Tactics Of Surgical Treatment Research Articles

Клинический случай оказания экстренной медицинской помощи пациенту с сочетанной травмой после дорожно-транспортного происшествия

Abstract. This research demonstrates a clinical observation of emergency medical care to a patient with associated trauma after a road traffic accident with the diagnosis: “Closed-skull brain injury. Brain concussion. Closed blunt chest trauma. Fracture of the IV–VII ribs on the right and left. Bruise of the right and left lungs. Closed comminuted fracture of the left femur in the middle third with displacement. Paresis of the left oculomotor nerve. Traumatic shock of the III degree”. The description of this case report allows to analyze the clinical and instrumental examination of the victim, tactics of intensive therapy and surgical treatment, clearly demonstrating that the primary task in the management of a victim with severe polytrauma after an accident is diagnosis, anti-shock therapy, pain relief, recovery of impaired vital functions of the body, stabilization of the patient’s condition and surgical treatment of damages and fractures. The research provides a demonstration of successful surgical treatment of a complex closed comminuted diaphyseal fracture of the left femur. A multidisciplinary approach to the treatment of a victim in a road traffic accident with combined trauma is an integrated approach that includes the coordinated action of specialists in various fields, aimed at maximizing the improvement of the victim’s condition. Correctly chosen tactics of diagnostic and treatment measures play a key role in ensuring a positive result and recovery of the victim. Thanks to the coordination of the actions of doctors of various specializations, the victim receives the necessary assistance at each stage of treatment, which contributes to rapid recovery and return to normal life.

Современные стратегии лечения дегенеративно-дистрофических заболеваний позвоночника: Обзор литературы

Currently, there is a wide range of methods for the treatment of herniated intervertebral disc, such as: conservative treatment, the use of epidural injections, therapeutic spinal blockades, methods of molecular therapy and genetic engineering, various methods of surgical treatment.The purpose of this review is to study the currently existing treatment methods for degenerative diseases of the spine, including their advantages and disadvantages.Level I studies have shown the advantages of surgical treatment methods. In the application of the surgical approach, there is currently a wide range of techniques (minimally invasive surgeries using endoscopy, interbody spondylodesis using various grafts and cages, including those using cellular technologies), which also complicates the task of choosing a particular treatment tactic. Surgical treatment options for intervertebral disc disease are controversial, with a medium- to low-quality evidence base supporting each modality: decompression, discectomy, spondylodesis formation, and interbody disc replacement. Surgical interventions carry certain risks and complications and should be offered after conservative measures have failed to improve the patient's quality of life. In general, the goal of all types of spinal surgeries for the pathology under study is to provide definitive treatment to the patient for long-term pain relief, reduce the incidence of complications and reoperations, and ensure good patient satisfaction. Recent advances in regenerative and reconstructive treatment strategies for degenerative-dystrophic spine diseases in molecular science in the areas of cell, gene therapy and intervertebral disc growth factor therapy are evolving in the hope of disc repair and regeneration, have some challenges but also show promising results. Surgery is the last option, with the choice of surgical treatment tactics being a matter of debate among physicians.Keywords: degenerative-dystrophic diseases of the spine, interbody fusion, cage, lumbar spine, treatment.

Хірургічні аспекти лікування перфоративних гастродуоденальних виразок із поєднаними ускладненнями пенетрацією, стенозом та гострою кровотечею

