Introduction. Radical cystectomy is a standard treatment for muscle-invasive bladder cancer (MIBC). The most important stage of such an operation involves urinary reconstruction through the mechanism of urinary diversion, which may be associated with various complications thus decreasing the patients’ quality of life.

Materials and methods. Patient G., 66 years old, was diagnosed with bladder cancer T2bN0M0. A robot-assisted radical cystprostate-vesiculectomy was performed with the formation of a neobladder according to the Studer technique. The article presents illustrations of the resection and reconstructive stages of the operation, as well as examination data 3 months after the surgical treatment.

Results and discussion. The operation lasted for 405 minutes. The volume of blood loss was 150 ml. According to the follow-up examination performed 3 months after the operation, the patient was able to independently control urination by contracting the muscles of the anterior abdominal wall. According to CT data, the patient showed no signs of a relapse. The formed ileal conduit was functioning successfully. Urinary reflux was not detected.

Conclusion. Radical robot-assisted laparoscopic cystectomy is an effective low-invasive method of surgical treatment in patients with bladder cancer. This method allows the hospitalization and postoperative period to be optimized. The continent urinary diversion method improves the period of social adaptation and the quality of life in such patients.

Introduction. The development of upper and lower urinary endoscopic surgery has brought about an increase in the number of urethral strictures after transurethral procedures.

Material and methods. A retrospective analysis was performed involving the treatment results of 72 patients with urethral strictures after transurethral surgery in 2011-2016. All the patients underwent standard examination, including US, residual urine analysis, uroflowmetry, retrograde and micturating urethrography, IPSS and QoL questioning and general clinical tests.

Results and discussion. The median of observation comprised 28 months. Bulbous urethra appeared to be the most frequent localisation of urethral strictures (87.5 %). The median stricture length was 2 cm with the mean maximum urine flow rate equal to 5.9 ± 2.7 mL/s. The median IPSS score counted 25 points. The type and number of surgical procedures were as follows: internal optic urethrotonomy (29), anastomotic urethroplasty (18), single-stage skin flap urethroplasty (3), single-stage urethroplasty using buccal mucosa graft (17), multiple-stage urethroplasty using buccal mucosa graft (1), meatotomy (1), single-stage navicular fossa urethroplasty using buccal mucosa graft (1). Internal optic urethrotonomy was to be effective in 52 % cases, while other surgical procedures showed 89 % effectiveness. The pathomorpho-logic studies revealed severe inflammation without signs of stroma fibrosis within urethral strictures.

Conclusion. Transurethral endoscopic procedures appear to be the main causative factor (in 54 % cases) for iatrogenic urethral strictures.

Introduction. Tumour neoplasms of the appendix represent a rare pathology with a frequency of up to 0.1 % and 0.5 % of all performed appendectomies and all forms of malignant tumours of the colon, respectively. Due to the lack of specific diagnosis and asymptomatic development of the disease, such neoplasms are diagnosed accidentally during an emergency operation for acute appendicitis or according to the results of a morphological study of postoperative material.

Materials and methods. A retrospective analysis of appendix neoplasm cases was performed in patients hospitalised in the surgical departments of City Clinical Hospital No. 8 in 2006-2016. A total of 3298 surgical interventions for acute appendicitis were carried out for this period in the patients aged from 18 to 86 years.

Results. Upon admission, all patients had a clinical status of appendicitis. In 3 cases, preoperative ultrasound revealed an expansion of the intestinal loops, pneumatosis and local fluid accumulation. In the setting of mucocele, the sonogram revealed a 70x48 mm ovoid thin-walled liquid formation with smooth contours and peripheral blood flow. In the remaining patients, no pathological changes were detected by ultrasound.

Discussion. According to the results of histological examination, 6 carcinoid tumours were diagnosed in 5 men and 1 woman aged 38-62 years (0.18 %). The appendix adenocarcinoma was diagnosed in 2 women and 1 man aged 7681 years (0.09 %). One case of an appendix mucinous tumour in a 67-year-old woman was established intraoperatively (0.03 %). The appendix neoplasm frequency comprised 0.3 % of all appendectomies performed.

Conclusions. The conducted analysis showed that, even with the possibility of the comprehensive examination of patients, the diagnosis of tumour diseases of the appendix in emergency surgical care remains to problematic.

Introduction. The aim of our work was to improve surgical delivery procedures in patients with a true placenta accreta.

