ACL arthroplasty by synthetic implant "DONA-M". Conclusion. The use of single- and double-bundle ACL arthroplasty with synthetic implant and ACL arthroplasty with autograft of semitendinosus (ST) and gracilis allows providing equally full-fledge restoration of injured knee joint, without statistically significant differences between the groups, in great majority of patients up to 12 months of follow-up period which is proved by normalized knee joint function, the absence of ACL failure and motor pathology signs estimated instrumentally. Key words: knee joint, anterior cruciate ligament (ACL), co

Aim: to develop a personalized approach to diagnostics and treatment of patients outcomes with degenerative and post-injury deformities of cervical spine. Material and Methods. Between January 2009 and January 2016, 520 patients at the age of 15-80 years with degenerative (227) and traumatic (293) lesions of cervical spine were treated in neuro-surgical department. We conducted a comparative analysis of two groups of patients: treated in the period from 2009 to 2012 (group 1: 235 patients) and in the period from 2013 to 2016 (group 2: 285 patients). The developed diagnostic algorithm was used in patients of group 2 when the operation was planned. Results. The frequency of all complications was significantly lower in group 2. In the analysis of complications it was revealed that more often in group 1 there were: dysphagia, dysphonia, severe postoperative pain in the neck and upper limbs; breakdown or malposition of the screw, graft or plate. Conclusion. The comprehensive algorithms for diagnosis and treatment of patients with degenerative and post-injury deformities of cervical spine that take into account their individual morphometric and functional data allow to form an effective personalized program of surgical rehabilitation and reduce the number of perioperative complications from 35 to 9%.

 Saratov Journal of Medical Scientific Research 2018; 14 (2): 240-243. The aim: the optimization of surgical treatment tactics at a customary shoulder dislocation, based on "on-track Hill-Sachs / off-track Hill-Sachs" concept. Material and Methods. The research group consists of 42 patients aged from 19 to 52 years with chronic recurrent anterior shoulder instability, who underwent a surgical treatment to restore previous shoulder anatomic and topographic correlations. Patients were divided into two subgroups according to diagnostic arthroscopy results. The first subgroup includes 14 patients with impaction visualized (off-track Hill-Sachs), the second one — 28 patients with head shoulder stability (on-track Hill-Sachs). Patients of the first subgroup underwent open surgical intervention according to Bristow — Latarjetand shoulder arthroscopic repair was carried out in the second group. Results. One month after the surgical treatment median total estimated figure exceeded by 1.8 times in patients of the first subgroup and by 1.2 times, by Rowe, in patients of the second subgroup and decreased by 2.1 times in patients of the first subgroup and by 1.7 times, by DASH, in the second subgroup in comparison with the indices before the operation, that was illustrative of a good treatment result. Six months after the operation median total estimated figure exceeded by 1.2 times, by Rowe, in patients both of the first subgroup and the second subgroup and decreased by 2 and 2.1 times, by DASH, in patients of the first and the second group, relatively in comparison with the indices found one month after the operation, that was illustrative of an excellent treatment result in the late postoperative period. Conclusion. Patients with anterior shoulder instability caused by a glenoid fossa deficiency less than 25% in combination with off-track Hill-Sachs lesion, the most convenient way is the replacement of the bone loss by coracoid process transposition. In patients with on-track Hill-Sachs lesion arthroscopic repair is preferable.

In recent decades, in the sphere of minimally invasive approach to preparing hard dental tissues, adhesive dentistry has made significant progress, revolutionizing many aspects of restorative dentistry. The attitude towards cavity preparation has changed due to adhesive systems as there is no necessary to prepare cavities with additional retention points to ensure mechanical adhesion with the filling material. Thus, the introduction of adhesive systems contributes to the preservation of more non-demineralized enamel and dentin in the preparation of hard dental tissues in accordance with the principle of "biological expediency". To achieve a better connection with the hard tissues of the tooth, a number of adhesive systems has been developed. The complexity of achieving a better connection is due to the heterogeneity of the structure and composition of the hard dental tissues, the hydrophilicity of the exposed dentin surface, smear layer formed during the preparation of the cavity and the characteristics of the adhesive system, such as its physical and chemical properties and the way it interacts with enamel and dentin. With the development of technologies, adhesive systems have evolved from systems that do not involve the etching of hard dental tissues to systems with preliminary total etching and self-etching adhesive systems.

Objective: to examine the catamnesis of infants born with very low and extremely low birth weight, as well as undergoing critical conditions in the early neonatal period. To assess the health status of children observed, recommendations for further rehabilitation and prognosis. Material and Methods. At the department of catamnesis 4373 children were observed (total 21343 admissions), 62% of them were preterm infants. Children with extremely low body weight and very low body weight (157 patients, 20.3%) were evaluated for physical development, somatic and psychoneuro-logical status. Results. Analyzing the structure of morbidity observed in children hematologic violations are revealed in the form of anemia of prematurity moderate and severe degree in 15 patients (11.4%), slowing growth and development 25 (19.4%), respiratory disorders (19 children, 14.5%). In the assessment of physical development, growth disharmony revealed in 20.9%, weight disharmony in 29.4% of patients. Neuro-psychological development corresponded to the postconceptual age at 49.2% of children. Breastfeeding saved in 44.6%, mixed and in vitro were transferred in 55.4%. In a group of children follow-up observations identified numerous pathological conditions and high morbidity, requiring subsequent mandatory correction. Many of the children belong to the Group of infectious diseases patients (28.4%), with lots of somatic pathology (78.1%). A direct impact of the dynamics of body weight during the first months after birth was revealed in figures physical development of a child and the incidence in the future. The most vulnerable preterm infants from multiple pregnancies, small for gestational body weight deficiency which recovers slowly and have them marked lower psychomotor development. Conclusion. Improving rehabilitation technology, previously early steps, the integrated use of various methods and means, phases taking into accountthe stage of the disease process and individual approach to a child significantly improve the efficiency and effectiveness of rehabilitation therapy.

Aim: to study the effect of hyperglycemia on the course and clinical outcome of ischemic stroke (IS) in the acute period. Material and Methods. A total of 862 patients with IS (370 men, 492 women), mean age was 66.1±10.8 years. The degree of neurological deficit (NIHSS scale) and functional disorders (Rankin scale), clinical outcome were assessed. When admitted to hospital, a study of the level of glycemia on an empty stomach was conducted. Results. In 186 (21.6%) patients type 2 diabetes Mellitus (DM) was diagnosed. In 27.8% of patients without DM and 76.3% of patients with DM hyperglycemia was detected. In patients without DM with hyperglycemia, higher than in patients with normoglycemia, the representation of women (by 9.9%), cardioembolic stroke (by 10.5%), severe neurological deficit (by 14.7%), gross impairment of vital activity (by 14.0%), a decrease in the frequency of noticeable positive dynamics (by 14.8%), an increase in mortality (by 11.5%). In patients with DM, hyperglycemia was associated with a higher assessment rate on the Rankin scale of 4-5 points (by 25.6%) and a decrease in the incidence of noticeable positive dynamics (by 27.7%). Conclusion. Development of IS is characterized by high representation of disorders of carbohydrate metabolism (21,6%). The severity of glucose metabolism disorders is interrelated with the severity and clinical outcome of the disease.