Review article on the endocrine regulation of fetal growth retardation. Somatomedins and growth hormone have a similar structure of the peptide, but their influence on fetal growth varies. During pregnancy, the insulin growth factor-2 plays an important role, after the birth-insulin-like growth factor-1. Hormonal profile of the mother, her somatic disorders, the impact of external factors, production of hormones by the placenta, and gene polymorphism insulin-like growth factors influence the development of the fetus and newborn.

The review presents the role of systemic inflammation in the pathogenesis of immune suppression with serious injury. Clinically, many patients with symptoms of systemic inflammation and organ damage immunologically caused, i.e. in the phase anticipated activation of pro-inflammatory mediators are both very susceptible to secondary infections. Particularly significant features of both dual activation and suppression appear in neutrophils. Organ dysfunction in critical condition is largely caused by neutrophils. The interaction with the immune system is one of the important effects of vitamin D. The active form of vitamin D regulates the acquisition and innate immunity, as vitamin D receptors are presented in many cells of the immune system such as macrophages, dendritic cells, and T- and B-lymphocytes. Many studies confirmed that the lack of vitamin D or its receptors can cause disorders of the innate and adaptive immunity. Effect of vitamin D on the immune system may be caused by inverse connection paracrine mechanism by which an inflammatory response is reduced, and by the influence on the differentiation of T helper lymphocytes and suppression of their function. In this regard, it is extremely important to understand the epidemiology of vitamin D deficiency among the resuscitation patients to find out the value of its deficit in the formation of multiple organ dysfunction syndrome in post-shock period and prognosis in severe concomitant injury.

A literature review on the role of age-related androgen deficiency in the pathogenesis of prostatic adenoma (benign prostate hyperplasia) (PA). Testosterone is the most important sex hormone that provides almost all of the prostate and bladder functions, and age-related decline synthesis in men coincides with the advent of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia. These and other well-known pathophysiological mechanisms of participation of the age-related androgen deficiency in the pathogenesis of PA are presented in this review. Based on an analysis of published data, we can conclude that prostate hyperplasia is a combined therapeutic problem, and pathogenic decision may be associated exclusively with the interdisciplinary approach, and among the most important levers we should consider the early detection and correction of age-related androgen deficiency in all men with LUTS/PA.

It was conducted a comparative analysis of the properties of synthetic drugs and herbal drugs in relation to medical treatment of nephrolithiasis. It was determined the ways of the influence of herbal drugs on the pathogenesis of urolithiasis. For example, “Ro-vatineks” drug demonstrated the possibility of using herbal medicines in the treatment of urolithiasis. Article is supplemented with a brief analysis of contemporary trends in the development of herbal medicine.

Recently, minimally invasive technology has become the main method of treating urinary incontinence in women. However, the simplicity of minimally invasive procedures does not guarantee its effectiveness, and it is often registered dissatisfaction with the intervention, in some cases - failure of treatment. Methods. Follow-up results of 132 trocar synthetic sling surgery (TSS) were analyzed in women with urinary incontinence. Results. In one fourth of the patients in the late post-surgery period there were urinary disorders with incontinence mandatory options that required pharmacological correction and destination α₁-blockers and M-anticholinergics. Conclusions. To improve the efficiency of treatment after TSS, the non-invasive clinical and urodynamic monitoring should be carried out for at least one year with the identification of patients who showed the conservative therapy for the normalization of the functional state of the lower urinary tract.

Background. Research objective is efficiency assessment of laparoscopic cholecystectomy (LCE) with fan-shaped laparolift and sustainable development of the algorithm of surgical treatment of acute calculous cholecystitis in patients with increased anesthetic risk. Methods. The results of treatment of 154 patients aged 43-87 with acute cholecystitis were summarized. In 78 cases the LCE was carried out in gas-free environment using laparolifta own design (the study group), 76 cases of LCE performed under carboxyperitone-um at a pressure of 6-8 mm/Hg. For objectification of assessing the severity of the general condition used SAPS II - Simplified Acute Physiology Score. Results. The median SAPS II in the study group was 31.9±1.6, the control - 29.8±1.4 points. The estimated risk of death in patients of the study group amounted to 9.5±0.6 %, which was 0.9 % less than in control group. The number of post-surgery complications when using fan-shaped laparolift was 27.3 % lower. In the control group mortality was 6.6 % (5 patients) in the group where LCE was performed with the use of fan-shaped laparolift, one person died (fatality rate 1.3 %). conclusions. Determining the severity of the general condition of SAPS II with the calculation of the prognostic index of hospital mortality at admission helps to choose the most rational method of surgery treatment of acute destructive cholecystitis in patients with increased anesthetic risk.