Materials and methods. We analysed 17 childbirth histories of patients who underwent organ-preserving surgeries on uterus during placenta rotation in 2018-2019. The choice of an optimal tactic for managing patients in the department of pregnancy pathology at the BSMU clinic, as well as each case of the surgical treatment of placenta accrete, was carried out jointly with specialists from I.M. Sechenov First Moscow State Medical University.

Results and discussion. All patients underwent surgery in a planned manner; their age and parity had no static differences (p > 0.1). The surgery performed according to the described technique did not lead to a significant increase in its duration. Additionally, the average blood loss of 2200 ml during surgery was not considered significant for this type of operations. We believe that these indicators will decrease with the accumulation of practical experience in performing such interventions.

Conclusion. The applied method of surgical intervention using temporary occlusion of the common iliac arteries has shown a high efficiency and allowed the amount of intraoperative blood loss to be reduced. Despite performing a bottom incision on the uterus to remove the fetus and excise the area of placenta rotation, the examined patients did not experience significant complications both during the surgery and in the early and late postoperative period. The first results allow this technique to be recommended as a method of choice during placenta rotation The monitoring of patients will continue.

Introduction. Obstructive jaundice is one of the most relevant problems in abdominal surgery. The prediction of complications and deaths when using minimally invasive technologies of biliary tract decompression on the basis of objective and reliable criteria will allow this disease to be treated under optimal conditions.

Materials and methods. The study was based on the clinical observations and studies of 219 patients with obstructive jaundice, who underwent minimally invasive biliary tract decompression by retrograde and antegrade stenting as the first stage of treatment. Using Statistica 10.0 and MedCalc 12.7.0. software, a retrospective analysis of case histories in 2 groups of patients with and without complications was performed.

Results and discussion. The patients were divided into 2 groups: group I — 51 (22.8%) with complications and fatal outcomes in 11 cases, group II — 168 (77%) patients without complications. In group I, external drainage was performed in 23 (45%) patients, and endoscopic stenting in 28 (55%) patients. In group II, external drainage was performed in 73 (43.5%) patients, and endoscopic stenting in 95 (56.5%) patients. Using multivariate ROC analysis, 14 interacting predictors of complications and deaths were identified for minimally invasive interventions of the biliary tract with a significant correlation during the first stage of endoscopic stenting (p < 0.0001). A formula was derived for calculating the prognostic coefficient, for which the values and coordinates of the ROC curve were all values above -1.5635 with a sensitivity of 80.4 and a specificity of 77.4. A software product was created for the formation of risk groups in terms of complications and deaths among patients undergoing minimally invasive biliary tract decompression interventions.

Conclusion. Multivariate statistical ROC analysis allows prediction of complications during minimally invasive interventions for biliary tract decompression in 80% of cases. The selection criteria are the location of the tumour, the duration of jaundice and the deviation of the main biochemical parameters from the norm.

Introduction. The drug-induced hemorrhagic syndrome in surgical patients has become a serious problem of contemporary surgery, complicating the choice of treatment tactics and often leading to death. The present study is aimed at optimising emergency surgical treatment of acute cholecystitis and strangulated hernia in patients receiving warfarin.

Material and methods. The study involved 18 patients with hypocoagulant state caused by warfarin (the main group). The control group (10 patients) consisted of patients taking no drugs affecting the coagulation profile. The study was conducted during 2013-2019. The range of diseases included acute cholecystitis and strangulated hernia. The scope of surgery was presented by laparoscopic cholecystectomy and cholecystectomy using minimally invasive technologies. In patients with strangulated hernias, prosthetic tension-free hernioplasty and local tissue rearrangement were used. In the main group, the INR values comprised 8.7 ± 2.8 and 8.4 ± 0.8 in the case of laparoscopic cholecystectomy and short-scar incision, respectively. In patients with strangulated hernias, the pre-surgery INR indices were 8.1 ± 2.7 and 8.0 ± 1.5 with local tissue rearrangement and prosthetic hernioplasty, respectively. The examination included: complete blood count, common urine analysis, US, endoscopic examination, etc.; in the setting of hemorrhagic syndrome, coagulogram, INR and others were added.

Results and discussion. In patients with hypocoagulation syndrome, no significant differences were observed in coagu-logram parameters of the pre- and postoperative period in spite of the corrective therapy by quarantine fresh-frozen plasma. The patients with acute cholecystitis receiving warfarin demonstrated the contact bleeding of the liver and longterm serous-hemorrhagic discharge through the drains. However, the rate of hemorrhage in the group of patients with short-scar incision cholecystectomy was observed to be significantly higher as compared to the laparoscopy-operated group. In patients with strangulated hernias, in cases of drainage of the postoperative wound, a long-term serous-hemorrhagic discharge was observed.

