Objective. To reduce the number of complications and traumatic surgical intervention in the treatment of malignant tumors of the paranasal sinuses and nasal cavity by introducing the algorithm of preoperative planning and the method of endoscopic endonasal surgical treatment, with improved functional and aesthetic results while maintaining oncological efficacy.

Materials and methods. The developed algorithm of preoperative planning, based on a comprehensive assessment of the anatomical structures of the skull using multispiral computed tomography and magnetic resonance imaging, consists of 8 stages and allows individualising surgical access to the paranasal sinuses and nasal cavity depending on the extent of the tumor. Endoscopic surgical treatment according to this technique, which includes 17 stages, was applied in 44 patients with malignant tumors of the nasal cavity and paranasal sinuses.

Results. Application of the proposed algorithm of preoperative planning and method of surgical treatment allowed minimising the number of intra- and postoperative complications and ensuring radical surgical intervention in 100 % of treated patients.

Conclusions. The developed algorithm of preoperative planning and the method of endoscopic endonasal surgical treatment of patients with malignant tumors of the paranasal sinuses and nasal cavity proved to be effective. They allowed to improve the quality of surgical interventions, minimise the risks of complications and improve functional and aesthetic results in patients suffering from malignant tumours of the paranasal sinuses and nasal cavity.

Objective. To study the parameters of invasive hemodynamics, investigated using PiCCO, Flow-Track technologies in patients with ischemic heart disease in the intraoperative period during coronary artery bypass grafting (CABG) under artificial circulation (AC) with extracorporeal autohemomagnetic therapy (EAHMT).

Materials and methods. All patients were divided into two groups. Group 1 (17 patients) included standard anesthesia for CABG under AC without the use of EAHMT. Group 2 (17 patients) included standard anesthesia for CABG under AC with the use of EAHMT. In patients of the two groups, the parameters of mean arterial pressure (MAP), dose of vasopressor support were assessed. In patients of group 2, the parameters of cardiac index (CI), cardiac output (CO), stroke volume index (SVI), stroke volume variability (SVV) were studied. The relative change in these parameters was calculated individually for each patient. Then, using Statistica 10 software (Statsoft Inc., USA), a descriptive analysis of the obtained data was performed (Me [25 %; 75 %]). The significance of the results was assessed using the dependent variables method with the nonparametric Wilcoxon test. When comparing independent groups with non-normal distribution of one or two quantitative variables, a nonparametric method was used — the Mann — Whitney U-test.

Results. When using EAHMT in addition to standard anesthesia, a statistically significant increase in MAP, CI, CO, SVI, SVV, as well as a relative change in these parameters were observed. A statistically significant decrease in vasopressor support was noted in group 2. A statistically significant increase in the duration of the operation was revealed in group 1.

Conclusions. The use of EAHMT improves key hemodynamic parameters and proves its effectiveness and safety in the intraoperative period during myocardial revascularization under AC conditions. It is worth noting a statistically significant decrease in vasopressor support.

Objective. To study implicit associations in patients with alcohol dependence syndrome.

Materials and methods. The study included 423 practically healthy participants, as well as 263 patients of the narcology department of the Vitebsk regional clinical center of psychiatry and narcology and citizens staying in the treatment and labor preventorium № 4 of Vitebsk. Statistical processing of the results was carried out in the R environment version 4.3.3.

Results. The patterns of patients with alcohol dependence: high duration of touch and decreased reaction speed were identified. The IAT index for individuals in the control group was 0.54 ± 0.34, and for groups of patients — 0.87 ± 0.27 and 0.78 ± 0.42, indicating a stronger association of «alcohol» with positive emotions than «fruit» in all groups studied. At the same time, the value of IAT index in the patient groups differed statistically significantly (p < 0.001).

Conclusion. The findings provide information about the structure of alcohol perception in different groups, but the results can also be used to build refined models that will be used not only to study patient preferences after admission to a drug treatment unit, but also to prevent possible addictive behavior.

In conjunction with other neuropsychological diagnostic methods, the IAT test can be used for screening diagnosis and early detection of alcohol dependence.

Gout is a chronic disease caused by the deposition of monosodium urate crystals in tissues, which most commonly manifests as inflammatory arthritis with a marked pain syndrome. Gout is often combined with cardiovascular disease and is an independent risk factor for cardiovascular events. Treatment includes managing exacerbations and taking medications to reduce uric acid levels to target values that ensure the absence of flares. At the beginning of urate-lowering therapy, many patients may experience exacerbations of arthritis. In order to prevent them, anti-inflammatory prophylaxis is carried out. The main drugs for anti-inflammatory prophylaxis are colchicine, nonsteroidal anti-inflammatory drugs, glucocorticoids. The optimal drug for anti-inflammatory prophylaxis of gout exacerbations in persons with cardiovascular disease should meet several requirements: effectively prevent gout exacerbations, have no contraindications for prescription in cardiovascular disease, and, ideally, reduce cardiovascular risks. The purpose of this review is to analyze the most commonly used drugs for compliance with these requirements.

