Purpose of the study: to analyse the results of organ-preserving operations in patients with localized renal cell carcinoma.

Materials and methods. The results of treatment of 458 patients who underwent organ-preserving treatment for renal cell carcinoma between 2009 and 2017 were analysed and evaluated. Of these, 286 were men (62.4 %) and 172 were women (37.6 %) with an average age of 54.7 ± 2.25 years (between 23 and 84 years).

Results. The size of the tumours ranged between two to eight centimetres (average tumour size 4.6 cm). The duration of “open” operations ranged from 30 to 110 minutes (average of 62 minutes); those using laparoscopy lasted between 85 and 180 minutes (average of 146 minutes). The volume of blood loss during the operation was an average of 133.6 ml (from 80 ml to 500 ml). In most patients, the tumour was in the first stage of the disease (443 cases, or 96.7 %). In 17 of patients operated on morphologically, invasion of paranephric fibre at the third stage (3.7 %) was detected. A further 8 patients had a second stage tumour more than 7 cm in size but without germination beyond the kidney (1.7 %). There were no cases of intra- or post-operative mortality. Discussion. No significant differences during the postoperative period were observed in patients undergoing “open” and laparoscopic surgery; the frequency of postoperative complications was also approximately the same in both cases.

Conclusion. Improvements in contemporary diagnostic methods have led to a sharp increase in the detection rate of small tumours. The results of studies comparing nephrectomy and kidney resection with a healthy contralateral kidney indicate the validity of the organ-preserving approach with small tumour sizes and localisation convenient for resection. In this regard, recently there has been a trend towards a wider use of kidney resection in renal cell carcinoma. Increased emphasis on the quality of life of cancer patients has led to an active study of the possibilities of using modern technologies in kidney cancer surgery.

Introduction. Despite recent achievements in medicine, many issues in the diagnosis and treatment of infective endocarditis (IE) remain outstanding. This is mainly due both to an increase in the incidence and changes in the clinical picture of this nosology. An important factor here is the continuing presence of existing principles governing the approach to the surgical treatment of infective endocarditis, including prosthetic endocarditis.

Objective: to evaluate the effectiveness of an integrated approach to the treatment of infective endocarditis in patients with valvular heart disease on the basis of 37 years of experience.

Materials and methods. An analysis of the surgical treatment of 1097 patients with infectious lesions of the valvular heart apparatus was carried out. The mean age of the sample was 35.1 ± 9.7 years (from 4 months to 68 years); 67.2 % were men, while women made up 32.8 %. Additionally, 122 patients had infectious lesions affecting 2 or more valves. In 109 cases, valvular prosthetic endocarditis was diagnosed; in 37 patients, IE was detected against the background of congenital heart defects. 99 patients had perianular abscesses. Of all surgical interventions carried out, 18 were repeated, including those with non-valvular congenital heart defects.

Results and discussion. Overall hospital mortality was 4.3 % (47 patients). In patients with IE complicated by a congenital heart defect (CHD), mortality was 14.7 %; with endocarditis of mechanical heart valves — 13.2 %; in drug-dependent patients — 4.5 %; with infectious destruction of native heart valves — 2.8 %; in patients with a background of electrodeinduced endocarditis, no deaths during hospitalisation were observed.

Conclusions. The effectiveness of surgical intervention of infective endocarditis can reach 85.4 %. When supplemented with pathogenetic and etiotropic therapy, surgical correction of affected heart structures contributes to the rapid and reliable sanitation of all infection foci, as well as to a reduction in multiple organ failure. Timely surgery significantly reduces the degree of heart failure and improves the NYHA functional class. In the long term, reconstructive interventions contribute to a better heart recovery than prosthetic operations. It should be noted that the proposed treatment approach for this group of patients creates conditions for adequate labour and social rehabilitation in a distant postoperative period. 

Introduction. Knowledge of the different variants of the structure of the celiac trunk and the hepatic artery is of great importance in the planning, treatment and choice of approaches for transcatheter vascular interventions.

Objective: to study features of variant hematopoietic anatomy from direct and multispiral computed tomography angiography (MSCTA) data in order to determine its significance in routine clinical practice.

