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Background. Acute heart failure (AHF) in patients with infective endocarditis (IE) is an independent indication for urgent cardiac surgery according to international guidelines. Preoperative risk factors for AHF in patients with IE empower to build the route of a patient rationally according to clinical status. The aim. To analyze clinically significant risk factors for AHF in patients with IE. Materials and methods. A retrospective single-center study was conducted which included clinical data of 311 patients with IE who were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from January 1, 2019 to October 22, 2021. The mean age of the patients was 47.9 ± 3.83 (19 to 77) years. The proportion of men in the study was 81.7% (254 patients). The mean duration of IE was 2.6 ± 0.1 (1 to 11) months. Global database for IE patients was divided into separate cohorts with different problems associated with this pathology. Diagnosis of IE was established according to the Duke criteria. The causative agent was identified and results of antibioticogram were evaluated. All the patients were divided into classes according to the New York Heart Association (NYHA) functional scale. Patients with signs of AHF were assigned to NYHA class IV. There were 2 groups of patients: 252 (81.1%) patients without signs of AHF before surgery, 59 (18.9%) patients with preoperative AHF. The risk factors for the occurrence of AHF were analyzed. Statistical significance was set at p < 0.05. The intensive care unit length of stay and hospital length of stay were evaluated. Results. Risk factors for preoperative AHF in patients with IE: IE of the aortic valve (odds ratio (OR), 2.97 [1.57-6.91]) (p=0.003); concomitant inflammatory pathology of the lungs (OR 3.37 [1.55-7.11]) (р=0.003); linezolid resistance of the pathogen (OR 2.34 [1.07-4.26]) (р=0.026); vancomycin resistance of the pathogen (OR 2.25 [1.13-4.74]) (p=0.032); IE of the prosthetic heart valve (OR 1.155 [1.01-1.1]) (p=0.036); nosocomial nature of the disease (OR 2.14 [0.83-4.37]) (р=0.049). The intensive care unit length of stay was significantly longer in the group of patients with AHF (8.8 ± 0.7 days) than in the group of patients without AHF (4.8 ± 0.2 days) (р˂0.001). For 311 surgical interventions, the number of deaths was 7 (2.3%). The analysis of deaths according to the type of complications revealed that 4 (1.5%) patients died due to cardiac causes (263 cardiac complications). Among them, the largest share was made up of patients with AHF: 3 (1.4%). Conclusions. In clinical work, it is important to identify preoperative factors that are associated with the tactics of treatment of patients with IE in order to improve the results of cardiac surgery.

Joint endoprosthetics is a treatment of choice for patients with decompensated osteoarthritis (OA), who have exhausted the possibilities of pharmacotherapy and other methods of conservative treatment. Preparation for endoprosthetics and rehabilitation after surgery usually includes measures to improve the muscle condition and local blood circulation in the joint area, and if necessary, pain management. The unique spectrum of anti-inflammatory effect of chondroprotectors based on chondroitin sulfate and glucosamine sulfate includes inhibition of NF-κB cascade, toll-like receptors, pro-inflammatory cytokines, metalloproteinases, and significantly alleviates the course of OA. Reducing the severity of OA is important for preparing for surgery, subsequent rehabilitation, and preventing the revision surgery.

BACKGROUND: Computer-aided design and three-dimensional printing have been used in various clinical and fundamental medicine fields, especially in surgery. For example, in the preoperative period, the correspondence of printed products to the anatomy can play an important role in evaluating pathological changes and correction methods. However, determining dimensional deviations of printed models involves ethical and technical difficulties associated with defining a reference and taking many measurements, respectively. Therefore, we propose to use a geometric object with known dimensions as a reference and estimate linear deviations using the Iterative Closest Point algorithm for each of the vertices of the prototyped polygonal mesh. AIMS: To evaluate the geometric deviations associated with creation of bone-like physical objects from computed tomography data using computer-aided design and additive manufacturing. MATERIALS AND METHODS: The source object was created using the FreeCAD application; Blender and Meshmixer software was used for polygon meshes correction and transformation. The 3D printing was carried out on an Ender-3 printer with copper-impregnated polylactide plastic BFCopper. Scanning was performed using a 128-slice tomograph Philips Ingenuity CT. A series of tomographic images were processed in 3DSlicer software to create virtual models by semiautomatic segmentation with threshold values of 500 HU, 0 HU, 500 HU, 750 HU, and manual segmentation. Reproduced and reference polygon meshes were compared using the Iterative Closest Point algorithm in CloudCompare software. RESULTS: The volume of reproduced models exceeded the volume of respective reference models by 1%27%. The average point cloud linear deviation values of reproduced models from the reference ones were 0.030.41 mm. A significant correlation between integral sums of linear deviations and changes in the volume of reproduced models was shown using Spearman's rank correlation coefficient ( = 0.83; temp = 5.27, p=0.05). CONCLUSION: The geometry of the reproduced object changes inevitably, while the linear deviations depend more on the chosen segmentation method than on the overall size of the model or its structures. The manual segmentation method can lead to greater linear deviations, though it saves all the necessary anatomical structures.

Objective: It is to evaluate the functional state of the adrenal cortex after surgical treatment in patients with corticosteromas for optimize of tactic of postoperative management.Materials and methods: We examined 143 patients (43 men and 100 women) aged 51.3 ± 10.1 years with incidentaloma of adrenal glands and 27 healthy peopels (control group) aged 45.5 ± 5.7 years. Cushing's syndrome was detected in 22 patients, autonomous cortisol secretion was detected in 43. All patients had an analysis of the complaints, objective, laboratory and instrumental data in the preoperative and early postoperative periods. Assessment of levels glucocorticoid and mineralocorticoid hormones in biological fluids was carried out by immunoassay and high performance liquid chromatography.Results: The signs of adrenal cortex insufficiency in the early postoperative period were obtained in 77.3% of patients with Cushing's syndrome and in 25% of patients with autonomous cortisol secretion according to immunoassay and high performance liquid chromatography. An increase of level of corticosterone in the serum of blood in the preoperative period indicate the possibility development of adrenal insufficiency in the early postoperative period in all patients. Аn increase of levels of 11-deoxycortisol and 18-OH-corticosteronein in the serum of blood аnd urinary excretion of free cortisone, 18-OH-corticosterone and 6β-hydroxycortisol indicate the possibility development of adrenal insufficiency in the early postoperative period in patients with Cushing's syndrome.Conclusions: The determination of cortisol and aldosterone precursors by high performance liquid chromatography increases the accuracy of the diagnosis of glucocorticoid and mineralocorticoid function of the adrenal cortex in patients with Cushing's syndrome and with autonomous cortisol secretion in the early postoperative period.

