The paper studies the issues of aortic stenosis etiology and pathogenesis, clinical assessment of severity based on the distinct symptoms of decompensated aortic defect and echocardiographic measures, and modern methods of aortic stenosis correction. Valve replacement is well known as the «gold standard» in the treatment of aortic stenosis. However, the older-age-group patients with different attendant pathologies are likely to have re-operative complications during the valve replacement operation. The alternative methods of aortic stenosis treating are balloon valvuloplasty and transcatheter implantation of the aortic valve. Analyzing the experience of using the minimally invasive methods of critical aortic stenosis correction convincingly shows reduction of re-operative danger among older-age-group patients with different attendant pathologies and persuades to hospitalize old-aged comorbid patients with significant degrees of aortic valve stenosis and advanced degrees of heart failure to special medical centers. There patients can get an integrated approach to the treatment of this disease that leads to improving treatment results and favorable prognosis in this challenging group of patients.

Chronic total occlusion of coronary arteries is a condition that is technically difficult to solve by the x-ray surgical methods of treatment, and that is one of the decisive factors in favor of coronary artery bypass grafting. The article presents the results about 27 retrograde recanalization of chronic coronary occlusions and the analysis of reasons of unsuccessful attempts, the frequency and severity of re-operative complications. Retrograde recanalization of chronic total coronary occlusions turned out to be effective in the condition of minimally invasive tactics of myocardial revascularization in single long occlusion. Good distal direction and class CC1 and CC2 collarile appeared to be the main criteria of successful retrograde recanalization. Retrograde recanalization complications are typical for x-ray surgical methods of diagnostics and treatment, they are easily predicted, and the prevention methods are well known and effective. Thus, retrograde recanalization of chronic total coronary occlusions is an efficient way of treatment in case of careful patients’ selection and it should be added to frequently used antegrade recanalization method. The key factors for development and widespread implementation of this method are integration of x-ray surgical methods of diagnostics and treatment together with visualization methods and fluoroscopy with IVUS.

To identify the most prognostically significant markers of the «increased vascular permeability» syndrome among patients with severe abdominal sepsis and septic shock an open prospective cohort study was carried out. That study involved 70 patients with severe abdominal sepsis and septic shock, the cause of which were generalized peritonitis in acute surgical diseases of abdominal cavity (APACHE II value is 17 marks). All patients were tested on the «capillary leak» presence, colloid «infusion load» and the indicators of Central and peripheral hemodynamics before and after colloid infusion were evaluated. As a result, it turned out that quite simple tests on «capillary leak» are prognostically significant for the severity evaluation of vascular wall damage in severe abdominal sepsis. The tests can be used to select the starting infusion therapy for patients with widespread peritonitis complicated by sepsis, septic shock and multiple organ failure.

The aim of research is to study the possibility to increase the security of the internal jugular vein catheterization through the choice of access to puncture it, based on the values of its size.

Materials and methods. Ultrasound scanning of IJV with the measurement of anteriorposterior and medial-lateral size was conducted among 20 healthy adult volunteers (control group) and 16 adult patients (observation group) who were treated in the Anesthesiology and Resuscitation Department.

Results. It was found that the test values in the control group the anterior-posterior and medial-lateral vein is larger than 7 mm in both inhalation and exhalation. Under the conditions of hypovolemia (observation group) anterior-posterior size IJV inspiratory became less than 7 mm, and the medial-lateral vein size, despite its decrease retained value of more than 7 mm in most subjects. Among healthy volunteers it was found that the rotation of the ultrasonic sensor 45 ° is accompanied by increase in the average values of the medial-lateral vein size by more than 50%. This maneuver may be useful for patients whose value of the medial-lateral vein size inspiratory was less than 7 mm.

Conclusion. The choice of central or lateral approach to puncture the internal jugular vein may be based on the actual values of the anterior-posterior and medial-lateral dimensions of it. The usage of lateral access for catheterization of internal jugular vein under ultrasound imaging can be more secure for patients with hypovolemia. The maneuver of ultrasonic sensor for 45° clockwise can be used to increase the size of the medial-lateral rotation. 

The analysis of organizational-methodical, legal and medical aspects of questions on organ donation was conducted on the example of FSBI “Academician V.I. Shumakov FRCTAO”, Ministry of Health of the Russian Federation activity. The question of life threatening emergencies organs transplantation becomes vital in accordance to the widespread growth of patients in the terminal stage of organ dysfunction. The first stage of clinical transplantation is organ donation that is considered to be a complex process, characterized by a large number of involved specialists from different fields of medicine and high level of coordination between them. The human organs donation for transplantation is strictly regulated by Law and it is a form of medical practice, too. The organs removal surgery of a deceased person for transplantation is gradually shifting from unique to regular surgical practice. The gold standard is a multi-organ removal from the donor with the brain death diagnosed, that allows getting the most suitable organs for the transplantation from the same donor. However, it is necessary to continue research in this area to improve the surgical technique of these operations and to make appropriate organizational and methodical efforts to improve the efficiency of the posthumous organ donation program.

