Tension-type headache (TTH) is the most common form of primary headache. The aim of the review is to analyse research on epidemiology and triggers of TTH. The search for full-text articles in Russian and English languages published within the past decade was performed in E-Library, PubMed, Springer, ClinicalKey and Google Scholar databases. A total of seven Russian and forty-two foreign epidemiological studies have been analysed. Thus, the global prevalence of TTH amounts to 32% (4.4% among these cases are chronic TTH). In Russia, its prevalence is 52.4%. The leading TTH triggers are stress and anxiety-depressive disorders. Insomnia, clinical and meteorological conditions, the ethnos and culture are possible triggers as well. Despite the high occurrence of this primary form of headache in clinical pictures of nervous diseases, it remains insufficiently considered to the date. The issue of TTH requires further investigation

The leading place among cardiovascular diseases in the world – 50% – belongs to the ischaemic heart disease. Coronary bypass grafting is the golden standard for treatment of patients with multivessel ischaemic heart disease. The modern level of coronary surgery makes it possible to perform safe and efficacious direct revascularisation with hospital lethality not exceeding 1-3%. This article presents a review of literature devoted to the history of coronary surgery development including analysis of relevant sources dated 2010-2020 published in PubMed and Google Scholar databases: from first experimental procedures in the beginning of the 20th century and indirect myocardial revascularisation methods to direct bypass grafting of the impaired heart vessels actively developed since early 1960s. The article describes types of grafts applied with description of advantages and disadvantages of each one as well as contemporary methods and conditions for coronary bypass grafting and further prospects in development of ischaemic heart disease surgery.

Aetiological and pathogenetic aspects in uterine cervix pathology associated with persistent viral infection by the high-risk human papillomavirus
(HR HPV) are considered in this scientific review. The article provides a concise description of the biological structure and life processes of the virus. The main stages of uterine cervix impairment by the viral agent crucial for cancer development are described. Additionally, some mechanisms in the escape of viral progression from the immune control are given insight into. It is considered that, alongside with the aggression of the virus toward the host cells, there is a decline of cellular and humoral immunity in the female’s genitourinary tract, which may determine the growth and development of the neoplasm as well. The article puts a large emphasis on the defensive mechanisms appearing in the female organism as a response to the invasion and the persistence of the human papillomavirus. It is assumed that complete knowledge of pathogenetic mechanisms in development of oncogenic potential of the virus would imply the absence of rampant CIN and cervical cancer development induced by invasion of the agent into the organism

Drug-induced (DI) acute pancreatitis (AP) is a difficultly diagnosed disease amounting to 2% among all AP cases that may lead to development
of life-threatening complications. This article considers potentially hazardous medicinal products as well as the most significant variants of the pancreas:
structural and functional impairment of the pancreatic duct, direct cytotoxic effects, metabolic disorders, vascular disorders, immune-mediated damage to
the pancreas and hypersensitivity. The review was performed based on the publications present in the E-library and PubMed databases dated 1965-2020. Due to regular publication of reports on potential associations between specific medicinal products and AP development, medical practitioners must be informed about the potentially hazardous drugs and mechanisms of DI AP development.

Hiatal hernia amounts to 90% of all diaphragmatic hernias. According to data obtained from large-scale epidemiological studies in Europe and the
USA, esophageal hernias may be revealed in 30-40% of the population, 15% among which require surgical treatment. The occurrence rate equals 91% for
small hernias, 6% for large hernias and 3% for giant hernias. The article presents a review of literature dated 2011-2020 and devoted to results of operative treatment of hiatal hernia of different sizes. The search for the publications was performed in the following databases: Web of Science, Scopus, PubMed, e-library, Ulrich's Periodicals Directory, Google Scholar and AGRIS. There is a large number of methods for surgical correction of diaphragmatic hernia. However, strict indications to their application have not been developed to the date. Alloplasty provides for improvement of the clinical picture and of the patients’ quality of life, but bears quite a high risk of recurrence. To this day, treatment of hiatal hernia frequently involves application of various prosthetic materials with their certain advantages and disadvantages. Therefore, the search for optimal surgical methods for treatment of diaphragmatic hernias of different sizes continues and requires further investigation.

