Presently, the financial component in the functioning of any healthcare organization is becoming increasingly important. There is a search for new, cost-effective forms of medical care and improvement of the existing ones [12, 25]. The process affects both outpatient and inpatient healthcare. The funding pattern characteristic of the national healthcare imposes restrictions on hospital stay of patients, for which reason inpatient-care-replac-ing technology, the relevance of which has increased over the past years, is becoming one of the most relevant trends in the Russian medical industry [6].

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the main classes of analgesics and indispensable component of an integrated program of pain management in anesthetic, surgical and traumatology patients. But the use of NSAIDs may be complicated by the development of a whole range of adverse reactions in the gastrointestinal tract (GIT), the cardiovascular system and kidneys and increase the risk of postoperative hemorrhage. Family of NSAIDs has a lot of drugs but none of them can be considered ideal in terms of efficacy and safety. Therefore, the development of a new representative of this drug group - amtolmetin guacil - is of great interest to practitioners. This drug has the characteristics of the pharmacological action defining its gastroprotective potential (primarily due to the increase in the concentration of nitric oxide in the mucosa), and the ability to greatly reduce the negative effects on the gastrointestinal tract. Although amtolmetin guaci is mainly used for the relief of pain in diseases of joints and spine (osteoarthritis, back pain, rheumatoid arthritis, etc.), it can be used for pain management in surgical patients.

Chronic venous diseases (CVDs) represent the most common pathology of peripheral vessels, the development of which involves different patho-genetic mechanisms leading to functional and structural abnormalities of the venous and lymphatic system of the lower extremities. One of the current trends in the correction of different stages and forms of CVD is pharmacological therapy which prioritizes the use of phlebotropic drugs (syn.: phleboprotectors, venoactive drugs (VADs)). The review summarizes the most recent data concerning the effect of phlebotropic drugs on macro- and microhemodynamics of CVDs.

The article tells about the results of compression therapy using VENOTEKS TREND legwear in patients with varicose veins of the lower extremities CEAP class C2-C3, which lasted for 3 months as monotherapy (group 1, n = 15) or following thermal ablation (group 2 , n = 10). The prospective study involved observation of the clinical symptoms, assessment of changes in limb circumference, measurement of venous blood flow during USDS, subjective assessment by patients of the effectiveness and quality of the knitwear. As a result of the compression therapy, the subjective symptoms of the disease, in particular, pain and edema syndrome, demonstrated a regression. Objectively confirmed effects include: reduction of limb circumference measures at the ankle level (group 1 - 70% and group 2 - 50% of patients) and at middle thirds of shank (group 1 - 86.7%, group 2 - 70 % of patients), as well as a significant increase in blood flow velocity in the popliteal and femoral veins (group 1). These results confirm the effectiveness of the studied knitwear in the treatment of varicose veins and after thermal ablation. The study revealed high adherence of patients to compression therapy with a positive assessment of the treatment in all cases.

The article tells about the current approaches to the treatment of deep vein thrombosis without the risk for embolism. Based on the findings of the global randomized controlled trials, as well as the updated Russian and international recommendations, the authors confirm the possibility, feasibility and safety of outpatient treatment of people with distal deep vein thrombosis with new anticoagulants administered per os.

In Moscow alone, according to the Russian Association of Phlebologists, CVI affects 67% of the active working-age population. Among the factors leading to the development of venous leg ulcers, the most common is chronic venous insufficiency accounting for more than 50%. Trophic lesions against a background of CVI cause long-term disability and invalidity in people in their most able-bodied and active ages, lead to considerable limitations in the basic spheres of life, from the ability to work to capacity for independent movement and self-care, thus reducing the quality of life. The total number of patients with a history of or currently suffering from venous trophic disorders of the lower limbs is 6% of the population. The incidence is increased in patients in older age groups, and complete elimination of the disease can only be achieved in every tenth patient. Even in cases of closure of trophic defects, the risk of recurrence is high. The article tells about the use of Actovegin®, its mechanism of action at different levels, as well as the etiology of CVI and its complicated forms, the appropriateness and adequacy of medical treatment with Actovegin®.

