Dear members of the Scientific Council, guests! The Soviet health care system, and in particular the state service for the protection of mothers and children, created for the first time in the world, is the most important social achievement of the October Revolution.

In the decree of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve public health" (1977), the attention of health workers was drawn to the need for extensive preventive medical examinations among which the leading place belongs to the clinical examination of the population, the transition to general medical examination of the population. Gradually, the transition to a general medical examination of the population is a long and difficult work associated with solving many problems of a different nature.

The decisions of the XXVI Congress of the CPSU and the decree of the Central Committee of the CPSU and the Council of Ministers of the USSR "On additional measures to improve the health of the population" set new tasks for Soviet health care, the most important of which are improving the quality of obstetric and gynecological care, prevention and early detection of diseases, and improving women's health and children and their dispensary observation.

In recent years, an increase in stillbirth and early neonatal mortality has been recorded in the city of Ivanovo. In order to identify the reserves and ways to improve the work of medical institutions for the prevention of perinatal pathology, a detailed analysis of each case of perinatal mortality in maternity hospitals in Ivanov was carried out. The study by an expert method made it possible to find out the reasons and conditions for the formation of perinatal pathology, to trace the organization of medical care at all stages of women's health protection. As a result of this analysis, violations were revealed not only in the work of individual medical institutions, but also in the process of mutual information exchange. Diagnostic and tactical errors of doctors of various medical institutions in the implementation of measures to protect the health of women and newborns were especially evident when transferring information from antenatal clinics to maternity hospitals, from general network polyclinics to antenatal clinics, from an ambulance station to maternity hospitals, etc. Elimination These organizational deficiencies could be one of the significant reserves for increasing the effectiveness of health care for women, fetuses and newborns. The search for forms and methods of work that would ensure close interaction of various medical institutions in the improvement of women and children led to the idea of ​​a functional integration of treatment and prevention institutions for obstetrics, children's and adult networks and to the creation on this basis of an experimental obstetric-therapeutic-pediatric complex (ATPC).

In the decisions of the XXV and XXVI congresses of the CPSU, in the decree of the party and the government "On measures to further improve public health", the need to improve the quality of medical and preventive care at the polyclinic level was noted. In connection with this, obstetricians-gynecologists of antenatal clinics should pay even more attention to the primary and secondary prevention of complications of pregnancy, childbirth and perinatal pathology. At the same time, early detection and rational treatment of extragenital diseases are of leading importance, among which cardiovascular lesions occupy the first place in the number of patients (0.5 - 7%) and as the cause of maternal mortality. Of these, acquired heart defects account for 90% and congenital - 10%.

As you know, in the system of obstetric and gynecological associations, a large place is given to the antenatal clinic. When monitoring pregnant women, special attention is currently paid to identifying risk groups [2]. The management of pregnant women with Rh sensitization in the TASSR is mainly carried out by the Rh center, created at the Republican Clinical Hospital. However, a significant and, most importantly, the initial part of the work falls on the antenatal clinic, in which, at the first visit to a pregnant woman, the blood group and Rh affiliation are determined, and then a monthly blood test of Rh-negative pregnant women is carried out for the presence of Rh antibodies. At the same time, it is important to correctly assess the course of each pregnancy, since immuno-conflict is possible for other antigens of the Rh - Hr system; edge addition, errors are not excluded when determining the Rh membership.

Women's consultation plays an important role in the system of maternal and child health care. Pathology leading to stillbirth and death of newborns occurs in 63% of cases in the antenatal period [3]. In this regard, the decrease in the incidence of newborns, the prevention and reduction of child and perinatal mortality depend on the increase in the effectiveness of antenatal protection of the fetus, at present, further improvement of the work of antenatal clinics deserves special attention, strengthening their connection with children's clinics, maternity hospitals and medical and preventive institutions serving women of childbearing age.

