Fournier gangrene (fulminant gangrene of the scrotum) is a rare form of infective necrotizing fasciitis genitalia and perineum polymicrobial aetiology. It refers to an acute surgical diseases characterized by rapid septic course and high mortality reaching 88 %. The review covers the epidemiology, etiology, pathogenesis, clinical and laboratory features, diagnosis, treatment, outcome and prognosis of the disease. Addressed the issues relating to the economic costs of treatment due to extended admission. Discussed new methods of adjuvant therapy: hyperbaric oxygen therapy, vacuum therapy. Payed attention that the prognosis of the disease depends primarily on timely diagnosis and timing of surgical intervention.

The literature review dedicated to regeneration mechanisms of bone tissue. Summarized the data on topochemistry and functions of morphogenetic and growth factors, their participation in the regulation of the regenerative processes on different levels of the fracture union. Given the detailed critical overview of the technologies of production and clinical use of morphogenetic proteins on the basis of recombinant technologies of gene engineering with reparative osseogenesis. One of the most promising ways of increasing the osteoinductive properties of biomaterials and bone tissue regeneration control process is the creation of various composites having osteoinductive and osteoconductive properties, containing growth factors, and at the same time performing the role of the osteogenic matrix.

Presented the main diagnostic and therapeutic aspects of the doctrine of pelvic polytrauma and injuries. Given the detailed review of the diagnostic manual enabling to reach the maximum informative value of the X-ray examination. Defined the surgical indications of patients with unstable pelvic ring injuries. Analyzed the main complications of pelvic ring injuries, including urinary tract damage to the lower divisions.

The review of correction methods of chronic venous insufficiency of the lower limb. The most common surgery for this disease is the extravasal correction. However, in modern vascular surgery preferred the intravasal methods of correction valves of the lower limb, which include valvuloplasty, transposition and transplantation of valves and flaps as well as the creation of artificial venous valves. Performing these operations abnormal venous blood flow is reduced by 98 %o. However, intravasal techniques require adequate diagnostic equipment, the use of a surgical microscope, the use of objective methods of diagnosing anatomical and functional condition of the valve bodies, and the high qualification of a surgeon.

Avascular necrosis of the femoral head is a multifactorial disease with progressive development of severe secondary coxarthrosis. There are two types of necrosis - secondary and idiopathic. The pathogenesis of the disease is associated with the local blood circulation disorders, coagulopathies and violation of bone tissue regeneration. A bone with a histologic lesion is characterized by the formation of empty lacunae with vascularized fibrous tissue around it, and the osteoclast activity increases in the subchondral and necrosis zone, while in the sclerosis zone the osteoblast activity enhance. Among the laboratory parameters determined a significant increase in the levels of inhibitor 1 plasminogen activator, Willebrand factor, inhibitor 1 plasminogen activator, C-reactive protein, interleukin 33, a decrease of the ghrelin and osteoprotegerin levels, cross-linked N-terminal telopeptide, the C-terminal peptide of procollagen 1, tumor necrosis factor a, miR-17-5p. In genetic studies revealed mutations in the gene COL2AI and prothrombin, the association of polymorphic loci of genes for factor V Leiden, methylenetetrahydrofolate, tissue-specific plasminogen activator inhibitor 1, plasminogen activator. Treatment includes surgery and correction of the cytological activity. There is evidence for the ability of bisphosphonates to prevent the collapse of the femoral head.

Osteoarthritis - the most widespread and socially significant diseases of the musculoskeletal system, the main problem is the lack of treatment which diagnostic and prognostic markers of early stages of the disease. The purpose of this review is an analysis of biomarker degradation of the subchondral bone in osteoarthritis. The article reviews subphenotypic molecules - cholecalciferol and parathyroid hormone, and biological substances produced by osteoblasts at various stages of bone differentiation. The review of the literature suggests an important diagnostic value of a variety of biological substances in osteoarthritis, among which the most interesting are osteocalcin, calcitonin, fibrillar protein degradation products of bone and cartilage matrix, cholecalciferol. It appears promising study the diagnostic value of biomarkers disclosed that a significant degree will contribute to the expansion of the diagnostic and prognostic tools, and allow more detailed assessment of a heterogeneous population of patients with osteoarthritis.

Presented the results of morphological and functional studies of the pathogenesis mechanisms of sudden cardiac death (SCD). Proved the hypothesis that susceptibility to SCD determined by the degree denervation changes in the cardiovascular system. The risk of SCD increases in conjunction with the progression of coronary heart disease and the presence of prior changes in the central nervous system and neurodystrophic processes in a body. Functional sympathectomy of the cardiovascular system is the result of age-related involution changes the sympathetic division of the autonomic nervous system in conjunction with a partial deafferentation heart. The method of spectral analysis shows that the sharp decrease in sympathetic activity that is fraught with the SCD, is much faster in hypertensive patients. The likelihood of sudden death associated with social stress and emotional status of the organism, and it is increased in the presence of bad habits and depressive states.

