Chronic venous disease of lower extremities is a common vascular problem in the developed countries. The aim of our study was to explore a potency of ambulatory selective varicose vein ablation under local anesthesia (ASVAL) without vein stripping. ASVAL method was carried out in 12 patients. All patients had reflux of great saphenous vein verified by duplex ultrasound before surgical treatment. Exclusion criteria were reflux of small saphenous vein, reflux of perforator veins and clinical class 4-6 by classification CEAP. Design of the study was series cases. Follow-up time lasted one year. The surgery was performed by tumescent anesthesia of 0.01% Lidocain. All patients were given Diclofenac 100 mg for one postoperative day. In all patients we observed decrease of size or disappearance of great saphenous vein reflux verified by duplex ultrasound. No recurrence of varicose veins for one year was detected.

Recently gastroesophageal reflux disease (GERD) was associated only with reflux-esophagitis and appeared to be a harmless disease with the most frequently noted symptom - heartburn. However, prolonged gastroesophageal reflux often provokes attacks of bronchial asthma, ischemic heart disease, is the cause of severe caries, repeated pneumonia and even cancer of the larynx. Terrible complications of GERD are ulcers of the esophagus with blood loss of various degrees, as well as stricture of the esophagus. It is with the widespread prevalence of GERD and its complications (in particular, Barrett's esophagus) that some authors associate an increase in the incidence of adenocarcinoma of the distal esophagus (up to 50 %) among all cases of esophageal cancer. In addition, according to some authors, GERD contributes to the occurrence of laryngeal cancer. Previously, GERD was understood as peptic or terminal esophagitis, but it is known that in more than 50 % of patients with reflux symptoms there is no visible lesion of the esophageal mucosa. It was found that with duodeno-gastral reflux, against a background of decreased acid formation in combination with anthropyloroduodenal dyskinesia, the alkaline contents of the duodenum affect the mucosa of the esophagus. Inflammatory-destructive changes in the mucous membrane of the esophagus may be more pronounced than caused by acid aggression. An important clinical fact is their resistance to conventional therapy. Part of patients with GERD have expressed motor disorders of the esophagus. Obviously, the existing motor disorders lead to the development of GERD, and subsequently, as a result of the direct effect of the inflammatory process on the nerve plexuses in the wall of the esophagus, motor dysfunction is aggravated.

Chronic venous disease of lower extremities is a common vascular problem in the developed countries. The aim of our study was to explore a potency of ambulatory selective varicose vein ablation under local anesthesia (ASVAL) without vein stripping. ASVAL method was carried out in 12 patients. All patients had reflux of great saphenous vein verified by duplex ultrasound before surgical treatment. Exclusion criteria were reflux of small saphenous vein, reflux of perforator veins and clinical class 4-6 by classification CEAP. Design of the study was series cases. Follow-up time lasted one year. The surgery was performed by tumescent anesthesia of 0.01% Lidocain. All patients were given Diclofenac 100 mg for one postoperative day. In all patients we observed decrease of size or disappearance of great saphenous vein reflux verified by duplex ultrasound. No recurrence of varicose veins for one year was detected.

Описан клинический случай эндогенного гиперкортицизма у 18-летнего пациента с синдромом Иценко Кушинга, обусловленным кортикостеромой левого надпочечника. Выполнена лапароскопическая адреналэктомия. Исследование препарата выявило пигментную нодулярную дисплазию надпочечника. Отмечен регресс симптомов гиперкортицизма, отсутствие рецидива в течение 2 лет наблюдения. Ретроспективный анализ выявил редкое наследственное заболевание Карни-комплекс. Адреналэктомия оказалась эффективной, но вероятность рецидива сохраняется.

We described a case of an endogenous hypercorticism in 18-years old patient with Itsenko - Cushing syndrome which was caused by a hormonally active adrenal tumor of the left adrenal gland. In a clinical picture of a disease the following symptoms dominated: arterial hypertension, increase in body weight, adiposity of the trunk, hands, neck, face, strips of extensions of skin on femurs. We found multiple nevus pigmentosus of black, yellowy-brown color from 1.5 to 10 mm on lips and mucous of a mouth, skin of a face and a trunk. The hormonal research established violations of a circadian rhythm of a hydrocortisone, increase in the free hydrocortisone of blood to 749.0 nmol/24 h (reference range 123.0-626.0), urine to 1314.0 nmol/24 h (reference range 60.0-413.0). The ACTH level decreased to 1.7 pg/ml (reference range 7.0-66.0). The negative result of the night overwhelming test with Dexamethazonum is received. Muitislice CT of adrenal glands revealed signs of a nodular hyperplasia of the left-hand adrenal gland. The laparoscopic adrenalectomy is made at the left. Pathoanathomical conclusion: a nodular pigmental hyperplasia of a glomerular and fascicular zone of bark of an adrenal gland with inclusion of a miyelolipomatoz. In the nodular corticocytes inclusions of lipofuscin granules were found. In the postoperative period symptoms of a hypercorticoidism regressed, throughout two years of observation there is no recurrence. Monitoring of hormones of blood in six months: hydrocortisone 359.5 nmol/l, ACTH 7.02 pg/ml. Retrospectively, the patient displays an infrequent heritable disease - Carney complex. The patient's mother at the age of 32 years underwent left-side adrenalectomy concerning Itsenko - Cushing disease with morphological confirmation of a nodular pigmental hyperplasia in adrenal gland. In both cases clinical convalescence occurred. Interest of the presented observation consists in its exclusive rarity. The unilateral adrenalectomy was efficient, but the probability of a recurrence of a hypercorticoidism and other manifestations of Carney complex remains.

