The article presents the data of scholarly publications on the general principles and organizational solutions for nasal ala reconstruction of full-thickness defects. The reconstruction of the full-thickness nasal ala defect includes restoration of the external skin and internal covering epithelium, formation of support structures to achieve a stabile shape and position of the alar subunit. With this end in view, plastic material in the form of composite grafts from the auricle is applied, and each tissue layer is formed separately in the region of the defect. The external skin is most often reconstructed with medial cheek cutaneous flaps. The support structures are formed with cartilage autografts. The reconstruction of the internal lining defect is performed with local mucosal or skin flaps, more rarely mucosal or skin grafts. The limiting factors are: risk for ischemic complications, surgical trauma, and secondary surgical correction. The agenda do not only include achievement of acceptable anatomical and functional results but also the quality of perioperative life, shorter time and duration of the surgical intervention and minimum changes in the donor site.

Strabismus (heterotropy, strabism) is a permanent or periodic misalignment of the eyes characterized by the deviation of one or two eyes from a common visual axis and violation of binocular vision. Heterotropy is not only a cosmetic defect that affects the psyche and formation of the children`s character, but also is accompanied by expressed functional deficiency. Due to the absence of binocular vision, the perception of the external world, movement, and orientation in space are limited.

The review presents the clinical factors of destabilization of remission and relapse in alcohol dependence. Traditionally, among these factors the leading role belongs to the pathological craving for alcohol. However, the craving for alcohol is a rare phenomenon in remission from alcohol dependence and even if expressed significantly it does not always become a predictive factor for relapse. Currently, there are many other clinical relapse-dangerous factors which must be taken into account in the treatment and rehabilitation of alcohol-dependent individuals.

Objective: determine the optimal checklist of diagnostic procedures, whose application will make it possible to effectively identify and differentiate malformations of the biliary system of the fetus accompanied by the absence of ultrasound imaging of the gallbladder. Material . The fetuses in single-fetal pregnancy in the period of gestation of 16-37 weeks were examined. Results. The study has determined the optimal checklist of the diagnostic procedures, including dynamic sonography, biochemical amniotic fluid test, magnetic resonance imaging, which should be carried out in the absence of ultrasound imaging of the gallbladder during the screening ultrasound examination of pregnant women aimed at the identification of the congenital malformations of the fetus. The cases and conditions of the biochemical amniotic fluid testing have been identified. The standards of the percentile values of the total alkaline phosphatase and gamma-glutamyl transpeptidase concentrations in amniotic fluid have been developed. Conclusion. If the gall bladder of the fetus cannot be visualized by ultrasound, isolated agenesis of the gall bladder, atresia of the biliary tract, cystic fibrosis, aneuploidy, multiple congenital malformations should be suspected. In view of the extremely unfavorable prognosis in case of biliary atresia, the verification ultrasound examination should be repeated dynamically several times over the next week, and if the gallbladder is not detected, then for the differential diagnosis it is necessary to use additional methods such as MRI and biochemical amniotic fluid test in order to determine changes in their concentration of digestive enzymes in comparison with the normative values determined by the authors.

Objective: to evaluate the immunohistochemical and microbiological features of the endometrium in female patients with miscarriage. Material and methods. 60 female patients of reproductive age have been examined. The study group comprised 40 (66.67%) patients with miscarriage, the comparison group included 20 (33.33%) patients without reproductive pathology who had been examined before pregnancy. All the patients underwent the immunohistochemical examination of the endometrium and cultural study of the material obtained from the uterine cavity. Endometrial biopsy in the patients was performed depending on the duration of the menstrual cycle on 7-9 days after ovulation using the aspiration curette ProfiCombi («Simurg», Belarus). Results. During the immunohistochemical examination of the endometrium 29 (72.50 %) patients with miscarriage were diagnosed with chronic endometritis, the comparison group did not reveal the pathology (c² = 28.06, p < 0.001). Microorganisms in the uterine cavity were detected in 22 (55.00 %) patients with miscarriage and in 1 (5.00 %) patient of the comparison group (c² = 14.10; p = 0.0002), 15 (37.50 %) patients of the study group observed massive growth of microorganisms (c² = 10.00; p = 0.002). The predominant type of microorganisms in the uterine cavity was Escherichia coli , isolated in 11 (27.50 %) patients with miscarriage (c² = 6.00; p = 0.03). Conclusion. Miscarriage is associated with chronic endometritis in 72.50 % of the patients (p < 0.001). The combination of chronic endometritis and miscarriage leads to the infiltration by CD56-lymphocytes (p < 0.001), which causes the development of local immune reactions of the recognition of the fertilized ovum and reproductive losses. Persistent infection in the endometrium in 55.00 % patients of the study group (p = 0.0002) can cause serious complications not only for the uterus, but also can affect the health of the fetus and newborn, which demands the microbiological examination of the endometrium aimed at the solution of the problem of miscarriage.

