Abstract: the article is devoted to the current direction of modern orthopedics - surgical treatment of osteochondritis dissecans of the knee joint. This disease accounts for up to 2% of all diseases of the knee joint and occurs in approximately 30 patients per 100.000 people.

Materials and methods: The authors of the article developed the technique of “Hybrid bone and cartilage transplantation”, based on the removal of pathological subchondral bone, its replacement by autologous bone and collagen matrix implantation. Such an operation technique was applied in 27 patients. The article presents the indications and technique of the operation, criteria for evaluating treatment outcomes.

Results: treatment outcomes up to 2 years were studied in all 27 patients. Good treatment results were observed in 22 patients. In all cases, high-quality consolidation of bone tissue and regeneration of the cartilaginous surface of osteochondral defects were achieved.

Conclusion: The analysis of treatment outcomes for patients after “hybrid osteochondral transplantation” allows the article authors to recommend this technique for widespread use in clinical practice.

Deep infiltrative endometriosis is a common disease affecting young socially active women. The urgency of the problem of deep infiltrative endometriosis is due to the complexity of diagnosis, the lack of a unified classification of the disease and, as a consequence, the lack of a unified strategy for the management of such patients. The importance of infiltrative endometriosis is emphasized by the fact that, as a rule, it is a multidisciplinary surgical intervention of high complexity, a feature of which is often the inability to determine the final volume of surgical intervention at the preoperative stage. In the structure of surgical interventions, surgeries for deep infiltrative endometriosis have a relatively high percentage of complications and in the context of operations that improve the quality of life, have many controversial aspects. Over the years of laparoscopic surgery, the approach to surgical interventions for deep infiltrative endometriosis has changed; the nature of interventions tends to be radical, while developing algorithms that ensure the safety of patients. To date, there is not only a complete classification of the disease, but, as a result, there is no single strategy for managing patients with deep infiltrative endometriosis. The international experience of gynecologists was compiled with the aim of comparing the knowledge accumulated at the present stage about the problem of deep infiltrative endometriosis of the rectovaginal septum with the involvement of the rectum.

Abstract: the trigger pathogenetic mechanism of local and systemic inflammatory changes in acute pancreatitis is the production of inflammatory mediators and, in particular, cytokines. It determines the positioning of the systemic inflammatory response as a target for therapeutic action.

The aim of research: evaluation of the analgesic effect of lornoxicam therapy, as well as studying the effect of the drug on the systemic inflammatory response in patients with acute pancreatitis.

Materials and methods: the randomized prospective study included 334 patients with acute pancreatitis aged 25 to 68 years. The patients were divided into two groups. Patients in group 1 (n = 246) were treated only with standard conservative OP therapy; 88 patients in group 2 were additionally treated with lornoxicam. The severity of the pain syndrome and the frequency of postoperative complications were evaluated.

Results: In the second group of patients, systemic complications developed statistically significantly less frequently (p = 0.00034), and mortality was also statistically significantly less (p = 0.006). In group 1 patients, on the third day of the inpatient period, there is an increase in the level of proinflammatory cytokine production, while in group 2 patients, cytokine secretion decreases statistically significantly.

Conclusion: the inclusion of lornoxicam therapy to the complex of conservative measures in patients with acute pancreatitis allowed to reduce not only the intensity of the pain syndrome, but also the frequency of complications of pancreatogenic toxemia and to reduce mortality in this category of patients.

Abstract: traditionally, evisceration is performed only through a complete median laparotomy, however, the rapid development of modern medical technologies, especially in the last ten years, allows for a fundamentally new level of surgical intervention.

The aim of research: evaluation of the effectiveness of laparoscopic pelvic evisceration in women.

Materials and methods: in the period 2011 to 2018, 19 laparoscopic eviscerations were performed in women aged 50-78 years due to locally advanced cancers of the pelvic organs. After the compulsory examinations - computed tomography (CT), magnetic resonance imaging (MRI), ultrasound of pelvic organs and abdominal cavity, colonoscopy, cystoscopy, excretory urography, rectal examination, oncomarkers, laboratory study (hemoglobin, residual nitrogen Blood serum), scintigraphy, positron emission tomography (PET CT), the presence of locally advanced lesions was confirmed, and the patients were sent for surgery.

Results: 6 of total, 7 front and 6 rear evisceration was performed. For the purpose of urine diversion was performed a Bricker operation, for the derivation of feces was formed a primary anastomosis with a circular stapler with an additional preventive stoma, or a terminal colostomy. Perioperative results of pelvic excretion are given.

Conclusion: When compared with the results of other works on open traditional pelvis exenteration, we can judge that with laparoscopic access there is significantly less blood loss, patients spend less time in intensive care, separation, and less the frequency of early postoperative complications. Such operations should be carried out by competent specialists and in specialized centers, which will reduce the number of complications, relapses, and also will allow to accumulate experience of multi-organizational interventions, for their subsequent introduction into general practice.

The article presents a literature review of the surgical pathology of acute pancreatitis, which takes the lead ahead of acute appendicitis and acute cholecystitis and accounts for 10-12% of the surgical pathology of the abdominal zone. In the morbidity structure, 85% are mild forms of acute pancreatitis, however, 15% of patients with severe forms of the disease make the main contribution to the percentage of complications and death. And if the total mortality rate is approximately 7%, then in severe form this figure increases to 30%, and with the development of purulent-septic complications it is 60-80%. A review of the literature on acute pancreatitis indicates a large number of unresolved issues regarding pathogenesis, early diagnosis and prediction of the development of a severe form of the disease, strategies for the use of membrane protectors, surgical treatment of patients with sterile necrosis and the stage of infection, which necessitates the continuation of research in this area.

