Introduction. Chronic back pain syndrome, which significantly restricts a person’s daily activity, can cause the formation of depressive states and is a significantly more difficult task for treatment compared to acute pain.Aim. To evaluate the efficacy and safety of caudal epidural catheterization (CEC) and local therapy with anesthetics and glucocorticoids for chronic nonspecific discogenic and chronic radicular low back pain (LBP) in young and middle-aged patients.Materials and methods. 42 patients aged from 29 to 59 years, who in the neurosurgical department of the Vologda City Hospital No. 1 in 2017–2019 underwent an operation to install a caudal epidural catheter and prolonged injection therapy of local anesthetics and glucocorticosteroids for chronic nonspecific discogenic and chronic radicular LBP.Results. There were no purulent-septic complications, hematomas of the spinal canal. In the group of patients with radicular syndrome the average values of LBP according to VAS were as follows: before CEC – 78.5 mm; 5 days after CEC – 24.1 mm; 6 months after CEC – 19.6 mm; after 12 months – 17.9 mm. In the group of patients with nonspecific discogenic LBP the average pain estimates for VAS were as follows: before CEC – 78.1 mm; 5 days after CEC – 21.7 mm; 6 months after CEC – 20.9 mm; after 12 months – 23.4 mm.Сonclusion. Our experience indicates a high long-term efficacy and safety of treatment with caudal epidural catheterization and local prolonged therapy with anesthetics and glucocorticoids for chronic radicular and chronic nonspecific discogenic pain in the lower back in young and middle-aged patients selected on the basis of a special system of criteria.

It is proved that the costs incurred at different points in time should be "weighted" or discounted to reflect the fact that those that occur in the near future are more important than those that occur in the distant future. This raises the question: should the advantages or consequences of alternative procedures also be discounted? The main arguments against discounting benefits are, firstly, that health is not a commodity resource that can be invested to create future health flows, nor does it have a monetary value that can be expected to increase over time with income, and, secondly, there is no evidence to support the opinion that people value future health conditions less highly than current ones. It is necessary to recommend this approach as a standard practice in the development of new methods and technologies of treatment not only in traumatology and orthopedics, but also in other fields of medicine, first of all, these methods of clinical and economic assessment should be applied in dissertation works to demonstrate the survival of the dissertation product in the economic link of domestic healthcare, and, accordingly, its demand in general. The purpose of the work: to find out the prerequisites for the introduction into routine practice of planning the use of various medical benefits in the provision of trauma care on the basis of an economic and clinical approach.

Abstract. Relevance. Angiofibroma (angiomyofibroblastoma) is a rare soft tissue benign tumor. There are no descriptions of foot angiofibrom observations in the Russian specialized literature, which makes publications of this kind of materials relevant. The aim of the study was to analyze the experience of treatment of large locally advanced angiofibroma of the foot. Material and methods of research. A 17-year-old patient, according to ultrasound scanning and MRI, had a significant soft-tissue encapsulated tumor of the right foot. On 06.09.2018, a tumor removal operation was performed from three anatomical approaches - medial, posterior and plantolateral - with the maximum possible compliance with the principles of oncosurgery. Results and discussion. There were no complications, the wound healed by primary tension. Conclusion of histological examination of the extracted fragments of the tumor – angiofibroma of the foot. There is no data on tumor recurrence at the moment – more than three years after surgery. Conclusion. Summing up the data of various authors and our own experience, it can be argued that angiofibroma (angiomyofibroblastoma) is a benign slowly expansively growing tumor, more often localized in the area of the external genitalia mainly in women, but also affecting the foot. An exhaustive preoperative examination using ultrasound scanning and MRI, careful preoperative planning based on the principles of oncosurgery, taking into account the complex topographic and anatomical features of the foot and the full implementation of this plan in a specialized hospital allows you to avoid complications and achieve a long relapse-free period in the surgical treatment of large locally advanced angiofibroma of the foot.

Abstract. Among all neoplasms of the skeleton, enchondroma is 12%, among benign bone neoplasms - 10 - 27%. Frequent localization of enchondroma - short tubular bones of the hands and feet. It is possible to transform an enchondroma of the foot into a chondrosarcoma. Clinical guidelines with a sufficiently substantiated clear diagnostic and therapeutic tactics for enchondromas and chondrosarcomas of the first degree have not been developed to date. The aim of the study was to evaluate the effectiveness of intralesional resection with adjuvant chemical ablation in the treatment of enchondroma and chondrosarcoma of the first degree of the toe on a clinical example. Materials and Methods: A 64-year-old female patient with long-term symptoms on the side of the 5th toe of the right foot and a significant progression of these symptoms over the past three months underwent removal of the soft tissue component of the tumor of this finger, intralesional resection of its distal phalanx, and adjuvant chemical ablation. Healing by primary intention. According to the histological examination, the excised tissue corresponded to an enchondroma with areas of degeneration into grade I chondrosarcoma. Results: The patient was followed up for two years after the operation. There was no tumor recurrence. The patient did not experience pain, difficulty walking, considered herself practically healthy. Conclusion: the above clinical observation confirms that intralesional resection with adjuvant chemical ablation in the treatment of enchondroma and chondrosarcoma of the first degree of the foot allows to avoid relapses and ensure good function in the near and long term.