The issue of the treatment of purulent-inflammatory conditions affecting the fingers is a significant one, given the high prevalence of such cases, with up to 1.5 million instances reported annually in our country. The results of surgical treatment are frequently unsatisfactory, particularly in regard to functional indices, even in cases of mild soft tissue injury. The primary determinant of successful whitlow treatment is adequate anaesthesia, which enables the performance of high-quality surgical wound treatment. OBJECTIVE:To conduct a comparative analysis of the efficacy of local anaesthetics (2% Novocain, 2% Lidocain and 2% solution of Artikain-Binergy) in conducting anaesthesia in accordance with the Oberst-Lukashevich technique for surgical treatment of patients with whitlow. MATERIAL AND METHODS:The retrospective observational study included 124 patients, of whom 83 (67%) were male and 41 (33%) were female, with an age range of 27 to 64 years. The patients were divided into three groups: the first group received 2% Novocaine (n=42), the second group received 2% Lidocaine solution (n=41), and the third group received 2% Articaine solution (n=41). The rapidity of onset of the analgesic effect (duration of latent period), its duration, and the absence of the need for repeated application of the drug were evaluated. RESULTS:For local anesthesia with articaine and lidocaine the same amount of drug was required - 2-3 ml, which is less than when using novocaine - 3-4 ml (p<0.05); articaine has the shortest latent period of 5-7 minutes, in contrast to lidocaine - 6-9 minutes and novocaine - 8-10 minutes (p<0.05); the duration of the analgesic effect of articaine is longer than that of lidocaine, novocaine - 3-3.5 hours, 0.83-1.33 hours and 0.58-0.66 hours, respectively (p<0.05); in the articaine group repeated anesthesia was not required either after 1 hour or after 2 hours. CONCLUSION:Articaine demonstrated the greatest efficacy as a local anaesthetic in the surgical treatment of whitlow. It has the shortest latency period, which facilitates manipulation. The prolonged analgesic effect with a reduced anaesthetic dose allows for surgical procedures to be conducted without the necessity for post-procedure analgesics.

In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, although theoretically the benefits of a sympathetic block are considered. Some sources recommend prophylactic sodium bicarbonate infusion to alleviate post-reperfusion syndrome, but its effectiveness is questionable. Purpose: to present the physiological, biochemical and hematological characteristics of recipients at the stages of orthotopic liver transplantation with an assessment of the feasibility of using sodium bicarbonate for the prevention of reperfusion complications. Materials and methods. An observational study, contains an analysis of data from 39 participants operated on in 2020 in the volume of: hepatectomy, an orthotopic liver transplantation, with an initial assessment on the Child- Turcott- Pugh scale of 11 points. All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three- component anesthesia according to the Breivik- Niemi method. There are 3 stages of data registration: the beginning of the anhepatic stage; the beginning of the neohepatic stage; the end of the operation. Results and discussion. Significant fluctuations in hemodynamics, violations of the acid-base state and energy metabolism were not revealed; a decrease in hepatic protein synthesis, a shift of the P50 point to the left, and moderate metabolic acidosis did not exceed the levels described in the literature. The dynamics of acidosis, РСО2 and natremia did not depend on the infusion of soda. There was no close correlation between arterial blood pH and lactate concentration. Conclusion. The benefits and safety of epidural anesthesia in orthotopic liver transplants are obvious and make it possible to recommend this component as a routine element of anesthesia during these operations. The indications for sodium bicarbonate infusion should be narrowed and consensus is needed to determine the critical pH value for sodium bicarbonate infusion.

