Achalasia cardiac (achalasia cardiac) is a disease of the esophagus, characterized by a loss of the neurons of the Auerbach’s plexus, a progressive de- crease in the tone of the tubular esophagus, leading to disruption of the peristalsis and reflex opening of the lower esophageal sphincter during swallowing. The etiology of achalasia cardiaс (AС) remains largely unknown and the theory of ganglionitis caused by an aberrant immune response to a viral infection explains the loss of esophageal neurons, especially in genetically predisposed individuals. As a result, the eaten food accumulates in the esophagus, which leads to symptoms of dysphagia, regurgitation, chest pain and weight loss and increases the risk of esophageal carcinoma. Currently, pneumatic dilatation and Geller’s esophagocardiomyotomy in conjunction with fundoplication are the most common methods of treating AС.

It is purulent -destructive complications of varying severity accompany from 30 to 80% of cases of severe acute pancreatitis (SAP). Lethality at SAP remains stable for several years and reaches 17-42% and at accession is purulent - destructive complications increases till 46-80%. It causes high interest in searching of the factors affecting on the course of pathological process and development of diagnostic and prognostic schemes. Research objective was development of a way of prediction of development is purulent - destructive complications of the II phase of the severe acute pan- creatitis (SAP) and assessment of diagnostic value of the offered way. Materials and methods: The basis of development of the offered way was formed by results of a research of 248 patients with severe acute pancreatitis, at 51 patients development was observed it is purulent - destructive complications in the II phase SAP.Carried out a computer angiography with bolus contrasting on the third week of a disease (14-21 days). Blood sampling for the developed analysis, defini- tions of integral hematological indexes and a blebbing of lymphocytes carried out also on the third week.On the basis of the obtained data the way of prediction of development was developed it is purulent - destructive complications in the II phase SAP. For approbation of the offered way the group of clinical observation of 72 patients SAP was created. Results: On the current of the II phase of severe acute pancreatitis the set of factors, including a condition of nonspecific immunity leukocytosis level, expressiveness of a lymphopenia, integral hematological indexes, activity of a blebbing of lymphocytes, damages of a pancreas and retroperitoneal space affects: visualization according to the KT-angiography of the devitalized tissues of a pancreas and a retroperitoneal fat, abundance of an inflammatory in- filtrate, and existence of vials of gas in a projection of liquid educations. Sensitivity of a way - 93,75%, specificity - 98,21%, accuracy - 97,22%, a prognostic significance of a positive take - 93,75%, a prognostic significance of the negative result - 98,21%. Conclusion: Prediction is purulent - the destructive processes is difficult a task.

Volatile fatty acids (VFA) are metabolites of facultative anaerobic and obligate anaerobic bacteria. The importance of anaerobic microflora and its metabolites for the diagnosis of pancreatic necrosis (PN) has not been sufficiently studied to date. The purpose of the study was to evaluate the informative value of the volatile fatty acid indicators for the diagnosis of PN. Materials and methods: The study included 35 patients with PN. After establishing the diagnosis of PN, 35 blood samples of patients with PN chroma- tography were studied. Analysis of the concentrations of VFA: acetic, propionic, oily and isovaleric by gas-liquid chromatography on an automated gas chromatograph “Crystallux-4000” with a capillary column “HP-FFAP” and a flame ionization detector. Results: Concentrations of acetic, propionic, butyric acids and the amount of VFA are higher, and the anaerobic index and the concentration of isovaleric acid in patients with PN are lower in comparison with those of practically healthy donors. The age of patients with PN of men was statistically significantly less in comparison with the age of patients with PN of women. The indicator of the amount of VFA of patients with PN of the age group from 21-35 years was statistically significantly higher in comparison with the index of the sum of the VFA of patients with PN of the age group of 36-54 years. The conclusion: The concentrations of volatile fatty acids in the blood are informative criteria for the diagnosis of PN. Patients with PN men were younger than in patients with PN women .

The article presents a detailed analysis of indicators of quality of life of patients who underwent anterior separation plastic surgery. The character- istics of patients, complications in the early and late postoperative period and their impact on the quality of life are described in detail. Life quality assess- ment was carried out with the help of a non-specific questionnaire MOS SF - 36 (Medical Outcomes Study the Short Form - 36) and a special questionnaire for patients with postoperative ventral hernias developed by eHS-euraHS Quality of Life score (eurahs QLS).

