The aim – to compare the results improvement of the surgical and palliative treatment and the decrease of complications amount the acute varicotrombophlebitis in progress against the background of recurrence the venous thromboembolism (VTE) among elderly and senile people.

Materials and methods. The surgical treatment effectiveness was analyzed among 94 elderly and senile patients (the middle age – 71.5 years) treated for the acute varicotrombophlebitis in progress (C2–C6 by CEAP); they were operated in the second surgical department during 2005–2009 years. Diagnostic-medical tactics included: the general clinical investigations, the interfacing experts’ consultations, the ultrasonic duplex angioscanning with blood circulation colored imaging and the surgical intervention depending on varicose overthrow localization. In 48 patients of the main group with acute varicotrombophlebitis the great or small saphenous vein resection with the collaterals ligation between the great or the small saphenous vein and cutting the perforants if existed were performed. In the comparing group 46 patients had palliative surgical treatment – crosectomy of the great and the small saphenous vein onflow.

Results and discussion. According to the clinical and sonography investigations VTE (trombophlebitis of the lung artery and thrombosis of the deep vein) took place in the main and the comparing groups – 2 (4.16 %) and 7 (15.28 %). In the comparing group there was 1 (2.17 %) case of the lethal outcome because of the mass PATE. There wasn’t completely necessity (1 (2.08 %) patient) to rehospitalize for the surgical treatment of the acute varicotrombophlebitis the patients of the main group who were operated because of the acute varicotrombophlebitis – 18 (39.06 %) or needed the planed surgical treatment for varicose disease – 44 (95.48 %).

Conclusions. The use of surgical total phlebotomy on the acute varicotrombophlebitis in progress among elderly and senile people due to the possibility on transmission the tromboetic process through the communicant veins and the collaterals from one to another vein system and to the deep vein from their own perforants, for 4 times the possibility of DVT during the early postoperative period was decreased, as a result, for 5 times the development of postthrombothic disease on operated part during prolonged period and for 18 times the development of the recurrence acute varicotrombophlebitis in future was decreased, comparing the patients with the palliative surgical treatment of acute varicotrombophlebitis.

Keywords: acute varicotrombophlebitis, total phlebotomy, ultrasonic duplex angioscanning, elderly and senile people.

The aim – to estimate tolerance and efficiency in deep vein thrombosis prevention with bemiparin sodium «Tsibor» in patients with varicose disease of the lower extremities.

Materials and methods. An open postmarketing research of bemiparin sodium «Zibor» tolerance and efficiency for deep vein thrombosis prevention in patients with varicose disease of the lower extremities was carried out. 60 patients with varicose have taken part in research. Patients have been distributed on two groups: control (30 persons at the age from 45 till 68 years (middle age – (57 ± 3.8) year), women – 12 (40 %), men – 18 (60 %)) in which prevention of DVT was done by unfractiond heparin administration (UFH), and the basic (30 persons at the age from 45 till 67 years (middle age – (56 ± 3.8) year), women – 14 (46 %), men – 16 (54 %)) in which prevention was done by low molecular weight heparin (LMWH) of second generation use. All patients had excessive body weight. Degree of postoperative tromboembolic complications risk (TEC) was by scale C. Samama and M. Samama (1999) in all patients was estimated as average. Randomization carried out on a method of envelopes. To all patients it is combined phlebectomy was executed.

Results and discussion. The TEC after the spent operative interventions in investigated groups of patients was not revealed that has been confirmed by USG results control. Lethal outcomes, allergic reactions on bemiparin sodium during research were not pointed.

Conclusions. The received results testify that LMWH of second generation is an effective and safe medication for lower extremities DVT preventive maintenance in patients with advanced varicose disease. Bemiparin sodium application during the postoperative period allows to lower local bleeding complications risk in comparison with UFH.

Keywords: varicose disease, phlebothrombosis prevention, bemiparin sodium.

The aim – studying of the long-term results of a tubular partial gastrectomy for peptic ulcer by means of patient long-term adaptation estimation.

Materials and methods. Multiple parameter investigation of 31 patients, operated due to a peptic ulcer was carried. Surveyed are parted on 2 basic groups: 17 patients who have sustained tubular partial gastrectomy and 14 patients, sustained a partial gastrectomy on Bilrot-I in its classical variant. Studying of the followed homeostasis systems was spent: level of adaptive hormones, (a corticotrophin, a hydrocortisone, insulin and thyroid hormones), research of gastric secretion, the tonus of vegetative nervous system, indicators of a peripheral blood.

