Pharmacotherapy plays a key role in the treatment of chronic venous diseases and their complications. This category of patients traditionally uses a variety of phlebotropic drugs, the vast majority of which are of plant origin, introducing specific therapeutic features due to decreased bioavailability and, consequently, the presence of a dose-dependent effect. That is why the modern trend in pharmacotherapy of chronic venous diseases is the use of phlebotropic drugs that have high bioavailability with rapid achievement of therapeutic concentration, as well as demonstrating a polyvalent mechanism of action on the main pathogenetic mechanisms of development and progression of chronic venous diseases. One of such preparations is calcium dobesilate, which is a calcium salt of 2,5-dihydroxybenzenesulfonic acid (C₁₂H₁₀CaO₁₀S₂) obtained by chemical synthesis. In terms of pharmacological properties calcium dobesilate belongs to capillary protectors with more pronounced pluripotent effect on venous and lymphatic sections of the microcirculation. To date, calcium dobesilate is the only synthetic phlebotropic drug registered in the Russian Federation.

Indications for the prescription of calcium dobesilate are microangiopathies of various genesis, but primarily associated with chronic venous and lymphatic failure.

Numerous experimental and clinical studies demonstrate a high clinical efficacy of calcium dobesilate regarding major venospecific symptoms and syndromes, for the elimination of which the drug can be prescribed in a standard daily dose of 1500 mg, both in monotherapy and in combination with other drugs.

Calcium dobesilate therapy is usually performed without undesirable reactions, the risk of which is low when using standard recommended daily doses of the preparation 500-1500 mg.

Classic sclerotherapy using drugs in the native (liquid) state is almost the oldest method of minimally invasive treatment of various forms of varicose veins of lower extremities and not only. Despite more than 300 years of development of the sclerotherapy methodology, enormous international experience and almost thorough study of its mechanisms, the development of new sclerosing drugs and technologies of their delivery to the lumen of the target vein continues. Measures aimed at reducing the frequency of undesirable side effects after sclerotherapy and improving the quality of life of patients during treatment and after its completion are discussed separately. Currently, there are several guidelines that regulate phlebosclerosing treatment in various clinical situations in terms of evidence-based medicine. This publication provides a brief historical background on the formation of sclerotherapy technology, presents basic principles for liquid sclerotherapy based on the analysis of international and Russian recommendations for the treatment of chronic venous diseases. Indications, contraindications and the basic methods of carrying out sclerotherapy with the use of officinal, registered in the Russian Federation phlebosclerosing detergent agents are presented, their actual physical and chemical properties, similarities and distinctions, and also optimal concentrations and doses are discussed. The classic sclerotherapy technique which has become known as “empty vein technique” is described in detail and illustrated.

In addition, current clinical examples demonstrating successful use of compression sclerotherapy are presented. Again, the authors conclude that liquid sclerotherapy with the use of modern phlebosclerosing agents such as lauromacrogol 400 and sodium tetradecyl sulfate, performed according to the classical “empty vein” technology, demonstrates high efficiency and safety regarding large varicose veins of various localizations.

Venous aneurysms continue to be one of the little studied sections of modern vascular surgery. Messages on the occurrence of this pathology in the medical literature are very few and describe extremely rare clinical cases, localized mainly in the deep veins of the lower extremities and leading to thromboembolic complications. Single publications describe venous aneurysms localized in superficial saphenous veins. The etiology and pathogenesis of this disease currently continues to cause debate. The article provides a literature review on this rare surgical vascular pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.

Introduction. Approaches to the treatment of superficial vein thrombosis associated with varicose veins (V-SVT) has undergone significant changes in the last decade as a result of randomized clinical studies on the effectiveness of anticoagulant therapy in V-SVT. At the same time, there is still not enough specific clinical data covering the results of treatment of patients with V-SVT and reflecting the willingness of doctors to abandon active surgical tactics in this variant of thrombophlebitis.

Aim – study the effectiveness of treatment of patients with superficial vein thrombosis associated with varicose veins (V-SVT) in real clinical practice.

Materials and methods. A retrospective non-comparative study of the results of treatment of 82 patients with V-SVT (w/m – 49/33, mean age – 55.5 years) who underwent of treatment in two departments of vascular surgery in 2019. A retrospective analysis of outpatient records of 81 patients with V-SVT discharged from the hospital was performed. Clinical and ultrasound parameters were highlighted to summarize the results. The methods of standard statistics applied using the program MS Excel 2016.