In recent years, a number of authors [1, 3 - 5] to substantiate the differentiated observation and health improvement of various dispensary groups use mathematical methods that make it possible to scientifically predict the course of the disease No. to influence its outcome. In the available literature, we did not find any reports on predicting septic complications in extraperitoneal caesarean section.

The protection of women's health in the USSR is not only a departmental function of the health authorities, it is ensured by a complex of socio-economic measures that have made it possible to reduce obstetric and perinatal pathology. In the field of maternal and child health care, specific preventive measures are being implemented following the decisions of the XXVI Congress of the CPSU and the decisions of the Central Committee. The CPSU and the Council of Ministers of the USSR 'to further improve the protection of public health.

The long-term consequences of the postponed late toxicosis of pregnancy, mainly of its severe forms, remain unfavorable. Renal dysfunction occupies a special place in the structure of residual pathology. There is no common view on the nature of residual complications: some authors consider them functional disorders, others - organic diseases (nephritis, secondary renal hypertension).

In recent years, there has been a tendency towards an increase in the frequency of functional diseases of the cardiovascular system among young people (20-30 years old). According to V.P. Nikitin (1961) and T.A. Sorokina (1979), the proportion of these diseases among patients who applied for therapeutic 1.4 - 6.7%, for cardiological - 38 - 56% [9, 10 ].

One of the most important tasks in the prevention of cardiovascular diseases is the identification of prehypertension and its initial forms [1]. The fight against arterial hypertension is now being carried out at the national level under the leadership of the All-Union Cardiological Scientific Center (VKNTs) of the USSR Academy of Medical Sciences. A promising epidemiological study of arterial hypertension has been carried out since 1977 on the basis of the program agreed with the VKNC at industrial enterprises in the city of Cheboksary [2–4].

Iron deficiency anemia is one of the most common diseases [2]. Its main cause is blood loss, increased iron consumption during periods of growth, lactation and pregnancy, as well as its nutritional deficiency [4]. Clinical experience and studies by various authors indicate the existence of protracted forms of anemia that are not amenable to conventional therapy with iron preparations. There are isolated reports on the importance of the endocrine system in the formation of resistance to iron preparations in anemia in children [5, 7]. However, the pathogenesis of refractory iron deficiency anemias in adults has not yet been established.

The results of clinical, X-ray, endoscopic studies and operational data were compared in 104 patients with pyloric stenosis of various etiology. Taking into account the literature data and our own observations, tables of the most important differential diagnostic signs of pyloric stenosis were compiled.

In 63 patients with acute pancreatitis, laparoscopic hypothermic lavage of the omental bursa was performed in complex treatment without prescribing antienzymes and cytostatics. In 42 patients in the control group, omental bursa lavage was not used, but antienzyme and cytostatic drugs were used. The terms of treatment in the main group compared with the control group were reduced by 1.6-2.5 times.

The results of 267 relaparotomies performed in 242 patients with various emergency conditions in the postoperative period (2.1% of the number of initially operated patients) were analyzed. The most frequent indications for reoperations were peritonitis, intestinal obstruction, and bleeding. Mortality after relaparotomies averaged 33.8% and depended on the type of complications and the timing of repeated surgeries. The value of reasonable and timely indications for relaparotomy was determined by comprehensive dynamic observation and the use of additional research methods.

The study involved 52 women with rheumatoid arthritis, aged 18 to 29, including 19 pregnant women. The comparison of the clinical features of the process activity with the content of cortisol in the blood, anti-lymphocytic antibodies and rheumatoid factor was carried out. In women with rheumatoid arthritis, a decrease in the content of cortisol with a tendency to an increase in the titer of anti-lymphocyte antibodies and a significant increase in these indicators during pregnancy was found. Low cortisol levels were observed in the exacerbation phase of the rheumatoid process. The data obtained indicate the effect of the concentration of cortisol in the blood and the titer of anti-lymphocyte antibodies on the pathogenesis of rheumatoid arthritis, as well as the need to develop a tactic for treating women with this pathology.