ЦЕЛЬ ИССЛЕДОВАНИЯ Анализ результатов эндоскопической диагностики и лечения пациентов с опухолями трахеи. МАТЕРИАЛ И МЕТОДЫ За период с 2003 по 2020 г. 47 пациентам с опухолями трахеи (31 мужчина и 16 женщин) в возрасте от 16 до 78 лет (средний — 58,12±14,33 года) выполнены эндоскопические вмешательства. У 27 (57,4%) была вторичная опухоль трахеи (рак щитовидной железы, пищевода, легких, рецидивы опухолей гортани, пищевода и щитовидной железы). РЕЗУЛЬТАТЫ При доброкачественных (16) опухолях трахеи проведено удаление опухоли. У 35 пациентов с первичными или вторичными злокачественными опухолями трахеи выполнена установка стента (у 28 использованы полностью покрытые металлические стенты, у 7 — силиконовые стенты типа Dumon). У 26 пациентов установка металлических стентов проводилась при сочетании нейролептанальгезии и местной анестезии. Осложнений в процессе установки не было. Вмешательство было успешным во всех случаях. При использовании силиконовых стентов осложнений в послеоперационном периоде не отмечено. У 3 (10,7%) пациентов при использовании полностью покрытых металлических стентов произошла частичная дислокация стента вниз в течение первых 2 сут после вмешательства. Повторные стентирования по типу стент в стент выполнены 2 (7,1%) пациентам (одному трижды). Итого 28 пациентам проведена установка 32 металлических саморасправляющихся стентов. ЗАКЛЮЧЕНИЕ Интервенционные вмешательства при опухолях трахеи как радикального, так и паллиативного характера позволяют эффективно и относительно безопасно восстановить и поддерживать проходимость дыхательных путей. Способ воздействия на опухоль и вид устанавливаемого стента зависят от оснащения лечебного учреждения и предпочтения врача-эндоскописта. Установка металлических саморасправляющихся стентов является оптимальной, позволяет полностью контролировать процесс позиционирования и раскрытия стента и осуществлять вмешательство на спонтанном дыхании, что важно у пациентов со сдавлением трахеи извне.

Introduction. The prevalence of colorectal cancer in the world is increasing every year. In more than 40% of patients, the disease debuts with a clinical picture of acute intestinal obstruction, while in one third of cases the tumor is located in the right half of the colon. This leads to the necessity to perform colon resection or bypass surgery, the main stage of which is making entero- colic anastomosis. However, up to 15% of these anastomoses has a leakage. Development of methods of forming a reliable anastomosis is thus critical.Materials and methods. 37 patients with acute intestinal obstruction, divided into 2 groups (17 and 20 people), are included into the study. All of them, as a surgical stage of treatment, underwent a right hemicolectomy with the formation of an entero- colic anastomosis or a bypass surgery. A double-row side-to-side anastomosis was used in the comparison group, and a single-row “end-to-side” anastomosis in the main group (patent No. 2709253). The incidence of anastomotic leakage and mortality were assessed. Comparison was performed using Fisher’s exact test.Results. There were no cases of anastomotic leakage and mortality in the main group. In the comparison group, there were 5 leakages and 1 death.Discussion. When a modified entero-colic anastomosis is formed, adequate blood flow is maintained in the walls of the anastomosed intestinal loops, which contributes to adequate regeneration.Conclusion. The first clinical experience with the modified end-to-side entero- colic anastomosis is successful. It is planned to further recruit patients and study the features of the postoperative period.

The category of newborns with congenital malformations is considered the most difficult to treat. The influence of “stress”factors on the body in a short period of time triggers a pathogenetically determined chain reaction that leads to the development of multiple organ failure syndrome. The forecasting methodology determines the timeliness and directions of intensive care to approach and achieve positive results in this group of patients.The aim of the study: is to show the diagnostic and practical value of metabolic markers and functional indicators of homeokinesis in newborns with congenital malformations of the gastrointestinal tract.Materials and methods. An observational study of 81 patients in the neonatal period. The prognostic assessment of functional parameters and biochemical markers was performed by ROC analysis.Results. In newborns with malformations of the gastrointestinal tract, the course of the pre-and early postoperative period is associated with cardiopulmonary maladaptation, which requires the protection of vital functions. By the end of the first week, priority is given to therapy aimed at restoring the motility of the gastrointestinal tract. The prognostic value of the adverse outcome was determined: stress index greater than 3503 Sp = 98.36% (95%CI 86.3–99.2) and Se = 99.2% (95%CI 87.3–100), lactatemia level greater than 3.3 mmol/L Sp = 73.7% (95% CI 59.6–84.7) and Se = 93.6% (95% CI 78.9–100). The control of the infectious process and the selection of antibacterial therapy is important, since the risks of developing septic shock are high. Prolonged epidural analgesia is the optimal method of analgesia and is indicated in suspected cases of failure to achieve 75% of the volume of enteral nutrition by the week of the postoperative period Sp 85.42% (95%CI 48.2–97.7), Se 46.8% (95% CI 62.0–84.2).Conclusions. Prognostic models allow predicting the outcome of critical conditions and timely adjusting the volume of therapy.

