CASE OF MALIGNATION OF GIANT INVERTED PAPILLOMA OF THE NOSE

Inverted transitional cell papilloma (Schneider papilloma), a rare benign tumor, accounts for about 0.5% of all neoplasms of the nose. Usually unilateral, recurrences of the tumor can occur after 5-10 years. The clinical case testifi es to the gigantic size of the neoplasm, the germination of the inverted papilloma into the paranasal sinuses, the malignancy of the process and the metastasis of the tumor, which was not previously described. The main treatment for preventing recurrence is radical surgery, possibly with ligation of the external carotid artery.

CORRECTION OF MENSTRUAL FUNCTION DISORDERS IN GIRLS WITH OBESITY

Based on the literature datа and the results of our studies, menstrual dysfunction in teen girls leads to disorders of the reproductive system in fertile age. Establishment of normal menstrual function in teen girls is an eff ective measure for the prevention of future reproductive health disorders, which leads to improved methods of menstrual disorders diagnostics in overweight girls by analyzing clinical and anamnestic data, biochemical markers, development of diagnostic algorithm and pathogenetically based correction of menstrual disorders. To gain this aim, it was proposed to include to the complex of conventional therapy, diet therapy and drugs myo-inositol (inofolic softgel) and metformin. Evaluation of the treatment eff ectiveness was performed on the regression dynamics of the disease main clinical symptom and the normalization of hormonal status indicators. The result of treatment was considered satisfactory when the patient had regular menstruation for 12 months on the background of the therapy, and the maintenance of irregular menstruation with a cycle duration of more than 38 days was unsatisfactory. As a result of treatment the body mass index has decreased in all the patients which received our complex of therapeutic measures, especially for obesity of the second and third degree what proves the eff ectiveness of complex treatment. The appointment of proposed complex of treatment measures for patients is pathogenetically based, because after treatment, previously detected insulin resistance decreased signifi cantly in all groups, but most and reliably in groups with obesity of the second and third degree and became almost within normal limits.

BINARY LECTURE AS A METHOD OF THE EDUCATIONAL PROCESS OPTIMIZATION IN A MEDICAL UNIVERSITY

The peculiarities of preparation and performance of two kinds of binary lectures which are a binary lecture- dispute and an interdisciplinary binary lecture are in detail described in this paper. They diff er in their essence, aim, tasks, means of preparation, the choice of lecturer- partner, the format of the material.The aim of the binary lecture- dispute is to organize a controversy on a problematic issue between two lecturers. The more lively the discussion, the more interesting it is for the students, and the easier it is to involve them into the discussion. The form of presenting the material is a powerful motivational stimulus. The professional competence of lecturers can be diff erent, their communication, expressiveness and acting skills are more important. Mostly they are teachers of one department. There is no necessity to distribute lecture material and time between lecturers. It also does not require rehearsals without students. Such a lecture is more interesting for them.The aim of the interdisciplinary binary lecture is to show the interdisciplinary continuity, when the basic data of one discipline are necessary for mastering of another one. It does not involve any dispute and is presented as a consistent monologue of two lecturers. It is not possible to involve the students, because previously acquired knowledge is forgotten, and the knowledge provided – is still unknown to them. Motivation for students is only the relevance of the theme and lecture skills. The lectures are always delivered by tutors of diff erent disciplines. Their intellectual and psychological compatibility and the same level of professionalism are also very important. The volume of lecture material is always increasing. It requires rehearsals without students. It is more di ffi cult for teachers in its preparation and implementation.

SURGICAL TECHNIQUES FOR TREATMENT OF COMPLICATED LARGE SIZE TRAUMATIC DIAPHRAGM HERNIA (CLINICAL CASE ANALYSIS)

The analysis of a clinical case of surgical treatment of a traumatic hernia of the left cupola of the diaphragm in a patient 66 years old, diagnosed 5 years after injury. The hernia was complicated by bowel perforation, gastrointestinal and cardiorespiratory syndrome due to organ translocation into the pleural cavity. Are noted the features of complications of traumatic hernias in the late period of their occurrence and associated diagnostic methods. The stages of diagnostics and treatment of this patient from the central district hospital to the regional clinical hospital have been analyzed; are presented the algorithm and methods of surgical treatment, the features of the postoperative period.The Department of Surgery No. 1 of the BSMU has extensive experience in the treatment of complicated diaphragm hernias, on the basis of which the article substantiates the indications for decompression of the mediastinal organs, gives the causes of pneumothorax, surgical techniques for its correction.Also are analyzed the types of surgical approaches for this pathology were are indicated the advantages and disadvantages of isolated laparotomy, thoracotomy, combined thoracoabdominal interventions.