Anemia of prematurity occurs in the vast majority of extremely immature newborns or infants with extremely low birth weight. It is known that this pathological condition develops the higher than shorter is baby’s gestational age. However, due to a number of factors, anemia of prematurity may occur in newborns with moderate or mild prematurity. This review summarizes and systematizes modern data on non-drug prevention of anemia of prematurity, which includes delayed umbilical cord clamping, umbilical cord milking, optimization of blood sampling, approaches to enteral and parenteral nutrition of premature infants. We also presented information about drug prevention and results of recent studies of treatment using blood transfusion and erythropoietin preparations.

This article discusses the importance of timely and quality provision of emergency medical assistance. An overview of the regulatory legal framework in the Republic of Belarus is presented. The main problems of providing emergency medical assistance in healthcare organizations, identified during the basic medical accreditation, are highlighted.

Objective. To clarify the etiology, to distinguish the variants of the course of the limited purulent pulmonary destruction (PPDL) according to the pathogenetic factors and on this basis to develop the differentiated treatment tactics.

Materials and methods. During 12 years 780 patients with purulent-necrotic processes in lungs were hospitalized in two departments of pulmonary surgery, 540 (69.2 %) of them were diagnosed with OHD. Variants of OHD course in all patients were revealed by clinical and roentgenologic, laboratory investigations. Computed tomography was performed in 124 patients. Abscess puncture through the chest wall in the phase of its formation was performed in 23 patients in order to identify the causative agent of the disease. Fibrobronchoscopy with diagnostic and therapeutic purposes was performed in 475 patients.

Results. Three variants of clinical course are observed in OHD: OHD with good bronchial drainage was revealed in 194 (35.9 %) patients; OHD with insufficient bronchial drainage — in 265 (49.1 %); OHD with complete disorder of bronchial drainage — in 81 (15.0 %) patients. The etiology can be established only by bacteriologic examination of purulent detritus obtained by thoracocentesis in the phase of abscess formation. Non-spore-forming anaerobes were detected in the amounts of 10⁷—10⁹ in 1 ml. Identification of etiology and variants of course allowed to apply differentiated treatment tactics.

Conclusion. The main factors ensuring the effectiveness of treatment in OHD are timely referral of patients to the pulmonary surgery department and application of methods of bronchial drainage improvement according to the variants of clinical course.

Objective. To create an experimental model of choledochojejunostomy stricture in laboratory animals, which would be as close as possible in its characteristics to clinical conditions, while assessing the role of biochemical markers associated with vascular damage, inflammation and fibrosis in the blood and tissues of the pathological process formation zone, in the development of extrahepatic bile duct strictures.

Materials and methods. All animals were divided into two groups: control (group 1) and main (group 2). The observation time after pathology modeling was 15 and 30 days. Group 1 — a standard choledochojejunostomy was formed on a Roux-en-Y loop; subgroup 2a — a choledochojejunostomy was formed on a Roux-en-Y loop with impregnation of the anastomosis zone with potassium nitrate to form a stricture; subgroup 2b — a choledochojejunostomy was formed on a Roux-en-Y loop with mechanical trauma to the anastomosis zone to form a stricture. After removal, material was collected (a section of the choledochojejunostomy zone) for subsequent morphological and immunological studies.

Results. In the control group (group 1), adequate healing of the anastomosis was noted on days 15 and 30 with the formation of unexpressed scar tissue in the anastomosis zone (as an element of standard regenerative processes during anastomosis formation). In subgroups 2a and 2b against the background of the effect of potassium nitrate on the anastomosis tissue and mechanical trauma, necrosis of the mucosa and deeper tissues was noted with the formation of a scar, formed as in ischemic tissue damage with the development of coarse connective tissue and anastomotic stricture.

Conclusion. As a result of experimental modeling of choledochojejunostomy stricture on laboratory animals, the role of specific biomarkers in establishing the causes of excessive scarring of biliodigestive anastomoses was revealed. The proposed model allows studying the phases of the pathological process and pathogenesis of the development of choledochojejunostomy stricture and outlining ways to prevent its formation in clinical conditions.