The review presents data on the prevalence of chronic venous insufficiency (CVI) of the lower limbs. Particular attention is paid to contemporary views of the risk factors and pathogenesis of this disease. Key approaches to the CVI therapy are considered. The article provides detailed information on the pharmacological effects of flavonoids, in particular, diosmin. It also provides data on the clinical efficacy and safety of a highly purified diosmin and the results of a comparative study of the therapeutic equivalence of the domestic drug Flebof 600 and the original drug.

The article is devoted to chronic vein diseases (CVD), initial manifestations of the disease (Ms, ds and С2s by СЕАР Classification), attention is focused on subjective complaints of the patient, pathophysiological mechanisms and CVD symptoms that significantly reduce the life quality. A modern drug therapy of phlebotropic drugs is proposed.

The article describes main principles of conservative treatment of chronic arterial insufficiency of the lower extremities. The role in treatment of metered physical load is underlined, we analyze the main pharmacological agents most often used for conservative treatment, their mechanism of action. Antiplatelet drugs, peripheral vasodilators (pentoxifylline, naftidrofuryl, dlostazol), sulodexide are considered. The of Actovegin, having a pleiotropic effect, is separately discussed.

Venous thromboembolic complications (VTEC) are a frequent pathology accompanied by high lethality. After VTEC the risk of their recurrence not equivalent for all patients remains. The anticoagulant therapy available currently effectively prevents VTEC increasing a possibility of hemorrhages. This means that at planning the secondary prevention it’s necessary to maintain the optimal balance between a possibility of recurrence of VTEC and development of hemorrhagic complications. Thus, selection of patients for secondary prevention must be accompanied by a comprehensive analysis of numerous factors as determining the possibility of VTEC recurrence as well as a risk of complications development. Warfarin is the most frequently used drug for long-term anticoagulant per os therapy, it requires frequent monitoring with periodic dose correction and strict dietary limitations. New oral anticoagulants (NOAC) are applied at a fixed dose without obligatory strict hemostasiologic control, which makes them rather attractive for continues secondary prevention of VTEC.

The choice of topical drug for treatment for the purpose of influencing the local infectious process is one of the most important tasks in the local wounds therapy. Povidone-Iodine is an effective antiseptic for local use. Povidone-iodine drugs can be used at Phases and 2 of the wound process, exist in several dosage forms, have a pronounced microbicide effect on micro-organisms in the absence of resistance, and penetrate the biofilm in combination with the low frequency of undesirable effects. Thus, povidone-iodine can be used extensively both to prevent wound infection and to treat acute and chronic wounds.

Due to the specific pathophysiological state of tissues in the chronic wounds and frequent limitations on the part of the patient the complex treatment of such wounds or wound debridement becomes quite a complicated therapeutic task. Due to HydroClean dressings that without any active components are fit for any patients and by this simplify and increase the quality of the wound debridement surgeons received modern unique hydroactive wound dressings for effective local therapy of chronic wounds of various etiology.

Venous thromboses and associated embolic complications (venous thromboembolic complications (VTEC)) remain the most dangerous complications of the perioperative period in patients with surgical profile. According to modern epidemiological studies, the incidence of pulmonary artery thromboembolia (PATE) reaches more than 1 case per 1,000 surgical interventions.

A small intestine malignant tumor reaches 2,1% in the structure of digestive tract neoplasms. This type of disease presented as duodenal (about 50%), jejunum (30%) and ileum (20%) malignant tumors. These non-epithelial lesions are stromal gastrointestinal tumors (GIST) and recently distinguished as an independent nosological unit, which has individual histological, immunohistochemical and molecular-genetic signs. Diagnostic confirmation of GIST is the measurement of c-Kit expression (CD-117) by immunohistochemistry. The main methods of GIST treatment is surgery and chemotherapy. Our report proves once again, that the diagnosis of small bowel tumor is extremely difficult. We operated a patient with 4th stage of the malignant disease. However, using such a simple method as an ultrasound has allowed to suspect abnormalities in the small intestine. Abdominal CT was performed after that. The key to successful treatment is the use of modern diagnostic methods - transrectal endosonography of pelvis and capsule endoscopy of the small intestine, that allows to diagnose correctly. The main method of treatment is removing of the GIST tumor with lymph node dissection and chemotherapy (Imatinib).