Background. Research objective is an efficiency and safety analysis of different ways of treatment of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH), including androgen substitutive therapy. Methods. The results of the survey and conservative treatment of 187 men with LUTS/BPH were analyzed. Monotherapy α1-blocker, 5α-reductase inhibitor and plant complex received 40, 35 and 30 patients, respectively. Another 40 people received combination therapy (α₁-blocker and 5α-reductase inhibitor) and 42 patients with age-related hypogonadism additionally received the testosterone undecenoate. Results. The efficacy of standard medical therapy without androgen status of patients was on average 70.2 %. Additional androgen substitutive therapy of testosterone with the undecanoate contributed significantly more pronounced therapeutic effect in hypogonadal men. Conclusions. The study confirmed the high clinical and urodynamic efficacy and safety of a combination of standard treatment and androgen substitutive therapy in hypogonadal men with LUTS/BPH.

Background. The success in the treatment of acute pancreatitis largely depends on early diagnosis and the use of modern high-tech minimally invasive surgery. Methods. A retrospective study of 105 cases of acute pancreatitis (53 men and 52 women aged from 18 to 82 years), which required surgical treatment, was made. Results. Informative function of the ultrasound scan depended on the severity of the disease and decreased in severe necrotizing pancreatitis (more than 60 % of non-informative study). The accuracy of CT in the early period of the disease was low and increased with the formation of lesions in the destruction of the pancreas. In mild and moderate pancreatitis more than 70 % of the patients were successfully treated with minimally invasive techniques, with severe necrotizing pancreatitis efficacy of minimally invasive procedures decreased to 7.4 %. Conclusions. The complex of current diagnostic and treatment techniques is effective in mild to moderate severity of acute pancreatitis, it is not sufficient in severe necrotizing pancreatitis in patients, particularly in early stage of the disease.

Background. Research objective is to determine whether the ureteral catheterization is an effective measure to prevent compromise of an urinary system in colorectal cancer (CRC) and to determine the indications for it. Methods. It was analyzed 321 cases of patients aged 36-78 who were treated for colorectal cancer. It was selected 28 cases (8.7 %) with suspected compromise of an urinary tract (in 19 cases ureteral catheterization was performed). Results. Based on this analysis, our observations were divided into two groups: 1) 10 patients who had complications of the urinary system as a result of a surgery (in 8 cases the ureter was damaged, in 2 cases the urethra was damaged); 2) 18 patients who had no complications of the urinary system. In group 1 ureteral catheterization was performed to one patient, in group 2 - to all patients. Conclusions. Ureteral catheterization prevents its compromise within a surgery for colorectal cancer or contributes to early diagnosis of damage. The catheter, installed in the upper urinary tract, makes it possible to perform intraoperative retrograde ureteropyelography and thus exclude or diagnose iatrogenic injury.

Background. Studies in experimental and clinical nephrology found mechanisms of development, and substantiated some ways to treat diseases of the cardiovascular system in anemia caused by chronic kidney disease. Nevertheless, the number of studies dedicated to the defeat of the cardiovascular system in patients with chronic glomerulonephritis (CGN) at a predialysis stage is still small, and the results are inconsistent. Methods. The study included 631 patients aged 16 to 65 years, with CGN in the predialysis stage of the disease. According to various aspects of the defeat of the cardiovascular system it was compared clinical and laboratory surveillance data of patients with and without anemia. Results. Among patients with CGN and anemia were significantly more frequent coronary heart disease, supraventricular and ventricular arrhythmias, and heart failure than in patients suffering from CGN without anemia. Conclusions. Structural changes in the cardiovascular system in patients with CGN develop in the predialysis period of the disease and the most common variants of defeat are coronary heart disease, arrhythmias and heart failure. The existence of anemia with cardiovascular complications in CGN is associated with deterioration of renal nitrogen-excretive function.

In 9 cases it was detected the genuine invasion of the CRC into the bladder with the formation of colovesical fistula in 5 cases. In the clinical picture in similar observations it was recorded the body temperature rise to 39-40°C, dysuria, pneumaturia, and fecaluria. Conclusions. Invasion into the bladder is found in 2.8 % of cases of CRC. Combination of fever and dysuria in patients with colorectal cancer, especially if these symptoms have stages, provide a reliable criterion for tumor invasion into the bladder. Only computed tomography of the abdominal cavity, retroperitoneal space and pelvis with intravenous contrast enables to establish the presence of colovesical fistula and its topographic and anatomical features.