Objective. The objective is to determine the probability and time of development of left ventricular myocardial hypertrophy (LVMH), depending on the impact of its predictor. Methods. The study of 2008-2013 involved 7959 workers aged 18-66 years of locomotive brigades of Trans-Baikal Railway, who suffered from cardiovascular diseases with the exception of essential hypertension 1 degree of stage I-II. We searched for risk factors, target lesions of cardiovascular disease with determination from among the predictors of LVMH. Results. In the first stage of research for LVMH established the following predictors: hypertension, age, retinopathy, diabetes, thickening of the complex «intima-media» more than 0.9 mm / atherosclerotic plaques of carotid arteries, body mass index greater than 25, aortic atherosclerosis, hyperglycemia and stress. The second stage was analyzed the survival function. Graphical evaluation of Kaplan-Meier method showed that it was dependent on the body mass index, presence of hypertension, hyperglycemia, retinopathy, arteriosclerosis of the aorta, carotid arteries subclinical and age. Stress as an independent risk factor had no value. Conclusions. Predictors of LVMH in its subclinical characteristics are heterogeneous in size damaging impact, the implementation of progressive course of endothelial dysfunction through an independent impact, or in combination with other predictors. LVMH is determined by the influence of not only traditional risk factors, but also the mutual negative effect of target organ damage.

Objective. The study objective is an analysis of the reproductive health condition in pregnant women with tuberculosis. Methods. Conducted the analysis of 45 labor and delivery reports, obstetric and perinatal outcomes in pregnant women with tuberculosis, arrived in Bishkek Perinatal Center from 2005 to 2015. Results. Pulmonary tuberculosis was diagnosed in 31 (69 %), extrapulmonary - 5 (11 %) cases, combined forms of the disease were detected in 4 (9 %), small and large residual changes - in 5 (11 %) patients. Open form of pulmonary tuberculosis recorded in 39 % of cases. In 58 % of pregnant women the disease was diagnosed for the first time. Conclusions. Determined the negative influence of tuberculosis on the reproductive function of women and birth outcomes. In family practice centers, it is necessary to conduct a full medical examination of pregnant women living in new buildings, where the largest number of women from socially vulnerable groups and be particularly alert to respiratory tuberculosis.

Objective. The clinical, sonographic and mammographic symptoms in breast sclerosing adenosis were analyzed. Methods. The study included 18 patients 28-51 years with histologically confirmed diagnosis of 'sclerosing adenosis'. In addition to sonography and mammography used Doppler and clinical evaluation process for BI-RADS categories. Results. Under the 3^nd BI-RADS category has got most determined preoperatively entities: 53.3 % for mammography and 61.1 % for sonography. BI-RADS category 4 has been assigned to each of the fifth observation. The absence of any pathological changes in mammography was noted in 4 patients, while sonography - in 3 patients. Doppler contouring showed no amplification of the vasculature in all cases. Conclusions. As a possible criterion for differential diagnosis of sclerosing adenosis and breast cancer it can be indicated the presence of palpable formation in the absence of pathological findings on ultrasound and X-ray studies. Doppler sonography has certain advantages: the absence of the gain pattern of the vasculature leads to the conclusion benign nature of the process. With the grade of the 4^th BI-RADS category it is necessary to conduct the histologic diagnosis verification.

Objegtive. Cystectomy with subsequent intestinal plasty of the urinary reservoir is considered one of the most difficult and traumatic operations in urology with a high risk of complications. Methods. Analyzed the results of surgical treatment with cystectomy and different types of urinary diversion in 105 patients 65-80 years old, suffering from bladder cancer in the X-stage T_2-4N_0-2M₀. Results. Postoperative complications were reported in 38 cases (36.2 %), and almost % of them could be classified as life-threatening. According to the modified classification of Clavien et al. grade I complications were diagnosed in 10, grade II - in 21, grade III - in 7 patients. Conclusions. It is necessary to continue studying of the etiology and pathogenesis of complications oncourological operations subject to a number of risk factors: age, sex, body mass index, duration of the operational benefits, such as diversion, presence of metastases, tumor grade, as well as the experience and technical skills of the surgeon. Such studies are suitable for the development of an effective scheme of management of patients, reducing the incidence of complications and the risk of postoperative mortality.