Results and discussion. The qualitative analysis of internal and intersystem indicators interrelation by a method correlated adaptometry is carried out, for each of groups correlation galaxies have been constructed and value of the correlation count is defined. The correlation galaxy of the II group contains larger quantity of structural elements which are bridged by strong enough correlation communications, basically the positive. On the contrary, at patients of the I group the correlation galaxy consists of small number of the structural elements bound both positive, and negative communications, and, means, is characterized by absence of a strain in system. Accordingly, the weight correlation column of I group is 6.32 while correlation column weight of II group makes 14.65, that is 2.3 times fold. Basic difference of homeostatic balance structure between I and II groups is absence of expressed neurohumoral influences on a condition of secretory stomach function though communications with the parameters characterizing a condition of the highest regulatory contour thus remain. For I group it is necessary to consider as feature of maintenance of a homeostasis smaller regulatory influence of ANS to vegetative maintenance of the functions, shown in low number neurohumoral communications through parameters of the hormonal status.

Conclusions. At the patients who have sustained a tubular partial gastrectomy, the smaller number of correlation interrelations between homeostasis key parameters, in comparison with the patients who have sustained a partial gastrectomy in a classical variant Bilrot-I became perceptible. Lower value (in 2.3 times) of the correlation count testifies to the best adapt possibilities of an organism in the long-term period after a tubular partial gastrectomy. Use of the complex rehabilitation program, corrective a condition of adaptive hormones systems, will improve formation of nonspecific organism resistance.

Keywords: a stomach and duodenum peptic ulcer, a tubular partial gastrectomy, a correlated adaptometry, a homeostasis, a hormonal balance.

The aim – the surgical treatment results improvement for acutely bleeding malignant tumors of the stomach (ABMTS).

Materials and methods. There were 1125 patients on treatment during 1991–2008 with ABMTS: a stomach carcinoma – in 1108 (98.5 %), a sarcoma – in 17 (1.5 %). I stage of disease is established in 46 (4.1 %) patients, II stage – in 210 (18.7 %), III stage – in 402 (35.7 %), IV stage – in 467 (41.5 %). Emergency diagnostics was provided with endoscopic researches which were supplemented with radiological, ultrasonic and laboratory methods.

Results and discussion. According to the established criteria of indications to operative measures, from 1125 patients with ABMTS surgical treatment was applied in 524 (46.6 %): radical operations – in 362 (69.1 %) patients, palliative and symptomatic – in 162 (30.9 %). In an emergency order (EO) 48 (9.2 %) patients were operated, among which radical operations was in 40 (83.3 %), nonradical – 8 (16.7 %). 13 (27.1 %) patients were died: after radical operations – 8 (20.0 %), nonradical – 5 (62.5 %). Operative treatment in the early delayed period (EDP) was done in 476 (90.8 %) patients: radical operations – 322 (67.6 %), nonradical – 154 (32.4 %). Has died 36 (7.6 %) patients: after radical operations – 11 (3.4 %), nonradical – 25 (16.2 %). Lymphodissection in volume D1 is executed at performed 220 (60.8 %) radical operations, in volume D2 – 142 (39.2 %), thus frequency of performance lymphodissection in volume D2 was done in 3.4 times more than at performed radical operations in EDP. Nonradicaly 162 patients were operated: in EO – 8 (4.9 %), in EDP – 154 (95.1 %). The lethality after not radical emergency operations has made 62.5 %, and after early delayed – 16.2 %. Therefore, we consider operations at height of a bleeding at patients with ABMTS very dangerous, and realisation endosurgical hemostasis and the subsequent carrying out of operative treatment in EDP is expedient.

Conclusions. The lethality after emergency operations is larger in 5.9 times after radical operations and in 3.9 times after palliative and symptomatic operations, in comparison with operations which are executed in EDP. The Specific gravity of lethal outcomes after radical operations is in 3.6 times smaller in comparison with palliative and symptomatic operations. Frequency of performance lymphodissection in volume D2 is in 3.4 times more after the radical operations done in EDP.

Keywords: malignant tumours of the stomach, gastrointestinal bleedings, endoscopic hemostasis, methods of operations.

The aim – comparative analysis the efficiency of rectovaginal fistulas and perineal tears treatment methods.

Materials and methods. Were analyzed the results of treatment 70 patients with perineal tears (III degree) and rectovaginal fistulas. The age of patients was from 16 to 52.

