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The study of the human microbiome is one of the most pertinent areas of science and medicine today. The impact of changes in the microbiome is widely discussed in the context of new approaches to the diagnosis, treatment and prevention of many diseases. At the same time, approaches to the management of patients with precancerous and cancerous diseases are changing along with the discovery of new approaches to the management of this category of patients. Scientists all over the world are studying changes in the vaginal microbiome and its role in the female oncological pathology. This article contains the latest information in this direction. It is known that the vaginal microbiome is predominantly composed of anaerobic and facultative anaerobic flora. Normally, the dominant bacteria in the vagina are lactobacilli. A decrease in the number of lactobacilli facilitates the penetration of pathogenic bacteria and the development of sexually transmitted diseases and precancerous transformations. Studies on the effectiveness of chemotherapy have shown that interventions in the vaginal-cervical microbiome can improve patient response to platinum-based drugs and enhance the therapeutic effect of chemotherapy. Several studies have reported an increased prevalence of Sneаthia spp. in the vaginal microbiome of patients with high-risk human papillomaviruses, cervical intraepithelial neoplasia and invasive cervical carcinoma. Further research is needed on microbiome changes in vaginal and vulvar cancer. The composition and functions of the vaginal microbiome have been shown to change in women with human papillomavirus. In future studies, it is necessary to conduct analyses in larger samples and more complex populations, taking into account differences in the clinical characteristics of women and focusing on dynamic changes in cancer occurrence, in order to understand the overall development of the disease and the general trend of microbiome changes in gynecological cancer. In addition, close attention should be paid to the development of individualized screening and treatment, and by studying differences in populations, screening and treatment plans can be more precisely formulated and have better results.

The purpose of the study is the development of indications and evaluation of the long-term results of surgical treatment of benign tumors and dysplastic processes of the mandible by the method of replantation of resected bone exposed to extraorganic freezing. Material and methods. A method for the surgical treatment of benign tumors and dysplastic processes of the mandible has been developed. It involves resection of an afflicted by pathological process segment of bone within healthy tissues, its mechanical processing, freezing in liquid nitrogen followed by slow thawing, and replantation. The evaluation of the treatment results has been carried out on the base of clinical, radiation and functional research methods. Long-term follow-up after surgery has been ranged from one to 25 years. Results and discussion. Positive results of surgical treatment were recorded in 72 patients (88,9 %). The indications for the developed method use have been established. It was found that the reconstruction of the mandible with a resected bone segment exposed to extraorganic cryosurgery, eliminates the recurrence of a benign tumor, provides for the restoration of the anatomical integrity of the jaw, and reduces the invasiveness of the operation. Conclusion. Long-term clinical experience has shown that mandible direct reconstruction in the surgical treatment of benign tumors and dysplastic processes with the method of resection, external freezing of the afflicted jaw area and its replantation is available, simple, and highly effective and can be recommended in the practice of medical institutions.

Background. Early diagnosis of benign liver tumors (BLT) is based on the use of methods for visualization of focal lesions of the liver. The final diagnosis of BLT is established using a comprehensive diagnosis, which includes a morphological study. The goal is to present the morphological characteristics of the BLT diagnosed in the Grodno region. Material and methods. The object of the study was liver biopsy sample obtained by performing aspiration liver biopsy in patients with focal liver disease, liver fragments excised during surgery, and also sectional material. Results. A detailed description of the morphological signs of the most frequently occurring focal lesions of the liver, referred to the BLT, is presented. Among the main BLT are tumors of epithelial and mesenchymal origin: hepatocellular adenoma, adenoma of the intrahepatic bile ducts, cystadenoma of the intrahepatic bile ducts, focal nodular hyperplasia, mesenchymal hamartoma, infantile hemangiendothelioma, hemangioma, adenomatous hyperplasia, liver damage by hematopoietic and lymphoid tissue, cysts, polycystic liver are different. Conclusion. For their morphological features BLT are different from malignant. However, under certain conditions, some BLT can increase to critical sizes, disrupt liver function, lead to complications in the form of internal bleeding and other negative consequences. The most unfavorable outcome of a number of BLT is their malignancy, which requires continuous monitoring of focal liver lesions by visualization methods, the study of molecular-genetic markers of early malignancy, and the use of morphological study of BLT (according to indications).

