Within epidemiologic monitoring of community-acquired pneumonia in the Amur region the analysis of the dynamics of the population morbidity, its dependence on the season, age structure of those who are ill and the etiology of the disease was done. In 2013 community-acquired pneumonia morbidity of the population of the Amur region was 574.1 in 100000 citizens, which was 11.7% lower than the values of the previous year (650.1), but it was higher than those values in Russian Federation (321.6) and Far-Eastern Federal District (347.9), respectively, by 78.5 and 65%. Among the patients 72.7±0.34% were adults. The intensive values of the morbidity were considerably higher among children and adolescents: 1010.9±126.2 in 100000 against 622.3±61.0 in 100000 among adults. During the year there are two periods of morbidity: from February till April and from September till December, and the peak of the morbidity is in March and October with annual average values 695.1±55.0 in 100000 of the total population in 2010-2013. There is a correlation of the season dynamics of community-acquired pneumonia morbidity with the level of morbidity with acute respiratory viral infection (r=0.89), which gives an opportunity to have preventive activities with a wide range of influence on epidemic process. Microbiologic monitoring indicates that on the territory of the Amur region there is the domination of pneumonia provoked by bacterial microflora (36.5%), including pneumococcus (32.9%); viral pneumonias are registered in 0.5% of patients, the part of unknown etiology community-acquired pneumonia is 63.0%. The specific gravity of patients with moderate clinical course is 90.9±0.2%, with severe course it is 5.6±0.6%, with mild degree of the diseases it is 3.5±0.6%. At the in-patient clinic 97.5±0.1% patients with community-acquired pneumonia are treated. The results of monitoring on the territory of the Amur region from 2010 till 2013 indicate the decrease of the death rate from 9.99 till 7.64 in 100000 of the total population, of the lethal outcome from 1.65% till 1.05% (on average it is 1.51±0.65%). But in comparison with the same data in Russian Federation these levels are high. The analysis of the data of epidemiologic monitoring of Russian Federal Service on Surveillance for Consumer rights protection and human well-being in the Amur region and the institutions of the state statistics revealed the features of pneumonia spread on the territory of the Amur region in order to develop and realize the complex of antiepidemic and preventive activities which have an aim to decrease the level of morbidity and death and to provide sanitary and epidemic welfare.

The complex of organizational-methodological activities, carried out by the institutions of Russian Federal Service on Surveillance for Consumer rights protection and human well-being in the Amur region, the Ministry of Health Care of the Amur region, scientific and education institutions dealing with the prevention of acute and chronic diseases of the respiratory system and sanitary-epidemiologic welfare of the population in the overflow zones in the river basin of the Amur river during the flood in 2013, has been presented in this paper. Within this activity «the program of actions and the plan of organizational-methodological and medical-preventive arrangements about medical aid for those who suffered from the flooding and the prevention of the respiratory pathology among the population of the Amur region in the overflow zones» has been prepared and realized. This program suggests the realization of operative and prospective arrangements including the provision of epidemiologic monitoring of acute and chronic respiratory diseases and the assessment of the influence of risk factors of the environment on their development in the zones of ecological ill-being; medical-social and sanitary-hygienic assessment of life support and the population habitat in the overflow zones of their territory; social-economic assessment of the damage and loss from acute and chronic respiratory diseases; the provision of availability and quality of advanced and specialized medical help to the pulmonologic patients; the prevention of acute and chronic respiratory diseases in overflow zones. «The program of organization of monitoring and clinical-epidemiologic assessment of efficacy and vaccination against pneumococcal disease among the Amur region population that suffered from flooding in 2013» has been prepared and realized. The aim of the program was to assess clinical and social-economic efficacy of vaccination against pneumococcal infection among the Amur region population that suffered flooding in 2013. In the process of realization of program activities there will be clinical-epidemiologic and social-economic assessment of efficacy of the use of the pneumococcal vaccine «Prevenar-13» for specific prevention of pneumococcal infections among the Amur region children who have risk factors of their development, conditioned by unfavorable influence of ecologic and social-economic conditions of life in the period of flooding of the territory. These arrangements are expected to improve the prevention of community-acquired pneumonias and will lead to the decrease of morbidity and the death of the population and will also let to optimize epidemiology on the territory of the Amur region.

