Article about a history of creation and development of the largest hospital of Vladivostok and Primorsky Krai - Vladivostok City Hospital No. 2. The big attention is given to the questions of providing of the specialized medical help, strategy of development, formation of economic model of functioning of hospital, the international cooperation. Progress in formation of team of professionally competent experts, their achievements in development of new medical technologies is shown

The review of the literature devoted to surgical ways of treatment of chronic pancreatitis. The specific features of the longitudinal pancreatojejunostomy, pancreatoduodenal resections (including with graining) and intra-parenchymal resections of the head of a pancreas are described. It is concluded, that a choice of this or that surgery at chronic pancreatitis should be based on the individual parameters received at exam of each patient. Probably, advantage further will be given to the combined surgeries combining both draining and resection components.

- On the basis of the data of the literature and own work the mistakes are analyzed at diagnostics and treatment of kidneys diseases. Mistakes can be found at all stages of exam of the nephrological patient: at a stage of revealing of symptoms and leading syndrome, at specification of the syndrome and at the estimation of nephropathy activity and functional condition of kidneys. The most typical mistakes at treatment of common symptoms and syndromes, mistakes at an estimation of results of lab and instrument researches, including biopsy, are shown. The important role in prevention of the erroneous diagnostic conclusions belongs to constant perfection of clinical thinking, the estimation of diagnostic role of all methods and opportunities of new methods of treatment

The samples of blood, synovia and synovial liquid at 78 patients with rheumatoid arthritis were investigated. Intensity of the apoptosis studied by TUNEL method (terminal deoxynucleotidil transferasemediated dUTP nick endlabeling), based on revealing of the fragmentized DNA chains. Intensity of programmed cellular death of synovial cells depend on balance of anti- and pro-apoptotic molecules on morphological (Bcl2 and p53) and humoral (sFas) levels. The received results specify low apoptosis intensity at early stage and its significant activization at late stages rheumatoid arthritis. In process of disease progressing the morphological structure of the apoptotic structures was changed to fibroblasts of stromal layer of the hypertrophied synovia.

Results of surgical treatment of 29 patients with trochanter femur fractures with use intramedular proximal femoral construction «Osteomed» in 2006-2008 are analyzed. Among the patients the ones of elderly and senile age (75.9%) at whom fractures have developed on background of osteoporosis prevailed. Operative intervention in 86.2% of cases was carried out by mini-invasive way. Clinical exam and X-rays are done in 1, 3, 6, 12 months after surgery. The remote results at 19 cases are: in all cases the healing was marked and restoration of the motor activity till 3 months after surgery.

Dosed tensometric axial loading - the important part of rehabilitation demanding the adequate attitude of the patient and regular control of the doctor. Results of treatment of 392 patients with diaphysis fractures of a shin after the osteosynthesis are submitted. 84 patients who were provided rehabilitation under the traditional scheme were the group of comparison. Smaller expressiveness of hypostasis, muscles atrophy and osteoporosis, the better reovasographic parameters, early terms of consolidation of fractures and smaller duration of time invalidity are shown at rehabilitation of victims with use of dosed axial loading on the limb.

On the basis of own researches and the data of the literature of ano-genital and rectal trauma are divided on connected and not connected with sexual crimes. Legal aspects of violent ano-genital penetration and rectal trauma are considered at defects of providing of medical help. Examples from practice, illustrating various aspects of this problem are resulted

Results of an osteosynthesis are analyzed at fractures of femur collum at 284 patients of elderly and senile age. The best results are marked at fractures such as B1, good and satisfactory results - at fractures such as B2 and B3 after surgery in early terms with successful reposition. Unsatisfactory results are registered in 1/3 cases, more often at fractures such as B2 and B3 at patients of senile age in case of infringement of techniques of an osteosynthesis. The author offers for last group of patients more effective surgical technologies like hemiartroplastics or total replacement of the joint

Results of the endoscopic dissections of the perforant veins are analyzed at severe chronic venous insufficiency at 141 patients (48 men and 93 women) in the age from 25 till 70 years in comparison with Linton method (26 cases). Patients suffered from severe forms of varicose and post-trombophlebitis illnesses. Good and satisfactory result at endoscopic intervention achieved in 97.2% of cases. Complications are registered in 2,1% of cases (at Linton method - 34.6%). It is judged, that endoscopic dissections is an effective method of treatment of chronic venous insufficiency of the 4-6th classes (on classification SEAP). At the expressed trophic changes it allows to provide one stage intervention on the perforant and superficial veins with significant reduction of purulent complications that reduces hospital stay of patients and charges on treatment.