Aim: evaluation of the effectiveness of various methods of surgical treatment of wound tissue defects in diabetic foot syndrome, based on the principles of evidence-based medicine and taking into account clinically relevant phenomena - outcomes based on a mathematical model for assessing efficacy. Materials and methods: Patients with diabetic foot syndrome who had wound defects of soft tissues and skin corresponding to the Wagner 2-4 classification who were on treatment at the center of the “Diabetic Foot” of Kazan in 2016 were included in the study. The patients were divided into two groups according to the procedure for closing the wound defect. Results and their discussions: The results of the treatment were evaluated on the basis of clinically meaningful outcomes for patients: favorable and unfa- vorable, as well as various indicators of relative and absolute risks and benefits for various wound healing methods. The conclusion: The use of modern bioplastic materials «G-DeRM» in the treatment of ulcerative defects of the diabetic foot syndrome is most justified and contributes to the epithelization of defects and the reduction of clinical manifestations of the disease, which leads to favorable outcomes in 100% of cases. When the defect is closed with autodermoplasty using a split free skin flap or using interactive dressings, the incidence of adverse clinical outcome was 16%.

The possibility of using apparatus plasmapheresis in the treatment of patients with obliterating atherosclerosis of the lower extremities are discussed in the article. It is shown that patients, in the complex of treatment of which apparatus plasmapheresis was included, significantly more often demonstrated normalization of hemostatic parameters, normalization of functions, as well as positive dynamics of blood circulation in the lower ex- tremities in comparison with patients receiving traditional treatment. The obtained data allow to recommend apparatus plasmapheresis as an effective method of treatment of patients with obliterating atherosclerosis of the lower extremities.

The analysis of the state of systems of cellular and humoral immunity in patients with peritonitis caused by diseases and traumas of the upper urinary tract is carried out against the background of complex therapy with the use of polyoxidonium. Patients of the main group intraoperatively injected polyoxidonium into the root of the small intestine mesentery at a dose of 6 mg (regional lymphatic therapy), and in the postoperative period - lymphotropi- cally after 1 day and then for 7 days daily at a dose of 0.1 mg / kg. Against the background of the therapy, the restoration of cellular humoral immunity fac- tors occurs in a shorter time. Thus, the positive effect of regional and lymphotropic therapy with polyoxidonium on the parameters of cellular and humoral immunity in peritonitis has been confirmed.

Patients urolithic a disease make 30-40% of patients with urological pathology. At an urolithiasis the violations of an urodynamics contributing to the development of a secondary infection develop. Bacteriuria in the postoperative period it is observed at an overwhelming majority of the patients oper- ated concerning an urolithiasis, also frequent complication is development of pyelonephritis, and in 1-2% of cases at patients such terrible complication as an urosepsis and septic shock is observed Research objective was to define features of integral hematological indexes, biochemical blood test, bulk analysis of urine depending on the revealed infec- tious complications. The materials and methods: The 1240 patients operated concerning an urolithiasis, which were on treatment in Railway Clinical Hospital at the station Krasnoyarsk during the period from 2015 to 2017. Assessment of the studied parameters was carried out at the time of identification of the heaviest postoperative infectious complication. The following inte- gral hematological indexes calculated the leukocytic index of intoxication by reference formulas according to Ostrovsky (LII), the jet answer of neutrophils (JAN), the index of a ratio of lymphocytes to blood sedimentation rate (IRLBSR), the index of a ratio of lymphocytes to granulocytes (ISLG).Results: Among postoperative complications of infectious character development of a bacteriuria of-7,42±0,74% prevails. This complication is not followed by intoxication and decrease in a reactivity of an organism. At serous pyelonephritis the subcompensated intoxication against the background of a normal nonspecific reactivity is noted. And the expressed changes in the analysis of urine. Development of purulent process is followed by increase of intoxication and decrease in a reactivity. Conclusion: The decrease in a reactivity of an organism revealed by routine methods against the background of intoxication at development of infectious complications of the postoperative period of a urolithic disease demonstrates the prospects of further studying of immunologic mechanisms of a pathogen- esis of development of this pathology and searching of risk factors for prediction and prophylaxis.