In 221 apparently healthy volunteers (140 men and 81 women) with the natural breathing through the nose the capnography parameters were identified: the concentration of CO₂ in the end tidal portion of the exhaled air (FetCO₂); breathing frequency (BF); structure of the respiratory cycle as the ratio of expiration time to the total time of the respiratory cycle (Rco₂), respiratory rate variability, the coefficient of variation (CV) of Rco₂ (CVRco₂). It was found out that in young males of 20-29 years old FetCO₂ was higher than in older people (5.1±0.3 and 4.9±0.4%, respectively, p=0.002) and higher than that for women of the same age (FetCO₂ was 4.7±0.4% on average, p<0.001). There were no gender differences in the people after 30 years old. Reference intervals of the capnography parameters for men aged 20-29 years old (n=100) were calculated: FetCO₂ (4.3-5.8%); BF (7.7-19.8 breaths per minute); Rco₂ (0.52-0.76); CVRco₂ (5.3-12.8%). In men and women after 30 years old (n=95), the following reference values were revealed: FetCO₂ (4.1-5.8%); BF (8.5-21.2 breaths per minute); Rco₂ (0.5-0.8); CVRco₂ (5.3-12.9%). Conclusion: gender and age are important at identification of the breathing pattern and pulmonary gas exchange reference values.

In order to assess the impact of cigarette smoking on health-related quality of life in patients with asthma, 96 patients divided into three groups were examined: active smokers, ex-smokers and non-smokers. Quality of life was assessed using the SF-36 and AQLQ questionnaires, the state of the emotional sphere by means of the Hospital Anxiety and Depression Scale. The level of asthma control was determined by questionnaire ACT. Respiratory function was assessed by spirometry. The study found that smokers are characterized by significantly lower levels of general and specific quality of life associated with impaired patency of the distal airways. They are characterized by great severity of anxiety and depression, which are, according to the correlation analysis, one of the leading factors in reducing the quality of life of patients. Regression models were developed to reflect the relationship of the individual domains of general and specific quality of life with the levels of anxiety and depression. Quitting Smoking cessation contributes to a significant improvement in the quality of life and asthma control.

The complex examination of 304 patients (185 women and 119 men) was done to find the correlation between the airway hyperresponsiveness to cold and hyposmotic stimuli and the pulmonary ventilation function impairment at bronchial asthma (BA). The protocol of the study included the detailed interview, objective examination to identify the severity of the disease and the features of its course, the questioning to estimate the clinical signs of cold airway hyperresponsiveness (CAHR), the study of the ventilation function of lungs by forced expiration spirometry method, the bronchodilation test with salbutamol and bronchial challenge test with isocapnic cold air hyperventilation (CAHV) and distilled water inhalation. By the results of bronchial challenge tests the patients were divided into groups: 1^st group included the patients with airway hyperresponsiveness to both stimuli (cold and osmotic), the 2^nd group was with hyperresponsiveness only to the inhalation with distilled water, the 3d group only to CAHV, the 4^th group without any response to both triggers. The frequency of CAHR in the population of BA patients was higher than osmotic hyperresponsiveness. The patients with hyperresponsiveness to hyposmotic stimuli complained about the worsening of the state at the contact with both cold and humid air. In patients with isolated CAHR the symptoms to cold prevailed and exceeded the frequency of its occurrence in response to the excessive air humidity in 2.5 times (χ²=11.6; p<0.001). The significant part of the patients of the 1^st group had a more full-scale clinical picture, uncontrolled (57%) and partly controlled (30%) course of the disease. The original bronchi patency (FEV₁, %) significantly influenced the intensity of the response (ΔFEV₁, %) obtained under bronchial challenge test and had a linear character (r=0.39; р˂0.05) in the test with the distilled water. Under CAHV this dependence was reverse (r=-0.44; р˂0.05). Thus, in the total population of BA patients in more than 30% of cases there is extremely high sensitivity of bronchi to the combined effect of natural-climatic factors in the form of physical characteristic of the air (low temperature and high humidity), which worsens their control over the disease. It can be suggested that there is a similar mechanism of formation of cold induced and osmoinduced response of bronchi mediated by the receptors of TRP family.