Aim of study. To reveal the most significant risk factors of chronic heart failure (CHF) decompensation against the background of rheumatoid arthritis (RA) and to carry out a regression analysis of galectin-3 level.
Material and methods. Study group: 134 CHF RA patients; comparison group: 122 CHF patients without RA. The functional CHF class of the study
participants was I-II according to the NYHA. The RA diagnosis was established based on X-ray examination and serological testing including determination of the rheumatoid factor, antibodies to the cyclic citrullinated peptide and C-reactive protein. The activity of the inflammatory process was evaluated using the DAS28 index and the visual analogue scale for pain. The X-ray stage of RA was I-III according to Steinbrocker classification in all patients enrolled. The medicines for CHF treatment were comparable in the groups. The disease-modifying anti-rheumatic drug was methotrexate. Patients who did not receive methotrexate due to development of adverse effect and/or individual intolerance were administered 20mg leflunomide per day. Additionally, NSAIDS were used (enteral, parenteral, local application). Haematological, biochemical and instrumental tests were used. The data processing was performed via the STATISTICA 10.0 software; the paper presents statistically reliable results. The significance level was set at p<0.05.
Results. As a result, logistic regression analysis revealed statistically significant associations between galectin-3 and the level of atrial natriuretic peptide (r=0.3; beta=0.36; p=0.02), triglycerides (r=0.3; beta=0.6; p=0.04), low-density lipoproteins (r=0.3; beta=0.2; p=0.001) and the glomerular filtration rate (r=0.5; beta=0.3; p=0.01).
Conclusion. The analysis has revealed data pointing to the possibility of heart failure compensation against the background of RA at the level of galectin-3
concentration of 17.6ng/ml or higher. The regression model attests to the association between the cytokine levels observed and the possible destabilisation of dyslipidaemia progression, kidney function and water-salt metabolism.

Aim of study. To evaluate the quality of life of children with total anomalous pulmonary venous connection corrected via two methods: the “sutureless” one and the conventional biatrial one.
Material and methods. This pilot bicentral simple blind prospective randomised study presents evaluation of patients’ quality of life after surgical correction
of total anomalous pulmonary venous connection in 1-year-old children via two methods: the “sutureless” correction (20 patients) and conventional biatrial
correction (20 patients). The total sample size amounted to 40 patients.
Results. All indices were at quite high levels. The indices of treatment, treatment-related anxiety, cognitive problems and sociability were significantly higher in the group treated via the “sutureless” method. However, the myocardium-related issues and symptoms as well as the appearance perception did not differ between the groups.
Conclusion. The quality of life of children after surgical correction of total anomalous pulmonary venous connection in long-term postoperative period
remains elevated in both groups despite the high variety of complications

The aim of the study is to investigate the influence exerted by short-term outpatient pulmonary rehabilitation on functional indices and the course of the perioperative period for patients with lung cancer against the background of COPD
Material and methods. According to the study design, lung cancer patients with planned surgical treatment were distributed between groups according to the COPD severity (stages II-IV). At the outpatient stage, evaluation of the pulmonary function and 6-minute walk test were performed. The results of the test and the functional indices were registered with further establishment of the pulmonary rehabilitation procedure complex for the patient. The exercises were performed at home and designed for the duration of two weeks. The complex included cycles of breathing, strength and aerobic exercises with individually adjusted intensity depending on the severity of clinical COPD manifestations and the baseline physical status. Upon completion of the training course, the patients underwent repeated spirometry and the 6-minute walk test. The results obtained were registered and analysed with subsequent surgical treatment of the patients.
Results. Minimal changes in functional indices upon completion of the course were registered in patients with COPD stage II, which prevented achievement
of statistical significance. Therewith, patients with COPD stages III and IV who had undergone the course of exercises were noted to show statistically reliable improvement of pulmonary function (FEV1) and improvement of the overall physical status, which is testified to by enhanced tolerance to externally imposed physical loads (p<0.01). Apart from that, decreased HR values (p<0.01)) growth of SpO2 values (p<0.01) and decreased shortness of breath (p<0.01) were registered in these groups after the 6-minute walk test. No statistically significant differences in relation to the number of postoperative complications or the term of in-hospital stay were revealed between the groups in the postoperative period.
Conclusion. Performance of a pulmonary rehabilitation course during the preoperative period reliably improves functional indices in patients with COPD
stage III and IV, which may be of crucial significance for determination of functional operability at the outpatient stage

