The aim — to estimate the EBUS TBNA diagnostic value for mediastinal lymphadenopathy.

Materials and methods. 75 patients with mediastinal lymphadenopathy have been studied with EBUS TBNA. The age of 58 (77.3 %) patients ranged from 20 to 60 years old. More often this pathology was revealed among men — in 43(57.3 %) cases.

Results and discussion. The informative and diagnostic method’s value in 75 cases of mediastinal lymphadenopathy was analyzed. Informativity of EBUS TBNA for etiology defining of intrasternal lymphadenopathy syndrome was 91.5 % during histological analysis and 88.0 % during cytological analysis.

Conclusions. EBUS TBNA is minimally invasive and secure method of mediastinal lymphadenopathy diagnosing. Whereas biopsy is ultrasound-guided, it allows to clearly define the withdrawal place, detectand controlling biopsy needle penetration depth and avoid the major vessels disruption nearby the researched lymph nodes collectors.

Keywords: mediastinal lymphadenopathy, biopsy, diagnostics.

The aim — to determine diagnostic algorithms of vertebral-basilar insufficiency (VBI) in vertebral artery compression syndrome () using criteria for perfusion-weighted magnetic-resonance imaging (PW-МRI).

Materials and methods. The method of PW-МRI in patients with VACS was based on main PWI indexes calculation- CBF (cerebral blood flow), PH (peak height) on time-concentration curve (TCC), TT (time to peak). These indexes were determined in three regions of brain stem: central part of pons varolii, left and right median cerebellar pedicles. During 2012 — 2014 period, 260 patients were examined by PW-МRI and divided onto two groups: 137 patients of I group (surgical treatment) and 123 patients of II group (conservative treatment). 58 patients of I group with verified clinical improvement after H. Hoffenberth (1990) scale received the control examination after surgical decompression. The results allowed verifying the developed diagnostic VACS algorithms using the PW-MRI method.

Results and discussion. The analysis of blood flow perfusion in examined patients revealed a small number of combinations with severe VBI clinical signs by H. Hoffenberth (1990) scale. Combinations were divided onto 5 options based on compliance with the worst indicators of cerebral blood flow in the brain stem and cerebellar hemispheres conventionally dominant in compare to the other hemisphere, the decreasing number of the combination. In the analysis of rank correlation between the variants of blood flow perfusion indicators combinations and the VBI degree by H. Hoffenberth scale, a close negative correlation (r_s = –0.723; p <0.001) was established in right-handers. Patients in Group 1 on the of VBN clinical signs significant regression by a Hoffenberth scale in 6 — 8 months after the surgery showed a significant improvement in perfusion (in areas «1» and «2» in right-handers).

Conclusions. Five main combinations of perfusion indexes in patients with compression vertebral artery syndrome were defined. High correlation was determined between CBF variations and vertebral-basilar insufficiency score.

Keywords: vertebral artery, perfusion-weighted regime, compression.

The aim — to identify the clinical and prognostic values of dynamic intra abdominal pressure (IAP) measuring in patients with combined cranio abdominal injury.

Materials and methods. A prospective study of 98 patients with combined cranio abdominal injury with IAP measuring in dynamics has been conducted. To determine the body fluid sectors balance the method of integrated dual-frequency impedance was used.

Results and discussion. It was established that the abdominal injury severity has a direct, moderate impact (r_s = 0.39) on the IAP level during acute period. The maximal IAP value during the traumatic disease depends on the overall injury severity (r_s = 0.54), but not on the abdominal component severity (r_s = 0.18). Dynamic IAP measurement has sensitivity 87.5 %, specificity of 36.4 % in the intraabdominal complications diagnostic.

Conclusions. Clinically significant intra abdominal 2 — 3 grades hypertension observed in patients with severe and extremely severe advanced trauma. Wherein, the abdominal injury severity has secondary importance. Independent factor_s influencing on intra abdominal hypertension development are retroperitoneal hematoma (r_s = 0.58), acidosis in acute period (r_s = 0.63), a massive blood substitutes infusion (r_s = 0.60). IAP dynamic correlates with the traumatic disease severity and complications development.

Keywords: cranio abdominal injury, intra abdominal pressure, abdominal compartment syndrome.

The aim — to optimize the tactics of patients’ management for venous thrombosis on a newly detected cancer background.

Materials and methods. The study involved 94 patients (52 women and 42 men) with idiopathic venous thrombosis (IVT) of the lower extremities that were treated at the Vascular Surgery department during the period from 2005 to 2014. Patients were divided onto two groups: study (n = 53) and control (n = 41) group. The groups were compared to age, gender and pathology. A standard clinical laboratory tests, ECG, ultrasound of the lower extremities and pelvic organs veins was performed for all patients. In the study group, the intensive non-invasive screening was conducted to identify malignancies occult forms.