The problem of surgical treatment of perforation of gastroduodenal ulcers (GDU) remains relevant and difficult, despite the introduction of new schemes of anti-ulcer and eradication therapy. Algorithms of surgical approaches and tactics of surgical treatment of patients with perforated GDU in combination with other complications in various combinations have not been developed. Purpose - to improve the results of surgical treatment of GDU with associated complications. Materials and methods. The results of surgical treatment of patients with complicated GDU for the period from 2000 to 2022 are presented. In total, 353 (100%) patients with perforated GDU in combination with other complications (a combination of two or more complications) were operated on. There were 52 (14.7%) patients with gastric ulcer perforation, and 301 (85.3%) patients with duodenal perforation. There were 267 (75.6%) patients with a combination of two complications; with a combination of three complications in 78 (22.1%) patients; four - 8 (2.3%) patients. The combination of perforation with gastrointestinal bleeding was observed in 138 (39.1%) patients. Results. The vast majority of patients (267 (75.6%)) had a combination of two complications. The number of patients with a combination of three complications was 78 (22.1%). The number of patients with a combination of all complications was insignificant - 8 (2.3%) people. The implementation of the developed algorithm made it possible to reduce the number of postoperative complications and mortality from 12% to 6.5%. The highest rate of complications and mortality was observed among patients with a combination of multiple (three and four) complications who underwent gastric resection - 3 (33.3%) patients, and the lowest mortality rate was observed among patients who underwent organ-preserving operations - 6 (2.8%) patients. Conclusions. In patients with perforated GDU in combination with bleeding, the use of endoscopic hemostasis made it possible to stabilize the patient and better prepare him for surgical intervention, and reduce the number of postoperative complications and mortality rates by almost 2 times. The use of resection techniques was extremely limited and had the highest rate of complications and mortality. Implementation of the developed algorithm made it possible to optimize surgical tactics when combining perforation with other complications of GDU. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

INVESTIGATING PREVALENCE OF ARTERIAL HYPERTENSION AS HIGH-RISK FACTOR IN PATIENTS WITH CORONARY HEART DISEASE ELIGIBLE FOR OFF-PUMP CORONARY BYPASS

The aim of the study was to analyze the prevalence of arterial hypertension in patients with coronary heart disease eligible for coronary bypass surgery on a working heart.
 Participants and methods. This study included 991 patients (786 men, 205 women) whose average age was 64.3 ± 1.4, the variation range of age was from 39 to 84 years. All study participants underwent coronary bypass surgery on a working heart. The design of the article is based on the analysis of the frequency of arterial hypertension in different clinical groups: with one-, two- and multi-vessel lesions of the coronary arteries.
 Results. The prevalence of arterial hypertension as a leading cardiovascular risk factor for ischemic heart disease after surgical treatment by performing coronary bypass surgery on a working heart was studied. We analyzed the prevalence of arterial hypertension in all clinical groups of the study as one of the leading factors that aggravate the course of coronary heart disease. Under a prolonged history of the disease, arterial hypertension has the potential to impact the structure of coronary arteries, leading to the formation of "tortuous vessels" i. e. structural changes in the coronary arteries that rise a number of question for the cardiovascular surgeons, determining the choice of tactics of surgical treatment of coronary heart disease.
 It was established that the frequency of arterial hypertension as a concomitant pathology in ischemic heart disease, is significantly higher in clinical groups with two- and multi-vessel lesions of the coronary arteries, mainly among male patients. It was also found that myocardial infarction occurred significantly more often in patients with coronary heart disease in the clinical group with multi-vessel lesions compared to its frequency in the clinical groups with one- and two-vessel lesions of the coronary arteries.
 Conclusion. Arterial hypertension patients with coronary heart disease presented for coronary bypass surgery on a working heart is a quite prevalent comorbidity, the frequency of which is higher among male patients and in clinical groups with multi-vessel lesions of the coronary arteries (lesions ≥ 3).

Surgical treatment of massive rotator cuff tears (literature review)