Results. The localization of thrombus in the system of the great saphenous vein (GSV) in 68 cases (82.9%), in system of the small saphenous vein (SSV) in 8 cases (9.8%), in both systems – 6 cases (7.3%). Localization of the top of the thrombus 20–80 mm from the sapheno-femoral (SFJ)/sapheno-popliteal junctions (SPJ) – 60 (67.5%), passage into deep veins – 12 (13.4%), localization of the top of the thrombus to the level of the middle third of the thigh – 8 (9.0%), in the tributaries and trunk of the GSV/SSV on the leg below knee – 9 (10.1%). The type of the thrombus proximal part: occlusal – 61 (68.5%), non-occlusal – 6 (6.7%), floating – 22 (24.7%). Surgical interventions: high ligation of SFJ – 49 (55.1%), dissection of the SPJ – 8 (9.0%), high ligation + thrombectomy – 12 (13.4%). Conservative treatment at vascular surgery department – 20 (22.5%). Recovery – 81 (98.7%). Death – 1 (massive pulmonary embolism upon admission). After 1 month in the outpatient period, a complete relief of the inflammatory process was registered in 76 patients (93.8%), partial in 5 patients (6.2%). Regression of the thrombotic process: complete in 7 patients (8.7%), partial in 74 patients (91.3%). A case of successful treatment of a patient with V-SVT using parnaparin sodium given in this article.

Conclusion. It is necessary to revise the drug therapy of V-SVT with increasing dose of anticoagulants and prolongation of anticoagulant therapy to achieve effective results in regression of thrombotic process in superficial veins of the lower extremities.

An actual problem in surgical practice is paresis of the gastrointestinal tract, the main manifestation of which is constipation after surgical treatment. Treatment of postoperative gastrointestinal paresis, which is manifested primarily by constipation, should be comprehensive and, if necessary, patients are shown taking laxatives to stimulate bowel function.

Sodium picosulfate is one of the most commonly used and effective drugs, belongs to the group of synthetic stimulant laxatives. The above review noted the safety and effectiveness of sodium picosulfate for atonic constipation, for regulating stool (hemorrhoids, proctitis, anus cracks), for preparing for surgical operations, instrumental and radiological examinations.

The presence of picosulfate in the clinic and hospital surgeon’s arsenal makes it possible to optimize the drug therapy in surgical patients with constipation syndrome at the hospital and outpatient treatment stage.

Plethysmography as a method for studying peripheral circulatory system was first proposed by wletney in 1953. In Russia, the first most significant research studies on the feasibility of plethysmography in studying peripheral blood flow and circulatory physiology taken together were conducted at the St. Petersburg Pavlov Institute of Physiology in 1961. From this time onwards, the possibilities of plethysmography as a non-invasive objective method for the diagnosis of hemodynamic disorders, particularly in arterial pathology, were studied intensively. These parameters were not determined for the venous blood flow, but in 1980s the authors were able to establish plethysmographic criteria not only for various forms of venous pathology, but also for degrees of chronic venous insufficiency using a device significantly improved by V.N. Pavlov and V.E. Maslov.

The purpose of this publication is to analyze the literature data on the use of aerial plethysmography and photoplethysmography in the study of hemodynamic disorders in patients with chronic diseases of the veins of the lower extremities. At present, in order to assess the venous blood flow in condition of air plethysmography, indicators of functional venous volume (VV), maximum venous outflow (MVO), venous filling index (VFI), evacuation volume (EV) and residual volume (RV), as well as an integral indicator – residual volume fraction (RVF) are determined in the world. A venous reflux test (VRT) is performed as part of photoplethysmography. The data published today show the high statistical reliability of the comparative analysis and the great scientific significance of the research. According to many foreign authors the use of plethysmographic methods of diagnosis allow to assess violations of venous blood flow in patients with chronic venous diseases of various clinical classes according to CEAP more precisely and to give a global assessment of disorders of the venous outflow from thrombotic occlusion of segmental to hypervolemia in patients with varicose veins in different forms of manifestations of chronic venous insufficiency. The analysis of the literature data allows to make a conclusion about the prospects of further research using these non-invasive methods of evaluation of venous blood flow in the lower extremities.