Results and discussion. In 14 (26.4 %) patients of the study group the malignant variously localized tumors were diagnosed, in 57 % the metastases were found. According to clinical data, IVT can not be recognized as an early cancer manifestation. IVT typically occurs in advanced forms of cancer. In the control group the occult tumors was revealed in 3 (7.3 %) patients. The effectiveness of intensive screening for latent malignancies forms compared to routine examinations was noted (26.4 % vs 7.3 %, p < 0.05). In the study group the patients with venous thrombosis on a newly detected cancer background the optimized management was used.

Conclusions. IVT can serve as a marker of latent cancer. Intensive non-invasive screening increases incidence of occult malignant forms from 7.3 to 26.4 % (p < 0.05) compared to routine examination in patients with IVT, allowing to begin basic treatment timely. It is necessary to perform follow-up examination with proposed algorithm every 6 months to identify occult forms of cancer in all patients with IVT. A collective choice of diagnostic-treatment tactics by vascular surgeons and oncologists prolongs the life of these patients. Low molecular weight heparins are medication to be chosen for initial and long-term treatment of venous thrombosis in patients with cancer.

Keywords: idiopathic venous thrombosis, occult forms of cancer.

The aim — to study structural changes in anterior pituitary, adrenal cortex and thymus at an experimental burn disease in rats after its treatment with HAES-LX-5 % and Lactoproteinum with sorbitol infusion.

Materials and methods. Experimental study of morphological changes in the adenohypophysis, adrenal cortex and thymus in burn disease (on 1, 3, 7, 14, 21, 30 days) and during hyperosmolar colloid infusion HAES-LX-5 % and Lactoproteinum with sorbitol action was performed on 90 male Wistar rats weighing 155 — 160 grams. Materials for morphological studies were processed by conventional methods.

Results and discussion. Therapeutic effect of hyperosmolar solutions with the of «flow» and «penetration» under condition of zones appearance in adenohypophysis, adrenal cortex and thymus in burn disease is not limited to detoxification, rheological and antishock effects, but also manifested by their cyto- and angioprotective effects.

Conclusions. It was established that Lactoproteinum with sorbitol protects the vessel wall and has a membranoplastic influence on the organic structure.

Keywords: burn, adenohypophysis, cortex of adrenal gland, thymus, light and electronic microscopy.

The aim — to assess the local and systemic immune parameters, cytokines and antioxidant status in acute ulcerative gastroduodenal bleeding (AUGDB) depending on the blood loss severity.

Materials and methods. 156 patients with AUGDB was studied and results have been analyzed. Gastric ulcer was in 37 patients (23.7 %), duodenal ulcer — in 112 (71.8 %) and concomitant — in 7 (4.5 %). The bleeding intensity was assessed by J. Forrest scale, blood loss severity — by О. О. Shalimov scale. Mild blood loss had 54 (34.6 %) patients, moderate — 51 (32.7 %) and severe hemorrhage — 51 (32.7 %) patients. In all patients the state of immunity, cytokine profile and antioxidant system in peripheral blood were examined on admission. The IL-6 level was also measured in the urine. In 107 patients, the lysozyme activity and IL -6 concentration were studied in the aspirated gastric mucous contents, and the level of IgA, M and G in the aspirated duodenal contents. In 20 patients with AUGDB the concentration of DC and MDA was studied in surrounding ulcer’s zone.

Results and discussion. Significant changes in immune, cytokine and antioxidant status on local and systemic level were revealed in patients with AUGDB on admission. Immunosuppression, cytokine imbalance and lipid peroxidation disorders rate in antioxidant protection system at the local and system level depended on the blood loss degree.

Conclusions. In acute gastroduodenal bleeding ulcer existing immunosuppression in lymphocyte-cellular and humoral immunity by a statistically significant reduction in the level of CD3⁺ — lymphocytes to 32,9 %, CD4⁺ — on 32,5 %, CD8⁺ — 13.3 %, the functional interval — 18.9 %, IgA — on 16,5 %, IgM — on 15,8 %, IgG — 10.7 % with an increase in the content of CD19⁺ — 58.8 % and 2.3 times the CEC. The depth of the irregularities in the immune status depends on the degree of blood loss. Acute gastroduodenal bleeding ulcer accompanied by cytokine imbalance, the depth of which is directly related to the severity of blood loss. There is an imbalance in the system of lipid peroxidation — antioxidant protection is accompanied by an endogenous intoxication and increase in blood loss in parallel increases.