Materials and methods. We analysed the most common variants of branching of the celiac trunk and anatomy of the hepatic artery according to direct angiography and MSCTA data in 112 patients with primary liver cancer. The sample comprised 71 men (63.3 %) and 41 women (36.7 %).

Results and discussion. It was found that the most frequent aberration was the passage of the replacement right hepatic artery from the superior mesenteric artery — type 3 according to N. Michels. The second aberration in terms of frequency was Michels type 2. We describe two unusual celiac trunk and hepatic anatomy variants: the first of these comprising a celiac trunk 22 cm long extending from the superior mesenteric artery; the second consisting in a complete absence of the celiac trunk, with all its elements (left gastric artery, common hepatic artery and splenic artery) departing independently from the abdominal aorta.

Conclusions. A typical anatomy of the celiac trunk and hepatic artery was found in 60 % of cases, the most frequent aberration being the Michels type 3, noted in 14.2 % of patients, and type 2 noted in 9.8 % of patients. Knowledge of individual blood supply features largely determines the procedure for conducting operations, permitting purposeful intraoperative revision and the selection of the optimal vascular reconstruction variant, and avoiding damage to aberrant arteries. 

Introduction. One of the biggest problems in the diagnosis of prostate cancer (PCa), which distinguishes it from many other solid tumour conditions, is the difficulty of detecting the tumour using standard imaging techniques. The primary method of diagnosis of PCa, which allows timely treatment, is prostate biopsy. However, under certain clinical situations a saturation biopsy allows a more accurate prediction of the volume and degree of malignancy of the tumour, which can be used to plan the tactics of treatment.

Materials and methods. 81 patients were examined, whose mean age was 63.5 ± 7.4. The average volume of the prostate was 59 ± 24.2 cm3 , while the average level of the prostate-specific antigen was 12.5 ± 8.9 ng/ml. All patients underwent at least one transrectal prostate biopsy. The average duration of the transperineal saturation biopsy of the prostate was 25.2 ± 7.4 minutes. The average number of biopsies was 25.

Results and discussion. Based on the results of transperineal saturation biopsy, prostate cancer was detected in 34 patients (43.2 %). Adenocarcinoma was detected in all patients with confirmed malignant pathology. Gleason grading was 6 points in 22 (27.1 %) patients, 7 in 9 (9.9 %) and 8 in 4 (4.9 %). Aggressive tumour types (Gleason 7 and 8) corresponded to PIRADS 4 and 5. In PIRADS 2 and 3, 80 % and 50 %, respectively, manifested prostatic adenoma without malignant manifestation. Following radical prostatectomy, the results of a planned morphological conclusion were studied alongside biopsy data. It was determined that in 80.0 % (n = 12) of cases the tumour did not go beyond the prostate capsule and in only 20.0 % (n = 3) of cases was not confined to the prostate. The coincidence of diagnosis based on biopsy results and morphological conclusion was 86.7 %.

Conclusion. The study showed that saturation transperineal biopsy is often a reference diagnostic method when, despite the presence of clinical suspicion of PCa, a standard biopsy, including targeted fusion biopsies, fails to provide sufficient information to confirm or exclude PCa. In such situations, the proposed technique provides an alternative approach, with a good frequency of detection of prostate cancer.

Introduction. According to scientific studies, adenocarcinoma coincides with adenomatous tissue within the same prostate gland in 10–83.3 % of cases (including incidental cancer). Clinical situations in which the adenoma reaches a significant size (typically greater than 80 cm3 ) and thus creates considerable difficulties for surgeons occurs in not more than in 8–10 % of all cases of prostatectomy. Given the limitations of external beam radiotherapy and brachytherapy related with prostate volume and poor quality of urination, radical prostatectomy in this group of patients remains the treatment of choice. Features of adenoma, such as large median and lateral lobes, the presence of cystostomy and bladder stones, significantly complicate operational benefits. When an enlarged prostate is one of the factors prior to surgery, robotic technology may have certain advantages.

The main goal of this work is to demonstrate the technical advantages of robot-assisted prostatectomy associated with enlarged prostate.

