Research objective - to compare efficiency of treatment of perineum postnatal ulcers by applications of Levomecol ointment and ablution solutions of antiseptics cavitated by low frequency ultrasound. Research included 30 women: in 1t group (n=15) ointment containing chloramphenicol and dioxomethyltetrahydropirimidine (Levomecol) was used, in 2nd group the wound was treated within 5 minutes with cavitated solution of 0.05% chlorhexidine. Secondary seams were overcast to patients of both groups while wound cleansing. Treatment efficiency assessment was performed on 3rd, 7th and 14th days of staying in specialized obstetric observation inpatient facility. Results: Subjective symptoms credibly weakened among patients from 2nd group: at 3rd day they assessed pain at 1,0+0,1p points, against 3,3+0,1 points in 1st group. Swelling in the area of the wound was observed in 1st group in 73,3%, in 2nd - 6,6% (р=0,01). Wound size in 1st group decreased to 28,6+0,4 mm, in 2nd group - 23,3+0,2 mm (р=0,04). 9 women (60.0%) in 1st group and no women in 2nd group (р=0,01) had fibrinous pellicle. Further, by 7th day dynamic of treatment of subjective and objective symptoms decreased in both groups, but credibly more intensive in the 2nd group. In 1st group secondary seams were overcast in average in 7,8 +1,0 days, in 2nd- in 5,2+0,8 days. Conclusions: 1) It is reasonable to treat postnatal ulcers in specialized obstetric observation inpatient facility; 2) Ablution of postnatal ulcer with solutions of antiseptics cavitated by ultrasound results in high therapeutic, rehabilitation and economic effect.

A comparative analysis of obstetric and perinatal outcomes of vaginal delivery in women with a scar on the uterus was performed. The main indications for urgent abdominal delivery in patients with a scar on the uterus were: the inconsistency of the scar on the uterus, the primary weakness of labor and the clinically narrow pelvis. Newborns from mothers with a scar on the uterus, which were naturally delivered, had more favorable health indicators (early discharge home, significantly less need for further nursing and supervision in the separation of neonatal pathology).

The analysis of the effectiveness of preparation for childbirth in primiparas was carried out. It was found that the use of complex physiopsychoprophylactic preparation for childbirth has positive effects on the psychoemotional status of the primipara, including optimization of the levels of situational and personal anxiety. Classes in school pregnant women increase the probability of forming the optimal type of psychological component of the gestational dominant (OR = 1.58) in patients and contribute to a greater satisfaction with the quality of life (RR = 1.30).

Surgical deactivation of ovarian function in women of reproductive age remains one of the urgent problems of modern medicine. This analysis was performed in 60 women of the main group aged 40-55 years in early surgical postmenopausal women who underwent abdominal gynecological operations with ovarian excision. Indications for surgical interventions on the organs of the reproductive system in women are ovarian tumors, combined pathology of the reproductive system, severe purulent processes of the genitals and others, the volume of which includes removal of the ovaries.

The choice of contraception, and ensuring a decent quality of sexual life is one of the important tasks in the work of an obstetrician-gynecologist. The purpose of our work was to elucidate the characteristics of the sexual life of women in the late phase of the menopausal transition. 569 women aged 46-49 years were under observation, beginning with the late phase of the menopausal transition: the presence of manifestations of a climacteric syndrome in 485 women (85.2%), and the rest (84 women, 14.8%) - menopausal disorders were not detected; among all women, a survey was conducted on their sexual activity in the next 6 months; the necessity of contraception and its influence on the quality of sexual life was clarified. Among women who are in the late phase of menopausal transitions, the avoidance of sexual contact occurs in 61.4% of the respondents, which may be due to their existing menopausal disorders (in 90.1%), including the physical causes of renunciation of sexual (in 78.9%), and dyspareunia and dryness during sexual intercourse (in 36.2%), and (possibly in part) the absence of emotional contact with the sexual partner (41.6%). Significant contribution to the deviations in the sexual life of patients makes the presence of sexual disorders among their partners (in 38.5%). When choosing a method of contraception and means of correction of menopausal disorders, it is necessary to take into account their possible influence on the sexual sphere of women.

