The article presents a literature review of modern techniques for laboratory and topical diagnostics of adrenal neoplasms. The advantages and disadvantages of different methods for determining hormonal activity of adrenal gland neoplasms, as well as the results and significance for visualization diagnostic techniques of adrenal glands are discussed.

The article presents a three-year clinical observation of 48 patients where the role of diabetes mellitus in the development of mediastinitis and instability of the sternum in cardiosurgical patients who have undergone complete median sternotomy is established. It is concluded that in patients with diabetes, osteopenic syndrome, which leads to the predominance of bone resorption processes over the processes of bone formation. The aim of the research: establish the role of diabetes in the development of mediastinitis and instability of the sternum in cardiac patients who underwent complete median sternotomy. Material and methods: During the period from 2015 to 2017, 1275 patients with various cardiovascular pathologies were operated through the sternotomy access in the cardiac surgical department of the Federal Center for Cardiovascular Surgery in Krasnoyarsk. In 48 (3.7%) of them, the postoperative period was complicated by sternomediastinitis. In 32 (66%) patients, diastasis of only soft tissues was diagnosed, and in 16 (34%) diastasis of soft tissues and ster- num was diagnosed. Among them, women were 38 (80%), men 10 (20%). The age of the patients was as follows: 60-69 years - 30 (62.5%) patients, older than 70 years - 15 (31%) patients. Thus, the majority of patients exceeded the age of 60 years. The results of the study: All patients with unstable sternotomy wound had accompanying diseases. They were distributed as follows: type 2 diabetes mel- litus -12 (25%), chronic obstructive pulmonary disease (COPD) - 8 (16%), dyscirculatory encephalopathy - 18 (37%), obesity + diabetes mellitus - 8 (16%) patients, repeated access - 3 (6%) patients. Thus, 20 (41%) of the 48 patients who developed sternomediastinitis in the postoperative period suffered from diabetes mellitus of varying severity. Conclusion: Strotonediastinitis developed in 3.5% of cardiosurgical patients after complete median sternotomy. 41% of patients with mediastinitis had type 2 diabetes. Thus, against the background of diabetes mellitus develops an osteopenic syndrome, which leads to insufficiency of the sternum. Changes in bone mineral density appear locally in the area of the surgical intervention on the sternum. This is due to the prevalence of bone resorption processes, whereas bone formation remains at the same level. As an additional method of diagnosing diabetic osteopenia in cardiosurgical patients, it is necessary to use the definition of enzymes for bone formation and bone resorption.

The authors compared the results of treatment of patients who underwent herniography and component separation. Purpose: to evaluate the nature of complications and quality of life of patients after anterior and posterior component separation. Methods: in our study was included 91 patients. The patients were divided into 2 groups. We describes the characteristics of the patients, early complications according the classification of Clavien-Dindo, late postoperative complications. The quality of life assessment was carried out in 3, 6, 12 months and then annually. In study was used 2 questionnaire: SF-36 and euraHS QLS. Results: in patients after anterior component separation the number of complications from postoperative wounds, both in the early and late postoperative period was greater than in patients undergoing posterior component separation. According to the euraHS quality of Life score and SF-36 questionnaires in women in both groups, the quality of life indicators improve faster than in men.

Inflammatory response is the systemic response of the body to damage. In the event of inflammation, first of all, there are changes in the meta- bolic processes, which are reflected in the blood indicators. C-reactive protein, one of the possible markers of inflammation, has several advantages: it is a convenient, fast, accurate and cheap marker of inflammation. In this regard, it is easy to apply in a surgical hospital for the diagnosis of most inflammatory diseases.