Relevance. Over the last decades, such technology substituting inpatient treatment as outpatient treatment has been actively discussed and used in practice. Despite this fact, many problems of outpatient treatment have not been solved in full, no effective leverages contributing to creating economic incentives for increasing the volume and range of medical services in day hospitals have been found in the mandatory medical insurance system.Objective. Based on an in-depth analysis of medical care provision to women with benign gynaecological neoplasms, to offer measures for improvement of medical care in outpatient facilities, particularly by using technologies substituting inpatient treatment, and to evaluate their effectiveness.Materials and methods. A comprehensive retrospective evaluation of outpatient and inpatient medical care was conducted in St. Petersburg over the period from 2008 to 2015. The information contained in the database of billed and paid invoices of the obligatory medical insurance system of St. Petersburg was studied. For the total period of eight years, the data on medical care provision to 81 622 women suffering from benign tumors of the female reproductive organs, particularly in day hospitals, were obtained. In the period 2015–2016, medical care provision to patients with benign neoplasms of the gynecological sphere was thoroughly analyzed. In 18 women’s health departments and 19 in-patient facilities in all districts of the city, all cases of treatment of patients in the basic women’s health departments and in-patient facilities were analyzed by experts. By Taking into account the obtained results, an organizational experiment on introducing substituting technologies followed by evaluating the effectiveness of their use was developed and implemented on the basis of the medical institutions in one of the districts of St. Petersburg.Results. The activeness of outpatient facilities for treatment of women with benign neoplasms of the gynecological organs within the system of mandatory medical insurance has been constantly decreasing: in 2008, the services of outpatient facilities were provided by 26 health institutions, in 2015 - only by 11.The costs for treatment of patients with such diseases were analyzed, and differences were found in the approaches practiced in different districts of St. Petersburg. Low hospitalization levels predetermine active work for early detection, treatment and rehabilitation of patients at the outpatient stage, however, the study showed that in the districts with low incidence of women’s hospitalization, high detection rates are not always the case for these diseases at the outpatient stage. Such cases can result from inadequate tactics for treatment of patients at the outpatient stage, when patients not requiring 24-hour medical supervision get into an inpatient facility. Given the problems identified during the retrospective analysis, in the framework of the research conducted, approaches to arranging the treatment of patients based upon interaction between the inpatient and outpatient lings were suggested. On the basis of the Gynecological Department of a district inpatient facility, 4 outpatient beds were provided. The data analysis of the institutional experiment showed the absence of any significant dynamics in the general hospitalization levels (113.6 per 100 thousand of the adult population in 2012 112.0 per 100 thousand of the adult population in 2016, t < 2). At the same time, the incidence of urgent and and day-to-day hospitalization decreased significantly: urgent hospitalization was 11.6 per 100 thousand of the adult population in 2012 and 9.0 per 100 thousand of the adult population in 2016 (t = 3.9; p < 0.05); the figure of day-to-day hospitalization was 7.0 per 100 thousand of the adult population in 2012 and 5.5 per 100 thousand of the adult population in 2016, t = 2.7; p

Relevance. Benign neoplasms of the gynecological field have a significant impact on reproductive health of the population. The efforts of the state authorities aimed at overcoming the demographic crisis; therefore, the questions of organization of medical care for women require special consideration.Goal of research – todevelop a system of measures to optimize the arrangement of medical care for women with benign neoplasms of the gynecological sphere and to evaluate its effectiveness.Materials and methods. In 2015-2016, the study of delivery of medical care of patients with benign neoplasms of the gynecological field was undertakenon the basis of the antenatal clinics of St. Petersburg. 2500 cases of treatment were analyzed with the involvement of experts. Completeness and validity of diagnostic and treatment activities, the degree of continuity in the work of health care organizations, the need of patients in treatment at different stages were estimated. Taking into account the obtained results on the basis of one of the districts organizational experiment to optimize the provision of health care to women was carried out, and further its effectiveness was evaluated: an opinion poll of 2190 patients was held, 3334 cases were analyzed according to the database of issued and paid bills and ambulatory medical records.Results. Optimization of delivery of outpatient medical care to patients with benign tumors of female genital sphere is possible by increasing the activity of their dynamic monitoring: information on the characteristics of the disease, monitoring of compliance with the schedule of doctor visits, which can increase the frequency of prophylactic visits from 1.2 to 1.8 per year (optimal frequency – no less than 1.56 visits per year). Increase of treatment efficiency is achieved by early medical rehabilitation – professional psychological support of patients. Adjusted volume of psychological problems of patients in connection with the identified benign neoplasm: consultation of psychotherapist is indicated to 67.0% of the patients, specialized treatment is prescribed to one third of them. The introduction of a two-level system of internal quality control of medical care, allows to perform the prescribed amount of medical care, to ensure continuity of outpatient and inpatient stages of its delivery and to reduce the frequency of emergency hospitalization from 11.6 to 9.0 per 100 thousand of the adult population.Conclusions. The experiment showed that the effective observation of patients is possible only under condition of close cooperation of medical organizations at all levels and building of a trusting relationship of the physician with his patient.