Results and discussion. We describe the anatomical landmarks and possible surgical methods for overcoming different variations of benign hyperplasia of the prostate using robot-assisted prostatectomy. This information is particularly useful to surgeons aiming to master robotic surgical platforms. Robot-assisted prostatectomy can be effectively used in the treatment of prostate cancer associated with benign prostatic hyperplasia, and patients can have confidence in the results of such an operation.

Conclusion. If a surgeon is sufficiently experienced, robot-assisted prostatectomy may become the method of choice in the treatment of patients with enlarged prostates. 

Introduction. A number of researchers point at a direct connection between mutations of genes affecting the haemostasis system and risks of venous thromboembolism and / or infertility. Quite often,  a thrombophilia diagnosis is a result of overdiagnosis, which may lead to ungrounded and even  dangerous medical prescriptions. In this context, the key goal of this work was to analyse the  homeostasis system in women with recurrent pregnancy loss and establishes the causes of this phenomenon.

Materials and methods. Over the course of this work, we analysed 79 women in various stages of pregnancy who were receiving treatment in the Pregnancy Pathology Department of the BSMU Clinic. We analysed their medical histories, Body Mass Indexes (BMI), polymorphisms of haemostasis system genes and thrombosis risk factors.

Results and discussion. BMI analysis found normal body mass in 39 patients (49.4 %) and excessive body mass in 40 patients (50.6 %). F2 and F5 gene polymorphisms were almost entirely absent. ITGA2  and ITGB3 gene mutations were found in the patients analysed in 48.1 % and 17.7 % of the cases,  respectively. PAI-1 gene mutations were found in 84.8 % of cases. MTR and MTRR gene polymorphisms  were detected in 35.4 % and 81.0 % of the patients, respectively. MTHFR mutations were found in more than 40 % of the patients.

Conclusion. Obesity and hereditary thrombophilia are primary factors in venous thromboembolism. Body weight loss and antithrombotic therapy reduce risk obstetric complications, improving prognosis and pregnancy outcomes.

Introduction. Wе invеstigаtеd thе еffеct оf tоtаl intrаvеnоus аnaеsthеsiа (TIVА) with prоpоfоl оn pоstоpеrаtivе nаusеа аnd vоmiting (PОNV) following rоbоt-аssistеd lаpаrоscоpic rаdicаl prоstаtеctоmy (RALP) in pаtiеnts аt lоw risk оf dеvеlоping PОNV in cоmpаrisоn tо bаlаncеd аnaеsthеsiа with dеsflurаnе (Des).

Mаtеriаls аnd mеthоds. Twеnty pаtiеnts wеrе rаndоmly аssignеd tо thе Dеs оr TIVА grоups. Prоpоfоl аnd fеntаnyl wеrе usеd fоr inductiоn оf аnaеsthеsiа in bоth grоups аnd fоr mаintеnаncе оf аnaеsthеsiа in thе TIVА grоup. In thе Dеs grоup, аnaеsthеsiа wаs mаintаinеd with dеsflurаnе аnd fеntаnyl. In bоth grоups, оndаnsеtrоn 8.0 mg wаs аdministеrеd аt thе еnd оf surgеry; pоstоpеrаtivе pаin management wаs pеrfоrmеd аccоrding tо thе cоncеptiоn оf multimоdаl аnаlgеsiа with аcеtаminоphеn, kеtоrоlаc аnd trimеpеridinе (VАS ≤ 4). Thе incidеncе оf PОNV, nаusеа аnd pаin was rеcоrdеd along with rеscuе аntiеmеtics аnd аnаlgеsics rеquirеmеnts.

Rеsults and discussion. Thе incidеncе оf nаusеа in thе pоst-аnaеsthеtic cаrе unit wаs 40 % in thе Dеs grоup аnd 10 % in thе TIVА (p = 0.001) grоup. Thе incidеncеs оf nаusеа аt 1–6 pоstоpеrаtivе hоurs were 70 % in thе Dеs grоup аnd 20 % in thе TIVА grоup (p = 0.001). Аt 6–48 pоstоpеrаtivе hоurs, thеrе wеrе nо significаnt diffеrеncеs in thе incidеncеs оf nаusеа bеtwееn grоups.