Our study was aimed at investigating dynamic phenotype pattern of peripheral blood NK cells in patients with widespread purulent peritonitis (WPP) during postoperative period depending on disease outcome. A total of 48 patients aged 30–63 with acute surgical diseases and abdominal injuries complicated by WPP were examined. Blood sampling was performed before surgery (preoperative period) as well as on day 7, 14 and 21 during postoperative period. 40 apparently healthy age-matched subjects were included in control group. Peripheral blood NK cell phenotyping was performed by using flow cytometry with directly immunofluorescently tagged antibodies. Mean fluorescence intensity was measured to estimate expression levels of NK cell surface receptors was measured. It was found that in patients with a favorable WPP outcome during preoperative period the percentage of mature NK cells was decreased that was restored by the end of the postoperative period (21 days post-surgery) due to elevated mature, cytotoxic and cytokine-producing NK cell subsets. In addition, percentage of CD11b-positive NK cell subsets was increased upon favorable outcome by the end of postoperative period as well as frequency of CD57-positive NK cells relative to the preoperative period. However, frequency of mature NK cells with unfavorable WPP outcome vs. control vs. favorable outcome was decreased during preoperative and entire postoperative period. Moreover, amount of cytotoxic NK cells was elevated during examination period upon unfavorable WPP outcome. Further, percentage of mature CD11b-positive NK cells in this patient cohort was decreased during preoperative period and post-surgery. Percentage of CD57-positive NK cells was decreased during entire postoperative period in patients with unfavorable vs. favorable outcome vs. control group. At the same time, patients with unfavorable outcome of this infectious-inflammatory disease were shown to display upregulated expression of CD28 and CD57 markers on NK cells. such features identified in phenotype of peripheral blood NK cells in patients with unfavorable WPP outcome reflect abnormal mechanisms in NK cell maturation and migration, which, in turn, determines disturbance in events regulating acute inflammatory reaction in WPP.

The aim of the study was to investigate the phenotype of blood T-lymphocytes in the dynamics of the postoperative period in patients with widespread purulent peritonitis (WPP) depending on the outcome of the disease. A total of 36 patients aged 30–65 with acute surgical diseases and abdominal injuries complicated by WPP years were examined. Blood sampling was performed before the operation (preoperative period), and also on the 7th, 14th and 21st day of the postoperative period. 40 relatively healthy people of the same age range were examined as a control. Study of the phenotype of blood T-lymphocytes was carried out by the method of 5-color f low cytometry using direct immunof luorescence of whole peripheral blood. Mean levels of fluorescence were used to evaluate the expression levels of surface receptors. It was established that in the preoperative period in patients with WPP regardless of the outcome of the disease against the background of a decrease in the absolute amount of total lymphocytes in the blood the content of T cells increases. The T-lymphocytes of patients with WPP are significantly more intense expressing the CD28 and CD62L receptors than the cells of healthy people. In the preoperative period and within two weeks of postoperative treatment with a favorable outcome of the WPP an increased amount of CD62L+T-lymphocytes is detected in comparison with the indices of patients with an unfavorable outcome of the disease. Other features of the phenotypic composition of T-lymphocytes in patients with a favorable outcome of WPP is an increase in T-regulatory activity which manifests itself both in the preoperative period and within two weeks of postoperative treatment. With a favorable outcome of WPP an increase in the number of activated cytotoxic T-lymphocytes is observed on the 14th day of treatment which with an unfavorable outcome is observed only on the 21st day of treatment. It is assumed that T-cell suppression and activation of cytotoxic T cells are the factors determining a decrease in the intensity of inflammatory processes in WPP and thereby increasing the level of the favorable outcome of the disease. In case of an unfavorable outcome of the disease, postoperative therapy has a weaker or delayed effect on the dynamics of the studied parameters than with a favorable outcome. With a favorable outcome of WPP an increase in the CD3+CD57+cell count is observed already from the second week of treatment and is more pronounced whereas in the case of an adverse outcome of WPP an increase in the level of these cells is observed only at the third week of treatment. However, the level of expression of CD57 on T-lymphocytes is more pronounced throughout the course of the examination with an unfavorable outcome of WPP.

This article outlines the main guidelines of the European Society of Anesthesiologists for Perioperative Venous Thromboembolism Prevention and the basic guidelines of the Society for Obstetric Anesthesia and Perinatology (SOAP) for Enhanced Recovery After Cesarean (ERAC). The search for effective methods of recovery after caesarean section, the desire to reduce the risks of postoperative complications, to shorten the length of the hospital stay led us to the introduction of the modern concept of rapid recovery. The concept of Enhanced Recovery After Cesarean is already used in the “Leleka” maternity hospital. The positive results of the implementation of the ERAC concept in obstetric practice make it necessary to modernize the traditional approach to the postoperative period.

Objective: To create a formalized method for predicting papillary thyroid cancer recurrence after hemithyroidectomy based on preoperative data., Material and Methods: At this stage of the study, we selected 101 patients with papillary thyroid cancer who underwent surgical treatment in 2017-2023. Recurrence was observed in in 47 patients. Fifty-four patients had no recurrence within 5 years after surgical treatment, i.e. these patients underwent surgery in 2017-2018. To find prediction rules, we used original classification method based on searching for subsets of variables and piecewise linear rules separating classes in pairs with subsequent voting of such rules to make a decision., Results: The exam was carried out using a training sample (101 cases) and sliding control method (10 tests on 10 random cases). On the training sample, sensitivity of predictive algorithm was 91%, specificity 78% and error rate 13%. The aggregated result of 10 trials using sliding control method revealed sensitivity of predictive algorithm 86%, specificity 75% and error rate 15%. This result is close to overall sample and confirms the effectiveness of this method for predicting recurrence., Conclusion: The pilot experiments revealed the patterns in data for potential prediction of recurrence based on preoperative indicators. Further study of this problem may be valuable for decision-making and adjustments in the management of patients with papillary thyroid cancer.

