Aim. To study the main causes of postoperative pneumonia in abdominal surgery and to develop methods of prevention and treatment.

Materials and methods. The results of complex diagnostics and surgical treatment of 310 patients with postoperative pneumonia were analyzed in this study. All patients were divided into 2 groups. The control group included 120 (38.7%) patients, which were treated by traditional methods. The main group included 190 (61.%) patients that underwent modern approaches of diagnosis and treatment.

Results and discussion. 132 patients underwent comprehensive X-ray examination where bronchopneumonia was observed in 78% of cases and chronic bronchitis in 22% of cases. The most severe course of pneumonia was observed in 42 patients with the intraabdominal pressure of more than 20 mmHg. In 32 patients with an average severity of the condition, the intraabdominal pressure was 12 mmHg with the oxygen saturation of 92±2.2%. In addition, duration of the surgery, duration of the mechanical ventilation (n=23), and the presence of hospital infection were counted as predisposing risk factors for postoperative pneumonia. To prevent the development of postoperative pneumonia, antegrade intubation method of the small intestine (n=11) which is performed by appendicostomy was developed. In the postoperative period, ofloxacin was inhaled twice a day in addition to the antibiotic therapy.

Сonclusion. Thus, early diagnosis and prevention of postoperative pneumonia of urgent abdominal pathology are greatly improving the immediate results of these patients treatment.

Aim. Early diagnosis, prognosis and prevention of hepatic failure during surgical treatment of spaceoccupying liver lesions.

Materials and methods. 64 patients having space-occupying liver lesions were observed. Subjects of research consisted of 52 (81,2%) man and 12 (18,8%) women of the 26-74 age range. To diagnose depression of liver cells during space-occupying liver lesions in a tissue, histochemical methods revealing the content of Nicotinamide adenine dinucleotide (NAD), Nicotinamide adenine dinucleotide phosphate (NADPH), Xanthine oxidase (XO), Malondialdehyde (MDA), Conjugated dienes (CD) with Sukhopar method (1989) were used. To prevent and treat hidden hepatic failure in the early post-operation period, patients of the main group received anti-hypoxic, anti-oxidant therapy with Reamberin 800,0-1,5% solution with liver metabolism inducing drugs during 5-6 days before and after the operation.

Results. In postoperative period 3 patients of the main group had complications in a form of cholestasis (2), subhepatic abscess (1) that required opening and drainage. There were no lethal outcomes. Patients of the control group in 7 cases had complications like the hepatic failure (4), post operation subdiaphragmatic abscess (2) and small intestine fistula with 4 lethal outcomes.

Conclusion. Adequate infusion therapy with Reamberin, liver metabolism inducing drugs, adequate anesthesia and careful surgery of space-occupying liver lesions before the operation can significantly reduce hepatic failure.

The article analyzes the intensity of the pain syndrome, physical activity, the results of the noninvasive method of pain relief in somatic, neuropathic and psychogenic pain in 30 patients with malignant tumors of the maxillofacial area and neck receiving palliative care or during diagnostic procedures. Analysis of the assessment of pain intensity shows that mild and moderate pain is observed in 80% of clinical observations, and a strong and unbearable pain in 20% of cases. That dictates the need for staged application of analgesics of increasing strength action for increasing intensity of pain. Normal and moderately reduced physical activity was observed in 77% of patients receiving palliative care. Recent data shows the possibility of outpatient palliative care for those patients. Application of the developed non-invasive method of pain relief by 20% Dimexidum solution with analgesics, direct action anticoagulants, NSAID and sedative drugs brings to the full or satisfactory level of analgesia in 87% of patients.

Aim. To optimize the choice of surgical approach for patients with traumatic constriction of the brain taking into account criteria of the cardiovascular system.

Materials and methods. 130 patients with traumatic compression of the brain were studied: the first group consisted of 41 patients with a Glasgow Coma Scale score of 6,8±0,93; the second group had 53 pa tients with a score of 10,3±0,86; the third group consisted of 36 patients with a Glasgow Coma Scale score of 13,4±0,78. The control group included 20 subjects. Hemodynamics system was examined by impendansometry dopler-cardiography method.