Background. In developed countries, the incidence of sepsis is 200-275 cases per 100,000 of population. Annualy in the United States it is recorded up to 500,000 cases of sepsis with a mortality rate of 20-50 %. Methods. It was conducted a retrospective analysis of 363 cases of patients with surgical infections, who had been hospitalized to the City Clinical Hospital and to the Amur Regional Clinical Hospital, Blagoveshchensk in the 1985-2014. Results. It was revealed the etiological role of gram-negative bacteria in patients with surgical sepsis. The role of microbial associations (Escherichia coli with Staphylococcus aureus, Staphylococcus epidermidis, and with bacteria of the genus Proteus) increased. The proportion of Pseudomonas aeruginosa increased among the sepsis pathogens (1.4 times) and fungi of the genus Candida (1.6 times). The number of mixed infections increased (up 16.9 %). Conclusions. The bacterial component in the etiology of surgical sepsis nowadays is characterized by a predominance of gram-negative bacteria, increasing of the frequency of microbial associations and fungi of the genus Candida, the predominant sensitivity of pathogens to drugs of carbapenems group (meropenem, imipenem, doripenem) and cephalosporins of III-IV generation (cefoperazone, cefepime, cefpirome, cefotaxime).

Background. Early diagnosis of destructive forms of acute pancreatitis (AP) enables to prevent the development of serious complications and reduce mortality rates. Methods. 194 patients took part aged 19-78 with AP took part in the study, including 164 patients with acute destructive pancreatitis and 30 patients with edematous form AP. Results. Leukocytal intoxication index was significantly higher in destructive pancreatitis. Diagnostic sensitivity of C-reactive protein with edematous pancreatitis was 86.4 %, and with destructive pancreatitis it was 87.5 %. In patients with destructive pancreatitis procalcitonin level was significantly higher than in patients with edematous form of AP: 1.24 and 0.34 ng/ml, respectively. The rest of the clinical and laboratory diagnostic tests showed wide variability. Conclusions. Most of the traditional clinical and laboratory diagnostic techniques of AP does not allow reliably differentiate not only different forms of destructive lesions of the organ, but in some cases also of destructive and swelling forms AP. The most valuable diagnostic markers can serve as acute phase reactants, pro-inflammatory cytokines, and procalcitonin.

Background. The morphological and functional properties of the isolates of Trichomonas vaginalis, excreted from habitats urogenital of men with chronic trichomoniasis. Methods. In 143 men with chronic urogenital trichomoniasis from scrapings of the urethra, ejaculates, and prostate secretion was allocated 205 cultures of T. vaginalis. We determined by the shape, size and structure of the nucleus and cell motility. Results. In 89.5 % of patients T. vaginalis were in only one clinical material, in the ejaculate. Trichomonas had high variability in shape, size, mobility and nuclear apparatus of the cell organization. Among the forms of the pathogen abnormal cells prevailed - mostly rounded, with a centrally located nucleus, large in size and mobility of the pendulum. Conclusions. The nature of the variability of the pathogen is determined by biotope urogenital tract of patients. So, in scrapings from the urethra was dominated pear-shaped, multi-core, small in size, with a wave-like mobility; in the ejaculate - round, single-core, with pendulum-type movement; and in prostate secret - amoeboid and oval, large, nuclear-free and immobilized forms of the parasite.

Background. The research objective is an analysis of the species composition of bacterial flora of ‘border’ burn wounds in the different phases of wound process. Methods. It was conducted the analysis of 571 studies results of microbiological composition of bacterial flora in surface burns in 509 patients. Time of biomaterial sampling ranged from 1 to 60 days after injury. Species identification and antibiotic sensitivity of the isolated microorganisms was determined spectrophotometrically. Results. It was found 50 species of pathogenic and conditionally pathogenic flora in traumatic discharge. Microbial wounds landscape was varied and presented to gram-positive and gram-negative flora, but the dominant species were Staphylococcus aureus and Pseudomonas aureginosa. Dissemination of conditionally pathogenic flora to the surrounding skin on the surface of the deified is the main route of contamination of wounds in the first days after the injury. When analyzing antibiotic grams strains of Staphylococcus epidermidis and Staphylococcus haemolyticus, sown in the first day, were susceptible to methicillin, oxacilline, cefazolin, and micro-organisms found in the later periods were resistant to these antibiotics. conclusions. Saprophytic and conditionally pathogenic flora, often represented by associations, less monoculture prevails in the first phase of wound process in the ‘border’ burn wound. Methicillinresistant staphylococci, gram-negative bacteria and P. aureginosa Acinetobacter baumannii dominates, and the amount of associative flora increases at the second and third phases of wound process in the ‘border’ burn wound. Most often in the ‘boundary’ burn wounds in the second and third phases of wound healing are encountered S. aureus, P. aureginosa and A. baumannii - 65,8 % of all pathogens. These pathogens are the most clinically important in the regeneration phase and the epithelialization.

