Introduction. The incidence rate of vein thrombosis stands at 180 cases per 100 thousand per year and reaches 200 cases per 100 thousand in older age population.

This study aims to assess the efficacy and safety of the proposed method of retrograde vacuum aspiration performed under the conditions of increased intra-abdominal pressure in patients with iliofemoral deep vein thrombosis.

Materials and methods. The analysis of surgical treatment of acute floating iliofemoral deep vein thrombosis in 52 orthopedic surgery patients following hip and knee arthroplasty. Acute floating iliofemoral deep vein thrombosis was identified in the postoperative period where the length of the floating part exceeded 4 cm. Patients received emergency treatment in the form of either the surgical prophylaxis of pulmonary embolism (study group n = 18) or a vena cava filter implantation in the infrarenal segment of the vein (control group n = 34).

Results and discussion. Patency of the iliofemoral segment was completely restored after the surgery in all the 18 patients in the study group. In the control group, however,, all the 34 patients (px2 < 0.001) retained thrombotic masses in the iliofemoral segment even at the time of discharge from hospital . The length of hospital stay was also different between the comparison groups, amounting to 7 ± 0.74 days for the study group and the patients without thromboembolic complications, and to 21 ± 1.5 days (pm u — 0.0124) for the control.

Conclusions 1. The new surgical method proposed for the treatment of acute floating iliofemoral deep vein thrombosis makes it possible to highly effectively restore the full patency of the vein in the shortest possible timeframe. This method is safe and more cost-effective than the classic surgical approach to the treatment of this pathology. 2. Further research into the efficacy and safety of the method proposed is needed as well as a longer term follow up on a larger number of patients.

Introduction. Despite the fact that the combined use of bevacizumab and interferon α -2A has been studied extensively and proved to be safe, there will always remain a group of patients for whom continuing the long-term drug treatment after a radical surgery would be unfeasible through personal reasons. This paper presents a comparison of the use of bevacizumab in combination with IFN α -2A and active monitoring in patients with metastatic kidney cancer.

Materials and methods. This is a retrospective treatment outcome analysis performed on 24 patients following radical surgery. The clear cell RCC was morphologically verified following the nephrectomy in all the cases. The patients’ ages ranged from 62 to 84, averaging at 73 ± 2.2.

Results. The outcomes for patients receiving treatment and those being actively monitored were then assessed for the total of 24 people counting both groups. The average length of time without progression amounted to 12.9 months and 9.8 months in the groups A and B, respectively. The median overall survival rate amounted to 22.3 and 18.7 months in the groups A and B, respectively.

Discussion. The results demonstrate rather good indicators for the group of patients with metastatic kidney cancer receiving no drug therapy in comparison with the group receiving treatment in accordance with the classic immunotherapy protocol. No significant or fundamental differences have been observed when the groups studied were compared.

Conclusion. A competent case-specific approach to treatment strategies for various metastatic kidney cancer patient cohorts is important both for planning satisfactory survival rate indicators and for maintaining the quality of life suited specifically for each patient.

Introduction. The role of the lipid content of atherosclerotic plaques in outcomes of stenting is in need of further investigation. This study is aimed at assessing the outcomes in patients with lipid-rich and non-lipid-rich plaques following the drug-eluting stent (DES) implantation using the method of optical coherence tomography (OCT).

Materials and methods. The total of 43 examined patients included 26 patients in the lipid-rich plaque group and 17 in the non-lipid-rich plaque group. The characteristics of plaques were examined by OCT. The percentages of sites presenting malapposition, tissue protrusion, dissection and thrombus were calculated according to established criteria.

Results and discussion. The percentage of patients with the type 2 diabetes, the percentage of malapposition and tissue protrusion were all higher in the lipid-rich plaque group. Residual thrombus was more frequent in the lipid-rich plaque group in comparison with the non-lipid -rich plaque group.

Conclusions. Lipid-rich plaques correlate with a higher incidence of malapposition, tissue protrusion, and thrombus following the stenting procedure, thus confirming the link between the atherosclerotic lesion type and suboptimal stenting outcomes.

Introduction. Accounting for 33.3 % of all the cases of large joints osteoarthritis, the knee osteoarthritis is one of the most common diseases of the musculoskeletal system. It is a frequent cause of temporary and long-term disability. In this regard, the main goal of this study was to analyze early postoperative outcomes in such patients, as well as to establish a relationship between the predisposing factors and the development of the disease.

Materials and methods. This paper presents a retrospective analysis of outcomes in 48 cases of arthroscopic treatment of the knee joint conducted at the Kuvatov Clinical Hospital. Patient population was predominantly female (36 cases), with the age averaging at 57. All the patients underwent arthroscopic surgery on the knee joint. The procedures included the resection of the damaged part of the meniscus, grinding and shaving off the damaged lateral or medial condyle hyaline cartilage, and debridement of the joint cavity. All the patients were assessed for pain using 10-point visual-analog scale of pain (pain VAS) prior to and two weeks after the surgery; the treatment efficacy was evaluated by the change in the number of points scored. The Leken algofunctional index was used for the assessment of the severity of gonarthrosis. The clinical symptoms of the disease were assessed prior to and two weeks after the arthroscopy.