Aim of study. Analysis of quality of life of patients attending to the unit for multiple sclerosis in the city of Krasnoyarsk.
Material and methods. A total of 54 patients with multiple sclerosis were studied. Investigation of their quality of life was performed via the SF-36 scale while revealing of anxiety-depressive disorders was carried out according to the HADS scale. Accordingly, the question of presence of employment and children was specified. The neurological status was assessed according to the EDSS disability index. Comparative analysis of patient surveying results and the data obtained from the control group formed from clinically healthy subjects.
Results. MS patients were observed to have statistically significant decline in physical function and overall health status. Correlation analysis within the main studied group revealed decrease of the physical component of quality of life and lower employment rate against the background of increased EDSS score. The larger result according to the depression HADS subscale restricted social function and the larger score in the anxiety subscale restricted the role emotional functioning.
Conclusion. The quality of life parameters have stronger correlation with the disability degree and negative expectations of the patients related to progression of the disease. Based on the study results, the MS unit is recommended to apply the HADS scale in its practice for rapid assessment of the emotional state of patients and prescription of relevant symptomatic therapy. The patients are recommended to support their level of social activity and adhere to regular intake of DMDs.

Aim of study. To compare short-term and long-term outcomes of surgical treatment for patients with chronic pancreatitis.
Material and methods. In the period of 2002-2020, a total of 123 patients underwent surgery for treatment of complications associated with chronic
pancreatitis. The patients were divided into three groups depending on the type of intervention. Patients in Group 1 underwent drainage (n=46), patients in Group 2 underwent resection (n=26) and patients in Group 3 combined resection and draining procedures (n=51).
Results. After Roux-en-Y cystojejunostomy of cysts in distal parts of the pancreas(n=11), the amount of complications was lower (3 (27 [6; 61]%)) than after distal resection (n=20): 10 (50 [27; 73]%)), and the quality of life (SF-36) was higher in the long term (PSC: 55.75, MCS: 53.53 against PCS: 48.09, MCS – 49,72) after resection repair. The frequency of postoperative complications and lethality rate were higher in patients after different variants of sparing resection of pancreatic parenchyma with duct system drainage than in the group of patients treated with longitudinal cystojejunostomy. In the long term, lower lethality (5 [0; 23]%; p<0.05) and a higher level of physical (PCS – 61.31) and mental (MCS – 61.73) health were registered after the original variant of combined resection and draining intervention in comparison with traditional pancreatojejunostomy and duodenum-preserving surgery.
Conclusion. Draining interventions on pancreatic cysts in distal parts of the pancreas is accompanied by better immediate and long-term results. Drainage without consideration for changes in the pancreatic head leads to a higher recurrence rate (27 [8; 55]%, р=0.013). Immediate results of the proposed combined resection and draining intervention are comparable with duodenum-preserving surgery but are characterised by lower mortality (5 [0; 23]%, р=0.06) and higher quality of life (SF-36) in the long term.

Aim of study. The inferior mesenteric vein has three variants of the ostium. Each variant of the inferior mesenteric vein ostium has its morphological
peculiarities. According to literatures, the occurrence is different between the variants of the confluence. The aim of this study was to determine the
morphometric characteristics of veins forming different variants of the inferior mesenteric vein ostium and the occurrence of the two formation types of this
vein (the magistral one and the transitional one).
Material and methods. Vessels (inferior mesenteric veins) of 53 male patients undergoing treatment in surgery departments of the Krasnoyarsk Regional
Clinical Hospital No.1 were enhanced with contrasting agents, studied and analysed. The work was performed using 3D-models of the vascular bed of the portal system (GE Advantage Workstations, Siemens singo.via) based on MSCT of the abdominal cavity with bolus contrast enhancement using the Ultravist-370 agent. We applied an original method for manufacturing of corrosion preparations of vessels (RF Patent for an invention “method of manufacturing models of human rectal veins” No.2545921 dated 26.02.15) and studied morphological parameters using 85 vein models of the colon, the sigmoid colon and the rectum.
Results. The occurrence rates are different for the variants of the inferior mesenteric vein confluence (serving as the root for the portal vein in 5.5%, as the tributary of the splenic vein in 17.5% and draining into the superior mesenteric vein in 77% of the cases). The length of the inferior mesenteric vein differs for its confluence variants and varies from 54.5mm to 108.5mm; the diameter varies from 4.0 to 7.2mm. The magistral formation type of the inferior mesenteric vein is revealed in 23% of the cases and is characteristic to its drainage into the splenic vein or to its immediate junction with the portal artery trunk. In 77% of the cases, its formation type is transitional.
Conclusion. The knowledge on ostium formation variants of the inferior mesenteric vein, inflow of its roots, characteristics of branches of the studied vessel is necessary for surgeons performing operations on the upper part of the abdominal cavity and for radiologists interpreting the images obtained at the stage before the operative intervention