Objective: to analyze short-term and long-term results of one-step surgery in resectable pancreatic head cancer (PHC), complicated by obstructive jaundice. Material and methods. The retrospective analysis of 123 consecutive cases of the surgical treatment of PHC has been performed. Group I (N = 33) consisted of patients with the total bilirubin level up to 100 µmol/l, group II (N = 31) - with the level of total bilirubin of 100-287 µmol/l who had undergone the one-step surgery. Group III (N = 59) included patients having undergone the surgical treatment with preoperative biliary drainage (PBD) in the form of the biliodigestive anastomoses or external drainage, with the total bilirubin level of 125-720 µmol/l. The frequency of postoperative complications, 90-day lethality and the overall survival rate were assessed by the Kaplan-Meier method. Results. The frequency of complications in the patients of groups I, II and III was 42.4, 48.4 and 35.6 %, lethality - 3.0, 3.2 and 6.8 %, respectively (P > 0.05); the 5-year survival rate - 39.7 ± 8.8 %, 30.1 ± 11.8 % and 4.9 ± 3.1 % (P = 0.004). Conclusion. The one-step surgical treatment of PHC with moderately severe obstructive jaundice was not accompanied with the increased frequency of postoperative complications and mortality. The overall survival rates were significantly higher in the patients undergoing the one-step surgery and did not correlate with the total bilirubin levels. The two-step surgery was accompanied by extremely low survival rates. The cancellation of the routine PBD procedure can be considered as one of the ways to improve the long-term outcomes of the PHC treatment.

Objective: to identify the interconnection of laboratory parameters with different courses of chronic lymphocytic leukemia (CLL) and to develop a comprehensive model for the assessment of the risk of the disease progression. Material and methods. The study included 127 patients with CLL whose laboratory parameters were evaluated (general and biochemical blood tests, β2-microglobulin, thymidinekinase, tissue polypeptide antigen (TPA), immunophenotypic markers, and also NOTCH1 gene mutations). Results. For the prediction of the course of the disease the most informative were such markers as β2-microglobulin, thymidinekinase, ZAP-70, CD38, and TPA. Based on the obtained data, a model of the risk assessment for CLL progression with high sensitivity and specificity was developed. The progressive-free survival (PFS) was evaluated in two groups of the patients of different risk (low and high) assigned to them according to the prognostic model. In the patients from the low-risk group PFS was determined to be 60 months, and in the high-risk group it was equal to 29.4 months. And it was found out that the patients without progression at the time of inclusion in the study with the presence of mutations of the NOTCH1 gene had a shorter PFS in comparison with the patients without mutations, which may indicate a link between the mutations of the NOTCH1 gene and the unfavorable prognosis for the disease progression. Conclusion . The integrated application of the prognostic factors in the form of a CLL progression risk assessment model allows to stratify CLL patients into high and low risk groups and to predict the probability and progression rate at the time of the diagnosis and during the treatment.

Objective: to study the concentration of endogenous lactoferrin in children with iron deficiency states before and during the treatment. Material and methods . The clinical and laboratory data of 31 patients with iron deficiency states (24 patients with iron deficiency anemia and 7 with latent iron deficiency) aged 0-17 (the median age was 9.7) and 7 healthy children (the median age was 12.4) who made up the control group have been analyzed. Hemogram and biochemical blood test were done according to the standard method. The concentration of endogenous LF in the blood serum was determined by the method of enzyme immunoassay using commercial test systems for the quantitative determination of human LF in the biological fluids (Elabscience) on the universal VICTOR2TM analyzer (Perkin Elmer, USA). Results . The study of ferrokinetics and LF concentration in the blood serum of the children with iron deficiency states has been performed. It has been shown that the children with iron deficiency reveal an increased LF level in the blood serum, which has variable values depending on age. The highest levels of the serum LF content are characteristic of patients under the age of three months, which is associated with the physiological mechanisms of the adaptation process of the hematopoietic system in newborns and infants. The LF concentration in the blood serum associated with ferrotherapy is increased compared to the corresponding indices before the treatment. Conclusion . From the results of the study its follows that the content of LF in the blood serum increases in iron deficiency and is associated with ferrotherapy. The obtained results will be used in further research aimed at the diagnosis of iron deficiency and prediction of the response to iron therapy.

