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Despite the large arsenal of diagnostic methods for studying the lymphatic system, there are isolated works on its morpho-functional state in chronic venous insufluciency. The purpose of the study was to study the anatomical and physiological state of the surface lymphatic system of the lower extremities in persons with different clinical classes of chronic vein diseases using fluorescence lifography. The study was conducted in 105 patients divided into six groups according to the clinical class of chronic diseases of the veins of the lower extremities according to the CEAP classiffication. We used fluorescent lymphography using sodium fluorescein to study the anatomical and functional capabilities of the lymphotone. The study revealed that morphofunctional changes in superficial lymphatic vessels in chronic lower extremity vein diseases depend on venous system decompensation. With an increase in the clinical class of chronic diseases of the veins of the lower extremities, the rate of lymph flow through the superficial lymphatic vessels is statistically significantly reduced. At the same time, the antegrade lymph cell is completely absent in С5-С6, with the appearance of retrograde outflow and discharge of the lymph into the deep lymph vessels. Thus, the progression of chronic venous insufficiency leads to proportional progression of morphofunctional changes in the superficial lymphatic system, which leads to the formation of lymphovenous insufficiency.

Massive lymphorrhea can cause severe dysfunction of organs and systems and result in death due to loss of vital metabolites from the bodyAim. To demonstrate low efficacy of conservative therapy and late lymph duct ligation in continuous massive postoperative lymphorrhea.Results. We treated a patient with previous subtotal gastric resection with single-plane pancreatic resection, D2 lymph node dissection, peritoneal draining due to poorly differentiated carcinoma in the lower third of stomach and total hysterectomy who developed external lymphorrhea through peritoneal drainage tubes 3 days after surgery. A fat-rich diet, endolymphatic sodium etamsylate administration, and lymphatic duct ligation were not successful in terminating the lymph leakage. Despite the intensive care including extracorporeal detoxification, the multi-organ failure progressed and on day 28 after the surgery the patient was pronounced dead.Conclusion. Damage to lymph ducts and lymph nodes can be complicated by massive lymphorrhea. If the source of lymphorrhea can be identified, an urgent surgical intervention is warranted to stop the lymph leakage, as well as the restoration of homeostasis to replenish the lost metabolites and prevent death of the patient.

Purpose of the study. To provide prevention of early and treatment of late postoperative lymphorrhea in patients with oncolog­ical profile using fluorescent lymphography, photodynamic, radiation and endolymphatic lymphostatic therapy.Patients and methods. In the process, the results of treatment of 2 groups of patients were evaluated. Group I (main group) — 310 people — were patients with localized malignant tumors, who underwent elective surgical treatment and to whom were applied developed measures for the prevention of early and treatment of late postoperative lym­phorrhea using fluorescent lymphography (168 people), photodynamic (68 people), radiation (48 people) and endo­lymphatic lymphostatic therapy (26 people). Group II (control group) — 310 people — who underwent elective surgical treatment of tumor diseases of similar localization using standard measures for the treatment of postoperative lym­phorrhea (punctures, pressure dressings, etc.). The groups were comparable by sex, age, nosology and the volume of surgical interventions.Results. We estimated the volume and duration of lymphorrhea by the amount of allocated to the drainage and evacuated puncture lymph. In the control group, the average lympho-loss in the hospital was 59.6 ml, at the outpatient stage — 15.8 ml. Of the 310 patients in the control group, postoperative complications were identified in 29 (9.4%) patients: wound suppuration (11), abscesses (4), pleural empyema (2), thromboembolism (3), adhesive disease (6), pyelonephritis (2) and myocardial infarc­tion (1). Initial lymphorrhea, more than 100 ml per day, was present in 27 (93%) of these patients.Lymphorrhea in the main group in the hospital was 32.7 ml, and at the outpatient stage — 8.1 ml. Complications in the main group were detected in 13 (4.2%) patients: wound suppuration, anastomotic failure and fistula — 3, abscesses — 1, thrombo­embolism — 1, bleeding from duodenal ulcer — 1, adhesive disease — 7.After the application of the proposed measures for the prevention and treatment of lymphorrhea in the main group, the dura­tion and volume of lymphorrhea decreased almost twice, as did the frequency of postoperative complications.Conclusion. Prolonged lymphorrhea leads to an increase in the incidence of postoperative complications. Fluorescent lymphog­raphy, photodynamic therapy, radiation therapy and endolymphatic lymphostatic therapy, taking into account indications and contraindications to each of these methods, can be used for the diagnosis, prevention and treatment of postoperative lymphatic lesions. An individual approach to the prevention of postoperative lymphorrhea leads to a decrease in its volume and duration, a decrease in the frequency of postoperative complications, a reduction in the patient’s stay in hospital and at the outpatient stage and allows for the timely start of special treatment in cancer patients.

