The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

Treatment results of 403 patients with the closed abdominal trauma, complicated by the retroperitoneal bleeding, was performed. Two types of echographic and CT picture of the retroperitoneal bleeding were distinguished - with clot formation and of impregnation type. The diagnostic and treatment algorithm was suggested. The use of the least allowed the location of the bleeding source in 40% of the operated patients and in 100% of those, who were treated conservatively. The indications to the retroperitoneal surgical revision were set basing on the information about the bleeding source or the localization and spreading of the hematoma. The use of the algorithm was successful in 98.9-100% of cases.

The thoracic ultrasound for the detection of hemothorax and hemopericardium was performed in 655 patients with penetrating thoracic trauma. Ultrasound findings were compared with the results of surgical exploration. Sensitivity and specificity of ultrasound in detection of hemothorax was 72.1 and 90.1%; in detection of hemopericardium - 70.6 and 73.7%, respectively. The results of the US diagnostics depended on patients' position (supine or when seated) and on time interval between the examination and surgery. The isolated US investigation in supine position leads to the increase of false negative results. We consider that in hemodynamically stable patients the doutbtfull US data in detection of hemopericardium is the indication to videothoracoscopy. The lower-chest injuries with the US signs of hemothorax are considered to be the indication for VATS except for the obvious left-side thoracoabdominal injuries.

BACKGROUND Penetrating chest injuries are a common cause of hospitalization for young patients.Various types of thoracotomy prevails over the other surgical approaches performed both under absolute and relative indications, depending on the location of wounds. PURPOSE To analyze the tactics and evaluate the possibility of thoracoscopy in order to reduce the number of unreasonable thoracotomies and reduce trauma due to surgical intervention. MATERIAL AND METHODS We studied 596 medical histories of victims who had been operated in 2002–2012. Thoracoscopy was performed in 236 patients, traditional tactics was applied in 360 victims. Wounds in the diaphragmatic area of the chest were in 210 victims, in the “heart” area — in 172 patients, in the intersection of these two zones — 44 cases, in the projection of the lung peripheral part — 49 cases and paravertebral area of the chest — in 52 patients. Typical thoracotomy (TT) was performed in 27% of cases, atypical thoracotomy (AT) — 42.5%, and drainage of the pleural space (DPS) — 30.3% of cases. RESULT Thoracoscopy (TS) could be carried out in 42.2% of patients who had undergone TT, and in 79.4% of patients who had undergone AT. Overall performance of the TS was possible in 70% of patients with penetrating chest wounds (PCW). Absolute contraindications for TS occurred in 29.1% of the victims.

The results of clinical and ultrasound diagnostics of acute venous lower limbs thrombosis in 206 patients are analyzed. The patients were divided in two groups; those in the first group (n=96) had a diagnosed pulmonary embolism, patients of the second (n=110) had no signs of it. 37 (18%) patients had an asymptomatic course of venous thrombosis, 25 (68%) of those were diagnosed with pulmonary embolism. 154 (74%) patients had floating thrombs, which resulted in pulmonary embolism in 53%. Clinical and ultrasound criteria of embologenic venous trombosis are developed. It allows prognose the pulmonary embolism development and optimize the treatment tactics.

The authors show the role of hepatobiliscintigraphy (HBSG) in cholelithiasis as a screening technique in evaluating the patency of the common bile duct, which allows cholecystectomy to be performed if there are normal values, without resorting to additional studies. They have reprospectively analyzed the results of clinical and instrumental studies in 101 patients with cholelithiasis and obstructive jaundice of various etiology in whom the diagnosis was verified by endoscopic cholangiopancreatography (ERCPG). The sensitivity, specificity, and diagnostic efficiency of the scintigraphic technique were 96.5, 36.3, and 86.1%, respectively. It is recommended that invasive diagnostic techniques, such as ERCPG and other direst X-ray contrasting methods, should be used after having a positive result of two techniques: ultrasonography and HBSG (in the above order).

Based on their own experience with punctures under the guidance of ultrasound study of the bulky formations of the lung and mediastinum in 254 patients, the authors show the potentialities of this technique. The paper describes the technique and its efficiency, shows difficulties and possible complications due to its use.