������������� �������� ������������� ���������������� ����������������� ����������

������������ ������������� ����������� ��������»��������� �������������� ����� ��� ���������

��� ������� ������ � �������������������� ������

����������� ����� II ������������������������������������������������������� ����� �

������������������»

������������ �������������. �������

�!"#$%&'(

�)*+,!"-',./ «�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#»

2012

��� 61(09)��� 5

!���������� � ������� — )+.. (+?!*3/@ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.-&/@ D%3231%% ���� �� �!"��� �%&)*3+.+ �/''%% *. 4. &., A3/?!''/3 "#$. %������

&'(")*+!,,-/�!$'0

1#2. 0���3�� — A3/3!(,/3 A/ &+2B&/@ 3+$/,! % 4!F*2&+3/*&G4 '.#)#4���� �� �!"��� �%&)*3+.+ �/''%%, *. 4. &. A3/?!''/3; +#". $����������� —A3/3!(,/3 A/ 2B!$&/@ 3+$/,! ���� �� �!"��� �%&)*3+.+ �/''%%, )+'"2F!&&G@ *!#-,!"- &+2(% ��, *. 4. &., A3/?!''/3; !#$. ��3���� — */5!&, (+?!*3G ,/A/13+?%B!'(/@+&+,/4%% % /A!3+,%.&/@ D%3231%% ���� �� �!"��� �%&)*3+.+ �/''%%, (. 4. &.

������� &+2B&GD 3+$/, II 4!F*2&+3/*&/@ &+2B&/-A3+(,%B!'(/@ (/&?!3!&5%% ',2-� 42 *!&,/. % 4/"/*GD 2B!&GD «�%3/1/.'(%! B,!&%#» / A/* 3!*. �L. �2(%B!.+. — �!"#$%&'( :

�)*N./ «�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#», 2012. — 243 '.

ISBN 978-5-94507-171-1

'$/3&%( &+2B&GD 3+$/, II 4!F*2&+3/*&/@ &+2B&/NA3+(,%B!'(/@ (/&?!3!&5%% ',2-*!&,/. % 4/"/*GD 2B!&GD «�%3/1/.'(%! B,!&%#» ./U"% 3!)2"-,+,G &+2B&GD %)G'(+&%@ ./$"+',% %',/3%B!'(/1/ &+'"!*%# �L�. �%3/1/.+, &/34+"-&/@ % A3%("+*&/@ +&+,/4%%, ("%-&%B!'(/@ D%3231%% % %&&/.+5%/&&GD /A!3+,%.&GD ,!D&/"/1%@.

4() 61(09);;) 5

© �/""!(,%. +.,/3/., 2012

ISBN 978-5-94507-171-1© �)*-./ «�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%-

5%&'(+# +(+*!4%#», 2012

3

�')*+= 1. +�0!&+%'�)!',"�1'(+',#+. �+&!>!$"

PIROGOV'S IDEAS AND MODERN ANGIOSURGERY

D.D. Alekhina (stud.)

Chelyabinsk state medical academyDepartment of topographic anatomy and operative surgery

Department of hospital surgery

Scientific adviser: D.I. Alekhin (ass., doctor of medicine),O.V. Peshikov (ass. prof., Ph.D. in medical sciences)

Fate has given us a scalpel in hand,not in order to handle it nicely and quickly,

but to rescue people from trouble.A.V. Veshnevsky

Nikolai Ivanovich Pirogov (1810–1881) was an outstanding Russian surgeon and anatomist, educa-tor, public figure and founder of field surgery and anatomical surgery experiment, a corresponding mem-ber of the St.Petersburg academy of Sciences (1846). He participated in the defense of Sevastopol (1854–55), the Franco-Prussian (1870–71) and the Russo-Turkish (1877–78) wars.

He was the first to perform surgical interventions under general anesthesia on the battlefield(1847), and developed his own technique of using plaster casts, invented various kinds of surgical opera-tions and the original surgical approaches, based on thorough knowledge of topographic anatomy. Hisatlas «Topographic anatomy of the human body» became famous all over the world. Pirogov receivedinvaluable experience working in the anatomical theatre. This work convinced him to become a surgeon.

Pirogov N.I. worked for five years in the surgical clinic of the university of Tartu (The universityof Yuryev), where he brilliantly defended his doctoral thesis (PhD), thus becoming Doctor of medicine,being only 26 years old.

Ligation of the abdominal aorta was the topic of Nikolai Pirogov’s dissertation. By this time liga-tion of the abdominal aorta was performed only once by Sir Astley Paston Cooper, an English surgeon,and it resulted in the fatal outcome. The conclusions of the thesis were equally important for both theoryand practice. Nikolai Pirogov was the first to study and describe the topography, that is, the location ofthe abdominal aorta in humans, blood circulation disturbances while bandaging, and blood circulationpathways in case of aorta obstruction as well as the causes of postoperative complications. Nikolai Piro-gov suggested transperitoneal and extraperitoneal ways of accessing abdominal aorta. When any damageto the peritoneum might cause death the second approach was particularly necessary. Astley Cooper, whoapplied a bandage to the area of aorta using transperitoneal approach, said that he had become acquaintedwith Pirogov’s dissertation, and he would have chosen the second method, if he had an opportunity toperform an operation once more. It is the highest recognition of Nikolai Pirogov’s merit. Current surgicalapproaches to the retroperitoneal organs and growths including the aorta and iliac arteries are based onNikolai Pirogov’s scientific studies. Today approaches developed by Nikolai Pirogov are still used.Surgeons fixed in their surgical procedure protocols that «access by Pirogov was made».

Nikolai Pirogov started his surgical practice with rhinoplasty: he had has made a new nose to thebarber without a nose. Then he recalled that it was the best nose of all made by him. After plastic surgeryhe started performing lots of inevitable amputations and removal of tumors.

«Surgical anatomy of arterial trunks and fascia», one of the most significant works of Nikolai Piro-gov, was completed in Dorpat. Surgical anatomy, a science which attracted Pirogov from his youth andwhich he developed and devoted his life to, constitutes the title of his work. Pirogov studied thoroughlythe structure of fascial sheaths, their pathways and their relation to the surrounding muscles, blood ves-sels, nerves, thus enabling modern vascular surgeons to access the areas accurately and safely.

According to Nikolai Pirogov, all discoveries were of great importance to him to present the bestsurgical (intervention) techniques, and primarily «to find the right arterial ligation technique». So the eraof a new science, created by Pirogov — surgical anatomy — begins.

Pirogov developed an access to the root of the tongue which enabled performing the safest isolationof the carotid arteries.

In the future, these fundamental studies of vascular system made by Pirogov created the basis forthe development of vascular surgery in Russia.

4

In 1841, Pirogov was invited to head surgery department in St. Petersburg academy of surgery andmedicine. He spent there over 10 years and opened first Russian surgery clinic.

The significance of Nikolai Ivanovich Pirogov’s contribution to the field of surgery is invaluable.He dedicated himself to surgery and made it a real science. He got acquainted physicians with evidence-based methods of surgery. His dissertation on the topic: «Is the ligation of abdominal aortic aneurysm inthe groin area easily feasible and safe intervention» was of great benefit.

Aneurysm is a localized dilatation (ballooning) in the wall of a blood vessel, resembling a tumor,with an opening for blood flow, caused by disease or injury of large blood vessels. When the size of ananeurysm increases, there is a significant risk of tremendous pressure to the other vessels, nerves, fusionof arteries with the veins, resulting in blood circulation disturbances in the body.

One way to treat an aneurysm is to isolate it from the circulatory system by feeding vessels ligationapplying a ligature, formed of waxed threads. When the swelling subsides, it shrinks like dried fruit on atree, creating an impassable for blood «plug».

Made by the famous English surgeon Astley Cooper ligation of abdominal aorta caused patient'sdeath. He died after the operation, as Cooper suggested, due to congestion of blood in the legs, followedby their paralysis. Russian doctor decided to find out the causes of patient's death in detail, suspecting thatlack of Astley Cooper’s knowledge of the circulatory system anatomy became the main reason for it.

To discover the multiple blood circulation pathways, consisting of many branches and connections,Pirogov made experiments on animals by applying ligations of vessels. After dissection the absence of cir-culation in the organs and muscles was easily observed. With the same purpose, he introduced a special dyein the vessels of corpses and checked the presence of the dye in any branch of the bypass after ligation. Byall means each experiment was performed several times on different size animals: cats, dogs, sheep.

Having obtained the experimental results Pirogov gave a concise definition of the abdominal aortain his thesis: «it is an elastic tube that carries blood directly from the heart to the lower limbs, organs ofthe abdominal cavity, the walls of the same cavity and the spinal cord». Hence, the new approach allowsus to refine description of anatomical structures.

The description of surgical interventions gives the detailed analysis of surgeon's maneuvers with ascalpel through tissue and vascular plexus. Besides Pirogov noted that the old method of abdominal aortaligation was dangerous because a surgeon could damage the peritoneum, causing peritonitis.

Pirogov thought over an interesting operation: mimicking the nature to increase compression of theabdominal aorta gradually with the purpose to stop blood circulation in the aneurysm. To gain such re-sults it was necessary to bandage the vessel with a twisted ligation, pushing the ends through the skin andadjusting the the degree of twisting from the outside, and then pull it out. He carried out surgery on sheep,dogs, cats, which lasted from three days to a week. These animals survive and move normally.

Research in the field of circulatory system anatomy was the basis for the development of vascularsurgery in the future.

Vascular surgery is one of their areas of surgery, aimed at treatment of blood or lymphatic vessels,using open classic, intravascular surgical approaches. Nowadays treatment of vessels meets modern stan-dards fully, and allows minimal invasive surgery. This principle is practiced not only in vascular surgery.

Vascular surgery became a separate surgery specialty due to not only clinical and experimentalachievements, but also significant technical progress.

Doppler examination of veins, magnetic resonance imaging (MRI) and angiography are main diag-nostic procedures in vascular surgery. They help detect vascular diseases at an early stage and start effec-tive treatment, sometimes before clinical manifestations of the vesicular changes can occur.

Organ-saving operations are performed nowadays by means of modern surgical techniques in vas-cular surgery. They are carried out both in the field of phlebology and treatment of arterial insufficiency.

The application of laser and radiofrequency is of particular interest. Surgeons use laser and radio-frequency to eliminate congenital or acquired defects in the venous structure with minimal damage andthe most successful results of blood flow restoration.

Laser technology eliminates venous insufficiency in case of varicose veins with minimal damagingeffect, avoiding venectomy.

It is known that insufficient arterial blood supply to the lower limbs leads to gangrene and subse-quent amputation of the limbs.

Surgical treatment of arterial diseases includes 1) a direct restoration of blood flow (bypass or pros-thetic surgery) — restoring arterial blood flow. 2) Indirect restoration of blood flow (called methods ofpalliative care) when angiogenesis in the area of vascular occlusion is stimulated or sympathetic effect onperipheral direction is eliminated.

5

To eliminate arterial insufficiency of the lower extremities the mechanisms of neoangiogenesis aresuggested: 1) surgical — laser channels in the muscle with the subsequent development of the microvas-culature, which compensates the lack of blood circulation are formed in the ischemic limb, and 2) thera-peutic — injection of stimulating neoangiogenesis agent to the ischemic tissue; and these agents can beboth synthetized or naturally produced ready vascular growth factors and those having an impact on theRNA to produce such growth factors.

Widespread vascular surgery implementation in the treatment and prevention of cerebrovasculardisease cannot be overestimated. Surgical intervention on the carotid arteries, the elimination of thrombo-sis of the carotid artery makes possible both restoration of the anatomical patency of the feeding brainartery and improvement of the patients’ quality of life.

Methods of impaired blood flow restoration as well as the blood flow closure in a particular areaare of great significance in vascular surgery. They are applied for the treatment of uterine leiomyomas,when a pharmaceutical agent (embolisate) is selectively injected in the uterine artery by means of angio-graphy procedure. It blocks the blood flow to the myoma node, thus, stops the blood flow in the vesselssupplying the tumor.

�A%'/( "%,!3+,23G:1. �+,!3%+"G 23-@ (XXVII) 4!F*2&+3/*&/@ (/&?!3!&5%% 3/''%@'(/1/ /$�!',.+ +&1%/"/1/.

% '/'2*%',GD D%3231/. «�+&(,N�!,!3$231». — 2012. — �. 23, 222.2. �/A/.'(%@, �. /'',+&/.%4 A3+.*2 / �. �/A/.'(%@. — �3/?%)*+,, 1950. — 229 '.3. �%&!"-&%(/., �L�. �,"+' +&+,/4%% B!"/.!(+: 2B. A/'. — 2-! %)*+&%!, ',!3!/,%A&/!. —

4 ,/4+D / �L�. �%&!"-&%(/., �L�. �%&!"-&%(/. — �.: �!*%5%&+, 1996. — 344 '.4. �24A!"%(, �. �,"+' /$�!@ D%3231%% / �. �24A!"%(N�+&?%"/.+. — 2010.5. �"!D%&, �L�. �2,% 2"2BU!&%# &!A/'3!*',.!&&GD 3!)2"-,+,/. 3!(/&',32(,%.&/@ D%323-

1%% �(',3+,/3+(+"-&GD +,!3/'("!3/,%B!'(%D A/3+F!&%@ '/&&GD +3,!3%@ / �L�. �"!D%& — �/./-'%$%3'(, 2000.

6. �"!D%&, �L�. �'A/"-)/.+&%! .G'/(/%&,!&'%.&/1/ "+)!3&/1/ %)"2B!&%# *"# "!B!&%# D3/-&%B!'(%D, *!(/4A!&'%3/.+&&GD 3+'',3/@',. .!&/)&/1/ % +3,!3%+"-&/1/ (3/.//$3+�!&%# (/&!B&/-',!@ / �L�. �"!D%& — �/./'%$%3'(, 2005.

THE SCIENTIFIC ACTIVITY OF N.I. PIROGOV IN OUR DAYS

V.O. Barysheva (stud.), O.E. Koryakova (stud.), Y.O. Oselkova (stud.)

Chelyabinsk state medical academyThe department of topographic anatomy and operative surgery

Scientific advisers: O.V. Peshikov (associate professor, Ph.D. in medical sciences),A.V. Chukichev (professor, M.D. in medical sciences)

I selflessly devoted my whole life to serving the truth and the Fatherland.N.I. Pirogov.

Pirogov Nikolay Ivanovich — a surgeon, a scientist, a teacherand a public figure, founder of experimental anatomic areas in sur-gery, corresponding member of St. Petersburg academy of sciences(1847), privy Counsellor (1859). Was born November 13, 1810, inthe family of the treasurer of the provision storehouse [9].Sincechildhood he has manifested craving for medicine. Famous professorof Moscow university E. Mukhin during trained with him individual-ly at the school. At age of 14 Nikolay, adding himself 2 years, en-tered Moscow university in the faculty of medicine. During his stu-dies Pirogov constantly moonlighted and finally got a job in the ana-tomical theatre. After graduating from the university, Pirogov con-tinued his studies at the Yuryev university in Dorpat (Tartu), whichat that time was the best in Russia. After working for five years inthe surgical clinic, Nicholay at 26 defended his doctoral dissertationand became a professor of surgery. Returning home, he took control

6

of clinic in Dorpat, where he wrote one of the most important works, «Surgical anatomy of arterial trunksand fascia» [5].

In 1841 Nikolay was invited to the St.-Petersburg medical-surgical academy as the head of the de-partment of surgery. Addition to teaching in St.-Petersburg, he was able to organize the first Russian hos-pital surgery clinic and directed it. In the course of training of military surgeons and the study of well-known surgical methods he has developed a completely new techniques and has fundamentally changedmany of the old methods. He created another new direction in medicine, hospital surgery. A great eventfor him was the highest approval of the project of the first Institute of anatomy. Among his achievements- a method that has preserved the name of «operation Pirogov», the opening of the discipline «topograph-ic anatomy», development of the atlas for the surgeons. October 16, 1846 marked the first test of etheranesthesia, quickly conquered the whole world. In 1847, Nikolai Ivanovich went to the Caucasus wherethe successful practice of the field surgery used his new developments. During the war in the Crimea heas the chief surgeon on the personal initiative operated on the wounded at the siege of Sevastopol, andhere he first applied the method of sorting of patients initiated the medical training of women-sisters ofmercy, began for the first time to apply the plaster bandages [11]. After the war Pirogov returned to St.-Petersburg, but falls in disgrace. After a few years he was dismissed from public office and sent to Odes-sa. While he was in exile, Pirogov organized in his estate in Vinnytsia free hospital, where he continueshis medical activities. There was written his well-known «the Diary of an old doctor» [5]. As a surgeonhe takes part in the Prusso-French and Russian-Turkish wars [12]. In 1881, N.I. Pirogov was the fifth ho-norary citizen of Moscow. In early 1881 Pirogov drew attention to the pain and irritation of the mucousmembrane of solid sky, 24 may 1881, N.V. Sklifosovsky established a cancer of the upper jaw. Died N.I.Pirogov on November 23, 1881. Pirogov body was embalmed his doctor D.I. Vyvodtsevym using theirnewly developed method, and was buried in a mausoleum in the village Vishnya [14]. The memory of agreat surgeon saved now. Every year on his birthday, to award prizes and medal in his name for hisachievements in the field of anatomy and surgery. In the house where he lived Pirogov, a museum of thehistory of medicine, in addition, his name is certain medical facilities and city streets [10].

But after Pirogov’s departure from life his contribution to the development of science is not fi-nished. He still contribute to this, because under the name of Pirogov there are a lot of different scientificevents in our days.

The first event, devoted to Pirogov was in 1885 1/*2. There were Pirogov’s congresses of doctors,that took place in the Russian empire at the end of XIX — beginning of XX century. These meetings tookplace under the patronage of organized in 1883 «the society of Russian doctors in memory of N.I. Piro-gov», that more known as Pirogov’s society. The society's Charter was approved on November 23, 1883.By this Charter the aim of the society is + scientific-practical development of medical, sanitary, andhousehold items connected by Russian doctors, scientists of medical societies and other medical organiza-tions. For this purpose the society made common and special the all-Russian congresses of doctors. Be-tween the Congresses worked the management Board that were elected by the congress that resulted inthe execution the decisions of congresses. From 1885 to 1913 there were organized 12 Pirogov’s con-gresses in Russia (8 in St.-Petersburg and 4 in Moscow). Also in 1910 took place a ceremonial meeting ofmedical societies of St.-Petersburg, devoted to 100th anniversary of the birth of N.I. Pirogov.

Members of the management board of the first fourcongresses are influential professors of St.-Petersburgthat also were the founders of the society (Sutugin, I. Be-renson, Eberman, Krassovskiy, Slavyanskiy, Sklifosovs-kii, etc.). Changes of the participants of the Pirogov’scongresses and direction of it work effected on the elec-tion of the Board on V�I — V�II congresses mostly fromliberal Moscow professors (Erisman, Bobrob, Korsakov,Gabrichevskiy were elected as the participants); and atlast in 1904 a big part of the Board was represented bynot the professors, +Zemstvo figures mostly from Mos-cow (Kurkin, Molkov, Zhbanov, Chertov, Shidlovskiy,Popov).

During V — IX congresses appears a lot of commissions that developed a significant activity. Onthe first place here is a permanent comission «The Commission for the dissemination of sanitary know-ledge around the people», that was found on the V congress in 1895, the Commission of the revision,amendment and addenda to the laws on the factory medicine 1866 and 1886 (between V and V� congres-

7

sions), on the harmonization of methods of sanitary-statistical research (1898), medical and food Commit-tee (1899), Commission for the study of tuberculosis (1900; on 1902 was changed in permanent commis-sion), for the study of malaria in Russia (1902; worked until 1907).

On the Pirogov’s congresses often discussed not only medical, but also political questions. So onMoscow congress in 1905 that was gathered with the aim of emergency measures against cholera, hedeputies managed to adopt and political resolution calling on doctors «to organize themselves for... astruggle... against the bureaucratic system to its complete elimination and for the convening of the consti-tuent assembly». From 1914 to 1919 took part 5 emergency Pirogov’s congresses that had a political type.

On November 22, 1917 the Pirogov’s congress made a resolution condemning the October revolu-tion, and the decree's commissars of the RSFSR, dated February 15, 1918 «On the abolition of the centralmedical-sanitary Council» the most of the luminary of Russian medicine who were on congress characte-rized like a document that «is extremely harmful implications on the work of the public medicine». In factthis was the beginning of the end of the Pirogov’s society. After the establishment on the territory of thecountry of the soviet power the bolsheviks did everything to destroy the opposition and in 1922 the socie-ty ceased to exist [4].

And for several tens of years the name of Pirogov in conferences was not mentioned. But in 1942in The Siberian state medical university in the city of Tomsk took place the first All-Russian final scien-tific student conference of N.I. Pirogov, that was organized by SSS of Pirogov. This conference has be-come a good tradition and since then is held annually in the spring. Since 1942, was held already 71 con-ference! Including, the 69-th all-Russian final scientific student's conference, dedicated to the 200 anni-versary of the birth of N.I. Pirogov, held on 11-13 may 2010 and All-Russian jubilee 70-th final scientificstudent conference, which was held from 16 to 18 may 2011.

This conference was the only «Pirogov» conferences in the world for several years, but it soonchanged. The first reading of Pirogov took place in Moscow, in December 1954. They were initiated bythe Presidium of the USSR academy of medical sciences and the All-union society of surgeons. Until1983 this event conducted annually in November and December, and then due to the complex politicaland social-economic situation in the country, they stopped [2].

With the strengthening of the authority and significance of the Pirogov readings the organization ofthese events was connected with ministry of health USSR and other medical societies, the administrationof educational and scientific institutions, local administrations of regions and cities, where they spentreading, except the academy of medical sciences and the national society of surgeons.

Pirogov readings conducted in a different organizational formats - from scientific meetings andscientific conferences to international scientific congresses. Due to the large number of participants, di-vided into sections, working on topics and areas of debate. In the framework of the Pirogov readings thecongresses doctors of different specialties.

Originally they were carried out on the basis of medical research and training institutions in the ci-ties, associated with the life and activities of Pirogov (Moscow, Vinnitsa, St. Petersburg, Tartu, Odessa).Internationally recognized venue for readings is Pirogov Vinnitsa (Ukraine) [3, 6].

At the initiative of the Deputy minister of health USSR I.G. Kochergin since December 1963 Piro-gov readings were held in cities across the country, scientific and medical centers, not connected with theactivity of Pirogov (Sverdlovsk, Minsk, Volgograd, Tbilisi, Voronezh, Ivanovo, Gorky, Perm, Makhach-kala) [2].

Pirogov readings resumed in 1995 in Vinnitsa (Ukraine) on the initiative of the academic Councilof Vinnitsa National medical university of Pirogov. Now Pirogov readings become international.

The value of the Pirogov readings increased to the level of animportant public event. On 12–13 October 1995 were «I Pirogovreadings», 3–4 June 2004 — «II Pirogov readings», October 5–6,2006 — «Third International Pirogov readings». After the «III Inter-national Pirogov readings» was adopted periodicity of Pirogov read-ings in the Vinnitsa — once in every four years.

In Vinnitsa at the National medical university of Pirogov,from 2 to 5 June 2010 passed a scientific 'ongress "IV InternationalPirogov readings». The congress was attended by scientists from 26countries in Europe, Asia and Africa.

There are also regional Pirogov readings (Orenburg, Mak-hachkala, etc.). Along with reading of doctors, are known Pirogovreadings of nurses [1] and Pirogov reading of students.

8

The tradition of the Pirogov congresses in Russia has been recreated in 1995. And 23 - 25.11.95 inMoscow was held the I (XVIII) All-Russian Pirogov congress of the doctors. Over the past years thisevent has been held for already eight times (1995, 1997, 1999, 2001, 2004, 2006, 2010). The last, eighthcongress was held on 27–28 October 2011.

Also the first regional student conference «Pirogov readings» took place in the Nizhny Novgorodstate medical academy in 1995. It was held annually and now consists of 17 events. The most recent con-ference was held on November 18, 2011.

The next year, on March 21, 1996 at RSMU of Pirogov (now RNIMU of Pirogov) in Moscow washeld the I All-Russian student conference «Pirogov readings». This conference is held annually everythird Thursday of March and since 2005 has the status of an international conference. The last XVI All-Russian (VII International) student conference «Pirogov readings» was held March 15, 2012.

In 2000 the Saratov state medical university named Razumovsky passed the first intrahigh student«Pirogov readings», which have been held annually since that time. And at this time there have been eheld 12 of them. For 7 years, every year consistently held 4–5 an annual events on N.I. Pirogov, but in2007, the national medical surgical center named after N.I. Pirogov held memorial international scientificPirogov readings on December 19. And in the same year, on May 17–18 in Penza was held the Russia-wide Pirogov readings. On May 15–16, 2008 in the walls of the Moscow state university of medicine andDentistry, an international Pirogov scientific-practical conference «Nailing and stenting», which broughttogether more than 400 experts from all around the world and has become not just a scientific event of theyear, but also a tribute to the great Russian surgeon - Nikolai Ivanovich Pirogov. Completed the openingof the Chairman of the program Committee, head of the Department of traumatology, orthopedics andmilitary-field surgery MGMSU, Honored worker of science of the Russian Federation, doctor of medicalsciences, Professor Zoray Vasily Ivanovich, noticed the invaluable contribution to the development of theworld surgery of Pirogov Nikolay Ivanovich: creation of the surgery as well as science, issue of the modelon the accuracy of anatomical atlases, development of plaster bandages [8].

On November 25, 2010 it marked 200 years from the birth of Nikolai Pirogov — the great son ofour country, the pride and glory of the Russian medicine and educational thought. Merits of the «miracledoctor» in the field of anatomy, surgery and military medicine. Jubilee of N.I. Pirogov was a powerfulincentive to rethink its enormous scientific, spiritual and literary heritage.

Two years ago in our country began preparations for the celebration of 200 anniversary of the birthof N.I. Pirogov. There were published by the Decree of the President of the Russian Federation «Aboutthe celebration of 200 anniversary of the birth of N.I. Pirogov» dated December 25, 2008. No. of 1850and the Order of the Government of the Russian Federation of June 24, 2009. �860-R on the preparationof the celebration of this memorable date.

On 18th of December 2009 started the Year of N.I. Pirogov in Russia. In the temple of Christ theSavior was a solemn joint session of scientific councils of the National Pirogov medical-surgical centerand the Russian state medical university, dedicated to the 150th anniversary of the publication of N.I. Pi-rogov «Illustrated topographic anatomy of the saw cut, produced in three dimensions through the frozenhuman body». The management and staff of National medical-surgical center them. N.I. Pirogov togetherwith the scientific research associates state medical university (Volgograd state medical academy, Rus-sian state medical university, Saratov state medical academy, Tomsk state medical academy) continue theglorious traditions of the great scientist, taking its name as the highest responsibility before the societyand history [7].

In the connection with this, in 2010 there was held a record number of events and that has reachedthirty around the world. Except performed annually, in 2010, were held many special conference.

The first of them in 2010, was the solemn opening ofthe year N.I. Pirogov passed on February 10 in RNI�Unamed after Pirogov.

On may 21 in the national medical-surgical centernamed after N.I. Pirogov was held a Moscow Banquetingday of national Pirogov centre, the programme consisted ofspeech, devoted to the anniversary, and the ceremony ofawarding diplomas of the centre and the order of the Piro-gov, and on November 23 in the same center took place theall-Russian scientific-practical conference «Nosocomial in-fection: state of the problem, the potential for prevention»,devoted to the anniversary of N.I. Pirogov.

9

On May 26 at Samara state medical university hosted an international scientific-practical confe-rence dedicated to the 200th anniversary of the birth of Nikolai Pirogov «healthy Lifestyles: Research andorthodox views».

On July 29 in the village of Gergebil held All-Russian scientific-practical conference of surgeons,orthopedists and traumatologists. In celebration of the 200th anniversary of outstanding Russian surgeonNikolai Pirogov, and in the village of Salta was VI outdoor scientific-practical conference dedicated tothe 200th anniversary of the birth of Nikolai Ivanovich Pirogov.

On September 22 in the state budget educational establishment of secondary professional educationof the medical college �30, was held in Moscow scientific student conference, dedicated to the 200 an-niversary of the birth of N.I. Pirogov — «N.I. Pirogov is the Russian scientist, a doctor, a teacher, publicfigure and an ardent patriot of the native land».

On September 24 in the city of Makhachkala was VIII scientifically-practical conference, devotedto the 200 anniversary of the birth of N.I. Pirogov.

On September, 30 in the Russian national research medical university named after N.I. Pirogov(RNRMU) took place «the All-Russian student conference, dedicated to the 200-anniversary of healthbeliefs and the historical role of N.I. Pirogov in the medical education».

On October, 8 in Moscow hospital for veterans of the wars � 3 took place regional Pirogov read-ings, devoted to the 200 anniversary of the birth of N.I. Pirogov «The role of the N.I. Pirogov in the de-velopment of nursing education in Russia» for nurses that were organized by Moscow regional publicorganization of nurses together with a medical college � 6 and the center of professional training andpost-graduate education.

On October 14–15 in Sevastopol (Ukraine) in CMC hospital named after academician Pirogov N.I.were international «Pirogov readings», organized by the Sevastopol naval clinical hospital of the blacksea fleet of the Russian Federation

On October 29 in Kolomna took place a regional anniversary scientific-practical conference, de-voted to the 200 anniversary of the birth of N.I. Pirogov with the support of the ministry of healthcare ofMoscow region, Moscow regional scientific-research clinical institute named after M.F. Vladimirskiy, theadministration of the urban district Kolomna, directorate of health Kolomna, municipal institution of pub-lic health «Kolomna central regional hospital».

On November 11-12 in the Russian academy of state service under the president of the RussianFederation in Moscow was the international jubilee scientific-practical conference «Modern injuries andtheir treatment», devoted to the 200 anniversary of the birth of N.I. Pirogov with the support of the minis-try of health and social development of the Russian Federation, the department of health of the city ofMoscow and the department of traumatology, orthopedics and military-field surgery MGMSU. Generalsponsor - OOO «medical company of new technologies».

On November 13 in Tula at the faculty of history and law of TSPU named after L.N. Tolstoy washeld a local institution conference, devoted to the 200 anniversary of the birth of N.I. Pirogov.

On November 18 in the Astrakhan state medical academy took place an international student'sscientific conference «Development of the ideas of N.I. Pirogov in the modern medicine».

On November 19 in the RNRMU named after N.I. Pirogov was the all-Russian student scientificconference «The heritage of N.I. Pirogov clinical and experimental surgery at the modern stage».

On November 24–28 in St.-Petersburg on the initiative of the ministry of health and social devel-opment of the Russian Federation, the government of St.-Petersburg, the committee for health protectionand the committee on science and higher school, Pirogov surgical society and the Saint-Petersburg stateuniversity was held the all-Russia forum «Pirogov’s surgical week», dedicated to 200 anniversary of thebirth of the outstanding Russian surgeon Nikolai Ivanovich Pirogov.

On November 25–27 in military medical academy of St. Petersburg hosted the international medi-cal conference «the Heritage of the Pirogov: past, present, future».

On November 25 in Yaroslavl state medical academy was held the interdisciplinary conference-competition of scientific-research works of students and young scientists «The heritage of N.I. Pirogov»,devoted to the 200 anniversary from the day of birth of the outstanding Russian physician and scientistN.I. Pirogov.

On December 1 in Kuala-Lumpur hosted a public meeting, devoted to the 200-anniversary of N.I.Pirogov in Malaysia.

On December 17 in the medical-psychological-social Institute of KSU named after N.F. Katanov inAbakan was held the Republican scientific-practical conference «Pirogov readings», devoted to the 200 anni-versary of the birth of the outstanding Russian surgeon, a naturalist and educator Nikolay Ivanovich Pirogov.

10

In 2011 activities on the occasion of celebration of 200 anniversary of the birth of Pirogov continued:On April 22 in Samara medical College named after Lyapina took place a regional student confe-

rence «The Heritage of Pirogov: past, present, future».On October 29 in Kolomna held the all-Russian Pirogov congress of doctors.On November 25 in Orenburg in MSCH named after Nicolay Pirogov held regional Pirogov read-

ings: «Actual questions of surgery».On February 25 in Chelyabinsk state medical academy was held an international scientific-practical

conference of students and young scientists, devoted to the 200 anniversary of the birth of N.I. Pirogov«Light for other, burning himself». In the work of the conference took part young scientists from Russia,Republic of Bashkortostan, Dagestan, Uzbekistan, Kyrgyzstan, Ukraine, Moldova and Belarus. The con-ference was attended by more than 500 students, young scientists and teachers and guests of the confe-rence. The participants of the conference — 43 persons, reports — 30, 5 sections — theoretical and 4clinical. At the conference was taken a decision to hold the conference every two years.

Thus all the events dedicated to the Pirogov in the USSR were held on 29 (24 of them in Moscowand by 1 in Leningrad, Minsk, Makhachkala, Volgograd and Vinnytsia), 182 in Russia(in Moscow- 54, inNizhny Novgorod — 17, in Saratov - 12, in Tomsk -71, in Chelyabinsk — 2, in Sevastopol - 8, in Saint-Petersburg - 4, 2 in Saratov and Kolomna and 1 in Yaroslavl, Penza, Abakan, Orenburg, Tambov, Tula,Astrakhan, Salta and Gerebile), 4 in Ukraine and 1 in Malaysia.

Among all of the conferences the status of the inter-departmental had 1, local institution 1, 3 urban,4 provincial, 20 regional, 116 Russian, 29-union, 28 international and 1 Republican

�A%'/( "%,!3+,23G:1. �3D%. 4+,!3%+"/. — ��� 4!*%5%&'(%D '!',!3, 1. �/'(.+.2. �&&%5-(%@ &+5�/&+"-&%@ 4!*%B&%@ 2&�.!3'%,!, �4. �L�. �%3/1/.+. — IV 4!F*2&+3/*&G!

�%3/1/.'(%! B,!&%#.3. �%3/1/.'(%! B,!&%# — ./A"/�!&%! %*!@ �L�. �%3/1/.+ / �!*%5%&'(+# 1+)!,+ «�*/3/.-!

�(3+%&G», �!*%5%&'(/! %)*+&%!, 4!*%5%&'(%! %)*+,!"-',.+ . �(3+%&!.4. http://bigmeden.ru5. http://kievsmi.net/lica/1514-nikolay-ivanovich-pirogov.html6. www.library.edu-ua.net/datas/upload/files/295340552.pdf7. http://nashavlast.ru/article_description/123/1699.html8. http://www.orthoexpo.ru/conf2010/about/arhiv/9. http://www.ozon.ru/context/detail/id/1537721/10. http://www.peoples.ru/medicine/surgery/pirogov/11. http://www.rasteniya-lecarstvennie.ru/3548-pirogov-nikolay-ivanovich-kratkaya-biografiya.html12. http://rufact.org14. http://ru.wikipedia.org

HUMANISTIC IDEAS IN PEDAGOGICAL HERITAGE OF N. PIROGOV

Yu.D. Bojchuk1 (prof., doctor of science in pedagogic), J#". Udovenko2 (research assistant),!.S. )ucheruk 1 (aspirant), I.N. Scherbak1 (faculty member),

!.G. Rovishena1 (post-graduate-student)1 Skovoroda National Pedagogical University, Ukraine

1 Department of human health and correctional education2 V.N. Karazin Kharkiv National University

2 Department of valeology

The famous Russian scientist Nikolai Pirogov (1810–1881), which belonged to the progressiveRussian intelligentsia of the nineteenth century, was not only a great doctor-surgeon and scientist-physician, but also an outstanding teacher educator and public figure of his time. In the history of theRussian science and culture, he entered as a classic of medicine and the Russian pedagogics.

The pedagogical activity of N. Pirogov — teacher and administrator — lasted almost 30 years.During the two-year management of the Odessa educational district Pirogov sought to elevate the

importance of the pedagogical councils in gymnasiums, inspired the directors and teachers of educationalinstitutions of the idea about the need for humane attitude toward children.

11

The appeal of N. Pirogov to humane approach in education of the younger generation were notrandom and arbitrary. The reality of the school of XIX century spurred on by this action. So, accordingto the «The situation on the primary public schools» (1864), in all schools of Ukraine training was con-ducted in the Russian language on the curriculum and programs, which acted on the territory of the allcountry. In 1863, the interior Minister P. Valuev stated that no special little Russian language has neverbeen, is not and can not be. School life was under the strict supervision of the authorities and the po-lice.

Humanistic orientation of educational points of N. Pirogov is characterized by the dynamics of theformation and development and is due to a number of socio-historical factors (strengthening of authorita-rianism autocracy in the field of culture, and especially the education and at the same time the democrati-zation of social relations in the country during the XIX c.), as well as the intensification of domestic andforeign pedagogical experience.

Pedagogical views N. Pirogov was the object of the study of a number of dissertations and mono-graphs such scientists — S. Ivanov, P. �+lyu, A. Krasnovsky, B. Pazinich, Sh. Sikharulidze,S. Starchenko, A. Khazanov, B. Khromov, etc.

Humanistic features of educational views N. Pirogov has been noted by many researchers herit-age of the scientist (N. Grigoriev, E. Dneprov, G. Zhurakovsky, N. Romaeva, V. Smirnov, V. Chorny,etc.).

The study of pedagogical heritage of N. Pirogov devoted special works and articles of the Ukrai-nian researchers A. Bachinsky, M. Dadenkov, N.Yevtuh, O. Kravchenko, G. Savenok, V. Chorny,G. Shevchenko and others.

In studies N. Romaeva, V. Chorny researched such humanistic features of educational views ofN. Pirogov, as respect for the personality of the child and the protection of his rights, the idea of humani-zation of education and training, attention to the personality of each student and the individualization ofprocess of training and education.

The basis of humanistic pedagogical conception of N. Pirogov were the following humanisticprinciples: the principle of respect for the personality of the child and the teacher as the main actors ofthe pedagogical process; the treatment of congenital qualities and abilities of the pupil; personalizationof the learning process; the treatment of age-specific peculiarities of the development of the organismand psyche of the child, respect for the right of human beings to carry out their professional and lifechoices.

Characteristic of N. Pirogov humanistic values orientation of pedagogical views allowed the scien-tist to drop any useful mercantile goals of education and to assert that the main purpose of upbringing andeducation is the formation of man as a person, harmonious development of all the abilities and talents ofchildren, creating conditions for comprehensive development and self-development of personality, instillin him a sense of dignity and approval of the self-respect of the formation of moral convictions, will,sense of civic responsibility and awareness of the need for self-education.

Characteristic for humanistic pedagogical views of Pirogov was the fact that he regarded the perso-nality of the teacher as the most important figure of the process of humane education, which should beestablished maximum opportunities for the manifestation of the personality, skills, self-realization, in-crease of professional qualities, the free creativity to each teacher (approval of the moral authority of ateacher's personality in the society and the school, and respect for the teacher and the teaching staff fromthe pupils, the sufficient level of evaluation of work of the teacher, etc.).

With humanistic position N. Pirogov was coming and to the problem of relations in the team ofteachers. He explained the important provisions of pedagogical ethics, which have not lost their relevancein the modern school: - teachers must appreciate their dignity and worry about its preservation in theircolleagues and students; - teachers and school leaders have to worry about the dignity of the (scientificand moral) mentor for children, as the humiliated and the insulted teacher may not be an example for theeducation of honor and human dignity in their pupils; - teachers, it is expedient to maintain the integrity,openness in relations with the disciples; teachers should strive for a relationship of trust, respect, coopera-tion in his band, the only way they will be able to achieve the educational goals, because the person of thestudent in school is still developing, it is largely the result of the joint activity.

So, the ideal for the N. Pirogov acted teacher - wise mentor, who leads the student on the path tothe knowledge of himself, of the human society and the world, capable of not only support and guide thestudent in the process of cognition, but also exacting to myself and to the disciple, capable to develop inthe student the moral resistance, strong moral beliefs, the will to self-education, self-education and self-knowledge, ability to fight with their vices. This is the content of the term «mentor», which N. Pirogov is

12

most often used when speaking about teachers. N. Pirogov is an example of such a humane and wise tu-tor. N. Pirogov recognized that, ideally, «and the director, and the inspector, and the mentor, and the of-ficers shall be persons of high morals, human vocation to his work, imbued with a truly christian love tothe disciples» and love should be the main principle of education. And in this, of course, manifested hu-manism of its educational views.

By N. Pirogov, as for the teacher is the most important, is that the main purpose of pedagogy - israising the «man», supply of all his human qualities and knowledge.

N. Pirogov, as a teacher drew attention to the development of the student dignity «of the people»;he laid the beginning of the healthy humanity, humanity in education. «Be a man — that's the thing thatshould lead education», — wrote N. Pirogov. He revolts against early, premature specialization of child-ren, which restricts their range of interest and inhibits their moral development.

One of the most important pedagogical ideas of N. Pirogov is the idea of humanity in education:the requirement of humane attitude toward children and formation of the humanity of the child; the re-quirement of respect for his dignity. The development of the child's best qualities of the human person,scientist-humanist one of the first among Russian teachers put forward as a center. The teacher calledon teachers, parents to bring children's human dignity, and not to allow their humiliation and thereby toprevent the development of negative qualities of character. Such approach to organization of trainingand education in the school fully complies with the humanitarian provisions of modern pedagogicalscience.

The basis of all educational process is the science, by the way and moral, in science is such an ac-tive moral and educational element, which never disappears, whatever its representatives. If only the men-tors were able to bring the scientific truth to an understanding of the student: it had not remain withouteffect, because in all truth, the abstract and sensuous, there is a share of educational force. Science takeshis own, and acting on the minds of the acts and to the mores.

N. Pirogov sharply acted against the estate school and early utilitarian and vocational training,which sought to introduce the tsarist government at the expense of reduction of the level of General edu-cation of the youth. He contrasted the official exchange rate of the formation of the idea of universal edu-cation, which should prepare the public life of a highly moral man with a broad intellectual interests. To-gether with the teacher emphasized that the school only then will become a truly humanistic and be ableto create a new man, when relationships in it will be built on the basis of mutual trust and respect betweenteachers, pupils and their parents.

Great importance attached to N. Pirogov self-education. It is through the moral self-improvementcan develop in oneself the qualities of a real man.

N. Pirogov also acted against the overload of students, which prevented the quality of learning. Thecurriculum by N. Pirogov was to include only material reflecting the latest achievements of the scienceand necessary for the education, upbringing and development of children of a certain age.

Of great importance, in its fiduciary activity, attached to the N. Pirogov strengthening of health ofstudents, caring, in particular, the introduction into the school curriculum of the teaching of the basicprinciples of occupational health doctors and about the psychological study of students, introduction ofreinforcing gymnastics. He proposed to look for laziness, indifference, carelessness, students not in theevil will of the children, and in the structure of their body, in the state of health of schoolboys. In this areaas well as in the field of higher education, the requirements and wishes of N. Pirogov were unacceptableto the official pedagogy of tsarist Russia and only in Soviet times they are held in a life with changes andimprovements in accordance with the development of the science of education.

N. Pirogov was one of the first Russian teachers-thinkers, who pointed to the inextricable link be-tween training and education, the necessity of their association in the framework of a holistic educationalprocess.

So, of his fruitful scientific activity, pedagogical works, in which expressed a lot of valuable ideas,N. Pirogov wrote a glorious page in the history of pedagogical science, and his idea of humane educationis still relevant in modern pedagogical theory and practice.

13

THE REFLECTION OF THE LEGACY OF PIROGOV N.I. IN THE ACTIVITYOF SURGEONS OF THE CHELYABINSK MEDICAL ACADEMY

A.A. Chikisheva (stud.)Chelyabinsk state medical academy

The department of public health and health care

Scientific adviser: I.S. Tarasova (lecturer), �.Y. Markina (ass.).

One of the most outstanding persons in the Russian medical science is the personality of the out-standing surgeon Nikolay Ivanovich Pirogov. His practical and scientific achievements in the sphere ofmedicine represent the honorary page of the Russian science. This great doctor and scientist, pedagogueand social activist devoted all his life to the selfless service to the national science and his nation.

Pirogov died on November, 23th (December, 5th) 1881, but the reminiscences of the great surgeonremain. Annually the grant and the prize named after him for achievements in the sphere of anatomy andsurgery are awarded on the date of his birthday. There is the museum of the history of the medical sciencein the house where Nikolay Pirogov lived; besides, several medical establishments and streets of somecities are named after him.

It is wonderful that the historic legacy of Nikolay Ivanovich Pirogov had an impact on the greatsurgeons of the Chelyabinsk medical academy too; it is clear that for the successful progress of the prac-tical and scientific activity it is necessary to venerate existing traditions which gather pace from genera-tion to generation and also one should take earlier invented technologies into account and on the basis ofthem create new, technologically modern technologies. If one speaks only about surgery in the SouthernUrals, one cannot forget about the topic of the surgical endocrinology which becomes more and more im-portant every decade.

The first steps in the sphere of the surgical treatment of diseases of the thyroid gland in Chelya-binsk and Chelyabinsk region were made in the middle of the previous century when diseases of the thy-roid gland started to be treated as endemic pathology.

At that time the operative therapy of diseases of the thyroid gland was being developed and carriedout on the basis of the department of the hospital surgery of the Chelyabinsk medical institute which wasbeing managed by the highly intelligent and talented theorist and surgeon, professor Georgy DmitrievichObraztsov, and his assistants Ivan Grogorievich Skvortsov and Tamara Moiseevna Lurie possessed mas-terful surgical skills. The mastership of Skvortsov I.G. was widely known not only in Chelyabinsk, butalso in the whole country.

Obraztsov Georgy Dmitrievich was born in 1898. In 1924 he graduated from the Military Medicalacademy. In 1936 he achieved his Master degree and in 1941 - his PhD degree on the topic of treatmentof the wound shock. In 1946 the professor Obraztsov G.D. was elected as the head of the department ofthe faculty surgery of the Krasnoyarsk medical institute, and in 1947 as a deputy manager of the institutein the sphere of scientific and academic work.

In 1950 he became the director and simultaneously the head of the department of the hospital sur-gery of the Chelyabinsk medical institute. Thanks to professor Obraztsov G.D. the following scientificand practical directions were being developed: the surgical endocrinology, the surgery of lungs and eso-phagus, the neurosurgery, the surgery of the gastrointestinal tract, occlusive mitral commissurotomy.

The name of Vladimir Antonovich Krizhanovsky fully deserves to be written down with red lettersinto the history of medical science not only of the Chelyabinsk and of the whole Urals, but also farbeyond their borders. The great operating surgeon, talented scientist, Doctor of medicine, professor, thehead of one of leading departments of the medical institute.

He was the first person in the Chelyabinsk region to give the intubation narcosis.Scientific results of Vladimir Antonovich in the sphere of surgery of diseases of the thyroid gland,

including malignant tumours, were pioneer in 70-80s not only in the Southern Urals, but also in the wholecountry. Unfortunately, this outstanding scientist and, as he was described by his contemporaries as: «Theman of a huge importance and professional tact», died very early.

«Vladimir Antonovich was an excellent clinician in keeping with the best traditions of our nationalmedical science. He was always saying that while determining a diagnosis, no matter how clear it is, oneshould doubt anyway and consider all pros and cons again and again. The ability to deny the diagnosiswhich you determined, to reconsider the data of a patient once again must be the norm and the diagnosiswhich was determined earlier should not weigh upon a doctor, without paying attention to authorities»,Valery Alekseevich Privalov was sincerely telling about Vladimir Antonovich Krizhanovsky. «The

14

speeches of Vladimir Antonovich in panel sessions of the surgical community and at conferences wereimpressive and memorable. As a rule, they were distinguished by their originality of thoughts and theirdistinct representation», confides her memories Fedchenko Larisa Georgievna, a surgeon, Candidate ofmedicine, an assistant of the department of the general surgery of the Chelyabinsk state medical academy.

The matter which was initiated by Vladimir Antonovich was held on by his followers. The most ta-lented of them, Valery Alekseevich Privalov, who became the Doctor of medicine, a professor, the Ho-noured Scientist of the Russian Federation, has headed the department and, keeping the traditions of histeacher, confidently leads the staff along the way of improving technologies of the operative treatment ofdiseases of not only the thyroid gland, but also other glands of internal secretion.

Valery Alekseevich Privalov was born in Zlatoust, Chelyabinsk region.After graduating from the Chelybinsk medical institute in 1964, he devoted all his life to the sur-

gery. From 1964 till 1967 he was working as an operating surgeon of the central regional hospital of thetown Sarapula in Udmurt Autonomous Soviet Socialist Republic, from 1967 till 1970 — as a hospitalphysician of the surgical department of the medical unit of the mechanical engineering plant in Zlatoust,Chelyabinsk region. Since 1970 Valery Alekseevich has been living and carrying out his practical medi-cine in Chelyabinsk.

After accomplishing his postgraduate studies at the department of the general surgery of the Chelya-binsk state medical institute in 1976, he achieved his Master degree on the topic «Peculiarities of the clini-copathologic detection and results of the operative treatment of some diseases of the thyroid gland com-bined with autoimmune processes». From 1975 till 1980 he was an assistant at the same department. From1980 till 1988 — an assistant professor, since 1988 — the head of the department of the general surgery.

In 1989 Valery Alekseevich passed his Doctor degree on the topic «The surgical approach to dis-eases of the thyroid gland depending on the evidence of the antithyroid autoimmune aggression».

Professor Privalov V.A. is a real professional, namely, an excellent surgeon, a famous scientist anda highly qualified and fair teacher.

Valery Alekseevich devoted a lot of years to his clinical practice, he is a chartered surgeon, he hascarried out dozens of surgeries. Privalov V.A. is one of the most famous endocrine and general surgeonsin the region and in the country. He has been the head of the large multi-field surgical clinic for manyyears, nowadays he is going on his active surgical activity using the most modern medical technologies.

Privalov V.A. has made a great contribution to the development of the specialized surgical endo-crinologic service in the Southern Urals. He is the initiator and the head of the regional Centre of the sur-gical endocrinology, a member of the academic board of the topical scientific centre of the Ministry ofHealth of the Russian Federation in the sphere of the surgical endocrinology, a member of the Bureau ofthe academic Board of the Russian academy of Medical Sciences and the Ministry of Health and SocialDevelopment of the Russian Federation in the sphere of endocrinology. One cannot but note his vast con-tacts with the medical community not only in our country, but also abroad. The Second All-Russian Con-ference of Endocrinologists (1991) and the Ninth All-Russian Symposium in the Sphere of the SurgicalEndocrinology (2000) were held in Chelyabinsk under his initiative guidance.

Scientific interests of professor Privalov V.A. are very different. He is an editor of the monograph«The Clinical Transfusiology», textbooks for students on the topic «Nursing process of surgical patients»have been published under his guidance.

For his great services and productive practical medicine professor Privalov has been awarded thebadge of honour «The Outstanding Person in the Sphere of Health Care».

His prominent works are: «Aseptics and Antiseptics», collections of scientific papers «Topical Is-sues of Malignant Tumours and Autoimmune Processes of the Thyroid Gland», «Topical Issues of theClinical medicine», «Papers of the IX Russian Symposium in the Sphere of the Surgical Endocrinology»,the chapter «Mini-Invasive Approaches to Adrenals» in the monograph «Surgical Approaches to Adren-als», the chapter «The Surgical Endocrinology» in the monograph «The Surgical Propedeutics», the mo-nograph «Controlled Abacterial Environment in Complex Treatment of Purulent Surgical Infection».Within the framework of international cooperation he and his department participate in the programme«Deviations Connected with Man-Caused Beaming in the Childhood as a Result of the Activity of theManufacturing Group "Mayak"» in association with the Institute of Biophysics (Russia), the NationalCancer Institute (USA), the Karolinska Institute (Sweden), the Research Fund of Radiation Effects «Hiro-shima and Nagasaki» (Japan).

Recent achievements of Valery Alekseevich have a direct connection with developing attenuatedminimally invasive operating technologies, including those which use high-intensity lasers. The devel-oped method of laser-based intratissual thermotherapy of palpable abnormalities of the thyroid gland has

15

been included into the inventory of the most important scientific results of Russia and has been noted inthe report of the presidium of the Russian academy of Medical Sciences and the Bureau of the academicBoard of the Ministry of Health of the Russian Federation in 2001. Professor Privalov V.A. was rightlyawarded the title «Man of the Year — 2002» (Chelyabinsk) in the category «Scientific Work».

With the support of the Governor of the Chelyabinsk region, he has become the initiator and thehead of the Interacademic Medical-Physical Centre. Joint work with physicists and biochemists has led tounequivocal encouraging results in the sphere of laser-based thermotherapy and photochemotherapy ofmalignant tumours which is rather important nowadays.

Valery Alekseevich successfully combines his surgical activity, scientific and pedagogical practicewith social activity. He is a member of the board of the All-Russian Association of Endocrinologists, he isthe president of the association of surgeons of the Chelyabinsk region, vice-president of the regional associ-ation of endocrinologists. He is a member of the academic Board of the South-Ural Scientific Centre of theRussian academy of Medical Sciences, a member of the Dissertation Council of the Chelyabinsk State Med-ical academy, a full member of the association of surgeons named after Pirogov P.I., a representative of theattestation commission in the sphere of surgery. For many years Privalov V.A. has been a member of thePresidium of the regional committee of the trade union of medical specialists in the Chelyabinsk region, heis the chairman of the state examination commission, a member of the attestation and accreditation commis-sion of the Ministry of Health of the Russian Federation and an expert of the Ministry of Health of the Rus-sian Federation in the sphere of attestation of graduates of medical higher education institutions.

Valery Alekseevich is a very miscellaneous man. Except surgery he was interested in water activi-ties. Moreover, he is interested in travelling, discovering new countries, studying the environment.

The unresting energy and the executive talent of Valery Alekseevich, his highest professionalism asa manager, a scientist and a pedagogue, his adherence to his principles and perfectionism in relation tohimself and to other people, simplicity and sincerity in communication have attained deepest respect ofhis colleagues to him.

Valery Alekseevich is loved and respected for his unequivocal contribution to the development ofsurgery, his executive talent, professionalism both as a scientist and an excellent teacher, for his strict butjust and kind relation to students.

Modern developments, equipment and usage of new progressive technologies not only lead to posi-tive results in struggling with diseases but also promote education and training of new scientific manpow-er. At present the scientific achievements of followers of Valery Alekseevich are becoming more andmore famous, e.g. works of the Doctor of medicine Sergiiko S.V., professors Seliverstov O.V. and Yait-sev S.V. The results being achieved and fresh and bold scientific ideas of the new generation of scientistsgive us the hope that the modern school of endocrine surgeons of the Southern Urals will improve andsuccessfully make progress in its development.

�A%'/( "%,!3+,23G:1. �+'"!*',.!&&G! (/3&% D%3231%%: 2B!$. A/'/$%! / �L�. �&*3%!.'(%D. — �!"#$%&'(:

�!"���, 2010.2. �%)&-, /,*+&&+# "�*#4: ./'A/4%&+&%# 3/*',.!&&%(/., *32)!@, (/""!1, 2B!&%(/. % A+5%-

!&,/. / "+*%4%3! �&,/&/.%B! �3%F+&/.'(/4 / '/',.: L�. �3%.+"/., �L�. �23+(/., �L�. �3!$!&-�%(/.. — �!"#$%&'(, 2004.

3. �!'!"!.%B, �L�., �4%3&/., �L�. �L�. �%3/1/.. — �., 1960.4. �',/3%# 4!*%5%&G / A/* 3!*+(5%!@ �L�. �!,3/.+. — �.: �!*%5%&+, 1954.5. �/1+&, �L�. �L�. �%3/1/.. — �., 1946.

NIKOLAI IVANOVICH PIROGOV — A GREAT MAN

K.U. Dubanova (stud.), T.V. Peskova (stud.)Chelyabinsk state medical academy

The department of public health and health care

Scientific adviser: I.S. Tarasova (lecturer), A.S. Divisenko (ass.)

There are characters to the end of remaining true to themselves, able to give himself wholly andcompletely to serving the favorite idea of having a temper to fight for it, and the ability to implement it.So is the character of legendary Russian physician, founder of field surgery, the public figure of the 19thcentury, the great man — Nikolai Ivanovich Pirogov.

16

Inquisitive mind Pirogov was very forces its way and persevere in his way, and the experience ofdiscovery. As a result, a number of years was marked by extraordinary success and distinct theoreticaland practical surgery in Russia called Pirogov period.Indeed his life unselfishly devoted participation in four wars, numerous studies in anatomy, trauma andsurgery. For the first time in the history of domestic and foreign medicine initiative Pirogov in theaterwere involved nurses. One of the first who began to use ether anesthesia and used a plaster cast, whichgreatly helps in the treatment of the wounded.

Just the first merit NI Pirogov is his «special ice Anatomy». With cuts of frozen corpses made thefirst anatomical atlas, on the basis of the Pirogov knowledge in this field in our time is computed tomo-graphy. Conducted osteoplastic amputation of his own methodology and to develop models of prostheses,which later began to produce the St. Petersburg plant. N.I. was an excellent teacher. The slogan of thePirogov ascended the pulpit: «Let me just learning from someone who wants to learn — that's his busi-ness. But the one who wants me to learn, he must have learned something». His merits, he immortalizedhis name around the world. Wherever NI Pies was not, he always helped people who needed it.

Observation of the life, unfortunately, shows that the circuit is the evil of our sad existence of almostcontinuous and hard dissolvable. But ringing and clanging, and the false glitter of the chain do not drown anddo not hide links in the chain of good. That's how determined Pies in his poems - and he wrote poems - what isthe happiness of life: «To be happy happiness of others ... Participation warm a cold heart, and love to touchparched soul». So he was evil all violence against others and their feelings and in his later years strongly re-proached himself for the suffering caused to animals in vivisection, and for the rude word, said forty years ago,a patient during surgery lithoclasty. That's why many of diary pages sounds tender compassion for human sor-rows and warm, loving attitude to his surroundings, for which he tries to think and feel.

Nations love to erect monuments to its outstanding people, but these people do their activities put a mo-nument to his people. Such a monument raised and cake, glorifying Russian name far beyond his homeland.

Charity work Pirogov saved many lives, and above all, the doctor described as a truly great man.His phrases scientists say his tools of the operating surgeon. After his death were brilliant works of globalsignificance in our time. Throughout his life to selfless service to the domestic science and people.

«LIVING IN THE WHITE LIGHT — this means constantly fight and constantly win» N.I. Pirogov.

�A%'/( "%,!3+,23G:1. �+3,!&'/&, �L. �%(/"+@ �.+&/.%B �%3/1/.: �B!3( !1/ /$�!',.!&&/@ *!#,!"-&/',% (+(

A3/?!''/3+, .3+B+ND%3231+, A%'+,!"# % A!*+1/1+ ' 24-1/ 4+# 1831 1. A/ 24-! 4+# 1881 1. [2-! %)*./B!3(+, &+A!B. . F23&. «�2''(+# ',+3%&+» 1881 1. �&. 3] [!(',] / �L. �!3,!&'/& — ��$.: %)*. �.�%((!3,+, 1881. — 53 '.

2. /"(/.%B, L�. �321 B!"/.!B!',.+ �L�. �%3/1/. — ��$., 1910.3. �+,2!., �L�. �+4#,% �%(/"+# �.+&/.%B+ �%3/1/.+ — ��$., 1911.4. �+."/.'(%@, �L�. �L�. �%3/1/. (+( ./!&&/NA/"!./@ D%3231 % (+( 124+&%', . ./!&&/-

'+&%,+3&/4 *!"!. — �%!., 1911.5. �/"/'/., L�. �L�. �%3/1/. (+( .3+B, % 4/3+"-&/! )&+B!&%! !1/ "%B&/',%. — ��$., 1911.6. �+)+&'(%@, �L. �%(/"+@ �.+&/.%B �%3/1/.. �1/ F%)&- % *!#,!"-&/',-. — �+)+&-, 1912.7. �%4/&/., �L�. �.!,"/@ A+4#,% �L�. �%3/1/.+. — �., 1916.8. �2U!., �L�. �L�. �%3/1/. (+( ,!3+A!.,. — 1927.9. �23*!&(/, �L�. �L�. �%3/1/. — /'&/./A/"/F&%( ./!&&/NA/"!./@ D%3231%%. — 1941.

N.I. PIROGOV — THE FOUNDER OF THE THEORY OF ASEPTIC AND ANTISEPTIC

A.O. Eremin (stud.)

Chelyabinsk state medical academyThe department of public health and health care

Scientific adviser: I.S. Tarasova (lecturer), A.S. Divisenko (ass)

The history of development of the theory of an asepsis and antiseptics starts since ancient times,fight against infection was begun long before A. D. and proceeds until now. In 500 years BC in India itwas known that smooth healing of wounds possibly only after their careful cleaning of foreign matters. InAncient Greece Hippocrates covered an operational field with a pure fabric, during operation used onlyboiled water. In traditional medicine within several centuries for antiseptics used to myrrh, an incense, a

17

camomile, a wormwood, an aloe, alcohol, honey, sugar, sulfur, kerosene, salt, etc. But the term «antisep-tics» was offered for the first time in 1750 by English doctor J. Pringle for designation of antiputrefactiveeffect of inorganic acids. Fight against an infection was begun long ago, but it is actual till today.

N.I. Pirogov — the person, whose scientific researches and openings belong to various areas ofmedicine, also strongly affected and asepsis and antiseptics development. He assumed existence «an in-fectious matter» in the pus, capable to pass from one patient to another various ways: through a bed, so-cial objects, by hands of the doctor and dressing. In the «Sevastopol letters and memories» Pirogov wrote:«Destiny of a science any more in hands of operative surgery... The favorable outcome of operation de-pends not only on ability of the surgeon... and with happiness», and later he made the conclusion: «It ispossible safely, to argue that the most part of wounded dies not so much of damages, how many from ahospital infection».

Gathered articles and Pirogov's statements represent a harmonous technique of fight against an in-fection. He recommended division of division of infection patients from not infected patients. Also herecommended various ways of cleaning of air and rooms, demanded to separate all personnel of hospital— doctors, sisters, medical assistants and attendants, to give them and special from other offices dressingmeans (a lint, bandage, rags) and special surgical tools.

N.I. Pirogov noted in his articles that he is« … the jealous supporter of an antiseptic way of treat-ment of wounds …». Till 1852 N.I. Pirogov applied at treatment of wounds the bandages impregnatedwith antiseptic substances (nitrate silver, sulf. zinc, wine alcohol, etc.).

Almost at the same time with N.I. Pirogov the Russian surgeon and anatomist I.V. Buyalsky whowas widely using solution of a chloric lime. Also F.K. Gugenberger and A.A. Kiter — obstetricians fromSaint-Petersburg used antiseptics in their practice.

Pirogov's activity was developed by English surgeon D. Lister who in 1867 invented a number oftechniques of destruction of microbes in air, on hands, in a wound, and also on the subjects adjoining to awound. As antimicrobic agent D. Lister used carbolic acid (phenol solution) which processed a wound,healthy skin round a wound, tools, hands of the surgeon, sprayed air in the operational. The success sur-passed all expectations — the number of pyoinflammatory complications and mortality considerably de-creased. Also, at the same time with D. Lister the Austrian doctor-obstetricianI. Zemmelveys on the basisof long-term supervision proved that the maternity fever being the main reason for death after the child-birth is transmitted in maternity hospitals through hands of the medical personnel. In the Vienna hospitalsit entered obligatory and careful processing of hands of the medical personnel by solution of a chloriclime. Incidence and mortality from a maternity fever as a result of this measure were considerably re-duced.

In Russia the big contribution to development against an infection brought S.I. Spasokukotsky. Heunderstood an asepsis in the widest sense of a word and introduced it in all links of surgical work. He as-pired to reduce always to a minimum percent of suppurations at pure operations. In cases of such suppu-rations he always accused of it the surgeon and his hand. Ways of washing of hands of the surgeon exist-ing before and auxiliary receptions were extremely difficult and insufficiently effective. S.I. Spasoku-kotsky in common with Kochergin carries out careful and numerous researches and establishes specialvalue of liquid ammonia. Systematic bacteriological researches of washing of hands of 1/2 % solution ofliquid ammonia yielded so good results that it allowed Spasokukotsky to propose the way of washing ofhands at the XXI congress of Russian surgeons. Washing of hands of 1/2 % solution of liquid ammoniabrought revolution in an asepsis, and at first this offer was met extremely watchfully. Clear superiority ofthis method, however, gave it wide popularity. Now this method is conventional and all surgeons washhands before operations on S.I. Spasokukotsky's method.

Whatever party from N.I. Pirogov's merits we took, everywhere there is a lot of original, useful,making a contribution to a science. N.I. Pirogov became one of the first who laid the foundation for anasepsis and antiseptics, having suspected fault of pathogenic organisms of infection emergence. Thanks tohis discoveries D. Lister, I. Zemmelveys, L. Pasteur and other scientists received new knowledge and de-veloped the comprehensive doctrine about an asepsis and antiseptics which is actual for today. Withopening and introduction the surgery and medicine as a whole began to develop in surgical practice ofantiseptics and an asepsis more actively, so importance of these opening can't be overrated.

�A%'/( "%,!3+,23G:1. �/"/.5!., �L. �L�L�%3/1/. — A3/./).!',&%( +'!A,%(% % +&,%'!A,%(% . A!3./@ A/"/.%&!

��� ',/"!,%#. — �., 1951.2. �2)%&, �L�. �&,%'!A,%(+ % +'!A,%(+ /, �L�. �%3/1/.+ */ &+U%D *&!@. — �., 1981.3. �/3/(%&+, L�. �',/3%# 4!*%5%&G. — �., 1994.

18

THE HISTORICAL HERITAGE OF N.I. PIROGOV IN THE FIELDOF ASEPSIS AND ANTISEPSIS

A.A. Isakova (stud.), V.Y. Tretyakova (stud.), V.O. Barysheva (stud.)Chelyabinsk state medical academy

The department of topographic anatomy and operative surgery

Scientific adviser: A.V. Chukichev (prof., doctor of medicine),O.V. Peshikov (ass. prof., Ph.D. in medical sciences)

Surgical operation during the middle of XIX century was a great danger for a patient and oftenmore perilous than the disease, on which this medical manipulation was aimed at. According to the statis-tical data of that time complications after operations were observed in 80 % of all operations, and deathsfrom this complications formed more than a half of operated patients. According to Pirogov’s researches,that he made during the company 1854–1856 in the Crimea, the overall mortality from infectious compli-cations after amputations and resections reached 86 %.

Nicolay Ivanovich Pirogov was one of the first who suggested that the contamination of wounds iscaused by hands of the surgeon and his assistants, and also by bedclothes and other medical accessorymaterial. He supposed that «the derivation of all form diseases (pyaemia, septicopyemia, erysipelas, de-cubitus ulcer) are miasmas, that these diseases are catching and contagious». Holding this opinion Piro-gov demanded the arrangement of «a special department» for contagious patients, solving the problem ofprevention of surgical infections. That’s how Pirogov approached to the formulation of an importantpostulate of asepsis (the principe of separation of flows «clear» and «purulent» patients), despite the factthat all his surgical work fell on the period before antiseptic.

For the prevention of festering and for the treatment of wounds during the Crimean war Pirogovused a solution of chloride lime, ethanol, the silver nitrate and also lunar caustic and alcohol tincture ofiodine. After «laying the Foundation» of asepsis and antisepsis Pirogov and other scientists began tocreate differetns means to prevent the inflectional complications [3].

According to the statistical data of the occurrence of infectious diseases the question about theasepsis and the antisepsis is actual in medicine in our days. The basic requirements claimed to the disin-fectant and antiseptics are lack of local irritating effect, minimum absorbability of the space of applica-tion, high bactericidal activity, the lack of allergenic action, low toxicity, the chemical stability of solu-tions, the lack or minimal damaging effect on the equipment, the lack of the unpleasant smell, good solu-bility in water or making of stable emulsions in it etc.

In our days a lot of different antiseptics and aseptics are classificated by attitude to various classesof chemical compounds. So there are halogens and halogenic compounds, oxidants, acids and alkalis,alcohols and aldehydes, salts of metals, etc. And the most popular are halogens and halogenic compoundsand also alcohols. But nowadays there is no such classification, that could combine the accumulated in-formation about its’ characteristics and the efficiency of application in the clinical practice.

We should note the last researches that shows that a lot of strains of microorganisms are steady totraditional antiseptics ( furazilin, water solution of chlorhexidine, solution ofpotassium permanganate). Itis known, that in the solution of furazilin Ps. aeruginosa is preserved in the number of 106 ���/ml. Andthe frequency of isolation of the clinically stable to furazilin Staphylococcus spp., Pneudomonas spp.around the comtaminators of antiseptics is 89,6 ± 2,7 and 100,0 ± 0,8 % accordingly. Also lots of meansbecome outdated morally because there is an inconvenience on the part of logistics, was formed an aller-gic reaction around the medical staff because of long using of the particular components and a discomfortin the preparation of «on application» means [1, 2].

Also it is important to notice that earlier as antiseptics and aseptics were used such matters thatcaused pronounced side-effects. For example, sublimate that has a strong antiseptic action and is verypoisonous was used. Sublimate poisoning are characterized by vomiting, exhaustion, weak pulse, pittingsof the gums, inflammation of the kidneys, etc. Another example is a iodoform, that earlier was used fortreatment of septic wounds and in small quantities caused a severe poisoning. According to this, nowa-days antiseptics and aseptics oriented to needs of treatment-and-prophylactic institutions are being devel-oped and used.

For the most actual in our time antiseptics for preparing the surgeon’s hands can be related the fol-lowing means. AHDEZ 3000, �HD 2000-special (ZAO «Petrospirt», Russia) that contains 80 % ethanolas an active substance. During the hygenic processing of the hands it is enough to inflict 3 ml ot the solu-tion on hands and to rub it into the skin until it drying up not less than 3 minutes. Lizanin OP (ZAO «Pe-

19

trospirt», Russia) — that contains also the ethanol as an active substance. During it’s using for preparingthe surgeon’s hands after washing with soap it is needed to inflict 5 ml of this remedy twice and to rub itinto the skin. Pervomur is the remedy prepared from the hydrogen peroxide and the formic acid just be-fore using. For desinfection of hands it is enough to put them into the container with solution on 1 minute.It is also important that in 1 container on 5 litres of such solution 10 people can process their hands serial-ly. It also should be noted that remedies that contains alcohols as an active substance are more wide-spread. The effect of tanning that is needed for closing pores of the skin aimed to maintain the most poss-ible long sterility of it’s surface is the basis for their frequent use in this matter.

We also want to notice that earlier were used such complicated methods as for example the methodof Spasokukozkii — Kochergin. Using this method the surgeon had to execute a number of stages. Firstof all washing with soap under the tap with warm water. Next washing with a gauze napkin in 2 basinsfor 3 minutes in 0,5 % solution of ammonia spirit. After that was going a drying of hands with a steriletowel and handling with a small napkin, moistened in 96 % ethanol. At last, the bed of the nails and skinfolds of the rear brush were greased with 5 % iodine solution. So we can see how modern antisepticsmade the process of preparing hands much more easier for medical staff. [4, 5].

For the processing of the operative field there are used such remedies as Klinex (��� «ROSHIM»,Russia) and Cutasept - F (Germany) the active substance in it is a propanol-2 and the exposure time afterthe end of the double-rubbing of the operative field is 2 minutes. Skiniya-OP (Russia), the main activesubstance of it are propanol-2 (35,9 %) and % propanol-1 (27,4 %), and the exposure time conforms toCutasept-F’s time. Ecobreeze (Russia)- a skin antiseptis that contains isopropyl alcohol and a complex ofQuaternary ammonium salts as an active substance. This named antiseptics for the processing of the oper-ative field are also used for preparing the surgeon’s hands, hygenic processing and a processing of injec-tion field.

For the processing of products of medical purpose the modern solutions are Ecodes (Russia) — anantiseptic that contains tree chloride (50 %) as the main active substance. It is used for desinfection ofsurfaces, sanitary-technical equipment, bedclothes, for General cleanings, etc. by rubbing the cloth soakedin a solution of the remedy or by irrigation through the hidropult. Very dirty surface are handled twice.For the sterilization of products of medical purpose from different materials (melalls, rubber, glass, plas-tic) it is used a 4 % solution of the remedy. Combides (Russia), Tetramin (ZAO «Petrospirt», Russia) thatcontain a complex of Quaternary ammonium compounds that is characterized by a good solubility in wa-ter, a lack of smell and corrosion properties and also a low toxicity is the main active substance. Also inthis group is Chlormisept that contains a 55 % of active chlorine and produced in the form of pills. It isstill actual using ethanol in our days because of it’s expressed antiseptic action.

A wide variety of chemical antiseptics in our days reaches a huge number. All it became possiblethanks to the historical heritage, first of all, of doctors and research workers of before-antiseptic period,that impulsed modern antiseptics and aseptics. One of such enlighteners was Nicolay Ivanovich Pirogov.V.A.Oppel wrote: «Pirogov really nocked at that door, behind what it was a scope of surgery, he racedwith thoughts concerning the prevention of infectious complications …».

�A%'/( "%,!3+,23G:1. �"!('!!. �L�., �32,%(/. �L�., �/$3/.&%(/. �L�. �!A'%' 2 /$/FF!&&GD: ./A3/'G *%+1&/-

',%(% A3/?%"+(,%(% % "!B!&%# // �&?!(5%# % +&,%4%(3/$&+# ,!3+A%#. — 2001. — � 3. — �. 74–76.2. �+*F%!., �L�. �%)(/%&,!&'%.&+# "+)!3&+# % %4A2"-'&+# %&*2(5%/&&+# 4+1&%,/,!3+A%# .

"!B!&%% 1&/@&GD 3+& : *%'. ... (+&*. 4!*. &+2( : 14.00.27. — �/'(.+, 2007. — �. 15–16.3. �+('%4/.+ �L�., �!U%(/. �L. !3&%',G@ A2,- �L�. �%3/1/.+ ( 4!*%5%&'(/42 D+"+,2,

+'!A,%(! % +&,%'!A,%(! // �$/3&%( &+2B&GD 3+$/, 4!F*2&+3/*&/@ &+2B&/NA3+(,%B!'(/@ (/&?!-3!&5%% ',2*!&,/. % 4/"/*GD 2B!&GD, A/'.#��&&/@ 200-"!,%� '/ *&# 3/F*!&%# �L�. �%3/1/.+. —�!"#$%&'(: �)*N./ «�!"���», 2011. — �. 14–16.

4. �$�+# D%3231%#: �B!$&%( *"# 4!*%5%&'(%D .2)/. / A/* 3!*. �L�. �2$+3!.+, �L. �/B!,(/-.+. — 3-! %)*., */A. % %'A3. — ��$.: �A!5�%,, 2011. — 607 '.

5. �A3+./B&%( .3+B+ /$�!@ A3+(,%(% / �L�. �/B(/., L�. �+'/&/., �L�. �+"!!.+. — �/'(.+:�('4/N�3!'', 2002.

20

TWINS

A.D. Jukova (stud.)

Chelyabinsk state medical academyThe department of public health and health care

Scientific adviser: I.S. Tarasova (ass., prof., Ph.D.)

Many Pirogov’s discoveries and elaborations formed the basis of vari-ous trends in modern pediatric surgery. Some of his ideas remain relevant.Nowadays these ideas are being developed in the work of Pediatric surgeryDepartment of Pirogov RSMU. Eighty years passed since the foundation ofthe Department and by this time its team has made a great progress in diag-nostics and treatment of surgical diseases in children.

Prominent representative of the department of pediatric surgery is Novo-kreschenov Lev. He became a pediatric surgeon, and in 1974 he received the sta-tus of Doctor of medicine. Since 1994, Levwas a member of New York academy ofSciences. Two years later, he was named amember of the Association of PediatricSurgeons of Russia. In 1953 he graduatedChelyabinsk State Medical Institution. Lev

Novokreschenov worked as a chief physician and surgeon of the Uraldistrict hospital. He is an author of 160 scientific articles and 5 inven-tions. His works address topical issues in urology surgery, Clinical Im-munology and pedagogy of higher education. For the first time, in theUSSR, Lev Novokreschenov successfully completed separation of con-joined twins with a common liver.

Novokreschenov is a pediatric surgeon of international fame. In 1990, he conducted a unique oper-ation to separate conjoined twins. Lev is a graduate of the Chelyabinsk Medical Institute. More than 50years of his life he dedicated his university. «Our Medical academy is a great scientific and medical cen-ter, which is known not only in our country but also abroad», — says Lev.

In the 90's they were legends. Siamese twins Anna and Tanya miraculously survived after a com-plicated operation. The attention of the whole country was attracted by them. People adored brilliantsurgeon and sincerely sympathized with the girls, who had a difficult life. Anya and Tanya could havedied on the operating table. In operation Lev Novokreschenov ventured after about a month.

«We were the first surgeons in the Soviet Union, whomade such operation without death, — says Lev. — Long inthe making, all carefully studied. We very worried, becauseafter such operations people rarely survive. The girls had oneliver; it had to be something to share. And we did it!». The op-eration lasted one hour and ten minutes, and all went well. An-na and Tanya is lucky, because of the 1000 division of con-joined twins survive only one pair. 14 years Ann and Tanyalived under the supervision of doctors in Chelyabinsk. Motheralways used to take them to a local doctor and Lev periodicallyhimself came to inspect the patients.

The basic meaning of all Pirogov’s activities is a dedi-cation and selfless work and he turned to science surgery,arming of evidence-based methods of surgery to doctors. Levis one of those doctors who continue its tradition in surgery.

21

PEDAGOGICAL VIEWS OF PIROGOV N.I.

K.!. Lukyanova (stud.), N.U. Yuldybaev (stud.), D.K Israelyan (stud.)Chelyabinsk state medical academy

The department of public health and health care

Scientific adviser: I.S. Tarasova (lecturer), �.Y. Markina (ass).

«What have you been preparing your son for? — somebody asked me.To be a human! — I answered…»

N.I. Pirogov.

All of us know Pirogov N.I. as an outstanding surgeon, an anatomist, the originator of the militaryfield surgery. But just a few people are familiar with his work in the sphere of pedagogics. Therefore, wewould like to consider his pedagogical activity and to tell about his initiatives which he was suggesting toimplement into the academic work.

Pirogov N.I. was a person of high morale and he was paying more attention to the spirituality. He wasconcerned not only with the science and medicine themselves but also with problems of the Russian society.Having come back from the Crimean war, Nikolay Ivanovich paid the attention of the emperor to all draw-backs of the Russian army, and as a result of this he fell into disfavour of Aleksandr II. In 1856 Pirogov N.I.was suspended from work in the Military Medical academy and he was appointed a curator of the Odessaand then in 1858 of the Kiev academic district. At that moment his pedagogical activity started.

Ideas of the great doctor in the sphere of pedagogics were ahead of time on the whole. Having ex-amined the whole system of education, he found out its negative characteristics. Innovations of Piro-gov N.I. often metsufficient resistance from officials of conservative views. A lot of times he had to pro-tect rights and freedoms of students from invasion of authorities. Nikolay Ivanovich believed that policeshould not interfere with internal affairs of universities and that, in general, higher education institutionsshould possess the autonomy but, of course, they should be rationally controlled. In this case higher edu-cation institution would be able to distribute financial funds according to their interests and to pay salariesto teachers, taking into account the extent of their hard work at the university but not their position. Niko-lay Ivanovich suggested to elect professors on a competitive basis, basing on their scientific works, onrecommendations from famous scientists and on the popularity of the candidate's lectures among students.

Pirogov N.I. wanted to change the existing situation not only in universities but also in schools andgymnasiums. He thought that the main objective of the pedagogical process itself, starting from its earli-est stages, was to bring up a Human, a good citizen of his or her Motherland. The scientist called for res-pecting the personality of a child and considered that it was necessary to develop morality, attention andability to work by himself or herself in children. Being a doctor and knowing the psychophysiologicalcharacteristics of the child's organism, Nikolay Ivanovich advised to pay attention to individual skills ofeach student. He protested against early specialization and considered that a student should have his orher own picture of the world, and then, after receiving basic knowledge in all spheres, he or she would beable to choose a profession according to his or her interests. Pirogov considered that science was one ofthe most important tools of the process of bringing up: «The science has got some kind of a moral andeducational element which will never be lost», — he said on this topic. According to Pirogov, methods ofeducation should be thoroughly considered, teachers should exchange experience with their colleagues.The education should be illustrative and it would be better if students would compile tables in order forthem to have an opportunity to systemize and compare their knowledge. Pirogov treated issues of discip-line from the point of view of humanism, therefore he protested against rods and stand-up fights. Thanksto his efforts, The charter of gymnasiums and progymnasiums» cancelled corporal punishment in 1864..

Ideas of Pirogov N.I. were idealistic to some degree and the major part of his innovations were notput to life. However, one should pay homage to the progressive thought of Nikolay Ivanovich because,having worked in the sphere of education for about 5 years, he put forth a great number of ideas whichremain important nowadays. We consider that nobody will argue that the modern Russian educationneeds such phisophers and pedagogues as Nikolay Ivanovich Pirogov.

�A%'/( "%,!3+,23G:1. �!'!"!.%B, �L�. �!,/A%'- F%)&% �L�. �%3/1/.+ (1810-1881). — �., 1976.2. �B!3(% A/ %',/3%% I �/'(/.'(/1/ %&',%,2,+ %4!&% �L�. �!B!&/.+. — �.: �!*1%), 1959.3. �%3/1/., �L�. �/$3+&%! '/B%&!&%@ . ./'-4% ,/4+D. — �!*1%), 1957–1962.4. �/1+&, �L�. �L�. �%3/1/.. — �., 1946.

22

CREATION OF THE MILITARY FIELD SURGERY

".Y. Markina (ass.), I.S. Tarasova (lecturer)

Chelyabinsk state medical academyThe department of public health and health care

Scientific adviser: Y.�. Tyukov (head of a chair, professor)

N.I. Pirogov is a founder and the most weighty representative of the military field surgery. Duringthe Second World War Soviet surgeons followed the famous provisions introduced by N.I. Pirogov —«war is a traumatic epidemy», «the triage», «it is not up to medicine but to the administration to play acrucial role in the process of helping the wounded and ill people at the theatre of war». These provisionsare still the foundations of the modern doctrine of the military field surgery nowadays.

During the process of creating the military field surgery Nikolay Ivanovich was relying on his ownexperience as a doctor and as a provider of medical care. He had to participate in several wars which werethen conducted by Russia — in the Caucausus, in the Crimea, in the Balkans. In 1854-1855 during theCrimean War N.I. Pirogov performed a lot of surgeries and headed the delivery of medical aid to thewounded in Sevastopol. He participated in the activity of the army medical service of the Russian Armyduring the Franco-Prussian (1870) and Russian-Turkish (1877–1878) wars.

The activity of N.I. Pirogov as a military field surgeon started in 1847 during the military expedi-tion to the Caucasus. There for the first time in the global practice he used the ether anaesthesia in thefield environment.

Nikolay Ivanovich was the first to use plaster bandages for treating broken limbs in the field envi-ronment which allowed to quicken the process of cicatrization. He was also the first to test the method ofbandaging of large arterial trunks in the field environment.

N.I. Pirogov was the first in the world to organize and use the woman care for the wounded in thearea of combat. The activity of sisters of mercy at the theatre of war became a convincing example of thefact of what an important role the woman medical staff can play in the process of relieving the fate of thewounded at war.

In conditions of battles N.I. Pirogov was carrying out surgeries, was organizing the care and treat-ment of the wounded and ill people, was developing the fundamental principles of the military field sur-gery. He pointed out the necessity of the thorough triage: «I was the first man to introduce the triage atSevastopol dressing stations and this way I managed to destroy the predominating chaos, «Pirogov wrote.«I am proud of this achievement».

While providing the first aid and treating the wounded people who suffered at the defence of Se-vastopol, N.I. Pirogov was the first to notice that at the certain stage of battles there were more virulentor, in other words, infectious patients than the wounded ones. The Pirogov’s main approach to the processof organizing the medical care for the wounded involved their clear subdivision into five categories,therefore, they received the necessary medical aid depending on their condition.

N.I. Pirogov demanded to follow a unified system of surgical service at all stages of evacuation andalso to make the medical care nearer to battle positions. Nikolay Ivanovich recommended the so-called«conservative surgery», protested against too early ablations and intubation of green wounds.

N.I. Pirogov is the author of the classical description of the shock picture, he was the first to intro-duce the notion of the wound exhaustion and to lay the foundations of the modern theory of sepsis. Evenduring the premicrobiological era Nikolay Ivanovich came to grips to the idea that the reasons of suppura-tive complications are living pathogenic organisms.

The knowledge and the experience of Nikolay Ivanovich were described in his famous works —«Foundations of general military field surgery», «Military medical practice and private aid at the theatreof war in Bulgaria», and also in his reports about his trips to the Caucausus, Alsace and Lotharingia.

N.I. Pirogov received his worldwide fame thanks to his works which created new ways of develop-ing the theoretical practical medicine of the war-time and peace-time. Main provisions of the field doc-trine developed by N.I. Pirogov remained important in the military medical practice for a long time andare being used nowadays although being a little altered.

The huge contribution of N.I. Pirogov to the creation of the military field surgery was recognizedby the academician N.N. Burdenko: «… Pirogov took on this colossal task and coped with it with the fullcompleteness for his epoch, with objective criticism, with admitting his own and other’s mistakes, withapproving new methods which replaced both his own opinions and the opinions of his advanced contem-poraries».

23

�A%'/( "%,!3+,23G:1. �23*!&(/, �L�. � �L�. �%3/1/.! ' %',/3%B!'(/@ ,/B(% )3!&%# // �/$3. '/B. — �., 1950–

1952. — . 1.2. /3/$-!. �L�., �!,3/.+ �L�. �%3231%# . %)/$3+)%,!"-&/4 %'(2'',.!. — �.: �����-

�!*%+, 2009.3. �!'!"!.%B, �L�. �!,/A%'- F%)&% �L�. �%3/1/.+ (1810–1881). — �., 1976.4. �+$"2*/.'(%@, �L�. �+).%,%! D%3231%% . �/''%% .XIX .!(!. �L�. �%3/1/.. — �., 1955.5. �%3'(%@, �L�. �%3231%# /, *3!.&/',% */ '/.3!4!&&/',%: �B!3(% %',/3%%. — �.: �+2(+,

2000.

FROM PIROGOV’S «ICE ANATOMY» TO IVANOV’S MAGNETIC RESONANCE ANATOMY

Y.V. Martemyanova (doc.), V.V. Kosovskaya (head of the division), V.O. Barysheva (stud.)Autonomous non-commercial organization medical-sanitary department of Magnitogorsk —

city administration and public corporation «MMK»Diagnostic centre

Roentgenologic [X-ray] departmentChelyabinsk state medical academy

The department of topographic anatomy and operative surgery

Scientific adviser: O.V. Peshikov (associate professor, Ph.D. in medical sciences)

The medicine that does not require proof...N.I. Pirogov and his «ice anatomy».

Nicolay Ivanovich was born in Moscow in 1810 in the family of military teasurer and major IvanIvanovich Pirogov (1772–1825). When he was 14-years old he entered the medical faculty of Moscowuniversity. Several years after receiving diploma he studied abroad. To professorial work Pirogov pre-pared in Professorial institute under the university of Derpt. In this surgical clinic Pirogov has worked for5 years, he brilliantly defended his doctoral dissertation and at the age of 26 was voted in Professor of theDerpt’s university (pic. 1).

In winter 1850 Nicolay Ivanovich went by Sennayasquare in biting frost. In a lot of meat shops traders set outpigs’ carcasses dissected by axe in different planes. A fro-zen carcass could be dissected in any direction withoutbreaking the situation of it’s components. Nicolay Ivano-vich took a good look at pigs’ cuts. He imagined amazinglyclear all of the brilliant opportunities in study of humanbody can give freezing of corpses. It was very unexpecteddiscovery.

After long and tiresome working day in surgical clin-ic Nicolay Ivanovich went to university’s anatomical build-ing, where in his small room he made saw cuts of frozencorpses. The corpse was under the influence of temperatureunder 20 degrees below zero during 2 or 3 days. Under thisinfluence corpse became hard as a tree. Mutual anatomicallocation of parts under consideration remained in its’ natu-ral look. Look of the scientist penetrated into the depths ofhuman’s body — here is the skin, the fatty tissue is locatedunder it, a thin stripe of fascia is deeper, clothing red falcatestripe of muscles, then fascia again, more muscles under it,periosteum, cut of cortical bone, bone marrow: there aredifferent circles on the cut — this circles are arteries; on thecut nerves and veins can be seen.

On the cuts of frozen corpse Pirogov retraced layer-by-layer everything that surgeon dissects dur-ing the operation on a living person. «During this work author came upon a happy thought — to study thelocation, form and connection of organs on frozen corpses without cutting them in different directions,

Pic. 1. N.I. Pirogov

24

but uncovering them on frozen corpse, like it is usually made in ordinary way. For this purpose the corpsewas frozen to a stone density and after it organs that were hidden in freezed layers were uncovered andshelled with a help of chisel, hammer, saw and hot water. Picture of normal heart position and viscerawere got with a help of this methods», — Pirogov wrote. That’s how a wonderful method of researchingthe human’s body — «the ice anatomy» was created by genius Pirogov and made his name immortal.Cutting frozen corpses on parallel plates enriched knowledge even such specialist in the field of anatomyas Nicolay Ivanovich. He found out that, «excepting the pharyngeal, nasal and ear cavities and canals ofrespiratory and inestinal canals, in no other part of the body in normal condition empty space can befound. Walls of other cavities fits closely to walls of organs that are located in this cavities. The same pic-ture we can see in joints: you will never find even the least space between the articular surfaces howeverless they conformed to each other. Brain as other organs fits closely to dura mater that covers the internalsurface of the cranium. The real direction of vertebral column and different it’s curvatures can be shownwell only on the cuts of frozen corpses... of chest and especially sculptural anatomy shows that contoursof heart and direction its apex can be extremely different; it was also found how great is the influence ofthe colon on the location of heart. The cross-sections of abdomen and also a sculpture anatomy shows thatemty and clenched stomach has a form of a horseshow and it’s body can be so bended, that lower curva-ture looks forward. The more the stomach is stretched the more it becomes straight...»

Pic. 2. 4 volumes of «The ice anatomy», united in 2 albums, that was presented to doctorsof Tambov scientific medical society by N.I. Pirogov

The science nowadays owns a powerful means of penetration to the secrets of structure and life ofhuman body –the method of radiography the organism with x-rays. But a lot of Pirogov’s discoveriessaved their menings for medicine [7].

The volumes of the atlas «Topographic anatomy of frozen cuts of human body, made in 3 direc-tions» have been printing for 8 years since 1851. The atlas of «ice anatomy» spread all over the universi-ties of whole world very fast and soon it became a bibliographical rarity (pic. 2). The big Demidov’s prizewas awarded to Pirogov by The academy of science for this genious work [5].

The foundations of roentgenologyAT the end of 1895 in Wurzburg (Bavaria) Wilhelm Konrad Roentgen (1845–1923), during his

research of passing of current through rare field gas, found out that from that part of a tube where hitsthe electrons, issues new rays, that have a wonderful quaity to passing through objects that non –transparent On November, 8 in 1895 1., Roentgen finished his work very late and was going to gohome. He turned off the light in the laboratory but forgot to turn off the high-tension current that passedthroutgh the kruxov’s tube(a glass vessel with all sealed off sides, all the air from which was pumpedout). In the darkness he noticed greern light, that was coming from the crystals of the platinum-cyanidebarium, laying on the table. It was enough only to switch off the current, passing through the tubed

25

covered with a cardboard case to immediately stop the light and appeared again when the current wasswitched on. All night on November, 9 1895 Roentgen spent in the laboratory, studying such a mysticalphenomenon.

After that night Roentgen placed in the laboratory a camp bed, curtained the windows with darkblinds and put his experiments alone, thoroughly analysing the results. In the next experiments to find outnew kinds of rays Roentgen used a screen — a piece of cardboard, covered with a layer of platinum -cyanide barium. Pe put a thick book between the tube and the screen he found a sharp luminiscrece of thelatter. Therefore rays penetreted through the glass of the tube, the cardboard covering it and through athick book.

In the sequel he found out that this rays passed through thin metall plated very easy and only thickplates of the same metalls were impermeable for them. Besides, plates of the same thickness but differentmetals differently let through or impeeded rays.

Even before Roentgen’s discovery it was known that the photographic records shouldn’t be holdedin the room with working kruxov’s tube: the records became ruined even if they layed in wooden boxesthat were impenetrable to light. Now was clear the reason of this phenomenon: rays that Roentgen foundout passed through the wood and provoked aphotochemical reaction in a light-sensitivelayer of the recordsimilar to reaction, caused by the rays of visible light.

After establishing a new feature of rays to make a photochemical effect the scientist has changedhis experiments: instead of the screen he put under the kruxov’s tube a wooden cassette with a photo-graphic plane. Between the tube and the cassette Roentgen placed his hand. When the cassette was devel-oped, a sharp image of hand’s bones was seen there. So the rays passed through wood, skin, muscles, butthe were retarded by hand’s bones, and as a result, shadows of the bones were imprinted on the photo-graphic plane. That’s how the first in the world picture of bones was made. For seven weeks of intensiveand laborious work Roentgen has found out basic features of a new kind of rays.

After repeated checkings of the results, finally certained that they are correct and accurate, hecommited this derived data to a brochure «About a new kind of rays», that was out in the middle of Janu-ary, 1886 [4]. Roentgen called the radiation discovered him the X-rays, similarly the mathematics callunknown quantity with the «X» term: not all in the nature of discovered rays was clear. On January 23,1896 on the session of physico-mathematical society in Wurzburg Roentgen made the first public reportabout his discovery. At the suggestion of the chairman of the Society, a famous anatomist and histologistKelliker, the new kind of rays was called Roentgen rays. This new name of x-rays was accepted by theSociety, afterwards it was accepted in the whole world (only in the literature of the USA and some othercountriesis still spread the name «x-rays». That’s because the American Lenard even before Roentgennoticed phenomena, that happened during the work with the kruxov’s tube, for example, damagind of thephotographic plates and afterwards he tried to obtain his priority in the discovery of x-rays, even trying to

give them his name, but undoubtedly the priority ofdiscovery the new kind of rays belongs to Roent-gen, who not only noticed them but also studiedthem first time in the world. This wonderful featureof the Roentgen rays immediately noticed attentionof doctors, who saw in it a new method of studythe internal structure of human body. And in thenext (1896) year started using of the Roentgen raysin medicine with diagnostic purpose. Since thattime the Roentden rays ave been using not only inmedicine but in a lot of other fields of science andtechnology . They helped to more full study thestructure of substance and the nature of light.Roentgen rays made an essential contribution insuch questions as a theory of the structure of theatom, molecules, crystals and liquids, in the devel-opment of chemistry, optics, the quantum theory oflight [6].

Pic 3. Roentgen machine OEC UroView 2800

26

The ultrasound diagnosticsPhysical base of the ultrasound diagnostics is a piezoelectric effect. After the deformation of mo-

nocrystals of some chemical compounds (quartz, barium titanate) under the influence of ultrasoundwaves, on the surface of this crystals appear opposite in sign electric charges — the straight piezoelectriceffect. When submitting a an alternating current on it, in the crystals' appears mechanical vibrations withradiation of ultrasound waves. That’s how one and the same piezoelement can be alternately a receiverana a source of ultrasound waves. This part in ultrasounds machines is called an acoustic transducer, atransducer or a sensor.

The ultrasound spreads in mediums in the form of alternate zones of compression and expansion ofmatter. Sound waves, including ultrasound, are characterized by the period of oscillation– time, for whatmolecule makes one full oscillation; frequency — a number of oscillations in a unit of time; length — adistance between points of one phase and a spreading rate, that mostly depends on elasticity and densityof the medium.

The length of the wave inversely proportional it’s frequency. The less the length of the waves, thehigher the resolving capacity of the ultrasound machine. In the systems of medical ultrasound diagnosticusually are used frequencies from 2 to 10 MHz. The resolving capacity of modern ultrasound machinescomes up to 1-3 mm.

Every media, including tissues of organism interfere with spreading of ultrasound and have differ-ent acoustic resistance, which value depends on their density and speed of sound waves spreading. Thanhigher this factors, the more is the acoustic resistance. This common characteristic of any elastic media isnamed «impedance».

After reaching a border of two medias with different acoustic resistance, a pencil of ultrasound wavesconsiderably changes: one part of it continues spreading in a new media continues to spread in the new me-dia, and more or less are absorbed by it, another part is reflected. A reflection coefficient depends on thedifference of value of acoustic resistance bordering to each other tissues: the more is this difference, themore is reflection and the more is an amplitude of registered signal, and so is lighter and brighter it will beseen on the screen of the machine. The border between tissues and the air is a full reflector [2].

In the easiest way of realization this method allows to estimate the distance to the border of diffe-rentation of density of two objects, basing on the time of passing of the wave, that was reflected from theborder of partition. More difficult methods of research (for example, based on the Doppler effect) allowsto determine the speed of moving of the dencity partition’s border and also the difference between densi-ties, making the board [1].

The ultrasound ripplings are submitted to the laws of the geometrical optics during their spreading.In the homogeneos mediathey spreads rectilinael and with a constant speed. On the board of differentmeias with differet acoustic density a part of the rays is reflected and another part is refracted, and contin-ues after that a rectilined spreading. The more is the gradient of the difference in the acoustic density themost part of the ultrasound ripplings is reflected. On the board of conversion the ultrasound from the airon the skin 99,99 % of ripplings are reflected, so during the ultrasound scanning of a patient the surface ofskin should be dubed by a water jelly that makes atransitional media. The refraction depends on the angleof incidence of the beam (the biggest is in the perpendicular direction) and the frequency of ultrasoundripplings (the more is frequency the most part is reflected).

For the examination af the abdominal organs and organs of retroperitoneal space, and a cavity ofpelvis minor is used the frequency 2,5–3,5 MHz, for the examination of the thyroid gland is used the fre-quency 7,5 MHz.

The Doppler effect causes an especial interest in the diagnostic. The essence of the effect includesin the changing of the sound frequency because of comparative mooving of the source and the receiversound. When the sound reflects from the mooving object, the frequency of the reflected signal changes (afrequency shift happens).

The modern ultrasound machines allows to have a good look at the features of the structure of in-ternal organs and their pathology (pic. 4). They help to distinguish tumors from cysts. The ultrasound isone of the most safe and harmless of examination nowadays. This method is widespread when the roent-gen diagnostic is impossible to use.

27

Pic. 4. The ultrasound machine Medison Accuvix XQ 4D (3D)

The basics of magnetic resonance tomographyThe magnetic resonance tomography is one of the youngest method of radio diagnostics. On the

basis of it lays a phenomenon of nuclear-magnetic resonance, that is known since 1946, when F. Blochand �. Purcell show that some nuclears, situated in the magnetic field induce an electromagnetic signalunder the influence of radio-frequency pulse. In 1952 they awarded a Nobel prize for this discovery.

Afterwards in 2003 the Nobel prize in medicine was awarded to British scientist Sir Peter Mans-field and his American colleague for researches in a field ofmagnetic resonance tomography. In the be-gining of the 70-s Paul Lauterbur discovered an opportunity to get a two-dimensional image making thegradient in the magnetic field. Analysing the characteristics of emitted radio waves, he could identify theorigin of them. It allowed to create a two-dimensional image, that could not be made in another method.

Doctor Mansfield developed the research of Lauterbur, finding out how it is possible to analyzesignals that are sent in the magnetic field by a human organism. He made a mathematical machine thatallows to transform this signals into a two-dimensional image very fast.

There were a lot of arguments around the discovery of magnetic resonance tomography. An Amer-ican physicist Raymond Damadian told that he is the real discoverer of magnetic resonance tomographyand a creator of the first tomograph in the world, but the prize was awarded to another people.

From another point of view princios of construction of the images of human body long beforeRaymond Damadian were developed by Vladislav Ivanoa (. nowadays he is a head of chair of measuringtechnologies and computer-aided tomography of St. Petersburg state university of fine mechanics andoptics).But the most important is that the researches seemed strictly theoretical in that time became sowidespread in clinics in several years (since 80-s of XX century).

For getting a magnetic resonance signal and an image afterwards is usually used a constant homo-geneous magnetic field and a radio frequency signal, that changes the magnetic field.

That’s because the basic components of any MR-imaging installation are:A magnet that makes an external constant magnetic field with a magnetic displacement vector /;

in the SI system the unit of the magnetic induction is 1 (Tesla); for comparison the magnetic field ofthe Earth is nearly 5 × 10-5 ; one of the main requirement for magnetic field is it’s uniformity in the cen-ter of the tunnel;

Gradient coils, that makes a weaf magnetic field in 3 directions in the centre of magnet and allowto choose the field of research;

28

radio frequency coils that are used for creating an electromagnetic excitation of protons in the pa-tient’s bdy (transmitting coils) and for registration of the answer of generated excitement (receivingcoils). Sometimes receiving and transmitting coils are matched in one in the study of different parts of thebody, for example, a head.

When performing MRI happens the following chain of events:The is placed in a strong magnetic field.A radio-frequency pulse is served and after it an internal magnetization changes with the gradual

return to the baseline.This changes of magnetization are repeatedly read for every point of the prototype system.The MRI examination nowadays takes the lider’s position in the diagnostic of internal organs and

osteo-articular system pathologies. This method allows to have a good look at internal organs in differentplanes, to recreate a 3D model of human body and take a good look at parts that not informative on theordinary roentgen images. It is safe for a man and allows to help clinical doctors choose the right tacticsof the patients in a short time [3].

Pic. 5. MR-imaging installation

�A%'/( "%,!3+,23G:1. �+&*+2 �L�., �%?U%5 �L�. !/3%# A/"#. — �.: �+2(+, 1988. — �. 158–159.2. �2B!.+# *%+1&/',%(+: 2B!$&%(. . 1 / A/* 3!*. �L�. 32?+&/.+ — �.: �����N�!*%+,

2009. — �. 39–40.3. ��&'?%"*, �. �G',3+# 4+1&%,&/N3!)/&+&'&+# ,/4/13+?%# // �'A!D% ?%)%B!'(%D &+2(. —

2005. — . 175. — � 10. — �. 1044–1052.4. �!&,1!&, L�. � &/./4 3/*! "2B!@ / �!&%&13+*, 1933. — �. 115.5. http://medlib.tamb.ru/news-print.html6. http://www.dogsmagic.ru7. http://www.medikal-enc.ru

ROLE OF ADMINISTRATION IN FORMATION OF DOMESTIC MEDICINE

E.S. Matveeva, I.S. Tarasova

Chelyabinsk state medical academyThe department of public health and health care

Pirogov N.I. activity covers different branches of medicine and public life. This genius scientist al-so paid great attention to the organization of medical business.

Pirogov was the first in the world to suggest, organize and use sorting of injured, saying that «atwar the main thing is not medicine, but administration». Among other useful undertakings of N.I. Pirogovin the field of organizational process one should mention realization of his idea of application of medical

29

nurses help, fearless fight for putting new discoveries into practice, introduction of statistical accounting,care to provide medical aid to citizenry during wars, et cetera. Despite the fact that Pirogov N.I. put ad-ministration first to medical aid itself for military men, this statement is also true as concerns citizenryand peacetime.

Attempts to organize medical aid to the population had always been undertaken but they remainedinefficient until common order, plan and control appeared. Thus, in 1912 the Interdepartmental Commis-sion for Medical — Sanitary Legislation Revision under the chairmanship of Rhane G.E. — a professorof All-Russian Medical academy of Midwifery and Gynecology, the chairman of the Medical Council ofthe Ministry of Internal Affairs, for the first time in history developed the standards for providing popula-tion with medical aid, amount of financing and the required number of doctors. The Commission sug-gested establishing the Main Administration of State Public Health having the rights of ministry. But thatidea of centralization was sharply objected to both by the ministries and departments, which had theirown medical services, and the representatives of zemstvo and municipal medicine. The 12th Pirogov Con-gress in 1913 criticized the project of the Commission headed by Rhanesharply, as doctors feared the bu-reaucratization of such bodies.

At the beginning of the XXth century the whole population of the country (159 million people in1913) was provided with medical care by 28 thousand doctors (on average two doctors per 10 thousandcitizens), moreover the majority of doctors practiced in large cities of the European part of the country. Inhospitals there were about 208 thousand places (1,3 beds per 1000 citizens).There were no hospitals at allin more than one third of cities in Russian state.

In rural locality, in spite of efforts taken by district councils and zemstvo doctors, things were stillworse. According to the official data of the Administration of Main Medical Inspector, in 1909 there were24,5 thousand inhabitants per a doctor in zemstvo provinces. To make things worse about 1/3 of districtcouncils did not have any areal system, which made doctor travel from village to village and waste a lotof time.

The whole country had only 9 female and children's consultations. Each year 2 million childrendied of diseases. Infantile mortality came up to 270–300 per 1000 children, and in some provinces —even up to 400. The mortality of children under 5 was 59 % in the general mortality pattern, in someprovinces - 76 %. Only 5 % of parturients obtained medical aid. About 30.000 women died of postnatalcomplications annually. The average life expectancy was 32 years.

In 1911 the journal «Public Doctor» issued under the aegis of the Society of Russian Doctors incommemoration of Pirogov N.I. published an article of Altzauzen N.F., dedicated to the problem of suck-lings care whose mothers worked at the factories. The article spotlit the idea that prosperity of a kid isachieved only through prosperity of his/her mother, and it should be looked upon as a comprehensivewhole. Besides, the article presented the attitude of the factory owners who tried to avoid solving thoseproblems and unwillingness of the government to interfere in that situation.

Doctor Ljvova after medical inspection of a group of girls working at the manufacture publishedthe following results: 77 % suffered from lagging in sexual development, 88 % mal development of circu-latory organs, every second girl suffered from strong spanaemia, about 90 % suffered from lagging inphysical development up to utter exhaustion.

As concerns sanitary state, Russia was the most adverse country in Europe. The epidemics of spot-ted and recurrent typhus, cholera, plague, smallpox, malaria, syphillis and tuberculosis were frequentphenomena. Preventive medicine was practically absent.

Under such conditions it was necessary to take urgent measures for solving this key problem. Forthe first time in the history of our country it became possible to realize the idea of people public health.

Many concepts were proposed, there was a discord among doctors, which seriously worsened thesituation. The top people of Pirogov society openly objected to establishing state medicine, calling uponto boycott the Soviet regime. Semashko N.A., who was at the head of the Soviet public health care, dem-onstrated unusual diplomatic abilities and within a very short period of time over came the boycott andestablished close relationship with the overwhelming majority of scientists and doctors.

On July 11, 1918 the Council of People Commissioners adopted the decree «About the Establish-ment of the People's Commissariat of Public Health Care». Thus, for the first time in the world the high-est public organ was established, which combined all branches of medical and sanitary business in thecountry. Semashko N.A. was appointed the first people commissioner of public health care of RSFSR.

Medical and social aid was organized for the most vulnerable part of the society as well, therebythe most important one, since it was the future of the state — children. The People's Commissariat ofState Charity was organized in November 1917 (social welfare). The Department of Motherhood and In-

30

fancy Protection was organized under the People's Commissariat and the program of urgent measures forprotecting health of children was adopted.

A school - sanitary division for protection schoolchildren health was created, which soon was re-named as the Division of Children and Adolescents Health Protection.

Only in 1918 under conditions of hunger and ruin 46 houses of child, 66 maternity hospitals, 59 an-tenatal clinics, 47 infant feeding centers , 407 day nurseries were opened in the country. And 1913 1 in-fant feeding center, 9 baby clinics, 19 day nurseries, 1 school for nurses were opened with assistance ofthe charitable organization «All-Russian Trusteeship for Motherhood and Infancy Protection».

The undertaken organizational measures resulted in considerable achievements. In 1925 SemashkoN.A. reported about great success of Soviet medicine in his report of the People's Commissariat of PublicHealth. Thus, mortality level was reduced from 27,9 people per 1000 (in 1913) to 22,7. A sickness ratewith mass infections decreased significantly. One should note that the number of medical health centersincreased rapidly including specialized ones.

A problem of health care manpower training was very urgent. By 1917 there were 17 higher medi-cal schools in Russia. 900 doctors graduated from medical institutes annually. In 1918–22 16 new medi-cal institutes were opened in the country Since 1930 all medical departments got independence and theybecame institutes; by 1935 their number reached 55. Pharmaceutical, stomatological, pediatric depart-ments appeared in them which contributed to establishment of medical universities. Internship, clinicalstudies, postgraduate course were introduced. PirogovN.I. worried about further improvement of doctorsqualification; that is why together with Zdekauer N.F. and Eykhvald E.E., professors of medicine, he putforward the idea of establishment of the Institute of Refresher Training of Doctors. On June, 3rd 1885 withthe blessing of Elena Pavlovna, grand duchess, this project was realized. According to Eykhvald E.E., itsfirst director, professor — therapeutic, personal doctor of grand duchess, the institute was to implementthe idea «of free medical school giving no rights but believing sincerely in love of the Russian people toscience and their conscientious attitude to the sacred duty of treating people».

The problem of establishment of the Institute of Refresher Training of Doctors in Moscow wassolved by the Board of People's Commissariat of Public Health Care in 1928. According to the decisionof the government of Russian Federation the central Institute of Refresher Training of Doctors wasopened on December 1st 1930.

Medical advanced studies turned into a unified state system in 1964.When sufficient number of qualified medical professionals were prepared, it became possible to

turn to scientific work combining it with practical health care.A great number of scientific research institutes and laboratories of state significance were orga-

nized. The academy of Medical Sciences headed by Burdenko N.N. was opened on June, 30th in 1944. Atpresent the academy of Medical Sciences of the USSR bears the name of Russian academy of MedicalSciences and its centers are located in many largest cities of Russia.

A real progress in people health protection is possible, if well organized preventive measures aretaken. Pirogov N.I. stated that «future belongs to preventive medicine». That is why a very important di-rection of Soviet medicine — a preventive one — was initiated. Semashko N.A. was of the opinion thatpreventive measures shouldn’t be looked upon very narrowly as only the task of public health authoritiesbut as the task of the whole state. In this connection measures aimed at health improvement of inhabitedsettlements, public catering organized on the basis of scientific hygienic norms, infection diseases preven-tion, health legislation development, organized struggle with tuberculosis, venereal diseases, alcoholismand other social diseases were taken as well as provision with available and qualified meical service.

Owing to the health care organizers, discoveries and inventions of medical science become publicdomain, to get medical help by all strata of society becomes quite possible. Such an organizer should pos-sess a lot of business qualities including civil courage to initiate solving a problem. There is a well knownfact in the activity of Belostotskiy I.S., the head of the Ural regional health care department. BelostotskiyI.S. started the construction of physiotherapy institute and

Institute of professional diseases before it was financed by the People's Commissariat of PublicHealth. Semashko N.A. threatened to bring him to court for illegal construction. «The institutes will becompleted by all means this year and start to provide Ural workers with highly qualified medical helpwho, being grateful to me, wilk come to visited me to the prison and will bring me parcels. You will beawkward», — answered Belostotskiy I.S.

Our another countryman Bunkin Nikolay Grigorjevich became an organizer of medical serviceagainst tuberculosis in the Ural. This man could find and unite people for solving different complicatedproblems. In April 1925 Shadrinsk tuberculosis dispensary was opened at his initiative. There in 1928 he

31

organized a sanatorium for children suffering from tuberculosis. In 1931 a scientific research institute oftuberculosis was established in Sverdlovsk by the decision of the executive committee of Ural RegionalSoviet of Deputies. In 1932 Bunkin Nikolay Grigorjevich was appointed the head of the methodical -technical department. He writes in his memoirs: «It was my destiny to organize struggle against tubercu-losis within Big Ural and it comprises five regions and two autonomous republics».

Bunkin Nikolay Grigorjevich was a polymathic person, a kind mentor and friend, was of much ac-count in the medical community and among the patients. «He had a big heart», — recollected Z.D. Rep-nitskaya, doctor of medical sciences, working with him. «It didn’t matter for him weather an ordinaryperson or an officer of high rank was in front of him. He did everything he could for everyone as a doctor,a friend, a person».

After the state putsch in 1991 health care system went serious transformations which resulted in thesituation that medical service stopped being available to various strata of society, influence of state bodiesand guarantees reduced and as a result standard of living and health indices of large strata of society de-creased. Scientific medical research without state financial support was significantly limited. Before 1996all reforms in the field of health care were of local character without having support from the state gov-ernment. In 1996–1997 the situation started to improve. It became possible after the government adoptedthe strategy for health care and medical science development, that is after an orderly management andorganization appeared.

Russian health care has a priority in developing unique organizational technologies. Among themone should mention organization of primary care centers, priority of preventive direction in medicine, inparticular, dispensary method of work, wide and strong enlightenment activity, formation of special clin-ics to serve workers of industrial enterprises, organization of health resorts, state system of maternity andchildhood protection.

In modern conditions the role of a specialist — health care organizer doesn’t go down. At presentsuch organizational technologies of providing medical service as family medicine, schools for chronicalpatients, economic methods of management, medical service quality control, medical insurance, hospitalreplacing and information technologies are developed and improved. Their aim is to make medical ser-vice available and of good quality for every citizen of Russian Federation.

NATIONAL SURGICAL ARMAMENTS

I.V. Medvedenko (stud.), K.S. Sinyova (stud.)

Chelyabinsk state medical academyThe department of public health and health care

The department of topographic anatomy and operative surgery

Research advisors: A.L. Citovich (ass. candidate of medicine),O.V. Peshikov (associate professor, candidate of medicine)

What kind of instrument does a surgeon need? Each surgeon preparing for a surgery chooses a setof surgical instruments depending on a type of surgical intervention. Because each experienced specialistknows «Convenient instrument means successful and quick operation». That is what told us a greatfounder of Russian field surgery Nikolay Ivanovich Pirogov.

Being abroad Pirogov saw carefully-composed surgeon kits of Grefe and Langenbek. The instru-ments in those kits were designed inventively but selfishly. They were the instruments only for A. Grefeor only for Langenbek. Designing them a surgeon thought only about himself. [1]

Only those could operate in A. Grefe’s hospital who followed two main regulations: to operate us-ing Grefe’s method and with obligatory use of the instruments designed by him. Nikolay Ivanovich told«Grefe was satisfied but he didn’t know that I could have made all those operations ten times better if Ihadn’t made them with inconvenient instruments».

Soon after coming to the capital Pirogov was designated to be a Director of engineering in St. Pe-tersburg medical instruments plant.

Peter the Great even in his times ordered: «To construct medical instruments in the General phar-macy». So they did. At the beginning of the last century at this plant a bondman Semen Badaev inventeda new method of steel preparation; the steel was called after him. The steel was distinct in a lot of valua-ble characteristics that improved the quality of instruments [2].

32

Designing new kinds of instruments and improving the old ones Nikolay Ivanovich didn’t repeatselfish mistakes of his eminent teachers. He imagined not a surgeon but a surgery. His idea was to designinstruments using which any surgeon was able to make quickly and successfully this or that operation.Not the instrument for professionals but the instruments to become a professional.

Pirogov knew how important for the success of surgery it was to have what is necessary at hand.He combines sets anew — fits of instruments. Under his rule the plant produced kits aimed at differentlevels of healthcare: feldshers and doctors pocket kits, kits for staffrooms, squadrons, regiments, corps,hospitals as well as obstetric and veterinarian. Each was designed sticking to the main principle: every-thing necessary, nothing excessive [1, 2].

«Before I start to describe each instrument I believe it to be necessary to state the principles that Iwas ruled by while combining these kits» Pirogov writes in his note.

He noticed as well «While combining doctor’s pocket kit I think especially of the way how to in-sert in little space first instruments used for so-called minor surgeries i.e. for bloodletting, lancing an ab-scess, wound suturing, embedment extraction and so on; and secondly instruments necessary for surgerieswhich admit no delays such as constricted hernia surgery, tie of artery, trachea disclosure and so on.

