Introduction. The number of patients that need repeated operations on aortic valve due to dysfunction or degeneration of previously implanted prosthesis is constantly increasing throughout the world because of the constant growth of number of operated patients. The aim of our study was to assess the clinical outcomes of repeated surgeries for aortic valves, held at the Heart Centre of the University of Leipzig (Germany) from 1994 to 2008. Materials and methods. The study included 155 patients, 86 patients of which have had aortic valve prosthesis without reconstruction of the aortic root (rAVS) and 69 patients aortic root replacement (rAVR). The average time between operations amounted to 6.7 ± 7.9 years for all patients; 2.9 ± 3.1 and 8.8 ± 6.7 years for patients with implanted mechanical and biological valves, respectively. Results. The findings showed early lethality of 4.5% for all patients (3.5% for rAVS without root and 5.8% for rAVR with root, p = 0.5). Five-and eight-year survival is 66 ± 5% and 61 ± 6% for all patients and does not differ between surgical groups. Left ventricular ejection fraction is less than 30% (OR 9.2, 95% CI 1.1 -80.3) and initial neurological deficit (OR 22.1, 95% CI 2.3 -197.4) were independent predictors of early mortality. Independent predictors of late mortality were: NYHA functional class IV (HR, 95% CI 2.2 = 1.5, p -3.2 < 0.01) and infective endocarditis (HR 2.2, 95% CI = 1.4 -3.1 p < 0.01). Conclusions. Thus, repeated surgeries on aortic valve is associated with the acceptable early and late survival.

Introduction. Ischemic damages play an important role in etiology, pathogenesis of diseases of the abdominal cavity, they acquire special relevance under conditions of emergency surgery in terms of diagnosis and assessment of the extent of these violations, and choice of pathogenetically valid methods of correction and treatment. The aim of this study was to estimate the capacity of laboratory, endoscopic, some instrumental methods to diagnose ischemic bowel violations experimentally and in a clinical setting. Materials and methods. This paper presents an analysis of the reliability of the laboratory, instrumental methods to diagnose ischemic bowel damage in patients with acute strangulated intestinal obstruction (n=79), acute disorders of mesenteric blood circulation (n=124) experimentally in animals with the model of intra-abdominal hypertension syndrome (compression). Patients have been examined for defining the level of blood lactate, pH of the gastric mucosa, ultrasonic dopplerography of visceral branches of the abdominal aorta, the examination determined the level of intra-abdominal pressure, and at the same time the patients have undergone the review X-rays of the abdominal cavity organs, and the coagulogram indicators have been analysed. In order to study the role of intra-abdominal hypertension in the developing ischemic infringements of abdominal organs, as well as lactate as a marker of ischemia, the simulation of the abdominal compartment syndrome by a tense pneumoperitoneum under pressure of 20 mm Hg. within two hours was carried out on 5 pigs weighing 60-70 kg and 7 piglets weighing 8-10 kg. The research suggested an algorithm of diagnosis at pre- and postoperative periods. Results. The findings show that modern laboratory techniques (level of lactate), tools (endoscopic, ultrasound, radiopaque, laser flowmetry, etc.) allow with precision > 90% to diagnose ischemic bowel violations. Conclusions. To monitor the status of bowels, the anastomoses zones it is recommended to use the technique of programmed fibrolaparoscopy through the control abdominal cavity drainage.

 Introduction. Due to the growth in the number and volume of surgical interventions on abdominal organs, as well as associated pathology, resulting in frequent postoperative complications, there has been an increase in the frequency and severity of the current adhesive disease of peritoneum. The main purpose of the project is to analyze early and delayed results in surgical treatment of peritoneal adhesions. Materials and methods. The work includes a retrospective analysis of data with emergency surgical pathology in the period 1997-2008 of 638 patients, that have undergone medical care regarding peritoneal adhesions at the clinic as a part of BSMU (city of UFA). In the total structure of patients the prevailing group was the one with acute ileus (52%), requiring emergency surgery. Depending on the type of surgery the operated patients were divided into two groups: an adheolysis group of 302 patients (91%); and a group of adhesiolysis + bowel resection with anastomosis of 30 patients (9%). Results. The findings showed that the early postoperative complications manifested in the form of early adhesive intestinal obstruction and anastomotic dehiscence, requiring repeated surgeries. In the group with the adhesiolysis, such interference was carried out for 42 patients (14%). Anastomosis group has undergone complications in 8 patients (27%): the subgroup of double layer anastomosis - in 6 patients (29%), subgroup of single layer anastomoses - 2 patients (22%). Conclusion. It has been noted that the frequency of early complications after anastomoses remains high (27%), and reliably is not different, as with the use of the double layer (29%), and with the use of single-layer intestinal stitch (22%). Deferred results demonstrate the return of symptoms during the first year in 217 patients (47%). And the high frequency to form clinical signs of peritoneal adhesions in 68% of patients still remains within two years after surgery.