Mucus hypersecretion is one of the causes of airway obstruction in patients with asthma. The unified airway model considers upper and lower airways as a single morphofunctional entity and predicts potentially similar responses of their mucosas to an asthma trigger. The objective of this study was an assessment of mucin secretion by nasal mucosa in asthmatics with varying degrees of disease severity in response to cold air breathing. Mucin secretion was estimated as changes in the content of total carbohydrates and mucins MUC5AC and MUC5B in the nasal lavage fluid before and after the cold air challenge in 16 patients with different degrees of asthma control and the disease severity, without accelerated decline in lung function. The majority of the subjects exhibited an increase in the carbohydrate level in the first minutes after the cold air challenge with a subsequent decrease to about the initial level during 30 min. The patients with moderate and uncontrolled asthma had higher content of mucin secretion measured as total carbohydrates as compared with the groups of mild and controlled disease. In opposite to the total carbohydrate changes, there was a reduction of MUC5AC and MUC5B in the lavage fluids, on average, after the exposure to cold air. High correlations between content of the two mucins in the samples before and after cold challenge suggest a possibility of a common site of their biosynthesis in nasal mucosa of asthmatics. The found correlations between the content of mucins in nasal lavage fluids and lower airway response to cold air makes nasal mucosa a promising model for studying mucin secretion in the development of bronchial hyperresponsiveness to cold air.

In the present work we investigated the cytochemical activity of myeloperoxidase (MPO) of neutrophils and eosinophils in induced sputum (IS) in 49 patients with bronchial asthma (BA) with cold bronchial hyperresponsiveness (cBHR), randomized into two groups. During 12 weeks in the 1^st group (23 patients) the mode of complex therapy of asthma with budesonide/formoterol (Symbikort^®Turbuhaler^®) at a dose of 320/9 mcg + montelukast 10 mg daily was used, in the 2nd group (26 patients) - budesonide/formoterol in the dose of 320/9mcg. The low MPO activity in the cytoplasm of neutrophils and eosinophils, intensive processes of degranulation and cells cytolysis, enzyme-containing granules exocytosis into the extracellular medium in patients of both groups in the introductory period were found. At the end of the study the intracellular MPO activity of eosinophilic and neutrophil leukocytes in IS of patients in both groups increased significantly, accompanied by a decrease in exocytosis of MPO against the reduction of degranulation and destruction of granulocytes. The reduction of MPO exocytosis was associated with the inhibition of destructive potential of granulocytes and accumulation of the enzyme in the bronchial tissue (intracellular) space that influence the inflammation degree. Reduced ejection of MPO from the leukocytes and the increase of its activity in the cytoplasm of leukocytes in IS by the end of the treatment period in both groups of patients were accompanied by improvement of clinical features used to estimate the antiinflammatory therapy effectiveness, and they were significantly higher in 1^st group compared with 2^nd one. Simultaneous increase of intracellular activity of the enzyme studied in patients of the 1^st group, which was significantly higher than in the 2^nd group, suggested a significant decrease in the level of bronchial inflammation. The data obtained allow to consider the MPO activity of neutrophil and eosinophil leukocytes not only as one of the biomarkers of chronic inflammation of the bronchi, but also as an additional criterion for evaluating the effectiveness of various modes of antiinflammatory therapy in asthmatics with cBHR. From the point of application of the criteria of enzyme cytochemical assessment of IS in clinical practice we have demonstrated the advantage of the use of complex pharmacotherapy (budesonide/formoterol + montelukast) to the regime of a fixed combination of budesonide/formoterol only in patients with cBHR.

The complex characteristic of morphofunctional changes in bronchi mucosa of bronchial asthma patients at different stages of the disease clinical course was conducted. Morphohistochemical and immunohistochemical methods were used to examine 75 patients with asthma of moderate and severe degree. It was found out that during the development of the disease there were severe morphofunctional changes in the bronchi mucosa. At moderate and severe forms of the disease a lot of lymphocytes and mast cells get into the mucosa; they send anti-inflammatory interleukins and biogenic active substances which penetrate into the epithelium through the basal membrane and form a great number of cells in the state of apoptosis. The epithelium disintegrates. At the severe disease there is the one-layer undifferentiated epithelium which is affected by NK-lymphocytes.