What comes to feldcher’s pocket kit it also has to fulfill two functions: it has to contain instrumentsnecessary for surgeries provided in hospitals usually by feldshers… and also instruments for minor opera-tions made by doctors in hospitals during the visitations».

Pirogov thoroughly and demanding evaluates quality of each surgical instrument. The worth of aninstrument is determined not only by its solidity and applicability to certain operations but also by con-venience of its construction for a surgeon. [3, 4]

While a scientist worked on a post of the Director St. Petersburg medical instruments plant left farbehind best foreign companies goods in matters of quality and perfection of produced instruments.

N.I. Pirogov used his lead-and-silk thread that had some distinct advantage over other kinds of ma-terials for stitches. His ligature needle also gained acceptance.

At the direction of the scientist the plant started to produce a device for deflation of toxic from astomach, great and minor scarificators (bloodletting cubes). It was he who modified latent lithotomeaimed for surgery inside bladder. At that period N.I. Pirogov modified Heines osteotome (special compli-cated chain saw for bone surgery). By his order the plant designed improved prosthesis named «Pirogov’slightweight leg» and prosthesis of a foot for those to whom he made surgery of ostheoplastic extension ofa surae with foot extirpation, this type of operation became a parent of all ostheoplastic operations. Alsothey designed aneurism needle, kit for staphylorraphy, orthopedic apparatus for clubfoot cure, prosthesisfor ostheoplastic foot amputation.

In conclusion we can say that Nikolay Ivanovich Pirogov developed some kits of instruments thatserved to Russian surgeons for a long time. Most of the instruments are being used still, a lot of lives willbe saved with their help.

�A%'/( "%,!3+,23G:1. �+&%B!., �L�. �+ �A,!(+3'(/4 /',3/.!. — �., 1957. — �. 62.2. �+"%', �L�. �%(/"+@ �%3/1/.. �1/ F%)&-, &+2B&+# % /$�!',.!&&+# *!#,!"-&/',-, �����.

— �. 1244. — �A. 2. — �. 667. — �.. 117. — �. 2.3. �%3/1/., �L�. �+B+"+ /$�!@ ./!&&/NA/"!./@ D%3231%%: 2-# B. — �. — �., 1944. — �. 2.

— �. 498.4. �/32*/4%&'(%@, . �%3/1/. %) 5%("+ (&%1 «�%)&- )+4!B+,!"-&GD "�*!@».

PIROGOV — SURGEON AND EDUCATOR

M.L. Mukhanov (resident medical practitioner)

Kuban state medical universityThe department orthopedics, traumatology and military field surgery

Scientific adviser: E.G. Lysykh (ass. prof.)

The great Russian surgeon Nikolay Ivanovich Pirogov was born in Moscow, in a military official'sfamily, on November 13/25, 1810. His father, Ivan Ivanovich Pirogov, was a treasurer in Moscow supplydepot and had the rank of a major. His grandfather, Ivan Mikheich Pirogov, had peasants origins and wasa soldier. Nikolay Pirogov got his secondary education at home first and continued it later in a privateboarding school. When he was fourteen, he enrolled in Medical Faculty of Moscow university.

33

Having graduated from the university in 1828 and received the degree of a healer, he was sentabroad to prepare himself for professorship. Pirogov got his Professor's degree at the age of 26 and tookcharge of the surgery clinic at the university of Dorpat. Five years later (in 1841) Pirogov was invited toPetersburg Medical surgery academy where he worked for almost 15 years (1841–1856) until his resigna-tion. Here, he established the institute of anatomy which was the first in Russia.

He was very popular with common people and wide students community. He was loved for hissimplicity, nobleness and unselfishness. He gave treatment to poor people for free and often providedthem financial assistance. This outstanding doctor and scientist, educator and public person devoted allhis life to whole-hearted service to Russian science and people.

Nikolay Pirogov is remarkable for the many principally new things he brought to medical science,education science and philosophy. Not only the value of his ideas has not been lost till today, the fertilityof their inner resourcefulness is revealed more and more with time and their significance for the medicalscience and public healthcare is growing constantly.

It is common in Russia and abroad that Nikolay Pirogov is considered to be the founder and themost distinguished person in military field surgery. But it is only the experience of modern wars, espe-cially World War II, that made utterly clear how deeply thought-out and almost absolutely evident thebasic principles established by Pirogov as guidelines for a field army medic are. The great corner stone ofmilitary field surgery laid by Pirogov is the principle of sorting the wounded, the requirement of strictlydifferentiated tactics of a surgeon for various severity of wounds and at various stages of evacuation frombattlefield to rear area hospital. The method of «sparing treatment of wounds» was exceptional in terms ofdeepness of medical thinking at the time when no antiseptics were available. One of the real manifesta-tions of this method was the famous «Pirogov’s» plaster bandage. In 1854, Pirogov published his famous,truly brilliant, osteoplastic foot operation, or, as it was called, «osteoplastic elongation of lower leg boneswith foot extirpation». Soon the operation was widely recognized and used due to its main principle —creation of strong «natural» prosthesis while keeping the length of a limb. The great idea of the above-mentioned Pirogov’s operation gave an impulse to the further development of osteoplastics for the foot aswell as for other parts of body.

Pirogov’s mastership as a surgeon was based on solid foundation of precise and full knowledge oftopographic anatomy and physiology. There are such worldwide-known records of that titanic work as«Surgical Anatomy of the Arterial Trunks and Fascia», the famous Pirogov’s Atlas of Fascia based on themethod of sawing frozen corpses and finding the normal position, interconnection and interrelation ofhuman organs («sculptural» or «ice» anatomy). These capital writings gained wide popularity at once,and Nikolay Pirogov was recognized worldwide as the most prominent expert in surgical anatomy. Thetimelessness of these writings is demonstrated in particular by the fact that today they appear in a newperspective: the «cross-sections» of the human body made by means of a computerized tomography scan-ner fully match with «Pirogov’s» «cross-sections» of frozen corpses; major guide books and atlases showboth of them together: computer-generated «cross-section» and the corresponding «Pirogov’s» one,which is clearer and more precise.

Pirogov’s attitude towards the critical analysis of his own work in general and surgery in particular,should be considered exceptional, taking into account his excellent education in topographic anatomy,high surgeon’s skill and his glory of an outstanding operator. Like no one in the world’s medical history,he analyzed his every mistake scrupulously in public, deeming it to be useful for himself as well as forother surgeons. «I took it as a rule for myself when I first entered the Chair to conceal nothing from mystudents and reveal to them any mistake I would make, if not at once then later and without delay, be it indiagnosis or in treatment of the disease». Pirogov’s main idea in education science that runs as a goldenthread through his numerous writings is firstly the necessity to provide, as much as possible, the condi-tions for unconstrained development of natural talents a human may have, and secondly, bringing humansup in the spirit of humanism, democracy and high civic consciousness. He is known for his opinion thatuniversities needed more autonomy and easier access without any rank- or nationality-based restrictions,and that early specialization without prior humanitarian education was wrong. Nikolay Pirogov believedthat the maximum effectiveness of education in a university can only be achieved if there are no elementsof involuntariness in the education process, if lectures can be attended freely, if professors lecture mostlyon their own findings in science and what is not written in textbooks. Pirogov’s special attention was fo-cused on demonstrativeness of education and the necessity for students to gain practical skills. He empha-sized that the education for young specialists should be a blend of «scholar» and «scientific» aspects. Ni-kolay Pirogov was virtually the first one to raise a concern about training highly-qualified teaching staff.He insisted on periodic advanced skill improvement for specialists and teachers. He required that Chair

34

professors were selected on a competitive basis and not appointed. He thought that periodic renewal ofeducational establishments with fresh teacher forces was absolutely necessary, that part-time work wasunacceptable and suggested raising teachers’ salaries to prevent that.

The image of the greatest doctor cannot be fully revealed and understood if we think of him as aprominent operator only, as we should not forget that this talent was combined in Pirogov with excep-tional clinicist’s talent. Pictures of shock, dynamics of wound process, its infectious complications, espe-cially gaseous gangrene, wound dystrophy, malignant and benign tumors, aneurysm, tuberculosis weredrawn by Pirogov so precisely and brightly that they remain unsurpassed until the present day and arereferred to as classical by many authors.

In fact, Nikolay Pirogov belongs to the few scientists in the world who were the closest to find asolution to the problem of fighting the post-operation infectious complications (J. Lister, I. Semmelweis).Practically all of his clinical works, especially the ones relating to military field surgery are literally satu-rated with deep thoughts about the causes of infectious complications, measures to fight them and preventthem � extensive ingress of fresh air to patients’ rooms, separation of patients with suppurative complica-tions from the rest of the patients («spreading» of the wounded), prevention of overcrowding in hospitalrooms, requirement of maximum cleanness etc. He got very close to the idea of a microbe as a live causa-tive agent of suppurative processes. «Miasma is not, like poison, a passive aggregate of chemically actingparticles: it is something organic, able to develop and reproduce». Pirogov was the first one in the worldto use ether anaesthesia at war.

October 16, 1846 is a remarkable date not only in the history of surgery but also in the history ofhumanity. On that day, a major surgical operation was made under full ether anaesthesia.

Another thing worth to be mentioned separately is Pirogov’s progressive thoughts about the ne-cessity of education for women and their wider involvement in public and scientific life of the country,in the issues of medical service organization and his attitude to the absolutely new practice of usingsisters of mercy at the battle ground. While high-rank Czar officials made cynical remarks about thisinitiative, Nikolay Pirogov became in fact the leader of this remarkable patriotic campaign of Russianwomen.

In the history of the world's medicine, Nikolay Pirogov impersonates the ideal image of a doctor �equally great thinker, practitioner and citizen. This is how he remains in history, this is how he lives on inour memories today serving a great example for new and new generations of Russian doctors.

�A%'/( "%,!3+,23G:1. Pirogov, N.I. Collected Writings. — �oscow, 1960. — V. 7. — P. 217.2. Streich, S.L. Nikolay Ivanovich Pirogov, Magazine / Newspaper Assocoation, Moscow, 1933.3. Smirnov, E.I. Pirogov N.I. — A Figure in Battlefield medicine. Readings from Pirogov, 1960. —

Moscow, 1961.4. Pirogov, N.I. Military Medical Practice. — Saint-Petersburg, 1879. — Ch. 2. — P. 9–11.5. Pirogov, N.I. // N.I. Pirogov. Selected Educational Writings. — Moscow, 1953. — P. 492.6. Pirogov, N.I. // Selected Educational Writings. — Moscow, 1953. — P. 731.7. Pirogov, N.I. // Selected Educational Writings. — Moscow, 1953. — P. 137.8. Pirogov N.I. // Selected Educational Writings — Moscow, 1953. — P. 403.

MEANING OF LIFE AS VIEWED BY THE OUTSTANDING SCIENTIST

M.Y. Pirogova (graduate)Chelyabinsk state medical academy

The department of psychiatry

The first pedagogical work of N.I. Pirogov under the heading ‘Life Issues’ was published in 1856.It was bound to become some kind of a plan of developing of pedagogics in Russia. In his article NikolayIvanovich describes main goals and objectives of upbringing in the light of information about a human. Itdeals with issues of social life, with the life of every human in the society, with his or her relationshipswith other people, with inevitability for everyone of us to resolve an issue of our personal attitude to so-cial needs and duties.

In his article «Life Issues» N.I. Pirogov severely criticizes the class school, he contrasted the offi-cial course of establishing to the idea of panhuman upbringing which should prepare a man of good mor-als with the broad-based knowledge for the social life.

35

The publication of the article of N.I. Pirogov had attracted great public attention. Thanks to it Piro-gov attracted public attention to himself by his advanced ideas about panhuman upbringing. The articlewas commented by famous public persons. Since then issues of education and upbringing has become oneof the main issues in the society. The social importance of the pedagogical activity has been admitted.

In his work Nikolay Ivanovich discussed the problem of the goal of upbringing, its contents in con-nection with issues of the essence of human nature, of the meaning of life.

In Pirogov’s opinion, the demonstration of the true essence of a human is expressed in his or herstriving for finding an answer about the meaning of our existence: « In the roughest misbeliefs of the pa-gan ancientry, which are always based on famous moral and religious principles and convictions, the mostsignificant attribute of the spiritual nature of a human — that is, striving for resolving the issue of lifeabout the goal of being — is demonstrated ». Depending on natural instincts and on the character of up-bringing, the majority of people choose this or that solution of the problem of the meaning of life which isaccepted in the society.

N.I. Pirogov emphasizes that many people do not even think of the meaning of their existence andnevertheless they are happy! The reason of this is that some of them «got a crummy privilege for idiotismfrom nature» and others live mechanically, thinking about nothing. Pirogov analyzes ways to resolve suchcontradictions: «One should either coordinate moral and religious foundations of upbringing with the realdirection of the society or alter the direction of the society or, at last, with the help of upbringing prepareus for the inner struggle, inevitable and fatal, also delivering us all ways and all the energy to survive inthis losing battle».

Nikolay Ivanovich was a follower of the ‘panhuman’ upbringing. Not depending on his or her tal-ents and vocations, every child should become a human in the full sense of this word. To begin with, forthis it is necessary to provide liberal education for children. N.I. Pirogov defines a knowledge which isnecessary for everyone and which is handed down from generation to generation and always remain as«lamps on the life journey both ancient and new human».

The goal of this upbringing should be not just handing down some professional knowledge andskills, not upbringing of «negotiants, soldiers, sailors, priests or lawyers », but upbringing of a personali-ty, its characterful and moral qualities, upbringing of an inner human: «Do not hurry with your appliedreality. Let an inner human grow and become strong; an outside human has got a lot of time to act: he orshe, who will come out later, maybe, is not so skilled..., but he is more reliable; he or she will not do whathe or she should not do».

Being a scientist, a doctor and just a human, N.I. Pirogov always advocated for the honourable hu-manist ideals, he was distinguished for his democratic character, civic consciousness, rectitude and unsel-fishness, honesty and striving for the scientific truth.

�A%'/( "%,!3+,23G:1. �B!3(% A/ %',/3%% I �/'(/.'(/1/ %&',%,2,+ %4!&% �L�. �!B!&/.+. — �.: �!*1%), 1959.2. �!,32&%&+, L�. �3/$"!4G '4G'"+ F%)&% . A!*+1/1%(! �L�. �%3/1/.+. — �/?%#: �2(/-

A%'&G@ F23&+" �$�!',.+ 3!.&%,!"!@ 32''(/@ ?%"/'/?%%. — � 1/2000.3. �%3/1/., �L�. �/$3+&%! '/B%&!&%@ . ./'-4% ,/4+D. — �!*1%), 1957–1962.4. �/32*/4%&'(%@, L�. �%)&-, ,G 5!"-� 4&! *+&+! — �.: �/". �.+3*%#, 1981.5. �/3/(%&+, L�. �',/3%# 4!*%5%&G: 2B!$., 8-! %)*. — �.: �� «�(+*!4%#», 2008.

N.I. PIROGOV’S ACHIEVEMENTS IN THE DEVELOPMENT OF ANESTHESIOLOGY

A.D. Ponomareva (stud.)Chelyabinsk state medical academy

The department of public health and health care

Scientific adviser: I.S. Tarasova (lecturer), A.S. Divisenko (ass.).

Several thousand people have been trying to find the means and methods of pain relief. They arestarting to develop in many countries, such as India, Egypt, China, etc. During the surgery, patients oftendie, but not from a disease wounds inflicted great harm to their body, and severe pain. And the first onewho has contributed to the development of anesthesiology was Nikolai Ivanovich Pirogov.

In autumn 1846, Nikolai Ivanovich began to study the influence of ether on a living organism. Dur-ing the experiments, and scientific experimentation Pirogov tried to find as much data and informationabout the properties of the ether, and its impact on the tissues and organs of the organism.

36

Almost a year of their studies Pirogov spent nearly 60 animal experiments on himself, on his assis-tants and volunteers.

In the study of Nikolai included:- The actions of ether on the nervous tissue;-Action-air introduced into the blood (veins and arteries);-The action of ether by inhalation of its vapor;-The action of air introduced through the rectum;In 1847, Pirogov conducted experiments in which air was injected into the dura. This type of anes-

thesia is used to this day and is called — epidural anesthesia.As for the experiments conducted in the bloodstream, the Pirogov watched them in the peripheral and

central arteries and veins. As a result of these experiments, it was found that after the introduction of air intothe bloodstream occurs instant death, because of the transition from a liquid to air in pairs. This was con-firmed at autopsy: the inferior vena cava and the right half of the heart were found numerous bubbles. Butwith the introduction of ether vapor into the femoral artery first comes the hind limb anesthesia, and thenanesthetized, and death does not occur. On this basis, Pirogov concluded that if the essential pair gently in-troduced into the central end of the vein, there comes narkotizirovanie, as well as the inhalation of ether.

Also in the study of air Nikolai tried to carry anestezirovanie by inhalation of its vapor. This typeof anesthesia was performed with a rubber tube, which is inserted through a tracheotomy hole. This me-thod can be compared with endotracheal, which is now widely used in modern medicine.

Several experiments devoted to the study of the Pirogov air on the body in liquid and vapor phaseis introduced through the tube into the stomach, intestines, and rectum. In the experiment on the rectumhas been proved that the liquid ether, which has a boiling point of 35 degrees Celsius, is becoming acouple, thus there is a strong irritant to the rectum, then there is swelling of the sigmoid colon and the en-tire colon, there are strong pain and the ejection of ether vapor through the rectum. This experience Piro-gov conducted on dogs.

Inhalation anesthesia was first used by Nikolai Ivanovich, only palliative purposes, his patient wasa woman of 30 years, who had breast cancer. Among the side effects were only dizziness and nausea.Pain during the surgery she did not feel. A little later, Pies has used inhaled ether and dressings. His firstpatient was a girl after amputation.

Cakes made for the year of about 300 operations under ether anesthesia, that is personally spentalmost half of all Russian ether anesthesia for 1847 (only in Russia in February 1847 to February 1848were produced 690).

Pirogov with the introduction of ether anesthesia and the onset of the different states observed inhumans. In his opinion, it was up to the different states of the central nervous system. Therefore, therewas a very important principle, which is used in our time — «Each patient has its own anesthetic».

Pirogov singled out several types of patients' state:1. Quick, without excitement, the onset of sleep. Basically this type had children and thin people.2. Strong excitement - people have strong, muscular drinkers.3. Hallucinations and peaceful sleep with little restlessness.4. The disappearance of sensitivity before losing consciousness. But this type are very rare.During anesthesia, Pirogov singled out the following symptoms: loss of consciousness, pupil dila-

tion, groans, body movements, relaxation or seizure of their reduction and automatic (involuntary)movements.

Very important are the study of rectal efirovanii Pirogov. It can fully assume the founder of the me-thod of anesthesia through the rectum. In - the first of rectal anesthesia does not irritate the respiratory,anesthesia and anesthesia occur independently of the will of the patient, there is no excitement and calmcomes a deep sleep.

After numerous N.I. Pirogov conducted research identified evidence for rectal anesthesia: the diffi-cult and lengthy operation, surgical cases, which require high muscular relaxation, contraindications, andan inhalation anesthetic, a therapeutic agent for spasmodic states gastrointestinal tract, urinary organs andvoluntary muscles in veterinary practice. Contraindications also identified in the study: inflammatory bo-wel disease, the accumulation of feces in the colon, etc.

Nikolai IvanovichPirogov for all his many studies of Anesthesiology has a simple, but very impor-tant point «operation carried out without pain, it is much safer than with pain». Many of the techniques,indications, contraindications, the findings Nikolai Ivanovich, and still used in many areas of medicine.

�A%'/( "%,!3+,23G:1. Zhorov, I. General anesthesia. — Acad. «Medicine», 1964

37

2. Geselevich, A.M. N.I. Pirogov. — M.: Medicine, 1969.3. Avis, P.B. Comments on labor Pirogov «Observations on the influence of ether vapor as boleuto-

litelnogo tools in surgical operation». — M., Medgiz, 1959. — T. III. — S. 466–470.

REMEMBER AND APPRECIATE OUR GREAT TEACHERS

N.M. Shlepotina (intern)

Chelyabinsk state medical academy1 The department of microbiology, virology, immunology and clinical laboratory diagnostics

2 The department of topographic anatomy and operative surgery

Scientific adviser: 1 M.V. Peshikova (senior professor, Ph.D. in medical sciences),2 O.V. Peshikov (associate professor, Ph.D. in medical sciences)

Every age in history of science is characterized by dominating definite theories, views, paradigmsand convictions. However, these convictions are no more than interpretations, which are considering astruth. For example, in last time the majority of people were convicted, that the Sun was hot coal and itrevolved around the Earth, that atoms were not divided… When these dogmatic views are refuted bysome scientists, the society resists to this challenges usually, even if scientists support their theories bynumerous reliable data. All scientific facts pass through so called «intellectual filter». And facts confirm-ing well-known theories pass through this filter easy. Ones spread among the scientists and students soon,also these facts are described in many textbooks. But facts contradicting the generally accepted theoriesremain known to a small group of people. After some time the critical mass of people will assimilate theinnovations and extraordinary theories will be accepted by the society. We can only guess what the resis-tance of ruling power, scientific dogmata and society was overcome by many prominent scientists. Due tothese scientists we can observe the highest level of scientific and technical progress today.

The destiny of the great scientist, surgeon, anatomist and talented organizer, N.I. Pirogov, did notbecome an exception. Some Russian physicians considered, that Pirogov «did not come out so colossusgenius, intelligence and self-sacrifice to the government and the people, as he was really, only because hehad no sympathy and support of the military medical administration». And was it only the military medi-cal administration? Officials of the Ministry of National Education and the majority of professors of theMedical-Surgical academy, educated at J. Wylie, treated to him no better and Thaddeus Bulgarin publiclyridiculed him in the «Northern Bee».

When Pirogov suggested establishing the Anatomical Institute at the Medical-Surgical academy, itcaused a strong resistance on the part of the administration and faculty. Paradoxically, but they arguedthat practical anatomy classes will do harm to other necessary disciplines. But Nikolay Ivanovichachieved the appointed purpose, and medical students began to study human anatomy directly and clearly— as it is studied today.

In the 1841-1856 years Pirogov led clinic hospital surgery, where he collided with evident hostility,envy and slander. His attempts to introduce measures for asepsis and antisepsis caused perplexity and in-dignation, and the suggestion to introduce in work of the hospital a special clothing — surgical coat - wasmet with hostility: for his innovation Nikolay Ivanovich had to spend 3 days in a psychiatric clinic.

Being in the theater of hostilities during the Crimean War, Pirogov had to himself fight against em-bezzlement and extortion of officials, for which in addition to the awards he received a reprimand fromthe war-lord Alexander Gorchakov for not courteous attitude to the authorities.

In follow years (1856–1861) when Pirogov served as trustee of Odessa and Kiev school districts,his reformative activity caused suspicions in freethinking and undermining of the regional authorities. Butin fact, Pirogov strived to keeping of morality and laws at the university, to create all the conditions forthe education of a highly moral, intelligent and cultured «inner human». Unfortunately, being misunders-tood, N.I. Pirogov was dismissed by imperial decree. At the height of his creative powers he was forcedto retire in his estate of Vishnya under Vinnitsa. But even then Pirogov continued to treat people, organiz-ing free hospital in the estate. He helped and cured the wounded men on the battle fields of the Franco-Prussian (1870) and the Balkans (1877–1878) wars; he carried out analysis of the military-medical affairsin Germany, France and Russia. But in science Demidov Prize winner could not do anything ... Next toPirogov a mediocrity felt uncomfortably. Even genuine talents faded in the glow of his superhuman ge-nius. Those who were at the helm of power prevented Russia, Russian medicine in the first place, to fullyexperience the intellectual and creative potential of Pirogov.

38

But this situation is not a paradox, but rather it is norm in the world of science. And there are a lotof examples of this.

Auenbrugger Leopold (1722–1809) — Viennese physician who worked out the method of percus-sion. He grew up in a family of wine merchants and often watched, as innkeepers knocked the barrels tomeasure a level of wine. Auenbrugger supposed that it was able to examine the condition of inner organsin this way. The results of seven years of careful clinical observations that are associated with these dis-sections, he set out in his treatise «The new method, as by percussion of the chest to diagnose diseasesinside the chest cavity» (1761). But the new method has been met with hostility as the Viennese physi-cians as their patients, because they got used to examination of pulse. Percussion opponents were sucheminent European physicians as Gerard Van Swieten and Anton de Haen. The Auenbrugger`s treatise notpaid any attention, and the percussion was adjudicated as method, which was «not worthy of a doctor». In1768 Auenbrugger was forced to quit his job at the hospital. His fate was tragic: the last years he spent ina psychiatric hospital, where he died in 1809. He did not find out about the wide acknowledgement of hismethod. After 47 years, in 1808, Jean Nicolas Corvisart published the translation of treatise with approv-ing comments and the results of own observations. But today a physician of each specialty uses the per-cussion in casual activity!

Ignaz Semmelweis (1818–1865) - Hungarian physician, one of the founders of asepsis and antisep-sis. In those years humanity didn’t know about the microorganisms and, especially, about their role in thedevelopment of sepsis. Hospitals made a disheartening impression; there were dirt, bad smell and lack offulfillment of any sanitarian and hygiene standards. Semmelweis, working as an assistant at the Viennaobstetric clinic, try to understand why the death rate from puerperal fever in the department, where theystudied students reached 36 %, while in the department, where students were excluded, the mortality ratewas low (about 2.7 %). He made a resplendent suggestion that puerperal fever had an infectious origin,which transfered through dirty hands of students who came after the dissection of corpses. In those yearsit was considered sufficient to wipe napkin the hands after work with cadaveric material. Semmelweisunderstood the cause of rampant epidemic among the puerperants and proposed the method of protection- the using of chlorinated lime solution for washing hands of medical staff handling before any manipula-tion. However, this innovation was not accepted his colleagues and the one caused a sharp criticism. EvenRudolph Virchow refuted this idea. Semmelweis could not prove his opinion, even when he together withassistant of Karl von Rokitansky, Lauthner, made nine experiments on rabbits, introducing them into theblood a secret from the uterus of puerperants with sepsis, and the rabbits fallen ill.

At the same time a high death rate of puerperal fever was explained the most incredible way: someconsidered that women was ill, when they admitted to the clinic; that priest, who wore a ringing bell, goton one`s nerves; that women, giving birth in the presence of men, felt shame, etc. Clinic Director, Dr.Klein, prohibited the publishing statistics of decrease of mortality after the introduction into the clinicalpractice the hand washing with chlorinated lime solution. He dismissed Semmelweis of Vienna clinic,though the results were stunning: the mortality in the department decreased to 1–3 %! Semmelweis wasforced to go to Pest, in Hungary, where he worked as a doctor in the obstetric department at the hospitalof St. Rochus. In 1850, he got degree of private-docent with many difficulties. Also, he was limited in hisrights, because he could teach only on models. In 1858–1860, when he was a professor, Semmelweis pub-lished a number of articles about puerperal fever and his classic work «Die Aethiologie der Begriffunddies Prophylaxis des Kindbettfiebers». However, describing material found few supporters. And in 1861–1862 he wrote five letters (four ones to prominent doctors and the common letter to obstetricians), inwhich he explicitly stated that he would inform the society about the dangers emanating from obstetri-cians who did not wash their hands in a chlorine solution before gynaecological examinations. But he re-mained an unnoticed. Semmelweis unheard by his contemporaries ended his life in a mental hospital inDoebling and died ironically from sepsis, as shortly before admission to hospital he did the autopsy ofinfant and injured finger ... During Semmelweis' life his discovery was not recognized adequately. Onlyafter years, when the society acknowledged the research works of Joseph Lister, Robert Koch, Louis Pas-teur, in 1906, in Budapest, it was a monument to Semmelweis with the inscription «Saviour of mothers».

It's amazing, but the way of Nobel Prize winner Mechnikov (by the way, he was one of the scien-tists who patronized by Pirogov) to the universal recognition was thorny. After detecting in Messina la-boratory of phenomenon of phagocytosis in starfish maggots, he had to endure 25 years of discussionabout the possibility of cellular immunity with such prominent opponents as R. Koch, P. Ehrlich, E.Buchner, R. Pfeiffer, E. Behring. Then most scientists adhered to the humoral theory of immunity, whichsupported by the resplendent achievements of this: the discovery of chemical vaccines, the detection ofbactericidal properties of blood, the discovery of antitoxins and successes of serotherapy. At first Mech-

39

nikov did not find support even in Russia. However, Virchow was on the side of the I.I. Mechnikov, be-cause he patronized all the adherents of cellular theory. Also, Louis Pasteur always sympathized with theRussian scientist. It should be noted that Mechnikov never denied the concept of humoral immunity, justtrying to combine both theories. Gradually the number of supporters of the theory of phagocytosis in-creased. In the future, and R. Koch admitted the rightness of I.I. Mechnikov. Great scientist had defendedhis discovery, and the world learned that there are both humoral and cellular immunity.

Now, when we entered the new millennium the discoveries of prominent scientists affect our col-lective consciousness, more than ever. In our views of the human body, its structure and function occurs asignificant shift. This opens up unprecedented possibilities for ensuring the health and longevity.

THE ROLE OF ACTIVITY OF RUSSIAN DOCTORS ASSOCIATION IN MEMORYOF N.I. PIROGOV AT THE END OF XIX — BEGINNING OF XX CENTURIES

N.M. Shlepotina (intern), K.S. Sinyova (stud.)

Chelyabinsk state medical academy1 The department of topographic anatomy and operative surgery

2 The department of microbiology, virology, immunology and clinical laboratory diagnostics

Scientific adviser: 1 O.V. Peshikov (associate professor, Ph. D. in medical sciences),2 M.V. Peshikova (senior professor, Ph. D. in medical sciences)

The beginning of social movement in Russia is connected to early modern period. The major pre-mises to the development of social initiative and doctors community consolidation started to form at thesecond half of XVIII century in the reign of Ekaterina II. Alexander II reforms were attended by noticea-ble liberalization of legislation regulating social organizations activities, which triggered their growth. Atthe second half of XIX century due to recovery of social life and non- governmental institutions activityextension there happened noticeable differentiation of society, including occupational pattern. At that pe-riod Russia was seriously behind European countries in the sphere of public health. The reasons for thatwere unsatisfactory level of healthcare organization, extremely unfavorable life conditions in countriesand absence of simple hygienic knowledge among population. The situation worsened because in thecountry there were no single centralized managing body for health and sanitary, which at that time wascoordinated by Medical Department of Ministry of Internal Affairs, as a result there started the process ofbasic self-administration principles formation. So, at the second half of XIX century social and economicconditions for territorial reform formed. With the united efforts of district councils and doctors originalterritorial medicine was founded, it was the system of country-side population medical treatment, whichbecame the absolute state priority of Russia having no analogies in the world’s practice. Objective need ofhealthcare profession in constant advance and collective sharing experience as well as doctors’ realizationof their professional and civil responsibility for preservation of people’s health — all these inspired for-mation of basic principles of professional management in healthcare sphere which found expression inorganization and carrying out of provincial conferences of doctors the first of which was organized Tverprovince in 1871. First provincial conferences were irregular nevertheless it was important stage on theway of doctors’ body corporate. The experience of regional cooperation formed the basis of foundation ofRussian doctors association in memory of N.I. Pirogov and carrying out of all-Russian doctors’ confe-rences n memory of N.I. Pirogov.

At first this idea formed in May of 1881 in Moscow during the celebration of 50 anniversary ofscientific, medical, educational and public activity of N.I. Pirogov. During the celebration a meeting ofgreat scientists of Moscow and St. Petersburg took place, they were students and esteemers of N.I. Piro-gov’s talent. They considered it to be necessary to pay the tribute to the memory of great Russian surgeonestablishing doctor’s association in his memory in purposes of further perfection and development ofmedical science and practice. With the initiative of academician A.Y. Krassovsky foundation-members ofthe Association collected cash fund of more than 1100 rubles. In 1883 on November 23d the project ofMoscow - St. Petersburg Medical Association charter was officially approved, it was worked out by pri-vat-docent of Moscow university A.N. Solovyev and professor N.V. Sklifosovskiy. Conferences in mem-ory of Pirogov in the process of their activity came through 3 basic stages: 1) 1885–1894 — first five con-ferences, 2) 1895–1916 — includes activity of VI-XIII conferences, 3) 1917–1919 — includes 3 emer-gency conferences.

40

The first conference of Moscow - St. Petersburg Medical Association triggered the organization ofmultiple medical societies on different specialties in Russia. So, for example, Russian Ophthalmologicalsociety was founded. Moreover, the members of the 1st Conference offered to organize constant scientificexchange between Association in memory of Pirogov and other provincial medical societies, and later tounite into All-Russian Medical Association in memory of Pirogov. Thus in July 15, 1886 the Associationwas renamed into «Russian doctors association in memory of N.I. Pirogov» and it saved this name duringall the period of its activity.

The period of the Association formation and carrying out its first conferences was characterized bynoticeable consolidation of territorial doctors, as well as rise and revival of territorial medicine in thecountry. Even during the first conferences they started to actively discuss the issue on necessity of organi-zation in Russia of high medical representation as independent Ministry of public healthcare. One of thefirst to be severe criticized was the law on Pharmacy Monopoly which served as an official protection forpharmacists who set extremely high prices for pharmaceuticals making them literally inaccessible forpoor social groups. The Association mainly paid its attention to the development of public health andmedical statistics. Members of II Conference in memory of Pirogov wrote the petition to the governmentabout the transferring of public statistics to territorial institutions, also they decided to found a committeefor development of project of new Sanitary charter. Within a framework of improvement of medical edu-cation they offered to institute the teaching an additional course of territorial medicine in universities.

Members of III Conference in memory of Pirogov initiated the creation of constant central bureaufor gathering and generalization of medical and statistic information on public healthcare within the coun-try. In January 8, 1886 Medical board of Ministry of Internal Affaires formed a special working group forworking out the issue of sanitary conditions improvement and mortality reduction in Russia. The activityof this Committee was first aimed at cooperation with Russian doctors association in memory of N.I. Pi-rogov. Except that on III Conference they admitted the necessity of foundation in territorial authorities ofcollegiate boards for deciding medical and sanitary questions (would-be sanitary committees and sanitaryboards). So they took a course to working out of common for the whole country program of sanitary andstatistic research and development of logical system of medicine and sanitary management. The founda-tion of united diseases nomenclature which was confirmed in 1990 was also the important step on thisway. Besides they came to a decision of publication of Territorial medicine edition with the purpose ofstudying of history of territorial medicine history, of stating the advantages and disadvantages of its or-ganization in different provinces as well as generalization of territorial medicine experience through thewhole period of its existence.

Choleric epidemics in 1891–1893, wide spread of venereal diseases, tuberculosis and typhoidamong population found their way in the activity of the Association in memory Pirogov. During the regu-lar V conference they clearly stated the reasons for sanitation-and-epidemiological troubles, these wereignorance and poverty. That was why the Section of public health started to actively work out activitiesaimed at wide spread of hygienic knowledge among the population through the quickest review of existedmedical knowledge, improvement of their quality, increase of circulation and carrying out public lections.Within the administration of the Association in memory of Pirogov they formed a constant committee fordiffusion of hygienic knowledge and school hygiene which appealed to assistance of public conscientiousattitude formation to epidemiology. In the years of Soviet system methodical groundwork of that Com-mittee formed scientific basis for Museum of social hygiene and healthcare exhibitions also it becamewidely used in Soviet social and health education. The important result of the first Conferences in memo-ry of Pirogov’s activity was writing of petitions for renewing of female medical courses, for review,change and addition of the law on manufacturing medicine.

Being decent successors of Pirogov’s mission members of the doctors Association in memory ofPirogov always remembered about their teacher and preceptor. In December 1890 Administration of theConference asked the government about starting the subscription for building in Moscow of monument toits honorary citizen. Expenses on working out of the project and building the monument of N.I. Pirogovwere almost on the whole raised by doctors during 6 years.

The activity of the VI–XIII Conferences in memory of Pirogov was marked with discussing andformulation of the basic principles forming the foundation of the State healthcare system, among thesewere state funding of public healthcare activities; free, accessible and equal for everybody medical ser-vice; basic on districts principle healthcare rendering; state system of medical institutions formation;working out of unified statistics and record of population sick rate; development of sanitary and preven-tive direction in medicine. The VI Conference in memory of Pirogov took place at a time of horrific star-vation and members of the Conference stated a question about a systematic starvation of population being

41

the most acute social problem. The Conference didn’t limit to statement of the fact but took some impor-tant practical steps to help the country’s starveling population: they offered to form a system of socialcommon food committees having their center in Kazani. These committees successfully worked till pass-ing of the law about the withdrawal of food business out of competence of county councils in 1900.

Questions on manufacturing medicine formed the new direction of the Conferences in memory ofPirogov. The organization of social insurance captured special attention. As a result some important lawsin the sphere of social insurance were passed, among these were law on «Welfare maintenance of work-men in case of illness» and law on «Employee’s accident insurance». We should particularly note acciden-tal «choleric» Conference of the year 1905 which was connected to epidemic danger in the country. Doc-tors were quick to work out preventive measures of struggling against the oncoming menace using the neg-ative experience of cholera spread in 1891–1893. Main aspects of the Conferences activities during thisperiod were struggle with alcoholism, tuberculosis, syphilis, starvation and infant mortality. The Commit-tee on studying of malaria in Russia, founded with support of The Association in memory of Pirogovmembers and headed by G.N. Gabrichevskiy, held a large-scale antimalarial campaign in the country.

The Association in memory of Pirogov made a solid piece of work during the World War I render-ing medical and sanitary healthcare and struggling with medication deficiency and disease outbreak.

Political changes in the country touched the Association in memory of Pirogov but most of itsmembers continued to be professionals serving to a single object — saving health and prosperity of Rus-sian people. After the deposition of monarchy activity of the Conferences was concentrated on workingout of basic approaches to reorganization of the healthcare system in new conditions.

Thanks for the Association in memory of Pirogov activity there were worked out unique approach-es to medical healthcare that based Soviet system of healthcare and are still up-to-date. Formed withincounty medicine and developed during the Conferences sanitary and preventive direction was and re-mains the most progressive in the world’s practice of public healthcare. And all this, doubtless, echoes toNikolay Ivanovich Pirogov’s words «I believe in hygiene. This is where genuine progress of our sciencelies. Future belongs to the medicine that is preventive».

�A%'/( "%,!3+,23G:1. �"/*!!.+, �L�. �/"- .3+B!$&/1/ '//$�!',.+ . ',+&/."!&%% '%',!4G 1/'2*+3',.!&&/1/

)*3+.//D3+&!&%# . �/''%% . (/&5! XIX — &+B+"! XX ... (&+ A3%4!3! �%3/1/.'(%D '�!)*/. .3+-B!@) / A/* 3!*. �+3(%'#&+ �L�. — �.: !3!,!#, 2006. — 300 '.

2. �!.%,, �L�. �,+&/."!&%! /$�!',.!&&/@ 4!*%5%&G . �/''%% / �., 1974. — 232 '.3. �B!3(% %',/3%% 32''(/@ /$�!',.!&&/@ 4!*%5%&G / A/* 3!*. �+"-� �L�. — �., 1965. —

298 '.4. �+4/@"/., L�. �',/3%# 3/''%@'(/@ 4!*%5%&G / �.: �A%*+.3, 1997. — 200 '.5. �,!A+&'(%@, �L�. �+4/*!3F+.%! % /$�!',.!&&G! /31+&%)+5%% �/''%% &+ 32$!F! XIX–

XX ... / �., 1980. — 96 '.

THE FORMATION OF FIELD SURGERY IN THE COURSEOF THE RUSSIAN MILITARY HISTORY

V.V. Shmakova (stud.)

Chelyabinsk state medical academyThe department of the topographic anatomy and operative surgery

Scientific adviser: O.V. Peshikov (associate professor, Ph. D. in medical sciences)

The technology of killing developed during the history of mankind. And every war became a basefor the development of the medicine. Thus we can trace the history of blighty surgery and improving ofthe organization of field surgery on the example of the Russian military history.

The Military surgery in differ from common surgery develops the methods of the wounded treat-ment in the combat. The preservation of the life after being wounded and evacuated to a field hospital atfirst, and then to the rear are in focus in this case. A field surgeonis not only a surgeon of the wide profile,but also he is the organizer of care for wounded in hostilities. He defines the need to evacuate thewounded or to provide on-site assistance.

Nevertheless, the military surgery formed separately from the issues of the organization of themedical care for the woundedat the first period of its history (the longest - until the XIX century).

42

During this period, there was an accumulation of the information about pathology and treatment ofnot gunshot and gunshot wounds, moreover principles of treatment of military trauma was not differ fromthe rules of the peacetime wounds treatment. Anesthesia, antisepsis and aseptic techniques are outstand-ing scientific discoveries of the XIX century, that radically influenced the development of the surgery.

The second period of the history of the military surgery has been marked by the development ofscientific bases of the medical evacuation support of the combat operations. The Russian troops usedtreatment and evacuation system that was developed by James Vasilyevich Ville during the war of 1812.This system based on his ‘Provision for temporary military hospitals with a large field army’ by Ville.Medical care in the Russian army provided on a dressing stations during the battle, then the woundedwere taken to the mobile hospitals and major hospitals. Russian system was better than Larrey's systemthat was applied in the French Army, because a surgical activity was in the rear and hospitals were ma-neuverable. Later, the Russian system as the most successful was borrowed by Prussia and Austria.

Nikolai Ivanovich Pirogov approached to the problems of the organization of the surgical care inthe war extensive and comprehensive. He summarized his vast experience in the fundamental work ‘Theonset of the military surgery’ (1865), and especially in the famous twenty positions. Many of them are notonly still relevant, but were developed, although Pirogov’s ideas have been fully implemented only in theGreat Patriotic War.

Beginning of the twentieth century was marked by the military conflicts. The theory of primary steril-ity of the gunshot wound was finally disproved in the First World War. The need for active surgical treat-ment of the wounded recognized at this period. The primary method of debridement substituted conserva-tive tactics. But medical care was not enough early, as foundational principles was ‘evacuated is preferred’.

The third period of military surgery was the development and implementation of the staged treat-ment of the wounded in the war. Significant contribution to the development of the medical evacuationsupport of the troops belong to distinguished surgeon Vladimir Andreevich Oppel. He was the first, whounited evacuation and treatment on practice during the First World War: ‘The wounded receives such as-sistance, if and where and when such assistance is need.’

Nikolai Nilovich Burdenko generalized experience of combat operations in the ‘Notes of militarysurgery’ 1941. He established a unified methods and tactics of the organization of surgical care at thestages of the medical evacuation, considered especially military injuries and diseases, proposed a unifiedtreatment and unified documentation. Meeting of the management team of the medical service took placein April 1941. It was decided to replace the doctors of the battalions by paramedics, to increase the num-ber of doctors in the sanitary battalions, to create a hospital company and independent companies of themedical amplification, to replace the divisional hospitals by mobile army hospitals.

The reformed system was subjected by severe test soon. The course of the Great Patriotic War de-pended on system of the medical provision. At the beginning division staff of the doctors was decreasedand hospital companys was removed due to high volume of the work and the small resources, also be-cause needed for maneuverability.

The number of the field mobile hospitals in the structure of the front-line medical facility improved(at least 50-60% of the total number of the beds).The structure of the evacuation hospitals was modifiedto improve the mobility, the number of the mobile units and the number of the transport of the medicalservices was increased. A series of the basic research in the etiology and pathogenesis of various injuriesof the war was carried out. A new methods of the treatment was developed, medication and technical fa-cilities was introduced: method of the overpleural novocaine blockade, polymeric adhesive membrane forcover the surgical field, water-soluble antiseptics, apparatus for the extrafocal osteosynthesis, for treat-ment of a wound by pulsating jet, for the surgical treatment of a deep burns (elektrodermatom, nekrotom,perforator, transplants stapler).

The fourth period of field surgery included elaboration of the organization of surgical care to thewounded in local wars and armed conflicts, the introduction of early specialized surgical care. New con-ditions was not only the character of the hostilities, but also the character of the lesions (radiation lesions),the phenomenon of ‘mutual arests.’

General-lieutenant of medical service K.M. Lisitsyn managed issues of the organization of the sur-gical care for the wounded in the Afghan war in (1979–1989). The aeromedical evacuation of thewounded been used on a large scale for the first time. But since the breaks in the aeromedical evacuationwere frequent, the sending of the specialized surgical groups gain widespread. The accumulated expe-rience in treating the wounded was the basis for the publication of 'Guidelines for military surgery USSRMinistry of Defense' in 1988., which first target the distinct surgical care to the wounded in local wars.The special medical teams were used for the first time for military operations in the North Caucasus re-

43

gion, including Chechnya in 1994–1996. Surgical care was provided for 2–5 hours after the woundingdue to the aeromedical evacuation. Attempts to send the specialized surgical teams were often unsuccess-ful because of the relocation. The casualty evacuation by helicopters after providing of the first medicalaid directly to specialized military hospitals became the best option of the medical evacuation. As a result,local surgeons have an elaborate system of the victim assistance for local conflicts, as well as for large-scale military operations.

Thus, the present system of the medical evacuation and the principles of the field surgery emergedduring the military history of the Russian state. Our victories and defeats introduced a wealth of expe-rience in providing care to the wounded in the theater of war, and formed the basis of modern surgerytechniques, including peacetime surgery.

�A%'/( "%,!3+,23G:1. Alexanian I.V., Knopov M.Sh. Military surgery during the Great Patriotic War. — Moscow:

Medicine, 2000.2. Alexanian I.V., Knopov M.Sh. Chief surgeons of the fronts and fleets in the Great Patriotic War

1941–1945. — M.: Medicine, 1985.3. Brusov, P.G. Military surgery at this stage. Topical issues of the organization of surgical care to

the wounded in local armed conflicts. The report of the jubilee scientific-practical conference dedicated tothe 15th anniversary of the Department of surgery: Abstracts. — M. — 1996. — 17–20.

4. Chige, I.M. Organizational basis of the building a modern healthcare system of the ArmedForces. Military medical journal. — 1996. — 1: 4–20.

5. Eryuhin I.A., Zubarev P.N., Hrupkin V.I. etc. The organization and maintenance of surgical care.The experience of the medical support in Afghanistan 1979–1989 years. — Moscow: hospital them. acad.N.N. BURDENK. — 2002.

6. Efimenko N.A., Gumanenko E.K., Samokhvalov I.M., Trusov A.A. Surgical care to thewounded in the armed conflicts: challenges and ways to improve. Military medical journal. 2000. 2: 31–35.

7. Fokin, Y.N. Main trends of the skilled and specialized emergency surgical care in the armed con-flict: Author. dis. M. D. Science. — M., 2001. — 6: 271.

8. Gumanenko E.K., Samokhvalov I.M. Military surgery of the local wars and armed conflicts: aguide for doctors. — Moscow: GEOTAR Media, 2011.

PIROGOV'S CONTRIBUTION TO VENEROLOGY DEVELOPMENT

K.V. Verein (stud.), O.V. Kotlovanova (stud.)

Chelyabinsk state medical academyDepartment of dermatology and venerology

Scientific adviser: J.V. Nefedieva (ass., candidate of medical sciences)

In a glorious galaxy of prominent Russian scientists, who played an important role in the history ofnational and international medical science, the pride place belongs to N. Pirogov.

N. Pirogov was engaged in organizing, educational and pedagogical activities. Many positions, me-thods and Pirogov's development in various branches of medicine didn't lose their importance today.

Certainly, N. Pirogov is better known as an outstanding surgeon. But it seemed to us interesting to tellabout another, less known, but not less important direction of his activity - the contribution to the develop-ment of venerology as a science in general, and to the prevention and treatment of syphilis in particular.

In Russia, syphilis appeared at the beginning of the 16th century, and it was not as widespread as inEurope. Serious consequences of a syphilitic infection in the form of characteristic uglinesses and physi-cal degradation, the possibility of transmission to the next generation always interested physicians, in-cluding leading Russian scientists, like: M.Mudrov, N. Pirogov, S. Botkin and F.Koch.

According to the ancient documents, the cases of syphilitic infection in 30-40 years of the 19th cen-tury were very high. So in the 1835 the incidence of syphilis in the army was 58 per 1,000, and in the civ-il medical network in 1857, 10% of patients were hospitalized with syphilis.

Due to the needs of medicine courses of skin and venerological diseases, which were delivered byclinical physicians, were organized in Russian universities and academies. N. Pirogov gave lectures onsexually transmitted diseases at the Department of surgery at St. Petersburg Medical-Surgical academy.

44

Practical knowledges of prevention and treatment N. Pirogov received in Derpth, where in his clinic pa-tients with such diagnosis were treated in.

In the works, named «The annals of Derpth clinic» (1834) and «The annals of surgical clinic»(1837) N. Pirogov opens the topical issues of treatment of syphilis, recommends to open free hospitals forpatients, to apply contraception methods, to extend the correct ideas of an illness, to fight against sorcery.N. Pirogov notes that in Russia questions of prevention and syphilis epidemiology aren't considered at all.

In the first volume of «The annals of Derpth clinic» N. Pirogov disassembled patient's records of201 patients who have passed through clinic of Derpth university, and among them — 16 patients withsyphilis. N. Pirogov makes the general observations about the reasons of high prevalence of this diseasein Derpth, about measures of fight against it: «Syphilis was widespread in Derpth in the considerable siz-es between students and burgher youth. Police sanitary measures didn't exist. I insisted on urgent intro-duction of these measures, saying that if it is impossible to protect poor children from falling, it is neces-sary to make it less harmful at least ». N. Pirogov defines brothels, as «a source of that illness which de-stroys a body, morals and reason».

N. Pirogov blames sanctimonious hypocrisy, which usually treats a problem of syphilis, attempts tobecome silent, bypass this question. N. Pirogov writes: «What poverty, what hunger can be comparablewith the most painful feeling that you are the carrier of poison, which penetrates deeper in a body trans-ferred from one generation to another».

He suggests «to concentrate activity on three main subjects: on a smallpox vaccination, eradicationof syphilis and establishment of the sanitary commission». From that point of view establishment of thesanitary commissions is represented to N. Pirogov very useful, it was also very important to organize me-dico-topographical descriptions of the occupied places and to survey them in the sanitary relation.

N. Pirogov suggests opening clinic for syphilitic patients at hospital of the St. Petersburg medico-surgical academy. The project was accepted by trustees and military department, which the academy be-longed to.

He gave great attention to questions of prevention venerological diseases, including syphilis. Themeasures of prevention offered by N. Pirogov, laid down in a basis of modern preventive actions:

1. Observance the rules of personal hygiene;2. An exception of casual sexual communications without usage of barrier contraception;3. Obligatory inundated accounting of all patients with syphilis, inspection family members and

persons who were in close contact with patients;4. Hospitalization of patients and the subsequent supervision over them within several months, con-

tinuous control supervision over treatment;5. Regular inspection of sexually transmitted infections of persons from group of risk;6. Prevention of congenital children syphilis;7. Additional preventive treatment of the pregnant women who have had syphilis.Observance the measures of prevention, early identification of disease and application the new me-

thods of treatment allowed to reduce considerably incidence of syphilis in Russian Federation as a wholeand in Chelyabinsk in particular.

So incidence of syphilis in Chelyabinsk for the last five years (2007–2011) decreased for 56 % thatin absolute figures means decrease the number of patients from 2315 in 2007 to 1017 in 2011.

There are a lot of ways of identification syphilis in Chelyabinsk, because exists a big variety of me-thods. So in 2011 23,5 % of patients with syphilis are revealed for the first time, in somatic hospitals22,7 % of the diseased, the self-address patients — 20,8 %, in skin and venereological clinics — 17,2 %,by other experts — 15,7 % of patients were revealed.

In structure of revealed STD in 2011 in Chelyabinsk region syphilis makes 12 %.Let's also consider statistical data on incidence of syphilis in Russia, Ural Federal District and Che-

lyabinsk for 2005–2010 presented in table 1.

Table 1

Comparative incidence of syphilis in Russia, Ural Federal District and Chelyabinskfor 2005–2010, the number of cases (people) to 100 thousand people

Region\Year 2007 2008 2009 2010 (%)Russia 63,1 59,5 53,3 44,9 -28,8UFD 58,8 58,7 51,0 42,3 -28,1Chelyabinsk 71,9 64,5 56,9 42,6 -40,8

45

From table 1 it is visible that in Russia, Uralsk Federal District and Chelyabinsk observed a posi-tive tendency of decrease the incidence of syphilis. It is necessary to note that in Chelyabinsk decreasegoes faster than as a whole in Russia and Ural Federal District.

In conclusion, it is worth saying that the cases of syphilis and other sexually transmitted infectionsare also registered nowadays, but the methods, which were offered by outstanding Russian scientistN. Pirogov still in 19th century, does not losing its great value.

�A%'/( "%,!3+,23G:1. �/1%"!.'(%@, �L�. �L�. �%3/1/. / �L�. �/1%"!.'(%@. — �/',/.N&+N�/&2: �/',/.'(/!

(&%F&/! %)*+,!"-',./, 1953.2. � 200-"!,%� �L�. �%3/1/.+. — �+2B&G@ ?%"-4. — ����. — 2010.3. �%(/"+@ �.+&/.%B �%3/1/.. — �+2B&G@ ?%"-4. — ����. — 2006.4. �+3,+4GU!., �L�. �/F&G! % .!&!3%B!'(%! $/"!)&%.5. �%3/1/., �L�. �&!.&%( ',+3/1/ .3+B+.

INNOVATIONS OF N.I. PIROGOV IN THE FIELD OF VASCULAR SURGERY

D.A. Zaharova (stud.), I.S. Fleisher (stud.), V.O. Barysheva (stud.)Chelyabinsk state medical academy

1 The department of public health and health care2 The department of topographic anatomy and operative surgery

Scientific adviser: 1A.L. Citovich (ass, Ph.D. in medical sciences),2O.V. Peshikov (ass.prof., Ph.D. in medical sciences)

The main achievements of Nikolay Ivanovich Pirogov in the field of vascular surgery, that becamea basic link in the evolution of operative surgery and provided a guide for the practical activity of manysurgeons and scientists are considered in this article. Analyzing the notes and the publication of contem-poraries of N.I. Pirogov, his personal letters, diaries, documents, the author emphasizes the importance ofthe fruits of many years of work of a gifted surgeon in the General store of medical knowledge.

Before N.I. Pirogov the vascular surgery stood at a low level. Many gaps of knowledge in the topo-graphy, normal and pathological physiology, operative surgery, and also the almost complete absence ofexperimental data created sometimes insurmountable difficulties for the diagnosis of diseases and injuriesand their surgical treatment. N.I. Pirogov thanks to his unselfish and self-sacrificing work and an unre-strained interest in the medical file, turned surgery in science.

One of the founders of the vascular and military-field surgery, an outstanding Russian surgeonV.A. Oppel wrote: « Pirogov created a school. His school is the whole Russian surgery, it was built by alot of surgeons — academic, university, counties, urban — all of these surgeons are grouped around thefigure of the genius of Pirogov».

Nicolay Ivanovich was born on November 13, 1810 in Moscow. On September 22, 1824, he be-came a student of the medical faculty of Moscow university and in 1828 was adopted in teaching Insti-tute, opened in Dorpat after a successful passing examinations in the Imperial St. Petersburg academy ofSciences. There N.I. Pirogov seriously engaged in the issues of the ligation of vessels and most of thetime he devoted to the study of morphology, resorting to experimental methods of research. In the end, in1829 goes out «a most excellent work» (for it Nikolai Ivanovich was awarded the gold medal of the uni-versity of Dorpat) under the title «About the ligation of arterial vessels».

In 1832 N.I. Pirogov defends a doctoral thesis«Num vinctura aortae abdominalis in aneurismate in-guinali adhibitu facile ac tutum sit remedium» («Is the ligation of the abdominal aorta with aneurysms inthe groin area easy and safe to be made»), written in the Latin language. In his thesis, he conducts ananalysis of the structures and functions of the abdominal aorta, indicates its location, methods of expo-sure, pathologic changes. The work of N.I. Pirogov was estimated by the professors and students of Yu-riev, and also attracted attention abroad. Later the thesis was transferred to the Russian and German lan-guages. In all the works of the great surgeon and deep researcher is traced the original idea — methods ofthe solution of fundamental problems, the methods by which you can achieve results in the solution ofapplied problems of clinical medicine.

In 1837 the work «Surgical anatomy of arterial trunks and fascias» opens a new era in the devel-opment of surgery. In «Sevastopol letters and memories» Pirogov wrote: «Since my anatomy of fascias,

46

arterial trunks paved the right ways to find arteries, I constantly guided the rules proposed in it and con-firmed them on, making more than 70 dressings». N.I. Pirogov gave specific recommendations on liga-tion of the occipital, temporal, nameless, common carotid, subclavian, shoulder, General and externaliliac and femoral and other major arteries and also the arteries of medium caliber. He also emphasise theneed for timely implementation of operations on the vessels. «If the artery will be exposed to all the rules,— he wrote, — than the imposition of the ligatures is not difficult at all, no matter how deep is the posi-tion of the vessel».

An important achievement of N.I. Pirogov in the vascular surgery were his classic accesses to largevessels — nameless, iliac, hypogastrial, language arteries. In addition, the conclusions of the essentialrole of adventitious membrane artery in the process of surgical treatment of vessels as well belong to theN.I. Pirogov. In 1836 on the proposal of Moeira N.I. Pirogov was elected a Professor of surgery of theuniversity of Dorpat. In the period from 1837 to 1839 the eminent surgeon wrote and published a two-volume edition «Annals of surgery Department of the clinic of the university of Dorpat». This work con-tained in the cause of medical errors, provoked the exacerbation of the disease, that caused the resentmentand discontent of the medical circle. However, there were such who, on the contrary thanked Nikolai Iva-novich for such. Professor of Mineralogy of the university of Engelhardt came one morning to Pirogovand said to him: «If everyone followed your noble example, dear Nikolai Ivanovich, medicine truly wouldbe mighty in the fight against disease! Only a man with pure heart and a head could write it!».

The eminent surgeon shared useful and important facts of practical activities. He first began to de-scribe the operations and accesses, for example described about a transection of two branches of the tem-poral artery and dissection of temporal fascia with a view to the elimination of pain in the left temple,about the ligation of iliac artery by a cut, parallel to Poupart's ligament.

Special attention Pirogov were awarded the injured vessels. Nikolai Ivanovich thoroughly ex-amined a technique of hemostatic operations by the ligation of the vessels. He did not welcomed pre-viously existing the pressure of the vessels, their twisting with piercing, acupressure. «Classification ofcauses of secondary bleeding», developed by Pirogov, is used to this day. In it a great importance is givento the infection of wounds, as a result of it is a softening of thrombotic masses, the eruption of ligatures,pitting the aneurysm.

Thus, based on the fundamental anatomical studies, N.I. Pirogov was the pioneer of vascular surgery:- he created a number of fundamental provisions defining anatomical and physiological approach to

the ligation of vessels;- he was the first who tested on a large number of wounded ligation of the major arterial trunks in

the military field;- for the first time he described the operational access to dress the lingual artery («the triangle of Pi-

rogov»);- he created an operative access to extraperitoneal approach to the iliac artery to it’s dressing;-he developed and offered to the projection line for dressing of the arteries (radiation, popliteal).

�A%'/( "%,!3+,23G:1. �%3231%#. �23&+" %4. �L�. �%3/1/.+. — 2011. — � 12 — �. 93–95.2. !',&%( D%3231%% %4. �L�. �3!(/.+. — 2010. — . 169 — � 5.3. �',/3%# 4!*%5%&G % D%3231%% : 2B!$&/! A/'/$%! *"# ',2*!&,/. 2B3!F*!&%@ .G'U. A3/?.

/$3+). / �. �. �%3'(%@. — �.: �����N�!*%+, 2010.4. �!.+',/A/"-'(%! A%'-4+ % ./'A/4%&+&%#. / �L�. �%3/1/. — �(+*!4%# &+2( ����. — 1950.

�4(];"&'2!&J"0!&"

�#$. $�� (����.)�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#

�+?!*3+ /$�!',.!&&/1/ )*/3/.-# % /31+&%)+5%% )*3+.//D3+&!&%#

�������������������: ���. ��������� (��. �� ., ����.)

�$�!%).!',&/, B,/ ,+"+&,"%.G@ B!"/.!( #."#!,'# ,+"+&,"%.G4 ./ .'!4. �,/ .G'(+)G.+&%!. A/"&/@ 4!3! 4/F&/ /,&!',% % ( �L�. �%3/1/.2. «�!?/34+,/3» — �,/, ,!34%& ,/B&!! .'!1/ D+-3+(,!3%)2!, !1/ *!#,!"-&/',-. '!, B!4 )+&%4+"'# �%(/"+@ �.+&/.%B, .'!, ' B!4 ,+( %"% %&+B! '/-A3%(+'+"+'- !1/ *!#,!"-&/',-, A/*.!31+"/'- ,�+,!"-&/42, 1"2$/(/42, .'!',/3/&&!42 +&+"%)2.

47

� )+,!4 .!"%(%@ 2B!&G@ 3+)3+$+,G.+" A"+& A3%&5%A%+"-&/1/ %)4!&!&%# '"/F%.U!@'# '%,2+5%%.+(, /& A3!*"/F%" &/.G@ A3%&5%A %)2B!&%# +&+,/4%%, '/)*+. &/.2� *%'5%A"%&2 — ,/A/13+?%B!-'(2� +&+,/4%�. �%3/1/. &+.'!1*+ %)4!&%" D%3231%�, $2*2B% A%/&!3/4 +&,%'!A,%(% % 3+)3+$+-,G.+# &/.G! 4!,/*G /A!3+,%.&GD .4!U+,!"-',..

� 3!)(%! '2F*!&%# % *!@',.%# 3!?/34+,/3/. .'!1*+ .G)G.+�, $23&/! &!1/*/.+&%! /(32-F+��%D, . ,/4 B%'"!, % ."+',!@. � �%(/"+@ �.+&/.%B &! $G" %'("�B!&%!4. �4!&&/ /AA/)%5%/&-&G! .)1"#*G �%3/1/.+ .G).+"% &!&+.%',- ."+',!@. �/'"! A3/%13+&&/@ �/''%!@ �3G4'(/@ ./@&G,/ (/,/3/@ �%3/1/.2 $G"/ %).!',&/ (+( /31+&%)+,/32 4!*%5%&'(/@ A/4/�% A3% /$/3/&! �!.+',/-A/"#, �%(/"+@ �.+&/.%B $G" A3%1"+U!& &+ A3%�4 ( �"!('+&*32 II. �& .G'(+)+" %4A!3+,/32 './!4&!&%! / A3/$"!4+D . ./@'(+D, &/ 5+3- &! )+D/,!" A3%'"2U+,-'# ( �%3/1/.2. �%$!3+"-&G! .)1"#-*G 2B!&/1/ .G)G.+"% 3!)(%@ &!1+,%.%)4. �,/ A3%.!"/ ( ,/42, B,/ .!"%(%@ 2B!&G@ .A+" . &!4%-"/',- % $G" /,',3+&!& /, &+2B&/@ *!#,!"-&/',% . /$"+',% 4!*%5%&G.

1856 1/*2 �%3/1/. $G" &+)&+B!& A/A!B%,!"!4 �*!''(/1/ 2B!$&/1/ /(321+. �+)&+B!&%! .!-"%(/1/ 2B!&/1/ &+ �,/, A/', '/)*+.+"/ .%*%4/',- )+$/,G 5+3'(/1/ A3+.%,!"-',.+ / &+3/*&/4 /$-3+)/.+&%%. �%3/1/. 2A3+."#" �*!''(%4 2B!$&G4 /(321/4 . ,!B!&%! *.2D "!,. �, (+( .'!1*+, A/*-.!31+" .'! ,�+,!"-&/42 +&+"%)2 % .G*.%1+" 3!?/34+,/3'(%! %*!%. �& %)"/F%" %D . 1856 1/*2 .',+,-! «/A3/'G F%)&%». &!@ +&+"%)%3/.+"%'- '/'"/.&G! .)1"#*G &+ /$3+)/.+&%! % ./'A%,+&%!,5+3%.U%! . /$�!',.! ,/1/ .3!4!&%. �"+.&/@ %*!!@ �,/@ ',+,-% $G"+ )+�%,+ /$�!B!"/.!B!'(/1//$3+)/.+&%#. �&+ A3/%).!"+ $/"-U/! .A!B+,"!&%! &+ '/.3!4!&&%(/.. �! A3%.!,',./.+"+ (+( $23-F2+)&/N"%$!3+"-&+#, ,+( % $23F2+)&/N*!4/(3+,%B!'(+# % 3!./"�5%/&&/N*!4/(3+,%B!'(+# A3!''+.�*!+" B!"/.!(+, (+( !1/ A/&%4+" �%3/1/., $G" %4 '?/342"%3/.+& . *2D! +$',3+(,&/1/ 124+&%)4+.

!"%(%@ 2B!&G@ 3+)3+$/,+" &/.G@ A3/!(, U(/"-&/@ '%',!4G, &+A3+."!&&G@ A3/,%. '/-'"/.&/@ U(/"G. �%3/1/. A3!*"+1+" U(/"-&2� '%',!42 %) &!'(/"-(%D ',2A!&!@, '/ '3+.&%,!"-&/&!A3/*/"F%,!"-&G4 '3/(/4 /$2B!&%# &+ (+F*/@. �!3.+# ',2A!&- — &+B+"-&+# *.2D"!,&## U(/"+.,/3+# ',2A!&- — A3/1%4&+)%# (&!A/"&+# '3!*&## U(/"+) *.2D ,%A/. ' B!,G3!D"!,&%4 (23'/4.3!,-# ',2A!&- — 1%4&+)%# ,+(F! *.2D ,%A/.: ' ,3!D-, A#,%"!,&!@ A3/*/"F%,!"-&/',-� /$2B!&%#.�,2 '%',!42 )+.!3U+!, B!,.!3,+# ',2A!&- — .G'U+# U(/"+ (2&%.!3'%,!,G % .G'U%! 'A!5%+"-&G!2B!$&G! )+.!*!&%#).

�A3+."## �*!''(%4 2B!$&G4 /(321/4, �%(/"+@ �.+&/.%B ',3!4%"'# A/*&#,- )&+B!&%! A!-*+1/1%B!'(%D '/.!,/. 1%4&+)%@, .&2U+" *%3!(,/3+4 % 2B%,!"#4 2B!$&GD )+.!*!&%@ 4G'"- / &!/$-D/*%4/',% 124+&&/1/ /,&/U!&%# ( *!,#4.

� )+'"21+4 �%3/1/.+ . �,/ .3!4# 4/F&/ /,&!',% 3+$/,2 A/ A/*1/,/.(! /,(3G,%# 2&%.!3'%-,!,+ . �*!''!.

� '&/.+ "%$!3+"-&+# *!#,!"-&/',- .!"%(/1/ 2B!&/1/ . (+B!',.! A/A!B%,!"# 2B!$&/1/ /(321+.G).+"+ 2 /*!''(/1/ 1!&!3+"N12$!3&+,/3+ A/*/)3!&%! . './$/*/4G'"%% % A/*3G.! +.,/3%,!,+ ."+-',!@. �%3/1/. $G" A!3!.!*!& . �%!. &+ */"F&/',- A/A!B%,!"# �%!.'(/1/ 2B!$&/1/ /(321+. �*!'-/& A3/*/"F+" 2"2BU+,- 3+$/,2 U(/", 3!(/4!&*/.+" 2B%,!"#4 A/'!�+,- 23/(% *321 *321+, A//�-3#" 4!,/*%B!'(%! %'(+&%# 2B%,!"!@, ..!" . A3+(,%(2 1%4&+)%@ .&!("+''&G! "%,!3+,23&G! $!'!*G,'A/'/$',./.+" /,(3G,%� . �%!.! /*&/@ %) A!3.GD . �/''%% ./'(3!'&GD U(/" *"# .)3/'"GD.

�/ . 1861 1/*2 �%3/1/. $G" .&/.- 2./"!& ' */"F&/',% A/A!B%,!"#. �3/13!''%.&+# /$�!',.!&-&/',- �%!.+ 2',3/%"+ !42 ,/3F!',.!&&G! A3/./*G. �!35!& &+A%'+" . F23&+"! «�/"/(/"», B,/ 2./"--&!&%! �%3/1/.+ — �,/ «/*&/ %) 4!3)!@U%D *!" �/''%% *23+(/. A3/,%. �/''%% 3+).%.+��!@'#».

�3+.%,!"-',./ '*!"+"/ .%*, B,/ /&/ &+4!3!&/ %'A/"-)/.+,- /AG, �%3/1/.+ (+( A!*+1/1+, %&+)&+B%"/ !1/ 32(/./*%,!"!4 /$2B+��%4%'# )+ 13+&%5!@ 32''(%4% (+&*%*+,+4% . A3/?!''/3+.

�%3/1/. .G$3+" 4!',/4 './!@ 3!)%*!&5%!@ �!@*!"-$!31, (2*+ A3%$G" . 4+! 1862. �*!'- /&&! ,/"-(/ .GA/"&#" './% /$#)+&&/',%, &/ % /(+)G.+" (+&*%*+,+4 . A3/?!''/3+, % B"!&+4 %D '!-4!@, % *32)-#4 "�$2�, . ,/4 B%'"! 4!*%5%&'(2�, A/4/�-. �*&+F*G /*%& %) (+&*%*+,/., 1"+.+32''(/1/ )!4"#B!',.+ �!@*!"-$!31+, A3/.�" '$/3 '3!*',. &+ "!B!&%! �+3%$+"-*% % 21/./3%" �%3/-1/.+ /'4/,3!,- 3+&!&/1/ �F2)!AA! �+3%$+"-*%. �%(/"+@ �.+&/.%B $!'A"+,&/ /'4/,3!" �+3%$+"--*%, /$&+32F%" % %)."!( &!)+4!B!&&2� A2"�. �,%4 �%3/1/. ,/1*+ 'A+' &/12, + '(/3!! .'!1/ %F%)&-, /'2F*�&&/42 *321%4% .3+B+4% �+3%$+"-*%. �,/, '"2B+@, .G).+" ?23/3 . �!,!3$231!, %�(3+'&G@», A/ 4&!&%� A3+.%,!"-',.+, �%3/1/. $G" 2./"!& ' 1/'2*+3',.!&&/@ '"2F$G *+F! $!)A3+.+ &+ A!&'%�. +(, . 1866 1/*2 .!"%(%@ D%3231, (32A&!@U%@ 2B!&G@, .%*&G@ /$�!',.!&&G@*!#,!"- % A!*+1/1 �%3/1/. */"F!& $G" 2*+"%,-'# — !�! . A/"&/4 3+'5.!,! ,./3B!'(%D '%" — .'./! &!$/"-U/! %4!&%! «%U&#» &+ �(3+%&!. +4 /& /31+&%)/.+" $!'A"+,&2� $/"-&%52. �& &!-&+*/"1/ .G!)F+" /,,2*+ ,/"-(/ )+ 13+&%52, + ,+(F! A/ A3%1"+U!&%� �!,!3$231'(/1/ 2&%.!3'%,!,+*"# B,!&%# "!(5%@. � �,/42 .3!4!&% �%3/1/. 2F! $G" B"!&/4 &!'(/"-(%D %&/',3+&&GD +(+*!4%@.�(/&B+"'# .!"%(%@ 2B!&G@ . 1881 1/*2.

48

�4# �%(/"+# �.+&/.%B+ �%3/1/.+ '/',+."#!, 1/3*/',- % '"+.2 /,!B!',.!&&/@ 4!*%5%&G %A!*+1/1%(%. �1/ ,32*&+# % 1!3/%B!'(+# F%)&- A3!*',+."#!, '/$/@ #3(%@ A3%4!3 A3%&5%A%+"-&/-',%, '4!"/',%, 3!U%,!"-&/',%, A/3#*/B&/',%, %&,!""%1!&,&/',% B!"/.!(+, 2A/3',.+ . */',%F!&%%5!"!@. �F! '+4+ $%/13+?%# .!"%(/1/ 2B!&/1/ "2BU! .'!1/ %""�',3%32!, /*&/ %) A/"/F!&%@ !1/'/$',.!&&/@ 3+$/,G «/A3/'G F%)&%»: «�',+!,'# ,3!,%@ A2,- — A3%1/,/.%,- &+' ./'A%,+&%!4 (.&2,3!&&!@ $/3-$!..., */',+.%. &+4 .'! 'A/'/$G % .'� �&!31%� .G*!3F%.+,- &!3+.&G@ $/@. �3%-1/,/.%,- &+' ' �&GD "!, ( �,/@ $/3-$!, )&+B%, %4!&&/ '*!"+,- &+' "�*-4%, ,. !. ,!4, B!1/ &! */'-,%1&!, &% /*&+ .+U+ 3!+"-&+# U(/"+ . 4%3!, )+$/,#'- '*!"+,- %) &+', ' '+4/1/ &+U!1/ *!,',.+, &!-1/5%+&,/., '/"*+,, 4/3#(/., *2D/.&GD A+',G3!@ %"% �3%',/.».

�A%'/( "%,!3+,23G:1. �%3/1/., �L�. �)$3+&&G! A!*+1/1%B!'(%! '/B%&!&%#. — �.: �!*+1/1%(+, 1985.2. �3+'&/.'(%@, �L�. �!*+1/1%B!'(%! %*!% �L�. �%3/1/.+. — �.: �BA!*1%), 1949.3. �/&',+&,%&/. �L�., �!*G&'(%@ �L�., �+$+!.+ �L�. �',/3%# A!*+1/1%(%. — �.: �3/'.!-

�!&%!, 1982.4. �1/3/., �L�. �3!',/4+,%# A/ %',/3%% U(/"G % A!*+1/1%(% . �/''%%. — �.: �3/'.!�!&%!,

1986.5. �%(/"+@ �.+&/.%B �%3/1/.. «/A3/'G F%)&%. �&!.&%( ',+3/1/ .3+B+». — �.+&/./, 2008

(PDF).6. �3+,(+# $%/13+?%# �L�. �%3/1/.+.7. �+D+3/., �. �%3231 �%(/"+@ �%3/1/.: ,32*&G@ A2,- ( .!3! // �+&(,N�!,!3$231'(%@ 2&%-

.!3'%,!,. — � 29 (3688), 10 *!(+$3# 2004 1/*+.8. �+A/U&%(/.+, �L. �&!.&%( ',+3/1/ .3+B+.9. �%3/1/., �L�. �)$3+&&G! A!*+1/1%B!'(%! '/B%&!&%#. — �.: �!*+1/1%(+, 1985. — 493 [3] '.

,#+. �+&!>!$+'>! «,"%"1"» $$!',,!��!1'$!/^+&4&>++

(#$. $����_�� (����.)�!"1/3/*'(%@ 1/'2*+3',.!&&G@ &+5%/&+"-&G@ %''"!*/.+,!"-'(%@ 2&%.!3'%,!,

�!*%5%&'(%@ ?+(2"-,!,, (+?!*3+ .&2,3!&&%D $/"!)&!@ � 2

�������������������: ���. !�����"�� (��. �� ., . �. �.)

�L�. �%3/1/. &! U!" A/ 2)(/42 (/3%*/32 /*&/@ ,!4G, *+F! /*&/@ 'A!5%+"-&/',%. �+D.+,G-.+# '/'!*&%! /,3+'"% 4!*%5%&G 3+)&G4% &+2B&G4% 4!,/*+4%, /& /,4!B+", B,/ &+2(% &! A3/',/13+&%B+, *321 ' *321/4, &/ % .)+%4&/ A3/&%(+�, *321 . *321+.

�13/4&G@ /AG,, A3%/$3!,!&&G@ �L�. �%3/1/.G4 '&+B+"+ &+ �+.(+)! (1847), )+,!4 . �3G4-'(/@ ./@&! (1854–1856), )+(3!A"!&&G@ A3% A/'!�!&%% ./!&&GD 1/'A%,+"!@ �!34+&%% (1870 1.), %,&+(/&!5, . �2''(/N,23!5(/@ ./@&! (1877–1878) A/)./"%" !42 &! ,/"-(/ A!3!'4/,3!,-, &/ % )+&/./A!3!3+$/,+,- /31+&%)+5%� ./!&&/NA/"!./1/ .3+B!$&/1/ *!"+. �& '?/342"%3/.+" /'&/.G («�+B+-"+», A/ !1/ .G3+F!&%�) ./!&&/NA/"!./@ D%3231%%.

�!#,!"-&/',- �%3/1/.+ (+( ./!&&/N4!*%5%&'(/1/ +*4%&%',3+,/3+ &+B+"+'- . 1847 1/*2.�.%*!,!"-',.2�, /$ �,/4 !1/ A!3.G! ,32*G A/ ./!&&/NA/"!./@ D%3231%%: «�$ 2B!&GD *!@',.%#DA3/?!''/3+ �%3/1/.+ &+ �+.(+)!» — 1847 1/*; «�,B!, / D%3231%B!'(%D A/'/$%#D, /(+)+&&GD 3+-&!&G4 ./ .3!4# /'+*G )+&#,%# 2(3!A"!&%# �+",G» — 1847 1/*; «�,B!, / A2,!U!',.%% A/ �+.(+-)2» — 1849 1/*. �).!',&/, B,/ . %�"! 1847 1/*+ A3% /'+*! +2"+ �+",G A3% /(+)+&%% A/4/�%400 3+&!&G4 . ./!&&/NA/"!.GD 2'"/.%#D �%3/1/. /'2�!',.%" 4+''/./! A3%4!&!&%! �?%3&/1/&+3(/)+. �,/, !*%&',.!&&G@ . 4%3! /AG, /& %)"/F%" . (&%1! «�,B!, / A2,!U!',.%% A/ �+.(+)2».�+&&/! %)*+&%! A/'"2F%"/ &+B+"/4 3+).%,%# ,+(/@ *%'5%A"%&G, (+( ./!&&/NA/"!.+# D%3231%#,(/,/3+# . *+"-&!@U!4 A/"2B%"+ U%3/(/! 3+).%,%!.

� '+4/1/ &+B+"+ 3+$/,G . �3G42 — 2F! . ,!B!&%! A!3.GD *.2D 4!'#5!. — �L�. �%3/1/.?/342"%32!, % ../*%, A/&#,%! '/3,%3/.(%, 3+)*!"## 3+&!&GD ' 1&/@&G4% % '!A,%B!'(%4% /'"/F-&!&%#4% /, A/3+F!&&GD ' B%',G4% 3+&+4% % '.!F!3+&!&GD. �,/ A/)./"%"/ '&%)%,- (/"%B!',./A/'"!/A!3+5%/&&GD /'"/F&!&%@ % 3+)132)%,- D%3231%B!'(%! "+)+3!,G.

�+ 37 "!, */ .4!U+,!"-',.+ �+',!3+ . /$"+',- '!A,%B!'(%D %&?!(5%@ (1878) % )+ 6 "!, */ +.-',3%@5+ �!44!"-.!@'+ .!"%(%@ �L�. �%3/1/. .G3+)%" './@ .)1"#* &+ '!A,%B!'(%! )+$/"!.+&%#,(+( &+ )+$/"!.+&%# %&?!(5%/&&G!. �L�. �%3/1/. ',/#" &!'3+.&!&&/ .GU! % *+"!(/ /A!3!*%" �%'-

49

,!3+, A3%*+.+.U!1/ 1"+.&/! )&+B!&%! )+3+F!&%� 3+& %) ./)*2D+. �%3/1/. 2,.!3F*+", B,/ 1&/@&/!)+3+F!&%! 3+'A3/',3+&#!,'# &! ',/"-(/ B!3!) ./)*2D, (/,/3G@ *!"+!,'# .3!*&G4 A3% '(2B%.+&%%3+&!&GD . )+(3G,/4 A3/',3+&',.!, '(/"-(/ B!3!) /(32F+��%! 3+&!&GD A3!*4!,G ($!"-!, 4+,3+-5G, A!3!.#)/B&G! '3!*',.+, ',!&G, A/") % *+F! '+&%,+3&G@ A!3'/&+".

#&.+3! 1855 1/*+, (/1*+ .'! !�! A3/*/"F+"+'- �3G4'(+# ./@&+, �L�. �%3/1/. A3%&#" &+'!$# 32(/./*',./ A!3!.#)/B&G4 A2&(,/4, 3+).!3&2,G4 . )*+&%% �./3#&'(/1/ '/$3+&%#. �*!'-, .2'"/.%#D 4+''/./1/ A/',2A"!&%# 3+&!&GD, /& .A!3.G! . %',/3%% ./!&&/@ 4!*%5%&G U%3/(/ A3%-4!&%" './@ A3%&5%A A!3.%B&/@ '/3,%3/.(% 3+&!&GD . )+.%'%4/',% /, ',!A!&% '3/B&/',% /(+)+&%#D%3231%B!'(/@ A/4/�%.

�+ .3!4# 2B+',%# . �3G4'(/@ (+4A+&%% D%3231%B!'(+# 132AA+ �%3/1/.+ &! ,/"-(/ )+&%-4+"+'- /31+&%)+5%!@ 4!*%5%&'(/@ A/4/�%, &/ % '+4+ .GA/"&%"+ /(/"/ 10 ,G'#B (32A&GD /A!-3+5%@. �3%B!4 .A!3.G! . 4%3/./@ A3+(,%(! .'! /A!3+5%% .!"%'- A/* D"/3/?/34!&&G4 &+3(/-)/4.

1870 1/*2 . D/*! �3+&(/NA32''(/@ ./@&G �L�. �%3/1/. &+ 4!',! )&+(/4%,'# ' 3+$/,/@ A!-3!.#)/B&GD A2&(,/., "+)+3!,/. % 1/'A%,+"!@. � . 1878–1879 11., 2F! $2*2B% . A3!("/&&/4 ./)3+'-,!, A3%&%4+!, 2B+',%! . /31+&%)+5%% % /(+)+&%% 4!*%5%&'(/@ A/4/�% 3+&!&G4 . �2''(/-,23!5(/@ ./@&!.

�L�. �%3/1/. A/',/#&&/ A/*B!3(%.+": ./!&&/NA/"!.+# D%3231%# ./ 4&/1/4 /,"%B+!,'# /,D%3231%% 4%3&/1/ .3!4!&%. �+ .'!D �,+A+D — /, A/"# '3+F!&%# */ 1/'A%,+"# — 4!*%5%&'(2�A/4/�- $/"-U/42 B%'"2 3+&!&GD A3%D/*%,'# /(+)G.+,- . A/"!.GD 2'"/.%#D.

�+ ./@&! )+3/F*+!,'# — % 3!+"%)2!,'# — %*!# */$3/./"-&/@ 4!*%5%&'(/@ A/4/�% ./ .3!-4# .!*!&%# $/!.GD *!@',.%@. �,+ %*!# . *+"-&!@U!4 "!1"+ . /'&/.2 '/)*+&%# 4!F*2&+3/*&/@ /3-1+&%)+5%% �3+'&/1/ �3!',+.

�4!&&/ �L�. �%3/1/. A3!*"+1+!, /$3+)/.+,- �!F*2&+3/*&G@ ./!&&/N.3+B!$&G@ (/4%,!,,(/,/3G@ /$�!*%&%" $G 2'%"%# 4!*%5%&'(/1/ A!3'/&+"+. �& '/$%3+!, 132AA2 '!',!3 4%"/'!3*%#*"# /$2B!&%# %D 2D/*2 )+ 3+&!&G4% % &+A3+."!&%# *"# A/4/�% )+�%,&%(+4 �!.+',/A/"#. �!',3G3+$/,+"% . +A,!(+D, A!3!.#)/B&GD % /A!3+5%/&&GD, '/A3/./F*+"% ,3+&'A/3, ' 3+&!&G4%.

1854 1/*2 /,*!"-&/@ $3/U�3/@ %)*+&+ 3+$/,+ �L�. �%3/1/.+ «�+"!A&+# +"!$+',3/.+# A/-.#)(+ . "!B!&%% A3/',GD % '"/F&GD A!3!"/4/. % *"# ,3+&'A/3,+ 3+&!&GD &+ A/"! '3+F!&%#», .(/,/3/@ /& 3!(/4!&*2!, %'A/"-)/.+,- 1%A' *"# %44/$%"%)+5%% A/.3!F*!&&GD (/&!B&/',!@ %/'2�!',."!&%# A3%&5%A+ «'$!3!1+,!"-&/1/» "!B!&%# /1&!',3!"-&GD 3+& % A!3!"/4/..

�(,%.&/! 2B+',%! D%3231+ . B!,G3!D (32A&GD ./@&+D A3!*/',+.%"/ �%3/1/.2 ./)4/F&/',-2)&+,- % A/&#,- 3+)&//$3+)&G! 2'"/.%# ./!&&/@ /$',+&/.(%, %D ."%#&%! &+ *!#,!"-&/',- ./!&&/-4!*%5%&'(/@ '"2F$G. �& .G#.%" /'/$!&&/',% % /,"%B%# ./!&&/NA/"!./@ D%3231%% /, D%3231%%4%3&/1/ .3!4!&%.

�+ /'&/.+&%% './!1/ 2&%(+"-&/1/ .3+B!$&/1/ /AG,+ �L�. �%3/1/. /A2$"%(/.+" 3#* (32A-&GD &+2B&GD ,32*/., . (/,/3GD '?/342"%3/.+" /'&/.&G! A/"/F!&%# A/ /31+&%)+5%% 4!*%5%&-'(/@ A/4/�% % "!B!&%� 3+&!&GD &+ ./@&!.

1864 1/*2 . �!34+&%% &+ &!4!5(/4 #)G(!, + . 1865–1866 11. . �/''%% &+ 32''(/4 #)G(!�L�. �%3/1/. %)*+!, «�+B+"+ /$�!@ ./!&&/NA/"!./@ D%3231%%, .)#,G %) &+$"�*!&%@ ./!&&/-1/'A%,+"-&/@ A3+(,%(% % ./'A/4%&+&%@ / �3G4'(/@ ./@&! % �+.(+)'(/@ �('A!*%5%%» (. *.2D B+'-,#D). / ..!*!&%% ( �,/142 (+A%,+"-&/42 ,32*2 �L�. �%3/1/. '(3/4&/ A%U!,: «� '//$�+� 4/%4B%,+,!"#4 3!)2"-,+,G ,/1/, B,/ .%*!" ./ .3!4# 4/!@ �+.(+)'(/@ �('A!*%5%% . 1847 1. % �3G4'(2�./@&2 . 1854 % 1855 11. % . 1/'A%,+"-&/@ A3+(,%(!, A3/*/"F+.U!@'# ' "%U(/4 25 "!,».

�+(,%B!'(% «�+B+"+» ',+"% 2B!$&%(/4 % 32(/./*',./4 *"# ./!&&/NA/"!.GD D%3231/..�,/"- /$�!4&/1/, 1"2$/(/ '/*!3F+,!"-&/1/, A/*3/$&/1/ A/ %)"/F!&%�, /D.+,G.+��!1/ .'! 3+)-*!"G ./!&&/NA/"!./@ D%3231%% 32(/./*',.+ *"# .3+B!@, /'&/.+&&/1/ &+ '/$',.!&&/4 .3+B!$&/4/AG,!, .3#* "% 4/F&/ &+@,% ./ .'!@ A/'"!*2��!@ %',/3%% ./!&&/NA/"!./@ D%3231%%.

�&/1%! %) A/"/F!&%@ �L�. �%3/1/.+ /$ /31+&%)+5%% 4!*%5%&'(/@ A/4/�% % "!B!&%� 3+-&!&GD, 3+)3+$/,+&&G! . A!3%/* /$/3/&G �!.+',/A/"# % �+.(+)'(/@ �('A!*%5%%, A/)F! &+B+"%/'2�!',."#,-'# ?3+&52)'(%4% % &!4!5(%4% D%3231+4%. �,/ (+'+"/'- /$!)$/"%.+&%#, 1%A'/./@A/.#)(%, 3!)!(5%% '2',+./., '$!3!1+,!"-&/1/ 4!,/*+ "!B!&%# % *3.

/ .3!4# A/'!�!&%# ,!+,3+ ./@&G &+ �+"(+&+D . 1877–1878 11. �L�. �%3/1/. ' 2*/."!,./3!-&%!4 (/&',+,%3/.+", B,/ 4&/1%! %) !1/ %''"!*/.+&%@ . ./!&&/NA/"!./@ D%3231%% A3!F&%D "!, 2'-A!U&/ %'A/"-)2�,'# %&/',3+&&G4% ./!&&G4% .3+B+4%. �1/, /*&+(/, /1/3B+"/, B,/ /$�%! 2'"/-.%#, . (/,/3GD /(+)G.+"+'- 4!*%5%&'(+# A/4/�-, /',+"%'- . )&+B%,!"-&/@ ',!A!&% A3!F&%4%.� )&+B%,, /&% &! 'A/'/$&G /$!'A!B%,- */"F&/1/ "!B!&%# 3+&!&GD.

50

�B+',%! . 32''(/N,23!5(/@ ./@&! 1877–1878 11. A/)./"%"/ �L�. �%3/1/.2 '/)*+,- )+.!3-U+��%@ 4/&24!&,+"-&G@ ,32* A/ ./!&&/NA/"!./@ D%3231%%: «/!&&/N.3+B!$&/! *!"/ % B+',&+#A/4/�- &+ ,!+,3! ./@&G . �/"1+3%% % . ,G"2 *!@',.2��!@ +34%% . 1877–1878» (. *.2D B+',#D). �,/4 ,32*! �%3/1/. /(/&B+,!"-&/ '?/342"%3/.+" *.+*5+,- /'&/.&GD A/"/F!&%@ ./!&&/@ 4!-*%5%&G % ./!&&/NA/"!./@ D%3231%%, .G*!3F+.U%D A3/.!3(2 .3!4!&!4 — .A"/,- */ &+U%D *&!@.�1/ +.,/3%,!, . /$"+',% ./!&&/NA/"!./@ D%3231%% % /31+&%)+5%% 4!*%5%&'(/1/ /$!'A!B!&%#./@'( A/"2B%" 4%3/./! A3%)&+&%!.

�&+B!&%! ,32*/. �L�. �%3/1/.+ ,32*&/ A!3!/5!&%,-. �!'4/,3# &+ A/B,% A/"2,/3+.!(/.2�*+.&/',-, !1/ (&%1% &! 2,3+,%"% './!@ 5!&&/',%. +F&!@U%! /$�%! )+(/&/4!3&/',% A+,/"/1%%,("%&%B!'(/1/ ,!B!&%# % "!B!&%# /1&!',3!"-&/@ 3+&G /',+"%'- ,! F!, B,/ % A3% �%3/1/.!. �& *+",+(/! A/"&/! % A/2B%,!"-&/! /A%'+&%! ("%&%(% /1&!',3!"-&GD 3+&!&%@, B,/ % '!1/*&# *"# 4/"/-*/1/ D%3231+ 3+$/,+ �%(/"+# �.+&/.%B+ «�+B+"+ /$�!@ ./!&&/NA/"!./@ D%3231%%» #."#!,'# &!-A3!.)/@*!&&G4 A/'/$%!4 A/ *%+1&/',%(! /1&!',3!"-&GD 3+&!&%@.

�+F*+# /,*!"-&/ .)#,+# !1/ %*!# 4/1"+ /$!''4!3,%,- %4# .!"%(/1/ 2B!&/1/. �!3!B%'"%4 D/-,# $G &!(/,/3G!:

- U%3/(/! A3%4!&!&%! &+3(/)+ . ./!&&/NA/"!./@ A3+(,%(!;- 1%A'/.+# %44/$%"%)%32��+# A/.#)(+, '/)*+.U+# 2'"/.%# *"# ,/3F!',.+ «'$!3!1+,!"-&GD»

4!,/*/. "!B!&%# % ,3+&'A/3,%3/.(% 3+&!&GD;- '/3,%3/.(+ 3+&!&GD (+( «1"+.&/! '3!*',./ *"# /(+)+&%# A3+.%"-&/@ A/4/�%»;- '%',!4+ «3+''!%.+&%# 3+&!&GD», A3%).+&&+# 'A/'/$',./.+,- A3!*2A3!F*!&%� 3+).%,%#

.&2,3%1/'A%,+"-&GD %&?!(5%@ % �A%*!4%B!'(%D )+$/"!.+&%@.�G 5!&%4 �L�. �%3/1/.+ % (+( '/)*+,!"# /31+&%)+5%/&&GD /'&/. ./!&&/@ 4!*%5%&G. �&%

/(+)+"% ."%#&%! &! ,/"-(/ &+ /,!B!',.!&&2� ./!&&2� 4!*%5%&2, &/ % &+ A3/13!'' . �,/@ /$"+',%)+ 32$!F/4. �/B,% .'! '/.3!4!&&G! 2(+)+&%# A/ ./!&&/NA/"!./@ D%3231%% %'D/*#, %) *.+*5+,%��+B+"» �L�. �%3/1/.+, '?/342"%3/.+&&GD . !1/ ,32*+D.

�%(/"+@ �.+&/.%B �%3/1/. $G" .!"%(%4 A+,3%/,/4 './!@ �/*%&G. �@ /& /,*+" .'! './% '%-"G, !@ /& A/'.#,%" .!'- './@ 4/12B%@ ,+"+&,. �& /31+&%B&/ '/B!,+" B!3,G .!"%(/1/ 4G'"%,!"# %13+F*+&%&+, ./A"/�+# '/$/@ %*!+"-&G@ /$3+) .3+B+. +(%4 /& /',+"'# . %',/3%%, ,+(%4 /& F%.!,. &+U!4 A3!*',+."!&%% '!1/*&#, #."## A3%4!3 *"# &/.GD % &/.GD A/(/"!&%@ .3+B!@.

�A%'/( "%,!3+,23G:1. �23*!&(/, �L�. � %',/3%B!'(/@ D+3+(,!3%',%(! +(+*!4%B!'(/@ *!#,!"-&/',% �L�. �%3/-

1/.+ (1836–1854) // �%3231%#. — 1937. — � 2. — �. 23–27.2. �%3/1/., �L�. �,B!, / A2,!U!',.%% A/ �+.(+)2. — ��$., 1879.3. �%3/1/., �L�. �!.+',/A/"-'(%! A%'-4+ % ./'A/4%&+&%#. — ��$., 1950.4. 23&!3, �L�. �+( ?/34%3/.+"+'- D%3231%#. — �!&%&13+*, 1927.

&!1]`)!1!>+%'�)+^0&+>>'&!$$2!&J+&!$",+++&"q$+0++1!&��"0!1!>++

)#". $ ������� (����.), )#$. (������ (����.), ,#�. �������� (����.), �#w. x������� (����.)�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#

1 �+?!*3+ $%/D%4%%2 �+?!*3+ 4%(3/$%/"/1%%, .%32'/"/1%%, %442&/"/1%% % ("%&%B!'(/@ "+$/3+,/3&/@ *%+1&/',%(%

�������������������: 1 !��. #��$� (��. �� ., . �. �.), 2 #��. ��%���� &��. �� ., . �. �.)

$�������. �!#,!"-&/',- �L�. �%3/1/.+ &!/$GB+@&/ 3+)&/',/3/&&## % 4&/1/13+&&+#: D%323-1%#, +&!',!)%/"/1%#, 1%1%!&+, /31+&%)+,/3'(+# % A!*+1/1%B!'(%@ A3/5!''… �+U% '/.3!4!&&%(%.G'/(/ 5!&#, &+2B&G! % A3+(,%B!'(%! */',%F!&%# �L�. �%3/1/.+ . 3+)"%B&GD /$"+',#D 4!*%5%-&G, %'A/"-)2�, %D . './!@ A3+(,%B!'(/@ *!#,!"-&/',% % 3+).%.+�, %D ' 2B!,/4 '/.3!4!&&GD /,-(3G,%@ . 4!*%5%&!.

1881 1/*2 .'! .GD/*%.U%! . �/''%% A!B+,&G! %)*+&%# (B+',&G! % /?%5%+"-&G!, 'A!5%-+"-&G! % /$�%!) 2*!"#"% 4&/1/ 4!',+ ',+,-#4 / �L�. �%3/1/.!, A/'.#��&&G4 A3!*',/#�!42�$%"!� .!"%(/1/ .3+B+. '! !.3/A!@'(%! 2B!&G! /$�!',.+ % 2&%.!3'%,!,G A3%'"+"% �$%"#32+*3!'+ % *%A"/4G &+ ).+&%! A/B!,&/1/ */(,/3+. �/"-U%&',./ 32''(%D 2&%.!3'%,!,/. %)$3+"/ !1/A/B!,&G4 B"!&/4 !�! */ U!',%*!'#,GD 1/*/. A3/U"/1/ .!(+. �+&(!,G . B!',- �L�. �%3/1/.+

51

A3%/$3!"% 13+&*%/)&G@ D+3+(,!3. �*&+(/ )+("�B%,!"-&G@ *!&- �$%"!@&/1/ ,/3F!',.+ $G" /4-3+B!& 2'%"!&%!4 $/"!)&% �%(/"+# �.+&/.%B+. �/,!3#. )+ 1/* */ ,/1/ A/'"!*&%@ (/3!&&/@ )2$A3+./@ .!3D&!@ B!"�',%, /& /,(+)G.+"'# .',+.%,- %'(2'',.!&&G! B!"�',%. �+ 4!',! .GA+.U%D)2$/. ',+"+ 3+).%.+,-'# #).+. &+B+"! 1881 1/*+ �L�. �%3/1/. /$3+,%" .&%4+&%! &+ $/"- % 3+)-*3+F!&%! &+ '"%)%',/@ ,.!3*/1/ &!$+, 24 4+# 1881 1/*+ �L. �("%?/'/.'(%@ 2',+&/.%" 2 �%(/"+#�.+&/.%B+ &+"%B%! 3+(+ .!3D&!@ B!"�',%. �4!3 �L�. �%3/1/. . 20 B+'/. 25 4%&2, 23 &/#$3# 18811/*+ /, 3+(+, A3%B%&/@ 3+).%,%# A/'"!*&!1/, .!3/#,&/, $G"/ B+',/! (23!&%!.

&+',/#�!! .3!4# $/"-U/@ %&,!3!' A3!*',+."#�, %''"!*/.+&%# ?+(,/3/., A/.3!F*+��%D'"%)%',2� .!3D&%D *GD+,!"-&GD A2,!@ % 3,+, + ,+(F! D+3+(,!3 %D ./)*!@',.%#. �A%*!4%/"/1%B!-'(%! &+$"�*!&%# 2$!*%,!"-&/ A/(+)+"%, B,/ ?+(,/3G /(32F+��!@ '3!*G %4!�, *+F! $�"-U!!)&+B!&%! *"# ("%&%B!'(%D A3/#."!&%@ )+$/"!.+&%@ *GD+,!"-&GD A2,!@, B!4 1!&!,%B!'(+# A3!*-3+'A/"/F!&&/',-.

*��z�����������. �)2B!&%! 3/"% �(/"/1%B!'(%D ,3%11!3&GD ?+(,/3/. . ?/34%3/.+&%% %3+).%,%% ���NA+,/"/1%% . �!"#$%&'(/@ /$"+',%.

J����� � ����� . 3+$/,! A3!*',+."!&G 3!)2"-,+,G %)2B!&%# 3/"% �(/"/1/-1!/13+?%B!'(%D ,3%11!3&GD ?+(,/3/. . ?/34%3/.+&%% % 3+).%,%% +""!31%B!'(%D 3%&%,/. % /,-*!"-&GD $/"!)&!@ /31+&/. *GD+&%# . *!,'(/@ % .)3/'"/@ A/A2"#5%#D �!"#$%&'(/@ /$"+',%.

J����� ��� �����������. �+&&G! /?%5%+"-&/@ ',+,%',%(% A/ 3+'A3/',3+&!&&/',%$/"!)&!@ /31+&/. *GD+&%# 2 *!,!@ 0–14 "!, % .)3/'"GD A/ 27 42&%5%A+"-&G4 /$3+)/.+&%#4 �!"#-$%&'(/@ /$"+',% )+ 2008–2010 1/*G, A3!*/',+."!&&G! ��� «�!"#$%&'(%@ /$"+',&/@ 4!*%5%&'(%@%&?/34+5%/&&/N+&+"%,%B!'(%@ 5!&,3».

�+&&G! / (/"%B!',.! .G$3/'/. )+13#)&#��%D .!�!',. . +,4/'?!32 A/ 27 42&%5%A+"-&G4/$3+)/.+&%#4 �!"#$%&'(/@ /$"+',% )+ 2008–2010 1/*G, A/"2B!&&G! . 3!)2"-,+,! �(/"/1%B!'(/1/&+*)/3+, A3/.!*!&&/1/ /,*!"/4 '/5%+"-&/N1%1%!&%B!'(/1/ 4/&%,/3%&1+ % /5!&(% 3%'(+ ������!&,3 1%1%!&G % �A%*!4%/"/1%% . �!"#$%&'(/@ /$"+',%».

�"# %''"!*/.+&%# /'/$!&&/',!@ 3+'A3/',3+&!&&/',% (+( /,*!"-&GD $/"!)&!@ /31+&/. *GD+-&%#, ,+( % $/"!)&!@ *+&&/1/ ("+''+ . 5!"/4 . *!,'(/@ A/A2"#5%% �!"#$%&'(/@ /$"+',% 3+''B%,+&+/$�+# )+$/"!.+!4/',- A/ /$3+�+!4/',% A/ +""!31%B!'(/42 3%&%,2, .G).+&&/42 AG"-5/@ 3+',!-&%@; /',3/42 &+)/?+3%&1%,2; 1%A!3,3/?%% +*!&/%*/. (2 *!,!@); +',4!, .("�B+# ',+,2'; A/ ("+''2��/"!)&% /31+&/. *GD+&%#» 2 *!,!@ 0–14 "!, % .)3/'"GD A/ 27 42&%5%A+"-&G4 /$3+)/.+&%#4 �!-"#$%&'(/@ /$"+',% )+ 2008–2010 1/*G.

�"# .G#."!&%# �(/"/1/N1!/13+?%B!'(%D /'/$!&&/',!@ ,!33%,/3%@ �!"#$%&'(/@ /$"+',%A3/+&+"%)%3/.+&G *+&&G! / (/"%B!',.! .G$3/'/. )+13#)&#��%D .!�!',. . +,4/'?!32 A/ 27 42-&%5%A+"-&G4 /$3+)/.+&%#4 �!"#$%&'(/@ /$"+',% )+ 2008–2010 1/*G.

�) .'!@ '/./(2A&/',% )+13#)&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32 42&%5%A+"--&GD /$3+)/.+&%@ �!"#$%&'(/@ /$"+',%, /,/$3+&G D%4%B!'(%! '/!*%&!&%#, /(+)G.+��%! A3!-%42�!',.!&&/! ."%#&%! &+ /31+&G *GD+&%#. �4% #.%"%'- 25 D%4%B!'(%D .!�!',. % %D '/!*%&!-&%@: +44%+(, $!&)%&, $2,%"+5!,+,, 1!('+&, *%.+&+*%@, +)/,&+# % '!3&+# (%'"/,G, (3!4&%@, ('%"/",4+1&%@, 4!*-, 4!,%"4!3(+A,+&, 4GU-#(, &+?,+"%&, &%(!"-, A3/A+&, '+F+, '!"!&, ,/"2/", ?!&/",?/34+"-*!1%*, ?,/3, D"/3, D3/4, �,%"+5!,+,. �#* )+13#)&#��%D .!�!',., '/*!3F+�%D'# . +,4/-'?!3! 42&%5%A+"-&GD /$3+)/.+&%@ �!"#$%&'(/@ /$"+',% % /$2'"+."%.+��%D D3/&%B!'(/! %&1+-"#5%/&&/! ./)*!@',.%!, .G)G.+�, 2 B!"/.!(+ &! ,/"-(/ 3+)*3+F!&%! '"%)%',GD /$/"/B!( *GD+-,!"-&GD A2,!@, &/ % +""!31%B!'(/! % '!&'%$%"%)%32��!! *!@',.%!, .("�B+# '%',!4&G! +""!31%-B!'(%! 3!+(5%%: *%.+&+*%@, 4+1&%@ % !1/ '/!*%&!&%#, &+?,+"%&, &%(!"-, ?!&/", ?/34+"-*!1%*,�,%"+5!,+,.

�"# /5!&(% 3/"% �(/"/1/N1!/13+?%B!'(%D ,3%11!3&GD ?+(,/3/. . ?/34%3/.+&%% % 3+).%,%%+""!31%B!'(%D 3%&%,/. % /,*!"-&GD $/"!)&!@ /31+&/. *GD+&%# . *!,'(/@ A/A2"#5%% �!"#$%&'(/@/$"+',% A3/.!*!& '3+.&%,!"-&G@ +&+"%) A/(+)+,!"!@ 3+'A3/',3+&!&&/',% %)2B!&&GD )+$/"!.+&%@% �(/"/1/N1!/13+?%B!'(%D D+3+(,!3%',%( 42&%5%A+"-&GD /$3+)/.+&%@ �!"#$%&'(/@ /$"+',%.

������������ ������� ��_��z����. �+&&G!, /$3+$/,+&&G! 4!,/*+4% .+3%+5%/&&/@',+,%',%(%, .G3+F+"% . .%*! '3!*&!@ +3%?4!,%B!'(/@ % !� ',+&*+3,&/@ /U%$(% (� �m), n — (/-"%B!',./ &+$"�*!&%@ . .G$/3(!. �3% /$�!4! .G$/3(% $/"-U! 20 &+$"�*!&%@ A3/.!3#"% ',+,%-',%B!'(2� 1%A/,!)2 / &/34+"-&/',% 3+'A3!*!"!&%# *+&&GD A/ (3%,!3%� �/"4/1/3/.+ — �4%3&/-.+. � */',/.!3&/',% 3+)"%B%@ A/(+)+,!"!@ '3+.&%.+!4GD 132AA A3% 4+"/4 /$��4! .G$/3(% '2*%-"% A/ (3%,!3%#4 &!A+3+4!,3%B!'(/@ ',+,%',%(% �+&&+ — �%,&% % ,/B&/42 (3%,!3%� �%U!3+.�3% $/"-U/4 /$�!4! .G$/3(% / */',/.!3&/',% 3+)"%B%@ A/(+)+,!"!@ '3+.&%.+!4GD 132AA '2*%"%A/  2 ' A/A3+.(/@ !,'+. �"# 4&/F!',.!&&GD '3+.&!&%@ %'A/"-)/.+"% A/A3+.(2 �/&?!33/&%. �!-

52

)2"-,+,G %''"!*/.+&%@ /$3+$+,G.+"% &+ ��� IBM ' %'A/"-)/.+&%!4 A+(!,+ A3%("+*&GD A3/-13+44 «Statistica for Windows 6.0».

&�_��z�� �����������. �'/$!&&/',% 3+'A3/',3+&!&&/',% +""!31%B!'(%D 3%&%,/. % /,-*!"-&GD $/"!)&!@ /31+&/. *GD+&%# . *!,'(/@ A/A2"#5%% �!"#$%&'(/@ /$"+',%

�+'A3/',3+&!&&/',- /',3/1/ &+)/?+3%&1%,+ . 1/3/*! �+3+$+U! */',/.!3&/ .GU!, B!4 . *32-1%D 42&%5%A+"-&GD /$3+)/.+&%#D �!"#$%&'(/@ /$"+',% % '/',+."#!, 49,55 ± 5,24 (p < 0,05). �$�+#)+$/"!.+!4/',- A/ /$3+�+!4/',% A/ 1%A!3,3/?%% +*!&/%*/. . �+3,+"%&'(/4 (48,15 ± 1,11;p < 0,05), �.!"-'(/4 (46,11 ± 2,26; p < 0,05) 3+@/&+D, 1/3/*+D �/A!@'(! (63,12 ± 6,78; p < 0,05), �%-+''! (63,52 ± 1,62; p < 0,05) )&+B%4/ .GU!, B!4 . *321%D ,!33%,/3%#D �!"#$%&'(/@ /$"+',%. �+'-A3/',3+&!&&/',- +""!31%B!'(/1/ 3%&%,+, .G).+&&/1/ AG"-5/@ 3+',!&%@, . 1/3/*+D �"+,/2',!(12,01 ± 2,32; p<0,05), �+1&%,/1/3'(! (12,81 ± 1,35; p < 0,05), �!"#$%&'(! (8,16 ± 0,53; p < 0,05) )&+-B%,!"-&/ .GU!, B!4 . *321%D 42&%5%A+"-&GD /$3+)/.+&%#D �!"#$%&'(/@ /$"+',%. �$�+# )+$/"!-.+!4/',- A/ /$3+�+!4/',% A/ +',4!, .("�B+# ',+,2', . 1/3/*+D �"+,/2',! (52,93 ± 0,35; p < 0,05),�+1&%,/1/3'(! (31,41 ± 1,16; p < 0,05), �!"#$%&'(! (30,57 ± 0,74; p < 0,05) '2�!',.!&&/ .GU!, B!4 .*321%D ,!33%,/3%#D �!"#$%&'(/@ /$"+',%, A3% �,/4 . �"+,/2',! )+4!,&/ .GU!, B!4 . �+1&%,/1/3-'(! (p = 0,001) % �!"#$%&'(! (p = 0,0002). �+'A3/',3+&!&&/',- $/"!)&!@ /31+&/. *GD+&%# . �31+-#U'(/4 (1468,09 ± 106,43; p < 0,05), �U%&'(/4 (1320,87 ± 21,14; p < 0,05), �,(2"-'(/4(1251,41 ± 250,11; p < 0,05), �+'"%&'(/4 (1685,38 ± 71,93; p < 0,05), �3+'&/+34!@'(/4(1341,36 ± 133,64; p < 0,05), �2'%&'(/4 (1432,71 ± 7,28; p < 0,05), �+,(%&'(/4 (1362,48 ± 98,55;p < 0,05) 3+@/&+D, 1/3/*+D !3D&!4 �?+"!! (1827,94 ± 132,35; p < 0,05), �"+,/2',!(1473,53 ± 44,5;p < 0,05), �/A!@'(! (1626,23 ± 54,02; p < 0,05), 3/%5(! (1531,32 ± 259,4; p < 0,05),�!"#$%&'(! (1527,97 ± 54,91; p < 0,05) */',/.!3&/ .GU!, B!4 . *321%D 42&%5%A+"-&GD /$3+)/.+&%-#D �!"#$%&'(/@ /$"+',%.

'���*�+*��*���������� ���-�������� ����������� ���$-������ �-�����. �&+"%) *+&&GD/?%5%+"-&/@ ',+,%',%(% A/(+)+", B,/ (/"%B!',./ .G$3/'/. )+13#)&#��%D .!�!',. . +,4/'?!32�!"#$%&'(/@ /$"+',% )+ 2008–2010 1/*G '/',+.%"/ 217 979,68 ,G'#B ,/&&.

�2&%5%A+"-&G! /$3+)/.+&%# �!"#$%&'(/@ /$"+',% 3+)"%B+�,'# A/ 23/.&� +&,3/A/1!&&/@&+132)(%. +(, &+A3%4!3, . +,4/'?!3! .'!D 42&%5%A+"-&GD 3+@/&/. % 1/3/*'(%D /(321/. 3!1%',-3%32�,'# )+13#)&#��%! .!�!',.+, ./)*!@',.2��%! &+ '"%)%',G! /$/"/B(% *GD+,!"-&GD A2,!@,&! /$"+*+��%! A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4. �*&+(/ %D (/"%B!-',./ '%"-&/ .+3-%32!, . )+.%'%4/',% /, ,!33%,/3%% /$"+',%: /, *.2D .!�!',. . �3!*%&'(/4 %+3&!&'(/4 3+@/&+D, */ 13 — . 1/3/*! �+1&%,/1/3'(!. �3% �,/4 . +,4/'?!3! �3!*%&'(/1/, +3-&!&'(/1/, �+,+.N�.+&/.'(/1/, �3+'&/+34!@'(/1/, �+1+@$+('(/1/, �#)!A!,3/.'(/1/ 3+@/&/. % 1/-3/*+ 3/%5(+ &! /$&+32F!&/ )+13#)&#��%D .!�!',., /$"+*+��%D A3#4G4 +""!31%)%32��%4 %'!&'%$%"%)%32��%4 *!@',.%!4, . *321%D F! ,!33%,/3%#D �!"#$%&'(/@ /$"+',% (/"%B!',./ A/-'"!*&%D .+3-%32!, /, /*&/1/ .!�!',.+ . �1+A/.'(/4, �31+#U'(/4, �U%&'(/4, �4+&F!"%&'(/4,�,(2"-'(/4, �+3+$+U'(/4, �+3,+"%&'(/4, �+'"%&'(/4, �2'%&'(/4, �+,(%&'(/4, �/'&/.'(/4,�.!"-'(/4, �!$+3(2"-'(/4 3+@/&+D, */ 6 — . 1/3/*! �!"#$%&'(!.

+,4/'?!3! 1/3/*/. !3D&!1/ �?+"!#, �"+,/2',+, �+3+$+U+, �/A!@'(+, �+1&%,/1/3'(+ %�!"#$%&'(+ (/"%B!',./ &+%4!&/.+&%@ )+13#)&#��%D .!�!',., ./)*!@',.2��%D &+ '"%)%',G! /$/-"/B(% *GD+,!"-&GD A2,!@, &! /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@-',.%!4, */',/.!3&/ $/"-U!, B!4 . *321%D ,!33%,/3%#D �!"#$%&'(/@ /$"+',% (p < 0,05). �3% �,/4 .+,4/'?!3! 1/3/*/. �"+,/2',, �+1&%,/1/3'( % �!"#$%&'( )&+B%4/ $/"-U! % (/"%B!',./ &+%4!&/-.+&%@ )+13#)&#��%D .!�!',., /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4*!@',.%!4 (p < 0,05).

+,4/'?!3! �1+A/.'(/1/, �31+#U'(/1/, �U%&'(/1/, �4+&F!"%&'(/1/, �,(2"-'(/1/, �+3,+-"%&'(/1/, �+'"%&'(/1/, �2&+U+('(/1/, �2'%&'(/1/, �+,(%&'(/1/, �/'&/.'(/1/, �.!"-'(/1/, �!-$+3(2"-'(/1/ 3+@/&/. % 1/3/*+ �%+''+ (/"%B!',./ &+%4!&/.+&%@ )+13#)&#��%D .!�!',., ./)*!@-',.2��%D &+ '"%)%',G! /$/"/B(% *GD+,!"-&GD A2,!@ ((+( &! /$"+*+��%D, ,+( % /$"+*+��%DA3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4), . '244! &! A3!.GU+"/ 10, B,/ '2-�!',.!&&/ 4!&-U!, B!4 . .GU! 2A/4#&2,GD A3/4GU"!&&GD 1/3/*+D (p < 0,05).

+,4/'?!3! �3!*%&'(/1/, +3&!&'(/1/, �+,+.N�.+&/.'(/1/, �3+'&/+34!@'(/1/, �+1+@$+('(/-1/, �#)!A!,3/.'(/1/ 3+@/&/. % 1/3/*+ 3/%5(+ &! /$&+32F!&/ )+13#)&#��%D .!�!',., /$"+*+��%DA3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4. �3% �,/4 % (/"%B!',./ )+13#)&#��%D.!�!',., ./)*!@',.2��%D &+ '"%)%',G! /$/"/B(% *GD+,!"-&GD A2,!@, &! /$"+*+��%D A3#4G4 +"-"!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4, )&+B%,!"-&/ 4!&-U!, B!4 . +,4/'?!3! 1/3/*/.!3D&%@ �?+"!@, �"+,/2',, �+3+$+U, �/A!@'(, �+1&%,/1/3'( % �!"#$%&'( (p < 0,05).