This publication presents the results of clinical application of the system of non-extensible compression adjustable bandage in the treatment of upper and lower limb lymphedema in 14 patients over a period of 2 to 34 months. An adjustable non-extensible compression bandage was used as monotherapy for stage I–IIa congenital limb lymphedema in 5 out-of-hospital patients. Progression of edema was not registered in any case during the follow-up period of up to 34 months. In 7 patients with stage IIB-III limb lymphedema, as well as in a 41-year-old patient with a diagnosis Of: Congenital abnormality development of the lymphatic system, Neurofibromatosis type 1, a disease Recklinghausen adjustable non-stretchable compression the product is used in combination with medical compression hosiery 1–2 compression class international standard RAL-Gz 387 from early (first show after 9–11 days after surgery) and continuing in the distant (period of use up to 22 months) postoperative periods. The return of edema (more than 1 cm when measuring the circumference) of the remodeled limb was observed in 3 patients after 4 months of follow-up. At 22 months (the maximum observation period), 2 patients showed an increase in the circumference of the operated limb to 2.5 cm. The system of non-extensible compression adjustable bandage in real clinical practice shows high efficiency in achieving edema reduction in stage I lymphedema of the extremities for at least 24 months. The use of adaptive compression banding system for the prevention of edema regression after surgical interventions for stage III limb lymphedema was reliably effective for 12 months.

Introduction: Lower extremity varicose vein disease is one of the common problems in vascular surgery. Clinically, this disease is accompanied by a wide range of complaints and external symptoms, which eventually lead to a worse patients’ quality of life. The integrated approach is being applied to the disease treatment, which involves the use of various phlebotropic drugs as conservative therapy along with minimally invasive surgical correction and sclerotherapy.

Objective: to improve the quality of phlebotropic therapy for patients with lower extremity varicose vein disease, based on the study of factors that shape the patient’s compliance with the effective treatment of clinical symptoms. The term «compliance» means the precise and informed implementation of the doctor’s recommendations during the treatment by the patient. Most often, «compliance» is assessed by the drug use index, which is the quotient of dividing the number of days on which the full dose of the drug was taken by the duration of the entire study period. Materials and methods: The analysis of 368 + 111 patients with lower extremity varicose vein disease was carried out. Of these, 111 patients turned out to be beyond the correct study of compliance (a phlebectomy was performed in a hospital). 368 patients were divided into the following groups: Group 1: the patients, who were assigned modern surgical treatment of varicose veins (endovenous laser coagulation, scleroobliteration); Group 2: the patients, who withdrew from assigned interventions. As it turned out, the different groups of patients differed in compliance.

Results. The patients who were shown and performed surgical treatment – 320 (86.9%), can be considered highly compliant with the prescribed conservative therapy – the average value of the compliance index is 0.83, compared to the representatives who refused to perform the recommended surgical procedures recommended by them – 48 (13.1%), the compliance index is 0.78.

In the course of the investigation, the factors shaping compliance with phlebotropic drugs were identified, a comparative assessment was carried out on the main indicators of the effectiveness of phlebotropic drugs.

Conclusion. Thus, the compliance of the patients suffering from LEVVV during the treatment with phlebotropic drugs varies depending on the multiplicity and convenience of the form of the drug, on the effectiveness of the proposed phlebotropic therapy according to the influence on the complaints and symptoms, on the psychological readiness of the patient to entrust the result of the final treatment of the disease to the surgeon.

Introduction. Diagnosis of Mortoan neuroma in some cases does not cause much difficulty and is based on typical signs, but in some cases it presents certain difficulties. Therapeutic tactics for this disease involves the use of conservative or surgical treatment.

Aim. Study of the results of differential diagnosis of Morton’s neuroma in the practice of an outpatient surgeon.

Material and methods. A study of the results of diagnostics and differential diagnostics in 15 patients with chronic foot pain at the age of 28 to 46 years was conducted. Among them, there were 14 women and 1 man. Differential diagnostics for foot pain syndromes allowed us to distinguish three groups of patients. The first group included 7 patients with Morton’s neuroma. The second group included 4 patients with plantar fasciitis and the third group-4 patients with arthritis, synoviitis of the metatarsophalangeal joints. To conduct differential diagnostics, we used anamnesis, physical examination, and data from instrumental diagnostic methods.

Results. Diagnosis of Morton’s neuroma was based on the use of standard research methods (anamnesis, data from a physical instrumental examination of the foot). It should be noted the importance of ultrasound examination of the soft tissues of the foot on the plantar surface for the diagnosis of Morton’s neuroma. This allows for differential diagnosis with foot diseases such as plantar fasciitis and metatarsophalangeal joint synovitis, which may show similar symptoms.