The prevalence of rotator cuff tears according to the literature ranges from 20 % to 40 %, and this injury occurs more often in people over 60 years of age. Massive rotator cuff tears account for 10–40 % of all rotator cuff tears. Massive rotator cuff tears are considered to be tears with a diastasis of more than 5 cm or tears involving two or more tendons. With such injuries, the kinematics of the shoulder joint changes: proximal subluxation of the humeral head and arthropathy of the shoulder joint occur, which subsequently causes pseudoparalysis. The main clinical manifestations are pain and dysfunction of the shoulder joint. Patients may experience a loss of active range of motion in the shoulder joint while maintaining passive range of motion. There is currently no unified approach to the choosing the tactics for surgical treatment. The most common options include partial rotator cuff repair, subacromial balloon plasty, replacement of tendon defects with allografts and autografts, proximal shoulder joint capsule plasty, muscle-tendon transfers, and shoulder joint arthroplasty. However, according to the literature data, the frequency of re-ruptures after surgery ranges from 11 % to 94 %. Despite the large number of methods for the treatment of massive rotator cuff tears, there are no clear algorithms for managing patients and choosing one or another surgical tactics. In addition, there is a high percentage of unsatisfactory outcomes of treatment. Taking all of these factors into account, the problem of improving the treatment of patients with massive rotator cuff tears remains relevant and timely.

Use of the Scales software complex in planning the surgical treatment of patients with lumbar degenerative spondylolisthesis

The aim of the study was to develop a virtual software package that, when it is based on personalized indicators, allows planning surgical tactics and performing differentiated treatment of patients with degenerative lumbar spondylolisthesis.The results of surgical treatment of retrospective group patients were the basis for creation of a virtual complex.A virtual software package has been developed. It is an expert system for making decisions about surgical tactics for patients with lumbar degenerative spondylolisthesis. The operation of the program is based on the automated analysis of a given list of input parameters. The core of the virtual complex is represented by two configurations, one of which contains an artificial neural network. As a result of virtual processing of the patient’s individual parameters, the program gives an answer in the form of two color scales with numerical labels: a scale of differentiated choice between isolated decompression and decompression supplemented with posterior fusion; scales for a differentiated choice between laminectomy supplemented with medial facetectomy and bilateral decompression of the spinal canal from a unilateral approach. Using the developed software package, surgical treatment of 26 patients with lumbar degenerative spondylolisthesis was performed.The Scales virtual complex, based on key general somatic and clinical and radiological parameters of a patient, creates an opportunity for a surgeon to make the most balanced and informed decision on the tactics of surgical treatment of lumbar degenerative spondylolisthesis. A personalized approach, accompanied by artificial intelligence technology, is aimed at reducing the likelihood of tactical errors and long-term complications of surgical interventions. The use of color scales with digital labels makes it possible to simplify the process of preoperative planning and to create conditions for achieving a balance between the decision of the program and the individual opinion of a specialist surgeon. The result of differentiated treatment of a group of patients using a virtual system was a significant and statistically significant ( p < 0.001) improvement in the life quality of operated patients in the long-term period.

Retrospective analysis of acute abdominal surgical diseases during the COVID­19 pandemic

The aim of the study was to improve the treatment results of acute abdominal surgical diseases during the COVID-19 pandemic. Material and methods. The object of the study was 200 patients who were randomized into 2 groups. The present study was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology developed against the background of COVID-19. The present study was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology developed against the background of COVID-19. Results. Cardiovascular and endocrinological background conditions were significantly less frequently recorded in the main group of patients. Perhaps the reason for this was that at the height of the pandemic, due to the excessive burden on the healthcare system, doctors did not pay enough attention to the presence of background conditions whuch could complicate the course of the main pathology. Patients in the comparison group were recruited in the post-pandemic period, when the functioning of the health system was normalized. Conclusion. The new SARS-CoV-2 virus will eventually line up with existing viruses and will periodically lead to COVID-19 outbreaks. A thorough analysis of acute abdominal surgical diseases during the COVID-19 pandemic leads to the correct tactics of surgical treatment with background and concomitant pathology. In this regard, the optimal planning of preventive and therapeutic measures requires the establishment of accurate diagnostics.

The models of patients with severe hot liquids scald (message two)

Purpose: to develop models of patients with severe hot liquid scald. Material and methods. Тhe analysis of scientific publications and own observations of the causes of hot liquids scald was carried out. Results. Based on the data obtained, four models of patients with severe hot liquids scald were formed: immersion injury (falling or prolonged stay in the bath), non-immersion injury (scalds in the shower or hot liquid splashing), cooking-related burns and a special type of immersion scald caused by communal incidence. According to the results of the study, 97% of patients with hot liquids scald corresponded to these four models. These models turned out to be homogeneous by gender, age, area, depth and localization of skin lesions, severity of the condition and other characteristics. Conclusion. Тhe use models of patients make it possible to form homogeneous groups of victims. Due to the homogeneity of these groups, it is possible to develop surgical treatment tactics for each of the formed models, which should improve the results of treatment of burned patients.