53

/������������������0� ��0���������� ��������������������*�����3�����������������-��3� -���0���� ��*����� ��3���$� �� 5���*�+*��*��������3� 3����������� ����������� ���$-��-�����-�����. �/A/',+.%. A/"2B!&&G! *+&&G! A/ /$�!@ )+$/"!.+!4/',% *"# 2(+)+&&GD &/)/"/1%-B!'(%D !*%&%5 A/ 27 42&%5%A+"-&G4 /$3+)/.+&%#4, .D/*#�%4 . '/',+. �!"#$%&'(/@ /$"+',%, %�(/"/1/N1!/13+?%B!'(%! D+3+(,!3%',%(% A/'"!*&%D, 2*+"/'- 2',+&/.%,- '"!*2��%! ,!&*!&5%%:

1. 42&%5%A+"-&GD /$3+)/.+&%#D /$"+',% ' &!$/"-U%4 (&! $/"!! 10) (/"%B!',./4 &+%4!-&/.+&%@ )+13#)&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G!/$/"/B(% *GD+,!"-&GD A2,!@, &! /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4*!@',.%!4, % /,'2,',.%!4 )+13#)&#��%D .!�!',., /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&-'%$%"%)%32��%4 *!@',.%!4 (�3!*%&'(%@, +3&!&'(%@, �+,+.N�.+&/.'(%@, �+1+@$+('(%@ % �#)!-A!,3/.'(%@ 42&%5%A+"-&G! 3+@/&G),. *!,'(/@ A/A2"#5%% */',/.!3&/ &%)(%! )&+B!&%# /$�!@ )+-$/"!.+!4/',% A/ /$3+�+!4/',% A/ ("+''2 «�/"!)&% /31+&/. *GD+&%#» (p < 0,05), .("�B+# /',3G@&+)/?+3%&1%, (p < 0,05), 1%A!3,3/?%� +*!&/%*/. (p<0,05), +""!31%B!'(%@ 3%&%,, .G).+&&G@ AG"--5/@ 3+',!&%@ (p < 0,05), % +',42, .("�B+# ',+,2' (p < 0,05).

2. 42&%5%A+"-&GD /$3+)/.+&%#D /$"+',% ' $/"-U%4 ($/"!! 10) (/"%B!',./4 &+%4!&/.+-&%@ )+13#)&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G! /$/-"/B(% *GD+,!"-&GD A2,!@, &! /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@-',.%!4, % &!$/"-U%4 (&! $/"!! 3) (/"%B!',./4 &+%4!&/.+&%@ )+13#)&#��%D .!�!',., /$"+*+�-�%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4 (�+3+$+U'(%@ 1/3/*'(/@ /(-321), '3!*% *!,'(/1/ &+'!"!&%# )&+B%4/ .G'/(%! A/(+)+,!"% 3+'A3/',3+&!&&/',% /',3/1/ &+)/?+-3%&1%,+ (p<0,05).

3. 42&%5%A+"-&GD /$3+)/.+&%#D /$"+',% ' &!$/"-U%4 (/"%B!',./4 &+%4!&/.+&%@ )+-13#)&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G! /$/"/B(% *G-D+,!"-&GD A2,!@ (+( &! /$"+*+��%D (&! $/"!! 10), ,+( % /$"+*+��%D A3#4G4 +""!31%)%32��%4% '!&'%$%"%)%32��%4 *!@',.%!4 (&! $/"!! 3) — �+3,+"%&'(%@ % �.!"-'(%@ 42&%5%A+"-&G! 3+@-/&G % �%+''(%@ 1/3/*'(/@ /(321— . *!,'(/@ A/A2"#5%% */',/.!3&/ .G'/(%! )&+B!&%# 3+'A3/-',3+&!&&/',% 1%A!3,3/?%% +*!&/%*/. (p < 0,05).

4. 42&%5%A+"-&GD /$3+)/.+&%#D /$"+',% ' $/"-U%4 (/"%B!',./4 &+%4!&/.+&%@ )+13#)-&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G! /$/"/B(% *GD+-,!"-&GD A2,!@ (+( &! /$"+*+��%D ($/"!! 10), ,+( % /$"+*+��%D A3#4G4 +""!31%)%32��%4 %'!&'%$%"%)%32��%4 *!@',.%!4 ($/"!! 3) — �"+,/2',/.'(%@£�+1&%,/1/3'(%@ % �!"#$%&'(%@1/3/*'(%! /(321+ — '3!*% *!,'(/@ A/A2"#5%% )&+B%4/ .G'/(%! A/(+)+,!"% 3+'A3/',3+&!&&/',%+""!31%B!'(/1/ 3%&%,+, .G).+&&/1/ AG"-5/@ 3+',!&%@ (p < 0,05), % +',4G, .("�B+# ',+,2'(p < 0,05).

�/,!"/'- $G ,+(F! /,4!,%,-, B,/ . �1+A/.'(/4, �4+&F!"%&'(/4, �2&+U+('(/4, �/'&/.-'(/4 % �!$+3(2"-'(/4 3+@/&+D . *!,'(/@ A/A2"#5%% */',/.!3&/ &%)(%! A/(+)+,!"% /$�!@ )+$/"!-.+!4/',% A/ /$3+�+!4/',% A/ ("+''2 «�/"!)&% /31+&/. *GD+&%#» (p < 0,05), .("�B+# /',3G@ &+)/-?+3%&1%, (p < 0,05); 1%A!3,3/?%� +*!&/%*/. (p < 0,05); +""!31%B!'(%@ 3%&%,, .G).+&&G@ AG"-5/@3+',!&%@ (p < 0,05); +',42, .("�B+# ',+,2' (p < 0,05). �*&+(/ . +,4/'?!3! *+&&GD ,!33%,/3%@ /$-"+',% A3%'2,',.2!, &!$/"-U/! (&! $/"!! 10) (/"%B!',./ &+%4!&/.+&%@ )+13#)&#��%D .!�!',.,.G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G! /$/"/B(% *GD+,!"-&GD A2,!@ (+( &!/$"+*+��%D, ,+( % /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4,B,/, A/ &+U!42 4&!&%�, 4/F!, $G,- '.#)+&/ '/ 'A!(,3/4 D%4%B!'(%D .!�!',., D+3+(,!3&GD *"#,/@ %"% %&/@ ,!33%,/3%% /$"+',%.

���-�������� ��� ��������������� �����*�����3� �������� �� ��������3� -���0���� ��*������3���$�����0������� � ��$������$-�������-�����. �$�+# )+$/"!.+!4/',- A/ /$3+�+!4/',% A//',3/42 &+)/?+3%&1%,2 . �U%&'(/4 (10,80 ± 0,39), �2'%&'(/4 (18,65 ± 2,17) 3+@/&+D, 1/3/*+D �+-3+$+U! (11,37 ± 0,26), �/A!@'(! (11,66 ± 0,43), �!"#$%&'(! (12,25 ± 0,21) */',/.!3&/ .GU!, B!4 .*321%D &+'!"!&&GD A2&(,+D �!"#$%&'(/@ /$"+',% (p < 0,05).

�+'A3/',3+&!&&/',- +""!31%B!'(/1/ 3%&%,+, .G).+&&/1/ AG"-5/@ 3+',!&%@, . 42&%5%A+"--&GD 3+@/&+D % 1/3/*'(%D /(321+D '/',+."#!, /, 0,2 */ 6,0 '"2B+# &+ 1 000 '//,.!,',.2��!1/ &+'!-"!&%#, B,/ '.%*!,!"-',.2!, / 1%A/*%+1&/',%(! *+&&/@ &/)/"/1%B!'(/@ !*%&%5G 2 .)3/'"/1/ &+'!-"!&%#.

�$�+# )+$/"!.+!4/',- A/ /$3+�+!4/',% A/ +',4!, .("�B+# ',+,2', . 1/3/*! �!"#$%&'(!(14,60 ± 0,11) )&+B%4/ .GU!, B!4 . *321%D &+'!"!&&GD A2&(,+D �!"#$%&'(/@ /$"+',%(p = 0,01).

�+'A3/',3+&!&&/',- $/"!)&!@ /31+&/. *GD+&%# . 1/3/*! �!"#$%&'(! (400,06 ± 9,51) '2�!',-.!&&/ .GU!, B!4 . *321%D &+'!"!&&GD A2&(,+D �!"#$%&'(/@ /$"+',% (p = 0,02).

54

/������������������0� ��0���������� ��������������������*�����3�����������������-��3� -���0���� ��*����� ��3���$� �� 5���*�+*��*��������3� 3����������� ����������� ���$-��-�����-�����. �/A/',+.%. A/"2B!&&G! *+&&G! A/ /$�!@ )+$/"!.+!4/',% *"# 2(+)+&&GD &/)/"/1%-B!'(%D !*%&%5 A/ 27 42&%5%A+"-&G4 /$3+)/.+&%#4, .D/*#�%4 . '/',+. �!"#$%&'(/@ /$"+',%, %�(/"/1/N1!/13+?%B!'(%! D+3+(,!3%',%(% A/'"!*&%D, 2*+"/'- 2',+&/.%,- '"!*2��%!:

1. &+'!"!&&GD A2&(,+D ' &!$/"-U%4 (&! $/"!! 10) (/"%B!',./4 &+%4!&/.+&%@ )+13#)-&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G! /$/"/B(% *GD+-,!"-&GD A2,!@, &! /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4, %"%$/ /,'2,',.%!4 )+13#)&#��%D .!�!',., /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%-32��%4 *!@',.%!4 (�3!*%&'(%@, +3&!&'(%@, �+,+.N�.+&/.'(%@, �3+'&/+34!@'(%@, �+1+@$+(-'(%@ % �#)!A!,3/.'(%@ 42&%5%A+"-&G! 3+@/&G % 3/%5(%@ 1/3/*'(/@ /(321), "%$/ A3%'2,',.%!4A/'"!*&%D . &!$/"-U/4 (/"%B!',.! (&! $/"!! 3) — �1+A/.'(%@, �31+#U'(%@, �4+&F!"%&'(%@,�,(2"-'(%@, �+3,+"%&'(%@, �+'"%&'(%@, �2&+U+('(%@, �+,(%&'(%@, �/'&/.'(%@, �.!"-'(%@, �!-$+3(2"-'(%@ 42&%5%A+"-&G! 3+@/&G % �%+''(%@ 1/3/*'(/@ /(321 — ./ .)3/'"/@ A/A2"#5%% */'-,/.!3&/ &%)(%! )&+B!&%# 3+'A3/',3+&!&&/',% ("+''+ «�/"!)&% /31+&/. *GD+&%#» (p < 0,05), .("�-B+# /',3G@ &+)/?+3%&1%, (p < 0,05), +""!31%B!'(%@ 3%&%,, .G).+&&G@ AG"-5/@ 3+',!&%@ (p < 0,05),% +',42, .("�B+# ',+,2' (p < 0,05).

2. 42&%5%A+"-&GD /$3+)/.+&%#D /$"+',% ' $/"-U%4 ($/"!! 10) (/"%B!',./4 &+%4!&/.+-&%@ )+13#)&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G! /$/-"/B(% *GD+,!"-&GD A2,!@, &! /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@-',.%!4, % "%$/ &!$/"-U%4 (&! $/"!! 3) — �+3+$+U'(%@, �/A!@'(%@ 1/3/*'(%! /(321+ — (/"%B!-',./4 )+13#)&#��%D .!�!',., /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4*!@',.%!4, "%$/ $/"-U%4 ($/"!! 3) — �!"#$%&'(%@ 1/3/*'(/@ /(321 — '3!*% .)3/'"/1/ &+'!"!-&%# )&+B%4/ .G'/(%! A/(+)+,!"% 3+'A3/',3+&!&&/',% /',3/1/ &+)/?+3%&1%,+ (p < 0,05).

3. 42&%5%A+"-&GD /$3+)/.+&%#D /$"+',% ' $/"-U%4 &+%4!&/.+&%@ )+13#)&#��%D .!-�!',., .G$3+'G.+!4GD . +,4/'?!32 % ./)*!@',.2��%D &+ '"%)%',G! /$/"/B(% *GD+,!"-&GD A2-,!@, (+( &! /$"+*+��%D ($/"!! 10), ,+( % /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%-32��%4 *!@',.%!4 ($/"!! 3) — �!"#$%&'(%@ 1/3/*'(/@ /(321 — '3!*% .)3/'"/1/ &+'!"!&%# )&+-B%4/ .G'/(%! A/(+)+,!"% 3+'A3/',3+&!&&/',% $/"!)&!@ /31+&/. *GD+&%# (p < 0,05), . ,/4 B%'"! %+',4G, .("�B+# ',+,2' (p < 0,05).

+(%4 /$3+)/4, . 3!)2"-,+,! %)2B!&%# 3/"% �(/"/1%B!'(%D ,3%11!3&GD ?+(,/3/. . ?/34%3/-.+&%% % 3+).%,%% ���NA+,/"/1%% . �!"#$%&'(/@ /$"+',% 2',+&/."!&/:

1. �2�!',.2!, A3#4+# '.#)- 4!F*2 �(/"/1%!@ % 3+'A3/',3+&!&&/',-� $/"!)&!@ /31+&/. *G-D+&%# (+( 2 *!,'(/1/, ,+( % 2 .)3/'"/1/ &+'!"!&%#.

2. ./)&%(&/.!&%% $/"!)&!@ /31+&/. *GD+&%# %13+�, 3/"- &! ,/"-(/ (/"%B!',./ 3+)"%B-&GD )+13#)&#��%D .!�!',., .G$3+'G.+!4GD . +,4/'?!32, &/ % %D 'A!(,3.

3. �$&+32F!&G 3+)"%B%# 3+'A3/',3+&!&&/',% ���NA+,/"/1%% . *!,'(/@ % .)3/'"/@ A/A2"#-5%#D �!"#$%&'(/@ /$"+',% . ',/3/&2 24!&-U!&%# /$"+',!@ ' .G'/(%4 3%'(/4 3+).%,%# )+$/"!.+-&%@ *GD+,!"-&GD A2,!@ 2 .)3/'"/1/ &+'!"!&%# /$"+',%, B,/, &+ &+U .)1"#*, '.#)+&/ ' ,!4, B,/ ./)-*!@',.%� &!$"+1/A3%#,&GD 2'"/.%@ $/"!! A/*.!3F!&G *!,%, ,+( (+( 3#* ?%)%/"/1%B!'(%D /'/-$!&&/',!@ A3!*/A3!*!"#!, /13+&%B!&&2� )+�%�!&&/',- *!,'(/1/ /31+&%)4+ /, B2F!3/*&GD .!-�!',. (�%/D%4%# …, 2007), + '%',!4+ *!,/('%(+5%% D%4%B!'(%D '/!*%&!&%@ 2 3!$!&(+ /,"%B+!,'#&!)3!"/',-� (�/1+&/.+ �L�. % *3., 2010).

$ ��� . �A3!*!"!&G &+'!"!&&G! A2&(,G �!"#$%&'(/@ /$"+',% ' &%)(%4 3%'(/4 3+).%,%#/,/3%&/"+3%&1/"/1%B!'(/@ A+,/"/1%%, D+3+(,!3%)2��%!'# &!$/"-U%4 (/"%B!',./4 &+%4!&/.+-&%@ . +,4/'?!3! )+13#)&#��%D .!�!',., ./)*!@',.2��%D &+ '"%)%',G! /$/"/B(% *GD+,!"-&GDA2,!@, &! /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4, % /,'2,',.%-!4 %"% A3%'2,',.%!4 . &!$/"-U/4 (/"%B!',.! &+%4!&/.+&%@ )+13#)&#��%D .!�!',., /$"+*+��%DA3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4 *!@',.%!4; ' .G'/(%4 3%'(/4 3+).%,%# /',3/1/&+)/?+3%&1%,+, 1%A!3,3/?%% +*!&/%*/. (2 *!,!@), +""!31%B!'(/1/ 3%&%,+, .G).+&&/1/ AG"-5/@3+',!&%@, % +',4G, .("�B+# ',+,2', D+3+(,!3%)2��%!'# A3%'2,',.%!4 . +,4/'?!3! /A3!*!"!&&/1/'/B!,+&%# )+13#)&#��%D .!�!',., ./)*!@',.2��%D (+( &+ '"%)%',G! /$/"/B(% *GD+,!"-&GD A2-,!@, (+( &! /$"+*+��%D, ,+( % /$"+*+��%D A3#4G4 +""!31%)%32��%4 % '!&'%$%"%)%32��%4*!@',.%!4.

55

,#+. �+&!>!$ — �'&$!�&!^!('*�&+J',',+=",'�0'q++,"0'"0&'$!/,-

J#+. >������� (����.)�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#

1 �+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%2 �+?!*3+ +&!',!)%/"/1%% % 3!+&%4+,/"/1%%

�������������������: 1 ���. ��%��� (��., . �. �.), 2 ���. ����3�� (��. . �. �.)

*+&&/@ ',+,-! /'.!�+!,'# 3/"- �L�. �%3/1/.+ . 3+).%,%% +&!',!)%/"/1%%. �3% �,/4 /'/-$/! .&%4+&%! 2*!"!&/ '"!*2��!42 A!3%/*2 !1/ *!#,!"-&/',% — ' %�"# 1847 1. A/ *!(+$3- 1849 1.�+ �,/4 &!A3/*/"F%,!"-&/4, &/ &+'G�!&&/4 �,+A! �L�. �%3/1/. A3/*/"F%" &+(+A"%.+,- /AG,+&!',!)%3/.+&%# A/'3!*',./4 �?%3+ % D"/3/?/34+ . 4%3&/@ /$',+&/.(!. �/, (3/4! ,/1/, /& A3%-"/F%" &!4+"/ 2'%"%@ *"# %)2B!&%# ./)4/F&/',% A3%4!&!&%# +&!',!)%% % &+ ,!+,3! ./!&&GD *!@-',.%@. �&/1/! ,/1*+ $G"/ '*!"+&/ %4 .A!3.G! . 4%3/./@ A3+(,%(!, B,/ A/)./"#!, &G&! ' A/"&G4/'&/.+&%!4 /,&/'%,- !1/ ( /'&/./A/"/F&%(+4 ./!&&/NA/"!./@ +&!',!)%/"/1%%.

�!&%+"-&/ A3!*.%*# /13/4&/! )&+B!&%! +&!',!)%3/.+&%# ' A/4/�-� �?%3+, 8 %�&# 1847 1.�L�. �%3/1/. . '/A3/./F*!&%% './!1/ +''%',!&,+ A3/?!''/3+ �L�. �!44!3,+ % ?!"-*U!3+ �. �+-"+U&%(/.+ .G!D+"% %) �!,!3$231+ &+ �+.(+) &+ /'&/.+&%% 2(+)+ %4A!3+,/3+ �%(/"+# I / (/4+&-*%3/.(!. �� 5!"- — /A3!*!"!&%! ./)4/F&/',% %'A/"-)/.+&%# �?%3+ &+ A/"! '3+F!&%# % /31+&%)+-5%# %'A/"-)/.+&%# �?%3+ A3% D%3231%B!'(%D /A!3+5%#D.

�3%$"%)%,!"-&/ */ 10 %�"# �L�. �%3/1/. 3+$/,+" . �#,%1/3'(/4 1/'A%,+"!, )+,!4 A3/!D+"B!3!) �/)*/(, �%)"#3, �+)%N�3,, �%3N�3, % &+B+" 3+$/,+,- . "+1!3! /,3#*+ ?!"-*4+3U+"+ (&#)#�L�. /3/&5/.+. �+ �+.(+)! $"%) +2"+ �+",G �L�. �%3/1/. .A!3.G! . %',/3%% 4%3/./@ 4!*%5%&GA3%4!&%" . *!@',.2��!@ +34%% �?%3&G@ &+3(/) ' 5!"-� /$!)$/"%.+&%# /A!3+5%@ &+ A/"! '3+F!-&%#. �,/ $G"/ .G*+��%4'# */',%F!&%!4 ./!&&/NA/"!./@ D%3231%%.

�!'4/,3# &+ A3!*2$!F*!&%! ( &+3(/)2 (+( 3+&!&GD, ,+( % &!(/,/3GD .3+B!@, �L�. �%3/1/./',+.+"'# . ,.�3*/@ 2.!3!&&/',% . A3+.%"-&/',% %)$3+&&/1/ A2,% *"# /$"!1B!&%# 2B+',% )+�%,-&%(/. �/*%&G. �L�. �%3/1/. $G" A3%4!3/4 2B�&/1/, ./A"/�+��!1/ . A3+(,%(2 3!)2"-,+,G './%D%''"!*/.+&%@. �& /$�!)F+" 1/'A%,+"%, 4&/1/ /A!3%3/.+" % 2B%" .3+B!@ A3/.!*!&%� +&!',!)%%A/'3!*',./4 +AA+3+,+. �+ A!3!.#)/B&GD A2&(,+D �L�. �%3/1/. A3%4!&%" �?%3 A3% "!B!&%% $/"--U/1/ B%'"+ 3+&!&GD % */(+)+" ./)4/F&/',- /$"!1B!&%# ',3+*+&%@ 3+&!&GD A3% D%3231%B!'(%D.4!U+,!"-',.+D. �& %'AG,+" . ./!&&/NA/"!.GD 2'"/.%#D './% +AA+3+,G �?%3&/1/ &+3(/)+ % /$2-B+" .3+B!@ %D A/"-)/.+&%�. ,!B!&%! U!',% &!*!"- �L�. �%3/1/. &+D/*%"'# . 2'"/.%#D A/',/#&-&GD .G"+)/(, A/*(/A/. % U,234+ +2"+ �+",G, (/1*+ &!'(/"-(%4 '/,&#4 3+&!&GD ,3!$/.+"+'- D%-3231%B!'(+# A/4/�-. +4 /& ' A/4/�-� 3+)3+$/,+&&GD %4 +AA+3+,/. A3%4!&#" «�?%3/.+&%!» &+A/"! $/!.GD *!@',.%@.

�+).�3&2,G@ A/"!./@ "+)+3!, A3% 1"+.&/@ (.+3,%3! '/',/#" %) &!'(/"-(%D U+"+U!@, '*!-"+&&GD %) *3!.!'&GD .!,.!@ % A/(3G,GD '/"/4/@. �) (+4&# $G"/ '"/F!&/ A/*/$%! D%3231%B!'(/-1/ ',/"+. �A!3%3/.+,- �L�. �%3/1/.2 A3%D/*%"/'- &+ (/"!&#D, '/1&2.U%'- &+* 3+&!&G4. 7 +.12',+/& *!"+!, A/* &+3(/)/4 +4A2,+5%� &%F&!@ (/&!B&/',% 3+&!&/42 '/,&%(2 �+1+3%&2, A/"2B%.U!423+&!&%! . &/12 ' 3+)*3/$"!&%!4 (/',%.

��F! . A!3.GD B%'"+D '!&,#$3# &/B% '*!"+"%'- D/"/*&G4%, % ,!4A!3+,23+ ./)*2D+ &+B+"+3!)(/ A/&%F+,-'# A/'"! )+D/F*!&%# '/"&5+; .4!',! ' �,%4 B%'"/ /A!3%3/.+&&GD 3+&!&GD, "!F+.-U%D . &+U%D $+"+1+&+D, 2.!"%B%"/'- . ,!B!&%! 5 A/'"!*&%D *&!@ (/, 9 */ 14 '!&,#$3#) */ 140....�+&%4+#'- $/"!! 12 B+'/. . '2,(% /*&/@ A!3!.#)(/@ % A3/%)./*',./4 /A!3+5%@, 4G !*.+ 2'A!.+-"% /'4+,3%.+,- .'!D 3+&!&GD. �/ &!*/',+,(2 '/"/4G $/"-&G! */"F&G /',+.+,-'# &!'(/"-(/ *&!@&+ ',+3GD A/*',%"(+D, A3/A%,+&&GD 1&/!4 % &!B%',/,+4%...».

�+ A3%4!3! './%D &+$"�*!&%@ (/*&/1/ . %?"%''(/4 % *.2D ./ "+*%(+.(+)'(/4 1/'A%,+-"#D) �L�. �%3/1/. A/(+)+" *321%! ./)4/F&/',% %'A/"-)/.+&%# �?%3&/1/ &+3(/)+ — ' *%+1&/',%-B!'(/@ 5!"-�: «�G 2A/,3!$%"% �?%3/.+&%# . *.2D '"2B+#D A3%,./3&GD $/"!)&!@, + %4!&&/: .A3%,./3&/@ &!A/*.%F&/',% A"!B!./1/ % "/(,!./1/ '2',+./.. /$/%D '"2B+#D, (+( '(/3/ A3%,./-3#.U%!'# .A+"% . A/"&/! $!'B2.',.%! % 4GU!B&+# '%',!4+ 3+''"+$"+, .GA3#4%"%'- % '/1&2,G!'2',+.G, "/(,!./@, .A3/B!4, &! '/.!3U!&&/; /, */"1/@ &!A/*.%F&/',% % '/1&2,/1/ A/"/F!&%#, .(/,/3/4 A3%,./3#.U%@'# A/',/#&&/ *!3F+" �,/, '2',+., /& '*!"+"'# '2D%4. �/1*+ 5!"- &+U+ $G"+*/',%1&2,+ �?%3/.+&%!4, 4G &+"/F%"% &!A/*.%F&2� (3+D4+"-&2� A/.#)(2 &+ 3+'A3+."!&&G!B"!&G % A3%.!"% . B2.',./ A3%,./3�%(/., %)24"�&&GD &!/F%*+&&G4 /,(3G,%!4 %D /$4+&+».

56

�A2',# 4!'#5 . '//,.!,',.%% ' A3%(+)/4 4%&%',3+ .&2,3!&&%D *!" /, 27 &/#$3# 1847 1. .'!4.3+B+4 3+)3!U+"/'- A3%4!&#,- �?%3 *"# &+3(/)+. �F! &+D/*#'- &+ A2,% . �+&(,N�!,!3$231, �L�.�%3/1/. . 3+)"%B&GD 1/3/*+D 2'A!U&/ *!4/&',3%3/.+" ./)4/F&/',% %'A/"-)/.+&%# �?%3+ % D"/-3/?/34+.

A/*.!*!&%! %,/1+ *!#,!"-&/',% �L�. �%3/1/.+ . +&!',!)%3/.+&%% A3%.!*�4 &!(/,/3G! !1//'&/.&G! A/"/F!&%#, A3!*',+."!&&G! . «�,B�,! / A2,!U!',.%% A/ �+.(+)2».

�!A!3-, 2A/,3!$%. +&!',!)%3/.+&%! $/"!!, &!F!"% . U!',%',+D '"2B+#D A/ 3+)&G4 'A/'/-$+4, 3+)"%B&G4% '3!*',.+4% % A3% 3+)"%B&GD /$',/#,!"-',.+D, # &+D/F2 '!$# .A3+.! %) '/$',.!&-&GD 4/%D /AG,/. '*!"+,- A/"/F%,!"-&G! )+("�B!&%# / A3+(,%B!'(/4 */',/%&',.! �,/1/ '3!*',.+.�+ A/"! '3+F!&%# # 2A/,3!$"#" *"# +&!',!)%3/.+&%# /*%& ,/"-(/ �?%3. �,/ D%3231%B!'(%D /A!3+-5%@ A/* ."%#&%!4 �?%3&GD A+3/. $G"/ A3/%).!*!&/ &+4% &+ A/"! '3+F!&%# A3% /'+*! �+",/., %,/"-(/ . *.2D '"2B+#D $G" 2A/,3!$"�& %)/$3!,�&&G@ 4&/@ 'A/'/$ �?%3/.+&%# B!3!) A3#42� (%U-(2. / .'!D A3/B%D '"2B+#D $/"-&G! $G"% �?%3/.+&G A/'3!*',./4 .*GD+&%#».

+(%4 /$3+)/4, . /,B�,! �L�. �%3/1/. A/(+)+", B,/ &! .'#(%! 'A/'/$G % '3!*',.+, U%3/(/A3%4!&#!4G! . 2'"/.%#D ("%&%(% % $/"-&%5G, 4/F&/ %'A/"-)/.+,- &+ A/"! '3+F!&%#; +AA+3+,G,3!(/4!&*2!4G! *"# ,+$!"-&/1/ /'&+�!&%# ./!&&GD 4!*%5%&'(%D 2B3!F*!&%@, &!/$D/*%4/ +A3/-$%3/.+,- &+ A/"! '3+F!&%#. �,% A/"/F!&%# A/*,.!3F*!&G % . A/'"!*2��%D "/(+"-&GD ./!&&GD(/&?"%(,+D. B+',&/',%, ./ .3!4# ./@&G . �?1+&%',+&! 4!,/*G �A%*23+"-&/@ % 'A%&+"-&/@ +&!-',!)%% 2 3+&!&GD A3% &!/,"/F&GD /A!3+5%#D %'A/"-)/.+"% 3!*(/ %)N)+ &!./'A/"&!&&/@ (3/./A/-,!3% % 1%A/./"!4%%, &!./)4/F&/',% &!3!*(/ /$!'A!B%,- 2'"/.%# +'!A,%(% % +&,%'!A,%(%, + ,+(F!B+',/1/ &+"%B%# 2 3+&!&/1/ ,#F�"/1/ '/B!,+&&/1/ A/.3!F*!&%#. �AA+3+, �� «����-5», 3+)3+-$/,+&&G@ ' 2B+',%!4 (+?!*3G +&!',!)%/"/1%% % 3!+&%4+,/"/1%% �!*�, A/'"! +A3/$+5%% A3%/(+)+&%% +&!',!)%/"/1%B!'(/@ % 3!+&%4+,/"/1%B!'(/@ A/4/�% 3+&!&G4 . �?1+&%',+&! % A/'"!-*2��!@ */3+$/,(% $G" A3%&#, &+ ,+$!"-&/! /'&+�!&%! ./!&&GD % 13+F*+&'(%D "!B!$&GD 2B3!F-*!&%@ % U%3/(/ %'A/"-)/.+"'# $/"!! 20 "!,.

�3% '3+.&%,!"-&/@ /5!&(! 3+)"%B&GD 4!,/*%( +&!',!)%3/.+&%# �L�. �%3/1/. /A3!*!"%" %D/'/$!&&/',% %, . B+',&/',%, 3+)"%B&/! *!@',.%! +&!',!)%3/.+&%# &+ &!3.&2� '%',!42. G#."!&G/,*!"-&G! 1"+.&G! A3/#."!&%# '/ ',/3/&G &!3.&/@ '%',!4G: A/,!3# B2.',.%,!"-&/',%, 13�)G %.%*!&%# A3% +&!',!)%3/.+&%%, *.%F!&%! ,!"+, %)4!&!&%# . *321%D '%',!4+D % /31+&+D. �! .'!1*+"!1(/, (+( (+F!,'#, /A3!*!"#"+'- */',+,/B&/',- ',!A!&% A/,!3% B2.',.%,!"-&/',%. �,/, ./A3/'�L�. �%3/1/. /A3!*!"#" &+ /'&/.+&%% &!'(/"-(%D A3%)&+(/.: A/,!3# '/)&+&%#, '2*/3/F&G! *.%-F!&%#, 3+''"+$"!&%! 4GU5, %''"!*/.+&%! $/"#�!@ B+',%. �"!*2!, /,4!,%,- 24!&%! �L�. �%3/1/-.+ �??!(,%.&/ A3%4!&#,- ',+,%',%B!'(%! 4!,/*G. �$ �,/4 '.%*!,!"-',.2�, «+$"%5G /A!3+5%@,'*!"+&&GD �L�. �%3/1/.G4 % *321%4% D%3231+4% �/''%% ' A/4/�-� +&!',!)%3/.+&%#» % %D +&+-"%). �/1"+'&/ '/.3!4!&&/42 )+(/&/*+,!"-',.2, A!3!* +&!',!)%!@ &!/$D/*%4/ A/"2B%,- 2 $/"-&/1/%&?/34%3/.+&&/! */$3/./"-&/! '/1"+'%! &+ &!�. �! . 4!&-U!@ ',!A!&% A3%*+.+" )&+B!&%! �,/42% �L�. �%3/1/., '/$"�*+# A3%&5%A %&*%.%*2+"-&/1/ A/*D/*+ % A3!*/',+."!&%# */',+,/B&/@ %A/&#,&/@ *"# A+5%!&,+ %&?/34+5%%, + ,+(F! A3%&5%A «&! &+.3!*%».

��) 100 /A!3+5%@ 6 3+) $G"/ A3/%).!*!&/ &+4% �?%3/.+&%! &+* 42'2"-4+&+4%... � /$�#.%"B!3!) A!3!./*B%(+ !42 (3+&!&/42) % '/$3+.U%4'# ./(321 &!1/ 42'2"-4+&+4, B,/ . '("#&(! ' �?%-3/4 )+("�B+!,'# '3!*',./, .*GD+&%! (/,/3/1/ A!3!&/'%, A3+./.!3&GD . 3+@ �+1/4!,+, . /$%,!"-$"+F!&',.+ % 123%@. �+&!&G@, ( 4/!42 2*%."!&%�, &! ,/"-(/ &! /(+)G.+" 4&! '/A3/,%."!&%# A/*-.!31&2,- '!$# *!@',.%� �?%3+, &!F!"% &+U% 32''(%! '/"*+,G, &/ *+F! ' &!(/,/3G4 &+'"+F*!&%!4.*GD+" . '!$# �?%3&G! A+3G. �3%U�" . '!$# A/'"! /A!3+5%%, '/',/#�!@ . 1"2$/(/4 3+'U%3!&%%3+&G, /& /$�#.%", B,/ &+D/*%"'# . (+(/4N,/ &!.G3+)%4/ A3%#,&/4 4!',!, . (/,/3/4 F!"+" $G !��*+"!! /',+,-'#, % �,%4 A/*,.!3*%" 4/� '(+)+&&/! / B2*!'&/4 *!@',.%% '3!*',.+».

�*&%4 %) .%*/. #."!&%@, (/,/3G@ .G*!"!& �L�. �%3/1/.G4 % )+'"2F%.+!, .&%4+&%#, #."#-!,'# $!''/)&+,!"-&+# B2.',.%,!"-&/',-, ,. !. 3!?"!(,/3&G! 3!+(5%% /31+&%)4+ &+ ,3+.42. �/1*+«...+&!',!)%3/.+&&G@ A3% A/"&/@ A/,!3! '/)&+&%# (3%B%,, A"+B!,, %)*+�, '+4G! F+"/$&G! ./A"% %/B!.%*&/ ',+3+!,'# /'./$/*%,-'# 3+)"%B&G4% *.%F!&%#4% ,!"+ /, A3%B%&�&&GD !42 &!A3%#,&GD.A!B+,"!&%@; "%U- ,/"-(/ 4G A!3!',+�4 !42 A3%B%&#,- �,% .A!B+,"!&%#, /& /A#,- *!"+!,'# 'A/-(/@&G4 % $!'B2.',.!&&G4 (/ .'!42 !1/ /(32F+��!42; A3/$2*%.U%'-, /& &%B!1/ &! )&+!,, B,/ '&%4 $G"/: �,/ &! A3/',G! 3!?"!(,/3&G! *.%F!&%#, A/,/42 B,/ /&% '/!*%&!&G &! ,/"-(/ ' %).!',-&/@ 5!"-�, &/ % *321%4% A3/#."!&%#4% B2.',.%,!"-&/',%. �3+.*+, �,/ #."!&%! 4/F&/ /$�#'&%,-% ,!4, B,/ 2 +&!',!)%3/.+&&/1/ '/D3+&%"+'- !�� '/)&+,!"-&+# B2.',.%,!"-&/',-, ,. !. /& *!@',.%-,!"-&/ B2.',.2!,, &/ ,/,B+' F! % )+$G.+!,, B,/ B2.',./.+"». +(%! 3!+(5%% /& &+$"�*+" A3% /A!-3+5%#D .$"%)% (32A&GD &!3./. % 'A"!,!&%@. �,/, ?+(,, A/*4!B!&&G@ 2B�&G4, . A/'"!*2��%! 1/-

57

*G A/"2B%" A/*,.!3F*!&%! . ("%&%B!'(%D &+$"�*!&%#D, /'/$!&&/ A3% /A!3+5%#D &+ /31+&+D132*&/@ % $3�U&/@ A/"/',!@: «…&+D/*#�%@'# . A/"&/4 &+3(/)! /31+&%)4 'A/'/$!&, ,!4 &! 4!-&!!, *+.+,- &+ '%"-&G! $/"!.G! 3+)*3+F%,!"% /,.!,&2� 3!+(5%�, .A/"&! A3%,/4 &!*.2'4G'"!&-&2�, . ?/34! ,/@ %"% %&/@ '%"G /A!3+5%/&&/1/ U/(+».

+(%4 /$3+)/4, 1"+.&+# 5!"- &+2B&/1/ A2,!U!',.%# �%3/1/.+ &+ ,!+,3 ./!&&GD *!@',.%@ &+�+.(+) — A3%4!&!&%! +&!',!)%3/.+&%# &+ A/"! '3+F!&%# — $G"+ */',%1&2,+ ' $"!',#�%4 2'A!-D/4, / B�4 /& A%'+" . /,B�,!: «� B2.',./4 .&2,3!&&!1/ '+4/*/./"-',.%# 4G 4/F!4 '(+)+,-, B,/4G A!3.G! /AG,/4 */(+)+"% ./)4/F&/',- A3%"/F!&%# +&!',!)%3/.+&%# &+ A/"! '3+F!&%#».

�'A!U&+# 3+$/,+ �L�. �%3/1/.+ &+ �+.(+)! A/ %'A/"-)/.+&%� �?%3&/1/ &+3(/)+ . ./!&&/-A/"!.GD 2'"/.%#D /,(3G"+ &/.2� ',3+&%52 . %',/3%% '/.!3U!&',./.+&%# +&!',!)%/"/1%B!'(/@A/4/�% 3+&!&G4. � 1/3*/',-� )+ './� ',3+&2 �L�. �%3/1/. A%'+": «�/''%#, /A!3!*%. �.3/A2&+U%4% *!@',.%#4% A3% /'+*! �+",G, A/(+)G.+!, .'!42 A3/'.!��&&/42 4%32 &! ,/"-(/ ./)4/F-&/',- . A3%"/F!&%%, &/ &!/'A/3%4/ $"+1/*!,!"-&/! *!@',.%! �?%3/.+&%# &+* 3+&!&G4% &+ A/"!'+4/@ $%,.G. �G &+*!!4'#, B,/ /,&G&! �?%3&G@ &+3(/) $2*!, '/',+."#,-, ,/B&/ ,+( F!, (+( % D%-3231%B!'(%@ &/F, &!/$D/*%42� A3%&+*"!F&/',- (+F*/1/ .3+B+ ./ .3!4# !1/ *!@',.%# &+ $3+&&/4A/"!».

�+ /,"%B%! &+ �+.(+)!, A3% .)#,%% '!"!&%# �+",G, 24 /(,#$3# 1847 1. �L�. �%3/1/. $G" A3/-%).!*�& . *!@',.%,!"-&G! ',+,'(%! '/.!,&%(%. �+ /,"%B&2� 2'!3*&2� % 3!.&/',&2� '"2F$2 6 *!-(+$3# 1847 1. /& $G" .'!4%"/',%.!@U! A/F+"/.+& (+.+"!3/4 /3*!&+ �.#,/@ �&&G 2-@ ',!A!&% '%4A!3+,/3'(/@ (/3/&/@.

� 4/4!&,+ /,(3G,%# /$�!@ +&!',!)%% A3/U"/ $/"!! ',/"!,%#. �+ �,/ .3!4# *+&&+# /$"+',-4!*%5%&G 1"/$+"-&/ %)4!&%"+'-, &/, &!'4/,3# &+ �,/, /'&/.G, )+"/F!&&G! �L�. �%3/1/.G4, /',+-"%'- (3!A(%4 ?2&*+4!&,/4 +&!',!)%/"/1%B!'(/@ A3+(,%(%. �3/4! ,/1/, &!4+"/.+F&/ /,4!,%,-,B,/ %4!&&/ �L�. �%3/1/. /*&%4 %) A!3.GD A/AG,+"'# /$�#'&%,- ?!&/4!& +&!',!)%%, 2,.!3F*+#,B,/ &+3(/,%B!'(%@ �??!(, �?%3+ A3/#."#!,'#, (/1*+ &+'G�!&&+# !1/ A+3+4% (3/.- «...A3%D/*%, .'/A3%(/'&/.!&%! ' /31+&+4% &!3.&/@ '%',!4G» (1848).

�3%,!3%% +*!(.+,&/',% +&!',!)%% */ '!1/*&#U&!1/ *&# /',+"%'- A3!F&%4%: $!)/A+'&/',- %(/4?/3, *"# $/"-&/1/ . '/B!,+&%% ' A3+(,%B!'(%4 2*/$',./4 *"# D%3231+. �!)/A+'&/',- $/"-&/1/— �,/, A3!F*! .'!1/, A/"&/,+ '.!*!&%@ / ?2&(5%/&%3/.+&%% /31+&/. % '%',!4 $/"-&/1/ . D/*!/A!3+5%%. �/"-U!@ B+',-� '!@B+' �,/ 3!U+!,'# 3+'U%3!&%!4 'A!(,3+ 4/&%,/3%32!4GD ?%)%/"/-1%B!'(%D A+3+4!,3/. )+ 'B!, A3%4!&!&%# &!%&.+)%.&GD (3!F! %&.+)%.&GD 4!,/*/. 4/&%,/3%&1+),,. !. 3!U+��!! )&+B!&%! A3%/$3!,+!, 3+'U%3!&%! % 21"2$"!&%! %&?/34+5%/&&/@ $+)G 'A!5%+"--&/',%. �/,# . 3!)2"-,+,! % */',%1+!,'# 2.!"%B!&%! $!)/A+'&/',% $/"-&GD &+ /A!3+5%/&&/4 ',/"!,&/ 2F! '!1/*&#, '/.3!4!&&+# /A!3+5%/&&+# &+A/4%&+!, A/ &+'G�!&&/',% 4/&%,/3+4% % A3%$/3+-4% (+$%&2 (/'4%B!'(/1/ (/3+$"#.

�&!',!)%/"/1% %4!�, . /A!3+5%/&&/@ 4%(3/A3/5!''/3&G! ,!D&/"/1%%: 4/&%,/3G, %&?2)%-/&&G! A/4AG, */)+,/3G "!(+3',.!&&GD A3!A+3+,/., &+3(/)&/N*GD+,!"-&2� +AA+3+,232, (+3*%/-',%42"#,/3G, '!A+3+,/3G (3/.%, (/&,3/""!3G 4%(3/("%4+,+ $/"-&/1/, B,/ ',+.%, '"!*2��2�A3/$"!42: %&?/34+5%/&&/@ A!3!132)(% +&!',!)%/"/1+. �*&/ %) /B!.%*&GD 3!U!&%@ �,/@ A3/$"!-4G, 3+'U%3!&%! '/',+.+ $3%1+*G, /$!'A!B%.+��!@ +&!',!)%�. �F! &+ '!1/*&# �,/ ,3+&'?2)%/"/1,A!3?2)%/"/1, &!@3/?%)%/"/1.

�"-,!3&+,%.+ — .&!*3!&%! '%',!4G +.,/4+,%B!'(/1/ 2A3+."!&%#. �3+(,%B!'(+# 3!+"%)+5%#.G3+F!&+ . %'A/"-)/.+&%% +.,/4+,%B!'(%D UA3%5!.GD */)+,/3/., 3+$/,+��%D A/ 5!"!./@ (/&-5!&,3+5%% A3!A+3+,+, %&,!""!(,2+"-&GD 3!F%4/. %'(2'',.!&&/@ .!&,%"#5%% "�1(%D, A3/13+44%-32!4/@ A+5%!&,/4 +&+"1!)%%, %'A/"-)/.+&%!4 %4A"+&,%32!4GD (+3*%/',%42"#,/3/. % +.,/4+,%-B!'(%D *!?%$3%""#,/3/. % *3. �"!*2��!@ .+F&!@U!@ )+*+B!@ *"# +&!',!)%/"/1+ #."#!,'# %'-A/"-)/.+&%! &+%$/"!! 'A!5%?%B&GD A3!A+3+,/.. �,/ /'2�!',."#!,'# A3%4!&!&%!4 .G'/(/'!"!(-,%.&GD (/3/,(/*!@',.2��%D '3!*',.: /,*!"-&/ *"# +&+"1!)%%, *"# 1%A&/)+, *"# +4&!)%% % *"#.!1!,+,%.&/1/ (/&,3/"#. �3%&5%A '!"!(,%.&/',% '//,&/'%,'# '/ '"!*2��%4 A3%&5%A/4 «4%&%-4+"-&/@ +13!''%.&/',%», (/,/3G@ /,&/'%,'# 2F! &! ,/"-(/ ( D%3231%B!'(/@ +13!''%%, &/ % +&!',!-)%/"/1%B!'(/@ +13!''%%, B,/ 4/F!, $G,- ?+(,/3/4 A/.3!F*!&%#, '.#)+&&G4 ' A3#4G4 ."%#&%!4&+ 1/4!/',+).

+(%4 /$3+)/4, )+ A3/U!*U%! 150 "!,, +&!',!)%/"/1%B!'(+# A3+(,%(+ A3/13!''%3/.+"+ /,.GA/"&!&%# A3/',GD )+*+B /$!)$/"%.+&%# % /$!)*.%F%.+&%# $/"-&/1/ ./ .3!4# /A!3+5%%, A3%&-5%AG (/,/3GD $G"% 3+)3+$/,+&G . ,32*+D ./!&&/NA/"!./@ D%3231%% �L�. �%3/1/.+, */ 3!U!&%#'"/F&GD A3/$"!4 )+�%,G A+5%!&,+ /, &!1+,%.&GD �??!(,/. '/$',.!&&/ D%3231%B!'(/1/ .4!U+-,!"-',.+ % 4%&%4%)+5%% '/$',.!&&/ +&!',!)%/"/1%B!'(/@ +13!''%.&/',%.

58

+�0!&+%'�)+'"��')0-$!',,!��!1'$!/^+&4&>++

$#,. >�����z (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ /$�!',.!&&/1/ )*/3/.-# % )*3+.//D3+&!&%#

�������������������: ��6. 7������ (���., . �. �.)

/!&&/NA/"!.+# D%3231%# — D%3231%# . 2'"/.%#D $/!.GD *!@',.%@, + ,+(F! 4!*%5%&'(+#*%'5%A"%&+, &+A3+."!&&+# &+ "!B!&%! $/!.GD ,3+.4. /,"%B%! /, /$�!@ D%3231%% ./!&&/-A/"!.+# D%3231%# ,+(F! 3+)3+$+,G.+!, 4!,/*G "!B!&%# 3+&!&GD . 2'"/.%#D $/!.GD *!@',.%@. �3%�,/4 +(5!&, *!"+!,'# &+ '/D3+&!&%! F%)&% A/'"! 3+&!&%# % �.+(2+5%�: .&+B+"! — . A/"!./@ 1/'-A%,+"-, + )+,!4 — . ,G".

/!&&G@ D%3231 — �,/ &! ,/"-(/ D%3231 U%3/(/1/ A3/?%"#, &/ ,+(F! /31+&%)+,/3 A/4/�%3+&!&G4 . 2'"/.%#D $/!.GD *!@',.%@, ,/ !',- /& /A3!*!"#!, 5!"!'//$3+)&/',- /(+)+&%# 4!*%5%&-'(/@ A/4/�% &+ 4!',! %"% �.+(2+5%% [1].

/!&&/NA/"!.+# D%3231%# $G"+, !',- % $2*!, /*&/@ %) .+F&!@U%D /,3+'"!@ . /$"+',% 4!*%-5%&G. «�/B!42?» — 'A3/'%,! .G. '! /B!&- A3/',/. � *3!.&!@U%D .3!4!& $G"% "�*%, (/,/3G!./!.+"% 4!F*2 '/$/@ )+ $/"!! (/4?/3,&2� A!�!32, A"/*/3/*&2� )!4"�, $/1+,G! A3%3/*&G! 3!-'23'G, *+ % A3/',/ %) A3%&5%A+ %"% $+&+"-&/1/ F!"+&%# ./!.+,-. �&% (+"!B%"% '!$#, '/�)&%(/. %.3+1/., &/, '(/"-(/ $G &% $G"/ "�*!@ A3/"%.+��%D (3/.-, .'!1*+ $G"% % ,!, (,/ A/4/1+" 3+&!-&G4, A!3!.#)G.+" %D, /',+&+."%.+" (3/./,!B!&%# % 'A+'+" F%)&%… �+ )!4"! A3/U"/ .!"%(/!4&/F!',./ (3/./A3/"%,&GD ./@& % A/$/%�, %, $"+1/*+3# %4, &+(/A%"/'- $/"-U/! (/"%B!',./)&+&%@ % &+.G(/., &!/$D/*%4GD *"# �??!(,%.&/@ A/4/�% 3+&!&G4 &+ A/"! $/#. �/'"! A/#."!&%#/1&!',3!"-&/1/ /32F%# ./!&&/NA/"!.+# D%3231%# A/ '2�!',.2 A3!.3+,%"+'- . D%3231%� /1&!-',3!"-&GD 3+&. �'/$2� ,#F!',- /1&!',3!"-&GD 3+&!&%@ ./!&&G! D%3231% /$�#'&#"% /,3+."!&%!43+&G A/3/D/4. �"# $/3-$G ' �,%4 /,3+."!&%!4 3+&G .GF%1+"% (+"�&G4 F!"!)/4, )+"%.+"% (%A#-�%4 4+'"/4 % *+F! /B%�+"% 4!D+&%B!'(%4% A3%�4+4%. �'/$+# 3/"- . ?/34%3/.+&%% ./!&&/-A/"!./@ D%3231%% (+( /,*!"-&/@ 4!*%5%&'(/@ *%'5%A"%&G A3%&+*"!F%, �%(/"+� �.+&/.%B2�%3/1/.2, (/,/3G@ . (&%1! «�+B+"+ /$�!@ ./!&&/NA/"!./@ D%3231%%» '?/342"%3/.+" !� /$�%!A/"/F!&%#. �%3231% XIX .. 2F! A3+.%"-&/ /A3!*!"#"% /'/$!&&/',% ',3/!&%# /1&!',3!"-&/@ 3+-&G, /*&+(/ /A!3+5%% './*%"%'- ,/"-(/ ( +4A2,+5%% (/&!B&/',!@. / .3!4# 1-@ 4%3/./@ ./@&G(1914–1918) A/"2B%"+ 3+'A3/',3+&!&%! D%3231%B!'(+# /$3+$/,(+ 3+& . '/B!,+&%% ' A3%4!&!&%!4+&,%'!A,%(/.. 1/*G !"%(/@ �,!B!',.!&&/@ ./@&G (1941–1945) �,+A&/! "!B!&%! "!1"/ . /'&/.23+).%,%# &/./@ '%',!4G "!B!&%# 3+&!&GD ./%&/. �/.!,'(/@ �34%%. �G"% /A3!*!"!&G )+*+B% (+-F*/1/ �,+A+ 4!*%5%&'(/@ �.+(2+5%%, D%3231%B!'(+# A/4/�- 4+('%4+"-&/ A3%$"%F+"+'- ( ./@-'(+4, B,/ )&+B%,!"-&/ '/(3+�+"/ '3/(% A/',2A"!&%# 3+&!&GD . 4!*%5%&'(%! 2B3!F*!&%#.

� 1956 1/*+ A/* 32(/./*',./4 1"+.&/1/ D%3231+ �� ���� �. �. %U&!.'(/1/ ./!&&/-A/"!.+# D%3231%# A/"2B%"+ &/./! &+A3+."!&%! . './!4 3+).%,%%.

�"!('+&*3 �"!('+&*3/.%B %U&!.'(%@ — +(+*!4%( ��� ����, )+'"2F!&&G@ *!#,!"- &+2(%�����, �!3/@ �/5%+"%',%B!'(/1/ 32*+, "+23!+, �!&%&'(/@ A3!4%%, �/'2*+3',.!&&/@ A3!4%%����, 1!&!3+"NA/"(/.&%( 4!*%5%&'(/@ '"2F$G, +.,/3 $/"!! 380 &+2B&GD 3+$/,, . ,/4 B%'"! 3#*+4/&/13+?%@. �+&&%! !1/ 3+$/,G A/'.#�!&G +&+,/4%B!'(/42 /$/'&/.+&%� 4!',&/@ +&!',!)%% 4!,/-*/4 «A/")2B!1/ %&?%"-,3+,+». A/'"!*2��%D A2$"%(+5%#D *+& +&+"%) 4!D+&%)4/. $/"% % *!@',.%#&/./(+%&/./@ $"/(+*G. �/&/13+?%# «�/./(+%&/.+# $"/(+*+ % 4+'"#&/N$+"-)+4%B!'(%! +&,%'!A,%(%(+( /'/$G@ .%* A+,/1!&!,%B!'(/@ ,!3+A%%» (1952), &+A%'+&&+# '/.4!',&/ ' �. . %U&!.'(%4, #."#-!,'# %,/1/4 4&/1/"!,&%D %''"!*/.+&%@ 3/"% &!3.&/@ ,3/?%(% . A+,/1!&!)! 3#*+ D%3231%B!'(%D )+-$/"!.+&%@ % /$/'&/.+&%!4 A3!*"/F!&&GD 4!,/*/. &!'A!5%?%B!'(/@ ,!3+A%% �,%D )+$/"!.+&%@ [2].

%U&!.'(%@ .&!' $/"-U/@ .("+* . 3+).%,%! '/.!,'(/@ ./!&&/NA/"!./@ D%3231%%. �2*2B% 2B+-',&%(/4 $/!. 2 3!(% �+"D%&N�/" (1939), /& .A!3.G! A3%4!&%" &/./(+%&/.G! $"/(+*G % A/(+)+" %D�??!(,%.&/',- . $/3-$! ' ,3+.4+,%B!'(%4 U/(/4 2 3+&!&GD, + ,+(F! /,4!,%" 5!"!$&/! *!@',.%!A/.#)/( ' 4+'"#&/N$+"-)+4%B!'(/@ �42"-'%!@ A3% "!B!&%% &+1&/%.U%D'# /1&!',3!"-&GD 3+&. �42',+&/."!&/ ,+(F!, B,/ &+ A!3!*/.GD �,+A+D 4!*%5%&'(/@ �.+(2+5%% D%3231%B!'(%! .4!U+,!"-',.+2 3+&!&GD 4/12, $G,- .GA/"&!&G A/* 4!',&/@ +&!',!)%!@ 4!,/*/4 «A/")2B!1/ %&?%"-,3+,+». �'-A/"-)/.+&%! 2(+)+&&GD 4!,/*/. *"# /(+)+&%# D%3231%B!'(/@ A/4/�% % "!B!&%# 3+&!&GD . A/"!.GD4!*%5%&'(%D 2B3!F*!&%#D %4!"/ )&+B!&%! . 1/*G !"%(/@ �,!B!',.!&&/@ ./@&G [3].

,!B!&%! A/'"!*&%D 10–15 "!, A3/%)/U"/ ',3!4%,!"-&/! 3+).%,%! '%" % '3!*',. .!*!&%# $/!-.GD *!@',.%@. �+"-&!@U!! '/.!3U!&',./.+&%! /1&!',3!"-&/1/ /32F%# U"/ A/ A2,% 2'(/3!&%# A/"!-

59

,+ 3+&#�%D '&+3#*/.. '! �,/ A3%.!"/, ' /*&/@ ',/3/&G, ( )&+B%,!"-&/42 2,#F!"!&%� 3+&!&%@, A/-#."!&%� &! ,/"-(/ '/B!,+&&GD, 4&/F!',.!&&GD, &/ % (/4$%&%3/.+&&GD A/3+F!&%@, ' *321/@ ',/3/-&G, ( ./)&%(&/.!&%� /B+1/. 4+''/./1/ A/3+F!&%# ./ .3!4# .!*!&%# $/!.GD *!@',.%@. '"2B+! A3%-4!&!&%# #*!3&/1/ /32F%# %)4!&%,'# ',32(,23+ '+&%,+3&GD A/,!3-, $2*2, A3!.+"%3/.+,- (/4$%&%3/-.+&&G! A/3+F!&%#. !*2�!! 4!',/ . (/"%B!',.!&&/4 /,&/U!&%% )+@42, /F/1% % (/4$%&%3/.+&&G!3+*%+5%/&&G! A/3+F!&%# '/ )&+B%,!"-&G4 2.!"%B!&%!4 B%'"+ A/',3+*+.U%D . '/',/#&%% U/(+. �,%D 2'"/.%#D 'A3+.!*"%./ .G'(+)G.+&%! �. �. %U&!.'(/1/: «�!4 �??!(,%.&!! '3!*',.+ A/3+F!-&%#, B!4 $/"-U! A/,/( A/3+F!&&GD, ,!4 A3/�! */"F&G $G,- 4!,/*G /(+)+&%# A/4/�%» [4].

�3/(%, A3%/$3!,!&&G! 4!*%5%&'(/@ '"2F$/@ //32F!&&GD �%" �� % *321%D ',3+& . .//-32F!&&GD (/&?"%(,+D, ',+"% ,/"B(/4 *"# ?/34%3/.+&%# &/./@ '%',!4G �,+A&/1/ "!B!&%# 3+&!-&GD. �&+ '/',/%, %) '"!*2��%D A/"/F!&%@: A!3./! — . "/(+"-&GD ./@&+D % .//32F!&&GD (/&-?"%(,+D .!"%B%&+ % ',32(,23+ '+&%,+3&GD A/,!3- &! A/',/#&&G % /A3!*!"#�,'# D+3+(,!3/4 % %&-,!&'%.&/',-� .!*!&%# $/!.GD *!@',.%@; .,/3/! — /31+&%)+5%# /(+)+&%# .'!D .%*/. 4!*%5%&'(/@A/4/�% 3+&!&G4 % %D "!B!&%! . "/(+"-&GD ./@&+D % .//32F!&&GD (/&?"%(,+D /,"%B+�,'# 4&/-1//$3+)%!4 .+3%+&,/. . 3+4(+D ("+''%B!'(/@ 'D!4G �,+A&/1/ "!B!&%#; ,3!,-! — %)4!&%"%'- D+-3+(,!3 % (+B!',./ */1/'A%,+"-&/@ A/4/�%, /$2'"/."!&&G! U%3/(%4 A3%4!&!&%!4 .!3,/"!,&/@�.+(2+5%%, B,/ ,3!$2!, A/"&/5!&&/@ A3!*�.+(2+5%/&&/@ A/*1/,/.(% 3+&!&GD &+ "�$/4 �,+A! 4!-*%5%&'(/@ �.+(2+5%%; B!,.!3,/! — A3% 3+).!3,G.+&%% A/"!.GD "!B!$&GD 2B3!F*!&%@ . )/&! .//-32F!&&/1/ (/&?"%(,+ /A,%4+"-&G4 /$�!4/4 (.+"%?%5%3/.+&&/@ D%3231%B!'(/@ A/4/�%, /(+)G-.+!4/@ 3+&!&G4, #."#!,'# A3/.!*!&%! &!/,"/F&GD % '3/B&GD /A!3+,%.&GD .4!U+,!"-',. % 3!+-&%4+5%/&&GD 4!3/A3%#,%@, + 3+'U%3!&%! !! /$�!4+ /A3+.*+&/ ,/"-(/ A3% )+*!3F(! �.+(2+5%%3+&!&GD; A#,/! — �U!"/&%3/.+&%! "!B!$&GD 2B3!F*!&%@, /(+)G.+��%D 'A!5%+"%)%3/.+&&2�D%3231%B!'(2� A/4/�-, A/)./"#!, 4+('%4+"-&/ A3%$"%)%,- !! ( 3+&!&G4 )+ 'B!, '?/34%3/.+&%#4&/1/A3/?%"-&GD ./!&&GD 1/'A%,+"!@ &+ 13+&%5! ' )/&/@ .!*!&%# $/!.GD *!@',.%@ &+ /'&/.&GD�.+(2+5%/&&GD &+A3+."!&%#D [5].

&+',/#�!! .3!4# 4&/1%! 1/'2*+3',.+ A3%*!3F%.+�,'# ,+( &+)G.+!4/@ A/"%,%(% #*!3&/1/'*!3F%.+&%#, ,/ !',- &+(+A"%.+�, #*!3&2� 4/�-. � A3% A3%4!&!&%% #*!3&/1/ /32F%# "�*% $2-*2, A/"2B+,- A/.3!F*!&%# &! /, A2"- % 13+&+,, + /, #*!3&/1/ %)"2B!&%#. �4!&&/ A/�,/42 '!@B+'4&/1%! 2B!&G! )+&%4+�,'# 3+)3+$/,(/@ "!(+3',.!&&GD '3!*',. % 4!,/*/. $/3-$G ' 3+)"%B&/1/3/*+ %)"2B!&%#4%, *+$G D/,- (+( ,/ A/4/1+,- 3+&!&G4 &+ A/"! $/#…

�A%'/( "%,!3+,23G:1. �+@, Wikipedia.org.2. �%*(/. �L�., �&%,(/ �L�., �2)-4%& �L. % *3. /!&&/NA/"!.+# D%3231%#: 2B!$. A/'/$%! /

A/* 3!*. �L�. �%*(/.+, �L�. �&%,(/. — �%&'(: ����, 2001. — 308 '.3. �"!('+&#& �L., �&/A/. �. �. /!&&/NA/"!.+# D%3231%# . 1/*G !"%(/@ �,!B!',.!&&/@

./@&G. — �!*%5%&+, 2000. — 264 '.4. �%3/1/., �L�. �+B+"+ /$�!@ ./!&&/NA/"!./@ D%3231%%…. �/$3. '/B. — . 5, 6. — �., 1961.5. �/)+&/. �L�., �?%4!&(/ ., �$+U%& L�., �/)+&/. L�., �?%4!&(/ �L�. /!&&/NA/"!.+#

D%3231%# / A/* 3!*. �?%4!&(/ �L�. — �!*%5%&+, 2002. — 528 '.

$-("w{+/�=","0!J,#+. �+&!>!$ — 24,("0!&)+'$�)!/","0!J+%'�)!/x)!1-

"#+. )���z���, +#$. (_����z���, "#$. J������+5%/&+"-&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4. �L�. �/1/4/"-5+

�+?!*3+ +&+,/4%% B!"/.!(+

�������������������: ��8. ������� (0��. ��., �. �. �., ���.)

�'"% $G �L�. �%3/1/., (3/4! +&+,/4%B!'(%D ,32*/.,&! /',+.%" A/'"! '!$# &%(+(%D ,32*/.,

,/ /& % ,/1*+ $G /$!''4!3,%" './� %4#.��9. ;�0�������.

13 &/#$3# 2012 1. %'A/"&%"/'- 202 1/*+ '/ *&# 3/F*!&%# �%(/"+# �.+&/.%B+ �%3/1/.+ —1!&%+"-&/1/ D%3231+, +&+,/4+, �('A!3%4!&,+,/3+, A!*+1/1+, /$�!',.!&&/1/ *!#,!"#. �4# �L�. �%-3/1/.+ A/ A3+.2 )+&%4+!, .G*+��!!'# 4!',/ '3!*% A"!#*G (/3%?!!. 4!*%5%&'(/@ &+2(% .'!1/

60

4%3+. �,(3G,%# % ,32*G �%3/1/.+ . '+4GD 3+)"%B&GD /$"+',#D 4!*%5%&G A3%)&+&G 5!&&!@U%4.("+*/4 . &+2(2. '! !! 1"+.&G! 3+)*!"G /)+3!&G 1!&%!4 �%3/1/.+. �3%4!&!&%! 4!*%5%&'(/@'/3,%3/.(%, &+3(/)+, 1%A'/./@ A/.#)(%, '/)*+&%! /'&/. 2B!&%# / ,3+.4!, /$!)$/"%.+&%#, $"!',#-�!! 4+',!3',./ . /$"+',% A"+',%B!'(/@ D%3231%%, ..!*!&%! �('A!3%4!&,+"-&/1/ 4!,/*+ . D%323-1%% % +&+,/4%%, %)/$3!,!&%! A3%$/3+ *"# ,3+&'?2)%% (3/.%, /A%'+&%! ("%&%(% U/(+, /',3/@ '/-'2*%',/@ &!*/',+,/B&/',%, +&+�3/$&/1/ '!A'%'+, +&+"%) ,+(,%(% A3% A!3!"/4+D, +&,%'!A,%B!'(%@4!,/* "!B!&%# 3+&, ("+''%?%(+5%# ?/34 "!1/B&/1/ ,2$!3(2"!)+, .A!3.G! A3/B%,+&&+# "!(5%# /3+(! "!1(%D (1844), '/.3!4!&&/! ,/"(/.+&%! &!?3/)+, +.%,+4%&/)+ «�», ',!3,GD ?/34 '(/3$2,+,2$!F*!&&/',- . «4!*%5%&! A3/?%"+(,%B!'(/@», /31+&%)+5%# %&',%,2,+ '!',!3 4%"/'!3*%#, A3%-)&+&%! A3+. F!&�%& &+ 4!*%5%&'(/! /$3+)/.+&%!, /$�!',.!&&/NA!*+1/1%B!'(+# *!#,!"-&/',- —A3%/3%,!,&G! )+'"21% �%3/1/.+, (/,/3G! A/',+.%"% !1/ .GU! 4&/1%D 2B!&GD ,/1/ .3!4!&%, %)&+B!&%! (/,/3GD &! A/,!3#&/ % . &+U! .3!4#.

�/"/''+"-&/! ."%#&%! �L�. �%3/1/.+ &+ 3+).%,%! 4!*%5%&'(/@ &+2(% $G"/ &!3+)3G.&/ '.#-)+&/ ' !1/ A/&%4+&%!4 1"+.&GD 3!+"-&GD !! /'&/. — +&+,/4%% % ?%)%/"/1%%. �/ �%3/1/.+ . �/'-'%% % )+ 32$!F/4 D%3231%#, &+A3%4!3, $G"+ A3+(,%B!'(% %)/"%3/.+&+ /, ?2&*+4!&,+"-&GD &+2(.�+&%4+#'- &+ 4!*%5%&'(/4 ?+(2"-,!,! �/'(/.'(/1/ 2&%.!3'%,!,+, (/,/3G@ /& /(/&B%" . 1828 1/-*2, �L�. �%3/1/. /'&/.+,!"-&/ %)2B+" (+&/&G +&+,/4%B!'(/@ &+2(%. � "/1%B!'(/@ A/'"!*/.+,!"--&/',-� /& A/*B%&#" &+2B&2� 3+$/,2 ,3!$/.+&%#4 ("%&%(%. �/ '"/.+4 A3/?!''/3+N+&+,/4+�L�. �G'!&(/.+, «+&+,/4%# $G"+ A!3./@ �&/U!'(/@ "�$/.-� �%3/1/.+». 1832 1/*2 (. «A3/?!'-'/3'(/4» %&',%,2,! �&%.!3'%,!,+ . �!3A,!) �L�. �%3/1/. )+�%,%" */(,/3'(2� *%''!3,+5%� &+/'&/.! &+2B&/1/ %''"!*/.+&%# A/ �('A!3%4!&,+"-&/@ +&1%/"/1%%, (/,/32� .GA/"&#" A/* 32(/./-*',./4 +&+,/4+ % D%3231+ �L�. �/@!3+ (2B!&%(+ )&+4!&%,/1/ +&+,/4+ �&,/&%/ �(+3A+).�L�. �%3/1/.2 A3!*'(+)G.+"% $"!',#�!! $2*2�!! . (+B!',.! A3/?!''/3+ ,/A/13+?%B!'(/@ +&+,/-4%%, &/ '!3*5! 1!&%# $G"/ /,*+&/ D%3231%%. � .'! F! +&+,/4%� �L�. �%3/1/. &%(/1*+ &! /',+."#".

�!3A,!, + )+,!4 . �!3"%&'(/4 2&%.!3'%,!,! &+ $+)! +&+,/4%B!'(/1/ ,!+,3+ �+3%,! �%3/-1/. '%',!4+,%B!'(% A3!A+3%3/.+" ,32AG, ,�+,!"-&/ %)2B+# ',32(,23G % ?2&(5%% /31+&/. B!"/.!-(+. �& $G" 2.!3!& . A3!./'D/*',.! D%3231%B!'(/1/ 4+',!3',.+ &+ $+)! ,/B&GD )&+&%@ +&+,/4%%.�"2$/(+# )+%&,!3!'/.+&&/',- 2B!&/1/ . 3+'A3/',3+&!&%% +&+,/4%B!'(%D )&+&%@ A/$2*%"+ �%3/-1/.+ $/3/,-'# )+ /31+&%)+5%� +&+,/4%B!'(/1/ %&',%,2,+ A3% �!*%(/ND%3231%B!'(/@ +(+*!4%% .�!,!3$231!. */("+*&/@ )+A%'(! �%(/"+@ �.+&/.%B %)"/F%" './% '//$3+F!&%# / A3%&5%A+D %5!"% /31+&%)+5%% +&+,/4%B!'(/1/ %&',%,2,+, (/,/3G! A/)./"#, ',2*!&,+4 ' '+4/1/ &+B+"+ /$2B!-&%# . +(+*!4%% % */ !! /(/&B+&%# A3+(,%B!'(% )+&%4+,-'# 3+)"%B&G4% 3+)*!"+4% +&+,/4%%, % (/-,/3G! 4/1"% $G, A/ 4&!&%� �%3/1/.+, «!�! $/"!! /'2�!',.%,- 1/'A/*',.2��!! ,!A!3- &+A3+."!-&%! . '/!*%&!&%% 4!*%5%&G ' +&+,/4%!@ % ?%)%/"/1%!@». �/'"! /31+&%)+5%% %&',%,2,+�L�. �%3/1/. ./)1"+.%" (+?!*32 A3%("+*&/@ +&+,/4%% ((+?!*3/@ /A%'+,!"-&/@ +&+,/4%% 32(/-./*%"% A3/?!''/3+ �L�. �+3+&/.%B % �L�. �+&*5!3,, + (+?!*32 '3+.&%,!"-&/@ +&+,/4%% ./)1"+-.%" A3/?!''/3 �L�. �!3). "%#&%! �%(/"+# �.+&/.%B+ &+ 3+).%,%! +&+,/4%% $G"/ (/"/''+"-&G4.�42 A3%&+*"!F%, B!',- '/)*+&%# &/./@ &+ ,/ .3!4# &+2(% — D%3231%B!'(/@ +&+,/4%%. «�&+,/-4%#, — A%'+" �L�. �%3/1/., — &! '/',+."#!,, (+( 4&/1%! *24+�,, /*&2 +)$2(2 4!*%5%&G, (/,/-32� 4/F&/ $!) .3!*+ % )+$G,-, (/1*+ 4G &+2B%4'# (/!N(+( B%,+,- A/ '("+*+4; %)2B!&%! !! ,+( F!&!/$D/*%4/ *"# &+B%&+��!1/ 2B%,-'#, (+( % *"# ,!D, (/,/3G4 */.!3#!,'# F%)&-».

�'A/"-)2# .A!3.G! 4!,/* 3+'A%"/. )+4/3/F!&&GD ,32A/. % A/"2B!&%! /,A!B+,(/. A/"/'-,!@, �%3/1/. 4+('%4+"-&/ ,/B&/ /A3!*!"%" ,/A/13+?%� .&2,3!&&%D /31+&/. B!"/.!(+ . &/34! %A3% A+,/"/1%B!'(%D %)4!&!&%#D. �+A/"&## A/"/',% ,!"+ F%*(/',-�, �%3/1/. */(+)+" )&+B%,!"--&G! %)4!&!&%# . '(!"!,/- % '%&,/A%% /31+&/., )+"/F%. ,+(%4 /$3+)/4 /'&/.G ?2&(5%/&+"-&/@,,/A/13+?%B!'(/@, A"+',%B!'(/@ +&+,/4%%. (+F*/4 '/.3!4!&&/4 2B!$&%(! /A%'+& ,3!21/"-&%(�%3/1/.+ &+ U!! (trigonum linguae), "%4?/%*&/! (/"-5/ 1"/,(% ((/"-5/ �%3/1/.+ — +"-*!@!3+),,/A/13+?%B!'(%! /'/$!&&/',% )+$3�U%&&/1/ A3/',3+&',.+ (A3/',3+&',./ �%3/1/.+ — �/13+,A3/',3+&',./ �%3/1/.+ — �!,5%2'+), /(/"/&/'/.GD A+)2D, ,3+A!5%!.%*&+# ?+'5%# . "/(,!./@ /$-"+',% (+A/&!.3/) �%3/1/.+), A"!B!./@ (+&+" �%3/1/.+ (canalis brachialis), A/*(/"!&&G@ (+&+" �%-3/1/.+, #3!4&G@ 21/" �%3/1/.+ (angulus venosus), $!"+# "%&%# F%./,+, /',- �%3/1/.+, "%4?+,%B!-'(%@ 2)!" �%3/1/.+ — �/)!&4�""!3+. �+F*G@ .3+B A/',/#&&/ A/"-)2!,'# ,/B(+4% % "%&%#4% �%-3/1/.+ *"# /A3!*!"!&%# A/"/F!&%# +3,!3%@ % '/'2*%',/N&!3.&GD A2B(/. ($!*3!&&/@, "2B!./@ +3-,!3%@, A"!B!./1/ % "2B!./1/ '/'2*%',/N&!3.&GD A2B(/.). './%D �('A!3%4!&,+"-&GD %''"!*/.+-&%#D .!"%(%@ 2B!&G@ /A3!*!"%" /'/$!&&/',% ',3/!&%# % ,/A/13+?%% /31+&/. . )+.%'%4/',% /,./)3+',+, A/"+, ?%)%B!'(/@ &+132)(%, )+"/F%. /'&/.G ./)3+',&/@ +&+,/4%%.

61

�G */"F&G A3!*/',+.%,- A+"-42 A!3.!&',.+ 1!&%� �%3/1/.+ % . 3+)3+$/,(! ./A3/'/./A/3&/N*.%1+,!"-&/1/ +AA+3+,+. �%3/1/. '+4/',/#,!"-&/, . /B!&- ,#F!"GD 2'"/.%#D, &+ /'&/.!'/$',.!&&/@ 4!,/*%(% ,�+,!"-&/ %)2B+" +&+,/4%� ?+'5%@, '.#)/(, (/',&/N?%$3/)&GD (+&+"/.,2*!"## /'/$/! .&%4+&%! *!,+"#4 ',3/!&%# (/',!@, .)+%4//,&/U!&%� '2',+.&GD A/.!3D&/',!@,3+'(3G" 4!D+&%)4G *.%F!&%# . '2',+.+D. �+ !1/ .)1"#*, /, �,/1/ )+.%'!"/ «,/B&!@U!! A/)&+&%!.G.%D/. % A!3!"/4/., A3+.%"-&/! %D .A3+."!&%!». �A%3+#'- &+ ,32*G �L�. �%3/1/.+, . (/&5! XIX',/"!,%# �L�. �!',1+?, /,(3G" )+(/&G ',3/!&%# '2',+./.. �%3/1/.G4 .A!3.G! 3+'(3G,/ )&+B!&%!(/',!@ )+A#',-# (+( './!/$3+)&GD 4!&%'(/. A3% *.%F!&%#D (%',% . 5!"/4. �3% %)2B!&%% A3/-*/"-&GD 3+'A%"/., '*!"+&&GD B!3!) 1/"!&- % ',/A2, �%3/1/. /A%'+" /A!3+,%.&2� ,!D&%(2 A"+-',%(% ',/AG. �/"-U/! .&%4+&%! �%3/1/. 2*!"#" %)2B!&%� ?2&(5%% 4GU5. */A%3/1/.'(%@ A!-3%/* . +&+,/4%% A3+(,%B!'(% &! 2*!"#"/'- .&%4+&%! .'A/4/1+,!"-&/42 +AA+3+,2 4GU5. 2B!$-&%(+D A/ +&+,/4%% (�!4A!"#) $G"% /A%'+&G ,/"-(/ U%3/(+# ?+'5%# $!*3+ % A/A!3!B&+# ?+'5%#F%./,+. �%(/"+@ �.+&/.%B .&!' A3+(,%B!'(% %'B!3AG.+��2� #'&/',- . +&+,/4%� ?+'5%@ % %DA3/%)./*&GD, /A3!*!"%" %D ?%)%/"/1%B!'(/! )&+B!&%!. A!3.G! %)2B!&G % /A%'+&G '/!*%&%,!"--&/,(+&&G! A3/',3+&',.+, A/ (/,/3G4 ./)4/F&/ 3+'A3/',3+&!&%! A+,/"/1%B!'(%D A3/5!''/..

�3/.!3%. &+ A3+(,%(! .)1"#*G % 4G'"% . /$"+',% +&1%/"/1%%, �%3/1/. /$/$�+!, %D . './%D3+$/,+D. '!4 %).!',!& ("+''%B!'(%@ ,32* 2B!&/1/ «�%3231%B!'(+# +&+,/4%# +3,!3%+"-&GD ',./-"/. % ?+'5%@». '!4%3&/! )&+B!&%! %4!�, �('A!3%4!&,+"-&G! 3+$/,G �%3/1/.+, A/'.#�!&&G!(/""+,!3+"-&/42 (3/.//$3+�!&%� A3% A!3!.#)(! %"% A/',!A!&&/4 ',!&/)! (&+ ,23&%(!,! �2#"--'(/1/) 4+1%',3+"-&GD '/'2*/.. �& .A!3.G! /A%'G.+!, ./)4/F&G! +&+',/4/)G, ./)&%(+��%! A3%A!3!.#)(! $3�U&/@ +/3,G, %''"!*2!, A+,/"/1%B!'(%! %)4!&!&%# . /31+&+D A3% &+32U!&%% (3/./-'&+$F!&%#, %)2B+!, ',3/!&%! ',!&(% +/3,G, )&+B!&%! !! .&!U&!@ /$/"/B(% . 3!1!&!3+,%.&GD A3/-5!''+D % 3!.+'(2"#3%)+5%% . /$"+',% &+"/F!&%# "%1+,23G, /A%'G.+!, &/.//$3+)/.+&%# (3/.!&/'-&GD '/'2*/. . /$"+',% U.+, )&+B!&%! ,3/4$//$3+)/.+&%# . A3/5!''+D 3!1!&!3+5%%. �!,/*%(%, (/-,/3G4% A/"-)/.+"'# �%3/1/. A3% %''"!*/.+&%% '/'2*/., % . &+U! .3!4# %4!�, $/"-U/! A3+(,%-B!'(/! )&+B!&%! — A3!A+3%3/.+&%! '/'2*/. &+ ,32A+D, �('A!3%4!&,+"-&/! %&�!(5%/&&/! ..!*!-&%! . '/'2*G �42"-'%@, 3+)"%B&GD (3+'%,!"!@, &+"/F!&%# "%1+,23 &+ '/'2*G. �L�. �%3/1/. A!3-.G4 %'A/"-)/.+" 4%(3/'(/A *"# %)2B!&%# A+,/"/1%B!'(%D %)4!&!&%@ ,(+&!@.

�+'"21+ �%3/1/.+ (+( +&+,/4+ )+("�B+!,'# . A3%4!&!&%% �('A!3%4!&,+ . +&+,/4%B!'(%D %'-'"!*/.+&%#D. �%3/1/. 1!&%+"-&/ /5!&%", B,/ ,/"-(/ ' A/4/�-� �('A!3%4!&,+ ./)4/F&/ 3+'(3G,-1"2$%&2 4/3?/"/1%B!'(%D A3/5!''/., /$�#'&%,- %D. !4 '+4G4 /& A!3.G4 .',+" &+ A2,- ?2&(-5%/&+"-&/@ +&+,/4%%. �1/ %*!% $G"% %'A/"-)/.+&G �L�. �!'1+?,/4, (/,/3G@ ,!/3!,%B!'(% /$/'-&/.+" ,3!$/.+&%# ?2&(5%/&+"-&/@ +&+,/4%% % 3+).%" %D . './%D %''"!*/.+&%#D *.%1+,!"-&/1/+AA+3+,+.

�&+B%,!"-&G@ .("+* .&!' �%3/1/. % . %)2B!&%! &!3.&/@ '%',!4G. �+ )+4/3/F!&&GD '3!)+D,'*!"+&&GD . 3+)&GD A"/'(/',#D, 2B!&G@ .A!3.G! &+B+" %)2B!&%! +&+,/4%B!'(/1/ ',3/!&%# 1/"/.-&/1/ % 'A%&&/1/ 4/)1+. �%3/1/. A!3.G4 /,(3G" #*3+ A/"2U+3%@ $/"-U/1/ 4/)1+, %''"!*/.+" ,/-A/13+?%� 4/)/"%',/1/ ,!"+, B!3!A&GD &!3./.. �/'"!*/.+,!"#4% �%3/1/.+ 4/F&/ 'B%,+,- .'!-4%3&/ %).!',&GD 2B!&GD �!5+, �"!('%1+. �&+B%,!"-&G@ .("+* . '/(3/.%�&%52 +&+,/4%B!'(%D%''"!*/.+&%@ �%3/1/. .&!' './%4% ,32*+4% / ,/A/13+?%% &!3.&GD ',./"/. («�/"&G@ (23' A3%-("+*&/@ +&+,/4%%»), 3+).!,."!&%#D A!3%?!3%B!'(%D &!3./.. �4 A3!*"/F!&G 3+)3!)G ,(+&!@ A3%/A!3+,%.&GD .4!U+,!"-',.+D, %'("�B+��%D %D A/.3!F*!&%!. �B!&G@ %)2B%" )+(/&G %&&!3.+5%%4GU5 % '/'2*/.. �)2B+# *!@',.%! �?%3+, �%3/1/. /$&+32F%" 3!+(,%.&G! %)4!&!&%# &!3.&GD ./-"/(/& A/* ."%#&%!4 %U!4%%, /$�#'&%" A3/%'D/F*!&%! A+3+"%B!@, ,!4 '+4G4 )+"/F%. /'&/.G&!@3/+&+,/4%%.

�+ .G*+��%!'# )+'"21% A!3!* 4!*%5%&'(/@ &+2(/@, ("+''%B!'(%! ,32*G % 4&/1/B%'"!&&G!A3%("+*&G! %''"!*/.+&%# A/ +&+,/4%% % D%3231%%, /31+&%)+5%� +&+,/4%B!'(/1/ %&',%,2,+, .G-*+��2�'# .3+B!$&2� *!#,!"-&/',- . */"F&/',% )+.!*2��!1/ �/'A%,+"-&/@ D%3231%B!'(/@ ("%-&%(/@ . 1847 1/*2 �%3/1/. $G" %)$3+& B"!&/4N(/33!'A/&*!&,/4 �(+*!4%% &+2(.

�L�. �%3/1/.2 &!/*&/(3+,&/ A3%'2F*+"%'- A3!4%% )+ ,32*G: «�%3231%B!'(+# +&+,/4%# +3-,!3%+"-&GD ',./"/. % ?+'5%@», «�/"&G@ (23' A3%("+*&/@ +&+,/4%% B!"/.!B!'(/1/ ,!"+», «�+,/-"/1%B!'(+# +&+,/4%# +)%+,'(/@ D/"!3G», «/A/13+?%B!'(+# +&+,/4%#, %""�',3%3/.+&&+# 3+)3!-)+4%, A3/.!*!&&G4% B!3!) )+4/3/F!&&/@ ,!"/ B!"/.!(+ . ,3!D &+A3+."!&%#D». �,"+'G �L�. �%3/-1/.+ */ &+',/#�!1/ .3!4!&% +(,2+"-&G. �/'"! %D .GD/*+ . '.!, &+B+"+'- &/.+# �3+ . %',/3%% +&+-,/4%%, &+B+"'# A3/5!'' /'&/.+,!"-&/1/ %'A/"-)/.+&%# +&+,/4%B!'(%D %''"!*/.+&%@ . ("%&%(!,%'B!) 3+)3G. 4!F*2 ,!/3!,%B!'(%4% &+2(+4% % A3+(,%B!'(/@ *!#,!"-&/',-� . 4!*%5%&!.

62

�L�. �%3/1/. A/*1/,/.%" 5!"2� A"!#*2 2B!&%(/. % A/'"!*/.+,!"!@. �%(/"+# �.+&/.%B+�%3/1/.+ A/ A3+.2 'B%,+�, /*&%4 %) /'&/.+,!"!@ �%!.'(/@ +&+,/4%B!'(/@ U(/"G. 1833 1., $2-*2B% . �!3"%&!, �L�. �%3/1/. '"2B+@&/ .',3!,%"'# ' L�. �+3+.+!.G4. �,+ .',3!B+ '$"%)%"+ %D, +)+,!4 A!3!3/'"+ . 4&/1/"!,&!! 1"2$/(/! .)+%4&/! ,!'&/! &+2B&/! '/,32*&%B!',./. �L�. �%3/1/.A%'+" . «�&!.&%(!»: «... � 4/12 A/ A3+.2 'B%,+,- �+3+.+!.+ /*&%4 %) './%D &+2B&GD A%,/45!.: #&+A3+.%" A!3.G! !1/ U+1% &+ A/A3%�! D%3231%% % '//$�%" !42 2F! %)$3+&&/! 4&/� &+A3+."!&%!. %)2B!&%% D%3231%%». L�. �+3+.+!. B!3!) 25 "!, . A3!*%'"/.%% ( 2B!$&%(2 A/ /A!3+,%.&/@ D%-3231%% (1886) &+)G.+" �%(/"+# �.+&/.%B+ �%3/1/.+ «'./%4 &!)+$G.+!4G4 &+',+.&%(/4». 1838 1. �+3+.+!. 2'A!U&/ )+�%,%" */(,/3'(2� *%''!3,+5%�, + .'(/3! !1/ A3%1"+'%"% . �%!. &+*/"F&/',- )+.!*2��!1/ (+?!*3/@ D%3231%% % *!(+&+ 4!*%5%&'(/1/ ?+(2"-,!,+ �&%.!3'%,!,+�.#,/1/ "+*%4%3+.

L�. �!5, A/',2A%. &+ /$2B!&%! &+ 4!*%5%&'(%@ ?+(2"-,!, �%!.'(/1/ 2&%.!3'%,!,+, '"2U+#"!(5%% �+3+.+!.+ % A3%'2,',.2# &+ )+&#,%#D A/ D%3231%%, A%'+": «�3/?!''/3 �+3+.+!. A/'"! �%-3/1/.+ /*%& %) .!'-4+ &!4&/1%D )&+,/(/. ,/A/13+?%B!'(/@ +&+,/4%% 2 &+' . �/''%% — ,/1/ A3!*-4!,+, (/,/3G@, ( '/F+"!&%�, A/'3!*',.!&&G4% &!A/.!3D&/',&G4% D%3231+4% A3!&!$3!1+!4, !'"%&! )&+(/4 %4 . &+*"!F+�!@ A/"&/,! $"+1/*+3# ,/42 ,/"-(/ )+$"2F*!&%�, B,/ A/* D"/3/?/34/44/F&/ ' F%.G4 B!"/.!(/4 A/',2A+,-, (+( ' ,32A/4».

�2*2B% A/A!B%,!"!4 �%!.'(/1/ 2B!$&/1/ /(321+, �L�. �%3/1/. $G" &+ /A!3+5%#D �+3+.+!.+,�"�$/.+"'# !1/ D2*/F!',.!&&G4 %'A/"&!&%!4». 3#*! '"2B+!. �+3+.+!., &! ',!'&##'-, A3!*"+1+"�L�. �%3/1/.2 2B+',./.+,- . (/&'2"-,+5%#D % /A!3+5%#D. L�. �+3+.+!. ,+(F! +(,%.&/ A/A2"#3%-)%3/.+" ,32*G './!1/ 2B%,!"#. 1854 1. /& A!3.G4 %) D%3231/. �/''%% .GA/"&%" (/',&/-A"+',%B!'(2� +4A2,+5%� 1/"!&%, ,/"-(/ B,/ 3+)3+$/,+&&2� �L�. �%3/1/.G4. +(/! ,!'&/! '/-,32*&%B!',./ �L�. �%3/1/.+ % L�. �+3+.+!.+, 4&/1/13+&&/! % A/"!)&/! A!3!A"!,!&%! %D %&,!3!-'/., &! 4/1"/ &! /,3+)%,-'# &+ /31+&%)+5%% 2B!$&/1/ A3/5!''+ &+ ,/"-(/ B,/ '/)*+&&GD (+?!*3+D2&%.!3'%,!,+. �3% /31+&%)+5%% (+?!*3G +&+,/4%% . �&%.!3'%,!,! �.#,/1/ "+*%4%3+, $!)2'"/.-&/, &+%$/"!! 2$!*%,!"-&G4% $G"% 3!(/4!&*+5%% �L�. �%3/1/.+. �!3.G4 )+.!*2��%4 (+?!*3/@+&+,/4%% . �%!.! ',+" 2B!&%( �%3/1/.+, 4/"/*/@ �&!31%B&G@ A3/?!''/3 (+?!*3G ,/A/13+?%B!-'(/@ +&+,/4%% 4!*%(/ND%3231%B!'(/@ +(+*!4%% %) �+&(,N�!,!3$231+ �%(/"+@ �""+3%/&/.%B �/)-"/.. �3/?!''/3 �/)"/. A3%.!) ' '/$/@ 2B!$&G! A"+&G "!(5%@ % A3+(,%B!'(%D )+&#,%@, &!(/,/3G!,+$"%5G % 3%'2&(% A3!A+3+,/. �L�. �%3/1/.+ — 2&%.!3'%,!,'(%! A/"/F!&%# / (+?!*3! +&+,/4%%,42)!! +&+,/4%%, U,+,&G! 3!(/4!&*+5%% A/ '/)*+&%� (+?!*3G % *321%! 4+,!3%+"G A/ !! 3+$/,!.�3/?!''/3 �/)"/. B%,+" (23' "!(5%@, )+&%4+"'# '/ ',2*!&,+4%, 1/,/.%" .4!',! ' A3/)!(,/3+4%+&+,/4%B!'(%! 2B!$&G! A3!A+3+,G. �/'"! ,3!D"!,&!@ 3+$/,G, ' 1841 A/ 1844 1., &+ (+?!*3! +&+,/-4%% . �%!.! �L�. �/)"/. .!3&2"'# . 4!*%(/ND%3231%B!'(2� +(+*!4%� �+&(,N�!,!3$231+.

'.#)% ' /,�!)*/4 �L�. �/)"/.+ )+.!*2��%4 (+?!*3/@ +&+,/4%% �%!.'(/1/ 2&%.!3'%,!,+$G" %)$3+& . 1844 1. A3/?!''/3 �"!('+&*3 �!,3/.%B +"-,!3. �&+4!&+,!"-&/! /$',/#,!"-',./, B,/�L�. +"-,!3, ./'A%,+&&%( �!3A,'(/1/ 2&%.!3'%,!,+, )&+" �L�. �%3/1/.+ !�! ./ .3!4# !1/ A3!-$G.+&%# . �!3A,!, 1/3*%"'# ,+"+&,/4 .!"%(/1/ +&+,/4+ % D%3231+. �$ %D /,&/U!&%#D 2.!3!&&/1/./3%, +$)+5 %) A3!*%'"/.%# 2B!$&%(+ �L�. +"-,!3+. 1855 1. �L�. +"-,!3 &+A!B+,+" 2-! %)*+-&%! «�23'+ +&+,/4%% B!"/.!B!'(/1/ ,!"+ *"# 2B+�%D'#». �/'"! A!3./1/ %)*+&%# �,/1/ )+4!B+-,!"-&/1/ 2B!$&%(+ A/#.%"%'- (3%,%B!'(%! )+4!B+&%# / ,/4, B,/ 2B!$&%( +"-,!3+ &+A%'+& A/ ,/@F! 'D!4!, B,/ % 2B!$&%( �L�. �%3/1/.+. �+ )+4!B+&%# (3%,%(+ / './!4 2B!$&%(! �L�. +"-,!3 /,-.!,%": «�/B%&%,!"- (3%,%(% 4/!1/ "�23'+ +&+,/4%% . �%$"%/,!(! *"# B,!&%#" &+U�", B,/ # '/',+-.%" './! '/B%&!&%! A/ �%3/1/.2; # &! 4/1 &! A/)&+(/4%,- $2*2�!! A/(/"!&%! 32''(%D .3+B!@ '/.'!4% ,32*+4% .!"%B+@U!1/ 32''(/1/ *.%1+,!"# % )&+,/(+ �,/@ &+2(%, &/ # A%U2 / 4&/1%D .!�+D,/ (/,/3GD �%3/1/. &% ',3/(% &! A%'+", ',+"/$G,- 1/'A/*%& (3%,%( &! )&+" '/B%&!&%@ &% �%3/1/-.+, &% 4/%D».

�L�. +"-,!3 .G'/(/ 5!&%" �%3/1/.+, % ((+( /& A%'+") «....'!1*+ .%*!" . ,! .3!4!&+ A!3./1/+&+,/4+ % 2B!&/1/...». �3/?!''/3 �L�. �A%3/. .(&%1! «�%!.'(+# U(/"+ +&+,/4/.» (1965) A/*B!3-(%.+", B,/ �L�. +"-,!3 «$G" &+',/#�%4 3!?/34+,/3/4 . A3!A/*+.+&%% +&+,/4%% . �%!.'(/42&%.!3'%,!,!». './%D "!(5%#D A/ +&+,/4%% �L�. +"-,!3 4&/1/(3+,&/ 5%,%3/.+" �L�. �%3/1/.+,*!"+" ''G"(% &+ !1/ ,/A/13+?/N+&+,/4%B!'(%! *+&&G!, !1/ 3%'2&(%, ,+$"%5G. !'- (23' A3!A/*+-.+&%# +&+,/4%% . �%!.! &+ (+?!*3!, (/,/32� ./)1"+."#" A3/?!''/3 �L�. �/)"/., A3/?!''/3 �L�.+"-,!3, + A/,/4 2B!&%( +"-,!3+ A3/?!''/3 L�. �!5, $G" &+'G�!& A!3!*/.G4% %*!#4%, 4%'"#-4% �L�. �%3/1/.+. �'"% A/'4/,3!,- 4%(3/'(/A%B!'(%! A3!A+3+,G A3/?!''/3+ L�. �!5+, D3+&#-�%!'# . 42)!! (+?!*3G +&+,/4%% B!"/.!(+ �+5%/&+"-&/1/ 4!*%5%&'(/1/ 2&%.!3'%,!,+ %4!&%�L�. �/1/4/"-5+, ,/ &!'"/F&/ 2$!*%,-'#, B,/ '3!)G %).%"%& $/"-U/1/ 4/)1+ '*!"+&G L�. �!5/4

63

. 3+)&GD A"/'(/',#D, A/*/$&/ 4+(3/'(/A%B!'(%4 A3!A+3+,+4 �L�. �%3/1/.+. L�. �!5 A3%&!' 4%-3/.2� '"+.2 2(3+%&'(/@ &+2(! ,32*+4% . /$"+',% 4/3?/"/1%% 5!&,3+"-&/@ &!3.&/@ '%',!4G. �2-&(5%/&+"-&/! &+A3+."!&%! (%!.'(/@ +&+,/4%B!'(/@ U(/"G, ?2&*+,/3/4 (/,/3/@ $G" .!"%(%@�%3/1/., A3/*/"F%"%: . %''"!*/.+&%#D .+3%+&,/. +3,!3%@ % .!& B!"/.!(+ — A3/?!''/3 �L�. %-D/4%3/.; . 3+$/,+D A/ +&+,/4%% "%4?+,%B!'(/@ '%',!4G — A3/?!''/3 �L�. �,!?+&%', A3/?!''/3�L�. �A%3/.; . %)2B!&%% 4/3?/"/1%B!'(%D /'&/. 4%(3/5%3(2"#5%% ?2&(5%/&+"-&/ 3+)&GD /31+-&/. B!"/.!(+ . /&,/1!&!)! — A3/?!''/3 �L�. �!?!"%, A3/?!''/3 �L�. �/$3%( % !1/ 2B!&%(%.

�2(/./*',.2#'- &+2B&G4 % A!*+1/1%B!'(%4 &+'"!*%!4 �%3/1/.+, 2B!&G! �%!.'(/1/ 2&%.!3-'%,!,+ �L�. �/)"/., �L�. +"-,!3, L�. �!5 A3!A/*+.+"% +&+,/4%� &+ '+4/4 .G'/(/4 . �.3/A!23/.&!.

+(%4 /$3+)/4 �%(/"+@ �.+&/.%B �%3/1/. A3%&%4+" '+4/! +(,%.&/! 2B+',%! . '/)*+&%%(+?!*3G +&+,/4%% �%!.'(/1/ 2&%.!3'%,!,+ �.#,/1/ "+*%4%3+. �*!% �L�. �%3/1/.+ (+( 1!&%+"--&/1/ 2B!&/1/ ',%42"%3/.+"% (%!.'(%D +&+,/4/. ( 3+)&G4 &/.G4 &+2B&G4 &+A3+."!&%#4, ,+(%D(+( %''"!*/.+&%! A/"2U+3%@ $/"-U/1/ 4/)1+, %)2B!&%# .+3%+&,/. ',3/!&%# +3,!3%@ % .!& B!"/.!-B!'(/1/ ,!"+ % *321%D, (/,/3G! A3/'"+.%"% �%!.'(2� +&+,/4%B!'(2� U(/"2 &+.'!1*+.

�A%'/( "%,!3+,23G:1. �%'%5G&, �L�. �',/3%# 4!*%5%&G. — �.: ��/,+3N�!*%+, 2008.2. �A%3/., �L�. �%!.'(+# U(/"+ +&+,/4/.. — �., 1965.3. �%3/1/., �L�. �+B+"+ /$�!@ ./!&&/NA/"!./@ D%3231%%. — �., 1944.4. �!3(+'/., L�. %*+,&%@ +&+,/4 �L�L�%3/1/. ,+ )+A/B+,(2.+&&# �%¤.'-(/¤ +&+,/4�B&/¤

U(/"% / �+,!3�+"% &+2(/./1/ (/&13!''2 «IV ��F&+3/*&� A%3/1/.'-(� B%,+&&#», A3%'.#B!&%@ 200-3�BB� �L�. �%3/1/.+. — �%3/1/.'-(� "!(5�¤ — �&&%5#, 2010. — � .18.

�!$&'J',,"= «1'(=,"=","0!J+=»

!#'. )������ (����.), ,#". ,������ (����.), "#!. ,������ (����.),w#!. !������ (����.), $#!. ;� 3�� (����.), (#'. >������ (��.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

�������������������: ���. ������ (0��. ��, ���., �. �. �.),���. ��%��� (��., . �. �.)

�./%4% 2'A!D+4% % '/.3!4!&&G4 '/',/#&%!4 +&+,/4%# . )&+B%,!"-&/@ ',!A!&% /$#)+&+2'/.!3U!&',./.+&%� 3+)"%B&GD 4!,/*/. !! %)2B!&%#.

�*&%4 %) &+%$/"!! A3+(,%B!'(% % %',/3%B!'(% )&+B%4GD 4!,/*/. %''"!*/.+&%# #."#!,'#�"!*#&+#» +&+,/4%# �L�. �%3/1/.+. �3/!)F+# . 1850 1/*2 A/ �!&&/@ A"/�+*%, /& /$3+,%" .&%4+-&%! &+ )+4/3/F!&&G! % 3+)32$"!&&G! (/3/.-% ,2U%, .G',+."!&&G! *"# A3/*+F%. �D .%* % A/*+"�%3/1/.2 4G'"- %'A/"-)/.+,- *"# A/'"/@&/1/ +&+,/4%3/.+&%# )+4/3/F!&&G! ,32AG. �3%U"/'-'/)*+.+,- A%"2 'A!5%+"-&/@ (/&',32(5%% % */"1%! B+'G 4!3)&2,- . D/"/*&/4 A/4!�!&%%, .G$%-3+# .!3&G@ 'A/'/$ 3+'A%"+. «�!*#&/@» 4!,/* *+.+" )+4!B+,!"-&G! 3!)2"-,+,G: 4/F&/ $G"/ &!/A+'+,-'#, B,/ ./)*2D ./@*!, ./ .'(3G,2� A/"/',-, B,/ /& '/F4!, /*&% B+',% %"% /(+F!,'# A3%-B%&/@ 3+'A+*+ *321%D. �(/"/ *!'#,% "!, '/)*+.+" �%3/1/. './� «"!*#&2�» +&+,/4%�, './@ «�,-"+' 3+'A%"/.». �& '*!"+" %D $/"!! ,G'#B%. �B!&G@ 2'"/F&#" './� )+*+B2. 3+)"%B&G! .&2,3!&-&%! A/"/',% /& ../*%" F%*(/',%, B,/$G .%*!,- A3% 3+'A%"+D ./)4/F&2� ',!A!&- '4!�!&%# )+-("�B!&&GD . &%D /31+&/.. �& )+4/3+F%.+" ,32AG . 3+)&GD A/"/F!&%#D — ' (/&!B&/',#4% ,/ '/-1&2,G4%, ,/ 3+)/1&2,G4%, ,/ /,.!*!&&G4% &+)+*, .A!3!*, . ',/3/&2. �,% 3+'A%"G '/',+.%"% /'&/-.2 &/./@ ,/A/13+?%B!'(/@ +&+,/4%%, 3+''(+)G.+��!@ /$ %',%&&/4 A3/',3+&',.!&&/4 3+'A/"/-F!&%% /31+&/., /$ %D /,&/U!&%% ( (3/.!&/'&G4 '/'2*+4 % &!3.+4.

�"!*2��%4 U+1/4 . 3+).%,%% +&+,/4%% ',+" 1896 1/*, (/1*+ .'! 2&%.!3'%,!,G % +(+*!4%%4%3+ $G"% .)$2*/3+F!&G '!&'+5%/&&/@ &/./',-�: &!(%@ %"-1!"-4 �/&3+* �!&,1!&, 4+"/ (/42%).!',&G@ &!4!5(%@ A3/?!''/3, /,(3G" (+(%!N,/ &/.G! "2B%, (/,/3G! /$"+*+"% 2*%.%,!"-&G4%'./@',.+4%. �!"/.!B!'(%@ 1"+) &! )+4!B+" %D, &/ /&% *!@',./.+"% &+ ?/,/13+?%B!'(2� A"+',%&-(2, % ' %D A/4/�-� 2*+.+"/'- *!"+,- '&%4(% *+F! . A/"&/@ ,!4&/,!. �3/4! ,/1/, &/.G! "2B% $/-"!! %"% 4!&!! './$/*&/ A3/D/*%"% B!3!) "�$G! A3!*4!,G, (+( '.!, B!3!) ',!("/. �&% A3/&%(+"%'(./)- A"/,&/ )+(3G,G! *.!3%, '(./)- 1"2D%! A!3!1/3/*(%, '(./)- /*!F*2 % B!"/.!B!'(/! ,!"/.

64

�'"% %4 A3!13+F*+"% A2,- (%',-� 32(%, ,/ &+ '.!,#�!4'# �(3+&! A/#."#"%'- ,!4&G! /B!3,+&%#(/',!@ — 32(+ '(!"!,+, U!.!"#�!1/ A+"-5+4%! �+U"%'- '3+)2 F! "�*%, (/,/3G! */1+*+"%'- A3%-4!&%,- &/.G! "2B% *"# A3+(,%B!'(/@ 5!"%. +( ./)&%("+ &/.+# &+2(+ — 3!&,1!&/+&+,/4%#. �&+A/)./"#!, A/"2B%,- *.2D4!3&/! %)/$3+F!&%! ,3�D4!3&/1/ /$�!(,+, B,/ '/A3#F!&/ ' A3/!(5%/&-&G4 &+'"/!&%!4 3+)"%B&GD +&+,/4%B!'(%D ',32(,23. &+U! .3!4# 3!&,1!&/+&+,/4%# 3+'A3/-',3+&!&+ A3+(,%B!'(% A/.'!4!',&/ % &! 2,3+,%"+ './� +(,2+"-&/',-.

�/#."!&%! 2"-,3+).2(/./1/ %''"!*/.+&%# )&+B%,!"-&/ 3+)*.%&2"/ 1/3%)/&,G 4!*%5%&G.�1/ A/,!&5%+" (+( "%*!3+ . /,/$3+F!&%% 4!*%5%&'(/@ *%+1&/',%(% $G" A3%)&+& ,/"-(/ . 1930-D% 1940-!, (/1*+ !/*/3 �2''%( % !1/ $3+, �3%*3%D A/AG,+"%'- %'A/"-)/.+,- 2"-,3+).2( *"# ,/1/,B,/$G *%+1&/',%3/.+,- /A2D/"% 4/)1+, + . 1970-D 3+$/,+ �,%D % *321%D A%/&!3/. %''"!*/.+&%@2"-,3+).2(+ 3!+"-&/ A3%&!'"+ A"/*G. /)4/F&/',% ���: /,/$3+F!&%! 4!D+&%B!'(%D './@',. ,(+-&%, /A3!*!"!&%! 3+)&%5G A/ F!',(/',%, �"+',%B&/',% % 3+',#F%4/',% )*/3/.GD % A+,/"/1%B!'(%%)4!&!&&GD ,(+&!@; A3!*/',+."!&%! %&?/34+5%% . 3+)"%B&GD +&+,/4%B!'(%D A"/'(/',#D *"# *%-+1&/',%(% '"/F&GD ("%&%B!'(%D '%,2+5%@; /A3!*!"!&%! &+"%B%# /$�!4&GD /$3+)/.+&%@ % ',!-A!&- .G3+F!&&/',% ',32(,23&GD *%??2)&GD %)4!&!&%@ /31+&/.; %)4!3!&%! A"/�+*% /$�!4&/1//$3+)/.+&%# % !1/ 4+('%4+"-&/1/ *%+4!,3+. �3!%42�!',./4 ��� #."#!,'# B!,(/',- A/"2B+!4/1/%)/$3+F!&%#, (/,/3/! /$!'A!B%.+!,'# ./)4/F&/',-� A3%4!&#!4/1/ . ��� 2"-,3+).2(+ /,3+F+,--'# A3% A/A+*+&%% "2B+ '(+&!3+ &+ 13+&%5G ,(+&!@ 3+)"%B&/@ A"/,&/',%. )+.%'%4/',% /, A"/,-&/',% .',3!B+!4GD ,(+&!@ % './@',. *+,B%(+ 2"-,3+).2( A3/&%(+!, &+ 3+)&2� 1"2$%&2 % /,3+F+-!,'# /, 3+)&GD ',32(,23. �+"!! (/4A-�,!3 A!3!3+$+,G.+!, ./'A3%&%4+!4G! /,3+F!&&G! '%1&+"G/, *+,B%(+ % ?/34%32!, (+3,%&(2 &+ �(3+&! — ,+( A/#."#�,'# (/&,23G /31+&/.. �)/$3+F!&%!,A/"2B+!4/! A3% %''"!*/.+&%%, A/#."#!,'# &+ �(3+&! ,!"!.%)%/&&/1/ 4/&%,/3+ . .%*! %)/$3+F!-&%# '3!)/. ,!"+, %4!��%! 3+)"%B&G! /,,!&(% B!3&/N$!"/1/ 5.!,+. �!*/',+,(% ���: /,'2,',.%!.%)2+"%)+5%% /31+&+ . 5!"/4 (,/"-(/ ,/4/13+?%B!'(%@ '3!)); 4+"+# %&?/34+,%.&/',- A3% F%3/-./@ %&./"�5%% (2"-,3+).2(/.+# (/&,3+',&/',- 4!F*2 /A2D/"!./@ % F%3/./@ ,(+&#4% '"+$+#);'2$�!(,%.&/',- %&,!3A3!,+5%% A/"2B!&&/1/ %)/$3+F!&%#; &!5!"!'//$3+)&/',- %'A/"-)/.+&%# *"#'(3%&%&1+ 3+(+ 4/"/B&/@ F!"!)G (&! 2*+!,'# .%)2+"%)%3/.+,- &!%&.+)%.&G! .&2,3%A3/,/(/.G!/A2D/"% . .%*! 4%(3/(+"-5%&+,/. $!) /A2D/"!./@ 4+''G). �3%4!&!&%! . A/'"!*&!! .3!4# A3%��� */AA"!3/13+?%% A/)./"#!, 'A!5%+"%',+4 &! ,/"-(/ /A3!*!"%,- '/',/#&%! .&2,3!&&%D /31+-&/., &/ % A3/+&+"%)%3/.+,- *%&+4%(2 %D 3+$/,G, B,/ &!4+"/.+F&/, &+A3%4!3, A3% %'A/"-)/.+&%%��� . %''"!*/.+&%% % *%+1&/',%(! 3+$/,G '!3*5+ % '/'2*/..

�+2(+ &! ',/#"+ &+ 4!',!, % A/#.%"'# &/.G@ *%+1&/',%B!'(%@ 4!,/*, (/,/3G@ A3/%).!" 3!-./"�5%� . 3!&,1!&/"/1%% % . 4!*%5%&'(/@ *%+1&/',%(! . 5!"/4. �)/$3!,!&%! �,/1/ 4!,/*+ .A!3-.G! A/)./"%"/ 2.%*!,- 4!"(%! +&+,/4%B!'(%! ',32(,23G .&2,3!&&%D /31+&/.. �/4A-�,!3&+# ,/-4/13+?%# (�) /'&/.+&+ &+ (/4A-�,!3&/@ 3!(/&',32(5%% %)/$3+F!&%#, A/"2B+!4/1/ A3% .GA/"-&!&%% (321/./1/ '(+&%3/.+&%# /$�!(,+ 2)(%4 A2B(/4 3!&,1!&/.'(/1/ %)"2B!&%#. �+( % .'! 4!,/*G3!&,1!&/"/1%B!'(/@ *%+1&/',%(%, � /'&/.+&+ &+ 'A/'/$&/',% 3+)"%B&GD /31+&/. % ,(+&!@ A/-1"/�+,- 3!&,1!&/.'(/! %)"2B!&%! ' 3+)"%B&/@ %&,!&'%.&/',-� % ./)4/F&/',% 3!1%',3%3/.+,-/',+,/B&/! %)"2B!&%! ,!D&%B!'(%4% '3!*',.+4%. �/"2B!&&G! . 3!)2"-,+,! /$'"!*/.+&%# %)/$3+-F!&%# /$3+$+,G.+�,'# % '244%32�,'# (/4A-�,!3/4. � %*!+"-&/ A/*D/*%, *"# *%+1&/',%3/.+-&%# (/',&GD A/.3!F*!&%@ % ,3+.4. �3/4! ,/1/, &+ � D/3/U/ .%*&/ '.!F!! (3/./,!B!&%!, A/�,/-42 *+&&G@ 4!,/* A3%4!&#�, A3% %''"!*/.+&%#D $/"-&GD ' ,3+.4+4% 1/"/.G, 132*&/@ ("!,(%,$3�U&/@ A/"/',%, + ,+(F! %&'2"-,/. . 3+&&!@ ',+*%%. �3!%42�!',./4 *+&&/1/ 4!,/*+ #."#!,'#(/3/,(/! .3!4# A3/5!*23G: ,+(, '(+&%3/.+&%! /*&/@ /$"+',% ,!"+ )+&%4+!, .'!1/ &!'(/"-(/ 4%&2,¥*/ ,3!D).

�*&+(/ /*&%4 %) '+4GD &/.GD, .G'/(/%&?/34+,%.&GD % &+%$/"!! *%&+4%B&/ 3+).%.+�-�%D'# 4!,/*/. "2B!./@ *%+1&/',%(% #."#!,'# 4+1&%,&/N3!)/&+&'&+# ,/4/13+?%# (��). +F&!@-U%4 A3!%42�!',./4 �� A/ '3+.&!&%� ' *321%4% *%+1&/',%B!'(%4% 4!,/*+4% #."#!,'# /,'2,',-.%! %/&%)%32��!1/ %)"2B!&%# %, (+( '"!*',.%!, A/"&/! %'("�B!&%! �??!(,/. (+&5!3/- % 42,+1!-&!)+. �� /$"+*+!, .G'/(/@ 4#1(/,(+&&/@ (/&,3+',&/',-� % A/)./"#!, A3/./*%,- %''"!*/.+&%! ."�$GD A"/'(/',#D ' 2B!,/4 +&+,/4%B!'(%D /'/$!&&/',!@ ,!"+ A+5%!&,+, + A3% &!/$D/*%4/',% —A/"2B+,- ,3!D4!3&G! %)/$3+F!&%# *"# ,/B&/@ /5!&(% 3+'A3/',3+&!&&/',% A+,/"/1%B!'(/1/ A3/-5!''+. /'&/.! �� "!F%, ?!&/4!& #*!3&/N4+1&%,&/1/ 3!)/&+&'+, /,(3G,G@ . 1946 1/*2 ?%)%-(+4% �. �"/D/4 % �. �!3'!""/4 (�/$!"!.'(+# A3!4%# A/ ?%)%(!, 1952) �2,- �,/1/ ?!&/4!&+ '/-',/%, . 'A/'/$&/',% #*!3 &!(/,/3GD �"!4!&,/., &+D/*#�%D'# A/* ./)*!@',.%!4 ',+,%B!'(/1/ 4+1-&%,&/1/ A/"#, A3%&%4+,- �&!31%� 3+*%/B+',/,&/1/ %4A2"-'+. �'A/"-)2!4G! *"# A/"2B!&%# %)/-$3+F!&%@ 4+1&%,&/! A/"! % 3+*%/./"&G, /(+)G.+��%! ./)*!@',.%! &+ +,/4G ./*/3/*+ (&+%$/"!!

65

3+'A3/',3+&!&&G@ �"!4!&, B!"/.!B!'(/1/ /31+&%)4+) . '%"-&/4 4+1&%,&/4 A/"!, )+',+."#�, %D'&+B+"+ «./)$2F*+,-'#», + )+,!4, %)"2B+# 3+*%/'%1&+", «2'A/(/%,-'#». �+)&G! .%*G ,(+&!@ ((/',%,4GU5G, '/'2*G % ,. *.) %4!�, 3+)"%B&/! (/"%B!',./ +,/4/. ./*/3/*+ % A/�,/42 /&% 1!&!3%32�,'%1&+" ' 3+)"%B&/@ %&,!&'%.&/',-�. /4/13+? 3+'A/)&+!, �,% '%1&+"G, *!U%?32!, %D % ',3/%,%)/$3+F!&%!.

�� /B!&- D/3/U/ «.%*%,» 4#1(%! ,(+&%: 4GU5G, &!3.G, 4/)1 (1/"/.&/@ % 'A%&&/@), 4!F-A/)./&(/.G! *%'(%, '.#)(% % A3.; ,+(F! !',- ./)4/F&/',- %''"!*/.+,- '/'2*G 1/"/.G % U!% $!)(/&,3+',%3/.+&%#, $"+1/*+3# !',!',.!&&/42 (/&,3+',2 /, (3/./,/(+. )&+B%,!"-&/@ B+',% '"2B+-!. �� %'A/"-)2!,'# (+( 4!,/* 2,/B&#��!@ *%+1&/',%(% 2 A+5%!&,/., 3+&!! /$'"!*/.+&&GD 'A/4/�-� 3!&,1!&/13+?%%, ���, �, '5%&,%13+?%%. �3% �,/4 4!,/* 4+1&%,&/N3!)/&+&'&/@ ,/4/-13+?%% /$!'A!B%" A!3!D/* . "2B!./@ *%+1&/',%(! /, A3%&5%A+ «/, A3/',/1/ ( '"/F&/42» ( A3%&-5%A2 «&+%$/"-U!@ %&?/34+,%.&/',%», )+4!&%. 5!"G@ 3#* 3+&!! %'A/"-)/.+.U%D'# 4!,/*%(.

�3/4! ,/1/, B,/ .GU!A!3!B%'"!&&G! 4!,/*G A/)./"#�, *%+1&/',%3/.+,- A+,/"/1%B!'(%!A3/5!''G . /31+&%)4! B!"/.!(+, &+ %D /'&/.! $G"% '/)*+&G (/4A-�,!3&G! A3/13+44G, /$"!1-B+��%! A/&%4+&%! ,/A/13+?%B!'(/@ +&+,/4%%. �,% 2&%(+"-&G! A3/13+44G /$!'A!B%.+�, 'A/-'/$&/',- %)2B%,- B!"/.!B!'(/! ,!"/ ' 3+)&GD A/)%5%@, .("�B+#: B+',&2�, '%',!4&2�, ("%&%B!-'(2�, A/.!3D&/',&2�, 3!1%/&+"-&2� % D%3231%B!'(2� +&+,/4%�.