The article generalizes the results of treating patients with IV stage stomach cancer according to the South-Kazakhstan regional oncological clinic data during 2003-2007yy. During this period 100 patients were operated, 49 (49 %) patients had a citoreductive subtotal resection of stomach, 31 (31%) patient had citoreductive gastrectomy and 20 (20%) patients had citoreductive proximal resection of stomach. The percentage of postoperative death is 13%. Sixty-one (61%) patients received system polychemotherapy. After a citoreductive resection relapses have arisen at 15,6 % of patients, among them 9,3% of patients after citoreductive distal resections, and 6,2 % of patients after proximal resections of stomach. Three-year survival rate after distal subtotal resection is authentically 3,3 times higher than after gastrectomy and 3,8 times higher than proximal resections. After distal subtotal resection of stomach 6,1% of patients lived during five years, they received about 4 rates of system chemotherapy.

The article gives a detailed analysis of examination and treatment of a patient with of coronary-right atrial and subclavian pulmonary- right atrial fistula. Coronary fistula is congenital anomaly when the coronary artery flows into chambers of heart that results in blood shunting and steal syndrome. The severity assessment of the clinical symptoms was performed by using ECG, x-ray chest, ECHO-CG, angiography. The embolization of the fistula using Gianturco coils and further estimation in one month and then in two months were conducted. As a result, the patient have decreased clinical symptoms of the disease i.e. walk distance increased, breath shortness decreased, lungs pneumatization increased, heart chambers size became normal. The endovascular embolization of coronary fistulas using coils is a highly effective and safe method, leading to improvement of the clinical picture.

One possible cause of resistant abdominal pain syndrome is a chronic intestinal ischemia caused by varying degrees of occlusion of the mesenteric vessels. Due to the variety of clinical manifestations, just noticeable their specificity and lack of awareness of general practitioners timely diagnosis of the syndrome of chronic abdominal ischemia is difficult. The method of choice of surgical treatment is percutaneous transluminal angioplasty and stenting of the arteries.

The search for new methods of adequate antegrade blood flow restoration in the coronary arteries of patients with acute coronary syndrome with ST-segment elevation (ACSesST) without hemodynamically significant atherosclerotic lesions of the coronary arteries is a poorly studied item. The author gives the clinical example of a patient with ACSesST without hemodynamically significant atherosclerotic lesions of the coronary arteries and deceleration of antegrade blood flow in the area of the anterior descending artery (ADA). Percutaneous temporary occlusion of the coronary sinus was done to the patient during 10 minutes in the balloon catheter «inflation-deflation». The procedure resulted in a positive impact on coronary hemodynamics such as distal coronary spasm cupping, myocardial perfusion improvement and restoration of adequate antegrade blood flow in the pool ADA.

Optical coherence tomography (OCT) is a method of intravascular imaging of coronary arteries with a superior resolution, based on interferometry. The following review presents the technical features of OCT systems, basic characteristics of OCT images. There has been analyzed the experience in detection of vulnerable plaque, distinguishing plaque morphology as a mechanism of acute coronary syndrome. This review focuses on the applicability of OCT in research and clinical practice in the field of invasive cardiology.

The paper deals with the review of literature devoted to one of the most important issues of contemporary oncology: treatment of malignant liver tumors. Much attention is paid to the analysis of modern endovascular treatment methods research, namely – transcatheter chemoembolization of the hepatic artery. The morphological and functional bases of chemoembolization are described in detail. The comparison between chemoembolization drugs are noted in the article, too. The results of research are shown. The conclusions about the efficiency that allows achieving positive dynamics and stabilization of the process are drawn.

One of the aim of higher education and additional professional education is to create a wide range of abilities and profoundly fixed practical skills without harm to patient’s health. That determines the interest to the development and implementation of various virtual simulators. However nowadays there is no simulation set capable to give the opportunity to practice the technique of surgical intervention performance on the cerebral section of the skull and the brain highly close to reality. That is why the chief aim of this work is create the simulator for manual surgical skills mastering on the cerebral section of the skull in a real topographic anatomical environment. Based on data of the physical and chemical properties of tissues and their simulating stuff a unique simulator was created. It includes the brain, made of Vaseline and paraffin mixture, the Dura mater and skin made of cotton fabric impregnated by silicone, the skull as a cast from protakril. At the stage of testing this unique simulator neurosurgeon experts pointed out the high level of the approximate reality of the tactile sensations of the craniotomy stages performance. The ellaborated model is successfully implemented and effectively used in the process of learning and control of mastering manual skills by students and medical interns at North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia.