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Recently gastroesophageal reflux disease (GERD) was associated only with reflux-esophagitis and appeared to be a harmless disease with the most frequently noted symptom - heartburn. However, prolonged gastroesophageal reflux often provokes attacks of bronchial asthma, ischemic heart disease, is the cause of severe caries, repeated pneumonia and even cancer of the larynx. Terrible complications of GERD are ulcers of the esophagus with blood loss of various degrees, as well as stricture of the esophagus. It is with the widespread prevalence of GERD and its complications (in particular, Barrett's esophagus) that some authors associate an increase in the incidence of adenocarcinoma of the distal esophagus (up to 50 %) among all cases of esophageal cancer. In addition, according to some authors, GERD contributes to the occurrence of laryngeal cancer. Previously, GERD was understood as peptic or terminal esophagitis, but it is known that in more than 50 % of patients with reflux symptoms there is no visible lesion of the esophageal mucosa. It was found that with duodeno-gastral reflux, against a background of decreased acid formation in combination with anthropyloroduodenal dyskinesia, the alkaline contents of the duodenum affect the mucosa of the esophagus. Inflammatory-destructive changes in the mucous membrane of the esophagus may be more pronounced than caused by acid aggression. An important clinical fact is their resistance to conventional therapy. Part of patients with GERD have expressed motor disorders of the esophagus. Obviously, the existing motor disorders lead to the development of GERD, and subsequently, as a result of the direct effect of the inflammatory process on the nerve plexuses in the wall of the esophagus, motor dysfunction is aggravated.

We described a case of an endogenous hypercorticism in 18-years old patient with Itsenko - Cushing syndrome which was caused by a hormonally active adrenal tumor of the left adrenal gland. In a clinical picture of a disease the following symptoms dominated: arterial hypertension, increase in body weight, adiposity of the trunk, hands, neck, face, strips of extensions of skin on femurs. We found multiple nevus pigmentosus of black, yellowy-brown color from 1.5 to 10 mm on lips and mucous of a mouth, skin of a face and a trunk. The hormonal research established violations of a circadian rhythm of a hydrocortisone, increase in the free hydrocortisone of blood to 749.0 nmol/24 h (reference range 123.0-626.0), urine to 1314.0 nmol/24 h (reference range 60.0-413.0). The ACTH level decreased to 1.7 pg/ml (reference range 7.0-66.0). The negative result of the night overwhelming test with Dexamethazonum is received. Muitislice CT of adrenal glands revealed signs of a nodular hyperplasia of the left-hand adrenal gland. The laparoscopic adrenalectomy is made at the left. Pathoanathomical conclusion: a nodular pigmental hyperplasia of a glomerular and fascicular zone of bark of an adrenal gland with inclusion of a miyelolipomatoz. In the nodular corticocytes inclusions of lipofuscin granules were found. In the postoperative period symptoms of a hypercorticoidism regressed, throughout two years of observation there is no recurrence. Monitoring of hormones of blood in six months: hydrocortisone 359.5 nmol/l, ACTH 7.02 pg/ml. Retrospectively, the patient displays an infrequent heritable disease - Carney complex. The patient's mother at the age of 32 years underwent left-side adrenalectomy concerning Itsenko - Cushing disease with morphological confirmation of a nodular pigmental hyperplasia in adrenal gland. In both cases clinical convalescence occurred. Interest of the presented observation consists in its exclusive rarity. The unilateral adrenalectomy was efficient, but the probability of a recurrence of a hypercorticoidism and other manifestations of Carney complex remains.

Acute mesenteric ischemia is one of the most severe pathological conditions in terms of its course and prognosis. In the case of bowel infarction it is accompanied by an extremely high fatality rate. At the present day, despite there are ways to determine the patency of the vascular bed of the intestine accurately, developed principles and methods for the treatment of surgical interventions in different variants of acute occlusion of mesenteric vessels, it is not always possible to save the lives of patients with this disease. However, knowledge of the clinical picture of the disease, the consistent implementation of objective methods of diagnosis, timely decision on the need for surgical treatment can restore blood flow in the basin of the superior mesenteric artery and provide recovery and rehabilitation of these patients.

Chronic venous disease of lower extremities is a common vascular problem in the developed countries. The aim of our study was to explore a potency of ambulatory selective varicose vein ablation under local anesthesia (ASVAL) without vein stripping. ASVAL method was carried out in 12 patients. All patients had reflux of great saphenous vein verified by duplex ultrasound before surgical treatment. Exclusion criteria were reflux of small saphenous vein, reflux of perforator veins and clinical class 4-6 by classification CEAP. Design of the study was series cases. Follow-up time lasted one year. The surgery was performed by tumescent anesthesia of 0.01% Lidocain. All patients were given Diclofenac 100 mg for one postoperative day. In all patients we observed decrease of size or disappearance of great saphenous vein reflux verified by duplex ultrasound. No recurrence of varicose veins for one year was detected.