Surgery is one of the leading treatment methods of patients with primary or recurrent malignant neoplasms in the thoracic or abdominal cavity. Extensive abdominal interventions are accompanied by such adverse outcomes as blood loss, hypoxia, inflammation, blood clotting abnormality, emotional and cognitive disorders, that increases the incidence of serious complications and worsens the treatment outcome and life quality in weakened oncological patients. Multimodal pre-rehabilitation before surgery can significantly decrease the incidence and severity of postoperative complications. The rehabilitation complex includes exercise therapy, nutritional and psychological support, smoking cessation and pharmacotherapy. Currently, there are a number of questions facing rehabilitation specialists and oncologists, that are related to the determination of pre-rehabilitation optimal timing and process duration, the choice of specific physical exercises, determining the load intensity. This review presents a current view on understanding of surgical stress in extensive abdominal interventions, its effect on the oncological process course, summarizes the experience of last years in choosing pre-rehabilitation program taking into account pathogenetic mechanisms of surgical stress and individual patient's characteristics. Special attention is paid to the comparison of physical exercises' various types, their action mechanisms at different stages of pathological process, the issues of load dosing during pre-rehabilitation activities.

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Since the widespread introduction of minimally invasive laparoscopic techniques in abdominal surgery there was a question - what are their physiological differences from operations withapproach by laparotomy. The study of these differences, mechanisms and their correction allows you to bring the results of operations with open approach to the laparoscopic. However, the possibility of an effective systemic exposure, allowing adapting body reaction to surgical procedures remains unresolved. To date, the use of melatonin in surgical practice is based on its functions as a neurotransmitter that can potentiate some natural protective reaction of the body. The paper analyzes the effects of melatonin, you can use as a biological adaptogenic control which generally acts as a trigger to launch a diver-seprocesses, including reparative ones in the body. The use of adaptive mechanisms initiated by melatonin in response to surgical trauma and tumor processes can be successfully applied to improve the results of surgical treatment of patients with surgical diseases operated as open and laparoscopic access.

In anesthetics practice exist different scales and indexes, &#95;through which the evaluation functional condition of the patient. The disadvantage of these scales and tests are subjective evaluation as a condition of the patient, who is able to re-evaluate their functionality and anaesthesiologist, co-tory may underestimate the presence of comorbidities and patient complications in the postoperative period. The method of improvement of objective assessment of the patient's functional reserves, of a cardiorespiratory exercise testing is given. The methodology of testing in 18 patients, who were later performed surgery on the abdominal organs. The definition-of anaerobic threshold was conducted using V-slope method. In all cases was reached and was 11,1 (10,1; 12) mI/kg/min. Maximum oxygen consumption was 15,7 (15,2; 18,3) ml/kg/min. The results show the possibility of using the selected duct la research to predict possible complications and post-operative period.

Aim: To evaluate the efficiency of nocturnal hyperalimentation in adult patients with cystic fibrosis (CF) and respiratory failure., Subjects and Methods: The investigation enrolled 17 patients older than 18 years (mean age, 25.6±4.2 years) diagnosed with very severe CF (forced expiratory volume in one second (FEV 1 ), < 30%; body mass index (BMI), < 18.5 kg/m 2 ); all the patients were on the waiting list for lung transplantation. Nutritional status and pulmonary function parameters, such as body weight, height, BMI, and FEV 1 , were measured at baseline, before and 6 and 9 months after tube feeding., Results: The study group showed a considerable increase in body weight and BMI after 6 and 9 months. The change in lung function was statistically insignificant. Lung transplantation was successfully conducted in 5 patients; 4 died while on the waiting list; the cause of death was respiratory failure., Conclusion: Supplemental PEG tube feeding improves the nutritional status (BMI, body weight) of patients with very severe CF.

Aim: To assess anxiety level and factors contributing to its development in patients undergoing surgical treatment for breast cancer., Material and Methods: The subjects of the study were 72 women, aged 20-80 years, with the diagnosis of primary breast cancer. The Basic Psycho-Oncological Documentation Scale (PO-BADO), the European Organization for Research, and the Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module (EORTC QLQ-C30; BR-23), the Hospital Anxiety and Depression Scale (HADS) were used., Results and Conclusion: The anxiety score showed negative correlation with EORTC QLQ-C30 'physical functioning', 'cognitive functioning', 'emotional functioning', 'global health status/quality of life' subscales (p≤0,002). Anxiety is a highly prevalent in women with breast cancer and has a marked negative impact, in particular on younger patients.

Aim: To monitor the hemostatic system during platelet concentrate transfusions using low-frequency piezothromboelastography in patients with coronary bypass surgery given aspirin therapy., Materials and Methods: The study involved 148 patients with coronary bypass surgery, with 76 ones undergoing intraoperative transfusion of platelet concentrate and 72 treated without transfusion. The control group consisted of 20 healthy individuals. In the perioperative period indicators of vascular-platelet, coagulation, anticoagulant and fibrinolytic components of hemostasis were evaluated by low-frequency pezotromboelastography using the ARP-01M "Mednord" hardware and software system (Russia)., Results: It was shown that the antiplatelet effect of aspirin in the preoperative period was manifest as inhibition of the initial stage of blood coagulation accompanied by increased thrombin potential, the total gain of anticoagulant and fibrinolytic activity of the blood. Heart-lung bypass was accompanied by structural and chronometric anticoagulation, reduction of anticoagulation and increase of blood fibrinolytic activity. In the postoperative period, structural and chronometric anticoagulation was more pronounced in patients who did not undergo transfusion of platelet concentrate than in the group of patients with transfusion. Donor platelets further increased the blood hemostatic potential by neutralizing the antiplatelet effect of aspirin. Perioperative thrombohemorrhagic complications were absent in both groups., Conclusion: Low-frequency piezothromboelastography provides a tool for real-time monitoring the functional state of hemostasis system. Transfusion of platelet concentrate is not advisable given that the thrombin potential is preserved as confirmed by the results of low-frequency piezothromboelastography.

The Aim: to determine patterns during combined anesthesia andfrequency ofcritical incidents, depending on the initial level of wakefulness and patient age., Materials and Methods: 158 patients of planning operated under combined anesthesia for colon tumors were divided into two groups of elderly patients (n= 79) and old (n= 79). Each group was divided into 3 subgroups, depending on level of wakefulness, the estimatedfor level of direct current potential: low, optimum and high levels ofwakefulness. Relations of age and level ofwakefulness with afrequency of critical incidents. In the number of registered incidents included hemodynamic incidents: hypotension, hypertension, bradycardia, arrhythmia and tachycardia; respiratory incidents: hypoxemia, hypercapnia, the needfor prolonged postoperative mechanical ventilation; metabolic incidents: hypothermia, slow recovery of neuromuscular conduction, slow postoperative awakening has been studied., Results: The most frequent incidents in our study were hemodynamic incidents, which prevailed in the structure of hypotension and hypertension. Among of the respiratory incidents dominated by hypoxia and hypercapnia. In the group of elderly patients the most incidents occurred in the subgroup with low level of wakefulness, while in the oldest patients statistically group significant differences between the groups were not found Conclusion. Frequency of critical incidents does not only depend from the age but also from a preoperative level of wakefulness; frequency was lower in elderly patients with an optimum level of wakefulness, and the low level of wakefulness - was high regardless of age.