Results and discussion. Fistulas passes through the sphincter were observed in 39 (55.7 %), skirts it outwardly – in 4 (5.7 %) and located internally to the sphincter – in 27(38.6 %) patients. We had worked and used in clinical practice the modificated method of rectovaginal fistulas removing. Among the patients with rectovaginal fistulas of I degree no relapse was noted. Among the patients with rectovaginal fistulas of II degree the relapse was found at 1 (6.25 %) patient, that was operated by our method and in 2 (14.3 %) patients, that were operated by traditional method.

Conclusions. Using of the modificated method of rectovaginal fistulas and perineal tears correction had improved the results of surgical treatment of this pathology on 8.05 %.

Keywords: rectovaginal fistulas, surgery traetment, relaps.

The aim – to analyze the treatment in patients with the severe injuries after dog’s bites, and to open discussion about surgical treatment standards: early surgical intervention as controversial to delaying tactic.

Materials and methods. Results of treatment of 9 patients who have suffered from dog’s bites with wounds which have demanded specialized medical aid, namely reconstructive-plastic operations have been studied. Terms of influx of patients in the centre, a kind and quantity of operative interventions, terms of stay in a hospital, complications and consequences of traumas are analyzed.

Results and discussion. All patients were effectively treated. Wound defects covered by use of different methods of plastic. But priority was given to methods of plastic by tissue complexes with an efficient blood circulation, containing skin, subcutaneous fat and fascia. Use a wide arsenal of plastic closure techniques made it possible to eliminate the wound defect in the shortest possible time. High level of anatomic integrity restoration in the damaged site, the greatest possible aesthetic restoration with possibility of the further surgical and cosmetology correction of the damaged sites are reached.

Conclusions. The problem of plastics recovery defects of skin and soft tissues for victims after dogs attack is more relevant than in mind the prevalence of this type of trauma, and also because these injury leading to persistent defects of appearance or loss function. Early surgical revision, wounds necrectomy and one-stage plastic cover by the flaps with an efficient blood circulation provides adequate restoration of lost skin and soft tissue and achieve the best possible result for aesthetic restoration. Plastics cover by flaps, containing not only the skin but also subcutaneous adipose tissue and fascia, provides not only a primary defect closure, but also reserving the possibility for further surgery and cosmetology correction of damaged areas.

Keywords: wound, dog bite, transplantation of skin, plastics by the flaps.

The aim – analysis of results of operative treatment of bedsores of different localization in patients with spinal trauma.

Materials and methods. 51 patients with the stable loss of motor functions and bedsores of different localization were operated. 80 operations were made. According to the localization of bedsores and tactic the patients are shared to 3 groups: I – with bedsores in area of tuber of ischium (25), II – with bedsores in area of greater trochanter (14), III – with bedsores in sacrococcygeal area (12).

Results and discussions. In I group the resection of tuber was made for 23 patients. In 2 patients (14.3 %) wound suppuration was notified after surgery. In II group the resection of greater trochanter was made for 10 patients; bedsores healed by primary intension in 10 (71.4 %) patients, in 3 (21.4 %) patients incompetence of sutures was notified due to the intension of wound edges and increased tonus of muscles, in 1 patient necrosis of skin flap was marked due to expressed rigidity of skin and disordered circulation. In III group in 5 patients the resection of coccyx was made with simultaneous or postponed plastic, in 9 of them – healing by primary intention. Analysis from 2 to 5 years after surgery the good results of treatment are marked in 49 patients (96 %), unsatisfactory result at 2 patients due to progress destruction of pelvic bones and relapse of bedsores.

Conclusions. The timely conducted radical surgery for bedsores enable to obtain stable healing. The obligatory condition of surgery radicalism was dissection and effective draining of purulent foci, excision of scarring tissues, fistulas, hypertrophied synovial bags, and resection of sublying bones regardless of their osteomyelitis involvement. Because of the low tendency to restriction of purulent process in the spongy matter of pelvic bones a preference was given to radical operations with the resections of bones, especially functionally insignificant: sciatic, coccyx, greater trochanter of thigh. 4. The stable result can be got only in the removal of defect of soft tissues and restoration of trauma-resistant skin in the completing part of surgery by the different kinds of non-free plasty and transposition of adequate on thickness and size dermal-fatty or dermal-fascial flap on the nutritive pedicle.

Keywords: bedsores, surgical treatment, spinal trauma.