- Immune cytochemichal method was used in investigation of localization and activity of the nitro-oxidsyntases in synovial cells on model of rheumatoid arthritis at 30 experimental animals at different stages of inflammatory process. Direct participation of the nitroxidergic mechanisms in the development of the adjuvant arthritis is found. The specified mechanisms are determined by synovial cells function, in which nitro-oxidsyntases activity was non-uniform: prevalence of the induced forms in acute phase on a background of permanent synthesis of the neuronal form in acute and chronic phases, that, probably, can play role in transformation of acute arthritis into chronic

The results of application in diagnostics of chronic virus hepatitis of a method needle biopsy of livers of 233 patients were analyzed. The complication which demanded conservative therapy has arisen in 1 (0,4%) cases. Morphological research of a tissue of livers in 100% cases allowed revealing indication of a chronic hepatitis, to estimate inflammatory changes and a stage of process

Complex trauma of the colon is one of the severe kinds of abdominal organ injury, sometimes creating complexities even for skilled surgeons. The high mortality level (up to 44%) determines the necessity of development of rational algorithm of medical diagnostic actions. Surgical tactics suggested by the Department of faculty surgery, developed on the basis of City Hospital No. 2 (Vladivostok), taking into account the degree of trauma, blood loss volume, terms from the moment of trauma, severity of damage to other anatomic areas, a degree of filling of colon, allows receiving quite satisfactory results in this category of patients.

The analysis of results of treatment of 61 patients with thoracic and lumbar spinal fractures treated with transpedicular systems and vertebroplastics is submitted. Clear advantages of use of vertebroplastics are revealed. Surgery gives the big opportunities for restoration of height of a body of the broken vertebrae, due to impactors used at reposition. The filling, formed thus in damaged vertebrae, of the bone defects by auto-tissue, restored the lost volume and, thus, raised stability of spine. At control research the insignificant loss of the correction achieved on surgery at 8 patients (13.1%), Damages of construction and destabilization of the fixed segment of spine
were revealed at no one patient.

The analysis of suicide poisonings by psychotropic medications on a material of toxicological department of Vladivostok City hospital No. 2 in 2003-2007 (718 cases) is submitted. Among the cases women in the age of 20-39 years prevailed (73.8%). More often with the purpose of a poisoning the tranquilizers, sleeping medicines and energizers were used. The amount of poisonings by psychotropic medications and their ratio among all suicide attempts (42%) remained stable during all analyzed period. Recommendations are given in process of prophylaxis of suicide poisonings by psychotropic medications.

94 patients (87 women and 7 men) with authentic rheumatoid arthritis in the age from 20 till 60 years are surveyed. Patients received metotrxate in a doze of 20 mg once a week intramuscularly. The quantitative definition of IL 1β, 6, 10 and the tumor necrosis alpha- factor in blood and synovial liquid and also spectrophotometric research of the nitrogen oxide metabolites in the same environments and urine. The increased content of the cytokines and nitrogen oxide metabolites is revealed only in synovial liquid and urine of patients (except IL6). Treatment by metotrxate was accompanied by increase in IL1 level, the tumor necrosis alpha-factor and nitrogen oxide metabolites in a peripheral blood. In synovial liquid there was a repeated decrease in concentration of these parameters. It is possible to assume, that the increase in production of the nitrogen oxide metabolites by synovial cells of a joint has some proinflammatory character and has close interrelation with cytokine dysregulation and auto immune inflammation.

The purpose of research was development of methods of epidemiological diagnostics and revealing of risk factors of cerebral palsy morbidity in Primorsky Krai. As a material of research the forms No. 12 for 1997-2006 were used. The analysis of long-term changes for the first time revealed and common morbidity is done, territorial distribution of average indices of incidence and prevalence is investigated, levels of morbidity are appreciated and cartograms are made. Results of research allow assuming the presence of risk factors, stable and connected with territorial features.

Results of clinical supervision of 144 children with pseudo-tuberculosis and intestinal iersiniosis and their combinations to virus hepatitis A. The clinical features of sporadic variants of the specified infections, their expressed severity, frequency and character of the exanthema syndrome, and also a combination of symptoms of iersiniosis and virus hepatitis A in mixed cases are submitted, that is necessary to take into account in diagnostics and treatment of children

113 children, in the age from 1 year till 14 years are surveyed, among which 51 (45.1%) were in the age from 1 year till 3 years. At patients with the immune ferment analysis and polymerase chain reaction verified the Epstein-Barr infection was found, mainly in moderate form (97.3%). The analysis of clinic has shown, that at children of early age in the beginning of illness the symptoms of acute respiratory disease with lymphadenitis prevailed in clinic, that complicated diagnostics of the infection, and only in the peak of illness typical complex of the signs has developed which was registered at children of advanced age already in the beginning of disease