The paper discusses the problem ofpredicting, prevention and therapy of massive intraoperative blood loss in patients with metastasis in spine and spinal cord. We analyze 60 surgical cases in last 14 years in our clinic. Amount of blood loss was more that 80% of total blood volume in each case (from 2.5 to 17 liters). Preoperative selective angiography data on intensity of tumor blood supply were essential for blood loss prediction. Simultaneous embolization oftumor during angiography dramatically reduced intraoperative blood loss. Combination of blood saving techniques (preoperative autodonation, acute normovolemic hemodilution and intraoperative cell salvage) led to effective compensation of blood volume deficit and minimizing of allogenic blood transfusion. Plasma-derived and recombinant factors were effective in management of hemostatic disorders associated with massive blood loss.

Aim: To evaluate the effectiveness of eyelid hygiene in patients with chronic allergic blepharoconjunctivitis (ABC) as a part of their preparation for laser refractive surgery., Material and Methods: The study involved 32 patients (12 males and 20 females aged 25-42 years) with refractive errors, namely, compound myopic astigmatism (23 patients) and hyperopic astigmatism (9 patients) suffering from chronic ABC and secondary dry eye syndrome (DES). All the patients initially received a standard treatment for ABC and DES, that is olopatodin hydrochloride instillations - 1 mg/ml 2 times daily, preservative-free hyaluronic acid preparation - 1 mg/ml 3 times daily, and polyacrylic acid and dexpanthenol gel at night for one month. The scheme, however, appeared not effective enough. Hence, the patients were prescribed eyelid hygiene (Blepharolotion or Blepharosalfetka plus Blepharogel-1 2 times daily) to relive meibomian gland dysfunction (MGD). They also underwent a conventional ophthalmic examination, allergy tests, evaluation of ABC and DES signs and symptoms, tear film break-up time test, Schirmer's test, meibomian glands evaluation, optical coherence tomography with meniscometry, xerosis index evaluation, and lissamine green staining for lid wiper epitheliopathy., Results: At the beginning of the study signs and symptoms of MGD-associated DES were predominant in all patients. Chronic ABC signs were mild. In 2-3 months, meibomian gland function and tear film break-up time improved significantly in most patients, while xerosis index decreased and lid wiper epitheliopathy resolved. Laser refractive surgery (LASIK) was performed in 81.25% of patients, all of whom were satisfied with the results., Conclusion: Inclusion of eyelid hygiene into preoperative management of patients with chronic ABC and DES allows to achieve optimum conditions for laser refractive surgery in most cases.

73 randomly selected from the entire array menopausal endometrial cancer patients (34 of whom were subjected to further surgery by laparotomy and 39 - by laparoscopic ap- proach) were examined 48-72 hours before surgery. Patients passed anthropometry, their medical history was collected, and in the blood serum, taken on an empty stomach, glucose, gly- cated hemoglobin, lipid fractions, insulin, thyrotropin, estradiol and testosterone levels were measured while insulin resistance index was calculated. Although patients who later went through laparoscopic surgery were characterized by somewhat higher body mass and waist circumference, other investigated pa- rameters did not differ between laparoscopy and laparotomy groups. Moreover a frequency of so called "metabolically healthy" obesity appeared to be even higher in laparoscopic group. Taken together this confirms the fact that the overweight should not be considered as contraindication for videosurgery in patients with endometrial cancer. At the same time it is desirable to compare distant oncological results with individual characteristics of pre-surgical hormonal-metabolic status of pa- tients depending on the surgery type and obesity phenotype.

Aim: to estimate the expression of p53 protein, effector caspases-3 and -7, and the antiapoptotic protein survivin in colorectal adenocarcinoma metastases to the liver in patients who have received preoperative cytotoxic and combined cytotoxic and target anti-VEGF therapies., Subjects and Methods: Intraoperative samples from 122 patients with colorectal carcinoma metastases to the liver were immunohistologically examined. The investigation included patients who had received preoperative treatment with cytotoxic drugs, combined cytotoxic and targeted anti-VEGF therapy. A control group consisted of patients who had not received preoperative anti-tumor drug treatment., Results: Expression of Caspase 3, including that of survivin, was significantly more frequently detected in the patients who had received combined cytotoxic and anti-VEGF therapy as compared to both those treated with only cytotoxic agents (p=0.00004) and the control group (p=0.0008) As compared to the latter, the women who had received cytotoxic therapy were found to have no survivin expression (p=0.015). Investigation of the expression of caspase-7 and p53 revealed no statistically significant differences between the three groups., Conclusion: Addition of bevacizumab to preoperative standard therapy regimens for colorectal adenocarcinoma metastases to the liver leads to activated apoptosis in tumor cells, by enhancing the expression of effector caspase 3. At the same time, standard cytotoxic chemotherapy regimens in women results in activated apoptosis, by decreasing the expression of the antiapoptotic protein survivin.

Patients presenting with noncoronary atherosclerosis are found to have accompanying lesions of coronary arteries revealed in 25-90% of cases and being a considerable factor deteriorating the prognosis. A particular case of the given problem concerned is the development of cardiac complications in operations on noncoronary arterial basins. Therefore, determining optimal policy for diagnosis of coronary artery disease (CAD) in patients of the cohort concerned still remains currently important problem in cardiology and cardiovascular surgery. Present-day approaches to solving this problem are being considered regarded in the European and international guidelines. The basis of preoperative diagnosis is a step-by-step algorithm which is convenient for practical application, allowing to making it possible to avoid unnecessary wanton diagnostic procedures with low risk of cardiac complications, but in patients with initially higher risk of cardiac complications in vascular operations the use of this algorithm does not allow to reveal patients with symptom-free lesions of coronary arteries. In the presented review the authors give a detailed consideration thoroughly discuss to the problems of diagnosis of CAD in patients before operations on noncoronary arterial basins, relying upon both own studies and the critical analysis of data of world literature.

