The aim — to evaluate the spiral contrast-enhanced computed tomography (CT) efficacy in peritoneal carcinomatosis (PC) revealing in patients with colorectal cancer (CC).

Materials and methods. The results of preoperative CT in 21 patients with CC and PC were retrospectively analyzed. Images of abdominal and pelvic organs were acquired with a single slice spiral CT scanner with contrast enhancement. Localization and size of peritoneal implants were estimated, comparing with the data obtained during following surgical exploration. Sensitivity, specificity, accuracy of the method were calculated for evaluation of CT diagnostic efficacy.

Results and discussion. CT sensitivity for peritoneal implants detecting was 26.5 % (95 % confidence interval (CI) 21.3 — 31.7), specificity was 96.4 % (95 % CI 94.2 — 98.6), and accuracy was 61.5 % (95 % CI 55.7 — 67.3). CT sensitivity was the lowest for tumor size less than 0.5 cm. The size of peritoneal implants visualized with CT were precisely estimated in 77.8 % of cases, underestimated in 16.7 % and overestimated in 5.5 %.

Conclusions. Single slice CT with contrast enhancement demonstrated poor diagnostic efficacy for PC diagnosis in patients with CC. Beside high specificity, CT has poor sensitivity in peritoneal metastases diagnosing, especially on early stages of PC development

Keywords: colorectal cancer, peritoneal carcinomatosis, computed tomography, sensitivity, specificity, accuracy.

The aim — to improve the diagnostics of acute calculous cholecystitis complicated by peri-cystic infiltration by classification development, depending on the infiltration extension and structure.

Materials and methods. The analysis of the ultrasound data of acute calculous cholecystitis complicated by peri-cystic infiltrates in 103 patients during 2006 — 2012, compared with the results of intraoperative observations and histological analysis was done

Results and discussion. To assess the extent of peri-cystic infiltrate, the ratio of the gallbladder area and peri-cystic infiltrate was used. Based on the extent of infiltration and its structure was developed a classification, according to which the I degree (local) is cases when the area of infiltration was smaller than the area of gall bladder, II degree (paravesical) — the area of infiltration is bigger than the doubled area of gall bladder, III degree (extended) — the area of the infiltration is bigger than the area of gall bladder by more, than two times. In loose infiltration, the density zone of infiltration was lower due to the presence of small decreased echogenicity areas and to the clear contour absence. In dense infiltration, the hyper-echogenicity zone was more homogeneous.

Conclusions. The obtained data allowed to determine the term of the surgery and mini-invasive technologies possibility

Keywords: acute calculous cholecystitis, peri-cystic infiltrates, ultrasonic study.

The aim — to perform a comparative analysis of laparoscopic cholecystectomy (LC) and traditional open cholecystectomy (OC) efficacy for acute cholecystitis (AC) treatment accompanied by ischemic heart failure in elderly patients.

Materials and methods. Treatment outcomes in 392 patients over 60 years old with AC accompanied by ischemic heart failure were compared. The control group (n = 178) included patients who were operated by OC, the study group (n = 214) — patients who were treated by LC. All patients underwent intraoperative inflammation focus sanitation by 0.9 % sodium chloride solution and Decasan solution. To assess the arrhythmias frequency and ischemia episodes duration the Holter monitoring was used.

Results and discussion. Postoperatively in the comparison group, the wound complications occurred in 18.5 % of patients, the abdominal complications — 3.9 %. Two patients died. In the study, group the wound complications encountered in 6.1 % patients, the abdominal cavity complications — 1.4 %. In the comparison group the ventricular arrhythmias episodes was observed in 51 (28.7 %) patients, atrial fibrillation — in 18 (10.1 %) and has decreased the total duration of ischemia at 61.4 %. In the study group the total duration of ischemic episodes per day decreased by 71.7 %. Ventricular arrhythmias were found in 25 (11.7 %) patients, atrial fibrillation — 12 (5.6 %).

Conclusions. LC can be performed in elderly patients for treatment of AC accompanied by hear failure. LC is associated with lower frequency of postoperative wound and abdominal complications, decreased ischemic episode duration in patients with IHD and cardiac dysrhythmia rate as compared to traditional cholecystectomy.

Keywords: acute destructive cholecystitis, laparoscopic cholecystectomy, traditional open cholecystectomy.