The study of immediate and long-term results and the evaluation of the effectiveness of stenting in cicatricial tracheal stenosis (CTS) were done. From 2008 to 2014, 102 patients with CTS at the age of 11 to 62 were treated. Patients with respiratory failure with decompensated and critical stenosis, after fiber-optic bronchoscopy, computer-aided tomography, CTS diagnosis went through laser photodestruction or diathermocoagulation of the constricted zone and bougienage with the expansion of the trachea lumen. The evaluation of the severity of the condition, taking into account the comorbidities was done, and the decision about the possibility of radical surgery - circular resection of the trachea was made. To patients with contraindications, tracheal stenting or insertion of different configurations endoprostheses was done in order to achieve long-term lumen dilatation in scar deformity and constriction. Analysis and comparison of long-term outcomes of patients with cicatricial stenosis of the trachea showed differences in the efficiency of the application of the tactics of a multimodal approach to the use of staged endosurgical technique, resection and reconstructive treatments. During the endosurgical stage in some patients adequate formation of the lumen of the trachea for breathing could be achieved, i.e. CST can be transferred from critical and decompensated stage in the form of compensation. In case of restenosis the performing of circular resection of the narrowed portion of the trachea is required. At the same time the conducted endosurgical treatment does not increase the extent of the zone of resection, and creates more favorable conditions for radical surgery. In patients with extensive tracheal stenosis due to the low efficiency of endosurgical treatment the radical surgery at the 1^st stage of the treatment should be performed. In the case of contraindications for reconstructive surgery the endosurgical stage composed of the combined treatment can be done in order to prepare for radical surgery, the treatment of comorbidities and rehabilitation of patients.

A useful model, the device for putting retrievable atraumatic sutures, has been developed. It was successfully tested in the experiments over 20 rabbits and while treating 34 patients with lung abscesses. The main difference of this model from all other known surgical suture devices is that it allows atraumatically and entirely to eliminate several surgical sutures from operated tissues at the estimated time. Any hydrophilic or hydrophobic but touch-string suture material can be used. The main idea of developing this device is to optimize atraumatic feature of the modified device for putting retrievable atraumatic sutures.

The aim of the research is prediction of the course of adaptive process and manifestation of respiratory pathology in foreign servicemen studying in military institutions of Russian Federation (RF). The article presents the details of the methodology of calculation of probability of risk groups formation by the development of respiratory pathology and in particular of out-patients pneumonia in 94 cadets of military institutions who arrived in RF from the Central Africa, South-East Asia and the countries of Middle East. In the calculation methodology the correlation coefficient including the region of the permanent residence of service men is used. The calculation method of respiratory pathology prediction is developed on the use of the data of the initial examination of cadets which includes anthropometric, clinical and laboratory indicators. Statistical model includes two calculation complexes. The first complex allows to make the integral estimation of the cardio-vascular system state, general adaptation responses, intensiveness of the common exchange, trophologic status in 2 and 6 months of foreign citizens being in the new conditions on the territory of RF. Integral coefficients for above-mentioned parameters are calculated on the basis of developed complexes of discriminant functions by the theory of Wald descriptive statistics. The second complex allows on the basis of the obtained data to make discriminate equations and distribute cadets into the risk groups according to the morbidity with respiratory pathology. Recommendations for foreign military specialists about the prevention of respiratory pathology development in the period of the initial adaptation during the first year of studying were made.