Objective: To assess the efficacy of pharmacological preconditioning with actovegin in carotid endarterectomy., Material and Methods: The study was based on the results of surgical treatment of 80 patients with hemodynamically significant uni- and bilateral lesions of carotid arteries. Half of the patients was operated immediately and others after pharmacological preconditioning with actovegin in dose of 1200 mg/daily during 1,5 months., Results: Pharmacological preconditioning with actovegin increased the cerebral perfusion determined with one-photon emission computed tomography that improved significantly results of the surgery. There were significant changes in patient's state 7 days and 6 months after surgery. The improvement was correlated with the less number of asymptotic post-surgery ischemic strokes in different brain areas., Conclusion: A positive role of pharmacological preconditioning with actovegin in surgical treatment of carotid artery stenosis has been demonstrated.

Results of treatment of 17 patients, operated primarily for adenoma of hypophysis (AH) using endoscopic transnasal access in clinic of transsphenoidal surgery of hypophysis adenoma, were analyzed. Anatomical variants of paranasal cavities (PNC) and preoperative criteria in accordance to the CT data, determining tactics of endoscopic interventions and technical peculiarities of its separate stages are adduced. While comparing MRI data on the stage of preoperative planning and multispiral CT (MSCT) PNC with additional layings of a patient detailed information about their variative anatomy was achieved. Quantitative virtual 3D estimation of PNC anatomy in accordance to MSCT criteria permits to determine individual peculiarities of cranial structure and the changed anatomic ratios, caused by pathological process, and to prevent iatrogenic complications.

Aim: To investigate the changes of iron metabolism values in patients with stomach cancer degree II and III within 7 days after surgery., Material and Methods: Levels of ferritin, transferrin, serum iron and unsaturated iron binding capacity were defined in 24 patients with stomach cancer preoperatively and in 1, 3 and 7 days after surgery using biochemical analyzer Cobas Integra 400. Comparison group included donors without cancer., Results: Studied parameters were normal before surgery excluding serum iron and hemoglobin. Level of ferritin significantly increased by 160% and transferrin decreased by 78% in comparison with those in donors in 7 days postoperatively (p<0.05; Mann-Whitney criterion). Total iron binding capacity considerably reduced by 300%. There are significant changes of serum iron values from the 1st to the 7th days postoperatively. It is suggested the supposition about detoxication role of increased level of ferritin as one of the mechanisms explaining efficiency of intraoperative autoplasmachemotherapy.

We studied the effect of rosuvastatin on the development of early postoperative cognitive dysfunction (POCD) in patients after coronary artery bypass grafting (CABG). One hundred nine men aged 45-70 year was divided into two groups. Group 1 comprised 69 patients (mean age 56.8 ± 5.2 years) who were given 20 mg of rosuvastatin for 10-14 days before CABG and until discharge. Patients of group 2 (n=40, mean age 55.9 ± 5.3 years) did not take rosuvastatin. It was shown that patients of group 2 had better neuropsychological parameters after CABG in comparison with the patients of group 2. Patients of group 1 had lower concentrations of interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor α, high sensitivity C reactive protein, and higher concentrations of IL-10. Group 2 patients had worse neuropsychological parameters which were associated with higher concentrations of proinflammatory cytokines. These results may indicate that preoperative therapy with rosuvastatin had decreased the severity of systemic inflammatory response and reduced the development of early POCD after CABG.

Unlabelled: Diastolic heart dysfunction occurs essentially in patients who suffer from chronic heart failure. In this context an investigation and application of different methods for diastolic function improvement remain a priority in the therapy of cardiovascular diseases., Objective: Our ain was to estimate coronary artery bypass grafting effect on the left ventricularfunctionality in patients with coronaty heart disease., Methods: Patients (30 men without myocardial infarction and 44 - with myocardial infarction) were investigated by Doppler Echocardiography before and after coronary artery bypass grafting for left ventricular diastolic function assessment. In addition, during the year after operation examinations were carried out. Analysis of the data allowed detecting two types of disorders of transmitral flow: rigid and pseudononnal., Results: Our investigation showed that transinitral parameters improved in patients after operation. Patients without myocardial infarction in anamnesis had a myocardium cell relaxation improvement (IVRT decreasing; p =0,046), but an active myocardium relaxation turned for the better (increasing of E/A (p <0,001) by component A lowering (p =0, 003). Changes of pulmonary veins parameters were followed by the improvement of left heart ventricle relaxation: active - PVD decreasing, p =0,051; and passive - PVA decreasing, p =0,028. Patients with myocardial infarction in anamnesis had an IVRT decreasing (p =0,040) and A decreasing (p =0,041). In addition, in this group left atrial function improved (PVS decreasing; p =0,037)., Conclusion: Coronary artery bypass grafting is effective in left ventricular diastolic function improvement and Doppler Echocardiography method can become an important criterion to estimate the treatment adequacy.

Purpose: to study effect of coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) on regional cerebral blood flow and cognitive function in patients with ischemic heart disease (IHD)., Material and Methods: We included into this study 22 patients with IHD subjected to CABG surgery with CPB. All patients underwent brain SPECT scanning and comprehensive neuropsychological testing 1 day before, 10-14 days and 6 months after surgery., Results: Overall CABG with CPB was followed by reduction of regional cerebral blood flow relative to baseline in frontal and parietal cortex (p < 0.01). Substantial reduction (> 5%) of cerebral perfusion in early postoperative period was observed in 15 patients (68%) while seven patients (32%) had no significant changes of regional cerebral blood flow. Changes of cerebral perfusion correlated with dynamics of cognitive status. Mean measures of immediate verbal memory, delayed memory, and learning decreased after surgery by 25.6 (p = 0.002), 43.3 (p = 0.000003), and 23.1% (p = 0.00000), respectively. Moreover after CABG with CPB patients demonstrated slowing of psychomotor speed by 13.6% (p = 0.03)., Conclusion: CABG with CPB was associated with reduction of cerebral perfusion leading to cognitive dysfunction. Immediate and delayed verbal and visual memory, learning and psychomotor speed were most sensitive to the negative effects of surgery.