VH Dissector Anatomy v.4.5.1 + Update to v.4.5.2�%',!4&G! ,3!$/.+&%#: /A!3+5%/&&+# '%',!4+ Windows 2000 %

$/"!! A/)*&%! .!3'%%.�+)3!U!&%! �(3+&+: 1024 × 768.�)G( %&,!3?!@'+: +&1"%@'(%@.VH Dissector /$!'A!B%.+!, ,3!D4!3&2� .%)2+"%)+5%� % A/A!-

3!B&G! '!B!&%# ?/,/13+?%B!'(/@ +&+,/4%%, .GA2�!&&G@ (/4A+&%!@Visible Human Project®. �3/13+44+ $G"+ '/)*+&+ &+ /'&/.! '3!)/.)+4/3/F!&&/1/ ,32A+ B!"/.!(+, A3%1/./3!&&/1/ ( '4!3,!"-&/@ (+)&%.VH Dissector '/B!,+!, . '!$! *%''!(5%� ,32A+ ' ,!D&/"/1%!@ .%3,2-+"-&/1/ 4%3+. �3/13+44+ — A/3,+,%.&G@ 3!'23', (/,/3G@ 2.!"%B%-.+!, /AG, A3!A+3%3/.+&%# ,32A+ ' A3!*',+."!&%#4% / .)+%4/3+'A/-"/F!&%% +&+,/4%B!'(%D ',32(,23, &! */',2A&GD . 3!+"-&/4 4%3!.�&+ /$!'A!B%.+!, A/"-)/.+,!"#4 */',2A ( %&,!3+(,%.&/42 ,32A2, '/-*!3F+�!42 $/"!! B!4 2 000 +&+,/4%B!'(%D ',32(,23. �%&2'+4% *+&-&/@ A3/13+44G #."#�,'#: &!(/33!(,&/ '*!"+&&G! 3+'A%"G 32(, &+"%-B%! +3,!?+(,/. (A/'"!*',.%# '4!3,&/@ (+)&%) % +&+,/4%B!'(%! /'/-$!&&/',% *+&&/1/ ,32A+.

VOXEL-MAN 3D-Navigator Brain and Skull Version 2.0�%',!4&G! ,3!$/.+&%#: /A!3+5%/&&+# '%',!4+ Windows �� % $/"!! A/)*&%! .!3'%%.�+)3!U!&%! �(3+&+: 1024 × 768.�)G( %&,!3?!@'+: "+,%&'(%@, +&1"%@'(%@, &!4!5(%@, ?3+&52)'(%@, #A/&'(%@.3!D4!3&G@ &+.%1+,/3 VOXEL-������� — �,/ '/B!,+&%! +&+,/4%B!'(/1/ % 3+*%/"/1%-

B!'(/1/ +,"+'+. �."#!,'# %&&/.+5%/&&G4, A/ (3+@&!@ 4!3!, . *.2D /,&/U!&%#D. /NA!3.GD, . /,-"%B%! /, (&%1 %"% ,3+*%5%/&&GD 42"-,%4!*%@&GD A3/13+44 A/)./"#!, %&,!3+(,%.&/ %''"!*/.+,-,3!D4!3&2� +&+,/4%B!'(2� 4/*!"-. �+F*+# ',32(,23+ 4+3(%3/.+&+ % A/*A%'+&+, B,/ )&+B%,!"-&/2"2BU+!, A/&%4+&%! % 3!&,1!&+, % A/A!3!B&GD 3+*%/"/1%B!'(%D %)/$3+F!&%@. �3/13+44+ /'&/-

.+&+ &+ 3+)"%B&GD 4/*!"#D ,!"+, /'&/-

./@ (/,/3GD #."#�,'# A/A!3!B&G! %)/-$3+F!&%#, A/"2B!&&G! A3% A/4/�%(/4A-�,!3&/@ % 4+1&%,&/N3!)/&+&'&/@,/4/13+?%%. �/*!3F%, $/"!! B!4 250,3!D4!3&GD +&+,/4%B!'(%D /$�!(,/..�!3!A, 4/)1 ' !1/ �"!4!&,+4%, ?2&(5%/-&+"-&G4% /$"+',#4%, '/'2*+4%, % /$-"+',#4% (3/./'&+$F!&%# 4/12, $G,-%''"!*/.+&G . 36 %&,!3+(,%.&GD '5!-&+D, 18 %) (/,/3GD ,+(F! */',2A&G .

66

',!3!/'(/A%B!'(/4 ((3+'&/4¦)!"!&/4) ?/34+,!. �5!&+ 4/F!, .3+�+,-'#, /$�!(,G 4/12, */$+.-"#,-'# % 2*+"#,-'# A/ F!"+&%� A/"-)/.+,!"#. �3/4! ,/1/, %4!!,'# ?2&(5%# A/%'(+. !(',/.+# %&-',32(5%# %""�',3%32!, ./)4/F&/',%, */',2A&G! *"# .G$3+&&/@ '5!&G. �*&%4 %) 4%&2'/. A3/-13+44G #."#!,'# !! 13+?%(+ % &!$/"-U/@ 3+)4!3 '&%4(/. (/4A-�,!3&/@ % 4+1&%,&/N3!)/&+&'&/@,/4/13+?%%.

Dental Anatomy & 3D Interactive Tooth Atlas�%',!4&G! ,3!$/.+&%#: /A!3+5%/&&+# '%',!4+ Windows 2000 % $/"!! A/)*&%! .!3'%%.�+)3!U!&%! �(3+&+: 1024 × 768.�)G( %&,!3?!@'+: ,/"-(/ +&1"%@'(%@. A/'"!*&!! .3!4# ,3!D4!3&+# 3!&,1!&/.'(+# 4%(3/,/4/13+?%# ',+"+ */',2A&+ *"# %''"!*/-

.+,!"!@ $"+1/*+3# A/#."!&%� 3#*+ (/44!3B!'(%D '%',!4. �/*/$&/ ,/42, (+( ,3+*%5%/&&+# (/4A-�-,!3&+# ,/4/13+?%# $G"+ %'A/"-)/.+&+ *"# '/)*+&%# A/*3/$&/1/ +&+,/4%B!'(/1/ +,"+'+ .'!1/ /31+-&%)4+ B!"/.!(+, 3!&,1!&/.'(+# 4%(3/,/4/13+?%# /(+)+"+'- 5!&&G4 % �??!(,%.&G4 %&',324!&,/4.%)2+"%)+5%% B!"/.!B!'(%D )2$/.. �+'(/"-(/ &+4 %).!',&/, .'!/$�!4"��!1/ +,"+'+ ' '/A/',+.%-4G4% *+&&G4% A/ B!"/.!B!'(%4 )2$+4 &! '2�!',.2!,. �+',/#�+# $+)+ *+&&GD $G"+ '/$3+&+ . ',3/-1/ (/&,3/"%32!4GD �('A!3%4!&,+"-&GD 2'"/.%#D, $"+1/*+3# (/,/3G4 ( (+F*/42 )2$2 A3%4!&#"'#/*%& % ,/, F! 4!,/* 3+$/,G. �+&&G@ +,"+' A3!*',+."#!, '/$/@ 5!&&/! 2B!$&/! A/'/$%! *"# %''"!-

*/.+,!"!@, %)2B+��%D 4/3?/"/1%� B!"/.!B!'(%D)2$/.. �&+,/4%# +A%(+"-&/@ ,3!,% (/3&!./1/ (+-&+"+ A3!*',+."#!, /'/$G@ %&,!3!', A/'(/"-(2 !!',3/!&%! ."%#!, &+ ,+(,%(2 "!B!&%#. +A%(+"--&/@ ,3!,% (+&+"+ 4/F!, %4!,-'# 4&/F!',./ /,-.!,."!&%@, %*2�%D . 3+)&GD &+A3+."!&%#D. �*-&/@ %) )+*+B «�,"+'+ )2$/.» #."#!,'# *!4/&',3+-5%# B+',/ .',3!B+��%D'# 3+)&/.%*&/',!@ +&+,/-4%% (/3&!.GD (+&+"/..

�/A/"&%,!"-&+# %&?/34+5%#: %)2B!&%!$/"-U/1/ B%'"+ )2$/. *+"/ ./)4/F&/',- .G-#.%,- % &! ',/"- U%3/(/ 3+'A3/',3+&!&&G! +&/-4+"%%.

Anesthesiology — Ultrasound-Guided Nerve Blocks on DVD Upper Limbs ; Lower Limbs�%',!4&G! ,3!$/.+&%#: /A!3+5%/&&+# '%',!4+ Windows XP % Vista.�+)3!U!&%! �(3+&+: 1024 × 768.�)G( %&,!3?!@'+: ,/"-(/ +&1"%@'(%@.�+&&+# A3/13+44+ '/',/%, %) *.2D *%'(/.. �!3.G@ '/*!3F%, 2&%(+"-&2� %&?/34+5%� /

,!D&%(! .GA/"&!&%# A!3%?!3%B!'(%D &!3.&GD $"/(+* *"# .!3D&!@ (/&!B&/',% A/* (/&,3/"!42"-,3+).2(+, /?/34"!&&GD ' A/4/�-� '%&D3/&%)%3/.+&&/1/ .%*!/ % ,3!D4!3&/@ +&%4+5%%. �+.,/3/4 *%'(! — %&?/34+5%# / ,!D&%(! .GA/"&!&%# A!3%?!3%B!'(%D &!3.&GD $"/(+* *"# &%F&!@(/&!B&/',%.

'/*!3F+&%! A!3./1/ .D/*#, .'! &+%$/"!! 3+'A3/',3+&!&&G! $"/(+*G .!3D&!@ (/&!B&/',%:4!F"!',&%B&+# $"/(+*+, &+*("�B%B&+# $"/(+*+, A/*4GU!B&+# $"/(+*+, $"/(+*+ '3!*%&&/1/ &!3.+¥&+ 23/.&! "/(,# % A3!*A"!B-#), $"/(+*+ "2B!./1/ &!3.+ &+ 23/.&! "/(,#, $"/(+*+ "/(,!./1/ &!3.+

&+ 23/.&! A3!*A"!B-#.�/*!3F+&%! .,/3/1/: $"/(+*+ $!*-

3!&&/1/ &!3.+, $"/(+*+ &+* A/*.)*/U&/@?+'5%!@, $"/(+*+ A/*(/F&/1/ &!3.+, $"/-(+*+ )+A%3+,!"-&/1/ &!3.+, $"/(+*+ '!*+-"%�&/1/ &!3.+ (A/*(/"!&&G@ % A/*�#1/-*%B&G@ */',2A), $"/(+*+ $/"-U!$!35/./1/&!3.+ &+ 23/.&! 1/"!&/',/A&/1/ '2',+.+.�+F*+# $"/(+*+ A3!*',+."!&+ . '"!*2��%D3+)*!"+D. �+)*!" «�&%4+5%#» — )*!'- /A%-'+&G A/(+)+&%# % A3/,%./A/(+)+&%#, %'-A/"-)2�,'# ,3!D4!3&G! %)/$3+F!&%#, (/-,/3G! /$�#'&#�,, +&+,/4%� % ,!D&%(2 "!1-

67

(%4 )+A/4%&+��%4'# /$3+)/4. «%*!/§3+)*!" A3!*/',+."#!, .%*!/("%AG (+F*/@ $"/(+*G % A/-(+)G.+!,, (+( /&% .GA/"&#�,'# &+ 4+&!(!&+D. �+ ,/4 F! �(3+&! .G .%*%,! (+F*G@ U+1 (+F*/@A3/5!*23G, (/,/3G! '%&D3/&%)%3/.+&G ' +&%4+5%!@, ).2(/.G4 '/A3/./F*!&%!4 % 2"-,3+).2(/-.G4% ("%A+4%. +(/@ A/*D/* *+!, )3%,!"� A/&#,&/! /$�#'&!&%! (+F*/@ $"/(+*G, + ,+(F! A/(+-)G.+!, 4!,/*G 2"-,3+).2(/./1/ %''"!*/.+&%# . A"/'(/',% % . /$�!4!. �,/4 3+)*!"! ,+(F! !',-("%AG *!4/&',3%32��%! 3+)4!�!&%! (+,!,!3+. 3+)*!"! «�%$"%/,!(+» A3!*',+."!&G ''G"(% &+'//,.!,',.2��2� "%,!3+,232 *"# (+F*/@ $"/(+*G. �+)*!" «�/*!"%3/.+&%!» .("�B+!, ,/, B,/*!@',.%,!"-&/ /,"%B+!, �,% DVD-*%'(% /, *321%D. �& A/)./"#!, %'A/"&#,- . 3!+"-&/4 .3!4!&%.%3,2+"-&G! $"/(+*G A/* (/&,3/"!4 2"-,3+).2(+. �,/ A/.GU+!, 23/.!&- /$2B!&%# A/"-)/.+,!"!@A2,!4 %&,!3+(,%.&GD 4!,/*/. .4!',/ A+''%.&/1/ /AG,+ A3!A/*+.+&%#. &+B+"! 3+)*!"+ !',-(3+,(/! 32(/./*',./ A/ %'A/"-)/.+&%� A3/13+44&/1/ /$!'A!B!&%# *"# 4/*!"%3/.+&%#. �,/ A3%-"/F!&%! A/)./"#!, A/"-)/.+,!"� 3%'/.+,- "%&%%, B,/$G &+4!,%,- /3%!&,%3G. �&/ ,+(F! A/)./"#-!, 2A3+."#,- 2"-,3+).2(/.G4 *+,B%(/4 % *+!, ./)4/F&/',- A3/*.%F!&%# %1"G &+ 3+)"%B&2� 1"2-$%&2 ./ .3!4# .GA/"&!&%# 4/*!"%3/.+&%# $"/(+*G. �.24# %&&/.+5%/&&G4% �"!4!&,+4% �,/1/3+)*!"+ #."#�,'# &+"%B%! ?2&(5%%, (/,/3+# A/)./"#!, .%)2+"%)%3/.+,- $+)/.G! ',32(,23G *"#"2BU!@ +&+,/4%B!'(/@ /3%!&,+5%%, + ,+(F! &+"%B%! 2"-,3+).2(/./1/ %)/$3+F!&%#, (/,/3/! A+-3+""!"-&/ *!@',.%#4 4/*!"%32!,'# . /,*!"-&/4 /(&! &+ ,/4 F! �(3+&!. �+)*!" «�&+,/4%#» *+!,1"2$/(/! A/&%4+&%! +&+,/4%% B!3!) A/A!3!B&/! '!B!&%! ',32(,23 % ,3!D4!3&G! %)/$3+F!&%#,(/,/3G! %4!�, ,+(%! ?2&(5%%, (+(: A/(+)+,-¦'(3G,-, .3+�!&%!, A!3!./* % 2.!"%B!&%!.

�!*/',+,(%. �/,# 2B!$&G! A/'/$%# 4+('%4+"-&/ A3/',/ '4/*!"%3/.+&G, %'A/"-)/.+,- %D,&! ,+( "!1(/ *"# A/"-)/.+,!"!@, (/,/3G! &! )&+(/4G ' %'A/"-)/.+&%!4 (/4A-�,!3/., B,/ 4/F!,/,."!B- .&%4+&%! /, &+2B&/1/ 4+,!3%+"+ . �,/4 3+)*!"!. �)N)+ /,&/'%,!"-&/ .G'/(/@ 5!&G A3/-13+44G 4&/1%! ',2*!&,GN4!*%(% 4/12, $G,- &! . '/',/#&%% A/)./"%,- '!$! A3%/$3!',% !!.

THIEME Atlas of Anatomy Image Collection - General Anatomy and Musculoskeletal System�%',!4&G! ,3!$/.+&%#: /A!3+5%/&&+# '%',!4+ Windows 2000 % $/"!! A/)*&%! .!3'%%.�+)3!U!&%! �(3+&+: 1024 × 768.�)G( %&,!3?!@'+: ,/"-(/ +&1"%@'(%@.

�3/13+44+ '/*!3F%, 1694 A/"&/5.!,&GD %)/-$3+F!&%# A/ +&+,/4%% (/',&/N4GU!B&/@ '%',!4G,2"/.%�+, .!3D&%D % &%F&%D (/&!B&/',!@, + ,+(F!(3+,(%@, &/ /B!&- %&?/34+,%.&G@ /$)/3 /$�%D +&+-,/4%B!'(%D (/&5!A5%@ &+ DVD ' ./)4/F&/',-� '/-D3+&!&%# . .G'/(/4 (+B!',.! ' A/*A%'#4% % $!) A/*-A%'!@. �,+ A3/13+44+ A/)./"#!, A/"-)/.+,!"� %4-A/3,%3/.+,- (+F*/! %)/$3+F!&%! . A3!)!&,+5%% A3/-13+44&/1/ /$!'A!B!&%# (&+A3%4!3, MS PowerPoint).�+F*+# %""�',3+5%# */',2A&+ ' 4+3(%3/.(/@ %"% $!)&!!. '! %)/$3+F!&%# A3!*',+."!&G . '//,.!,',.%% '/1"+."!&%!4 (&%1%. G 4/F!,! "!1(/ &+@,% %""�',-3+5%�, ''G"+#'- &+ ,+$"%52, '/*!3F+&%!, %"% ' A/-

4/�-� ?2&(5%% A/%'(+ A/ ("�B!.G4 '"/.+4. �&%(+"-&G! /'/$!&&/',% *+&&/@ A3/13+44G '/',/-#, . ,/4, B,/ /&+ &! ,3!$2!, 2',+&/.(% % )+&%4+!, 4%&%4+"-&/! (/"%B!',./ (/4A-�,!3&/@ A+4#-,%. �2�!',.2!, ,+(F! THIEME Atlas of Anatomy Image Collection — Neck and Internal Organs.�3!*',+."!& &+ DVD-*%'(!, %4!!, ,! F!, B,/ % A3!*G*2�%@ +,"+', '%',!4&G! ,3!$/.+&%# % ./)-4/F&/',%.

3D Head and Neck with Pediatric Comparisons by Primal- 3D�%',!4&G! ,3!$/.+&%#: /A!3+5%/&&+# '%',!4+ Windows 2000 %

$/"!! A/)*&%! .!3'%%.�+)3!U!&%! �(3+&+: 1024 × 768.�)G( %&,!3?!@'+: ,/"-(/ +&1"%@'(%@.�/,3#'+��%! 3D-(/4A-�,!3&+# 13+?%(+, 4/*!"% 1/"/.G, U!%,

1/3,+&%, 1"/,(% % #)G(+ .)3/'"/1/, A/*3/',(+ % 3!$!&(+ A/)./"#!,%)2B%,- /'&/.&G! 3+)"%B%# 4!F*2 &%4%. �!*%+,3%B!'(+# .("+*(+ '/-*!3F%, /$'2F*!&%# *!,'(/@ ?2&(5%/&+"-&/@ +&+,/4%%, .("�B+# *!,-'(%! 3!?"!('G, 4!D+&%)4G F!.+&%# % *.%F!&%# #)G(+ ./ .3!4# '/'+-

68

&%#. �3!%42�!',.+: %'A/"-)/.+&%! 4+,!3%+"+ . A3!)!&,+5%#D % "!(5%#D, "!1(/',- %'A/"-)/.+&%#¥4/F&/ .G$3+,- .%*, .3+�+,- % */$+."#,-, 2*+"#,- ',32(,23G %) 3D-4/*!"%), &+"%B%! ?2&(5%%3!*+(,%3/.+&%#.

Real Anatomy Software DVD v1.0 Win & Mac OSX�%',!4&G! ,3!$/.+&%#: /A!3+5%/&&+# '%',!4+ Windows 2000 % $/"!! A/)*&%! .!3'%%.�+)3!U!&%! �(3+&+: 1024 × 768.�)G( %&,!3?!@'+: +&1"%@'(%@.Real Anatomy — 2*/$&+# A3/13+44+ '

*/',2A&G4 %&,!3?!@'/4. �3/13+44&/! /$!'A!-B!&%! A/)./"#!, ',2*!&,+4 %)2B+,- ',3/!&%!/31+&%)4+ B!"/.!(+ . 5!"/4 %"% ',32(,232 /,-*!"-&GD /31+&/. B!"/.!(+. !'- /31+&%)4 B!"/-.!(+, + ,+(F! ',32(,23+ /'&/.&GD /31+&/.A3!*',+."!&G . 3D-?/34+,!, %D 4/F&/ A/./3+-B%.+,-, B,/$G A/'4/,3!,- %)/$3+F!&%! ' 3+)-&GD ,/B!(. �/"-)/.+,!"% 4/12, .'(3G,- */ 44'"/!. ,!"+. ',3/!&&G@ «)24» *+�, A/"-)/.+,!-"#4 ./)4/F&/',- A/"2B%,- (32A&G@ A"+& /,-*!"-&/1/ ?3+14!&,+ %)/$3+F!&%# . *!,+"#D. «�/4!&,+"-&G!» '&%4(% "�$/1/ %)/$3+F!&%# — '2.!"%B!&&G4% ?3+14!&,+4% %"% "�$/1/ '"/# — 4/12, $G,- '/D3+&!&G (+( JPEG *"# %'A/"-)/.+-&%# . A3!)!&,+5%# %"% *"# *321%D 5!"!@. /)4/F&/',- A3/'4/,3+ ,(+&!@ &+ 3+)&GD 23/.&#D 2.!-"%B!&%#. �%',/"/1%# ,!'&/ '.#)+&+ ' +&+,/4%!@, /$!'A!B%.+# "2BU!! A/&%4+&%! .)+%4/'.#)% 4!-F*2 ?/34/@ % ?2&(5%!@.

3D Head and Neck Anatomy with Special Senses and Basic Neuroanatomy�%',!4&G! ,3!$/.+&%#: A3/13+44+ )+A2'(+!,'# ' "%5!&)%/&&/1/ *%'(+, 3+$/,+!, &+ .'!@ A+-

&!"% Windows, &! 3+$/,+!, &+ &!,$2(+D.�+)3!U!&%! �(3+&+: 1024 × 768.�&,!3+(,%.&G@ 3!'23', (/,/3G@ *+!, */',2A ( 3D-(/4A-�,!3&/@ 13+?%(! 1/"/.G, U!%, "%-

5+, 1/3,+&% % 1"/,(%, &+32F&/1/, '3!*&!1/ % .&2,3!&&!1/ 2D+, /3$%,G, 1"+)+, 3/,/./@ % &/'/./@A/"/',!@, #)G(+, A3%*+,/B&GD A+)2D &/'+, + ,+(F! 'A"!,!&%@ —A"!B!./1/ % U!@&/1/. �3/4! ,/1/, A/"-)/.+,!"- 4/F!, .G$3+,-/*&2 %) 10 A/*3/$&GD 3D-3!(/&',32(5%@ 1/"/.&/1/ 4/)1+ % 13%)/$3+F!&%@ B!3!A&GD &!3./.. �"+1/*+3# ?2&(5%#4 *+&&/@ A3/-13+44G 4/F&/ A/.!3&2,- 4/*!"- %)/$3+F!&%# &+ 360°, */$+.%,-%"% 2*+"%,- +&+,/4%B!'(%@ '"/@ /31+&+. �3% ("%(! 4GU(/@ A/-#."#!,'# ''G"(+ &+ .'! ,!(',/.G! */A/"&!&%#, '"+@*G, *%+13+4-4G, .%*!/?+@"G % %""�',3+5%%. �2&(5%# 3!*+(,%3/.+&%# A/)./-"#!, �('A/3,%3/.+,- % 3+'A!B+,+,- "�$G! A/&3+.%.U%!'# %)/-$3+F!&%# % %'A/"-)/.+,- %D . (+B!',.! /$2B+��!1/ 4+,!3%+"+%"%, &+A3%4!3, A3% '/)*+&%% A3!)!&,+5%@.

GlasklarHuman 3D�/''%@'(+# A3/13+44+, .GA2�!&&+# . 2008 1/*2. �,/ 42"-,%4!*%@&G@ +,"+' ,!"+ B!"/.!(+,

(/,/3G@ 4/F!, $G,- A/"!)!& .'!4, (,/ D/B!, $/"-U! 2)&+,- / ',3/!&%% B!"/.!(+. �+&&2� A3/-13+442 4/F&/ &+).+,- /$2B+��%4 ,3!D4!3&G4 .%*!/,2-3/4, (/,/3G@ A3!*',+."!& . .%*! 3D-+&%4+5%% ' 1/"/'/-.G4 '/A3/./F*!&%!4. �,"+' .("�B+!, . '!$# $/"!! 400*!,+"%)%3/.+&&GD %""�',3+5%@ % 4!*%5%&'(%@ '"/.+3- '$/"!! B!4 A#,-� ,G'#B+4% ,!34%&/., ,G'#B+ %) (/,/3GD%4!!, "+,%&'(%@ A!3!./*. �4!��+#'# A/%'(/.+# ?2&(5%#2A3/�+!, 3+$/,2 ' *+&&/@ A3/13+44/@. GlasklarHuman 3D.("�B+!, . '!$# 3+)*!"G: '(!"!,¦4GU5G/c2',+.G; (/F+;*GD+,!"-&+# '%',!4+; '%',!4+ (3/.//$3+�!&%#;(3/.-¦%442&%,!,; ("!,(% % %D 3+).%,%!; A%�!.+3%,!"-&+#'%',!4+; �&*/(3%&&+# '%',!4+; &!3.&+# '%',!4+ % /31+&G

69

B2.',.; '%',!4+ 4/B!.G*!"!&%#; A/"/.+# '%',!4+. �+F*G@ %) 3+)*!"/. %4!!, './% A/*3+)*!"G %,!4G. � '/F+"!&%�, &! .'! ,!4G A3!*',+."!&G . .%*! 3D-+&%4+5%%, &/ �,/ &%'(/"-(/ &! 24+"#!,*/',/%&',. *+&&/@ A3/13+44G.

Anatomilab II &Bonelab�%',!4&G! ,3!$/.+&%#: A3/13+44+ )+A2'(+!,'# ' "%5!&)%/&&/1/ *%'(+, 3+$/,+!, &+ .'!@ A+-

&!"% Windows.�+)3!U!&%! �(3+&+ — 1024 × 768.� A/4/�-� �,/@ A3/13+44G 4/F&/ A/$G.+,- &+

3D-�('(23'%% A/ '/$',.!&&/42 ,!"2. !',% .+' $2*!,1/"/'/./@ A/4/�&%(, *!,+"-&/ D+3+(,!3%)2��%@ $/-"!! 450 (3+'/B&GD %""�',3+5%@ ' ,!(',/4. �!.)%3+#&+ +&1"%@'(/! &+).+&%! '$/3&%(+, . &!4 %4!!,'# 32'-'(/! 4!&� % ,!(',G.

Bonelab — 2&%(+"-&+# A3/13+44+, '/*!3F+�+#*!,+"%)%3/.+&&2� 4/*!"- 3D-'(!"!,+, ,3!D4!3&G!4/*!"% (/',!@, *%'(/., D3#�!@ % )2$/.. �+&&+# A3/-13+44+ $2*!, A/"!)&+ (+( *"# ',2*!&,/. % A3!A/*+.+-,!"!@ 4!*%5%&'(%D .2)/., ,+( % *"# A3+(,%(2��%D.3+B!@. +(, ',2*!&,G '4/12, 2B%,- '(!"!, B!"/.!(+,%'A/"-)/.+,- '"/.+3% *"# /$�#'&!&%# ,!34%&/.; A3!-A/*+.+,!"% — &+1"#*&/ A3/*!4/&',3%3/.+,- �"!4!&,G'(!"!,+ &+ ,3!D4!3&/@ 4/*!"%, + .3+B% — /$�#'&%,-A+5%!&,2 /'/$!&&/',% )+$/"!.+&%# %"% ,3+.4G. �3!-%42�!',./4 A3/13+44G #."#!,'# ,/, B,/ 4/F&/ */$+.-"#,- '/$',.!&&G! (/44!&,+3%% ( %)/$3+F!&%#4.

�+''4/,3!&&G! &+4% (/4A-�,!3&G! A3/13+44G$2*2, %&,!3!'&G &! ,/"-(/ A3/',G4 A/"-)/.+,!"#4, A3/#."#��%4 %&,!3!' ( +&+,/4%% B!"/.!B!-'(/1/ ,!"+, &/ % A3/?!''%/&+"-&G4 .3+B+4 (+( .'A/4/1+,!"-&/! '3!*',./ *"# $/"!! *!,+"-&/1/A3/&%(&/.!&%# . 1"2$%&G B!"/.!B!'(/1/ ',3/!&%#.

�A%'/( "%,!3+,23G:1. �+@./3/&'(%@, �L. �/34+"-&+# +&+,/4%# B!"/.!(+. — . 1. — ��$.: �A!5�%,.2. �3%D/*-(/, �L�. �!,/*G "2B!./@ *%+1&/',%(%. — 2008.3. �-#&GD, �L�. // !',&%( 3!&,1!&/"/1%% % 3+*%/"/1%%. — 2004. — � 6. — �. 50.4. Sinitsyn, V.E. // J Magn Reson Imaging. — 2001. — 13(4). — 645–7.5. http://www.studytemple.com/forum/medical-softwares/47294-vh-dissector-anatomy-4-5-1-update-

4-5-2-a.html6. http://www.acco.be/medical/en/publication/all/9783642012112/voxel-man+3d+navigator+

version+2.0+dvd7. http://journals.lww.com/anesthesiology/fulltext/2009/05000/ultrasound_guided_nerve_blocks_

on_dvd__upper_and.59.aspx8. http://search.barnesandnoble.com/THIEME-Atlas-of-Anatomy-Image-Collection-General-

Anatomy-and-Musculoskeletal-System/Michael-Schuenke/e/97815889048989. http://www.studytemple.com/forum/anatomy/8619-3d-head-neck-anatomy-pediatric-comparisons-

primal-pictures.html10. http://thepiratebay.se/torrent/6760583/

�&!=$>4J",�qJ4$�'(">!>�%,+^�!>1=("^J#�. �+&!>!$"

!#�. )������ (��.), w#(. ;����� (����., �. �. �.)�+3(�.'-(%@ &+5�/&+"-&%@ A!*+1/1�B&%@ 2&�.!3'%,!, �4!&� �L�. �(/./3/*%

�+?!*3+ )*/3/.ª# "�*%&% � (/3!(5�@&/¤ /'.�,%

� ',+,,� A3/+&+"�)/.+&/ A!*+1/1�B&2 *�#"-&�',- �. �%3/1/.+ � /D+3+(,!3%)/.+&/124+&�',%B&2 '("+*/.2 @/1/ A!*+1/1�B&%D A/1"#*�., 3/)(3%,/ ¤¤ )&+B!&&# *"# '2B+'&/¤ A!*+1/1�(%.

70

�&!=$1',+=>4J",+qJ"$�'(">!>+%'�)+^$q>1=("^,#+. �+&!>!$"

!#�. )������ (��.), w#(. ;����� (����., �. �. �.)

�+3-(/.'(%@ &+5%/&+"-&G@ A!*+1/1%B!'(%@ 2&%.!3'%,!, %4. �L�. �(/./3/*G�+?!*3+ )*/3/.-# B!"/.!(+ % (/33!(5%/&&/1/ /$3+)/.+&%#

�&+4!&%,G@ 32''(%@ 2B!&G@ �%(/"+@ �%3/1/. (1810–1881), (/,/3G@ A3%&+*"!F+" ( A3/-13!''%.&/@ 32''(/@ %&,!""%1!&5%% XIX .., $G" &! ,/"-(/ .!"%(%4 .3+B/4ND%3231/4 % 2B!&G4-4!*%(/4, &/ % .G*+��%4'# A!*+1/1/4NA3/'.!,%,!"!4 % /$�!',.!&&G4 *!#,!"!4 './!1/ .3!4!&%. %',/3%� /,!B!',.!&&/@ &+2(% % (2"-,23G /& ./U!" (+( ("+''%( 4!*%5%&G % 32''(/@ A!*+1/1%(%.

�!*+1/1%B!'(+# *!#,!"-&/',- �. �%3/1/.+ — A3!A/*+.+,!"#, &+',+.&%(+, +*4%&%',3+,/3+ —*"%"+'- A/B,% 30 "!,.

,!B!&%! *.2D"!,&!1/ 2A3+."!&%# �*!''(%4 2B!$&G4 /(321/4 �%3/1/. ',3!4%"'# A/*&#,-)&+B!&%! A!*+1/1%B!'(%D '/.!,/. 1%4&+)%@, .&2U+" *%3!(,/3+4 % 2B%,!"#4 2B!$&GD )+.!*!&%@4G'"- / &!/$D/*%4/',% 124+&&/1/ /,&/U!&%# ( *!,#4 [1].

�$3+�!&%! �. �%3/1/.+ ( 124+&&/42 A/*D/*2 . /$3+)/.+&%% % ./'A%,+&%% A/*3+',+��!1/A/(/"!&%# &! $G"/ '"2B+@&G4 % &!/$/'&/.+&&G4. �+4+ 3!+"-&/',- U(/"G '!3!*%&G ��� .!(+A/*,+"(%.+"+ ( �,/42. +(, '/1"+'&/ «�/"/F!&%� / &+B+"-&GD &+3/*&GD U(/"+D» (1864). A/ .'!DU(/"+D �(3+%&G /$2B!&%! .!"/'- &+ 32''(/4 #)G(! A/ 2B!$&G4 A"+&+4 % A3/13+44+4, (/,/3G!*!@',./.+"% &+ ,!33%,/3%% .'!@ ',3+&G. 1863 1. 4%&%',3 .&2,3!&&%D *!" �. +"2!. )+#.%", B,/&%(+(/1/ /'/$/1/ 4+"/3/''%@'(/1/ #)G(+ &%(/1*+ &! $G"/, &!, % $G,- &! 4/F!,. �(/"-&+# F%)&-A3/D/*%"+ A/* ',3/1%4 &+*)/3/4 &+B+"-',.+ % A/"%5%%.

�24+&%',%B!'(+# &+A3+."!&&/',- A!*+1/1%B!'(%D .)1"#*/. �%3/1/.+ D+3+(,!3%)2!,'# *%&+-4%B&/',-� ',+&/."!&%# % 3+).%,%# % /$2'"/."!&+ 3#*/4 '/5%+"-&/N%',/3%B!'(%D ?+(,/3/. (2'%-"!&%! +.,/3%,+3%)4+ '+4/*!3F+.%# . /$"+',% (2"-,23G %, /'/$!&&/, /$3+)/.+&%# % /*&/.3!4!&&/*!4/(3+,%)+5%# /$�!',.!&&GD /,&/U!&%@ . ',3+&! . ,!B!&%! XIX ..), + ,+(F! +(,%.%)+5%!@ /,!-B!',.!&&/1/ % )+32$!F&/1/ A!*+1/1%B!'(/1/ /AG,+.

�!*+1/1%B!'(%! .)1"#*G �. �%3/1/.+ #."#"%'- /$�!(,/4 %''"!*/.+&%# 3#*+ *%''!3,+5%@ %4/&/13+?%@ ,+(%D 2B!&GD (+( �. �.+&/., �. �+"-�, �. �3+'&/.'(%@, �. �+)%&%B,�. �%D+32"%*)!, �. �,+3B!&(/, �. �+)+&/., �. �3/4/. % *3.

�24+&%',%B!'(%! B!3,G A!*+1/1%B!'(%D .)1"#*/. �. �%3/1/.+ /,4!B+"% 4&/1%! %''"!*/.+-,!"% &+'"!*%# 2B!&/1/ (�. �3%1/3-!., �. �&!A3/., �. �23+(/.'(%@, �. �/4+!.+, . �4%3&/.,L�/3&G@ % *3.).

�)2B!&%� A!*+1/1%B!'(/1/ &+'"!*%# �. �%3/1/.+ A/'.#,%"% 'A!5%+"-&G! 3+$/,G % ',+,-%2(3+%&'(%! %''"!*/.+,!"% �. �+B%&'(%@, �. �+*!&(/., �. �.,2D, �. �3+.B!&(/, �. �+.!&/(,. �/3&G@, �. �!.B!&(/ % *3.

%''"!*/.+&%#D �. �/4+!./@, . �/3&/1/ %''"!*2�,'# ,+(%! 124+&%',%B!'(%! B!3,G A!*+-1/1%B!'(%D .)1"#*/. �. �%3/1/.+, (+( 2.+F!&%! ( "%B&/',% 3!$!&(+ % )+�%,+ !1/ A3+., %*!% 124+-&%)+5%% /$3+)/.+&%# % ./'A%,+&%#, .&%4+&%! ( "%B&/',% (+F*/1/ 2B!&%(+ % %&*%.%*2+"%)+5%#A3/5!''/. /$2B!&%# % ./'A%,+&%#.

�'&/.2 124+&%',%B!'(/@ A!*+1/1%B!'(/@ (/&5!A5%% �. �%3/1/.+ '/',+."#"% '"!*2�%!124+&%',%B!'(%! A3%&5%AG: A3%&5%A 2.+F!&%# ( "%B&/',% 3!$!&(+ % 2B%,!"# (+( 1"+.&GD*!@',.2��%D "%5 A!*+1/1%B!'(/1/ A3/5!''+; 2B!, .3/F*!&&GD (+B!',. % 'A/'/$&/',!@ 2B!&%-(+; %&*%.%*2+"%)+5%# A3/5!''+ /$2B!&%#; 2B!, ./)3+',&GD /'/$!&&/',!@ 3+).%,%# /31+&%)4+ %A'%D%(% 3!$!&(+, 2.+F!&%! ( A3+.2 B!"/.!(+ '+4/42 /'2�!',."#,- './@ F%)&!&&G@ % A3/?!'-'%/&+"-&G@ .G$/3.

�./@',.!&&+# �. �%3/1/.2 124+&%',%B!'(+# 5!&&/',&+# /3%!&,+5%# A!*+1/1%B!'(%D .)1"#-*/. A/)./"%"+ 2B!&/42 /,$3/'%,- "�$G! A/"!)&G!, 4!3(+&,%"-&G! 5!"% /$3+)/.+&%# % 2,.!3-F*+,-, B,/ 1"+.&G4% 5!"#4% ./'A%,+&%# % /$3+)/.+&%# #."#�,'# ?/34%3/.+&%! B!"/.!(+ (+( "%B-&/',%; 1+34/&%B&/! 3+).%,%! .'!D 'A/'/$&/',!@ % ,+"+&,/. *!,!@; '/)*+&%! 2'"/.%@ *"# 3+)&/',/-3/&&!1/ 3+).%,%# % '+4/3+).%,%# "%B&/',% 2B!&%(+; ./'A%,+&%! 2 &!1/ B2.',.+ '/$',.!&&/1/ */'-,/%&',.+ % 2,.!3F*!&%! '+4/2.+F!&%#; ?/34%3/.+&%! &3+.',.!&&GD 2$!F*!&%@, ./"%, B2.',.+13+F*+&'(/@ /,.!,',.!&&/',% % /'/)&+&%! &!/$D/*%4/',% '+4/./'A%,+&%#.

�+3+(,!3&G4 *"# 124+&%',%B!'(%D A!*+1/1%B!'(%D .)1"#*/. �%3/1/.+ $G"/ ,/, B,/ /& 3+'-'4+,3%.+" "%B&/',- 2B%,!"# (+( .+F&!@U2� ?%1232 A3/5!''+ 124+&&/1/ ./'A%,+&%#, (/,/3/@*/"F&G $G,- '/)*+&G 4+('%4+"-&G! ./)4/F&/',% *"# A3/#."!&%# %&*%.%*2+"-&/',%, 4+',!3',.+;'+4/3!+"%)+5%%; A/.GU!&%# A3/?!''%/&+"-&GD (+B!',.; './$/*&/1/ ,./3B!',.+ *"# (+F*/1/ 2B%-

71

,!"# (2,.!3F*!&%! 4/3+"-&/1/ +.,/3%,!,+ "%B&/',% 2B%,!"# . /$�!',.! % U(/"!, 2.+F!&%! ( 2B%-,!"� % 2B%,!"-'(/1/ (/""!(,%.+ '/ ',/3/&G 2B!&%(/., */',+,/B&+# ',!A!&- /5!&(% ,32*+ 2B%,!"#% ,. *.).

� 124+&%',%B!'(%D A/)%5%@ �. �%3/1/. A/*D/*%" % ( A3/$"!4! /,&/U!&%@ . '+4/4 (/""!(-,%.! 2B%,!"!@. �& /$/'&/.+" .+F&G! A/"/F!&%# A!*+1/1%B!'(/@ �,%(%, (/,/3G! &! A/,!3#"% +(,2-+"-&/',% . '/.3!4!&&/@ U(/"! [4]:

- 2B%,!"# */"F&G 5!&%,- './! */',/%&',./ % $!'A/(/%,-'# / !1/ '/D3+&!&%% 2 './%D (/""!1% 2B!&%(/.;

- A!*+1/1% % 32(/./*',./ U(/"G */"F&G $!'A/(/%,-'# / '/D3+&!&%% */',/%&',.+ (&+2B&/1/% 4/3+"-&/1/) &+',+.&%(+ . 1"+)+D 2B!&%(/., ,+( (+( 2&%F!&&G@ % /$%F!&&G@ 2B%,!"- &! 4/F!,$G,- A3%4!3/4 *"# ./'A%,+&%# B!',% % B!"/.!B!'(/1/ */',/%&',.+ . './%D 2B!&%(/.;

- 2B%,!"#4 5!"!'//$3+)&/ A/**!3F%.+,- B!',&/',-, /,(3G,/',- . /,&/U!&%#D ' 2B!&%(+-4%;

- 2B%,!"#4 '"!*2!, ',3!4%,-'# ( /,&/U!&%#4 */.!3%#, 2.+F!&%#, '/,32*&%B!',.+ . './!4(/""!(,%.!, ,/"-(/ ,+(%4 /$3+)/4 /&% '4/12, */',%B- A/',+."!&&/@ A!*+1/1%B!'(/@ 5!"%, .!*-"%B&/',- 2B!&%(+ . U(/"! !�! ,/"-(/ 3+).%.+!,'#, /&+ ./ 4&/1/4 #."#!,'# A3/*2(,/4 '/.4!',&/@*!#,!"-&/',%.

+(, %*!+"/4 *"# �. �%3/1/.+ .G',2A+" 2B%,!"- — 42*3G@ &+',+.&%(, (/,/3G@ .!*!, 2B!-&%(+ A/ A2,% A/)&+&%# '+4/1/ '!$#, B!"/.!B!'(/1/ /$�!',.+ % /(32F+��!1/ 4%3+; 'A/'/$&G@ &!,/"-(/ A/**!3F%.+,- % &+A3+."#,- 2B!&%(+ . A3/5!''! A/)&+&%#, &/ % ,3!$/.+,!"-&G@ ( '!$! % (2B!&%(2; 'A/'/$&G@ .G3+$/,+,- . 2B!&%(+ 4/3+"-&2� ',/@(/',-, ,.!3*G! &3+.',.!&&G! 2$!F*!-&%#, ./"� ( '+4//$3+)/.+&%�, '+4/./'A%,+&%� % '+4/A/)&+&%�, 'A/'/$&/',- ( $/3-$! '/ './%4%A/3/(+4%. �4!&&/ ,+(/./ '/*!3F+&%! ,!34%&+ «&+',+.&%(», (/,/3G@ �. �%3/1/. B+�! .'!1/ %'-A/"-)2!,, 1/./3# /$ 2B%,!"#D. �+4 F! �. �%3/1/. #."#!,'# A3%4!3/4 ,+(/1/ 124+&&/1/ % 42*3/1/&+',+.&%(+.

�. �%3/1/. A3%)&+.+", B,/ . %*!+"! «% *%3!(,/3, % %&'A!(,/3, % &+',+.&%(, % &+*)%3+,!"%*/"F&G $G,- "%B&/',#4% .G'/(/@ &3+.',.!&&/',%, /*2U!."!&&G! A3%).+&%!4 ( './!42 *!"2,A3/&%(&2,G! %',%&&/ D3%',%+&'(/@ "�$/.-� ( './%4 ./'A%,+&&%(+4», + "�$/.- */"F&+ $G,-1"+.&G4 A3%&5%A/4 ./'A%,+&%#. � . �,/4, &!'/4&!&&/, A3/#.%"'# 124+&%)4 !1/ A!*+1/1%B!'(%D.)1"#*/..

�"# �%3/1/.+ (+( *"# A!*+1/1+ '+4/! .+F&/!, )+("�B+!,'# . ,/4, B,/ /'&/.&+# 5!"- A!*+1/-1%(% — �,/ ./'A%,+&%! «B!"/.!(+», '&+$F!&%! !1/ .'!4% /$�!B!"/.!B!'(%4% './@',.+4% % A/-)&+&%#4% [2].

�%3/1/. (+( A!*+1/1 /$3+,%" .&%4+&%! &+ 3+).%,%! . 2B!&%(+ */',/%&',.+ «B!"/.!(+»; /&A/"/F%" ,!4 '+4G4 &+B+"/ )*/3/./@ 124+&&/',%, B!"/.!B&/',% . ./'A%,+&%%. «�G,- B!"/.!(/4— ./, ( B!42 */"F&/ .!',% ./'A%,+&%!», — A%'+" �%3/1/.. �& ./'',+!, A3/,%. 3+&&!@, A3!F*!-.3!4!&&/@ 'A!5%+"%)+5%% *!,!@, (/,/3+# '2F%.+!, %D (321/)/3 % ,/34/)%, %D 4/3+"-&/-&3+.',.!&&/! 3+).%,%! [3].

�*&+ %) .+F&!@U%D A!*+1/1%B!'(%D %*!@ �. �%3/1/.+ — %*!# B!"/.!B&/',% . ./'A%,+&%%:,3!$/.+&%! 124+&&/1/ /,&/U!&%# ( *!,#4 % ?/34%3/.+&%# B!"/.!B&/',% 2 3!$!&(+; ,3!$/.+&%!2.+F!&%# !1/ */',/%&',.+. �*&%4 %) A!3.GD '3!*% 3/''%@'(%D A!*+1/1/. 2B!&G@N124+&%', )+*+B23+).%,%# 2 3!$!&(+ "2BU%D (+B!',. B!"/.!B!'(/@ "%B&/',% .G*.%&2" (+( 5!&,3+"-&2�. �!*+1/1A3%)G.+" 2B%,!"!@, 3/*%,!"!@ A3!A/*&/'%,- B!"/.!B!'(/! */',/%&',./ *!,!@, &! */A2'(+,- %D2&%F!&%# % ,!4 '+4G4 A3!*/,.3+�+,- 3+).%,%! &!1+,%.&GD (+B!',. D+3+(,!3+. +(/@ A/*D/* (/31+&%)+5%% /$2B!&%# % ./'A%,+&%# . U(/"! A/"&/',-� '//,.!,',.2!, 124+&&G4 A/"/F!&%#4 '/-.3!4!&&/@ A!*+1/1%B!'(/@ &+2(%.

�'&/.2 .'!1/ ./'A%,+&%#, 4!F*2 A3/B%4 % &3+.',.!&&/1/, '/',+."#!, &+2(+. &+2(! (3/!,'#,+(/@ *!#,!"-&G@ &3+.',.!&&/N./'A%,+,!"-&G@ �"!4!&,, (/,/3G@ &%(/1*+ &! A3/A+*+!,, (+(/.G$G &% $G"% !! A3!*',+.%,!"%. �%U- $G &+',+.&%(% '24!"% */.!',% &+2B&2� %',%&2 */ A/&%4+&%#2B+�!1/'#: /&+ 2F! &! /',+&!,'# $!) *!@',.%#, A/,/42 B,/ ./ .'#(/@ %',%&!, /,."!B!&&/@ % B2.',-.!&&/@, !',- */"# ./'A%,+,!"-&/N/$3+)/.+,!"-&/@ '%"G. �+2(+ $!3!, './! %, *!@',.2# &+ 24G, *!@-',.2!, % &+ &3+.G.

�. �%3/1/. 3!)(/ .G',2A+" A3/,%. '/'"/.&/@ U(/"G % 3+&&!@ 2,%"%,+3&/-A3/?!''%/&+"-&/@ .G2B(%, (/,/32� ',3!4%"/'- ..!',% 5+3'(/! A3+.%,!"-',./ )+ 'B!, '&%F!&%#23/.&# /$�!1/ /$3+)/.+&%# 4/"/*!F%. �& A3/,%./A/',+."#" /?%5%+"-&/42 (23'2 /$3+)/.+&%#%*!� /$�!B!"/.!B!'(/1/ ./'A%,+&%#, (/,/3/! */"F&/ A/*1/,/.%,- ( /$�!',.!&&/@ F%)&% .G'/-(/&3+.',.!&&/1/ B!"/.!(+ ' U%3/(%4 %&,!""!(,2+"-&G4 (321/)/3/4.

72

4!',! ' ,!4 A!*+1/1 A/*B!3(%.+", B,/ U(/"+ ,/"-(/ ,/1*+ ',+&!, *!@',.%,!"-&/ 124+&%-',%B!'(/@ % '4/F!, '?/34%3/.+,- &/./1/ B!"/.!(+, (/1*+ .)+%4//,&/U!&%# . &!@ $2*2, ',3/%,-'#&+ /'&/.! .)+%4&/1/ */.!3%# % 2.+F!&%# 4!F*2 2B%,!"#4%, 2B!&%(+4% % %D 3/*%,!"#4%.

�/"-U/! )&+B!&%! �. �%3/1/. A3%*+.+" '+4/./'A%,+&%�. �4!&&/ A2,!4 4/3+"-&/1/ '+4/-'/.!3U!&',./.+&%# 4/F&/ .G3+$/,+,- . '!$! (+B!',.+ &+',/#�!1/ B!"/.!(+.

�& ,+(F! .G',2A+" A3/,%. A!3!132)(% 2B+�%D'#, (/,/3+# 4!U+"+ (+B!',.!&&/42 2'./!&%�)&+&%@. �B!$&G@ A"+& A/ �%3/1/.2 */"F!& $G" .("�B+,- ,/"-(/ 4+,!3%+", /,3+F+��%@ A/'"!*-&%! */',%F!&%# *+&&/@ &+2(% % &!/$D/*%4G@ *"# /$2B!&%#, ./'A%,+&%# % 3+).%,%# *!,!@ /A3!*!-"!&&/1/ ./)3+',+.

�/"-U/! )&+B!&%! . './!@ A/A!B%,!"-'(/@ *!#,!"-&/',% �. �%3/1/. A3%*+.+" 2(3!A"!&%�)*/3/.-# 2B+�%D'#, )+$/,#'-, . B+',&/',% / ..!*!&%% . U(/"-&2� A3/13+442 A3!A/*+.+&%# /'-&/.&GD &+B+" 1%1%!&G .3+B+4% % / A'%D/?%)%B!'(/4 %''"!*/.+&%% 2B+�%D'#, ..!*!&%% /$�!-2(3!A"#��!@ 1%4&+',%(%. �& A3!*"+1+" %'(+,- "!&/',-, 3+''!#&&/',-, &!.&%4+,!"-&/',-, 2B+-�%D'# &! . )"/@ ./"! *!,!@, + . ',3/!&%% %D /31+&%)4+, . '/',/#&%% )*/3/.-# U(/"-&%(/.. �,/@ /$"+',% ,+( F!, (+( % . /$"+',% .G'U!@ U(/"G, ,3!$/.+&%# % A/F!"+&%# �%3/1/.+ $G"%&!A3%!4"!4G *"# /?%5%+"-&/@ A!*+1/1%(% 5+3'(/@ �/''%%, % ,/"-(/ A3% '/.!,'(/@ ."+',% %'!@B+' /&% A3/./*%"%'- . F%)&- ' %)4!&!&%#4% % 2"2BU!&%#4% — . '//,.!,',.%% ' 3+).%,%!4&+2(% / ./'A%,+&%%.

�. �%3/1/. $G" /*&%4 %) A!3.GD 32''(%D A!*+1/1/.N4G'"%,!"!@, (/,/3G@ 2(+)+" &+ &!3+)-3G.&2� '.#)- 4!F*2 /$2B!&%!4 % ./'A%,+&%!4, &+ &!/$D/*%4/',- %D /$�!*%&!&%# . 5!"/',&/4A!*+1/1%B!'(/4 A3/5!''!.

�,+(, './!@ A"/*/,./3&/@ &+2B&/@ *!#,!"-&/',-�, A!*+1/1%B!'(%4% ,32*+4%, . (/,/3GD.G'(+)+&/ &!4+"/ 5!&&GD %*!@, �. �%3/1/. .A%'+" '"+.&2� ',3+&%52 . %',/3%� A!*+1/1%B!'(/@&+2(%, + !1/ %*!# 124+&&/1/ ./'A%,+&%# A3/*/"F+!, /',+.+,-'# +(,2+"-&/@ . '/.3!4!&&/@ A!*+1/-1%B!'(/@ ,!/3%% % A3+(,%(!.

�A%'/( "%,!3+,23G:1. �/&',+&,%&/., �L�. �!*+1/1%B!'(+# *!#,!"-&/',- % .)1"#*G �L�. �%3/1/.+ / �/&',+&,%-

&/. �L�., �!*G&'(%@ �L�., �+$+!.+ �L�. — �.: �3/'.!�!&%!, 1982. — 375 '.2. �2"!U/., �L. �+U! �,!B!',./ / �L. �2"!U/., �L. /"/$2!., �L�. �%./.+3. — �.: ��-

��, 1991. — 390 '.3. �%3/1/., �L�. �)$3+&&G! A!*+1/1%B!'(%! '/B%&!&%# / [�/',. �L�. �"!('�(, �L�. �+.!&/(].

— �.: �!*+1/1%(+, 1985. — 496 '.4. �/3&%@, L�. �+2(/./NA!*+1/1�B&+ *�#"-&�',- �L�. �%3/1/.+: �/ 180-3�BB# ) *&# &+3/*-

F!&&#. — �.: N./ «�&+&&#» - ����, 1990. — 32 '.

q,"%',+'�'(">!>+%'�)!>!,"�1'(+=,#+. �+&!>!$"

+#$. J��������� (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ /$�!',.!&&/1/ )*/3/.-# % )*3+.//D3+&!&%#

�������������������: ��6. 7������ (���., . �. �.)

8����������-�����������������������������������,����������-<����$, ���������, ��������-<����$��0����-���. /������-�������������=��������� �������, 3���-%��������������%��������-���, ��$���*������������ �-��0������-���<��, �����������������, 3�������=�����

������������� ����������������*�� ��$��$�.��9. ����*��.

�%(/"+@ �.+&/.%B �%3/1/. — �,/ %4#, (/,/3/! '/',+."#!, 1/3*/',- % '"+.2 /,!B!',.!&&/@A!*+1/1%B!'(/@ &+2(%, &+3/*&/1/ /$3+)/.+&%#, ./!&&/NA/"!./@ D%3231%%. �./!@ .G*+��!@'# *!#-,!"-&/',-� (+( . /$"+',% 4!*%5%&G, ,+( % &+3/*&/1/ /$3+)/.+&%# �L�. �%3/1/. )+'"2F%" A3%)&+-,!"-&/',- U%3/(%D 4+'' % A!*+1/1%B!'(/@ /$�!',.!&&/',%. �B!&G@ .&!' /13/4&G@ .("+* . 5!"2��A/D2 A!*+1/1%(% % 4!*%5%&G. �1/ A!*+1/1%B!'(%! %*!% #."#�,'# %',/B&%(/4 &+2B&/1/ ,./3B!',-.+ % A3+(,%B!'(/@ *!#,!"-&/',%. �&% $"%)(% &+4 % '!1/*&#, +(,2+"-&G % A/ '!@ *!&-.

73

&+U! .3!4#, . .!( &/.GD %&?/34+5%/&&GD ,!D&/"/1%@, A!*+1/1%B!'(%! %*!% %&/1*+ 2D/-*#, &+ .,/3/@ A"+&, �%(/"+@ �.+&/.%B ..!" /'&/.&G! &+2B&G! &+A3+."!&%#, &+ (/,/3GD /'&/.G-.+!,'# &+2(+ A!*+1/1%(+. �,% %*!% &!/$D/*%4/ A/4&%,- % %'A/"-)/.+,- %D . A3+(,%(!. /'A%,+&-&%(% �L�. �%3/1/.+ !',- ./A"/�!&%! A!*+1/1%B!'(%D %*!@, %',/3%B!'(/! &+'"!*%! .!"%(/1/ B!"/-.!(+ [1].

�,/$G '2*%,- /$ %',/3%B!'(%D )+'"21+D �%3/1/.+, &+4 '"!*2!, A/4&%,- '"/.+ L�. �!&%&+:��',/3%B!'(%! )+'"21% '2*#,'# &! A/ ,/42, B!1/ &! *+"% %',/3%B!'(%! *!#,!"% '3+.&%,!"-&/ ' '/-.3!4!&&G4% ,3!$/.+&%#4%, + A/ ,/42, B,/ /&% *+"% &/./1/ '3+.&%,!"-&/ '/ './%4% A3!*U!',.!&-&%(+4%» [1, 3].

�$�!A3%)&+& 1!&%@ �%(/"+# �.+&/.%B+(+( �%3/1/.+, 2B!&/1/, &/.+,/3+, ,32*+4% (/,/3/1/,&+B%&+#' !1/ 3+&&!@ 4/"/*/',%, A/"-)/.+"%'- &! ,/"-(/ !1/ 2B!&%(%, &/ % !1/ 2B%,!"# ./ .'!D(2"-,23&GD ',3+&+D 4%3+. �+ A3/,#F!&%% .'!@ './!@ F%)&% �%3/1/. &!A3!',+&&/ A3%"+1+" .'!2'%"%# ( ,/42, B,/$G '/)*+,- *"# .G'U!@ % '3!*&!@ U(/"G ,+(%! 2'"/.%#, (/,/3G! .'!4!3&/ ./)-*!@',./.+"% $G 3/',2 &+2(% % (2"-,23G % 2',3+&#"% $G .'!, B,/ 4!U+"/ 3+).%,%� '+4/',/#,!"--&/@ 32''(/@ &+2(% [2].

�& %'(3!&&! ',3!4%"'# ( /'2�!',."!&%� A/"&/5!&&/1/ /$3+)/.+&%# *"# .'!D, &!)+.%'%4//, ',+,2'+, &+5%/&+"-&/',% % 4!',&/',%. �%(/"+@ �.+&/.%B *+.+" '.!, )+$G,G4 4+"!&-(%4 '!"--'(%4 U(/"+4, A/**!3F%.+" &/.G! %*!%, 3!U+" '"/F&G! 4!,/*%B!'(%! ./A3/'G, 'A/'/$',./.+"/,(3G,%� "+$/3+,/3%@ % 2'/.!3U!&',./.+&%� 2B!$&GD +2*%,/3%@.

�!F*2 ,!4 %',%&&+# 3/"- �L�. �%3/1/.+ . 3+).%,%% 4!*%5%&G . XIX .. A3%)&+.+"+'- )+32-$!F&G4% 'A!5%+"%',+4% $!)/1/./3/B&/.

�B�&G@ .&!' )&+B%,!"-&G! 2"2BU!&%# . 3+$/,2 A!*+1/1%B!'(%D '/.!,/. 1%4&+)%@, 3+'U%-3%" '/*!3F+&%! /$'2F*+!4GD ./A3/'/., ..!" . '%',!42 */("+*G % /$4!& 4&!&%#4% A/ *%*+(,%B!-'(%4 ./A3/'+4, .'#B!'(% A//�3#" 4!,/*%B!'(%! %)G'(+&%# 2B%,!"!@, 3!(/4!&*/.+" .)+%4&/! A/-'!�!&%! 23/(/.. �'&/.&G4% *%*+(,%B!'(%4% A3%&5%A+4% �%3/1/. 'B%,+" /'4G'"!&&/',- /$2B!-&%#, +(,%.&/',- % &+1"#*&/',-, B,/ . ,! .3!4!&+ % . &+U! .3!4# %13+!, /*&2 %) 1"+.&GD 3/"!@ ./'4G'"!&%% ,32*&/1/ 2B!$&/1/ 4+,!3%+"+.

3!$2#, B,/$G 2B%,!"# % 32(/./*%,!"% 1%4&+)%@ D/3/U/ %)2B+"% 2B+�%D'# % %D 2'A!.+!-4/',-, �%(/"+@ �.+&/.%B A3!*"+1+" A!3!./* %) ("+''+ . ("+'' A3/%)./*%,- A/ 3!)2"-,+,+4 1/*/-./@ 2'A!.+!4/',%L�$2B!&%! . .G'U!@ U(/"! %4!"/ '4G'" A3% A3%."!B!&%% ( 2B!$&/42 A3/5!''22B!&GD. �+&#,%# $G"% A!3!.!*!&G . '!4%&+3'(%! B+'G, B,/ . A3%&5%A! '2�!',.2!, % A/ '!@ *!&-,&/ &!4&/1/ . %)4!&!&&/@ (. '//,.!,',.%% ' ,3!$/.+&%#4% '/.3!4!&&/1/ 4%3+) ?/34! [4].

�+ 1/3%)/&,! 4%3/./@ %',/3%% 4!*%5%&G % A!*+1/1%(%, �%(/"+@ �.+&/.%B �%3/1/. A3!*-',+."#" '/$/@ 3!*(/! /"%5!,./3!&%! %*!+"-&/1/ /$3+)+ .3+B+ % A!*+1/1+ — /*%&+(/./ .!"%(/1/4G'"%,!"#, A3+(,%(+, &/.+,/3+.

+(%4 /& /',+"'# . %',/3%%, ,+(%4 /& F%.�, . &+U!4 A3!*',+."!&%% / &�4 % '!1/*&#, #."#-#'- A3%4!3/4 % 1/3*/',-� *"# 32''(/1/ &+3/*+.

�A%'/( "%,!3+,23G:1. �/&',+&,%&/. �L�., �!*G&'(%@ �L�., �+$+!.+ �L�. �',/3%# A!*+1/1%(%. — �.: �3/'.!-

�!&%!, 1982. — C. 202–2032. �%3/1/., �L�. �)$3+&&G! A!*+1/1%B!'(%! '/B%&!&%#. — �.: �!*+1/1%(+, 1985.3. �3+'&/.'(%@, �L�. �!*+1/1%B!'(%! %*!% �L�. �%3/1/.+. — �.: �BA!*1%), 1949.4. http://ru.wikipedia.org/wiki

,#+. �+&!>!$ — �'&$!!0)&-$"0'1]!�'&"0+$,!>!$J'x"0'1]�0$"�!(`2+&,-J,"&)!q!J$&!��++

+#$. J��������� (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ /$�!',.!&&/1/ )*/3/.-# % )*3+.//D3+&!&%#

�������������������: ��6. 7������ (���., . �. �.)

&+',/#�!! .3!4# A/B,% (+F*/! /A!3+,%.&/! .4!U+,!"-',./ A3/./*%,'# A/* /$�%4 &+3(/-)/4. �'"% $G &! $G"/ ,+(/1/ 4!,/*+ /$!)$/"%.+&%#, &! A3/%)/U"% .!"%(%! /,(3G,%# . /$"+',%D%3231%% % ,3+.4+,/"/1%%.

74

A!3.G! �?%3&G@ &+3(/) $G" A3%4!&!& 16 /(,#$3# 1846 1/*+ �%"-#4/4 �/3,/&/4 $/"-&/-42 ' /A2D/"-� U!%. �L�. �&/)!45!. A3%4!&%" �?%3&G@ &+3(/) A3% /A!3+5%% 7 ?!.3+"# 1847 1/-*+, + �%(/"+@ �.+&/.%B �%3/1/. — 14 ?!.3+"# 1847 1/*+.

�*&+(/ A!3.!&',./ �L�. �%3/1/.+ . A3%4!&!&%% �?%3&/1/ &+3(/)+ . ./!&&/NA/"!./@ D%323-1%% &!/'A/3%4/, % . *+"-&!@U!4 !1/ .&!*3!&%! . ,+(%D 2'"/.%#D $"+1/*+3# �%(/"+� �.+&/.%B2A/"2B%"/ U%3/(/! 3+'A3/',3+&!&%! &! ,/"-(/ . �/''%%, &/ % ./ .'!4 4%3!. �%3/1/. ' &!.%*+&&G4%&,!3!'/4 ',+" %''"!*/.+,- *!@',.%! &+3(/)+ &+ F%./,&GD, A3/./*%,- 3+)"%B&/1/ 3/*+ �('A!3%-4!&,G, + )+,!4 %'A/"-)/.+" !1/ &+ A/"! $/# [1].

�& '(/&',32%3/.+" /'/$2� 4+'(2, A/)./"#��2� .*GD+,- ,/B&/ )+*+&&/! (/"%B!',./ �?%3+.� &+B+"'# /AG, &+ '!$!. �%3/1/. %'AG,G.+" 1/"/./(32F!&%!, /& A/132F+"'# . 4%3 A3%)3+(/. %,&+(/&!5, 1"2$/(/ )+'GA+". �3/$2F*!&%! '/A3/./F*+"/'- ,/U&/,/@, 1/"/.&/@ $/"-�, 3+)$%,/-',-�. �/ /& */$%"'# 1"+.&/1/: A3/.!*!&%! /A!3+5%@ $!) $/"% % ' &+%4!&-U%4% A/,!3#4%, B!1/ &!D.+,+"/ . ,/ .3!4#.

�!3.+# /A!3+5%# ' A3%4!&!&%!4 �?%3&/1/ &+3(/)+ $G"+ '*!"+&+ F!&�%&!. � &!! $G" 3+(4/"/B&/@ F!"!)G. �A!3+5%� $!) /$!)$/"%.+&%# /&+ $G &! .G&!'"+. �A!3+5%# A3/U"+ 2*+B&/.

1847 1/*2 &+ �+.(+)! AG"+" ./!&&G@ A/F+3. �+4%"- .!" A3/,%. �/''%% «'.#�!&&2�»./@&2... � (3!A/',% �+",G �%(/"+@ �.+&/.%B 2'A!" 3+).!3&2,- A/"!./@ "+)+3!,... B%'"! 3+&!-&GD (+)+(/. $G" '/,&%( �3%@ �+1+3%&, A/"2B%.U%@ 3+&!&%! . &/12. �A!3+5%# A/* &+3(/)/4'A+'"+ !42 F%)&-.

�3%&!'"% A!3.GD 3+&!&GD 4�3%*/.. �F+. )2$G, 1/35G 4/"B+ A!3!&/'%"% ',3+U&2� $/"- /,3+&. %*#, B,/ &%(+(%4% 21/./3+4% &! 2$!*%,- 4�3%*/. &+ D%3231%B!'(%! /A!3+5%%, �%3/1/.A/U!" &+ D%,3/',-. �& A/*/U!" ( /*&/42 %) &+%$/"!! ',3+*+��%D 1/35!. % '/ .'!@ '!3-!)&/',-�'A3/'%": «�! D/B!U- "%, (2&+( (*321), &!4&/1/ /,*/D&2,-? � 4!&# !',- ,+(/! "!(+3',./, (/,/3/!4/F!, ,!$# .3!4!&&/ A!3!&!',% &+ &!$/, ( 3+@'(%4 123%#4. �(+F% ,/"-(/ '"/./ — % # %'A/"&�'./! /$!�+&%!». �/3!5 '/1"+'%"'#. �/,# 2B!&G@ '%"-&/ 3%'(/.+". �A!3+5%# A3/U"+ 2*+B&/, 1/3!5/B&2"'# % A/$"+1/*+3%", &+).+. �L�. �%3/1/.+ B2*!'&%(/4. �/'"! �,/1/ 2B!&/1/ A3/'%"% *!"+,-/A!3+5%% A/* &+3(/)/4 .'! B+�! % B+�! [2].

�/ ./).3+�!&%% . �!,!3$231 . 1848–1849 11. /& /A2$"%(/.+" A/*3/$&G! *+&&G! / (+.(+)-'(/@ �('A!*%5%% . «�,B!,! / A2,!U!',.%% A/ �+.(+)2». �)"/F%. . &!4 +&+"%) './!1/ "%B&/1//AG,+ )+ A!3.G@ 1/* A3%4!&!&%# �?%3&GD A+3/. (+ /& '/',+."#" A3%4!3&/ 50 % .'!D A3/%).!*!&-&GD . �/''%% &+3(/)/.), �L�. �%3/1/. 3+''!#" '2�!',./.+.U!! 4&!&%! / .3!*&/4 ."%#&%% &+3(/-)+ &+ /31+&%)4 A/'"! /A!3+5%%, &+ ,!B!&%! % )+F%."!&%! 3+&, &+ %'D/*G /A!3+5%@ % "!,+"-&/',-A3% &%D» [3].

�) 100 /A!3+5%@ 6 3+) /$!)$/"%.+&%! $G"/ A3/%).!*!&/ 42'2"-4+&+4. �D %&,!3!'/.+"/ '/-*!3F%4/! ?"+(/&+, %) (/,/3/1/ F%*(/',- (+A"#4% A+*+"+ &+ 4+'(2. �!3!) A!3!./*B%(+ �%(/"+@�.+&/.%B /$�#'&%", B,/ . '("#&(! ' �?%3/4 '/*!3F%,'# '3!*',./, A/'"! .*GD+&%# (/,/3/1/ A3+-./.!3&G@ ,2, F! A!3!&/'%"'# . 3+@ �+1/4!,+ % . !1/ /$%,!"- $"+F!&',.+ % 123%@. �/'"! ,+(/1//$�#'&!&%# 42'2"-4+&%& ' &!/$G(&/.!&&G4 &+'"+F*!&%!4 &+B%&+" .*GD+,- . '!$# �?%3&G! A+-3G. � A/'"! /A!3+5%% /&% A/B,% .'! 3+''(+)G.+"%, B,/ *!@',.%,!"-&/ &+D/*%"%'- . &!.G3+)%4/A3%#,&/4 4!',!, . (/,/3/4 F!"+"% $G A3/$G,- .'� /',+.U2�'# F%)&-.

�AG, �L�. �%3/1/.+ A/ A3%4!&!&%� &+3(/)+ &!%)4!3%4/ ./)3/' ./ .3!4# �3G4'(/@ ./@&G1854–1855 11. +4 /& &+(/A%" 13/4+*&G@ 4+,!3%+" A/ /$!)$/"%.+&%�, A3%4!&%. &+3(/) /(/"/10 ,G'#B 3+). A/'"!*2��%! 1/*G, &+$"�*+# )+ 3+$/,/@ '+&%,+3&GD '"2F$ ./ .3!4# ?3+&(/-A32''(/@ ./@&G . 1870 1., . �/"1+3%% . 1877–78 11., �%(/"+@ �.+&/.%B .G'(+)G.+"'# / .+F&/',%/$!)$/"%.+&%# % /$#)+,!"-&/',% !1/ A3%4!&!&%# &+ ./@&! [3,4].

�B!&G@A3%U�" ( .G./*2, B,/ «$!'B2.',.%! A/'"! �?%3/.+&%# 4/F!, A3/%'D/*%,- A3% *.2D2'"/.%#D: 1) (/1*+ A+3G �?%3+ ./@*2, . (3/.//$3+�!&%! % 2) (/1*+ &+'G�!&&+# �?%3&G4% A+3+4%(3/.- A3%*�, . A3%(/'&/.!&%! ' /31+&+4% &!3.&/@ '%',!4G». �& ,+(F! AG,+"'# /,.!,%,- !�� &+/*%& ./A3/': «�!@',.2!, "% �?%3/.+&&+# (3/.- &+ .'� &!3.&2� '%',!42, ,. !. % &+ 5!&,3+"-&G!/31+&G, % &+ A!3%?!3%B!'(%! %D B+',%, %"% ."%#&%! !� '/'3!*/,/B%.+!,'# &+ ,/4 %"% *321/4 /,*!-"! �,/@ '%',!4G?».

�L�L�%3/1/. 'B%,+", B,/ �?%3, &+D/*#�%@'# . (3/.%, *!@',.2!, 3+&-U! .'!1/ &+ 5!&,3+"--&2� &!3.&2� '%',!42, &+ 4/)1. �,/ $G"/ /B!&- "/1%B&/ %4 3!U!&/ &+ /'&/.+&%% ,/1/, B,/ &+3(/)A3/#."#!,'# 3+&-U! .'!1/ %)4!&!&%!4 )3+B(+, U24/4 . 2U+D, $!'A/(/@',./4. �& A%'+": «�/1*+*!@',.%! �?%3&/1/ A+3+ &+ &!3.&2� '%',!42 */',%1+!, '+4/@ .G'U!@ ',!A!&%… .'# F%)&!&&+#*!#,!"-&/',- ,/1*+ '/'3!*/,+B%.+!,'# ,/"-(/ . /*&/4 /13+&%B!&&/4 A3/',3+&',.! — . A3/*/"1/-.+,/4 4/)1!, 2A3+."#��%4 *GD+&%!4». �,/, 3+)*!" �L�L�%3/1/. )+(/&B%" '"!*2��%4 .G./*/4:

75

��/$',.!&&/ 4!D+&%)4 *!@',.%# &+�?%3/.+&&/@ (3/.% &+ &!3.&2� '%',!42 /',+�,'# *"# &+' &!A/-',%F%4G4» [5].

+(%4 /$3+)/4, '"!*2!, /,4!,%,-, B,/ D%3231%#, +&!',!)%/"/1%# $"+1/*+3# �L�. �%3/1/.2'*!"+"% /13/4&G@ 3G./( .A!3!*. !*- &+3(/) — &!/,�!4"!4+# B+',- "�$/@ /A!3+5%%. �+ *+&&G@4/4!&, A3%4!3&/ 90 /A!3+5%@ %) 100 A3/./*%,'# A/* /$�%4 �?%3&G4 &+3(/)/4. �',!',.!&&/, .(/&5! 20-1/ % &+B+"! 21-1/ .!(/. �,/, 4!,/* $G" 2'/.!3U!&',./.+&, &/ !1/ *!@',.%! /',+!,'# &!%)2B!&&G4 */ (/&5+.

�A%'/( "%,!3+,23G:1. �.+3/., �L�. ("+* �L�. �%3/1/.+ . 3+).%,%! D%3231%B!'(/1/ /$!)$/"%.+&%# / �L�. �.+3/.

// !',&%( D%3231%% %4!&% �. �. �3!(/.+. — 1985. — . 135. — � 11. — �. 19–22.2. �/1%"!.'(%@, �L�. �%3/1/. / �. �. �/1%"!.'(%@. — �.: �!*1%), 1961 — �. 68–73.3. �!'!"!.%B, �L�. �L�. �%3/1/. / �. �. �!'!"!.%B. — �.: �!*%5%&+, 1969. — 27 '.4. �3!F&!., �. �%3/1/. / �. �3!F&!.. — �.: �/"/*+# 1.+3*%#, 1990 — �. 106–211.5. http://www.critical.ru/calendar/1402Pirogov.htm

!�!;',,!�0+^+&4&>+%'�)!>!!;'��'%',+=�"&0+q",�)!>!($+�',+=$>!(-$'1+)!/!0'%'�0$',,!/$!/,-

"#$. J���_�� (����.)

�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ A3/A!*!.,%(% .&2,3!&&%D $/"!)&!@

�������������������: 9�#. >�������$ (��., . �. �.)

"����z����z. �(/"-(/ $G "!, &! /,*!"#"/ &+' /, !"%(/@ �,!B!',.!&&/@ ./@&G, "�*%.'!1*+ $2*2, B,%,- �,% 1!3/%B!'(%! 1/*G.

�,/ $G"+ A/*"%&&/ .'!&+3/*&+# ./@&+, + A/$!*+ (/.+"+'- (+( &+ ?3/&,!, ,+( % . ,G"2 .3+1+.�"/./ «A+3,%)+&G» A3%./*%"/ &!45!. . 2F+'. A+3,%)+&'(%D /,3#*+D �!"+32'% B%'"%"/'- $/"!!370 ,G'#B $/@5/.. �3/4! ,/1/, A/B,% 400 ,G'#B B!"/.!(, A3/F%.+��%D . *!3!.&#D % "!'&GD "+1!-3#D, '/',/#"% &+ 2B!,! . A+3,%)+&'(%D /,3#*+D % $3%1+*+D % '/',+."#"% A+3,%)+&'(%@ 3!)!3..

/@&G $!) A/,!3- &! $G.+!,. � 4!*%5%&'(+# A/4/�- $G"+ &! 4!&!! .+F&+, B!4 $/!.+#. �'/-$!&&/ �,/ /�2�+"/'- . &+B+"-&G@ A!3%/* ./@&G . ,G"2 .3+1+, (/1*+ . A+3,%)+&'(%D /,3#*+D 4!-*%(/. A3+(,%B!'(% &! $G"/. �&/@ 3+) A2',#(/.G! 3+&G %)N)+ /,'2,',.%# 4!*%5%&'(%D 3+$/,&%(/.,"!(+3',., A!3!.#)/B&GD 4+,!3%+"/. A3%./*%"% ( '4!3,%.

*��z. �)2B!&%! /'/$!&&/',!@ 4!*%5%&'(/1/ (% . B+',&/',% D%3231%B!'(/1/) '&+$F!&%#, +,+(F! 3/"% 4!*%(/. . /$!'A!B!&%% $/!'A/'/$&/',% A+3,%)+&'(%D /,3#*/..

J����� � ����� . �G"% %)2B!&G ,32*G, A/'.#��&&G! 4!*%5%&'(/42 *.%F!&%� ./.3!4# !"%(/@ �,!B!',.!&&/@ ./@&G, '/',/#"%'- .',3!B% % %&,!3.-� 4!*%5%&'(%D 3+$/,&%(/. —2B+',&%(/. % /B!.%*5!. ./!&&GD '/$G,%@.

&�_��z�� . �/F&/ .G*!"%,- 3#* /'/$!&&/',!@ 4!*%5%&'(/1/ (% . B+',&/',% D%3231%B!-'(/1/) '&+$F!&%# A+3,%)+&'(%D /,3#*/..

1. �!3./! / B�4 ',/%, A/*24+,-, (/1*+ 3!B- %*�, / 4!*%5%&'(/4 '&+$F!&%%: �,/, (/&!B&/F!, (.+"%?%5%3/.+&&G@ A!3'/&+". �!3.G! A+3,%)+&'(%! /,3#*G % 132AAG %4!"% .!'-4+ /13+&%-B!&&/! B%'"/ 4!*%5%&'(%D 3+$/,&%(/.. � A3%4!32, . (/&5! 1941 1. . A+3,%)+&'(%D ?/34%3/.+&%-#D $G"/ .'!1/ U!',- .3+B!@ (%) (/,/3GD A#,- $G"% D%3231+4%) % B2,- $/"-U! '3!*&%D 4!*%5%&-'(%D 3+$/,&%(/.. �*&+(/, (+( ,/"-(/ . A+3,%)+&'(%D /,3#*+D ',+"% A/#."#,-'# A!3.G! $/"-&G! %3+&!&G!, ,/ '3+)2 F! ./)&%("+ A/,3!$&/',- . 4!*%5%&'(%D 3+$/,&%(+D, 4!*%(+4!&,+D, A!3!.#)/B-&/4 4+,!3%+"!.

�!3.G! 4!*%5%&'(%! A2&(,G, '+&%,+3&G! B+',% % 1/'A%,+"% $G"% '/)*+&G . A+3,%)+&'(%D'/!*%&!&%#D �!"+32'% . 1942 1. �'&/.&G4 '/*!3F+&%!4 %D 3+$/,G $G"+ �(',3!&&+# 4!*%5%&-'(+# A/4/�- 3+&!&G4 % $/"-&G4. �/ 4!3! /31+&%)+5%/&&/1/ /?/34"!&%#, 2(/4A"!(,/.+&%#(+*3+4% '?!3G % D+3+(,!3 "!B!$&/NA3/?%"+(,%B!'(/@ *!#,!"-&/',% 3+'U%3#"%'-. �$GB&/ A!3-.G! A+3,%)+&'(%! 1/'A%,+"% 24!�+"%'- . 3–4 )!4"#&(% (/*&+ )!4"#&(+ &!/$D/*%4+ (+( /A!3+-5%/&&+#, .,/3+# — *"# 3+)4!�!&%# 3+&!&GD % $/"-&GD, ,3!,-# %'A/"-)/.+"+'- (+( %)/"#,/3 —*"# A+3,%)+&, )+3+)%.U%D'# %&?!(5%/&&G4% )+$/"!.+&%#4%. !�� /*&/@ A3!*A/"+1+"/'- 3+)-4!�+,- +A,!(2).

76

�/',+,/B&/ B!,(+# ',32(,23+ 4!*%(/N'+&%,+3&/@ '"2F$G '?/34%3/.+"+'- ( &+B+"2 1943 1.A/'"! '/)*+&%# '+&%,+3&GD /,*!"/. �!&,3+"-&/1/ % �!"/32''(/1/ U,+$/. A+3,%)+&'(/1/ *.%F!-&%#. �D /31+&%)+,/3+4% % &+B+"-&%(+4% $G"% �%D+%" �.+&/.%B �/.+"!&/( % �.+& �&%'%4/.%B�&'+3/., (/,/3G! . A/'"!./!&&G! 1/*G ',+"% 4%&%',3+4% )*3+.//D3+&!&%# 3!'A2$"%(%.

2. �',3+# % A/',/#&&+# &!D.+,(+ 4!*%(+4!&,/. % A!3!.#)/B&/1/ 4+,!3%+"+. A!3.G! 1/*G ./@&G (+,+',3/?%B!'(% &! D.+,+"/ 4!*%(+4!&,/.. �/4+&*%3 A+3,%)+&'(/@

$3%1+*G %4!&% �L. �32&)! �L�. �+D+3/. . (&%1! «/@&+ . (3+� /)�3» A%U!,: «�!',3+ (3!A(/*!3F+"+ 3+&!&/1/, .'(+(%.+��!1/ /, &!',!3A%4/@ $/"%. �!3*5! /$"%.+"/'- (3/.-�, (/1*+ D%3231$3+" . 32(% /$G(&/.!&&2� '+*/.2� A%"2 % $!) &+3(/)+ A3/%)./*%" +4A2,+5%�...

/ 4&/1%D '"2B+#D A3%D/*%"/'- 3+''B%,G.+,- ,/"-(/ &+ �������� .3+B!@, ������ %4%����� ����. �, 4&/1%D A3/',!@U%D +1!&,/. % &!(/,/3GD %&?!(5%/&&GD $/"!)&!@ )+ &!%4!&%!4"!(+3',. $G"/ /*&/ '3!*',./: .&2,3%4GU!B&/ ../*%"% 4/"/(/, B,/ .G)G.+"/ '%"-&!@U2� ,!34/-1!&&2� 3!+(5%�, % . 3!)2"-,+,! $G',3/1/ A/.GU!&%# ,!4A!3+,23G 2'"/.%# F%)&% % 3+)4&/F!&%#+1!&,+ $G"% &+32U!&G. �/"-&G4 ' A/.3!F*!&&G4% B!"�',#4% ."%.+"% B!3!) 3!)%&/.2� ,32$/B(2A%,+,!"-&G@ 3+',./3 %) #%5, 4/"/(+, 4!*+ % (%A#B!&/@ ./*G. �3% ,#F!"GD /A!3+5%#D, (/1*+$/"-&/42 A3%D/*%"/'- /'/$!&&/ ,21/, % .3+B $/#"'#, (+( $G &% &+',2A%" U/(, . (+B!',.! &+3(/,%-B!'(/1/ '3!*',.+ A3%4!&#"% '+4/1/&.

�&+$F+"% 4!*%(+4!&,+4%, &! .!*+# / ,/4, % 1%,"!3/.5G. �A/'/$',./.+"+ �,/42 %D +"B&/',-:&+U% "�*% . 1/3/*+D '(2A+"% 2 /((2A+&,/. 4!*%(+4!&,G, D/,# /$D/*%"%'- /&% */3/1/: 1%,"!3/.-'(%! *!"-5G ,3!$/.+"% )+ *!?%5%,&G! "!(+3',.+ $+'&/'"/.&G! *!&-1%»

3+).%,%% '%',!4G 4!*%5%&'(/1/ /$!'A!B!&%# A+3,%)+&'(%D ?/34%3/.+&%@ .+F&2� 3/"-'G13+"+ '%',!4+,%B!'(+# '.#)- A+3,%)+&'(%D )/& ' ,G"/4 A/ ./)*2D2.

� A/4/�-� +.%+5%% '+&%,+3&G@ /,*!" 3!U+" ./A3/'G 4!*%5%&'(/1/ '&+$F!&%# A+3,%)+&-'(%D '/!*%&!&%@. �!*%5%&'(/! %42�!',./ */',+."#"/'- A/ ./)*2D2 .4!',! ' /32F%!4 % $/!A3%-A+'+4%, + %&/1*+ — 'A!5%+"-&G4% 3!@'+4%. � 1943 1. A/ %�&- 1944 1. A+3,%)+&'(%4 ?/34%3/.+-&%#4, *!@',./.+.U%4 &+ ,!33%,/3%% �!"+32'%, $G"/ /,A3+."!&/ 44 318 (1 4!*%5%&'(/1/ %42�!-',.+. A!3.2� /B!3!*- &+A3+."#"%'- '3!*',.+ *"# /(+)+&%# D%3231%B!'(/@ A/4/�% % A3/.!*!&%#'+&%,+3&/NA3/,%./�A%*!4%B!'(%D 4!3/A3%#,%@, . B%'"! (/,/3GD — A/"!.G! '24(% *"# ?!"-*U!-3/. % 4!*%5%&'(%D '!',�3 ' &+$/3+4% *"# /(+)+&%# A!3./@ 4!*%5%&'(/@ A/4/�% &+ A/"! $/#.

3. �!*/',+,/( %"% /,'2,',.%! &!/$D/*%4/1/ 4!*%5%&'(/1/ %&',324!&,+3%# %13+"% )&+B%-42� 3/"-. �+F! ,+(/@ &!/$D/*%4G@ A3%$/3, (+( ',!,/'(/A A3%D/*%"/'- (/&',32%3/.+,- '+4%4.3+B% $3+"% ,32$G, './3+B%.+"% "%',G. � D%3231%B!'(%4 %&',324!&,+3%!4 *!"+ /$',/#"% !��D2F!. � 4!',&GD (2)&!5/. D%3231% *!"+"% '!$! '(+"-A!"#, %1"G % *321%! &!/$D/*%4G! %&',32-4!&,G. �+ .!' )/"/,+ 5!&%"%'- ,3/?!@&G@ %&',324!&,+3%@, (/,/3G@ &+D/*%"% &+ 4!',+D 3+)13/4+1%,"!3/.5!.. �)N)+ *!?%5%,+ %&',324!&,G «$!3!1"% … ',3/F!, A/F+"2@, B!4 /32F%!».

4. �'!A,%B!'(%! % +&,%'!A,%B!'(%! 2'"/.%#, A/*/$&G! '/.3!4!&&G4, (/&!B&/, &!./)4/F&/$G"/ '/)*+,- . A+3,%)+&'(%D 1/'A%,+"#D. (+B!',.! +'!A,%B!'(%D 4!3 A3%D/*%"/'- /A!3+5%% *!-"+,- (+( 4/F&/ $G',3!!, ./ %)$!F+&%! $/"-U/1/ /$'!4!&!&%# 3+&G (/A!3+5%% B+',/ A3/D/*%"%A/* /,(3G,G4 &!$/4). (+B!',.! +&,%'!A,%B!'(%D 3+',./3/. %'A/"-)/.+"%'- "�$G! 'A%3,/'/-*!3F+�%! F%*(/',%. �%3/(/ A3%4!&#"%'- 4!3G ,!34/+&,%'!A,%(% — A3%F%1+&%! (A3% (/F&GD$/"!)&#D % 3+&+D) % (3%/+&,%'!A,%(% ('B%,+"/'-, B,/ /$("+*G.+&%! "-*/4 &+ 304%& — B+' *"#4&/1%D 4%(3//31+&%)4/. #."#"/'- B%',/@ '4!3,-�.)

5. �)N)+ B+',/1/ A!3!4!�!&%# /,3#*/. 4!*/$!'A!B!&%! (+F*G@ 3+) /31+&%)/.G.+"% .&/.- %.&/.-. �*&+(/ % ?+U%',G &! ',/#"% &+ 4!',!. � &%D $G"+ ,/F! D/3/U/ A/',+."!&+ 3+).!*(+, $G"%3+'A3/',3+&!&G (+3+,!"-&G! /A!3+5%%. ,+(%D 2'"/.%#D A+3,%)+&+4 &+*/ $G"/ B+',/ 4!&#,-'./� 4!',/ *%'"/(+5%%, + �,/ )&+B%,, B,/ .'� &+*/ &+B%&+,- )+&/./ — ./)./*%,- $+&%, 1/'A%,+"%.�) ./'A/4%&+&%@ (/4+&*%3+ 99-@ A+3,%)+&'(/@ $3%1+*G %4!&% �2"#!.+ L�. �(/.!&(/: «�+$/,&%-(% 1/'A%,+"# )+ /*&2 &/B- A!3!$+)%3/.+"%'- . *321/@ &+'!"!&&G@ A2&(,. �+ .,/32� /31+&%)/.+"%,+4 1/'A%,+"-, &! D2F! ,/1/, %) (/,/3/1/ /&% A3%$G"%».

$ ��� . �/"-U2� 3/"- . /$!'A!B!&%% $/!'A/'/$&/',% A+3,%)+& 'G13+"% 4!*%(%, /,*+.+.-U%! .'! ?%)%B!'(%! % *2U!.&G! '%"G './!@ $"+1/3/*&/@ A3/?!''%%. �/F&/ /,4!,%,- &!(/,/3G!/'/$!&&/',% 4!*%5%&'(/1/ /$!'A!B!&%# A+3,%)+&'(/1/ *.%F!&%#:

1. �+*3/.G@ ./A3/', /'/$!&&/ . &+B+"-&G@ A!3%/* ./@&G $G" &+%.+F&!@U%4.2. �',3+# % A/',/#&&+# &!D.+,(+ 4!*%(+4!&,/. % A!3!.#)/B&/1/ 4+,!3%+"+.3. �!*/',+,/( %"% /,'2,',.%! &!/$D/*%4/1/ 4!*%5%&'(/1/ %&',324!&,+3%#.4. 32*&/',% . .GA/"&!&%% A3+.%" +'!A,%(% % +&,%'!A,%(%.5. �)N)+ B+',/1/ A!3!4!�!&%# /,3#*/. 4!*/$!'A!B!&%! (+F*G@ 3+) /31+&%)/.G.+"% .&/.-

% .&/.-.

77

�+( .'A/4%&+!, L�. �(/.!&(/, ( '!3!*%&! 1943 1/*+ "�$+# /A!3+5%# A+3,%)+&'(/@ $3%1+*G$G"+ /$!'A!B!&+ ' 4!*%5%&'(/@ ',/3/&G. �,/ %4!"/ /13/4&/! )&+B!&%!. �*# . $/@, A+3,%)+& )&+",B,/ . '"2B+! 3+&!&%# /& $2*!, �.+(2%3/.+& ' A/"# '3+F!&%# % A/"2B%, A!3.2� 4!*%5%&'(2� A/-4/�-. �/)&+&%! �,/1/ A/.GU+"/ $/!'A/'/$&/',- $/@5/.. �!'"2B+@&/ +.,/3 (&%1% )+(+&B%.+!,1"+.2 / 4!*%(+D '"/.+4%: «�%)(%@ A/("/& %4 /, .'!D A+3,%)+&».

�A%'/( "%,!3+,23G:1. !"%(+# �,!B!',.!&&+# ./@&+ 1941–1945 11. �&5%("/A!*%# (A/* 3!*. 1!&!3+"+ +34%% A3/-

?!''/3+ �L�. �/)"/.+). — �.: �/.!,'(+# �&5%("/A!*%#, 1985. — �. 816–817.2. "!'+D �!"/32''%%: ./'A/4%&+&%# '/.!,'(%D A+3,%)+& % &!4!5(%D +&,%?+U%',/..

�%&'(: �!"+32'-, 1977. — 384 '.3. �+D+3/., �L�. /@&+ . (3+� /)�3. ,/3/!, A!3!3+$/,+&&/! % */A/"&!&&/! %)*+&%!. — �&.:

�!"+32'-, 1973. —�. 161–164.4. %�!&(/, �L�. �$�+# D+3+(,!3%',%(+ 4!*%(/N'+&%,+3&/1/ *!"+ �!"/32''%% . A!3%/*

,/3/@ 4%3/./@ ./@&G // �!*-4+# &+2B&+# (/&?!3!&5%# A/ %',/3%% 4!*%5%&G �!"+32'%, A/'.#-�!&&+# 50-"!,%� /(/&B+&%# ,/3/@ 4%3/./@ ./@&G: '$/3&%( 4+,!3%+"/.. — �%&'(, 1995. —�. 11–14.

5. �(/.!&(/, L�. �+3,%)+&'(/! 4!F*23!B-!. — �.: �/"%,%)*+,, 1976. — �. 8–11, 147–148.

$!��+0",,+)+ «�+&!>!$*"» — ,"x+4%+0'1=

"#$. ,����� (����.), "#,. ;��� 3�� (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

�������������������: ���. ������ (0��. ��., ���., �. �. �.),���. 6��� (��., . �. �.), ���. ��%��� (��., . �. �.)

/'A%,+&&G@ &+ "2BU%D ,3+*%5%#D 32''(/@ 4!*%5%&'(/@ U(/"G, .!3&G@ A/'"!*/.+,!"-%*!@ �L�. �2D%&+, �L. �2#"-'(/1/ �L�. �%3/1/. 3+).!3&2" U%3/(2� ,./3B!'(2� &+2B&2� *!#-,!"-&/',-, A3/*/"F+.U2�'# '.GU! 45 "!,.

�L�. �%3/1/. 2F! . A!3.G! 1/*G './!@ *!#,!"-&/',% /$3+,%" .&%4+&%! &+ /13/4&/! )&+B!-&%! *"# A3+(,%B!'(/@ D%3231%% ,/B&/1/ )&+&%# +&+,/4%% % .4!',! ' ,!4 .'� './� F%)&- */(+)G-.+", B,/ «A/,3!$&/',% D%3231/., %D )+A3/'G ,/"-(/ % */"F&G /A3!*!"#,- &+A3+."!&%! +&+,/4%B!-'(%D ,32*/.». 1837 1/*2 .GU"+ . '.!, !1/ «�%3231%B!'(+# +&+,/4%# +3,!3%+"-&GD ',./"/. %?+'5%@». �+$/,+4% �L�. �%3/1/.+ $G"/ A/"/F!&/ &+B+"/ %)2B!&%� ?+'5%+"-&GD /$3+)/.+&%@,!"+ B!"/.!(+. �&% A/'"2F%"% &+B+"/4 4&/1/B%'"!&&GD %''"!*/.+&%@ A/*/$&/1/ 3/*+ (+( . �/'-'%%, ,+( % )+ 32$!F/4. �&,!3!' ( �,/@ A3/$"!4! &! %''#( % A/ &+',/#�!! .3!4#.

�$3+�+# /'/$/! .&%4+&%! &+ ,/A/13+?%B!'(/! '//,&/U!&%! /31+&/., �L�. �%3/1/. '/)*+�,&/.G@ 4!,/* %''"!*/.+&%# — 4!,/* 3+'A%"/. )+4/3/F!&&GD ,32A/. . ,3�D .)+%4&/ A!3A!&*%(2-"#3&GD A"/'(/',#D: '+1%,,+"-&/@, ?3/&,+"-&/@ % 1/3%)/&,+"-&/@. �,/1/4 3+$/,G A/ %)2B!&%�3+'A%"/. ,32A/. #.%"/'- '/)*+&%! +,"+'+ ,/A/13+?/N+&+,/4%B!'(%D ,+$"%5 «Anatomia topografica»(1859). �+ 3%'2&(+D +,"+'+, '/$',.!&&/32B&/ .GA/"&!&&GD +.,/3/4, A3!*',+."!&G . 3+)"%B&GDA3/!(5%#D .)+%4//,&/U!&%# /31+&/. % ,(+&!@.

�+&&G!, A/"2B!&&G! �%3/1/.G4 $/"!! ',+ "!, &+)+*, &! A/,!3#"% './!1/ )&+B!&%# % . &+U!.3!4#. �/)*+&&G@ %4 4!,/* %)2B!&%# 3+'A%"/. «A%3/1/.'(%D '3!)/.» U%3/(/ %'A/"-)2!,'# ,/A/-13+?/+&+,/4+4% . '/.3!4!&&GD &+2B&GD %''"!*/.+&%#D % . A3!A/*+.+&%% A3!*4!,+.

�,*+.+# *+&- A+4#,% .!"%(/1/ 32''(/1/ 2B!&/1/, D%3231+, +&+,/4+, ',2*!&B!'(%@ &+2B&G@(32F/( &+ (+?!*3! ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%% &+)G.+!,'# «�%3/1/.!5».�3!A/*+.+,!"% % %D ./'A%,+&&%(% 2'A!U&/ A3/*/"F+�, .!"%(/! *!"/ .!"%(/1/ B!"/.!(+ % D%323-1+ �L�. �%3/1/.+. �+$/,+ (32F(+ &+B+"+'- . 70-! 1/*G XX .!(+ A/* 32(/./*',./4 )+.!*2��!1/ (.,! 1/*G — */5!&,+, + A/)*&!! — A3/?!''/3+) *. 4. &. �"!1+ �!31!!.%B+ �2U+(/.'(/1/ A3% &!A/-'3!*',.!&&/4 2B+',%% A3!A/*+.+,!"!@. �"!1 �!31!!.%B /A2$"%(/.+" 147 &+2B&GD 3+$/,; #."#!,'#+.,/3/4 23 %)/$3!,!&%@ % 61 3+5%/&+"%)+,/3'(/1/ A3!*"/F!&%#, +(,%.&/ .&!*3#" ',2*!&B!'(2�&+2(2 . /$3+)/.+,!"-&G@ A3/5!''.

1975 1/*2 &+ (32F/( A3%U�" ',2*!&, ,3!,-!1/ (23'+ �!31!@ �/,/.. /1*+ F! A/ A3!*"/-F!&%� �2U+(/.'(/1/ �L�. /& A3%&#"'# )+ /31+&%)+5%� ',2*!&B!'(/1/ (32F(+. ,/, A!3%/* .

78

���� U"/ +(,%.&/! .&!*3!&%! /A!3+5%@ +/3,/(/3/&+3&/1/ U2&,%3/.+&%# (���). �32F(/.5GA/.,/3%"% /A!3+5%% ��� % 4+44+3/(/3/&+3&/1/ +&+',/4/)+ . �('A!3%4!&,! &+ '/$+(+D ' %'-A/"-)/.+&%!4 '/'2*/'U%.+��!1/ +AA+3+,+. &+',/#�!! .3!4# �!31!@ �!,3/.%B �/,/. — '/'2-*%',G@ D%3231, *. 4. &., )+.!*2��%@ /,*!"!&%!4 '/'2*%',/@ D%3231%% ���� ��� � 8 1. �!"#-$%&'(+.

�"!('+&*3 �%(/"+!.%B �/"1/. A3%U!" &+ (+?!*32 /A!3+,%.&/@ D%3231%% '/',/#.U%4'# D%-3231/4. 1991 1/*2 /& )+�%,%" (+&*%*+,'(2� *%''!3,+5%� &+ ,!42 «�+)3+$/,(+ % �('A!3%4!&-,+"-&/! /$/'&/.+&%! 4!,/*%(% ?/34%3/.+&%# +/3,+"-&/1/ +&+',/4/)+ '(3!A/B&G4 U./4 A3% +/3-,/N(/3/&+3&/4 U2&,%3/.+&%%». !4+ !1/ *%''!3,+5%% % "!1"+ . /'&/.2 3+$/,G ',2*!&B!'(/1/ &+-2B&/1/ (32F(+ «�%3/1/.!5».

�2*2B% ',2*!&,/4, )+&%4+"'# &+ (+?!*3! /A!3+,%.&/@ D%3231%% % ,/A/13+?%B!'(/@ +&+,/-4%% &G&!U&%@ )+.!*2��%@ (+?!*3/@ ?+(2"-,!,'(/@ D%3231%% *. 4. &. A3/?!''/3 %(,/3 �%(/-"+!.%B �/3*2&/.'(%@. �3/./*# �('A!3%4!&,G A/ .&!*3!&%� ('!&/1!&&/@ $3�U%&G . A3+(,%B!-'(2� D%3231%�, /& A%'+" &+2B&2� 3+$/,2 &+ �,2 ,!42. �3%.�) *+&&2� 4!,/*%(2 %) �%U%&�.+ )+-.!*2��%@ (+?!*3/@ �L�. ¬!3$+(/.. �'!&/1!&&2� $3�U%&2 %'A/"-)/.+"% (+( A"+',%B!'(%@ 4+-,!3%+" *"# )+4!�!&%# ,.�3*/@ /$/"/B(% 'A%&&/1/ 4/)1+, . (+B!',.! ,2$2'+ *"# )+4!�!&%# (/',-&GD ',32(,23, 2(3!A"!&%# +A/&!.3/)/., *"# ?%('+5%% (/',&GD /,"/4(/.. �!)2"-,+,G �('A!3%4!&-,/. A/ A"+',%(! '!"!)�&(% %'A/"-)/.+"%'- . &+2B&/@ 3+$/,!. �3% ,+(/@ A"+',%(! %'A/"-)2!,'# %"+)!3. �!,/*%(+ A/"2B%"+ &+).+&%! «"+)!3&/@ '.+3(%»: /&+ A3!*/,.3+�+!, A/#."!&%! A"+�!.%*-&/@ 1!4+,/4G % 'A/'/$',.2!, /',+&/.(! (3/./,!B!&%#. � 1980 1/*2 $G"% '/$3+&G /$��4&G! ("%-&%B!'(%! 4+,!3%+"G ($/"!! 100 '"2B+!.). �+,!4 $G"/ 3+).%,%! ,!4G +AA+3+,&/NA"+',%B!'(/1/ U.+A!B!&%. � '&/.+ )*!'- &+U"+ './� A3%4!&!&%! ('!&/1!&&+# $3�U%&+. �� %'A/"-)/.+"% A3% 3!)!(-5%% A!B!&%, A3% (%',/)&GD /$3+)/.+&%#D A!B!&%. !D&%(+ /A!3+5%% '/',/#"+ . '"!*2��!4: 2$%-3+"% B+',- (+A'2"G /31+&+, .GF%1+"% B+',- A+3!&D%4G "+)!3/4, *+"!! . (+B!',.! $%/"/1%B!'(/1/1!4/',+)+ %'A/"-)/.+"% ('!&/$3�U%&2 + '+"-&%( (+2,/,3+&'A"+&,+,). �A!3+5%% — $!'(3/.&G! )+'B�, ,/1/, B,/ $3�U%&+ '/*!3F%, «/1/"�&&G@» '"/@ (/""+1!&/.GD ./"/(/& % A/"&/',-� /',+&+.-"%.+!, (3/./,!B!&%!. �'"/F&!&%@ A/'"! /A!3+5%@ &! $G"/. +(F! 3+''4+,3%.+"+'- A3/$"!4+'(./)&GD 3+&!&%@ A!B!&%. �*!'- ('!&/,3+&'A"+&,+, %'A/"-)/.+"'# . (+B!',.! 1!4/',+,%(+ . .%*!$%/"/1%B!'(/1/ ,+4A/&+. � ' 2002 1/*+ "+)!3 +(,%.&/ ./U�" . A3+(,%(2 A3/?!''/3+ % !1/ 2B!&%-(/.. �& A3%4!&#!,'# . D%3231%% 4/"/B&/@ F!"!)G, *"# '!"!(,%.&/@ A3/('%4+"-&/@ .+1/,/4%%.�'A!D% */',%1&2,G % . D%3231%% F!"2*(+. �,+&*+3,&+# 3!)!(5%# F!"2*(+ A/*3+)24!.+!, 2*+"!&%!2/3 3!)!5%32!4/@ A/.!3D&/',%. &+',/#�!! .3!4# ',+"% 2'A!U&/ A3/./*%,-'# /A!3+5%% A/ '/-D3+&!&%� ½ F!"2*(+, A%"/3/'/D3+&#��%! 3!)!(5%% (�+2B%&+ L�.). ��� /*&/@ A3/$"!4/@ . D%-3231%% #."#!,'# *%+$!,%B!'(+# ',/A+. �,%4 ./A3/'/4 '!@B+' )+&%4+�,'# �L�. �3!(/.+, �L. �!-$!*!.+, �L. �/.+"�., L. �!"/., �L. �%3/$/(/.+.

'� $/"-U/! &+B%&+!,'# ' 4+"/1/, ,+( F! % .!"%(%! &+2B&G! /,(3G,%# % */',%F!&%# &+B%-&+�,'# ' A3%"!F&/1/ A3%'2,',.%# &+ '/$3+&%#D «�%3/1/.5+».

�1'(=,"=","0!J+=» ,#+. �+&!>!$" — �&!!;&"q0!�!>&"2+%'�)!/","0!J+++14%'$!/(+">,!�0+)+

(#!. ���������� (����.), "#!. ���������� (����.)

�!"1/3/*'(%@ 1/'2*+3',.!&&G@ &+5%/&+"-&G@ %''"!*/.+,!"-'(%@ 2&%.!3'%,!,�!*%5%&'(%@ ?+(2"-,!,, (+?!*3+ .&2,3!&&%D $/"!)&!@ � 2

�������������������: ���. !�����"�� (��. �� ., . �. �.)

�+( 1/3&G! D3!$,G %4!�, /$GB&/ A/ *.!N,3% .!3U%&G, ,+( % . &+2(! '3!*% 4&/1%D %).!',-&GD !! *!#,!"!@ .G*!"#�,'# &!'(/"-(/ %4!&, (/,/3G! &+.'!1*+ /',+�,'# . %',/3%%. � ,+(%4 .!"%-(%4 2B!&G4 A3%&+*"!F%, �L�. �%3/1/..

�%3/,+ 4!*%5%&'(/@ *!#,!"-&/',% �L�. �%3/1/.+ A/3+F+!,. �! '"2B+@&/ (32A&!@U%@ '/-.!,'(%@ A+,/"/1 �L. �+.G*/.'(%@ A/',+.%" ,+(/@ ./A3/': «�,/ $G" �%3/1/. A/ 'A!5%+"-&/-',%?». �+ �,/ /,.!,%,- &!A3/',/. �3!F*! .'!1/ �%3/1/. $G" U%3/(/ /$3+)/.+&&G4 .3+B/4. ,/F! .3!4# /& $G" +&+,/4/4, D%3231/4, A+,/"/1/4, /31+&%)+,/3/4. �2''(%@ 2B!&G@ A3/'"+.%"'# &!,/"-(/ (+( )+4!B+,!"-&G@ D%3231, &/ % (+( '/)*+,!"- '/.3!4!&&/@ D%3231%B!'(/@ +&+,/4%%: /&A!3.G4 . 4%3! A3%).+" /A!3%3/.+,- &! &+ «1"+)/(», + &+ /'&/.+&%% ,/B&/1/ )&+&%# .)+%4&/1/3+'A/"/F!&%# ,(+&!@ . (+F*/@ /$"+',% ,!"+. 32*G �%(/"+# �.+&/.%B+ A/ ,/A/13+?%B!'(/@ +&+-

79

,/4%% ',+"% ("+''%B!'(%4%, /&% A3%&!'"% !42 .'!4%3&2� %).!',&/',- % &!A3!3!(+!4G@ +.,/3%-,!, '3!*% +&+,/4/. % D%3231/.. �!'(/"-(/ '"/. / )+4/3/F!&&GD 3+'A%"+D �%3/1/.+, %"% / ,+(&+)G.+!4/@ «"!*#&/@ +&+,/4%%» �%3/1/.+.

�"!4!&,G ,/A/13+?%% %4!"% 4!',/ % */ �L�. �%3/1/.+ . ,32*+D �L�. �+1/3'(/1/ % !1/ 2B!-&%(/., /'/$!&&/ . 3+$/,+D �L. �2#"-'(/1/. �*&+(/ .'! /&% $G"% A/'.#�!&G /A%'+&%� /,*!"--&GD /A!3+5%@, A/'"!*/.+,!"-&/',% D%3231%B!'(%D 4+&%A2"#5%@ A3% 13GF!'!B!&%%, (+4&!*3/$-"!&%%, A!3!.#)(! (32A&GD (3/.!&/'&GD '/'2*/..

!"%(%! 2B!&G! �VI–�VIII .!(/. A3!*A/B%,+"% '(/3!! A3/',G! 3%'2&(%, &!F!"% ,/B&G!B!3,!F% 3+'A%"/.. �&+"%)%32# +&+,/4%B!'(%! ,32*G A3!*U!',.!&&%(/., �L�. �%3/1/. A%'+":��,+(, %) %)"/F!&&GD )+4!B+&%@ / 3+'A%"+D '"!*2!,, B,/ A3%4!&#!4G! */ &+',/#�!1/ .3!4!&%/,*!"-&G! +&+,/4%B!'(%! A/'/$%# .3#* "% #."#�,'# */',+,/B&G4% *"# %''"!*/.+&%# A/"/F!&%#/31+&/.. �$/ .'! +&+,/4G 3+''!(+"% . ,32A+D /A3!*!"!&&G! 2B+',(% ,!"+ % 3+)"%B&G! /31+&G, &!%&+B! (+( . 5!"/4 4!&## %D 3+'A/"/F!&%!, % 3+'A%"G './% /&% A3/./*%"% &! . !*%&/4 A/3#*(! %&! %'(2'&/. �/, /*&+(/, &%(,/ */ 4!&#, &+'(/"-(/ # )&+�, &%(/1*+ &% A3%4!&#" &% ,+(/@ 4+&%A2-"#5%%, (/1*+ )+4/3/F!&&/! B!"/.!B!'(/! ,!"/ %)2B+!,'# ,+(%4 /$3+)/4, B,/, A/*/$&/ $3!.&2, A/-'"!*/.+,!"-&/ . ,3!D &+A3+."!&%#D 3+'A%"%.+!,'# &+ ,/&B+@U%! A"+',%&G, &% '(2"-A,23&/1/ 4!-,/*+ %''"!*/.+&%# )+4/3/F!&&GD .&2,3!&&/',!@».

�'2�!',."## './@ )+4G'!", �L�. �%3/1/. A3/.!" 4&/1/B%'"!&&G! 3+'A%"G . ,3!D %)4!3!-&%#D )+4/3/F!&&GD B!"/.!B!'(%D ,32A/.. �+'A%"G .GA/"&#"%'- 4!D+&%B!'(/@ A%"/@, '(/&',32%-3/.+&&/@ &+A/*/$%! ,/@, (/,/3/@ 4+',!3+N(3+'&/*!3!.�%(% /$GB&/ 3+''!(+�, *!3!./ &+ ,/&B+@-U%! A"+',%&G. '! 2B+',(% ,!"+ 3+'A%"%.+"%'- ,+(%4 /$3+)/4, B,/$G /,*!"-&G! /$"+',% )+4/3/-F!&&/1/ ,!"+ 3+)*!"#"%'- A/'"/@&/ &+ 4&/F!',./ A+3+""!"-&GD *%'(/.: "%$/ A/A!3!B&GD, "%$/A3/*/"-&GD, "%$/ A!3!*&!)+*&%D, "%$/ (/'GD ,/"�%&/@ 1­­, 1/2­­, 1/4 ­­ (1­­ — /*%& ?3+&52)'(%@*�@4, 3+.!& 2 '4). �+,!4 ',!("/ %"% $24+12 3+)"%&/.G.+"% &+ 4+"!&-(%! 3/.&G! (.+*3+,G % ,+(-A3%("+*G.+"% ( *%'(+4, B,/$G A"/'(/',% '/.!3U!&&/ '/.A+*+"%, % A3/'.!B%.+��%! B+',% ' 4+-,!4+,%B!'(/@ ,/B&/',-� A!3!3%'/.G.+"% &+ 3+)"%&/.+&&2� $24+12. +(%4 'A/'/$/4 ,/B&!@U%4/$3+)/4 $G"% /$3%'/.+&G 3+'A/"/F!&%! % .&!U&%@ .%* /$"+',!@ ,!"+ % /31+&/. . '//,.!,',.%% '%D !',!',.!&&G4 A/"/F!&%!4. � B,/$G "2BU! $G"/ 3+''4+,3%.+,- 3+)"%B&G! %)1%$G A!3!1/3/*/(% $/"!! 1"2$/(/ 3+'A/"/F!&&G! /31+&G % %D 13+&%5G (&+A3%4!3, '("+*(% A"!.3G, $3�U%&G,'+"-&%(%, ("+A+&G '!3*5+), '!3/)&+# F%*(/',- %"% )+4!3)U+# (3/.- «3+'A2'(+"%'- ,!A"/@ ./*/@;'"/%, '/!*%&!&&G! D/"/*/4, A/',!A!&&/ 3+)*.%1+"%'-, (2'/B(% "-*+ /',/3/F&!@U%4 /$3+)/42*+"#"%'- +&+,/4%B!'(%4% �%A5+4%». �3+&%5G '!3/)&GD /$/"/B!(, "%U!&&G! .&2,3!&&/',!@, &+3%'2&(+D /$./*%"%'- ,3!4# "%&%#4%, %) (/,/3GD '3!*&## /$/)&+B+"+ cavea seroza, /',+"-&G! *.!— laminaparietalis % laminavisceralis.

�3% A3/.!*!&%% 3+'A%"/. �L�. �%3/1/. ',+.%" 5!"%:1) A/(+)+,- .%* % ?/342 A/"/',!@, (/,/3G! .("�B+�, /31+&G B2.',., %D 3+'A/"/F!&%! %

13+&%5G;2) %''"!*/.+,- .)+%4&/! 3+'A/"/F!&%! % 'A/'/$, (+(%4 2',3/!&G A3/4!F2,/B&G@, A3/*/"-

1/.+,G@ 4/)1, 1+&1"%% % F!"2*/B(% 4/)1+;3) A3/*!4/&',3%3/.+,- . A/*"%&&/4 .%*! A/"/F!&%! /31+&/., &+A3+."!&%!, 13+&%5G % (3%-

.%)&2 (+&+"/., #4/( % A+)2D;4) %''"!*/.+,- 3#*G % '"/% /'&/.&GD 4GU5, '/'2*/. % &!3./..�"# ,�+,!"-&/1/ %''"!*/.+&%# 3+'A/"/F!&%# B+',!@ ,!"+, (/,/3G! %)4!&#�,'# A3% 3+)"%B-

&GD *.%F!&%#D, &+ D/"/* A/4!�+"% B+',% ,32A/. (+( '%"-&/ '/1&2,G!, ,+( % 3+',#&2,G!, (+( /,-.!*!&&G!, ,+( % .G.%D&2,G! %"% '"/4+&&G!; )+,!4 F! . )+4/3/F!&&/4 '/',/#&%% %D 3+''!(+"% .,3!D &+A3+."!&%#D.

+(%4 /$3+)/4, '/',+.%"/'- '%',!4+,%B!'(/! %)"/F!&%! 3+)3!)/. .'!D B+',!@ ,!"+, '&#,GD '&+,23G . !',!',.!&&/@ .!"%B%&!. �!3.G! 3%'2&(% 3+'A%"/., A3/.!*!&&G! �,%4% 4!,/*+4% &+ )+-4/3/F!&&GD ,32A+D, $G"% /$&+3/*/.+&G �L�. �%3/1/.G4 . 1851 1. . �!,!3$231!. 1853 1. A!3-.G! ',3+&%5G �,/1/ ,32*+ $G"% A3!*"/F!&G &+ '2* �+3%F'(/@ +(+*!4%% &+2(. �+ /'&/.+&%% �,/-1/ ./ �3+&5%% $G"/ %)*+&/ ./'!4- .GA2'(/. 50 3%'2&(/. ,32*+ �L�. �%3/1/.+ '/ '"!*2��%4 &+-).+&%!4: «�""�',3%3/.+&&+# ,/A/13+?%B!'(+# +&+,/4%# 3+'A%"/. )+4/3/F!&&/1/ B!"/.!B!'(/1/,!"+, A3/.!*!&&GD . ,3!D &+A3+."!&%#D».