Aim: to assess the effect of the natural course of chronic hepatitis C in young women, on fertile function. Material and methods. 71 patients with CHC were examined in a complex manner in comparison with the results of 32 healthy women of reproductive age, conducted on the basis of the infectious disease department of 5 VKG VNG RF (Ekaterinburg) in 2017-2018.Results: In interpreting the results it was found that in women with HCV infection, in comparison with healthy women, infertility is more often diagnosed, the frequency of infection with human papillomavirus is higher, the incidence of genital herpes, gastrointestinal tract diseases, ovarian cysts , uterine fibroids; with the progression of liver fibrosis, the levels of folicle-stimulating hormone (FSH) and testosterone decrease. Conclusion: The natural course of HCV-infection in fertile women is characterized by hormonal changes, mainly at the F3-F4 stage, moderate cytolytic syndrome, a decrease in vitamin D levels, and is accompanied by comorbidity from gynecological diseases and pathology of the gastrointestinal tract. Early diagnosis and timely treatment of HCV will prevent the development of violations of female reproductive function.

According to world statistics, about 30% of women are subjected to surgery on the genitals, and 1 place is occupied by surgery for uterine fibroids. In the study of biocenosis of the vagina and cervical canal in 67% of women with uterine fibroids in the vaginal discharge revealed a pattern of bacterial vaginosis. To date, the issue of complex treatment of vaginal dysbiosis in patients with uterine myoma remains relevant and insufficiently studied. The frequency of pyo-inflammatory postoperative diseases is increased in women with all types of vaginal microcenosis. Considering that operations concerning uterine fibroids take the first place among gynecologic operations, it is necessary to carry out complex treatment of a dysbacteriosis of a vagina which leads to postoperative complications.

The main aim of this study is to evaluate the quality of the Breast Cancer Screening Program performed in the Khanty-Mansiysk State Region - Ugra. The screening covers women over 40 years old. The screening interval is 2 years, with two-view mammography and single reading as the standard. During 2007-16 within the Program, 451139 women were screened in the region. The screening coverage rate (2015-16 round) was 41%. 9,3% of screened were referred for further assessment. The screen detection rate was 3.5 per 1000 screened. The test sensitivity for the first round was estimated as 80%. A 42% increase in newly diagnosed stage T1N0M0 breast cancer and 21% reduction in breast cancer detected with tumour size over 20 mm were observed compared to expected absolute number from the 2002-06 trend. Mammographic screening has contributed to a significant reduction in breast cancer mortality - 23,7% reduction using absolute mortality results. Continuous 10-year mammographic screening in Ugra has contributed to a significant improvement in the early disease diagnosis and, as a result, a reduction in absolute mortality rate from breast cancer were observed. In clinical terms, since the findings to date suggest a benefit of the screening, the main aim should be to improve coverage of the population with screening.

Early diagnosis of breast cancer certainly affects the reduction in mortality from this disease. The article shows and analyzes the indicators that determine the effectiveness of mammographic screening among the female population of Khanty-Mansiysk in the period from 2008 to 2016. The screening procedure for breast cancer in the period under review covered 22681 women of age groups 40-49 years old, 50 years and older. All examined women underwent a mammogram in direct and oblique projections at intervals of 2 years. Analysis of the results showed the relevance and significance of breast cancer screening. In the 40-49 age group, the detection rate of breast cancer per 1000 surveyed was 3.7, in the 50-year-old group and the scare, the corresponding figure was 5.1. The article also substantiates the importance of controlling the incidence of breast cancer in patients of different age groups.

The incidence of multifocal (MF) and multicentric (MC) carcinomas varies widely among clinical studies, depending on definitions and methods for pathological sampling. Magnetic resonance imaging is increasingly used because it can help identify additional and conven-tionally occult tumors with high sensitivity. However, false positive lesions might incorrectly influence treatment decisions. Therefore, preoperative biopsies must be performed to avoid unnecessary surgery. Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors. However, the rate of local recurrences is usually low after breast conservative treatment (BCT) of MC/MF tumors. It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years, with small tumors and absence of extensive ductal carcinoma in situ. A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial. Surgery should achieve both acceptable cosmetic results and negative margins, which requires thorough preoperative radiological workup and localization of lesions. Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity, namely fibrosis. In conclusion, BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists, surgeons and radiotherapists.

Purpose was research and diagnostic evaluation of heart rate deregulation in patients with hyperten-sion disease (HD) by help of high-resolution rhythmocardiography (RCG) and analysis of heart rate variability(HRV) by apparatus-program complex CAP-RC-01-“Micor”(APC), (Certificate № 022б2005/2447-06). 1281 patients with HD were investigated by the RCG. Other diseases were ex-cluded because high-resolution of the APC. Here were peculiarities were defined for every HD stages - prevalence of the autonomic sympathetic HRV-waves at the HD 1 st, amplitude reduction of all waves at the HD 2 stage, as marker of heavy disease and syndrome of autonomic cardioneuropathy with high risk of lethal outcome.

