The article discusses the main points of the treatment of thrombophlebitis of the superficial veins of the lower extremities in patients who have undergone a new coronavirus infection, the tactics of conservative treatment in a hospital and at the outpatient stage in 42 patients. The proposed method of treatment refers to the use of venotonic Vasoket, oral fibrinolytic Thrombovazim and direct oral anticoagulants in combination with the basic treatment of this pathology. The proposed method is described in detail and the effectiveness and safety of this treatment are analyzed in comparison with standard therapy.

The hyaline cartilage damage problem is actual, but existing recovery methods are not fully sufficient. A promising solution of this problem can be the implantation of a tissue-engineered structure (TEC), consisting of a cell culture and a biodegradable scaffold. In this experiment we created a construct consisting of a polylactide scaffold and a human dermal fibroblasts culture. After implantation of TEC in the modeled defect area we analyzed the experimental group regeneration results in comparison to the control group.

Aneurysmal lesion of the abdominal aorta is a common disease, the frequency of which exceeds 8% [1, 2]. A quarter of the initially examined patients at risk of this pathology are diagnosed with complicated forms [3], which negatively affects the life expectancy of this category of patients. Their lethality reaches 83% [4]. The frequency of various complications associated with the duration and trauma of open surgical interventions ranges from 7 to 39% [5, 6]. At the same time, the existing algorithms for examining patients with AAA, aimed at the timely detection of preand postoperative complications, require significant correction [6, 7]. The presented data and the variety of X-ray methods and techniques for diagnosing an aneurysm of the abdominal aorta indicate the need for further search for ways to solve this urgent problem. Determining the role of magnetic resonance imaging in the algorithm for radiological diagnosis of diseases and complications of abdominal aortic aneurysm.

The discrepancy of echocardiographic signs of right ventricular overload with the clinical picture and the level of plasma troponin concentration may underestimate the severity of the condition and lead to an inadequate choice of therapy, since all these parameters are currently determining the tactics of treatment of patients.

Objective: to assess the prevalence and clinical characteristics of patients with pulmonary embolism with inconsistency of clinical, laboratory and instrumental picture.

Material and methods. The course of the disease of 456 patients with pulmonary embolism was analyzed. 21 patients had a fatal outcome, the rest recovered. All patients underwent general clinical and biochemical blood tests, determination of the level of D-dimer and troponin, electrocardiography, echocardiography, ultrasound of the veins of the lower extremities, CT angiopulmonography, analysis of the results obtained.

Results. It was found that among patients with high- and moderate-risk pulmonary embolism, women more often than men have an increase in the plasma concentration of troponin levels by 2.4 times, as well as a 3-fold discrepancy in the clinical and laboratory-instrumental picture with the presence of signs of right ventricular overload according to echocardiography data, which appear in dynamics. The phenomenon of "delayed echocardiography signs of overload of the right heart" is recorded in 0.8% of all patients with pulmonary embolism. At the same time, in patients with a high risk of early pulmonary embolism – associated death, its occurrence is 2.1%, and in patients with a moderately high risk – 4.4%. When comparing the prevalence of clinical and instrumental symptoms of pulmonary embolism in these patients with the data of patients with high and moderate risks of early death from pulmonary embolism, no statistically significant differences were found, including in terms of echocardiography in dynamics. The delay of еchocardiography signs of overload of the right parts of the heart" by 12–36 hours from the clinical picture, including in patients with hemodynamically significant pulmonary embolism, can be detected only with a series of еchocardiography, which allows, if necessary, timely review scope of treatment. In patients with pulmonary embolism with a pronounced lesion of the pulmonary artery, due to the rapidly progressing course of the disease, it is possible that the еchocardiography criteria of the disease do not have time to develop. In this case, an assessment of the stroke volume may play an important role, hover this parameter is non-specific for this disease.

Topicality. In modern medical practice, the issue of studying and developing methods for assessing pain syndrome is acute, which is associated not only with the complexity of interpreting this sensation, but also with the lack of a unified idea of the mechanism for forming pain sensations. The development of diagnostic capabilities in the field of medical practice and the possibility of widespread use of modern equipment allowed us to take a new look at the possibility of instrumental and projection assessment of pain syndrome.

The purpose of this study is to study the possibility of using instrumental and projection assessment of pain syndrome in medical practice.

Material and methods. The study was carried out on the basis of a compilation of data from modern domestic and foreign scientific sources in the field of the possibility of using instrumental and projection assessment of pain syndrome.