Methods. The study enrolled patients with postoperative ventral hernias (n=157). Standard IC-plasty was performed in 81 patients, comprising the group of clinical comparison (CCG). The advanced version of the mentioned afore surgery was performed in 76 patients. These patients formed the main group (MG). Results. It was established that in early terms the postoperative complications occurred after the operation in 7 (8,6%) patients in the CCG. Seromas formed in 2 (2,6%) patients from MG which were accessible for puncture. A single case of suppuration was registered in CCG. Thus, the using of less traumatic version of IC-plasty is claimed to be associated with less recurrence and complication rate. In early terms more extensive and long pain manifestations had been registered after the surgery in CCG in comparing with MG. In 5 cases the specific pain was registered in the sites of strips conducting formed at the edges of a polypropylene mesh through the muscle-aponeurotic tissues in CCG. There were no similar cases and fatal outcomes in MG. In terms from 1-3,5 years period surgery outcomes were studied in 73 (MG) and in 75 (CCG) patients. One recurrence in CCG without any delayed complications was observed. In later periods after the intervention no recurrences and complications were registered. Conclusion. IC-plasty being an effective treatment method in case of postoperative ventral hernia has been evolved over the period of years. Technological advances of IC-plasty have been demonstrated to be favorably affected on the outcomes of the operation and the incisional period. To reduce the number of foreign material inserted into the human body in comparision with standard IC-plasty is also important.

IC-ПЛАСТИКА ПРИ ПОСЛЕОПЕРАЦИОННЫХ ВЕНТРАЛЬНЫХ ГРЫЖАХНУЗ «Дорожная клиническая больница на ст.Иркутск-Пассажирский» ОАО «РЖД» 1 , ГБОУ ДПО «Иркутская государственная медицинская академия последипломного образования» 2 , Российская Федерация Цель.Оценить эффективность усовершенствованного варианта IC-пластики.Материал и методы.Проведено исследование, в которое было включено 157 пациентов с послеоперационными вентральными грыжами.Стандартная IC-пластика выполнена у 81 пациента, они составили группу клинического сравнения (ГКС).Усовершенствованный вариант вышеуказанной операции использован в 76 случаях.Эти пациенты составили основную группу (ОГ

Acute mesenteric ischemia is one of the most severe pathological conditions in terms of its course and prognosis. In the case of bowel infarction it is accompanied by an extremely high fatality rate. At the present day, despite there are ways to determine the patency of the vascular bed of the intestine accurately, developed principles and methods for the treatment of surgical interventions in different variants of acute occlusion of mesenteric vessels, it is not always possible to save the lives of patients with this disease. However, knowledge of the clinical picture of the disease, the consistent implementation of objective methods of diagnosis, timely decision on the need for surgical treatment can restore blood flow in the basin of the superior mesenteric artery and provide recovery and rehabilitation of these patients.

НУЗ «Дорожная клиническая больница на ст.Иркутск-Пассажирский» ОАО «РЖД» 1 , ГБОУ ДПО «Иркутская государственная медицинская академия последипломного образования» 2 , Российская Федерация Цель.Провести сравнительный анализ результатов операции I.L. Lichtenstein и CS-пластики при паховых грыжах.Материал и методы.Проведено исследование, в которое было включено 172 пациента.Операция I.L. Lichtenstein выполнена у 88 пациентов, которые составили группу клинического сравнения (ГКС).По предложенной нами методике «combined seam» (СS-пластика) прооперировано 84 пациента.Они составили основную группу (ОГ).Результаты.При выполнении герниопластики по I.L. Lichtenstein (ГКС) продолжительность оперативного вмешательства составила 50,2±13,2 мин, при использовании CS-пластики (ОГ

We present a clinical case of endogenous hypercortisolism. After examination, 18-year-old patient was diagnosed with Cushing's syndrome, presumably caused by corticosteroma of left adrenal gland. Left laparoscopic adrenalectomy was performed. Pathologohystological conclusion was adrenal pigmented nodular dysplasia. In postoperative period hypercortisolism symptoms regressed. During the 2-year lasting observation of patient no relapse was found. In retrospect, the patient revealed symptoms of a rare hereditary disease - Carney complex. The interest of submitted observation lies in its exceptional rarity. Unilateral adrenalectomy was effective, but the probability of recurrence of Cushing’s syndrome and other manifestations of Carney complex still exists.

The article presents an overview of domestic and foreign literature on the etiology, diagnosis and treatment of recurrent varicose veins. Two current classification schemes to assess the recurrence of varicose veins of the lower limbs, depending on the primary surgery: REVAS and PREVAIT have been proposed. Moreover the incidence of recurrence of varicose veins after different methods of eliminating of primary disease has been analyzed. The literature review summarizes the views of a number of foreign authors concerning the definition of the concept of «recurrence of varicose veins of the lower extremities». The conventional concepts and current hypotheses concerning the causes of this complication are presented. The significance of ultrasound duplex angioscanning leg veins as the best diagnostic method to identify accurately the main pathological and hemodynamic causes of disease recurrence has been highlighted. The feature of both classical and current correction methods of recurrent lower limb varicose veins is given in the review. The using of the combination of various non-surgical treatment techniques depending on the definite clinical situation allows increasing the modern high quality medical aid provided to such severe patients is demonstrated.