Cоnclusiоn. In оrdеr tо prеvеnt PОNV аftеr RALP in thе еаrly pоstоpеrаtivе pеriоd, аnaеsthеsiа using TIVА with prоpоfоl is rеquirеd rеgаrdlеss оf pаtiеnt-rеlаtеd risk fаctоrs. 

Introduction. An urgent issue facing contemporary medicine is the problem of cancer. According to official Russian Federation statistical data, of the 2,132,050 deaths recorded in 2015, 286,900 of them resulted from cancer. In this connection, an analysis of mortality due to malignant neoplasms of lymphatic and hematopoietic tissues is a relevant activity.

Materials and methods. We analysed data showing the dynamic rate and structure of mortality from malignant neoplasms of lymphatic and haematopoietic tissues in the Republic of Bashkortostan both of the population as a whole and persons of working age. Data covering the period 2006–2015 was derived from the Federal State Statistics Service for the Republic of Bashkortostan.

Results and discussion. As a result of the research, an increase in the overall intensive mortality rates from malignant neoplasms of lymphatic and haematopoietic tissues was noted along with an absence of significant differences between the indicators in the Republic of Bashkortostan and those for the Russian Federation as a whole. Our work has shown that malignant neoplasms of haematopoietic and lymphoid tissues are the leading medical and social problem of contemporary oncology.

Conclusion. This work was carried out in order to identify the most common clinical cases of malignant tumours of haematopoietic and lymphoid tissue, as well as to predict the incidence and further planning of specialised haematological care to the population. 

Introduction. Despite recent significant progress in chemotherapy treatment of primary non-metastatic cancer of the right half of the segmented intestine, surgery remains the primary method of treatment. Radical surgery includes removal of the tumour within the healthy tissues and regional lymph glands. Considering localisation of the primary tumour in the right half of the segmented intestine, hemicolectomy is typically performed on the right side. W. Hohenberger et al. have formulated a new concept of radical surgical treatment of the segmented intestine, consisting of the following components: complete mesocolic excision, early ligation of the lymphovascular pedicle and lymph dissection in the D3 volume.

Purpose of the research: to analyse the early results of surgical treatment of cancer in the right half of the segmented intestine in the volume of the right-side hemicolectomy with D3 lymph node dissection depending on the method of surgical treatment.

Materials and methods. At the premises of the Surgical Department No. 3 of the Republican Oncologic Dispensary (city of Ufa) a retrospective analysis of data of 59 patients was performed following right-side hemicolectomy using complete mesocolic excision, ligation lymphovascular pedicles and lymph node dissection in the D3 volume. Depending on the surgical access, all patients were divided into two main groups: group I (48 patients) — surgeries were performed using open method; group II (11 patients) — using laparoscopy.

Results and discussion. Table 2 shows that the surgery performed with laparoscopy takes longer. However, statistically it results in significantly less blood loss. Patients who underwent open surgery were characterised by a longer stay in hospital. One of the effectiveness criteria is the number of removed lymph glands not differing for either group.

Conclusion. Extended lymph dissection in the D3 volume for segmented intestine on the right side during cancer is a possible and safe method in case of laparoscopic and open procedures.

Introduction. According to the national clinical recommendations, endovascular intervention should be used in the case of infrarenal aneurysm of aorta or common iliac artery in patients with high risk of cardiopulmonary complications during open surgery or serious concurrent conditions. However, despite the reduced risk of minimal invasive intervention, the likelihood of complications remains: the most common of these is endoleak. Type I endoleak is caused by stent graft failure in the area of proximal or distal fixation, leading to an increase of pressure inside the aneurysmal pouch, which can cause it to rupture. In this clinical case, the cause of the endoleak was the short neck of the aneurysm with severe angulation. Leakages of this type must be eliminated by means of a retentive intraluminal cuff or by open surgery. However, the emergency of open surgical intervention in patients with baseline organ dysfunction increases the frequency of complications, often neutralising the advantages of the original endovascular intervention.

Materials and methods. The clinical case example demonstrates the effectiveness of embolisation of the endoleak area in a patient with severe cardiac pathology as an alternative to open surgery.