Results. Patients of the first group had hypokinetic type of blood circulation with a decompensated cardiac failure. In second group patients, hyperkinetic type of circulation with a hypertrophic type of cardiac failure was observed. Patients of the third group had a eukinetic type of blood circulation and subcompesated cardiac failure.

Conclusion. Considering revealed indicators of hemodynamics, patients of the first group need urgent surgical intervention, patients of the second group need delayed surgical intervention and the third group patients need conservative therapy.

Aim. To optimize diagnosis and surgical treatment of focal and diffuse liver diseases complications.

Materials and methods. The study focuses on the results of complex diagnosis and urgent treatment of 180 patients with complications of focal and diffused liver diseases (echinococcosis, cirrhosis, nonparasitic cysts, hemangioma, abscess). 105 (58,3%) of patients were men and 75 (41,7%) women of 18 to 82 age range.

Clinical, laboratory and biochemistry tests revealing molecules of middle mass (MMM), lipid oxidation products (LOP), malondialdehyde (MD), conjugated diene (CD) and instrumental methods like ultrasound, EGD, ERPC, abdominal x-ray, laparascopy and CT were conducted.

Results. Focal and diffused diseases of the liver in most of the cases have severe complications like suppuration (33,9%), bleeding (24,4%), mechanical jaundice (24,4%), peritonitis (17,3%) that need urgent surgical correction.

The surgery of complications of focal and diffused diseases of the liver brings to a high frequency of complications in the postoperative period (42,7%) and lethal outcomes (21,1%).

Conclusion. Early diagnosis and timely performance of planned surgeries of focal and diffused diseases of the liver significantly decrease severe complications.

Aim. To improve the results of related kidney transplantation by optimizing the treatment of bacterial complications.

Material and methods. The study included the results of 80 allotransplantations of the related kidney from 2011 to 2017 in the kidney transplant department of the NSCOTT and in the department of kidney transplantation of the Dangara regional hospital. The average follow-up time after kidney transplantation was 1276 ± 52 days. The study group included 56 (70 %%) men and 24 (30%) women.

The average age of recipients at the time of kidney transplantation was 38.19 ± 0.917 years, the median age was 39.0 years (14.4-62.5 years), the maximum age was 62.5 years and the minimum age was 14.4 years.

Results. Changes in the immune status of the kidney recipients against the background of wound infection and sepsis were analyzed. Revealed changes are confirming severe disorder in the humoral chain of the immune system.

Conclusion. In case of wound infection the concentration of C3 and C4 complement components changes insignificantly, and on the background of sepsis the С3 component decreases with a significant increase of C4 component, which indicates the launch of an alternative pathway for complement activation. The increase in the level of "cautious" proteins in case of wound infection and sepsis is observed.

Aim. To improve the diagnosis and surgical treatment of pancreatic-biliary complications of peptic ulcer disease.

Material and methods. This work is based on surgery of 74 patients with pancreatic-biliary complications (PBC) of duodenal ulcer (DU). The interpretation of clinical data showed that from 74 patients, 45 (60.8%) had manifestations of the pancreatic syndrome, 21 (28.4%) had the biliary syndrome and 8 (10.8%) had mixed pancreatic and biliary syndrome.

Results. Clinical manifestations of PBC of DU are usually atypical and observed in a form of 3 clinical syndromes. In case of penetration of duodenal ulcer into the head of the pancreas (n = 28) and major duodenal papilla (n = 17), clinical signs of indurative chronic pancreatitis with high activity of pancreatic enzymes in the blood and urine were observed. In the 18 cases of ulcers penetration to the common bile duct, the clinical picture of lesions of the biliary tree with persistent pain and recurrent jaundice dominated. In 31 observations, the clinical picture of biliary syndrome showed domination of cholangitis signs due to the formation of the choledochoduodenal fistula.

Conclusion. The clinical picture of PBC is atypical and accompanied by the presence of various complications. The surgical approach is non-standard and requires performance of the primary resection of the stomach by Roux combined stem vagotomy and corrective interventions in the extrahepatic bile ducts on indications.