Objective: To evaluate corneal status in patients with bullous keratopathy before and after endothelial keratoplasty., Material and Methods: A total of 16 patients (18 eyes) with bullous keratopathy were examined before and after DSAEK. Confocal microscopy ("Nidek", Japan) was used for corneal status evaluation., Results: Follow-up examinations were performed 3, 6, and 24 months after the surgery. In all patients minor corneal opacity persisted for the whole follow-up period but tended to decrease. It is shown that visual acuity is most dependent on light scattering in the anterior stroma., Conclusion: Anterior stromal haze is shown to have greater impact on visual acuity than opacities, folds, and birefringent deposits within the host-donor interface. Duration of bullous keratopathy, patient's age, and comorbidity are the factors that influence anterior and deep stromal haze development and changes over time.

Objective: To evaluate the efficacy of surgical treatment of lumbar vertebral canal stenosis based on the study of patient's pain and emotional status, quality of life and level of disability before and after surgical treatment., Material and Methods: A complex examination of 163 patients with lumbar vertebral canal stenosis was carried out. The visual analogous scale, Paindetect (PD) and Douleur neuropathique 4 (DN4), the Chronic Pain Coping Inventory, the Oswestry low back pain disability questionnaire were used. Affective disorders were measured using Beck depression scale. Blood serum and thrombocytic serotonin were determined with ELISA. Patients were examined at admission before the surgery, at discharge from the hospital after surgical treatment and one year after the surgery., Results and Conclusion: Before surgery, the patients had chronic pain syndrome of mixed etiology (nociceptive and neurotic type) and neurological disorders that significantly affected quality of life and work capacity. Neuropathic pain and depression, reduced quality of life and daily activities were more pronounced in patients with central canal stenosis compared to patients with lateral stenosis. The timely surgical treatment of lumbar vertebral canal stenosis promoted the decompression of nervous structures. A significant reduction of pain syndrome and the level of depression as well as the improvement of quality of life were observed.

The study was aimed at examining efficacy of preoperative preparation (pharmacological preconditioning) for carotid endarterectomy in patients with chronic cerebrovascular insufficiency. For this purpose, we analysed the outcomes of surgical treatment in a total of 80 patients presenting with haemodynamically significant unilateral and bilateral lesions of carotid arteries. Of these, 40 patients were operated on immediately and a further 40 patients underwent surgery after pharmacological preconditioning with Actovegin taken at a daily dose of 1,200 mg for 1.5 months. It was demonstrated that preoperative preparation prior to surgery increases cerebral perfusion which is determined by means of single-photon emission computed tomography, thus substantially improving the outcomes of surgical treatment. Statistically significant differences in cognitive function of these groups of patients were revealed 7 days and 6 months after the operation. Improvement of cognitive functions was associated with fewer symptom-free postoperative cerebral ischaemic foci in various regions of the brain. A conclusion was made on a positive role of pharmacological preconditioning with Actovegin in surgical management of cerebrovascular insufficiency, first of all in relation to more complete restoration of cognitive functions.

Unlabelled: Despite the obvious progress in modern neurosurgery, surgery for glial tumors of the insular lobe is often associated with a high risk of postoperative neurological deficit, which is primarily caused by damage to perforating arteries of the M1 segment of the middle cerebral artery., Objective: The work is aimed at evaluating the effectiveness of high resolution time-of-flight (3D-TOF) MR angiography in imaging of medial and lateral lenticulostriate arteries and determining their relationship to tumor edge in patients with gliomas of the insula., Material and Methods: 3D-TOF MR angiography data were analyzed in 20 patients with primarily diagnosed cerebral gliomas involving the insula. All patients underwent non-contrast enhanced 3D-TOF MR angiography. In 6 cases, 3D-TOF MRA was performed before and after contrast enhancement., Results: 3D-TOF angiography before intravenous contrast injection was capable of visualizing the medial lenticulostriate arteries in 19 patients (95% of all cases) and lateral lenticulostriate arteries in 18 patients (90% of all cases). Contrast-enhanced 3D-TOF angiography allows for better visualization of both the proximal and distal segments of lenticulostriate arteries. Three variants of relationship between the tumor and lenticulostriate arteries were identified. Variant I: the tumor grew over the arteries without their displacement in 2 cases (10% of the total number of observations); variant II: the tumor caused medial displacement of arteries without growing over them in 11 cases (55% of the total number of observations); variant III: the tumor partially grew over and displaced arteries in 2 cases (10%). In 25% of cases (5 patients), tumor was poorly visualized on 3D-TOF MR angiograms because their signal characteristics did not differ from those of the medulla (tumor tissue was T1 isointense). As a result, it was impossible to determine the relationship between the tumor and lenticulostriate arteries., Conclusion: High spatial resolution time-of-flight MR angiography can be recommended for preoperative imaging of lenticulostriate arteries to plan the extent of neurosurgical resection in patients with glial tumors of the insular lobe.

Objective: To study the effects of cytotoxic and targeted anti-VEGF drugs on some mechanisms of apoptosis., Material and Methods: The effects of cytotoxic and targeted anti-VEGF drugs on the expression of the apoptosis activators Bax and PML and the apoptosis inhibitor Bcl-2 were studied in the colorectal cancer (CRC) liver metastases; a comparison group comprised patients receiving no chemotherapy., Results: Immunohistochemical examination revealed lower Bax and PML expressions and higher Bcl-2 expression in the majority of untreated patients, suggesting the suppressed mechanisms triggering tumor cell apoptosis. Cytotoxic therapy resulted in a statistically significant rise in the expression of the apoptosis activator Bax (p = 0.01), a reduction in the level of the apoptosis inhibitor Bcl-2 (p = 0.04) and a slight increase in PML that controlled the induction of apoptosis. Adding an anti-VEGF agent to cytotoxic therapy exerted no statistically significant impact on Bax and Bcl-2, but caused more frequent positive PML expression than in the control and cytotoxic chemotherapy groups., Conclusion: Our study showed that cytotoxic and targeted anti-VEGF agents activate the apoptosis of tumor cells in the CRC liver metastases.

This article presents results of surgical treatment of 2963 patients with cholelithiasis. The majority of them (71.8%) had an elective surgery, though 28.2% of patients underwent an emergency operation. A comparative assessment of obligate treatment criteria was made in 2 groups. A first group consisted of 803 patients and it was before introduction of Roman selection criteria used for surgical treatment of patients. A second group included 2963 patients in the period after introduction of selection criteria. Preoperative planning of surgery with evaluation of technical complexity of all stages of intervention with prognosis for possible complications should be the base of reasonable choice of surgical method of treatment of cholelithiasis and safety protection of surgery. The study completed and results obtained allowed decrease of the rate of postoperative complications to 1.4% and lethality--to 0.3%, respectively.