Pain syndrome in the practice of many specialists, including of dispensary component, is the important and vital problem. In the treatment of pain syndrome by effective and safe preparations appear the selective inhibitors of cyclooxygenase, representative of which is the nimesulid. Being inhibitor cyclooxygenase -2 it, although it does not exceed traditional nonselective non-steroid anti-inflammatory drugs on its activity, they ensure greater safety of application in patients both with the sharp surgical and with the chronic somatic pathology. This survey makes it possible to draw the conclusion that Nimesulid is the preparation of selection in the prehospital and hospital stage in patients with the acute and chronic pain syndromes, especially in patients with the komorbid conditions.

This study is aimed to assess the efficacy of endoscopic techniques in the diagnosis and treatment of colon polyps in healthcare centre environment.

The article presents the main indications for bowel examination and data on the qualitative preparation of patients for the early diagnostics of malignant neoplasms and inflammatory bowel diseases.

The results of the Russian part of the CHORUS International Multicenter Screening Program aimed at examining the frequency of symptoms and the risk factors of hemorrhoids in real life conditions are presented to identify possible relationships between hemorrhoids and chronic vein diseases (CVD). A survey of 2 668 patients applying for hemorrhoids was presented. Among them 1 438 (53.9%) women and 1 230 (46.1%) men aged between 18 and 92 years. All the patients passed study of the colon, anascopy and the hemorrhoids stage was established. On the basis of examinations and complaints in 1539 (57.9%) of patients CVD signs were detected. The relationship between hemorrhoids and CVD was identified. A comparative analysis showed that the symptoms of hemorrhoids, repeated visits to doctors and the frequency of repeated visits to doctors for hemorrhoids in a group of CVD patients were more significant than in a group without CVD. With the increase in hemorrhoids stage the incidence of CVD is also increasing significantly among patients. The impairment of the intestinal transit was estimated by the length of defecation and consistency of the stool. The data obtained showed that every fourth patient who applied to the doctor due to hemorrhoids had constipation. Also the relationship between the constipation and the gravity of hemorrhoids was shown. In patients with constipation the symptoms of hemorrhoids are more frequent, and the number of patients with III and IV stage hemorrhoids is significantly higher.

The study objective was to generalize the experience of outpatient management of patients with deep vein thrombosis (DVT) of the lower extremities by a multidisciplinary medical team. Materials and methods. Three aspects of activity were analysed: 1. 5-year outpatient management of 190 patients with DVT (arm 1 -134, initial anticoagulation therapy (ACT) in hospital settings, arm 2 -56, initial ACT in outpatient settings). 2. Identification of genetic thrombophilia (n = 18), 3. Outpatient management of patients using rivaroxaban (n = 27). The article presents the clinico-diagnostic algorithm for managing patients with DVT. Results. It was revealed that the initial ACT conducted both in hospital and outpatient settings was equally efficient and safe, made it possible to obtain hypocoagulation and antithrombotic effects, achieve different degrees of recanalization of the venous bed (arm 1 - 85.4%, arm 2 - 78%) with insignificant number of small hemorrhagic complications (2.2% and 1.8%). During a 5-year period after thrombosis, the recanalization processes depend on the lesion site of the venous bed and the level of the upper border of the initial thrombosis, the adherence of patients to ACT was reported in 92.1% of cases, relapse of DVT amounted to 2.8% (4 episodes). In the group of patients examined for the genetic thrombophilia following mutations have been registered: (FII G2021A - 5.6%), Leiden mutation (FV R506Q 1691 - 42.1%), PE development accounted for 26.3%. A clinical success was achieved in 27 patients treated with Rivaroxaban in the form of a reduction in pain syndrome and edema. In all cases, US-angioscanning showed signs of good recanalization, relapses of DVT and PE were not recorded. Conclusion. The application by a team of specialists of the outpatient multidisciplinary management algorithm for patients with DVT makes it possible to identify possible causes of thrombosis, achieve effective therapy using modern protocols and drugs, solve the problem of preventing DVT relapses, identify genetic predisposition and eliminate the thrombophilic risk factors.

The comparative evaluation of conservative therapy of pregnant women suffering from chronic venous insufficiency (CVI) of clinical classes C0-C3 (according to the international classification of chronic vein diseases CEAP) was conducted in the study. Patients of the comparison group (n = 52) received non-drug therapy (compression knitwear) throughout pregnancy and phleboprotector courses (escin-based medication) 1 time per trimester, from the second trimester of pregnancy. Patients of the main group (n = 52) were treated with clinical grade of CVI. It was found that the correction of CVI in pregnant women in the clinical class significantly prevents the progression of the disease, and significantly improves the course of gestation in later periods, due to a decrease in the frequency of preeclampsia, disorders of uteroplacental blood flow and fetal development retardation syndrome.