A polyp is a benign epithelial tumor, which is a mass on a pedicle or broad base that rises above the mucous membrane. The aim of the work was to study the molecular genetic mechanisms of the pathogenesis of rectal polyps. The study was carried out theoretically, through the analysis of scientific articles related to the pathogenesis of colon polyps, published in the latest issues of well-known scientific journals. As a result of the study, it was established that in the pathogenesis of rectal polyps, 2 main mechanisms can be distinguished: chromosomal instability and microsatellite instability. Chromosomal instability (CIN) is a pathogenetic pathway, the implementation of which consists in a violation of suppressive mechanisms. This pathway of carcinogenesis includes both activation and inactivation of the following genes: APC, KRAS, BRAF, SMAD2 / 4 (DCC), p53. The second mechanism for the development of rectal polyps is associated with the development of microsatellite instability. Microsatellite instability (MSI) is a phenotype characterized by an increased likelihood of mutations occurring as a result of disruption of the unpaired DNA base repair system. The following genes belong to the repair system: MSH2, MSH6, MSH3, MLH1, PMS2. This mechanism is associated with the inactivation of genes of the DNA repair system (MisMatch Repair system - MMR). Thus, the development of rectal polyps is a multistage polyetiological process, in the development of which a number of genes play a primary role, mutations of which lead to the accumulation of these deviations, the differentiation of epithelial cells.

Полипы толстой кишки представляют собой облигатное предраковое заболевание, в связи с чем диагностика и своевременное лечение данных доброкачественных новообразований является актуальной проблемой современной колопроктологии [1, 2, 3].

The article describes the observation of a clinical case of a combination of echinococcal lung and liver cysts in a patient born in 1961. Brief information is given on the features of etiology, pathogenesis, clinical features, differential diagnosis and treatment of this pathology, according to modern literature data. The study of the given clinical case indicates that multispiral computed tomography with contrast makes it possible to differentiate echinococcal cysts with a high degree of accuracy. The two-stage method of surgical treatment of combined lesions of echinococcal cysts of the lungs and liver by video-assisted resection of the lower lobe of the right lung and subsequent laparoscopic resection of the liver with an interval of three months during treatment with ambendazole is characterized by a high degree of radicalism and rehabilitation potential.

Полипы толстой кишки относятся к доброкачественным опухолевым образованиям, которые являются предраковыми заболеваниями. В большинстве случаев именно полипы толстой кишки, малигнизация которых занимает около 8-10 лет, приводят в последствии к развитию колоректального рака [1, 3]. Диагностическая трудность полипов толстой кишки заключается в том, что данное заболевание, зачастую, протекает бессимптомно [2. 3]. Очевидно, что снижение заболеваемости колоректальным раком обусловлено своевременным выявлением и удалением доброкачественных полипов. Поэтому исследование данной патологии актуально для современной медицины [1, 2, 3].

Согласно современным научным данным колоректальный рак является одним из самых распространенных онкологических заболеваний. Основную группу риска, по данному заболеванию, образуют пациенты старше 55 лет. Наблюдается достоверная тенденция роста заболеваемости относительно молодого населения [1, 4]. В большинстве случаев, появлению злокачественной опухоли предшествует накопление мутаций в клетках эпителия толстой кишки, что морфологически проявляется доброкачественной опухолью – полипом, которая клинически протекает бессимптомно [1, 2, 3]. По данным многих исследователей, риск развития

The classical approach to radical surgery of cancer of the lower rectal ampulla requires abdominoperineal resection which is technically easy to perform and is often applied in surgical units, however the procedure leads to life-long disability. The aim of the present research was to justify performing abdominoperineal resection for low rectal carcinoma (less than 5 cm from the dentate line). The research showed that the given procedure is a highly radical surgery requiring ten postoperative months for complete rehabilitation.

The classical approach to radical surgery of cancer of the lower rectal ampulla requires abdominoperineal resection which is technically easy to perform and is often applied in surgical units, however the procedure leads to life-long disability. The aim of the present research was to justify performing abdominoperineal resection for low rectal carcinoma (less than 5 cm from the dentate line). The research showed that the given procedure is a highly radical surgery requiring ten postoperative months for complete rehabilitation.