Results and discussion. Following elective endovascular implantation of the prosthesis on the control, angiograms are determined by endoleak type I in the area of proximal fixation of endoprosthesis. This is presumably due to incomplete adhesion of endoprosthesis body in the area of the right renal artery. The decision was taken to embolise the zone of leakage. Using a 190.0 cm Abbott Whisper MS 0.014 guide-wire, an Ev3 Rebar-18 2.4F/2.7F. microcatheter was pulled across the area of leakage into the aneurysmatic pouch. An Onyx 18 — 1.5 ml liquid embolic system was pulled through a microcatheter to the area of leakage. Control angiography — embolisation was found to be sufficient. There were no signs of non-target embolisation.

Conclusion. If a surgeon is sufficiently experienced and technically capable, type I endoleak embolisation can become a method of choice in the treatment of patients with high-risk open surgery.

Introduction. Rhinosinusitis polyposa consists in a chronic inflammation of the mucous membrane of the nose and paranasal sinuses, followed by recurrent growth of polyps and characterised by a high prevalence. Nasal polyps may be associated with the presence of viscous mucin; their characteristic CT signs are hyperostosis of the walls of the affected sinuses and thinning cavity walls until the bone is destroyed, this being a sign of aseptic osteomyelitis. The same sign is typical for inverted papilloma, the most common benign tumour of the nose and sinuses.

Materials and methods. The present article presents a clinical observation. What makes it interesting is that a benign tumour was diagnosed against the background of bilateral rhinosinusitis polyposa. The clinical picture did not have nasal bleeding, which is typical for inverted papilloma; this was most likely due to the initial growth of the tumour. Thickening bone structures (hyperostosis) was balanced due to the pathogenetic peculiarities of the rhinosinusitis polyposa development with viscous mucin. Inverted papilloma was suspected during rhinoscopy, which revealed asymmetric growth of polyps. Final verification of the clinical diagnosis was carried out following computerised tomography of the nose and paranasal sinuses and histological examination of biopsy material.

Results and discussion. This clinical case is of interest due to rhinocytogram data suggesting a viral and inflammatory etiology of the development of inverted papilloma. Therefore, the observed nucleoli of the nuclei of the columnar epithelium are characteristic of intracellular infection — in particular, viral. Remodelling of cells of the cylindrical epithelium is a sign of chronic inflammatory process.

Conclusion. Thus, accurate performance of the diagnostic algorithm with histological verification of all removed material allows the identification of a neoplasm of the nasal cavity even in difficult cases, along with other diseases of the nasal cavity. Rhinocytogram data can help suggest the etiology of the intracellular type of infection in the epithelial cell and pathogenesis of inverted papilloma in a particular case.

Introduction. Increasing the initial number of caesarean delivery operations involves certain risks when planning and carrying subsequent pregnancies. Despite the trend towards operative childbirth being gradually being replaced by natural, the frequency of recurrent caesarean is higher than the prevailing rate due to scar inconsistency and the presence of a “classic” (corporal) scar on the uterus. The use of corporal access to date is gradually being replaced by less traumatic access. The operation of “slow” caesarean section is considered as an alternative approach to surgical delivery.

Purpose and objectives. To analyse the operation of “slow” caesarean section in the presence of corporal scars on the uterus.

Materials and methods. The resulted clinical case of incomplete rupture of the uterus by corporal scar in the second pregnancy at a period of 38 weeks. Corporal scarring as a result of caesarean operations in the case of interruption of first pregnancy at a period of 22–23 weeks.

Results. The patient was discharged in a satisfactory condition on the 5th day with the child. Postoperative period without complications; results of analyses performed prior to discharge within normal limits.

Discussion. The conducted corporal incision at the first pregnancy was inexpedient due to presenting increased risks in subsequent pregnancies. For the termination of pregnancy in the second trimester, it was necessary to consider therapeutic methods, the operations of a minor caesarean section or a caesarean section in the lower segment of the uterus.

Conclusion. Conducting “slow” caesarean section has the following advantages over classic caesarean section: soft adaptation of the foetus to environmental conditions, purification of the mucous oropharynx of the foetus, establishing a stronger bond between the mother and her future child. In future, we plan to conduct a clinical evaluation of children delivered through a “slow” caesarean section.