Objective: to analyze the dynamics of the immediate and long-term results of the treatment of resectable pancreatic head cancer (PHC) for the period from 1989 to 2019. Material and methods. The retrospective analysis of 123 consecutive cases of the treatment of resectable PHC has been performed. During period I (from 1989 to 2000) 11 patients were operated, during period II (from 2001 to 2013) - 72, and period III (from 2014 to 2019) - 40 patients. The structure and frequency rate of postoperative complications, 90-day mortality and the overall survival rate (by the Kaplan-Meier method) have been assessed. Results. The frequency rate of the postoperative complications in I, II, and III periods were 63.6, 48.6, and 52.5%, mortality - 0, 5,6 and 5.0 %, respectively (P > 0.05). The most common complication and cause of death in all the cases were pancreatic fistula. The indicators of the 3-year survival in I, II, and III periods were 10.0 ± 9.5 %, 18.5 ± 4.7 % and 35.3 ± 9.6 %, the median survival - 10, 13, and 22 months, respectively (P = 0.07). Conclusion . A high frequency rate of the postoperative complications with a relatively low rate of the postoperative mortality was observed in all the analyzed periods. Pancreatic fistula prevailed in the structure of the complications and was the cause of death in all the cases. In the last period there was a clear tendency to improve the long-term results of the treatment, which may be due to more active surgical tactics, increased frequency of combined operations with the resection of vessels and proportional decrease in the share of palliative (R2) operations, standardization of the volume of lymph node dissection, an increased proportion of one-stage operations and increasing the number of patients receiving adjuvant chemotherapy.

Objective: to study the gender and somatotype features of the diameters of the small saphenous vein (SSV) and to search for a possible relation between the SSV, body mass index (BMI) and thickness of subcutaneous fatty tissue (SFT) on the posterior surface of the shin. Material and methods. The SSV diameter and SFT thickness were measured by duplex ultrasonography in 130 patients of both the genders and different somatotype and BMI. Results. It has been found that the SSV diameter does not depend on gender (p = 0.565) and SFT thickness (rs = 0.068). Dolichomorphic patients have a smaller SSV diameter than patients with other somatotypes (p = 0.0013). Patients with normal weight have a smaller SSV diameter than patients with overweight (р = 0.0417) and adiposity (р = 0.0165); there is a weak direct correlation between the diameter of SSV and BMI (rs = 0.228). Conclusion. The revealed information about the dependence of the SSV diameter on somatotypes and BMI could be used for the correction of the results of ultrasonography of the venous bed of the lower limbs.

Objective: to evaluate the nature of the histomorphometric changes in the bone tissue in the bodies of the lumbar vertebrae depending on their functional purpose. Material. Fragments of the bone tissue of the L_II, L_III and L_IV vertebrae obtained during autopsy from 14 men (the average age was 59.1 ± 12.0) and 16 women (the average age was 59.1 ± 15.8). Results. Statistically significant differences were found between the indicators characterizing the severity of osteopenic dystophia in L_III (more pronounced changes) and L_II, L_IV (less pronounced changes). Conclusion. The severity of osteopenic dystrophy at the level of the lumbar spine is determined by the location or otherwise, the functional purpose of the vertebrae: the lowest values of the indicators characterizing the severity of osteopenic dystrophy should be expected at the level of L_III, and the highest at the levels of L_II, L_IV and, possibly, L_V.

Objective: to reveal the features of PGRMC1 and Galectin-1 expression of the tumor microenvironment of endometrioid adenocarcinoma (EA) of the uterine body exposed to gamma radiation. Mаteriаl аnd methods. The surgical material of 80 female patients was analyzed in this retrospective study. The group of patients undergoing radiotherapy included 42 cases, the group of those who did not included 38 cases. The measurements were made in 10 non-overlapping fields of vision with ×400 magnification. The expression was evaluated separately in the stroma and parenchyma. The comparison of the groups was performed by means of the Mann-Whitney test according to the presented parameters. Results. Statistically significant differences (p < 0.001) were found in the expression of PGRMC1 and Galectin-1 both in the stroma and in EA parenchyma. Conclusion. The obtained data are indicative of the suppression of the secretion of some of the most active promoters of progression in the tumor microenvironment of EA.

Objective: to study the effectiveness of the application of low doses of epsilon-aminocaproic acid (EACA) (8-12 g) during cardiac operations under cardiopulmonary bypass (CPB) with the assessment of the effect on blood loss, number of transfusions, complications, and thromboelastometry parameters. Material and methods. The prospective, randomized study included 113 patients undergoing routine cardiac surgery under cardiopulmonary bypass. Two groups were formed: group 1 (n = 51) - an EACA bolus of 75 mg/kg was administered intravenously with titration of 30 mg/kg/h during CPB; group 2 (n = 62) was the control group. Conclusion. The introduction of low doses of EACA (10.2 (8.9; 11.4) g) reduces the thoracic-drainage volume by 30 %, reduces the frequency of donor blood transfusions by 38 % within 36-48 hours after the surgery without increasing the number of complications.