Aim of study. Investigation of the dynamics of incidence of the skin and subcutaneous tissue diseases in the population and evaluation of the mortality from these diseases.
Material and methods. During the study, data on primary and overall incidence, mortality and the mean age of the population who died from the skin and subcutaneous tissue diseases within the period of 2009-2019. The group contribution of the mortality from complications of these diseases to the average life expectancy decline has been studied. The increment rate (%) was calculated for evaluation of the dynamics of the indices. Assessment of the relations between the indices was performed via the Spearman’s rank-order correlation.
Results. Over the period from 2009 to 2019, the overall and primary incidence of skin and subcutaneous tissue diseases in the population demonstrated a decrease by 21.54% and 27.67%, respectively, in Krasnoyarsk; by 9.55% and 11.87%, respectively, in the Siberian Federal District; by 8.89% and 17.33%, respectively, in the Russian Federation. We have revealed statistically significant correlations between the overall incidence and the contribution to the life expectancy (r=-0.745, p=0.008), overall incidence and mortality (r=-0.682, p=0.021), mortality and the contribution to the life expectancy (r=0.936, p<0.001) as well as between the mortality and mean age at death (r=0.800, p=0.003).
Conclusion. Diseases of the skin and subcutaneous tissue remain a severe medical and social problem. The correlations revealed between the incidence and mortality testify to the low detection rate of skin diseases, which points at the necessity to increase the quality of detection and diagnosis of this group of diseases in the Krasnoyarsk Krai territory in order to decrease the mortality from their complications and increase the life expectancy for the population of this region.

Deep infiltrating endometriosis with bowel involvement remains the most difficultly treated form of the endometriosis. It is defined as endometriosis penetrating greater than 5mm beneath the peritoneum. Treatment of severe forms of deep infiltrating endometriosis with bowel wall involvement is one of
the most complex issues in modern surgical gynaecology. Efficacy of the multidisciplinary approach to operative treatment of patients with deep infiltrating endometriosis and bowel involvement is demonstrated via an example of our own clinical case.

At the present time, cases of gas infection are extremely rarely encountered. The incidence of anaerobic gas infection totals 0.1-1.0 cases in 1,000,000
of the population per year. The clinical case presented describes peculiarities in clinical progression of the disease, of its surgical and complex treatment. The dynamics of multiple organ dysfunction markers has been shown. On admission, the predicted lethal outcome rate totalled 66.7% to 82%. The treatment included local and peroral application of an oxygenated pharmaceutical. Tissue oximetry revealed elevation of blood oxygen saturation 30 and 60 minutes after the oxygenated pharmaceutical intake. The surgical tactics employed and the pathogenetic therapy combined with local and peroral application of the oxygenated pharmaceutical made it possible to achieve a positive treatment outcome

A clinical case of Muckle-Wells syndrome in a 3-years old child is presented. Muckle-Wells syndrome is among the group of human autoinflammatory
diseases (cryopyrin-associated periodic syndromes) – rare genetic diseases characterised by systemic inflammation in absence of other revealed autoimmune and infectious reasons. The disease is characterised by the combination of fever, skin rash and other symptoms accompanied by development of potentially disabling or life-threatening complications. The clinical case presented illustrates the course as well the difficulties in diagnosis and treatment of Muckle-Wells syndrome.