The article is devoted to the study of integral hematological and hemodynamic parameters, as well as their relationship in patients with hypertension in the acute period of hemorrhagic stroke. The study included 95 patients with hypertension from 29 to 91 years (mean age 54.9±11 years). It was found that the majority of patients had decompensation in terms of arterial pressure (AP). Statistically significant differences LI, LII, ISL, ILG, ISNL and IS with reference values. Integral hematological parameters have a significant relationship with systolic and pulse arterial pressure (SAP and pAP).

This literature review presents a modern understanding of hereditary neurodegenerations with iron accumulation in the brain - a heterogenous group of hereditary diseases, based on a violation of iron metabolism and its deposition in various brain structures with the development of pathological changes. The main and most common clinical forms, their etiopathogenetic and molecular genetic aspects, as well as possible treatment options are described.

Leptin and its receptor are widely distributed mainly in white adipose tissue. Serum leptin concentration correlates with body mass index, and its levels decrease with fasting. Insulin appears to increase leptin messenger RNA, protein expression and release by adipocytes, both synthesized both in advance and de novo, and reduces the levels of adiponectin and its receptors. According to the literature, chronic hyperinsulinemia increases leptin levels. This review summarizes the latest knowledge on the effect of insulin on leptin synthesis and secretion; cellular mechanisms that control the synthesis and release of white adipose tissue are presented.

Detecting the localization of epileptogenic focuses (seizure lateralization) in cases of epilepsy is an important diagnostic step aimed at choosing tactics and improving treatment outcomes. Currently, EEG (electroencephalography), magnetic resonance imaging (MRI) and, to a lesser extent, single photon emission computed tomography (SPECT) are most commonly used to diagnose epilepsy. The sensitivity of extracranial EEG does not exceed 56%, while at intracranial EEG the risk of complica-tions is high. Despite the fact that the diagnostic value of MRI is quite high, in a number of patients (especially with pharmacoresistant epilepsy), it is not possible to detect morphological changes. One of the most promising methods today is diagnostics using positron emission tomography, combined with computed tomography (PET/CT), using 18-fluorodeoxyglucose (18F-FDG) as a radiotracer. This article is a review of the literature on this issue in recent years. Data on informativity and diag-nostic value of PET / CT with 18F-FDG in patients with epilepsy are presented.

Aim. Development of a diagnostic and therapeutic algorithm for optimizing the treatment of gallstone disease based on ultrasound and CT of the gallbladder. Materials and Methods.235 patients (31% of men) were included in the study, mean age (Mediana) = 48 years, mean duration of the disease (Mediana) = 1.8 years. In all cases gallstones have been diagnosed by abdominal ultrasound. Disease risk factors were identified: irregular meals - 78%, heredity - 40%, obesity - 35%; comorbid diseases of the gastrointestinal tract - 75%, heart ischemic disease and arterial hypertension -41%, diabetes mellitus and glucose intolerance-38%, urolithiasis and gout -11%. The technique of Philips CT scanner "MX-8000 IDT-16CT" have been used to evaluate the stones density in Hounsfield Units (X-ray negative stones - < 100 Hounsfield Units). The same method has been used to evaluate steatosis of the liver and pancreas and atherosclerosis of the abdominal part of aorta. Results. All patients were divided into 3 groups: 1) with biliary sludge (bile rheology disorder) -10% (n = 24), 2) with the gallstones density < 100 Hounsfield Units (HU), 41% (n = 98), 3) with the gallstones density > 100 HU - 49% (n = 113). The patients from group 3 were recommended to perform cholecystectomy. Patients with biliary sludge and gallstones <100 HU (N=122), which occupying < 1/3 of the gallbladder volume, were recommended to fol-low hypolipidemic diet, physical activity, body weight normalization, litolytic therapy with ursodeoxicholic acid (UDCA) was administered in daily dose of 10 mg / kg of body weight for 3 months. After the end of this period repeated CT was done. Depending on the result therapy with UDCA was either ended or continued. Steatosis of the liver was detected in 35% of cases (n = 74, Me = 32 units), pancreas - in 32% (n = 70, Me = 28 units). The gallstones density correlated (r = 0.5) with the degree of liver and pancreas steatosis, abdominal aorta atherosclerosis deformation and increased volume of gallbladder, liver cysts and hemangiomas, patients age. After 6 months of UDCA administration biliary sludge resolved in 91.7%, gall-stones with density < 100 HU resolved in 11.3%. After 9 months of such a treatment biliary sludge resolved in 100%, gallstones with density < 100 HU - in 52% of patients. After 12 months, the dissolution of stones reached 81.3%. In 18.7% of cases (n = 18) therapy was unsuccessful. The steatosis of the liver (Me = 55 units) and pancreas (Me = 44 units) decreased according to CT at month 6 and month 12 (p <0.05).Conclusion.Litoliyic therapy with UDCA for 6 months resulted in biliary sludge resolution in 100% cases, the same therapy for 12 months resulted in resolution of gallstones < 100 HU in 82% cases which accompanied with regression of liver and pancreas steatosis. In other conditions cholecystectomy is indicated.