The aim — to improve the surgical treatment results in patients with complicated forms of chronic pancreatitis and to analyse the early and long-term outcomes.

Materials and methods. Treatment results of 96 patients with complicated forms of chronic pancreatitis, who have underwent different surgeries, were analysed. Evaluation of long-term surgical treatment results was carried out by visual inspection using instrumental studies and modified SF-36 questionnaire completing.

Results and discussion. Frey’s surgery was performed in 18 cases (18.7 %), longitudinal pancreaticojejunostomy — in 31 (32.3 %), pancreaticoduodenal resection — in 4 (4.1 %), cystenterostomy — in 9 (9.4 %), distal pancreatic resection — in 6 (6.2 %), endoscopic trans-papillary interventions on the main pancreatic duct — in 12 (12.5 %), endobiliary stenting with bypasses (gastroenteroanastomosis, biliary-digestive anastomosis) — in 6 (6.2 %), endoscopic duodenocystostomy — in 4 (4.1 %) and external drainage of purulent pseudocysts — in 3 (3.1 %) cases. After surgery, 2 patients died (postoperative mortality — 2.1 %). Long-term results of surgical treatment were studied in 50 (52.1 %) patients. The results were estimated as unsatisfactory in 5 (5.2 %) patients, particularly after longitudinal pancreaticojejunostomy in 3 patients, after endoscopic interventions in the pancreatic duct in 2 patients. The results of surgeries in other 45 patients were estimated as good and satisfactory.

Conclusions. In 26 % of patients chronic pancreatitis was complicated by biliary hypertension, in 10.4 % — by chronic duodenal obstruction, in 8.3 % — by the local pancreato-biliary venous hypertension. The priority in the treatment of chronic pancreatitis is considered the use of direct parenchyma-preserving surgery.

Keywords: complicated forms of chronic pancreatitis, operative treatment.

The aim — to study the early results of a prospective randomized trial comparing laparoscopic crural repair and two-layer plastic lightweight partially absorbable graft repair for large hiatal hernias.

Materials and methods. The LARGE double-blind phase III trial (№ NCT01408108, Clinicaltrials.gov) was started on January 2013. Patient recruitment was finished on June 2014. Main inclusion criteria: 1) types I, II and III hiatal hernias, especially including complicated by GERD ones, 2) HSA of 10 — 20 сm² (intraoperative). Main exclusion criteria: 1) ASA > II, 2) age < 20 and > 80 years, 3) BMI < 16 or > 39 kg/m², 4) oesophageal motility disorders, 5) oesophagal peptic strictures, 6) shortened oesophagus (intraoperative), 7) Barrett‘s oesophagus. With 100 patients previously involved, 6 patients did not mach eligibility criteria, 2 patients refused participating. 92 patients were randomized in 2 groups: I group — crural repair (46 patients), II group — mesh repair (46 patients).

Results and discussion. The groups were proved to be statistically comparable by demographic data, objective and subjective preoperative and intraoperative parameters. Thus, patient recruitment may be finished and study should be continued for results assessment in determined terms. Significant difference between groups was revealed in operative time. All postoperative complications were I class by Clavien — Dindo, there were no significant differences in their rates between groups, and they were not related to compared techniques, which allows to continue the trial.

Conclusions. The prospective randomized study that compared two methods of repair for large herni as is required for the final report.

Keywords: hiatal hernia, alloplasty, lightweight partially absorbable mesh, crural repair, prospective randomized trial.

The aim — to conduct the comparative evaluation of different surgical technologies in the thoracoscopic and video-assisted lung resections performance.

Materials and methods. Treatment results of 861 patents after different methods of thoracoscopic lung resections with sewing apparatus and sutureless electrosurgical technologies for different thoracic pathologies were analyzed.

Results and discussion. After various endothoracic operations 855 patients were discharged, the average hospitalization stay was 5.7 days. Death was registered in six (0.7 %) patients. Complications were marked in 3.7 % cases. Despite of endostapler’s use advantages, sutureless electrosurgical methods can be an alternative in the atypical lung resection with a significant reduction of the intervention cost.

Conclusions. Thoracoscopic lung resections can be executed not only with sewing apparatus, but with also using sutureless electrosurgical technologies.

Keywords: thoracoscopic and video-assisted lung resections, endostaplers, electro-sealing surgical technology.