Aim. Analysis of the dynamics of morphological changes in the intestinal wall under the influence of resonant electrical stimulation in the correction of intra-abdominal pressure and intestinal paresis in patients with severe acute pancreatitis.

Materials and methods. The treatment outcome of 105 patients who were in surgical clinics for severe acute pancreatitis for the period 2015-2018 was analyzed. 2 study groups were formed: the main (n-62, group 1) and comparisons (n-43, group 2), comparable in age, sex and severity of condition. The treatment was carried 

out in accordance with the regulatory documents of the Moscow City Health Department and NKR ROH. Additionally, the method of selective resonant digestive tract electrical stimulation was included in the medical arsenal of the 1st group for the prevention and correction of motor evacuation disorders and intra-abdominal hypertension. For enteral support, a jejunal feeding tube with endoscopic placement was used, and during the installation, a forceps biopsy of the mucosa of the duodenojejunal transition on the 1st and later on the 7th day of treatment was performed. Such manipulation made it possible to assess the degree of reduction of intra-abdominal hypertension (as a result of the therapy), as well as the restoration of the motor-evacuation function of the digestive tract in the study groups.

Results. In total, we performed 47 biopsies of jejunum mucosa on 1 day from the start of treatment: in group 1 - in 32 patients (51.6%), in group 2 - in 15 patients (34.9%). Subsequently, on the 7th day, the same patients underwent repeated gastroscopy with examination of the area of the duodenojejunal transition and biopsy for repeated morphological evaluation of the obtained material. In the study groups, when analyzing the initial histological preparations, identical morphological changes were traced, which proved the common pathogenetic cascades and the universality of certain morphological findings. In the dynamics of treatment, there was a dissociation of the morphological picture of the study groups with a more torpid regression of interstitial, mainly submucosal edema, as well as the persistence of severe atrophy of the crypts and sites of desquamation of enterocytes. Based on intravital histological studies, we systematized the obtained data with a point estimate of the degree of morphological findings, which proved the degree of influence of early correction of intra-abdominal hypertension and the prevention of motor evacuation disorders in the study groups.

Conclusion The early monitoring and elimination of intra-abdominal hypertension, as well as the restoration of adequate intestinal motility in severe acute pancreatitis by the method of selective resonant stimulation, is objectified by the dynamics of morphological changes during juvenile biopsies in comparison with the initial data at the start of the disease and treatment without the use of electrical stimulation technologies.

Primary multiple malignancies are rarely observed in clinical practice. Literature data indicate the existence of potential risk factors, primarily genetic ones (Li-Fraumeni or Beckwith–Wiedemann syndromes) for the development of such diseases. Most of the tumors found in various organs are metachronous. This paper presents a variant of managing a patient with primary multiple neoplasia of the kidney, prostate, and colon. The patient (61 years old) was admitted to clinic with diagnosis: primary multiple metachronous cancer: left kidney cancer cT3aN0M0, prostate cancer cT1bN0M0, neoplasm of the right colon (tubular adenoma with high-grade dysplasia). Comorbidities: coronary heart disease, paroxysmal form of atrial fibrillation, arterial hypertension. The clinic held a multidisciplinary consultation involving an oncologist, a coloproctologist, an urologist, a radiologist, a chemotherapist, an anesthesiologist, a cardiologist, and a rehabilitation specialist. Simultaneous laparoscopic prostatectomy, nephrectomy, and right hemicolectomy were performed. The patient was managed according to the standard protocols of the "rapid recovery" program.

Distinctive feature of the patient we observed was that the kidney tumor was detected 8 years ago during an outpatient examination, although we could not confirm this fact documented. Since the association between renal cell carcinoma and the risk of developing other malignant tumors has been shown in the literature, we can assume with high probability that patients with renal cell carcinoma have an increased risk of developing a subsequent primary malignancy.

A 31-year-old man admitted to clinic with complains of occasional pains in the right upper quadrant unrelated to the food. Results of laboratory tests were in the normal range. There were wall thickening of the ascending colon with sites of calcification located intramural according to abdominal contrast-enhanced multislice computed tomography. The above-mentioned structures accumulated contrast during a venous phase of computed tomography. A barium X-ray was performed, filling defects in right colon were detected but barium follow throughs was normal. Multiple dilated vascular structures of variable sizes l affecting the bowel submucosa in ascending colon for more than 10 cm were detected during the colonoscopy. The patient was diagnosed with hemangiomatosis of colon. Because of the high risk of massive large-bowel hemorrhage and malignization the laparoscopic right hemicolectomy was performed. Morfologic findings were interpreted as vascular malformation of colon. The patient has been activated fully on 1-st day after surgery, discharged on 6-th day in hospital. Gastrointestinal vascular malformation is an infrequent disorder of blood vessel formation characterized by existence of tumor-like vascular structures through the entire gastrointestinal tract. Nowadays there is no single approach to the management of this group of diseases. Surgery is the only radical metod of the treatment of vascular malformation. The laparoscopic approach has substantional advantages in treatment of this infrequent group of diseases.

The article highlights the measures of prevention and control of infectious diseases in railway transport. Infectious diseases are currently account for at least 50-60% of all human pathology. Among the causes of death, they still rank 3rd in Europe and 4th in the United States (after cardiovascular and cancer diseases).

The RUT MIIT medical College implements a program for training middle-level specialists in the specialty «Medical care» for further work in medical institutions of transport, including at Russian Railways facilities. In addition to occupational diseases in railway workers, College students are study the basics of epidemiology and infectious diseases.

The paper describes the principles of prevention of infectious diseases in railway transport, as well as anti-epidemic measures for detecting the disease.

The descriptive nature of the work suggests using it as a textbook for students of medical colleges and universities.