Observation of practice. On the basis of the neurophysiological model, developed by the authors, it is explained the clinical symptoms and urodynamic parameters in patients with neurogenic bladder. It was used the original method uroflowmetry at home, which has allowed to make a differential diagnosis and justify the treatment regimen. This example suggests that the urodynamic examination in such cases is not necessary for the verification of bladder outlet obstruction, but to determine the nature of the disease.

From 2006 to 2013 in the urology department of CCH No. 52 it was observed 8 patients aged from 20 to 69 years with calculi in the transplanted kidney. In 5 cases, it was performed the extracorporeal lithotripsy. We present the observation of practices, where with contraindications to extracorporeal lithotripsy it was successfully performed the litholytic local drug therapy ‘Blemaren’. Keywords: urolithiasis disease, extracorporeal lithotripsy, litholitic therapy, Blemaren.

Background. The study objective is to evaluate the role of endo-sonography and fine-needle puncture under the control of endoscopic ultrasonography (EUS) in the diagnosis and staging of pancreatic tumors. Methods. It was evaluated the results of EUS and the fine-needle puncture under the control of EUS with cytological examination on the material of 17 clinical observations. Results. In 13 patients EUS confirmed the data of magnetic resonance and computed tomography. In 7 cases it was diagnosed a highly differentiated adenocarcinoma in 3 cases - moderately differentiated adenocarcinoma, in 1 case - undifferentiated pancreatic cancer and in one case - metastasis of clear cell renal cancer. Conclusions. Endosonography is a minimally invasive, fairly safe and effective method of diagnosis of pancreas tumors, allowing in combination with fine-needle puncture and cytological study to evaluate the resectability and curable tumor as well as determine the future tactics of patients even at the stage of development of the methodology.

Background. The research objective is to evaluate the clinical efficacy and safety of a_rblocker silodosin in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods. 26 ambulatory patients aged 52-87 with LUTS in BPH received Silodosin (8 mg daily) for 8 weeks. Treatment efficacy was assessed by IPSS, quality of life by the index of QoL. Results. After 4 weeks, the total score on the IPSS decreased by 33 % and by 8th week - 54.5 % of the original. The average sum of scores on QoL also decreased by 27 % in the 4^th week of observation, and by 51.2 % - to the end of the study. The overall incidence of adverse events was 19.2 % (5 patients). Conclusions. Effective impact on LUTS with minimal negative effects on the cardiovascular system, and high uroselektiveness allow assigning Silodosin as monotherapy or as part of a combined treatment of BPH.

Background. The differential diagnosis of pancreatic cystic lesions is still the most debatable issue in abdominal surgery. Among the cystic tumors the non-tumor lesions are often encountered in this region. Endoscopic ultrasonography is becoming of more importance in terms of diagnosis, treatment strategy and cure of patients with pancreatic cystic lesions. The aim of this study is to define diagnostic criteria and evaluate significance of the endoscopic ultrasonography in the differential diagnosis of pancreatic cystic lesions. Methods. 125 patients with pancreatic cystic lesions underwent the examination, including endoscopic ultrasonography, abdominal ultrasosonography, computed tomography, magnetic resonance imaging. A comparative analysis of efficiency of these methods was performed. Results. The sensitivity of the endoscopic ultrasonography is 91,4 %, specificity is 95,4 %, accuracy is 93,5 %. The efficiency of the endoscopic ultrasonography exceed other diagnostic methods. The main criteria in the differential diagnosis of pancreatic cystic lesions were defined. conclusions. The endoscopic ultrasonography should be use for complex evaluation of patients with pancreatic cystic lesions in multi-disciplinary surgical hospitals.

Background. It was suggested a way of laparoscopic left partial nephrectomy performed through a ‘window’ in the mesentery of the colon. Methods. It was conducted an analysis of treatment results of 40 patients with renal tumors (TjN₀M₀), after laparoscopic left partial nephrectomy, 19 of them was operated transmesentricaly. Results. Conversions, post-surgical complications, and deaths were not registered. In one case during the traditional laparoscopic surgery the splenic capsule was damaged and caused bleeding, the complication was corrected conservatively. The duration of renal ischemia, duration of surgery and time of hospital stay between the two groups had no statistically significant difference. Conclusions. Transmesentric partial nephrectomy access has a number of advantages and can be considered as an alternative to standard laparoscopic nephrectomy.

