Aim. To improve the effectiveness of perioperative use of the nitric oxide donator - Tivortin in patients with mechanical benign jaundice.

Material and methods. The prospective randomized study of the perioperative period course of 80 patients with mechanical jaundice was conducted. In the 1st -the main group of 42 patients (52.5%), Tivortin was included in the infusion therapy at a dose of 200 ml/day for 5 days before surgery and 8 days in the postoperative period. The 2nd – control group included 38 (47.5%) patients who underwent perioperative infusion therapy without the use of Tivortin.

Results and discussion. Preoperative use of Tivortin provided a reduction in levels of Medium Mass Molecules (MMM) (from 3.7±0.06 standard units to 2.46±0.05 standard units), the Malonic Dipeptide (MDP) level (from 5.2±0.09 nmol/L to 4.4±0.02 nmol/L). Patients of the main group showed an increased level of nitric oxide (from 16.4±3.2 μmol/L to 27.2±1.4 μmol/L) on the background of decreasing concentration of endotoxin (ET) (from 415.3±6.3 units/ ml to 0.5±0.2 units/ml) and endothelin 1 (from 2.1±1.2 μmol/l to 0.6±0.18 μmol/l), and Desquamated endothelial cells circulating in the blood (from 13.3±1.4 cell/100 to 4.9±0.4 cell/100).

Conclusion. The inclusion of a nitric oxide donator - Tivortin in the complex of peri and post-decompression drug therapy for patients with mechanical benign jaundice reduces the frequency of post-decompression liver failure.

Aim. To study the features of the enzymatic activity of the Krebs pathway in peripheral blood lymphocytes in children with iron deficiency anemia (IDA).

Material and methods. 54 children aged 2 to 15 years, suffering from IDA of varying severity were examined. Laboratory data and the cytochemical status of peripheral blood lymphocytes were studied.

Results and discussion. In children suffering from iron deficiency anemia, noticeable changes in laboratory research methods were found: reduction of serum iron, erythrocyte hypochromia, decrease in the average diameter and average volume of erythrocytes, microcytosis, poikilocytosis, hypo-, and dysproteinemia. When analyzing the myelogram, erythrocyte hypochromia and an increase in the number of mitoses of red blood (hyperplasia of the erythroid hematopoietic germ) was found. In addition, the study of the enzymatic status of blood lymphocytes revealed varying degrees of depression of the main enzymes of the Krebs pathway: succinate dehydrogenase (SDH) and alpha-glycerophosphate dehydrogenase (α-GPDH) depending on the severity of the anemic process.

Conclusion. The result of studies of the enzymatic status of blood lymphocytes indicates a decrease in the activity of intracellular dehydrogenases, which are caused by chronic hemic hypoxia and sideropenia in children. The depth of metabolic disorders in sick children was directly proportional to the severity of the anemic process.

Aim. To determine the role of respiratory and mechanical patterns in patients with traumatic brain compression and its relationship to the severity of the injury.

Material and Methods. The study was conducted on 60 victims with traumatic brain compression, aged 18 to 60 years. The victims were divided into 3 groups, 20 persons in each. In the 1st group, the degree of coma severity, according to the Glasgow scale, was estimated to be 13.1±1.2 points, in the 2nd group, 10.2±1.82 points, and in the 3rd group, 6.6±1.93 points. Respiratory patterns were studied using CГ-1M apparatus, Astrup apparatus (pH/BloodGaElectrolytes 1650), Karsbetriebsan-leitung Oxydig apparatus, and a 6+mono vacuum gauge with the calculation of elasticity in cm of water.

Results and discussion. The following respiratory patterns were reduced: functional residual capacity, alveolar ventilation uniformity, arterial blood oxygen tension; mixed venous blood oxygen tension, increased alveolar-arterial oxygen difference, pulmonary shunt, physiological dead space. Elasticity, distensibility, and airway resistance were decreased.

Conclusion. The study of respiratory and mechanical patterns revealed the development of respiratory insufficiency in patients with severe cerebral compression, the depth of which depended on the severity of the craniocerebral injury. The presence of I degree ARDS was revealed in 2 patients of the first group, II degree ARDS in 3 patients of the second group, and III-IV degree ARDS in 9 patients of the third group.

Aim. Improving the immediate results of surgical treatment of penetrating stenotic duodenal ulcers.

Material and methods. The article presents the result of the analysis of the medical history of 62 patients with stenotic penetrating duodenal ulcers, in whom gastric resection “for exclusion” was applied. There were 51 (82.2%) men and 11 (17.8%) women. The ratio of M. - J. is 4.6: 1. The age of the patients ranged from 22 to 67 years, the average age was 42.6 ± 3.7 years. The main research methods for patients with penetrating stenotic ulcers, along with clinical and laboratory examination, are X-ray contrast examination of the stomach and duodenum and esophagogastroduodenoscopy.