The aim —— to determine the surgery technique for recurrent breast ptosis based on a comparative three-year prospective effectiveness analysis of known and proprietary methods.

Materials and methods. 116 women with recurrent breast ptosis were included in study. Mean age was 28.6 ± 0.5 years (19 — 48 years). In control group (n = 52) the conventional methods (Pitanguy-Ribeiro mastopexy (PR) was performed in 4 (7.7 %), PR in combination with endoprosthesis (EP) — in 37 (71.2 %), periareolarmastopexy (PAM) with EP — in 11 (21.2 %) patients), in study group (n = 64) the developed methods using mesh-fascial duplication and/or capsule duplication around EP (6 variants) were performed. 18 (15.5 %) patients had breast ptosis of I stage, 60 women (51.7 %) were diagnosed breast ptosis of II stage, 38 (32.4 %) — breast ptosis of III stage, groups were not statistically different, p > 0.05. 5 types of primary mammoplasty were performed in patients of both groups. Recurrent breast ptosis after re-surgery was evaluated during three-year prospective study.

Results and discussion. Breast ptosis recurrence was observed in 7 (10.9 %) women of main group and in 16 (30.8 %) patients of control group at the end of three-years observation period, p = 0.008. Recurrent breast ptosis of first stage was diagnosed in 5 (7.8 %) patients, of II stage — in 2 (3.1 %) women of the main group. Ptosis of I and II stage were observed in 8 (15.4 %) cases. Groups were differed on the level of statistical significance, p = 0.019 due to different ptosis stages. Recurrent breast ptosis occurred in one year after surgery, its frequency gradually increased over three years, but most cases were diagnosed during the second year of observation.

Conclusions. The mesh-fascial technique as additional method for breast ptosis correction surgery including the developed techniques creates a more reliable fixation structure. The latter provides significantly lower three-year recurrent ptosis rate (10.9 %) and its grade compared to traditional re-surgery (30.8 %) and leads to significantly greater frequency of good results (84.4 % vs 57.7 %).

Keywords: recurrent breast ptosis, mastopexy, duplication of posterior Scarpa’s fascia sheet, mesh allograft.

The aim — on the base of surgical treatment data analysis of thyroid cancer (TC) with size less than 10 mm, combined with different types of thyroid focal benign lesions, to detect carcinogenesis susceptibility and to establish prognostic factors for some combinations’ clinical course.

Materials and methods. The data of surgical treatment in 1177 patients with thyroid gland focal lesions was retrospectively analysed. The Surgery unit archive data of Clinical Hospital for the period from 2008 to 2013 were used in study.

Results and discussion. Histological examination revealed that the invasion of its own capsule was observed in 6.7 % of patients with isolated microcarcinomas, in 8.6 % — with cancer in combination with focal hyperplasia, in 11.9 % — with TG cancer combined with diffuse focal autoimmune thyroiditis, and was not detected in patients with adenomas. TG pericapsular space, capsule or vessels invasion was found in 2.2 % of patients with TG cancer and without background pathology, in 1.7 % of patients with thyroid cancer and TG lobular hyperplasia and in 4.6 % of patients with autoimmune thyroiditis. The invasion was not detected in patients with adenomas. Multifocal microcarcinoma was revealed in 13.4 % of patients with thyroid cancer, in 10.3 % with the combination of thyroid cancer with lobular hyperplasia, in 10 % of patients with thyroid cancer and adenomatosis hyperplasia and in 22.7 % of patients with thyroid cancer and diffuse-focal autoimmune thyroiditis.

Conclusions. Based on the results of the «small cancer» forms combined with TG benign diseases analysis it can be argued that the most risk of thyroid cancer has patients with diffuse-focal autoimmune thyroiditis, since that thyroid cancer in this group was detected by 9.3 % more than in patients with thyroid cancer and focal hyperplasia, and by 42 % more than in patients with thyroid cancer adenomatosіs hyperplasia.

Keywords: thyroid microcarcinoma, thyroid cancer, thyroid focal benign thyroid pathologies.

The aim — to evaluate the diagnostic value of different imaging techniques for complex anal fistula.

Materials and methods. The study was conducted on a group of 646 patients aged from 20 to 62 years, operated in Regional Hospital from December 2003 to April 2014 for the anal fistula various forms.