The models of patients with severe flame burns (message one)

Purpose: to develop models of patients with severe flame burns.Material and methods: the analysis of scientific publications and own observations of the causes of flame burns was carried out.Results: based on the data obtained, six models of patients with severe flame burns were formed: residential fires, liquefied petroleum gas-related burns, cookstove-related burns, flammable liquids-related burns, self-immolation and smoking-related burns. According to the results of the study, 94% of patients with flame burns corresponded to these six models. These models turned out to be homogeneous by gender, age, area, depth and localization of skin lesions, severity of the condition and other characteristics.Conclusion: the using models of patients make it possible to form homogeneous groups of victims. Due to the homogeneity of these groups, it is possible to develop surgical treatment tactics for each of the formed models, which should improve the results of treatment of burned patients.

Experience in surgical treatment of extra-intracranial tandem ICA stenosis at the National Medical Research Center for High Medical Technologies named after A. A. Vishnevsky of the Ministry of Defense of the Russian Federation

To date, the effectiveness and safety of reconstructive surgery for steno-occlusive lesions of the internal carotid artery (ICA) have been proven by multicenter cooperative studies Despite this, the indications and tactics of surgical treatment of patients with extra-intracranial tandem stenotic lesions of the ICA remain controversial. In the period 2010-2020, 32 patients with symptomatic (15 cases) and asymptomatic tandem ICA lesions were hospitalized for surgical treatment. The distribution of tandem lesions was as follows: 10 patients had bicarotid hemodynamically significant stenotic and occlusive lesions of the ICA ostium in combination with stenosis of more than 50% of the petrous (4 cases), cavernous (8 cases), and clinoid segments (5 cases), of these, four had bilateral intracranial stenosis; 22 patients with hemodynamically significant lesions of the ICA and vertebral artery (VA) in combination with stenosis of more than 50% of the petrous (10 cases), foramen lacerum (2 cases), cavernous (16 cases), clinoid (14 cases), and ophthalmic segments (1 cases), of these, six had bilateral intracranial stenosis of the ICA. All patients underwent staged surgical interventions on the arteries of the carotid and vertebrobasilar systems. In the postoperative period, there was one case of repeated ischemic stroke in the territory of the reconstructed artery after the application of extra-intracranial microanastomosis (EICMA). There were no relapses of restenosis or acute cerebrovascular accident (CVA) in the follow-up. Staged reconstructive and revascularization treatment is safe and effective for tandem extra-intracranial lesions of the ICA. It is necessaryto continue further study of this issue in order to develop unified tactics and methods of surgical treatment.

Modern concept of neovascular glaucoma (review)

The aim of this study is analysis of current methods for diagnosis and treatment of neovascular glaucoma to assess their effectiveness, and based on these data, further development of a method of surgical treatment based on morphological factors involved in its progression. The review was performed using the domestic RSCI database and the international PubMed database, with the search keywords being neovascular glaucoma, secondary glaucoma, ophthalmic hypertension. An analysis of 39 literature sources was performed. The search depth was 13 years (20092022). Variants of neovascular glaucoma development of and of its diagnosis were considered, it was noted that it is necessary to pay attention to the study of minimally invasive methods for diagnosing the anterior segment using optical coherence tomography, which will help in the future to choose the right tactics for medical or surgical treatment. Particular attention is paid to the analysis of surgical treatment methods, which often turn out to be ineffective and require re-operations. It is necessary to develop a new method of surgical treatment of neovascular glaucoma, which provides the most sparing approach to surgical treatment, which will improve the anatomical and functional results and help reduce the number of intra- and postoperative complications and provide a longer period without re-operations.