The signs, parameters of EEG, transcranial Doppler investigation, computer and MRI tomography of brain at 182 patients with intracranial vascular malformations are analyzed. The received results have allowed allocating 3 groups of criteria of the non-invasive diagnostics of vascular malformations on prehemorrhagic stage. Authentic diagnosis is considered, when the data on malformations localization of any of four listed methods completely coincide with the data of three others. The diagnosis becomes probable at concurrence of the given three methods and presumable at concurrence of the given two methods and an opportunity of reception of an explanation to the mechanism of discrepancy of the data of the third method.

For the first time the concept of the patella-femoral gradient as radiological attribute of existence of dysplastic patellar instability is formulated. It is meant as a difference between corners of the congruency of the right and left patella-femoral joints which in norm does not exceed 0-5°. Calculation of the patella-femoral gradient can be used in the substantiation of the diagnosis of patellar instability as in combination to pathological role of a corner of the congruency of patella-femoral joint and inter-tuberculin depth, and as independent diagnostic criterion

With the purpose of search of an accessible, reliable and simple method of an estimation of severity of brain trauma the complex exam of 17 patients in the age of 18-55 years with the analysis of the level of neuron specific protein S-100 in blood is done. It is shown, that concentration of this marker of cellular damage considerably rises in the acute period of brain trauma. At favorable current of pathological process level S-100 was considerably reduced already on 2^nd day of illness. At negative changes the concentration of S-100 remained practically constant or even raised, that testified about secondary reperfusion brain damages.

In conditions of reforming of public health the increase of efficiency of use of medications and other supplies is one of key economic problems. The purpose of this work was perfection of system of calculation of expenses for medicamentous maintenance of patients on the basis of department of ICU of Vladivostok City Hospital No. 2 by introduction of medical information system «Personificated account of medications and other supplies». It has allowed developing one of real ways of perfection of financial economic management of work of department as the received system of the account really determines the charges on medicamentous maintenance of each concrete patient in natural and cost expression

Results of work of the Department of clinical pharmacology in a versatile surgical hospital are analyzed by the example of Vladivostok City Hospital No. 2. The data of an expert estimation of reports of pharmacotherapy, the analysis of maintenance and financial expenses for medical products are submitted. Role of service of clinical pharmacology in optimization of use of medical products is shown

In preliminary research the information on the patients with a multiple sclerosis living in Primorsky Krai and Vladivostok is received. Parameters of prevalence were 12 in rural area and 17 on 100 000 population in Vladivostok. Prevalence among women is marked. The data on distribution of multiple sclerosis among indigenous population are not received. The further researches of connection of morbidity with various climatic zones and synoptic seasons are planned

To Vladivostok and Primorsky Krai the true growth of the general oncological morbidity which occurs on a background of the loss and aging of the population is observed. Among patients of municipal polyclinics of Vladivostok (potential oncological patients) there are 64,3+2,2% visitors with the income below a living level, 75,0+1,2% of oncological patients also have the income below a living level i.e. they are poor citizens. Poverty of the population and the long psycho- emotional and social stress in a society represent important social hygienic risk factors of oncological diseases. Prognostic exponential model of intensive parameters testifies to stable growth of oncological morbidity in Primorsky Krai which can by 2010 under condition of preservation of the same onco-epidemiological tendencies, to achieve 350,0 cases on 100 thousand population

Standards of medical technologies are the basis of the control of system of quality of medical services. Experience of development of standards of medical services in toxicology in territory of Primorsky Krai is described. The created model allows determining the guaranteed volume of diagnostic and medical procedures, manipulations, medical products, account materials, etc., and also terms of treatment. Precomputations of cost have allowed increasing the tariff on ICU bed from 210 rubles in December, 2005 up to 2000 rubles in 2007, on toxicological bed - from 40 rubles in 2005 up to 267 rubles in 2007. It is judged, that introduction of models of complex medical services will promote increase of level of medical help, distribution of positive experience and introduction in practice of last achievements of medical science

Case from practice. The first in Primorsky Krai reconstructive microsurgical surgery on free plastics of a complex flap is described at extensive face defect. The surgery has been executed at the woman of 50 years with through face defect after beam therapy for salivary gland cancer. For plastics the free fibula flap was suggested. Surgery has passed successfully; the plastic of a lower lip is now planned to the patient, also chin plastics and dental implantation.