The review of the literature devoted to modern methods of treatment of chronic heart insufficiency. On the basis of the data of the multi-center randomized trials the high efficiency of the heart resynchronization therapy is shown. The importance of this method of treatment of chronic heart insufficiency for Russia is emphasized.

The analysis of a modern condition of a problem of the peri-operation antibiotic prophylaxis in urgent abdominal surgery is done. Risk factors of the wound infection in conditions of use of various schemes of the peri-operation antibiotic prophylaxis are analyzed. The algorithm of a choice of peri-operation antibiotic prophylaxis for acute appendicitis is suggested. Some possible directions of the pharmaco-epidemiological and pharmaco-economic research in this area are reflected.

The review of the literature devoted to the treatment of the pain by methods of neuro-stimulation. Indications and contra-indications to Spinal Cord Stimulation, Deep Brain Stimulation, and Motor Cortex Stimulation are considered. It is concluded necessity of the complex approach to the treatment of the severe forms of the syndrome of pain.

Till now there are no authentic diagnostic biochemical and immunologic markers used for the estimation of a pain syndrome, the pain remains subjective sensation. We studied the features of change of the some molecules-bioregulators in blood at patients, who underwent abdominal surgery, in case of acute pain and at stages of the early postoperative period at various analgesics. It is shown, that postoperative pain reaction is accompanied by increase in blood of a level of the nitrogen oxide metabolites, the products of the lipid peroxidation, some cytokines — the tumor necrosis factor A, IL 1 and 8 and CD95⁺ cells. There were no authentic distinctions of efficiency at traditional analgesia with narcotic analgesics and combined analgesia (Promedol and Ketoprophen), allowing to reduce the amount of a used narcotics.

The experience of pre-hospital thrombolytic therapy on a material of 50 supervisions of acute MI in Vladivostok in 2005—2006 (group of comparison — 50 cases, similar diagnosis, sex and age) is analyzed. The symptoms in the early and late periods, the dynamics of MI, frequency of life-threatening complications were compared. Authors confirm high efficiency of the thrombolytic therapy at a pre-hospital stage and recommend it to use.

On 35 supervision the efficiency of the cardio-resynchronizing therapy and frequency of irregular rhythm at patients with heart insufficiency were studied. The conclusion is that the implantation of the bi-ventricular cardiostimulators with function of the cardioversion-defibrillation is indicated to the patients with the severe heart insufficiency and ventricular dissinchronia with the purpose of primary prophylaxis of sudden death. In authors opinion to determine the pro-aritmogenic influence of the cardio-resynchronizing therapy the further researches are necessary.

The results of the endovascular procedures at 66 patients with relapse of a stenocardia after coronary shunting are analyzed. The coronary stents with a covering are implanted to 26 patients; coronary stents without a covering are implanted to 40. Control group — 36 cases when coronary angioplasty and stenting were done as primary intervention. By the end of the hospital period positive clinical dynamics of the revascularization is marked at 76.9% of patients of the 1st group, 77.5% — 2^nd and 88.9% — 3^rd. In the remote period (6—24 months) relapse of a stenocardia is revealed at 15.4% of patients of the 1^st group, 35% — of the 2^nd group and 30.6% — of the 3 rd group. Angiographically confirmed resthenosis of the stented segment was revealed at 32.5% of the patients of the 2^nd group and 25% - 3^rd, and no one cases of the resthenosis in the 1^st group. The frequency of the repeated endovascular procedures was 23.1 % in the 1^st group, 30% - in the 2^nd group and 30.5% - in the 3^rd group.

The results of treatment of 396 patients of Krasnoyarsk regional hospital in 2005 with acute MI are analyzed. 7 patients have been hospitalized within one year with repeated MI. 262 patients (65%) arrived to the Regional hospital during the acute period of disease. We compared the levels of hospital mortality at 299 patients with technically successful trans-catheter coronary intervention and 104 patients without such procedure. Annual hospital mortality at acute MI was 6.2%. Thus the mortality in the 1^st group was 4.7%, in 2^nd — 10.6%. Authentic reduction of the hospital mortality in group of patients with technically successful trans-catheter coronary intervention is marked.

