Today, quality of life assessment is an informative, reliable and economical method of studying health, both at the individual and group levels, and is an important integral indicator of the severity and dynamics of the pathological process in different nosologies. The most convenient way to measure the quality of life is to use questionnaires, which are divided into general, used for all diseases, and specialized, used for a particular nosological unit. Proper construction of quality of life questionnaires is extremely important for obtaining objective information, and in the case of using foreign language versions, it is necessary not only to make a correct translation, but also to follow the procedure of transcultural adaptation and validation. A number of general quality of life questionnaires (SF-36, Euro-Quality of Life 5D-5L) have Ukrainian versions and have been adapted and validated in accordance with international requirements. As for specialized phlebological questionnaires for quality of life assessment, after analyzing the available information resources, we did not find any description of the process of transcultural adaptation and validation of questionnaires for patients with varicose veins of the lower extremities in Ukrainian language, which became the basis of our work, during which, in accordance with the recommendations of the WHO and the Professional Society for Health Economics and Outcomes Research, the process of transcultural adaptation of the specialized phlebological questionnaire for quality of life assessment, Aberdeen Varicose Vein Questionnaire, was conducted. The validity of the adapted Ukrainian version of the questionnaire was determined using various methods: by analyzing the internal stability (Cronbach's coefficient), which according to the study is 0.76, which is comparable to the original version of the questionnaire and shows the internal consistency of the questionnaire. The next tool used to determine the validity of questionnaire questions is the "test-retest" method: conducting two tests with an interval of 14 days. According to the results of this method, a strong direct relationship with the overall Spearman coefficient = 0.965 (p <0.01) prevailed, which indicates a reliable repeatability of the test. The result of the Lawshe validation assessment aimed at the involvement of specialized experts and confirmed the importance of all 13 questions of the questionnaire for assessing the quality of life in patients with varicose veins of the lower extremities. Based on the study, the following conclusions were made: the Ukrainian language version of the AVVQ phlebological questionnaire, performed in accordance with international standards of language and cultural adaptation is an effective tool for assessing quality of life in patients with varicose veins of the lower extremities. The total quality of life assessment significantly complements the characteristics of the pathological process in patients with varicose veins of the lower extremities, its dynamics under the influence of various treatment measures, provides valuable information about the patient's response to the disease and treatment. The Ukrainian-language version of AVVQ can be used as a guide to record changes in the quality of life of people with varicose veins of the lower extremities and used in the future as an independent, no less important indicator than the usual clinical and sonographic criteria.

Objective — to improve the surgical treatment of patients with thyroid cancer with metastatic lesions of the neck lymph nodes by means of an individual approach to diagnostics, intraoperative imaging, and choice of optimal surgical technique. Materials and methods. The analysis involved results of examinations and treatment of 749 patients. The following was taken into account: complaints, thyroid and lymph nodes ultrasound, thyroid hormones level, results of general clinical examinations. Levels of parathyroid hormone, vitamin D, magnesium, total and ionic calcium were determined at the preoperative stage. In some cases, computer tomography results were included. A fine‑needle aspiration (FNA) biopsy was performed to all patients. Women prevailed: 607 from 749 (81.0%; 95% CI 78.0—83.8). The mean age of the patients was 51.3% (45.6—59.1) years. The causes of disease included: colloid nodular goiter 566 (75.6%; 95% CI 72.3—78.6), nodular (adenomatous) goiter with follicular neoplasm 72 (9.6%; 95% CI 7.6—12.0), papillary carcinoma 54 (7.2%; 95% CI 5.5—9.3), suspicious for papillary thyroid carcinoma (according to the cytology results) 17 (2.3%; 95% CI 1.3—3.6), medullary carcinoma 12 (1.6%; 95% CI 0.8—2.8), anaplastic thyroid cancer 6 (0.8%; 95% CI 0.3—1.7), other tumors 22 (2.9%; 95% CI 1.8—4.4). Statistical processing of the obtained results