The results of studies aimed at solving an important problem of the organism protection against stress and environmentally unfavorable factors are presented. In experimental conditions the possibility to correct free radical lipid oxidation of rats’ organism membranes was studied with the introduction of the succinate containing drugs called Remaxol^® and Cytoflavin^® (Polysan, St. Petersburg). The animals were divided into 4 groups and each of them had 15 rats: intact animals which were held in standard conditions of vivarium; the control group in which rats were exposed to heat during forty-five minutes daily; the experimental group in which before the effects of heat animals had a daily intra-abdominal intake of the Remaxol in a dose of 50 mg/kg; the experimental group in which before the effects of heat animals had a daily intra-abdominal intake of Cytoflavin in a dose of 50 mg/kg. It was found out that the daily exposure to heat for 45 minutes contributes to the increase of lipid hydroperoxides level (by 32-36%), of diene conjugate (by 36-38%), and of malonic dialdehyde (by 51-59%) against the decrease of antioxidant system activity in the blood of intact animals. The introduction of the succinate containing drugs to rats in the conditions of heat exposure contributes to the significant decrease of lipid hydroperoxides by 10-19%, of diene conjugates by 13-23% and of malonic dialdehyde by 17-32% in the blood in comparison with the rats of the control group. While analyzing the effect of the succinate containing drugs on the activity of the components of antioxidant system it was shown that the level of ceruloplasmin in the blood of animals was significantly higher by 9-23%, of vitamin E by 14-26%, of catalase by 25-41% in comparison with the same parameters of the rats of the control group. So, the application of the succinate containing drugs called Remaxol and Cytoflavin in the conditions of long-term exposure of the organism of experimental animals to heat leads to the stabilization of the processes of peroxidation against the increase of antioxidant system activity.

Improving human adaptation capabilities to damaging effects of adverse environmental factors with the help of pharmacological agents is important for prophylaxis of different diseases and pathologies development. In experimental conditions the possibility to correct free radical lipid oxidation of rats’ organism membranes was studied with the oral introduction of the tincture of herb chickweed that contains the complex of natural antioxidants. The animals were divided into 5 groups and each of them had 10 rats: intact animals which were held in standard conditions of vivarium; the control group (1) in which rats were exposed to cold during three hours daily; the control group (2) in which rats were exposed to ultraviolet radiation during three minutes daily; the experimental group in which before cooling animals had a daily oral intake of the tincture in a dose of 5 ml/kg; the experimental group in which before ultraviolet radiation animals had a daily oral intake of the tincture in a dose of 5 ml/kg. It was found out that in the blood of experimental animals a daily cold exposure during three hours and a daily ultraviolet radiation during three minutes contributes to the increase of lipid hydroperoxides level (by 39-48%), of diene conjugate (by 49-57%), and of malonic dialdehyde (by 48-63%) against the decrease of antioxidant system activity in the blood of intact animals. The introduction of the tincture to rats in the conditions of oxidative stress contributes to the reliable decrease in the blood of lipid hydroperoxides by 13-15%, of diene conjugates by 20-27%, malonic dialdehyde by 19-24% in comparison with the rats of the control groups. While analyzing the effect of the tincture on the activity of the components of antioxidant system it was shown that the level of ceruloplasmin in the blood of animals was significantly higher by 25-27%, of vitamin E by 22-23%, of catalase by 40-53% in comparison with the same parameters of the rats of the control groups. So, the application of the mentioned tincture in the conditions of oxidative stress induced by the influence of cold and ultraviolet rays leads to the stabilization of the processes of peroxidation against the increase of antioxidant system activity.

The article is devoted to the research of atmospheric suspensions of Petropavlovsk-Kamchatsky by methods of laser granulometry, high resolution mass spectrometry (HR-ICP-MS) and scanning electronic microscopy. It is shown that the sea has the most important impact on the structure of suspensions - in all samples there are salt rock and sylvinite in significant amounts. Near a large rotary, nanoparticles (40-120 nanometers) which are the particles of soot and metals (Fe, W, Ti, Co, Ba) were found. Park zones are characterized by large particles (more than 100 microns) which in their composition are minerals, organic detrity and compounds of metals (Fe, Ti, Ba, W, Co, etc.). Around combined heat and power plants (CHHP-1 and CHPP-2), coal, black and metallic (Fe, Ba, W, Ti, Co, V) particles of 10-50 microns in size were found in samples. Thus, the level of air pollution in Petropavlovsk-Kamchatsky is not high; there are more natural components rather than technology-related ones in the air of the city. At the same time findings of a high proportion of metallic and soot nanoparticles in the samples taken from the rotary is of great concern. It is obvious that the more cars there are, more negatively they will influence the health of a person.