Unlabelled: The aim of the present study was a comprehensive study of the features autonomic nervous system in cholelithiasis before and after cholecystectomy., Materials and Methods: 88 patients aged 40 to 60 years. 55 patients with cholelithiasis before and after laparoscopic cholecystectomy (CE). Control group consisted of 33 patients of similar age and gender. To investigate the function of the autonomic nervous system were evaluated themes complaint history, physical examination data, and used less Tod mathematical analysis of cardiac rhythm by Baevsky RM using the author's computer-related programs "Korveg" with the definition of heart rate variability and table--Solovevoj Wayne., Results and Conclusions: The study of autonomic provision in rest and during exercise were increased sympathetic activity, exceeding those in the control group. Studies indicate a tendency to sympathicotonia patients with gall stones before and after cholecystectomy, which is enhanced adaptive compensatory mechanisms to maintain homeostasis in the body. Identify logical connections between clinical and autonomic indicators will predict flow pattern cholelithiasis before and after cholecystectomy, as well as pick individual therapy for each patient taking into account the autonomic features that can be widely used in practical medicine--not.

Objective: To evaluate the possibility of acupuncture, as an element of preoperative preparation of the patient to carotid endarterectomy, for increasing the tolerance of patients with brachiocephalic stenosis to cerebral ischemia., Material and Methods: We studied 40 inpatients with low tolerance to carotid compression test. Ultrasound examination of brachiocephalic and intracranial blood flow was carried out, including carotid compression, apneic and hyperventilation tests. We examined 20 people from the control group before traditional medicinal treatment as well as after first and second therapeutic courses; 20 patients from the main group were tested before and after medicinal treatment, and after acupuncture course., Results: We couldn't identify any significant changes in cerebral hemodynamic reserve in patients with severe carotid stenosis after medicinal therapy; at the same time we registered its reliable 2.16 fold growth after acupuncture treatment., Conclusion: Аcupuncture treatment leads to cerebral hemodynamic reserve growth in most patients with significant brachiocephalic stenosis. The inclusion of acupuncture in therapeutic complex improves the quality of preoperative preparation to carotid endarterectomy and its tolerability.

The article presents an analysis of the features of primary peritonitis in children. Medical reports of 182 patients with primary and appendicular peritonitis were analyzed. It was significant, that the sick girls aged 4-7 years often had the primary peritonitis after acute inflammatory processes, which took place a month earlier. Chronic infection foci were noted in these patients. The age-specific features of maturation of the immune and reproductive systems predisposed the disease.

An article presents an analysis of treatment of 113 patients (aged from 60 to 91 years old) with stomach cancer. On this basis, an algorithm of examination of given age group was developed. Preoperative diagnostics wasn't directed only to an establishment of prevalence, a stage of main process. At the same time, it was aimed to determination and correction of accompanying somatic pathology, which required an application of multidisciplinary approach. An echocardiography was used for a functional condition assessment of cardiovascular and respiratory systems. The strategy allowed the indication rise for operation up to 96.5% in given group of patients.

The traumatic disease course was studied up in 287 injured persons with polytrauma and shock, 195 (67.9%) of them were admitted to hospital with continuing internal (noncontrolled) hemorrhage. The traumatic disease outcome was analyzed depending on the medical aid volume, delivered on prehospital stage, its duration, the arterial pressure level while admittance to the hospital and the blood loss volume. Maximal lethality was noted while nonconducting of infusion therapy on prehospital stage, as well as in aggressive infusion conduction with early normalization of arterial pressure; optimal outcome was achieved using intensive therapy before surgical hemostasis conduction while application of the hypotensive resuscitation regimen with minimal tissue perfusion and in systolic arterial pressure in the 80-90 mm Hg range.

The study enrolled 76 infants under 1 year of age (120 eyes) who underwent a total of 837 complex ophthalmological assessments, including ultrasound biometry and automatic refractometry. The assessment consisted of keratometry performed prior to cataract surgery, ultrasound biometry before and in different terms after the surgery, and evaluation of refraction in pseudophakic eyes. The power of intraocular lenses to be installed was determined using the principle of undercorrection. The follow-up periods ranged from 1 to 4 years. In 3.5-4.0 years after the surgery developmentally normal refraction was present in 58.5% of cases. According to analysis of refractive errors, the undercorrection prescribed to infants with preexisting II degree axial microphthalmia should be 2-3 diopters.

Despite of significant development of modern surgery results of treatment of acute diffused peritonitis and acute intestinal obstruction are still unsatisfactory. Successful treatment of these conditions depends considerably on timely and adequate diagnosing as it gives a choice of optimal treatment tactics. Measuring of a human body heat flow in areas of organs affected by pathology in cases of acute diffused peritonitis and acute intestinal obstruction provides a possibility to improve the principles of early differential diagnosing, to form new approaches to treatment tactics and monitoring of general health status of a patient during early postoperative treatment. 47 patient suffering from acute diffused peritonitis and 42 patients suffering from acute intestinal obstruction have been examined; the patients were divided into groups based on abdominal cavity exudates character, intestinal obstruction type and intra-abdominal hypertension grade. Measurement of abdominal cavity heat flow was performed by a contact method with use of thermoelectric medical thermometer. Intra-abdominal hypertension was measured by generally used transvesical method. It has been established that abdominal cavity heat flow correlates with character of abdominal cavity exudates; this is also confirmed by reliable difference between serous peritonitis and fibrinopurulent peritonitis indices. Indices in case of acute intestinal obstruction are lower than ones in case of acute diffused peritonitis as there are no inflammatory changes of peritoneum. Development of intra-abdominal hypertension of grades 3-4 directly influences the heat flow extent; this is explained by accelerated and aggravated pathological changes of inner organs cased by the main disease. Thus, abdominal cavity heat flow fully reflects degree of purulent and inflammatory processes of abdominal cavity organs and can be used for additional diagnosing and clinical course monitoring.