The options of ultrasound biomicroscopy in the diagnosis of post-traumatic pathology of the anterior segment of the eyeball

BACKGROUND: In the literature, there are scarce publications on the use of ultrasound biomicroscopy in patients with post-traumatic changes in the anterior segment of the eyeball.
 AIM: The aim of this study is to study the anatomical and topographic features of post-traumatic conditions of the anterior segment of the eyeball, to determine the criteria for the progression of the disease, to evaluate the possibilities of using the data obtained to determine the tactics of surgical treatment and of individual approach to the choice of implantable optical and diaphragmatic implants.
 MATERIALS AND METHODS: The study is based on the analysis of the results of ultrasound biomicroscopy of 360 patients with the sequelae of traumatic injuries of the anterior segment of the eyeball. The patients were divided into groups depending on the nature and degree of damage to the iris. The IA group combined clinical cases where the iris defect was less than 30%; the IB group more than 30%.
 RESULTS: Using ultrasound biomicroscopy, not only the zones of interest were visualized, but the anatomical relationship between the morphological structures of the anterior eye segment and the ciliary body was determined in vivo, their acoustic density was evaluated, and the necessary linear parameters of the eye were measured in the case of ordering and subsequent implantation of intraocular products.
 CONCLUSIONS: Ultrasound biomicroscopy should be considered as an integral part of the diagnostic examination of patients at the stage of preparation for opto-reconstructive procedure.

Possibilities of differential diagnosis of uterine leiomyosarcoma

Uterine leiomyosarcoma is a rare malignant neoplasm consisting of smooth muscle cells, characterized by an aggressive course and poor prognosis.
 Differential diagnosis of uterine leiomyosarcoma is challenging due to the nonspecificity and low severity of symptoms, particularly in the early stages. Patients with uterine leiomyosarcoma commonly present with complaints in of pelvic pain, abnormal uterine bleeding, and symptoms of compression of nearby organs. The same clinical symptoms are characteristics of patients with uterine leiomyomas.
 Leiomyosarcoma is often detected after histologic examination of material obtained during surgery for uterine myoma. At the same time, preoperative verification of the malignant nature of the neoplasm is crucial in determining the optimal tactics of surgical treatment. For instance, the use of organ-preserving techniques and morcellation in the treatment of presumed uterine leiomyoma may result in the dissemination of tumor cells and significantly worsen the prognosis in patients with undiagnosed leiomyosarcoma.
 This review discusses existing methods of preoperative diagnosis of uterine leiomyosarcoma, their efficacy, as well as the possibilities of application in clinical practice.

Our experience of surgical treatment of peripheral retinoschisis without capturing the macular zone using scleral buckling

Purpose: to present our experience of surgical treatment of peripheral retinoschisis without macular involvement using a scleral buckle.Material and methods. 31 patients (31 eyes) with peripheral retinoschisis (PR) without macular involvement, including 19 cases complicated by retinal detachment, underwent scleral buckling with cryoretinopexy of rupture zones and vitreoretinal degeneration and transscleral drainage of subretinal fluid.Results. In 12 (39 %) cases, the retina reattached within 24 hours after the operation, in 11 (35 %) cases, it reattached within 1 week, while in 8 (26 %) cases complete resorption of the subretinal fluid and retinal reattachment occurred 1 to 6 months after the operation. By the end of the 6-month follow-up period, retinal reattachment was achieved in all cases.Conclusion. The surgical treatment tactics of PR without macular involvement by scleral buckling is effective and pathogenetically validated, especially in the case of progressing lretinoschisis.