Objective. Central resection is the main treatment for intraductal papillomatosis of the breast. However, after such an operation, complications can arise in the form of the formation of cysts. Methods. It was conducted the retrospective analysis and postoperative examination of 10 patients of 35-68 years old, operated on for intraductal papillomatosis. Results. In five cases, after 6 to 12 months after surgery, noted the appearance of cysts distal to the intervention zone. Cyst size ranged from 5 to 13 mm. Conclusions. This category of patients is necessary to minimize surgical trauma. There is a need to develop and implement the practice of intervention, sparing breast ducts.

Objective. The study objective is to analyze the results of the X-ray, surgical and combined therapy of the lower lip cancer. Methods. The analysis of the therapy included 474 patients with lower lip cancer. 385 patients received X-ray therapy; 57 patients -surgical therapy; and 32 patients received combined therapy. Distribution of the observation of TNM: T₁N_0-1M₀ - 95, T₂N_0-3M₀ - 248, T₃N_0-3M₀ - 99, T₄N_0-3M₀ - 32. Conducted 189 resections of the lower lip (77 of them on the author's method of cheiloplasty), 222 cervical lymph node dissection (41 of them - modified). Long-term results of treatment were evaluated by Kaplan-Meier. Results. Cancer recurrence after X-ray, the combined and surgical treatment diagnosed in 241 (62 %), 6 (19 %), and 7 (12.2 %) patients, respectively. 3- and 5-year survival of patients were 56.7±2.3 and 49.6±3.4 %, 76.0±9.3 and 70,7±11,9%, 77.6±7.9 and 72.4±8.3 % for all stages of cancer after X-ray, the combined and surgical treatment methods, respectively. Conclusions. It is necessary to conduct active surgical tactics in the treatment of cancer of the lower lip. Cheiloplasty method and a modified version of the functional neck dissection may reduce postoperative complications and recurrences.

Objective. Summarized 10-year (2005-2015) experience in the treatment of various forms of adhesive disease of the peritoneum Methods. Conducted a retrospective and prospective, non-randomized controlled study of 279 cases of adhesive disease, using traditional surgical and laparoscopic techniques. On a material of 19,711 cases of laparoscopic surgery compared to abdominal surgery, urology and gynecology in the presence and absence of adhesions in the abdominal cavity. Results. Determined significant advantages of laparoscopic surgery: reduction in the duration of intervention, intraoperative blood loss, pain intensity, frequency of early adhesive intestinal obstruction, the term hospital treatment and the frequency of relapses. Any significant difference to the same criteria in the presence and absence of adhesions with laparoscopic procedures in the abdominal cavity is not registered. Conclusions. Surgical treatment of adhesive disease and its complications of the laparoscopic approach has significant advantages over the open surgery. Having certain manual skills and technical equipment performing total adhesiolysis is possible only using laparoscopic method. Adhesive process stage 3-4 is not a contraindication for laparoscopic correction of abdominal and retroperitoneal pathology. Moreover, in order to prevent recurrence of adhesions laparoscopic approach should be seen as a priority.

Objective. Study objective is to identify statistically significant risks affecting the outcome of the factors of mortality among hypertensive intracerebral hemorrhage. Methods. Presented the results of the analysis of postoperative mortality of 38 patients aged 38-86 with hypertensive intracerebral hemorrhage. Results. The most likely factor in mortality was the hematoma volume, and subsequently the level of consciousness and the degree of dislocation of brain structures. There was no mortality, depending on age. The distribution limit of the average values of the hematoma volume among the dead and survivors - 70 cc, the level of consciousness is 7 on the Glasgow Coma Scale. The volume of the hematoma was not correlated with inhibition of consciousness before surgery. Shown the relationship between the volume of the hematoma and depression of consciousness during the first day after surgery, as well as between consciousness after surgery and outcome of stroke. Conclusions. Overall post-surgery mortality was 87 %; in patients with supratentorial hemorrhages in a coma - 91.3 %, with a hematoma volume of more than 60 cc - 88.9 %, more than 70 cc - 91.6 %. With the volume of subcortical hematoma to 60 cc and level of consciousness more than 7 points postoperative mortality does not exceed 33 %.

Objective. The study objective is an assessment of bone tissue condition and a prevalence of osteopenic syndrome in adolescents with chronic diseases of the gastrointestinal (GI) tract. Methods. Examined a total of 127 adolescents aged 10-15 years of dentoalveolar anomalies, including 77 people with chronic gastroduodenitis. We determines the rate of propagation of ultrasound in bone tissue, broadband ultrasound attenuation, bone strength index was calculated, assessed the presence and severity of osteopenia. To assess the risk factors of osteopenic syndrome conducted rapid surveys on the basis of an international validated tool to assess the quality of food - FFQ (Food Frequency Questionnaire). Results. Almost every teenager with dentoalveolar anomalies in conjunction with gastrointestinal diseases showed signs of calcium deficiency. Broadband ultrasound attenuation in bone tissue among boys in this group was by 2.3-2.7 lower, and most important indicators of both boys and girls were registered at 1.5-2 years later than adolescents without disease of GI tract. The incidence of osteopenic syndrome in patients with gastrointestinal diseases was by 2.4-4.3 higher. Conclusions. All teenagers with dentoalveolar anomalies in preparation for orthodontic treatment should receive advice on diet correction, and one of the combined drugs, correcting macro-and microelements homeostasis in conditions of osteopenia.