Purpose of the study. To study the peculiarities of blood toxicity in various vascular beds and the state of the lungs detoxification function in puerperants with hepatopulmonary syndrome who had severe preeclampsia and eclampsia.

Materials and methods. The study results of 54 women who had severe preeclampsia and eclampsia which was complicated by hepatopulmonary syndrome in the postpartum period and 20 generally healthy women were observed. Depending on the severity of condition all patients were divided into 3 groups. The first group consisted of 15 (27.8%) patients with an average severity of the condition. The second group included 22 (40,7%) patients with a severe condition and the third group had 17 (31,5%) patients with an extremely severe condition. All the subjects underwent screening of venous blood, mixed venous blood, and arterial blood.

Results. The study revealed that puerperants with the hepatopulmonary syndrome have detoxification mechanisms in their lungs that act against endogenous toxic substances and affect the entire spectrum of toxic substances.

Сonclusion. The functional state of the detoxification function of lungs depends on the severity of the hepatopulmonary syndrome course, as well as the functioning of other detoxifying systems and excretory organs. It also has stages of disorder (compensated, sub compensated and decompensated) that can be used in early diagnosis of the endogenous intoxication syndrome, the severity of the hepatopulmonary syndrome, development of the multiple organ failure syndrome and prognosis of outcomes.

Aim. To improve diagnosis and treatment of the syndrome of endogenous intoxication in patients with complicated forms of the diabetic foot syndrome.

Material and methods. The study is based on the results of clinical observation and treatment of 110 patients with complicated forms of DFS. The study group included 65 (51.9%) men and 45 (48.1%) women.

The age of patients ranged from 30 to 70 years. Type, the severity of the course and stages of diabetes were determined according to the WHO classification (1985). Diabetes type 1 was detected in 4 (6.5%) cases, type 2 diabetes in 106 (93.5%) cases, and in 5 (3.8%) cases DM was detected for the first time.

Results. The results of the study showed that in patients with complicated forms of the diabetic foot syndrome, critical increase in the content of lipid peroxidation products in the blood plasma was: MDA- 6.3 ± 1.25, DK 0.92 ± 0.14, SOD 11.4 ± 0,2. In patients with a prevalent purulent-septic processes the numbers were: MDA - 7.82 ± 0.92, DK - 1.24 ± 0.05, SOD 10.1 ± 0.2. In patients of the control group the MDA was 5.9 ± 1.23 μm / ml, DK - 0.90 ± 0.32 and SOD up to 10.1 ± 0.2 μm / ml. These numbers were significantly higher before the treatment in patients of the main group with complicated forms of diabetic foot syndrome, which was the reasons of the rapid development and spread of the purulent-septic process under the influence of LPO products.

Conclusion. Oxidation stress was revealed in patients with complicated forms of the diabetic foot syndrome, where a direct relationship between the intensity of LPO and the severity of the purulent-necrotic process was noted. An excessive amount of products of disturbed metabolism, intermediate and final products of LPO that have a toxic effect, which leads to damage and cell death, appears with the progression of the pathological process and the activation of LPO. But the most significant cause is probably the developing antioxidant deficiency, which confirms the positive effect of antioxidants that hinder oxidative stress.

Aim. To improve the results of related kidney transplantation by optimizing immunosuppressive therapy

Material and methods. The study included the results of 80 allotransplantations of the related kidney (ATPP), performed to patients from 2011 to 2017 in the kidney transplant department of the NSCOTT and in the department of kidney transplantation of the Dangara regional hospital. The average follow-up time after kidney transplantation was 1276 ± 52 days. The study group included 56 (70 %%) men and 24 (30%) women.

The average age of recipients at the time of kidney transplantation was 38.19 ± 0.917 years, the median age was 39.0 years (14.4-62.5 years), the maximum age was 62.5 years and the minimum age was 14.4 years.

Results. The frequency of occurrence of urinary tract infection in recipients receiving different patterns of basic immunosuppression after related kidney transplantation was analyzed.