To assess the morphological structure of the bronchial mucosa and the endothelium of blood vessels, histological sections of the lungs of 10 dead fetuses infected with cytomegalovirus at the 17^th week of gestation were studied. Histological sections, paraffin-embedded, were stained by wan Gizon, alcian blue by Stidment and galloсianine. The study revealed that many of the cambial cells of the bronchial mucosa increase in size and have a large, dark-colored core. One part of epithelial cells increases in height and gets beyond the epithelial layer, acquiring the rounded shape at the apical pole, falling into the lumen of the bronchus. Vascular endothelial cells increase in size, round off and fall into the lumen of the vessel. The results indicate that intrauterine infection with cytomegalovirus leads to the disruption of histogenesis in fetal lung and is the cause of his death

Functional and morphological state of hepatobiliary system in 26 babies born at the 38-40^th weeks of gestation and liver morphology in 25 dead newborns with intrauterine parainfluenza of 1 and 3 types (the main group) were studied. The control group consisted of 30 healthy newborns and 25 dead children of perinatal age. The contents of the whole protein, albumin, total, direct and indirect bilirubin, cholesterol, high density lipoproteins, triglycerides as well as the activity of alanine aminotransferase, aspartate transaminase, glutamyltranspeptidase, lactic dehydrogenase, alkaline phosphatase were detected in the blood serum of all examined ones. The children of the main group in comparison with the control one did not have the change of enzymes activity. But they had the increase of the concentration of total bilirubin till 31.3±1.36 mkmole/l (in the control it was 25.4±1.67 mkmole/l, р<0.01), indirect bilirubin till 29.1±1.39 mkmole/l (in the control group it was 23.3±1.66 mkmole/l, р<0.05), as well as of high density lipoproteins till 0.66±0.04 mmole/l (in the control it was 0.53±0.03 mmole/l, р<0.05). This can be explained by the influence of hypoxemia and endotoxemia on hepatocytes. At pathomorphologic study of the liver, subcapsular haemorrhage, intensive dystrophic changes of hepatocytes, moderate development of loose conjunctive tissue and singular clump of lymphocytes in portal tracts were found.

The purpose of the research is to study the effectiveness of treatment of primary oligomenorrhoea in girls-teenagers to preserve the reproductive function. We examined 45 women aged 20.96±0.63 years with a history of primary oligomenorrhoea (main group): 30 received treatment and rehabilitation in adolescence (1^st subgroup), 15 have not received (2^nd subgroup). The control group consisted of 30 women of similar age with normal menstrual cycles. The level of Anti-Mullerian hormone (AMH), the basal level of follicle-stimulating hormone (FSH), luteinizing hormone, thyroid-stimulating hormone, prolactin, cortisol, dehydroepiandrosterone sulfate (DHEA-S), total testosterone, estradiol on 3-5^th day and progesterone on 22-24^th day of the menstrual cycle were studied in the blood serum with immune-enzyme method. The transvaginal ultrasound investigation was performed to determine ovarian volume and the number of antral follicles. In women of the main group the level of AMH was higher (p<0.01), but the level of FSH, estradiol and progesterone was lower if compared with the control group (p<0.01), which indicates the role of the normogonadotropic function of the pituitary and ovarian hypofunction. According to clinical data, the level of total testosterone and DHEA-S, hyperandrogenism was not revealed. AMH in 1 subgroup had no statistically significant differences with the control group, in the 2^nd subgroup it was higher - 8.04±1.77 ng/ml (p<0.01). AMH negatively correlated with FSH (r=-0.773; p<0.05), which does not exclude the role of AMH in reducing ovarian stimulation. Ovarian volume in 1^st subgroup was 13.91±2.96 ml, in 2^nd subgroup it was 20.42±4.48 (p<0.001) due to the number of antral follicles of 2-5 mm in diameter. They had a direct correlation with AMH (r=0.733; p<0.05). In 1^st subgroup 74.6% of women had ovulatory menstrual cycles; among those planning pregnancy 73.6% became pregnant. In 2^nd subgroup in 60% of women multifollicular ovaries structure and anovulatory menstrual cycles were visualized, which is a predictor of functional ovarian reserve decline and the risk of polycystic ovaries development.