Results. The latest methods of assessing pain syndrome are aimed at the maximum possible objectification of pain sensations, which allows making the most reliable clinical assessment of the patient's condition. Currently, research methods such as neuroimaging, determination of cutaneous electroconductivity, analgesic nociceptive index, surgical plethysmographic index, electroencephalography, plethysmography are being actively introduced. The instrumental methods described above are the latest methods for objectively assessing not only the intensity of pain syndrome, but also the degree of nociceptive protection when applying intraoperative analgesia methods. The ambiguity of the results obtained during clinical trials as part of the evaluation of the validity of these criteria for assessing the strength of nociception dictates the need to continue further research in the field of this issue.

Conclusion. In modern medical practice, the issue of developing methods to ensure an adequate, objective assessment of the intensity of pain syndrome remains acute. This issue mainly concerns surgical doctors, which is associated with the need to provide an adequate anesthesiological allowance in the intraoperative period, which will avoid the development of postoperative pain syndrome. Solving this problem will contribute to a significant improvement in the results of therapeutic interventions and reduce the risk of developing chronic pain in the patient.

The article reflects topical issues of natal trauma and its consequences in children born surgically, with a comparison of different views of domestic and foreign scientists. Risk factors for natal trauma, features of the caesarean section technique, options for complications and outcomes for the newborn are presented. Data from a study of the health of 93 children aged 1 to 16 years who were born surgically by caesarean section were analyzed, approaches to the occurrence of natal trauma and its consequences, as well as their diagnosis and treatment in pediatric patients were considered. It is concluded that the treatment of natal trauma and its consequences after operative delivery should be aimed at eliminating the causes and undesirable symptoms of birth trauma.

Relevance. Currently, there is an increase in combined injuries worldwide, with more than a third of the victims of this category dying from various complications in the post-traumatic period.

Objective: To determine the possibility of performing optimal surgical interventions in patients with multiple and combined trauma, including anti-shock, with shock of varying duration against the background of intensive therapy.

Research material. The paper analyzes the surgical tactics of complex treatment of 150 victims with severe combined trauma. In the course of the study, we divided them into five clinical groups with various shock phenomena. Prediction and determination of the expected duration of shock against the background of intensive therapy was carried out using the table "Score assessment of shockogenicity of trauma" and nomograms developed at the I.I. Janelidze. Research Institute of Emergency Medicine.

The results of the work. For clinical and prognostic groups, we noted a correlative relationship between the predicted duration of shock and the time of possible recovery operations, as a result, the coefficient of multiplicity of recovery was revealed. Dividing the average bed-day in hours by the duration of the shock in the forecast groups, we calculated the coefficient of multiplicity "K", which averaged 11 days. K= (144:12 + 184:18 +224:25) : 3 ≈ 11 ( days).

Conclusions. Predicting the duration of shock allowed us to develop in an experiment and propose for implementation into clinical practice sparing surgical interventions that are of the nature of anti-shock, as well as to determine the most optimal time for performing reconstructive operations on the principle of simultaneous polysegmental osteosynthesis:
1. Operations for damage to the organs of the upper and lower floors of the abdominal cavity and pelvis.
2. Primary stabilization of fractures of the pelvic bones by an external fixation device in our modification.
3. Fixation of floating rib plastrons by the external fixation device of our modification.
4. Simultaneous polysegmental osteosynthesis.

 Modern aspects of etiology, pathogenesis, clinic, diagnosis and surgical treatment of vascular injuries of the extremities are considered. The surgical tactics in acute vascular injury are covered in detail in practical terms. 

Background. Up to 45% of ischemic strokes are cryprogenic.

Aim is to study which variant of permanent AF without intra-heart thrombi is the most unfavorable in appearing of stroke.

Methods. We observed 202 patients with permanent AF without intra-heart thrombi and hemodynamically not significant carotid bifurcation atherosclerotic stenosis. We performed echocardiography, 24-hours monitoring of electrocardiography (ECG), ultrasound of brachiocephalic arteries, sphygmography of common carotid arteries, computer tomography of the brain, hemostasiograms, lipid profile, hemoglobin A1c. According to the 24-hours ECG monitoring data, we divided patients into two groups up to the maximum pauses between ventricular complexes in AF: patients with a pause <1,5 seconds (113); ≥1,5 seconds (89). Both groups were on the same standard therapy including novel oral anticoagulants. We observed the patients during 1 year to analyze the verified stroke or transient ischemic attack (TIA).

Results. In ultrasound, there was an increase of linear blood flow velocity in the area of carotid stenosis during the spread of the pulse wave after the long pause between ventricular contractions in group 2 up to 2,5 m/sec as in hemodynamically significant stenosis. In 1-year observation, there was the higher stroke in group 2.

Conclusion. The appearance of stroke and TIA in AF is higher in patients who have 1,5 seconds and more of maximum duration pauses between ventricular contractions. The reason of cryptogenic stroke can be the atherosclerotic plaque defragmentation with further embolism, caused by additional mechanical impact of increased hemodynamical parameters of pulse wave after long pause between ventricular contractions.

