Aim. To improve methods of diagnostic and treatment of acute kidney failure in children depending on the etiology factor of the disease. Material and methods. The results of the complex diagnostic and treatment of 144 children with acute kidney failure were analyzed. The main researched group included 60, 4% of boys. Patients received standard clinical laboratory and instrumental examinations. Analysis of the laboratory indicator was conducted at admission and after the extracorporeal detoxication. Results and discussion. The result of conducted research shows, that one of the leading mechanisms of acute kidney failure in children is a prerenal mechanism that was observed in 79 (55%) patients. Complex and intensive treatment (detoxication, enterosorption, correction of metabolic disorders, modern surgical manipulations) of patients with acute prerenal kidney failure decreased mortality by as much as 24%, 19 lethal outcomes out of 79 cases. Conclusion. Timely conduction of clinical laboratory and instrumental examinations using modern technologies is a ground for early diagnosis of acute kidney failure.

Aim. To study features of congenital malformations of reproductive organs among women in consanguineous marriage Material and methods. Patients with isolated and combined congenital malformations of reproductive and urinary organs admitted to the department of gynecological endocrinology in the number of 182 during 2015-2018. Results and discussion. The rate of congenital malformations of reproductive organs among women in consanguineous marriage in the current study was 39, 0%. The density of congenital malformations was 70, 4%. The rate of congenital malformations of reproductive organs did not correlate with the number of deliveries and obstetric anamnesis. However, a relation to the sequence of childbirths was found: the number of anomalies among firstborn children made 42,3%, second-born children 30, 2%, third-born children 15,4%, fourth-born children 7,1%. Conclusion. A high rate of congenital malformations of reproductive organs is observed in 39,0% of consanguineous marriages. The study also shows a high density of congenital malformations of reproductive organs 70, 4% in this group. Additionally, the relation of congenital malformations to the sequence of childbirths was found.

Aim. To study the state of some indicators of the non-respiratory function of the lungs in children with surgical diseases, which was a basis for therapy to prevent complications. Material and methods. Non-respiratory lung functions of 305 patients were studied by a comparative analysis of mixed venous and arterial blood. Through the study of the hemostasis system, hemocoagulation lung function was assessed. Results and discussion. No disorders of non-respiratory lung functions were observed in 67 (22%) of 305 patients. Non-respiratory lung function disorder of a stage I was observed in 103 (43.3%) out of 238 patients. 89 (37.4%) out of238 patients with disorder of stage II did not show a significant difference in hemocoagulation properties of arterial blood in comparison to mixed-venous blood manifested in functional lung failure that affects hemostasis. Conclusion. The study of coagulating lung function helps in the early detection of lung damage in the form of microcirculatory disorders and local pulmonary microvascular thrombosis. The participation of the lungs in the regulation of the rheological properties of blood can help to assess the onset of the development of interstitial pulmonary edema, hemostasis disorder, and to plan appropriate early correction methods.

Aim. To study the features of a hemostatic shift in premature infants with pneumonia. Material and methods. 32 preterm infants aged 9 days to 1 month with severe and very severe pneumonia were observed in the study. The first group included 19 children with severe pneumonia and the manifestation of 1st stage respiratory failure; the second group included 13 children with very severe pneumonia with respiratory failure of 2nd and 3rd stages. Examined children along with general clinical examination underwent coagulatory and paracoagulatory examination of hemostasis. Results and discussion. The coagulogram revealed a noticeable shortening of the coagulation time according to Lee-White in patients of the first group and a significant elongation in children of the second group compared to the same indicators in the control group. The average values of the prothrombin index, the degree of thrombotest, and fibrinogen in patients of the first group were lower, while patients of the second group showed significantly lower indices than healthy patients and patients of the first group. Fibrinolytic activity in patients of the first group was within a normal range, while patients of the second group had significantly higher indices than a control group. Conclusion Thus, premature infants with severe pneumonia show moderate and premature patients with a very severe course of the pneumonic process show significant hemostatic shifts.