Keywords: diabetic foot, critical ischemia, acellular dermal matrix

The aim – to find the expediency for tunnel plastic using in renewal of the circular soft tissues lost of fingers and the hand with highenergy injuries.

Materials and methods. The treatment of 16 patients (13 men and 3 women) with hand injury (with bones, tendons traumas, blood circulation disorders and soft tissue loss) after high-energy traction-compressive trauma treated in Combined trauma surgery clinic for period 2008–2009 has been analyzed. Men were 13, women were 6. In 6 patients the cut off segments were not subject for replantation, therefore stump have been formed on metacarpal bones and carpal joint level, in 4 patients arterial palm arches and manual arteries revascularization was executed. Six of them had circular defects of soft tissues on the hand and fingers. In four of them were used the combination of the hand plastic by the groin flap according to McGregory with tunnel plastic (2) and thin skin graft (2). Two patients underwent only tunnel plastic.

Results and discussions. In 6 (37.5 %) patients for skin recovery after circular soft tissue defects on the dorsal hand surface and fingers full skin graft were used. The first urgently debridement, thendoraphy, osteosythesis and implantation of the hand or fingers under the skin of lumbar or groin area were made. The next stage the hand has been mobilized and functionally applicable soft tissues have been formed.

Conclusions. The use of tunnel plastic after the hand traction injury allows to create functionally soft tissues and to recover the function of the hand.

Keywords: hand injury, defects of soft tissues, tunnel plastic.

The aim – studying prevalence of Dupuytren’s contracture in injured persons and liquidators of the Chernobyl nuclear power plant accident consequences as a socially significant pathology resulting in affection of the hand which is one of the most delicate instruments of the human body.

Materials and methods. 6632 persons injured in result of the Chernobyl nuclear power plant accident were examined. There were 4652 women and 1980 men of all cohorts of the examined persons. Dupuytren’s contracture was diagnosed in 424 patients (384 persons of them were liquidators of the accident at the Chernobyl nuclear power plant). Practically, 59.9 % (254) patients did not complain about this pathology (its availability was revealed by means of questioning during the complex examination).

Results and discussion. Dupuytren’s contracture was diagnosed in all examined persons (424 patients) at the age from 45 to 75 years. Among them there were 9.4 % (40) women and 90.6 % (384) men (1/10). Both hands were affected in 79.9 % (339) patients. Among 424 patients – 46.2 % (196) patients had the first stage of Dupuytren’s contracture (classification by A.P. Beyul). 36.8 % (156) patients had the second stage of Dupuytren’s contracture. 17.0 % (72) patients had the third stage of Dupuytren’s contracture. Ledderhose sickness (degeneration of the plantar aponeurosis) was observed in 32.1 % (136) patients. Peyronie’s disease (degeneration of the cavernous bodies of a penis) was observed in 8.0 % (34) patients with Dupuytren’s contracture. A connection of appearance of the listed pathological changes with the stage of Dupuytren’s contracture was not observed.

Conclusions. Studying of Dupuytren’s contracture frequency demonstrated that 6.4 % of patients had that pathology. This pathology likes population in the range from 45 up to 75 years old when work efficiency is maximal. Majority of the patients (90.6 %), in the structure of this pathology, are liquidators of consequences of the accident at the Chernobyl nuclear power plant with affection of the both hands (79.9 %) and beginning of degeneration of the palmar aponeurosis on the right hand (64.9 %). Studying a degree of intensity of Dupuytren’s contracture has shown that 46.2 % patients have I stage, 36.8 % patients have II stage, 17.0 % patients have III stage. Investigation of the other changes being specific for this pathology has shown an absence of their correlated connection with the stage of intensity of Dupuytren’s contracture.

Keywords: Dupuytren’s contracture, a palm

The aim – to define efficiency and optimal terms for free autodermoplasty with split skin flap among patients with legs’ trophic ulcer.

Materials and methods. We have analyzed the treatment of 113 patients with legs’ trophic ulcers for the period from 2005 till 2010. The patients’ age ranged from 42 to 86. Patients have been distributed on four clinical groups. The first group have made 46 (40.7 %) patients with chronic venous insufficiency, for which venectomy has been executed (by Troyanov–Trendelenburg, Babcock, Narrate) and subfacsial perforating shin veins ligation, in the second – 27 (23.9 %) patients with trophic leg skin ulcers (TLSU) and contrainindications for radical operative intervention (age, an accompanying somatic pathology), in third – 15 (13.2 %) patients with diabetic TLSU, in the fourth – 25 (22.2 %) patients with TLSU caused by obliterating atherosclerosis of leg vessels. All the groups were subject to free flap autodermoplasty with split skin flap.

