Aim. Improvement of the results of the treatment of patients with closed combined abdominal traumas. Material and methods. The study is based on the diagnosis and treatment of263 patients with combined abdominal and lower limbs traumas. The control group consisted of 126patients who were treated traditionally. 137patients were included in the main group that received video-endo-laparoscopy as a part of the complex treatment of abdominal component. Ultrasound and video-laparoscopy were used for the diagnosis of abdominal trauma component. Results. The video-endo-surgical method was used for all 137 patients of the main group. Hemoperitoneum was found in 86 (63.2%) patients. The reason was rupture of the liver in 48 (55.8%) cases, rupture of the spleen in 17 (19.8%) cases and, damage of intestines in 12 (14.0%) cases. In 9 (10.4%) cases injuries of abdominal organs were not visible. In that case, postabdominal hematoma reaching the level of the lower pole of kidneys was a source of a hemoperitoneum. Endo-video-laparoscopy was applied to 47patients as a treatment. Hemoperitoneum was caused by injury of the liver in 30 patients and by spleen trauma in 8 patients. The wound was moderately bleeding in all patients. All of them received video- endo-laparoscopic coagulation by monoelectrodes. Then the abdominal cavity sanation and subsequent drainage was performed. The frequency of extra-abdominal complications in the main group decreased in comparison with control by 2.6 times. Conclusion. Endosurgery is a high-informative and low-invasive method in diagnosis and treatment of the closed abdominal injuries. Its application as a treatment method for closed combined abdominal traumas is highly effective.

Aim. To create a high-quality ligament-joint anatomical specimen of the knee joint to provide an opportunity to demonstrate it to students while teaching syndesmology. Material and methods. The object of the study was a sectional material of the knee joint, intended for the educational process in normal anatomy. The generally accepted research methods of practical anatomy were applied. Results. Analyzed statistical data included information on the most common damage of the knee joint and its ligaments. The procedure of the manufacturing an anatomical specimen included a number of processes: the study of the anatomical features of the knee joint and its ligament apparatus; the preparation process and the mummification of the specimen at the initial stage by placing it in a preservative liquid; fixing and drying the specimen in the air; whitening and degreasing of the specimen; covering it by a colorless varnish; mounting on a wooden stand; numbering of the anatomical structures of the specimen. Conclusion. The dissection and manufacture of the anatomical specimen will further contribute to better development of the necessary knowledge and understanding of this anatomical region. The work is relevant since injuries of the knee joint and ligamentous apparatus are among the most common injuries at the most active age from 21 to 50 years. This is why in-depth knowledge of anatomy will allow future traumatologists and physical therapists to correctly treat it.

Aim. To improve treatment results of patients with complicated neuropathic forms of the diabetic foot syndrome. Material and methods. The results of treatment of 42 patients with complicated neuropathic forms of the diabetic foot syndrome were studied. Patients had diabetes for 10 to 25 years. 24 men (57,2%), and 18 (42,8%) women participated in the study. Patients were divided into two groups: main group - 22 (52,3%); control group 20 (47,7%). The diagnosis was made on the basis of clinical, laboratory and instrumental methods. Results. Patients of the main group received Insulipon along with traditional medicines. 600 mg Insulipon of with 200 ml of 0, 9% physiological solution was applied within 10 days. Afterward, patients took the medicine for 1 month in tablets, one per day. ENMG analyzed the velocity of nerve impulse conduction, latent period and amplitude of m-answer. Electroneuromyography (n=24) allowed revealing deviations in patients with lack of clinical signs of peripheral nervous system damage. The results showed a reduction of impulse conduction velocity and amplitude of m - answer on peroneal and tibial nerves in all patients of the main and control groups. The latent period of lower extremities motor nerves had increased. Conclusion. High frequency of diabetic neuropathy and the decrease of the activity of reparative processes indicate the necessity of inclusion of the neurotrophic medicine Insulipon into comprehensive treatment for patients with complicated forms of diabetic foot syndrome. It increases the velocity of impulse conduction along peroneal and tibial nerves and also reduces the latent period of lower extremities motor nerves that activate processes of wound cleansing and reparation. That reduces the number of amputations and hospital lethality.