The SF-Qualiveen is a short questionnaire that measures the impact of urinary symptoms on the quality of life of patients with neurogenic bladder. It was not acceptable in Russian before. The aim of the study was translation and validation of the Russian version of the SF-Qualiveen for multiple sclerosis (MS) patients. Methods. SF-Qualiveen had been translated into Russian according to the cultural and lingual adaptation algorithm. The study included 60 respondents: 50 MS patients with neurogenic bladder and 10 healthy controls. All participants filled out the SF-Qualiveen and NBSS two times with an interval of two weeks. Data were used to determine the internal consistency (Cronbach’s alfa), external validity (Pearson correlation), and test-re-test reliability with interclass correlation coefficient. Results.The mean of the SF-Qualiveen total in patients with neurogenic bladder was 2,51±0,79, that significantly (p<0.001) exceeded score in control group (0,1 ±0,02, р<0,001). The Cronbach’s alfa was more than 0.9, which confirms very good internal consistency of the Russian version of SF-Qualiveen. External validity was verified by the relevant correlations with NBSS. Test-retest reliability was excellent. The interclass correlation coefficients were >0.8 (p<0.001) for all subdomains and the overall score. Conclusion. The Russian version of the SF-Qualiveen demonstrated good validity and reliability and may be recommended for use in patients with multiple sclerosis.

A review of the literature is presented in which the authors consider the problem of varicose veins (RVV) of the pelvic organs. The first cases of the disease description by domestic and foreign scientists are given. It was found that of 25% of all patients with varicose veins (WB) 2/3 are women and in 75% of cases the pathology develops during pregnancy. According to the literature in the etiology and pathogenesis of ERW of the genitals during pregnancy, there was a mechanical theory of vasodilation, which was that the increasing uterus compresses the veins of the pelvic organs, leading to increased hydrostatic pressure, lower blood flow rate. Other authors believe that this theory does not explain the complex pathogenesis of vascular wall dilation and why, in some cases, the disease appears in the early stages of gestation, when the mechanical effect of the pregnant uterus is not yet expressed? It is believed that an equally important role is played by ovarian occlusion and pelvic vein thrombosis in history. Arteriovenous dysplasia of the deep veins of the lower extremities and compression of the veins by the pelvic organs (pregnant uterus, retro and anteflexio of the uterus, which leads to an in-flection of the uterine ligaments with a further violation of the outflow of venous blood) are also important. The problem is very urgent, since a large part of women with external and internal genital organs often occurs at a young age, is latent, and the doctor does not always associate these processes with pregnancy and childbirth.

The article presents data on the study of the etiological structure of chronic salpingoophoritis and the development of complex therapy for 120 women of reproductive age (mean age 28, 5 ± 7, 2 years). Chlamydia detected in 45% of the examined women; Mycoplasmas and urea plasmas were isolated from 32 and 23% of patients, respectively. The results of clinical and microbiological studies showed the effectiveness of antibiotic therapy with the inclusion of the polyoxidonium immunomodulator and Wobenzyme polyenzyme.

The reasons for the significant increase in the number of women who decide to give birth after the age of 35 are the rapidly changing conditions of modern life. In recent decades, the number of births in women over 35 years of age has increased by 44% in Russia. In the 90s, if the pregnancy occurred in the late reproductive age,it was taken as a mistake in family planning. Over the past few years, attitudes have changed. Domestic and foreign scientists agree on the need for special attention to pregnant women over 35 years due to the high risk of various complications of gestation.