INCORRECT REPOSITIONING OF ENTRAPPED INGUINAL HERNIA

The case presents entrapped inguinal hernia and its incorrect repositioning with resulted strangulation of small intestine. The purpose of the work. Prevention of such cases in surgery and observance of strict rules of classical canons in the surgical environment, which remain relevant today. Patient M., 45 years old, was urgently hospitalized with complaints of intense, intractable, painful protrusion in the hernia in the right groin. From the anamnesis – suff ers from right inguinal hernia for 3 years. The day before, during exercise, an intractable, painful protrusion appeared at the site of the hernia, which began to increase. When examining the abdomen in the projection of the outer ring of the right inguinal canal there is a hernial protrusion, which does not disappear and does not change in size when changing body position. The protrusion is tense, dense, painful, the symptom of «coughing» in the area of protrusion is not transmitted, and coughing increases the pain. No free air and Kloiber’s bowls were found in the abdomen. According to laboratory and instrumental examination and objective signs, the diapatient was diagnosed with strangulated right inguinal hernia. During the examination of the patient, the hernial protrusion was exercised, so the patient was dynamically monitored. The next day the patient left the surgical department due to family circumstances. After 3 days, the patient again went to the surgical department with complaints of thirst and abdominal pain, vomiting with small intestine content and no discharge of gases and no bowel movements for 5 days. On examination, the patient’s condition is moderate. Taking into account the anamnesis, clinical evolution of the disease, laboratory and instrumental examination data and objective signs, it was concluded that the patient has acute surgical pathology. Diagnosed with: Acute small intestinal obstruction. The clinical case shows a misalignment of a strangulated inguinal hernia. After self-repositioning of the hernia, patients should be hospitalized to the surgical department for an elective surgery.

PECULIARITIES OF THE PRACTICAL SKILLS BY STUDENTS OF THE MEDICAL FACULTY IN THE STUDY OF CLINICAL ANATOMY AND OPERATIVE SURGERY

The article provides basic information about the peculiarities of the acquisition of practical skills by students of the medical faculty in the study of clinical anatomy and operative surgery.A pedagogical experiment was conducted in which 65 students took part, who were divided into two groups and studied clinical anatomy and operative surgery. The fi rst group, after getting acquainted with the theory of operative surgery, began to perform operations on animals. The second group, after studying the theory, trained in the gym and began operations on animals. It was found that students of the fi rst group made 27.5% of mistakes when performing operations and manipulations on animals, and the second group – 11.25%.The results of the study show that the most adequate and full-fl edged practical skills in operative surgery are students who study in stages with the acquisition of the required minimum of theoretical knowledge, with practical skills in the gym, with surgical interventions on experimental animals and detailed analysis of time of operations, complications, consequences at diff erent times of the postoperative period and surgical corrective actions to eliminate them.

THE IATROGENIC FOREIGN BODY OF THE MAXILLARY SINUS

Iatrogenic foreign bodies of the paranasal sinuses are extremely rare and, as a rule, during medical procedures. In this clinical case, a fracture of the needle for puncture of the maxillary sinus required surgical treatment.

EFFICIENCY OF THE COMBINATION BASED ON BONE AUGMENTATION MATERIALS AND MULTIPOTENT MESENCHYMAL STROMAL CELLS OF ADIPOSE TISSUE IN PATIENTS OF STUDY GROUPS BEFORE DENTAL IMPLANTATION

In recent decades, the most common method of treating partial or complete adentia is the use of dental implants. Often, due to insufficient jaw bone volume due to atrophy in the are of the removed teeth, it is impossible to perform intraosseous implantation. In order to eliminate the defi cit of bone tissue before the installation of dental implants, surgical interventions are required. Examination and treatment with dental implants were performed on 140 patients who had previously undergone surgery and used bone augmentation materials and their combinations with multipotent mesenchymal stromal cells of adipose tissue to increase the volume of jaw bone tissue. 3 months after the installation of dental implants in patients of group I, in which the restoration of the volume of bone tissue of the jaws was performed using bone augmentation material «Colapan–L», and in persons of group II, where augmentation was used a combination of drug «Colapan–L», multipotent mesenchymal stromal cells of adipose tissue and platelet-rich plasma, the values of the OHI–S index corresponded to the data before treatment, p>0.05, and were equal to each other, p2>0.05. In the control group III, the values of this index increased 1.4 times relative to baseline, p <0.05, and were signifi cantly higher than in patients of groups I and II, p1<0.01. After 3 months of observation, a decrease in the PMA index data relative to baseline values was determined: 1.2 times in group I, p, p1 <0.01, and 1.1 times in group II, p <0.05, p1, p2<0,01. At the same time, in patients of group III the values of this parameter increased and were 1.3 times higher than the reference values, p <0.01. After 6 months of studies in patients of groups I and III, the values of the SchillerPisarev test were higher than the initial data, p<0.05, and were equal to each other, p1>0.05. In patients of group II, the values of this parameter were equal to the initial data, p>0.05, and were probably lower data in persons of groups I and III, p1, p2<0.01. It was found that in patients in whom a combination based on multipotent mesenchymal stromal cells of adipose tissue, the drug «Colapan–L» and platelet- enriched blood plasma was used to fi ll bone defects, peri-implant tissues were completely restored after dental implants. The effectiveness of our proposed osteoplastic combination in patients of the study groups was confi rmed by the positive dynamics of the values of the hygienic index OHI-S, periodontal index PMA and Schiller- Pisarev test during the observation.