Results and discussion. We noted that the transplanted skin flap had 98.9 % acceptance within the first patients group. In 1.2 % of cases suppurative melting rejection of skin flaps was observed. The optimal terms for transplantation were 9th -10th day from commencement of conservative treatment of the trophic ulcer. The second patients group showed higher rate of vital capacity lack of the transplanted skin flap comprising 22.1 %. The acceptance of split skin flaps happened among 77.9 % of patients. The optimal terms for autodermoplasty were 18th–20th day. The term for the third group comprised 24–28 days from start of treatment. The rate of complete acceptance of transplanted skin among patients of this group comprised 86.7 %. Therefore suppurative and necrotic rejection of transplanting was observed among 13.3 % of patients. Patients with atherosclerosis of leg vessels (the fourth group of patients) showed 72.4 % of accepted transplanted skin. All other patients showed full rejection of skin flaps.

Conclusions. Autodermoplasty is effective (72.4–98.9 %) method of TLSU complex treatment of a various etiology; allow improving considerably results of treatment and quality of life of patients. Optimum terms (from 9 to 28 day) for autodermoplsty performance with a free flap depend on the main disease stage indemnification and accurate granulations occurrence, that have to consider at planning of skin transplantation in TLSU site.

Keywords: legs’ trophic ulcers, autodermoplasty.

The aim – to perfect the burn sepsis diagnostic algorithm, define procalciotonin marker efficiency for diagnostics and treatment in acute burn diseases period.

Materials and methods. The study and treatment results were analyzed in 46 burnt children in age from 5 to 15 years old which were on treatment in Center of Thermal Trauma, with the defeat area more than 20 % TBSA and defeat gravity index 30 unit. Patients were divided into two groups: a basic group is 30 children which in the acute period of burn diseases. Early surgical intervention was executed on 3–4 hour after burn trauma, and from the second hour was appointed the de-escalation antibiotic therapy chart (in 10 patients – karbopenem with metronidazole, at 20 – karbopenem with glycopeptides). A control patients group was made by 16 children suffering from burns to which on the treatment stages the intensive therapy was conducted, excision of necrotic tissue was executed later on 9–11th hours after trauma and the escalation chart of antibacterial therapy was conducted to them also. Performed microbiological researches with determination of composition and amount of microorganisms, research of level of serum procalciotonin was conducted by a semi quantitative express method.

Results and discussion. Studied dynamic syndrome of multyorgan dysfunction (MOD) was estimated by the SOFA scale. It is certain that plenty of pathogenic microorganisms in burn wound (і 106/ g) correlates with gravity of patient status (8.95 ± 3.15 by the SOFA scale). The reliable decline of MOD gravity and diminishing of PCT level was observed on 21st hour after burn trauma, after complete excision of all necrotizing scab. It is well-proven, that the burn diseases treatment result in victims with the enhanceable PCT blood level largely depends on initial antibacterial therapy character. The chart of de-escalation therapy was used in the patients of basic group – karbopenem and glycopeptides. For patients with the PCT level of Ј 2 ng/ml the chart of escalation antibacterial therapy was used. Positive connection is set between estimation on the SOFA scale, the PCT level and quantitative colonization of burn wounds.

Conclusions. In the acute period of burn disease bacterial contamination presence in burn wound nosocomial microflora more than a 105 /g considerably worsens the prognosis of disease and approaches a patient to the sepsis. Combination of bacterial colonization of burn wounds in an amount a 105 /g with the level of PCT

Keywords: bacterial infection of wounds, burn sepsis, procalciotonin marker.

The aim – to explore patterns and clinical course, determine the choice of priority surgical treatment or diverticulitis Meckel in other acute abdominal surgical pathology at the present stage.

Materials and methods. Study the results of treatment of 163 clinical cases of detection of Meckel diverticulum in the period from 1999 to January 2010 patients treated in pediatric department. Boys were 63.8 %, girls 36.2 %. Children up to one year was 1 (0.6 %), from 1 to 3 years 6 (3.7 %), from 3 to 7 years 47 (28.8 %), from 7 to 10 years 36 (22.1 %) than 10 years was 73 (44.8 %). The control grup consisted from 100 patients in corresponding age with non-diffuse peritonitis without Meckel diverticulum.