The aim of the work was to visualize morphofunctional condition of bacteria and microscopic fungi (micromycetes) directly multicomponent gold mining waste. Print preparations were obtained from long-time placer gold-concentrating plant wastes containing reserves of heavy metals, including gold and man-made mercury. When studying them with electronic microscope it was found out that bacteria, mold fungi and yeasts live in the wastes, individual conidia (sporules) can also be revealed. Bacteria are transformed into various options of L-forms and form a biofilm from the association of elementary bodies and rod-shaped cells without adsorption of visible dense particles. Elementary bodies retain the ability to divide, rod-shaped cells - to the formation of filamentous structures. Circular or oval sculpture formations are on the surface of yeast cells. Dead fragments of mycelium and conidia of unidentified mold fungi whose surface is covered with a variety of dense particles were found in big quantities. All biotic factors along with the dust and heavy metals affect the health of workers of riverbed gold mining.

Multiple primary malignant tumors or polyneoplasia (PNP) as it is termed by many Russian scientists is not such a rare disease. A great number of Russian and foreign publications present a lot of information about it. Timely diagnosis of PNP allows to make successful decisions about single-step and maximally radical surgery or stereotactic ablative radiotherapy. Either palliative surgery or symptomatic treatment is done to patients with metastases. A lot of criteria for diagnosis of PNP have been developed and the differential diagnose with metastases is conducted. Verification of the diagnosis before the operation is achieved through the use of endobronchial, interbronchial, transthoracic, endovideosurgical, thoracoscopic biopsies, and if histological structure of tumors coincide, immunohistochemical studies are carried out to exclude metastases. The majority of doctors consider the radiologic method and first of all computer-aided tomography which allows to do the necessary post processing of images to be the most important in the differential diagnosis of PNP. This work presents one of three clinical observations of synchronic multifocal pulmonary multicentric PNP. The analytical survey of the literature published in recent years and reflecting the clinical characteristics of PNP and modern methods of diagnosis with the help of multislice computed tomography is presented. Besides, deferential-diagnostic algorithms which can be used both at the outpatient-polyclinic stage and within specialized centers have been shown.

The review of literature presents data on such a form of tuberculous process as tuberculoma. Brief historical background about study of tuberculoma is given. On the morphological level the processes of the formation of various types of tuberculoma are shown, a detailed morphological description and classification are given with the application of the personal material. The investigation of the cellular composition of all structural elements of tuberculoma allows to study the mechanisms of progression and healing and thus to make a qualitative and quantitative assessment of tuberculosis.

Influenza is the disease which occurs most often in the human life. It sometimes leads to many complications resulting in the lethal outcome. Immune and preventive medical care is not always effective as the virus can mutate. In 2009 the whole world suffered from the influenza caused by the virus A (H1N1sw). In winter of 2013-2014 the given type of the virus again reminded of itself. In the Amur region there were some cases of influenza caused by the virus A (H1N1sw) with severe complications. This showed the necessity to study the problem in detail. In the city clinical hospital of Blagoveshchensk 5 cases of influenza A (H1N1) were confirmed, 3 patients died because of the complications. The diagnose of influenza with the visceral involvement and pneumonia was confirmed during the autopsy. In one case there was bilateral virus pneumonia, in the two cases there was bilateral polysegmental virus-bacterial pneumonia. The case of the severe course of virus pneumonia caused by A (H1N1) with the lethal outcome is presented.

Postradiation pneumonitis is one of the most frequent complications after X-ray therapy. The frequency of occurrence varies from 15.4 till 61% of cases, and in 3.7% of patients the disease is the cause of the death. This is conditioned by the fact that pulmonary tissue has low tolerance to radiation which leads to the damage of pulmonary parenchyma. In modern literature there are not enough data and recommendations about the treatment of the patients with postradiation pneumonitis. The presented clinical case of late postradiation pneumonitis allowed to have accurate differential diagnostics. The disease imitated influenza-like syndrome, pneumonia, tuberculosis with pleuritis; these diagnoses were denied after a careful study. With the help of computer-aided tomography, thin structural changes of pulmonary parenchyma and of the bronchial tree were revealed. The course of systemic corticosteroids helped to stabilize the response of the damaged pulmonary tissue.