Prostate cancer is in third place in the structure of mortality in men. The most significant factor influencing the tactics of treatment and the likelihood of tumor progression after radical treatment is the degree of tumor malignancy. The aim of the study was to analyze the influence of the group of grade of malignancy of prostate adenocarcinoma on the survival rate of patients with localized forms in the Samara region. The study included all patients with newly diagnosed localized prostate cancer in the Samara region in 2010–2016 – 2535 patients registered in the database of the population cancer registry of the Samara Regional Clinical Oncological Dispensary. When analyzing the investigated indicator, the dependence of the general and cancer-specific survival of patients with localized prostate cancer on the degree of tumor malignancy is traced. In patients with an increase in tumor grade, the risk of death from prostate cancer increases.

In diabetes mellitus II type hyperglycemia contributes to the development of endothelial dysfunction. It leads to hypercoagulation and severe microcirculation disorders, which are the cause of ischemia in periodontal tissues and the development of inflammatory processes. The aim of the study hemostasis indicators associated with endothelial dysfunction to study the etiology of periodontitis in patients with type II diabetes mellitus. Materials and methods. 46 people aged 50–80 years were examined. 20 patients planned hospitalized, with compensated type II diabetes mellitus without complications and other diseases and 26 healthy people were examined as a control group, comparable in age and sex to the patients with SDS. Blood was taken when patients were admitted to the hospital before the treatment. For all studied parameters, a multiple and pairwise comparison was carried out. Results. Considerable changes in endothelial function were found in patients with DFS. There was a significant increase in the concentration in blood serum of indicators such as d-dimers (10.5 times more compared with the control values), factor XIIa (8.4 times more), Willibrand factor (2 times more). The increase in the concentration of fibrinogen, INR and antiplasmin in the plasma of patients with DFS was also revealed. In addition, there was a significant decrease in antithrombin content by 17% compared to control values. Conclusions. The hemostatic system is involved in a wide variety of pathogenetic links in the inflammatory process in periodontal tissues. Due to endothelial disfunction and the damaging effect of hyperglycemia on the cell membranes, hemostasis is activated, so it leads to the thrombosis. This is the cause of severe microcirculation disorders, which further contribute to changes in the periodontal tissues and to the development of inflammatory processes in patients with type II diabetes mellitus.

 Piriformis syndrom is a complex pathology, compression-ischemic neuropathy, accompanied by a persistent pain syndrome, that significantly reduces the quality of patients life. It is of interest to evaluate the effect of new methods of treating patients with piriformis syndrom, in particular, the method of directed contact diathermy (TRtherapy). The paper reflects the features of the use of TR-therapy. We analyzed in dynamic the effect of the TR-therapy using ultrasound examination of the pathology zone. The advantage of TR-therapy has been proven in comparison with the traditional method of piriformis syndrom treatment. 

Erectile dysfunction, remaining an urgent problem of our time, is pushing the world urological community to develop new methods of diagnosis and treatment. Currently, urologists have in their arsenal a variety of both conservative and surgical methods for correcting erectile dysfunction. This manuscript provides an overview of modern surgical treatment methods based on world literature data.

A clinical case of laparoscopic splenectomy with resection of an aneurysmically altered splenic artery is presented. A 55-year-old female patient was diagnosed with a splenic artery aneurysm on computed tomography. Performed transfemoral angiography – fusiform aneurysm, X-ray endovascular embolization is not feasible. The operation was performed laparoscopy, resection of the aneurysm of the proximal splenic artery, splenectomy. The postoperative period was uneventful. The patient was discharged with recovery. The possibility of performing such a surgical intervention was due to the anatomical and topographic conditions of the location of the aneurysm and was aimed at achieving radical treatment with low invasiveness and trauma of the intervention.

The aim of the study is to develop a finite element model of postmortem heat exchange of the head in the presence of an open penetrating traumatic brain injury and to assess the degree of its influence on the postmortem temperature field of this area of the body. Using the ELCUT 6.5 application, based on the finite element method, modeling of the geometry and postmortem heat exchange of anatomical structures of the human head in the absence and presence of a penetrating wound and associated intracranial membrane hemorrhages was carried out. A twodimensional finite element model of finding the postmortem temperature field of the head with an open penetrating craniocerebral injury under conditions of convective heat exchange with the air environment has been developed. The absence of a significant local effect of an open penetrating head wound on the postmortem dynamics of cranioencephalic and surface temperature is proved. It is concluded that cranioencephalic temperature can be used to determine the postmortem interval in the presence of an open penetrating traumatic brain injury.