The combination of the biliary pathology with diaphragmatic hernia and gastro-esophageal reflux disease is marked in 8-12% of cases. Since 1999 to 2005 on the basis of the St.-Petersburg City Endovideosurgical Center we treated 205 patients with biliary stoned combined with gastro-esophageal reflux disease and diaphragmatic hernia. 150 patients underwent simultaneous surgeries. The group of comparison included 55 patients who underwent only cholecystectomy. Follow-up in 1 and 6 months after operation has shown, that at combined diseases simultaneous surgeries are indicated with the use of the endovideo-surgical technologies.

The analysis of treatment of a pain syndrome in a complex of preoperative treatment at 60 patients with a critical ischemia of the legs is done. We used the epidural anesthesia of the Ropivacain (control), epidural anesthesia and intramuscular Ketoprophen (1^st group), and also epidural anesthesia, Ketoprophen and analgetic doze of the Kethamine (2^nd group). It is shown, that multimodal and preventive method of preoperative treatment statistically significantly improves the peripheral blood flow, and also allows influencing the pathogenesis of the chronic ischemic pain syndrome due to effective efferent blockade, anti-prostaglandine action of the Ketoprophen and blockade of NM DA-receptors.

It is submitted 10-year experience of treatment of 288 patients with distal gastric cancer, operated by Billroth-1 and Billroth-11. Postoperative mortality in 1^st group was 6.9%, in 2^nd — 8.7%. Postoperative complications were in 11.2 and 17.4% of cases respectively. The 5-years survival rate in 1^st group was 57%, 10-years - 41%, in 2^nd group - 41 and 29%. The amount of patients with high quality of life after gastric resection on Billroth-1 - 59.3%, after a resection on Billroth-11 - 31.5%. The conclusion is that gastric resection on Billroth -1 at a cancer provide the higher quality of a life and do not worsen both direct, and the remote results of treatment.

Experience of treatment of 26 patients with complex abdominal trauma and renal injury is analyzed. The author judges, that indications to paranephral hematoma revision at laparotomy is its distribution to pelvic level or prolapsing to the abdomen in the absence of other reasons of its formation, and also the pathologically changed kidney trauma. Before the paranephral hematoma revision the revision of renal arteries from their aortic location is shown. The excess of number of indications to paranephral hematoma revision results in increase of unreasonable nephrectomies.

Cellular parameters of the immune status are investigated, as well as qualitative-quantity indicators of phagocytes activity and cytokine structure at 32 patients with severe burns trauma (the index of Franc — 31-60 units) in 1—3 days after trauma. As the control we used the data received at similar parameters of 30 healthy donors. The secondary immunodeficiency, functional inferiority of phagocytes, deep disintegration of the cytokine answer are found; that is one of principal causes of development and generalization of the infection at such severe stresses as burns.

150 men in the age of 36—55 years with hypertonic disease and with a secondary arterial hypertension at chronic diseases of kidneys are surveyed. The Doppler US of renal arteries and intra-renal vessels was done. It is shown, that at a syndrome of an arterial hypertension and at hypertonic disease the increase in arterial pressure correlates with the peripheral resistance of a vascular channel of kidneys and reduction in blood flow speed.

Experimental research of reaction of mastocytes on a trauma. It is shown, that the answer to mechanical damage to a mucous membrane of the maxillofacial sinus of rats is the degranulation of the mastocytes, achieving the maximum on 3—7^s day. The re-growth of the cellular pool occurred in 3 weeks after trauma.

Materials of examination of 111 disabled children of 7—17 years studied in secondary schools are submitted. The high frequency of the slowed development, functional insufficiency of the cardiorespiratory system and bones is found in comparison with children with the same somatic pathology (the control 96 cases). The effective complex of rehabilitation exercises for disabled children in conditions of ordinary school is offered, despite of short duration of it; it has allowed to improve the quality of a life of the disabled children due to correction of motor development.

Indications and contra-indications to medical and surgical treatment of the essential tremor are considered. Among surgical methods the basic attention is given to the stereotaxic thalamotomia and Deep Brain Stimulation. The advantages of last method are shown, as well as the criteria of selection of patients for Deep Brain Stimulation.

Supervisions of duodenal ulcers complicated with a bleeding are shown, on the basis of Vladivostok city hospital No. 2 in 2005-2007 (107 cases). The efficiency of the endoscopic hemostasis is shown, allowed to fix the bleeding in 92% of cases. It is judged, that endoscopic hemostasis are indicated in ulcer bleedings of 1^st and 2^nd groups on Forrest classification, but can be inefficient at a proceeding bleeding. The most productive is the combination of the different methods of the endoscopic hemostasis (infiltration, coagulation, denaturation).