Results and discussion. The sensitivity of transrectal ultrasound study in the complex anal fistula diagnosis was 90.6 % and specificity was 84.4 %. The accuracy of the diagnostic test was 86.7 %. The fistulography allowed determining correctly the anorectal fistula complexity degree in significant number of patients. The sensitivity of this method was 79.4 %, specificity — 72.7 %, accuracy — 47.4 %. The diagnostic accuracy of MRI with 3D STIR imaging in branching fistula and pus extension detecting was 100 %. Application of this imaging has improved the preoperative diagnosis to 90.2 %.

Conclusions. Transrectal ultrasound is a more effective method for complex anal fistula diagnosing than traditional fistulography (diagnostic test accuracy for transrectal ultrasound study exceeds by 39.3 % than in fistulography).

Keywords: anorectal fistula, diagnostics, medical imaging.

The aim — to increase the of complex surgical treatment effectiveness for purulent-necrotic complications of diabetes mellitus type II by cryo-placental blood, and of polarized polychromatic irradiation sessions use.

Materials and methods. The complex surgical treatment (CST) analysis in 147 patients with diabetic foot syndrome (DFS) of the III—V severity degree according to Meggit — Wagner scale was performed. Patients were divided into two groups. The control group included 50 patients, in whom the conventional CST was performed, the study group included 97 patients, to whom the 1 ml of umbilical cord serum Cryocell-Cryocord were administered intramuscularly for 5 days. For severe endogenous intoxication in 38 patients, the dose was increased to 2 ml. in all the patients of this group the polarized polychromatic irradiation sessions were performed on the operation day and during 12 — 15 days.

Results and discussion. Common correction of purulent-inflammatory complications has decreased average molecular weight peptides level on the 5 — 7th day to 0.480 ± 0.014 st.un. (p > 0.01), and the Cryocell-Cryocord inclusion into the treatment scheme — to 0.295 ± 0.15 st. un. (p < 0.01). The more rapid stabilization of glycaemia with the insulin dose decrease by 25 — 30 % was observed during cord serum therapy. In the study group the secondary delayed sutures were imposed on the 15 — 17th day after non-traumatic amputations and necrectomy with healing and epithelialization on the 10 — 12th day in 17 (70 %) patients. Under the Cryocell-Cryocord and of polarized polychromatic irradiation sessions effect, the significant positive changes were recorded in the course of wounds’ secondary intention healing phases, compared with the control group. Postoperative wounds’ healing by primary intention in the control group was in six (12 %), and in the study one — in 68 (70.1 %) of patients. Healing of postoperative wounds with the effective dermoplasty requirement in the control group — was in one (2 %), and in 4 (4.1 %) patients respectively, process’ progression demanded the major amputation performance of the lower limb was in 9 (18 %) and in 2 (2.1 %) patients.

Conclusions. Use of Cryocell-Cryocord combined with local polarized polychromatic irradiation in complex surgical treatment of purulent-necrotic complications of diabetic foot syndrome significantly improves metabolic indexes, greatly accelerates the wound healing phases’ course. Postoperative wounds healing by primary intention in the study group was observed at 58.1 % more than in the control group. Major amputation of the lower limb due to process progression in the study group was performed at 15.9 % less than in the control group.

Keywords: purulent-inflammatory complications of diabetes mellitus, metabolic changes, endotoxemia, cryo-preserved cord blood, polarized polychromatic irradiation sessions.

The aim — to improve local therapy of trophic ulcers on a background of lower limbs varicose vein disease (LLVVD) and concomitant diabetes mellitus (DM).

Materials and methods. The treatment results in 40 patients with a DM and LLVVD complicated forms were analyzed. LLVVD duration from 5 to 15 years (mean — 9.9 ± 0.4 years). Trophic ulcers’ area — from 2 to 5 cm² (average — 3.6 ± 0.1 cm²). In all patients, the microbial associations on trophic ulcer surface were determined before treatment and on the 8th day of treatment. Patients received vascular therapy to improve blood rheology and local mupirocin ointment therapy.

Results and discussion. In 97.5 % of patients ulcer surface was colonized by microorganisms, in 87.6 % of cases — by mixed flora, dominated by Gram-positive bacteria (7.8 %). When using mupirocin on the 8th day the composition of bacterial associations had changed. No growth of pathogens such as Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa, Enterobacter spp., Citrobacter spp was observed. In 22 (55 %) patients, microbial colonies were absent, that has stimulated the fresh granulation emergence and improved the process of regeneration.

