ON THE RESULTS OF A SYSTEMIC MULTIFACTOR ANALYSIS WITH MATHEMATICAL MODELING OF THE INDICATORS OF MEDICAL EXPERTISE OF YOUNG MALES WITH SURGICAL DISEASES IN THE REPUBLIC OF ARMENIA.

Medical aspects of the organization of replenishment of the Armed Forces with healthy and physically strong personnel are of great importance, and the deficit in the number of conscripts and their low-quality condition have become one of the main and important problems for the Armed Forces. The aim of the study was to improve the medical care of male conscripts aged 18-27 years by revealing the regularities and peculiarities of the expert assessment of surgical diseases among this category of young men on the basis of mathematical modeling. The object of the research was the study of the names of surgical profile articles, according to which these people were recognized as unfit or restricted fit for service, and the results of military medical expertise. Descriptive, social, and statistical methods were applied in the course of the study. The final stage was to conduct a systemic multifactor analysis in order to obtain a mathematical model of the process under study. The values of the influence coefficients of the mentioned indicators for 2013-2019 on the obtained mathematical models from the point of view of military-medical expertise of young men with surgical diseases both in the Republic of Armenia as a whole and in its separate regions are presented. Summarizing, it can be stated that from the point of view of military-medical expertise of young men with surgical diseases it is impossible to consider Yerevan city and the regions of RA as separate parts of the Republic of Armenia. Yerevan and the regions of the Republic of Armenia as separate parts, as they appear as a single whole according to the results of systemic multifactor analysis with mathematical modeling.

[Features of innate immunity indicators in patients with recurrent exudative otitis media]. / Osobennosti pokazatelei vrozhdennogo immuniteta u patsientov s retsidiviruyushchim ekssudativnym srednim otitom.

The article presents the features of the indicators of the innate immune response (TLR4, IL1B, TGFB, HBD1, and HBD2) in the exudate of the tympanic cavity in patients with recurrent exudative otitis media (EOM) with normal patency of the auditory tube and its dysfunction. The results of the study demonstrate changes in the indices of the innate immune response characteristic of the inflammatory process in patients with recurrent EOM against the background of dysfunction of the auditory tube in comparison with the group where it is absent. The data obtained can be used to clarify the pathogenesis of otitis media with dysfunction of the auditory tube, to develop new methods of diagnosis, prevention and therapy.

[Enucleation of pancreatic tumors: a multiple-center study]. / Enukleatsiya opukholei podzheludochnoi zhelezy (mnogotsentrovoe issledovanie).

OBJECTIVE: To evaluate the immediate results of enucleation of pancreatic neuroendocrine tumors (pNETs). MATERIAL AND METHODS: The results of enucleation of pancreatic neuroendocrine tumors (pNETs) were analyzed in 95 patients between 2016 and 2021. Functioning tumors (mean size 16.8 mm) were found in 70 patients, non-functioning (mean size 25 mm) - in 25 patients. Intraparenchymal tumors were found in 48 people, extraorganic lesion - in 47 patients. RESULTS: There were 262 patients with pNETs who underwent various surgeries between 2016 and 2021. Various resections were performed in 167 (63.8%) cases, enucleations - in 95 (36.2%) patients. Traditional surgical approach was used in 65 patients. Pancreatic fistula occurred in 21 patients (type B - 17, type C - 4), while arrosive bleeding occurred in 6 patients with unfavorable outcomes in 2 cases. Minimally invasive surgeries were performed in 30 patients. Eight patients with intraparenchymal tumors required conversion to open surgery. Type B pancreatic fistula occurred in 5 patients that led to arrosive bleeding in 2 cases (hemostasis was provided by endovascular method). Comparison of intraparenchymal and extraorgan tumors regarding the incidence of pancreatic fistula revealed odds ratio 5.26 (95% CI 1.5355; 18.0323, p=0.0041). Postoperative mortality was 2.1%. CONCLUSION: Enucleation is advisable for highly differentiated pancreatic neuroendocrine tumors up to 2 cm. Minimally invasive enucleation is indicated for extraorgan tumors. Intraparenchymal tumors significantly increase the risk of postoperative complications.

[External-internal sigmoid-vesical fistula following sigmoid diverticulum perforation into the patent urachus]. / Naruzhno-vnutrennii sigmovidno-mochepuzyrnyi svishch kak oslozhnenie perforatsii divertikula sigmovidnoi kishki v nezarashchennyi urakhus.

A patient with external-internal sigmoid-vesical fistula is presented. The authors describe surgical intervention (urachus excision, removal of infiltrate with resection of bladder bottom and fistula-related segment of sigmoid). Surgical challenges due to localization of fistula and appropriate literature data are discussed.

[Auditory tube dysfunction in children. Part 2]. / Disfunktsiya slukhovoi truby v detskom vozraste. Chast' 2.