Conclusion. Laparoscopic cholecystectomy is the operation of choice in patients receiving warfarin and developing acute cholecystitis. However, in case of strangulation in patients with hernias, the optimal operation consists in local tissue rearrangement.

Introduction. In briefly to have eight symptoms of Qi disease and very common one which is including all symptoms is Lower back pain. By the WHO research pain here can be intense and is one of the top causes of missed work. This disease has very painful, recurrence and needs period of treatment time, cost expensive. Most of the damages for patients are diagnosis, surgery, pain relief medicines. Thus, we made this theory with practice research on traditional manual therapy for qi originated Lower back pain. Purpose: to compare the traditional diagnostic methods of manual therapy and modern diagnostic methods of X-ray with lower back pain by using assessment of a quality of life developed by WHOQOL.

Materials and methods. 100 patients with lower back pain were examined. The treatment results were evaluated after the application of traditional rhythmic vibration therapy. These treatment results were obtained using traditional diagnostic methods and using radiography of the lower back, which were compared with each other. The WHOQOL questionnaire was used to assess quality of life.

Results and discussion. Therapy was carried out for 10 days. Manual therapy has shown its positive results within a day. Although the anatomical and morphological structure of the lower back showed no significant improvement within 7-10 days of treatment (75 %), but the space of the spine increased (80 %), and spinal mobility was asymptomatic (90 %).

Conclusion. Patients treated with manual therapy symptomatically recovered after a year (60 %). Of 100 patients, they were completely cured by 15 % and improved by 30 %.

Introduction. At the present stage of the development of oncological surgery, pelvic evisceration (PE) has ceased to be used as a palliative method and has established itself as an effective method of surgical treatment for locally distributed pelvic tumours. This type of intervention using the methods of the reconstructive plastic restoration of postoperative defects allows the number of postoperative complications to be reduced and the patients’ quality of life to be improved.

Materials and methods. A 49-year-old man with a progressive locally distributed bladder cancer involving the anterior abdominal wall underwent an anterior PE with the formation of a Bricker ileal conduit, an extensive resection of the anterior abdominal wall with the reconstructive repair of the defect by a thoracodorsal skin-muscular-fascial transplant.

Results and discussion. The operation lasted for 435 minutes, of which the reconstructive stage of the operation lasted for 320 minutes. The estimated blood loss was 700 ml. The patient remained in the intensive care unit for 2 days and was discharged on the 11th day after the operation.

Conclusion. In the described clinical case, the performed pelvic evisceration with the simultaneous reconstruction of the anterior abdominal wall allowed radical oncological results to be achieved as evidenced by the absence of disease recurrences.

Introduction. Basal cell carcinoma represents one of the most common malignant skin tumours. This malignant skin neoplasm is characterised by slow growth and a weak tendency to metastasis, although the fatal outcome with an aggressive tumour growth is also possible. On the example of a clinical case, an analysis of diagnostic errors regarding this disease was carried out.

Case Description. Patient B., 67 years old, sought medical assistance in the Republican Dermatovenerologic Dispensary with complaints of a lesion on the nasal dorsum. The anamnesis indicated that the patient initially turned to a dermatologist at the place of residence, who prescribed a combined dermatic treatment containing a topical corticosteroid. Due to the lack of dynamics, the patient suggested a neoplasm and sought medical assistance from an oncologist at his place of residence. After excluding oncological pathology, the oncologist recommended observation and treatment by a dermatologist.

Results and discussion. Repeatedly, the patient requested medical assistance only after a year and a half with complaints of an increase in the lesion on the nasal dorsum, the appearance of black crusts and bleeding. The results of a dermatoscopic examination demonstrated the absence of a pigment network, thus confirming the tumour process of non-melanocytic skin lesion. Based on the data of the clinical examination and histological examination of the tumour biopsy, the assumption was confirmed and the diagnosis of st. I T1N0M0 gr. III nasal skin cancer, was made. Under the conditions of the Republican Dermatovenerologic Dispensary, the patient underwent X-ray therapy according to the radical program in 5 days a week by the Xstrahl-300 (0545) instrument with the single and summary tumour doses on the area of the nasal skin tumour equal to 400 and 4000 cGy, respectively. Positive dynamics was noted (the lesion focus was epithelised) and the patient is currently under the supervision of an oncologist at the place of residence.