The work was carried out to determine the prospects for the use of videotoracoscopy (VTS) and videolaparoscopy (VLS) in the diagnosis and treatment of victims with large trauma. The article presents the results of management of 456 cases with a closed combined trauma of the chest and abdo- men, who were treated in the Ivanovo regional clinical hospital. The cases in the control groups demonstrate a tactic with the traditional approach, based on the use of non-invasive diagnostics and open surgery without taking into account the morphology and severity of injuries. The general samples show the ex- perience of videotoracoscopy and videolaparoscopy application for diagnosis and simultaneous surgical correction of identified pathology, including their consistent sequenced use. After a comparative observation, the indications for videotoracoscopy and videolaparoscopy, depending on the presence and severity of shock, as well as indications for a one-time minimally invasive intervention, depending on the video audit data, are proposed. Minimally invasive technologies in 2/3 of the victims were the comprehensive type of intervention. At the same time, low traumaticity and shortened time of videoendoscopic operations are indispensable in cases of traumatic shock. An approximate tac-tical algorithm based on the active use of endovideosurgical technologies in patients with combined trauma is presented.

Introduction: We can’t cure choledocholithiasis endoscopically often and we have problem with choice of treatment - laparoscopic or laparotomic choledo-chotomy. Goal is development a treatment algorithm and analysis of treatment patients with choledocholithiasis.Materials and methods: patients with choledocholithiasis and/or with stenotic duodenal papillitis (weren’t treatment endoscopic) were separated into two statistically homogeneous groups. Main group (n=47) - patients operated laparoscopically and control group (n=50) patients operated laparatomicically. Results: In main group was done suproduodenal choledochotomy and sanitation of choledochus. In 29 cases was done choledochoscopy with lithoextrac- tion by instruments. For 7 patients was done antegrade papillosphincterotomy. After rebuildability hepatitis was done choledochography with drainage by Holsted-Pikovsky or was done choledochoduodenostomy.In main group operation was continued about 101,26±19,81 min, In control group about 96,8±14,25 min. Level of pain by ten-point scale surgery after 6 hours in main group was 2,51±2,13, in control group was 3,04±1,85 (p<0,05). Narcotic analgesics received 2 patients in main group and 41 patients of control group. At the first day in main group dose of narcotic analgesic was 0,45±0,93 mg and in control group was 8,11±4,62 mg. Slight postoperative com- plications (classification by Clavien-Dindo) noticed at 17 patients of main group and at 24 patients of control group. Complications of the second degree noticed at 3 patients of control group. Complications of the third a (3 a) degree noticed at 1 patient of main group. In each group noticed 1 case insolvency of holedohoduodenoanastomosis which were operated successfully again.Conclusion: The proposed algorithm showed efficiency and safety. Laparoscopic surgery at patients with choledocholithiasis and/or with stenotic duodenal papillitis are surgery of choice.

640 patients of dispensary groups were interviewed. The questionnaire included direct, clarifying and checking questions. The satisfaction of the patients of dispensary groups on direct questions is high, only 1.3% are rarely satisfied with medical care and 6.3% are rather dissatisfied with dispensary supervision. The answers to the clarifying questions in general show the high availability of medical care: only 5% of respondents indicated the difficulty of recording at the reception. Timely information of patients was revealed: 63.7% indicated that they were informed on the current reception about the date of the upcoming visit and 55% - about notification when they missed the planned visit. Revealed good interaction with the doctor: 78.7% of respondents indicated that the attending physician always explains the prescribed scheme of diagnosis and treatment, and 62.4% always discuss the planned results of treatment. Checking questions made it possible to establish that a third of the respondents did not know that they were on dispensary observation, of which 31.3% were not aware of a specialist who was carrying out dispensary follow-up, and 25% did not know the disease, about which they are on dispensary registration.

Critical ischemia of the lower extremities is an extremely low circulatory state in the limb that develops in the finals of obliterating arterial diseases and leads to constant patient suffering and, ultimately, to limb loss if blood flow is not restored.An effective means of arresting critical ischemia is to improve blood circulation with balloon angioplasty and stenting of the arteries. This operation can be performed with a positive effect in most patients. However, the effect of angioplasty of the arteries of the shin remains short and after 6-24 months a signifi- cant portion of the angioplasty undergoes reocclusion. In this case, repeated interventions or a shunt are required. In this study, a review of the literature on the successful treatment of CINC was conducted.