The aim of the study is the evaluation of results of endoscopic tunnel interventions in submucosal tumors and achalasia.Material and methods. Endoscopic tunnel interventions during 2017–2020 years were performed in 80 patients (34-men, 46-women). The duration of the age ranged from 15 to 72 years. The indications for interventions were: achalasia in 53, subepithelial tumors in 27.Results. During the intervention, complications occurred in 22 patients. Among the complications: carboxyperitoneum in 16 cases, carboxytorax in 2, esophageal mucosa perforation in 2, bleeding moderate intensity bleeding in 2. Most of the complications (20) were in patients with esophageal achalasia. Postoperative complications were observed in two patients operated for esophageal achalasia (bleeding and hematoma, esophageal mucosa necrosis). All patients were treated by using conservative methods. The results of the interventions were assessed in terms of 1 month to 3 years. There were no violations of food or liquid the passage through the cardia. Patients after operation for submucous tumors of the esophagus had no complaints. The main complaint of patients after myotomy was heartburn. Endoscopic examination revealed erosive reflux esophagitis (A-C) in 18 patients.Conclusion. Tunnel endoscopic interventions in patients with esophageal achalasia and submucous tumors are highly effective and low-traumatic, allowing relatively safe restoration of the patency of the cardia and removal of the subepithelial neoplasm. The problem of gastroesophageal reflux after oral endoscopic myotomy requires further accumulation of data in order to develop optimal tactics. The limiting factor for the these operations performance is the material and technical equipment of medical institutions and the lack of trained specialists.

Introduction . Most modern classifi cations of chronic benign diseases of the anorectal region are based on an assessment of the severity of the morphological changes that occur with these diseases. However, the direct relationship between the stage of the disease and the severity of its clinical manifestations is not always traced. Thus, there is a need to develop a tool for assessing the severity of the disease as a complement to the current morphological classifi cation. Material and methods . The study was carried out in 2018–2019, 239 patients (110 men, 129 women) were included. The median age was 35 years (ranging from 19 to 70 years). Nosological composition: 175 patients with chronic hemorrhoids, 37 with chronic anal fi ssure, 19 patients with a combination of anal fi ssure and hemorrhoids, 8 patients with idiopathic anal itching. All patients were interviewed for the main symptoms of anorectum diseases. After that, it was proposed to evaluate their condition on a visual analogue scale (VAS), from 0 to 10. Then, a model was constructed for the dependence of the severity of the disease on the frequency of symptoms in the form of a linear regression equation with calculation of regression coefficients. Results . The data obtained is a score for the contribution of each of the symptoms, which can be used as a scale for assessing the severity of anorectum diseases. Discussion . The results of our study provide an opportunity to stratify the symptoms of participation in the formation of the clinical picture of the disease. The contribution of each symptom was evaluated individually using mathematical modeling methods. Such a combination would make it possible to give an exhaustive description of the condition, including both the organic manifestations of the disease and clinical symptoms. Conclusions . The results of this study made it possible to create an assessment tool — a scale for determining the severity of chronic benign diseases of the rectum as an addition to the existing classifi cations based on morphological changes.

Recently, studies comparing various variants of operations to establish the optimal method of surgical treatment for chronic pancreatitis with pancreatic head lesions from the point of view of evidence-based medicine have been carried out in the world. However, these comparative studies do not take into account differences in the clinical and morphological forms of the disease, in particular, chronic pancreatitis with a predominant and isolated lesion of the head. Subtotal resection of the pancreatic head with proximal pancreatojejunostomy, suitable for an isolated lesion of the head, does not solve all the problems of chronic pancreatitis with a predominant lesion of the head. In this case, the violation of the outflow of pancreatic juice along the pathologically changed main pancreatic duct from the left half of the gland is not eliminated. It is impossible to unambiguously support the hypothesis of the feasibility of performing subtotal resection of the pancreatic head with proximal pancreatojejunostomy in chronic pancreatitis with a predominant lesion of the head with a uniformly expanded main pancreatic duct. With this form of chronic pancreatitis, cicatricial strictures can form in the main pancreatic duct, which can lead to ductal hypertension and serve as an indication for reoperation. The feasibility of using Beger operation in chronic pancreatitis with a predominant lesion of the head is doubtful, since the intersection of the isthmus and the need for a T-shaped longitudinal pancreatojejunostomy makes this intervention technically difficult and unsafe. Based on the studies performed, it is impossible to say with certainty about the reliable advantages of one type of operations over another. To obtain reliable results, it’s necessary to conduct evidence-based studies comparing subtotal resection of the pancreatic head with longitudinal pancreatojejunostomy with other types of interventions only for chronic pancreatitis with a predominant head lesion, excluding from the study patients with chronic pancreatitis with isolated head lesion.