was carried out by using the standard program package «Statistica 6.0 for Windows» (StatSoft, USA). Results. Surgical interventions were performed in 89 of 749 (11.9%; 95% CI 9.7—14.4) patients with malignant tumors of the thyroid gland. The variety of surgical procedures performed on the thyroid gland: thyroidectomy performed in 81 of 89 patients (91%; 95% CI 83.1—96.0), hemithyroidectomy in 8 of 89 patients (9.0%; 95% CI 4.0—16.9). The reasons for the hemithyroidectomy: in 2 of 89 patients (2.2%; 95% CI 0.3—7.9) the diagnosis was not confirmed by express histological examination with suspicion for papillary thyroid carcinoma. In 6 other cases, single micro adenocarcinomas that ranged in size from 0.4 to 0.8 mm were found, without invasion into the tumor capsule, which was confirmed during a planned pathological examination. Lymphodisection of the central tissue, as an addition to thyroidectomy, was performed by us in 76 of 89 cases (85.4%; 95% CI 76.3—92.0). Metastatic lesions of the central tissue during pathological examination were found in 29 (32.6%; 95% CI 23.0—43.3) patients with papillary carcinoma, in 5 with medullary cancer (5.6%; 95% CI 1.8—12.6), in 6 cases with anaplastic thyroid cancer (6.7%; 95% CI 2.5—14.1). In 11 patients (12.4%; 95% CI 6.3—21.0) due to the metastatic spread to the platysma of the lateral triangle of the neck, its excision was performed. In 9 (10%; 95% CI 4.7—18.3) patients were performed thyroidectomy with sheath‑fascial excision (removal) of the neck tissue. The precession method was used to visualize the upper laryngeal nerve in order to prevent traumatization. The upper parathyroid glands served as the first anatomical landmark of the recurrent nerve, which were identified in 72 (80.9%; 95% CI 71.2—88.5) patients. Temporary unilateral vocal fold paresis was observed in 3 (3.4%; 95% CI 0.7—9.5) patients. Wound drainage was carried out separately by leaving micro‑drainage, for active aspiration, which was evacuated in 2 days. Соnclusions. One of the main prerequisites for the high‑quality performance surgery of thyroid gland is the precise nature of surgical manipulations with careful observance of tactical and technical requirements for a surgeon: timely identify and precisely mobilize. The choice of the final surgical intervention on lymphatic collectors in thyroid cancer is directly dependent on the preoperative and intraoperative pathological examination. However, given the substantial proportion of metastatic lesions of the central zone lymph nodes (level VI), the technical complexity of repeated operative interventions in this area, it is recommended to perform a preventive removal of the central fiber.

The aim of the work is to analyze the effectiveness and safety of thermal methods (endovenous laser coagulation (EVLC) and radiofrequency ablation (RFA)) for the treatment of varicose veins of the lower extremities and the impact on the quality of patient life. Materials and methods. An open, prospective study of the comparative efficacy of EVLC (124 patients) and RFA (112 patients) for the treatment of patients with varicose vein disease was conducted. Both groups were compared by age, sex, body mass index, clinical manifestations of the venous pathology severity and assessed the risk of potential complications. Determination of quality of life criteria was performed using the AVVQ questionnaire. Results. The average number of cycles performed for the RFA procedure was 13.8 (7; 14), and the energy was 60.1 (8; 80) J/cm for EVLC. The average value of the VAS during the first 14 days after treatment in the EVLC group was 2.2 (sd 1.9), RFA – 0.8 (sd 0.9), P > 0.05. The majority of patients who underwent EVLC used painkillers – 82 (66.1 %), RFA – 48 (42.9 %), P < 0.001. The results of duplex monitoring in the first 48 hours recorded 100 % occlusion of the treated segments of the great saphenous vein in both study groups; after 1 and 12 months – in 98.4 % (96.0 %) of patients after EVLC and in 100.0 % (98.2 %) – after RFA, respectively. One or more adverse events during the first 2 weeks after treatment were reported by 86 patients (69.4 %) in EVLC group, 52 (46.4 %) – in RFA group. The differences between EVLC and RFA were statistically significant (P < 0.001). VCSS and AVVQ values were significantly decreased one month after treatment, continuing the positive trend for up to 12 months. However, no significant difference between ablation methods was observed (P > 0.05). Conclusions. Endovenous laser coagulation and radiofrequency ablation are safe and effective thermal treatments for varicose veins of the lower extremities, which lead to a statistically significant improvement in the quality of patient life. Radiofrequency ablation has the advantage of a lower risk of developing general complications.