Purpose: to evaluate the influence of postoperative lymphatic leakage volume and duration on homokinesis and incidence of postoperative complications in oncosurgury patients underwent different operative interventions.Material and methods. The results of treatment of 310 patients subjected to standard elective surgical intervention for a malignant pathology of different organs with regional lymph node dissection were evaluated. The selection criterion was prolonged (more than 7 days) and prominent (over 50 ml a day) lymphatic leakage during the postoperative period. The fluid discharged during the postoperative period was identified as a lymph by cytology. The diagnosis of a malignant pathology was verified in all patients after histological examination and patients were distributed according to established diagnosis.Results. The duration of lymphatic leakage including the outpatient treatment stage varied from 9 days to 1 year and 2 months depending on the type of surgery. The longest lymphatic leakage occurred in 2 patients after radical mastectomy. During the 1st week of observation in patients with daily lymph losses up to 100 ml, no changes in the blood composition were noted. Prolonged lymphatic leakage (1–2 weeks after operation) in a volume over 100 ml a day resulted in reduced protein content in blood plasma, severe lymphocytopenia, increased platelet count. During the postoperative period, complications were detected in 31 patients; at that, during the 1st week of observation, 27 patients experienced initial lymphatic leakage over 100 ml a day. Analysis of fatal outcomes (7 patients) showed that in all patients the lymphatic leakage exceeded 150 ml a day and lasted 1 to 2 weeks. The longest inpatient time was typical for patients after Wertheim's hysterectomy and cystectomy, whereas the longest outpatient treatment was experienced by patients after radical mastectomy and inguinofemoral lymph node dissection.Conclusion. In case of lymphatic leakage over 100 ml a day in oncosurgury patients, it was necessary to make up protein losses and after 7 days of persistent lymphatic leakage it became necessary to consider use of active surgical tactics aimed at liquidation of lymph losses.

The relevance of the research has been substantiated. Russia has faced extraordinary economic circumstances. Russia is under unprecedented external pressure from a wide range of economic sanctions. In this connection, there is an objective need for a systematic analysis and forecasting of measures taken to support the Russian economy. The purpose of the research is to study measures to support the Russian economy and identify possible macroeconomic consequences of sanctions. In the research such methods of modern scientific knowledge as analysis, synthesis, induction, abstraction have been used. This article discusses the main directions of the anti-sanctions plan of the Russian Government, such as tax incentives, subsidies and the weakening of state control. The current price situation has been considered. The financial measures taken by the government to ensure the stability of the economy and support citizens in the condition of sanctions, as well as tax support measures have been considered. The possible results of the measures taken have been indicated. Some results of the forecast for the Russian economy made by S&P Global Market Intelligence have been presented. In addition, these data are compared with the first macroeconomic consensus forecast of the Bank of Russia since the expansion of Western sanctions against Russia and the extension of blocking to the reserves of the Central Bank itself. The author's presentation of the macroeconomic mechanism of sanctions has been augmented.

Acute otitis externa is a common disease in the pediatric population, characterized by diffuse inflammation of the external auditory canal. Typical symptoms of acute otitis externa include otology, itching, congestion, and a feeling of fullness in the sore ear. In the case of active inflammation, the process can go to the tympanic membrane, and acute otitis media will join the external one. Primary therapy for diffuse uncomplicated acute otitis externa should include a local antimicrobial drug, without systemic antibiotic therapy. Topical therapy with antibacterial drugs in combination with anesthetics is the most rational. A clinical case of a 12-year-old patient with acute diffuse otitis externa and otitis media with effusion; acute nasopharyngitis; and adenoiditis, which was established based on anamnesis and clinical data is presented. Complex therapy was prescribed, which included local antibiotic therapy with a complex topical drug for the treatment of imperforated otitis externa and imperforated otitis media. At reexamination 5 days later, the patient demonstrated positive dynamics, pain in the left ear was eliminated. In cases of uncomplicated diffuse otitis externa, as well as in cases of its combination with otitis media with effusion, topical antibiotic therapy is a major priority. It should be borne in mind that the topical medication is more effective with the cleansing of the external auditory canal from inflammatory secretion. If it is used correctly, it would provide positive dynamics without systemic antibiotic prescription. It preserves the microbiome and mobilizes the body’s defenses. The application of complex topical antibiotic drugs can be widely recommended in pediatric practice.

Susceptibility to 16 antimicrobial agents in 421 Klebsiella pneumoniae strains, isolated in a multidisciplinary medical centre from patients with nosocomial infections in 2015, was tested. The majority of studied strains were resistant to antibiotics: ampicillin/clavulanic acid (91.4%), ticarcillin/clavlanic acid (81.9%), piperacillin/tazobactam (69.4%), fluorochinolones (83.6%), III and IV generation of cephalosporines (79.8%), gentamycin (72.9%); one third (34.2%) demonstrated resistance to amikacin. K. pneumoniae strains demonstrated high level of carbapenem resistance (53.0% — to ertapenem, 42.8% — to meropenem and 37.1% — to imipenem), associated resistance to at least 3 different classes of antibiotics — caphalosporins, aminoglycozides, fluorochinolones, that amounted to more than half of the strains (57.7%), including 44.2% of the strains, additionally resistant to carbapenems. The lowest level of resistance was found to fosfomycin (8.5%) and tigecycline (7.4%), resistant cultures showed intermediate resistance with MIC 2 μg/ml to the latter. High diversity of antimicrobial resistance spectra was found, with high level of multidrug resistant strains (87.2%). Resistance to carapenems in K. pneumoniae isolated in the multidisciplinary medical center was determined by either blaOXA-48 (59.3% of isolates, resistant to carbapenems) or blaNDM-1 (40.7%).