The presented literature review examines in detail the methods for diagnosing the auditory tube, the history of development of studies of the Eustachian tube and the treatment of its dysfunction in children. The issue of dysfunction of the auditory tube as one of the causes of the formation of chronic hearing loss in childhood is increasingly being identified because of the rapid development of technologies and methods for examining patients. Aim is to study the multiple etiologic factors of the disease and the need for an integrated approach to the study of this condition.

[Auditory tube dysfunction in children (literature review, part 2)]. / Disfunktsiya slukhovoi truby v detskom vozraste (obzor literatury, chast' 2).

The presented literature review examines in detail the methods for diagnosing the auditory tube, the history of development of studies of the Eustachian tube and the treatment of its dysfunction in children. The issue of dysfunction of the auditory tube as one of the causes of the formation of chronic hearing loss in childhood is increasingly being identified because of the rapid development of technologies and methods for examining patients. Aim is to study the multiple etiologic factors of the disease and the need for an integrated approach to the study of this condition.

[Artificial temporal bone]. / Iskusstvennaya visochnaya kost'.

This article presents assembly technology and the main stages of dissection on artificial temporal bone. This sample of artificial temporal bone is a domestic product. The use of this material makes it possible to develop basic dissection skills, such as anthromastoidotomy, posterior tympanotomy, and facial nerve decompression. Artificial temporal bone can be used as a teaching tool for students, residents and postgraduate students who train otosurgical skills in the form of basic stages of dissection work on complex structures of the temporal bone.

[Exudative otitis media as a manifestation of spontaneous otoliquorrhea]. / Ekssudativnyi srednii otit kak proyavlenie spontannoi otolikvorei.

Spontaneous otoliquorrhea (SOL) often mimics the picture of exudative otitis media (EOM), which leads to delayed diagnosis of the underlying disease. PURPOSE OF STUDY: Is to evaluate causes, clinical features and diagnostic algorithm for patients with SOL. PATIENTS AND RESEARCH METHODS: From 2007 to 2018, 33 patients with SOL underwent examination and treatment in the Department of Ear Microsurgery of the Institute. At the preoperative stage, all patients underwent a complete examination, including examination of ENT organs, anthropometric, biochemical, audiological, ultrasound and radiological tests, which made it possible to make the correct diagnosis. RESULTS: SOL was more likely to occur in women over 50 who are obese (69.7%, stage II-III). The disease onset in 51.6% of patients was preceded by conditions accompanied by a short-term or prolonged increase in intracranial pressure. SOL was manifested by the clinical picture of EOM in 72.7% of cases, only in 45.5% of cases was accompanied by release from the ear and nose, was often intermittent and complicated by meningitis in 12.1% of patients. Difficulties in diagnosing the disease are caused by clinical manifestations of exudative or acute otitis media in the absence of a causative factor, which led to the verification of SOL from 1 to 4 years in 81.9% of patients who received long-term treatment for other ENT diseases. CONCLUSION: The master factors in the diagnosis of SOL are otomicroscopy and endoscopy of the nasopharynx, Halo test and screening determination of glucose level in the obtained discharge, as well as high-resolution CT of the temporal bone, which allows to localize the cerebrospinal fluid fistula and to determine the size of the defect.

[Auditory tube dysfunction in children (literature review, part 1)]. / Disfunktsiia slukhovoi truby v detskom vozraste (obzor literatury, chast' 1).

We present the review of the literature on the anatomical and physiological features of the structure of the auditory tube in children, epidemiology, etiology, and the pathogenesis of the formation of auditory tube dysfunction is presented. The first part of the article presents in more detail the structural and functional differences in the Eustachian tube in children, the classification and mechanism of the occurrence of the auditory tube dysfunction in pediatric practice.

[Variants of treatment of the head direction at the festulars of the labi-rint of inflammatory genesis]. / Varianty lecheniia golovokruzheniia pri fistulakh labirinta vospalitel'nogo geneza.

PURPOSE: To analyze the effectiveness of various methods of treating dizziness with fistulas of the labyrinth (FL) of inflammatory genesis. An analysis of the surgical treatment of 216 patients with chronic suppurative otitis media (CSOM) with cholesteatoma complicated by FL using a variety of FL treatment methods is presented. All patients underwent a debridement operation on the middle ear or revision of the postoperative cavity: in 48 patients with a matrix of cholesteatoma in situ on the fistula, in 109 patients with matrix removal followed by plastic repair or FL filling with various autotissues, in 59 patients with matrix conservation, plastic removal or filling FL and SLD labyrinth. In the last two groups, filling of a semicircular canal (SC) defect was performed in 33 patients, and mastoidoplasty - in 47. CONCLUSION: All used FL treatment techniques are effective in the treatment of peripheral vestibular disorders. Careful treatment of SC fistula after removal of all pathological conditions in the absence of active inflammation and the appointment of hormone therapy in the postoperative period are the main factors in preserving the functions of the labyrinth in any surgical technique. Filling of the lumen of the SC and mastoidoplasty in patients with CSOM with FL can eliminate peripheral dizziness.