The acropathology appears to be the most significant recovery problem after the cerebral apoplexy. Post-stroke arthropathies of the glenohumeral joint come amid the pain syndrome and movement disorders. To correct the pathology of the glenohumeral joint in the late recovery period an emerging technology bandage was proposed. The effectiveness of using a bandage on the dynamics of pain syndrome and the amovement amplitude is proved.

Morbid obesity, associated with various metabolic disorders leading to a decrease in the quality of life and its duration. Conservative treatment of morbid obesity is often ineffective, and therefore bariatric surgery is becoming more common. The review analyzed clinical recommendations and our experience in selecting patients for bariatric surgery, assessed the effectiveness and safety of various types of operations, and outlined the main problems of these operational benefits.

Relevance. In recent years, the number of operations performed on the adrenal glands has increased significantly. This is also related to the improvement of diagnostic methods for various pathologies of adrenal diseases in the general population. objective: 1) the identification of potential indications for bilateral adrenalectomy (BA) in the conditions of the updated therapeutic algorithms of CS; 2) to compare the efficacy and side effects of various therapeutic options for treating hypercorticism with the results of a BA to better determine the indications for it in the 21st century. Materials and methods. Literature search with the search term: "Bilateral adrenalectomy”. Source: PubMed, Medline. Results. Review of 174 viewed publications, signs of hypercorticolism (hypertension, obesity and depression) improved in most patients after BA (7 studies, 195 patients). Approximately 46% of patients died in the first year after surgery. Conclusions. To study the effect of BA, its timeliness in the treatment of patients.

The results of treatment of patients suffering from diabetes mellitus, complicated by diabetic microangiopathies in sanatoriumresort conditions are presented in the work. The study included 94 patients, of whom 62 with diabetic angiopathy of the retina and renal vessels, undergoing rehabilitation in the sanatorium Obukhovskiy and 32 patients undergoing rehabilitation in outpatient settings. The results of treatment showed a significant improvement in the ophthalmologic status, metabolic processes and the state of renal hemodynamics in patients receiving balneotherapy in sanatorium-resort conditions.

The goal of comparative investigation was to reveal the distinctive features of the DNA content and cell distribution in the phases of the cell cycle of recurrent STS. DNA cytometry in the tumor tissue of 30 primary soft tissue sarcomas (T2a-2bN0M0) and 30 STS recurrences (T2-3N0M1) was carried out using the method of flow cytofluorometry. The tumor ploidy and cell distribution in the cell cycle phases were analyzed. Results. A number of differences in the DNA cytometric parameters of primary and recurrent STS have been revealed, they include: an increase in the proportion of aneuploid tumors in case of recurrence, the number of tumors with DNA index within the mitotic cycle, an increase in the proportion of cells in G2+M- phase of diploid and aneuploid tumors and a decrease in S- phase of aneuploid ones. It has been shown that with a G2 differentiation degree, the proportion of cells in G2+M., S- and IP of recurrent STS is significantly lower than the primary parameters. An increase in the proportion of cells in G2+M- phase and a decrease in the rate of proliferation of recurrent STS, depending on the stage, are shown only in case of stage III. Conclusion. The revealed features of DNA content and cell cycle of tumor cells of soft tissue sarcomas will allow to approach to understanding of biological bases of recurrence of this malignant disease.

Study was made of the difference of levels of sex hormones in men undergoing surgery for a varicocele on the left. Difference between the levels measured simultaneously by examining blood serum for the determination of sex hormones from the cubital vein and the vein pampiniform plexus. Investigation of sex hormones (testosterone, estradiol, progesterone) were performed in 35 patients with varicocele, operated by the method of Marmar (microsurgical varicocelectomy). The control group took patients who were operated on the scrotum over hydrocele, inguinal hernias, as well as other testicular pathology, not related to a vari^cele (a total 25 people). The highest level of sex hormones observed in patients with varicocele veins pampiniform plexus (in excess of estradiol - a 205.91 +95.29 fold excess of testosterone - 220.96+30.79-fold). In the control group level differences were lower.