Тактика хирургического лечения пациента с непроникающей травмой роговицы, после ранее перенесенной операции ФемтоЛАЗИК (клинический случай)

Purpose. to present the tactics of surgical treatment of a patient with non-penetrating corneal trauma after previously undergone FemtolaSIK surgery. Material and methods. Patient m., 28 years old, addressed to the clinic of Volgograd branch with complaints of decreased visual acuity and feeling of foreign bODy on the right eye after trauma. during the repair of the braking system foreign bODies got into the right eye, which resulted in the rupture of the corneal flap in the paracentral region, with multiple metal foreign bODies getting into the corneal flap, under the corneal flap and into the stromal bed. Results. the patient underwent surgery: repositioning of the corneal flap with removal of multiple foreign bODies. mechanical partial deepithelization of the corneal flap in the zone of nonpenetrating corneal wound was performed. Foreign bODies and epithelial cells from the surface of the corneal bed and the back side of the epithelial-stromal flap were completely removed. the corneal flap was straightened and adapted. a soft contact lens was applied. Conclusion. repositioning of the corneal flap with removal of foreign bODies and epithelial cells in nonpenetrating corneal trauma allowed to preserve high visual functions in the patient after FemtolaSIK. Keywords: FemtoLASIK, keratorefractive surgery, corneal foreign body, non-penetrating corneal wound

Systemic approach to imaging of acute abdominal surgical infection: a prospective study

INTRODUCTION: The relevance of this work is due to the complexity of the treatment of severe acute surgical, especially destructive, infections of the abdominal cavity. The basis for improving results is the improvement of early radiological diagnosis of these diseases.OBJECTIVE: Of this study was to systematize the approaches in the radiodiagnosis of acute abdominal surgical infection.MATERIALS AND METHODS: The study analyzed the results of studies of 300 observations (men — 182, women — 128) aged 36 to 72 years who were treated at the Budgetary Institution «Surgut Regional Clinical Hospital» in the period from 2019 to 2022. The mean age of the patients was 49.2 years (59.7 years for men and 51 years for women). In the course of the study, a comparative analysis of the results of various methods of radiological examination in acute abdominal surgical infection was carried out, and key aspects of the radiodiagnosis algorithm were presented.Statistics. Statistical processing and systematization of these methods of radiation diagnostics was carried out with the calculation of sensitivity and specificity. The description of categorical variables was carried out using absolute values and a fraction of the whole — n (%). The results of calculating the indicators did not reveal significant differences in the group of men and women examined.RESULTS: At the initial stage of diagnosis, two main X-ray morphological syndromes of acute abdominal surgical infection were identified: a widespread inflammatory process (peritonitis and pancreatic necrosis) and a delimited inflammatory process (abscesses of various localizations). Based on the syndromic approach, not only the nosological diagnosis of this pathology wassubsequently carried out, but also approaches to the tactics of surgical treatment of patients were determined.DISCUSSION: The choice of the method of radiation examination of these patients, justified by the leading clinical and radiological syndrome, leads to early diagnosis and treatment of acute abdominal surgical infection.

Surgical approaches to the treatment of complicated ulcers of the stomach and duodenum

Surgical treatment of combined complications of peptic ulcer disease of the stomach and duodenum currently remains a complex and not fully resolved problem in abdominal surgery. Algorithms, surgical approaches and tactics of surgical treatment of patients with multiple combined complications have not been developed. The relative number of patients with a combination of complications has increased and is accompanied by significant mortality. The aim was to improve the results of surgical treatment of complicated gastroduodenal ulcers. The presented materials are the results of the analysis of the surgical treatment of patients with complicated gastroduodenal ulcer for the period from 2000 to 2022, which was carried out on the basis of the Kyiv City Clinical Hospital No.12 (Gastro Intestinal Bleeding Center of the city of Kyiv). 395 patients operated on for complicated gastroduodenal ulcers (combination of 2 or more complications) were analyzed. By time period, all patients were divided into 2 periods: group A (2000–2014) – 209 patients, group B (2015–2022) – 186 patients. Of which 299 (75.7%) patients had a combination of two complications in different combinations, 88 (22.3%) patients had a combination of three complications, and the remaining 8 (2.3%) had four complications. Gastrointestinal bleeding was observed in 164 (41.5%) of 395 patients, and ulcer perforation complications were observed in 353 (89.4%) patients. 352 (89.1%) emergency operations were performed, 43 (10.9%) early-term operations. The use of modern measures of endoscopic hemostasis made it possible to operate on patients with EDP, and their share increased 2.6 times (from 13 (6.2%) to 30 (16.1%)) and made it possible to perform radical operations in most cases (from 174 (83.2%) to 182 (97.8%)) both organ-preserving and organ-sparing. The total mortality in group A was 21 cases per 209 patients (10.1%), and in group B it decreased to 12 cases per 186 operated (6.5%). The highest rate of complications and mortality is associated with gastric resection – 42.9% (3 out of 7 patients). The lowest rate of mortality was among patients who underwent OSO, 3.3% (8 out of 245 operated on). Keywords: complicated gastroduodenal ulcer, perforation, bleeding, stenosis, penetration, early delayed period.