Objective. Treatment of chronic pancreatitis is still a matter of debate and a different approach to tactics and the choice of surgical technique. Methods. We studied the immediate and long-term results of surgical treatment of 76 patients 26-64 years with chronic pancreatitis. It was performed such pancreas surgery as draining, resection, and mixed operations. Results. Postoperative mortality was not registered, early complications reported in 29.4 % of cases. In 86.4 % of patients after surgery for Puestow registered positive analgesic effect. The weight of operated patients, body mass index increased on average from 19.2 to 22.9 kg/m². Diabetes developed after surgery in 16.4 % of cases. Three people who had undergone resection of the pancreatic tail, came to the clinic after 3-6 months after the intervention with ketoacidosis. 18 % of operated patients needed substitution therapy of pancreatic enzymes due to steatorrhea. Conclusions. In chronic pancreatitis with ductal dilatation longitudinal pancreatostomy is a safe and reliable means of pain relief with minimal loss of exocrine and endocrine organ functions. In the calcinosis of a gland and the absence of diabetes resected surgery is indicated. In the decompensated stage of chronic pancreatitis with moderate pain syndrome surgery is inappropriate.

Summarry. The brief historical review of literature covers the emergence and development of the collapse therapy of lungs in tuberculosis. Described the five-year experience of pneumoperitoneum in the postoperative period, and the application of thoracoplasty as a separate and additional treatment, including patients with multi-drug resistance.

Objective. The purpose of research is a comparative evaluation of the results of prostate bipolar vasoresection using a variety of electrosurgical units. Methods. 34 patients (study group) was performed bipolar vasoresection on Thunderbeat platform, and 40 (control group) - with UES-40 Electrosurgical Unit. Results. The operative time was 62±2,8 min for main group and 79±2,9 min for the control one. Saline flow during operation amounted to 14.7±0.7 and 19.4±0.9 L, respectively. The volume intraoperative blood loss in the study group was 44.9±3.1 ml (15 to 85 ml) in control - 76.3±7.6 mL (20 to 200 ml). Conclusions. The use of modern electrosurgical systems can significantly facilitate the surgeon's work and protects the patient from different electro-complications. In our experience, the use of advanced "smart" bipolar electrosurgical unit brought prostate vasoresection to a new level.

It was developed a method for treating cancer of the pyriform sinus: special skin incision allows you to carry out surgical operations simultaneously and efficiently on the neck tissue and primary focus area, i.e. to perform radical surgical intervention program. On the other hand, due to the cut, at the final stage of the operation a reliable wound closure is achieved. As the plastic material used the mucosa and soft tissues of the intact half of the larynx. In this method, it was treated 61 patients with primary cancer of the pyriform sinus of the stage 3-4. Satisfactory results were obtained. The act of swallowing was restored in all cases in the 10-16^th day. At the time of writing the article, 35 patients (57 %) were alive, 3- and 5-year survival was 62.8 and 58.6 %, respectively.

The article describes the author's technique of using acellular dermal matrix based on porcine collagen to cover the lower pole of the implant with simultaneous breast reconstruction with skin saving radical mastectomy. In the center of Surgery, Medical Center of Far Eastern Federal University from January 2014 to June 2016 operated on 35 patients using the developed technique. Excellent, good and satisfactory results were recorded in 19 (54 %), 12 (34 %) and 4 (12 %) cases (unsatisfactory results were not registered).

Regional Clinical Center of Specialized Types of Medical Care (30/37 Uborevicha St. Vladivostok 690091 Russian Federation) Summary. Presented three clinical cases of congenital, genetically determined diseases in children with the analysis of the diagnostic search. For verification of Wilson's disease it took more than 1.5 years of the survey and follow-up in different specialists. The presence of additional infectious factors complicated the diagnosis. Analysis of the case calls for the inclusion of children in the survey with standard hepatitis of unknown etiology copper metabolism markers. Analysis of the patient's other diseases suggests that rectal prolapse - a condition requiring the exclusion of cystic fibrosis, even when there is no neonatal screening and respiratory history. The third case shows that the combination of pronounced intrahepatic cholestasis with malformations of the skeletal system, the heart, the organ of vision and phenotypic features requires the exclusion of Alagille syndrome.