In 93 women in labor, a new method of non-drug pain relief of the first stage of labor was applied - percutaneous electroneurostimulation using the Eliman-101 apparatus. A complete and satisfactory effect of pain relief was achieved in 83 women in labor. Transcutaneous electroneurostimulation did not have a harmful effect on the mother and child.

Childbirth was carried out and studied in 87 women with severe forms of late toxicosis, who were treated during pregnancy according to the generally accepted scheme. In the 2nd stage of labor, the ganglion blocker pentamine was used, which made it possible to reduce the frequency of the operation of applying obstetric forceps by almost 4 times. The condition of mothers and their children after delivery is satisfactory.

In order to clarify the pathogenesis, classification and choice of rational therapy for genital infantilism, clinical and laboratory examination and treatment of 407 patients aged 18–35 years were carried out. 5 pathogenetic forms of genital infantilism have been established. The immediate and long-term results of treatment showed that the effectiveness of only hormonal therapy for genital infantilism is lower than the combined use of hormonal and non-hormonal agents.

The use of transillumination as an element of microsurgical technique on the fallopian tubes made it possible to identify the individual characteristics of the blood supply in 22 patients, to differentiate the smallest intraorgan vessels of the fallopian tubes, to perform their precise ligation under a microscope, and to distinguish the border between the adhesive structures and the serous membrane of the fallopian tubes. The proposed

The state of the osmoregulatory function of the kidneys was studied in patients with malignant neoplasms of the urinary bladder, as well as in those who had undergone cystectomy with various methods of urine diversion. The most pronounced disorders of the components of the osmoregulatory function of the kidneys were established after ureterocoloanastomosis: hypoosmia, decreased osmotic concentration of urine and osmolar clearance. After urethrocutaneostomy, hypoosmia occurs, a decrease in the osmotic concentration of urine. The greatest threat to the body in both cases is hypoosmia. After replacing the bladder with a segment of the intestine, the osmotic pressure of the plasma does not change. From a functional point of view, a rational way of urine diversion is the formation of an artificial bladder from the intestinal segment.

Renal artery occlusions occur in patients with severe aortic atherosclerosis, panarteritis, as well as as a result of previous operations and are severe vascular pathology. It is very difficult to restore renal blood circulation in such patients, since this often affects the areas of bifurcation or trifurcation of the renal arteries. Cases of multiple renal arteries are especially difficult. It is known that surgical treatment for occlusions consists in creating bypass anastomoses, in particular the anastomosis of the superior mesenteric artery with the renal artery using the great saphenous vein [5]. However, the formation of this anastomosis is feasible only when treating a single renal artery, while its multiplicity is observed in 15–38% of cases [1–3].

On the material of 60 pineal glands, taken from those who died from cancers of various localization, by morphological and histochemical methods, as well as using electron microscopy, it was shown that changes in the pineal glands are similar to involutive ones, however, they are more pronounced and are observed at a younger age. It was found that a decrease in the functional activity of the gland is manifested by a decrease in its mass and specific volume of the parenchyma, changes in the nuclear-nucleolar apparatus, accumulation of lipids, a decrease in the activity of lunoamine oxidase, the amount of RNA and secretory granules in the cytoplasm of pinealocytes. The depth of changes does not depend on the localization of the tumor, but is determined by the stage and duration of the disease.

In the extensive literature on the pathomorphology of diphtheria, we did not find information about the effect of diphtheria toxin on mitosis in the affected tissues. Only in one of the works devoted to the description of the cytotoxic effect of the toxin on tissue culture was the disappearance of mitotic figures in an intoxicated cell culture noted [5].