On the issue of surgical treatment of patients with congenital orofacial clefts combined with other organ and system comorbidities

Relevance. Surgical treatment of patients with congenital orofacial clefts and comorbidities of other organs and systems remains a complex problem in specialized surgery, and it requires concentration of knowledge of individual characteristics and diagnosed disorders during their implementation, taking into account the sequence, volume and time of execution.Purpose. Optimize the tactics of surgical treatment of children born with orofacial clefts combined with disorders of other organs and systems, improving rehabilitation effectiveness.Material and methods. The work focuses on the results of a study of 2475 patients with congenital orofacial defects during the long-term follow-up period (1998-2022) in the Bonum Medical Center (Yekaterinburg). There were 823 cases of congenital orofacial clefts combined with disorders of other organs and systems. The disease combination groups were systematized and determined the tactics of surgical treatment of orofacial defects and the rehabilitation techniques for comorbid defects.Results. To date, out of 823 patients with orofacial clefts and comorbidities of other organs and systems, 591 (71.81%) patients are known to have received comprehensive surgical rehabilitation, part of them turned 18 years and were withdrawn from the long-term follow-up care, the rest – 232 (28.19%) continued to receive specialized care in the Bonum Center system. Of the 823 patients, 370 children needed primary cheilo-rhinoplasty, 196 people (52.97%) had surgery at the traditionally accepted time (in the first six months of the child's life), 302 children (81.62%) had surgery by the age of nine months, and 329 children (88.92%) by one year. Based on the individual indications, thirty-six children (9.73%) had surgery after one year, of which eight patients (2.16%) after two years. Of the 823 patients, 770 people needed palatoplasty (cleft repair of hard and soft palates), while in the conditions of special preparation, the operation was performed in 360 children (46.75%) by 18 months, in 483 children (62.73%) by24 months, and 588 children (76.36%) by the age of 3 years. Considering the cleft palate complexity, 102 children (13.25%) needed further treatment later due to physical condition restrictions and social reasons.Conclusion. The proposed strategy of surgical treatment of children with orofacial clefts combined with disorders of other organs and systems allows treatment of congenital orofacial malformation in the most favourable period based on the patient's physical condition.

Adamantinoma in a 4-year-old child (clinical case)

The article describes a clinical case of development of a rare malignant tumor adamantinoma in a 4-year-old child, difficulties in its diagnosis, and tactics of surgical treatment. Literature data on epidemiology, differential diagnosis, and treatment methods for this pathology, as well as statistical data on local and metastatic recurrences, are presented. Recommendations on dynamic observation of patients with adamantinoma are given.

Clinical observations of surgical treatment of patients with Pair syndrome

The article provides a brief overview of the frequency and prevalence of Pair syndrome, the causes of its development, the clinical picture and diagnosis of this form of splanchnoptosis, the tactics of surgical treatment depending on the stage of the disease. There are 2 clinical cases of successful surgical treatment of chronic constipation in patients with Pair syndrome. At the same time, in the classical picture of the disease, left-sided hemicolectomy with a thick-colonic anastomosis "end to end" was performed, in a patient with concomitant diverticular disease - an extended hemicolectomy. All patients are discharged with recovery, all have an independent regular stool every 1-3 days