Uterine fibroids is one of the most common benign tumors of the pelvic organs in women. Up to 20% of women over 35 and up to 40% of women over 50 have this disease. The socio-medical significance of uterine fibroids is due to: rejuvenation of the disease, late diagnosis and treatment, which lead to complications resulting in emergency surgical interventions, the likelihood of tumor recurrence after primary surgery, which leads to a violation of generative function and reduce the quality of life of women. In planned gynecological hospitals, surgery for uterine fibroids is performed in more than 50% of patients. Of the total number of gynecological medical services in the emergency room, urgent gynecological care accounts for between 26% and 40%. Uterine bleeding remains one of the urgent problems in emergency gynecology, and in the structure of causes of mortality is 18-23%. Bleeding is one of the main symptoms of uterine fibroids. In urgent situations, the main task is to quickly and effectively stop bleeding and its prevention. Conservative methods to stop bleeding, hormone therapy and a minimal-ly invasive method - hysteroscopy followed by curettage of the uterine mucosa does not always lead to the desired result with large sizes of myoma nodes, as well as with multiple uterine myoma. Conservative myomectomy belongs to the category of reconstructive plastic surgery and is associated with higher risks of peri- and postoperative complications than radical interventions. Naturally, in an emergency situation, in a serious condition of the patient, severe anemia, hysterectomy is performed more often than myomectomy. In the available foreign and domestic literature there are very few works devoted to a comprehensive assessment of the possibility of organ-preserving surgical treatment of uterine fibroids in urgent gynecology. The lack of consensus about the tactics of management of patients of reproductive age with uterine myoma when providing emergency gynecological care, analyzing the results of surgical treatment for reproductive function does not allow to develop a single algorithm for managing patients, both in the operative and postoperative periods, putting this problem among the current.

The purpose of the study is to improve the treatment results after reconstructive plastic operation of the hand. A complex of preoperative adaptive preparation and a rational postoperative rehabilitation, improving regional and peripheral blood circulation in the area of surgical intervention, has been developed. The complex has been applied to 40 patients, 92% of cases have positive long-term results of medical rehabilitation.

The article presents an analysis of the arthroscopic treatment of the knee joint for intra-articular pathology in 450 patients. Revealed common pathological processes in the knee joint. The regularity of the increase in their number in the age and sex aspects is established. The most characteristic pathologies of the knee joint and their combinations for different age groups, differing by gender, were diagnosed.

Clinical observations of 64 patients with phlegmon of the foot were analyzed. Patients consisted of two clinical groups. Group II (control n = 31) included patients in whom surgical treatment of phlegmon of the foot was performed in the traditional way. Group I (main n = 33) included patients who had been diagnosed with acute tissue hypertensive syndrome (compartment syndrome), and, according to the indications, decompressive fasciotomy was performed on the plantar surface of the foot. According to the original method (patent for invention No. 2554326). It was shown that the trigger for the development of compartment syndrome of the foot is an increase in tissue pressure by 20-25 mm Hg. from the initial level (8-10 mm Hg). The decompressive fasciotomy performed according to indications has a beneficial effect on the course of the wound process. At the same time, in patients of the first clinical group, after 6 months-1 year after surgery, good results were obtained in 92.8% (in control, 64.7%).

The objective: To determine the diagnostic accuracy of non-invasive methods of diagnosis of liver fibrosis, as well as to analyze the interaction of laboratory parameters and the stage of liver fibrosis. Patients and methods. The work was performed in the infectious Department of 5 EKG of VNG of the Russian Federation in Yekaterinburg, 168 patients with CHC participated in the study. Before the administration of antiviral treatment to all CHC patients diagnosed with stage of liver fibrosis using three methods: needle biopsy of the liver, fibroelastometry and FibroTest. In the future, the sensitivity and specificity of non-invasive diagnostic methods depending on the stage of liver fibrosis were determined. Results. According to the results of liver puncture biopsy, patients with CHC depending on the stage of fibrosis were distributed as follows: with minimal fibrosis (F0-1) - 50.6% (85 people), moderate fibrosis (F2) - 25.6% (43 people), with severe fibrosis (F3) - 11.9% (20 people) and liver cirrhosis (F4) - 11.9% (20 people). According ROC curve analysis FibroTest highly informative only at the stage F4 fibrosis (AUROC=0,972), whereas fibroelastometry effective in severe F3 fibrosis (AUROC=0,847), and cirrhosis F4 the biopsies and elastography almost comparable (AUROC=0,994). In most patients with CGS at the stage of minimal and moderate fibrosis F≤2 it is advisable to use at least two non-invasive methods of diagnosis of liver fibrosis. Puncture liver biopsy is still a universal method of assessing the stage of liver fibrosis in patients with chronic viral infection. Conclusion. The sensitivity and specificity of noninvasive diagnostic methods for liver fibrosis in patients with CGS at stage F≤2 is unsatisfactory. In order to determine the true picture of the pathological process, a puncture liver biopsy is necessary.