Objective: to develop a method for the differential diagnosis of age-related dystrophic changes and also changes arising from functional overload on the iliolumbar, long dorsal sacroiliac and sacrotuberous ligaments. Material and methods . The iliolumbar, long dorsal sacroiliac ligaments and sacrotuberous ligaments taken from 101 corpses including 65 men and 36 women aged 24-83. Results. The data describing the intensity of the dystrophic changes in the iliolumbar, long dorsal sacroiliac and sacrotuberous ligaments for different age periods have been collected. Conclusion . The comparison of a particular patient’s results on Bonar scale with the permissible age-related changes makes it possible to differentiate between the age-related changes and those resulting from the functional overload.

Objective: to determine the most common sites of localization and number of the intrapelvic anastomoses of the internal pudendal artery. Material and methods. The material for the research was 141 dead bodies of men (at the age from 27 to 75) and 29 dead bodies of women (at the age from 32 to 82) who had died of causes not related to pelvic pathology. The vascular injection method, preparation method, and statistical processing of the obtained data were used to achieve the aim of the research. Results. It has been found out that in the men and women the intrapelvic anastomoses of the internal pudendal artery are most often formed in the proximal and middle one thirds of the intrapelvic part of the artery, significantly rarely - in its distal one third. There is no linear correlation between the sizes of the diameters of the internal pudendal artery and sizes of the diameters of its intrapelvic anastomoses in the women but there is such a correlation in the men. Conclusion. The performed research has demonstrated that the intrapelvic anastomoses of the internal pudendal artery in the men and women have a definite pattern of their origination.

Objective: to assess the potential of a healthcare institution for the implementation of teleconsulting aimed at the provision of primary medical care to population using the SWOT analysis. Material and methods. The method of expert estimations, method of SWOT analysis, sociological, statistical methods were employed during the research. The object of the research was the health care institution «Ostrovets Central District Hospital», and the work was done together with the primary care specialists. The facilities and activities of Ostrovets Central District Hospital over 2013-2017 were analyzed. Results. The potential of the health care institution for the implementation of teleconsulting aimed at the provision of primary medical care to population using the SWOT analysis has been assessed. It has been shown that the method of SWOT analysis can be used by the head of the healthcare institution for strategic planning and management. The stages of the research and SWOT analysis during the implementation of teleconsulting in the provision of primary health care have been described. Conclusion: The application of SWOT analysis made it possible to substantiate the strategy of management decision for the implementation of teleconsulting in the activities of the healthcare institution.

Objective: to investigate the accumulation of¹³⁷Cs and⁹⁰Sr in the tissues of various species of fish from different types of the water bodies within the Belarusian sector of the Chernobyl NPP Zone of Alienation and to assess the potential dose loads on the population consuming the fish from the contaminated water bodies. Material and methods: 11 species of the typical representatives of the ichthyofauna of the Polesye State Radiation-Ecological Reserve (PSRER) were the objects of the research. The specific activity of¹³⁷Cs was measured by the method of gamma-ray spectrometry,⁹⁰Sr - by the instrumental or radiochemical method. Results: The accumulation of¹³⁷Cs and⁹⁰Sr in the tissues of the fish in the water bodies of the PSRER depending on their type has been studied. The study has found reliable differencies between the accumulation of¹³⁷Cs by predatory fish and fish with other types of nutrition. It has been revealed that the specific activity of¹³⁷Cs in the muscle tissue of the fish is 1.4-1.6 times higher than the accumulation of the radionuclide in their bone and adipose tissues.⁹⁰Sr is characterized by its highest accumulation in the bone tissue, where its specific activity was as up to 16 times as high as that of the muscle tissue. The assessment of the possible dose of internal irradiation following the consumption of the fish from the polluted water bodies has showed that it will be from 0.01 to 0.07 mSv/year and up to 2 mSv/year from stagnant water bodies. Conclusion: The studies have confirmed the necessity of strict radiation control of freshwater fish in the areas affected by the Chernobyl NPP Accident.

The article is devoted to the discussion of the specific features of Castleman disease, a clinical case of its multicentric variant, and analyzes the patient`s case report, the clinical data and results of the laboratory and instrumental methods of research.

The article presents up-to-date literary data on the etiopathogenesis, prevalence of lichen sclerosus, defines the clinical manifestations and classification of the disease, and considers the issues of its diagnosis and treatment. The article also describes 3 clinical cases of genital lesions in female patients with localized scleroderma. In our opinion, lichen sclerosus is one of the forms of localized scleroderma.