The purpose of the study was to assess the level of quality of life in the postoperative period in patients with bullous emphysema of the lungs operated on by «open» access and using minimally invasive technologies using the SF-36 questionnaire. Material and methods. The results of a survey of 50 patients with bullous emphysema were analyzed. The patients were separated into 2 groups depending on the method of access. The first group (main) consisted of the patients underwent video-assisted thoracoscopy, resection of a bulla-modified lung tissue, subtotal parietal pleurectomy. The second group (comparison) consisted of the patients underwent thoracotomy, resection of a bulla-modified lung tissue, subtotal parietal pleurectomy. The survey was conducted using the SF-36 quality of life questionnaire for 1, 3, 6 and 12 months. Results and discussion. The main indicators of the quality of life of respondents in terms of 1, 3 and 6 months after the intervention were statistically significantly higher in the group of patients who underwent thoracoscopy. Only a year after the operation, the main indicators of the questionnaire were not statistically significantly different between groups of patients, but the indicators of vital activity, social functioning, mental health and psychological component of health remained significantly higher in patients of group 1. The results indicate the need for long-term postoperative rehabilitation of patients with bullous emphysema lungs, operated in an «open» way. Follow-up survey with the specific questionnaires is required for more detailed assessment of the level of quality of life in patients with thoracic organs pathology.

A complex morphological study of the auricle to determine the human age was performed by evaluating the metric sizes between fixed points in each auricle with axial guidelines. The auricular elastic cartilage in different age periods was characterized by thickening of the cartilaginous plate, different mature and immature cartilage zone ratio, variations in the volume density of the intercellular substance and elastic fibers, and change in the numerical density of individual chondrocytes and isogroups. Aggrecan content in the cartilage was shown to increase in different age periods. Age-related structural changes in the auricular cartilage expand the possibilities of forensic medical examination and hold much promise for the identification of personality.

We studied ultrastructural changes in cardiomyocytes and blood capillary endotheliocytes in the ventricular myocardium in response to mechanical injury of the heart of varying severity in Wistar rats. Acute alterative changes in cardiomyocyte and endotheliocyte ultrastructure indicate impairment of the energy-producing, contractile, and protein-synthesizing functions of the cells after mechanical injury. These disorders play the key role in the development of acute contractile insufficiency of the myocardium in mechanical injury to the heart.

A case of the myocardial contusion associated with the closed blunt chest injury in the girl aged 1 year 7 months is presented. The autopsy revealed hemorrhage of an irregular oval shape, coloured dark-red, and confined to the region with the area of 4.0 x 3.5 cm. It penetrated throughout the entire thickness of the lower part of the left atrial myocardium and the upper and middle parts of the left ventricle. No other changes were found in the heart, nor were congenital cardiac and vascular malformations documented. The main factors playing an important role in the formation of the myocardium contusion are discussed. The authors emphasize that it is the children having the narrow chest with the pliable wall who constitute the group at the highest risk of accidents resulting in the chest injury and myocardial contusion.

The article presents the results of diagnostics and treatment of 12 patients with Boerhaave's syndrome (men--9, women-- 3). The age of the patients was 19-68 years old. The prescription of spontaneous rupture of the oesophagus was 7 h-2 days from moment of the rupture to hospital admission. General aspects of disease were noted in 10 patients, though only 5 patients were directed to the hospital with suspicion on Boerhaave's syndrome. Emergency surgeries were performed on all patients. At first the opening was carried out, than drainage of posterior lower mediastinum were performed by Savinykh-Rozanov method with wound closure of the oesophagus walls. The complications were noted in 2 patients (the first case-pleural empyema, the second case-pulmonary embolism). Late complications, such as esophagostenosis in the place of wound closure were followed up in 3 patients in terms more than one month after operation.

This article reports the case of death of a puerperal woman resulting from amniotic fluid embolism. The diagnosis was established based on the results of the pathohistological study that revealed the presence of mucoproteides and epithelial scales in pulmonary blood vessels and capillaries.