Clinical observation of a patient, I., 40 years old, who was diagnosed with acute phlegmonous parasitic cholecystitis of moderate severity caused by acute opisthorchosis, a hepatocholangial variant, and surgical intervention, laparoscopic cholecystectomy, was diagnosed in 1 surgical ward of 5 VCH FNG Russia. The question of diagnosis of opisthorchiasis has been studied in sufficient detail, but the initial manifestations of the disease may not have a typical clinical picture, which often causes some difficulties for the doctor. Developing against the background of the disease, damage to organs requires, among other things, surgical treatment, attention is drawn to the lack of tactics and technique of surgical interventions for opisthorchosis of the gallbladder. The sources of information do not have a characteristic description of the type of internal organs in case of their opisthorchosis lesion, which, when performing laparoscopy, indicated this pathology. In our clinical case, during surgery, a revision of the abdominal organs macroscopically revealed changes in the structure of the liver, marked adhesions in the upper floor of the abdominal cavity, which are also described by the authors on the sectional material. In the gallbladder, proliferation of the mucous membrane epithelium with the formation of papillomas, desquamation of epithelial cells and often adhesions between the gallbladder and surrounding organs, atrophy and eosinophilic infiltration of all layers of the gallbladder wall are noted. Severe fibrosis of the gallbladder is a common histological feature of cholecystitis among people with opisthorchiasis, which was confirmed histologically in the study of the patient's macropreparation.

The article describes a case of laparoscopic segmental resection of the spleen in a non-parasitic spleen cyst and presents a literature reference.

According to WHO, tuberculosis still remains the leading cause of death from infectious diseases in the world, ahead of HIV/ AIDS. The main causes of luck of the TB situation are the HIV pandemic and multidrug-resistant tuberculosis in all countries. The aim of the analytical review is to determine the trends and interdependence of the HIV and tuberculosis epidemic in North-West Region of Russia. The materials and methodological basis of the epidemiological analysis were the state statistical reporting forms on HIV-infection and tuberculosis from 2007-2017, some data - from 2000. Results. In the North-West Region of Russia, as well as in the whole country, the TB situation is improving. However, the main HIV indicators, in contrast to the federal data, have tended to decline during the recent years, especially in the Kaliningrad region, which came out of the number of territories with a high burden of HIV. However, there has been an increase in the number of patients with proficient HIV stages and in heterosexual route in the spread of human immunodeficiency virus. Conclusion. The HIV epidemic with an accumulation of patients with advanced HIV-stages and potentiated by the growth of the heterosexual route is the main factor in maintaining the tension of the TB situation in the North-West Region, as well as in the whole Russia, which requires strengthening measures to tackle HIV epidemic in the federal level.

Infections of the pulmonary system, being the most common pathologies in humans, can cause serious complications. In this regard, it is essential to select etiopathogen and to provide adequate treatment of different clinical forms of respiratory infections, to solve the issue of necessary, the appointment of antibacterial therapy, to choose the drugs most active against the alleged causal germs. In recent years, there has been an increasing amount of evidence that has led to a review of traditional views on the etiology and regimens of antibacterial chemotherapy for respiratory infections.

One of the main methods of diagnosis are functional diagnostic methods. The modern development of medical science and practice requires health care organizers to constantly monitor changes in this area. A great contribution to this is made by scientific research. The aim of the work was to analyze the activity of the functional diagnostics service of the Udmurt Republic for 2014-2016.the paper used the annual reports of the Federal statistical observation and annual reports on the state of health of citizens of the Udmurt Republic for the analyzed period. The results established the stability of the functional diagnostics service in the Udmurt Republic. There was an increase in the volume of work performed by specialists of functional diagnostics of the Udmurt Republic. In General, the diagnosis of the population of the region was carried out at the level of outpatient service. The provision of medical personnel in the functional diagnostics service of the Udmurt Republic showed their deficit. This was accompanied by a large proportion of compatibility of specialists with higher medical education. The electrocardiography method prevailed in the share of all functional diagnostic methods. The results can be used by the organizers of health of the Udmurt Republic to make the necessary organizational and management decisions.

The purpose of the study is to improve the organization of medical care for victims of multiple, combined and shock injuries, as well as injury prevention. Material and methods. The study material included an analysis of data from the Chelyabinsk Regional Bureau of Forensic Medical Examination, annual reports on the activities of medical organizations were studied, and federal and regional regulatory documents were analyzed. Mathematical and analytical research methods were used. Results. One of the key moments of the effective work of trauma centers is to optimize the work of medical organizations, taking into account the routing and increasing the flow of patients from the territories included in the service area of the injury centers. In addition to improving the organization of medical care, the organization of preventive measures for the occurrence of injuries is needed. Prevention should be interdepartmental in nature and aimed at preventing people in public places or driving while intoxicated with being in public places. Such preventive measures can reduce the death rate from injuries by more than 40.0%.