Aim. To evaluate the main immunological changes that are specific to fungal lung lesions. Material and methods. The study observation included 90 patients with chronic forms of respiratory diseases with bacteriologically confirmed fungal contamination in a titer of more than 103 CFU. This category ofpatients was classified as a group with lung candidiasis (group 1). To acquire more reliable indicators for comparison, an examination of the 2nd group (50 people) with acute and protracted forms of inflammatory lung diseases without the presence of fungal infection was conducted. Results and discussion. During the lung candidiasis against the background of chronic bronchopulmonary pathology (background diseases), the dynamics of a decrease in the absolute and percent contents of lymphocytes, CD3 + and CD4 + lymphocytes, as well as a slight increase in the number of CD20 lymphocytes, are recorded. This may indicate a decrease in the immunological response and an increase in the duration of the disease, as well as the severity of the main disease. Conclusion: Mycological analysis is necessary during long-term broncho-pulmonary diseases. Positive fungal growth of fungi in the titer of CFU more than 103, immunological studies are rational. The immune response of depression and immunodeficient state that develops with pulmonary candidacies justifies the use of immune-correction therapy in the complex treatment of such patients.

Aim. To study the state of central hemodynamics and external respiration in women in labor at different periods of delivery during epidural analgesia. Material and methods. The state of central hemodynamics and external respiration was studied in 43 parturient women initially and during the labor under the epidural analgesia. The parameters were studied at admission - stage 1; after epidural analgesia in the 1st period of labor - stage 2; in the 2nd period of childbirth - stage 3. Puncture and catheterization of the epidural space were performed according to the generally accepted methodology at the level of T12 - L1, L1 - L2 or L2 - L3 depending on the indications for prolonged epidural analgesia. A solution of ropivacaine 0.2% was used as a local anesthetic. Results and discussion. An increased mean arterial pressure, tachycardia, decreased stroke volume and increased total peripheral vascular resistance characterize the initial state of central hemodynamics. The state of the external respiration shows a decrease in tidal volume and vital capacity of the lungs, an increase in respiratory rate and increase of the minute and alveolar ventilation. Against the background of epidural analgesia, the changes in the central hemodynamics and external respiration listed above get normalized. Conclusion. Epidural analgesia provides adequate pain relief at the first and second stages of labor.

Material and methods. 60 pregnant women, which were examined at different periods of pregnancy participated in a study of the role of magnesium ions and the level of ascorbic acid in the occurrence and development of chronic hemorrhoids Results. The study of the magnesium level of red blood cells in women with chronic hemorrhoids and chronic hemorrhoids combined with rectocele showed hypomagnesemia of various severity. Drug treatment of chronic hemorrhoids in pregnant women was carried out in 39 (65%) cases. A comprehensive study of the pathogenetic mechanisms of chronic hemorrhoids in pregnant women showed that hypomagnesemia takes the main place in the pathogenesis of the disease. Conclusion. Thus, the use of complex correction of hypomagnesemia contributes to a decrease of the chronic hemorrhoids progression, its complications and an adequate course of pregnancy in the observed pregnant women.

Aim. To assess the quality of combined anesthesia with an application of epidural anesthesia in children. Materials and methods. The clinical course of anesthesia of 61 patients, aged 2 to 14 years, who underwent planned surgical interventions for malformations of the urinary tract in the Hospital of pediatric surgery, was analyzed. 38 of the operated patients had bilateral congenital obstructive diseases of the upper urinary tract. Of these, 21 patients had dysplasia of the vesicoureteral segment and 13 patients had dysplasia of ureteropelvic segment Results and discussion. In the postoperative period, minimal usage of drugs was recorded, with an improvement of hemodynamics, oxygen saturation of arterial blood, and early restoration of intestinal passage. Patients were divided into 2 groups according to the applied approaches of postoperative analgesia. The 1st group included 31 patients that received prolonged epidural analgesia + promedol (0.1 ml/kg) as postoperative analgesia. The 2nd group included 30 patients who underwent extended epidural analgesia with a lidocaine solution. The duration of analgesia was 3-4 days. Given the relative ease of the implementation, a shorter latent period and a more pronounced analgesia in the postoperative course, during surgeries lasting more than 1.5 hours, and when it is necessary to maintain a constant level of anesthesia in the intra- and postoperative period, it is recommended to use balanced epidural anesthesia with catheterization in the postoperative period. Conclusion. Methods of combined anesthesia with epidural anesthesia in pediatric urology allow to abandon the use of narcotic analgesics, muscle relaxants, or significantly reduce the dosage, provide reliable analgesia, quick consciousness recovery and a favorable emotional background in the early postoperative period.

Aim. To improve results of postoperative complications of reoperation of the anorectal zone. Material and methods. From 2007 to 2019 the department of pediatric surgery № 1 accepted 62 patients for repeated reconstructive operations of the anorectal area. All patients underwent complex examination: clinical examination including rectal examination, laboratory diagnostics, ultrasound with doppler scanning of the abdominal cavity and pelvic organs, myography of sphincter apparatus of the rectum, x-ray examination, MRI and endoscopic examination. Results and discussion. Studying the results of follow-up observation and clinical data of 62 patients that require recurrent postoperative surgery, some errors, and flaws of diagnostic methodic and technical character were discovered. Conclusion. Analysis of the etiology, optimization of diagnostics, intra-operational correction approach and postoperative prevention measures improve the results of recurrent reconstructive surgery of anorectal area in children. Keywords: postoperative complications, recurrent reconstructive surgery, anorectal area, methodic and technic errors.