Conclusion. Morton’s neuroma is not a rare disease of the foot, which in the initial stages of the disease has a blurred clinical picture, similar to other diseases of the foot. This can lead to diagnostic errors, but the use of modern diagnostic methods, including sonographic methods, allows in most cases to establish an accurate diagnosis and choose an appropriate treatment strategy.

Introduction. According to epidemiological researches, such mammary gland disease as fibrocystic breast disease takes the leading place in the structure of pre-tumor diseases in women. Pathological cell proliferation is the common starting point for pathogenesis of both mastopathy and breast cancer. Patients with fibrocystic breast disease complain of pain unrelated to the menstrual cycle in the area of the mammary glands, swelling of breast tissue, nipple discharge. An important problem is the effective treatment of mastitis and lactostasis, during and after which the possibility of breastfeeding was maintained. Mastitis is a formidable complication of the postpartum period and the cause of lactation failure. For a long time, all patients with infectious mastitis underwent surgical treatment of the area of infection with subsequent drainage. As a rule, with the prescription of broad spectrum antibiotic drugs. Often, against the background of such stress for the body the ability to breastfeed dies down. Timely diagnosis and adequate treatment of mastitis and lactostasis help to preserve breastfeeding and improve the health of mother and child. Treatment of mastitis and lactostasis, fibrocystic breast disease is a complex problem of modern mammology.

Aim. This paper presents a pathogenetic approach to the treatment of fibrocystic breast disease from the point of view of evidence-based medicine using micronized progesterone. In order to avoid surgical interventions on the mammary glands and to preserve the maximum possible period of breastfeeding, we studied and proposed the method of mini-invasive and evidence-based approach to the treatment and prophylaxis of mastitis and lactostasis using a drug containing the strain L. Fermentum CECT5716.

Materials and methods. 13 patients with mastitis symptoms were included in the study. The main complaint of all patients who applied was lactostasis (100%). According to breast ultrasound, most patients were diagnosed with infiltrative mastitis – 8 (61.5%), serous mastitis – 4 (30.7%). Only one patient was diagnosed with purulent mastitis (7.7%). After prescription of treatment for mastitis and lactostasis after 21 days of clinical and radiological mammary gland image in 10 cases (77%) without pathology, duct ectasia was found in three women, which is the physiological norm in breastfeeding. All breastfeeding women have recovered normal lactation without symptoms of lactostasis. Almost all patients according to pain VAS noted not exceeding 1 point (mean was 1 ± 0.7). In most cases, the punctate cytogram corresponded to acute inflammation and purulent inflammation, 7 (53.9%) and 6 (46.1%). Results of a bacteriological study: Staphylococcus aureus – 11 (84.6%). Three patients had mixed microflora, Staphylococcus aureus/Staphylococcus epidermidis and Staphylococcus aureus/Staphylococcus saprophyticus, 2 (15.3%) and 1 (7.7%), respectively. One patient was diagnosed with Enterococcus faecalis. These data affected the choice of therapy. All patients were prescribed therapy with a drug containing the strain of L. Fermentum CECT5716 one capsule per day for 28 days, with subsequent assessment of the therapeutic effect on the 10th, 21st days.

Results. After treatment on the 10th day of control examination all the patients had galactorrhea cytogram without morphological signs of inflammation. According to the data of the bacteriological study of cultures, complete elimination of pathogenic microflora was revealed in most cases – 8 (61,5%), in 5 patients there were titers of less than 104 CFU/ml, which was the norm indicator. Clinical examples of treatment are given.

Conclusions. Our experience in treating such patients with a drug containing the strain L. Fermentum CECT5716 can successfully replace the standard of medical care for the treatment of mastitis and lactostasis. However, a combination with antibiotic therapy can be used for high bacterial load and mixed microflora. In all cases (100%) on the 10th day after the start of therapy all symptoms and clinical and radiological signs of lactostasis and mastitis were cured.

Introduction. Acute mesenteric ischemia is a rare, but extremely severe life-threatening condition with a mortality rate of 40 to 60%, despite the development of modern high-tech diagnostic and treatment methods. Unfortunately, acute mesenteric ischemia does not have any pathognomonic symptoms or highly specific laboratory and instrumental symptoms and manifests as abdominal pain syndrome, which makes it harder to differentiate diagnosis and results in a delay in taking appropriate therapeutic measures.