Keywords: acute gastroduodenal bleeding, immune status, cytokine status, lipid peroxidation.

This review contains the questions of intra abdominal postoperative complications in hepatobiliary surgery. The most common of these are bile ducts injuries. Aetiology, different classifications, clinical manifestation, instrumental diagnostics abilities and patients management planning have been reviewed. This issue is focused on diagnostic and therapeutic minimally invasive endoscopic and ultrasound technologies detailed with respect to the external biliary fistula.

Keywords: iatrogenic bile ducts injury, external biliary fistulas, ultrasound diagnostic, transpapillary interventions.

In the literature review, modern diagnostic and therapeutic approaches in gastric bleeding of tumor genesis were presented. The execution order and informative value of various instrumental diagnostic methods of bleeding source was determined. The role of X-ray surgical method among of alternative hemostasis methods was determined. Differences in the treatment approach for this pathology in our country and in foreign clinics were identified.

Keywords: gastric bleeding, stomach cancer, diagnosis, treatment approaches.

The analyses of published studies testify the high importance of molecular and genetic abnormalities for diagnosis and prognosis of well-differentiated and medullary thyroidcarcinoma. Foreign and domestic scientists researches have been arguing that abnormalities in RET, BRAF, RAS, PPАR-γ genes as well as determination of MIB-1 proliferative index could be a general utility for diagnosis and prognosis of well-differentiated and medullary thyroidcarcinoma. Implementation of these markers in routine clinical practice may improve treatment outcomes for different types of thyroid cancer significantly.

Keywords: well-differentiated thyroid carcinoma, medullary thyroid carcinoma follicular, RAS, PPАR-γ, RET, BRAF, МІВ-1 index, apoptosis.

The literature review is devoted to the additional opportunities search to improve the treatment results of cancer. The modern publications about low molecular weight heparins use not only for the treatment of thromboembolic complications, but also for prevention ones, by blocking the pathways of tumor metastasis have been analyzed. A review of studies that provide scientific justification for such opportunities has been introduced.

Keywords: cancer pathology, mechanisms of metastasis, low molecular weight heparin, the prospects for treatment.

This paper reviews the recent literature on trends and prospects for application of biomorphic silicon carbide ceramics in medicine, created by the biomimetic principles. The obtaining ways has been described. Benefits of the material’s use and interaction with the living body cells have been studied. The possibility inland biomorphic silicon carbide use in medicine, particularly in the Maxillofacial Surgery and Dentistry is highlighted.

Keywords: biomorphic ceramics, silicon carbide, implant, reconstructive surgery.

Pancreatic cancer is one of the most lethal malignancies and is associated with a very poor overall survival. The only curative option remains an aggressive surgical approach capable of obtaining a radical resection. The 57-years- old patient’s case with a pancreatic head cancer invading superior mesenteric vein is presented. Whipple procedure with superior mesenteric vein resection was performed. The continuity of the superior mesenteric vein was restored by autograft from ovarian vein. An aggressive surgical approach allows to expand the indications for pancreatoduodenal resection and to achieve better results for remote survival in this patients group.

Keywords: pancreatic head cancer, pancreatoduodenal resection, vascular invasion, combined resections.

A clinical experience in treating the giant size ovarian tumors, complicated by perforation and diffuse purulent peritonitis in a patient 57 years has been described. Approximately 16 liters of pus and right ovarian giant tumor 50 ˟ 60 ˟ 40 cm with perforations was revealed intraoperatively. Hysterectomy with appendages, removal of the greater omentum, small bowel intubation, debridement and drainage of the abdominal cavity have been performed. Bacteriological research of the abdominal cavity contents has been performed at 1st, 3d, and 5th day. The postoperative period was without complications. On the fifth day, there has not been detected micro-floral growth in abdominal cavity fluid. Peristalsis has resumed on a fifth day. By 10th day of treatment patient has been discharged in satisfactory condition. With development of such a complication of an ovarian tumor as festering of its contents with a perforation and peritonitis, surgery with radical extraction of destructive inflammation source, intra-operational sanitation and adequate small intestinal and abdominal cavity drainage is an effective method of an abdominal infection elimination, that decrease lethality rate in such patients.

Keywords: ovarian tumor, complication, diffuseperitonitis, surgical treatment.

The case of successful treatment of 41 years old patient with complicated nonspecific ulcerative colitis, treated in the surgical department, has been described. Patients underwent subtotal colectomy with the conclusion of the proximal end ileostomy, sanitation and drainage of the abdominal cavity.

Keywords: nonspecific ulcerative colitis, perforation, peritonitis, complications, colectomy, fistula.