Introduction. Breast cancer is now the most common malignant tumor among women with annually increasing incidence. One of the new, advanced and minimally invasive breast cancer treatment directions is intra-arterial neoadjuvant chemotherapy. The main purpose of the project is to analyze the results of intraarterial chemotherapy in 30 patients with breast cancer during the period 2004-2006. Materials and methods. Intraarterial chemotherapy was carried out by selective internal thoracic artery catheterisation (a. Thoracica interna), supplying blood for the area of tumor lesions of the breast. Chemotherapy used the common scheme - Taxotere 75 mg/m2 + Doxorubicin 60 mg/m2, doses of chemotherapy are calculated on the basis of the nomogram in dosages for intravenous infusion, the speed of infusion was 8001000 ml/h. The sequential intraarterial injection of chemotherapeutic agents took 3-4 hours. Preoperative chemotherapy consisted of 4 courses. The interval between courses was 3 weeks. Results. As a result of treatment after 2-year chemotherapy a partial regression process is registered in 19 (63.3%) patients, 11 (36.7%) patients got stabilized. After 4 treatments a complete regression is registered in 15 (50%) patients, partial regression - in 12 (40%) patients, stabilization of the process - in 3 (10%) patients. As a result of the above kind of treatment, 27 (90%) patients have managed to undergo radical mastectomy. Conclusion. Application of intraarterial chemotherapy in patients during advanced IIIa, IIIb stages of cancer allows to achieve partial regression even after 2-year therapy. However, despite the effectiveness of the method the intra-arterial chemotherapy is only a step before radiotherapy or surgical treatment, so the method should be used as an initial, important link in the combined treatment of breast cancer.

Introduction. Various techniques of controllable level of negative pressure are presently a trending treatment of purulent-necrotic wounds. Despite the widespread view in the literature about the obvious benefits of this method, there are still no extensive research, free from commercial interests. In this context, the main objective of this study was to evaluate early results of vacuum therapy in complex treatment of purulonecrotic wound. Materials and methods. The work includes data of multi-dimensional follow-up study with non-parallel (historical) control. Retrospective study included analysis of case histories in the period 2010 - 2012 (140 patients), prospective study was to analyse the effectiveness of vacuum therapy in complex treatment of purulent diseases in patients hospitalized in purulent surgery department at Republic Clinical Hospital. G.G. Kuvatov UFA) during the period 2012-2016 (142 patients). Results. The findings show that the application of negative pressure treatment method in complex treatment of patients with infected wounds of soft tissues is indicated in cases where there has been a slowing of wounds cleansing and reparative processes - the method allows to reduce number of bandaging for a patient, the timing of wound cleansing and accelerate the transition to the phase of plastic closure of the wound. Conclusions. To reduce the risk of bleeding on vacuum therapy, following extensive surgical interventions, it is optimal to comply with temporary pause between surgical effect on wound and installing of apparatus NPWT (8-16 hours). The best effect in the treatment of wounds can be achieved when applying the following NPWT mode: the first 24 hours after the beginning of vacuum therapy - a constant level of negative pressure at 100-140 mm Hg.; second day and further - intermittent level of negative pressure with alternating modes at 60-75 mm Hg. - 5 minutes and 120-130 mm Hg. -5 minutes.

Introduction. The following article contains the consideration of issues, related to rationale for the technics of jejuno- and colostomies’ application for treatment purposes in patients with acute intestinal obstruction and peritonitis. Currently such methods as Brooke’s ileostomy, double-barrel stoma and Maydl stoma are used in case intestinal stoma application is indicated. However, these types of operations have several disadvantages, resulting in stoma malfunction, exteriorized intestine necrosis and incarceration in a paracolostomal canal. These complications, among others, affect the treatment outcomes and mortality rate in acute intestinal obstruction and peritonitis. Materials and methods. The authors have proposed and applied new variants of trunk-shaped jejuno-, ileo- and colostomy and a new technology of stoma formation on an intestine, fixed in the abdominal cavity. Results. A comparative analysis of applied stomas has revealed a bigger correspondence of trunk-shaped stomas to such technical requirements as simplicity, reliability, efficacy and safety, in comparison with other treatment options, which results in treatment outcomes improvement and favorable prognosis in this complicated category of patients.