Conclusions. Use of mupirocin as ointments bandages for patients with trophic ulcers on a background the LLVVD and concomitant diabetes mellitus results in the improvement of reparative-regeneration processes due to microbial contamination reduction on the trophic ulcer surface and improves the treatment results of this patient’s category.

Keywords: lower limbs varicose veins disease, chronic venous insufficiency, venous ulcer, diabetes mellitus, mupirocin, reparation, regeneration.

The aim — to investigate the prevalence of Zenker’s diverticulum (ZD) and to describe the first in Ukraine clinical experience of ZD treating by flexible endoscopic diverticulotomy with esophagoplasty (FEDEP).

Materials and methods. In the period from May 2008 to May 2014 in the clinic during esophagogastroduodenoscopy was discovered two (0.06 %) patients with ZD from 3184 surveyed (95 % confidence interval — 0 — 0.2 %). One patient was directed to the surgeon; in another, the FEDEP was performed. The duration of the operation — 25 minutes.

Results and discussion. Water swallowing was fully restored immediately after FEDЕP surgery. No swallowing disturbances were diagnosed by fluoroscopy control. Patient was discharged on the third postoperative day in satisfactory condition. When viewed within 6 months there were no complaints, no swallowing disorders.

Conclusions. Endoscopic treatment of ZD by FEDЕP is method of choice in these kinds of patients, because it is less traumatic, safe intervention, and can be performed regardless of the age and general condition of the patient.

Keywords: Zenker’s diverticulum, flexible endoscopic diverticulotomy with esophagoplasty.

The diagnosis and surgical treatment results of two patients with skin filariasis were analyzed. Based on complaints, examinations and epidemiological anamnestic data the filariasis can be suspected. Clinical manifestation is directly dependent on the location and parasite’s development stage. For the skin filariasis diagnosis, the most informative are ELISA, ultrasound and histological studies. The lesion site excision with albendazole once use promotes recovery.

Keywords: filariasis, surgery, skin.

The use of photodynamic therapy, as an alternative treatment method of hard palate mucosa melanoma is described. Patients underwent removal of the submandibular salivary gland metastasis of melanoma and photodynamic therapy applied to the primary site. The positive dynamics marked for 4 months of observation.

Keywords: melanoma, hard palate, photodynamic therapy.

A clinical observation of rare combination of Shereshevsky — Turner syndrome and acquired bowel disease (Crohn's disease) is described. Morphological substrate of Crohn's disease was the anal fissure with severe pain syndrome. Chosen tactics of conservative treatment of Crohn's disease followed by surgery on the rectum gave a positive result.

Keywords: Crohn's disease, anal fissure syndrome Shereshevsky — Turner, pain in the anal canal.

Number of patients with oncology disease in the world increases. Venous thromboembolism — the most common and dangerous its complication that is why venous thromboembolism prophylaxis and treatment tactics in these patients remained actual. This review presents different approaches to venous thromboembolism prevention in patients with cancer that were applied in therapeutical or surgical treatment. The problems of the modern treatment is highlighted. The main perspective prophylaxis directions is determined.

Keywords: prophylaxis and treatment, venous thromboembolism, patients with cancer.

In accordance with Article 5 of the Law of Ukraine «About emergency medical care» from 05.07.2012, in the emergency medical system (EMS) of Ukraine the «emergency department (emergency) medical care» Is introduced. In developed countries, the problem of EMS providing is relevant, as evidenced by the assignment of the EMS organization to the Government’s priorities. EMS systems creating in these countries began in the 70th years of last century and lasted more than 20 years, because of the healthcare system restructuring and considerable expenses. However, experience has shown that it is justified, since the new EMS system decreases mortality and disability of patients and injured. Study of existing EMS systems showed that regardless of the regional characteristics, the main directions of their activities based on common principles — the EMS timeliness and quality, pre-hospital and hospital early stages continuity, the common standards and algorithms use in EMS providing. Conceptual structure and organization provisions of the EMS departments activities based on experience analysis in countries with market economies is highlighted.

Keywords: emergency medical care, emergency department (emergency), conceptual program.