Treatment of hernia by the method of Dr. Koss is used in cases where conventional physiotherapy exercises are already late and therefore ineffec- tive and surgery is inevitable. This can sometimes be the consequence of the rupture of the fibrous ring, when self healing is unrealistic.After the classical surgical operation, the disc herniation is formed in adjacent vertebral segments, where previously there were disc protrusion. The true relapse after removal of the disc intervertebral herniation is considered to be the recurrence of herniation at the same level that there are more than 80% of cases from the total number of operations. The reason for the recurrence of hernia is the inability to completely remove the entire affected disc. The contin- ued load on the resected disc leads to degeneration of the remaining non-removed parts of the disc and the re-more significant loss of the pulpous nucleus in the spinal canal. For example, if the intervertebral hernia before surgery at the lumbar level was 8-9 mm in size, then the recurrence of the hernia due to a postoperative defect of the fibrous ring will be more impressive in size and most often with the formation of a sequestered hernia.In other words, a possible relapse can only be due to surgery, but if you consider the treatment in the way of Dr. Koss, when all manipulations are only minimally invasive treatment, the risk of a “true relapse” is extremely unlikely.

Bladder cancer worldwide tends to rise and ranks ninth among all malignant tumors, 7th in terms of incidence among men and 17 among women, and 14th among the leading causes of death from cancer. In Kyrgyzstan, this indicator is significantly lower (1.4% of cases per 100 thousand inhab- itants), since this is an edge with environmentally favorable factors, where almost 97% are occupied by mountain ranges. The article presents an analysis of statistical data on the dynamics of the incidence of bladder cancer in the Kyrgyz Republic over the past 60 years based on medical documents on cancer patients. The authors found that during certain periods there are significant differences in the incidence rate depending on the national composition of the population of the republic, which is due to migration (1956-1970) and the re-emigration (1990-1993) of a significant part of the adult population of Russia.

According to modern authors, at present there is an annual increase in the incidence of diseases associated with occlusive-stenotic lesions of the arteries of the lower extremities. This pathology in recent years is one of the most common in the structure of morbidity. According to modern literary sources, about 3% of the world’s population aged 40 to 60 years have atherosclerotic lesions of the arteries of the lower extremities. Among persons older than 70 years, this indicator increases to 20% [1, 2]. The constant increase in the prevalence of lesions of peripheral arteries is constantly increasing, which is associated with an increase in the incidence of diseases of the cardiovascular system, and obesity and diabetes. [3, 4]. Thus, solving the problem of develop- ing optimal tactics for surgical treatment of patients with lesions of the arteries of the lower limbs is one of the highest priorities for modern vascular surgery.

The authors analyzed age and sex differences of erythrocyte, leukocyte and thrombocyte blood parameters. Studied 19 parameters of blood, which allowed details to identify the features of the blood parameters. It was found that at the age from 18 to 60 years the average indicators of the total number of platelets are higher in women, unlike men.

Occlusion-stenotic lesions of the arteries (OSPANK) are the main cause of the development of critical ischemia of the lower extremities due to the progressive severe damage to the arterial bed, which results in the failure of hemodynamic and metabolic mechanisms to compensate for the damaging effect of circulatory hypoxia on the tissues of the distal limb.According to modern authors, critical ischemia against the background of progression of atherosclerotic lesions of the lower limbs occurs with a frequency of 50-100 cases per 100 thousand population in North America and europe. At the same time, in almost 25% of patients with OSPANK there is a need for limb amputation. The prevalence and severity of the OSPANK, first of all, affects the age composition of the population. The highest prevalence of OSPANK was noted among patients older than 70 years.

The paper presents an analysis of management functions in a medical organization. The insufficient level of functioning of separate divisions of the medical organization in connection with insufficiency of accomplishment of technology regulations is revealed. Ways of optimization of a situation are presented.