The current understanding of the development and course of pathological processes in chronic vascular diseases implies a widespread use of medications. Medications that are pathogenetically substantiated and have a good evidence base for their effectiveness are considered the most appropriate. With regard to chronic venous diseases, product files for drugs containing dios-min and its derivatives are the most complete. This group of drugs enjoys the most extensive and reliable scientific evidence. Pathogenetic value of these medications has been studied, and data was obtained in relation to clinical manifestations of chronic venous diseases (CVDs) and symptoms of chronic venous insufficiency (CVI). These studies are of fundamental importance in understanding the pathophysiological processes, and they continue today enriching the treasury of research.

Venous trophic ulcers (VTUs) develop as a result of progressive venous insufficiency and are common among the population of the industrialized countries, with a prevalence of 2-3%. The basic principle of VTUs treatment is elimination of the clinically significant veno-venous reflux and local treatment aimed at promoting the healing of ulcers. The described clinical case demonstrates the first experience with the new generation hydroactive wound dressings HydroClean® plus (2.0) after endovenous laser surgery to remove veno-venous reflux.

One of the most common causes of pain, about which patients outpatient turning to the surgeon, is a pain in traumatic injuries and inflammatory changes in the musculoskeletal system. Results of numerous foreign and domestic researches allow to consider nimesulide as an option in a group of drugs NSAIDs for the relief of pain in traumatic and inflammatory diseases of the periarticular soft tissues.

Subungual melanoma is a rare malignancy of which practitioners in various fields including oncologists know little; the work, therefore, is of great practical importance, since it could improve the diagnosis of melanoma not only by oncologists, but also by surgeons, general practitioners, dermatologists and other specialists. The article provides full and detailed information on the clinical manifestations of subungual melanoma, especially in the early stages, recommends an algorithm for timely diagnosis, suggests the optimum volume of surgical treatment, outlines prognostic factors for this form of melanoma.

Pain, as a powerful trigger of stress response to surgery, largely determines the results of surgical treatment through neurohormonal, endocrine, immune, metabolic and hemostatic mechanisms. The most commonly used NSAID is ketorolac (ketorol) which is administered parenterally. Improvements in the quality of postoperative analgesia predetermined the creation of a protocol with NSAIDs as the basic medications. For the treatment of postoperative pain, the Clinical Centre currently uses a combination of drugs with different mechanisms of action depending on the type of surgery, the nature and severity of primary and associated pathology in patients. For this purpose, NSAIDs are initially administered as they reduce activation of nocicep-tors in peripheral tissues; anesthesia with preferential inhibition of transmission of pain impulse at the segmental and suprasegmental levels is also applied.

RETRACTED ARTICLE

Qualitatively new techniques in the preparation of the colon for endo-scopic, radiological, ultrasonic methods of investigation, as well as surgical interventions, allow for a more reliable visualization of all parts of the intestine. These techniques help to carry out a more productive investigation of the large intestine, while the new, gentle preparation is better tolerated by patients. One of the novel medications for bowel preparation is Phospho-soda which is easy to use and has a high safety profile.

The article describes the problem of treatment of chronic hemorrhoids of III degree; the results of the study on sclerosing treatment of hemorrhoids in conjunction with ultrasound cavitation to ensure more intense and uniform distribution of drugs in the impact zone with preoperative preparation of patients by using phlebotrophic drugs are provided.

The study of the course of the immediate postoperative period in 200 patients with various injuries of the colon (100 - with stab wounds and 100 with gunshot wounds). In the result of the study it was established that the nature of injury of the colon has an impact on the change of rheologi-cal properties of blood in the immediate postoperative period, with stab wounds of the colon these changes are less pronounced, and recovery is faster - 5-7 postoperative days. In the group of patients with gunshot wounds, they were more pronounced and recovered later - on the 11- 13th postoperative day.

This article represents the data on using of macrogol in preparation for rontgenological and endoscopic examination of large intestine.

Post-traumatic pain syndrome caused by peripheral nerve injury: the specifics of pathogenesis, clinical manifestations and treatment. Pain is the symptom of various acute and chronic diseases. It influence different human life activities and causes serious medical, social and economic problems. Pain syndrome caused by traumatic injury of nerves of extremities has special features of pathogenesis and clinical picture. Despite achieved success in the understanding or pathogenesis and searching of new therapeutic methods post-traumatic pain syndrome treatment remains difficult complicated problem requiring complex approach. At the moment non-steroidal anti-inflammatory drugs come as an effective part of combined treatment of this disorder. Ketorolac is characterized as medication with the most significant analgetic action.