Intensive indicator in the Republic of Dagestan is more than 5 times lower than in the Russian Federation. At the same time, the proportion of late hidden syphilis in the Republic of Dagestan in 2017 is 38.2% (24.2% in the Russian Federation). In the Republic of Dagestan, the “vassermanization” of the decreed contingent determines the “major share” of the incidence rate of syphilis. At same time by specialists of Ambulance Institution of all profiles except dermatologists 13.2% were found in Dagestan, which is lower than the average Russian and regional indicators (17.6% and 16.8%, respectively). There is potential in this direction and it is necessary to intensify the work of all Ambulance Institution, patients whose risk group for the incidence of syphilis. The proportion of patients with syphilis identified during various types of medical examinations in the North Caucasus Federal District and Dagestan is approximately the same (18.7% and 21.3%, respectively) among the number of patients with newly diagnosed. But statistics vary significantly depending on the types of medical examinations. There are zero indicators of our region in comparison with the Russian Federation (12.7%) and the North Caucasian Federal District (6.9%) in the column "during preventive examinations.” This line of active identification of the population infected with syphilis in Dagestan needs to be “reanimated” and phased in. At the same time, it was established that work with sexual and household contacts was established in the dermatovenerological service of Dagestan not up to standard, which is reflected in the overall picture of the incidence of syphilis in Dagestan.

One of the common and difficult to predict complications of injuries is fat embolism. Lethality rate is up to 67% even with intensive modern therapy. The variety of manifestations of fat embolism, the lack of a unified theory of its occurrence and development, the multiplicity and ambiguity of risk factors for fat embolism make it necessary to study in detail the risk factors for the development of fat embolism for its effective prevention and timely therapy. The results of forensic studies of corpses have been studied. The risk of fat embolism is correlated with the functional state of the organism at the time of injury, the peculiarities of injury, the presence and duration of medical care. Statistical processing of the obtained data using the program MedCalc Statistical for biomedical research, software manual (2014) has been performed. Direct negative regression of the ratio of soft tissue and internal organ damage to the degree of fat embolism has been reliably revealed. A slight direct positive regression between the extent of skeletal bone damage and the degree of fat embolism has been found. The development of fat embolism is associated with the presence of infectious and inflammatory processes in the lungs in 30-40% of cases. The fact of polytrauma does not significantly affect the degree of fat embolism. It was reliably determined that a high degree of fat embolism in a smaller part of cases was diagnosed with a combination of soft tissue damage and internal organs. Currently, the existing schemes of medical care for victims do not have a significant impact on the development of fat embolism. A detailed analysis of the provisions of biochemical and colloidal-chemical theories of fat embolism development is necessary for the development and implementation of recommendations for the prevention of embolism in certain categories of traumatological patients.

The article discusses the relationship between the conduct of educational research works by students and the improvement of their performance. An example of the participation of students in the study of posture over three semesters is given. The conclusion is made about the need to organize such work to increase the motivation of students to the qualitative study of human anatomy.

The data of research of elemental content of erythrocytes in patients with age-associated pathology were presented in article. The received data testified about aggravation of pathological processes with growth the degree of polymorbidity, tension of sanogenetic manifestations and about larger susceptibility of elderly patients to pathological processes, which can influence on oxygen and carbonic metabolism.

The study focused on the pathogenetic orientation of the therapy of transient « dry eye» syndrome (corneal-conjunctival xerosis (ССХ)) in patients after surgery for laser vision correction. Patients suffering from postoperative ССХ received, in the form of instillation of eye drops, preparations with an immunomodulatory effect, a para-aminobenzoic acid derivative interferon inducer in addition to the standard combination therapy regimen, including tobramycin, dexamethasone, and a preparation containing dextran-70 and hypromelase. To exclude chemical interaction, the time intervals for drug instillation were observed. When analyzing the dynamics of the course of CCX, the data of clinical and laboratory indicators of lacrimation, the results of instrumental examination, indicators of the course of the inflammatory process IL4 in the anterior chamber of the eye were taken into account. Based on a comparative analysis, a conclusion was made about the clinical and pharmacological advantage of complex therapy with the use of immunomodulatory agent.