�/"&/! &+).+&%! �,/1/ )+4!B+,!"-&/1/ ,32*+: «Anatomia topographica sectionibus, per corpushumanum congelatum triplice directione ductis, illustrata» (%)*. 1852–1859 11.); 4 ,/4+, 3%'2&(% (224,+$"%5G, &+ (/,/3GD A3!*',+."!&/ 970 3+'A%"/.) % /$�#'&%,!"-&G@ ,!(', &+ "+,%&'(/4 #)G(! &+768 ',3L.GU"% . '.!, . 1859 1. . �!,!3$231!.

80

� A/"&G4 A3+./4 % /'&/.+&%!4 4/F&/ 2,.!3F*+,-, B,/ '/)*+&%! «�&+,/4%%» #."#!,'# .!-"%B+@U%4 &+2B&G4 % 13+F*+&'(%4 A/*.%1/4, 3+.&GD (/,/3/42 &! $G"/ . %',/3%% 4!*%5%&'(/@&+2(%.

32* '/',/%, %) B!,G3!D ,/4/.. �!3.G@ ,/4 $G" A/'.#�!& /A%'+&%#4 3+'A%"/. 1/"/.G, U!%% A/)./&/B&/1/ ',/"$+. / .,/3/4 ,/4! A3!*',+."!&G A/A!3!B&G! 3+'A%"G A/"/',% 132*&/@ ("!,(%;. ,3!,-!4 — A/A!3!B&G! 3+'A%"G A/"/',% F%./,+, 42F'(/1/ % F!&'(/1/ ,+)+; . B!,.!3,/4 — 3+'A%-"G, A3/.!*!&&G! . ,3!D &+A3+."!&%#D B!3!) (/&!B&/',% % '2',+.G .!3D&%D % &%F&%D (/&!B&/',!@. �,%D ,32*+D *!,+"-&!@U%4 /$3+)/4 A3!*',+."!&G 3%'2&(% ' A/*3/$&G4 /$�#'&!&%!4 (+F*/1/ %/$/)&+B!&%!4 .D/*#�%D . &!1/ +&+,/4%B!'(%D �"!4!&,/.. A/#'&%,!"-&/4 ,!(',! *+&G '(32A2"!)-&/! /A%'+&%! ,+$"%5, /$�%@ /$)/3 ,/A/13+?%% ,/@ %"% %&/@ B+',% ,!"+ %"% A/"/',%, A+,/"/1/+&+-,/4%B!'(%! )+("�B!&%#. �A%'+&+ ,/A/13+?%# ?+'5%+"-&GD ."+1+"%�, &!3.&GD ',./"/., '/'2*/..�A%'+&%! D+3+(,!3%)2!,'# A3/*24+&&G4 A/*$/3/4 (+F*/1/ '"/.+, (+F*/1/ /$/3/,+ 3!B%. � /'/$/@,�+,!"-&/',-� $G"% .GA/"&!&G 3+'A%"G 1/"/.G, /31+&/. B2.',., U!% % A/)./&/B&%(+ % A3!*',+.-"!&/ *!,+"-&/! /A%'+&%! (+F*/1/ +&+,/4%B!'(/1/ 3+'A%"+ (+( &!%)4!&!&&GD /31+&/., ,+( % /31+-&/., A/*.!3F!&&GD$/"!)&#4. �+F*G@ 3+)*!" +&+,/4%%, A/4%4/ /A%'+&%#, '/A3/./F*+!,'# D%323-1%B!'(%4% .G./*+4%, . (/,/3GD *+�,'# 3!(/4!&*+5%% A/ A3/.!*!&%� /A!3+,%.&GD .4!U+,!"-',. %3+)"%B&GD 4+&%A2"#5%@, &!3!*(/ '/.!3U!&&/ /3%1%&+"-&G!. �L�. �%3/1/. A%'+": «�+U% 4!,/*G%''"!*/.+&%# 4/12, $G,- A/"!)&G &! ,/"-(/ *"# ,/A/13+?%B!'(/@ +&+,/4%%, &/ % *"# 1%',/"/1%% %A+,/"/1%%. �/�,/42 4G A3%"+1+!4 ( &+U!42 ,32*2 4&/F!',./ 3%'2&(/., &+ (/,/3GD A3!*',+."!&G'/',/#&%# /31+&/., %)4!&!&&GD $/"!)&-�». �3!*"/F!&&G@ �%3/1/.G4 4!,/* 3+'A%"/. )+4/3/F!&-&GD ,32A/. )+',+.%" )+&/./ A!3!'4/,3!,- /'&/.G ,/A/13+?%B!'(/@ +&+,/4%%, ,+( (+( 3+'A%"G, A3/-.!*!&&G! . ,3!D .)+%4&/ A!3A!&*%(2"#3&GD &+A3+."!&%#D, '/)*+.+"% %',%&&/! A3!*',+."!&%! /,/A/13+?%% /31+&/., %D .)+%4/3+'A/"/F!&%%, .!"%B%&! % ?/34!.

�/.!3U!&&/ /B!.%*&/, B,/ 4!,/*/"/1%B!'(%! A/*D/*G ( %)2B!&%� &/34+"-&/@ % A+,/"/1%-B!'(/@ +&+,/4%%, )+"/F!&&G! . ,32*+D �L�. �%3/1/.+, &+ ',/"!,%# /A!3!*%"% 3+).%,%! 4!*%5%&-'(/@ &+2(%. /"-(/ . (/&5! �� .!(+ A/#.%"+'- ./)4/F&/',- A/"2B+,- %)/$3+F!&%# B!"/.!B!'(/1/,!"+ . ,3!D %)4!3!&%#D. �,/42 A3!*U!',./.+"/ '*!"+&&/! $/"!! 100 "!, &+)+* /,(3G,%!L�. �!&,1!&+, %'("�B%,!"-&+# )&+B%4/',- (/,/3/1/ A/)./"%"+ &! ,/"-(/ A/"2B+,- %)/$3+F!&%!A+,/"/1%B!'(%D %)4!&!&%@ $!) .&!*3!&%# . /31+&%)4, &/ % '*!"+"/ �,/ %)/$3+F!&%! */(24!&,%-32!4G4, /$�!(,%.&G4. �+ 100-"!,&�� %',/3%� 3+).%,%# 3!&,1!&/.'(%D 4!,/*/. %''"!*/.+&%#,!D&/"/1%B!'(+# .//32F!&&/',- % *%+1&/',%B!'(%! ./)4/F&/',% "2B!./@ *%+1&/',%(% )&+B%,!"--&/ ./)3/'"%. �)/$3!,!&%! . &+B+"! 1970-D 1/*/. (/4A-�,!3&/@,/4/13+?%% (�), + &!'(/"-(/ A/)-F! 4+1&%,&/N3!)/&+&'&/@ ,/4/13+?%% (��) $G"/./'A3%&#,/ (+( (32A&!@U%@ .("+* . 3+).%,%!"2B!./@ *%+1&/',%(% ' 4/4!&,+ /,(3G,%# 3!&,1!&/.'(%D "2B!@. �/"2B+!4+# �,%4% 4!,/*+4% %&-?/34+5%# +$'/"�,&/ /$�!(,%.&+, ,+( (+( /'&/.+&+ %"% &+ 13+*%!&,! A/1"/�!&%# �&!31%% 3!&,1!-&/.'(/1/ %)"2B!&%# (A3% A/"2B!&%% (/4A-�,!3&/N,/4/13+?%B!'(%D %)/$3+F!&%@), %"% &+ 3+)"%-B%% %'A2'(+!4GD 3+)"%B&G4% ,(+&#4% A3% /A3!*!"!&&GD 2'"/.%#D �"!(,3/4+1&%,&GD '%1&+"/.¥A3% A/"2B!&%% 4+1&%,&/N3!)/&+&'&/1/ %)/$3+F!&%#). �)2B+# 3%'2&(%, .GA/"&!&&G! �L�. �%3/-1/.G4, % '3+.&%.+# %D ' %)/$3+F!&%#4%, A/"2B+!4G4% '!1/*&# ' A/4/�-� '/.3!4!&&GD 4!,/*/.4!*%5%&'(/@ .%)2+"%)+5%%, 4G 2$!F*+!4'# . %D +$'/"�,&/@ %*!&,%B&/',%.

�/ )+4G'"2 �%3/1/.+ '3!)G . (+F*/@ A"/'(/',% A3/%)./*%"%'- '!3%@&/, ,. !. . ',3/1/@ A/'"!-*/.+,!"-&/',%. !4 '+4G4 $G"+ A3/.!*!&+ +&+,/4%B!'(+# ,/4/13+?%# .'!D /31+&/.. �!1/*&# A3!*-',+."#!,'# ./)4/F&/',- '3+.&%,- �',+4AG +&+,/4%B!'(%D '3!)/. ' ,/4/13+44+4%. +(%4 /$3+)/4,�L�. �%3/1/.+ '"!*2!, A/ 'A3+.!*"%./',% 'B%,+,- A3!*,!B!@ ,3%24?+ (/4A-�,!3&/@ ,/4/13+?%%.

q��������. 4+! 1881 1/*+ . '.#)% ' A3+)*&/.+&%!4 50-"!,%# &+2B&/@ *!#,!"-&/',%�L�. �%3/1/.+ «3+B!$&G! .!*/4/',%» A%'+"%: «�$�!',./ &+U! !�! &! 4/F!, .A/"&! /5!&%,-)+'"21% �%3/1/.+. �/ B!4 $/"!! A3/@*!, .3!4!&%, B!4 $/"-U! $2*!, 3+).%.+,-'# /$�!',./, ,!4.%*&!! *"# &!1/ $2*!, .!"%B+.+# ?%123+ &+U!1/ )&+4!&%,/1/ 2B%,!"#, ,!4 #'&!! /&/ /'/)&+!, !1/.+F&/! % 4%3/./!, % &+5%/&+"-&/! )&+B!&%!».

�,% '"/.+ A/"&/',-� A/*,.!3*%"%'-. �!1/*&# 4G /,*+!4 *+&- /13/4&/1/ 2.+F!&%# % A3%-)&+,!"-&/',% �L�. �%3/1/.2 — &+U!42 .!"%(/42 '//,!B!',.!&&%(2. �L�. �%3/1/. /31+&%B&/ '/-B!,+" B!3,G .!"%(/1/ 4G'"%,!"# % 13+F*+&%&+, ./A"/�+# '/$/@ %*!+"-&G@ /$3+) .3+B+. +(%4 /&/',+"'# . %',/3%%, ,+(%4 /& F%.!, . &+U!4 A3!*',+."!&%% '!1/*&#, #."## A3%4!3 *"# &/.GD % &/-.GD A/(/"!&%@ .3+B!@.

�A%'/( "%,!3+,23G:1. �2A3%#&/., L. �',/3%B!'(/! )&+B!&%! &+'"!*%# �L�. �%3/1/.+ A/ /,)G.+4 %&/',3+&-

&GD 2B!&GD // !',&%( ����. — 1997. — � 1 (3). — C. 86–92.

81

2. �%3/1/., �L�. /A3/'G F%)&%. �&!.&%( ',+3/1/ .3+B+. — �.+&/./, 2008.3. �!,3/.'(%@ �L., �/&',+&,%&/. �L�., �/1/3+* �L. «�!*#&+# +&+,/4%#» �L�. �%3/1/.+ —

.!"%(/! A3/%).!*!&%! 4%3/./@ &+2(%. — �., 1999.4. �!.B!&(/ �L�., �/)/.!&(/ �L�. �2)!@ �L�. �%3/1/.+. — ��$., 2005.5. �!.B!&(/, �L�. �, «"!*#&/@ +&+,/4%%» */ (/4A-�,!3&/@ ,/4/13+?%%. �(,/.+# 3!B-

( 150-"!,%� '/ *&# %)*+&%# �L�. �%3/1/.G4 «�""�',3%3/.+&&/@ ,/A/13+?%B!'(/@ +&+,/4%%3+'A%"/., A3/%).!*!&&GD . ,3!D %)4!3!&%#D B!3!) )+4/3/F!&&/! B!"/.!B!'(/! ,!"/». — �., 2009.

+�0!&+=&"��&!�0&",',+=)4&',+=�!$&'J',�+&!>!$"+(!,"x+^(,'/

"#". ������ (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

�������������������: ���. ��%��� (��., . �. �.)

�23!&%! — '+4+# (/.+3&+#, '+4+# )"/.!�+# "/.2U(+, '/)*+&&+# '/.4!',&G4% 2'%"%#4% B!-"/.!(+ % A3%3/*G. �,/ !*%&',.!&&+# "/.2U(+, . (/,/3/@ &!, &%(+(/@ A3%4+&(%, *+F! 4+"�'!&--(/1/ (2'/B(+ 'G3+. �+( F! &+B%&+"+'- %',/3%# ,+$+(/(23!&%#? �',/(% (23!&%# ,+$+(+ 2D/*#, .*+"!(/! A3/U"/!. �4!3%(+&'(%! %&*!@5G, /*&%4% %) A!3.GD &+B+.U%! A/,3!$"#,- ,+$+(, %'A/"--)/.+"% !1/ . 4+"GD */)+D (+( ',%42"%32��!! '3!*',./, *"# A/*+."!&%# 1/"/*+ % F+F*G, + ,+(F!(+( $/"!2,/"#��!!. G(23%.+&%! &!$/"-U/1/ (/"%B!',.+ ,+$+(+ A3/./*%"/'- ./ .3!4# ./!&&GDA!3!1/./3/., *"# A/*,.!3F*!&%# *32F$G, 2'%"!&%# $/!./1/ *2D+ ./%&/.. �3/4! ,/1/, %&*!@5+4$G"/ %).!',&/, B,/ $/"-U%! */)G ,+$+(+ ."%#�, &+ '/)&+&%!, % �,/ './@',./ %'A/"-)/.+"/'- *"#3!"%1%/)&GD 5!"!@: ..!*!&%! . ,3+&', /$�!&%! ' *2D+4%. +(%! /'/$!&&/',% ./)*!@',.%# ,+$+(+A3%*+.+"% !42 '.#�!&&G@ ',+,2'. �3% �,/4 ',/%, /,4!,%,-, B,/ (23!&%! &! $G"/ 1"+.&G4 'A/'/-$/4 A/,3!$"!&%# ,+$+(+. �+�! %&*!@5G */$+."#"% ,+$+( . A%�2, F!.+"% "%',-#, A%"% '/( ,+$+(+%"% '%3/A. �!(/,/3G! %''"!*/.+,!"% 2,.!3F*+�,, B,/ A!3.G4% &+ )!4"! (23%"-�%(+4% $G"%!1%A!,'(%! ?+3+/&G. /*&/@ %) 13/$&%5 II ,G'#B!"!,%# */ &+U!@ �3G &+@*!&G 1"%&#&G@ (+"-#& %*321%! (23%,!"-&G! A3%&+*"!F&/',%. 1492 1/*2 �3%',/?/3 �/"24$ /,(3G" *"# �.3/AG &!,/"-(/ �4!3%(2, &/ % &/./! 3+',!&%! — ,+$+(, (/,/3G@ .&+B+"! A/"2B%" 3+'A3/',3+&!&%! (+( "!-B!$&/! '3!*',./. �*&+(/ &+3#*2 ' ./'D.+"!&%!4 ,+$+(+ B!3!) &!(/,/3/! .3!4# A/#.%"%'- ,+(F!A3!*/',!3!F!&%# "�$%,!"#4 (23!&%#. �G"/ % ,+(/! .3!4#, (/1*+ ' (23!&%!4 ,+$+(+ .!"+'- F!',/-(+# $/3-$+ A/B,% ./ .'!D ',3+&+D. �/ 2(+)2 (+,/"%B!'(/@ 5!3(.% )+ 2A/,3!$"!&%! ,+$+(+ '+F+"% .,!4&%5G % *+F! (+)&%"%.

�/''%% */"1/! .3!4# 2A/,3!$"!&%! ,+$+(+ &! A//�3#"/'-. A!3.G! ,+$+( A/#.%"'# . �/'-'%% A3% �.+&! �3/)&/4. �1/ )+.!)"% +&1"%@'(%! (2A5G. �23!&%! &+ (/3/,(/! .3!4# A3%/$3!"/ A/-A2"#3&/',- '3!*% )&+,%. �3% 5+3! �%D+%"! �!*/3/.%B! �/4+&/.! ,+$+( 'B%,+"'# «*-#./"-'(%4)!"-!4», + (23!&%! &+(+)G.+"/'- 3+'�!A"!&%!4 &/'+ (.G3G.+&%!4 &/)*3!@) % (&2,/4. 1697 1/*2'!3%!@ 2(+)/. 5+3- �!,3 �"!('!!.%B (�!,3 I), 1/'2*+3-N3!?/34+,/3, *"# (/,/3/1/ &+32U!&%! ,3+-*%5%/&&/1/ 2',/# F%)&% $G"/ &!A3!4!&&G4 2'"/.%!4 A3+."!&%#, "!1+"%)/.+" A3/*+F2 ,+$+(+ %2',+&/.%" A3+.%"+ !1/ 3+'A3/',3+&!&%#.

�+4G@ A%( 3+'A3/',3+&!&&/',% ,+$+(/(23!&%! A/"2B%"/ . 19-4 .!(!. 1828 1/*2 1!34+&-'(%! D%4%(% ��*.%1 �!@4+&& % %"-1!"-4 �/''!"-, .G*!"%"% &%(/,%&, % 2F! . U!',%*!'#,GD1/*+D $G"/ &+B+,/ A3/4GU"!&&/! A3/%)./*',./ '%1+3!,, (/,/3/! /(+)+"/'- .!'-4+ */D/*&G4.+(, . 1867 1/*2 %)/$3!,+,!"- �2%' �2'%&% A3!*',+.%" &+ .'!4%3&/@ .G',+.(! . �+3%F! '%1+3!,-&2� 4+U%&2 A3/%)./*%,!"-&/',-� 3 600 '%1+3!, . B+'. 1883 1/*2 +4!3%(+&'(%@ %&F!&!3�F!@4' �"$!3, �/&'+( (/&',32%32!, 4+U%&2 A3/%)./*%,!"-&/',-� 15 ,G'. '%1+3!, . B+'. �/',/-#&&/ ./)3+',+��+# '(/3/',- /$/32*/.+&%# '*!"+"+ '%1+3!,G *!U!.G4 A3/*2(,/4, B,/ #.%"/'-,/"B(/4 ( %D U%3/(/42 3+'A3/',3+&!&%�. � (/&52 19-1/ .!(+ (23!&%! A3/&%("/ *+F! . $!*&!@-U%! ',3+&G 4%3+.

�+12$&/@ A3%.GB(! $G"% A/*.!3F!&G ,+(%! %).!',&G! "%B&/',%, (+( �L. �+D4+&%&/.,�L�. �/3-(%@, 32''(%@ .3+B % 2B!&G@ �L�. �/,(%&. �4%3+# .'!1/ . 57 "!,, �/,(%& '(+)+": «�'"%$G # &! (23%", # 2$!F*�&, B,/ $!) ',3+*+&%@ A3/F%" $G !�� &!'(/"-(/ "!,». � *+F!, .!"%(%@ 2B!-&G@ % .3+B �L�. �%3/1/. 2A/,3!$"#" ,+$+B&G! %)*!"%#. �3/(23%. 4&/1/ "!,, �%3/1/. )+$/"!" &!-/F%*+&&/, (/1*+ 2F! A3/F%.+" A/',/#&&/ . './!4 %4!&%% %U&#. .!3D&!@ B+',% B!"�',% /$3+-

82

)/.+"+'- #).+. �/AG,(% A3%(3G.+,- !! (2'/B(+4% $24+1%, '4+)+&&/@ % A3/A%,+&&/@ 12',G4 /,.+-3/4 "-&#&/1/ '!4!&%, &! *+"% �??!(,+. �!3.G4% (/&'2"-,+&,+4% $G"% �L. �("%?/'/.'(%@ %�L. �!3,!&'/&. 24 4+# 1881 1/*+ �L. �("%?/'/.'(%@ 2',+&/.%" &+"%B%! 3+(+ .!3D&!@ B!"�',% %'B%,+" &!/$D/*%4G4 '3/B&/ /A!3%3/.+,- $/"-&/1/. 32*&/ A3!*A/"/F%,-, B,/ �L�. �%3/1/., $"!-',#�%@ D%3231, *%+1&/',, B!3!) 32(% (/,/3/1/ A3/U"% *!'#,(% /&(/"/1%B!'(%D $/"-&GD, &! 4/1'+4 A/',+.%,- *%+1&/).

�).!',%! / ,/4, B,/ 2 &!1/ )"/(+B!',.!&&+# /A2D/"-, A/.!31"/ �%(/"+# �.+&/.%B+ . ,#F!-"!@U2� *!A3!''%�. �,(+)+.U%'- /, /A!3+5%%, /& 2!)F+!, ( './!42 2B!&%(2 . �%"-3/,2 . !&2 &+(/&'2"-,+5%� . '/A3/./F*!&%% .,/3/@ F!&G �"!('+&*3G �&,/&/.&G % "%B&/1/ .3+B+ �. �("#-3!.'(/1/. !&! . �%"-3/, /'4/,3!" $/"-&/1/, 2$!*%"'# . ,#F!"/4 *%+1&/)!, /*&+(/ A/&#", B,//A!3+5%# &!./)4/F&+ %)N)+ ,#F!"/1/ 4/3+"-&/1/ % ?%)%B!'(/1/ '/',/#&%# $/"-&/1/, A/�,/42 /&�/,.!31» *%+1&/), A/',+."!&&G@ 3/''%@'(%4% .3+B+4%. �,/, /$4+& «./'(3!'%"» �%3/1/.+: «�2,!'"% G 4&! �,/ 1/./3%,! — ,/ # 2'A/(+%.+�'-». �G" &+)&+B!& /,.+3 "-&#&/1/ '!4!&% % A/"/'(+-&%! 3,+ 3+',./3/4 (.+'5/.. �%(/"+@ �.+&/.%B .!3&2"'# */4/@ 2'A/(/!&&G4. �!'4/,3# &+ A3/-13!''%3/.+&%! $/"!)&%, 2$!F*!&%!, B,/ �,/ &! 3+(, A/4/1+"/ !42 F%,-, *+F! (/&'2"-,%3/.+,-$/"-&GD, 2B+',./.+,- . �$%"!@&GD ,/3F!',.+D, A/'.#�!&&GD 70-"!,%� '/ *&# !1/ 3/F*!&%#. �+*.+*5+,- *&!@ */ '4!3,% �L�. �%3/1/. &+ ("/B(! $24+1% &+A%'+": «�% �("%?/'/.'(%@, +"- %�32$!, &% �%"-3/, &! 2)&+"% 2 4!&# ulcusorismer. mul. cancerosumserpiginosun, %&+B! A!3.G! ,3% &!'/.!,/.+"% $G /A!3+5%%, + .,/3/@ &! A3%)&+" $G $/"!)&- )+ */$3/(+B!',.!&&2�…». 23 &/#$3#1881 1/*+ . 8 B+'/. 25 4%&2, A!3!',+"/ $%,-'# '!3*5! .!"%(/1/ 32''(/1/ A+,3%/,+, 2B!&/1/, 4G'-"%,!"# % 13+F*+&%&+.

/ .3!4# �!3./@ 4%3/./@ ./@&G ,+$+( A/"2B%" .!'-4+ U%3/(/! 3+'A3/',3+&!&%!. �3%.GB-(+ (23!&%# "!1(/ 3+'A/")+"+'- % A3%F%.+"+'- '3!*% /13/4&GD (/&,%&1!&,/. 42FB%&, &+D/*#�%D-'# . 2'"/.%#D '(2B!&&/',%, &!2',3/!&&/1/ $G,+, A/',/#&&/1/ ',3!''+ % *"%,!"-&/1/ .G&2F*!&&/-1/ $!)*!"-#. �%1+3!,G, ,+$+( .D/*%"% ,/1*+ . !F!*&!.&G@ '/"*+,'(%@ A/!(, % 4&/1%!, *+F! &!3+'A/"/F!&&G! ( (23!&%�, A3%/$�+"%'- ( &!42.

�!3.+# 4%3/.+# ./@&+ '*!"+"+ ,+$+B&G! %)*!"%# ,/.+3/4 /$/3/&&/1/, ',3+,!1%B!'(/1/ )&+-B!&%#. �/./"-&/ $G',3/ (23!&%! A/"2B%"/ /13/4&/! 3+'A3/',3+&!&%! % A/A2"#3&/',-. �23%"%'/"*+,G % 1!&!3+"G, 3+$/B%! % B%&/.&%(%, +(,!3G % A%'+,!"%. �,/ $G"+ &+',/#�+# �A%*!4%#, /A/'"!*',.%#D (/,/3/@ ,/1*+ &%(,/ &! A/*/)3!.+". �23%"% $!))+$/,&/, &% / B!4 &! $!'A/(/#'-. �,/$G"/ )/"/,/! .3!4# *"# (23%"-�%(/. % ,+$+B&/@ %&*2',3%%. "+*%4%3 �+#(/.'(%@ &+A%'+" ,+(%!3!("+4&G! ',3/B(%: «�/./! .3!4#. �2D /)+3!&%#. «�.G» ,+$+B&/@, �2D .*/D&/.!&%#». � (23!&%%A!"% A!'&%: «�+.+@ )+(23%4, ,/.+3%�, A/ /*&/@». �%(,/ ,/1*+ &! A21+" % &! A3!*2A3!F*+" (2-3%"-�%(/., &! $/3/"'# ' (23!&%!4. �!3.G@ ,3!./F&G@ '%1&+" A3/).2B+" . 1938 1/*2, (/1*+ �+@-4/&* �%3", A3/?!''/3 $%/"/1%% . ���, A3/+&+"%)%3/.+. A3/*/"F%,!"-&/',- F%)&% 6 813 F%,!-"!@ /*&/1/ %) 4+"!&-(%D 1/3/*(/. �4!3%(%, 2',+&/.%": $/"!! 60 "!, A3/F%"% 66 % &!(23#�%D %,/"-(/ 46 % %) B%'"+ (23%"-�%(/.. �+3+""!"-&/ �,/42 . 1930–40-D 1/*+D &+5%','(+# �!34+&%#.A!3.G! . %',/3%% B!"/.!B!',.+ A3/./*%"+ (32A&/4+'U,+$&2� (+4A+&%�, 5!"-� (/,/3/@ $G"/)+',+.%,- &!45!. /,(+)+,-'# /, (23!&%#. �4!&&/ ,/1*+ .A!3.G! $G"% /A3/$/.+&G 4&/1%! 4!,/*G,&G&! A3%4!&#!4G! A3+.%,!"-',.+4% ',3+& 4%3+ . $/3-$! ' (23!&%!4. 1954 1/*2 A/#.%"'# */(-"+* �4!3%(+&'(/1/ /$�!',.+ $/3-$G ' 3+(/4, . (/,/3/4 '//$�+"/'-, B,/ '4!3,&/',- /, 3+(+ '3!-*% (23#�%D 42FB%& &+ 75 % .GU!, B!4 '3!*% &!(23#�%D.

�!1/*&#, A/ *+&&G4 ��, . 4%3! . '3!*&!4 (+F*G! U!',- '!(2&* 24%3+!, /*%& B!"/.!( /,)+$/"!.+&%@, '.#)+&&GD ' (23!&%!4 ,+$+(+, + !F!1/*&/ A/ �,/@ A3%B%&! 24%3+�, A#,- 4%""%/&/.B!"/.!(. �23!&%! 3+'A3/',3+&!&&/ '3!*% .'!D '"/!. &+'!"!&%#, '3!*% .'!D A3/?!''%@. �3!*% .3+-B!@ (23#, /(/"/ 40 % 42FB%& % A/B,% 20 % F!&�%& (�(3+%&+). �''"!*/.+&%# 4!*%5%&'(/1/ 2&%-.!3'%,!,+ �/3!% .G#.%"/, B,/ '3!*% .3+B!@ 35 % — (23%"-�%(%. �"# '3+.&!&%#: . !"%(/$3%,+-&%% % ��� �,/ (/"%B!',./ '/',+."#!, /, ,3!D */ B!,G3!D A3/5!&,/..

+(F! A+12$&+# A3%.GB(+ U%3/(/ 3+'A3/',3+&!&+ '3!*% U(/"-&%(/. % ',2*!&,/. .G'U%D2B!$&GD )+.!*!&%@, . ,/4 B%'"! ',2*!&,/. 4!*%5%&'(%D .2)/.. +(, . �!"#$%&'(/@ 1/'2*+3',.!&-&/@ 4!*%5%&'(/@ +(+*!4%% $G"/ A3/.!*!&!&/ .G$/3/B&/! +&(!,%3/.+&%! 200 ',2*!&,/.. �B+�%!-'# *!"%"%'- &+ *.! 132AAG A/ &+"%B%� %"% /,'2,',.%� A3%',3+',%# ( A+12$&/@ A3%.GB(!. (+F-*/@ 132AA! %)2B+"/'- '//,&/U!&%! A/"/. % &+"%B%! &%(/,%&/./@ )+.%'%4/',%. �G"% A/"2B!&G'"!*2��%! 3!)2"-,+,G. �//,&/U!&%! 42F'(/1/ (24,5 %) % F!&'(/1/ (75,5 %) A/"/. (+( /*%& (,3!4. �/"%B!',./ (23#�%D ',2*!&,/.£%) B%'"+ /A3/U!&&GD '/',+.%"/ 25,5 % (51), %) &%D A3/5!&,(23#�%D *!.2U!( — 67 % (34), 42FB%& — 33 % (17). �3/5!&, 2B+�%D'#, &! 2A/,3!$"#��%D ,+-$+B&G! %)*!"%#, — 74,5 (149). 17 % ',2*!&,/. �!"��� &+B+"% (23%,- A/'"! 16 "!,, + 8,5 % — */

83

16. �+ ?/&! .G'/(/@ 3+'A3/',3+&!&&/',% (23!&%# */./"-&/ .!"%( 2*!"-&G@ .!' ,!D, (,/ (23%, .(/"%B!',.+D, /(+)G.+��%D '2�!',.!&&/! &!1+,%.&/! ."%#&%! &+ )*/3/.-!. +(, '3!*% ',2*!&,/.$/"-U! A+B(% . *!&- (23%, 1 %, + 4!&!! 20 '%1+3!, !F!*&!.&/ — 24,5 %.

�!'4/,3# &+ (+F2�2�'# $!)/$%*&/',-, (23!&%! #."#!,'# ',3+U&G4 /32F%!4 4+''/./1/2&%B,/F!&%#, 2&/'#�%4 . 1/* $/"-U! F%)&!@, B!4 2&/'%"+ "�$+# ./@&+. � !'"% ,!&*!&5%# &+3+'-,+&%# 3+'A3/',3+&�&&/',% (23!&%# &! $2*2, '&%F+,-'#, ,/, A/ A3/1&/)+4, ( 2020 1/*2 !F!1/*&/$2*2, A3!F*!.3!4!&&/ 24%3+,- 10 4"& B!"/.!(, + ( 2030 1/*2 — (23!&%! ,+$+(+ ',+&!, /*&%4 %)'+4GD '%"-&GD ?+(,/3/., A3%./*#�%D ( A3!F*!.3!4!&&/@ '4!3,%.

�A%'/( "%,!3+,23G:1. �+$+&/., �L�L�+'A3/',3+&!&%! ,+$+(/(23!&%# '3!*% 4!*%5%&'(%D 3+$/,&%(/. // �*3+./-

/D3+&!&%! ��. — 2006.2. �+33, �. �!1(%@ 'A/'/$ $3/'%,- (23%,- — �.: �/$3+# �&%1+, 2008.3. �+('%4!&(/., �L�. �%(/"+@ �.+&/.%B �%3/1/.. — �.: �!*1%), 1961.4. �/1%"!.'(%@, �. �%)&- �%3/1/.+ — �., 1996.5. �3%.+"/., �. � $/3-$! ' (23!&%!4 — �.: �('A!3,, 2008.6. �+*$%"- �L�., �/4+3/. �L�. �23!&%! — �.: �!*%5%&+, 1988. — 157 '.7. �1"/., �L�. �23!&%! — 3+)32U%,!"- 1!&!,%B!'(/1/ (/*+ — �.: �����N�!*%+, 2009.

")04"1],!�0]�'(">!>+%'�)!>!,"�1'(+=,+)!1"=+$",!$+%"�+&!>!$"

0#". &��� ��� (����.), "#$. ������� (����.), )#$. )����� (����.), J#$. ;����z (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#1 �+?!*3+ $%/D%4%%

2 �+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%�������������������: 1 !��. #��$� &��. �� ., . �. �.), 2 ���. ��%��� &��., .�. �.)

$�������. 1881 1/*2�%(/"+@ �.+&/.%B �%3/1/. ',+" A#,G4 A/B!,&G4 13+F*+&%&/4 �/-'(.G «. '.#)% ' A#,%*!'#,%"!,&!@ ,32*/./@ *!#,!"-&/',-� &+ A/A3%�! A3/'.!�!&%#, &+2(% %13+F*+&',.!&&/',%». �).!',&/, B,/ �L�. �%3/1/. .&!' $/"-U/@ .("+* . 3+).%,%! /,!B!',.!&&/@A!*+1/1%(%. './!@ ',+,-! «/A3/'G F%)&%» /& 3+''4/,3!" ?2&*+4!&,+"-&G! A3/$"!4G 3/''%@-'(/1/ ./'A%,+&%#. �L�. �%3/1/. .G*.%&2" . (+B!',.! 1"+.&/@ 5!"% ./'A%,+&%# ?/34%3/.+&%! .G-'/(/&3+.',.!&&/@ "%B&/',%, 1/,/./@ /,3!U%,-'# /, �1/%',%B!'(%D 2',3!4"!&%@ 3+*% $"+1+ /$�!-',.+. �B!&G@ 'B%,+", B,/ *"# �,/1/ &!/$D/*%4/ A!3!',3/%,- .'� '%',!42 /$3+)/.+&%#, $+)%32#'-&+ /'&/.! A3%&5%A/. 124+&%)4+ % *!4/(3+,%)4+. �/ 4&!&%� �L�. �%3/1/.+, '%',!4+ /$3+)/.+&%#,/$!'A!B%.+��+# 3+).%,%! "%B&/',%, */"F&+ ',3/%,-'# &+ &+2B&/@ /'&/.! — /, &+B+"-&/@ */.G'U!@ U(/"G — % /$!'A!B%.+,- A3!!4',.!&&/',- .'!D '%',!4 /$3+)/.+&%#.

�*&+(/ '/.3!4!&&+# +(+*!4%B!'(+# &+2(+ A3!,!3A!.+!, 1"2$/(%@ (3%)%'. �/ 4&!&%� &!(/-,/3GD 2B!&GD, �,/ /$2'"/."!&/ ,!4, B,/ . './! .3!4# �. �+3(' % �. �&1!"-', ?/342"%32# A3%&5%-AG *%+"!(,%B!'(/1/ 4+,!3%+"%)4+, A3!A+3%3/.+"% 1!1!"!.'(2� ?!&/4!&/"/1%� 4%3/./1/ *2D+:/',+.%"% !1/ *%+"!(,%(2, &/ )+4!&%"% *2D 4+,!3%!@, .'"!*',.%! B!1/ &+B+"/'- 3+).%,%! 4+,!3%+-"%',%B!'(/1/ 4%3/./))3!&%#. �!"/.!B!',./ */',%1"/ &!.!3/#,&GD 2'A!D/., ."+*!!, ,!D&/"/1%#4%&+ 23/.&! &+2B&/@ ?+&,+',%(%, &/ F%.!, . A/',/#&&/4 ',3+D!, &+ 13+&% �(/"/1%B!'(/@ (+,+',3/-?G (�/$!5 �L�., �21/.GD �L�., 2011).

�3/./*# +&+"%) ?%"/'/?'(%D ,32*/., 4G .G#.%"%, B,/ �A/D+"-&/! 21"2$"!&%! .)1"#*/. %4!,/*/. ?%"/'/?'(/1/ /'4G'"%.+&%# 3!+"-&/',%, '+4/1/ A3!*4!,+ ?%"/'/?%% &+B+"/'- ' (3%,%-B!'(/1/ ,!)%'+ �+&,+. �%"/'/? '4!',%" .&%4+&%! ' '/*!3F+&%# A/)&+��!@ % /5!&%.+��!@ 4G'-"% &+ ?/342 % 4!D+&%)4 4GU"!&%#. � . ,/4 B%'"! '4!',%" +(5!&,%3/.(% A/&%4+&%# �(/"/1%B!-'(%D A3/$"!4 (�&%'%4/. �L�., 2008; �"+)+B!. �L�., 1998). 2)(/4 % ,3+*%5%/&&/4 '4G'"! �(/"/-1%# %)2B+!, A3/$"!4G (/�./"�5%% A3%3/*G % B!"/.!B!',.+, '/D3+&!&%# A3%3/*&/1/ 3+)&//$3+)%#&+ &+U!@ A"+&!,!, /D3+&G F%./@ A3%3/*G. U%3/(/4 '4G'"!, 4/F&/ 1/./3%,- /$ �(/"/1%% B!"/-.!B!'(/1/ 3+)24+, �(/"/1%% A/)&+&%# % ,./3B!',.+, �(/"/1%% 4G'"% % '"/.+. / .'!D '"2B+#D 3!B-%*!, / B!"/.!(! % /(32F+��!4 !1/ 4%3!, (/,/3G@ '/)*+!,, (/&',32%32!, /& '+4 % (/,/3G@ '/)*+!,!1/ '+4/1/ (�&#)!.+ �L�., �23*�4/. �L�., 2007; �&#)!.+�L�., 2009; �/3!& �., 2006; LamL., 1998).

�+*%(+"-&G! A3!/$3+)/.+&%# 3/''%@'(/1/ /$�!',.+ '.#)+&G ' �(/"/1%)+5%!@ /$3+)/.+&%#.�3%&5%A%+"-&G! %)4!&!&%# &+5%/&+"-&GD '%',!4 /$3+)/.+&%# /$!'A!B%.+�, &!A3!3G.&G@ A3/-

84

5!'' ?/34%3/.+&%# �(/"/1%B!'(/@ (2"-,23G, &+A3+."!&&G@ &+ ?/34%3/.+&%! /$�!@ �(/"/1%B!-'(/@ (2"-,23G, �(/"/1%B!'(/@ /,.!,',.!&&/',% (+F*/1/ 13+F*+&%&+ (�/'2&/.+ �.A., �+3(/.%B�L�., 2009). �/&5!A5%# &+5%/&+"-&/@ $!)/A+'&/',% �/''%@'(/@ �!*!3+5%% /,&/'%, ( B%'"2 .+F-&!@U%D )+*+B /$!'A!B!&%# &+5%/&+"-&/@ $!)/A+'&/',% (/3!&&/! 2"2BU!&%! �(/"/1%B!'(/@ /$-',+&/.(% . ',3+&! % A3#4/ '.#)G.+!, 213/)2 2D2*U!&%# �(/"/1%B!'(/@ '%,2+5%% %4!&&/ ' &%)(/@�(/"/1%B!'(/@ (2"-,23/@ &+'!"!&%# % 'A!5%+"%',/.. �).!',&/, B,/ )+13#)&!&%! /(32F+��!@ '3!-*G A3%.!"/ ( A/#."!&%� �(/"/1%B!'(/@ A+,/"/1%% (��, �!&!.+, 1989). �+'A3/',3+&!&&/',- +"-"!31/A+,/"/1%% &+%$/"!! .G'/(+ . 3!1%/&+D ' �(/"/1%B!'(% &!$"+1/A3%#,&/@ /$',+&/.(/@, /$2-'"/."!&&/@ +&,3/A/1!&&G4 ./)*!@',.%!4 &+ /(32F+��2� '3!*2 % )+.%'%, (+( /, D+3+(,!3+ +"-"!31!&&/1/ /(32F!&%#, ,+( % /, ("%4+,/N1!/13+?%B!'(%D /'/$!&&/',!@ 3!1%/&+ (�+3+&/. �L�. %*3., 2006; �/1/4%"-'(%@ �L�. % *3., 2010; �+'�( L�., 2008). �&+B%,!"-&/! )+13#)&!&%! /(32F+�-�!@ '3!*G, 3/', )+$/"!.+!4/',% &+'!"!&%# /$2'"+."%.+�, &!/$D/*%4/',- A3/.!*!&%# U%3/(%D�(/"/1%B!'(%D % �A%*!4%/"/1%B!'(%D %''"!*/.+&%@ (BajajJ.S., 1993).

*��z. �/34%3/.+&%! /$�!@ �(/"/1%B!'(/@ (2"-,23G % �(/"/1%B!'(/@ /,.!,',.!&&/',% ',2-*!&,+ &+ A3%4!3! %)2B!&%# �A%*!4%/"/1%% +""!31%B!'(%D )+$/"!.+&%@ /31+&/. *GD+&%# 2 .)3/'-"GD 1. �!"#$%&'(+ % 2',+&/."!&%# ./)4/F&/',% ."%#&%# �(/"/1%% 1/3/*+ &+ �,%/A+,/1!&!) A/-'"!*&%D.

q��������������:1. �+2B%,- ',2*!&,+ /'4G'"!&%� "/(+"-&GD 3!)2"-,+,/. %''"!*/.+&%# . A3!"/4"!&%% (

1"/$+"-&G4 /$�!B!"/.!B!'(%4 A3/$"!4+4 '/.3!4!&&/',%.2. �)2B%,- '/',/#&%! )*/3/.-# &+'!"!&%# 1. �!"#$%&'(+ A/ *+&&G4 /?%5%+"-&/@ ',+,%',%(%

¥A+3+4!,3 — /31+&G *GD+&%#).3. �)2B%,- �A%*!4%/"/1%B!'(%! D+3+(,!3%',%(% +""!31%B!'(%D 3%&%,/. % $3/&D%+"-&/@ +'-

,4G 2 .)3/'"GD 1. �!"#$%&'(+ % .G#.%,- /'/$!&&/',% �(/"/1%B!'(/@ /$',+&/.(% 1. �!"#$%&'(+)+ A/'"!*&%! ,3% 1/*+.

J����� ������ . �3/+&+"%)%3/.+&G *+&&G! /?%5%+"-&/@ ',+,%',%(%, A3!*/',+."!&-&G! 2A3+."!&%!4 )*3+.//D3+&!&%# +*4%&%',3+5%% 1. �!"#$%&'(+ % �!&,3+ 1%1%!&G % �A%*!4%/"/-1%% . �!"#$%&'(/@ /$"+',%. �3/.!*!& 3!,3/'A!(,%.&G@ +&+"%) ("%&%(/N�A%*!4%/"/1%B!'(%D A/-(+)+,!"!@ +""!31%B!'(%D 3%&%,/. % $3/&D%+"-&/@ +',4G 2 .)3/'"GD 1. �!"#$%&'(+ A/ /$3+�+!4/-',% . +""!31/"/1%B!'(%! (+$%&!,G (%'A/"-)/.+"%'- /,B!,G .3+B!@N+""!31/"/1/., +4$2"+,/3&G!(+3,G A+5%!&,/., /$3+,%.U%D'# ( +""!31/"/12N%442&/"/12 )+ A/'"!*&%! ,3% 1/*+).

&�_��z�� . �3/.!&- /$�!@ )+$/"!.+!4/',% . 1. �!"#$%&'(! %4!!, ',/@(2� ,!&*!&5%�( 2.!"%B!&%�. �$�+# )+$/"!.+!4/',- A/ /$3+�+!4/',% &+'!"!&%# 2.!"%B%"+'- &+ 32,3 % )+ 10"!,, + A!3.%B&+# /$3+�+!4/',- — &+ 22,3 %. �%&+4%(+ )+$/"!.+!4/',% A3+(,%B!'(% &! )+.%'%, /,./)3+',+ % %4!!, ,!&*!&5%� ( 3/',2 ./ .'!D ./)3+',&GD 132AA+D. �/"!)&% /31+&/. *GD+&%# ',/#,&+ A!3./4 3+&1/./4 4!',! '3!*% *!,!@, A/*3/',(/. % .)3/'"GD. ',32(,23! A3%B%& '4!3,&/',%&+'!"!&%# 1. �!"#$%&'(+ $/"!)&% /31+&/. *GD+&%# .D/*#, . A#,!3(2 &+%$/"!! B+',GD, A/'"! $/-"!)&!@ '%',!4G (3/.//$3+�!&%# % /31+&/. A%�!.+3!&%#, ,3+.4, /&(/A+,/"/1%%. ',32(,23! )+-$/"!.+!4/',% ' .3!4!&&/@ 2,3+,/@ ,32*/'A/'/$&/',% &+%$/"-U!! )&+B!&%! %4!�, $/"!)&% /31+-&/. *GD+&%# (34,6 % — 2010 1.), '3!*&## *"%,!"-&/',- .3!4!&&/@ 2,3+,G ,32*/'A/'/$&/',% ,+(F!"%*%32!, A/ $/"!)&#4 /31+&/. *GD+&%# (26,0 % — 2010 1.). �,% A/(+)+,!"% ',+$%"-&G . ,!B!&%!*!'#,(+ "!,. �3!*% ("+''/. $/"!)&!@, /A3!*!"#��%D A3%B%&2 A!3.%B&/@ %&.+"%*&/',%, 3+''4+,-3%.+!4/@ A+,/"/1%% &!,, .&! )+.%'%4/',% /, ./)3+',+. �',+&/."!&+ ',32(,23+ +""!31/A+,/"/1%%A/ /$3+�+!4/',% ' 2009 A/ 2011 11. �'&/.&G4% +""!31%B!'(%4% )+$/"!.+&%#4% 2 .)3/'"/1/ &+'!-"!&%# #."#�,'# +',4+ % +""!31%B!'(%@ 3%&%,. �3%B!4 . 2009 1/*2 .A!3.G! 3%&%, .GU!" &+ A!3./!4!',/ . ',32(,23! +""!31/A+,/"/1%% A/ /$3+�+!4/',%, /A!3!*%. $3/&D%+"-&2� +',42. �/ &+U%4*+&&G4, . ',32(,23! +""!31%B!'(%D 3%&%,/. 2 A+5%!&,/., A3/F%.+��%D . 1. �!"#$%&'(!, A3!/$-"+*+!, A!3'%',%32��%@ +""!31%B!'(%@ 3%&%, — 94,85 %, %&,!34%,,%32��%@ +""!31%B!'(%@ 3%-&%, '/',+."#!, 5,15 %. �3!*% A+5%!&,/. ' +""!31%B!'(%4% 3%&%,+4% 42FB%& — 47,4 %, F!&�%&— 52,6 %.

D/*! /'2�!',."!&%# �(/"/1%B!'(/1/ &+*)/3+ 2',+&/."!&/ (/"%B!',.!&&/! )&+B!&%! .G-$3/'/. )+13#)&#��%D .!�!',. . +,4/'?!32 1. �!"#$%&'(+ )+ A/'"!*&%! ,3% 1/*+. �) .'!@ '/./(2A-&/',% )+13#)&#��%D .!�!',. $G"% .G*!"!&G D%4%B!'(%! '/!*%&!&%#, /(+)G.+��%! ."%#&%! &+/31+&G *GD+&%#. �/ "%,!3+,23&G4 *+&&G4, ./)*!@',.%! &+ /31+&%)4 3!+"%)2!,'# 3+)*3+F!&%!4,A/.3!F*!&%!4, 4!',&G4% ./'A+"%,!"-&G4% 3!+(5%#4%, /F/1+4% (. .G'/(%D (/&5!&,3+5%#D) '"%-)%',GD /$/"/B!(. �!+(5%# &+ .*GD+&%! '!&'%$%"%)%32��%D )+13#)&#��%D .!�!',. 4/F!, $G,-+""!31%B!'(/@, . ,#F!"GD '"2B+#D ./)&%(+�, % '%',!4&G! +""!31%B!'(%! 3!+(5%% — +""!31%B!-

85

'(%! 3%&%,G % $3/&D%+"-&+# +',4+ (�/*4!& �., 1988; �&2&#&5 �L�., 1988). � 36,1 % A+5%!&,/.&+B+"/ *+&&/1/ )+$/"!.+&%# /,4!B!&/ . *!,'(/4 ./)3+',!. � 40,2 % A+5%!&,/. A/.GU!& 23/.!&-Ig � .GU! 100 ��¦4" (/, 103 */ 1963,8 ��¦4"); . '3!*&!4 —398,4 ��¦4".

�!&'%$%"%)+5%# ( +""!31!&+4 /,4!B!&+ 2 59 A+5%!&,/., B,/ '/',+.%"/ 60,8 % /, .'!D A+5%-!&,/. ' +""!31%B!'(%4% 3%&%,+4%; %) &%D, 53 B!"/.!(+ (89,8 %) — ' B2.',.%,!"-&/',-� ( $G,/-.G4 % �A%*!34+"-&G4 +""!31!&+4 % 36 B!"/.!( (61 %) — ( AG"-5!.G4 +""!31!&+4, 36 B!"/.!((61 %) — ' A/"%'!&'%$%"%)+5%!@ ( *.24 132AA+4 +""!31!&/..

'!1/ )+3!1%',3%3/.+& 181 +""!31!&, 70 (38,7 %) — $G,/.G! % �A%*!34+"-&G! % 111 (61,3 %)— AG"-5!.G!. +(/! (/"%B!',./ +""!31!&/. 2 59 A+5%!&,/. /$�#'&#!,'# &+"%B%!4 A!3!(3!',&/@3!+(5%% &+ 3/*',.!&&G! +""!31!&G. �3!*&!! (/"%B!',./ +""!31!&/., A3%D/*#�!!'# &+ B!"/.!(+,— 3,1, *"# $G,/.GD +""!31!&/. % �A%*!34+"-&GD — 1,3, *"# AG"-5!.GD — 3,1.

q��������. �G A/"&/',-� A/**!3F%.+!4 % ./A"/�+!4 . F%)&- A!*+1/1%B!'(%! .)1"#*G�%(/"+# �.+&/.%B+ �%3/1/.+, (/,/3G@ 'B%,+", B,/ 1"+.&+# %*!# ./'A%,+&%# — �,/ ./'A%,+&%!A/"!)&/1/ ',3+&! 13+F*+&%&+, .G'/(/&3+.',.!&&/1/ B!"/.!(+ ' U%3/(%4 &3+.',.!&&/ (321/)/3/4.�/�,/42 2"2BU!&%! �(/"/1%B!'(/@ /$',+&/.(% . ',3+&! A3#4/ '.#)&/ ' A/.GU!&%!4 �(/"/1%B!-'(/@ (2"-,23G 'A!5%+"%',/.. 3+4(+D (/&5!A5%% &+5%/&+"-&/@ $!)/A+'&/',% �/''%@'(/@ �!*!-3+5%% % /$!'A!B!&%# (/3!&&/1/ 2"2BU!&%# �(/"/1%B!'(/@ /$',+&/.(% . ',3+&! A3!*"+1+!4 A3/./-*%,- (32F(/.2� 3+$/,2 '/ ',2*!&,+4% A/ A+3+""!"-&/42 %''"!*/.+&%� (/&(3!,&GD �(/"/1%B!-'(%D % 4!*%(/N'/5%+"-&GD A3/$"!4. �!/$D/*%4/ &+5!"%,- 4/"/*/1/ B!"/.!(+ &+ /'4G'"!&%! "/-(+"-&GD 3!)2"-,+,/. %''"!*/.+&%# . A3!"/4"!&%% ( 1"/$+"-&G4 /$�!B!"/.!B!'(%4 A3/$"!4+4'/.3!4!&&/',%. �+&&G! A3!*',+."!&&/@ 3+$/,G 5!"!'//$3+)&/ %'A/"-)/.+,- . A!*+1/1%B!'(/@*!#,!"-&/',% (*%'5%A"%&G: '/5%/"/1%#, ?%"/'/?%#, 13+*/',3/%,!"-'./, �(/"/1%#, $%/D%4%#, /,/-3%&/"+3%&1/"/1%#, +""!31/"/1%#N%442&/"/1%#), B,/ $2*!, 'A/'/$',./.+,- ?/34%3/.+&%� �(/"/-1%B!'(/1/ '/)&+&%#, %)4!&%, )&+B%4/',- A3!*',+."!&%@ /$ �(/"/1%B!'(/@ /,.!,',.!&&/',% B!"/-.!(+ )+ './! A/.!*!&%!.

+(%4 /$3+)/4, . *+&&/@ 3+$/,! %'A/"-)2�,'# &/.G! ?%"/'/?'(%! A/*D/*G ( ?/34%3/.+-&%� �(/"/1%B!'(/1/ '/)&+&%# ./ .)+%4/*!@',.%% ' A3/.!*!&%!4 +(,2+"-&/@ %''"!*/.+,!"-'(/@3+$/,G, B,/ 4!&#!, '4G'"/.2� 1"2$%&2 &+2B&GD %)G'(+&%@, A!*+1/1%B!'(2� )&+B%4/',- A3!*-',+."!&%@ /$ �(/"/1%B!'(/@ /,.!,',.!&&/',% B!"/.!(+ )+ './! A/.!*!&%!. !4 '+4G4 A3% %)4!&!-&%% A/&%4+&%# �(/"/1%B!'(%D A3/$"!4, A3% '4!�!&%% +(5!&,%3/.(% &+ 4!D+&%)4G '+4//31+&%-)+5%%, '/)*+!,'# &/.+# % A/)%,%.&+# A!3'A!(,%.+, /'&/.+ 3+)3+$/,(% A/*"%&&GD ',3+,!1%@ 3!U!-&%# A3/$"!4, . ,/4 B%'"! 4!*%5%&'(%D.

"J�40"*+= — ,"�1'(+',+)!1"=+$",!$+%"�+&!>!$"

>#$. ��������� (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ /$�!',.!&&/1/ )*/3/.-# % )*3+.//D3+&!&%#

�������������������: ��6. 7������ (���., . �. �.)

��"2F%,- A3+.*! — (+( . &+2B&/4, ,+( % . &3+.',.!&&/4 '4G'"! �,/1/ '"/.+. �G,- B!"/.!-(/4» — �,% '"/.+ �L�. �%3/1/.+ 4G */ '%D A/3 .',3!B+!4 ./ 4&/1%D &+2B&GD %',/B&%(+D.

�3!*% A"!#*G .G*+��%D'# *!#,!"!@ /,!B!',.!&&/@ 4!*%5%&'(/@ &+2(%, !*.+ "% &! A!3./!4!',/ )+&%4+!, %4# �%(/"+# �.+&/.%B+ �%3/1/.+. �1/ *!#,!"-&/',- $!'(/&!B&/ 4&/1/13+&&+, +&+2B&G! */',%F!&%# &+',/"-(/ )&+B%4G, B,/ !1/ A/ A3+.2 &+)G.+�, 1!&%!4 32''(/@ 4!*%5%&G.�1/ ,32*G &+4&/1/ /A!3!*%"% './� .3!4# % +(,2+"-&G % . &+U% *&%. �&/1%! %) !1/ %*!@ A/"2B%"%*+"-&!@U!! 3+).%,%! % '/',+."#�, ?2&*+4!&, '/.3!4!&&/@ 4!*%5%&G.

�%(/"+@ �.+&/.%B ',+" A/%',%&! 2B%,!"!4 .'!@ D%3231%B!'(/@ U(/"G �/''%%. �A!3%32# .1/'A%,+"#D, �%3/1/. A/*B+' ,./3%" B2*!'+, &! /,(+)G.+#'- /, '/4&%,!"-&GD %, (+)+"/'- $G, $!)&+-*!F&GD '"2B+!.. �& A!3!.#)G.+" +3,!3%%, . ,/4 B%'"! '/&&2�, A/*.)*/U&2�, $!*3!&&2�, +4A2,%-3/.+" (/&!B&/',%, 2*+"#" 32(2 .4!',! ' "/A+,(/@, .G"2�%.+" /A2D/"%, *!"+" 1"+)&G! /A!3+5%%,)+&%4+"'# A"+',%B!'(/@ D%3231%!@. � $G',3/,!, ' (/,/3/@ .!"%(%@ D%3231 /A!3%3/.+", D/*%"% "!-1!&*G. �+A3%4!3, "%A/,/4%� (%)."!B!&%! (+4&!@) /& *!"+" )+ *.! 4%&2,G. �+F*+# !1/ /A!3+5%#'/$%3+"+ 4&/F!',./ )3%,!"!@, (/,/3G! ' B+'+4% . 32(+D '"!*%"% )+ !! A3/*/"F%,!"-&/',-�. �+''(+-)G.+"%, B,/ A/(+ &+$"�*+��%! .G,+'(%.+"% %) (+34+&/. B+'G, B,/$G )+'!B- .3!4#, D%3231 2F! .G-$3+'G.+" %)."!B!&&G! (+4&%. �'"% A3%&#,- ./ .&%4+&%!, B,/ . ,/ .3!4# !�! &! $G"/ &+3(/)+, ',+-

86

&!, #'&/, A/B!42 4/"/*/@ D%3231 */$%.+"'# �,/@ 'A+'%,!"-&/@ $G',3/,G. �& A3/.!" $/"-U2� 3+-$/,2 A/ %)2B!&%� ."%#&%# �?%3+ % D"/3/?/34+ &+ /31+&%)4. 1847 1/*2 /& *!"+!, './� A!3.2�/A!3+5%� A/* &+3(/)/4. �$!*%.U%'- . !! �??!(,%.&/',%, �%(/"+@ �.+&/.%B . ,!B!&%! 1/*+ '*!"+"300 ,+(%D /A!3+5%@ % A3% �,/4 (+F*2� A3/+&+"%)%3/.+". A!3.G! . �('A!3%4!&,! /& A3%4!&%" %&-,3+,3+D!+"-&G@, A3#4/(%U!B&G@, .&2,3%.!&&G@ &+3(/), ../*%" +&!',!,%( . 'A%&&/4/)1/./@ (+&+".

�/ &+',/#�!1/ .3!4!&% A/.'!4!',&/! 3+'A3/',3+&!&%! %4!�, 3+)"%B&G! )+$/"!.+&%# '/'2-*/. % A!3%?!3%B!'(%D &!3./., /',3G! % D3/&%B!'(%! %&?!(5%/&&G! A3/5!''G (/&!B&/',!@, '+-D+3&G@ *%+$!,, '"!*',.%!4 (/,/3GD 4/F!, ',+,- &!/$D/*%4/',- .GA/"&!&%# +4A2,+5%@. �/ '%DA/3 &+$"�*+!,'# */./"-&/ */',+,/B&/ .G'/(+# "!,+"-&/',- A/'"! +4A2,+5%@ (15–20 %), B,/ /$2-'"+."%.+!, &!/$D/*%4/',- *+"-&!@U!1/ '/.!3U!&',./.+&%# �,/@ /A!3+5%% ' 2B!,/4 %&*%.%*2-+"-&GD /'/$!&&/',!@ $/"-&/1/ % !1/ )+$/"!.+&%#.

4/!@ &+2B&/@ 3+$/,! 4&! D/,!"/'- A3/'"!*%,- %)4!&!&%# 'A/'/$/. +4A2,+5%% '/ .3!4!&.!"%(/1/ �L�. �%3/1/.+ */ &+',/#�!1/ .3!4!&%.

�2F&/ '(+)+,-, B,/ +4A2,+5%# (/&!B&/',% #."#!,'# /*&/@ %) *3!.&!@U%D /A!3+5%@. �.!*!-&%# / &!@ A/#.%"%'- !�! . IV .!(! */ &. �.

�%AA/(3+, 3!(/4!&*/.+" /,'!(+,- (/&!B&/',- . A3!*!"+D &!(3/,%B!'(%D ,(+&!@, ,. (. �,/ &!'/A3/./F*+"/'- (3/./,!B!&%!4. �%AA/(3+,+ 4/F&/ A/&#,-, A/'(/"-(2 . ,! .3!4!&+ 'A/'/$G /',+-&/.(% (3/./,!B!&%# $G"% &!'/.!3U!&&G4% (4/F&/ *+F! &+).+,- %D .+3.+3'(%4%). �',+&/.(+ (3/-./,!B!&%# /'2�!',."#"+'- A/132F!&%!4 (2"-,% (/&!B&/',% . (%A#�!! 4+'"/, '4/"2, 4!* %"% A3%-F%1+&%!4 '/'2*/. % /(32F+��%D ,(+&!@ (+"!&G4 F!"!)/4, B,/ &!%)$!F&/ A3%./*%"/ ( &!(3/)2,(+&!@ (2"-,%, 3+).%,%� ,3+.4+,%B!'(/1/ U/(+. +(%4 /$3+)/4, 3!(/4!&*+5%% �%AA/(3+,+ 4/F&/A3%)&+,- 3+)24&G4% % 3+5%/&+"-&G4%. � $"+1/*+3# +.,/3%,!,2 �%AA/(3+,+, + ,+(F! A/**!3F(!�+"!&+ («�+&/&G 4!*%5%&G») �,% 3!(/4!&*+5%% A3/'2�!',./.+"% '.GU! A#,&+*5+,% .!(/..

.%*2 .G'/(/@ "!,+"-&/',% A/'"! ,+(%D +4A2,+5%%, A3%B%&+4% (/,/3/@ #."#"%'- ,3+.4+,%-B!'(%@ U/(, 3+).%,%! %&?!(5%%, %&,/('%(+5%# A3/*2(,+4% +2,/"%)+, .,/3%B&G! (3/./,!B!&%#,$G"% A3!*A3%&#,G A/AG,(% '/.!3U!&',./.+&%# 4!,/*%(% /A!3+5%%.

I .!(! &. �. �!"-' A3!*"+1+" A3/./*%,- +4A2,+5%� (/&!B&/',% . A3!*!"+D )*/3/.GD ,(+-&!@, /A%"%.+,- (/',- .GU! 4#1(%D ,(+&!@, + '/'2*G A!3!.#)G.+,- ' 5!"-� /',+&/.(% (3/./,!B!-&%# "%1+,23/@.

�*&+(/ 3+$/,G �!"-'+ &! $G"% )+4!B!&G '/.3!4!&&%(+4%. �1/ A3!*"/F!&%# ',+"% %'A/"-)/-.+,- ,/"-(/ . XVI .!(!. B+',&/',% "%1+,232 *"# A!3!.#)(% '/'2*/. ./)3+*%" �4$32+) �+3�. � �,/1/.3!4!&% +4A2,+5%% 2'!B!&%# (/&!B&/',% ',+"% %&,!&'%.&/ 3+).%.+,-'# % '/.!3U!&',./.+,-'#.

�/.3!4!&&/! A3!*',+."!&%! /$ +4A2,+5%#D '/)*+&/ &+ /'&/.! 13/4+*&/1/ A3!*U!',.2��!-1/ /AG,+ 3+).%,%# D%3231%%, . B+',&/',% 3+).%,%# 2B!&%# /$ +4A2,+5%#D. &+U! .3!4# A/"&/-',-� '/D3+&#�, )&+B!&%! '"/.+ �L�. �%3/1/.+: «�% /*&+ %) /A!3+5%@ &! ,3!$2!, ',/"-(/ '//$3+-F!&%#, ',/"-(/ )*3+./1/ '4G'"+ % .&%4+&%# '/ ',/3/&G .3+B+, (+( 3+5%/&+"-&/! % /,B!,"%./! '/-',+."!&%! A/(+)+&%# ( +4A2,+5%%». �!*%5%&+ *.%F!,'# .A!3�*, % 4G &! )+$G.+!4 /$ �,%D .!"%(%D% &+',/"-(/ ,/B&GD '"/.+D, A/�,/42 . &+',/#�!! .3!4# ./ .3!4# A3/.!*!&%# +4A2,+5%@ A3/./*#,3#* A3!*/A!3+5%/&&GD 4!3/A3%#,%@.

�3!*.+3%,!"-&+# +4A2,+5%# — 3+'U%3!&&+# D%3231%B!'(+# /$3+$/,(+ 3+&G, (/,/3+# .G-A/"&#!,'# A3% &!./)4/F&/',% A!3./&+B+"-&/ ,/B&/2',+&/.%,- 23/.!&- +4A2,+5%%. �(/&B+,!"--&+# +4A2,+5%# — /$3+$/,(+ 3+&G, /'2�!',."#!4+# $!) A/'"!*2��!@ 3!+4A2,+5%%, /&+ *!"+!,'# .'"2B+#D, (/1*+ &!, /'&/.+&%@ /F%*+,- /A+'&GD ./'A+"%,!"-&GD /'"/F&!&%@ % /$3+)/.+&%# &!A3%1/*&/@ *"# A3/,!)%3/.+&%# (2"-,%.

)+.%'%4/',% /, '3/(+ % A/(+)+&%@ ( A3/%)./*',.2 .GA/"&!&%# +4A2,+5%% 3+)"%B+�, A!3-.%B&G!, .,/3%B&G! % A/.,/3&G! +4A2,+5%%, %"% 3!+4A2,+5%%. �!3.%B&+# +4A2,+5%# .GA/"&#!,'#&!4!*"!&&/ A/'"! */',+.(% $/"-&/1/ . 2B!$&/! 2B3!F*!&%! %"% . ,!B!&%! 24 B+'/. A/'"! ,3+.4G,,/ !',- !�! */ 3+).%,%# ./'A+"%,!"-&GD #."!&%@ . /$"+',% A/.3!F*!&%#. ,/3%B&/@ &+)G.+!,'#+4A2,+5%#, A3/%)./*%4+# . $/"!! A/)*&%! '3/(%, . A3!*!"+D 7–8 *&!@. �!3.%B&G! % .,/3%B&G!+4A2,+5%% /,&/'#,'# ( /A!3+5%#4, A3/%)./*%4G4 A/ 3+&&%4 A/(+)+&%#4.

�/ '%D A/3 .'! D%3231% A/"-)2�,'# «F!"!)&G4 A3+.%"/4», .G'(+)+&&G4 �L�. �%3/1/.G4:��+*/ /A!3%3/.+,- ,+( &%)(/, (+( ./)4/F&/».

�4A2,+5%% A3/%)./*#, . B!,G3! �,+A+:1. �+''!B!&%! (/F% % *321%D 4#1(%D ,(+&!@.2. �+'A%" (/',!@.3. �$3+$/,(+ 3+&G, A!3!.#)(+ '/'2*/., 2'!B!&%! &!3./..4. �U%.+&%! 3+&G.

87

�/ ?/34! 3+''!B!&%# 4#1(%D ,(+&!@ 3+)"%B+�, &!'(/"-(/ .%*/. +4A2,+5%%, A3%B!4 A3!F*!.'!1/ */"F&+ $G,- 2B,!&+ &!/$D/*%4/',- 2(3G,%# (/',&/1/ /A%"+. � �,/@ 5!"-� 4#1(%! ,(+&%A!3!'!(+�, ' 2B!,/4 %D 3!,3+(5%% &%F! 23/.&# A!3!A%"%.+&%# (/',%.

�A!3+5%# �%3/1/.+ — (/',&/A"+',%B!'(%@ 4!,/* 2*+"!&%# 1/"!&% &+ 23/.&! "/*GF!( A3%.G"2�%.+&%% ',/AG, .A!3.G! /A%'+&&G@ �L� �%3/1/.G4 . 1854 1/*2. / .3!4# /A!3+5%% 3+'A%"1/"!&% A3/%)./*%,'# . 3+@/&! A#,/B&/@ (/',%, B,/ A/)./"#!, '/)*+,- D/3/U2� /A/3&2� (2"-,�.

�+ 4/4!&, '/)*+&%# 4!,/*+ $G"+ %).!',&+ /A!3+5%# �+@4+, .("�B+��+# ,! F! (/F&G! 3+)-3!)G, B,/ % A3% /A!3+5%% �%3/1/.+. �*&+(/ . 1852 1/*2 �%(/"+@ �.+&/.%B A3!*"/F%" )+(3G.+,-'A%" (/',% +4A2,%32!4/@ 1/"!&% 'A%"/4 (/',% A#,(%. �3!*"/F!&&G@ 'A/'/$ +4A2,+5%% ',+"$/"-U%4 /,(3G,%!4 ,/1/ .3!4!&%, ,+( (+( A/'"2F%" /'&/./@ *"# .'!D (/',&/A"+',%B!'(%D 4!,/-*/.: �3%,,%, �+$+&!!.+, %3+. �'&/.&G4 &!*/',+,(/4 /A!3+5%% #."#!,'# &+,#F!&%! �D%""/.+ '2-D/F%"%#. �/4%4/ �,/1/, ,/B(+ /A/3G . (2"-,! /,"%B+!,'# /, A3%&#,/@ /$GB&/, B,/ 4/F!, A3%.!'-,% ( %)�#)."!&%� (/F%.

!4 &! 4!&!!, /A!3+5%# �%3/1/.+ *+"+ /13/4&G@ ,/"B/( ( 3+).%,%� (/',&/A"+',%B!'(%D4!,/*/.. &+',/#�!! .3!4# '2�!',.2!, ,3!D4/4!&,&G@ 'A/'/$ �%3/1/.+, &+)G.+!4G@ !�! (/&2-'/(321/.G4. �& '/',/%, . '"!*2��!4:

+) 5%3(2"#3&G@ 3+)3!) (/F%, A/*(/F&/@ ("!,B+,(% % ?+'5%%;$) 3+''!B!&%! .'!D 4GU5 /, (3+# '/(3+,%.U!@'# (/F% */ (/',%;.) .,/3%B&/! A!3A!&*%(2"#3&/! 3+''!B!&%! 4GU5, A/'"! ,/1/ (+( +''%',!&, /,,#&!, (/F2 %

4GU5G . A3/('%4+"-&/4 &+A3+."!&%%.�"!*2!, 3+'A%" (/',% &+ ,/4 F! 23/.&!.�+4+ ,!D&%(+ +4A2,+5%@ % �()+3,%(2"#5%% '/',/%, %) ,3!D �,+A/.:1. �+''!B!&%! 4#1(%D ,(+&!@.2. �+'A%"+(/',% %"% .GB"!&!&%# '2',+./..3. �$3+$/,(+ 3+&G.�#1(%! ,(+&% 4/F&/ 3+''!B- A/ *.24 ("+''%B!'(%4 'A/'/$+4: 5%3(2"#3&/ ((321/./@ 'A/-

'/$) % ' "/'(2,/4.�3% (321/./4 'A/'/$! ,(+&% 3+''!(+�, &/F/4, *!3F+ !1/ A!3A!&*%(2"#3&/ ( A3/*/"-&/@ /'%

(/&!B&/',%. �4A2,+5%% ' "/'(2,/4 ,3!$2�, &+("/&&/1/ 3+'A/"/F!&%# &/F+ % '/)*+&%# (/F&/-4GU!B&/1/ "/'(2,+. �3% +4A2,+5%% A/ A/./*2 ,3+.4 .G(3+%.+�, "/'(2,G 4+('%4+"-&GD 3+)4!3/..�(/&B+,!"-&/! ?/34%3/.+&%! (/F&GD "/'(2,/. A3/%)./*#, . (/&5! /A!3+5%%. �"# '/D3+&!&%# F%)-&!'A/'/$&/',% (/F&GD "/'(2,/. &! '"!*2!, /,'"+%.+,- %D /, +A/&!.3/)+. �/"&/'"/@&/',- ,+(/1/"/'(2,+ %4!!, /'/$/! )&+B!&%! A3% +4A2,+5%% ' &+32U!&%!4 (3/.//$3+�!&%# (/&!B&/',%.

+F&+ A3% +4A2,+5%% /$3+$/,(+ &!3.&GD ',./"/.. �,/ '.#)+&/ ' ,!4, B,/ 2 3#*+ $/"-&GDA/'"! +4A2,+5%% ./)&%(+�, ,+( &+)G.+!4G! ?+&,/4&G! $/"%, /$2'"/."!&&G! ./)&%(&/.!&%!4A+,/"/1%B!'(%D &!.3/4 %"% ./."!B!&%!4 &!3./. . 32$!5. &+',/#�!! .3!4# A3%&#,/ A!3!'!(+,-&!3.G $3%,./@ %"% /',3G4 '(+"-A!"!4 A3% /,/*.%1+&%% 4#1(%D ,(+&!@ . A3/('%4+"-&/4 &+A3+.-"!&%% &+ 5–6 '4; A3% �,/4 3!(/4!&*2!,'# &! .G,#1%.+,- &!3.. �!*/A2',%4+ A!3!3!)(+ &!3.+ &/F-&%5+4%. +F&/! )&+B!&%! *"# $"+1/A3%#,&GD %'D/*/. +4A2,+5%% % A/'"!*2��!1/ A3/,!)%3/.+-&%# %4!!, /$3+$/,(+ (/',!@. �/'"! (321/./1/ 3+''!B!&%# &+*(/',&%5G 3!(/4!&*2!,'# 3+)*.%1+,-3+'A+,/3/4 &+*(/',&%52 *%',+"-&!!. �!3!A%"%.+&%! (/',% '"!*2!, A3/%)./*%,- (+( 4/F&/ 4!*-"!&&!!, A/',/#&&/ /3/U+# 4!',/ 3+'A%"+ 3+',./3+4% &/./(+%&+ % &+,3%# D"/3%*+. �/'"! A!3!A%-"%.+&%# (/',% &+32F&G@ (3+@ .'!1/ (/',&/1/ /A%"+ )+B%�+�, &+A%"-&%(/4 ' (321"/@ &+'!B(/@.

�,.!,',.!&&G4 4/4!&,/4 +4A2,+5%% 'B%,+!,'# 1!4/',+). �!3!* A!3!.#)(/@ /'./$/F*+�,(32A&G! '/'2*G /, 4#1(%D ,(+&!@. �%1%3/.+&%! (32A&GD +3,!3%@ .4!',! ' 4GU5+4% 4/F!, A3%-.!',% ( A3/3!)G.+&%� % '/'(+"-)G.+&%� "%1+,23 ' A/'"!*2��%4 (3/./,!B!&%!4. �/'2*G A!3!.#-)G.+�, (!,12,/4. �!3!.#)(+ (!,12,/4 #."#!,'# A3/?%"+(,%(/@ "%1+,23&GD '.%�!@. �/'"! A!3!-.#)(% (32A&GD '/'2*/. F12, %"% $%&, 2*+"#�,. �/#.%.U%!'# (3/./,!B!&%# A3/U%.+�, (!,12,/4. "%1+,232 &+*/ $3+,- 4!&-U! ,(+&!@, B,/$G . 3+&! $G"/ 4!&-U! &!(3/,%)%3/.+&&GD ,(+&!@.

+(%4 /$3+)/4, $"+1/*+3# &+'"!*%� �%(/"+# �.+&/.%B+ �%3/1/.+ +4A2,+5%# (/&!B&/',!@ %4&/1%! /A!3+5%% ',+"% . &+U% *&% &! ,/"-(/ ./)4/F&G4%, &/ % 4+('%4+"-&/ $!)/A+'&G4%.

�A%'/( "%,!3+,23G:1. �+"%', �L�. �%(/"+@ �%3/1/.. �1/ F%)&-, &+2B&+# % /$�!',.!&&+# *!#,!"-&/',-, ���-

��. — �. 1244. — �A. 2. — �. 667. — �.. 117. — �. 2.2. �%3/1/., �L�. �+B+"+ /$�!@ ./!&&/NA/"!./@ D%3231%%: 2 B. — �.-�., 1944. — �. 2. — �. 498.3. �+@, Wikipedia.org.4. �+@, pirogov.com.ua.

88

�1+*!$&"%"» )")+�0!&+%'�)!',"�1'(+',+)!1"=+$",!$+%"�+&!>!$"

+#�. 2���3�� (����.), (#". q���� (����.)�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ /$�!',.!&&/1/ )*/3/.-# % )*3+.//D3+&!&%#

�������������������: ��6. 7������ (���., . �. �.)

',+,-! 3+''4+,3%.+!,'# ./A3/' "%B&/',&GD (+B!',., (/,/3G4% */"F!& /$"+*+,- .3+B, &+A3%4!3! F%)&% �%(/"+# �.+&/.%B+ �%3/1/.+ (+( .!"%B+@U!1/ 3/''%@'(/1/ D%3231+, &+2B&/1/*!#,!"# % B!"/.!(+ .G'/(%D &3+.',.!&&GD (+B!',..

�)2B+# )+4!,(% '/.3!4!&&%(/. �L�. �%3/1/.+, + ,+(F! !1/ "%B&G! A%'-4+, *&!.&%(%, */(2-4!&,G % +.,/$%/13+?%�, +.,/3 A/'"!*/.+,!"-&/ +&+"%)%32!, "%B&/',- �L�. �%3/1/.+ . 3+4(+D*+&&/@ ,!4G.

�3/$"!4+ "%B&/',&GD (+B!',. .3+B+ .!'-4+ +(,2+"-&+ . &+',/#�!! .3!4# % A3%."!(+!, ( '!-$! A3%',+"-&/! .&%4+&%! (+( ���, ,+( % &+'!"!&%#. � '/F+"!&%�, &!1+,%.&/! /,&/U!&%! ( .3+B2(+( ( "%B&/',% ',+"/ '/.'!4 A3%.GB&G4 #."!&%!4. '� B+�! ',+" )+*+.+,-'# ./A3/' / (/4A!,!&,-&/',% .3+B+ (+( B!"/.!(+, 3+$/,+��!1/ . '?!3! 4!*%5%&G. +( (+(%4 F! B!"/.!(/4 */"F!& $G,-.3+B? �+(%4% (+B!',.+4% */"F!& /$"+*+,- B!"/.!( *+&&/@ A3/?!''%%?

�"# /,.!,+ &+ �,/, ./A3/' &!/$D/*%4/ /$3+,%,-'# ( %',/3%% % A3/'"!*%,- )+ F%)&-� .!"%-(%D .3+B!@ A3/U"/1/. �*&%4 %) ,+(%D "�*!@ $G" )&+4!&%,G@ 32''(%@ .3+B % +&+,/4, +.,/3 +,"+'+% /'&/.+,!"- ,/A/13+?%B!'(/@ +&+,/4%%, /'&/./A/"/F&%( ./!&&/NA/"!./@ D%3231%%, /'&/.+,!"-+&!',!)%% B"!&N(/33!'A/&*!&, �+&(,N�!,!3$231'(/@ +(+*!4%% &+2(, !',!',./%'AG,+,!"- �%(/"+@�.+&/.%B �%3/1/. (1810–1881).

�/4%4/ './!@ &+2B&/@ % .3+B!$&/@ *!#,!"-&/',%, .+F&/',- (/,/3/@ '"/F&/ A!3!/5!&%,- %(/,/3+# A/ '!@ *!&- #."#!,'# /*&%4 %) '+4GD .G*+��%D'# A3%4!3/. . /$"+',% 4!*%5%&G, �%(/-"+@ �.+&/.%B �%3/1/. $G" )+4!B+,!"-&G4 A3!A/*+.+,!"!4, ?%"/'/?/4, +(,%.&G4 /$�!',.!&&G4*!#,!"!4, 124+&&G4 % 1"2$/(/ .!32��%4 B!"/.!(/4.

� '+4/1/ &+B+"+ './!@ *!#,!"-&/',% . /$"+',% 4!*%5%&G, + %4!&&/ ' A/',2A"!&%# &+ 4!*%-5%&'(%@ ?+(2"-,!, . �/'(/.'(%@ 2&%.!3'%,!, . 1824 1/*2, �%(/"+@ �.+&/.%B �%3/1/. $G", (+(/& '+4 A%'+" «$/@(%@, &!"!&%.G@ % "�$%.U%@ 2B!&-! 4+"-B%(». �+F! '+4 ?+(, !1/ A/',2A"!&%# .�/'(/.'(%@ 2&%.!3'%,!, . B!,G3&+*5+,%"!,&!4 ./)3+',! 2F! 1/./3%, &+4 / &�4, (+( / ,32*/"�-$%./4 % /*+3�&&/4 B!"/.!(!.

�/ /(/&B+&%% �/'(/.'(/1/ 2&%.!3'%,!,+ �%(/"+@ �.+&/.%B A3/*/"F%" /$2B!&%! . �!3A,-'(/4 2&%.!3'%,!,! %, $"!',#�! )+�%,%. */(,/3'(2� *%''!3,+5%�, . 1836 1/*2, . ./)3+',! .'!1/"%U- *.+*5+,% U!',% "!,, $G" %)$3+& A3/?!''/3/4 (+?!*3G D%3231%% �!3A,'(/1/ 2&%.!3'%,!,+.�!/$D/*%4/ /,4!,%,-, B,/, $2*2B% A3/?!''/3/4 �!3A,'(/1/ 2&%.!3'%,!,+, + )+,!4 % A3/?!''/3/4�!,!3$231'(/@ 4!*%(/ND%3231%B!'(/@ +(+*!4%%, �%(/"+@ �.+&/.%B �%3/1/. &%B!1/ &! '(3G.+"/, './%D 2B!&%(/. % /,(3/.!&&/ '/)&+.+"'# A!3!* &%4% . './%D /U%$(+D. �,/ /,(3G,/',- A/ /,-&/U!&%� ( ',2*!&,+4, 1/,/.&/',- A/4/B- %4 . 3!U!&%% A3/$"!4 '*!"+"% !1/ A/B%,+!4G4 B!"/.!-(/4 . ',2*!&B!'(/4 /$�!',.!. �+( A/)*&!! 1/./3%" A3/?!''/3 �L�. �31+3*,, «&! 4/12 A3/@,%4/"B+&%!4 $"+1/*!,!"-&/1/ ."%#&%# .+U!1/, (+( B+',&/1/ B!"/.!(+, ."%#&%# %'AG,+&&/1/ (+F-*G4, (,/ ,/"-(/ F!"+" ./'A/"-)/.+,-'# .+U!� F%.%,!"-&/� $!'!*/�. �.!3- .+U+ $G"+ /,(3G,+*"# .'!D; &! .D/*%" . &!� ,/"-(/ ,/,, (,/ '+4 &! D/,!"».

�+2B&/@ *!#,!"-&/',-� �%(/"+@ �.+&/.%B �%3/1/. &+B%&+!, )+&%4+,-'#, !�� $2*2B% ',2-*!&,/4 �/'(/.'(/1/ 2&%.!3'%,!,+, /,*+.+# !@ .'� './� .3!4#, 24!&%! % �&!31%�. �+%$/"!! A"/*/-,./3&G@ A!3%/* . F%)&% 2B�&/1/ &+B%&+!,'# ' 1841 1/*+. �1/ ,32*G, '/)*+&&G! . �,/, A!3%/*, */'%D A/3 #."#�,'# 32(/./*',./4 *"# .3+B!@ 3+)&GD 'A!5%+"-&/',!@.

/(,#$3! 1854 1/*+ �%(/"+@ �.+&/.%B �%3/1/. ' 132AA/@ .3+B!@ */$3/./"-&/ .G!D+" .�3G4 . *!@',.2��2� +34%�. �,/, A/',2A/( #."#!,'# %',%&&G4 /$3+)5/4 42F!',.+ % /,.+1%,A+,3%/,%)4+ % 1"2$/(/1/ /'/)&+&%# './!1/ 13+F*+&'(/1/ */"1+. '# *!#,!"-&/',- !1/ (+( . �,/,A!3%/*, ,+( % &+ A3/,#F!&%% .'!@ F%)&% $G"+ A3/&%(&2,+ F!"+&%!4 /$"!1B%,- ',3+*+&%# 3+&!-&GD. �& 3+$/,+", &! �+*# '%", A/3+F+# /(32F+��%D 3+$/,/'A/'/$&/',-�, ',3!4"!&%!4 .!)*! 2'-A!,- /(+)+,- A/'%"-&2� A/4/�-. !"%B+@U+# &+$"�*+,!"-&/',- �%(/"+# �.+&/.%B+ �%3/1/.+,&+',/@B%.+# $/3-$+ ' &!.!F!',./4 % (/'&/',-� . /31+&%)+5%% 4!*%5%&'(/1/ *!"+ A/*./*#, !1/ (.G./*2 / ,/4, B,/ «&! 4!*%5%&+, + +*4%&%',3+5%# %13+!, ("�B!.2� 3/"- . *!"! A/4/�% 3+&!&G4% $/"-&G4 &+ ,!+,3! ./@&G».

89

!3&2.U%'- . �+&(,N�!,!3$231 A/ /(/&B+&%% ./@&G, �%(/"+@ �.+&/.%B �%3/1/. A/A+" .&!4%"/',- %4A!3+,/3+ �"!('+&*3+ II. '.#)% ' �,%4 $G" .G&2F*!& 2!D+,- '&+B+"+ . �*!''2, 1*!!1/ A/AG,(% 3!?/34%3/.+,- '%',!42 /$3+)/.+&%# .G).+"% (/&?"%(, ' ."+',#4%, + )+,!4 . �!@-*!"-$!31. 3!)2"-,+,! $G" 2./"!& ' 1/'2*+3',.!&&/@ '"2F$G % $G" .G&2F*!& 2!*%&%,-'# . './�4%4!&%% &!A/*+"�(2 /, %&&%5G . 3+'5.!,! ,./3B!'(%D '%". �,/, %&5%*!&, &+1"#*&/ A/(+)G.+!,&!A/'3!*',.!&&2� A3%&+*"!F&/',- �L�. �%3/1/.+ ( ,+(/42 ?!&/4!&2 32''(/@ (2"-,23G, (+(�32''(+# %&,!""%1!&5%#». �/ �%(/"+@ �.+&/.%B &! '/$%3+"'# '*+.+,-'# %, &! A/("+*+# 32(, ,32-*%"'# &+ $"+1/ �/''%%, / B�4 '(+)+": «� &! A!3!',+&2 '"2F%,- !@ (�/''%%) ,+( F! .!3&/, (+( '"2-F%" .4!',! ' .+4%. � ,!A!3- "%, (/1*+ �/''%#, 32(/./*%4+# $"+1/*!,!"-&G4 �/&+3D/4, .',2A+!, .&/.2� �32 !� '2�!',./.+&%#, (,/N&%$2*- %) &+' /'4!"%,'# &+32U%,- '.#,/',- */"1+, /',+.+#'- .$!)*!@',.%% ». +(%4 /$3+)/4, &!'4/,3# &+ A3/,%./*!@',.%! '/ ',/3/&G ."+',!@, �%(/"+@ �.+&/-.%B �%3/1/. /',+.+"'# .!3!& '/$',.!&&G4 %*!+"+4 % &!2',+&&/ 3+$/,+" &+* 3+)3+$/,(/@ A3/!(,/.A/ 2"2BU!&%� 2',3/@',.+ �/''%%. «�%,- &+ $!"/4 '.!,! — )&+B%, A/',/#&&/ $/3/,-'# % A/',/#&-&/ A/$!F*+,-».

'?!3! /$3+)/.+&%#, �%(/"+@ �.+&/.%B �%3/1/. .G',2A+" )+ +.,/&/4%� 2&%.!3'%,!,/. %.'!/$�!! &+B+"-&/! /$3+)/.+&%!; A3!*"+1+" .)#,- )+ /'&/.2 /$3+)/.+&%# ./'A%,+&%! .G'/(/&3+.-',.!&&/@ "%B&/',%, 1/,/./@ /,3!U%,-'# /, �1/%',%B!'(%D 2',3!4"!&%@ 3+*% $"+1+ /$�!',.+, ./'-A%,+&%! A/"!)&/1/ ',3+&! 13+F*+&%&+: «�! /$#)+,!"-&/ "% /$�!',./ % 1/'2*+3',./, — A3!*A/"+-1+#, B,/ /&/ $/1+B! % '3!*',.+4% % 4G'"#4%, — A/4/1+,- */',%F!&%� .'!',/3/&&!1/ 3+).%,%#'A/'/$&/',!@ % */$3GD '("/&&/',!@ 3!$�&(+? � �,% /$#)+&&/',% /$�!',.+ % 1/'2*+3',.+ &! *!"+-�,'# "% !�� '.#�!&&!! ,+4, 1*! /&% A3%)&+�, ./'A%,+&%! './!@ 4/&/A/"%!@?». �& $G" #3G4 A3/-,%.&%(/4 '/'"/.&/1/ /$3+)/.+&%#, 3+&&!@ % A3!F*!.3!4!&&/@ 'A!5%+"%)+5%% *!,!@, ,!"!'&GD&+(+)+&%@ *!,!@ («�*!"+@,! ,+(, B,/$G &+(+)+&%! )+ A3/',2A/( $G"/ &! .&!, + .&2,3% .%&/.&/-1/ — % .G */@*�,! */ %*!+"+ &3+.',.!&&/1/ ./'A%,+&%#»).

�!'4/,3# &+ .'! './% )+'"21% % */',%F!&%#, �%(/"+@ �.+&/.%B �%3/1/. .'!1*+ /',+.+"'#B!"/.!(/4 '(3/4&G4 % '+4/(3%,%B&G4. �).!',&G '"/.+ �.+&+ �!,3/.%B+ �+."/.+ . /,&/U!&%%�%(/"+# �.+&/.%B+: «+(+# $!'A/�+*&+# /,(3/.!&&+# (3%,%(+ ( '!$! % './!@ *!#,!"-&/',% !*.+"% .',3!B+!,'# 1*!N&%$2*- . 4!*%5%&'(/@ "%,!3+,23!. � �,/ — /13/4&+# )+'"21+! (+B!',.! .3+B+/(/"/ $/"-&/1/, (/,/3G@ /,*+�, './� '2*-$2 . .+U% 32(%, % A!3!* 2B!&%(/4, (/,/3/1/ .G 2B%,!,..%*2 A/B,% .'!1*+ &!A/'%"-&/@, &/ /$#)+,!"-&/@ )+*+B%, 2 .+' /*&/ 'A+'!&%!, /*&/ */',/%&',-./ — �,/ A3+.*+, &%B!4 &! A3%(3G,+# A3+.*+».

�L�. �%3/1/. ,+( F! &+ A3/,#F!&%% .'!@ F%)&% /',+.+"'# A3/', . /$�!&%% ' "�*-4% %�&!31%B&/ A/**!3F%.+" (+F*/! %D &+B%&+&%!. +(, &+A3%4!3, )+.!*2��%@ A/*/"-'(/@ ./'(3!'&/@U(/"G �L�. �"!A2U(%& 1/./3%" A3/ &!1/: «'#(+# */$3+# 4G'"-, .'#(/! %',%&&/ A/"!)&/! &+B%-&+&%! .',3!B+"/ . .+' .'1*+ 1/3#B2� A/**!3F(2 % /*/$3!&%!». �3/?!''/3 �L�. �31+3*, ,+( F!/,4!B+" "�1(/',- . /$�!&%% ' �%(/"+!4 �.+&/.%B!4: «'!1*+U&## 1/,/.&/',- /,*+,- &3+.',.!&-&G@ /,B�, . (+F*/4 A/',2A(! .+U!4, 1/,/.&/',- A3%&#,- .'#(/! 3+)24&/! ./)3+F!&%!, 1/,/.&/',-A/*!"%,-'# A"/*+4% .+U%D ,32*/. % /AG,+, .'� �,/ &! ' .G'/,G A3!./'D/*#�!1/ .!"%B%#, + A3/-',/ — /, 3+.&/1/ ( 3+.&/42, ./, B,/ *!"+"/ &+U2 $!'!*2 ,+(/@ *3+1/5!&&/@ % ."%#&%! !� ,+(%4$"+1/*!,!"-&G4».

�/$',.!&&+# 4/"%,.+ �%(/"+# �.+&/.%B+, A/,3#'+��+# (+F*/1/, (,/ !� A3/B,�,, ,+( F!4&/1/ 1/./3%, &+4 /$ �,/4 )+4!B+,!"-&/4 B!"/.!(!:

��*/',/@ 4!&# $G,- /32*%!4 4%3+ ./!1/,�,/$G # A3/�+" — 1*! /$%F+�,,�,/$G # '/!*%&#" — 1*! ''/3+,�,/$G # ./)*.%1&2" .!32 — 1*! *+.%, '/4&!&%!,�,/$G # ./)$2F*+" 3+*/',- — 1*! 1/3! F%.�,.�*/',/@, &! B,/$G 4!&# 2,!U+"%, &/ B,/$G # 2,!U+",�! B,/$G 4!&# A/&%4+"%, &/ B,/$G # *321%D A/&%4+",�! B,/$G 4!&# "�$%"%, &/ B,/$G # *321%D "�$%",�$/ (,/ *+�, — ,/, A/"2B+!,, (,/ '!$# )+$G.+!, — ,/, /$3!,+!,,�,/ A3/�+!, — ,/42 A3/�+!,'#,�,/ 24%3+!, — ,/, A3/'GA+!,'# ( .!B&/@ F%)&%». 1870 1/*2, ./ .3!4# ?3+&(/NA32''(/@ ./@&G, 2F! A/F%"/@ �%(/"+@ �.+&/.%B �%3/1/.

$G" A3%1"+U�& &+ ?3/&, /, %4!&% �!F*2&+3/*&/1/ �3+'&/1/ �3!',+. �/)*&!!, . 1877 1/*2, ./.3!4# �2''(/N,23!5(/@ ./@&G .'A/4&%" / �%(/"+! �.+&/.%B! (+( / &!'3+.&!&&/4 D%3231! % "2B-U!4 /31+&%)+,/3! 4!*%5%&'(/@ '"2F$G &+ ?3/&,! % %4A!3+,/3 �"!('+&*3 II. �$+ 3+)+ �%(/"+@

90

�.+&/.%B �%3/1/. &!)+4!*"%,!"-&/ A/(%*+" './� %4!&%! $"%) %&&%5G % A3%$G.+" &+ ?3/&,, 1*!/31+&%)/.G.+" "!B!&%! '/"*+,, 2D/* )+ 3+&!&G4% % $/"-&G4% . ./!&&GD 1/'A%,+"#D. �!'4/,3# &+A3!("/&&G@ ./)3+',, /& '+4/',/#,!"-&/ A3/*/"F+" /A!3%3/.+,- 3+&!&GD.

�/*./*# %,/1, &!/$D/*%4/ /,4!,%,-, B,/, %''"!*2# F%)&- .!"%(/1/ 32''(/1/ .3+B+ �%(/"+#�.+&/.%B+ �%3/1/.+, 4/F&/ .G*!"%,- /'&/.&G! B!3,G D+3+(,!3+, (/,/3G4% */"F!& /$"+*+,- (+-F*G@ 3+$/,&%( . /$"+',% 4!*%5%&G: ,32*/"�$%!, "�$/.- ( &+2(!, /,)G.B%./',-, '/',3+*+&%!,/,(3G,/',- "�*#4, A3/',/,+ . /$�!&%%, '+4/(3%,%B&/',- % '(3/4&/',-, 42F!',./ % A+,3%/,%)4,124+&&/',-, .!3&/',- .&2,3!&&%4 %*!+"+4, &+',/@B%./',-, 13+F*+&'(+# A3!*+&&/',-, &+$"�*+-,!"-&/',-, /,(3/.!&&/',-, */$3/,+, F!"+&%! $G,- A/"!)&G4 /$�!',.2, */,/U&/',- % '+4/A/F!3,-./.+&%!, $!)./)4!)*&/',-. /, ,/, B!42 &+' 2B%, �%(/"+@ �.+&/.%B �%3/1/. &+ A3%4!3! '/$',-.!&&/@ F%)&%. �,/ % !',- !1/ %',/3%B!'(/! &+'"!*%!.

�A%'/( "%,!3+,23G:1. �%3/1/., �L�. /A3/'G F%)&%. �&!.&%( ',+3/1/ .3+B+ [�/',. �L�. �3%(/.]. — �.+&/./,

2008.2. �3/�+&%! �%!.'(/1/ 2B!$&/1/ /(321+ ' �L�. �%3/1/.G4. — �. 4, �%!.'(%@ ,!"!13+?. —

1861 1/*, 20 +A3!"#.3. +,+3%&/.+, �L�. �!*+1/1%B!'(+# *!#,!"-&/',- �L�. �%3/1/.+.4. �!B!&(/ �L�., �/)/.!&(/ �L�. �+'"!*%! ,3+*%5%@ % *2D/.&/',% �L�. �%3/1/.+ . "!B!$-

&/@, &+2B&/@ % /$3+)/.+,!"-&/@ *!#,!"-&/',% �%3/1/.'(/1/ 5!&,3+. — �B!$&/! A/'/$%!.5. �+@, pirogov.com.ua.6. �+@, Wikipedia.org.

�('=q">"1],!1w(�])!>!$+^!$",,=$�'(">!>�%,�/��"({+,�J#�. �+&!>!$"

+#,. {���� (��. ����.), w#(. ;����� (����., �. �. �.)

�+3(�.'-(%@ &+5�/&+"-&%@ A!*+1/1�B&%@ 2&�.!3'%,!, �4. �L�. �(/./3/*%

� ',+,,� .%'.�,"!&/ A/1"#*% �L�. �%3/1/.+ &+ )+1+"-&/"�*'-(! .%D/.+&&#, )+.*#(% #(/42"�*%&+ .B%,-'# 'A�"(2.+&&� ) �&U%4% "�*-4%, .B%,-'# 5�&2.+,% ,+ A/.+F+,% ¤D&� A3+.+, �/ .'./� B!312 )+$!)A!B2¯ ¤¤ A/.&/5�&&! �'&2.+&&# #( 2 ).%B+@&/42 '!3!*/.%��, ,+( � . /'.�,&-/42.

+('=!;{'%'1!$'%'�)!>!$!��+0",+=$�'(">!>+%'�)!J,"�1'(++,#+. �+&!>!$"

+#,. {���� (��. ����.), w#(. ;����� (����., �. �. �.)

�+3-(/.'(%@ &+5%/&+"-&G@ A!*+1/1%B!'(%@ 2&%.!3'%,!, %4. �L�. �(/./3/*G

�''"!*/.+&%! 'A!5%?%(% ',+&/."!&%# /$3+)/.+,!"-&/@ '%',!4G % A!*+1/1%B!'(/@ 4G'"% ./,*!"-&/4 3!1%/&! ',3+&G #."#!,'# B+',-� &!/$D/*%4/1/ $+)%'+ *"# 2,/B&!&%#, 3+'U%3!&%# %/,/$3+F!&%# /$�!(,%.&/1/ '/*!3F+&%# %',/3%% A!*+1/1%(%. *+&&/4 +'A!(,! /$3+�!&%! ( *!#-,!"-&/',% �L�. �%3/1/.+ . A!3!"/4&G@ 4/4!&, ((/&!5 50-D — &+B+"/ 60-D 11. XIX ..), A/)./"#!, .&!(/,/3/@ ',!A!&% (/4A!&'%3/.+,- *+&&G@ &!*/',+,/(, A/(+)+,- %',/3%(/NA!*+1/1%B!'(%@ A3/-5!'' . 3!1%/&! (+( '/',+.&2� B+',- /$�!1/ %',/3%B!'(/1/ A3/5!''+ 3+).%,%# /$3+)/.+&%# [1].

�&+"%) '/',/#&%# %)2B!&%# 124+&%',%B!'(/@ &+A3+."!&&/',% A!*+1/1%B!'(%D .)1"#*/.�L�. �%3/1/.+ A/(+)+", B,/ !1/ A!*+1/1%B!'(/! &+'"!*%! .'!1*+ #."#"/'- /$�!(,/4 A3%',+"-&/1/.&%4+&%# %''"!*/.+,!"!@ [1]. �"+1/*+3# !1/ .G',2A"!&%#4 % *!#,!"-&/',% . A!*+1/1%(! % . /$�!-',.!&&/4 4&!&%% .'! $/"!! ',+"+ 2,.!3F*+,-'# ,+ ,/B(+ )3!&%#, B,/ ( 3!$!&(2 &!/$D/*%4/ A/*D/-*%,- (+( ( %&*%.%*2+"-&/',%, B,/ (+F*G@ 3!$!&/( &!A/.,/3%4, B,/ �,/ 5!"G@ 4%3, B,/ . (+F*/43!$!&(! )+"/F!&G A3%'2�%! ,/"-(/ !42 'A/'/$&/',% % *2U!.&G! )+*+,(%. �,'�*+ �L�. �%3/1/..G./*%" 1"+.&2� 5!"- ./'A%,+&%# % /$3+)/.+&%#. �&+ */"F&+ )+("�B+,-'# . /$3+)/.+&%% B!"/.!-(+, . ',+&/."!&%% B!"/.!(+ (+( "%B&/',%, . 3+).%,%% .'!D )+*+,(/. % 'A/'/$&/',!@ 3!$!&(+. �4!&-&/ ,+(2� %&,!3A3!,+5%� %4!" . .%*2 �L�. �U%&'(%@, (/1*+ 1/./3%", B,/ �L�. �%3/1/. «A!3.G@ 2&+' .)1"#&2" &+ *!"/ /$3+)/.+&%# ' ?%"/'/?'(/@ ,/B(% )3!&%#» [5].

�L�. �%3/1/. 2,.!3F*+", B,/ /$3+)/.+&%! 5!&&/ '+4/ A/ '!$!, % &! &2F&/ A3!'"!*/.+,- (+(%D-"%$/ 4!3(+&,%"-&GD 5!"!@. �"+.&G4 . /$3+)/.+&%% #."#!,'# 3+'(3G,%! .'!D ?%)%B!'(%D % *2D/.-

91

&GD 'A/'/$&/',!@, + &! './!(/3G',&G@ 3+'B!, &+ $2*2�!! «.G1/*&/!» 2',3/@',./ 2B+�!1/'# . F%)-&%. %*# . 3!$!&(! 3+).%.+��2�'# "%B&/',-, �L�. �%3/1/. /,',+%.+" A3+./ 3!$!&(+ '+4/42 *!"+,-'./@ F%)&!&&G@ % A3/?!''%/&+"-&G@ .G$/3. �!"/.!( .G$%3+!, A3/?!''%�, B,/$G . /$�!',.!&&/@*!#,!"-&/',% (+( 4/F&/ A/"&!! 3!+"%)/.+,- '!$# . '/5%+"-&/@ % /$3+)/.+,!"-&/@ '3!*!.

�L�L�%3/1/. ',3+',&/ A3/,!',2!, A3/,%. A/*/$&/1/ '+4/2A3+.',.+ % A3/%)./"+ 3/*%,!"!@[3]. +(F! /& A3!*"+1+" 3!+"%)/.+,- .G*.%&2,2� %4 124+&&2� 5!"- A!*+1/1%(% A2,!4 «/$�!B!-"/.!B!'(/1/ /$3+)/.+&%#». �+4+ %*!# «/$�!B!"/.!B!'(/1/ /$3+)/.+&%#» $G"+ &! &/./@. �&+ %4!-"+ A3!*U!',.!&&%(/. �L�. �%3/1/.+ . "%5! �L�. �!5(/1/, �L�. �(/./3/*G, �L�. �/.%(/.+,L�. �!"%&'(/1/. �*&+(/ %4!&&/ . A!*+1/1%B!'(/@ (/&5!A5%% �L�. �%3/1/.+ �,+ %*!# A3%/$3!,+!,.A/"&! (/&(3!,&G!, %4!��%! A3+(,%B!'(2� &+A3+."!&&/',-, B!3,G. �"# ,/1/, B,/$G &+1"#*&!!A3!*',+.%,- '!$! B!"/.!B!'(2� (/&5!A5%� «/$�!B!"/.!B!'(/1/ /$3+)/.+&%#» �L�. �%3/1/.+, %!1/ 124+&%',%B!'(%! A!*+1/1%B!'(%! ./))3!&%#, *"# ,/1/, B,/$G '/!*%&%,- 3+)3/)&!&&G! 4G'"% .!*%&2� /$�2� (+3,%&2, /&+ $G"+ A3!*',+."!&+ &+4% &+ /'&/.+&%% ,�+,!"-&/1/ +&+"%)+ 4%3/./)-)3!&%# % A!*+1/1%B!'(%D .)1"#*/. 2B!&/1/ . &!'(/"-(%D +'A!(,+D: «)//"/1%B!'(%@» B!"/.!( (+(3+)24&/! '2�!',./ % B!"/.!( (+( *2D/.&/! ).!&/. �',%&&/ 124+&&/! /$3+)/.+&%!, ,+(%4 /$3+)/4,*/"F&/ $G,- &+A3+."!&/ &+ 3+'(3G,%! B!"/.!B!'(/@ '2�&/',% ./ .'!D 2(+)+&&GD &+A3+."!&%#D.

�B%,G.+# &+5!"!&&/',- A!*+1/1%B!'(/@ (/&5!A5%% �L�. �%3/1/.+ &+ .'!',/3/&&!! 3+).%,%!B!"/.!B!'(/@ '2�&/',% 3!$!&(+, 4G 4/F!4 A/&#,- '4G'", (/,/3G@ 2B!&G@ .("+*G.+" . ,!34%&�/$�!B!"/.!B!'(/1/ /$3+)/.+&%#». �&/1%! '/.3!4!&&%(%, . ,/4 B%'"! �L�. �U%&'(%@ %�L�. �/$3/"�$/., 1/./3%"% / ,/4, B,/ �L�. �%3/1/. &! /$�#'&%" */"F&G4 /$3+)/4, B,/ /& %4!" ..%*2, (/1*+ A%'+" /$ «/$�!B!"/.!B!'(/4 /$3+)/.+&%%» [5].

�//"/1%B!'(+#, A3%3/*&+#, '2�&/',- B!"/.!(+ )+("�B+!,'# . ,/4, B,/ A/ A3%3/*&G4 )+(/-&+4 A3/%'D/*#, 3/', % 3+).%,%! !1/ /31+&%)4+, ./'',+&/."!&%! ?%)%/"/1%B!'(%D '%',!4 % ?2&(-5%@ (&+3+�%.+&%! "/.(/',% % '%"G /31+&%)4+, ',+&/."!&%! !1/ ?%)%B!'(%D ?2&(5%@, A3!'!B!&%!.3!*&GD A3%.GB!( *!,!@, (/,/3G! A3%./*#, '/ .3!4!&!4 ( &+32U!&%#4 )*/3/.-#).

��+)24&/!» /$3+)/.+&%!, ,. !. /."+*!&%! /'&/.+4% &+2B&GD )&+&%@, A3%).+&/ . A!3.2� /B!-3!*- 3+).%.+,- 24',.!&&G! 'A/'/$&/',% *!,!@, %D '//$3+)%,!"-&/',-, .&%4+,!"-&/',-, A+4#,-,?/34%3/.+,- 24!&%! A/*.!31+,- '+4/',/#,!"-&/42 +&+"%)2 #."!&%# % '/$G,%# *!@',.%,!"-&/',%,*!"+,- '+4/',/#,!"-&G! .G./*G % /$/$�!&%# A/ 3+)&G4 ,!4+4 % &+A3+."!&%#4. +(%4 /$3+)/4,B!"/.!( 3+).%.+!,'# (+( '2�!',./ 3+)24&/!. �!) '/*!3F+,!"-&/1/ (/4A/&!&,+, $!) )&+&%@, "�$/!/$3+)/.+&%! &!./)4/F&/, /&/ &! %4!!, '4G'"+ [1].

�/"-U/! .&%4+&%! . A!*+1/1%B!'(/@ (/&5!A5%% �L�. �%3/1/.+ 2*!"#!,'# &3+.',.!&&/42 %13+F*+&'(/42 ./'A%,+&%�. �"+1/*+3# ,+(/42 &+A3+."!&%� ./'A%,+&%# B!"/.!( 2B%,'# /$�!&%� 'A/*/$&G4% '!$! "�*-4%, 2)&+!, './! B!"/.!B!'(/! */',/%&',./, 2B%,'# 5!&%,- */',/%&',./ %2.+F+,- A3+.+ *321%D "�*!@, /'/)&+!, './� /,.!,',.!&&/',- A!3!* /$�!',./4, &+B%&+!, A/&%-4+,-, B,/ ,+(/! *32F$+, "�$/.- % *321%! B!"/.!B!'(%! B2.',.+. �3/%'D/*%, ',+&/."!&%! B!"/.!(+(+( /$�!',.!&&/1/ '2�!',.+. �3/4! ,/1/, B!"/.!(2 &!/$D/*%4/ /'./!&%! ,!D &/34 /$�!&%#, (/-,/3G! .G3+$/,+&G /$�!',./4 . A3/5!''! !1/ %',/3%B!'(/1/ 3+).%,%#, (+( A3+./.GD, ,+( % 4/-3+"-&/N&3+.',.!&&GD (+,!1/3%@. �!"/.!( (+( '2�!',./ */"F!& 24!,- *!"+,- .G$/3 A/.!*!&%# (+(' A/)%5%@ &3+.',.!&&GD 2$!F*!&%@, ,+( % ' A/)%5%@ 13+F*+&'(/NA3+././@ &3+.',.!&&/',%, «)+-(/&&/',%», (+( 1/./3%, �L�. �%3/1/., + ,+(F! /,',+%.+,- './% .)1"#*G % 2$!F*!&%# [1].

�,+(, «/$�!B!"/.!B!'(/! /$3+)/.+&%!», A/ 4&!&%� �L�. �%3/1/.+, */"F&/ /D.+,%,- .'!',/3/&G B!"/.!B!'(/1/ '2�!',.+ % '.#)+,- . !*%&2� '%',!42 /,*!"-&G! B+',% A!*+1/1%B!'(/@(/&5!A5%% 2B!&/1/, + A/3/@ % /,*!"-&G! 4G'"%, .G'(+)G.+&%#, %*!%, (/,/3G! . A!*+1/1%B!'(/4&+'"!*%% 2B!&/1/ '2�!',.2�, 3+)3/)&!&&/. � �L�. �%3/1/.+ &! $G"/ /$/$�+��!1/ ,32*+ A/ A!-*+1/1%(!, .!*- './% A!*+1/1%B!'(%! ./))3!&%# /& 3+'(3G.+" . A3/5!''! (/&(3!,&/@ A!*+1/1%B!-'(/@ *!#,!"-&/',%. �*&+(/ %) +&+"%)+ A!*+1/1%B!'(%D .)1"#*/. 2B!&/1/ #'&/ .%*&/, B,/ «/$�!B!-"/.!B!'(/! /$3+)/.+&%!» */"F&/ /D.+,G.+,- .'! ',/3/&G ',+&/."!&%# B!"/.!B!'(/1/ '2�!',.+,,3+(,/.(2 (/,/3/1/ 4/F&/ 3+''4+,3%.+,- . U%3/(/4 '4G'"!, (+( ?%"/'/?'(%@ A/*D/* ( '+4/@%*!! /$3+)/.+&%# % ./'A%,+&%# B!"/.!(+ ./ .'!D !1/ A3/#."!&%#D. +(/! A/&%4+&%! «/$�!B!"/.!-B!'(/1/ /$3+)/.+&%#» . U%3/(/4 '4G'"! %4!!, ,!/3!,%B!'(2�, 5!"!A/"+1+��2�, ',3+,!1%B!'(2�&+A3+."!&&/',- [1].

��$�!B!"/.!B!'(/! /$3+)/.+&%!» . $/"!! 2)(/4 '4G'"! ,+(F! )+&%4+!, . A!*+1/1%B!'(/@(/&5!A5%% �L�. �%3/1/.+ /A3!*!"!&&/! 4!',/. �,+.# 1"+.&/@ 5!"-� A!*+1/1%(% .'!',/3/&&!!3+).%,%! B!"/.!B!'(/@ '2�&/',% 3!$!&(+, /& 'B%,+", B,/ /$2B!&%! */"F&/ $G,- '.#)+&/ A/'"!*/-.+,!"-&/',-� /A3!*!"!&&GD A!3%/*/., (/,/3G! /& D+3+(,!3%)2!, (+( /$�!B!"/.!B!'(/! % 'A!5%-+"-&/! /$3+)/.+&%!. )+%4/'.#)- �,%D *.2D A!3%/*/. /$3+)/.+&%#, A/ 4&!&%� 2B!&/1/, )+("�B+-

92

!,'# . ,/4, B,/ A3!F*!, B!4 A/"2B%,- /A3!*!"!&&2� 'A!5%+"-&2� 'A!5%+"-&/',-, .G$3+,- './@F%)&!&&G@ A2,-, 2B+�%@'# */"F!& '?/34%3/.+,-'# (+( B!"/.!(, (+( "%B&/',-. �L�. �%3/1/. 1/-./3%": «�+@,! .G3+$/,+,-'# % 3+).%,-'# .&2,3!&&!42 B!"/.!(2!» [5].

��$�!B!"/.!B!'(/! /$3+)/.+&%!», ' ,/B(% )3!&%# �L�. �%3/1/.+, A3%).+&/ 3!U+,- 3#* .+F-&!@U%D )+*+B. /NA!3.GD, 3+'(3G,- A/'3!*',./4 &+2(% %&*%.%*2+"-&G! 'A/'/$&/',% 3!$!&(+,1"+.&G4 /$3+)/4 24',.!&&G!, B,/$G '*!"+,- 2B+�%D'# «./'A3%%4B%.G4% ( 3+)"%B&G4 /,3+'"#4'.!*!&%@», )+%&,!3!'/.+,- %D 2B!&%!4, &+2B%,- '+4/',/#,!"-&/ 4G'"%,-. /N.,/3GD, &!/$D/*%4/A3%2B%,- 4/"/*/1/ B!"/.!(+ ' 3+&&%D "!, ( '+4//$3+)/.+&%�, A/*1/,/.%,- !1/ 24 ( «'+4/',/#-,!"-&/@ *!#,!"-&/',% &+ A/A3%�! 2B!&%#», B,/$G /(/&B%. 2B!$&/! )+.!*!&%!, A/"2B%. /$3+)/.+-&%!, B!"/.!( 4/1 '+4/',/#,!"-&/ 4G'"%,-, '/.!3U!&',./.+,- '!$#. N,3!,-%D, «/$�!B!"/.!B!'(/!/$3+)/.+&%!» */"F&/ A/*1/,/.%,- 3!$!&(+ ( F%)&% . /$�!',.!, ,. !. *+,- ./)4/F&/',- 2'./%,-/A3!*!"!&&G! &3+.',.!&&G! ,3!$/.+&%#, )+"/F%,- /'&/.G /$�!B!"/.!B!'(/@ 4/3+"%. �+(/&!5,&!/$D/*%4/ A/*1/,/.%,- B!"/.!(+ ( '+4/./'A%,+&%� % '+4/A/)&+&%�, &+2B%,- !1/ )+1"#*G.+,- .'./� *2U2 % /,.!B+,- A!3!* './!@ '/.!',-�.

/"-(/ &+ ,+(/4 ?2&*+4!&,! 4/F&/ /'2�!',."#,- % 'A!5%+"-&/! /$3+)/.+&%!, (/,/3/!*/"F&/ *+,- 2B+�%4'# 'A!5%+"-&G! ,!/3!,%B!'(%! )&+&%# % /$#)+,!"-&/ A3+(,%B!'(%! &+.G(%3!+"%)+5%% �,%D )&+&%@ . %)$3+&&/@ /$"+',%. �%U- &+ /'&/.! «/$�!B!"/.!B!'(/1/ /$3+)/.+&%#»,'B%,+!, �L�. �%3/1/., 4/F&/ A/"2B%,- *!"-&/1/, /,.!,',.!&&/1/ 'A!5%+"%',+, (/,/3G@ ( ,/42 F!$2*!, % 13+F*+&%&/4 './!@ ',3+&G. �321%4% '"/.+4%, (+( /,4!B+"�L�. �',3/1/3'(%@, «�L�. �%-3/1/., 1/./3#, B,/ (+F*/42 — .3+B2, '/"*+,2 % A3., &+*/ .'!1*+ $G,- B!"/.!(/4, ,!4 '+4G4 2(+-)G.+", B,/ /$�+#, "B!"/.!B!²(+#" 4/3+"- */"F&+ '"2F%,- (3%,!3%!4 .'#(/@ "A3/?!''%/&+"-&/@4/3+"%"» [4]. �L�. �%3/1/. 'B%,+", B,/ «/$�!B!"/.!B!'(/! /$3+)/.+&%!» */"F&/ /'2�!',."#,-'#. /'&/.&/4 . ',!&+D &+B+"-&/@ % '3!*&!@ U(/"G. �/'"! �,/1/ 2B+�%!'# 4/12, ' A/"&/@ /,.!,',-.!&&/',-� A/*/@,% ( .G$/32 A3/?!''%%, A/"2B%. *+"-&!@U!! /$3+)/.+&%! . 'A!5%+"-&GD .G'U%D2B!$&GD )+.!*!&%#D %"% . 2&%.!3'%,!,!. �*&+(/, '2�!',./.+.U+# ,/1*+ U(/"+ '/.!3U!&&/ &!2*/."!,./3#"+ A/*/$&G4 ,3!$/.+&%#4.