Introduction. Congenital inguinal hernia is a common pediatric surgical disease. It is traditionally treated by open herniotomy with high ligation of the hernia sac. To date despite the technical capabilities the incarcerated inguinal and inguinal-scrotal hernias are a contraindication to laparoscopic surgery, and in the available literature there is no information about using endovideolaparoscopic method to treat this pathology in children. In this context, the main objective of this work is to develop a method of laparoscopic treatment of incarcerated inguinal and inguinal-scrotal hernias in children. Materials and methods. The paper presents the results of the diagnosis and laparoscopic treatment of 23 children aged 1 month to 3 years, with incarcerated inguinal and inguinal-scrotal hernias, that has been carried out at the clinic of Pediatric Surgery of BSMU based at City Children Clinical Hospital №17 in UFA in the period 2002-2016  with original method of endovideosurgical dis-incarceration with simultaneous plasty of hernia orifice. Results. According to the results of the analysis the average operation time was 25±4.2 min. The method facilitated early activation and early enteral meal. There were no local complications in aftercare period by trocar wounds, the stitches were removed on the 5th day. The average duration of hospitalization was 6 days. Long-term results through 3 and 6 months have demonstrated the absence of any asymmetry of the groin, tightness of the testicle, increased or reduced testicle volume. Conclusion. Thus, the findings show that laparoscopic hernioplasty for inguinal and inguinal-scrotal hernia, is a new technique and it gives opportunity to solve this problem in children at a whole new level.

Introduction. The study reviewed the experience of surgical treatment of 145 patients in Samara State Clinical Hospital (SSCH) №1 named after N.I. Pirogov, city of Samara, during the period 2013 - 2016, which had 146 reconstructive operations on carotid arteries during acute period of ischemic stroke. Materials and methods. Indications for urgent intervention were 3 groups of clinicalmorphological criteria (analysis groups): 1. Stenosis of the internal carotid artery  (ICA) over 55% of lumen with unstable neurological symptoms; stenosis of ICA more than 70% of lumen with stable neurological symptoms; heterogeneous atherosclerotic plaque with tire defect, according to  colour duplex ultrasonography of brachiocephalic artery – in 94 patients, 81 of them have undergone everting  carotid endarterectomy (CEAE), 13 of them -CEAE with plasty of the autovenous patch.  2. Pathological tortuosity of ICA on the side of symptom-based brain injury in combination with or without stenosis + unstable neurologic symptoms - in 22 patients, 18 of them have undergone everting CEAE in combination with resection of ICA, 4 patients have undergone resection of ICA and elimination of pathologic tortuosity. 3. Thrombotic occlusion of ICA on the side of the stroke, regardless of stability of neurological symptoms - in 29 patients, 17 of them have undergone resection of ICA with plasty of the external carotid artery, 6 patients have undergone thrombendarterectomy from ICA with plasty with the autovenous patch, 6 patients have undergone everting CEAE for thrombotic occlusion of ICA. Results. By the time of discharge from the hospital the regression of neurological symptoms reported for 124 (85%) patients. Early lethality was 3.4%. Conclusions. Thus, the findings allow considering that under conditions of multispeciality hospital, with strict compliance with the selection criteria, the surgical treatment on the brachiocephalic vessel in the acute period of ischemic stroke, has the right to be regarded as one of the most effective treatments for this disease.

Aims: The purpose of the study is to study the clinical and laboratory features of jaundice with the identification of the most informative differential diagnostic signs of diseases in patients sent to an infectious inpatient facility. Materials and methods. 127 outpatient and inpatient maps of patients with jaundice syndrome were analyzed. Additional methods of investigation (general and biochemical blood tests, serological and genetic-molecular markers of viral hepatitis, FGDS, ultrasound, CT and MRI of abdominal cavity organs) were used. Results. Conducted a comprehensive analysis of the clinical anamnesis data and additional tests patients referred to hospital infectious clinical № 4 Ufa with suspected acute, chronic hepatitis and cirrhosis of viral etiology. The most informative clinical and anamnestic data, clinical-biochemical and seroimmunological indices in the differential diagnosis of superhepatic, hepatic non-viral etiology and subhepatic jaundice caused by acute surgical pathology (toxic hepatitis, Gilbert’s syndrome, calculous cholecystitis, acute pancreatitis) and oncological diseases of the abdominal cavity organs (liver, pancreas, stomach, intestines). As a result, non-infectious jaundice was established and patients were transferred to profile hospitals. The conclusion. Timely correct evaluation of the type of jaundice determines further medical tactics, the volume of medical measures and the place of their conduct. In the differential diagnosis of jaundice should carefully analyze the clinical and medical history, liver function tests, also use additional instrumental examination methods.