Results and discussion. Diverticulectomy was executed in 157 (96.32 %) patients, in 74 (45.4 %) of them the apendicular purulent peritonitis was present.All the children have recovered. Complications – adhesive obstruction was in one patient (0.6 %). The average bed-day in this group of patients did not significantly exceed, such as patients with apendicular diffused peritonitis without Meckel diverticulum and amounted to 11.1.

Conclusions. Simultaneous removal of Meckel diverticulum without visual changes when it detects in urgent abdominal surgery for other reasons appropriate, even in apendikulyarnogo purulent peritonitis.

Keywords: children, surgery, Meckel diverticulum, peritonitis, abdominal cavity.

The aim – to analyze the efficiency of different methods of breast cancer treatment as well as potentialities of their applications in specialized oncologic establishments and public medical network.

Materials and methods. The results of 58 patients with breast cancer in Chernovtsy Region Oncologic Dispensary and 131 diseases with breast cancer in Zhitomir Region Oncologic Dispensary and department for oncology of Shupic National Academy for post-graduate education have been analyzed. Variants of performed radical and organ-saving as well as complex treatment are presented.

Results and discussion. The received results testify to advantages of inclusion cryodestruction to complex treatment of patients with breast cancer. Low surgery activities as well as an absence of possibility for application of special methods of treatment such as chemotherapy and X-Ray therapy in public medical clinic are noted.

Conclusions. Treatments of oncologic diseases have been carried out in specialized oncologic establishments where there are potentiality and means for organ-saving treatment with pre- or intraoperative cryodestruction as well as with chemotherapy and X-Ray therapy. In group of diseases with I (Т1N0M0), II (Т1N1M0, Т2N0–1M0, Т3N0M0) stages after complex therapy with cryodestruction 3-year relapse-free survival rates vary from 94.6 to 100 %. The tumor cryodestruction method can be recommended for introduction in practice not only in regional oncological clinics, but also in surgical departments of public medical network.

Keywords: breast cancer, organ-saving treatment, complex treatment, cryodestruction.

Keywords: apudoma of the lung, diagnosis, surgery treatment.

The aim – description of a successful surgery case of clear cell carcinoma in a huge multilocular renal cyst masked as retroperitoneal tumor.

Materials and methods. Patient Ch., aged 59, has been admitted to Vinnitsa Regional Oncological Specialiasied Clinic with the diagnosis: Sa of retroperitoneal tumor, clinical group II. The ultrasound examination and computer-aided tomography detected the following: on the right side of the abdominal cavity there can be visualized a pathologic solid-fluidic entity of incorrect form, with heterogeneous and hypoechoic contents, occupying almost all the space (from the diaphragm to the brim of the true pelvis area), displacing viscera. The capsule is thickened full-length. The right kidney is not visualized. The patient was hospitalized to the Surgical Department for operative therapy though the entity was of a big size.

Results and discussion. The patient’s radical surgery was possible in spite of the tumor size. The suboperational characteristics were the same as during the ultrasound examination and computer-aided tomography of the abdominal cavity organs. The combined extirpation of the abdominal entity by means of nephrectomy was performed. The surgical specimen showed that the entity has multilocular character, the cavities of the separate cysts are not connected with each other and they contain brown fluid; the renal tissue is not found in the parietes of the cysts. Histological Conclusions. Renal cell carcinoma, cyst form, predominantly clear cell variant. The patient has developed no post-surgical complications. The patient was discharged from hospital on the 18-th day for domiciliary rehabilitation with a course of postoperative radiotherapy to follow.

Conclusions. The рresented case has all the signs of a multilocular renal cyst. These signs are as follows: a fibrotic capsule that separates the cyst from the renal tissue, plenty of cysts not connected with each other, including those with the epithelial lining, separated by connective cauls of different thickness with the structures with no cellular atypical signs. At the same time there can be found structures which are typical for clear cell carcinoma which have developed because of the multilocular cyst described above. The large size of a tumor does not always signify incurability.

Keywords: hypernephroma, clear cell carcinoma, multilocular cyst, surgery.

Keywords: fibroadenoma, seroma, implant rupture, mammoplasty

Keywords: iatrogenic perforation, esophagus, newborn.

Keywords: single laparoscopic incision, single laparoscopic incision surgery.

Keywords: laparoscopic hernioplasty, open hernioplasty, ventral hernias, grids.

Keywords: acute pancreatitis, diagnosis, treatment.