Results and discussion. We established that positive changes were clearly present two weeks following the surgery. Patients reported feeling better in general, lesser pain when walking, reduced swelling. In addition, the pain severity scores halved in comparison to the initial values.

Conclusion. Our findings indicate that arthroscopic surgery is a clinically effective surgical treatment method. After the surgery, the patients demonstrated a drop in the pain intensity score, their knee joints felt less stiff, the motor functions of the knee joint were partially restored.

Introduction. This article presents data on the manifestations of changes in the microenvironment of the peritoneal cavity in patients with carcinomatosis, expressed by the mineralization of the peritoneum, which in turn leads to functional changes in drainage of the peritoneal cavity.

Materials and methods. We examined autopsy tissue of the peritoneum with symptoms of carcinomatosis and intact peritoneum using comparative scanning electron microscopy.

Results and discussion. The study of the ultrastructure of peritoneum in patients with PC, revealed the phenomenon of SLL mineralization. The resulting elemental composition profile showed a high content of Ca, P, Na.

Conclusions. 1. Carcinomatosis is not a local, but rather a systemic process. Determining the role of mineralization in carcinomatosis is of fundamental importance in carcinogenesis. 2. The serous membranes mineralization in patients with carcinomatosis can become a new treatment target, the impact on which may increase life expectancy and improve the quality of life. 3. The serous membranes demineralization can serve as a part of a combination treatment that includes the subsequent endolymphatic anti-tumour drug therapy.

Aim. This paper aims to examine the state of the renal blood circulation in patients with purulent pyelonephritis and to improve the quality of treatment through the use of our own technique.

Materials and methods. The author personally examined and operated on 30 patients with confirmed purulent pyelonephritis in the conditions of a urology department at the regional clinical hospital. The author used his own method of treatment. A retroperitoneoscopic decapsulation of the affected kidney was performed on all the patients within the first 24 hours; this was combined with continuous regional arterial infusion of alprostadil within the next 72 hours. All the patients prior to surgery had undergone the following diagnostic procedures: general clinical examination, bolus contrast-enhanced MSCT of kidneys, renal duplex ultrasound, morphology examination.

Results and discussion. The postoperative period in all the cases was good with the reduced number of days needed for treatment. On the first day after operation, the patients noted a reduction in the pain intensity in the affected side. The bolus contrast-enhanced MSCT imaging of kidneys in comparison to the data obtained prior to treatment demonstrates the disappearance of the destruction foci in the kidney and a clearly visible restored blood circulation in the affected side achieved rather fast. No patient required a nephrectomy.

Conclusion. Every stage of the proposed treatment technique is an inalienable part of the method as a whole. Every stage is necessary to deliver the impact on its level of circulation, on the parenchyma affected by microabscesses, and on the infected areas. The method makes it possible to restore blood flow in the kidney and open up a path for the delivery of antibiotics into the organ parenchyma.

Introduction. Vulvar cancer belongs to the group of rare neoplasms and accounts for about 4% of all gynecological malignant tumours. One of the important barriers to the spread of the tumour cell population is the lymph nodes. Most oncologists recognize the existence of the so-called sentinel lymph nodes. A proper assessment of the status of this node makes it possible to predict the extent of the spread of cancer, which in turn secures a better surgical treatment outcome.

Materials and methods. 87 patients with vulvar malignant neoplasms received surgical treatment in 2015-2018 at the Department of Oncogynecology of the Republican Oncology Center. Vulvectomy was performed on 19 patients with verified vulvar cancer; sentinel lymph node detection was employed. The methods used were the contrast lymphography and indirect intraoperative radioisotope lymphoscintigraphy. This resulted in the minimal number of postoperative complications recorded.

Results. The scope of surgical treatment for vulvar cancer was optimized based on sentinel lymph node verification.

Conclusions. Detection of sentinel lymph nodes in vulvar cancer is an effective method of planning for the scope of the surgery. Using this method reduces the number of postoperative complications. The reduction of the number of postoperative complications improves the patients’ quality of life.

Introduction. Prolapse of the pelvic organs, atypical hyperplasia of the endometrium, uterine scar dehiscence, and endometriosis are some of the most common conditions found in gynecological practice. Women with these disorders suffer from the deterioration of their quality of life, social status and reproductive potential. There are many surgical techniques available for the treatment of these patients. This article offers a discussion on a surgical treatment with the use of the da Vinci robotic system. Robot-assisted surgery with the use of the da Vinci robotic system is demonstrating a recent gain in popularity. Whenever possible, it is now the method of choice for the surgical treatment strategy for patients with premorbid obesity.

Aim: to assess the outcomes of the first robot-assisted gynecologic surgical procedures performed at the Department of Robotic Surgery at the Clinical Hospital of the Bashkir State Medical University (Ufa).