Results. The choice of gastric resection “for exclusion” was due to the unresectability of the ulcer. In the postoperative period, complications occurred in 10 (16.1%) patients, failure of the sutures of the duodenal stump was observed in one (1.8%) patient. In the long term, peptic ulcer of the anastomosis was detected in 2 (3.2%) patients. Good and satisfactory outcomes were observed in 96.8% of patients.

Conclusions. Recognition by the surgeon of the unresectability of the stenotic penetrating duodenal ulcer is an indication for the use of gastric resection “for exclusion”. The best option for sealing the duodenal stump is our modified method of forming the supra-pyloric duodenal stump.

Aim. To study the results of treatment of infectious complications in children with acute lymphoblastic leukemia.

Materials and methods. Results of 255 courses of chemotherapy and treatment of infectious complications in 53 children with acute lymphoblastic leukemia were analyzed. Carbapenems were used as the main antibiotic.

Results and discussion. The use of antibiotics in the treatment of children with acute lymphoblastic leukemia was necessary for 53 (20.8%)patients. The indication for antibiotic therapy in 18 cases was bronchopneumonia, in consolidation (1.9%) and induction (31.1%), respectively. An infectious process in the soft tissues (furuncle, carbuncle, and hidradenitis) resulted in the need for antibiotics in 3 (6.7%) children during induction and in 5 (2.4%) children during consolidation. In cases of hyperthermia of unclear etiology, antibiotics were used in 5 (11.1%) children during induction and in 7 (3.3%) children during consolidation. In 7 (15.5%) children during induction and 3 (1.4%) children during consolidation, bacteremia was detected and antibacterials were used.

Conclusion. In children with acute lymphoblastic leukemia, the cause of infectious complications is more often gram-negative than gram-positive bacteria.

Aim. To optimize diagnosis and prediction of the outcomes of craniocerebral injuries in patients with cranio-abdominal injuries.

Materials and methods. The work is based on a retrospective analysis of the examination data of 36 patients between 2019-2020. Among the victims, there were 24 men (66.7%), women - 12 (33.3%). Young people (from 18 to 40 years old) made up 48.1%, patients from 41 to 60 years old - 38.5%. There were 13.4% of patients over 60 years old. For the quantitative determination of the S100 protein and NSE parameters, serum or blood plasma is used, analyzed by an enzyme-linked immunosorbent assay using an ELISA diagnostic kit.

Results. The results of the study of the S100 protein and NSE in the blood serum of patients with CAI showed that there is a direct correlation between these parameters with the severity of TBI and the nature of damage to the abdominal organs.

Conclusion. S100 and NSE scores are the most effective markers for early diagnosis and prognosis of TBI in cranio-abdominal injuries.

Aim. To improve the results of surgical treatment of patients with chronic subdural hematoma (CSH).

Materials and methods. We analyzed the effectiveness of neurosurgical treatment of 20 patients with CSH who were treated in the neurosurgical department of the State Institution National Medical Center - “Shifobakhsh” based on the Department of Neurosurgery and Concomitant Trauma of the Abu SEI “Avicenna Tajik State Medical University” for 2019-2020. The average age of the patients was 27-65 years, including 8 (40%) women and 12 (60%) men. All patients underwent clinical and neurological, instrumental, laboratory examinations, computed tomography (CT), and magnetic resonance imaging (MRI) of the brain.

Results. A retrospective analysis revealed a complication of hematoma remnants and air absorption into the cavity in the postoperative period.

Conclusion. The effectiveness of the methods of treating chronic subdural hematomas using minimally invasive surgical interventions with mandatory two queen drainage is doubtless.

Aim. To study the state of hemostasis in patients with concomitant trauma of the pelvis.

Materials and methods. 93 patients with concomitant pelvic trauma the state of hemostasis were examined by coagulation tests. The control group included 20 patients.

Results and discussion. An increase of blood coagulation properties was revealed on the background of inhibition of fibrinolytic and anticoagulative system indexes. At the same time, there was an increase in the content of fibrinogen decomposition products.

Conclusion. Thus, an increase of blood coagulation potential, suppression of the activity of its fibrinolytic and anticoagulant systems are observed in patients with combined pelvic trauma. Also, the appearance of products of fibrinogen decomposition proves the changes of hemostasis by the type of subacute form of DIC syndrome.

Aim: To evaluate the effectiveness of endovenous laser coagulation (EVLC) in the treatment of varicose veins.

Material and methods. A prospectus study of the results of using EVLC as the main method of treating VB NC in 107 patients 23 (21.5% men and 84 (78.5%) women aged 18-65 years was conducted. All observations showed varicose veins of the trunk of the great saphenous vein and its tributaries in the lower leg and thigh.

Results. Venous thromboembolic complications after EVLC were not observed in any cases. Suppuration of the postoperative wound after crossectomy was observed only in 2 patients. The average score of pain syndrome on the first day after EVLC was 4.2±0.9, on the seventh day – 1.9±0.5 points (P0, 001). The average duration of taking painkillers was 3.5±0.7 days. 77.6% of patients had ecchymosis, and 4.7% had transient paresthesia due to thermal damage to the skin nerve. The average duration of hospitalization was 3.7±0.5 days.