Conclusions. The lack of proper examination by a dermatologist and oncologist at the place of residence contributed to the progression and growth of a malignant neoplasm in the patient. The diagnostic significance of the dermatoscopic method in the early stages of the malignant tumour process is substantiated.

Introduction. The performance of interventional procedures on carotid and sometimes coronary arteries through radial access remains to be a challenging task. The presence of a. lusoria (a. l.) is an example of the complex anatomy of the aortic arch and its branches, which is considered to be a contraindication for interventions on the coronary and carotid arteries through radial access. In this study, an analysis of the intervention strategy for combined atherosclerotic lesions of the carotid and coronary arteries was carried out using a clinical case of a. l.

Materials and methods. Patient K., 56 years old, with multifocal atherosclerosis. Control angiography revealed an abnormal aortic arch with abnormal branches. The atherosclerotic lesions included a chronic occlusion of the right coronary artery (RCA) in the proximal segment with a significant stenosis of the right internal carotid artery.

Results and discussion. Given the significant difficulties in catheterising the right common carotid artery through a.l., it was decided to catheterise the left radial artery distally. To achieve reliable support of the guiding catheter, the Claret technique was used. To that end, a JR 7.5F (ASAHI) guiding catheter was remodeled into a Simmons catheter. To facilitate the selective catheterisation of the right common carotid artery, a Pigtail 5F diagnostic catheter was used as an extension (mother-child technique). The presented strategy enabled a successful catheterisation of the right common carotid artery, eventually allowing passing all the necessary instruments through the guiding catheter into the internal carotid artery to perform the intervention. The second stage was the recanalisation of a chronic occlusion of the right coronary artery. For RCA catheterisation, the left radial artery was chosen. A JFR 6F Adroit (Cordis) guiding catheter proved to be the most convenient. With its proper support, the RKA was re-canalised using a Gaia Third coronary guide (ASAHI). In order to determine the position of the guide in the RCA distal part, a contrasting was performed from the LCA system. After the RCA re-canalisation, stents with an antiproliferative coating were implanted with a good angiographic result.

Conclusion. The described clinical case and technical solutions allow endovascular care through radial access to be provided to patients with abnormalities of the aortic arch.

This review article discusses important issues concerned with the epidemiology, classification and diagnosis of such widespread malignant skin neoplasms, as melanoma, basal cell carcinoma and squamous cell carcinoma. The relevance of these aspects is associated not only with a rapid increase in the incidence of malignant skin neoplasms, but also with the emergence of new, more accurate, methods for diagnosing such conditions. The use of non-invasive diagnostic tools can increase the accuracy of clinical diagnosis, thus allowing malignant skin tumours to be detected at early stages and the number of unreasonable surgical interventions to be reduced. A belated diagnosis of malignant skin tumours causes diagnostic errors and inadequate management tactics for patients with skin neoplasms. In this regard, timely identification of skin neoplasms should be treated as an interdisciplinary problem, the solution of which requires joint efforts of various medical specialists. The importance of correcting the existing classifications of malignant skin neoplasms and pre-cancers is highlighted, along with the development of regulations for their timely diagnosis and treatment.

The establishment of oncology as a discipline in Russia should be considered taking into account the specifics of national history, as well as key historical events. In 2020, Russia celebrates the 75th anniversary of Victory in the Great Patriotic War (World Was II). Russian oncology also celebrates its 75th anniversary. April 30, 1945 is considered the birthday of the Russian oncological service connected with the publication of a historical resolution of the Council of People’s Commissars of the USSR No. 935 “On measures to improve oncological care to population.”

In pre-revolutionary Russia, oncological care had the character of a private initiative, rather than a well-organised process. The tsarist government did not bear responsibility for organising the fight against cancer. The Great October Socialist Revolution contributed to the organisation of the fight against malignant neoplasms at the state level, based on the decisions of party congresses and healthcare laws. This created favourable conditions for improving and expanding anticancer care to the population. Soviet scientists-enthusiasts made a significant contribution to the development of oncology in the USSR. The organisation of medical professional societies facilitated the determination of main directions in the development of oncology as a discipline in the country. By the beginning of World War II, oncology in the USSR had acquired the character of an oncological care system, implementing measures aimed at developing and transferring into clinical practice early detection methods and those of treating malignant tumours, as well as their prevention. By the beginning of World War II, this system had comprised a large number of oncological dispensaries, located in almost all the republics of the Soviet Union. However, at that moment, there was still no unity in the creation of practical oncological institutions. Neither was practiced the registration of cancer cases, their account and observation, which measures are necessary for the prevention and early diagnosis of malignant tumours and precancerous diseases.