Case from the practice, showing the opportunity of the trans-esophageal electrocardial stimulations in diagnostics of ischemic heart disease. It is emphasized, that by this method it is possible to diagnose coronary insufficiency and painless myocardial ischemia, to find the optimum dozes of the antianginal drugs, to the find the candidates for coronaroangiography.

Till now in pediatric practice there is no accessible and reliable system of an estimation of severity of pneumonia. With the purpose of definition of the diagnostic and prognostic importance of a scale of a complex estimation of severity of pneumonia 75 children with severe pneumonia have been surveyed. It is revealed, that the group of patients with severe pneumonia is non-uniform on the structure. For objective estimation of the clinical, laboratory and radiological data at children with severe inflammatory disease the scale of a complex estimation can be recommended. The parameter more than 2.5 points correlates severe pneumonia, 2.9 and more points — very severe pneumonia.

The authors' description of 6 thoracoscopic surgeries of fixings thoracic spine fractures. The technique of intervention is described, advantages of the endoscopic access are emphasized, earlier activization and rehabilitation of patients is marked.

The purpose of work to improve the results of surgical treatment of patients with diseases of abdomen by development and introductions of complex system of principles of use of the mini-laparoscopic technologies. The estimation is given to technical features and opportunities of the mini-laparoscopic equipment. The accesses are optimized, the basic techniques for safety of the mini-laparoscopic operations. Indications, contraindications are proved, clinical and technical conditions to application of the mini-laparoscopic operative techniques in treatment of diseases of abdomen.

At an estimation of working conditions of medical workers of Primorski Krai the high (3-4th) degree of harmful influence of occupational factors is established. The leading harmful factors forming the general and occupational morbidity are chemical and biological, and also intensity of work. Criteria working today do not allow to estimate objectively the specificity of the professional activity of physicians and to develop the criteria of professional safety.

Experience of introduction of the thrombolytic therapy at Ambulance of Yakutsk is described. Till January, 1, 2008 the therapy is rendered in 24 cases at acute MI, at 19 people the effective recanalization of the coronary arteries is achieved. The value of continuity in work of pre-hospital and hospital stages of medical aid is emphasized. The materials of city conference are resulted; by results of which the Ministry of Health of Saha republic decided to organize the specialized department for transcutaneous coronary interventions on the basis of city hospital.

On a material of work of Ambulance of Vladivostok the efficiency of algorithms of the heart-lung resuscitation is compared. It is judged that application of new algorithms (ACLS-2005) at a pre-hospital stage allows to achieve increase of efficiency of the resuscitation in 1.6 times, and also to reduce resuscitation time till effective independent blood circulation.

Results of introduction of modern methods heartlung resuscitation in Yakutsk Ambulance are submitted. High efficiency of it is shown. So, in 2007 at 57 patients from 210 with the case of clinical death, it was possible to restore heart activity. Time of coming of the Ambulances in case of emergency in 2007 was 8.0±1.3 minutes in 95.3% of cases. Authors emphasize the importance of development of the uniform approach to resuscitation actions, high resuscitation activity of brigades, introduction of modern medical technologies and continuous training of the personnel.

Experience of use of the perftorane artificial "blood" with gas-transport function due to the submicronic emulsion of the perftororganic connections is generalized. It is shown, that the substance is effective anti-ischemic and antihypoxic medication which can be used at an early stage even at small bleeding when infringement of delivery of oxygen is caused not by RBC deficit, but change of RBC quality, increase of viscosity of blood, change in the realogic characteristics of blood cells, increase in vascular resistance, an overload of heart and an angiospasm. The expanded list of indications to use of a preparation is formulated.

The review of the literature devoted to systems of the automatic chest decompression and their advantages vs. manual heart-lung resuscitation. It is emphasized, that the mechanical chest compression provides an adequate blood flow and enables to carry out other actions: defibrillation, ventilation, introduction of medications, and also allows to combine transportation of the patient with effective reanimation and to win time in a critical situation.

Case from practice: acute MI at the man of 55 years with ventricular fibrillation during the thrombolytic therapy. Defibrillation in time by the specialized Ambulance brigade resulted in restoration of the heart rhythm. The importance of algorithm of reanimation and continuity of actions of specialists is emphasized.