Aim. Finding correlation between the clinical course of cutaneous anthrax and localization of anthrax carbuncles in an adult population of Afghanistan. Material and methods. Clinical data of 49 patients with cutaneous anthrax were the subject of the study. Among them 26 men (53,1%) and 23 women (46,9%). The age of the surveyed ranged from 16 to 70 years. The diagnosis of anthrax in all patients was confirmed by clinical, epidemiological and laboratory methods. Results. It was found that in 81.7% of cases anthrax had mode-rate and severe forms. The mild form of the disease was observed in patients of 16 to 20 years (18,3%); the moderate and severe course of the disease was found in patients of 21 and 50 years old (32.6%). The state of cutaneous anthrax severity depends on the localization of anthrax carbuncles. Severe cases (32,6%) were observed when anthrax carbuncles were localized in the head and neck. Conclusion. In 97,2% of cases, carbunculosis variety of cutaneous anthrax, where 25(51%) cases were with a localization in the head and neck were observed in adults. In 22 patients (45%) it was moderately severe and in 36,7°% cases severe.

Aim. Improvement of the results of surgical treatment of acute biliary pancreatitis (BP), using combined miniinvasive technologies. Materials and methods. The work is based on an analysis of the results of diagnosis and treatment of 126 patients with acute BP. The age of the patients ranged from 21 to 82 years. 92 (73.0) women and 34 (27.0%) men participated in a study. Methods like analysis of complaints, anamnesis data, objective examination, laboratory and instrumental methods of investigation were used to diagnose BP. Results. The study of cytokine status in patients with BP in the presence of purulent cholangitis against a background of conservative therapy revealed an increase in the concentration of the blood plasma TNF-a, IL-6 and IL-8 in first 3-4 days, and a decrease ofIL on 4-7 days after the surgery. The combination of minimally invasive interventions with conservative therapy effectively reduced levels of TNF-a, IL-4, and IL-6 in the bile of patients with BP. Comparing with the preoperative period the concentration of TNF-a, IL-4 and IL-6 in bile were significantly less at 71.0%, 47.7%, and 70.6% respectively. In order to predict the risk of BP development, the method of endoscopic ultrasonography was developed. In 96% of the cases, this method confirmed the presence of BP. In the postoperative period after the combined minimally invasive interventions against the background of the therapy, at the first 3 days, the improvement of the condition was noted in all 60 patients. The average bed-day was 8.4 ± 1.2 days, in comparison with the patients in the second group with 26.6 ± 2.4 days. The postoperative complication was noted in 5 (8.3%) patients, in contrast to 12 (18.2%) in the group of patients after traditional operations. Two (3.0%) patients died after the traditional operation from the progressive multi-organ failure. Conclusion. Modern laboratory and instrumental research methods can predict complications of biliary pancreatitis. Combined minimally invasive interventions allow improving the immediate results of BP treatment.

Aim. To improve the results of treatment of patients with the post-cholecystectomy syndrome. Materials and methods. The analyzed materials reflect the results of complex diagnostics and surgical correction of reflux gastritis in 42 patients with post-cholecystectomy syndrome treated in the city clinical hospital of emergency in Dushanbe for the period of 2016-2018. Patients were divided into two groups: primary (n = 18) and control (n = 24). The control group included patients that received only conservative treatment. Results. All patients under examination had a reflux-gastritis of various degrees. In three cases (16.7%) patients with hypokinetic disorders of duodenum motility had a surgical correction by laparoscopic novocaine blockade of the celiac plexus (chemical neurectomy). In 8 (44.4%) cases, patients with a high location of the jejunal nerve loop due to peritoneal process (n = 3) and expressed periduodenitis (n = 5) received video-laparoscopic dissection of the adhesions (Strong’s operation). In 2 (11.1%) cases, during hyperkinesia of the duodenum surgery was limited to traditional open surgery in a form of a «dashed» seromyotomy. 5 (27.8%) patients with subcompensated and decompensated duodenal patency disorder and arterio-mesenteric compression of the duodenum, received shunting and combined operations on the duodenum. Conclusions. In the case of reflux gastritis in patients with the post-cholecystectomy syndrome, minimally invasive correction is recommended. Conservative treatment temporarily relieves patients. According to the results of the study, the most radical method of reflux-gastritis treatment is a laparoscopic correction, which significantly reduces the incidence of postoperative complications.