The article presents non-typical cases from the practice of surgeons of the oncourologic department of the National Center of Oncology and Hematology of the Kyrgyz Republic. Also, mistakes in the diagnosis and treatment of surgical diseases, ways of their elimination, and rational approaches to the choice of treatment of pathology are described, depending on the situation that has arisen. In addition, the authors give an opportunity to study each described extraordinary case in more detail by providing a complete history of life and illness of patients, describing the course of treatment and the com- plications arising from operative and nonoperative methods of treatment. The article contains excerpts from serious clinical observation that will be useful for doctors of all surgical specialties, as well as family doctors and senior students of medical academies and medical faculties.

One of the urgent problems of modern gynecology is pelvic pain, frequency of which is high and the downward trend has not. Genital endome- triosis, particularly adenomyosis diagnosed in 70-90% of women with various symptoms of pelvic pain. The aim of the study was to improve the efficiency of treatment of pelvic pain associated with adenomyosis. Material and methods: Prospective study was conducted at the clinical bases of the Department of obstetrics and gynecology with course perinatologyRUDN- University in the period from October 2017 to May 2018. The study included 30 (n=30) patients of reproductive age with pelvic pain of severeintensity due to adenomyosis, verified on the basis of sonographic and magnetic resonance tomography study. The average age of the surveyed patients withpelvic pain associated with adenomyosis was 33,8 ±0,2 years. All patients were prescribed agonists - GnRH at the 3,75 mg 1 time a month for 3 months. The results of the study: The results showed that after 3 months of treatment of pain is preserved only in 2(6,7%) patients, while pain was of short duration and mild intensity. evaluation of effectiveness after 6 months from the start of treatment demonstrated that mild pain was observed in 6(20,0%) women. After 12 months, pain of low intensity disturbed 9(30,1%) patients and the average algological profile of the severity of the pain made of 0,065±0,02. Conclusion: Pathogenetically justified treatment of pelvic pain of severe intensity associated with adenomyosis should be considered as the application of agonists - GnRH, with the ability to inhibit the neurogenesis in the myometrium, as well as effectively reducing the severity of pain.

This article provides original method of portal hypertension control in patients with liver cirrhosis during endoscopic variceal ligation under moderate sedation. This method helps to lower the risk of variceal bleeding during the ligation.Clinical experience of combined perioperative arterial and venous pressure monitoring in 141 intervention group patients and in 12 control group patients with national surgical society premedication was analysed. All of these patients had portal hypertension of various etiology complicated by esophageal varices, which were treated by endoscopic ligation.Performance of endoscopic variceal ligation in patients with liver cirrhosis (class B and C) complicated by variceal bleeding under anesthesia with Harvard standard monitoring, endoscopic balloon esophagomanometry and additional controlled hypotension with nitroglycerin has provided better control over arterial and portal venous pressure and lowered postoperative bleeding rate from 33,6% to 1,9%.

Topical issues related to the features of etiopathogenesis, clinical picture, diagnosis, treatment and prevention of ascending gonorrhea are con- sidered. Analysis of literature data suggests that ascending gonorrhea is a consequence of late diagnosis of gonorrhea in the early stages, which requires massive complex therapy in both dermatovenereological and obstetrical practice. On the one hand, this is due to improper self-treatment, on the other hand - frequent asymptomatic course of the disease.

With the beginning of the production of surgical gloves, only powder coating was used.Powder is initially used to ease donning of the latex gloves whose surface is usually tacky if not treated. The production of powder-free examination glovesemerged in the late 1980s. The powder-free gloves were produced mainly via the chlorination process. Since 1999, Malaysian manufacturers have embarkedin mass production of polymer-coated, powder-free examination gloves.The polymer selected for polymer coating of rubber gloves must adhere well to the rubber film and provide good wet and dry donning properties and du-rability. It must be able to stretch as much as the rubber film and when it breaks it will not dislodge but still stick on the rubber film. Initially, the polymerused on the donning side of medical gloves was mainly polyurethanes which are generally more expensive and more difficult to process than acrylics. Later,the coating surface could either be blends of acrylics and polyurethane or acrylics alone.