The investigation objective have had constituted comparative characteristic of the magnet resonance cholangiography (MRCHG) and intraoperative cholangiography (IOCHG), which were applied in 186 patients, suffering biliary calculous disease. Basing on results of the performed standard operational investigations, three groups of the general biliary duct (GBD) risk affection were delineated: high, middle and low. In the high risk group were included 82 patients, in whom in GBD its widening and echopositive mass presence were revealed, as well as cholangitis, pancreatitis, obturation jaundice and raising of the cholestatic enzymes activity. The middle risk group was presented by 41 patients, in whom the ultrasound investigations data did not show the changes, but nonspecific raising of the hepatic enzymes activity was registered or they have had jaundice and pancreatitis in anamnesis. In the low risk groups were included 63 patients, in whom preoperative investigations did not show pathologic changes. The GBD affection was diagnosed in 82 patients. The investigation results have shown, that along with lowering of the GBD risk affection revealing, the MRCHG sensitivity lowers (in the groups--93.1, 80 and 57.1%, accordingly), and specificity is raising (90, 96.7 and 98.2%). Conduction of intraoperative cholangiography is indicated to all patients in high and middle risk of GBD affection, in low risk--in necessity. In a distal affection of GBD MRCHG owes low sensitivity and specificity.

Objective: To make an algorithm for the optimal planning of a surgical procedure in patients with jaw cysts., Material and Methods: Sixty-six patients were operated on using cystotomy. The planning stage used radiation examination, including 7 survey radiographies, 62 orthopantomographies, and 33 computed tomographies (CT). The informative indicators of the most commonly used radiation techniques for this abnormality were compared. High technology radiation techniques (CT) showed the highest informative and diagnostic values., Conclusion: The investigation indicated the relationship of a surgical technique and the anatomic and topographic relations of a pathological process. The findings make it possible to prevent complications and recurrences during this treatment modality and to create favorable conditions for bone regeneration.

In order to assess the effectiveness of compression elastography of the thyroid gland as a method for differential diagnosis to studies conducted in the pre-operative period, there were involved 34 patients with a mean age 46.6 +/- 2.7 years. Elastography in the real time was characterized, according to the method of estimating, by a relatively high sensitivity (85.2-92.5%) and accuracy (70.6-79.4%), but low (30%) specificity. The specificity of the method, as it turned out, could be improved by taking into account the level of thyroid stimulating hormone (TSH) in the blood or body mass index (BMI) of the patients and, therefore, reducing the number of false-positive findings. Further improvement in the pre-operative diagnosis of malignant tumors of the thyroid gland and the formation of appropriate risk groups could be based on a combination of cytologic, hormonal, genetic and instrumental methods, including the so-called shear wave elastography.

The aim of this work was to estimate hepatic dysfunction and improve treatment of benign mechanical jaundice using an injection hepatoprotector. The study included 124 patients of whom 74 were given remaxol. 50 control subjects received basal therapy. The patients were randomized by the random sampling method. Severity of cholestasis was evaluated from the total and fractional bilirubin content and γ-glutamyl transpeptidase (GGT) level; AST and ALT activities were used to detect cytolysis. Liver synthetic function was estimated from prothrombin index (PTI) and coagulation function from fibrinogen level, PTI and APTT. Endogenous intoxication during biliary tract decompression was assessed by calculating the leukocyte intoxication index from the Kalf-Kalif formula. It was shown that remaxol suppresses cytolysis, reduces total and fractional bilirubin levels, improves bilirubin excretion in bile and decreases activity of hepatocyte excretory enzymes.

The absolute sensitivity signs of breast cancer to the drug have not yet been developed. Data from clinical trials on the study of experimental laboratory predictive markers of chemosensitivity: TOP2alpha (topoisomerase 2-alpha), beta-tubulin (subunit of dimeric protein tubulin), and BRCA1 (breast cancer 1) are contradictory and not numerous. Analysis of the results by the end of the clinical trial will allow examining the correlation between the effectiveness of preoperative taxane-chemotherapy and the level of experimental and standard molecular markets that is important for development of algorithm of treatment tactics for patients with locally advanced breast cancer.

The preoperative transabdominal ultrasonics duplex scanning (UDS) of celiac artery was made in quiet breathing, in inspiration, in expiration, using vertical position in 180 patients. As well as the intra-abdominal UDS was made before the decompression of the celiac artery using the pulmonary ventilation during narcosis and relaxation. Peak systolic blood velocity, degree of stenosis, arterial pressure gradient in the celiac artery and volume blood velocity were hemodynamically significant in quiet breathing, in expiration and intraoperatively, reliably lower in inspiration in vertical position. It is important to use respiratory and orthostatic tests in diagnostics of compressive stenosis of the celiac artery. The data, which were obtained in quiet breathing using vertical position, should be taken into account in order to distinguish the compressive stenosis from atherosclerotic stenosis or other origin.

In nowadays the wide propagation of surgical treatment of metabolic syndrome using the laparoscopic gastro-bypass surgery can be explained hy severe consequences of clinical manifestation of metabolic syndrome. The risk of the mentioned method has to be clear-cut assessed. The comprehensive analysis of changes in indicators of metabolism has to be applied to patients with metabolic syndrome before and after laparoscopic gastro-bypass surgery. The study was carried out on the sampling of 41 patients, 16 patients before and 25 after laparoscopic gastro-bypass surgery. In patients with metabolic syndrome after laparoscopic gastro-bypass surgery the normalization of concentration of glucose and glycated hemoglobin was established. The level of triglycerides, low density lipoproteins and reactive protein reliably decreased as compared with indicators of in non-operated patients. After laparoscopic gastro-bypass surgery, the positive dynamics of activity of enzymes of blood serum was noted.

From November 2010 to December 2011, 56 patients with coral nephrolithiasis underwent percutaneous nephrolithotomy. To assess the renal function before surgery and before discharge (6 to 7 days after surgery), glomerular filtration rate (GFR) by Cockcroft-Gault equation was defined. Preoperative renal functional reserve was evaluated by method using a single oral loading of protein drugs. 46.4% of patients have decreased GFR before surgery, and before discharge the proportion of such patients was 39.3%. In 80% of patients with reduced GFR, postoperative filtering function of the kidneys in response to a protein load was increased, but did not reach the pre-operative no-load values, and in 7.5% of cases corresponded to a load indicators. Filtering function of the kidneys before discharge below baseline and load levels was observed only in 8.9% of cases. The data obtained in most cases allowed to predict GFR decline in the postoperative period in patients with coral nephrolithiasis. 87.5% of patients before surgery were characterized by the absence of renal functional reserve, but in 28.6% of patients in the postoperative period there was an increase in GFR, indicating the positive impact of endoscopic percutaneous nephrolithotomy on the functional state of the kidneys in the immediate postoperative period.