+(%4 /$3+)/4, «/$�!B!"/.!B!'(/! /$3+)/.+&%!» . 2)(/4 '4G'"! — ,+(/! /$3+)/.+&%! B!-"/.!(+, (/,/3/!, $2*2B% &+A3+."!&/ &+ 3+).%,%! ?%)%B!'(%D, 24',.!&&GD % *2D/.&/N&3+.',.!&&GD'A/'/$&/',!@, A/)./"#!, B!"/.!(2 /'/)&+&&/ % 4/,%.%3/.+&&/ *!"+,- './@ F%)&!&&G@, A3/?!'-'%/&+"-&G@ % 13+F*+&'(%@ .G$/3, /'&/.G.+#'- &+ )&+&%#D, /A3!*!"!&&/4 F%)&!&&/4 /AG,! %'?/34%3/.+.U%D'# 2$!F*!&%#D, + ,+(F! &+ /'&/.! '+4/./'A%,+&%#. +(/! A/&%4+&%! «/$�!B!"/-.!B!'(/1/ /$3+)/.+&%#» 'B%,+!,'# $/"!! A3+(,%B!'(%4, (/&(3!,&G4, % �,/ 4/F!, $G,- ,+(,%B!-'(%4 /3%!&,%3/4 . A!*+1/1%B!'(/@ (/&5!A5%% 2B!&/1/.

�/.3!4!&&+# (/&5!A5%# /$3+)/.+&%# ./ 4&/1/4 A3/*/"F+!, % 3+).%.+!, %*!% A!*+1/1/.-124+&%',/. A3/U"/1/, . ,/4 B%'"! % �L�. �%3/1/.+. �*&+(/ '/.3!4!&&+# (/&5!A5%# /$3+)/.+&%#/$/1+�+!,'# % &/.G4 '/*!3F+&%!4, A/#."#�,'# &/.G! 13+&%, .G).+&&G! ( F%)&% %',/3%B!'(/@'%,2+5%!@. �L�. �%3/1/. /*&/.3!4!&&/ $G" ',/3/&&%(/4 *.2D &+A3+."!&%@ . /$3+)/.+&%%: ("+'-'%B!'(/1/ % 3!+"-&/1/. �!/$D/*%4/',- �,/1/ /& .%*!" . ,/4, B,/$G, ' /*&/@ ',/3/&G, 2*/."!,./-3%,- )+A3/'G 1/'2*+3',.+ . 'A!5%+"%',+DNA3+(,%(+D, + ' *321/@, — &! *+,- «)+'/D&2,-» .!,.% '2-12$/ &+2B&/1/ /$3+)/.+&%#. �*&+(/ A/*/$&/! 3+)*!"!&%! &+A3+."!&%@ /$3+)/.+&%#, A/ 4&!&%�2B!&/1/, &%(/%4 /$3+)/4 &! */"F&/ %'("�B+,- «/$�!B!"/.!B!'(/1/ /$3+)/.+&%#». «�/'3!*',./4"% %)2B!&%# *3!.&%D #)G(/. % 4+,!4+,%(%, %"% A/'3!*',./4 &/.GD % !',!',./.!*!&%# '/.!3U%,'#/$�!B!"/.!B!'(/! /$3+)/.+&%! .+U!1/ 'G&+, .'! 3+.&/ — "%U- $G '*!"+,- !1/ B!"/.!(/4» [5].

�+&&2� A3/$"!42 '/.3!4!&&G! 2B!&G! AG,+�,'# /'4G'"%,- % 3!U%,- A2,!4 124+&%,+3%)+-5%% /$3+)/.+&%# [2]. �2,- A3/$"!4G '/',/%, &! . ,/4, B,/$G !',!',.!&&/&+2B&/!, ,!D&%B!'(/! /$3+-)/.+&%! A/*4!&%,-, .G,!'&%,- 124+&%,+3&G4, + . ,/4, B,/$G % !',!',.!&&G!, % 124+&%,+3&G! A3!*-4!,G A/.!3&2,- ( %&,!3!'+4 B!"/.!(+, &+A3+.%,- &+ ?/34%3/.+&%! 124+&%',%B!'(/@ "%B&/',%.

�/34%3/.+&%! . 3!$!&(! '+4/',/#,!"-&/',% % /,.!,',.!&&/',% *+', ./)4/F&/',- !42 './-$/*&/ B2.',./.+,- '!$# . "�$/@ '3!*!, /'/$!&&/ �,/ .+F&/ . A!3%/* A!3!D/*+ 3!$!&(+ %) 4"+*U%D("+''/. . ',+3U%!. �//$3+)%,!"-&/',-, .&%4+,!"-&/',-, 24!&%! A/*.!31+,- '+4/',/#,!"-&/42+&+"%)2 #."!&%# % '/$G,%# *!@',.%,!"-&/',%, *!"+,- '+4/',/#,!"-&G! .G./*G % /$/$�!&%# A/-4/12, 3!$!&(2 $G',3!! /'./%,-'# . "�$/@ /$3+)/.+,!"-&/@ '3!*!. �/�,/42 .)1"#*G �L�. �%3/1/-.+ 4/12, ',+,- /'&/./@ % A"+5*+34/4 3+''4/,3!&%# ./A3/'+ / ?/34%3/.+&%% 3!$!&(+ . �(/"/1/-/3%!&,%3/.+&&/@ '3!*!, B,/ . './� /B!3!*- ,3!$2!, *+"-&!@U!1/ %)2B!&%#.

�A%'/( "%,!3+,23G:1. �24+&�)+5�# ,+ 124+&�,+3%)+5�# A3/?!'�@&/¤ /'.�,%: �+2(.-4!,/*. )$. / �!*. (/".: �L�. �#)�&,

L�. �+@B2(, L�. �/&�@, �L�. �%B(+"/ ,+ �&. — �., 1995. — 160 '.

93

2. �3+'&/.'(%@, �L�. �!*+1/1%B!'(%! %*!% �L�. �%3/1/.+. — �., 1949. — 196 '.3. �',3/1/3'(%@, �L�. �L�. �%3/1/. % !1/ A!*+1/1%B!'(%! )+.!,G (/B!3(% A/ %',/3%% 32'-

'(/@ A!*+1/1%B!'(/@ 4G'"%). — ��$., 1914. — 179 '.4. �%3/1/., �L�. �)$3+&&G! A!*+1/1%B!'(%! '/B%&!&%#. — �.: �!*+1/1%(+, 1952. — 702 '.5. �U%&'(%@, �L�. �!*+1/1%B!'(%! '/B%&!&%# . 6 ,. — .2. — �.: �!*+1/1%(+, 1988. —

496 '.

�')*+= 2. �!$&'J',,-'"��')0-","0!J+++�"0","0!J++

CHANGE IN THE MORPHOLOGICAL STRUCTURE OF THE ADRENAL CORTEXIN EXPERIMENTAL HEMORRHAGIC SHOCK

A.A. Chekushkin (doc.), Y.V. Yunyashina (ass.)

Penza state universityThe institute of medicine

The department of clinical morphology and forensic medicine with a course of oncology

Scientific adviser: S.A. Mozerov (prof.)

Relevance. Acute blood loss is one of the leading causes of death of people aged 5 to 44 years. Inthe overall structure of the share of deaths from non-compensated blood loss accounts for about 10 % ofcases, and a significant downward trend is not observed, in spite of the use in the practice of innovativedrugs and therapies [1]. In response to acute blood loss in the patient develops a complex response of com-pensatory and protective reactions having a universal character [2, 3]. The inclusion of these reactions isthe direct participation and under the control of the endocrine system. The greatest interest has always ledthe researchers to study the role of adrenal hormones due to the participation of hormones of this complexof the endocrine system in the regulation of key life processes of cellular and subcellular structures, con-trolling the most important types of metabolism and function of almost all organs and tissues, managingurgent and long-term adaptation and homeostatic responses to different levels of the body.

Functions and role of the adrenal cortex in shock is most well understood. However, on this ques-tion findings are quite contradictory. Interpretation of the regularities, mechanisms and the value of thefunctional changes in the dynamics of shock differ contradictions and controversy.

Since the days of Hans Selye to assume that in the adrenals, in all types of shock, develop the sametypes of change - hyperemia, stasis and hemorrhage. However, our studies have shown that varieties ofchanges are developing here that are specific to different types of shock states, and for the time of thestudy of the organ after the shock.

The aim of the study was to investigate the changes in the morphological structure of the adrenalcortex in hemorrhagic shock.

Materials and methods of study: The study was carried out in accordance with the order of theUSSR Ministry of Higher Education from 13.11.84 � 742 «On approval of rules for work with experi-mental animals» and � 48 dated 23.01.85 «About the control over working with the use of experimentalanimals» by 25 mongrel dogs, weighing from 10 to 23 kg. For model of acute blood loss after prepara-tions aseptically catheterized right femoral artery and performed free bloodletting in volume 0,24 � 22,83ml/kg. Duration of bleeding was 0,20 � 3,87 min.

To confirm the severity of the injury and the presence of hemorrhagic shock during the experimentwere measured hemodynamic parameters such as blood pressure (BP), central venous pressure (CVP),peripheral venous pressure (CVP), heart rate (HR). Besides the parameters of hemodynamic respiratoryrate (RR) and hematocrit (Ht) were studied.

Based on the purposes and objectives of the study, the experimental animals were divided into 2groups:

The first group consisted of 10 dogs whose changes in the morphological structure of the adrenalglands in 6 - 12 hours after the shock genicity injury were studied by light microscopy. In the secondgroup, 10 animals were studied in morphological changes in the dynamics of the adrenal glands in 24hours.

94

The results of the study. In the adrenal glands of dogs in Group 1, the most striking feature was thehyperplastic in the glomerular zone.

Cells of glomerulosa`s area formed tightly packed group of prismatic cells. Slabobazofilnaya cy-toplasm of cells in glomerular area was full of bright fat inclusions in some cells inclusions of fat formedlarge vacuoles. Small, round, oval, sometimes rod-shaped nucleus differed pronounced hyperchromic.The full-blooded sinusoidal capillaries were located between glomerulus. Certain parts of the glomerulararea differed in lighter color of cytoplasm endocrine cells. Beam area consisted of radially arranged cordsof large endocrine epithelial cells of polygonal form with centrally located nucleuses. The cytoplasm hadvacuolated lighter color. It had a large number of lipid inclusions. Between the strands of cells of fascicu-lar area were full-blooded sinusoidal capillaries.

In the analysis of histological preparations of the adrenal glands in dogs of Group 2 it is interestingto note the sharp hyperplasia glomerular area, which in the form of strands infiltrated among the cells ofthe beam area. Endocrin/'ytes of glomerular zone formed a variety of structures, among which the domi-nants were strands of glomeruli. The cytoplasm of cells of glomerular area, compared with the previousseries differed by more intense color. The nucleuses of most cells were rod-shaped. Sinusoidal capillarieswere slightly dilated. Between the strands of cells of all layers edema was marked.

Endocrine of fascicular area were abruptly decreasing in size. Nuclear-cytoplasmic ratio was in-creasing in favor of the nucleus. Cytoplasm was more intensely colored due to the reduction of lipid in-clusions, which in the form of small droplets were evenly distributed in the cytoplasm. Full-blooded sinu-soidal capillaries had normal width or were slightly dilated.

Mesh area of the adrenal cortex has not changed much in dogs of both groups.Conclusions. The results of our work show that the greatest changes of the morphological structure

occur in the glomerular area of the adrenal cortex. In acute massive blood loss during the day, hyperplasiaof the glomerular area takes place progressive. Despite the important role of glucocorticoids in the patho-genesis of shock, beam area structurally reacts to a lesser extent. Also note worthy that fact that in spiteof the significant violations in hemodynamics, microcirculation of adrenals violated slightly.

�A%'/( "%,!3+,23G1. Koziev, M.P. The value of adaptive responses in acute blood loss to determine the tactics of in-

fusion therapy in the prehospital setting: the dissertation ... Ph D (14.00.37). — Novosibirsk, 2009. —P. 95.

2. Zorkin, A.A., Nigulyanu V.I. Pituitary-adrenal system and metabolism in shock. — Chisinau:Shtiintsa. — 1977. — P. 131 .

3. Davydov, V.V. State and the role of the endocrine system in shock - Materials of Int. Congresson pathophysiology, May 28 — June 1, 1991. — Moscow. — 1991. — P. 351.

THE ANALYSIS OF THE REASONS OF A LETHALITY IN HOSPITALSOF CHELYABINSK REGION ON MATERIALS OF AUTOPSIYNY EXAMINATIONS

1 A.S. Divisenko (ass.)1 Chelyabinsk state medical academy

The department of public health and health care2 Chelyabinsk regional pathoanatomical bureau

Scientific adviser: 1 J.A. Tjukov (prof., doctor of medical sciences),2 G.V. Sychugov (candidate of medical sciences)

Integrally sick, unauthoritativethe statistics of mortality can be curedonly openings.

I.V. Davydovsky.

Urgency: The state of health of the population is traditionally estimated both by data about preva-lence of diseases, and by data about mortality. In turn, indicators of mortality reflect influence on a stateof health of the population of social problems and are important components of criterion of quality ofprovided medical care in treatment-and-prophylactic establishments. The most solid statistical data on acause of death can be received only as a result of pathoanatomical opening. The diagnosis which is estab-lished by results of an autopsiya, is final and synthesizes in itself all pathological changes available forthe patient.

95

Purpose: development of the data containing in annual reports of pathoanatomical services ofmunicipalities of Chelyabinsk region for the purpose of receiving data on the reasons for mortalityamong the population of area, identification of causes of death which take leading places by results ofopenings.

Materials and methods: annual reports of pathoanatomical services of municipalities of Chelya-binsk region from 2001 y. were analyzed. on 2010 y.

Results: For the studied period (with 2001 y. on 2010 y.) the data presented in table 1 are obtained.

Table 1

Specific weight (%) the pathology which has served as an initial cause of deathin hospitals of Chelyabinsk region by results of pathoanatomical openings the first 10 places

(excepting the violent reasons)Classes on ICD X 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

IX Diseases of bodies ofblood circulation 36,7 34,5 34,5 35,8 32,9 35,3 38,7 34,7 37,8 35,4

II neoplasm 12,8 10,3 10,4 13,0 11,5 11,8 12,4 10,6 14,5 11,6XI Diseasesof digestive organs 9,3 9,5 9,5 11,7 11,3 14,4 15,2 13,5 14,6 13,8

I Some infectiousand parasitic diseases 8,0 6,7 6,7 7,1 8,2 7,0 6,8 5,7 6,7 6,1

XVI The separateconditions arisingin the perinatal period

8,7 5,8 5,8 5,5 13,1 8 8,7 10,3 5,5 6,1

X Diseasesof respiratory organs 7,46 5,5 5,5 6,26 5,5 5,2 5,4 5,3 6,5 5,4

XVII Congenitalanomalies (defectsof blood), deformationsand chromosomalviolations

3,07 4,69 4,7 3,63 4,2 2,8 2,8 2,4 2,8

V Mental disordersand behavior frustration 2,8 4,1 4,1 2,9 2,4 2,9 1,9 1,9

XIV Diseasesof urinogenital system 2,5 2,1 2,2 2,0 2,0 2,2 1,8 1,9 3,5

XIX Traumas,poisonings and some oth-er consequencesof influence of the exter-nal reasons

2,6 1,9 1,9 2,1 2,1 1,0 1,0 1,0 1,2

Thus, in structure of the reasons of mortality of the population of Chelyabinsk region 1 rangovyplace belongs to diseases of system of blood circulation — on the average 35,6 % for the studied periodthe 2nd place occupy new growths — on the average 11,8 % for the studied period, on the 3rd place - dis-eases of digestive organs — on the average 12,3 % for the studied period (17 %). Also growth of diseasesof digestive organs with 20011 is noted. on 20101. (from 9,3 % to 13,8 %).

Conclusions: Mortality indicators from cardiovascular, tserebrovaskulyarny and other vascular dis-eases take 1 rangovy place in structure of the reasons of a lethality of the population of Chelyabinsk re-gion that testify to a high incidence from class pathology diseases of system of blood circulation amongthe population, reflect quality of medical care in all stages of its rendering and are one of the main medi-co-social problems. Development of the integrated complex measures for prevention, early identification,timely high-quality treatment and medical examination is necessary for decrease in these important de-mographic indicators.

�A%'/( "%,!3+,23G:1. �+@3+,-#&5, �L. �/342"%3/.(+ % '/A/',+."!&%! ("%&%B!'(/1/ % A+,/"/1/+&+,/4%B!'(/1/

*%+1&/)/.: �A3+./B&%( / �L. �+@3+,-#&5, �L. �+(,23'(%@. — �.: �!*%5%&'(/! %&?/34+5%/&&/!+1!&,',./, 2008. — 420 '.

2. �!*.!*!., �L�. �!,/*%B!'(%! +'A!(,G ?/342"%3/.(% A3%B%& '4!3,% . A+,/"/1/+&+,/-4%B!'(/@ A3+(,%(!: �!,/*. 3!(/4!&*+5%% / �L�. �!*.!*!.. — ��$., 2005.

96

3.�!F*2&+3/*&+# ',+,%',%B!'(+# ("+''%?%(+5%# $/"!)&!@ % A3/$"!4, '.#)+&&GD '/ )*/-3/.-!4. �!'#,G@ A!3!'4/,3 (���-10). ��. — �!&!.+ (A!3. ' +&1".), . 1–3. — �., 1995–1998.

4. ¬!1"/., �L�. �2,/A'%# % !� )&+B!&%! / �L�. ¬!1"/., �L�. 32'/. // �+4!',%,!"- 1"+.&/1/.3+B+. — 2006. — � 4. — �. 101–103.

5. ¬!1"/., �L�. �'/$!&&/',% ?/342"%3/.+&%# A3%B%& '4!3,% . 3+)"%B&GD ("+''+D ��� 10 /�L�. ¬!1"/., �L�. 32'/., �L. �G'/.+ // �+4!',%,!"- 1"+.&/1/ .3+B+. — 2006. — � 4. — �. 73–88.

DIVERGENCE OF THE CLINICAL AND PATHOANATOMICAL DIAGNOSISAS CRITERION OF QUALITY OF WORK OF MEDICAL INSTITUTIONS

1 A.S. Divisenko (ass.)1 Chelyabinsk state medical academy

The department of public health and health care2 Chelyabinsk regional pathoanatomical bureau

Scientific adviser: J.A. Tjukov 1(prof., doctor of medical sciences),G.V. Sychugov 2(candidate of medical sciences)

Urgency. The analysis of lethal outcomes was entered into health care practice at the initiative ofacademician I.V.Davydovsky and legalized in 1935y. situation Narkomzdrava of the USSR No. 641.This act essentially raised a role of pathoanatomical service, having turned it into control and diagnos-tic division of health system. Indicators of pathoanatomical researches are used during the licensing,LPU accreditation, at an assessment of quality of medical and diagnostic process at all its stages. Theexpert role of the pathoanatomical researches defining legal and financial responsibility of medicalworkers now raises.

Purpose. Development of the data containing in annual reports of pathoanatomical services of mu-nicipalities of Chelyabinsk region with 2000 y. on 2010 y. for the purpose of receiving data on the rea-sons of divergences of diagnoses on the main disease.

Materials and methods. The system of an assessment of quality of medical and diagnostic activ-ity of establishments of health care on the basis of results of posthumous pathoanatomical researcheswas developed in the USSR in the eighties the twentieth century and is applied so far. Among criteriaof quality of medical and diagnostic activity it is considered the leader an indicator of frequency of adivergence of the final clinical and pathoanatomical diagnosis on the main disease. Specific weight (%)all cases of discrepancy of diagnoses of in aggregate carried-out autopsiya died in concrete treatment-and-prophylactic institution (LPU) in nosological forms (units), on an etiology, localization of patho-logical process, and also erroneous treatment of the main disease as the accompanying is thus consi-dered. It is necessary to note that the concepts «coincidence» or «divergence» of clinical and pathoana-tomical diagnoses are applicable only for checking of headings «the main disease» (an initial cause ofdeath). Ascertaining of coincidence or a divergence of all components of clinical and pathoanatomicaldiagnoses is an exclusive prerogative of pathoanatomical service. The divergence of clinical and pa-thoanatomical diagnoses is established in the following cases: at discrepancy of diagnoses on an etiolo-gichesky sign, at discrepancy by a nosological principle, at discrepancy of the main localization of pa-thological process, at disease hyper diagnostics, at the wrong determination of nature of pathologicalprocess, in cases of late (untimely) diagnostics, in connection with the wrong formulation of the finalclinical diagnosis.

As a result of the kliniko-expert analysis at a divergence of diagnoses define the reason of their di-vergence (one of groups of the objective and subjective reasons).

1. Objective reasons of a divergence of diagnoses: the diagnostic mistakes connected with insuffi-cient study of not distinguished disease at modern level of knowledge; the diagnostic mistakes caused byweight of a condition of the patient, interfering carrying out necessary inspection (there were objectivecontra-indications); the errors of diagnostics connected with short duration of stay of the patient in a hos-pital (for the majority of diseases standard term of diagnostics makes 3 days, but for the sharp diseasesdemanding emergency, urgent, intensive therapy, including cases of urgentny surgery, this term is indi-vidual and it can be estimated for hours and minutes); the diagnostic mistakes which have arisen in theabsence of clinical, including of anamnestichesky data, characteristic for this disease, an atipichnost of itsclinical manifestations, inaccessibility of the pathological center to its identification by diagnostic aidsmodern or available in this medical institution.

97

2. Subjective reasons of a divergence of diagnoses: insufficient inspection of the patient, includingdefectively collected anamnesis; will teach less clinical data; will teach less or reassessment of these la-boratory, radiological and other additional methods of research; will teach less or reassessment of theconclusion of the adviser; wrong design of the final clinical diagnosis; hyper diagnostics of the main dis-ease or its deadly complication that actually is one of options of the wrong assessment of clinical data.

The subjective reasons of divergences of diagnoses are always connected with defects of diagnosticprocess in this medical institution.

Results. In the analysis of frequency of a divergence of diagnoses on the main disease at died inhospitals of Chelyabinsk region from 20001. on 20101. the data presented in table 1 are obtained.

Table 1Divergences of diagnoses on the main disease in hospitals of Chelyabinsk region (%).

Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Specific weightof divergences (%) 20,2 18,8 20,3 22,3 23,1 23,7 25,6 26,4 22,5 22,2 25

The indicator of a divergence of diagnoses for the studied period is stable and on the averagemakes 22,7 %.

In the analysis of the reasons of a divergence of diagnoses at the persons who have died in hospitalsof Chelyabinsk region the data presented in table 2 are obtained.

Table 2Specific weight (%) the objective and subjective reasons of divergences

of diagnoses in hospitals of Chelyabinsk region

Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Specific weightof divergencesfor the objective reasons(%)

47,0 49,0 49,7 48,6 52,0 50,1 45,8 45,0 53,9 51,2 52,8

Specific weightof divergencesfor the subjective reasons(%)

53,0 51,0 50,3 51,4 48,0 49,9 54,2 55,0 46,1 48,8 47,2

For the studied period the objective reasons of a divergence of diagnoses averaged 49,5 %, and thesubjective reasons — 50,5 %.

In the analysis of structure of the subjective and objective reasons of divergences of clinical and pa-thoanatomical diagnoses in hospitals of LPU of Chelyabinsk region data presented in table 3 are obtained.

Table 3Structure of the reasons of divergences of diagnoses in hospitals

of LPU of Chelyabinsk region with 2000 on 2010 yy

Reasons of divergences Average % for the studied periodObjective reasonsfrom them: 49,5

� weight of a condition of the patient 23,0� short duration of stay of the patient in a hospital 24,0� difficulty of lifetime diagnostics 6,0Subjective reasonsfrom them: 50,5

� insufficiency of inspection of the patient 11,0� underestimate clinical data 8,0� wrong treatment of laboratory tests and other methods of inspection 5,5� diagnostic mistakes of consulting physicians 1,5� wrong registration of the final clinical diagnosis 16,0other subjective causes 5,0

Thus among the objective reasons the greatest specific weight weight of a condition of the patientand short duration of stay of the patient in a hospital (occupy 23 % and 24 % from all reasons of diver-

98

gences of diagnoses), and among the subjective reasons the greatest specific weight the wrong design ofthe final clinical diagnosis (on the average occupies 16 % from all reasons of divergences for the studiedperiod).

Conclusions:1. The indicator of a divergence of diagnoses for the studied period stable also averages 22,7 % that

testifies to insufficient quality control of medical care in LPU of Chelyabinsk region.2. Among the reasons of a divergence of diagnoses of 53,3 % it is the share of the subjective rea-

sons (insufficient inspection of the patient; will teach less or reassessment of the conclusion of the advis-er; the wrong design of the final clinical diagnosis) that should aim heads of medical institutions of Che-lyabinsk region at more detailed analysis of the subjective reasons of a divergence of diagnoses and de-velopment of actions for their elimination.

3. Among the subjective reasons of a divergence of diagnoses the greatest specific weight is occu-pied by the wrong design of the final clinical diagnosis that testifies to need of refresher courses of doc-tors according to the diagnosis theory.

4. Thus, the materials presented above testify that the analysis of kliniko-pathoanatomical compari-sons essentially helps implementation by the management of establishments of health care of quality con-trol of medical and diagnostic process.development of actions for their elimination.

�A%'/( "%,!3+,23G:1. �/.+"!&(/, L�. �"%&%(/NA+,/"/1/+&+,/4%B!'(+# �('A!3,%)+ (+B!',.+ 4!*%5%&'(/@ A/-

4/�% . 2'"/.%#D ',3+D/./@ 4!*%5%&G: 2B!$. A/'/$%! / L�. �/.+"!&(/, �L�. �+"!., �L�. �+"!.+.— �!"#$%&'(, 2004.

2. �%U&!., �L�. �,+,%',%(+ "!,+"-&/',% % 3+'D/F*!&%# *%+1&/)/. A/ *+&&G4 +2,/A'%@ .2000–2005 11. (.)3/'"+# '!,-) / �L�. �%U&!., �L�. 32'/., �L. �3+.B!&(/, �L�. ¬!1"/. // �+4!'-,%,!"- 1"+.&/1/ .3+B+. — 2007. — � 4 (11). — �. 5–142.

3. �+@3+,-#&5, �L. �/342"%3/.(+ % '/A/',+."!&%! ("%&%B!'(/1/ % A+,/"/1/+&+,/4%B!'(/1/*%+1&/)/.: �A3+./B&%( / �L. �+@3+,-#&5, �L. �+(,23'(%@. — �.: �!*%5%&'(/! %&?/34+5%/&&/!+1!&,',./, 2008. — 420 '.

4. �+(%3/.+, �L�. �&+B!&%! ("%&%(/N+&+,/4%B!'(/1/ +&+"%)+ . *!#,!"-&/',% ��� /�L�. �+(%3/.+, �L�. �+3%& // �$/3&%( «�(,2+"-&G! A3/$"!4G A+,/"/1/+&+,/4%B!'(/@ '"2F$G42&%5%A+"-&GD 2B3!F*!&%@ )*3+.//D3+&!&%#». — 2008. — �. 76–77.

TUMORS OF SALIVARY GLANDS ON TOTAL OPERATIONAL MATERIAL

T.A. Kokovina, A.S. Shichipitsyna, K.I. Zamyatina

Ural state medical academyThe department of pathological anatomy

Scientific adviser: L.N. Zajtseva (assistant professor)

Urgency.Tumors of salivary glands (TSG) have enough big relative density among diseases of oro-facialis area and tumoral diseases of the person. According to V.V. Panikarovsky and A.I.Pachesa, theymake from 0,5 to 5 % of all new growths at the person [4]. In big stomatological surgical clinics OSZHmake about 3 % from total number of surgical operations. They are characterized with different clinicaldeseases, various localization and difficult gistological structure that complicates diagnostics and judge-ment about the disease forecast. Under the statistical data of the Russian oncological center of science, anew growth of salivary glands make 1–5 % among all oncological diseases of the person and 3 % amongtumors of a head and a neck [6].

Numerous researches testify to considerable prevalence good-quality TSG (80 % in structure oftumoral defeats of salivary glands). The basic morphological types are polymorphic adenoma and adeno-lymphoma [6].

Among TSG of epitelium 90–95 % of all new growths of the given localization are necessary a tu-mor. More often TSG are observed in parotid gland (75 %), small salivary glands (about 14 %) and insubmandibular gland (11 %) [4].

According to A.I. Pachesa, adenomas for 2009 make from 70 to 80 % of all epithelium TSG. Fromthem about 75 % good-quality of epitelium tumors 12 % to - in submandibular and small salivary glands,more often in the field of the sky, and about 3 % - in hypoglossal salivary gland are localized in parotid

99

salivary gland. Adenomas arise at women (a parity man's and female 1:1,7), age peak of 50–60 years ismore often. Cases of occurrence of an adenoma at children are rare [6].

Among good-quality epithelium TSG of the most frequent is [olymorphological adenoma. This tu-mor mainly meets in age group of 50–60 years. A parity of men and women 1:1,7. The tumor is more of-ten localized in the big salivary glands (in 75 % in parotid gland, in 13 % - in submandibular and hypog-lossal) and in small salivary glands of 12 %, from them in 9 % in the field of the sky [5, 7].

Mioepitelioma — a variant of monomorphological adenomas which consists exclusively from ma-ture mioepitelium cells, but in some cases in it is possible to observe presence of epitelium component ofchannels. Consider that classical mioepitelium meet seldom, on their share it is necessary about 4 % fromall TSG [1].

Adenilimfomum (a tumor of Uortina, papillary limphomatosum cystadenoma) — good-quality epi-thelium tumor which on frequency of occurrence occupies the second-third place among all TSG. Arisesexclusively in parotid glands. It is observed at men is more senior 40 years [3] more often.

The oksikfilnaja adenoma (oncocytoma or oncocellum adenoma) - rare good-quality TSG, arisesmainly in parotid gland. It makes less than 1 % of new growths of the given localization [8].

The most frequent form of carcinomas SG is mucoepidermalis a cancer. It is marked at the agefrom 50 till 60 years. The parity of men and women among patients makes 1:2,5 [2].

One of frequent carcinomas of salivary glands is adenocystosum (adenocystosum cancer, cylin-droma) a cancer. It makes from 1,2 to 10 % of all malignant TSG and is carcinoma SG second for fre-quency [1]. Primary localization of the given tumor - small salivary glands in the field of the sky and pa-rotid gland. The parity man's and female 1:1,6, and age peak falls for 6–7 decades [6].

The carcinoma inpolymorphological to an adenoma meets from 2 to 10 % of cases. This version ofa carcinoma makes from 1,5 to 6 % among all TSG, from 15 to 20 % among malignant new growths ofthe given localization [6]. The age peak is necessary for 4 decade (30 % of cases) [6, 7].

Toadenocarcenimum carry malignant epitelium tumors. Are characteristic prolipheration of epithe-lium in formations in the form of papillary, tubulus structures and a variety of types of tumoral cages [7].

Research objective.To study TSG on a total operational material.Materials and research methods.We carry out the retrospective analysis of an operational materi-

al on a pathology official areas in laboratory clinical pathomorphology of Regional clinical hospital �1for 3 years (2009–2011). Studying of histologic preparations was spent on the cuts painted hematoxilingand eosinum and on Van Gizonu.

Results of research and their discussion.In total 769 cases of a different pathology orofacialis areasare studied. TSG are diagnosed for 90 patients that makes 11,70 %. In 7 cases clinical diagnosis ���after histologic research has been rejected.Distribution of patients with TSG on age groups and a floor is presented in table 1.

Table 1

Distribution of patients with TSG on age groups and a sex

Agegroups

Male Female Both sexQuantity % Quantity % Quantity %

10–19 1 1,1 1 1,1 2 2,220–29 6 6,7 3 3,3 9 10,030–39 9 10,0 9 10,0 18 20,040–49 5 5,6 11 12,2 16 17,850–59 7 7,8 13 14,4 20 22,260–69 7 7,8 7 7,8 14 15,670–79 2 2,2 7 7,8 9 10,080–89 0 0,0 2 2,2 2 2,2In total 90 100,0

The age of patients with TSG varied from 18 till 83 years.The greatest relative density TSG is necessary on age groups: 50–59 years — 20 cases (22,2 %),

30–39 years–18 cases (20,0 %), 40–49 years — 16 cases (17,8 %). Thus, 54 cases (60,0 %) TSG wereobserved in age groups of 30–59 years.

Among 90 patients with TSG men was 37 (41,1 %), women 53 (58,9 %).

100

+ble 2

Localization of TSG

Salivary gland Quantity %Parotideus 76 84,5Hypoglossal 3 3,3Submandibular 6 6,7Small salivary glands 3 3,3Not specified localization 2 2,2In total 90 100,0

From table � 2 follows that primary localization TSG is parotid salivary gland — 76 cases(84,5 %).

On histogenesium tumors epitelium origins prevailed: good-quality — 75 cases (85,5 %), malig-nant — 11 cases (14,5 %).

Neepitelialnye tumors have made 4 cases (4,4 %):neurophibroma — 2 cases (2,2 %), nonpigmen-tum a melanoma — 1 case (1,1 %) and a lipoma — 1 case (1,1 %).

In our research polymorpological adenoma has met in 57 clinical cases (76,0 % from total numberof all adenomas), mainly in age groups of 30–40 years (17 cases) and 50–60 years (13 cases). A parity ofmen and women 1:1,48. Tumor localization in parotid salivary gland has made 82,5 %, in submandibular— 7 %, in hypoglossal — 5,25 %, in small salivary glands of 5,25 % — of a case.

Macro: the tumor is presented usually by one knot dense or elasic to a consistence, the size from 1to 5–6 sm in diameter. On a cut a tumor of belesovato-yellow color or belovato-gray color, lobular, withthe centers mucosa. Histologically allocate mesenchymal (chondroical and mycsoidal zones, gyalinosum)and epithelium components.

Mioepitelium has met in 1 case at the patient of 69 years in parotid salivary gland (1,3 % fromnumber of adenomas). Mscro: this knotty roundish formation of zheltovato-gray color with a hilly sur-face, the sizes 3 × 3 × 4 see, with a clear boundary; it is presented dense whiteting by a fabric.

Adenilymphoma it is diagnosed in 6 clinical cases, for patients-men at the age from 40 till 70 years(8 % from number of adenomas). Macro: on a cut has is pale-gray coloring with loys of smal of the largecysts filled with serous contents.

The oksifilnaja adenoma was observed in 1 case in parotid salivary gland at the patient-woman atthe age of 82 years (1,3 % from total number of adenomas).

The mukoepidermoidnaja tumor has met in 4 cases, the parity of men and women makes 1:3, agebrackets from 60 till 80 years (36,4 % from total number of all malignant epitelium tumors). Micro:a tu-mor picture owing to a variety of proportions mucosecretual cells, epidermoidus and intermediate.

Cylindromum it is diagnosed in 5 cases, a parity of men and women 1:1,5; in 3 cases it is localizedin parotid salivary gland and 2 cases — in small salivary glands (45,5 % from total number of all malig-nant epitelium tumors).

Macro: the tumor is presented by dense knot in the size from 1 to 4–5 sm in diameter, on a cut ofgray or serokvato-yellow color with indistinct borders.

The carcinoma in po to an adenoma has met in 1 case in parotid gland at the patient-man of 74years.

Adenocarcenomum has met in 1 case at the patient-woman of 49 years, in parotid salivary gland.Conclusions:1. On total operational material TSG among a pathology orofacialis areas makes 11,7 %.2. According histogenesis epitelium tumors prevail - 86 cases, 95,6 %.3. The most frequent TSG is the polymorphic adenoma (57 cases, 63,3 %).4. TSG were localized mainly in parotid salivary gland (76 cases, 84,4 %).

�A%'/( "%,!3+,23G:1. Belous T.A. of «the Tumour of salivary glands» in the book «Pathoanatomical diagnostics of

tumors of the person» under Kraevskogo N.A., Smoljannikova A.V., Sarkisova D.S.'s edition, Moscow,1993 - with. 529–556.

2. Varshavskij A.I. «Mukoepidermoidnaja a carcinoma of parotid and submaxillary salivary glands:diagnostics and treatment», "Stomatology" � 2, 2007 - with. 42–46.

3. Iosava «Materials to studying gystogenesum tumors of salivary glands», the dissertation au-thor's abstract, Tbilisi, 1967 – with. 5-8

101

4. Karapetjan I.S., Gubajdullina E.J., Tsegelnik L.N. «tumors and tumorgenesum defeats of bodiesof an oral cavity, jaws, persons and necks», Moscow, MIA, 2004 – with. 68–74.

5. Nikitina N.I. «Cytologic diagnostics of the so-called mixed tumors of salivary glands», «oncolo-gy Questions» ,. 7, � 2, 1961 - with. 43–48.

6. Paches A.I., Tabolinsky Etc. «Tumours of salivary glands», Moscow, 2009 – with. 40-42, 136–150.

7. Solntsev A.M., Kolesov V. S, Kolesova N.A. of "Disease of salivary glands», Kiev, 1991 – with.127–160.

8. Ustinova B. I, etc. «Epitelialno – 4mioepitelium of a carcinoma of salivary glands», «pathologyArchive» � 3, 2004 - with. 47–50.

REASONS OF ADVERSE TRAUMA OUTCOME

S.I. Zarkov (Senior professor, candidate of medicine), K.S. Sinyova (stud.)

Chelyabinsk state medical academy1 The department of public health and health care

2 The department of topographic anatomy and operative surgery

Research advisors: 1 Y.A. Tukov (prof., doctor of medicine),2 O.V. Peshikov (ass. Prof. candidate of medicine)

Timeliness.The outcome of any disease is determined by complex of objective and subjective fac-tors, where objective factors are those difficult to control, and subjective ones among which we can namemisdiagnosing and treatment errors are fairly corrected and needed to be studied. The goal of this researchis study of nowadays existing term «adverse trauma outcome» and factors leading to it/

Data (pl.) and methods: to achieve the targeted goal we analyzed present legal and regulatoryframework and researches on this issue.

Results of research.E.I. Nesterenko divides terms «treatment result» and «trauma outcome». Thefirst one is an integral indicator representing homogeneous components aggregate, which is the result ofdoing certain actions as a part of diagnostic and treatment process. The second one is determined as con-sequence, sum vector of heterogeneous components combination only one of which is professional ac-tions of healthcare staff [2].

According to D.N. Ushakov’s dictionary adverse means not corresponding to some necessary ordesirable demands, bad undesirable characteristic, and outcome means end, completion, result [3]. In oth-er words adverse outcome in medicine means not corresponding to some necessary or desirable demands,bad undesirable result in process of medical aid.

Y.D. Sergeev and A.A. Mohov resume that in medical literature is often used the term «adverseoutcome». However despite of this definition wide spread in special literature, healthcare workers, aspractice shows, cannot say what exactly they understand under adverse outcome in medicine. So, underadverse outcome in medicine 27 % of respondents understand fatal outcome or disability irrespectively ofreasons that lead to that; 38 % of respondents see adverse outcome in medicine as fatal outcome through afault of medical staff; 31 % of those surveyed get it as patient’s irreversible bodily injury; 1 % of respon-dents appeared to be undecided[4, 5].

Article 8 of Federal law �73-FZ (May, 31, 2001) «On state forensic examiner activities in Rus-sian Federation» determines basic requirements to expert report content: objectivity, omnitude andcompleteness. This means that in the course of study one should analyze all circumstances relevant formaking a right decision. The necessary stage in learning the state of the case is setting out and checkingleads [6].

A mostly wide-spread lead about the reasons for adverse outcome seems to be the lead about aguilty wrongful act of medical workers. The level of occurrence of inappropriate healthcare resulting inadverse outcome to patients’ health range in different countries from 3,0 % in Germany to 20,5 % in Rus-sia of the total number of cases of healthcare [5].

However, it is known that adverse including fatal outcome of disease under definite objective con-ditions is not unnatural, i.e. explicable, independent on medical workers actions [7].

Oftimes, circumstances independent on will and perception of medical workers determine adverseoutcome while carrying out prophylactic, diagnostic and healthcare measures, which is called accident inmedicine [8].

102

Action (failure to act) of the patient himself or his official representatives also can cause adverseoutcome of disease [9].

At last, adverse outcome of disease can be connected to professional errors of medical worker asbona fide mistake in force of professional rules [10].

E. N. Nesterenko offers the following expertise algorithm of adverse trauma outcome reasons:1. Setting out expert leads about adverse trauma outcome reasons.2. Expertise of trauma that patient had.3. Expertise of organization and conditions of diagnostic and treatment process.4. Expertise of accuracy, completeness, timeliness and adequacy of diagnostic and treatment

process. Stating correspondence to regulatory legal acts, modern medicine requirements (present know-ledge), generally accepted clinical experience.

5. Expertise of diagnostic and treatment process results and causal relation characteristics [2].Conclusions.Doing the study we defined:1) term «adverse outcome» and other terms closely connected to it;2) factors, leading to adverse outcome;3) algorithm of expertise reasons of adverse trauma outcome.

�A%'/( "%,!3+,23G:1. �/"!.+, �L. �&+"%) /U%$/( % /'"/F&!&%@ . &!.3/"/1%B!'(/@ ("%&%(! A3% "!B!&%% $/"--

&GD ' 1!4/33+1%B!'(%4% %&'2"-,+4% (4!*%(/NA3+./.G! +'A!(,G A3/$"!4G): �.,/3!?. *%'. …(+&*. 4!*. &+2( / �/"!.+ �L. — �., 2009. — 25 '.

2. �!',!3!&(/, �L�. �"1/3%,4 �('A!3,&/1/ +&+"%)+ (+B!',.+ /(+)+&%# 4!*%5%&'(/@ A/4/�%A3% &!$"+1/A3%#,&/4 %'D/*! )+$/"!.+&%# %"% ,3+.4G / �L�. �!',!3!&(/, �L. �/"2&%&+, �L�. �!-*/3/., �L�. �+D+3/., L. �/A/. // �"+..3+B. — 2006. — � 3. — �. 41–51.

3. �U+(/., �L�. �/"-U/@ ,/"(/.G@ '"/.+3- 32''(/1/ #)G(+ / A/* 3!*. �L�. �U+(/.+. — �.:��, 2009. — 1268 '.

4. �!31!!., �L�. �!&+*"!F+@U!! .3+B!.+&%!: ./)4!�!&%! .3!*+ )*/3/.-� % F%)&% A+5%!&-,+. / �L�. �!31!!., �L�. �/D/.. — �: �����N�!*%+, 2007. — 312 '.

5. �!31!!., �L�. �!&+*"!F+@U!! /(+)+&%! 4!*%5%&'(%D 2'"21 % ?+(,/3G 3%'(+ !1/ ./)&%(-&/.!&%# / �L�. �!31!!., �L. �+&2&&%(/.+ // �!*%5%&'(/! A3+./. — 2007. — . 20, � 4. — �. 3–6.

6. �,+3B!&(/, �L�. �3+./.G! +'A!(,G *!#,!"-&/',% .3+B+. / �L�. �,+3B!&(/, �L�. �+A%@,�L�. �%?4+&. — �!,3/)+./*'(: �&,!"!(, 2003. — 335 '.

7. �+"!&%&+, �L�. �!"/.!( % 4!*%5%&+ . '/.3!4!&&/4 A3+.!. �B!$&/! % A3+(,%B!'(/! A/'/-$%! / �L�. �+"!%&+. — �.: ���, 1995. — 260 c.

8. �/./'!"/., L�. �3/?!''%/&+"-&+# *!#,!"-&/',- 3+$/,&%(/. )*3+.//D3+&!&%#: �,.!,',-.!&&/',-, A3+.+, A3+./.+# )+�%�!&&/',-. / L�. �/./'!"/.. — �/./'%$%3'(: �+2(+, 2001. — 312 '.

9. �/&5!.%B, �L�. �/"1 % /,.!,',.!&&/',- .3+B+. �2*!$&/N4!*%5%&'(%! +'A!(,G / �L�. �/&-5!.%B. — �%!.: G'U+# U(/"+, 1983. — 112 '.

10. �/@(/, �L�. �"%&%(/N+&+,/4%B!'(%@ +&+"%) .3+B!$&GD /U%$/( / �L�. �/@(/, �L�. �%-"#!.+. — �%&'(: G'U+# U(/"+, 1994. — 107 '.

0!�!>&"2!�","0!J+%'�)"=^"&")0'&+�0+)"!�'&"0+$,!>!(!�04�"�&+&"q,-^",0&!�!J'0&+%'�)+^�"&"J'0&"^�"*+',0!)

�&")!J0'1"J"0)+$4�1!$+=^","0!J+%'�)!>!`)��'&+J',0"

"#!. "������ (��.)

�!34'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%# %4. +(. �L�. +1&!3+�+?!*3+ &/34+"-&/@, ,/A/13+?%B!'(/@ % ("%&%B!'(/@ +&+,/4%%, /A!3+,%.&/@ D%3231%%

�������������������: 9��. ?�������� (0��. ��., ���., �. �. �.)

"����z����z %''"!*/.+&%# /$2'"/."!&+ 'A!5%?%B&/',-� *+&&/1/ )+$/"!.+&%#, + %4!&&/1!/13+?%B!'(%4% /'/$!&&/',#4% 3+'A3/',3+&!&%#, ,+( (+( . �/''%% )+$/"!.+!4/',- 3+(/4 ,!"+4+,(% '/',+."#!, 13,9 %, + '4!3,&/',- — 4,6 %. �3% �,/4 %''"!*/.+,!"% (/&',+,%32�,, B,/ . 4%3!. 1/3 .'!D '"2B+!. 3+(+ ,!"+ 4+,(% 2 A+5%!&,/( &+$"�*+!,'# /F%3!&%!. �4!&&/ A/�,/42 %)2B!&%!+&,3/A/4!,3%B!'(%D /'/$!&&/',!@ $/"-&GD 3+(/4 ,!"+ 4+,(% % %D .)+%4/'.#)% ' 3+5%/&+"-&G4/A!3+,%.&G4 */',2A/4 ' A/)%5%% +*!(.+,&/@ "%4?/*%''!(5%% A/'"2F%"/ A3%B%&/@ ( A3/.!*!-

103

&%� *+&&/1/ %''"!*/.+&%#. �*%&',.!&&/ 3+*%(+"-&G4 'A/'/$/4 "!B!&%# 3+(+ ,!"+ 4+,(% /',+!,'#D%3231%B!'(%@, /*&%4 %) /'&/.&GD �,+A/. (/,/3/1/ #."#!,'# A/"&+# "%4?/*%''!(5%# . A/*-.)*/U&GD /$"+',#D. �+*%(+"-&+# "%4?/*%''!(5%# */',%1+!,'# B!3!) /A,%4+"-&G@ D%3231%B!'(%@*/',2A, /$!'A!B%.+��%@ &+%$/"-U%@ A3/',/3 % ./)4/F&/',- "2BU!1/ /'4/,3+ *+&&/@ /$"+',%, .(/,/3/@ &+*"!F%, .GA/"&%,- /A!3+,%.&/! .4!U+,!"-',./. � A+5%!&,/( ' 3+(/4 ,!"+ 4+,(% +*!(-.+,&/',- D%3231%B!'(/1/ */',2A+ ./ 4&/1/4 )+.%'%, /, %&*!('+ 4+''G ,!"+ (��). �+4% $G" .G-$3+& /A!3+5%/&&G@ 3+)3!) — &%F&## '3!*%&&+# "+A+3/,/4%#, ,+( (+( /& /$!'A!B%.+!, . A!3.2�/B!3!*- D/3/U%@ /$)/3 /31+&/. 4+"/1/ ,+)+ % "!1(2� */',2A&/',- ( &%4. �+ /'&/.2 (/"%B!',.!&-&/@ /5!&(% D%3231%B!'(/1/ */',2A+ 4G .)#"% (3%,!3%%, 3+)3+$/,+&&G! �L�. �/)/&N�3/U!.%B!4(1954), /$�!(,%.&/ /5!&%.+��%! /A!3+5%/&&G@ */',2A.

J����������� �����������. �G A3/.!"% +&+,/4%B!'(%@ �('A!3%4!&, &+ 42 ,32A+DF!&'(/1/ A/"+, (/,/3GD 4G ,+(F! . './� /B!3!*- 3+)*!"%"% &+ 132AAG . )+.%'%4/',% /, ��.�+F*+# 132AA+ '/',/#"+ %) 21 /$�!(,+ %''"!*/.+&%#. I 132AA2 .("�B%"% /$�!(,G ' �� 4!&!!35,0 (1¦4², ./ II 132AA2 — ' ��, 3+.&G4 35,0 (1¦4² % $/"!!.

�+F*+# %''"!*2!4+# 132AA+ . './� /B!3!*- A/ ./)3+',2 24!3U%D F!&�%& $G"+ 3+)*!"!&+ &+,3% ./)3+',&GD A!3%/*+: .,/3/@ A!3%/* )3!"/1/ ./)3+',+ (7 /$�!(,/. %''"!*/.+&%#), A/F%"/@ ./)-3+', (7 /$�!(,/. %''"!*/.+&%#), ',+3B!'(%@ ./)3+', (7 /$�!(,/. %''"!*/.+&%#). +&+,/4%B!'(/4�('A!3%4!&,! 4G .GA/"&#"% &%F&�� '3!*%&&2� "+A+3/,/4%�, A/'"! B!1/ )+4!3#"% 1"2$%&2 3+-&G, 21/" /A!3+5%/&&/1/ *!@',.%#, 21/" &+("/&!&%# /'% /A!3+5%/&&/1/ *!@',.%#, .!3D&�� +A!3-,232 % *&/ 3+&G A3% �(',%3A+5%% 4+,(%.

&�_��z�� �����������. �3!*&!! )&+B!&%! 1"2$%&G /A!3+5%/&&/@ 3+&G . +&+,/4%B!-'(/4 �('A!3%4!&,! 2 /$�!(,/. %''"!*/.+&%# I 132AAG ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ '/',+.-"#!, 175,86 ± 0,45 44, . A/F%"/4 ./)3+',! *+&&G@ A/(+)+,!"- 3+.!& 155,64 ± 0,56 44, . ',+3B!'(/4./)3+',! — 144,17 ± 0,51 44. �1/" /A!3+5%/&&/1/ *!@',.%# ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+3+.!& 74,86 ± 0,51 13+*2'+, . A/F%"/4 ./)3+',! — 79,86 ± 0,40 13+*2'+, . ',+3B!'(/4 ./)3+',! —84,71 ± 0,81 13+*2'+. �1/" &+("/&!&%# /'% /A!3+5%/&&/1/ *!@',.%# ./ .,/3/4 A!3%/*! )3!"/1/./)3+',+ 3+.!& 76,29 ± 0,68 13+*2'+, . A/F%"/4 ./)3+',! — 82,86 ± 0,60 13+*2'+, . ',+3B!'(/4 ./)-3+',! — 88,2 9± 0,82 13+*2'+. �)2B+# '//,&/U!&%! .!"%B%& .!3D&!@ +A!3,23G % *&+ 3+&G, 4G A/-"2B%"% ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ )&+B!&%!, 3+.&/! 1:0,7, . A/F%"/4 ./)3+',! — 1:0,9, .',+3B!'(/4 ./)3+',! — 1:1 (,+$". 1).

+$"%5+ 1

�3!*&%! )&+B!&%# A+3+4!,3/. 3+&G 2 /$�!(,/. %''"!*/.+&%# I 132AAG (n = 21)

� /)3+',&/@ A!3%/* ��44

���13+*.

�����13+*. �¦��

1. ,/3/@ A!3%/* )3!"/1/ ./)3+',+ (n = 7) 175,86 ± 0,45� 74,86 ± 0,51� 76,29 ± 0,68� 1:0,7

2. �/F%"/@ ./)3+',(n = 7) 155,64 ± 0,56� 79,86 ± 0,40� 82,86 ± 0,60� 1:0,9

3. �,+3B!'(%@ ./)3+',(n = 7) 144,17 ± 0,51� 84,71 ± 0,81� 88,29 ± 0,82� 1:1

�3%4!B+&%!: '3!*&%! )&+B!&%# A/(+)+,!"!@ */',/.!3&G A3% 3 � 0,05

�3!*&!! )&+B!&%! 1"2$%&G 3+&G 2 /$�!(,/. %''"!*/.+&%#II 132AAG ./ .,/3/4 A!3%/*! )3!-"/1/ ./)3+',+ '/',+."#!, 257,79 ± 0,5044, . A/F%"/4 ./)3+',! *+&&G@ A/(+)+,!"- 3+.!&234,73±0,57 44, . ',+3B!'(/4 ./)3+',! — 206,24 ± 0,64 44. �1/" /A!3+5%/&&/1/ *!@',.%# ./ .,/-3/4 A!3%/*! )3!"/1/ ./)3+',+ 3+.!& 49,57 ± 0,92 13+*2'+, . A/F%"/4 ./)3+',! — 53,71 ± 0,68 13+*2-'+, . ',+3B!'(/4 ./)3+',! — 58 ± 0,98 13+*2'+. �1/" &+("/&!&%# /'% /A!3+5%/&&/1/ *!@',.%# ./.,/3/4 A!3%/*! )3!"/1/ ./)3+',+ 3+.!& 56,71 ± 0,57 13+*2'+, . A/F%"/4 ./)3+',! — 59,86 ± 0,7413+*2'+, . ',+3B!'(/4 ./)3+',! — 67,43 ± 0,57 13+*2'+. �)2B+# '//,&/U!&%! .!"%B%& .!3D&!@+A!3,23G % *&+ 3+&G, 4G A/"2B%"% ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ )&+B!&%!, 3+.&/! 1:0,6, .A/F%"/4 ./)3+',! — 1:0,8, . ',+3B!'(/4 ./)3+',! — 1:0,8 (,+$". 2).

104

+$"%5+ 2

�3!*&%! )&+B!&%# A+3+4!,3/. 3+&G 2 /$�!(,/. %''"!*/.+&%#II 132AAG (n = 21)

� /)3+',&/@ A!3%/* ��44

���13+*.

�����13+*. �¦��

1. ,/3/@ A!3%/* )3!"/1/ ./)3+',+(n = 7) 257,79 ± 0,50� 49,57 ± 0,92� 56,71 ± 0,57� 1:0,6

2. �/F%"/@ ./)3+',(n = 7) 234,73 ± 0,57� 53,71 ± 0,68� 59,86 ± 0,74� 1:0,8

3. �,+3B!'(%@ ./)3+', (n = 7) 206,24 ± 0,64� 58 ± 0,98� 67,43 ± 0,57� 1:0,8

�3%4!B+&%!: '3!*&%! )&+B!&%# A/(+)+,!"!@ */',/.!3&G A3% 3 � 0,05

�/',2A&/',- ( A/*.)*/U&G4 "%4?+,%B!'(%4 2)"+4 2 ,32A/. F!&�%& I 132AAG ./ .,/3/4A!3%/*! )3!"/1/ ./)3+',+ '/',+."#!, 71,29 ± 0,69 %, . A/F%"/4 ./)3+',! *+&&G@ A/(+)+,!"- 3+.!&65,71 ± 0,81 %, . ',+3B!'(/4 ./)3+',! — 58,0 ± 0,76 %. �/"%B!',./ /$�!(,/. %''"!*/.+&%#, 2 (/,/-3GD */',2A&/',- ( A/*.)*/U&G4 "%4?+,%B!'(%4 2)"+4 %) *+&&/1/ */',2A+ $G"+ )+,32*&%,!"-&+,./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ 3+.&/ 28,71 ± 0,34 %, . A/F%"/4 ./)3+',! — 34,29 ± 0,41 %, .',+3B!'(/4 ./)3+',! — 42,0 ± 0,48% (,+$". 3).

+$"%5+ 3

�3!*&%! )&+B!&%# (/"%B!',.+ '"2B+!. /A,%4+"-&/@ % )+,32*&%,!"-&/@ */',2A&/',%( A/*.)*/U&G4 "%4?+,%B!'(%4 2)"+4 .I 132AA! +&+,/4%B!'(/1/ �('A!3%4!&,+ (n = 21)

�/)3+',&/@ A!3%/*

�A,%4+"-&+# */',2A&/',-( A/*.)*/U&G4 "%4?+,%B!'(%4

2)"+4, %

�+,32*&%,!"-&+# */',2A&/',-( A/*.)*/U&G4 "%4?+,%B!'(%4

2)"+4, %

1. ,/3/@ A!3%/* )3!"/1/ ./)3+'-,+ (n = 7) 71,29 ± 0,69� 28,71 ± 0,34�

2. �/F%"/@ ./)3+',(n = 7) 65,71 ± 0,81� 34,29 ± 0,41�

3. �,+3B!'(%@ ./)3+',(n = 7) 58,0 ± 0,76� 42,0 ± 0,48�

�3%4!B+&%!: '3!*&%! )&+B!&%# A/(+)+,!"!@ */',/.!3&G A3% 3 � 0,05

�3!*&!! )&+B!&%! '"2B+!. /A,%4+"-&/@ */',2A&/',% ( A/*.)*/U&G4 "%4?+,%B!'(%4 2)"+42 ,32A/. F!&�%& II 132AAG ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ '/',+."#!, 66,0 ± 0,53 %, . A/F%-"/4 ./)3+',! *+&&G@ A/(+)+,!"- 3+.!& 59,0 ± 0,49 %, . ',+3B!'(/4 ./)3+',! — 52,29 ± 0,42 %. �/-"%B!',./ �('A!3%4!&,/., A3% (/,/3GD */',2A&/',- ( A/*.)*/U&G4 "%4?+,%B!'(%4 A2,#4 $G"+)+,32*&!&+ ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ '/',+.%"/ 34,0 ± 0,32 %, . A/F%"/4 ./)3+',! —41,0 ± 0,41 %, . ',+3B!'(/4 ./)3+',! — 47,71 ± 0,48 % (,+$". 4).

+$"%5+ 4

�3!*&%! )&+B!&%# (/"%B!',.+ '"2B+!. /A,%4+"-&/@ % )+,32*&%,!"-&/@ */',2A&/',%( A/*.)*/U&G4 "%4?+,%B!'(%4 2)"+4 ./II 132AA! +&+,/4%B!'(/1/ �('A!3%4!&,+ (n = 21)

� /)3+',&/@ A!3%/*�A,%4+"-&+# */',2A&/',-

( A/*.)*/U&G4 "%4?+,%B!'(%42)"+4, %

�+,32*&%,!"-&+# */',2A&/',-( A/*.)*/U&G4 "%4?+,%B!'(%4

2)"+4, %

1. ,/3/@ A!3%/*)3!"/1/ ./)3+',+ (n = 7) 66,0 ± 0,53� 34,0 ± 0,32�

2. �/F%"/@ ./)3+',(n = 7) 59,0 ± 0,49� 41,0 ± 0,41�

3. �,+3B!'(%@ ./)3+',(n = 7) 52,29 ± 0,42� 47,71 ± 0,48�

�3%4!B+&%!: '3!*&%! )&+B!&%# A/(+)+,!"!@ */',/.!3&G A3% 3 � 0,05

�,+(, A/*./*# %,/1 3!)2"-,+,/. %''"!*/.+&%#, A3!*',+."!&&GD . *+&&/@ 1"+.!, '"!*2!, /,-4!,%,-, B,/ 2 F!&�%& I % II 132AA /A3!*!"#�,'# '2�!',.!&&G! 3+)"%B%# . '3!*&%D )&+B!&%#D 1"2-

105

$%&G 3+&G, 21"+ /A!3+5%/&&/1/ *!@',.%#, 21"+ &+("/&!&%# /'% /A!3+5%/&&/1/ *!@',.%#, . '//,-&/U!&%% .!"%B%& .!3D&!@ +A!3,23G % *&+ 3+&G.

�3/.!*!&&G@ +&+"%) A/)./"%, .G$3+,- 3+5%/&+"-&G@ D%3231%B!'(%@ */',2A . )+.%'%4/',%/, ,%A+ ,!"/'"/F!&%#. �/"2B!&&G! *+&&G! / ,/A/13+?/N+&+,/4%B!'(%D /'/$!&&/',#D ,+)+ $/"--&GD 3+(/4 ,!"+ 4+,(% A3% 3+)"%B&/@ (/&',%,25%% *+*2, ./)4/F&/',- /$�!(,%.&/ % +3124!&,%3/-.+&/ 3!U+,- ./A3/'G /$ /$�!4! "%4?/*%''!(5%%, + ,+(F! A/N./)4/F&/',% 3+)3+$/,+,- */A/"&%-,!"-&G@ D%3231%B!'(%@ %&',324!&,+3%@ *"# 2"2BU!&%# .%)2+"-&/1/ /$)/3+ /A!3+5%/&&/1/ A/"#,B,/ A/)./"%, /A,%4%)%3/.+,- A+3+4!,3G /A!3+,%.&/@ */',2A&/',% ( A/*.)*/U&G4 "%4?+,%B!-'(%4 2)"+4 2 A+5%!&,/( ' %&*!('/4 4+''G ,!"+, 3+.&G4 35 % $/"!!, % 3!(/4!&*/.+,- !1/ A3% .G-A/"&!&%% /A!3+5%% �(',%3A+5%% 4+,(% ' A3%*+,(+4% ' *.2D',/3/&&!@ A/*.)*/U&/@ "%4?/*%'-'!(5%!@*"# .&!*3!&%# . 'A!5%+"%)%3/.+&&GD /,*!"!&%#D.

�/"2B!&&G! '.!*!&%# / .)+%4/'.#)% ,/A/13+?%% 3+5%/&+"-&/1/ D%3231%B!'(/1/ */',2A+ ',%A/4 ,!"/'"/F!&%# $/"-&GD 3+(/4 ,!"+ 4+,(% *"# A3/.!*!&%# +*!(.+,&/@ "%4?/*%''!(5%% */-A/"&#�, % 3+'U%3#�, %4!��%!'# A3!*',+."!&%# /$ /A!3+,%.&/4 "!B!&%% $/"-&GD ' *+&&/@ A+-,/"/1%!@, %4!�, A3+(,%B!'(2� )&+B%4/',- % A/)./"#�, %'A/"-)/.+,- �,% *+&&G! . 3+$/,! D%323-1/.N1%&!(/"/1/. /&(/"/1%B!'(%D ',+5%/&+3/..

�A%'/( "%,!3+,23G:1. �/D4+&, �L. �2(/./*',./ A/ /&(/1%&!(/"/1%% / �L. �/D4+& // �L�$: «��� �)*N./ �/"%-

+&,», 2002. — �. 195–229.2. Trentham-Dietz, A. Weight change and risk of endometrial cancer / �. Trentham-Dietz,

H.B. Nichols, J.M. Hampton, P.A. Newcomb // Int. J. Epidemiol. 2006; 35 (1). �. 166–8.3. Wing, R. Weight gain at time of menopause / R. Wing, K. Matthews, L. Kuller // Ann. Int. Med.

— 1991. — � 151. — �. 97–102.4. Xu, W.H. Weight history and risk of endometrial cancer among Chinese women / W.H. Xu,

Y.B. Xiang, X. Zhang // Int. J. Epidemiol. — 2005. — � 35 (1). — �. 166–8.

",0&!�!J'0&+%'�)+'^"&")0'&+�0+)+�',{+,(!+�!�1')!&&')*+++q;-0!%,!>!$'�"

"#;. $���� (��.)�!34'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%# %4. +(. �L�. +1&!3+

�+?!*3+ &/34+"-&/@ ,/A/13+?%B!'(/@ % ("%&%B!'(/@ +&+,/4%%, /A!3+,%.&/@ D%3231%%

�������������������: 9��. ?�������� (0��. ��., ���., �. �. �.)

"����z����z. �F%3!&%! #."#!,'# A3!*3+'A/"+1+��%4 ?+(,/3/4 ( 3+).%,%� *%'"%A%*!-4%% (*/ 30 % "%5 ' /F%3!&%!4 %4!�, 1%A!3"%A%*!4%�), '+D+3&/1/ *%+$!,+ II ,%A+ (*/ 80 % $/"--&GD *%+$!,/4 II ,%A+ %4!�, %)$G,/B&2� 4+''2 ,!"+ %"% /F%3!&%!), +3,!3%+"-&/@ 1%A!3,!&)%%¥A3%4!3&/ A/"/.%&+ "%5 ' /F%3!&%!4 /*&/.3!4!&&/ %4!�, +3,!3%+"-&2� 1%A!3,!&)%�), .&!)+A-&/@ '4!3,%.

�''"!*/.+&%#, A/'.#�!&&G! A3/$"!4! /F%3!&%#, . $"%F+@U!! .3!4# .3#* "% 2,3+,#, './�+(,2+"-&/',-, A/'(/"-(2 B%'"/ "%5, ',3+*+��%D %)$G,/B&G4 .!'/4, A3/13!''%.&/ 2.!"%B%.+!,'#.�,/ '.%*!,!"-',.2!, / &%)(/@ �??!(,%.&/',% %4!��%D'# 4!,/*/. $/3-$G ' "%U&%4 .!'/4. G-)G.+!, &!*/24!&%! ,/, ?+(,, B,/ . %)2B!&&/@ &+4% "%,!3+,23! A'%D/*%&+4%B!'(+# (/33!(5%# %)-$G,/B&/1/ .!'+ 3+''4+,3%.+!,'# %)/"%3/.+&&/ /, +&,3/A/4!,3%B!'(%D /'/$!&&/',!@ ,!"+ A+5%!&-,/., B,/ A/'"2F%"/ A3%B%&/@ ( A3/.!*!&%� *+&&/1/ %''"!*/.+&%#.

*��z�����������. �3/.!',% +&+"%) �??!(,%.&/',% A'%D/*%&+4%B!'(/@ (/33!(5%% %)$G-,/B&/1/ .!'+ ' %'A/"-)/.+&%!4 +&,3/A/4!,3%% % /$/'&/.+,- ("%&%B!'(/! )&+B!&%! .G#."!&&GD)+(/&/4!3&/',!@.

J����� ������ �����������. �+$/,+ /'&/.+&+ &+ 3!)2"-,+,+D +&,3/A/4!,3%B!'(/1/%''"!*/.+&%# 104 A+5%!&,/(, A3/D/*%.U%D (23' A'%D/*%&+4%B!'(/@ (/33!(5%% %)$G,/B&/1/ .!'+. A!3%/* ' 2008 A/ 2009 11. /)3+', A+5%!&,/( .+3-%3/.+" /, 20 */ 50 "!,, .'! ,32*/'A/'/$&/1/./)3+',+ (100 %).

�"# �,/1/ 4G %'A/"-)/.+"% '"!*2��%! +&,3/A/4!,3%B!'(%! 4!,/*G %''"!*/.+&%#:� �/',.� �+''2 ,!"+.

106

� �,!A!&- /F%3!&%#.� �*!+"-&2� 4+''2 ,!"+ (�*�).� �"/�+*- A/.!3D&/',% ,!"+.� /"�%&2 (/F&/NF%3/.GD '("+*/(.� �$'/"�,&/! % /,&/'%,!"-&/! '/*!3F+&%! F%3+.� �(32F&/',- $!*!3.� �(32F&/',- ,+"%%.&�_��z�� �����������. �3% /A3!*!"!&%% '3!*&%D A/(+)+,!"!@ +$'/"�,&/1/ '/*!3F+-

&%# F%3+ (���) A/"2B%"% '"!*2��%! )&+B!&%#. +(, &+ 4/4!&, &+B+"+ (/33!(5%% .!'+ ��� .'3!*&!4 '/',+."#!, 40,78 ± 0,92 (1. �+('%4+"-&/! )&+B!&%! ��� */',%1+!, 65,37 (1, 4%&%4+"-&/!)&+B!&%! ��� A3% A!3.%B&/4 /$3+�!&%% 3+.&/ 27,75 (1.

�!3!) 1/* A3/.!*!&%# A'%D/*%&+4%B!'(/@ (/33!(5%% 4+''G ,!"+ ��� A+5%!&,/( . '3!*&!43+.!& 17,64 ± 0,32 (1; 24,96 (1 — &+%$/"-U!! )&+B!&%! ���, )+?%('%3/.+&&/! . &+U!4 %''"!*/-.+&%%, 13,64 (1 — &+%4!&-U!! )&+B!&%! ���.

�3% %)2B!&%% /,*+"!&&GD 3!)2"-,+,/. �??!(,%.&/',% A'%D/*%&+4%B!'(/@ (/33!(5%% 4+'-'G ,!"+ )&+B!&%! ��� . '3!*&!4 '/',+."#!, 17,75 ± 0,29 (1; 4+('%4+"-&G@ A/(+)+,!"- ��� 3+.!&23,79 (1, 4%&%4+"-&G@ — 13,34 (1.

�&+B!&%! 4!*%+&G A/*,.!3F*+!, D+3+(,!3 3+'A3!*!"!&%# *+&&GD A/ )&+B!&%� '3!*&!@+3%?4!,%B!'(/@ % 24!&-U+!,'# /, 40,75 (1 (. 4/4!&, &+B+"+ (/33!(5%% .!'+) */ 24,14 (1 (B!3!)1/* (/33!(5%% % . /,*+"!&&GD 3!)2"-,+,+D).

�%&+4%(+ ��� A+5%!&,/(, (/,/3G4 A3/./*%"+'- A'%D/*%&+4%B!'(+# (/33!(5%# %)$G,/B-&/1/ .!'+, A3!*',+."!&+ . ,+$"%5! 1.

+$"%5+ 1

�$'/"�,&/! '/*!3F+&%! F%3+ 2 A+5%!&,/( ' %)$G,/B&G4 .!'/4 A3% A!3.%B&/4 /$3+�!&%%. ("%&%(2, A/'"! "!B!&%# % B!3!) ,3% 1/*+ A/'"! (/33!(5%%, (1 (n = 104)

� M ± m �+D �in ´ �! P

1. 40,78 ± 0,92 65,37 27,75 9,43 40,75 p < 0,05

2. 17,64 ± 0,32 24,96 13,64 3,23 17,50 p < 0,05

3. 17,75 ± 0,29 23,79 13,34 2,95 17,50 p < 0,05

�3%4!B+&%#:� 1 — 3!)2"-,+,G %''"!*/.+&%# +$'/"�,&/1/ '/*!3F+&%# F%3+ &+ 4/4!&, &+B+"+ (/33!(5%% .!'+;� 2 — 3!)2"-,+,G %''"!*/.+&%# +$'/"�,&/1/ '/*!3F+&%# F%3+ A/'"! "!B!&%#;� 3 — /,*+"!&&G! 3!)2"-,+,G %''"!*/.+&%# +$'/"�,&/1/ '/*!3F+&%# F%3+.

�3% /A3!*!"!&%% '3!*&%D A/(+)+,!"!@ '3!*&!@ ,/"�%&G (/F&/NF%3/./@ '("+*(% (����)A/"2B%"% '"!*2��%! )&+B!&%#. +(, &+ 4/4!&, &+B+"+ (/33!(5%% .!'+ ���� . '3!*&!4 '/',+.-"#!, 14,94 ± 0,26 44. �+('%4+"-&/! )&+B!&%! ����*/',%1+!, 20,5 44, 4%&%4+"-&/! )&+B!&%!���� A3% A!3.%B&/4 /$3+�!&%% 3+.&/ 11,5 44.

�!3!) 1/* A3/.!*!&%# A'%D/*%&+4%B!'(/@ (/33!(5%% 4+''G ,!"+ ���� A+5%!&,/( . '3!*-&!4 3+.!& 7,67 ± 0,12 44; 1044 — &+%$/"-U!! )&+B!&%! ����, )+?%('%3/.+&&/! . &+U!4 %'-'"!*/.+&%%, 6,36 44 — &+%4!&-U!! )&+B!&%! ����.

�3% %)2B!&%% /,*+"!&&GD 3!)2"-,+,/. �??!(,%.&/',% A'%D/*%&+4%B!'(/@ (/33!(5%% 4+'-'G ,!"+ )&+B!&%! ���� . '3!*&!4 '/',+."#!, 7,77±0,12 44; 4+('%4+"-&G@ A/(+)+,!"- ����3+.!& 9,93 44, 4%&%4+"-&G@ — 6,14 44.

�&+B!&%! 4!*%+&G A/*,.!3F*+!, D+3+(,!3 3+'A3!*!"!&%# *+&&GD A/ )&+B!&%� '3!*&!@+3%?4!,%B!'(/@ % 24!&-U+!,'# /, 15,23 44 (. 4/4!&, &+B+"+ (/33!(5%% .!'+) */ 7,50 44 (B!3!)1/* A3/.!*!&%# A'%D/*%&+4%B!'(/@ (/33!(5%% % . /,*+"!&&GD 3!)2"-,+,+D).

�%&+4%(+ ���� A+5%!&,/(, (/,/3G4 A3/./*%"+'- (/33!(5%# %)$G,/B&/1/ .!'+, A3!*',+.-"!&+ . ,+$"%5! 2.

107

+$"%5+ 2

�3!*&## ,/"�%&+ (/F&/NF%3/./@ '("+*(%A+5%!&,/( ' %)$G,/B&G4 .!'/4 A3% A!3.%B&/4 /$3+�!-&%% . ("%&%(2, A/'"! "!B!&%# % B!3!) ,3% 1/*+ A/'"! (/33!(5%%, 44 (n = 104)

� M ± m �+D �in ´ �! P

1 14,94 ± 0,26 20,5 11,5 2,68 15,23 p < 0,05

2 7,67 ± 0,12 10 6,36 1,20 7,50 p < 0,05

3 7,77 ± 0,12 9,93 6,14 1,23 7,50 p < 0,05

�3%4!B+&%#:� 1 — 3!)2"-,+,G %''"!*/.+&%# '3!*&!@ ,/"�%&G (/F&/NF%3/./@ '("+*(% &+ 4/4!&, &+B+"+ (/33!(5%%.!'+;� 2 — 3!)2"-,+,G %''"!*/.+&%# '3!*&!@ ,/"�%&G (/F&/NF%3/./@ '("+*(% A/'"! "!B!&%#;� 3 — /,*+"!&&G! 3!)2"-,+,G %''"!*/.+&%# '3!*&!@ ,/"�%&G (/F&/NF%3/./@ '("+*(%.

�3% /A3!*!"!&%% /(32F&/',% ,+"%% (�) A/"2B%"% '"!*2��%! )&+B!&%#. +(, &+ 4/4!&,&+B+"+ (/33!(5%% .!'+ � . '3!*&!4 '/',+."#!, 108,15 ± 0,26 '4. �+('%4+"-&/! )&+B!&%! �*/'-,%1+!, 135 '4, 4%&%4+"-&/! )&+B!&%! � A3% A!3.%B&/4 /$3+�!&%% 3+.&/ 91 '4.

�!3!) 1/* A3/.!*!&%# A'%D/*%&+4%B!'(/@ (/33!(5%% 4+''G ,!"+ � A+5%!&,/( . '3!*&!43+.!& 76,30 ± 0,12 '4; 90'4 — &+%$/"-U!! )&+B!&%! �, )+?%('%3/.+&&/! . &+U!4 %''"!*/.+&%%,65 '4 — &+%4!&-U!! )&+B!&%! �.

�3% %)2B!&%% /,*+"!&&GD 3!)2"-,+,/. �??!(,%.&/',% A'%D/*%&+4%B!'(/@ (/33!(5%% 4+'-'G ,!"+ )&+B!&%! � . '3!*&!4 '/',+."#!, 78,04 ± 0,12 '4; 4+('%4+"-&G@ A/(+)+,!"- � 3+.!& 90'4, 4%&%4+"-&G@ — 65'4.

�&+B!&%! 4!*%+&G A/*,.!3F*+!, D+3+(,!3 3+'A3!*!"!&%# *+&&GD A/ )&+B!&%� '3!*&!@+3%?4!,%B!'(/@ % 24!&-U+!,'# /, 106,50 '4 (. 4/4!&, &+B+"+ (/33!(5%% .!'+) */ 76 '4 (B!3!) 1/*A3/.!*!&%# A'%D/*%&+4%B!'(/@ (/33!(5%%).

�%&+4%(+ � A+5%!&,/(, (/,/3G4 A3/./*%"+'- (/33!(5%# %)$G,/B&/1/ .!'+, A3!*',+."!&+ .,+$"%5! 3.

+$"%5+ 3

�(32F&/',- ,+"%% A+5%!&,/( ' %)$G,/B&G4 .!'/4A3% A!3.%B&/4 /$3+�!&%% . ("%&%(2,A/'"! "!B!&%# % B!3!) ,3% 1/*+ A/'"! (/33!(5%%, '4 (n = 104)

� M ± m �+D �in ´ �! P

1. 108,15 ± 0,26 135 91 10,97 106,50 p < 0,05

2. 76,30 ± 0,12 90 65 7,49 76 p < 0,05

3. 78,04 ± 0,12 90 65 7,40 77 p < 0,05

�3%4!B+&%#:� 1 — 3!)2"-,+,G %''"!*/.+&%# /(32F&/',% ,+"%% &+ 4/4!&, &+B+"+ (/33!(5%% .!'+;� 2 — 3!)2"-,+,G %''"!*/.+&%# /(32F&/',% ,+"%% A/'"! "!B!&%#;� 3 — /,*+"!&&G! 3!)2"-,+,G %''"!*/.+&%# /(32F&/',% ,+"%%.

$ ��� ������������:1. �/33!(5%# A%�!./1/ 3+5%/&+' %'A/"-)/.+&%!4 +&,3/A/4!,3%B!'(%D A/(+)+,!"!@ A/)./-

"%"+ */',%B- */',/.!3&/1/ % */"1/.3!4!&&/1/ '&%F!&%# �� . 62,5–66,4 % '"2B+!..2. �/B!,+&%! (/33!(5%% %)$G,/B&/1/ .!'+ ' %''"!*/.+&%!4 +&,3/A/4!,3%B!'(%D A+3+4!,3/.

,!"+ *+!, ./)4/F&/',- A3/1&/)%3/.+,- *%&+4%(2 A%�!./1/ ',+,2'+ % /A3!*!"#,- *+"-&!@U2� ,+(-,%(2 .!*!&%# A+5%!&,/(.

�A%'/( "%,!3+,23G:1. �.('!&/.+, �L�. �/"- /F%3!&%# . A+,/1!&!)! 3!A3/*2(,%.&GD &+32U!&%@ 2 F!&�%& /

�L�. �.('!&/.+ // �!34'(%@ 4!*%5%&'(%@ F23&+". — 2008. — /4 25. — � 4. — �. 41–43.2. �/'G1%&+, �L. �/./! . A+,/1!&!)! /F%3!&%#: +*%A/(%&G — 1/34/&G F%3/./@ ,(+&% //

�3/$"!4G �&*/(3%&/"/1%% — 2009 — . 55 (1) — �. 44–51.

108

3. �%(/"+!., L�. �!,/*G /5!&(% %&*%.%*2+"-&/N,%A/"/1%B!'(%D /'/$!&&/',!@ ?%)%B!'(/-1/ 3+).%,%# B!"/.!(+ / L�. �%(/"+!., �L�. �+3+@(%&+, �L. �%&*!!.+, L�. �?3!4/.+, L�. �+-A/F&%(/.. — �3+'&/#3'(: �3+'���, 2005. — 111 '.

4. �%&D+'/., �L�. �+32U!&%# A%�!./1/ A/.!*!&%# % A3!*A/B%,+!4G! 3+5%/&G A%,+&%# 2F!&�%& ' +"%4!&,+3&/N(/&',%,25%/&+"-&G4 /F%3!&%!4 / �L�. �%&D+'/., �L�. �/3%&,L�. �!"#,%5(+# // �%$%3'(%@ .!',&%( A'%D%+,3%% % &+3(/"/1%%. — 2009. — � 1 (52). — �. 80–83.

5. �+31+!.+, �L�. �'/$!&&/',% +&+4&!)+ % ?+(,/3G 3%'(+ '!3*!B&/N'/'2*%',GD )+$/"!.+&%@2 *!.2U!(NA/*3/',(/. % 4/"/*GD F!&�%& ' /F%3!&%!4 / �L�. �+31+!.+, �L�. �%'"#(, �L. �,+3/-*2$/.+ // �3%"/F!&%! ( F23&+"2 «�+3*%/.+'(2"#3&+# ,!3+A%# % A3/?%"+(,%(+». — 2008. — � 7(6) — �. 328–329.

1"q'&,"�!1=&+J'0&�==)J'0!((+2(�">,!�0+)+J!&2!1!>�%,+^qJ�,�'&'(J�^4&!$!�q"1!q+

)#". $�������� (��., �. �. �.)

�2(/.%&'-(%@ *!3F+.&%@ 4!*%B&%@ 2&�.!3'%,!,�+?!*3+ D�3231�¤ ,+ 23/"/1�¤

����������@���: ��/. B����� (0��@����������������*@F, �������, �. �. �.)

�3/.!*!&/ */'"�*F!&&# !?!(,%.&/',� .%(/3%',+&&# "+)!3&/¤ A/"#3%4!,3�¤ ) 4!,/�*%?!3!&5�+"-&/¤ *�+1&/',%(% */$3/#(�'&/¤ 1�A!3A"+)�¤ � 3+(2 A!3!*4�D23/./¤ )+"/)%. %)&+B!&/D+3+(,!3&� )4�&% A/(+)&%(�. *"# */$3/#(�'&%D &/./2,./3!&- A3/',+,% � *"# )"/#(�'&%D. �+ /'&/.�5%D *+&%D 4/F&+ 3/)3/$%,% � .A3/.+*%,% . ("�&�B&2 A3+(,%(2 &/.� 4!,/*% *%?!3!&5�+"-&/¤*�+1&/',%(% */$3/#(�'&/¤ 1�A!3A"+)�¤ ,+ 3+(2 A!3!*4�D23/./¤ )+"/)%.

)����������: *%?!3!&5�+"-&+ *�+1&/',%(+, "+)!3&+ A/"#3%4!,3�#, 3+( A!3!*4�D23/./¤ )+-"/)%, */$3/#(�'&+ 1�A!3A"+)�# A!3!*4�D23/./¤ )+"/)%.

1"q'&,"=�!1=&+J'0&+=)")J'0!((+2(+">,!�0+)+J!&2!1!>+%'�)+^+qJ',',+/�&'(�0"0'1],!/�'1'q-

)#". $�� ����� (��., �. �. �.)�2(/.%&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

�+?!*3+ D%3231%% % 23/"/1%%�������������������: ��/. B����� (0��. �����������*��, ���., �. �. �.)

"����z����z. �3/$"!4+ *%+1&/',%(% 3+&&%D ',+*%@ 3+(+ A3!*',+,!"-&/@ F!"!)G (���)/',+!,'# A3%/3%,!,&/@. &+',/#�!! .3!4#, A/ ',+,%',%B!'(%4 *+&&G4, ./ 4&/1%D ',3+&+D ���)+&%4+!, .!*2�%! 4!',+ A/ B+',/,! "!,+"-&GD '"2B+!. /, )"/(+B!',.!&&GD /A2D/"!@ '3!*% 42F-B%&. �3% +2,/A'%% ��� A3/#."#!,'# . 20 % '"2B+!. 2 42FB%& . ./)3+',! 50 "!, % A/B,% 2 43 %42FB%& . ./)3+',! 80 "!,. �/.3!4!&&G! *%+1&/',%B!'(%! ',+&*+3,G A3!*2'4+,3%.+�, A3/.!*!&%!A+"-5!./1/ 3!(,+"-&/1/ %''"!*/.+&%#, '/&/13+?%B!'(%D 4!,/*/. *%+1&/',%(% % /A3!*!"!&%#23/.&# A3/',+,'A!5%?%B!'(/1/ +&,%1!&+ *"# '(3%&%&1/./1/ /$'"!*/.+&%# 42FB%& ' '%4A,/4+4%&%F&%D 4/B!.GD A2,!@. �/, ( '/F+"!&%�, *+&&G@ +"1/3%,4 '(3%&%&1+ %4!!, &!*/',+,(%, B,/ A3/-#."#!,'# '"2B+#4% %&5%*!&,+"-&%D ��� [1]. �+%$/"!! */',/.!3&G4 4!,/*/4 *%??!3!&5%+"-&/@*%+1&/',%(% */$3/(+B!',.!&&/@ 1%A!3A"+)%% A3!*',+,!"-&/@ F!"!)G (����) % ��� #."#!,'#1%',/"/1%B!'(/! %''"!*/.+&%! 4+,!3%+"+, (/,/3G@ $G" A/"2B!& ./ .3!4# $%/A'%% %"% A/'"! /A!-3+,%.&/1/ .4!U+,!"-',.+. �%',/"/1%B!'(/! %''"!*/.+&%! ,+(F! %4!!, /A3!*!"!&&G! &!*/',+,(%— )+.%'%4/',- %&,!3A3!,+5%% 4/3?/"/1%B!'(%D %)4!&!&%@ /, /AG,+ .3+B+, (/,/3G@ .GA/"&#!,*+&&/! %''"!*/.+&%!. �).!',&/, B,/ 4!&!! 70 % 3+)"%B&GD ?/34 ��� ./)&%(+!, . A!3%?!3%B!-'(/@, 20 % — . A!3!D/*&/@ % 10 % — . 5!&,3+"-&/@ )/&!, D/,# 4!F*2 &%4% /,'2,',.2!, .%*%4+#+&+,/4%B!'(+# 13+&%5+. �/�,/42 .!'-4+ .+F&G4 #."#!,'# 5!"!&+A3+."!&&/! %''"!*/.+&%! %4!&&/�,%D )/&, (/,/3G! &+%$/"!! B+',/ A/*.!31+�,'# (+&5!3/1!&!)2 [2]. �/'"!*&%! A+,/4/3?/"/1%B!-'(%! *+&&G! / &!/A"+',%B!'(%D A3/5!''+D . A3!*',+,!"-&/@ F!"!)! '.%*!,!"-',.2�, / )&+B%,!"--&/@ 3/"%, (/,/32� %13+!, . �,/4 A3/5!''! ',3/4+ /31+&+. A3/5!''! (+&5!3/1!&!)+ %)4!&!&%#',3/4+"-&/1/ (/4A/&!&,+ A3!*',+,!"-&/@ F!"!)G A3!*U!',.2�, %)4!&!&%#4 �A%,!"%# [3,4]. �B%-,G.+# .GU!A!3!B%'"!&&G! *+&&G! %)2B!&%! % '/.!3U!&',./.+&%! 4!,/*/. *%+1&/',%(% )+$/"!.+-

109

&%@ A3!*',+,!"-&/@ F!"!)G #."#!,'# +(,2+"-&G4, + 3+)3+$/,(+ 4!,/*+ *%+1&/',%(% )+$/"!.+&%@A3/',+,G ' A/4/�-� "+)!3&/@ A/"#3%4!,3%% (��) #."#!,'# A!3'A!(,%.&/@.

*��z�����������. �''"!*/.+,- �??!(,%.&/',- % */',/.!3&/',- *%?*%+1&/',%(% ���� %��� ' A/4/�-� ��.

J����� � ����� . 23/"/1%B!'(/4 /,*!"!&%% ���� 1. �!3&/.5G /$'"!*/.+&/75 $/"-&GD ���� % ���, (/,/3G! /$3+�+"%'- )+ 4!*%5%&'(/@ A/4/�-� . ,!B!&%! 2004–2011 11.�,% *+&&G! / *%?*%+1&/',%(! ���� % ��� ' %'A/"-)/.+&%!4 �� A3/+&+"%)%3/.+&G % ',+,%',%-B!'(% /$3+$/,+&G ' A/4/�-� A3/13+44 Matlab % Statistica 6.0. /)3+', $/"-&GD (/"!$+"'# /, 57*/ 88 "!,. �+5%!&,/. ' ���� — 49 (1-# 132AA+), ' ��� — 26 (2-# 132AA+). '!4 $/"-&G4 $G"/A3/.!*!&/ ',+&*+3,&/! ("%&%(/N"+$/3+,/3&/! /$'"!*/.+&%!, 1%',/"/1%B!'(/! %''"!*/.+&%! % *%-+1&/',%(+ ' A/4/�-� �� A/"2B!&&/1/ ./ .3!4# /A!3+5%% 4+,!3%+"+, + ,+(F! '/&/13+?%B!'(/!/$'"!*/.+&%! A3/',+,G % �&*/'(/A%B!'(%@ /'4/,3, (/,/3G@ /'2�!',."#"'# 3!)!(,/'(/A/4 KarlStorz . A3!*/A!3+5%/&&/4 A!3%/*!. �"# A3/.!*!&%# �� %'A/"-)/.+"/'- .%'/(/(/1!3!&,&/! "%-&!@&/NA/"#3%)/.+&&/! %&?3+(3+'&/! %)"2B!&%! ' *"%&/@ ./"&G 0,85–0,90 4(4. �''"!*/.+"% .+-3%+5%% (/�??%5%!&,+ /$3+,&/1/ /,3+F!&%# A3% A3/.!*!&%% /'!.GD '(+&%3/.+&%@ A/* 3+)&G4%21"+4% A/"#3%)+5%%.

&�_��z�� �����������. �&+"%) A/"2B!&&GD *+&&GD A/)./"%" .G#.%,- /$�%! )+(/&/-4!3&/',% (3%,!3%+"-&GD 4+,!4+,%B!'(%D A/(+)+,!"!@ *"# .!3%?%(+5%% *+&&GD �� . )+.%'%4/',%/, .%*+ /A2D/"%, (+( *"# ���� ,+( % *"# ���. �3% .%)2+"%)+5%% 4+,3%5G /$3+,&/1/ /,3+F!&%#&+%$/"!! )&+B%4G! 3+)"%B%# A/"2B!&G A3% %'A/"-)/.+&%% 21"/. A/"#3%)+5%% 0° % 90° (3%'. 1–6).

�%'. 1. �,32(,23+ ',3/4G 2 $/"-&/1/ ' */$3/-(+B!',.!&&/@ 1%A!3A"+)%!@ A3!*',+,!"-&/@F!"!)G. �+)!3&+# A/"#3%4!,3%# ' 21"/4 A/-"#3%)+5%% 0°. �%(3/A3!A+3+,. �..: /$. 8, /(.10

�%'. 2. �,32(,23+ ',3/4G 2 $/"-&/1/ ' 3+(/4A3!*',+,!"-&/@ F!"!)G. �+)!3&+# A/"#3%4!-,3%# ' 21"/4 A/"#3%)+5%% 0°. �%(3/A3!A+-3+,. �..: /$. 8, /(. 10

�%'. 3. �,32(,23+ ',3/4G 2 $/"-&/1/ ' */$-3/(+B!',.!&&/@ 1%A!3A"+)%!@ A3!*',+,!"--&/@ F!"!)G. �+)!3&+# A/"#3%4!,3%# ' 21"/4A/"#3%)+5%% 45°. �%(3/A3!A+3+,. �..: /$. 8,/(. 10

�%'. 4. �,32(,23+ ',3/4G 2 $/"-&/1/ ' 3+(/4A3!*',+,!"-&/@ F!"!)G. �+)!3&+# A/"#3%4!-,3%# ' 21"/4 A/"#3%)+5%% 45°. �%(3/A3!A+-3+,. �..: /$. 8, /(. 10

110

�%'. 5. �,32(,23+ ',3/4G 2 $/"-&/1/ ' */$3/-(+B!',.!&&/@ 1%A!3A"+)%!@ A3!*',+,!"-&/@F!"!)G. �+)!3&+# A/"#3%4!,3%# ' 21"/4 A/"#-3%)+5%% 90°. �%(3/A3!A+3+,. �..: /$. 8, /(. 10

�%'. 6. �,32(,23+ ',3/4G 2 $/"-&/1/ ' 3+(/4A3!*',+,!"-&/@ F!"!)G. �+)!3&+# A/"#3%4!-,3%# ' 21"/4 A/"#3%)+5%% 90°. �%(3/A3!A+-3+,. �..: /$. 8, /(. 10.

�3% 4+,!4+,%B!'(/@ /$3+$/,(! A/"2B!&&GD 3!)2"-,+,/. .G#."!&/, B,/ A/(+)+,!"% +'%44!,-3%% % �('5!''+ A3% %'A/"-)/.+&%% 21"/. A/"#3%)+5%% 45° % 90° %4!�, */',/.!3&/ (3 < 0,05) $/"!!.G'/(%! A/(+)+,!"% A3% ��� (,+$"%5+ 1).

+$"%5+ 1

�!)2"-,+,G "+)!3&/@ A/"#3%4!,3%% 2 A+5%!&,/. ' */$3/(+B!',.!&&/@ 1%A!3A"+)%!@% 3+(/4 A3!*',+,!"-&/@ F!"!)G (x ± Sx)

�''"!*/.+&%! ' 3+)&G4% 21"+4%A/"#3%)+5%% A+5%!&,/. ' ���� (n–49)

�''"!*/.+&%! ' 3+)&G4% 21"+4%A/"#3%)+5%% A+5%!&,/. ' ��� (n–26)

0° 45° 90° 0° 45° 90°

�'%44!,3%# 401,16 ±27,98

780,53 ±76,45

566,30 ±59,33

640,74 ±32,47

883,46 ±61,73

121182,32 ±4198,54

�('5!'' 80886,38 ±7369,24

157680,27 ±14865,90

84254,92 ±6932,37

110421,27 ±9819,07

730460,10 ±31902,95

165181,86 ±12981,04

$ ��� :1. �!)2"-,+, /A3!*!"!&%# .%*+ /A2D/"% A3!*',+,!"-&/@ F!"!)G A3% 1%',/"/1%B!'(/4 %''"!-

*/.+&%% . )&+B%,!"-&/@ ',!A!&% )+.%'%, /, /AG,+ .3+B+N1%',/"/1+.2. �+"%B%! (3%,!3%+"-&GD 4+,!4+,%B!'(%D A/(+)+,!"!@ *"# .!3%?%(+5%% *+&&GD %''"!*/-

.+&%# ' A/4/�-� �� A/)./"#!, 2'/.!3U!&',./.+,- *%+1&/',%(2.3. /)4/F&/',- /A3!*!"!&%# &+B+"-&GD %)4!&!&%@ ',3/4+"-&GD (/4A/&!&,/. ,(+&%, %''"!-

*/.+&&/@ ' A/4/�-� ��, A/.GU+!, *%+1&/',%B!'(2� 5!&&/',- *+&&/1/ 4!,/*+ A3% .G#."!&%%(+&5!3/4+,/)&/@ ,3+&'?/34+5%% A3!*',+,!"-&/@ F!"!)G.

�A%'/( "%,!3+,23G:1. "+*%B!&(/, �L�. �/.%@ 4!,/* *%?!3!&5�@&/¤ *�+1&/',%(% */$3/#(�'&/¤ 1�A!3A"+)�¤ A3/-

',+,% ,+ 3+(+ A!3!*4�D23/./¤ )+"/)% / �+,!3. VII &+2(. (/&?. ) 4�F&. 2B. «�(,2+"-&� A3/$"!4%1!3/&,/"/1�¤ ,+ 1!3�+,3�¤», A3%'.#B!&/¤ A+4ª#,� +(+*!4�(+ /"/*%4%3+ !&�+4�&/.%B+ �3/"-(�'+. —�.: �&N, 1!3/&,/"/1�¤ ����, 2006. — �. 31–32.

2. "+*%B!&(/ �L�., µ34/"!&(/ �L�., �!*/32( �L�. %(/3%',+&&# "+)!3&/¤ A/"#3%4!,3�¤ *"#*%?*�+1&/',%(% */$3/#(�'&/¤ 1�A!3A"+)�¤ ,+ 3+(2 A!3!*4�D23/./¤ )+"/)% / �+,!3. '!2(3. &+2(.-A3+(,. (/&?. «�(,2+"-&� A%,+&&# 23/"/1�¤». — �!3&�.5�: ����, 2006. — �. 116–117.

3. "+*%B!&(/ �L�., µ34/"!&(/ �L�., �!*/32( �L�., % *3. %)&+B!&&# ',32(,23&%D )4�&A!3!*4�D23/./¤ )+"/)% A3% 3/).%,(2 */$3/#(�'&/¤ 1�A!3A"+)�¤ ,+ 3+(2 A3/',+,% )+ */A/4/1/�"+)!3&/¤ A/"#3%4!,3�¤ / �+,!3. 4�F&. &+2(.-A3+(,. (/&?. «�/.3!4!&&G! &+A3+."!&%# ,!/3!,%B!-'(%D % A3%("+*&GD %''"!*/.+&%@». — �*!'+: �!3&/4/3-!, 2006. — �. 38–40.

4. �+,!&, �(3+¤&% 15760, � 61 B 1 / 00 �A/'�$ *%?!3!&5�@&/¤ *�+1&/',%(% */$3/#(�'&/¤1�A!3A"+)�¤ A3/',+,%,+3+(2 A!3!* 4�D23/./¤)+"/)%)+*/A/4/1/� "+)!3&/¤A/"#3%4!,3�¤ / "+*%B!&(/�L�., µ34/"!&(/ �L�., �!*/32( �L�.; �+#.". 19.01.2006; �A2$". 17.07.2006. — ��". «�3/4%'"/.+."+'&�',-». — � 7. — 2 '.

111

!�!;1+$!�0�"1]0'&"0+$,+^qJ�,�'%�,)+�&+')��'&+J',0"1],!J4�+,(&!J�>!�0&!>!4x)!(�',,=1'>',]

>#>. >��� (��.), J#+. J���� (���.)!3&/A�"-'-(%@ *!3F+.&%@ 4!*%B&%@ 2&�.!3'%,!, �4!&� �L�. �/3$+B!.'-(/1/

�3% 4/*!"�.+&&� 1/',3/1/ 23+F!&&# "!1!&- U"#D/4 �&,3+,3+D!+"-&/1/ ..!*!&&# 1�*3/D"/-3%*&/¤ (%'"/,% .',+&/."!&/, �/ /'/$"%./',#4% +"-,!3+,%.&%D )4�& A!B�&(% A3% !('A!3%4!&,+"--&/42 *+&/42 '%&*3/4� ¯ &+#.&�',- /'!3!*(/./1/ A/¯*&+&&# "�,%B&%D � A�(&/,%B&%D )4�&1!A+,/5%-,�.�)&+(/A%B!&&#4 4/&/&2("!+3&%D ("�,%& A3% .�*'2,&/',� A/"�4/3?&/("�,%&&%D "!@(/5%,�. &+?/&� A/32U!&&# (3/.//$�12, �/ D+3+(,!3&/ *"# +A/A,/)2.

!�!;',,!�0+"1]0'&"0+$,-^+qJ',',+/�'%',+�&+`)��'&+J',0"1],!J�+,(&!J'!�0&!>!�!$&'�(',+=1'>)+^

>#>. >��� (��.), J#+. J���� (���.)

!3&/A/"-'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4!&% �L�. �/3$+B!.'(/1/�+?!*3+ ("%&%B!'(/@ "+$/3+,/3&/@ *%+1&/',%(%

�������������������: H�H. ?����� (0��. ��., ���.)

�).!',&/, B,/ /',3/! A/.3!F*!&%! "!1(%D .G)G.+!, .G3+F!&&G! %)4!&!&%# A3/5!''/. 4!-,+$/"%)4+ % 3+).%,%! .,/3%B&/@ .%'5!3+"-&/@ A+,/"/1%%, (/,/3/! . ("%&%(! %).!',&/ (+( A/"%-/31+&&+# &!*/',+,/B&/',- [1].�*&/ %) !! A3/#."!&%@ — A/.3!F*!&%! A!B!&%. &+U! .3!4# 2',+-&/."!&/, B,/, ' A/)%5%% A3%("+*&/@ +&+,/4%%, 3+&&%4 /$�!(,%.&G4 4!,/*/4 /$/'&/.+&%% 4/3-?/N?2&(5%/&+"-&GD A3/#."!&%@ 3!4/*!"%3/.+&%# A!B!&%# ."#!,'# 4/3?/"/1%B!'(%@ +&+"%) '2B!,/4 A3/5!''/. ?%)%/"/1%B!'(/@ 1%$!"% 1!A+,/5%,/. [2].

�'D/*# %) %)"/F!&&/1/, 5!"-� &+U!1/ %''"!*/.+&%# $G"/ .G#'&%,- ',32(,23&/-?2&(5%/&+"-&G! /'/$!&&/',% 3!/31+&%)+5%% A!B!&%% *%&+4%(2 +A/A,/)N/A/'3!*/.+&&GD ?+(,/-3/. A3% '%&*3/4! /',3/1/ A/.3!F*!&%# "!1(%D.

�"# %''"!*/.+&%# .G$3+"% &!@,3/?%"N)+.%'%42� 4/*!"- /',3/1/ A/.3!F*!&%# "!1(%D [3] '%&,3+,3+D!+"-&G4 ..!*!&%!4 (3G'+4 HCl, pH 1,2 . */)! 1,0 4"¦(1 &+ .*/D! % ?%)%/"/1%B!'(/1/3+',./3+ . */)! 1,0 4"¦(1 &+ .*/D! F%./,&G4 (/&,3/"-&/@ 132AAG(n = 6).�!3!) 6 (n = 6) % 24 B+'+(n = 6) A3/./*%"% �2,+&+)%� F%./,&GD, 4+,!3%+"/4 *"# %''"!*/.+&%# $G"+ A!B!&- $!"GD (3G'.

�%',/"/1%B!'(% /,4!B!&/ A/',!A!&&/! &+3+',+&%! A3/#."!&%@ *%',3/?%B!'(%-&!(3/,%B!'(%D %)4!&!&%@ 1!A+,/5%,/.. �,4!B!&/, B,/ 1%$!"- 1!A+,/5%,/. A3/%'D/*%"+ *.24# A2-,#4%: &!(3/)/4 % +(,%.+5%!@ +A/A,/)+. +(, A3% &!(3/)! &+$"�*+"%'- #."!&%# 5%,/"%)+, + *"#+A/A/)+ $G"/ D+3+(,!3&/ '4/3�%.+&%! #*3+ '/ )&+B%,!"-&G4 &+(/A"!&%!4 1!,!3/D3/4+,%&+ A3%/,'2,',.%% ./'A+"%,!"-&/@ 3!+(5%% &+ 4!',! A/1%$U%D 1!A+,/5%,/..

�2$4%(3/'(/A%B!'(%! %''"!*/.+&%# A/(+)+"% '2�!',.!&&G! %)4!&!&%# (+( 1!4/(+A%""#3/.,,+( % 1!A+,/5%,/. A3% '%&*3/4! /',3/1/ A/.3!F*!&%# "!1(%D. +(, A3/'.!, $/"-U%&',.+ 1!4/(+A%"-"#3/. $G" 3+'U%3!&&G4, / B!4 '.%*!,!"-',.2!, %',/&B!&%! %D ',!&(% % 24!&-U!&%! (/"%B!',.+/31+&!"" &+ A"/�+*- �&*/,!"%/5%,+. +(%! %)4!&!&%# D+3+(,!3&G *"# A/"&/(3/.%#, B,/ A/*,.!3-F*+!,'# '"+*F+4% �3%,3/5%,/. % /$3+)/.+&%!4 4%(3/,3/4$/. B!3!) 24 B+'+ �('A!3%4!&,+.

�)4!&!&%# 1!A+,/5%,/. %4!"% ',+*%@&G@ D+3+(,!3. �!3!) 6 B+'/. �('A!3%4!&,+ A3!/$"+*+-"% +*+A,+5%/&&G! %)4!&!&%#, (/,/3G! D+3+(,!3%)/.+"%'- )&+B%,!"-&G4 &+(/A"!&%!4 �2D3/4+,%-&+, 1%A!3A"+)%!@ #*3GU!( % (/4A+(,&G4 3+'A/"/F!&%!4 /31+&!"" 5%,/A"+)4G. �!3!) 24 B+'+ &+-$"�*+"/'- '4/3�%.+&%! #*3+ '/ )&+B%,!"-&G4 &+(/A"!&%!4 1!,!3/D3/4+,%&+, *!',32(5%!@ /31+-&!"" % &+"%B%!4 4%!"%&/.GD /$3+)/.+&%@. �3/4! �,/1/, 2.!"%B%.+"/'- (/"%B!',./ A"+)4/5%,/. .�,%D 1!A+,/5%,+D.

�(+)+&&G! %)4!&!&%# '/ ',/3/&G #*3+ % 5%,/A"+)4G 4G 3+'5!&%.+!4 (+( A3/#."!&%! +A/A-,/)+, 4%!"%&/.GD /$3+)/.+&%@ — . 3!)2"-,+,! +(,%.+5%% A!3!(%'&/1/ /(%'"!&%# "%A%*/., + &+(/-A"!&%! A"+)4/5%,/. — (+( '*.%1 124/3+"-&/1/ ).!&+ %442&%,!,+, B,/ &+U"/ './! A/*,.!3F*!&%!. $%/D%4%B!'(%D % %442&/"/1%B!'(%D A/(+)+,!"#D.

�"!*/.+,!"-&/, /'/$!&&/',#4% +"-,!3+,%.&GD %)4!&!&%@ A!B!&% A3% �('A!3%4!&,+"-&/4'%&*3/4! /',3/1/ A/.3!F*!&%# "!1(%D #."#!,'# &+"%B%! /B+1/./1/ '/B!,+&%# "%,%B!'(%D % A%(-&/,%B&GD %)4!&!&%@ 1!A+,/5%,/. ' &+(/A"!&%!4 4/&/&2("!+3&GD ("!,/( A3% /,'2,',.%% A/"%-4/3?&/("!,/B&GD "!@(/5%,/. &+ ?/&! &+32U!&%# (3/.//$3+�!&%#, B,/ D+3+(,!3&/ *"# +A/A,/)+.

112

�A%'/( "%,!3+,23G:1. Ware, B.L. Theacuterespiratorydistresssyndrome / B.L. Ware, M.A. Matthay // N. Engl. J. Med.

— 2000. — Vol. 342. — P. 1334–1349.2. �/3?/"/1%B!'(%! A3%)&+(% /',3/1/ A/.3!F*!&%# "!1(%D 3+)"%B&/@ �,%/"/1%% (�('A!3%-

4!&,+"-&/! %''"!*/.+&%!) / L. �/3/), �L�. �/"2$!., �L. �+3B!&(/. % *3. // �$�+# 3!+&%4+,/-"/1%#. — 2010. — /4 VI. — � 3. — �. 29–34.

3. Matute-Bello, G. Animalmodelsofacutelunginjury / G. Matute-Bello, C. Frevert, T. Martin //Am. J. Physiol. LungCellMol. Physiol. — 2008. — V. 295. — P. 379–399.

!�!;1+$!�0I )1�,�)+0"(�">,!�0+)+^$!&!;+J','0&�'

�#,. >��������

�+5�/&+"-&%@ 4!*%B&%@ 2&�.!3'%,!, �4. �L�. �/1/4/"-5#�+?!*3+ D�3231�¤ � 3

����������@���: K��. Q� ���� ( ���., �. �. �.)

�./3/$+ �!&!,3�! (D3/&�B&%@ 1�A!3,3/?�B&%@ A/"�+*!&/4+,/)&%@ 1+',3%,) #."#¯,-'#.+F(/*�+1&/',/.+&%4 )+D./3�.+&&#4 ) &!#'&%4 A+,/1!&!)/4. �"�&�B&/ A3/#."#¯,-'# )$�"-U!&&#4 '("+-*/( /$/"/&(% U"2&(2 ,+ )&+B&/� .,3+,/� $�"(+. �A!5%?�B&/1/ "�(2.+&&# &!4+¯. � D�3231�B&%D4!,/*�. A!3!.+1+ &+*+¯,-'# ,/,+"-&�@ 1+',3/!(,/4�¤.

!�!;',,!�0+)1+,+)++(+">,!�0+)";!1'q,+J','0&+'

+#,. >�������� (����.)�+5%/&+"-&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4!&% �L�. �/1/4/"-5+

�+?!*3+ D%3231%% � 3

�������������������: U��. Q� ���� ( ���., �. �. �.)

�/"!)&- �!&!,3%! (D3/&%B!'(%@ 1%A!3,3/?%B!'(%@ A/"%+*!&/4+,/)&G@ 1+',3%,) #."#!,'#3!*(%4 % ,32*&/ *%+1&/',%32!4G4 )+$/"!.+&%!4, B+',/,+ (/,/3/1/ &! A3!.GU+!, 1:200000.

�,%/"/1%# % A+,/1!&!). �+ '!1/*&#U&!@ *!&- .G*!"#�, *.! ?/34G $/"!)&% �!&!,3%!:.)3/'"2� % *!,'(2�, (/,/3G! 'D/F% .%)2+"-&/ % A+,/4/3?/"/1%B!'(%, &/ %4!�, 3+)&2� �,%/"/-1%�, 3+)&/! ("%&%B!'(/! ,!B!&%! % 3+)&G@ %'D/*. �"# *.2D ?/34 $/"!)&% D+3+(,!3&+ 1%A!3,3/?%#'("+*/( F!"2*(+, .G'/,+ (/,/3GD 4/F!, */',%1+,- 3,5 '4, )+4!�!&%! A+3%!,+"-&GD ("!,/( &+ 42-5%&NA3/%)./*#�%! % ?/.!/"#3&+# 1%A!3A"+)%# (2*"%&!&%! #4/(, A/#."!&%! 4%(3/'(/A%B!'(%D/B+1/.GD A3/"%?!3+,/. %) .G'/(/A3%)4+,%B!'(/1/ �A%,!"%#).

�/ *+&&#4 BluthR.F. % *3. (DepartmentofDermatology,MayoClinicFoundation, Rochester, MN, USA.), &+ ?/.!/"#3-&/� 1%A!3A"+)%�¥3%'. 1) ."%#!, ,3+&'?/34%32��%@ ?+(-,/3 3/',+ (TGF¶), (/,/3G@ /,&/'%,'# ( '�4!@',.2 �A%*!34+-"-&/1/ ?+(,/3+ 3/',+ % #."#!,'# +(,%.+,/3/4 3!5!A,/3/.�A%*!34+"-&/1/ ?+(,/3+ 3/',+ (epidermal growth factorreceptor, EGFR, ErbB-1). �& $G" /$&+32F!& A3% %442&/1%'-,/D%4%B!'(/4 +&+"%)! *+&&GD ("!,/(. �3% �,/4 A3/4!F2,-(% 4!F*2 ?/.!/"#3&G4% ("!,(+4% 2.!"%B%.+�,'#, B,/ %#."#!,'# &!A/'3!*',.!&&/@ A3%B%&/@ /$%"-&/@ A/,!3% 'G-./3/,/B&/1/ $!"(+.

�%'. 1. �/.!/"#3&+# 1%A!3A"+)%#.�(3+'(+ 1!4+,/('%"%&/4 % �/)%&/4, 2.. (×140)

�('A!3%4!&,+"-&/ $G"+ */(+)+&+3/"- ,3+&'?/34%32��!1/ ?+(,/3+ 3/',+ (TGFalpha) . )+-�%,! '"%)%',/@ F!"2*/B&/N(%U!B&/1/ ,3+(,+ . /,.!, &+ /',3G@ 3+)*3+F%,!"-. D/*! �('A!3%-4!&,+ &+ (3G'+D$G" 'A3/./5%3/.+& 1+',3/�&,!3/(/"%,. /',3/4 �('A!3%4!&,! '"%)%',G! F!"2*-(+, ,/&(/1/ % ,/"',/1/ (%U!B&%(+ $G"% /,A3+."!&G . "+$/3+,/3%� *"# *+"-&!@U!1/ %)2B!&%# A3%A/4/�% %442&/1%',/D%4%%. �/ *+&&G4 P. Hovmann, J. M. Zeeh % *3., $G"/ )+4!B!&/ 2.!"%B!&%!

113

TGFalpha . 3–4 3+)+ B!3!) 4–8 B+'/. A/'"! %&*2(5%% (/"%,+ % ./).3+�!&%! . A3!*!"G &/34G . ,!-B!&%! 24 B+'/.. �!)2"-,+,G %''"!*/.+&%# A/(+)+"%, B,/ . 4!',+D, 1*! (/"%B!',./ TGFalpha $G"/.G'/(%4, &!(3/) %4!" 4!',/, &/ $!) A3%)&+(/. 2"-5!3/1!&&/',%, % &+/$/3/,, . 4!',+D' &+%4!&--U%4 (/"%B!',./4 TGFalpha A3!/$"+*+" 2"-5!3/1!&&G@ (/4A/&!&,. �*!"+& .G./*, B,/ TGFalpha%13+!, .+F&2� 3/"- . 3!A+3+5%% '"%)%',/@ F!"2*/B&/N(%U!B&/1/ ,3+(,+. �*&+(/ A/ '!@ *!&- &!,*/',/.!3&GD ?+(,/., 3+'(3G.+��%D 4!D+&%)4G %&*25%3/.+&%# TGFalpha.

�3% *!,'(/4 .+3%+&,! $/"!)&% �!&!,3%! 4&/1%! +.,/3G '("/&#�,'# ( %&?!(5%/&&/42 A3/%'-D/F*!&%� $/"!)&%, + %4!&&/, ( 5%,/4!1+"/.%32'&/@ %&?!(5%%. �A%'+&/ $/"!! 50 '"2B+!. )+$/"!.+-&%# 2 *!,!@, .G).+&&GD %4!&&/ �,%4 .%32'/4. � *!,!@ $/"!)&- A3/#."#!,'# A/,!3!@ $!"(+, 1+',3/-A+,%!@ % D+3+(,!3&/@ 1%A!3,3/?%!@ '("+*/( '"%)%',/@ F!"2*(+. /,"%B%! /, /$GB&/1/ D3/&%B!-'(/1/ )+$/"!.+&%# 2 .)3/'"GD ,!B!&%! )+$/"!.+&%# 2 *!,!@ %4!!, */$3/(+B!',.!&&G@ D+3+(,!3.

�+'"!*',.!&&+# A3!*3+'A/"/F!&&/',- ( *+&&/42 )+$/"!.+&%� #."#!,'# *%'(2,+$!"-&/@,/*&+(/, A/ 4&!&%� &!(/,/3GD +.,/3/. (B. Larsen, U. Tarp, E. Kristensen; Medical DepartmentSilkeborg, Hospital Silkeborg, Denmark, 1987), %''"!*/.+.U%D 200 A+5%!&,/. ' $/"!)&-� �!&!,3%!,&+'"!*',.!&&G@ D+3+(,!3 $G" 2',+&/."!& "%U- . 3 '"2B+#D % ,/"-(/ '3!*% $3+,-!. % '!',!3. �!&!-,%B!'(%@ +&+"%) A/(+)+" */4%&+&,&/',- 1!&+, �('A3!''%32��!1/ �A%*!34+"-&G@ ?+(,/3 3/',+¥1"+.&G@ ?+(,/3 ,3+&'?/34+5%% A+3%!,+"-&GD ("!,/( . 425%& A3/%)./*#�%!).

�"%&%(+. �'&/.&G4% ("%&%B!'(%4% '%4A,/4+4% $/"!)&% �!&!,3%! #."#�,'# $/"% . �A%1+-',3%%, 3./,+ (./)4/F&/ ' A3/F%"(+4% (3/.%), F%*(%@ ',2", '&%F!&%! +AA!,%,+. �/"-&G! 4/12,,!3#,- . .!'! */ 10–20 (1, D+3+(,!3&/ &+3+',+&%! /,�(/. &%F&%D (/&!B&/',!@ % .!(, A/#."!&%! +'-5%,+. �!"2*/B&G! (3/./,!B!&%# 2 $/"-U%&',.+ $/"-&GD ,#F!"G!. �+$"�*+!,'# 1%A/A3/,!%&!4%#' A/&%F!&%!4 ?3+(5%@ +"-$24%&+ % 1"/$2"%&+. �&*/'(/A%B!'(% .%*&G 1%A!3,3/?%3/.+&&G!'("+*(% '"%)%',/@ /$/"/B(% F!"2*(+, .G'/,+ (/,/3GD 4/F!, */',%1+,- 3,5 '4. �("+*(% '"%)%',/@A3% %&'2?"#5%% &! 3+'A3+."#�,'#, '/'2*%',G@ 3%'2&/( &!#3(/ .G3+F!&. �,4!B+!,'# A/.GU!&&/!(/"%B!',./ .#)(/@ '"%)%.