Aim. To study a condition of the lipid peroxidation and content of nervous tissue damage markers in teenagers with complicated perinatal history and reasonable antioxidant medication. Materials and methods. The study was based on neurologic branch NMC RT and center for rehabilitation of Sugd area. Results. The results show that the level of MDA increased to 19,1% and the level of catalase is significantly lower in the basic group - 31, 3% in comparison to control group (р <0,05). Conclusion. The increase of the lipid peroxidation products and depression of antioxidant systems in the basic groups are connected to consequences of central nervous system injury, levels of hypoxia and ischemia.

Aim. To study the influence of the mother’s age on the course of pregnancy and childbirth with an assessment of prenatal outcomes. Material and methods of the study. The history of childbirth with the study of the course of pregnancy, childbirth, and the postpartum period with an estimate of prenatal outcomes in 63 adolescents delivered to the clinic of SRI AG and P from the RRS in 2015-2017 was retrospectively analyzed. The results of the research and their discussion. The results of the research and their discussion. It has been established that in juvenile pregnant women of the youngest group (n <0.01, n- <0.5), complications of the gestation and delivery tendencies were more frequent than in pregnant women of the older age group: threat of abortion, premature birth, premature birth of amniotic fluid, FGRS, threatening rupture of perineum and perineotomy, as well as longer duration of stay in the hospital. Conclusion. In this article are presented specific features of pregnancy in adolescents depending on age. The carried-out analysis showed that younger the age of young mother, the more frequently encountered complication such as: premature rupture of membranes, premature birth, syndrome of fetal growth retardation, traumatism of mother.

Aim. To improve the results of hysteroscopic surgical treatment of submucous uterine myoma. Material and methods. The work is based on the analysis of the results of diagnosis and hysteroscopic treatment of 26 women with submucous uterine myoma. In order to determine the criteria for selecting the optimal method of hysteroscopic myomectomy, the classification of K. Wamsteker was applied. Nodes of type 0 were found in 7 (26.9%) cases, nodes of type I in 9 (34.6%) cases and patients with nodes of type II were observed in 10 (38.5%) cases. To clarify the endometrial pathology, diagnostic fluid hysteroscopy was performed before the intervention. Results. For each type of submucous node, an individual approach was applied. Taking into account the diameter, the localization, nodes were removed by 2mm and 4mm tools, vaporizing the nodes in combination with instrumental removal of destruction products, by monopolar electrosurgical resection, in one intervention with minimal blood loss. Conclusion. The instrumental technique of hysteroscopic myomectomy without prior suppression of the endometrium and myometrium, in more than 80% of cases provides primary radical removal of submucous nodes of all types, without additional application of vaporization.

Aim. To evaluate the ultrasound characteristics of the skin and its blood flow in men of different age groups and the search for ways to correct age-related changes. Material and methods. 92 men aged 25 to 64 years were the object of the study. Patients underwent Doppler ultrasound of the skin to determine age-related changes. The angio-protective drug was prescribed in a group of men 45-54 years old, and a drug with antioxidant and nootropic effects in the group of men 55-64 years old, as a method of correcting identified age-related changes. Results. It was found that the thickness of different layers of the skin decreases with an age, especially in a temporal region of the face. Since the age of 45, decrease of the blood flow velocity of the skin (5.98 ± 0.04 cm / s and 5.51 ± 0.04 cm/s) as compared to younger age men (6.10 ± 0.05 cm/s and 6.14 ± 0.02 cm/s) is observed. An increase in pulse activity indexes and resistance (1.80 ± 0.03 and 1.11 ± 0.02) indicating a decrease in vascular elasticity was also noted. Conclusions. The use of prophylactic courses of angio-protective agents with antioxidant and nootropic properties in men of older age groups can significantly improve the blood flow in the skin, which in turn will lead to a clinical decrease in the intensity of the main and secondary signs of skin aging.