Over the past two decades, the interest of clinicians in the state of the cardiovascular system in patients with pulmonary tuberculosis has significantly increased, which is associated both with the use of advanced technology, which allows a more in-depth study of hemodynamics, and with the pathomorphosis of tuberculosis. If in the pre-antibacterial era cor pulmonale was detected in phthisiatric patients in 6.6% of cases [36], now it is diagnosed in chronic pulmonary tuberculosis in 40-50%, in cirrhotic form in 75-80% [26]. Pulmonary heart failure in such patients reduces performance and can cause disability [31]. The frequency of deaths in chronic pulmonary tuberculosis due to chronic pulmonary heart disease reaches 58.6% [17], and specific cardiac lesions in deaths from tuberculosis are only 2.5-4% [26]. The state of the cardiovascular system in pulmonary tuberculosis requires study in connection with the development of pulmonary surgery. Pathogenetic correction of hemodynamic changes in phthisiosurgical patients expands the limits of operability in common processes and in old age [2].

A real way to detect breast cancer is dispensary observation using a set of diagnostic measures. To improve the quality of such monitoring and its economic efficiency, it is necessary to distinguish among healthy women who have undergone a preventive examination, a group of increased risk and patients with precancerous diseases.

Female workers in the production of industrial rubber goods have direct skin contact with the glue, and also inhale the fumes from the glue base. The content of gasoline and other components of the glue base in the air of the industrial premises has significant fluctuations, but does not exceed the maximum permissible concentrations (gasoline concentration 250-300 mg / m3). The forced posture of female workers is also a harmful occupational factor. Vapors of solvents are removed from the workshops using general ventilation systems.

We tried to identify concomitant pathological conditions of the genitals that occur in internal endometriosis. A retrospective study of the case histories of 113 women who were operated on for uterine myoma, cervical canal cancer, and tumors of the uterine appendages, in whom internal endometriosis was histologically established in the removed macro-preparations, was carried out. In 94 of them, internal endometriosis was associated with uterine fibroids, in 18 - with cancer of the cervical canal, and in 1 - with papillary ovarian cancer. The patients were between 36 and 60 years old, more than half of them were between 40 and 50 years old.

Based on the feasibility of determining the activity of serum 5'-nucleotidase as an indicator of thromboplastinemia in myocardial infarction and traumatic brain injury, in this work, we studied the content of 5'-nucleotidase in placental tissues as a possible marker of thromboplastin entering the bloodstream during the development of thrombohemorrhagic syndrome during pregnancy and childbirth.

The restoration of the working capacity of patients after acute myocardial infarction is an urgent problem of modern cardiology. In 1979, on the basis of the Vasilievsky sanatorium, a department for the rehabilitation of patients with acute myocardial infarction was organized. Using the questionnaire method, we analyzed the effectiveness of rehabilitation treatment of patients based on long-term results for three years (1979-1981). 800 questionnaires were sent out. The aim of the study was to clarify the patient's condition, the duration of disability during the illness (hospital, sanatorium, polyclinic), current ability to work, as well as questions about whether the patient is a disabled person, whether the treatment continues under conditions of dispensary observation, what is the volume of his physical activity. This study involved 526 (65.7%) people who answered all the questions.

For the organization and forecasting of specialized medical care activities and the orientation of scientific research, knowledge of the trends in the spread of certain diseases among various population groups is of great importance.

The purpose of this work was to study the incidence of basophilism among schoolchildren and to elucidate its possible causes for the development of ways of prevention. To take into account the influence of geographical and social characteristics, it seemed expedient to examine schoolchildren in different points of the Soviet Union. We examined 6072 schoolchildren aged 10 to 16 years (2977 boys, 3095 girls) 2608 in Perm, 783 in the Perm region and 2681 in the Smolninsky district of Leningrad. At the same time, we paid attention to the physical and sexual development of the condition of the skin (the presence of stretch marks, pigmentation, dryness) and internal organs, the level of blood pressure, the size of the thyroid gland. When basophilism was found, these adolescents were surveyed in detail using a special questionnaire, and their development maps were studied.

Among patients who have had an acute myocardial infarction, complaints often arise that cannot be explained by a single heart pathology. So, middle-aged people suffer from myocardial infarction, who often have degenerative lesions of the cervical spine, complicating the course of heart disease.