�!&,1!&/"/1%B!'(/! %''"!*/.+&%! A/)./"#!, .G#.%,- D+3+(,!3&G! B!3,G $/"!)&%. G*!"#-�, *.! ?/34G: 3+'A3/',3+&!&&2� % /13+&%B!&&2�. �3% /13+&%B!&&/@ ?/34! $/"!)&% �!&!,3%!/$&+32F%.+�, '(/A"!&%! ,/"',GD %).%"%',GD '("+*/( '"%)%',/@, (/,/3G! )&+B%,!"-&/ .G',2A+-�, . A3/'.!, F!"2*(+ % A3!*',+."#�, '/$/@ *!?!(, &+A/"&!&%# &!A3+.%"-&/@ ?/34G, '/',/#�%@%) «A/*2U(//$3+)&GD» /$3+)/.+&%@ (3%'. 2). %A%B&/@ "/(+"%)+5%!@ '(/A"!&%# '("+*/( A3% *+&-&/4 )+$/"!.+&%% #."#�,'# *&/ % ,!"/ F!"2*(+, A3% �,/4 +&,3+"-&G@ /,*!" . A+,/"/1%B!'(%@ A3/-5!'' &! ./."!B�& (3%'. 3). �+'A/"/F!&%! '("+*/( A3% /13+&%B!&&/@ % 3+'A3/',3+&!&&/@ ?/34+D'/D3+&#!, /A3!*!"!&&G@ A/3#*/(. �,!&(% F!"2*(+ '/D3+&#�, �"+',%B&/',-, A!3%',+"-,%(+ 3!1%-',3%32!,'# (+( A/ 4+"/@, ,+( % A/ $/"-U/@ (3%.%)&!.

�%'. 2. �%A!3,3/?%3/.+&&G! '("+*(% '"%)%',/@F!"2*(+

�%'. 3. �3�U&+# (/4A-�,!3&+# ,/4/13+?%# —*%??2)&/! 2,/"�!&%! ',!&(% F!"2*(+ . .%*!1%A!3,3/?%3/.+&&GD '("+*/(. /"�%&+ ',!&(%3,2 '4 . 4+('%4+"-&/4 %)4!3!&%%

�!B!&%!. �A!5%?%B!'(/1/ "!B!&%# �,/@ $/"!)&% &!,. ,!B!&%! A/'"!*&%D 10 "!, &+B+"% %'-A/"-)/.+,- 4/&/("/&+"-&G! +&,%,!"+ A3/,%. �A%*!34+"-&/1/ ?+(,/3+ 3/',+, &/ % /&% &! .'!1*+A/(+)G.+�, './� �??!(,%.&/',-. �) 4!,/*/. D%3231%B!'(/1/ "!B!&%# A3!*A/B,!&%! /,*+!,'# ,/-,+"-&/@ 1+',3�(,/4%%.

114

�A%'/( "%,!3+,23G:1. PHoVmann, J. M. Zeeh, J. Lakshmanan et al. Increased expression of transforming growth fac-

tor á precursors in acute experimental colitis in rats // Gut. 1997. 41: 195–202.2. Remes-Troche1 Jose Maria, Zapata-Colindres Juan Carlos et al. Early gastric cancer in Mene-

trier’s disease// BMJ, Case Reports, 2009.3. Coffey R.J., Washington M.K., Corless C.L. et al. Ménétrier disease and gastrointestinal stromal

tumors: hyperproliferative disorders of the stomach// J. Clin. Invest. — 2007. — �. 70–80.4. Coffey R.J., Romano M., Goldenring J. Roles for transforming growth factor-a in the stomach //

J. Clin. Gastroenterol. 1995. 21:Suppl 1: S. 36–S.39.5. Scharschmidt, B.F. The natural history of hypertrophic gastropathy (Menetrier’s disease): report

of a case with 16 year follow-up and review of 120 cases from the literature// Am. J. Med. 1977 63: 644–652.

6. Searcy R., Malagelada J-R. Menetrier’s disease and idiopathic hypertrophic gastropathy. Ann In-tern Med. 1984. 100: 565–70.

7. Maimon S.N., Bartlett J.P., Humphreys E.M., Palmer W.L. Giant hypertrophic gastritis. Gastro-enterology. 1947. 8: 397–428.

�&+%+,,!��1'(�0$',,"=�$=q]J'�(4)1+,+%'�)+J0'%',+'J,'0&"$J"0+%'�)+^$,40&+J!q>!$-^)&!$!+q1+=,+/

+!�!;',,!�0=J+�0&!',+=*',0&"1],-^�'&2!&+&4w{+^"&0'&+/>!1!$,!>!J!q>"

+#'. '����� (��.), "#"0������ (����.), "#,. �������� (����.)�3+'&/#3'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4. A3/?. L�. /@&/N�'!&!5(/1/

�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%�+?!*3+ &!.3/"/1%% % &!@3/D%3231%% ' (23'/4 ���

�������������������: ���. /�������� ( ������ �������, ���., �. �. �.),#�8. W���X ( ���., �. �. �.), ��8. Q�$�� (. �. �., ����+�����3����*)

�) .'!D '/'2*%',GD )+$/"!.+&%@ 1/"/.&/1/ 4/)1+ . &!@3/D%3231%% 1%A!3,!&)%/&&G! .&2,-3%4/)1/.G! (3/./%)"%#&%# /',+�,'# &!/*&/)&+B&/@ A3/$"!4/@.

'.#)% ' +(,2+"-&/',-� *+&&/@ A3/$"!4G A/',+."!&+ ���z: .G#.%,- .+3%+&,G ',3/!&%#5!&,3+"-&GD A!3?/3%32��%D +3,!3%@ 1/"/.&/1/ 4/)1+ % A3/.!',% ("%&%(/N4/3?/"/1%B!'(2�A+3+""!"- 4!F*2 /'/$!&&/',#4% +&1%/+3D%,!(,/&%(% % ("%&%B!'(%4 ,!B!&%!4 1!4/33+1%B!'(/1/%&'2"-,+. �+ A!3%/* 2008–2011 11. $G"% %''"!*/.+&G:

1. �/"-&G! ' 1!4/33+1%B!'(%4 %&'2"-,/4(n = 52).2. �3!A+3+,G 1/"/.&/1/ 4/)1+, %)�#,G! 2 "%5, 24!3U%D /, A3%B%&, &! '.#)+&&GD ' A/3+F!-

&%!4 ��� (n = 50)3. �3!A+3+,G 1/"/.&/1/ 4/)1+, %)�#,G! 2 "%5, 24!3U%D /, 1!4/33+1%B!'(/1/ %&'2"-,+

(n = 23).�+ ,32A+D A3/./*%"/'- (3+&%/4!,3%B!'(/! %''"!*/.+&%!. �/'"! ?%('+5%% 4/)1+, %)2B+"+'-

+&+,/4%# 5!&,3+"-&GD A!3?/3%32��%D .!,.!@ '3!*&!@ % )+*&!@ 4/)1/.GD +3,!3%@,(�,% +3,!3%%B+�! A/*.!3F!&G 3+)3G.+4). �1-'!14!&, '3!*&!@ 4/)1/./@ +3,!3%% — 2B+',/( /, !� &+B+"+ */$%?23(+5%%. �, &!1/ /,D/*#, 5!&,3+"-&G! A!3?/3%32��%! .!,.% — "!&,%(2"/',3%+3&G! +3,!-3%%. G*!"#�, ,3% 132AAG "!&,%(2"/',3%+3&GD +3,!3%@: 4!*%+"-&2�, A3/4!F2,/B&2� % "+,!-3+"-&2�, ,+( &+)G.+!4G@ ("+''%B!'(%@ ,%A ',3/!&%#. �/ &+U%4 *+&&G4, ("+''%B!'(%@ ,%A.',3!B+!,'# . 62 % '"2B+!., B+�! 2 */"%D/5!?+"/. — . 80 % '"2B+!.. �+4% $G" .G*!"!& A3/4!-F2,/B&G@ ,%A ',3/!&%# "!&,%(2"/',3%+3&GD +3,!3%@ (20 % '"2B+!.) % A2B(/./@ ,%A ',3/!&%#(18 % '"2B+!.), (/,/3G@ B+�! .',3!B+"'# 2 $3+D%5!?+"/. % &! .',3!B+"'# 2 */"%D/5!?+"/.. �1-'!14!&, )+*&!@ 4/)1/./@ +3,!3%% 3+'A/"/F!& /, 3+).%"(% $+)%"#3&/@ +3,!3%% */ '/!*%&!&%#��� ' )+*&!@ '/!*%&%,!"-&/@ +3,!3%!@. �, �1-'!14!&,+ /,D/*%, 132AA+ )+*&%D ,+"+4/A!3?/3%-32��%D +3,!3%@ (/, 3 */ 6). '.#)% ' B+',/ .',3!B+!4G4 .+3%+&,/4 ,+(/1/ ',3/!&%#, &+)/.�4 ,%A("+''%B!'(%4: /& .',3!B+"'# . 65 % '"2B+!., &+%$/"!! B+',/ — 2 */"%D/- % 4!)/5!?+"/.. �+4%$G" .G*!"!& A2B(/./@ ,%A ',3/!&%# )+*&%D ,+"+4/A!3?/3%32��%D +3,!3%@, .',3!B+��%@'# .35 % '"2B+!., &+%$/"!! B+',/ — 2 ,32A/. ' $3+D%5!?+"-&/@ ?/34/@ B!3!A+ (60 %). �''"!*/.+&/20 A3!A+3+,/. 1/"/.&/1/ 4/)1+ ' A2,+4!&+"-&G4% (3/./%)"%#&%#4% % 3 A3!A+3+,+ ' (3/./%)"%#-

115

&%#4% . ,+"+4%B!'(2� /$"+',-. �3% A2,+4!&+"-&GD (3/./%)"%#&%#D ("+''%B!'(%@ ,%A ',3/!&%#&+ ',/3/&! 1!4+,/4G .',3!B+"'# . 30 % '"2B+!., A3/4!F2,/B&G@ ,%A — . 40 % '"2B+!., A2B(/./@,%A — . 30 % '"2B+!..

�+&&GD A/ ',3/!&%� )+*&%D ,+"+4/A!3?/3%32��%D +3,!3%@ 2 "%5, 24!3U%D /, ,+"+4%B!-'(%D (3/./%)"%#&%@ &!*/',+,/B&/ (n = 3) *"# A/"2B!&%# )&+B%4GD 3!)2"-,+,/.. �3/*/"F+!,'# &+-$/3 4+,!3%+"+. �3% /$'"!*/.+&%% $/"-&GD ' 1!4/33+1%B!'(%4 %&'2"-,/4 . A2,+4!&+"-&/@ /$"+'-,% 4G .G*!"%"% *.! 132AAG $/"-&GD: (/4A!&'%3/.+&&G! % *!(/4A!&'%3/.+&&G!. �3% /A3!*!"�&-&/4 /$��4! .&2,3%4/)1/./@ 1!4+,/4G, .G)G.+��!@ *%'"/(+5%� '3!*%&&GD ',32(,23 (> 704"),.'! $/"-&G! $G"% *!(/4A!&'%3/.+&GL�3% /$�!4! 30–70 4" &! .G#."!&/ B�,(/@ )+.%'%4/',% 4!F-*2 23/.&!4 '/)&+&%# % /$�!4/4 (3/./%)"%#&%#. �+ &+U .)1"#*, �,/ '.#)+&/ ' '/A2,',.2��!@%U!4%!@ A/*(/3(/./N',./"/.GD ',32(,23 3+)&/@ ',!A!&% .G3+F!&&/',%. �3% 3+)3G.! /*&/@ %)"!&,%(2"/',3%+3&GD .!,.!@ % 3+).%,%% (3/./%)"%#&%# . A2,+4!&+"-&/@ /$"+',% A3% A2B(/./4,%A! ',3/!&%# .!'- A2B/( . /'&/.+&%% $2*!, '*+."!& .&2,3%4/)1/./@ 1!4+,/4/@, B,/ .G)/.!, ,/-,+"-&2� %U!4%� . /$"+',% (3/./'&+$F!&%# +3,!3%@, + '/A3/./F*+��%@ )/&2 %U!4%% /,�( .G)/-.!, *%'"/(+5%� 4/)1/.GD ',32(,23 ' (/4A3!''%!@ ',./"+ 1/"/.&/1/ 4/)1+ (*!(/4A!&'%3/.+&&/!'/',/#&%! A+5%!&,+). '"2B+!, (/1*+ %4!!,'# ("+''%B!'(%@ ,%A ',3/!&%#, ,/"-(/ B+',- +3,!3%@$2*!, '*+."!&+ 1!4+,/4/@, % /',+&!,'# */',+,/B&/! (/"%B!',./ ?2&(5%/&%32��%D +3,!3%@ ((/4-A!&'%3/.+&/! '/',/#&%! A+5%!&,+).

D/*! 3+$/,G $G"% '*!"+&G � ��� :1. G*!"!&G ("+''%B!'(%@, A3/4!F2,/B&G@ % A2B(/./@ ,%AG "!&,%(2"/',3%+3&GD +3,!3%@

'3!*&!@ 4/)1/./@ +3,!3%%.2. �3% /$��4! .&2,3%4/)1/./@ 1!4+,/4G $/"!! 70 4" .'! $/"-&G! $G"% *!(/4A!&'%3/.+&G

% &+D/*%"%'- . (/4!.3. �U!4%B!'(%! %)4!&!&%# . A/*(/3(/./N',./"/.GD ',32(,23+D #."#�,'# /*&%4 %) .!*2�%D

?+(,/3/. 1!4/33+1%B!'(/1/ %&'2"-,+, /A3!*!"## A3/1&/) A+5%!&,+.4. �2B(/./@ ,%A ',3/!&%# "!&,%(2"/',3%+3&GD +3,!3%@ .',3!B+!,'# 2 "%5 ' $3+D%5!?+"-&/@

?/34/@ B!3!A+ B+�!.

�A%'/( "%,!3+,23G:1. �/@,, �L�. �%3231%B!'(+# +&+,/4%# 1/"/.G % U!%. — �/'(.+: ���A3!''N%&?/34, 2006.

— 128 '.2. �%(/"+!, L�. +3%+&,G '/'2*/. ,!"+ B!"/.!(+ / L�. �%(/"+!., �L�. �+,2D,%&+, �L�. �!-

3!.5/.+, �L. �3U/.. — �3+'&/#3'(: �+2B&/N%&&/.+5%/&&G@ 5!&,3, 2009. — 163 '.3. �+3%$!(#&, �L�. �%3231%B!'(/! "!B!&%! 1!4/33+1%B!'(/1/ %&'2"-,+ 4!,/*/4 A2&(5%/&-

&/@ +'A%3+5%% % "/(+"-&/1/ ?%$3%&/"%)+. — �/'(.+: ���A3!''N%&?/34, 2009. — 289 '.4.�(./35/.+ L�., �3G"/. L. �!4/33+1%B!'(%@ %&'2"-, — �.: �����N�!*%+, 2007. —

361 '.5. �2'"%&+ �L�., +3+(%& �L�., !3!�+1%& �L. �/'2*%',G! )+$/"!.+&%# 1/"/.&/1/ 4/)1+ —

�.: �����N�!*%+, 2006. — 328 '.6. �!&!3%5% �L�., �/12'"+.'(% �., �+((/ �L�. �&'2"-,. �"%&%B!'(/! 32(/./*',./. — �.:

�!*A3!'', 2006. — 264 '.

J!&2!J'0&+%'�)+'�!)"q"0'1+�'("1+{,!>!,'&$"4J4�%+,q&'1!>!$!q&"�0"

0#,. �������� (��.)

�!34'(+# �/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%# %4. +(. �L�. +1&!3+�+?!*3+ &/34+"-&/@, ,/A/13+?%B!'(/@ % ("%&%B!'(/@ +&+,/4%%, /A!3+,%.&/@ D%3231%%

�������������������: 9��. ?�������� (0��. ��., ���., �. �. �.)

"����z����z�����������. �/.3!F*!&%# (32A&GD 4+1%',3+"-&GD &!3.&GD ',./"/. . &+-',/#�!! .3!4# .',3!B+�,'# .'! $/"!! B+',/. �+( A3+.%"/, /&% ("+''%?%5%32�,'# (+( ,#F!"G! A/-.3!F*!&%# A!3%?!3%B!'(/@ &!3.&/@ '%',!4G, A3%./*#�%! ( *"%,!"-&/@ 2,3+,! ,32*/'A/'/$&/',%. '+4/4 +(,%.&/4 ./)3+',!. &+',/#�!! .3!4# . '.#)% ' 3/',/4 */3/F&/N,3+&'A/3,&/1/ ,3+.4+-,%)4+, + ,+(F! . )/&+D ./!&&GD (/&?"%(,/. &+$"�*+!,'# 2.!"%B!&%! (/"%B!',.+ '"2B+!. A/.3!F-*!&%@ '!*+"%�&/1/ &!3.+, ./)&%(+��%D A3% A!3!"/4+D (/',!@ ,+)+ % &%F&%D (/&!B&/',!@. �+%-

116

$/"!! B+',/ ,+(%4 A/.3!F*!&%#4, (+( A3+.%"/, A/*.!3F!&G "%5+ )3!"/1/ ./)3+',+ (' 2B!,/4 ./)-3+',&/@ A!3%/*%)+5%!@ /&,/1!&!)+ B!"/.!(+, A3%&#,/@ &+ VII '!'/�)&/@ (/&?!3!&5%% A/ A3/-$"!4+4 ./)3+',&/@ 4/3?/"/1%%, ?%)%/"/1%% % $%/D%4%% ��� ���� . �/'(.! . 1965 1/*2). �+&-&G@ ./)3+', D+3+(,!3%)2!,'# (+( A!3%/* &+%$/"!! +(,%.&/@ F%)&!*!#,!"-&/',%, A/�,/42 �??!(-,%.&/! "!B!&%! ,+(%D A+5%!&,/. %4!!, &! ,/"-(/ $/"-U/! 4!*%5%&'(/!, &/ % /13/4&/! '/5%+"--&/! )&+B!&%!. �/#.%.U%!'# ./)4/F&/',% *"# A3/.!*!&%# 4%(3/D%3231%B!'(%D /A!3+5%@ &+ &!3.-&GD ',./"+D A3!*�#."#�, &/.G! ,3!$/.+&%# (+( ( ,!D&%(! /A!3+5%@, ,+( % ( 23/.&� )&+&%@ /.&2,3%',./"-&/@ ',32(,23! /,*!"-&GD &!3.&GD ',./"/..

'! �,/ /$2'"/.%"/ +(,2+"-&/',- 3+$/,G % &+U %&,!3!' ( $/"!! *!,+"-&/42 %)2B!&%� '!*+-"%�&/1/ &!3.+ %4!&&/ . .GU!2(+)+&&/4 ./)3+',!. �+3#*2 ' ,!4, B,/ 4/3?/"/1%# &!3./. . *!,-'(/4 ./)3+',! %''"!*/.+&+ */',+,/B&/ A/*3/$&/, %4!�,'# )&+B%,!"-&G! A3/$!"G . )&+&%#D ./)-3+',&/@ %)4!&B%./',% %D .&2,3%',./"-&/@ ',32(,23G &+ �,+A+D A/',&+,+"-&/1/ /&,/1!&!)+. "%-,!3+,23! 4G .',3!,%"% "%U- &!(/,/3G! &!A/"&G! *+&&G! /,&/'%,!"-&/ %&*%.%*2+"-&GD /'/$!&-&/',!@ A!3%?!3%B!'(%D &!3./., A3%B!4 $/"-U%&',./ %''"!*/.+&%@ A3/.!*!&/ &+ F%./,&GD, % A/-�,/42 %D 3!)2"-,+,G "%U- ' */',+,/B&/ $/"-U/@ A/A3+.(/@ 4/F&/ A!3!&!',% &+ B!"/.!(+. �*&+(/% �,% *+&&G! /,3G./B&G % A3/,%./3!B%.G.

*��z�����������. �3/%).!',% 4+(3/- % 4%(3/4!,3%B!'(%! %''"!*/.+&%# '!*+"%�&/1/ &!3-.+ . 4!',! !1/ .GD/*+ %) A/*132U!.%*&/1/ /,.!3',%# % *+,- '3+.&%,!"-&2� D+3+(,!3%',%(2 A/(+)+-,!"#4 !1/ .&2,3%',./"-&GD ',32(,23 2 42FB%& A!3./1/ % .,/3/1/ A!3%/*/. )3!"/1/ ./)3+',+.

J����� ������ �����������. �+,!3%+"/4 %''"!*/.+&%# A/'"2F%"% *+&&G! +2,/A-'%@ 37 ,32A/. 42F'(/1/ A/"+, A/1%$U%D /, ,3+.4, ' +&+4&!',%B!'(%4% *+&&G4%, %'("�B+��%4%A+,/"/1%� A!3%?!3%B!'(/@ &!3.&/@ '%',!4G. �+,!3%+" $G" 3+)*!"!& &+ ./)3+',&G! 132AAG . '/-/,.!,',.%% ' ./)3+',&/@ A!3%/*%)+5%!@ /&,/1!&!)+ B!"/.!(+ (�/'(.+, 1965). �+$/3 4+,!3%+"+A3/%)./*%"% &+ 23/.&! .GD/*+ '!*+"%�&/1/ &!3.+ %) A/*132U!.%*&/1/ /,.!3',%#. �/'"! .G*!"!-&%# %) ,(+&!@ ',./"+ '!*+"%�&/1/ &!3.+ A3/./*%"% )+4!3G !1/ /(32F&/',% % 3+''B%,G.+"% A"/-�+*- A/A!3!B&/1/ '!B!&%#. %''"!*/.+&%% A3%4!&!&G 4+(3/4!,3%B!'(%@, 1%',/"/1%B!'(%@ 4%(-3/4!,3%B!'(%@ % ',+,%',%B!'(%@ 4!,/*G %''"!*/.+&%#. �%',/"/1%B!'(%! A3!A+3+,G /(3+U%.+"%1!4+,/('%"%&/4 % �/)%&/4 % A/ 4!,/*2 +&N�%)/&. �"# /(3+'(% 4%!"%&/.GD /$/"/B!( % #*!3 /"%-1/*!&*3/1"%% . $!"/4 .!�!',.! %'A/"-)/.+"% /(3+'(2 A/ �A%"-4!@!32. �%(3/4!,3%B!'(% A3/%)-./*%"% /A3!*!"!&%! (/"%B!',.+ &!3.&GD A2B(/. % .D/*#�%D . &%D &!3.&GD ./"/(/&, ' *%??!3!&-5%+5%!@ &+ 4%!"%&/.G! % $!)4%!"%&/.G!. �+,!4 /A3!*!"#"% *%+4!,3, /(32F&/',- % A"/�+*- A/-A!3!B&/1/ '!B!&%# 4%!"%&/.GD % $!)4%!"%&/.GD ./"/(/& ' )+4!3/4 ,/"�%&G 4%!"%&/./@ /$/-"/B(%. �!)2"-,+,G %''"!*/.+&%@ $G"% ',+,%',%B!'(% /$3+$/,+&G.

�/"2B!&&G! 3!)2"-,+,G &! .G#.%"% )&+B%,!"-&GD (/"%B!',.!&&GD % (+B!',.!&&GD %)4!&!-&%@ ',32(,23G '!*+"%�&/1/ &!3.+ . ,!B!&%! *.2D ./)3+',&GD A!3%/*/.. �&+"%) 4+(3/4!,3%B!-'(%D %''"!*/.+&%@ A/(+)+", B,/ /(32F&/',- '!*+"%�&/1/ &!3.+ 2 42FB%& . A!3./4 A!3%/*! )3!-"/1/ ./)3+',+ '/',+."#!, . '3!*&!4 38,42 ± 0,135 44 (p < 0,05), + ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+'-,+ �,/, A/(+)+,!"- 3+.!& 38,28 ± 0,092 44 (p < 0,05), ,. !. 3+)4!3 ?+(,%B!'(% /*%&+(/.. �%+4!,3'!*+"%�&/1/ &!3.+ . A!3./4 A!3%/*! )3!"/1/ ./)3+',+ '/',+."#!, . '3!*&!4 12,24 ± 0,042 44(p < 0,05), B,/ A/B,% '/.A+*+!, A/(+)+,!"!4 *%+4!,3+ 2 42FB%& ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+'-,+, (/,/3G@ 3+.!& 12,19 ± 0,032 44 (p < 0,05). �"/�+*- A/A!3!B&/1/ '!B!&%# '!*+"%�&/1/ &!3.+ 242FB%& . A!3./4 A!3%/*! )3!"/1/ ./)3+',+ . '3!*&!4 '/',+."#!, 117,54 ± 0,83 442 (p < 0,05), + ./.,/3/4 A!3%/*! )3!"/1/ ./)3+',+ !! 3+)4!3G 3+.&G 116,66 ± 0,55 442 (p < 0,05).

�3% /A3!*!"!&%% (+B!',.!&&GD % (/"%B!',.!&&GD A/(+)+,!"!@ A2B(/. '!*+"%�&/1/ &!3.+3+''4+,3%.+"%'- '"!*2��%! A+3+4!,3G: (/"%B!',./ A2B(/., /,&/'%,!"-&+# A"/�+*- A/A!3!B&/1/'!B!&%# '/!*%&%,!"-&/@ ,(+&% % A2B(/. &!3.&GD ./"/(/&, '3!*&## A"/�+*- A/A!3!B&/1/ '!B!&%#/*&/1/ A2B(+, A/(+)+,!"% 4%!"%&/.GD % $!)4%!"%&/.GD ./"/(/&. �%(3/4!,3%B!'(/!%''"!*/.+&%! (/"%B!',.+ &!3.&GD A2B(/. '!*+"%�&/1/ &!3.+ A/(+)+"/, B,/ %D (/"%B!',./ ?+(,%-B!'(% /*%&+(/./ (+( . A!3./4, ,+( % ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ (63,47 ± 0,42 % 63,6 ± 0,39,'//,.!,',.!&&/) (p < 0,05). �+('%4+"-&G@ A/(+)+,!"- A"/�+*% /*&/1/ A2B(+ /*%&+(/. (+( 2 42F-B%& A!3./1/ A!3%/*+, ,+( % 2 42FB%& .,/3/1/ A!3%/*+ )3!"/1/ ./)3+',+ (0,22 ± 0,008 4(42)(p < 0,05). �"/�+*-, )+&%4+!4+# A2B(+4% &!3.&GD ./"/(/& . '!*+"%�&/4 &!3.!, ,+(F! /*%&+(/.+. /$/%D %''"!*2!4GD ./)3+',&GD A!3%/*+D. �&+ '/',+."#!, . '3!*&!4 35,64 ± 0,13 4(42 (p < 0,05).�"/�+*-, A3%D/*#�+#'# &+ '/!*%&%,!"-&2� ,(+&-, . /$/%D ./)3+',&GD A!3%/*+D 3+.&+64,36 ± 0,14 4(42 (p < 0,05). �3% %)2B!&%% ',32(,23G A2B(/. ' %'A/"-)/.+&%!4 'A!5%+"%)%3/.+&-&/1/ A3/13+44&/1/ /$!'A!B!&%# *"# 4!*%5%&G % $%/"/1%% BioVision, version 4,0 &+4 2*+"/'- .G-#.%,- '"!*2��!!. '!*+"%�&/4 &!3.! . A!3./4 A!3%/*! )3!"/1/ ./)3+',+ &+'B%,G.+!,'# . '3!*-

117

&!4 80446,32 ± 158,2 &!3.&GD ./"/(/& (p < 0,05), + ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ /,4!B+!,'#&!)&+B%,!"-&/! 2.!"%B!&%! %D (/"%B!',.+ */ 80493,13 ± 155,3 (p < 0,05).

�3% %''"!*/.+&%% 4%!"%&/.GD % $!)4%!"%&/.GD &!3.&GD ./"/(/& &+ A3!A+3+,+D, /(3+U!&-&GD 1!4+,/('%"%&/4 % �/)%&/4, 2B+',(% 4%!"%&+ .%)2+"%)%3/.+"%'- (+( &!$/"-U/! /(321"/!A3/',3+&',./, '/*!3F+�!! ,/"-(/ &!3.&/! ./"/(&/. �+ &+32F&/@ A/.!3D&/',% 4%!"%&%)%3/.+&-&/1/ A3/',3+&',.+ $G"+ .%*&+ $"!*&//(3+U!&&+# 5%,/A"+)4+ U.+&&/.'(/@ ("!,(%. �+D/*#�%!'#. &!3.&/4 A2B(! #*3+ A3%&+*"!F+, U.+&&/.'(%4 ("!,(+4, ?%$3/$"+',+4 �&*/&!.3%# % �&*/,!"%-+"-&G4 ("!,(+4 (+A%""#3/. (,/F! /,&/'#�%4'# ( �&*/&!.3%�). �+ A3!A+3+,+D, /(3+U!&&GD /'-4%!4, 4%!"%&, /(32F+��%@ &!3.&/! ./"/(&/, $G" B!3&/1/ 5.!,+, + 4%!"%&/.+# /$/"/B(+ %4!"+.%* )+B!3&!&&/1/ (/"-5+. �3% /A3!*!"!&%% A+3+4!,3/. 4%!"%&/.GD &!3.&GD ./"/(/& /$&+32F%-"%, B,/ A"/�+*- %D A/A!3!B&/1/ '!B!&%# 2 42FB%& A!3./1/ A!3%/*+ )3!"/1/ ./)3+',+ % 2 42FB%&.,/3/1/ A!3%/*+ )3!"/1/ ./)3+',+ %4!!, &!)&+B%,!"-&2� 3+)&%52 % '/',+."#!, 160,65 ± 2,084(42 %161,76 ± 2,88 4(42 (p < 0,05), '//,.!,',.!&&/. /"�%&+ 4%!"%&/./@ /$/"/B(% ,+(F! 4!&#!,'# &!-)&+B%,!"-&/: ' 6,46 ± 0,05 4(4 (. A!3./4 A!3%/*! )3!"/1/ ./)3+',+) */ 6,52 ± 0,07 4(4 (./ .,/3/4A!3%/*! )3!"/1/ ./)3+',+) (p < 0,05). �!)4%!"%&/.G! &!3.&G! ./"/(&+ #."#�,'#, (+( 2(+)G.+!,$/"-U%&',./ %''"!*/.+,!"!@, $/"!! 2',/@B%.G4% ( 3+)"%B&G4 A/.3!F*+��%4 ?+(,/3+4, &/ %/&% A/*.!3F!&G ./)3+',&G4 %)4!&!&%#4. G./* /$ �,/4 4/F&/ /$/'&/.+,- A/"2B!&&G4% 4%(3/-4!,3%B!'(%4% %''"!*/.+&%#4%. �+('%4+"-&G! A/(+)+,!"% *%+4!,3+, /(32F&/',% % A"/�+*% A/-A!3!B&/1/ '!B!&%# $!)4%!"%&/.GD &!3.&GD ./"/(/& '!*+"%�&/1/ &!3.+ .G#."!&G 2 %''"!*2!4GD/$�!(,/. A!3./1/ A!3%/*+ )3!"/1/ ./)3+',+, + ./ .,/3/4 A!3%/*! /,4!B+!,'# &!)&+B%,!"-&/! '&%-F!&%! �,%D A/(+)+,!"!@. +(, *%+4!,3 $!)4%!"%&/.GD &!3.&GD ./"/(/& 24!&-U+!,'#, '/',+."## 242FB%& A!3./1/ A!3%/*+ )3!"/1/ ./)3+',+ 1,38 ± 0,06 4(4 % 2 42FB%& .,/3/1/ A!3%/*+ )3!"/1/./)3+',+ — 1,31 ± 0,06 4(4 (p < 0,05). �(32F&/',- �,%D ./"/(/&, '//,.!,',.!&&/, ,+(F! A3!,!3A!-.+!, %)4!&!&%#: . A!3./4 A!3%/*! /(32F&/',- $!)4%!"%&/.GD &!3.&GD ./"/(/& 3+.&+ 4,32 ± 0,194(4, ./ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ — 4,11 ± 0,27 4(4 (p < 0,05). �3% �,/4 A"/�+*- A/A!3!B-&/1/ '!B!&%# 24!&-U+!,'#: 2 %''"!*2!4GD /$�!(,/. A!3./1/ A!3%/*+ )3!"/1/ ./)3+',+ /&+ '/',+.-"#!, 1,54 ± 0,164(42, 2 /$�!(,/. .,/3/1/ A!3%/*+ )3!"/1/ ./)3+',+ — 1,42 ± 0,144(42 (p < 0,05).�//,.!,',.!&&/ 24!&-U+!,'# (/"%B!',./ /'!.GD 5%"%&*3/., /,.!B+��%D )+ 'A/'/$&/',- &!3.+ (3+',#F!&%�. 3!)2"-,+,! 4!&#!,'# A/(+)+,!"- 4+('%4+"-&/@ /,&/'%,!"-&/@ *!?/34+5%% '!*+-"%�&/1/ &!3.+ % '&%F+!,'# /$�+# A3/B&/',- &!3.+.

/"�%&+ �A%&!.3%# . A!3./4 A!3%/*! )3!"/1/ ./)3+',+ 3+.&+ 148,59 ± 0,42 4(4, ./ .,/3/4A!3%/*! )3!"/1/ ./)3+',+ /&+ */',%1+!, 153,15 ± 0,51 4(4 (p < 0,05), 2.!"%B%.+#'- ' ./)3+',/4 )+'B!, 3+)3+',+&%# '/!*%&%,!"-&/@ % F%3/./@ ,(+&!@, A3%'2,',.2��%D . !1/ '/',+.!.

�''"!*/.+&%! A!3%&!.3%# A/(+)+"/, B,/ !1/ ,/"�%&+ &+ A3/,#F!&%% %''"!*2!4GD ./)3+'-,&GD A!3%/*/. &! %)4!&#!,'# % '/',+."#!, 12,64 ± 0,059 4(4 (p < 0,05).

�/*./*# %,/1, &!/$D/*%4/ /,4!,%,-, B,/ .&2,3%',./"-&+# ',32(,23+ '!*+"%�&/1/ &!3.+ ..!3D&!@ ,3!,% $!*3+ 2 42FB%& . A!3./4 % .,/3/4 A!3%/*+D )3!"/1/ ./)3+',+ .G3+F!&&GD 3+)"%-B%@ &! %4!!,.

/ .,/3/4 A!3%/*! )3!"/1/ ./)3+',+ (/"%B!',./ &!3.&GD ./"/(/& . '!*+"%�&/4 &!3.! 2.!"%-B%.+!,'# . '3+.&!&%% ' A!3.G4 A!3%/*/4, &/ &!)&+B%,!"-&/, A3% �,/4 &+$"�*+!,'# 24!&-U!&%!*%+4!,3+, /(32F&/',% % A"/�+*% A/A!3!B&/1/ '!B!&%# $!)4%!"%&/.GD &!3.&GD ./"/(/& % '/'2*/.�A%&!.3%#. 4!',! ' ,!4 A3/%'D/*%, 2,/"�!&%! �A%&!.3%#, B,/, $!)2'"/.&/, '(+)G.+!,'# &+ A3/B&/-',&GD D+3+(,!3%',%(+D &!3.+. �/"2B!&&G! A3% %''"!*/.+&%% 4/3?/4!,3%B!'(%! %)4!&!&%# A+3+-4!,3/. 4/12, 2(+)G.+,- &+ &+B+"-&G! �,+AG ./)&%(&/.!&%# ./)3+',&/@ A!3!',3/@(% .&2,3%',./"--&GD ',32(,23 '!*+"%�&/1/ &!3.+. �',+&/."!&&G! +&+,/4/4!,3%B!'(%! A+3+4!,3G '!*+"%�&/1/&!3.+ 4/12, A/'"2F%,- /'&/./@ ( '/',+."!&%� &/34+,%.&GD ,+$"%5 *"# A!3./1/ % .,/3/1/ A!3%/*/.)3!"/1/ ./)3+',+. �/"2B!&&G! 3!)2"-,+,G A/)./"#, . ("%&%(! A3% /A!3+,%.&GD .4!U+,!"-',.+D %&-*%.%*2+"%)%3/.+,- 4%(3/D%3231%B!'(%! A3%�4G, + ,+(F! *%??!3!&5%3/.+,- A/'"!*',.%# ,3+.4+-,%B!'(/1/ ./)*!@',.%# &+ A/#'&%B&/N(3!',5/.2� /$"+',- % &%F&�� (/&!B&/',-. A3/)!(,/3'(/@A3+(,%(! % A3% 1%',/"/1%B!'(/4 %''"!*/.+&%% '!*+"%�&/1/ &!3.+ )&+&%! !1/ A+3+4!,3/. . 3+)"%B-&GD A!3%/*+D A/',&+,+"-&/1/ /&,/1!&!)+ A/)./"%, /A3!*!"%,- ./)3+', /$�!(,+ %''"!*/.+&%#.

�A%'/( "%,!3+,23G:1. �.,+&*%"/., �L�. �!*%5%&'(+# 4/3?/4!,3%# / �L�. �.,+&*%"/.. — �.: �!*%5%&+, 1990.

— �. 384.2. �+*F%!., �L�. �!(/,/3G! %,/1% %)2B!&%# .&2,3%',./"-&/1/ A2B(/./1/ ',3/!&%# A!3%?!-

3%B!'(%D &!3./. / �+*F%!. �L�., �+'G4/. �L�., �""+D.!3*%!. �. �., �+'24/. �. �. // �+,N"G XXI'!'/�)&/1/ '�!)*+ +&+,/4/., 1%',/"/1/. % �4$3%/"/1/.. — �/",+.+, 1992. — �. 51.

118

3. �+'G4/., �L�. �,32(,23&G! A3!/$3+)/.+&%# �A%&!.3+"-&/@ /$/"/B(% A!3%?!3%B!'(%D&!3./. .A/',&+,+"-&/4 /&,/1!&!)! / �+'G4/. �L�., �+*"%&'(%@ L�., �+'24/. �L�. // �,32(,23-&G! A3!/$3+)/.+&%# /31+&/. % ,(+&!@ &+ �,+A+D /&,/1!&!)+ . &/34! % A3% ./)*!@',.%% +&,3/A/-1!&&GD ?+(,/3/.: (/&?!3!&5%#, A/'.#�!&&+# 100-"!,%� '/ *&# 3/F*!&%# A3/?. �L. �/A/./@-�+,(%&/@ / �+,!3%+"G. — �',3+D+&-, 1996. — �. 46.

4. �+"4%&, �L. �&*%.%*2+"-&+#, ./)3+',&+# % $%"+,!3+"-&+# %)4!&B%./',- A2B(/./1/',3/!&%# '!*+"%�&/1/ &!3.+ / �L. �+"4%& // �2&(5%/&+"-&+# 4/3?/"/1%# % ("%&%B!'(+# 4!*%-5%&+: �$/3&%( &+2B&GD 3+$/,. — �/',/.N&+N�/&2, 2000. — �. 35–36.

5. �+"4%& �L., �!("�*/. �L�., �%(/"!&(/ L�. �A3!*!"!&%! $%/"/1%B!'(/1/ ./)3+',+ A/.&2,3%',./"-&/@ ',32(,23! A!3%?!3%B!'(%D &!3./.: �B!$&/N4!,/*%B!'(%! 3!(/4!&*+5%%. — �+-3+,/., 1997. — �. 20.

6. �+"4%&, �L. �,32(,23&G! /'&/.G A3/B&/',% A!3%?!3%B!'(%D &!3./. / �+"4%& �L. //�'A!D% '/.3!4!&&/1/ !',!',./)&+&%#. — 2002. — � 1. — �. 78.

7. �/3F!.'(%@, �L�. �3%4!&!&%# 1!4+,/('%"%&+ . 1%',/"/1%B!'(/@ ,!D&%(! / �L�. �/3F!.-'(%@ // �/3?/"/1%#. — 2007. — . 132, � 6. — �. 77–82.

8. �+('%4!&(/., �L�. &2,3%',./"-&/! ',3/!&%! A!3%?!3%B!'(%D &!3./.. / �L�. �+('%4!&-(/.. — �.: �!*%5%&+, 1963. — �. 280.

9. �!(/,/3G! %,/1% %)2B!&%# .&2,3%',./"-&/1/ A2B(/./1/ ',3/!&%# A!3%?!3%B!'(%D &!3././ �L�. �+*F%!., �L�. �+'G4/., �L�. �""+D.!3*%!., �L�. �+'24/. // �+,N"G XXI '!'/�)&/1/'�!)*+ +&+,/4/., 1%',/"/1/. % �4$3%/"/1/.. — �/",+., 1992. — �. 51.

10. �*&/3+"/., �L�. &2,3%',./"-&+# ',32(,23+ A!3%?!3%B!'(%D &!3./. 2 B!"/.!(+ /�L�. �*&/3+"/. // ,/3+# �(3+%&'(+# (/&?!3!&5%# +&+,/4/., 1%',/"/1/., �4$3%/"/1/. % ,/A/-13+?/+&+,/4/.: ,32*G. — �+3-(/., 1958. — �. 389–401.

,')!0!&-'"��')0-4��'x,!>!�&'�!("$",+=","0!J++$��!&0+$,!J$4q' (,"�&+J'&';>42))

'#;. )��� (���.), >#J. ;��������� (����.), 1#". 1���� (���.)

�!"/32''(%@ 1/'2*+3',.!&&G@ 2&%.!3'%,!, ?%)%B!'(/@ (2"-,23G�+?!*3+ +&+,/4%%

�&+,/4%# #."#!,'# $+)/./@ *%'5%A"%&/@ . .2)! 'A/3,%.&/1/ A3/?%"#, ,+( (+( A/)./"#!, A/-"2B%,- 5!"/',&/! A3!*',+."!&%! / ',3/!&%% ,!"+ B!"/.!(+, + &+ /'&/.! A/"2B!&&GD A/ *+&&/42A3!*4!,2 )&+&%@ *+!, ./)4/F&/',- ',2*!&,+4 2'A!U&/ 2'./%,- *321%! *%'5%A"%&G 4!*%(/-$%/"/1%B!'(/1/ 5%("+ (?%)%/"/1%�, 'A/3,%.&2� 4!*%5%&2, $%/4!D+&%(2 % *3.).

�,2*!&,G 1-1/ (23'+ (*%'5%A"%&+ «�&+,/4%#» A3!A/*+!,'# . ����� . ,!B!&%! ,/"-(/A!3./1/ 1/*+ *&!.&/@ % )+/B&/@ ?/34+D /$2B!&%#) A3!*',+."#�, /'/$2� '/5%+"-&2� 132AA2,(/,/3+# %'AG,G.+!, A/.GU!&&/! A'%D/N�4/5%/&+"-&/! ./)*!@',.%! '/ ',/3/&G .G'U!1/ 2B!$-&/1/ )+.!*!&%#. �,/ '.#)+&/ ' %)4!&!&%!4 2'"/.%@ F%)&% ',2*!&,/., A!3!D/*/4 &+ &/.G@ 23/-.!&- /$2B!&%#, .G'/(/@ '244+3&/@ 2B!$&/@ % ?%)%B!'(/@ &+132)(/@, &/.%)&/@ % '"/F&/',-�4+,!3%+"+, /'/$!&&/',#4% A'%D/"/1%B!'(%D '/',/#&%@ % +*+A,+5%% (/ .'!42 A!3!B%'"!&&/42.�!3!*(/ �,/ 4/F!, A3%./*%,- ( 3+).%,%� ?2&(5%/&+"-&GD % /31+&%B!'(%D )+$/"!.+&%@, + ,+(-F! '2�!',.!&&/ ."%#,- &+ A/(+)+,!"% 24',.!&&/@ % ?%)%B!'(/@ 3+$/,/'A/'/$&/',% ',2*!&,/..+(, A/ *+&&G4 (/4%,!,+ �('A!3,/. '!4%3&/@ /31+&%)+5%% )*3+.//D3+&!&%#, 2',+&/."!&/, B,/'3!*% ',2*!&,/. )+ 1/*G 2B!$G 2.!"%B%.+!,'# B%'"/ ?2&(5%/&+"-&GD &+32U!&%@ '!3*!B&/-'/'2*%',/@, &!3.&/@ % �&*/(3%&&/@ '%',!4, #."#��%D'# '"!*',.%!4 *!)+*+A,+5%%. �/�,/42)+*+B!@ .'!D A3!A/*+.+,!"!@ (+?!*3G +&+,/4%% ����� #."#!,'# ?/34%3/.+&%! 2 ',2*!&,/.)+%&,!3!'/.+&&/',% A3!*4!,/4, %'A/"-)2# A3% �,/4 4+('%4+"-&/ '/D3+&#��%! )*/3/.-! ,!D&/-"/1%%. �U%$(+ 4&/1%D A!*+1/1/. — ',3!4"!&%! ."/F%,- . A+4#,- ',2*!&,+ $/"-U/@ /$�!4 %&-?/34+5%%, /*&+(/ A/"2B%,- A3% �,/4 .G'/(%@ 23/.!&- )&+&%@ &! 2*+!,'#, ,+( (+( )+A/4%&+�,2B+�%!'#, . /'&/.&/4, ,2 %&?/34+5%�, (/,/3+# .G).+"+ 2 &%D %&,!3!'. �'&/.&/@ % +(,2+"-&/@A3/$"!4/@ A3!A/*+.+&%# +&+,/4%% #."#!,'# /,'2,',.%! &+1"#*&/',%, %$/ �,/, A3!*4!, &/'%,*!4/&',3+5%/&&G@ D+3+(,!3, . '.#)% ' B!4 2'./!&%! +&+,/4%% )+,32*&#!,'#. �/�,/42 ./)&%(+!,&!/$D/*%4/',- A3%4!&!&%# ,+(%D '3!*',. /$2B!&%#, (/,/3G! /$!'A!B+, ',2*!&,+4 &+1"#*&/',-%, '//,.!,',.!&&/, +(,%.%)%32�, $/"-U!! (/"%B!',./ ,%A/. A+4#,% ()3%,!"-&+#, '"2D/.+#, 4/-,/3&+#, ,+(,%"-&+#, �4/5%/&+"-&+# % *3.).

119

�"# /$!'A!B!&%# 2'A!U&/1/ 2'./!&%# A3!*4!,+ ',2*!&,+4% .'! +2*%,/3%% &+ (+?!*3! +&+-,/4%% ����� #."#�,'# A3/?%"-&G4%, /'&+�!&G 4+(!,+4% /31+&/., A"+(+,&G4%, ,+$"%B&G4% %%""�',3+,%.&G4% 4+,!3%+"+4%, B,/ /$!'A!B%.+!, &+1"#*&/',-. +(F! 3+$/,+!, 42)!@ &+,23+"--&GD +&+,/4%B!'(%D A3!A+3+,/., . (/,/3/4 A3!*',+."!&G /31+&G .'!D ?2&(5%/&+"-&GD '%',!4/31+&%)4+. �"+1/*+3# �,/42 3!U+!,'# A3/$"!4+ .%)2+"%)+5%%, % ',2*!&,G %4!�, ./)4/F&/',-2.%*!,- /31+&G . &+,23+"-&2� .!"%B%&2, + ,+(F! 3+''4/,3!,- %D . 3+)"%B&GD 3+)3!)+D.

�!(5%/&&G@ (23' A/',3/!& ' %'A/"-)/.+&%!4 '/.3!4!&&GD ,!D&%B!'(%D '3!*',. /$2B!&%#¥42"-,%4!*%@&+# A3!)!&,+5%#, (/4A-�,!3&+# 13+?%(+ % +&%4+5%#), B,/ A/)./"#!, 2*!3F+,- .&%-4+&%! ',2*!&,/. &+ A3/,#F!&%% .'!1/ .3!4!&% "!(5%%.

�/)*+&G 2B!$&/N4!,/*%B!'(%! (/4A"!('G A/ 4&/1%4 ,!4+4 *%'5%A"%&G, 'A/'/$',.2��%!&! ,/"-(/ "2BU!@ A/*1/,/.(! ',2*!&,/., A/.GU!&%� %D 4/,%.+5%% ( %)2B!&%� ,32*&/1/ 4+,!-3%+"+, &/ % A/)./"#��%! /'2�!',."#,- A3%&5%A A3!!4',.!&&/',% 4!,/*%(% A3!A/*+.+&%# A3!*-4!,+. /'&/.! '/)*+&%# ,+(%D (/4A"!('/. "!F%, .G'/(%@ 23/.!&- )&+&%@ A3!A/*+.+,!"!@ (+?!*-3G, %D A3/?!''%/&+"%)4 % /,,/B!&&/! 1/*+4% 4+',!3',./ A3!A/*+.+&%# *%'5%A"%&G, 2B%,G.+�-�%D A/',/#&&2� &/.%)&2 (+( ,!D&%B!'(%D, ,+( % %&?/34+5%/&&GD '3!*',..

�AG,&G! % .G'/(/A3/?!''%/&+"-&G! A3!A/*+.+,!"% (+?!*3G '/)*+�, 2B!$&%(%, 2B!$&G!&+1"#*&G! A/'/$%# *"# ',2*!&,/., + ,+(F! 4!,/*%B!'(%! 3!(/4!&*+5%% ( (+F*/42 "+$/3+,/3&/42)+&#,%� *"# 4/"/*GD A3!A/*+.+,!"!@. �+ &+U!@ (+?!*3! B,2, /AG, % 42*3/',- A3!*G*2�%D A/-(/"!&%@ % &! )+$G.+�, / )+'"21+D ,!D A!*+1/1/., (/,/3G! .&!'"% $/"-U/@ .("+* . /'&+�!&%! (+-?!*3G % '/)*+"% &!A/.,/3%42� 4!,/*%(2 A3!A/*+.+&%# +&+,/4%%.

�+ (+?!*3! .!*!,'# 3+$/,+ '/ ',2*!&,+4% &! ,/"-(/ ./ .3!4# 2B!$&GD )+&#,%@, &/ % ./ .&!-23/B&/! .3!4#. �3!A/*+.+,!"% (+?!*3G A/**!3F%.+�, &+2B&G! ',3!4"!&%# ',2*!&,/., #."##'- %D32(/./*%,!"#4% . .GA/"&!&%% &+2B&GD 3+$/,, 3!)2"-,+,G (/,/3GD */("+*G.+�,'# &+ !F!1/*&GD(+?!*3+"-&GD &+2B&GD (/&?!3!&5%#D, + ,+(F! 4!F*2&+3/*&GD &+2B&/NA3+(,%B!'(%D (/&?!3!&5%#D&+U!1/ 2&%.!3'%,!,+ % *321%D .2)/.. �+2B&G! 32(/./*%,!"% *!"#,'# /AG,/4 '/ ',2*!&,+4%, A!3!-*+�, %4 )&+&%#, 2B+, "/1%B&/ % +&+,/4%B!'(% 13+4/,&/ 1/./3%,- % %)"+1+,- './% 4G'"%. !4G *"#&+2B&GD 3+$/, ',2*!&,G .G$%3+�, B+�! .'!1/ . '//,.!,',.%% ' %D %&,!3!'+4% % 'A/3,%.&/@ 'A!-5%+"%)+5%!@, %)2B+# /'/$!&&/',% ',3/!&%# ,!"+ 'A/3,'4!&+ . '.#)% ' %)$3+&&G4 .%*/4 'A/3,+ %(.+"%?%(+5%!@. +(/@ .%* 2B!$&/@ *!#,!"-&/',%, (+( &+2B&G! (/&?!3!&5%%, 3+).%.+!, %&,!3!' (A3!*4!,2, A/.GU+!, 23/.!&- )&+&%@ ',2*!&,/., &+',3+%.+!, &+ *+"-&!@U%@ A2,- A/ &+2B&/@ ,3/A!.

+(%4 /$3+)/4, &+ )+&#,%#D A/ *%'5%A"%&! «�&+,/4%#» . ����� %'A/"-)2�,'# %'("�B%-,!"-&/ )*/3/.-!N'$!3!1+��%! A!*+1/1%B!'(%! ,!D&/"/1%%, 2'A!U&/',- (/,/3GD )+.%'%, /, "%B&/-',% A3!A/*+.+,!"#, !1/ 4+',!3',.+, D+3+(,!3+ 2B!$&/N./'A%,+,!"-&GD ./)*!@',.%@ &+ ',2*!&,/..�+&#,%#, /'&/.+&&G! &+ A/"/F%,!"-&/4 �4/5%/&+"-&/4 ./)*!@',.%% &+ 2B+�%D'#, ./ 4&/1/ 3+)4!&!! 2,/4%,!"-&G. �3!*',.+ % ?/34+ A/*+B% 2B!$&/1/ 4+,!3%+"+ 2B%,G.+�, ./)3+',, 2B!$&G!./)4/F&/',% ',2*!&,/. % ',!A!&- %D 2,/4"#!4/',%.

�"+1/*+3# /,4!B!&&G4 /'/$!&&/',#4 2B!$&/1/ A3/5!''+, /$!'A!B%.+!,'# 2',/@B%./ ',+-$%"-&/! '/',/#&%! )+%&,!3!'/.+&&/',% ',2*!&,/. % &+$"�*+!,'# %D .G'/(%@ 23/.!&- 3+$/,/'A/-'/$&/',% . ,!B!&%! (+F*/1/ )+&#,%# A/ A3!*4!,2 «�&+,/4%#», B,/ &+U"/ A/*,.!3F*!&%! . A3/.!-*!&&GD ,!',+D.

41]0&"�0&4)04&,-="�";1�$"�*I *'1,=/&!,Ý>��0"J�,`&>�%,">"=(&"'2 >��"0"1"J4�"�"*4)"

�"�1=�4;0"0"1],"/0&-**"*�^$�1�,,"/ Ix`JII >"1"�,!>"J!q>4

$#;. )�_�����, =#�. )� 3�����, (#>. �3����

�3/*)!&'(� *)#3F+¸&G 4!*G5G&'(� 2&�.!3'�,�,�+?!*3+ 1�',+"/1��, 5G,+"/1�� � �4$3G#"/1��

��3�$3+"-&+# �U�4�# A3+.+(2! ?!34!&,+,G¸&G# A3+5�'G, #(�# A3G./*)#5- *+ &!@3+&+"-&GDA+U(/*F+&&#¸. ��',+4�& )&�F+! '�"2 A+U(/*F+&&#¸, .G("�(+&GD �U�4�#@, A3+) 1�',+4�&+.G# �23�5�A,+3G. �+'"#�U�4�B&+! ¸.#*)!&&! 1�'5�*)�&+, A+A#3�*&�(+ 1�',+4�&+ � +&,+1+&�',+ �33�5�A,+3+¸ 5�/A!3+4�*+ )4#1B+! #( &+',2A',.G �&?+3(,2 4/)12, ,+( � +**+"#! 1�$!"- &#@3/&+¸. �1+"+¸&G4 4/)12 1�',+4�& "+(+"�)2!55+ A!3+.+F&+ ¸ 1�',+4�&�31�B&GD &#@3/&+D. �*&+(�"-,3+',32(,23&G# +'+$"�.+'5� 1�',+4�&�31�B&GD &#@3/&+¸A3G �U�4�� 1+"+¸&/1+ 4/)12 &!.G.2B+&G.

120

��,+ 1�,+1+ *+'"!*+.+&&#: G#.�5- 2"-,3+',32(,23&G# +'+$"�.+'5� &#@3/&+¸1�',+4�&�31�B&+1+ #*3+ �2 1�A+,+"+42'+ A+52(+ (#( &+@$/"-U 3�A3�)!&,+,G¸&+1+) A+'"#'2$,+,+"-&+@ ,3G55+5�D.�"�&&+@ �U�4�� 1+"+¸&/1+ 4/)12.

�!,+*G *+'"!*+.+&&#: �"!(,3/&&+4�(3+'(+A�B&G, 1�',+D�4�B&G.� +3,G(2"! +A�'+&G +'+$"�.+'5� 2"-,3+',32(,23&G# +'+$"�.+'5� &#@3/&+¸ 1�',+4�&�31�B&+1+

#*3+ �2 1�A+,+"+42'+ A+52(+ (#( &+@$/"-U 3�A3�)!&,+,G¸&+1+) ¸ &/34! � A+'"# '2$,+,+"-&+@,3G55+5�D.�"�&&+@ �U�4�� 1+"+¸&/1+ 4/)12.

G'&/.G:1. �+'"# 30-D.�"�&&+@ '2$,+,+"-&+@ �U�4�� 1+"+¸&/1+ 4/)12 ¸ 1�',+4�&�31�B&+4 #*3G �2

.G"2B+�55+ *.+ .�*G )4#&!&&#¸ 2 5!"+D &#@3/&+¸: A+ '.!,"+42 (A!3UG) � 5�4&+42 (*321�) ,GA2 -A!3+.+F+�5- A+ (/"-(+'5� &+* A!3UG4�.

2. � &#@3/&+D A!3U+1+ ,GA2 +*)&+B+&G .G#¸"!&G# A3G(4!,G *�',32(5G�, .G("�(+&+@1�A+('�#@. � 5!"+D &#@3/&+¸ *321/1+ (5�4&+1+) ,GA2 1�',+4�&�31�B&+1+ #*3+ �2 A+'"# 30-D.�"�&&+@'2$,+,+"-&+@ �U�4�� 1+"+¸&/1+ 4/)12 A3G'2,&�B+�5- A3G(4!,G *�',32(5G�, .G("�(+&G# 1�A+('�#@,+"! A!3+.+F+�5- A3G(4!,G +(,G.+5G� '�&,�,GB&GD A3+5�'+¸.

41]0&"�0&4)04&,-'!�!;',,!�0+0'1,'/&!,!$>+�0"J+,'&>+%'�)!>!=(&"'2 >+�!0"1"J4�")&-�-

�!�1'�4;0!0"1],!/0&+(*"0+J+,40,!/+x'J++>!1!$,!>!J!q>"

$#;. )�_����� (��. ����., �. �. �.), '#+. )��3����� (����.), (#>. �3����� (����.)

�3/*&!&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ 1%',/"/1%%, 5%,/"/1%% % �4$3%/"/1%%

�������������������: /�#. >������ (0��. ��., ���., �. -. �.)

�!3!$3+"-&+# %U!4%# A3/./5%32!, ?!34!&,+,%.&G! A3/5!''G, A3%./*#�%! ( &!@3/&+"--&G4 A/.3!F*!&%#4. �%',+4%& '&%F+!, '%"2 A/.3!F*!&%@ .G).+&&GD %U!4%!@, '4#1B+!, A/'"!*-',.%# %&?+3(,+ 4/)1+, /,*+"#!, 1%$!"- &!@3/&/. [2]. 1/"/.&/4 4/)1! 1%',+4%& "/(+"%)2!,'#A3!%42�!',.!&&/ . 1%',+4%&!31%B!'(%D &!@3/&+D[3, 4, 5]. �*&+(/ 2"-,3+'32(,23+ 1%',+4%&!31%-B!'(%D &!@3/&/. A3% %U!4%% 1/"/.&/1/ 4/)1+ &! %)2B!&+.

*��z. G#.%,-2"-,3+',32(,23&G! /'/$!&&/',% &!@3/&/. 1%',+4%&!31%B!'(/1/ #*3+ E2 A/-'"! '2$,/,+"-&/@ ,3%*5+,%4%&2,&/@ %U!4%% 1/"/.&/1/ 4/)1+.

J����������� . �''"!*/.+&%# A3/.!*!&G &+ 10 $!"GD (3G'+DN'+45+D A/3/*G Wistar. ./)3+',! 4–6 4!'#5!., 4+''/@ 190–210 1. �!3.+# 132AA+ F%./,&GD — (/&,3/"-&G! (3G'G(n = 5), .,/3+# 132AA+ — (3G'G A/'"! '2$,/,+"-&/@ ,3%*5+,%4%&2,&/@ %U!4%!@ 1/"/.&/1/ 4/)-1+ (n = 5). �U!4%� 1/"/.&/1/ 4/)1+ 4/*!"%3/.+"% A2,�4 A!3!.#)(% *.2D /$�%D '/&&GD +3,!3%@&+ 30 4%&2,. �!(+A%,+5%� F%./,&GD A3/./*%"% A/* 1"2$/(%4 ,%/A!&,+"/.G4 &+3(/)/4. �$-3+)5G 4/)1+ )+4/3+F%.+"% A2,!4 A/132F!&%# . F%*(%@ +)/,. �.+ ?3/&,+"-&GD (3%/',+,&GD'3!)+ 1%A/,+"+42'+ (,/"�%&/@ 20 4(4 % 60 4(4) 1/,/.%"% A3% -150� &+ 23/.&! � ¹ — 3.80. �!3-.G@ '3!) /(3+U%.+"% &+ .G#."!&%! 'A!5%?%B!'(/1/ 4+3(�3+ 1%',+4%&!31%B!'(%D &!@3/&/.��� � [1]. ,/3/@ '3!) . (+4!3! (3%/',+,+ A/4!�+"% . A3!*.+3%,!"-&/ /D"+F*�&&G@ */ +4 /�1 % Os-?%('+,/3. �/* (/&,3/"!4 4+3(%3/.+&&/1/ '3!)+ .G*!"#"% )/&2 '/*!3F+�2� 1%',+4%-&!31%B!'(/! #*3/ �2 1%A/,+"+42'+ (3G'G. �"-,3+,/&(%! '3!)G %)1/,+."%.+"% &+ 2"-,3+4%(3/-,/4! �-7000 (���). �/"2B!&&G! A3!A+3+,G %)2B+"% . �"!(,3/&&/4 4%(3/'(/A! JEM-1011(JEOL). �"# 4/3?/4!,3%% 2"-,3/',32(,23 &!@3/&/. 1%',+4%&!31%B!'(/1/ #*3+ �2 %'A/"-)/.+"%A3/13+442 iTEM.

&�_��z�� �����������. �/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%% 1/"/.&/1/ 4/)1+ .1%',+4%&!31%B!'(/4 #*3! �2 .G*!"#�,'# *.+ .%*+ %)4!&!&%@ . ,!"+D &!@3/&/.: A/ '.!,"/42 (A!3-./42) % ,�4&/42 (.,/3/42) ,%A2 (3%'. 1).

121

� �

�%'. 1. �%',+4%&!31%B!'(%! &!@3/&G #*3+ �2. �. (�/&,3/"-). �"!(,3/&&/13+44+ 2.. ×5000.�. �%',+4%&!31%B!'(%! &!@3/&G #*3+ �2 .,/3/1/ ,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%%1/"/.&/1/ 4/)1+). �"!(,3/&&/13+44+ 2.. ×5000. . �%',+4%&!31%B!'(%! &!@3/&G #*3+ �2 A!3./1/,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%% 1/"/.&/1/ 4/)1+). �"!(,3/&&/13+44+ 2.. ×5000.

�!@3/&G A!3./1/ ,%A+ !*%&%B&G, %D 5%,/A"+)4+ &+$2D+!,, #*3+ /(321"#�,'#, D3/4+,%& A!-3!3+'A3!*!"#!,'# A/ A!3%?!3%%, /$3+)2# A3/'.!,"!&%# . 5!&,3+"-&/@ B+',%, #*3GU(/ 2A"/,&#!,-'#, 24!&-U+!,'# (/"%B!',./ A/3 . #*!3&/@ /$/"/B(!. �%,/D/&*3%@ 4+"/, /&% /,�B&G, A/B,% $!)(3%',, 3+'A/"/F!&%! (/,/3GD &! ',32(,23%3/.+&/. �,4!B+!,'# .G3+F!&&/! 3+'U%3!&%! 5%',!3&�3��, 24!&-U!&%! &+ !� A/.!3D&/',% (/"%B!',.+ 3%$/'/4, + &+ &!(/,/3GD, */./"-&/ A3/,#F!&-&GD, 2B+',(+D A/"&/! %D /,'2,',.%!. �/4A"!(' �/"-*F% .+(2/"%)%32!,'#. �%)/'/4G &!4&/1/B%'-"!&&G, ' A3!/$"+*+&%!4 A!3.%B&GD "%)/'/4.

�!@3/&G .,/3/1/ ,%A+ )&+B%,!"-&/ A3!/$"+*+�, A/ (/"%B!',.2. �,32(,23+ %D &!/*&/)&+B-&+. �,4!B+!,'# .G3+F!&&+# 1%A!3,3/?%# '%&,!,%B!'(/1/ +AA+3+,+. �.!"%B!&%! A"/�+*% A/.!3D-&/',% #*3+, )+ 'B�, %).%"%',/',% (+3%/"!44G, 2.!"%B!&%! (/"%B!',.+ % 3+)4!3/. A/3, 2.!"%B!&%!(/"%B!',.+ 3%$/'/4 &+ .&!U&!@ 4!4$3+&! #*!3&/@ /$/"/B(%, *!(/&*!&'%3/.+&&G@ D3/4+,%&,3+'A3!*!"�&&G@ 3+.&/4!3&/ A/ .'!42 #*32. �.!"%B!&%! (/"%B!',.+ 3%$/'/4 &+ A/.!3D&/',% 13+-&2"#3&/@ �&*/A"+)4+,%B!'(/@ '!,%, 3+'U%3!&%! 5%',!3& �3��, B,/ 4/F&/ ,3+(,/.+,- % (+( 2'%-"!&%! '%&,!)+ $!"(+, ,+( % (+( &+$2D+&%! — 3!+(5%# &+ 1%A/('%� (3%'. 2).

� �

��%'. 2. �%',+4%&!31%B!'(%! &!@3/&G #*3+ �2. �3��. �+3%/"!44+. �. (�/&,3/"-). �"!(,3/&&/-13+44+ 2.. ×60000. �. �!@3/&G .,/3/1/ ,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%% 1/"/.&/1/4/)1+). �3��, 4%,/D/&*3%%, "%)/'/4G. �"!(,3/&&/13+44+ 2.. ×60000. . �!@3/&G A!3./1/ ,%A+.�"!(,3/&&/13+44+ 2.. ×60000. �. �!@3/&G .,/3/1/ ,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!-4%% 1/"/.&/1/ 4/)1+). �).%"%',/',- (+3%/"!44G, ' /$3+)/.+&%!4 (32A&GD .G3/',/. #*3+. �"!(-,3/&&/13+44+ 2.. ×40000

122

�.!"%B!&%! (/"%B!',.+ +AA+3+,/. �/"-*F%, 2.!"%B!&%! (/"%B!',.+ .+(2/"!@ (+( &+ !1/ cis-,,+( % &+ trans-A/.!3D&/',%, 2.!"%B!&%! (/"%B!',.+ 5%',!3& . *%(,%/'/4! (3%'. 3). �.!"%B!&%! (/-"%B!',.+ './$/*&GD 3%$/'/4. �.!"%B!&%! (/"%B!',.+ 4%,/D/&*3%@.

� �

�%'. 3. �%',+4%&!31%B!'(%! &!@3/&G #*3+ �2. �/4A"!(' �/"-*F%. �. (�/&,3/"-). �"!(,3/&&/-13+44+ 2.. ×25000. �. �!@3/&G .,/3/1/ ,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%% 1/"/.&/1/4/)1+). �"!(,3/&&/13+44+ 2.. ×40000. . �!@3/&G A!3./1/ ,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@%U!4%% 1/"/.&/1/ 4/)1+). �"!(,3/&&/13+44+ 2.. ×40000

�+3#*2 ' .GU!A!3!B%'"!&&G4% A3%)&+(+4%, &!"-)# &! /,4!,%,- *!',32(,%.&G! &+32U!&%# -$/"-U/! B%'"/ "%)/'/4, ' A3!/$"+*+&%!4 .,/3%B&GD "%)/'/4 % "%A/?2'5%&/.GD 13+&2", 2.!"%-B!&%! (/"%B!',.+ 42"-,%.!)%(2"#3&GD ,!"!5, A3!*U!',.!&&%(/. "%)/'/4, &+$2D+&%! 4%,/D/&*-3%@, 24!&-U!&%! (/"%B!',.+ (3%',, 3+'U%3!&%! 5%',!3& �/4A"!('+ �/"-*F%, #*3GU(/A/*/$&G!.("�B!&%# . 5%,/A"+)4!, ,. !. ',32(,23&G! B!3,G, '.%*!,!"-',.2��%! / &+"%B%! . ("!,(! A3/5!'-'/. (+,+$/"%)4+ (3%'. 4).

� �

�%'. 4. �%',+4%&!31%B!'(%! &!@3/&G #*3+ �2. �%)/'/4G. �. (�/&,3/"-). �"!(,3/&&/13+44+ 2..×25000. �. �!@3/&G .,/3/1/ ,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%% 1/"/.&/1/ 4/)1+).�"!(,3/&&/13+44+ 2.. ×40000. . �!@3/&G A!3./1/ ,%A+ (A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!-4%% 1/"/.&/1/ 4/)1+). �"!(,3/&&/13+44+ 2.. ×25000

�*&+(/ %) .'!1/ .GU!%)"/F!&&/1/ .%*&/, B,/ . ,�4&GD &!@3/&+D (.,/3/1/ ,%A+) A/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%% 1/"/.&/1/ 4/)1+ A3!/$"+*+�, '%&,!,%B!'(%! A3/5!''G.

$ ��� :1. �/'"! 30-4%&2,&/@ '2$,/,+"-&/@ %U!4%% 1/"/.&/1/ 4/)1+ . 1%',+4%&!31%B!'(/4 #*3!

�2 .G*!"#�,'# *.+ .%*+ %)4!&!&%@ . ,!"+D &!@3/&/.: A/ '.!,"/42 (A!3./42) % ,�4&/42 (.,/3/42),%A2 - A3!/$"+*+�, A/ (/"%B!',.2 &+* A!3.G4%.

2. &!@3/&+D A!3./1/ ,%A+ /,4!B!&G .G3+F!&&G! A3%)&+(% *!',32(5%%, .G).+&&/@ 1%A/(-'%!@. ,!"+D &!@3/&/. .,/3/1/ (,�4&/1/) ,%A+ 1%',+4%&!31%B!'(/1/ #*3+ �2 A/'"! 30-4%&2,&/@'2$,/,+"-&/@ %U!4%% 1/"/.&/1/ 4/)1+ A3%'2,',.2�, A3%)&+(% *!',32(5%%, .G).+&&G! 1%A/('%!@,&/ A3!/$"+*+�, A3%)&+(% +(,%.+5%% '%&,!,%B!'(%D A3/5!''/..

�A%'/( "%,!3+,23G:1. �%4+,(%&, �L�. �%',/D%4%B!'(%@ 4!,/* %''"!*/.+&%# +(,%.&/',% 4/&/+4%&/('%*+)G � %

. 4/)1! / �L�. �%4+,(%&, L�. �G*%( // �/3?/"/1%#. — 1994. — � 4. — �. 157–161.2. Adachi, N. Anti-inflammatory action by histamine H (2) receptor stimulation is a likely mechan-

ism responsible for theim provement / N. Adachi // academic JournalCerebral ischemia and brain hista-mine. — 2005. — Vol. 50. — � 2. — P. 637–672.

123

3. The five subgroups of the tuberomammillary nucleus of the rat: an analysis of the histaminergicefferent projections to the medial preoptic area and inferior colliculus / N.Inagaki [et al.] // Exp. BrainRes.. — 1990. — V. 80. — �. 374–380.

4. Panula, P. Histamine-containing neurons in the rat hypothalamus / P. Panula, Y. Yang// Proc.Natl. Acad. Sci. U.S.A. — 1984. — V. 81. — �. 2572–2576.

5. Zimatkin, S.M. Spatial organization and morphometric characteristics of histaminergic neuronsin the rat brain / S.M. Zimatkin, V.B. Kuznetsova, O. N. Strik // Neuroscience and Behavioral Physiology.— Vol. 36, �. 5. — 2006. — �. 55.

�0",!$1',,=0!�!>&"2���&+$4x,+^�1+,,+^q"1!q4�1!(�$0&'0]!>!0&+J'�0&4$,40&�x,]!40&!;,!>!&!q$+0)4

1#�. 1���� (��.), �#w. !������ (����., �. �. �.)�2(/.%&'-(%@ *!3F+.&%@ 4!*%B&%@ 2&�.!3'%,!,

�+?!*3+ +&+,/4�¤, ,/A/13+?�B&/¤ +&+,/4�¤ ,+ /A!3+,%.&/¤ D�3231�¤

�+ 23 A"/*+D "�*%&% 270,0–375,0 44 ,�4ª#&/N(2A3%(/./¤ */.F%&% (,3!,�@ ,3%4!',3.&2,3�U&-/2,3/$&/1/ 3/).%,(2) )+ */A/4/1/� 4!,/*�. ).%B+@&/1/ � ,/&(/1/ A3!A+32.+&&# A�*(/&,3/"!4 $�&/(2"#3&/¤ "2A%, 4+(3/4�(3/'(/A�¤ ,+ 4/3?/4!,3�¤ .%.B!&/ +&+,/4�B&� /'/$"%./',�/31+&�. � ',32(,23 A3%.2U&/NF2.+"-&/¤ *�"#&(%. %#."!&/ 2��"-&!&&# ?+'5�+"-&/N("�,(/.%&&%D2,./3!&- . 4�'5#D ,�'&%D ,/A/13+?/+&+,/4�B&%D .)+¯4/.�*&/U!&- ¤¤ /31+&�. � ',32(,23.

�0",!$1',+'0!�!>&"2++!)!1!4x,-^�1w,,-^�'1'q4�1!(!$0&'0]'>!0&+J'�0&"$,40&+40&!;,!>!&"q$+0+=

1#�. 1���� (��.), +#w. !���� � (����., �. �. �.)

�2(/.%&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ +&+,/4%%, ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

"����z����z. �,+&/."!&%! /31+&/. — /B!&- '"/F&G@ A3/5!'', (/,/3G@ % &G&! /(/&B+-,!"-&/ !�� &! %)2B!&. �/�,/42 ',3/!&%! /31+&/. % '%',!4 .+F&/ %)2B+,- . '.#)% ' /'&/.&G4%A3/5!''+4% 4/3?/1!&!)+ (/.( �L�., �/4%&%D L�., 2003) [1], &+ /'&/.! *+&&GD �4$3%/1!&!)+¥�./3&%( L�., 24+(/.+ �L�., 2006) [2]; (�+)/&/. �L�., 2006) [3]). �&+&%# A3!*G*2�%D ',+*%@�4$3%/&+"-&/1/ 3+).%,%# % /A3!*!"!&%# &+A3+."!&%# A3/5!''/. /31+&/1!&!)+, A3% (/,/3GD A/-'"!*',.%# /*&/@ ',+*%% A3!.3+�+�,'# . 2'"/.%# A/'"!*2��!@, #."#!,'# $!)2'"/.&G4 ?+(,/3/4¥�D,!4�@B2( �L., 2008) [4], 'A/'/$',.2��%4 1"2$/(/42 A/&%4+&%� +&+,/4%B!'(%D A3!/$3+)/-.+&%@ A3% &/34+"-&/4 �4$3%/1!&!)!. �.!*!&%# / ',+&/."!&%% ,/A/13+?%% % /$/'&/.+&%! 4/3?/-"/1%B!'(%D A3!*A/'G"/( ./)&%(&/.!&%# .3/F*!&&GD A/3/(/. /(/"/2U&/@ '"�&&/@ F!"!)G¥���) B!"/.!(+ ?3+14!&,+3&G! % &!'%',!4+,%)%3/.+&G (�+.3�. �L�., �"�@&%( �L�., 2012) [5], +/,*!"-&G! +'A!(,G %D 4/3?/1!&!)+ ('3/(% % 4!D+&%)4G 3+).%,%# A/3/(/.) ,3!$2�, *%'(2''%%.G#'&!&%# %',/B&%(/. )+("+*(%, /'/$!&&/',!@ 3+).%,%# % ',+&/."!&%# ,/A/13+?%% $/"-U%D'"�&&GD F!"!) . 3+&&!4 A!3%/*! A3!&+,+"-&/1/ 3+).%,%# B!"/.!(+ %4!!, .+F&/! )&+B!&%! *"# 5!-"/',&/1/ A/&%4+&%# ',32(,23&/N?2&(5%/&+"-&/@ /31+&%)+5%% '+"%.+5%/&&/1/ +AA+3+,+ % 3/,/./@A/"/',% . 5!"/4 (�D,!4�@B2( �L., �"�@&%( �L�., 2009; �+.3�. �L�., �"�@&%( �L�., 2012) [6, 7].

*��z� &+U!1/ %''"!*/.+&%# ',+"/ %)2B!&%! ',+&/."!&%# ,/A/13+?%% ��� 2 A"/*/.,3!,-!1/ ,3%4!',3+ .&2,3%2,3/$&/1/ 3+).%,%# B!"/.!(+ (��).

J����������� . �''"!*/.+&%! ��� .GA/"&!&/ &+ 23 A"/*+D B!"/.!(+ ,3!,-!1/ ,3%4!-',3+ �� (270,0–375,0 44 ,!4!&&/N(/AB%(/./@ *"%&G /��/) $!) A3%)&+(/. A+,/"/1%% ���, A/-"2B!&&GD .'"!*',.%! A3!F*!.3!4!&&GD 3/*/. /, A3+(,%B!'(% )*/3/.GD F!&�%& %"% .'"!*',.%!+$/3,/. A/ 4!*%5%&'(%4 A/(+)+&%#4 '/ ',/3/&G 4+,!3% %"% '/5%+"-&G4 A/(+)+&%#4%. �''"!*/-.+&%# A3/.!*!&G ' '/$"�*!&%!4 /'&/.&GD A/"/F!&%@: �/&.!&5%% �/.!,+ �.3/AG / A3+.+D B!"/-.!(+ % $%/4!*%5%&! (/, 04.04.1997 1.); �!"-'%&'(/@ *!("+3+5%% '!4%3&/@ 4!*%5%&'(/@ +''/-5%+5%% /$ �,%B!'(%D A3%&5%A+D A3/.!*!&%# &+2B&GD 4!*%5%&'(%D %''"!*/.+&%@ ' 2B+',%!4 B!-"/.!(+ (1964–2008 11.); A3%(+)+ �� �(3+%&G � 690 /, 23.09.2009 1. D/*! %''"!*/.+&%# %'A/"--)/.+"% 4!,/*G: ,/&(/1/ A3!A+3%3/.+&%# ��� % /(/"/2U&/NF!.+,!"-&/@ /$"+',% A/* (/&,3/"!4$%&/(2"#3&/@ "2AG; 4+(3/- % 4%(3/'(/A%%; 4/3?/4!,3%%; 4+(3/?/,/13+?%% ?/,/+AA+3+,/4

124

«OLIMPUS º 1000 All-weather 10,0 MPix»; 4%(3/?/,/13+?%% 5.!,&/@ 5%?3/./@ CMOS (+4!3/@*"# 4%(3/'(/A/. «T100 SCIENCELAB 10,0 M�ix»' 4%(3/4!,3/4.

&�_��z�� ������������������������. ,3!,-!4 ,3%4!',3! �� ��� A"/*/. B!"/-.!(+ (270,0–375,0 44 ��) 3+'A/"+1+!,'# . 1"2$/(/@ .A+*%&! A/)+*% .!,.% &%F&!@ B!"�',%, .)+*&!B!"�',&/@ #4(!. �,/4 ./)3+',&/4 A!3%/*! ?/34+ F!"!)G .A/"&! '//,.!,',.2!, ',!&(+4�,/1/ "/F+ % %4!!, &!A3+.%"-&G!, '"/F&/ ' B!4N"%$/ '3+.&%4G! /B!3,+&%#. �+$"�*+"% '"!*2�-�%! .+3%+&,G ?/34G ���: /.+"-&2�, ,3!21/"-&2�, &!A3+.%"-&GD B!,G3!D21/"-&%(+ % 4&/1/-21/"-&%(+, A3%)4+,%B!'(2�, �""%A'/.%*&2� % A%3+4%*+"-&2�.

�(3+'(+ F!"!)G — '!3/NF!",/.+,+#, $"%)(+# ( 5.!,2 /(32F+��!@ A/*(/F&/NF%3/./@ ("!,-B+,(%, /, (/,/3/@ F!"!)+ /,"%B+!,'# $/"!! .G3+F!&&G4 '!3G4 /,,!&(/4, */"!.G4 ',3/!&%!4 %$/"-U!@ A"/,&/',-�. �$�!4 F!"!)G .+3-%32!, . )&+B%,!"-&/@ ',!A!&%, '//,&/U!&%! &+%4!&-U!@%) F!"!) %''"!*2!4/1/ ./)3+',&/1/ A!3%/*+ ( &+%$/"-U!@, (+( 1:3. �3!*&## 4+''+ ��� �,/1/ ./)-3+',&/1/ A!3%/*+ — 14–21 1.

�+A'2"+, /(2,G.+# F!"!)2, *+!, .1"2$- F!"!)G A!3!1/3/*(% % ,!4 '+4G4 3+)*!"#!, !! &+ /,-*!"-&G! */"-(%. /(321 (+A'2"G 3+'A/"/F!&G ?+'5%+"-&G! /$3+)/.+&%# A3%"!1+��%D ',32(,23:'&+32F% — A/.!3D&/',&+# A"+',%&(+ ?+'5%% U!%; ')+*% — A3!*A/)./&/B&+# (A3!.!3,!$3+"-&+#)A"+',%&(+; .&2,3% — U%"/N1"/,/B&G@ +A/&!.3/) % '/'2*%',/! ."+1+"%�!. �$GB&/ �,/, 3#* ?+'-5%@ /A%'G.+�, (+( /*%& 5!"G@, '/!*%&%,!"-&/,(+&&G@ B!D/" F!"!)G, 3+)"%B+# . &!4 A/.!3D&/-',&G@ (.&!U&%@) % 1"2$/(%@ (.&2,3!&&%@) "%',(%. �!(/,/3G! B+',% (+A'2"G ��� (&+32F&+# A/-.!3D&/',- F!"!)G % !! &%F&%@ A/"�') /'/$!&&/ 2 A"/*/. 9–10-1/ 4!'#5+ �� $/"!! .G3+F!&G,(3!A(%!, *321%! (B+',-, A3%"!1+��+# ( 1"/,(! % &+32F&/42 '"2D/./42 A3/D/*2), &+/$/3/,, /B!&-,/&(%!. G*!"!&%! F!"!)G ' (+A'2"G 2*+!,'# ' $/"-U%4 ,32*/4. �'/$!&&/ ,32*&/ .G*!"%,-.&!U&�� B+',- % A!3!*&%@ (3+@ F!"!)G. ,/ F! .3!4# ��� "!1(/ .G*!"#!,'# ' (+A'2"G . /$"+'-,% &+32F&/1/ '"2D/./1/ A3/D/*+, F!.+,!"-&/@ 4GU5G, 4GU5 U%"/.%*&/1/ /,3/',(+ % *.2$3�U-&/@ 4GU5G (!� &%F&!1/ A/"�'+), B,/ &+ &+U .)1"#* '.#)+&/ ' A3/*/"F!&%!4 ?/34//$3+)/.+,!"--&GD A3/5!''/. ��� . �,/, A!3%/* 3+).%,%#.

!3D&## B+',- ��� )+(3G.+!, )&+B%,!"-&2� B+',- (+A'2"G .%'/B&/N&%F&!B!"�',&/1/ '2'-,+.+ (���) % '3+',+!,'# ' &!@. �%F&%4 A/"�'/4 ��� 13+&%B%, ' "/F!4 A/*&%F&!B!"�',&/@'"�&&/@ F!"!)G (3%'. 1).

�%'. 1. �3+.+# /(/"/2U&/NF!.+,!"-&+# /$"+',- A"/*+ B!"/.!(+ 300,0 44 �� ' A3%"!1+��%4% /3-1+&+4% % ',32(,23+4%. �+(3/?/,/. �.. ×3,5. 1 — /(/"/2U&+# '"�&&+# F!"!)+; 2 — .G./*&/@ A3/-,/( /(/"/2U&/@ '"�&&/@ F!"!)G; 3 — F%3/./! ,!"/ �!(%; 4 — F!.+,!"-&+# 4GU5+; 6 — ?3+14!&,A/*(/F&/@ 4GU5G U!%; 7 — ?3+14!&, 132*%&/N("�B%B&/N'/'5!.%*&/@ 4GU5G; 8 — .%'/B&+#4GU5+ (A/(3G,+ ?+'5%!@); 9 — A/.!3D&/',&G@ .%'/B&G@ '/'2*; 10 — (321/.+# 4GU5+ 1"+)+

&2,3!&&%4 3!$3/4 ��� A3%"!F%, ( 1"/,(!, &!3!*(/ */D/*# */ !! ',!&(%, /$3+)/.+&&/@.!3D&!@ 4GU5!@N'FG4+,!"!4 1"/,(%. �*!'- 3+'A/"/F!&G !1/ .!,.%, .!,.% B!"�',&/@ +3,!3%% %./'D/*#�+# &!$&+# +3,!3%#; . 1"2$%&! ..!3D2 A3/D/*%, (/&!B&+# B+',- '"2D/./@ ,32$G. � A/4/-�-� &!)&+B%,!"-&/@ ?%$3/)&/@ A!3!1/3/*(% )+*&## A/.!3D&/',- ��� /,*!"!&+ /, '/'2*%',/-&!3.&/1/ A2B(+ U!%.

13

8

5

4

67

2

9 10

125

�"+.&G@ .G./*&/@ A3/,/( (��) ��� 2 A"/*/. *+&&/1/ ./)3+',+ $!3!, './! &+B+"/ &+ A!-3!*&!N.&2,3!&&!@ A/.!3D&/',% F!"!), .$"%)% A!3!*&!1/ %D (3+# (&+ 13+&%5! &%F&!@ % '3!*&!@,3!,%). ,+(/4 '"2B+! �� ��� /$3+)2!,'# A2,!4 '"%#&%# *.2D A/B,% 3+.&/5!&&GD A/ *%+4!,32A3/'.!,+ 4!F*/"-(/.GD A3/,/(/., 'D/*#�%D'# A/* 21"/4. *321%D '"2B+#D �� ��� ?/34%32-!,'# 1"2$/(/ . .!�!',.! F!"!)G, %*!, (/'/N..!3DN.!&,3+"-&/, A3%&%4+!, &+ './!4 A2,% ('.!3D2 %'&%)2) /, 5 */ 14 .G./*&GD A3/,/(/. */"!@ F!"!)G. �/'"! .GD/*+ %) F!"!)G �� '"!*2!, *+"!!(/'/N..!3DN.A!3!*. �! */D/*# &+ 5,0–15,0 44 */ '(2"/./@ *21% /& A/./3+B%.+!, .A!3!* % %*!, 1/-3%)/&,+"-&/ A/ &+32F&/@ A/.!3D&/',% F!.+,!"-&/@ 4GU5G . '/A3/./F*!&%% A/A!3!B&/ &+A3+.-"!&&/@ "%5!./@ +3,!3%% (3+'A/"/F!&&/@ B2,- .GU! ��) % .!,.!@ "%5!./1/ &!3.+, (/,/3G! A3/-D/*#,: /*&+ — &+* �� ���, + *321+# — A/* &!@. *+"-&!@U!4 �� ��� %*!, A/.!3D F!.+-,!"-&/@ 4GU5G; A/ !1/ A!3!*&!42 (3+� /$3+)2!, %)1%$, /$3+�!&&G@ .GA2("/',-� (A!3!*%; A/-./3+B%.+!, .!&,3/4!*%+"-&/; A3/&%)G.+!, F%3/./! ,!"/ �!(%; (/'/ A3/&%(+!, B!3!) �!B&2�4GU52, %*!, 4,0–6,0 44 A/* '"%)%',/@ % /,(3G.+!,'# . A3!**.!3%% 3,+ &+ '"%)%',/@ /$/"/B(!�!(% . .%*! 2)(/@ �!"%. �&/1*+ �,/ /,.!3',%! &+D/*%,'# &+ ./).GU!&%% . .%*! '/'/B(+. �"%&+1"+.&/1/ .G./*&/1/ A3/,/(+ ��� . A3!*!"+D 19,0–37,0 44 ' *%+4!,3/4 A3/'.!,+ */ 1,5–2,5 44.�&/1*+ &+ A!3!*&!@ A/.!3D&/',% F!.+,!"-&/@ 4GU5G 4/F&/ /$&+32F%,- A3%"!1+��2� ( ����� */A/"&%,!"-&2� */"� F!"!)G, .G./*&/@ A3/,/( (/,/3/@ .A+*+!, . A3/,/( F!"!)G. �4!&&/A/�,/42 !! '"!*2!, 'B%,+,- &! */A/"&%,!"-&/@ '+4/',/#,!"-&/@ F!"!)/@, + */A/"&%,!"-&/@ */"!@���. �+"%B%! */A/"&%,!"-&/@*/"%���, (/,/3+# 3+)4!�!&+ &+F!.+,!"-&/@4GU5! %A3%"!-F%,¥/(2,G.+#) ( �� ���, A/*,.!3F*!&/ 1%',/"/1%B!'(%4 %''"!*/.+&%!4. G./*&G! A3/,/(%-���.&2,3% */"!(.G',"+&G*.2D3#*&G4(2$%B!'(%4%"%A3%)4+,%B!'(%4 �A%,!"%!4. 4!F*/"-(/-./@ '/!*%&%,!"-&/@ ,(+&% /*&/.3!4!&&/ ' 2,/"�!&%!4 .G./*&GD A3/,/(/. %D �A%,!"%@ A/'"!*/-.+,!"-&/ %)4!&#!,'#. �&+B+"+ /& A3%$"%F+!,'# ( 4&/1/3#*&/42, )+,!4 —( 4&/1/'"/@&/42 (2$%-B!'(/42 %, &+(/&!5, . $"%F+@U%D ( '"%)%',/@ /$/"/B(! 3/,/./@ A/"/',% 2B+',(+D, �� — 2A/-*/$"#!,' #4&/1/'"/@&/42 A"/'(/42 �A%,!"%�.

�%&,/A%# ��� '"/F&+ (+( ' /31+&+4%, "!F+�%4% .&! "/F+ F!"!)G (.&!U&## '%&,/A%#), ,+-(% ' ,+(/.G4% .&2,3% "/F+ (.&2,3!&&## '%&,/A%#). �/F! ���, /'./$/F*!&&/! /, '/*!3F%4/1/¥3%'. 2), A3!*',+."#!, '/$/@ .A+*%&2 ' ,3!4# ',/3/&+4%, ' &+%$/"-U%4 .!3,%(+"-&G4 3+)4!3/4.

�%' 2. �+(3/A3!A+3+, "/F+ "!./@ /(/"/2U&/@ '"�&&/@ F!"!)G A"/*+ B!"/.!(+ 275,0 44 �� (8-@4!'#5 ��). �(/"/2U&+# '"�&&+# F!"!)+ 2*+"!&+. �3%!&,%3+4 13+&%5 "/F+ ��� '//,.!,',.2!,(3+'&G@ ,3!21/"-&%(. �+(3/?/,/. �.. ×4,0

$/"-U!@ B+',% "/F! ��� A/(3G,/ ,/&(%4 '"/!4 ("!,B+,(% (. &!(/,/3GD 4!',+D $/"!!,/"',G4, 1%',/"/1%B!'(% A/*/$&G4 +A/&!.3/)2). �+32F&+# A/.!3D&/',- "/F+ !',- ,/"-(/ A3% 5!-"/',% /(/"/2U&/@ ?+'5%%, ' 2*+"!&%!4 !! /$3+)2!,'# /,.!3',%! . .%*! .!3,%(+"-&/@ �!"%, A!-3!*&%4 (3+!4 (/,/3/@ #."#!,'# )+*&%@ (3+@ .!,.% &%F&!@ B!"�',%. �+*&%@ (3+@ /,.!3',%# /$3+-)/.+& '/'5!.%*&G4 /,3/',(/4 % 132*%&/N("�B%B&/N'/'5!.%*&/@ 4GU5!@. !3D&%@ (3+@ .D/*+/$3+)2!,'# .%'/B&/N&%F&!B!"�',&G4 '2',+./4 % &+32F&G4 '"2D/.G4 A3/D/*/4; &%F&%@ (3+@/$3+)2!, A!3!1/3/*(/@ 4!F*2 "/F!4 ��� % A/*&%F&!B!"�',&/@ '"�&&/@ F!"!)G. �!3!*&## A/-

126

.!3D&/',- "/F+ /$3+)2!,'# .!,.-� &%F&!@ B!"�',% % A3%"!1+��%4% ( &!@ 4GU5+4%: F!.+,!"--&/@ 4GU5!@ — '&+32F%; (3G"/.%*&/@ 4GU5!@ — %)&2,3%. �!F*2 &%4% % ��� A3/D/*%, /'&/.-&/NB!"�',&+# '.#)(+. �+*&## A/.!3D&/',- "/F+ /$3+)2!,'# )+*&%4 $3�U(/4 *.2$3�U&/@ 4GU5G,U%"/.%*&G4 /,3/',(/4 ' !1/ *.24# '.#)(+4%, ,3!4# 4GU5+4% % U%"/N1"/,/B&G4 +A/&!.3/)/4.�%F&��, U!@&2� /'&/.2 "/F+ /$3+)2!, 4!F*2F!"!)&+# A!3!1/3/*(+. !3D&##, .%'/B&+# /'&/.+"/F+ /$3+)2!,'# *.24# '(+,+4%: )+*&%4 - &+32F&G@ '"2D/./@ A3/D/* % A!3!*&%4 - .%'/B&/-&%F&!B!"�',&/@ '2',+.. �2A/" "/F+ ?/34%32!,'# /'&/.+&%!4 2B+',(+ B!3!A+.

�!"!)+ $/1+,+ &+ '/'2*G % &!3.G. �! +3,!3%% $!32, &+B+"/ %) 4&/1%D %',/B&%(/.: .'! �,%'/'2*G *+�, +3,!3%+"-&2� '!,(2, (+A%""#3G (/,/3/@ A/*D/*#, ( '/$',.!&&/@ /$/"/B(! F!"!)G,&! .',2A+# . (/&,+(, ' '!(3!,/3&G4 �A%,!"%!4 F!"!)G. !&G A3/D/*#, . 4!F*/"-(/.GD A!3!1/-3/*(+D, &!'# (3/.- ./ .&2,3!&&�� #3!4&2� .!&2. �,,/( "%4?G A3/%'D/*%, B!3!) 4&/1/B%'"!&-&G! 3+)"%B&/1/ A3/'.!,+ "%4?+,%B!'(%! '/'2*G, A3/D/*#, ,+(F! . A!3!1/3/*(+D */"!(. �%4?+,%-B!'(%! '/'2*G "%U!&G ("+A+&/., &!'2, "%4?2 . "%4?+,%B!'(%! 2)"G ���. �!3.G ��� A/"2B+!,%) ,3!D %',/B&%(/.: /, 2U&/N.%'/B&/1/ &!3.+, $/"-U/1/ 2U&/1/ &!3.+ % '%4A+,%B!'(%D .!,.!@¥3%'. 3).

�%'. 3. �+(3/A3!A+3+, "/F+ "!./@ /(/"/2U&/@ '"�&&/@ F!"!)G A"/*+ B!"/.!(+ 350,0 44 �� (10-@4!'#5 ��). �(/"/2U&+# '"�&&+# F!"!)+ 2*+"!&+. �+(3/?/,/. �.. ×3,5: 1 — F%3/./! ,!"/ �!(%; 2— A/.!3D&/',&G! .%'/B&G! +3,!3%# % .!&+; 3 — 2U&/N.%'/B&G@ &!3.; 4 — .%'/B&G! % '(2"/.G!.!,.% "%5!./1/ &!3.+; 5 — �!B&G! .!,.% "%5!./1/ &!3.+; 6 — (3+!.+# &%F&!B!"�',&+# .!,.-; 7 —F!.+,!"-&+# 4GU5+; 8 — (321/.+# 4GU5+ 1"+)+; 9 — ?3+14!&, A/*(/F&/@ 4GU5G U!%

'! �,% &!3.G 3+).!,."#�,'# . 4!F*/"-(/./@ '/!*%&%,!"-&/@ ,(+&% F!"!)G, 3+'A+*+#'- &+4%!"%&/.G! % $!)4%!"%&/.G! ./"/(&+, /$3+)2��%! ./(321 A!3.%B&GD B+',%5 'A"!,!&%#, ./"/(&+(/,/3GD A3/&%(+�, . '+4% */"-(%. �*&% %) �,%D .!,.!@ — &+',/#�%! .+)/4/,/3G, *321%! — '!(-3!,/3&G!. �!(3!,/3&+# %&&!3.+5%# ��� /'2�!',."#!,'# )+ 'B!, A+3+'%4A+,%B!'(/@ &!3.&/@ '%'-,!4G.

�(./)- ,/"�2 ��� A3/D/*#, ('4. 3%'. 3) "%5!./@ % 2U&/N.%'/B&G@ &!3.G. �%5!./@ &!3.,A/'"! .GD/*+ %) B!3!A+ B!3!) U%"/N'/'5!.%*&/! /,.!3',%! .',2A+!, . ,/"�2 ��� &+A3+."##'-:(/'/ ')+*%N&+A!3!*, %)&2,3%N&+32F2 % &!4&/1/ '.!3D2N.&%). �&+B+"+ &!3. "!F%, 1"2$/(/ %, A3/-*.%1+#'- .A!3!*, A3%$"%F+!,'# ( .&!U&!@ A/.!3D&/',% F!"!)G, 3+'A/"+1+#'- .'!1*+ &+32F2 /,&+32F&/@ '/&&/@ +3,!3%% % .&2,3!&&!@ #3!4&/@ .!&G. � )+*&!1/ (3+# .!,.% &%F&!@ B!"�',%, +%&/1*+ % 3+&-U! (!�! . ,/"�! F!"!)G), &!3. 3+'A+*+!,'# &+ './% 1"+.&G! .!,.%. �U&/N.%'/B&G@

8

4

1

9

7 6

5

3

2

127

&!3. /,*!"#!,'# /, &%F&!B!"�',&/1/ &!3.+ B+�! .'!1/ *.24# .!,.#4%, /D.+,G.+!, '3!*&�� 4/)-1/.2� +3,!3%�, A3/D/*%, 4!F*2 /$!%4% (3G"/.%*&G4% 4GU5+4% .GU! B!"�',&/@ +3,!3%% %A/)+*% '2',+.&/1/ /,3/',(+ &%F&!@ B!"�',% A3/&%(+!, . ���, 1*! /& (&!3.) 3+'A+*+!,'# &+ 3#*',./"/.. �!3.G@ %) &%D ./).3+�+!, ..!3D, %*!, .4!',! % ')+*% A/.!3D&/',&/@ .%'/B&/@ +3,!3%%.�,+ .!,.- /$3+)2!, +&+',/4/) ' "%5!.G4 &!3./4. ,/3/@ (/3/,(%@ ',./" *+!, . './!@ A!3%?!3%@-&/@ B+',% 2,/"�!&%# . .%*! A"+',%&(%, %) (/,/3/@ .GD/*#, 4&/1/B%'"!&&G! ,/&(%! .!,/B(%.�+',- .',2A+!, . (/F2 2U&/@ 3+(/.%&G % &+32F&/1/ '"2D/./1/ A3/D/*+, +&+',/4/)%32!, ' '%4A+-,%B!'(%4 'A"!,!&%!4 .&2,3!&&!@ '/&&/@ +3,!3%% % !! .!,.!@, B+',- F! . .%*! 4&/1/B%'"!&&GD,/&(%D .!,/B!( .',2A+!, . ���. �!3.G, +&+',/4/)%32# 4!F*2 '/$/@, /$3+)2�, &!3.&2� '!,- .1"2$/(/@ A/.!3D&/',% F!"!)G, /,(2*+ %*2, (/&!B&G! .!,.% . .!�!',./ ���.

G./*G. �/3?/1!&!) % ',+&/."!&%! ,/A/13+?%% /(/"/2U&/@ '"�&&/@ F!"!)G ' A3%"!1+�-�%4% +&+,/4%B!'(%4% ',32(,23+4% /(/"/2U&/NF!.+,!"-&/@ /$"+',% 2 A"/*/. ,3!,-!1/ ,3%4!',3+.&2,3%2,3/$&/1/ 3+).%,%# (270,0–375,0 44 ,!4!&&/N(/AB%(/./@ *"%&G) &+D/*%,'# A/* '/./(2A-&G4 ."%#&%!4 A3/',3+&',.!&&/N.3!4!&&GD ?+(,/3/., '.#)+&&GD ' *%&+4%(/@ % ,!'&/@ '%&,/A%-B!'(/@ (/33!"#5%!@ /31+&/., '/'2*%',/N&!3.&GD /$3+)/.+&%@ % ?+'5%+"-&/N("!,B+,/B&GD ',32(-,23 . (/&5! A"/*&/1/ A!3%/*+ /&,/1!&!)+. ,3!,-!4 ,3%4!',3! .&2,3%2,3/$&/1/ 3+).%,%# &+$"�-*+!,'# 2A"/,&!&%! ?+'5%+"-&/N("!,B+,/B&GD /$3+)/.+&%@ "/F+ /(/"/2U&/@ '"�&&/@ F!"!)G,/'/$!&&/ . 2B+',(+D ,!'&GD ,/A/13+?/N+&+,/4%B!'(%D .)+%4//,&/U!&%@ /31+&/. % ',32(,23. �!-F*2 &+32F&/@ (+A'2"/@ /(/"/2U&/@ '"�&&/@ F!"!)G, A3%"!1+��%4% '/'2*+4%, &!3.&G4% .!,-.#4% % ?+'5%+"-&G4% /$3+)/.+&%#4% %''"!*2!4/1/ 2B+',(+ &+$"�*+�,'# A"/,&G! '3+�!&%#, B,/'"!*2!, 2B!',- A3% /A!3+,%.&GD .4!U+,!"-',.+D . A3!*!"+D /(/"/2U&/NF!.+,!"-&/@ /$"+',%.�/3?/"/1%B!'(%! +'A!(,G ',+&/."!&%# ',32(,23 % ./)&%(&/.!&%# .3/F*!&&GD A/3/(/. /(/"/2U-&/@ '"�&&/@ F!"!)G . /&,/1!&!)! B!"/.!(+ %)2B!&G &!*/',+,/B&/ %"% (. B+',% "!(,%&/-1%',/D%4%B!'(%D /'/$!&&/',!@) &! %''"!*/.+&G ./.'!, + &!(/,/3G! ./A3/'G /',+�,'# *%'(2''%-/&&G4% (.+3%+&,&+# +&+,/4%#, A3%B%&G, '3/(% % 4!D+&%)4G 3+).%,%# A/3/(/. /(/"/2U&/@ '"�&-&/@ F!"!)G). �"# /$/'&/.+&%# A3%B%& % 4!D+&%)4/. ./)&%(&/.!&%# .3/F*!&&GD A/3/(/. /(/"/-2U&/@ '"�&&/@ F!"!)G /'/$2� +(,2+"-&/',- A3%/$3!,+!, %)2B!&%! !! 4/3?/"/1%B!'(%D /'/$!&-&/',!@ . $/"!! 3+&&%! A!3%/*G A3!&+,+"-&/1/ /&,/1!&!)+.

�A%'/( "%,!3+,23G:1. /.(, �L�. !/3!,%B&! ,+ A3+(,%B&! )&+B!&&# �&*%.�*2+"-&/¤ +&+,/4�B&/¤ 4�&"%./',� A+-

)2D ,.!3*/¤ /$/"/&(% 1/"/.&/1/ 4/)(2 "�*%&% / �L�. /.(, L�. �/4�&%D // �'&%( A3/$"!4$�/"/1�¤ � 4!*%5%&%. — �/",+.+, 2003. — � 3. — �. 9–11.

2. �./3&%(, L�. ��',/"/1�B&! */'"�*F!&&# 3!5!A,/3&/1/ +A+3+,2 ."+'&/ F2.+"-&/1/ 4ª#)2 /L�. �./3&%(, �L�. 24+(/.+ // �'&%( A3/$"!4 $�/"/1�¤ � 4!*%5%&%. — 2006. — %A. 2. — �. 198–200.

3. �+)/&/., �L�. �%&+4�(+ ',32(,23&/¤ A!3!$2*/.% (/3!&�. 4/"/B&%D )2$�. / �L�. �+)/&/. //�"�&�B&+ +&+,/4�# ,+ /A!3+,%.&+ D�3231�#. — 2006. — . 5. — � 2. — �. 54.

4. �D,!4�@B2(, �L. �+3%'% !4$3�/,/A/13+?�¤ / �L. �D,!4�@B2( — �!3&�.5�: %*+.&%B%@*�4 «�2(3!(», 2008. — 200 '.

5. �+.3�. ,�L�. �/3?/"/1�B&� A!3!*24/.% 3/).%,(2 A3%3/*F!&%D .+* A3%.2U&/¤ '"%&&/¤ )+-"/)% / �L�. �+.3�., �L�. �"�@&%( // �"�&�B&+ +&+,/4�# ,+ /A!3+,%.&+ D�3231�#. — 2012. — . 11. —� 1 (39). — �. 91–94.

6.�D,!4�@B2(, �L. �"�&�(/N4/3?/"/1�B&� +'A!(,% */'"�*F!&&# .!"%(%D '"%&&%D )+"/) /�L. �D,!4�@B2(, �L�. �"�@&%( // �"�&�B&+ +&+,/4�# ,+ /A!3+,%.&+ D�3231�#. — 2009. — . 8, � 3(29). — �. 76–80.

7. �+.3�., �L�. �/3?/1!&!) A3%.2U&/¤ '"%&&/¤ )+"/)% 2A"/*�. "�*%&% 9-1/ 4�'#5#.&2,3�U&-/2,3/$&/1/ 3/).%,(2 / �L�. �+.3�., �L�. �"�@&%( // �"�&�B&+ +&+,/4�# ,+ /A!3+,%.&+D�3231�#. — 2012. — . 11, � 3 (41). — �. 58–61.

128

+,(+$+(4"1],"=+qJ',%+$!�0],"(�!%'%,+)!$-^"&0'&+/:!0%"�0,!>!)!;{'J4

"#". 1�������� (��.)�+3-(/.'(%@ &+5%/&+"-&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

�+?!*3+ /A!3+,%.&/@ D%3231%% % ,/A/13+?%B!'(/@ +&+,/4%%

�������������������: ���. 6������ (�����, ���., �. �. �.)

"����z����z. A/'"!*&%! *.+ *!'#,%"!,%# %)2B!&%� +&1%/+3D%,!(/&%(% &+*A/B!B&%(/.B!"/.!(+ 2*!"#!,'# */',+,/B&/ $/"-U/! .&%4+&%!. �,/ '.#)+&/ . A!3.2� /B!3!*- ' .&!*3!&%!4&/.GD 4!,/*/. *%+1&/',%(% % "!B!&%# )+$/"!.+&%@ (+( '+4%D &+*A/B!B&%(/., ,+( % '4!F&GD /3-1+&/. [1, 2]. ,/ F! .3!4# &+ '!1/*&#U&%@ 4/4!&, &! '2�!',.2!, /$�!A3%&#,/@ ("+''%?%(+5%%+3,!3%@ % .!& &+*A/B!B&%(/. B!"/.!(+. +(F!, A/ *+&&G4 "%,!3+,23G, .+3%+$!"-&/',- (3/./-'&+$F!&%# &+*A/B!B&%(/. %4!!, './% 1!/13+?%B!'(%! /'/$!&&/',%. +(, . 3+$/,+D %&*%@'(%D2B!&GD A3/'"!F%.+!,'# */',+,/B&/ .G'/(%@ 23/.!&- +$!33+&,&GD &+*A/B!B&%(/.GD +3,!3%@ [3,4]. %''"!*/.+&%#D 2(3+%&'(%D 2B!&GD /'&/.&/! 4!',/ )+&%4+�, %)2B!&%! %)4!&!&%@ (3/.!&/'-&/1/ 32'"+ &+*A/B!B&%(/. A/* *!@',.%!4 &!$"+1/A3%#,&GD ?%)%B!'(%D, D%4%B!'(%D ?+(,/3/. %�4$3%/&+"-&/1/ 3+).%,%# '/'2*/. &+*A/B!B&%(/. [5, 6].

�B%,G.+# %)"/F!&&/!, ���z��3�������������� ',+"/ %)2B!&%! +&+,/4%B!'(/@ %)4!&-B%./',% +3,!3%@ &+*A/B!B&%(/. B!"/.!(+ *"# 2,/B&!&%# '2�!',.2��%D *+&&GD % '%',!4+,%)+5%%+&+,/4%B!'(/@ &/4!&("+,23G.

J����� � ����� . �+&&/! %''"!*/.+&%! A3/.!*!&/ &+ 90 %)/"%3/.+&&GD /31+&/(/4-A"!('+D )+$3�U%&&/1/ A3/',3+&',.+, (/,/3G! .("�B+"% &+*A/B!B&%(%, $3�U&2� +/3,2 ' !� .&!-/31+&&G4% .!,.#4%, &%F&�� A/"2� .!&2 ' A/B!B&G4% % A!B!&/B&G4% .!&+4%, A/#'&%B&2� B+',-*%+?3+14G % F%3/.2� ("!,B+,(2. �3!A+3+,G A3/4G.+"%'- . A3/,/B&/@ ./*! % A/*1/,+."%.+"%'-( A3/.!*!&%� (/4A"!('&/@ 4!,/*%(% %''"!*/.+&%# &+*A/B!B&%(/./@ +&1%/+3D%,!(,/&%(%, (/,/-3+# .("�B+"+ )+A/"&!&%! '/'2*%',/1/ 32'"+ 4+,!3%+"/4 *"# %&�!(5%%. �+&&G@ 4+,!3%+" A3!*-',+."#" '4!'- (+2B2(+ '"%(/&/./1/ ,!D&%B!'(/1/ A/"%D3/4&/1/, '23%(+ '.%&5/./1/ % '(%A%*+3+/B%�!&&/1/ . '//,&/U!&%% 7,5/1/1,5 '//,.!,',.!&&/. �/'"! %&�!(5%% A3!A+3+, A/*.!31+"'# 3!&,-1!&/13+?%% % ?%('%3/.+"'# . 10 %-&/4 3+',./3! ?/34+"%&+. *+"-&!@U!4 /'2�!',."#"+'- 4+(-3/-, 4%(3/A3!A+3/.(+ % ?/,/13+?%3/.+&%!. �+("�B%,!"-&G4 �,+A/4 4!,/*%(% $G"/ %)1/,/."!&%!1%',/"/1%B!'(%D A3!A+3+,/..

&�_��z�� �����������. D/*! %''"!*/.+&%# 2',+&/."!&/, B,/ &+*A/B!B&%(/.G! +3,!-3%% .+3%+$!"-&G . A3/%'D/F*!&%%, .!,."!&%% % /$3+)2�, ,3% 132AAG . '//,.!,',.%% '/ '&+$F+!-4/@ B+',-� F!"!)G: .!3D&%!, '3!*&%!, &%F&%!.

!3D&%! &+*A/B!B&%(/.G! +3,!3%% (��) — &+%$/"!! A/',/#&&G!, .',3!B+"%'- &+ .'!DA3!A+3+,+D % $G"% A3!*',+."!&G *.24# /'&/.&G4% ,%A+4%. I ,%A $G" A3!*',+."!& /'&/.&G4',./"/4 �� . 17 (18,9 %) '"2B+#D, (/,/3G@ /,D/*%" /, (/3/,(/@ (3,6–7,3 '4) .&!*%+?3+14+"-&/@B+',% &%F&!@ *%+?3+4+"-&/@ +3,!3%% (���) . 15 '"2B+#D % . 2 — /, $3�U&/@ +/3,G. II ,%A(81,1 %) $G" A3!*',+."!& 4&/F!',.!&&G4% ��, (/,/3G! /,D/*%"% /, A3/,#F!&&/@, )+"!1+��!@.*/"- .!3D&!1/ A/"�'+ &+*A/B!B&%(+, .&!*%+?3+14+"-&/@ B+',% ���.

�3!*&%! &+*A/B!B&%(/.G! +3,!3%% A3%'2,',./.+"% &+ 54 (60 %) A3!A+3+,+D % $G"% A3!*-',+."!&G /*&%4 ',./"/4 . 85,2 % % *.24# — . 14,8 % '"2B+!.. *.2D '"2B+#D '3!*&## &+*A/B!B-&%(/.+# +3,!3%# %'D/*%"+ /, &+B+"-&/1/ /,3!)(+ A/B!B&/@ +3,!3%% % *!"%"+'- A/ '4!U+&/42 ,%-A2. � &%F&!1/ (3+# F!"!)G /&+ /,*+.+"+ */ 5 .!,.!@ A!3./1/ A/3#*(+, /*&+ %) (/,/3GD &+A3+."#-"+'- A/ &%F&!42 (3+� ( .!3D!42 (/&52 A/B(% % /,*+.+"+ .!,.% ( .!3D&!N"+,!3+"-&/@ B+',% F%3/-./@ (+A'2"G.

�%F&%! &+*A/B!B&%(/.G! +3,!3%% (���) /,'2,',./.+"% &+ 9 (20 %) A3!A+3+,+D 'A3+.+ % &+6 (13,3 %) A3!A+3+,+D '"!.+. /',+"-&GD '"2B+#D ��� $G"+ A3!*',+."!&+ 1–3 ',./"+4%, (/,/3G!/,D/*%"% /, A/B!B&GD +3,!3%@. !,."!&%! ��� /'2�!',."#"/'- A3!%42�!',.!&&/ *%D/,/4%B!-'(%. �+''GA&/@ ,%A D+3+(,!3!& *"# .!,.!@ ��� I A/3#*(+, (/,/3G! . *+"-&!@U!4 *!"#,'# *%D/,/-4%B!'(%. �3,!3%% A/'"!*&!1/ A/3#*(+ .D/*#, . (+A'2"2 &%F&!@ A/"/.%&G A!3!*&!@ A/.!3D&/',%F!"!)G '"!.+ % &%F&!@ A/.!3D&/',% — 'A3+.+.

�/$+./B&G! &+*A/B!B&%(/.G! +3,!3%% (���) .G#."!&G &+ 69 (76.7 %) A3!A+3+,+D . (/"%B!-',.! /, 1 */ 22. �+ './!4 A2,% /&% /,*+.+"% .!,.% ( .!3D&!@ B+',% F%3/./@ (+A'2"G A/B(% % B3!-.&G4 '%4A+,%B!'(%4 2)"+4. �+%$/"!! B+',G4 %',/B&%(/4 ��� $G"+ *21/.+# +3,!3%# F%3/./@(+A'2"G A/B(% (�����), (/,/3+# A3%'2,',./.+"+ &+ 65 (72,2 %) A3!A+3+,+D % $G"+ !*%&',.!&-

129

&G4 %',/B&%(/4 ��� . 57,8 % '"2B+!.. �/* ����� $G" '/"%,+3&G4, $!) /*&/%4!&&GD .!&. �'-,/B&%(/4 ����� $G"%: +/3,+, . ,/4 B%'"! /$�%@ ',./" '/ '3!*&!@ &+*A/B!B&%(/./@ +3,!3%!@,A/B!B&+# +3,!3%#, . ,/4 B%'"! /$�%@ ',./" ' &%F&!@ &+*A/B!B&%(/./@ +3,!3%!@. / .'!D '"2B+#D����� %4!"+ 4+1%',3+"-&G@ ,%A .!,."!&%#, + /'&/.&/@ ',./" )+"!1+" &+ 23/.&! &%F&!@ A/"/-.%&G F!"!)G: 'A3+.+ . 33,3 % — A/ )+*&!N&%F&!@ A/.!3D&/',% % . 66,7 % — A/ A!3!*&!N&%F&!@,'"!.+ . 97,8 % — A/ )+*&!@ % . 2,2 % — A/ A!3!*&!@ A/.!3D&/',% &+*A/B!B&%(+. ��� %) $+''!@&+����� &+A3+."#"%'- ( (+A'2"! &+*A/B!B&%(+ . (/"%B!',.! 8–15 'A3+.+, 9–18 '"!.+ % %4!"% *%-D/,/4%B!'(%@ ,%A .!,."!&%# ' (/"%B!',./4 A/3#*(/. /, 2 */ 4.