Conclusion. The study showed that improvement of immunosuppression (reduction of steroid doses, administration of CsA in medium doses in combination with Aza) allowed reducing the incidence of urinary tract infections in patients after TP.

Aim. To improve the diagnosis and surgical treatment of choledochoduodenal fistulas due to ulcer and cholelithiasis.

Material and methods. The results of complex diagnostics and surgical treatment of 54 patients with choledochoduodenal fistulas were analyzed. Choledochoduodenal fistulas due to cholelithiasis occurred in 35 (64.8%) patients, and in 19 (35.2%) cases the cause was the peptic ulcer. In the clinical manifestations of the choledochoduodenal fistulas, three types of the disease course were distinguished. The first type (n = 17) was asymptomatic, the second type (n = 16) had a clinical picture of duodenal ulcer and the third type (n = 21) had a predominance of clinical characteristics of cholangitis and choledocholithiasis.

Results. Ultrasound examination in 24 (44.4%) cases revealed a dilatation of the common bile duct and the presence of the aerobilia in 14 cases. In 8 cases, endoscopy revealed the appearance of bile from the crater of an ulcer. Radiologic examination in 27 (50%) of observations revealed a contrast agent entering the bile ducts, and the aerobolia in 14 cases.

Сonclusion. The non-standard surgical situations in the treatment of the choledochoduodenal fistulas require a strictly differentiated approach in each specific case.

Aim. To study the results of Holter monitoring of ECG in women with acute myocardial infarction in the perimenopausal period.

Materials and methods. The work is based on the study of clinical and functional features of ischemic heart disease of 99 women of the 45-60 age range in the perimenopausal period during acute myocardial infarction.

Depending on a level of menstrual function impairment patients were divided into 2 groups. The first group consisted of 50 women in the premenopausal period including women with the irregular menstrual cycle in last 3-11 months (average age 45,1±0,6). The second group consisted of 49 women (average age 60,6±0,6) without menstrual function during one year or women in the postmenopausal period.

Daily monitoring of ECG was held with “Astrocard Holtersystem” equipment in three leads V4, V 5, V6 that take electric potentials from a front, lower and lateral walls of the left ventricle.

Results. According to the results of study women with acute myocardial infarction in the perimenopausal period can have episodes of heart rhythm disturbances, paroxysms of supraventricular tachycardia, supraventricular extrasystole, atrial fibrillation, atrial flutter and ventricular extrasystoles of high grades by Loun- Wolff (II-V cl).

Conclusion. The study showed a high frequency of heart rhythm disturbances, which is 88% in both study groups. That is a sign of high risk of cardiovascular complication, which is myocardial infarction in this case.

The article observes the influence of diabetes mellitus on the course of pregnancy, childbirth and prenatal outcomes. The data on placental insufficiency in various types of diabetes mellitus and the peculiarities of pregravid preparation show the importance of further research.

The paper presents some of the historical aspects of the treatment of the urgent complication of peptic ulcer – the perforation and its literature review. It gradually highlights topical issues of disease and its social orientation, existing traditional methods of operation and the use of modern technologies, which certainly affects the efficiency of patients.

A digestive tract duplication is a group of rare malformations. Anatomically they are divided into tubular and cystic types of duplications. This article describes the case of one-stage endovideosurgical removal of the tubular esophagus duplication with the transition to the stomach in a 2-year-old child. Usage of minimally invasive surgical intervention has reduced operational injury and allowed to perform one-stage extirpation of a pathological intestinal tube located in both the chest and abdominal cavity.

The clinical case of imperfect osteogenesis of the 22-month young patient is described. Clinical and xray examination demonstrates the presence of the system osteoporosis with pathologic traumas, physical and kinetic development delay and signs of hypoplasia of some muscle groups. Densitometry showed the decrease of mineral density of the bone tissue. Laboratory tests showed a deviation of Ca, parathormone, vitamin D and alkaline phosphate. For the first time in Tajikistan patient with imperfect osteogenesis of the third type received therapy with inhibitors of osteoclast resorption – pomidrone acid.