This work is related to the determination of the expediency and effectiveness of the use of thermopuncture in the complex treatment of pyelonephritis, which developed against vesicoureteral reflux (PMR) and reflux-nephropathy (PH) in children with an undifferentiated form of dysplasia of connective tissue of moderate severity. As a result of the conducted studies, it was revealed that patients with this pathology who received additionally in the treatment of thermopuncture sessions have stable remission in comparison with the control group, where treatment was carried out only in accordance with the protocol "Diagnosis and treatment of pyelonephritis in children" (Korovina N.A., 2007) with the mandatory use of antibiotics.

In the field of professional activity professional development is a priority task requiring constant improvement and modernization of forms and methods of pedagogical and scientific-methodical activity. Modern trends in education are aimed at increasing the level of knowledge, competencies and skills of specialists. The article gives the experience of the Department of Pharmacy of the Institute of Continuous Professional Development of The Tyumen State Medical University on training of personnel of the highest qualification on the basis of innovative educational technologies.

A 26-year-old patient with multiple tumor-like formations attended by moderate itching, consulted a dermatologist. The presented clinical case demonstrates a late diagnostics of a relatively rare disease - type I neurofibromatosis (Recklinghausen disease).

To date, a number of specific proteins have been proposed as markers for the diagnosis of melanoma, S100 and sCD44std are among them. The aim of the study was to determine the diagnostic value of these oncomarkers in the blood serum of patients in complex cases of differential diagnosis of skin melanoma. The serum for S100 and sCD44std proteins was studied in 24 patients with melanocytic neoplasms of the skin. When assessing the sensitivity, specificity and diagnostic accuracy, it was established that for the differential diagnosis of skin melanoma, these indicators were 16.7%, 88.89% and 70.83%, respectively. Thus, the currently proposed oncomarkers for the diagnosis of skin melanoma do not have sufficient diagnostic value necessary for the detection of skin melanoma. The inclusion of a serum study on S100 and sCD44std proteins in a diagnostic algorithm in cases of complex differential diagnosis of melanocytic neoplasms of the skin is not advisable.

The reform of the health care system adopted in the Russian Federation is definitely to improve the quality of medical care. The main task is the innovative development of modern medical care for citizens. It is necessary to introduce a highly developed potential in the levels of prevention and treatment of diseases of the population, training of qualified specialists who meet all modern requirements. Qualitative transformation of the situation in the health care system is possible under the conditions under which the main emphasis will be placed on improving the professional level of human resource use, namely the average medical personnel-nursing.

In order to develop recommendations to improve the quality and efficiency of nurses work, a study was conducted on the basis of city polyclinics of the Republic of Dagestan Makhachkala. We studied the organization of work of 32 nurses, the opinion of 356 people on the quality of nursing care. It is established that on average 57,4% of working time is spent on performance of the main activity of the nurse. Significant costs of registration of medical documentation to 31.8%. Poor-quality performance of medical manipulations is established in more than a third of cases, defective patronage-in 50.4% of cases, insufficient compliance with sanitary and anti-epidemic regime - in 25.6%; poor - quality maintenance of medical documentation-in more than half of cases. On the basis of materials of research methodical recommendations on improvement of quality and efficiency of work of nurses of city policlinics are developed.

Introduction. The article describes a rare, chronic inflammatory, often relapsing skin disease of the scalp, less often inguinal and axillary areas, characterized by the formation of abscesses, followed by cicatricial atrophy, -absessing undermining folliculitis and perftolliculitis Hoffmann (APPGG). Patients with APFIG seek medical help for both dermatovenerologic doctors and surgeons, who generally view this disease as pyoderma and accordingly prescribe antibacterial drugs, use surgical methods of treatment that are often ineffective. The goal is to describe the clinical cases of patients observed at the clinical base of the Department of Skin and Sexually transmitted Diseases of the Federal State Educational Establishment of Higher Medical Education in the UGMU of the Ministry of Health of the Russian Federation in the Department of Internal Affairs of the Ministry of Health. Determination of the tactics of interdisciplinary interaction between dermatovenereologists and surgeons. Differential diagnosis of the disease with various dermatoses. Results. The described cases of patients (4 people) prove complex differential diagnosis with such dermatoses as furunculosis, infiltrative-suppuration trichophytosis. Also, interdisciplinary management of patients by dermatovenerologists and surgeons is described. Conclusions: APPGG is a rare dermatosis in clinical practice requiring joint work of related specialists, differential diagnosis using laboratory methods of investigation.