Clinical case. This clinical case report describes a case of a 70-year-old patient who was admitted to the cardiology department after undergoing percutaneous coronary intervention due to acute myocardial infarction. On the third day, the patient developed severe diffuse abdominal pain and diarrhea. After the series of diagnostic measures have been performed, an acute impairment of mesenteric circulation was suspected and a decision was made to perform spiral computed tomography, which confirmed the presence of a thrombus in the superior mesenteric artery. The patient underwent X-ray endovascular thrombospiration, transluminal balloon angioplasty and stenting of the superior mesenteric artery. Due to the persistence of abdominal pain on the following day, the patient also underwent a diagnostic laparoscopy using ICG technologies to assess the presence and severity of ischemic and necrotic intestinal changes. After six months from the date of discharge, the patient continues to be followed-up by a cardiologist.

Conclusions. The timely performance of spiral computed tomography in patients with suspected acute mesenteric ischemia in the vascular regimen, angiography, endovascular interventions to restore blood supply to the intestine and ICG control of perfusion is appropriate to improve the treatment outcomes of this category of patients.

Introduction. This article is devoted to one of the urgent problems of modern emergency abdominal surgery – the result of surgical treatment of ulcer bleed in patients with ischemic heart disease.

Undoubtedly intensive hemostatic conservative therapy and endoscopic hemostasis methods are the main treatment methods for this group of patients. However, in a certain number of patients with NGDK with various variants of IHD, such treatment is ineffective and there is a need to perform surgical hemostasis in an emergency and urgently.

Surgical methods of hemostasis of NGDK patients with different variants of IHD are shown only in cases of inefficiency of conservative and endoscopic treatment methods. Among surgical interventions, radical surgeries are more preferable, which, if performed against the background of intensive resuscitation support, allow to achieve reliable hemostasis and thus avoid postoperative recurrent bleeding. Palliative surgery should be used when radical surgery is not possible due to the severity of the patient’s condition or lack of technical skill of surgeons. Finally, it is clear that in order to improve treatment results in patients in this category, correction of changes caused by the accompanying IHD is necessary.

Materials and methods: In our research material, 89 out of 997 patients had such a need, which was 8.9%. It mainly corresponds to the modern literature data.

Results: An analysis of the results of these patients’ palliative and radical surgical interventions clearly showed that the last ones were more preferable.

The basis for this judgment was the high percentage of mortality after palliative care compared to radical care with approximately the same number of postoperative complications.

In addition, it is noteworthy that postoperative complications typical of palliative care in the form of recurrent ulcerative bleeding are often fatal, because half of these patients in our observations have not experienced repeated radical interventions.

Conclusion: At the same time, the necessary condition for performing radical operations is, firstly, appropriate technical skill of the surgeon, and secondly, providing the latter with intensive resuscitation support. In case of impossibility of performance of these conditions the method of a choice should serve palliative care.

This analysis is based on the study of materials from scientific electronic libraries (elibrary.ru, PubMed, scientific library of the Petrovsky National Research Centre of Surgery, Moscow, Russia). The problem of treating the pathology of the upper gastrointestinal tract is caused by the high prevalence of benign and malignant diseases of this zone, their severity, the complexity of diagnosis and often the low efficiency of conservative therapy. Intensive implementation of innovative scientific technologies in medical practice, aimed at increasing the effectiveness of treatment and diagnostic measures, minimizing their negative impact on the patient’s body and reducing the risk of complications, which, at the same time, have sufficient economic attractiveness. In full, all of the above can be attributed to endoscopy, which has been actively developing in recent years, both in the diagnostic and in the operational areas. In the treatment of various diseases of the gastrointestinal tract in recent years, combined methods based on the use of two or more minimally invasive technologies, for example, endoluminal endoscopic and thoraco or laparoscopic methods, have entered the world practice. The data of scientific articles on the problem of surgical treatment of patients with benign and malignant diseases of the upper gastrointestinal tract, carried out using intraoperative intraluminal endoscopic assistant, are analyzed. The use of intraluminal endoscopy, in particular, allows to increase the radicality of surgical interventions in patients with malignant neoplasms of the upper gastrointestinal tract, perform intraoperative topical diagnosis of non-palpable tumors, and use it in the surgical treatment of esophageal diverticulums of various localization. Also, another area of application of intraoperative intraluminal endoscopy is the assessment of tightness and anastomosis zone during surgical interventions on the organs of the gastrointestinal tract. However, this technique is in the process of implementation in clinical practice and has not been sufficiently studied both in foreign and domestic literature.