Резюме. Сучасні тенденції розвитку охорони здоров’я вимагають від медичних фахівців усіх спеціальностей використання мультидисциплінарного та висококомпетентнісного підходу. Саме тому вдосконалення освітнього процесу післядипломної підготовки фахівців є важливим елементом реформування галузі охорони здоров’я та медичної освіти. Ця робота присвячена аспектам удосконалення методики оцінювання практичних навичок, набутих в процесі навчання лікарями-інтернами за спеціальністю «Хірургія», та підвищення рівня післядипломної підготовки шляхом імплементації новітніх світових технологій навчання та оцінки знань інтернів. У роботі наведено основні принципи та досвід впровадження на кафедрі хірургії післядипломної освіти об’єктивного структурованого клінічного іспиту (ОСКІ) для перевірки знань і умінь лікарів-інтернів. Деталізовано методику проведення іспиту, визначено перелік станцій, які мають засвоїти інтерни-хірурги впродовж навчання. Інструментами оцінювання дій лікаря-інтерна були чек-листи та глобальна рейтингова шкала, за допомогою яких проводили комплексну оцінку знань. Проведення об’єктивного структурованого клінічного іспиту дозволило виявити переваги і недоліки такого формату оцінювання та сформувати перспективи подальшого впровадження та удосконалення. В процесі роботи відзначено, що використання методології проведення іспиту за системою ОСКІ дало новий досвід, як інтернам, так і викладачам кафедри, дозволило довести до автоматизму засвоєння практичних навичок в процесі навчання в інтернатурі. Об’єктивний структурований клінічний іспит є одним із дієвих інструментів підвищення якості освітнього процесу післядипломної підготовки фахівців за спеціальністю «Хірургія».

The aim of the work is to improve the radiofrequency ablation (RFA) protocol in order to minimize disease recurrence and to improve the life quality of patients with lower extremity varicose veins disease (LEVVD). Materials and methods. An open-label, prospective study of the effectiveness of a modified RFA protocol for the treatment of 210 consecutive patients with clinical grade C2-C6 of LEVVD was conducted. The effectiveness and safety of the procedure were evaluated by the anatomical success of vein obliteration, the dynamics of the severity of venous pathology according to the VCSS scale, quality of life indicators determined using the AVVQ-UA questionnaire, and development of postoperative complications. Results. Sonographic control was conducted in the first 48 hours, 7 days and 1 month after the RFA procedure and recorded 100 % occlusion of the great saphenous vein, obtaining the effect of “radiofrequency crossectomy” in the jugular area. After 6 months and 1 year of follow-up, 208 (99.1 %) patients experienced vein occlusion and 2 (0.9 %) patients had partial vein occlusion within 1 cm of the sapheno-femoral junction without pathological reflux. After 2 years the partial occlusion was diagnosed in 4 (1.9 %) patients. During the first 2 weeks after treatment, 64 (30.5 %) patients reported complications, which didn’t require treatment. However, in 2 (0.9 %) cases asymptomatic distal DVT and in 1 (0.5 %) EHIT II were diagnosed. Anticoagulant therapy was prescribed. Regression of clinical symptoms with a statistically significant difference in the VCSS score (p < 0.001) was observed 6 months after RFA. The application of the proposed RFA protocol made it possible to statistically significantly improve the quality of life indicators 1 month after treatment by 3.36 ± 0.81 (р < 0.001) with further positive dynamics. Conclusions. The application of the proposed RFA protocol in patients with LEVVD has a good safety profile, allows to minimize disease recurrences, performing the effect of “radiofrequency crossectomy”, and has a positive effect on the regression of clinical symptoms and quality of life indicators.