Background. It was analysed the results of the treatment of patients with complicated benign prostatic hyperplasia (BPH) by the bipolar (BP) transurethral resection (TUR). Methods. In the study included 604 patients with BPH, who were divided into two groups. the main group included 271 patients who received treatment after the introduction of the practice of BP TUR. In the control group (333 patients), the treatment was carried out before the introduction of BP TUR. Results. Complicated BPH was at 51.8 % of patients. The age of patients with high-risk of BPH (median - 70 years) was significantly higher than in patients without complications (median - 64 years). Prostate volume was also greater in complicated BPH (median - 77 and 64 cm³, respectively). BP TUR significantly more often performed in complicated BPH, than monopolar TUR. Due to it the main group achieved a reduction in the number of open prostatectomy and epitsistostomy. The mean duration of hospitalization in the study group (10 days) was significantly lower than in the control group (14 days). conclusions. More than half of the patients with BPH, surgery is performed only at the stage of development of complications. Age and prostate volume are risk factors for complications of BPH. Application of BP TUR reduces the need for epitsistostomiyah and open prostatectomy reduces the period of hospitalization. BP TUR has a good safety profile, including complicated BPH.

Urine flows taken at home with the help of the device for uroflowmetric monitoring show significant differences of the rates in different times of the day. Changes indicators reflect daily fluctuations in volumes and therefore dependent upon the flow of urine, which should be considered when uroflowmetry. These changes are a consequence of the effect of the control of the central nervous system, and the bladder, pelvic floor and the reflex apparatus are, in fact, only the executive organs. Based on these data it was concluded that it is impossible to adequately assess the function of the lower urinary tract as a result of a single uroflowmetry. It was used known nomogramms to calculate urinary structures, the examples of records of urine flows were presented, and it is suggested a way for an objective assessment of uroflowmetric monitoring on the basis of a series of records.

It is presented the comparative characteristic of different methods of single-stage breast reconstruction with preservation of the nipple-areola complex and it is described the author>s method of reconstructive surgery for breast cancer.

Background. Despite more than a century of study to date choice of surgical treatment method criteria of Zenker diverticula are not defined. Methods. Retrospectively 37 cases with Zenker>s diverticulum were analyzed in Vladivostok clinics from 2007 to 2013. All patients underwent endotracheal anesthesia surgery: traditional diverticulum resection (23 cases), stapled ezofagodiverculostomy (7 cases), and endoscopic ezofagodiverculostomy (7 cases). Results. The average time of the traditional surgery - 47±16 min (recovery in 100 % of the cases). The average time of stapled ezofagodiverculostomy - 70±22 min. Regurgitation and dysphagia have been preserved in one case, relapses were found in four cases, diverticulitis - in two patients. One patient 3 years after the surgery was diagnosed malignancy residual cavity diverticulum. The average time of endoscopic ezofagodiverculostomy - 62±21 min. Regurgitation and dysphagia persisted in two cases, recurrences are found in two patients. Conclusions. The gold standard of treatment of Zenker>s diverticulum is surgery. The average performance time of traditional resection of diverticulum is less than that of stapled ezofagodiverculostomy because of using trans-illumination. Patients with severe concomitant diseases, large and giant diverticula is prescribed for relief of dysphagia symptoms the stapled ezofagodiverculostomy.

A large number of non-radical surgeries for cancer of the bladder are the basis for the search of new, more efficient technologies and imaging tumors surgical resection borders. A number of methods enable to obtain objective information on the tissue structure; however, they are not widespread. Another set of techniques can improve the visualization of tumors of the urinary system using filters. At the same time getting sharper images and better detection of suspicious areas is possible with the computer image processing. Our experience with this technique in 45 patients allowed at 18.9 % improving bladder cancer diagnosis in the stage of development of the method.

Intracorporeal suture (ICS) is regarded today as a mandatory element, which the surgeon must possess before the development of laparoscopic surgery in the operating room. At the Department of Surgery No. 1 MSMSU proposed a simulation method of effective teaching ICS on box simulators. The testing method was attended by 255 students: students of medical universities, interns, residents, and practicing surgeons. Only 20 % of doctors have shown the necessary level of knowledge of manual skills to start learning the art of ICS. All students, interns, residents, and 80 % of physicians had to start training with basic exercises unit. During testing, the proposed method of separate training of ICS has demonstrated high performance, availability, and economic benefits.