Aim. To study prognostic methods of research for benign ovarian neoplasms in women and to identify the most significant prognostic criteria for diagnosis. Material and methods. The study included 177 women with benign ovarian formations under observation at the Consultative and Diagnostic Polyclinic of the Scientific and Research Institute of Hygiene and Epidemiology, as well as those hospitalized at the gynecological department of the Institute from 2014 to 2018. All patients underwent general clinical examination. The echographic study and doplerometry with “Aloka” production equipment were performed. Tumor markers CA-125, REA, CA 19-9 were studied according to standard methods. The immune-histochemical analysis was also performed. Results. A correlation between prognostic criteria of the benign ovarian tumor was made. There is a direct relation between the tumor blood flow resistance index and a tumor marker CA 125. The relationship between CA 125 and the malignancy index was also revealed. Conclusions: One of the essential criteria for eliminating the malignancy of ovarian formation is the calculation of the malignancy index. The analysis confirms the importance of MI as a criterion of malignancy in the preoperative diagnosis of patients with cystic ovarian formations. A differentiated approach according to malignancy index and vascular Dopplerometry allows optimizing the organizational aspects of managing such patients by changing approach and sending the patient to a specialized institution

The paper presents a case of diagnosis and surgical treatment of a 36-year-old woman with acute adhesive intestinal obstruction during the pregnancy for a period of 31-32 weeks. After conservative treatment methods turned to be ineffective, it was decided, along with obstetrician-gynecologists, to eliminate the causes of intestinal obstruction surgically without interruption of the pregnancy or interventions on the uterus. The procedure was performed with great technical difficulties, due to the large size of the uterus filling the entire abdominal cavity. In the postoperative period, the patient developed symptoms of peritonitis. Due to this, she was taken to a second laparotomy on the third day. Cesarean section, supra-vaginal amputation of the uterus with appendages was performed. Closed nasal-intestinal intubation of the small intestine with sanitation and drainage of the abdominal cavity was made. The child has died on the first day after the surgery. The postoperative period was severe, but the patient had recovered. She was discharged from hospital in satisfactory condition on the 17th day after the operation.

Aim. The aim of this study was to evaluate the quality of the PUST program in FM by assessing the experience of the current residents on different aspects of the learning environment. Material and methods. In order to assess the experience of residents, a questionnaire was developed. It was based On internationally validated questionnaires, that used to evaluate similar programs [3; 4; 6; 2]. All the residents in the first and in the second year of the PUSTprogram in FM (total of 51 individuals) were invited to participate in the study. Furthermore, 20 FM interns from clinics in Dushanbe and neighboring districts were invited, in order to compare between FM residents inside and outside the PUST program. Results. The average score of residents of the 2-year PUST program in FM was 254.54 out of320 (79.5% of the maximum reachable score). This by 0.5 lower than an excellent score (80.0%). That indicates that the residents are positively perceiving the program, while there is still room for improvement in some fields. Conclusion. The residents of the 2-year PUST program in FM reported very high satisfaction and good experiences with the program, while only a few issues were encountered. The 2-year PUST program in FM scored significantly higher than the one-year Internship, especially in the categories related to the practical job and teaching. Residents of the 2-year program reported higher satisfaction with clinical exposure, skill development, and role autonomy during the practical job. Very good results were reached in the ratings of both, residents trained at the PGMI training base and residents trained in the district.

Chronic paraproctitis (fistula of the rectum) is a chronic inflammatory process in the anal crypt, inter-sphincter space and pararectal tissue due to the formation of a fistula. Patients with this pathology make 15-25% of all proctology patients. The most difficult and controversial is the treatment of extra-sphincteric fistulas of the rectum, in which relapses occur in 8-16% cases. Due to this, the treatment of rectum fistulas is a topical problem. This article reviews the literature on the etiology, pathogenesis, classification, diagnosis, and treatment of fistulas of the rectum.

The article presents an overview of modern literature on the screening of cancer, the results of randomized and cohort studies on particular diseases, problems related to the development and implementation of screening programs. The experience of different countries on the screening of cancer of various localizations is given. Screening programs of breast cancer, cervix cancer, prostate, and colorectal cancer were found an effective method of decreasing the mortality and morbidity of these forms of cancer. Some features of the approaches to the problem of screening in CIS countries and prospects of screening in other localizations were identified.