Currently, the key mechanisms of carcinogenesis are epigenetic events. Epigenetic factors include DNA methylation, histone modifications, microRNA expression and higher chromatin organization. Non-coding RNAs include microRNAs, small interfering RNAs or siRNAs, piRNAs, long noncoding RNAs or lncRNAs. According to recent data, most of these RNAs are directly formed from mobile genetic elements or have a transposon origin. Non-coding RNAs specifically affect the methylation of the genome and the modification of histones in ontogenesis. This is facilitated by evolutionarily programmed features of activation of transposons, since non-coding RNAs are formed from transposons. Thus, the material basis of epigenetic heredity are the transposons. Stress and aging increase the likelihood of developing cancer. This can be explained by an increase in the number of abnormal activation of mobile genetic elements that are sensitive to stress and hormones. Abnormal activation of transposons in cells leads to genomic instability-most such cells undergo apoptosis. However, in some cases, progressive genomic instability leads to damage to oncospressor genes and oncogenes activation - as a result of apoptosis does not occur, and cells acquire the ability of uncontrolled proliferation with the accumulation of a variety of mutations due to the progressive genomic instability caused by the mobilization of transposons. In each type of malignant tumors, specific cascade mechanisms of activation of mobile genetic elements with the participation of non-coding RNA are triggered. The study of epigenetic mechanisms of development of each type of cancer will enable to develop effective methods for early molecular genetic diagnosis of cancer, as well as targeted therapy at different stages of carcinogenesis.

Introduction. At the moment, there is an «epidemic» of an adrenal incident. The frequency of detection is about 7% among the population. Under incidentaloma is understood, the accidentally revealed education in the adrenal glands, regardless of hormonal activity. Radiation methods of research play an important role in determining the nature of formations and tactics of reference. In recent decades, there has been a breakthrough in the diagnosis of adrenal gland formation. It is complex radiation imaging in combination with ultrasound, CT, MRI that allowed to conduct preoperative diagnostics of adrenal tumors, to determine the type of tumor, to establish the stage and prevalence of the process. Despite such a comprehensive study of diagnostic methods, this once again shows the relevance of the adrenal gland problem. Do not forget that with the high diagnostic effectiveness of modern radiation methods for diagnosing adrenal tumors, hormonal studies are needed to establish an accurate diagnosis. Materials and methods. The review examines the possibilities and limitations of these methods, and presents a technical specification. This review considers the relevance of the application in scientific research and clinical practice in the field of retroperitoneal pathology. Conclusion. With most positive confessions, the problem of differential diagnostics of adrenal gland remains open and needs further study.

Introduction. To date, in penal institutions of the Russian Federation annually there are not less than 10000 accurately registered facts of self-mutilation, causing immediate or delayed medical care in terms of surgical hospital. In this context, the main objective of this work is to analyze cases of self-mutilation, simulating an acute surgical pathology, to show essential diagnostic difficulties and medico-economic effects upon inadequate therapy in this group of patients, exemplified by clinical cases.  Materials and methods. The research covered the analysis of 150 cases of selfmutilation, to simulate acute surgical pathology, among penitentiaries of the Republic of Bashkortostan in the period 2014-2016. Results. The findings showed that all the facts of self-mutilation are characterized by a certain typology of the process: localization, self-mutilation mechanism, means of implementation, and reduced compliance of patients. It is shown that the development of complications is due to the late delivery of adequate treatment because of false anamnesis provided by the prisoners. A specific clinical example showed how a false version of the disease development, despite the use of the most expensive and modern methods of research and diagnosis leads to tactically wrong treatment strategies. It is shown that understanding the true situation for a doctor is important both in terms of preventing medical errors as prescribing unfounded invasive research methods, polyprognosis and/or intensification of therapy, and economic considerations, since damage to health resources in treating complications of self-mutilation may be quite substantial. Conclusion. All medical personnel with at least a small chance to encounter medical assistance to prisoners should have access to special training programs that have to be implemented even at the stage of teaching at higher medical schools. These programs should include peculiarities and internal organization of different types of correctional institutions, ethical risks that relate to their activities on health protection.