RECONSTRUCTION OF THE FEMALE UROGENITAL COMPLEX IN THE PRENATAL PERIOD OF ONTOGENESIS

In 9-weeks prefetuses, urogenital complexes are located lower than in prefetuses of previous age groups. In the vertical sections of the urogenital cords, the paramesonephric ducts diff erentiate into the uterine tubes. Above the entrance to the pelvis, the urogenital cords pass obliquely in the vertical direction, at the level of which the paramesonephric ducts are connected, on both sides of which the mesonephric ducts are located. The primary kidneys are completely reduced in their upper two-thirds, the reduction of mesonephric cells in the lateral areas of the lower third of the kidneys begins. The caudal divisions of the paramesonephric ducts touch dorsally to the wall of the urogenital sinus, while the lower ends of the mesonephric ducts are in the thickness of the wall. The urogenital cords (mesonephric and paramesonephric ducts) protrude above the upper ends of the primary kidneys and below the permanent kidneys. The mesonephric and paramesonephric ducts are clearly demarcated by a layer of loosely spaced mesenchymal cells.In 10-weeks prefetuses, due to the connection of the lower vertical parts of the paramesonephric ducts, a common uterine- vaginal canal is formed, lined with pseudolayered epithelium. Mesonephric ducts retain their lumen in fragments.In 11-weeks prefetuses, the upper vertical sections of the urogenital cords, in connection with the reduction of the mesonephric ducts, contain mainly paramesonephric ducts, which are separated from each other by a loose layer of the mesenchyme. From these sections of paramesonephric ducts uterine tubes are formed. Oblique (middle) sections of the paramesonephric ducts with further development are transformed into intrauterine parts of the uterine tubes. The lower caudal sections of the paramesonephric ducts are transformed into the uterus and the upper two-thirds of the vagina.In 12-weeks prefetuses, the primary kidneys are almost completely reduced. Only single mesonephric tubules within their caudal area are determined. In parallel, there are intense processes of formation of internal female reproductive organs. The cranial ends of the uterine tubes expand, acquiring a funnel- shaped shape. The outer border of the infundibulum of the tube reminds a zigzag line, which is evidence of the beginning of the formation of the fi mbria of the uterine tube. The lumens of the mesonephric ducts are reduced to 6±0.1 μm, and in some parts of their walls are in contact with each other. Transformation of paramesonephric ducts into their derivatives (uterine tubes, uterus, upper part of the vagina) is accompanied by corresponding histological changes of their walls.

HISTORICAL AND MODERN ASPECTS OF TREATMENT OF LOWER LIMB VARICOSE VEIN DISEASE (THE LITERATURE REVIEW)

In developed countries, lower limb varicose vein (LLVV) is determined in 25% of the adult population. The high prevalence of varicose vein disease and the likelihood of severe complications developments determine the socio- economic importance of fi nding the eff ective methods of treatment this pathology. Age, height, female gender, overweight and heredity are well known traditional risk factors. The pathogenesis of LLVV is a complex and multifactorial process.The aff ected of endothelial cells is the main pathogenetic link in the LLVV development, that leads to a violation of their antithrombogenic properties. In the future, other membranes of the vein wall are involved in the pathological process. The development of LLVV is associated with a violation of the venous valves and their damage as well. The main method for diagnostic LLVV is ultrasound CT angiogram, that allows you to simultaneously visualize the researched vessel, determine the direction of blood fl ow and its parameters, its individual anatomical features. There are conservative and surgical methods of LLVV treatment. The fi rst attempts of the conservative management for this disease were wrapping the aff ected leg, as evidenced by the rock paintings that had been found in the Sahara Desert. The current analogue is the compression therapy, which plays a major role in the conservative management of venous diseases. Before the conservative method of treatment of LLVV the drug therapy is used as well. The use of various herbs for the management of blood vessels was common in ancient India. Currently, there is the wide range of modern pleotropic drugs. Aulus Cornelius Celsus removed varicose veins with a tiny hook, which is an extremely early version of a varicose vein treatment performed today. In the following centuries, the methods of surgical treatment of this disease were constantly have been improved. Nowadays, the most frequently used methods of varicose vein obliteration are based on endovasal thermal damage of the venous wall, that leads to the occlusive fi brosis and transformation of the vein into a connective tissue cord. The main advantages of these interventions are minimal trauma, speedy rehabilitation, and good cosmetic result.