Materials and methods. This paper offers a description and assessment of the first robot-assisted procedures performed as part of the “Robot-assisted Surgery in Gynecology” master class.

Results and discussion. The following types of procedures were used for the outcome assessment: robot-assisted laparoscopy, supracervical hysterectomy with appendages, sacro-vaginopexy with prolene flap; robot-assisted hysterectomy with appendages; robot-assisted metroplasty and robot-assisted laparoscopy with excision of retrocervical endometrial infiltrate.

Conclusions. The robot-assisted surgical treatment method is the most beneficial management strategy ensuring the ease of the actual surgery as well as a speedy recovery of patients and the reduction of possible complications in the early postoperative period.

Introduction. When a pathological process emerges in a part of the cardiac conduction system, it results in various cardiac arrhythmias causing cardiac activity disorders affecting the entire body and posing a threat to the patient’s life.

Today, the endovascular treatment of arrhythmias has replaced many open heart surgeries becoming a widely accepted alternative to drug therapy. The key techniques of x-ray-guided endovascular treatment of arrhythmias includes the implantation of various devices, transcatheter radiofrequency ablation of arrhythmogenic zones and cryoablation. An excellent comparison of ablation techniques has been presented in the most extensive international randomized clinical trial FIRE AND ICE.

The implantation of single-and two-chamber pacemakers, electrophysiological research, radio frequency ablation are all performed at the Bashkir State Medical University Clinic.

Material and methods. The electrophysiological research and transcatheter radiofrequency endocardial ablation using the Carto 3 system for complex rhythm disorders have been carried out at the Bashkir State Medical University Clinic since 2013.

Results and discussion. 159 EPIs and RFAs have been performed at the Bashkir State Medical University Clinic.

Conclusions. X-ray guided endovascular surgery is the method of choice in the treatment of various forms of arrhythmias.

Introduction. Liver transplantation is currently considered to be the only method of radical treatment for adults and children with incurable liver diseases. The most important aspects of liver transplantation are the correct selection of an appropriate recipient and compilation and maintenance of a liver transplant waiting list. This article aims to analyze the structure of the severe chronic liver disease patient population included in the liver transplant waiting list at the G. G. Kuvatov Republican Clinical Hospital (the City of Ufa).

Materials and methods. We analyzed the waiting list drawn and maintained over the 2007-2018 period based on the examination of 789 patients with liver cirrhosis of various etiologies.

Results and discussion. Out of all the patients with liver cirrhosis of different etiologies (Child-Pugh score classes A, B, and C) 149 (18.8 %) were included in the waiting list. The ages of patients included in the liver transplant waiting list ranged from 19 to 69. The mortality rate amounted to 38.9 % (58 people); of these patients 31 (53.4 %) had hepatic cirrhosis (HC) of autoimmune etiology, 18 (31.0 %) — HC of viral etiology, and 6 (10.3 %) — alveococcosis of the liver. The rate of the waiting list expansion for patients aged 20-29 compared to those aged 0-19 amounted to 1.32 %. Such a dynamics for the 30-39 age group compared to the 20-29 age group was 11.51 %. The number of people aged 40-49 compared to the preceding age group remained the same.

Conclusion. Our analysis of the waiting list sets the percentage of patients with autoimmune HC in the population of patients with this disease at 59 %. These patients are characterized by a rapid progression of liver failure and high mortality. The statistical analysis of liver transplant waiting lists facilitate the optimization of procedures used to select and manage such patients, as well as to prevent, in a timely manner, the development of complications thus improving the prognosis of survival.

Introduction. Myocardial lymphoma is one of the rarest lesion localizations among all the lymphoproliferative diseases. Regardless of the current lack of generally accepted specific recommendations for the treatment of primary and secondary myocardial lymphomas the chemotherapy is carried out in accordance with clinical guidelines for the treatment of lymphoproliferative diseases, which in some cases results in a successful outcome.

Materials and methods. The article presents a clinical example of the diagnostic procedure and treatment of a 65-year-old female with the following diagnosis: non-Hodgkin’s lymphoma st. II BE gr. II with the involvement of myocardium, cervical and mediastinal lymph nodes, and the right palatine tonsil. The patient received six courses of R-CEOP chemotherapy.

Results and discussion. An echo-positive structure 28mm by 20 mm in size attached to the interatrial septum was found inside the right atrium following the second course of chemotherapy. Ejection fraction: 61%. Effect: regression exceeding 50%. Four months following the completion of treatment the ejection fraction was 63%, regression – exceeding 80%, thus implying a partial response.

Conclusion. The diagnosis of lymphoma with a lesion in the myocardium has been positively verified by histology and IHC. Currently less invasive techniques are normally preferred, transesophageal cardiac echo guided biopsy being one. Similar to any other lymphoproliferative disease, myocardial lymphoma is a chemosensitive tumour that responds well to treatment. In each individual case, the treatment strategy must be patient-specific and take into account the somatic status of the patient, the tumour size and the degree of its spread, the tumour morphological type, and whether it would be possible to arrange adequate specialized support needed.