в статье представлен клинический случай сочетанной патологии нейрогенной медиастинальной доброкачественной опухоли с кистой перикарда. приводятся краткие сведения об этиологии и патогенезе данных заболеваний. в качестве примера использованы статистические данные клиник по частоте встречаемости нейрогенных опухолей средостения и кист перикарда среди различных возрастных групп. описаны особенности клинико-рентгенологической картины и этапы диагностического поиска. обосновывается выполнение торакоскопического удаления опухоли средостения и кисты перикарда в качестве эффективного хирургического лечения. литературные источники, а также собственное практическое наблюдение показали, что сочетание доброкачественной нейрогенной опухоли средостения с кистой перикарда – редкая патология с неспецифической симптоматикой, для которой характерны трудности в диагностическом процессе. высокая точность дифференциальной диагностики с онкологической патологией может быть достигнута посредством пункционной биопсии. в результате наблюдения и анализа литературных источников установлено, что торакоскопическое удаление кисты и опухоли с резекцией легкого или без него является приоритетным с точки зрения эффективной диагностики и обосновано в качестве малоинвазивного и эффективного хирургического лечения данной патологии. Ключевые слова: нейрофиброма средостения, киста перикарда, пункционная биопсия, торакоскопия, резекция легкого, удаление кисты

Objective. To develop a new way to enhance single-layer colonic anastomosis with oksitselanim tissue and to assess its effectiveness in comparison with anastomosis, reinforced by latex tissue adhesive (LTA). Material and methods. The study was performed on 48 white mongrel male rats. Both the groups underwent intersection of the colon with subsequent formation of anastomosis in an «end-to-end» single-row Pirogov-Mateshuk suture that in the control group was strengthened by latex tissue adhesive, and in the experimental group by oksitselanim tissue. The derivation of the experiment was carried out on 3, 7, 14, 30 days. Such parameters of blood as wbc, phagocytic index, phagocytic number, the level of circulating immune complexes, the activity of complement were studied. The swab was taken from the anastomosis zone for bacteriological examination. The presence of effusion, adhesions, abscess, anastomotic narrowing, expansion of the leading department were macroscopically evaluated. The mechanical strength of the anastomosis was determined by pneumohydropression method. The area of tanastomosis was taken for histological examination. Results. The comparison of the morphological patterns of the abdominal cavity, the results of microscopic and bacteriological study suggests a lower expression of local inflammatory changes and bacterial permeability of colonic anastomoses reinforced with «oksitselanim» tissue. The mechanical strength of anastomoses in the experimental group exceeds those in the control group. The comparative analysis of leukocyte counts, phagocytosis, levels of circulating immune complexes and complement activity suggests a more rapid and less intense non-specific inflammatory response in the experimental group. Conclusion. The «oksitselanim» preparation makes it possible to prevent quickly the development of infectious complications with minimal response of the body and provide better conditions for the tissue regeneration after the formation of intestinal anastomosis.

Obtaining of some pharmacoepidemiological data, including the list and the rate of out–patient use of diuretics and some other (including «traditional») hypotensive drugs employed in treatment of arterial hypertension (AH) was the goal of the present work in the first stage. For this purpose the retrospective analysis of 664 out–patient case histories (Grodno, Kobrin, Shchuchin) and the results of the questioning of 118 doctors of polyclinics (Grodno, Gomel, Zhlobin) has been carried out. It has been revealed, that only four drugs from the group of diuretics were used: furosemide, hydrochlorothiazide, spironolactone and indapamide. The tendency of increase in quantity of the patients receiving diuretics in AH has been revealed. The essential drawbacks of pharmacotherapy however remain: 1) preference of furosemide by some doctors (probably because of its cheapness); 2) use of spironolactone for monotherapy; 3) insufficient use of modern drugs (indapamide); 4) administration of low doses of diuretics. The use of so–called «traditional» antihypertensive drugs remains rather high. In the second stage of the investigation the received list of preparations has been estimated by means of the standard pharmacoeconomic technique of «cost–minimization analysis». It has been revealed, that the most economically grounded treatment is treatment of AH with hydrochlorothiazide diuretics and with Adelphane — Esidrex as a «traditional» antihypertensive drug and treatment of hypertensive crises with clonidine.

The pharmacotherapy is one of the most fast-growing areas of the public health into services, requiring more and more material resources. Due to this introduction of pharmacoeconomic criteria into daily clinical practice for optimization of medical treatment is actual. It is natural, that economic benefit of similar actions is most notable in treatment of the most common illnesses, for example, arterial hypertension (AH). In the present work the analysis of treatment of AH with using ACE inhibitors from the point of view of the method of “cost-minimization analysis” is undertaken. For this purpose the retrospective researche of out-patient’s cards of 532 patients receiving out-patient antihypertensive treatment in 4 medical institutions of Grodno and Kobrin as well as the analysis of 64 questionnaires of doctors from 4 out-patient hospitals of Grodno and 54 doctors from 3 out-patient hospitals of Gomel and Zhlobin was carried out. The actual leader among ACE inhibitors (as well as among all others hypotensive remedies), is medical preparations of enalapril. By method of “cost-minimization analysis” it has been established that treatment with enalapril preparations (excluding invoril and renitec) is the least expensive. Avantage in the cost of AH treatment course possess: enalapril (Belarus production), enalapril (Maxpharma/Intas) and enan LM.