Benign tumors are affecting the proximal part of the femur in 19% of all cases. Their distinctive feature is the relatively late diagnosis, which requiring the necessity, in addition to removing the tumor and bone grafting, to solve the problem of deformations correction. We have discovered the reasons of deformity appearance of the 31 patients aged 3-16 years. The following types of deformation were defined: ductile (12), after pathological fracture (12) and as a result of growth plate dysfunction (7). The correction of deformation, along with the tumour removing was performed at 15 patients: 3 - Oilier disease, 6 - fibrous dysplasia, 4 - bone cysts, 2 - exostotic chondrodysplasia. In 2 cases the correction of deformity was supposed unreasonable by its severity and accompanying pathology, and in 14 - the deformities were considered as permissible, that not required operative adjustment.

The authors presented results of blood flow examination in soft and bone tissues masses of lower extremities. Qualitative and quantitative blood flow indices were studied compared and systematized using color-coded Doppler technique and spectral dopplerography.

Writing this article is prompted by growing interest in the technology of high intensity focused ultrasound (high-intensity focused ultrasound, HIFU), which, in turn, is associated with a wide range of potential points of use, minimal invasiveness of this method, minimal impact on the patient’s body, characterized by a short period of rehabilitation. Also, this treatment method has a high reproducibility, which in turn contributes to the rapid spread of HIFU therapy in practice. The review is devoted to the history of development, study and application of the method of ultrasonic ablation, the modern view on how to conduct HIFU therapy, the currently available technical possibilities for non-invasive high-intensity focused ultrasound therapy as well as demonstrate the effectiveness of this treatment in patients with malignant and benign tumors of different localization, as in a standalone version or in combination with other treatment options (surgery, drug therapy, radiation therapy), an attempt to systematize the early and remote results of treatment. The article represents the data of world and national literature. One of the important directions of the study of the described technique is an expansion of possible application in various malignant pathologies, both local and generalized nature of the lesion. A separate item is the application of HIFU therapy in the treatment of chronic pain syndrome.

Objective: to study the possibilities of enhancing the efficiency of differential diagnosis of solitary lung masses by optimizing the quantitative analysis of positron emission tomography (PET) data when two radiopharmaceuticals (RP) (18F-fluorodeoxyglucose (18F-FDG) and 11C-methionine) are used alone and in combination.Material and methods. A comprehensive examination involving 18F-FDG and 11C-methionine PET was made in 116 patients with solitary lung masses of various genesis. A final diagnosis in the examinees was established from the results of postoperative material morphological analysis and/or laboratory tests and those of X-ray follow-up.Results. No 18F-FDG and 11C-methionine hyperfixation was found in patients with benign tumors and in the majority of patients with focal pneumofibrosis. At 18F-FDG and 11C-methionine PET, RP accumulation was recorded in all patients with lung cancer (LC) and in patients with inflammatory diseases. Three patients with 18F-FDG PET-negative typical carcinoid tumors were noted to have increased 11C-methionine uptake. At 11C-methionine PET, RP accumulation was recorded in the projection of formation in all the patients with LC and in 38 of the 42 patients with inflammatory diseases. Regardless of the used RP, the Standardized Uptake Value (SUV) was significantly lower in the patients with inflammatory diseases than in those with LC (p ≤ 0.05).Conclusions. When RP is used alone, the diagnostic efficiency of 11C-methionine PET in the differential diagnosis of lung tumors and inflammations is higher than that of 18F-FDG PET. At the same time, the highest informative value of PET is seen when 18FFDG and 11C-methionine are used in combination.

The article analyzes the effectiveness of use of exogenous nitric oxide in outpatient settings for the treatment of traumatic purulent soft tissue infection complicated by inflammation and trophic lesions against a background of lower extremity varicose veins and diabetic foot syndrome.

The main condition in achieving a favorable outcome is surgical treatment of patients with tumor-like diseases and benign bone tumors erosion of neoplasm within the healthy tissues. To reduce the number of recurrences the various chemical and physical methods on resection areas have been performed. The authors have proposed a new method of low temperature plasma treatment of bone tissue with the temperature of 20000°C. Exposing the plasma flow on bone tissue leads to loss of all cellular elements including neoplastic elements with preservation of the mineral bone structure. The direct correlation between the capacity of the plasma flow and intensity of bone destruction has been defined. This allows a differentiated use of plasma destruction in skeletal bones according to anatomy, size and type of bone tissue (spongy or cortical) as well as patient's individual condition of the tissue

The article represents modern data of aetiology and pathogenesis of tumor growths and benign ovarian tumors as systemic diseases of organism. These diseases appear on the cellular level and involve the presence of polymorphous metabolic, endocrine and immune disorders. Exogenous and endogenous risk factors of ovarian carcinomas are considered