Conclusions. Endovenous laser coagulation is a highly effective minimally invasive treatment for varicose veins. A lower frequency of complications after EVLC is observed when using radial emission light guides.

Aim. To determine indications for various methods of surgical correction of focal forms of congenital hyperinsulinism (CH).

Materials and methods. 14 children with focal forms of CH according to PET-CT data, had surgery in the Department of Pediatric Surgery at the V.A. Almazov Scientific Research Center in 2017-03.2019. The data of 2 children out of 14 was doubtful.

Results and discussion. 13 (93%) patients had complete resolution of hyperinsulinism, significant improvement of psychomotor development. 10 (71%) out of 14 children completely recovered. In 1 (7%) patients significant positive dynamics was achieved. 3 (21%) patients required minimum-dose insulin replacement therapy. They were all children with an atypical (mixed adenomatous-diffuse) form of hyperinsulinism.

Conclusions. Partial pancreatectomy is indicated for focal pancreatic lesions with maximal preservation of healthy (according to express biopsy data) gland tissue at any localization of the lesion; in atypical forms, the volume of pancreatectomy is determined individually.

Aim. To study the morphological characteristics and patterns of glands morphogenesis in the sphincter zones of ICA in the postnatal ontogenesis.

Material and methods. 39 corpses, whose death was related to injuries, asphyxia, etc., and not combined with the pathology of the digestive and immune system. The cross and longitudinal sections in the area of the sphincter and in the area of comparison among people of different ages (from newborns to 90 years) were studied by histological methods.

Results and discussion. According to our data, the length of the intestinal glands sphincter in these areas 1.2 times greater, the density of glands is 1.3 times greater than in adjacent (extra-sphincteral) parts of the mucosa. So the absolute number of epithelial cells on longitudinal sections of intestinal glands from the ICA area is 1.4 – 1.6 times greater than in adjacent areas of the intestinal walls.

Conclusions. Glandular structures located in the region of the sphincter zones of ICA is characterized by regional specificity, regardless of age, more than in the region of comparison.

Aim. To assess the advantages and disadvantages of the neurotization technique for proximal damage to the nerves of the upper extremities.

Material and methods. The work presents a comparative description of the methods of reconstruction of the nerves of the upper limb with proximal injuries for 61 patients like neurotization and autologous nerve plastic surgery. All patients, for the convenience of the assessment of the immediate and long-term results, were divided into clinical groups: group I consisted of 28 patients who underwent neurotic methods; Group II included 33 patients who underwent autologous nerve plastic surgery.

Results and discussion. When studying functional recovery 12 months after reconstructive operations on the nerves of the upper extremities, an improvement was noted in the neurotization group: in the first group, the average disability was 47.4±1.9%, in the second -59.8±2.3%. The results of the assessment of discriminatory sensitivity, thermometry, as well as electroneuromyography also confirmed the advantage of using neurotization.

Conclusion. The data obtained suggest that the neurotic technique is more preferable than autologous nerve plastic surgery, especially in case of severe damage to the nerve trunks of the upper limbs. The use of switching operations for proximal lesions of the nerves of the upper extremities has proved to be effective and appropriate, both from a functional point of view and from a practical one.

Aim. To study comparative TB morbidity among workers of health care facilities in the health system over the last 10 years.

Material and methods. The reports about new cases of TB among employees of medical facilities for 2009-2018 from regional, district/city Centers on the protection of the population from TB were used.

Results. The data indicates that during the analyzed 10 years, the total TB incidence of medical workers does not tend to decrease. In opposite, over the past three years, there has been an increased tendency of incidences. This growth was mainly noted among medical workers of extra-tuberculosis institutions, rather than medical workers of TB facilities. The number of people who became ill and expectorate MTB each year among employees of extra-tuberculosis institutions was also higher than among the employees of TB facilities, which contributes to a greater spread of tuberculosis infection among them.

Complications of acute colonic diverticulitis, including its perforation, are increasingly common in the practice of surgical hospitals for emergency medical care. Despite the high morbidity in the predominantly elderly population of developed countries, discussions about the optimal surgical approaches are continuing. The study aims to review the various methods of surgical treatment of this disease, used in different countries in different historical periods.

This literature review explores the most important aspects of etiopathogenesis, diagnosis, and treatment of pathological tortuosity of the vertebral artery. The data show that vertebral artery tortuosity remains a leading cause of cerebral circulatory disorders and vertebrobasilar insufficiency. Many congenital and acquired factors play an important role in its development. It was found, that despite the emergence and introduction of endovascular methods, open surgery aimed at elimination of the deformity with subsequent restoration of the vessel continuity remains the main method of treatment of vertebral artery tortuosity up to now. Domestic and foreign research data prove that early diagnosis and correctly chosen tactics of revascularization in most cases contribute to complete regression of cerebral ischemic disturbances and good treatment results.