Aim. To analyze the life quality of patients with varicose veins of lower limbs (VVLL) during hospital and longterm observation after endovenous laser obliteration (EVLO) and combinedphlebectomy (CF). Material and method. This prospective study included 408 patients with varicose veins of lower limbs who underwent surgery for the period from 2013 - 2017. Based on treatment strategy, patients were divided into two groups: the first group included 257 (63%) patients that underwent EVLO; patients of the second group included patients that underwent CF in the number of 151 (37%) patients. At the preoperative stage, the spectrum of clinical manifestations of CVI was determined based on the clinical, etiological, anatomical and pathophysiological classification system (CEAP). To assess the life quality, two types of scales were used: Chronic Venous Disease quality of life Questionnaires (CIVIQ) and SF-36 Health Status Survey. Results and discussion. 2 years after the treatment, according to the CIVIQ scale, statistically significant life quality dynamics using both treatment tactics were observed. Comparison of the indicators two years after the treatment revealed a statistically significant difference (p = 0.008) due to the presence of the phenomenon of recanalization (relapse) according to ultrasound and a partial return of CVI symptoms in patients of the CF group. A comparison of the survey results between groups according to the SF-36 scale in 2 years after the treatment showed significant differences. tTe EVLO group showed higher levels of life quality in most indicators. Conclusion. Thus, both treatment strategies statistically significantly increased the life quality of patients in the long-term postoperative follow-up period. However, EVLO showed greater effectiveness in the dynamics of this indicator in comparison to CF, which was most likely due to the presence of recanalization in every second patient of the second group after two years of observation.

Aim. To study and analyze the causes of mortality in health facilities of the Republic of Tajikistan. Materials and methods. The main factors of mortality in the structure of hospital facilities of the Republic of Tajikistan during 2017 - 2018 were studied based on regulatory documents. Results and discussion. Mortality in the compared years was 5272/5239, which makes 0.54 and 0.52% of hospital deaths. The main causes of death in adults in the hospital are diseases of the cardio-vascular system (45.2% / 45.4%), injuries and poisoning (14.6% / 13.5%), among children - perinatal period diseases (58.7% / 64.1%), and respiratory diseases (14.8% /10.8%). There is a high incidence of postoperative mortality after surgery on the gastrointestinal tract (46.2% / 44.0%), the nervous system (15.1% /12.0%) and after heart surgery (5.4% /10.6%). As a result of assessing the causes of maternal mortality, 147 specialists got administrative penalties, 80 specialists recieved disciplinary sanctions, in 77 cases qualifications were decreased, and 90 workers were denied the right to work. Conclusions. In order to determine the cause of death, as well as the difference between the final clinical diagnosis and the results of the pathological examination, it is necessary to establish the work of the the deaths analysis commission.

The article provides a review of modern literature intending to study the issues of diagnosis, surgical treatment of liver echinococcosis and its complications. The analysis confirms that despite the achievement of science in the field of prevention, diagnosis and surgical treatment, liver echinococcosis remains an urgent problem in modern surgery. The urgency of the problem is associated with a high incidence of the disease, a high percentage of relapses and postoperative complications. There is still no consensus among surgeons regarding the choice of surgical procedure, methods of antiparasitic treatment and elimination of the residual cavity after echinococcectomy.

The study analyses modern literature on the problem of diagnosis and surgical treatment of chronic exudative pericarditis. It is providing. Information on the frequency, causes, features of the clinical course, modern diagnostic capabilities and surgical treatment of pericardial effusion. The lack of consensus on the effectiveness of minimally invasive and video-assisted thoracoscopic treatment of chronic exudative pericarditis was revealed.

The article presents various views on the problem of choosing adequate surgical tactics for generalized peritonitis when it is necessary to take into account not only the etiology, spread, and degree of pathological changes in the abdominal cavity, but also the degree of endogenous intoxication and multiple organ failure, the prognosis of peritonitis outcome. The emphasis was placed on the possibilities of video laparoscopy in the surgical treatment of various forms of peritonitis. The main indications and contraindications to the use of endo-video surgical interventions in conditions of peritonitis were analyzed.