�"!*2��%4% ��� A/ B+',/,! &+$"�*!&%@ (10 %) $G"% */$+./B&G! &%F&%! &+*A/B!B&%(/-.G! +3,!3%% (����), %',/B&%(/4 (/,/3GD $G"+ A/B!B&+# +3,!3%# '//,.!,',.2��!@ ',/3/&G¥!*%&',.!&&+# %"% 4&/F!',.!&&G!). �A3+.+ */$+./B&+# &%F&## &+*A/B!B&%(/.+# +3,!3%# $G"+A3!*',+."!&+ /*&%4 ',./"/4 . 5 '"2B+#D, '"!.+ ���� .G#."!&G . 3 '"2B+#D . .%*! /*&/1/ ',./"+% . /*&/4 '"2B+! 2 ',./"+4%. �A3+.+ ���� &+A3+."#"%'- ( &%F&!@ A/.!3D&/',% &+*A/B!B&%(+,'"!.+ — ( A!3!*&!N&%F&!@ A/.!3D&/',% % %4!"% *%D/,/4%B!'(%@ ,%A .!,."!&%# ' (/"%B!',./4A/3#*(/. /, 2 */ 3.

�''"!*/.+&%! .&2,3%/31+&&/@ +&1%/+3D%,!(,/&%(% A/(+)+"/, B,/ �(',3+/31+&&G! +3,!3%%A/'"!*&!1/ A/3#*(+ . ,/"�! (+A'2"G &+*A/B!B&%(+ /,*+�, ( &!@ '/$',.!&&G! +3,!3%% A/ 4+1%',-3+"-&/42 ,%A2 % &+ 13+&%5! (+A'2"G ' (/3(/.G4 .!�!',./4, )+ 'B!, (/3(/.GD +3,!3%/", ?/34%-32�, A/*(+A'2"-&/! 'A"!,!&%! % A!,"%',G! (+A%""#3&G! '!,% ./(321 ("!,/B&GD '(/A"!&%@ .'!D'"/!.. �/)1/.G! +3,!3%/"G A3/$/*+"% (/3(/./! .!�!',./ % (3/./'&+$F+"% 4/)1/./! .!�!',./.

!�����������_��z����. �B%,G.+# ,/, B,/����� .',3!B+!,'# $/"!! B!4 . A/"/.%&! '"2-B+!., !! D/* % .!,."!&%! A/*/$&G /'&/.&G4 &+*A/B!B&%(/.G4 +3,!3%#4 % A3%/3%,!,&/',- . &+-).+&%% +3,!3%% A/ (3/./'&+$F+!4/42 /31+&2 &+4% A3!*"+1+!,'# /,&!',% ����� ( /'&/.&G4 %"%*/$+./B&G4 (. )+.%'%4/',% /, 23/.&# /,D/F*!&%#) '3!*&%4 &+*A/B!B&%(/.G4 +3,!3%#4. �B%,G-.+# A!3'A!(,%.&/',- )/& (3/./'&+$F!&%# &+*A/B!B&%(+ % ',!A!&% 2B+',%# (+F*/@ %) &+*A/B!B&%-(/.GD +3,!3%@ . (3/./'&+$F!&%% F!"!)G &+4 A3!*',+."#!,'# &!/$D/*%4G4 %'A/"-)/.+&%! ,!34%-&+ A3!(+A'2"-&G! +3,!3%% *"# .!,.!@ A/'"!*&!1/ A/3#*(+ .!3D&%D, '3!*&%D, % &%F&%D &+*A/B!B-

)1"��+2+)"*+=,"(�!%'%,+)!$-^"&0'&+/%'1!$')"

�������� � ����������� �

�/ %',/B&%(2 ./)&%(&/.!&%#:-��������+��-�������+�-���������

�/ )/&! (3/./'&+$F!&%#:-���3���+�������+��=���

-� ��������������� ¥( ?%-$3/)&/@ (+A'2"! &+*A/B!B-&%(+)

-���������������� (?/3-4%32�, A/*(+A'2"-&/!'A"!,!&%!)

-��0*��������������

-�� ��-, ������- ������ �-��������� ���$���/ (/"%B!',.2:

+���������-���=���������

�/ ',!A!&% .!,."!&%#:������� 1-*�� ��$���\\ ��� ���������������

130

&%(/.GD +3,!3%@. +(F! A3!*"+1+!,'# %'A/"-)/.+&%! ,!34%&/. (+A'2"-&G! +3,!3%%, (/3(/.G! %4/)1/.G! +3,!3%/"G *"# .&2,3%/31+&&GD .!,.!@, (/,/3G! (3/./'&+$F+�, '//,.!,',.2��%! B+',%F!"!)G. )+.%'%4/',% /, 4!',+ /,D/F*!&%# &+*A/B!B&%(/.G! +3,!3%% *!"#,'# &+ /'&/.&G!, */-$+./B&G! % +$!33+&,&G!. �/$+./B&G! &+*A/B!B&%(/.G! +3,!3%% %'D/*#, %) ,/1/ F! '/'2*+, B,/ %/'&/.&G!, +$!33+&,&G! — %) *321%D %',/B&%(/.. �$�+# ("+''%?%(+5%# &+*A/B!B&%(/.GD +3,!-3%@ A3!*',+."!&+ &+ 3%'. 1.

$ ��� :1. !3D&## &+*A/B!B&%(/.+# +3,!3%# #."#!,'# &+%$/"!! A/',/#&&/@, %4!!, 4+1%',3+"-&/!

.!,."!&%! % A3!*',+."!&+ *.24# ,%A+4%.2. �21/.+# +3,!3%# F%3/./@ (+A'2"G A/B(% . 72,2 % #."#!,'# %',/B&%(/4 */$+./B&GD &+*-

A/B!B&%(/.GD +3,!3%@ ( '3!*&!@ B+',% F!"!)G. �! D/* % .!,."!&%! '//,.!,',.2!, /'&/.&G4 &+*-A/B!B&%(/.G4 +3,!3%#4. �3!*"+1+!,'# /,&!',% *21/.2� +3,!3%� F%3/./@ (+A'2"G A/B(% ( '3!*-&!@ &+*A/B!B&%(/./@ +3,!3%%.

3. �/$+./B&G! &%F&%! &+*A/B!B&%(/.G! +3,!3%% #."#�,'# .!,.#4% A/B!B&GD +3,!3%@.4. &!/31+&&G! +3,!3%% A/'"!*&!1/ A/3#*(+, A/'"! /,D/F*!&%# '/$',.!&&GD +3,!3%@ ( (+A-

'2"! &+*A/B!B&%(+, ,!3#�, 4GU!B&G@ '"/@ % ',+&/.#,'# (/3(/.G4% % 4/)1/.G4% +3,!3%/"+4%,(/,/3G! /$3+)2�, A!,"%',G! (+A%""#3&G! '!,%. �/3(/.G! +3,!3%/"G ,+(F! /$3+)2�, A/*(+A'2-"-&/! 'A"!,!&%!.

5. �3!*"/F!&+ ("+''%?%(+5%# &+*A/B!B&%(/.GD +3,!3%@, (/,/3+# . (+B!',.! &/.GD '/',+.-"#��%D .("�B+!,: A3!*(+A'2"-&G! +3,!3%% — .&!/31+&&G! +3,!3%% A/'"!*&!1/ A/3#*(+ %) "�$/-1/ %',/B&%(+, (+A'2"-&G! +3,!3%% — '/$',.!&&G! +3,!3%% ?%$3/)&/@ (+A'2"G &+*A/B!B&%(+ %+$!33+&,&G! +3,!3%% — &+*A/B!B&%(/.G! +3,!3%%, ./)&%(+��%! %) +,%A%B&/1/ %',/B&%(+.

�A%'/( "%,!3+,23G:1. Sèbe P., Peyromaure M., Raynaud A. and Delmas V. Anatomical variations in the drainage of

the principal adrenal veins: the results of 88 venograms// Surg. and Radiol. Anatomy. — 2002. —Vol. 24. — � 3–4. — P. 222–225.

2. �+D+3!&(/, �L�. /A/13+?/N+&+,/4%B!'(/! /$/'&/.+&%! '/'2*%',/@ %)/"#5%% A!B!&% A3%!� A!3?2)%% // �L. �2D"#*+, �L. �+@.+3/&'(%@, �L�. �!"#!., �L�. �+D+3!&(/, �L�. �23/. // �/'.&+2B.-A3+(,. F23&. «�(/3+# 4!*. A/4/�-». — 2004. — . 4. — � 3. — �. 245–246.

3. Dutta, S. Suprarenal gland arterial supply: an embryological basis and clinical importance// RomJ Morphol Embryol. 2010. 51 (1): 137–40.

4. Wadhwa A., Soni S. A study of middle suprarenal arteryin 30 adult humancadavers — clinicalimplications // International Journal of Basic and Applied Medical Sciences. — 2012. — Vol. 2, �. 1. —P. 99–103.

5. �4+3+, L. �3/ .+3�+$!"-&�',- */*+,(/.%D &+*&%3(/.%D +3,!3�@ 2 &/./&+3/*F!&%D // �+-,!3LA!3U/¤ &+2(/./NA3+(,. (/&?. A/B+,(2�B%D &+2(/.5�. ,+ 4/"/*%D .B!&%D �2(/.%&%. —�!3&�.5�, 1996. — �. 76–77.

6. �2,(+, �L. �/3?/?2&(5�/&+"-&� /'/$"%./',� 1!4/4�(3/5%3(2N"#,/3&/1/ 32'"+ (����) ,+A+3!&D�4% &+*&%3&%(/.%D )+"/) &+ .%'/,� *�¤ )+1+"-&/¤ 1"%$/(/¤ 1�A/,!34�¤ / �L. �2,(+, L. �&#)!-.%BN�/3&+ // �*/$2,(% ("�&�B&/¤ � !('A!3%4!&,+"-&/¤ 4!*%5%&%. — 2007. — � 2. — �. 178–180.

�&!')*+!,,"=","0!J+=�0&4)04&>!1!$,!>!J!q>"�&+!;�'J,-^�!&"�',+=^.

!#=. J� ��� (��.)

�3!&$231'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ /A!3+,%.&/@ D%3231%% % ("%&%B!'(/@ +&+,/4%% %4. �L�. �%D+@"/.+

�������������������: 9�9. !�*�� (0. �. �. ;B, ���., �. �. �.)

�.!*!&%# / A3/!(5%% % 1"2$%&! 3+'A/"/F!&%# 1"2$/(%D ',32(,23 1/"/.&/1/ 4/)1+ #."#�,'#.+F&G4% % )&+B%4G4% A3% A"+&%3/.+&%% &!@3/D%3231%B!'(%D .4!U+,!"-',.. (+B!',.! /$�!(-,/. %''"!*/.+&%# $G"% .G$3+&G ,+(%! +&+,/4%B!'(%! /$3+)/.+&%# 1/"/.&/1/ 4/)1+, (+( 4/)/"%-',/! ,!"/, B!B!.%5!/$3+)&/! #*3/, U%U(/.%*&+# F!"!)+, 4!FF!"2*/B(/.G! /,.!3',%#, 1%A/?%).�,% ',32(,23G .G$3+&G &! '"2B+@&/: ' /*&/@ ',/3/&G, /&% #."#�,'# /*&%4% %) '+4GD ?2&(5%/-&+"-&/ )&+B%4GD +&+,/4%B!'(%D /$3+)/.+&%@ 1/"/.&/1/ 4/)1+; ' *321/@ ',/3/&G, %4!&&/ �,%

131

',32(,23G %'AG,G.+�, 3+)"%B&G! '4!�!&%# % *!?/34+5%% A3% /$�!4&GD A3/5!''+D . A/"/',%B!3!A+.

*��z �����������. �A3!*!"%,-A3/!(5%% 1"2$/(%D ',32(,23 1/"/.&/1/ 4/)1+ &+ (/F&G!A/(3/.G 1/"/.G A3% /$�!4&GD /$3+)/.+&%#D $/"-U%D A/"2U+3%@ 2 "%5 )3!"/1/ ./)3+',+ . )+.%-'%4/',% /, "/(+"%)+5%% A+,/"/1%B!'(/1/ /$3+)/.+&%# 4!,/*/4 4+1&%,&/N3!)/&+&'&/@ ,/4/13+-?%%. �+4% $G"% .G*!"!&G '"!*2��%! .%*G "/(+"%)+5%@ /A2D/"!@ $/"-U%D A/"2U+3%@: 1) A!-3!*&##; 2) .!3D&!$/(/.+#; 3) $/(/.+#; 4) &%F&!$/(/.+#; 5) '3!*%&&+#, 6) )+*&##.

J����� ������ . � %'A/"-)/.+&%!4 A3/13+44G e-Film A3/+&+"%)%3/.+&G 4+1&%,&/-3!)/&+&'&G! ,/4/13+44G 1/"/.&/1/ 4/)1+ 82 A+5%!&,/. (40 42FB%& % 42 F!&�%&) . ./)3+',! /,20 */ 59 "!, ' /$�!4&G4% /$3+)/.+&%#4% . A/"/',% B!3!A+. �/"2B!&&G! 4/3?/4!,3%B!'(%! A/(+-)+,!"% /$3+$+,G.+"%'- ' %'A/"-)/.+&%!4 ',+,%',%B!'(/@ A3/13+44G «Microsoft Exel, 2007».

&�_��z�� �����������.1. �!3!*&## "/(+"%)+5%# /$�!4&/1/ /$3+)/.+&%#.�3% +&+"%)! A/"2B!&&GD 3!)2"-,+,/. /A3!*!"#!,'# +'%44!,3%# . A3/!(5%/&&GD 3+'',/#&%-

#D /, ,+(%D ',32(,23, (+( B!B!.%5!/$3+)&/! #*3/ % 1%A/?%). +(, 3+'',/#&%! /, &+32F&/@ A/.!3D-&/',% B!B!.%5!/$3+)&/1/ #*3+ */ (/F% .%'/B&/@ /$"+',% 4!&-U! &+ ',/3/&! A/3+F!&%# (3 ¼ 0,05),B!4 A3% ?%)%/"/1%B!'(/@ &/34!. +(+# F! )+(/&/4!3&/',- A3/'"!F%.+!,'# % . /,&/U!&%% 1%A/-?%)+: A3/!(5%/&&/! 3+'',/#&%! /, (3+# 1%A/?%)+ */ (/F% .%'/B&/@ /$"+',% ,/@ ',/3/&G 4!&-U!,. A/"2U+3%% (/,/3/1/ "/(+"%)2!,'# /$�!4&/! /$3+)/.+&%!. �3% A!3!*&!@ "/(+"%)+5%% /A2D/"%2.!"%B%.+!,'# 3+'',/#&%! /, 4!FF!"2*/B(/.GD /,.!3',%@ */ (/F% "/$&/@ /$"+',%(0,01 ¼ 3 ¼ 0,05) . '3+.&!&%% ' &/34+"-&G4% )&+B!&%#4%. /,&/U!&%% *321%D A3/!(5%/&&GD 3+'-',/#&%@ */',/.!3&/ )&+B%4GD 3+)"%B%@ .G#."!&/ &! $G"/ (*%+13+44+ 1).

�%+13+44+ 1. �3/!(5%/&&+# +&+,/4%# ',32(,23 1/"/.&/1/ 4/)1+A3% A!3!*&!@ "/(+"%)+5%% /A2D/"%

0,0

20,0

40,0

60,0

80,0

100,0

120,0

1 2 3 4 5 6 7 8 9 10 11 12 13

������������ �����

��

����� ������� ��� ������������������������

�3/!(5%/&&G! 3+'',/#&%# (*%+13+44G 1, 2, 3, 4, 5): 1 — /, (/"!&+ 4/)/"%',/1/ ,!"+ */ (/F% "/$-&/@ /$"+',%; 2 — /, ',./"+ 4/)/"%',/1/ ,!"+ */ (/F% ,!4!&&/@ /$"+',%; 3 — /, .+"%(+ 4/)/"%-',/1/ ,!"+ */ (/F% )+,G"/B&/@ /$"+',%; 4/5 — /, &+32F&/@ A/.!3D&/',% B!B!.%5!/$3+)&/1/ #*3+*/ (/F% .%'/B&/@ /$"+',% 'A3+.+¦'"!.+; 6/7 — /, U%U(/.%*&/@ F!"!)G */ (/F% ,!4!&&/@/ )+,G-"/B&/@ /$"+',!@; 8/9 — /, A3+./1/¦"!./1/ "+,!3+"-&/1/ (3+# 1%A/?%)+ */ (/F% .%'/B&/@ /$"+',%;10 — /, A!3!*&!@ A/.!3D&/',% 1%A/?%)+ */ A!3!*&!@ ',!&(% /'&/.&/@ A+)2D%; 11/12/13 —/, 4!FF!"2*/B(/.GD /,.!3',%@ */ (/F%"/$&/@¦,!4!&&/@¦)+,G"/B&/@ /$"+',!@.

132

2. !3D&!$/(/.+# "/(+"%)+5%# /$�!4&/1/ /$3+)/.+&%#.

�%+13+44+ 2. �3/!(5%/&&+# +&+,/4%# ',32(,23 1/"/.&/1/ 4/)1+A3% .!3D&!$/(/./@ "/(+"%)+5%% /A2D/"%

0,0

20,0

40,0

60,0

80,0

100,0

120,0

1 2 3 4 5 6 7 8 9 10 11 12 13

������������ �����

��

����� ������������� ��� ��������������������������

�) *%+13+44G 2 .%*&/, B,/ 3+'',/#&%! /, ',./"+ 4/)/"%',/1/ ,!"+ */ (/F% ,!4!&&/@ /$"+'-,% 4!&-U! A3% /A2D/"#D .!3D&!$/(/./@ "/(+"%)+5%%, B!4 &/34+"-&G! )&+B!&%# (3 ¾ 0,05). �/',/-.!3&/ )&+B%4G4% (0,01 ¼ 3 ¼ 0,05) #."#�,'# 24!&-U!&%! 3+'',/#&%@ /, U%U(/.%*&/@ F!"!)G %4!FF!"2*/B(/.GD /,.!3',%@ */ (/F% ,!4!&&/@ /$"+',%. �321%! A3/!(5%/&&G! 3+'',/#&%# '//,-.!,',.2�, )&+B!&%#4 A3% ?%)%/"/1%B!'(/@ &/34!.

3. �/(/.+# "/(+"%)+5%# /$�!4&/1/ /$3+)/.+&%#.�3% +&+"%)! A/"2B!&&GD 3!)2"-,+,/. /A3!*!"#!,'# 24!&-U!&%! 3+'',/#&%# /, ',./"+ 4/)/-

"%',/1/ ,!"+ % 4!FF!"2*/B(/.GD /,.!3',%@ */ (/F% ,!4!&&/@ /$"+',%, . '3+.&!&%% ' &/34+"--&G4% )&+B!&%#4% (3 ¼ 0,01). �3/4! ,/1/, 4!&#!,'# 3+'',/#&%! /, &+32F&/@ A/.!3D&/',% B!B!.%5!-/$3+)&/1/ #*3+ */ (/F% .%'/B&/@ /$"+',%: &+ ',/3/&! A/3+F!&%# �,/, A/(+)+,!"- 2.!"%B%.+!,'#¥3 ¼ 0,01), + &+ A3/,%./A/"/F&/@ — "%$/ /',+!,'# . A3!*!"+D ?%)%/"/1%B!'(/@ &/34G, "%$/ &!-)&+B%,!"-&/ 24!&-U+!,'#. �',+"-&G! A/(+)+,!"% A3/!(5%/&&GD 3+'',/#&%@ &+D/*#,'# . A3!*!"+D&/34+"-&GD )&+B!&%@ (*%+13+44+ 3).

�%+13+44+ 3. �3/!(5%/&&+# +&+,/4%# ',32(,23 1/"/.&/1/ 4/)1+A3% $/(/./@ "/(+"%)+5%% /A2D/"%

0,0

20,0

40,0

60,0

80,0

100,0

120,0

1 2 3 4 5 6 7 8 9 10 11 12 13

������������ �����

��

����� �������� ��� ��������������������������

133

4. �%F&!$/(/.+# "/(+"%)+5%# /$�!4&/1/ /$3+)/.+&%#.

�%+13+44+ 4. �3/!(5%/&&+# +&+,/4%# ',32(,23 1/"/.&/1/ 4/)1+A3% &%F&!$/(/./@ "/(+"%)+5%% /A2D/"%

0,0

20,0

40,0

60,0

80,0

100,0

120,0

1 2 3 4 5 6 7 8 9 10 11 12 13

������������ �����

��

����� ������������ ��� ��������������������������

�) *%+13+44G 4 .%*&/, B,/ A3% &%F&!$/(/./@ "/(+"%)+5%% /$�!4&/1/ A3/5!''+ /A3!*!"#-!,'# 24!&-U!&%! .'!D A3/!(5%/&&GD 3+'',/#&%@ (A!3!*&!1/, .!3,%(+"-&/1/, )+*&!1/) /, 4/)/"%-',/1/ ,!"+ */ (/F% 1/"/.G (3 ¼ 0,05).�+'',/#&%! /, &+32F&/@ A/.!3D&/',% B!B!.%5!/$3+)&/1/ #*3+*/ (/F% .%'/B&/@ /$"+',% 4!&-U!, A/ '3+.&!&%� ' ?%)%/"/1%B!'(/@ &/34/@ (3 ¼ 0,05), A3%B!4(+( &+ ',/3/&! A/3+F!&%#, ,+( % . A3/,%./A/"/F&/4 A/"2U+3%%. �,+,%',%B!'(% */',/.!3&G4 #.-"#!,'# 24!&-U!&%# A3/!(5%/&&GD 3+'',/#&%@ /, "+,!3+"-&/1/ (3+# 1%A/?%)+ */ (/F% .%'/B&/@/$"+',% % /, 4!FF!"2*/B(/.GD /,.!3',%@ */ (/F% "/$&/@ /$"+',%, B,/ A/(+)G.+!, &+"%B%! A/A!-3!B&/1/ % /'!./1/ '4!�!&%# ',32(,23 1/"/.&/1/ 4/)1+ A3% &%F&!$/(/./@ "/(+"%)+5%% /A2D/"%.

5. �3!*%&&+# "/(+"%)+5%# /$�!4&/1/ /$3+)/.+&%#.�,+,%',%B!'(% */',/.!3&GD %)4!&!&%@ A3/!(5%/&&GD 3+'',/#&%@ A3% '3!*%&&/@ "/(+"%)+-

5%% /$�!4&/1/ A3/5!''+ .G#."!&/ &! $G"/.

6. �+*&## "/(+"%)+5%# /$�!4&/1/ /$3+)/.+&%#.�3% +&+"%)! A/"2B!&&GD 3!)2"-,+,/. /A3!*!"#!,'# 24!&-U!&%! 3+'',/#&%@ /, &+32F&/@

A/.!3D&/',% B!B!.%5!/$3+)&/1/ #*3+ */ (/F% .%'/B&/@ /$"+',% % /, 4!FF!"2*/B(/.GD /,.!3',%@*/ (/F% ,!4!&&/@ /$"+',% (0,01 ¼ 3 ¼ 0,05). �!)&+B%,!"-&/ 4!&-U! .'! A3/!(5%/&&G! 3+'',/#&%#/, 4/)/"%',/1/ ,!"+ % U%U(/.%*&/@ F!"!)G. �321%! A/(+)+,!"% '/D3+&#�,'# . A3!*!"+D ?%)%/-"/1%B!'(/@ &/34G (*%+13+44+ 5).

�%+13+44+ 5. �3/!(5%/&&+# +&+,/4%# ',32(,23 1/"/.&/1/ 4/)1+ A3% )+*&!@ "/(+"%)+5%% /A2D/"%

0,0

20,0

40,0

60,0

80,0

100,0

120,0

1 2 3 4 5 6 7 8 9 10 11 12 13

������������ �����

��

����� ����� ��� ��������������������������

134

$ ��� . �3% +&+"%)! A3/!(5%/&&GD 3+'',/#&%@ 2 A+5%!&,/. ' /$�!4&G4% A/3+F!&%#4%1/"/.&/1/ 4/)1+ $G"/ .G#."!&/, B,/ . &+%$/"-U!@ ',!A!&% 4!&#�,'# 3+'',/#&%# (24!&-U+�,'#)A3% &%F&!$/(/./@ % )+*&!@ "/(+"%)+5%#D /A2D/"%, . ,/ .3!4# (+( A3% '3!*%&&/@ "/(+"%)+5%% .'!A/(+)+,!"% &+D/*#,'# . A3!*!"+D ?%)%/"/1%B!'(%D )&+B!&%@.

�!(/,/3G! A3/!(5%/&&G! 3+'',/#&%# /',+.+"%'- ',+$%"-&G4% .&! )+.%'%4/',% /, "/(+"%-)+5%% /$�!4&/1/ A3/5!''+, ,+(%! (+( 3+'',/#&%# /, A!3!*&!@ A/.!3D&/',% 1%A/?%)+ */ A!3!*&!@',!&(% /'&/.&/@ A+)2D% % /, 4!FF!"2*/B(/.GD /,.!3',%@ */ (/F% )+,G"/B&/@ /$"+',% (�,% A/(+-)+,!"% A3+(,%B!'(% '/.A+*+�, %"% &!)&+B%,!"-&/ /,"%B+�,'# /, '3!*&%D A+3+4!,3/. 132AAG .5!"/4).

�321%! F!, &+/$/3/,, %)4!&#"%'- A3+(,%B!'(% A3% "�$/@ "/(+"%)+5%% /A2D/"%: 3+'',/#&%#/, &+32F&/@ A/.!3D&/',% B!B!.%5!/$3+)&/1/ #*3+ */ (/F% .%'/B&/@ /$"+',% % /, 4!FF!"2*/B(/-.GD /,.!3',%@ */ (/F% "/$&/@ % ,!4!&&/@ /$"+',!@.

�',+"-&G! A3/!(5%/&&G! 3+'',/#&%# 4!&#"%'- ((+( A3+.%"/, 24!&-U+"%'-) . )+.%'%4/',%/, "/(+"%)+5%% /$�!4&/1/ /$3+)/.+&%#.

+(%4 /$3+)/4, . &!@3/D%3231%B!'(/@ A3+(,%(! &!/$D/*%4/ 2B%,G.+,- 3+)"%B%# . 3+'',/#-&%#D /, &!(/,/3GD 1"2$/(%D ',32(,23 1/"/.&/1/ 4/)1+ */ (/F% 1/"/.G 2 "%5 ' 3+)&/@ "/(+"%)+5%-!@ /$�!4&/1/ /$3+)/.+&%# . A/"/',% B!3!A+.

�A%'/( "%,!3+,23G:1. �D+*/., L�. �+1&%,&/N3!)/&+&'&+# ,/4/13+?%# A3% /A2D/"#D. / �L. �D+*/.. — �.: �+2-

(+, 2003. — 329 '.2. �+@*+3, �L. �3+(,%B!'(+# &!@3/D%3231%# / A/* 3!*. �L. �+@*+3+ — ��$: �%AA/(3+,,

2002 . —647 '.3. �,32(/.+, �L�. �&*%.%*2+"-&G! 3+)"%B%# % ./)3+',&+# *%&+4%(+ +&+,/4/4!,3%B!'(%D

A/(+)+,!"!@ 1"2$/(%D ',32(,23 1/"/.&/1/ 4/)1+ . *!,'(/4 ./)3+',! A/ *+&&G4 4+1&%,&/-3!)/&+&'&/@ ,/4/13+?%%: +.,/3!?. *%'. … (+&*. 4!*. &+2(. — �3!&$231, 2006. — 30 '.

4. Lavaroni A., Leonard M. Neuroradiological diagnostics of brain tumor in adults // Rev. Neurol.(Paris) — 1993. — Vol. 35, � 1. — P.41–54.

5. Yong, G.S. Advanced MRI of adult brain tumors // Neurol. Clin. — 2007. — Vol. 25. — � 4.— P. 947–973.

J!&2!J'0&+%,"!*�,)"�0&4)04&+,'4&"�',!��0�,)+($","(*=0+�"1!�)+x)+4�0"0'$!,'q&�1+^{4&�$

"#$. J�_z, (#J. ;������

!3&/A�"-'-(%@ *!3F+.&%@ 4!*%B&%@ 2&�.!3'%,!, �4. �L�. �/3$+B!.'-(/1/�+?!*3+ +&+,/4�¤ "�*%&%

�/3?/4!,3%B&%4% 4!,/*+4% .%.B!&/ /'/$"%./',� ',32(,23% &!23+F!&/¤ ',�&(%*.+&+*5#,%A+"/¤ (%U(% 2 ',+,!./&!)3�"%D �23�.. ',+&/."!&/, �/ ',�&(+ *.+&+*5#,%A+"/¤ (%U(%2 ',+,!./&!)3�"%D �23�. D+3+(,!3%)2¯,-'# 4!&U/� ,/.�%&/� '"%)/./¤, 4ª#)/./¤ /$/"/&/( ,+A�*'"%)/./¤ /'&/.% A/3�.&#&/ �) ',+,!./)3�"%4% ,.+3%&+4%, A/',�@&�',� #*!3&/N5%,/A"+)4+,%B&%D'A�..�*&/U!&- . !A�,!"�/5%,+D ,+ 4!&U%4 .�*&/'&%4 /$ª¯4/4 A/U(/*F!&%D !A�,!"�/5%,�..

J!&2!J'0&+%'�)"=!*',)"�0&4)04&-,'�!$&'�(',,!/�0',)+($',"(*"0+�'&�0,!/)+x)+4;'1-^,'�!1!$!q&'1-^)&-�

"#$. J�_z (��.), (#,. ;������ (����.)

!3&/A/"-'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4. �L�. �/3$+B!.'(/1/�+?!*3+ +&+,/4%% B!"/.!(+

"����z����z. A/'"!*&!! .3!4# 4/3?/4!,3%# .'! $/"-U! %'A/"-)2!,'# . 4!*%(/-$%/"/1%B!'(%D %''"!*/.+&%#D. �/3?/4!,3%B!'(%! 4!,/*G *+�, ./)4/F&/',- A/"2B%,- (/"%-B!',.!&&2� D+3+(,!3%',%(2 ?%)%/"/1%B!'(%D % A+,/"/1%B!'(%D A3/5!''/. % $/"!! 1"2$/(/ %*!,+"-&/ %D %''"!*/.+,- % "/1%B!'(% /$�#'&%,-. �!/$D/*%4/ /,4!,%,-, B,/ ./)3+',&G! ',32(-,23&/N?2&(5%/&+"-&G! /'/$!&&/',% ',!&(% *.!&+*5+,%A!3',&/@ (%U(% %''"!*/.+&G &!*/',+-,/B&/.

135

�'D/*# %) .GU!'(+)+&&/1/, ���z��3������ ',+"/ 4/3?/4!,3%B!'(/! %)2B!&%! ',32(-,23G &!A/3+F!&&/@ ',!&(% *.!&+*5+,%A!3',&/@ (%U(% 2 $!"GD (3G' . ./)3+',&/4 +'A!(,!.

J����� � ����� . �/4A"!('/4 4/3?/"/1%B!'(%D 4!,/*/. %)2B!&+ ',32(,23+ ',!&(%*.!&+*5+,%A!3',&/@ (%U(% 2 24 (/&,3/"-&GD $!"GD (3G', &+D/*#�%D'# . /$GB&GD 2'"/.%#D .%-.+3%# &+ ',+&*+3,&/4 3+5%/&!. ,!B!&%! *.2D *&!@ /&% A/"2B+"% .&2,3%F!"2*/B&/ /$�!4 /"%.-(/./1/ 4+'"+, %*!&,%B&G@ /$�!42 50 %-&/1/ 4+'"#&/1/ 3+',./3+ ,!3+D"/34!,+&+, (/,/3G@ ../*%-"% (3G'+4 �('A!3%4!&,+"-&/@ '!3%%. �/&,3/"-&G! F%./,&G! $G"% 3+)*!"!&G &+ *.! 132AAG:A!3.+# .("�B+"+ 12 &!A/"/./)3!"GD (3G', .,/3+# — 12 A/"/./)3!"GD (3G'. �/*!3F+&%! F%./,-&GD % �('A!3%4!&,G A3/./*%"%'- . '//,.!,',.%% ' A/"/F!&%#4% «�.3/A!@'(/@ (/&.!&5%% / )+-�%,! A/)./&/B&GD F%./,&GD, %'A/"-)2!4GD *"# �('A!3%4!&,+"-&GD % *321%D &+2B&GD 5!"!@».�/'"! �.,+&+)%%, .G3!)+"% (2'/B(% %) '3!*&!@ B+',% *.!&+*5+,%A!3',&/@ (%U(% % ?%('%3/.+"%%D . 10 %-&/4 &!@,3+"-&/4 3+',./3! ?/34+"%&+. �/'"! '//,.!,',.2��!@ /$3+$/,(% 4%(3/,/4&G!'3!)G (3+'%"% 1!4+,/('%"%&N�/)%&/4 A" 4!,/*2 )+ +&N�%)/&+, �+""/3%, !@1!3,+.

&�_��z�� �����������. �) 3!)2"-,+,/., /,3+F!&&GD . ,+$". 1, .%*&/, B,/ 2 &!A/"/./)-3!"GD (3G' ,/"�%&+ '"%)%',/@ /$/"/B(%, A/*'"%)%',/@ /'&/.G, 4GU!B&/@ % '!3/)&/@ /$/"/B!(&!A/3+F!&&/@ *.!&+*5+,%A!3',&/@ (%U(% $G"+ */',/.!3&/ 4!&-U!: '//,.!,',.!&&/ &+ 11,6 %¥3 < 0,01), 26,8 % (3 < 0,001), 33,3 % (3 < 0,001) % 13,7 % (3 < 0,05).

+$"%5+ 1

�/3?/4!,3%B!'(+# D+3+(,!3%',%(+ &!A/.3!F*!&&/@ *.!&+*5+,%A!3',&/@ (%U(%$!"GD (3G' . ./)3+',&/4 +'A!(,! (� ± m)

�/(+)+,!"- �32AA+ F%./,&GD�!A/"/./)3!"G! �/"/./)3!"G!

/"�%&+ '"%)%',/@ /$/"/B(%, 4(4 463,31 ± 12,303 < 0,01 524,15 ± 10,33

/"�%&+ A/*'"%)%',/@ /'&/.G, 4(4 31,9 ± 1,263 < 0,001

43,55 ± 1,41

/"�%&+ 4GU!B&/@ /$/"/B(%, 4(4 86,23 ± 3,023 < 0,001 129,18 ± 2,90

/"�%&+ '!3/)&/@ /$/"/B(%, 4(4 5,11 ± 0,133 < 0,002 5,92 ± 0,07

�/*'"%)%',/N'"%)%',G@ %&*!(' 0,069 ± 0,0033 < 0,05 0,083 ± 0,004

�/*'"%)%',/N4GU!B&G@ %&*!(' 0,370 ± 0,0063 > 0,05 0,338 ± 0,012

�"%&+ ./3'%&/(, 4(4 288,50 ± 3,233 < 0,002 330,15 ± 5,27

�%3%&+ ./3'%&/(, 4(4 52,03 ± 1,393 < 0,01 62,15 ± 1,52

�"2$%&+ (3%A,, 4(4 94,32 ± 3,143<0,001 133,68 ± 3,02

�%3%&+ (3%A,, 4(4 20,82 ± 1,443 < 0,01 30,50 ± 1,33

G'/,+ A/(3/.&GD �A%,!"%/5%,/.,4(4

17,03 ± 0,363 > 0,05 17,86 ± 0,40

�%+4!,3 #*!3 �A%,!"%/5%,/., 4(4 5,10 ± 0,113 > 0,05 5,25 ± 0,10

�*!3&/-5%,/A"+)4+,%B!'(%!/,&/U!&%# . �A%,!"%/5%,+D

0,079 ± 0,0023 > 0,05 0,081 ± 0,002

�,&/'%,!"-&G@ /$�!4A/.3!F*!&&GD �A%,!"%/5%,/., %

1,63 ± 0,173 < 0,001 3,46 ± 0,22

�3%4!B+&%!: 3 — 3+)&%5+ */',/.!3&+ A/ '3+.&!&%� &!A/"/./)3!"GD ' A/"/./)3!"G4% F%./,&G4%.

�,/ (+'+!,'# /,&/'%,!"-&GD 4/3?/4!,3%B!'(%D A+3+4!,3/., ,/ . 2(+)+&&/@ 132AA! %''"!*/-.+&%# */',/.!3&GD %)4!&!&%@ (3 < 0,05) A/,!3A!" "%U- A/*'"%)%',/N'"%)%',G@ %&*!(', (/,/3G@'/',+."#" 0,069 ± 0,003, B,/ &+ 16,9 % 4!&-U! A/ '3+.&!&%� ' A/"/./)3!"G4% F%./,&G4%. � &!-A/"/./)3!"GD (3G' *"%&+ ./3'%&/( */',/.!3&/ $G"+ &+ 12,6 % 4!&-U! A/ '3+.&!&%� ' A/"/./)-3!"G4% F%./,&G4% (3 < 0,002). �%3%&+ ./3'%&/( ,+(F! */',/.!3&/ $G"/ 4!&-U! &+ 16,3 % A/

136

'3+.&!&%� ' A/"/./)3!"G4% F%./,&G4% (3 < 0,01). �&+"/1%B&+# ,!&*!&5%# &+$"�*+"+'- % /,&/-'%,!"-&/ 1"2$%&G % U%3%&G (3%A, 2 &!A/"/./)3!"GD (3G', (/,/3G!, '//,.!,',.!&&/, $G"% &+29,5 % % 31,7 % */',/.!3&/ 4!&-U!. G'/,+ A/(3/.&GD �A%,!"%/5%,/. % *%+4!,3 #*!3 �,%D ("!-,/(, ,+( F! (+( % #*!3&/N5%,/A"+)4+,%B!'(%! /,&/U!&%# . �A%,!"%/5%,+D &!A/.3!F*!&&/@ *.!&+-*5+,%A!3',&/@ (%U(% &!A/"/./)3!"GD (3G' */',/.!3&/ &! /,"%B+"%'- /, +&+"/1%B&GD A/(+)+,!-"!@ A/"/./)3!"GD F%./,&GD. �,/ (+'+!,'# /,&/'%,!"-&/1/ /$�!4+ A/.3!F*!&&GD �A%,!"%/5%,/. .%''"!*2!4/4 /31+&! . 2(+)+&&/@ 132AA! (3G', ,/ /& '/',+."#" 1,63 ± 0,17 (3 < 0,001), B,/ A/B,% &+53 % 4!&-U! A/ '3+.&!&%� ' A/"/./)3!"G4% F%./,&G4%. !3/#,&/, &+"%B%! /,&/'%,!"-&/1/ /$�-!4+ A/.3!F*!&&GD �A%,!"%/5%,/. *.!&+*5+,%A!3',&/@ (%U(% 2 (3G' (/&,3/"-&/@ '!3%%, 4/F&//$�#'&%,- A3/5!''+4% +A/A,/)+, (/,/3G! %4!�, 4!',/ . &!A/.3!F*!&&GD /31+&+D.

$ ��� :1. �,32(,23+ ',!&(% &!A/.3!F*!&&/@ *.!&+*5+,%A!3',&/@ (%U(% $!"GD &!A/"/./)3!"GD (3G'

D+3+(,!3%)%32!,'# 4!&-U!@ ,/"�%&/@ '"%)%',/@, 4GU!B&/@ /$/"/B!(% A/*'"%)%',/@ /'&/.G.2. �/',/#&',./ #*!3&/N5%,/A"+)4+,%B!'(%D /,&/U!&%@ . �A%,!"%/5%,+D '.%*!,!"-',.2!, /

',+$%"-&/',% ("!,/B&/1/ ',32(,23&/1/ 1/4!/',+)+ &!A/"/./)3!"GD (3G'.3. � &!A/"/./)3!"GD (3G' A3/5!''G +A/A,/)+ )&+B%,!"-&/ 4!&!! .G3+F!&G . '3+.&!&%% '

A/"/./)3!"G4% F%./,&G4%.

J!&2!1!>+%'�)+'+qJ',',+=,+�,'>!$')"4;!1],-^+,$!1w*+!,,-J`)0&!�+!,!J

�#,. &�����, �#;. "���3��, >#2. J���������

�!"/32''(+# 4!*%5%&'(+# +(+*!4%# A/'"!*%A"/4&/1/ /$3+)/.+&%#�+?!*3+ /?,+"-4/"/1%%

�!&%"-&G@ �(,3/A%/& #."#!,'# &+%$/"!! B+',G4 '"2B+!4 *%'A/)%5%% &%F&!1/ .!(+, .',3!-B+!4G@ . A3+(,%(! /?,+"-4/"/1/. [1]. !B!&%! )+$/"!.+&%! /'"/F&#!,'# 3+).%,%!4 D3/&%B!'(/1/./'A+"!&%# /$/"/B!( 1"+)+, ?/,/?/$%!@, A/3+F!&%!4 3/1/.%5G ' A/'"!*2��%4 '&%F!&%!4 )3!-&%# [2, 3]. � 132AA! 3%'(+ 3+).%,%# %&./"�5%/&&/1/ �(,3/A%/&+ A3%&+*"!F+, "�*% ',+3U! 60 "!,.'"!*',.%! ./)3+',&/@ '"+$/',% 4GU5G % '.#)/B&/1/ +AA+3+,+, + ,+(F! *3#$"/',% (/F% .!(+, &+-$"�*+!4G4% &+ ?/&! D3/&%B!'(/1/ ./'A+"!&%# (/&��&(,%.G [1–6]. �*&+(/ '"!*2!, /,4!,%,-, B,/./)3+',&G! %)4!&!&%# '.#)/B&/N4GU!B&/1/ +AA+3+,+ 1"+)+ &+$"�*+�,'# 2 .'!D A/F%"GD A+5%!&-,/., &/ B+',/,+ .',3!B+!4/',% *+&&/1/ )+$/"!.+&%# '/',+."#!, ,/"-(/ 16,7 % '3!*% "�*!@ ',+3U!80 "!, [7]. !3/#,&/, A3%B%&+ 3+).%,%# '!&%"-&/1/ �(,3/A%/&+ '.#)+&+ ' .G3+F!&&/',-� 4%(3/-'(/A%B!'(%D %)4!&!&%@ ',32(,23&GD (/4A/&!&,/. '.#)/B&/N4GU!B&/1/ +AA+3+,+ 1"+)+ &+ ?/&!%D ./)3+',&/@ ,3+&'?/34+5%%.

*��z� *+&&/1/ %''"!*/.+&%# #.%"'# +&+"%) 4/3?/"/1%B!'(%D %)4!&!&%@ ?3+14!&,/. &%F-&!1/ .!(+ A+5%!&,/. ' '!&%"-&G4 �(,3/A%/&/4.

J����� � ����� . �/3?/"/1%B!'(/42 %''"!*/.+&%� A/*"!F+"% ?3+14!&,G &%F&!1/.!(+: (/F&G@ "/'(2,, 3!,3+(,/3 % A3!,+3)+"-&+# 4GU5+, 2*+"!&&G! ./ .3!4# /A!3+5%% 2 $/"-&GD' %&./"�5%/&&G4 �(,3/A%/&/4 &%F&!1/ .!(+. �/'"! ?%('+5%% . 10%-&/4 3+',./3! &!@,3+"-&/1/?/34+"%&+ % A3/./*(% A/ 'A%3,+4 ./)3+',+��!@ (/&5!&,3+5%% ?3+14!&,G 2*+"!&&/@ ,(+&% )+-"%.+"%'- . A+3+?%&. �3!)G /(3+U%.+"%'- 1!4+,/('%"%&/4 % �/)%&/4 A/ ',+&*+3,&/@ 4!,/*%(!.�"# +&+"%)+ %)4!&!&%@ '/ ',/3/&G �"+',%B!'(/1/ % (/""+1!&/./1/ (+3(+'+ %''"!*2!4GD ',32(,23A3/./*%"+'- 'A!5%?%B!'(%! 1%',/D%4%B!'(%! /(3+'(%: &+ �"+',%B!'(%! (A/ !@1!3,2) % (/""+1!-&/.G! (A/ +&N�%)/&2) ./"/(&+. �&+"%) 4/3?/"/1%B!'(%D %)4!&!&%@ A3/./*%"'# ' A/4/�-� '.!-,/./1/ 4%(3/'(/A+ ?%34G «Zeizz» ' %'A/"-)/.+&%!4 3+)"%B&GD 2.!"%B!&%@ (D 100, D 200 % D 400).

&�_��z�� �����������.�32AA+ A+5%!&,/. (n = 26),.("�B!&&GD . %''"!*/.+&%!, $G"+A3!*',+."!&+ (+( 42FB%&+4%, ,+( % F!&�%&+4% . '//,&/U!&%% 1:1,5 (�¿�). �3!*&%@ ./)3+',$/"-&GD '/',+.%" 75,8 1/*+.

/ .'!D %''"!*/.+&&GD ?3+14!&,+D (/F&/1/ "/'(2,+ &%F&!1/ .!(+ .G#."!&G +(+&,/) % A+-3+(!3+,/) 4&/1/'"/@&/1/ A"/'(/1/ �A%,!"%#. �"+$/ .G3+F!&&+# ./'A+"%,!"-&+# %&?%"-,3+5%#,A3!*',+."!&&+# "%4?/5%,+4% % A"+)4/5%,+4% ' A3%4!'-� !*%&%B&GD '!14!&,/#*!3&GD &!@,3/-?%"/., &+$"�*+"+'- ,/"-(/ . '2$�A%,!"%+"-&GD /,*!"+D % D+3+(,!3%)/.+"+'- A!3%.+'(2"#3&G43+'A/"/F!&%!4. �/ ',/3/&G (/&��&(,%.G .G3+F!&&GD ./'A+"%,!"-&GD %)4!&!&%@ ,+(F! &! /$-&+32F!&/: (321"/("!,/B&+# %&?%"-,3+5%# $G"+ /,4!B!&+ . .%*! 4!"(%D '2$�A%,!"%+"-&GD /B+F-

137

(/. $!) (/&5!&,3+5%% ("!,/( ./'A+"!&%# ./(321 '/'2*/.. /',+"-&GD /,*!"+D (/&��&(,%.G ./'-A+"%,!"-&/@ %&?%"-,3+5%% &! .G#."!&/. �,3/4+ (/F&/1/ "/'(2,+ .!(+, (+( % ',3/4+ (/&��&(,%-.G A3!*',+."!&+ )3!"/@ '/!*%&%,!"-&/@ ,(+&-�. / .'!D '"2B+#D /,4!B+"'# /,!( *!34G 3+)&/@',!A!&% .G3+F!&&/',%, (/,/3G@ '/A3/./F*+"'# 3+)./"/(&!&%!4, %)4!&!&%!4 ,/"�%&G %¦%"% 1/-4/1!&%)+5%!@ (/""+1!&/.GD ./"/(/&. �%&%4+"-&G@ /,!( &+$"�*+"'# . 9,2 % %''"!*2!4GD /$3+)-5/. % D+3+(,!3%)/.+"'# A3!%42�!',.!&&/@ "/(+"%)+5%!@ . '2$�&*/,!"%+"-&GD /,*!"+D ' 3+'A3/-',3+&!&%!4 &+ 1"2$/(%! '"/% *!34G, A3% �,/4 /B+1/./ .G#."!&G .G3+F!&&G! *%',3/?%B!'(%D%)4!&!&%# ?%$3/)&/@ ,(+&% &%F&!1/ .!(+, (/,/3G! D+3+(,!3%)/.+"%'- 2,/"�!&%!4 % 1/4/1!&%)+-5%!@ (/""+1!&/.GD ./"/(/&L�4!3!&&G@ /,!( *!34G /,4!B!& . 45,4 % &+$"�*!&%@, A3% �,/4 ,+(F!/,4!B+"/'- 3+)./"/(&!&%! % &!3+.&/4!3&G4/! %',/&B!&%! (/""+1!&/.GD ./"/(/& . '/B!,+&%% '4%('/4+,/)/4 ',3/4GL /',+"-&GD 45,4 % '"2B+!. .G#."!& .G3+F!&&G@ /,!( ',3/4G, (/,/3G@3+'A3/',3+&#"'# &+ .'! /,*!"G *!34G (/F% .!(+ % ',3/4G %''"!*/.+&&GD 2B+',(/. (/&��&(,%.G.�3% �,/4 /,4!B+"%'- %',/&B!&%! (/""+1!&/.GD ./"/(/&, A3!3G.%',/',- % A/,!3# A+3+""!"-&/@&+A3+."!&&/',% A/'"!*&%D. �/""+1!&/.G! ./"/(&+ *!34G $G"% A3!*',+."!&G . .%*! ,/&(%D,?3+14!&,%3/.+&&GD, 3+)&/&+A3+."!&&GD, 4!',+4% ' %)/1&2,G4 D/*/4 &%,!@, (/,/3G! &!3+.&/-4!3&/ 3+'A3!*!"!&G . /,!B&/@ ',3/4!. �+&&G! %)4!&!&%# (/""+1!&/.GD ./"/(/& #."#!,'# A3/#.-"!&%!4 .G3+F!&&/1/ "%)%'+ A/'"!*&%D.

�/3?/"/1%B!'(%! %)4!&!&%# �"+',%B!'(/1/ (+3(+'+ (/F% &%F&!1/ .!(+ D+3+(,!3%)/.+"%'-?3+14!&,+5%!@ %"% A!,"!.G4 D/*/4 �"+',%B!'(%D ./"/(/&. %''"!*2!4/@ /$3+)5+D ?3+14!&,/.(/F% &%F&!1/ .!(+ $/"-&GD %&./"�5%/&&G4 �(,3/A%/&/4 %)4!&!&%# �"+',%B!'(/1/ (+3(+'+ *!3-4G &/'%"% 3+)&//$3+)&G@ D+3+(,!3: /, 4%&%4+"-&GD */ .G3+F!&&GD A3/#."!&%@ �"+',/"%)+. 9,1 % &+$"�*!&%@ �"+',%B!'(%! ./"/(&+ %4!"% A3!3G.%',G@ .%*, &/ D+3+(,!3%)/.+"%'- .G'/(/@A"/,&/',-� 3+'A/"/F!&%#, A3% �,/4 /,4!B+"'# 4%&%4+"-&G@ /,!( *!34G. /',+"-&GD &+$"�*!-&%#D, 1*! /,4!B+"'# 24!3!&&G@ %"% .G3+F!&&G@ /,!( ',3/4G, .G#."!&G $/"!! )&+B%,!"-&G! A3/-#."!&%# �"+',/"%)+: ?3+14!&,%3/.+&&G!, ' ./"&%',G4 D/*/4 �"+',%B!'(%! ./"/(&+ .',3!B+"%'- ..%*! /,*!"-&GD A2B(/., /,*!"-&GD ./"/(/& %"% A/"&/',-� /,'2,',./.+"%.

�,32(,23&G! %)4!&!&%# /,4!B!&G % . ,(+&% 3!,3+(,/3+ &%F&!1/ .!(+. )3!"/@ '/!*%&%-,!"-&/@ ,(+&% A/'"!*&!1/ ,+(F! .G#."!&G A3!3G.%',/',- % 3+)./"/(&!&%! (/""+1!&/.GD ./"/-(/&, B,/ #."#"/'- A3/#."!&%!4 *%',3/?%B!'(%D % *!',32(,%.&GD %)4!&!&%@ A/'"!*&%D. �/"-U%&-',./ (/""+1!&/.GD A2B(/. D+3+(,!3%)/.+"%'- ./"&%',G4 D/*/4 ' A+3+""!"-&G4 3+'A/"/F!&%!4./"/(/&, /B+1/./ .G#."!&G %',/&B!&%! (/""+1!&/.GD &%,!@ % '"+$G@ /,!(. �/3?/"/1%B!'(%! %)-4!&!&%# (/""+1!&/./1/ (+3(+'+ 3!,3+(,/3+ $G"% 4!&!! .G3+F!&&G4% A/ '3+.&!&%� ' *!',32(5%-!@ (/""+1!&/.GD ./"/(/& *!34G &%F&!1/ .!(+ 2 $/"-&GD '!&%"-&G4 �(,3/A%/&/4. /,"%B%! /,%)4!&!&%@ �"+',%B!'(/1/ (+3(+'+ 3!,3+(,/3+ % *!34G, 1"2$/(%@ "%)%' �"+',%B!'(%D ./"/(/& '/B+1+4% A/"&/1/ %D %'B!)&/.!&%# .G#."!& (+( . ',3/4! *!34G, ,+( % . ,(+&% 3!,3+(,/3+ &%F&!1/.!(+. �)4!&!&%# '/ ',/3/&G 1"+*(%D 4GU5 3!,3+(,/3+ &%F&!1/ .!(+ $/"-&GD '!&%"-&G4 �(,3/-A%/&/4 D+3+(,!3%)/.+"%'- +,3/?%!@ % F%3/.G4 A!3!3/F*!&%!4 A/'"!*&%D.

�/3?/"/1%B!'(%! %)4!&!&%# ',32(,23G A3!,+3)+"-&/@ 4GU5G &%F&!1/ .!(+ ,+(F! &/'%"%*%',3/?%B!'(%@ % *!',32(,%.&G@ D+3+(,!3. A/.!3D&/',&GD /,*!"+D /,4!B+"+'- +,3/?%# 4G-U!B&/@ ,(+&% .A"/,- */ A/"&/1/ 3+)32U!&%# 4GU!B&GD ./"/(/& % )+4!�!&%# %D ?%$3/)&/@ ,(+-&-�. �%',3/?%B!'(%! %)4!&!&%# ("!,/( A/A!3!B&/A/"/'+,/@ 42'(2"+,23G A3!,+3)+"-&/@ 4GU5G&%F&!1/ .!(+ D+3+(,!3%)/.+"%'- A/,!3!@ A/A!3!B&/@ %'B!3B!&&/',% ' 3+).%,%!4 1/4/1!&%)+5%%5%,/A"+)4G 4GU!B&GD ("!,/(, . +,3/?%3/.+&&GD 4GU!B&GD ("!,(+D /,4!B+"+'- .+(2/"%)+5%#5%,/A"+)4G ' (+3%/"%)%'/4 #*!3. 1"2$/(%D /,*!"+D A3!,+3)+"-&/@ 4GU5G &%F&!1/ .!(+ ,+(F!/,4!B+"%'- *%',3/?%B!'(%! % +,3/?%B!'(%! %)4!&!&%# 4GU!B&GD ("!,/(, +,3/?%# (/,/3GD '/-A3/./F*+"+'- 3+'U%3!&%!4 �&*/4%)%# % A!3%4%)%# )+ 'B!, 3+)3+',+&%@ ?%$3/)&/@ ,(+&%.

$ ��� :- . (/F! &%F&!1/ .!(+ 2 $/"-&GD '!&%"-&G4 �(,3/A%/&/4 .G#."!&G A3%)&+(% *!)/31+&%)+-

5%# '/!*%&%,!"-&/@ ,(+&% *!34G ' /B+1+4% A/"&/1/ "%)%'+ �"+',%B!'(%D ./"/(/& % B+',%B&/1/3+)32U!&%# (/""+1!&/.GD ./"/(/&, B,/ '/A3/./F*+"/'- 3+).%,%!4 4%('/4+,/)+ % .G3+F!&&G4/,!(/4 ',3/4G, .G3+F!&&/',- ./'A+"%,!"-&GD %)4!&!&%@ $G"+ 4%&%4+"-&/@;

- ',32(,23&G! %)4!&!&%# 3!,3+(,/3+ &%F&!1/ .!(+ $/"-&GD '!&%"-&G4 �(,3/A%/&/4 D+3+(-,!3%)/.+"%'- 3+)32U!&%!4 �"+',%B!'(/1/ % 1"+*(/4GU!B&/1/ (/4A/&!&,+ . '/B!,+&%% ' &!)&+B%-,!"-&G4% *!',32(,%.&G4% A3/5!''+4% (/""+1!&/./1/ (+3(+'+;

- ',32(,23&G! %)4!&!&%# A3!,+3)+"-&/@ 4GU5G &%F&!1/ .!(+ $/"-&GD '!&%"-&G4 �(,3/-A%/&/4 D+3+(,!3%)/.+"%'- A3!%42�!',.!&&/ +,3/?%B!'(%4% %)4!&!&%#4% ' A/,!3!@ 4GU!B&/@4+''G % )+4!�!&%!4 A/'"!*&!@ '/!*%&%,!"-&/@ ,(+&-�.

138

- .G#."!&&G! ',32(,23&G! %)4!&!&%# 3!,3+(,/3+ &%F&!1/ .!(+, (+( % +,3/?%B!'(%! %)4!&!-&%# A3!,+3)+"-&/@ 4GU5G '.%*!,!"-',.2�, / '&%F!&%% ?2&(5%/&+"-&/@ +(,%.&/',% '.#)/B&/-4GU!B&/1/ +AA+3+,+ &%F&!1/ .!(+ 2 $/"-&GD %&./"�5%/&&G4 �(,3/A%/&/4, B,/ ,3!$2!, D%323-1%B!'(/@ (/33!(5%% *+&&/1/ )+$/"!.+&%#.

�A%'/( "%,!3+,23G:1. �D.!3*%!.+, L�. �%3231%B!'(/! "!B!&%! '!&%"-&/1/ �(',3/A%/&+ &%F&!1/ .!(+: 2(/3/-

B!&%! ,+3)+"-&/@ A"+',%&(% % /A!3+5%# LAZY-T (A!&,+1/&+"-&+# 3!)!(5%# .!(+ ' )+./3/,/4 '"!)-&/@ ,/B(%) / L�. �D.!3*%!.+ // �?,+"-4/"/1%#. — 2012. — . 1. — � 8. — �. 50–52.

2. Piskiniene, R. Eyelid malposition: lower lid entropion and ectropion. / R. Piskiniene // Medicina(Kaunas). — 2006. — Vol. 42. — � 11. — �. 881–884.

3. Manners R.M., Weller R.O. Histochemical staining of orbicularis oculi muscle in ectropion andentropion / R.M. Manners, R.O. Weller // Eye. — 1994. — Vol. 8. — �. 332–335.

4. The histopathology of involutional ectropion and entropion / F.A. Kocaoglu [at al.] // Can. J.Ophthalmol. — 2009. — Vol. 44, � 6. — �. 677–679.

5. Lateral tarsal strip technique for correction of lower eyelid ectropion / M.A. Marzouk [at al.] //Journal of American Science. — 2011. — Vol 7, � 5. — �. 394–405.

6. External (subciliary) vs internal (transconjunctival) involutional entropion repair / G.J.B.Simon[at al.] // Am J Ophthalmol. — 2005. — Vol. 139. — �. 482–487.

7. A 5-years retrospective review of Asian ectropion: how does it compare to ectropion amongstnon-asians? / J. Chua [at al.] // Ann Acad Med Singapore. — 2011. — Vol. 40. — �. 84–89.

J!&2!J'0&+%'�)"=^"&")0'&+�0+)""1]$'!1=&,-^!0&!�0)!$$'&^,'/%'1w�0+4$q&!�1!>!%'1!$')"�&+&"q1+%,!/2!&J'

'>!1+*'$!>!%'&'�"

�#�. 2������ (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ +&+,/4%% B!"/.!(+

�������������������: ��#. /������� (��., ����.)

"����z����z. �3% A"+&%3/.+&%% D%3231%B!'(%D .4!U+,!"-',. . /$"+',% +"-.!/"#3&GD/,3/',(/. .!3D&!@ B!"�',% .+F&/! )&+B!&%! %4!!, &! ,/"-(/ )&+&%! %D +$'/"�,&GD 3+)4!3/., &/% ./)4/F&/',- %)4!&B%./',% ,!D %"% %&GD (/',&GD ',32(,23 +"-.!/"#3&GD /,3/',(/. . )+.%'%4/-',% /, A/"+, ./)3+',+, + ,+(F! ?/34G "%5!./1/ B!3!A+. /)3+',&+# % A/"/.+# %)4!&B%./',- (3+-&%/4!,3%B!'(%D A+3+4!,3/. "%5!./1/ B!3!A+ */',+,/B&/ D/3/U/ %)2B!&+ % A/*3/$&/ /'.!�!&+ .'A!5%+"-&/@ "%,!3+,23!. �+&&GD /$ %)4!&B%./',% 3+)4!3/. +"-.!/"#3&GD /,3/',(/. . )+.%'%4/-',% /, ?/34G "%5!./1/ B!3!A+ A3+(,%B!'(% &! .',3!B+!,'#.

*��z�����������. �3/.!*!&%! '3+.&%,!"-&/@ 4/3?/4!,3%B!'(/@ /5!&(% ',3/!&%# +"-.!-/"#3&GD /,3/',(/. 2 .)3/'"/1/ B!"/.!(+ . )+.%'%4/',% /, ?/34G !1/ "%5!./1/ B!3!A+.

J����� ������ . �+,!3%+"/4 %''"!*/.+&%# '"2F%"% 14 4+5!3%3/.+&&GD B!3!A/. $!)&%F&%D B!"�',!@ /, "�*!@ )3!"/1/ ./)3+',+ %) &+2B&/@ (/""!(5%% (+?!*3G &/34+"-&/@ +&+,/-4%% �!"#$%&'(/@ 1/'2*+3',.!&&/@ 4!*%5%&'(/@ +(+*!4%%. �"# %''"!*/.+&%# %'A/"-)/.+"%'- B!-3!A+ $!) )2$/B!"�',&GD +&/4+"%@, *!?/34+5%@ % A+,/"/1%B!'(%D %)4!&!&%@. �)4!3!&%# +"-.!/-"#3&GD /,3/',(/. % 3+)4!3/. "%5!./1/ B!3!A+ A3/./*%"%'- A/ 4!,/*%(! �. �+3,%&+ ' '/$"�*!&%-!4 '2�!',.2��%D ,3!$/.+&%@ (3+&%/4!,3%%, A/*3/$&/ /A%'+&&GD . 4/&/13+?%% L�. �"!('!!.+% �L�. �!$!5+, A3% A/4/�% U,+&1!&5%3(2"# ' "%&!@(/@ ' 5!&/@ *!"!&%# 1 44. �,+&*+3,&G! 3+)-4!3G "%5!./1/ B!3!A+ (*"%&+ /'&/.+&%# "%5+, .!3D&## U%3%&+ "%5+, '(2"/./@ *%+4!,3, '3!*&##U%3%&+ "%5+, .!3D&## .G'/,+ "%5+, .G'/,+ 1"+)&%5G, U%3%&+ 1"+)&%5G), .!3D&!@ B!"�',% (U%3%-&+ &/'+, .G'/,+ &/'+, *"%&+ &�$+, U%3%&+ &�$+), +"-.!/"#3&GD /,3/',(/. (.G'/,+ +"-.!/"#3&/1//,3/',(+ /, &+)/'A%&+"-&/@ ,/B(% */ A3/',%/&+) %)4!3#"%'- 4!F*2 ',+&*+3,&G4% ,/B(+4%, A3%-&#,G4% . (3+&%/"/1%%. �"# %)4!3!&%# +"-.!/"#3&GD /,3/',(/. ,+(F! A3!*"/F!&/ 96 &!',+&*+3,-&GD 3+)4!3/., %'A/"-)2!4GD *"# /A%'+&%# U%3%&G +"-.!/"#3&/1/ /,3/',(+ &+ 23/.&! +"-.!/"3!)5/., ("G(/., A3!4/"#3/. % 4/"#3/.; U%3%&G 4!*%+"-&/@ % "+,!3+"-&/@ ',!&/( +"-.!/", 4!-F+"-.!/"#3&GD A!3!1/3/*/(, 1"2$%&G, + ,+(F! A/A!3!B&/1/ 3+)4!3+ (+F*/@ %) +"-.!/". �+,!3%+"%)4!3!&%@ /$3+$/,+& &+ (/4A-�,!3! . A3%("+*&/4 A+(!,! Statistica 6.0 ' 5!"-� /,$/3+ A3%)&+(/.

139

"%5!./1/ B!3!A+, %4!��%D .G3+F!&&G! '.#)% ' 3+)4!3+4% +"-.!/"#3&GD /,3/',(/.. �5!&(+ ,!'-&/,G '.#)% 4!F*2 (3+&%/4!,3%B!'(%4% A3%)&+(+4% A3/./*%"+'- .&2,3% %''"!*2!4/@ 132AAG¥.&2,3%132AA/.+# (/33!"#5%#) A/ .!"%B%&! (/�??%5%!&,+ (/33!"#5%% «r». �,!A!&- '.#)% /5!&%-.+"+'- A/ '%',!4! ��&*!" (1978):

1 < 0,10 — '.#)- /,'2,',.2!,;0,1 < 1 < 0,3 — '"+$+# ',!A!&- '.#)%;0,3 < 1 < 0,6 — 24!3!&&+# ',!A!&- '.#)%;0,6 < 1 < 0,8 — '%"-&+# ',!A!&- '.#)%;0,8 < 1 < 1,0 — ,!'&+# '.#)-.&�_��z�� �������������. �"# D+3+(,!3%',%(% %)2B+!4/1/ (3+&%/"/1%B!'(/1/ 4+,!3%+-

"+ A3/./*%"/'- %''"!*/.+&%! (+B!',.+ .G$/3(% B!3!A/. A2,!4 /5!&(% )&+B!&%@ A3%)&+(/. A/,+$"%5+4 (+,!1/3%@ +$'/"�,&GD 3+)4!3/. B!3!A+ L�. �"!('!!.+ % �L�. �!$!5+ (1964). �/'"! �,/-1/ /A3!*!"#"+'- ,%A/.+# A3%&+*"!F&/',- B!3!A/. ' A/4/�-� 4!,/*+ 3+'B!,+ A/(+)+,!"!@ "%5!./-1/ B!3!A+. �G"/ .GB%'"!&/ 4 2(+)+,!"#: .!3D&%@ "%5!./@, &�$&G@ *"%&&/NU%3/,&G@, 1"+)&%B&G@% &/'/./@ 2(+)+,!"%. �+"!! .'! B!3!A+ . %)2B!&&/@ (3+&%/"/1%B!'(/@ '!3%% $G"% 3+)*!"!&G &+,3% 132AAG . '//,.!,',.%% '/ )&+B!&%#4% .!3D&!"%5!./1/ 2(+)+,!"#:

• 2)(/"%5G! ("!A,/A3/)/AG) (%&*!(' ¼ 51,2);• '3!*&## U%3%&+ "%5+ (4!)/A3/)/AG) (%&*!(' 51,3–54,7);• U%3/(/"%5G! (�@3%A3/)/AG) (%&*!(' ¾ 54,8). %''"!*2!4/@ &+4% .G$/3(! A3!/$"+*+�, B!3!A+ '/ '3!*&!@ ?/34/@ "%5!./1/ B!3!A+, B,/

'.%*!,!"-',.2!, / &/34+"-&/',% 3+'A3!*!"!&%# . .G$/3(!.�&+"%) ',+,%',%B!'(%D *+&&GD A/(+)+", B,/ U%3%&+ +"-.!/"#3&/1/ /,3/',(+ &!/*%&+(/.+ .

3+)"%B&GD !1/ /,*!"+D % %)4!&#!,'# '"!*2��%4 /$3+)/4. /$"+',% 4!*%+"-&/1/ 3!)5+ /&+ '/-',+."#!, . '3!*&!4 7,5 ± 0,2 44, . /$"+',% "+,!3+"-&/1/ 3!)5+ 24!&-U+!,'# */ 7,1 ± 0,2 44, *+"!!)&+B!&%# ./)3+',+�, % */',%1+�, &+%$/"-U%D . /$"+',% A!3./1/ 4/"#3+ (13,7 ± 0,5 44), A/'"! B!-1/ '&/.+ 24!&-U+�,'# % &+ 23/.&! ,3!,-!1/ 4/"#3+ '/',+."#�, 12,3 ± 0,4 44.

�,&/U!&%! U%3%&G +"-.!/"#3&/1/ /,3/',(+ ( 1"2$%&! +"-.!/"G 4!*%+"-&/1/ 3!)5+ '/',+.-"#!, . '3!*&!4 0,72 ± 0,04, *+"!! )&+B!&%# 24!&-U+�,'# % ',+&/.#,'# 4%&%4+"-&G4% . /$"+',%("G(+ (0,63 ± 0,03). �+B%&+# ' A!3./1/ A3!4/"#3+ (1,01 ± 0,05) /,&/U!&%! U%3%&G +"-.!/"#3&/1//,3/',(+ ( 1"2$%&! +"-.!/"G ./)3+',+!, % */',%1+!, &+%$/"-U%D )&+B!&%@ . /$"+',% A!3./1/ 4/-"#3+ (1,57 ± 0,1). �/"2B!&&G! *+&&G! '.%*!,!"-',.2!, / ,/4, B,/ . /$"+',% A!3!*&%D )2$/. .G'/,++"-.!/"#3&/1/ /,3/',(+ A3!/$"+*+!, &+* !1/ U%3%&/@, ,/1*+ (+( . /$"+',% $/(/.GD % )+*&%D )2$/.?/34+ +"-.!/"#3&/1/ /,3/',(+ '4!&#!,'# &+ $/"!! &%)(2� % U%3/(2�.

�//,&/U!&%# 4!F*2 3+)4!3+4% "+,!3+"-&/@ % 4!*%+"-&/@ ',!&/( +"-.!/" ,+(F! 3+)"%B&G.�%3%&+ 4!*%+"-&/@ ',!&(% +"-.!/" /$/%D 3!)5/., A!3./1/ A3!4/"#3+ % .'!D 4/"#3/. A3!/$"+*+!,&+* U%3%&/@ "+,!3+"-&/@ ',!&(%, . ,/ .3!4# (+( . +"-.!/"+D ("G(+ % .,/3/1/ A3!4/"#3+ "+,!-3+"-&+# ',!&(+ U%3! 4!*%+"-&/@.

�,+,%',%B!'(%@ +&+"%) *+&&GD A/(+)+", B,/ /,&/U!&%! U%3%&G +"-.!/"#3&/1/ /,3/',(+ (1"2$%&! +"-.!/" (/33!"%32!, ' .!3D&!"%5!.G4 2(+)+,!"!4 ('%"-&G! /,3%5+,!"-&G! '.#)%), 1"+)-&%B&G4 2(+)+,!"!4 (24!3!&&G! /,3%5+,!"-&G! '.#)%), &/'/.G4 2(+)+,!"!4 (24!3!&&G! A/"/F%-,!"-&G! '.#)%), *"%&&/NU%3/,&G4 &�$&G4 2(+)+,!"!4 (24!3!&&G! A/"/F%,!"-&G! '.#)%). �%3%-&+ 4!*%+"-&GD ',!&/( +"-.!/" (/33!"%32!, ' .!3D&!"%5!.G4 2(+)+,!"!4 (24!3!&&G! /,3%5+,!"--&G! '.#)%), &/'/.G4 2(+)+,!"!4 ('%"-&G! A/"/F%,!"-&G! '.#)%). �%3%&+ "+,!3+"-&GD ',!&/(+"-.!/" (/33!"%32!, ' 1"+)&%B&G4 2(+)+,!"!4 ('%"-&G! /,3%5+,!"-&G! '.#)%) % ' &/'/.G4 2(+)+-,!"!4 ('%"-&G! A/"/F%,!"-&G! '.#)%).

�&+"%) A/ ?/34! "%5!./1/ B!3!A+ (�@3%-, 4!)/-, "!A,/A3/)/AG) A/(+)+", B,/ 2 "!A,/A3/)/-A/. U%3%&+ +"-.!/"#3&/1/ /,3/',(+ */',/.!3&/ $/"-U!, B!4 2 4!)/- % �@3%A3/)/A/.. �"2$%&++"-.!/" 2 4!)/A3/)/A/. */',/.!3&/ 4!&-U!, B!4 2 �@3%- % "!A,/A3/)/A/., + U%3%&+ "+,!3+"-&GD% 4!*%+"-&GD ',!&/( +"-.!/" &! %4!!, */',/.!3&GD 3+)"%B%@ &+ B!3!A+D ' 3+)"%B&/@ ?/34/@ "%-5!./1/ B!3!A+.

$ ��� . �3/.!*!&&/! +&+,/4%B!'(/! %''"!*/.+&%! &+ 4+5!3%3/.+&&GD B!3!A+D A/)./"%"/A3!*',+.%,- 4+,!4+,%B!'(2� 4/*!"- +"-.!/"#3&GD /,3/',(/. . )+.%'%4/',% /, ,%A+ "%5!./1/ B!3!-A+. �,/ ',+"/ ./)4/F&G4 $"+1/*+3# %'A/"-)/.+&%� 3#*+ &!',+&*+3,&GD %)4!3!&%@ +"-.!/"#3&GD/,3/',(/. */A/"&%,!"-&/ ( '2�!',.2��!@ A3/13+44! %''"!*/.+&%# ',+&*+3,&GD 3+)4!3/. B!3!A+.

�A%'/( "%,!3+,23G:1. �"!('!!. L�., �!$!5 �L�. �3+&%/4!,3%#: �!,/*%(+ +&,3/A/"/1%B!'(%D %''"!*/.+&%@. —

�.: �+2(+, 1964.

140

2. �/"/,+3!.+ L., /A/3/. �L�. �%3231%B!'(+# +&+,/4%# 1/"/.G. — �.: �!*%5%&+, 1968.— 227'.

3. �%D+@"/. �L�., �/"!'&%(/. �L�. �&+,/4%B!'(%! /'&/.G ,/4/13+?%% "%5+: �,"+' — �.:�!*%5%&+, 1976. —216 '.

4. �A!3+&'(%@ L�., �+@B!&(/ �L�. �/34+ % (/&',32(5%# B!3!A+. — �.: �!*%5%&+, 1980.5. �!3&+*'(%@, �L�. �'&/.G B!"�',&/N"%5!./@ D%3231%% % D%3231%B!'(/@ ',/4+,/"/1%%. —

3-! %)*. — �.: �!*. "%,!3+,23+, 2007. — 408 '.

!�!;',,!�0+J!&2!1!>+%'�)!/(+">,!�0+)+^&!,+%'�)!>!0!,q+11+0"$2"q')1+,+%'�)!/&'J+��++

$#$. %������ (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#1 �+?!*3+ &/34+"-&/@ +&+,/4%%2 �+?!*3+ /,/3%&/"+3%&1/"/1%%,

�������������������: 1 U�6. !������ ( ���., �. �. �.), 2 !�/. >��$���� (���., ����.)

"����z����z. �3/&%B!'(%@ ,/&)%""%, (�) — �,/ %&?!(5%/&&/N+""!31%B!'(/! )+$/"!.+-&%! ' 4!',&G4% A3/#."!&%#4% . .%*! ',/@(/@ ./'A+"%,!"-&/@ 3!+(5%% &!$&GD 4%&*+"%&, 4/3?/-"/1%B!'(% .G3+F+��!@'# +"-,!3+5%!@, �(''2*+5%!@ % A3/"%?!3+5%!@L�+$/"!.+!4/',- D3/&%B!-'(%4 ,/&)%""%,/4 '3!*% ,32*/'A/'/$&/1/ &+'!"!&%# */',%1+!, 11–16 % (�/A+ L�., 1984; �/"*+-,/. �L�., 1994; �+"-B2& L., 1998; �).%& �L�., 2004). �2�!',.2!, 3#* A+,/"/1/+&+,/4%B!'(%D("+''%?%(+5%@ �. �+,/"/1/+&+,/4%B!'(+# ("+''%?%(+5%# � L�. �+(+ (1933) .G*!"#!, ,3% /'-&/.&GD ,%A+ �:

1. �3/&%B!'(%@ A/.!3D&/',&G@ ,/&)%""#3&G@ "+(2&%,, #).!&&G@ %"% &!#).!&&G@. /'A+"%-,!"-&G@ A3/5!'' "/(+"%)2!,'# A3!%42�!',.!&&/ . "+(2&+D 4%&*+"%&.

2. �. �3/&%B!'(%@ A+3!&D%4+,/)&G@ ,/&)%""%, (/$/',3!&&G@). �+%$/"-U%! %)4!&!&%# &+-$"�*+�,'# . "%4?+*!&/%*&/@ ,(+&% (/B+1% 3+)4#1B!&%#, '4+)+&&/',- 13+&%5 ?/""%(2"/.).

�. �/.!3D&/',&G@ D3/&%B!'(%@ A+3!&D%4+,/)&G@ '("!3/,%B!'(%@ ,/&)%""%,. �+ A!3.G@A"+& .G',2A+!, /$%"-&/! 3+)3+',+&%! '/!*%&%,!"-&/@ ,(+&% . A+3!&D%4! 4%&*+"%&, ?/""%(2"GA/B,% .'!1*+ /,'2,',.2�,, �A%,!"%@ /',+!,'# 4+"/%)4!&!&&G4.

3. �"2$/(%@ D3/&%B!'(%@ A+3!&D%4+,/)&G@ '("!3/,%B!'(%@ ,/&)%""%,. �+3+(,!3%)2!,'#/$%"-&G4 3+)3+',+&%!4 '/!*%&%,!"-&/@ ,(+&% .$"%)% (+A'2"G % A+3+,/&)%""#3&/@ ,(+&%.

�).!',&/, B,/ A/"2(/"%B!',.!&&+# /5!&(+ ./'A+"%,!"-&/N3!A+3+,%.&/1/ A3/5!''+ . A+,/-4/3?/"/1%% %'A/"-)2!,'# */',+,/B&/ U%3/(/ (�32%& �L�., 1991, 1993, 1994, 1997, 1998; �/&/&/.�L., 1999; �23!&(/. �L�., 2000; �/.+"!&(/ L�., �23!&(/. �L�., �/(U+3/. L�., 2001; �.,2U!&(/�L�., 2003), &/ */ &+',/#�!1/ .3!4!&% /&+ &! A3%4!&#"+'- *"# 4/3?/"/1%B!'(/@ D+3+(,!3%',%(%./'A+"%,!"-&/1/ A3/5!''+ A3% � . ?+)! ("%&%B!'(/@ 3!4%''%% )+$/"!.+&%#.

A+,/4/3?/"/1%% U%3/(/ A3%4!&#!,'# 4!,/* /A3!*!"!&%# +(,%.&/',% 3+@/&/. #*3GU(/-.GD /31+&%)+,/3/. (��) (CrockerJ., NarP., 1987; CrockerJ., EganM. J., 1988; �3/(!3 �., 1999; �2-3!&(/. �L�., �+''/D%& �L�., �+D+3/. �L�., 2004), B,/ *+!, ./)4/F&/',- /5!&%,- ',!A!&- &+A3#-F!&&/',% 3%$/'/4+"-&/1/ '%&,!)+ . ("!,(+D 3+)"%B&GD ,(+&!@. �3% �,/4 +(,%.&/',- 3+@/&/. #*-3GU(/.GD /31+&%)+,/3/. . ("!,(+D 3+)"%B&GD '"/!. 4&/1/'"/@&/1/ A"/'(/1/ �A%,!"%# '"%)%',/@/$/"/B(% (��) &!$&GD 4%&*+"%& (��) A3% � . ?+)! ("%&%B!'(/@ 3!4%''%% */ &+',/#�!1/ .3!-4!&% &! /A3!*!"#"%. �,% 4!,/*G 4/12, $G,- %'A/"-)/.+&G &! ,/"-(/ *"# 4/3?/"/1%B!'(/@ D+3+(-,!3%',%(% ./'A+"%,!"-&/N3!A+3+,%.&/1/ A3/5!''+ . '"%)%',/@ /$/"/B(! ��, &/ % *"# /5!&(% ,!-3+A!.,%B!'(/1/ A+,/4/3?/)+ � . ?+)! ("%&%B!'(/@ 3!4%''%% )+$/"!.+&%#.

*��z �����������. %)2B%,- /'/$!&&/',% 4/3?/"/1%B!'(/@ *%+1&/',%(% D3/&%B!'(/1/,/&)%""%,+ . ?+)! ("%&%B!'(/@ 3!4%''%% )+$/"!.+&%# ' %'A/"-)/.+&%!44!,/*+ A/"2(/"%B!',.!&-&/@ /5!&(% ./'A+"%,!"-&/N3!A+3+,%.&/1/ A3/5!''+.

J����� ������ . �+',/#�+# 3+$/,+ .GA/"&!&+ &+ $+)! (+?!*3G /,/3%&/"+3%&1/"/1%%% (+?!*3G &/34+"-&/@ +&+,/4%% ���� �� �!"��� �%&)*3+.'/53+).%,%# �/''%%. �/* &+U%4&+$"�*!&%!4 &+D/*%"/'- 26 42FB%& % 8 F!&�%& . ./)3+',! 18–36 "!, ('3!*&!! )&+B!&%!:22,2+0,897 1/*+) ' *%+1&/)/4 D3/&%B!'(/1/ ,/&)%""%,+ . ?+)! ("%&%B!'(/@ 3!4%''%%. � .'!D A+-5%!&,/., 2B+',./.+.U%D . %''"!*/.+&%%, A3/./*%"'# �&*/'(/A%B!'(%@ /'4/,3 ���N/31+&/., $3+-"+'- A3%5!"-&+# $%/A'%# &!$&GD 4%&*+"%& (��). �"# /5!&(% �� %'A/"-)/.+"%'- 2 U(+"G: A/"2-

141

(/"%B!',.!&&+# 4+(3/'(/A%B!'(+# /5!&(+ ',32(,23&GD %)4!&!&%@ &!$&GD 4%&*+"%& A3% �, '/-1"+'&/ (/,/3/@ /5!&%.+"%'- '"!*2��%! (3%,!3%%: 1%A!3A"+)%# &!$&GD 4%&*+"%&, ',!A!&- 2.!"%-B!&%# *%+4!,3+ 2',-# "+(2& &!$&GD 4%&*+"%&, ',!A!&- 'A+#&&/',% 4%&*+"%& ' *2F(+4%, ',!A!&-.+"%(//$3+)&/1/ 2,/"�!&%# (3+!. A!3!*&%D % )+*&%D *2F!( (A3%)&+( �L�. �3!/$3+F!&'(/1/,1938), &+"%B%! (+)!/)&/N1&/@&GD A3/$/( . "+(2&+D &!$&GD 4%&*+"%&, &+"%B%! F%*(/1/ 1&/# . "+-(2&+D, ',!A!&- .G3+F!&&/',% '("!3/)+, 2.!"%B!&%! 3!1%/&+3&GD "%4?+,%B!'(%D 2)"/., /,!B&/',-.!3D&!1/ (3+# *2F(% (3+# 4%&*+"%&G . 4!',! A!3!D/*+ A!3!*&!@ *2F(% . )+*&�� (A3%)&+(L�. �+(+, 1933), 1%A!3!4%# A!3!*&%D *2F!( (A3%)&+( �%)!, 1921) % A/"2(/"%B!',.!&&G@ 4!,/*/5!&(% ',!A!&% .G3+F!&&/',% ("!,/B&/@ %&?%"-,3+5%%, (/,/3G@ A/)./"#" %)2B%,- ,+(%! A/(+)+-,!"%, (+( +(,%.&/',- ./'A+"%,!"-&/1/ A3/5!''+, "%4?/5%,+3&+# %&?%"-,3+5%#, 4+(3/?+1+"-&+#%&?%"-,3+5%#, '/*!3F+&%! ?%$3/$"+',/., %&?%"-,3+5%# A"+)4/5%,+4%, ',+), /,!( �� ��, '/-*!3F+&%! (+A%""#3/., ?%$3/). �"# (+F*/1/ A+3+4!,3+ /A3!*!"#"%'- ',!A!&% .G3+F!&&/',%, /5!-&%.+!4G! . $+""+D. �%',/"/1%B!'(%@ 4+,!3%+", A/"2B!&&G@ A3% A3%5!"-&/@ $%/A'%%, /$3+$+,G-.+"'# ,3+*%5%/&&G4 'A/'/$/4, %)1/,+."%.+"%'- 1%',/"/1%B!'(%! '3!)G, (/,/3G! /(3+U%.+"%'-'"!*2��%4% 4!,/*+4%:

- 1!4+,/('%"%&/4 % �/)%&/4 *"# A3/.!*!&%# /$)/3&/@ 4%(3/'(/A%%;- A%(3/?2('%&/4 A/ +&N�%)/&2 *"# %*!&,%?%(+5%% (/""+1!&/.GD ./"/(/&- ?2('!"%&N"%,%!.G4 (+34%&/4 A/ !@1!3,2 *"# .G#."!&%# �"+',%B!'(%D ./"/(/&;- 4!,/* %4A3!1&+5%%3+',./3/4 +)/,&/(%'"/1/ '!3!$3+ A/ �/4/3% *"# /A3!*!"!&%# 3!,%(2-

"#3&/1/ (+3(+'+ ?3+14!&,/. �� ��.- ' 5!"-� 4/3?/"/1%B!'(%@ %*!&,%?%(+5%% A"+)4+,%B!'(%D ("!,/( . '/',+.! ./'A+"%,!"--

&/1/ ("!,/B&/1/ %&?%"-,3+,+ '/$',.!&&/@ A"+',%&(% '"%)%',/@ /$/"/B(% �� % /5!&(% &+A3#-F!&&/',% $!"(/./'%&,!,%B!'(%D A3/5!''/. . �A%,!"%% '"%)%',/@ /$/"/B(% &!$&GD 4%&*+"%&A3/.!*!&+ 3!+(5%# ' A%3/&%&/4 G- 4!,%"/.G4 )!"!&G4 A/ 4!,/*%(! �3+U!.

- ' 5!"-� .G#."!&%# (%'"GD A3/,!%&/., +''/5%%3/.+&&GD ' 3+@/&+4% #*3GU(/.GD /31+&%-)+,/3/. . �A%,!"%+"-&GD ("!,(+D �� �� A3% � *!A+3+?%&%3/.+&&G! 1%',/"/1%B!'(%! '3!)G%4A3!1&%3/.+"%'- (/""/%*&G4 3+',./3/4 +)/,&/(%'"/1/ '!3!$3+.

�"# /5!&(%+ (,%.&/',% �� . �A%,!"%+"-&GD ("!,(+D �� �� A/*'B%,G.+"% +$'/"�,&/!B%'"/ #*3GU!(, %&,3+&2("!/"#3&GD % �(',3+&2("!/"#3&GD .("�B!&%@, +$'/"�,&/! '244+3&/!B%'"/ .("�B!&%@ &+ �A%,!"%+"-&2� ("!,(2, B%'"/ �A%,!"%/5%,/. 1-1/ % 2-1/ ,%A/..

&�_��z�� . �"# A+3+4!,3/., %''"!*/.+&&GD A3% A/"2(/"%B!',.!&&/@ 4+(3/'(/A%B!'(/@/5!&(!, $G"% .G#."!&G '"!*2��%! *%+1&/',%B!'(%! (3%,!3%%:

1. �%A!3A"+)%# &!$&GD 4%&*+"%& (A/ �L�. �3!/$3+F!&'(/42, 1956): 0 $+""/. — &!$&G! 4%&-*+"%&G 3+'A/"+1+�,'# )+ *2F(+4%; 1 $+"" — 1%A!3A"+)%# &!$&GD 4%&*+"%& 1 ',!A!&% (4%&*+"%&+A!3!(3G.+!, /*&2 ,3!,- 3+'',/#&%# 4!F*2 '!3!*%&/@ './$/*&/1/ (3+# A!3!*&!@ *2F(% % .!3,%(+"--&/1/ 23/.&# #)GB(+); 2 $+""+ — 1%A!3A"+)%# &!$&GD 4%&*+"%& 2 ',!A!&% (4%&*+"%&+ A!3!(3G.+!,*.! ,3!,% 3+'',/#&%# 4!F*2 '!3!*%&/@ './$/*&/1/ (3+# A!3!*&!@ *2F(% % .!3,%(+"-&/1/ 23/.&##)GB(+); 3 $+""+ — 1%A!3A"+)%# &!$&GD 4%&*+"%& 3 ',!A!&% (4%&*+"%&+ */D/*%, */ '3!*&!@ "%&%%3+'',/#&%# 4!F*2 '!3!*%&/@ './$/*&/1/ (3+# A!3!*&!@ *2F(% % .!3,%(+"-&/1/ 23/.&# #)GB(+).

2. �,!A!&- 2.!"%B!&%# *%+4!,3+ 2',-# "+(2& &!$&GD 4%&*+"%&: 1 $+"" — "+(2&G &!$&GD4%&*+"%& 1–2 44 . *%+4!,3!; 2 $+""+ — "+(2&G &!$&GD 4%&*+"%& 3–5 44 . *%+4!,3!; 3 $+""+ —"+(2&G &!$&GD 4%&*+"%& 6–8 44 . *%+4!,3!.

3. �,!A!&- 'A+#&&/',% &!$&GD 4%&*+"%& ' *2F(+4%: 1 $+"" — 4%&*+"%&G ' &!$&G4% *2F-(+4% &! 'A+#&G; 2 $+""+ — %4!�,'# !*%&%B&G! 'A+@(% 4%&*+"%& ' &!$&G4% *2F(+4%; 3 $+""+ —4%&*+"%&G ' &!$&G4% *2F(+4% 'A+#&G )&+B%,!"-&/.

4. �,!A!&- .+"%(//$3+)&/1/ 2,/"�!&%# (3+!. A!3!*&%D % )+*&%D *2F!( (A3%)&+( �L�. �3!-/$3+F!&'(/1/, 1938): 0 $+""/. — .+"%(//$3+)&/! 2,/"�!&%! (3+!. A!3!*&%D % )+*&%D *2F!( /,-'2,',.2!,; 1 $+"" — .+"%(//$3+)&/! 2,/"�!&%! (3+!. *2F!( 1–2 44; 2 $+""+ — .+"%(//$3+)&/!2,/"�!&%! (3+!. &!$&GD *2F!( ('.GU! 2 44).

5. �+"%B%! (+)!/)&/N1&/@&GD A3/$/( . "+(2&+D &!$&GD 4%&*+"%&: 0 $+""/. — /,'2,',.%!(+)!/)&/N1&/@&GD A3/$/( . "+(2&+D &!$&GD 4%&*+"%&; 1 $+"" — (+)!/)&/N1&/@&G! A3/$(% %4!�,-'# . "+(2&+D &!$&GD 4%&*+"%&.

6. �+"%B%! F%*(/1/ 1&/# . "+(2&+D &!$&GD 4%&*+"%&: 0 $+""/. — /,'2,',.%! F%*(/1/ 1&/#. "+(2&+D &!$&GD 4%&*+"%&; 1 $+"" — F%*(%@ 1&/@ %4!!,'# . "+(2&+D &!$&GD 4%&*+"%&.

7. �,!A!&- .G3+F!&&/',% '("!3/)+ &!$&GD 4%&*+"%&: 0 $+""/. — /,'2,',.%! '("!3/)+ &!$-&GD 4%&*+"%&; 1 $+"" — '"+$G@ '("!3/) &!$&GD 4%&*+"%&; 2 $+""+ — 24!3!&&G@ '("!3/) &!$&GD4%&*+"%&; 3 $+""+ — .G3+F!&&G@ '("!3/) &!$&GD 4%&*+"%&.

142

8. �.!"%B!&%! 3!1%/&+3&GD "%4?+,%B!'(%D 2)"/. (A/ L. �+"-B2&2, 1974):0 $+"" — /,'2,-',.%! 2.!"%B!&%# 3!1%/&+3&GD .!3D&!N$/(/.GD U!@&GD % )+B!"�',&GD"%4?+,%B!'(%D 2)"/.;1 $+"" — 2.!"%B!&%! /,*!"-&GD 3!1%/&+3&GD .!3D&!N$/(/.GD U!@&GD % )+B!"�',&GD "%4?+,%-B!'(%D 2)"/.; 2 $+""+ — *%??2)&G@ U!@&G@ "%4?+*!&%,.

9. �,!B&/',- .!3D&!1/ (3+# *2F(% 4%&*+"%&G . 4!',! A!3!D/*+ A!3!*&!@ *2F(% . )+*&��¥A3%)&+( L�. �+(+, 1933): 0 $+""/. — /,'2,',.2!,; 1 $+"" — %4!!,'#.

10. �%A!3!4%# A!3!*&%D *2F!( (A3%)&+( �%)!-Guiser, 1921): 0 $+""/. — /,'2,',.2�,; 1 $+""— %4!!,'#.

�3% 4%(3/'(/A%B!'(/@ /5!&(! A/"2B!&G '"!*2��%! (3%,!3%%:1. �,!A!&- .G3+F!&&/',% "%4?/("!,/B&/@ %&?%"-,3+5%% �� �� A3% �: 1 $+"" — .

',3/4! '"%)%',/@ /$/"/B(% �� 3+'A/"+1+�,'# *%??2)&/ 3+''!#&&G!, /*%&/B&G! "%4?/5%,G;2 $+""+ — /$&+32F%.+�,'# 4&/1/B%'"!&&G! *%??2)&/ 3+''!#&&G! "%4?/5%,G $!) ,!&*!&5%% (/B+1/.G4 '(/A"!&%#4%; 3 $+""+ — &+3#*2 ' *%??2)&/ 3+'A/"/F!&&G4% "%4?/5%,+4% .%*&G %D/B+1/.G! '(/A"!&%#.

2. �,!A!&- .G3+F!&&/',% A"+)4+,%)+5%% ',3/4G '"%)%',/@ �� �� A3% �: 0 $+""/. — .',3/4! '"%)%',/@ /$/"/B(% �� /,'2,',.2�, A"+)4+,%B!'(%! ("!,(%; 1 $+"" — . ',3/4! '"%)%',/@/$/"/B(% �� 3+'A/"+1+�,'# !*%&%B&G! A"+)4+,%B!'(%! ("!,(%; 2 $+""+ — .G#."#�,'# *%??2)&/3+''!#&&G! /*%&/B&G! A"+)4+,%B!'(%! ("!,(%; 3 $+""+ — &+3#*2 ' *%??2)&/ 3+''!#&&G4% A"+)-4+,%B!'(%4% ("!,(+4% /$&+32F%.+�,'# %D /B+1/.G! '(/A"!&%#.

3. �,!A!&- .G3+F!&&/',% %&?%"-,3+5%% ?%$3/$"+',+4%: 1 $+"" — . ',3/4! '"%)%',/@ /$/-"/B(% �� 3+'A/"+1+�,'# !*%&%B&G! ?%$3/$"+',G; 2 $+""+ — .G#."#�,'# *%??2)&/ 3+''!#&&G!/*%&/B&G! ?%$3/$"+',G; 3 $+""+ — &+3#*2 ' *%??2)&/ 3+''!#&&G4% ?%$3/$"+',+4% /$&+32F%-.+�,'# %D /B+1/.G! '(/A"!&%#.

4. �,!A!&- .G3+F!&&/',% �/)%&/?%"-&/@ %&?%"-,3+5%% �� �� A3% �: 0 $+""/. — .',3/4! '"%)%',/@ /$/"/B(% �� �/)%&/?%"G /,'2,',.2�,; 1 $+"" — *%??2)&/ 3+''!#&&G!, /*%-&/B&G! �/)%&/?%"G; 2 $+""+ — /$&+32F%.+�,'# 4&/1/B%'"!&&G! *%??2)&/ 3+''!#&&G! �/)%&/-?%"G $!) ,!&*!&5%% ( /B+1/.G4 '(/A"!&%#4%; 3 $+""+ — &+3#*2 ' *%??2)&/ 3+'A/"/F!&&G4%�/)%&/?%"+4% .%*&G %D /B+1/.G! '(/A"!&%#.

5. �,!A!&- .G3+F!&&/',% 4+(3/?+1+"-&/@ %&?%"-,3+5%% �� �� A3% �: 0 $+""/. — .',3/4! '"%)%',/@ /$/"/B(% �� 4+(3/?+1% /,'2,',.2�,; 1 $+"" — *%??2)&/ 3+''!#&&G!, /*%&/B-&G! 4+(3/?+1%; 2 $+""+ — /$&+32F%.+�,'# 4&/1/B%'"!&&G! *%??2)&/ 3+''!#&&G! 4+(3/?+1%.

6. �,!A!&- .G3+F!&&/',% '/*!3F+&%# (+A%""#3/. . '/$',.!&&/@ A"+',%&(! �� �� A3% �:1 $+"" — . '/$',.!&&/@ A"+',%&(! '"%)%',/@ /$/"/B(% �� 3+'A/"+1+�,'# /*%&/B&G! (+A%""#3G;2 $+""+ — 24!3!&&/! (/"%B!',./ (+A%""#3/.; 3 $+""+ — $/"-U/! (/"%B!',./ (+A%""#3/..

7. �,!A!&- .G3+F!&&/',% ',+)+ �� �� A3% �: 1 $+"" — . ',3/4! '"%)%',/@ /$/"/B(% ��',+) .G3+F!& '"+$/; 2 $+""+ — ',+) .G3+F!& 24!3!&&/; 3 $+""+ — ',+) .G3+F!& 3!)(/. �,!A!&-.G3+F!&&/',% /,!(+ �� �� A3% �:1 $+"" — . ',3/4! '"%)%',/@ /$/"/B(% �� /,!( .G3+F!&'"+$/; 2 $+""+ — /,!( .G3+F!& 24!3!&&/; 3 $+""+— /,!( .G3+F!& 3!)(/.

8. �,!A!&- .G3+F!&&/',% ?%$3/)+ ',3/4G �� �� A3% �: 1 $+"" — . ',3/4! '"%)%',/@/$/"/B(% �� ?%$3/) .G3+F!& '"+$/; 2 $+""+ — ?%$3/) .G3+F!& 24!3!&&/; 3 $+""+ — ?%$3/).G3+F!& '%"-&/.

9. �,!A!&% +(,%.&/',% ./'A+"!&%#: /,'2,',.%! +(,%.&/',% ./'A+"!&%# — &!@,3/?%"G /,-'2,',.2�,, &%)(+# ',!A!&- +(,%.&/',% ./'A+"!&%# — &!@,3/?%"G %&?%"-,3%32�, ,/"-(/ '/$',-.!&&2� A"+',%&(2 '"%)%',/@ /$/"/B(%; 24!3!&&+# ',!A!&- +(,%.&/',% ./'A+"!&%# — &!@,3/?%"G%&?%"-,3%32�,, A/4%4/ '/$',.!&&/@ A"+',%&(% '"%)%',/@ /$/"/B(%, A/.!3D&/',&G@ % (3%A,+"--&G@ �A%,!"%@. �3% .G'/(/@ ',!A!&% +(,%.&/',% ./'A+"!&%# &+3#*2 ' .G3+F!&&/@ %&?%"-,3+5%!@'/$',.!&&/@ A"+',%&(% % �A%,!"%#, &+$"�*+!,'# 3+)32U!&%! �A%,!"%+"-&/1/ A"+',+ % .GD/* &!@-,3/?%"/. . A3/'.!, #4/( % &+ A/.!3D&/',- '"%)%',/@ /$/"/B(% &!$&GD 4%&*+"%&.

$ ��� :1. �/"2(/"%B!',.!&&+# /5!&(+ ',32(,23&GD %)4!&!&%@ �� A3% � A/)./"#!, 2&%?%5%3/-

.+,- A/*D/*G ( *%+1&/',%(! *+&&/1/ )+$/"!.+&%#;2. �3!*"/F!&&+# 4!,/*%(+ 4/F!, $G,- %'A/"-)/.+&+ &! ,/"-(/ *"# 4/3?/"/1%B!'(/@ D+3+(-

,!3%',%(% ./'A+"%,!"-&/ - 3!A+3+,%.&/1/ A3/5!''+ .�� ��, &/ % *"# /5!&(% ,!3+A!.,%B!'(/1/A+,/4/3?/)+ D3/&%B!'(/1/ ,/&)%""%,+ . ?+)! ("%&%B!'(/@ 3!4%''%% )+$/"!.+&%#.

143

�')*+= 3. ")04"1],-'�&!;1'J-)1+,+%'�)!/^+&4&>++

«SUPERLYMPH» TREATMENT OF DIABETIC FOOT SYNDROME AT PATIENTSWITH INSULIN-INDEPENDENT DIABETES (TYPE II)

O.A. Devyatkina (stud.)

Russian national research medical university in the name of N.I. PirogovThe department of endocrinology

Scientific adviser: G.N. Gudukina (candidate of medical science)

Relevance of the subject: There are a lot of unstudied questions of pathogenesis at patients with in-sulin-independent diabetes (type II) with diabetic foot syndrome. Arising scientific efforts show immunitymodifications, efficiency of treatment and normalization of immunological status with using of «Super-lymph» preparation.

Research objective: Results research of multimodality therapy of patients with insulin-independentdiabetes (type II) complicated with diabetic foot syndrome with using of «Superlymph».

Methods and materials: In research took part 30 patients with various forms and severities of di-abetic feet. Executed: microbiological research, clinical blood analysis, biochemical blood analysis, ultra-sound investigation of feet.

Research results: In the beginning of research patients were split into 2 groups depending on treat-ment regimens. First group included 10 patients with traditional treatment (antibacterial therapy, disag-gregants, angioprotectors, antioxidants, correction of hyperglycemia rate, surgical treatment, bandagewith ointments based on polyethylene glycol). Second group included 20 patients with using of «Super-lymph» preparation. This preparation delivered every day during 10 days per rectum with suppositorycontaining 25 units of active substance.

Schedule 1

Patients dividing according to complications pattern of diabetic foot syndrome

Disease forms of feet The 1st

groupThe 2nd

group Altogether

Deep ulceration usually infected but without invasion of articulationsor osseous tissue (the 2nd rate) 2 5 7

Deep ulceration with abscess formation with invasion of osseous tissueor septic arthritis (the 3rd rate) 6 11 17

Local gangrene of toe or forefoot (the 4th rate) 1 3 4

Gangrene of entire foot (the 5th rate) 1 1 2

Total 10 20 30

Microbiological research of wound exudate was executed to appraise the suppurative focus. In mi-crobiological research of wound exudate of 30 patients with syndrome of diabetic foot were detached 136stock cultures, which have 55 % of gram-positive flora and 45 % of gram-negative flora. Aerobic micro-scopic flora dominated in wound exudate: staphylococcus (48 %), Escherichia (18 %), proteus (16 %),streptococcus (8 %), pseudomonades (6 %), enterobacterium (4 %).

The majority of patients had frank vascular abnormalities. During ultrasound investigation of footvessels blood flow was completely absent on the diseased side at 8 patients. Vessel constriction on thelong stretch was diagnosticated at 13 patients. 6 patients had visual aneurismal extensions of femoral andpopliteal artery, 3 patients had aneurysm of minute vessels. 18 patients had atherosclerosis plaques.

Abnormalities of blood flow propertyAs you see in represented data (schedule 2) there is breakdown of flow properties against hyperfi-

brinogenemia. The rate of fibrinogen is 2,8 times higher than control index.

144

Schedule 2

Data on blood flow properties at patients with diabetic foot syndrome

Hemorheological indices Control groupN = 10

Patients with diabeticfoot syndrome

N = 30Hematocrit, % 34,5 38,76Fibrinogen, (g/l) 2,83 8,01Totalprotein, (g/l) 61,92 75,39Albumins, (%) 56,0 51,0Globulins, (%) 43,1 50,0A/Gindex 1,25 1,04

After execution of complex therapy the patients with syndrome of diabetic foot have improving ofblood flow properties. The rate of fibrinogen was decreased against complex therapy including cytokinetherapy.

Clinical blood analysis. Firm arising of rate of white blood cells was registered in peripheral blood.During neuropathic form the rate of lymphocytes was 1,6 times reduced, during ischemic form — 2 timesreduced. The shortage of lymphocytes shows immunodeficient disease of patients with.

Schedule 3

Alteration of peripheral blood during different forms of diabetic foot syndrome

GroupsData

Neuroischemic formof diabetic foot syndrome

Neuropathic formof diabetic foot syndrome

Ischemic formof diabetic

foot syndromeControl

White blood cells D109/l 7,2 9,7 9,5 6,6Stab neutrophils, % 2,8 3,6 3,5 2,1Segmented neutrophils, % 72,1 72,6 75,5 61,1Eosinocyte, % 1,3 2,4 3,2 2,6Monocytes, % 4,4 5,3 4,8 6,3Lymphocytes, % 19,7 17,3 14,6 28,8Blood sedimentation rate,mm per hour 10,7 45,6 45,2 7,2

Red blood cells D 1012/l 4,8 4,3 4,4 4,6Hemoglobulin, g/l 148 133 132 145

Patients in group using «Superlymph» preparation had shorter terms of disappearance of fever andintoxication signs up to 4 days, without «Superlymph»-6 days. Edema and hyperemia subsided in 9–10days using «Superlymph» preparation and 12-13 days without «Superlymph». Wound cleansing of puru-lo-necrotic mass and its filling with granulations was signed accordingly in 10–11 days and 13–14 days.

Conclusion: complex therapy of patients with insulin-independent diabetes (type II) with syndromeof diabetic foot including «Superlymph» preparation have an effect on faster wound healing, fast disap-pearance of intoxication signs, decline of patients required amputation of feet and compensation of insu-lin-independent diabetes.

List of references:1. Diabetic foot Udovichenko O.V., Grekova N.M.2. Interpretation of clinical laboratory analysis Khiggins K.3. Abnormality of hemolymphocirculation during surgical phase of diabetic foot syndrome and its

correction with prostaglandin E1 preparation Ereshko N.A.4. Preventive measures and medication of diabetic foot syndrome in ambulatory conditions Khra-

milin V.N.5. Ways of tactics improvements and surgical treatment of purulo-necrotic complications of diabet-

ic foot, Antonyuk S.M., Sviridov M.V., 2012

145

THE UTILIZATION OF OSTEOTROPIC MATERIAL «COLLOST»FOR FILLING BONE DEFECTS

E.Y. Dyachkova, D.Y. MilyukovaThe First Moscowstate medical university in the name of I.M. Sechenov

Department of surgical dentistry and maxillofacial surgery

Scientific adviser: Yu.A. Medvedev (prof., M. D.)

Actuality. The bone-plastic operations in dentistry and maxillofacial surgery are characterized withsome special features (high risk of wound infection, elimination transplantated or implantated materials,difficult configuration of defect, e.t.c.) and variety of clinic cases, what are needed principal different me-thods of treatment.

Today maxillofacial surgeons utilizate great number of osteotropic materials. Thus, there is noideal material on the world. It means that for each case doctors must choose optimal drugs and method oftreatment according to patological process, general condition of patient, own practice and volume of ma-nual skills.

In our practice during 3 years we successfully use osteoropic material Collost based on collagen Itype from skin of bulls.

The purpose of stydy was increasing of treatment effect of patients with different bone jaw defectsutilizating material Collost.

Materials and methods. On hospital-based oral and maxillofacial surgery The First MSMU of Se-chenov were followed 76 patients: 14 patients were with a diagnosis of odontogenic cysts of the upper (5cases) and lower (9 cases) jaw, mandibular fractures within the tooth row were in 37 cases, dystopic im-pacted third molars of the lower jaw (15 cases), maxillary sinus wall defects of the different nature (5 cas-es), oroantral fistula (5 cases).

Table

The distribution of patients according to disease

Groups of patients with different disease Number of patients, abs.Odontogenic cysts of jaws 14Fracture of mandibula 37Dystopic impacted third molars 15Defects of maxillary sinus walls 5Oroantal fistula 5

All patients after complex standard examination were carried out surgery to the extent necessarydepending on the diseases: the jaw cysts- cystectomy, removing of a tooth with filling material defect«Collost» (balls); fractures of the lower jaw within the tooth row- osteosynthesis with removing of a toothand filling of cavity of the bone using material «Collost» (cords and / or powder diluted on saline); dys-topic impacted third molars on the lower jaw, removing of the tooth and filling defect with material «Col-lost» (cords and small membrane); oroantral fistula- elimination of junction with the plastic oroantral fis-tula with local tissues and the using of membranes "Collost". There were comprehensive medical treat-ment and daily bandages.

Results. The postoperative period in all patients was smooth. Complications were absent.In carrying out the control X-ray and CT studies in 1 month a rapid start osteoreparative process af-

ter implantation of the material "Collost" wereindicated regardless of the type of defects.After 3 months the process of osteointegration and biodegradation were continued, defects were

filled on half, with newly formed bone.After 6 months no defects were detected almost on the X-ray examination. Clinically, signs of bone

cavity in any group of patients were notfound.Conclusion. The using of osteotropic material «Collos» showed excellent results during recon-

structive surgery for filling bone defects of the jaws. We therefore consider it appropriate to its applica-tion on practice of maxillofacial surgeons, and we recommend using it for filling bone cavities, regardlessof their nature and volume.

146

EPIDEMIOLOGY OF BREAST CANCER AMONG WOMEN OF FERTILE AGEIN THE CHELYABINSK REGION

".Y. Markina (ass.)Chelyabinsk state medical academy

The department of public health and health care

Scientific adviser: Y.�. Tyukov (head of a chair, professor)

The urgency of the issue. One of the most important issues of medical care is the female health inthe reproductive age. The reproductive age is one of main criteria which influence the frequency ofspreading women malignant tumours. According to the information of the International Agency for Re-search of Cancer (IARC), annually about 1 mln. 200 thousand become ill and suffer and 600 thousandwomen in the world at the age of 15-44 years die because of malignant breast tumours. Here, the morbidi-ty rate is 14,1 per 100000 women, high rates are noted in developed countries (26,9 °/////) and low ratesare noted in developing countries (10,6°/////)

The goal of the research is the comparative analysis of statistical data of the structure and dynamicsof oncological breast diseases of women of fertile age in the Chelyabinsk region.

Study materials and methods of the research. Fundamental study materials were primary medicaldocuments and official blanks of statistical reporting. The analysis of the morbidity of malignant breasttumours has been carried out in accordance with the International Statistical Classification of Diseasesand Related Health Problems (MKB-H), according to the the following heading: breast (�-50).

While carrying out the research we used the mathematical-statistical method. The morbidity of ma-lignant breast tumours has been studied on the basis of intensive («rough») and standardized indices per100 000 women. The authenticity of differences between compared values has been measured through theconfidence criterion (the criterion of accuracy t). In order to define the statistical importance of differenc-es or similarities of indices of compared complexes we have resorted to the calculation of non-parametricWilcoxon-White test for disconnected complexes ().

Results and discussion. The general negative tendency for the growth of malignant tumours of fe-male reproductive system is determined by the growth of malignant breast tumours, the morbidity ofwhich within the period of the research accurately (t > 2 when 3 < 0,05) grew from 67,6+3,0 to 80,6+3,0cases per 100 thousand women. This negative tendency for the growth of malignant breast tumours in theChelyabinsk region coincides with the dynamics of morbidity (r=+0,93+0,009) in the Russian Federationin general, and morbidity rates of the compared territories are not differentiated statistically (t < 2).

Higher morbidity rate of malignant tumours among women of fertile age is being registered forbreasts.Within the period of the research its rate was changing from 36,5+2,1 cases in 2006 to 38,5+2,2cases per 100 thousand women of reproductive age in 2008 and within the whole period of the research itwas statistically significantly higher (t > 2 when 3 < 0,05) than indices in the Russian Federation in gener-al. However, we did not manage to find out statistically (t< 2) significant dynamics of the index of theChelyabinsk region within the period of the research, morbidity rates were changing according to theyears of the research within the limits of random fluctuations. Besides, the dynamics of the morbidity inthe Chelyabinsk region was slightly correlated (r=+0,3+0,009) with indices in the Russian Federation.

While studying the role of the morbidity of malignant breast tumours among women of fertile agein the general morbidity of this pathology on the whole among women in the Chelyabinsk region wefound out that the morbidity among women of fertile age did not determine (T < T0,5) the general high rateof this pathology on the whole among women, i.e. the main cohort who are amenable to malignant breasttumours are located outside the limits of fertile age.

The forecast of morbidity of malignant breast tumours demonstrates its stabilization at the rate of38,9 cases per 100 thousand women of reproductive age.

While studying the dynamics of age-specific morbidity according to the years of the research wefound out that morbidity rates of malignant breast tumours did not have accurately confirmed dynamics ofindices according to the years of the research in any age interval. Rates of age-related morbidity werechanging within the limits of random fluctuations.

It has been determined that every third breast tumour is determined during preventive examina-tions(32,0 %).

The important forecasting criterion is the detectability of a tumour at the certain stage of the patho-logical process. While studying this issue for malignant breast tumours we found out that at the averageonly 60,0 % of tumours were detected at early (I-II) stages of the tumour process. Moreover, this indexwas constantly decreasing from 62,0 % in 2006–2007 to 57,0 % in 2010 within the period of the research.

147

At the third stage of the pathological process about 28,7 % of all breast tumours were detected atthe average within the period of the research. The dynamics of detectability of this stag according to theyears of the research is not subjected to a certain tendency, indices altered at random.

The terminal stage of the development of the pathological process of malignant breast tumours wasdetected at the average in 11,3 % of cases within the period of the research. Besides, this index had a neg-ative dynamics for five years of the research — it was constantly increasing from 9,9 % in 2006 to 12,9 %in 2010.

On the whole, the detectability of early stages of malignant breast tumours among women of fertileage is not high and only every third tumour is detected (58,6 %).Besides, this index for five years of theresearch had a negative tendency for decreasing. The terminal stage of the tumour process was registeredin 11.3 % of cases of malignant breast tumours.In contrast to the index of detectability of early stages, thedetectability of terminal stages did not have a tendency for decreasing, moreover, the growth of detecta-bility of the fourth stage was noticed.

Thus, one can forecast the growth of rates of failures of morbidity of malignant breast tumoursamong women of fertile age.

�A%'/( "%,!3+,23G:1. �%'/., L�. �"/(+B!',.!&&G! &/.//$3+)/.+&%# . �/''%% . 2010 1/*2 ()+$/"!.+!4/',- %

'4!3,&/',-) / L�. �%'/., L. �,+3%&'(%@, �L. �!,3/.. — �., 2012. — 260 '.2. �+D%*)!, �L. �!3,%"-&/',-, $!3!4!&&/',- % 1%&!(/"/1%B!'(%@ 3+(/ �L. �+D%*)!. — �.-

��$., 2004. — 286 '.3. �',3!$/., �L�. �/',/#&%! )*/3/.-# % /31+&%)+5%# 4!*%5%&'(/@ A/4/�% &+'!"!&%�

�3+"-'(/1/ �!*!3+"-&/1/ /(321+ (A/ %,/1+4 2003 1/*+) / �L�. �',3!$/., �L�. �/"2$!., L�. �/*-1+!.+ // �/.3!4!&&G! A3/$"!4G A3/?%"+(,%B!'(/@ 4!*%5%&G, '3!*G /$%,+&%# % )*/3/.-# &+'!"!-&%# A3/4GU"!&&GD 3!1%/&/. �/''%% : '$. &+2B. ,3., A/'.#�. 75-"!,%� /31+&%)+5%% �(+,!3%&$231-'(/1/ 4!*%5%&'(/1/ &+2B&/1/ 5!&,3+ A3/?%"+(,%(% % /D3+&G )*/3/.-# 3+$/B%D A3/4A3!*A3%#,%@/ A/* 3!*. �L�. �&%�!&(/. — �(+,!3%&$231, 2004. — �. 98–107.

DIE SPEZIFIK DER DURCHFÜHRUNG TRANSKUTANERULTRASCHALLUNTERSUCHUNG DER ERKRANKTEN AN KEHLKOPFKREBS

AUF AKTUELLER ETAPPE

D.N. Worgowa (acc.)

Die staatlich finanzierte Lehranstalt für höchste berufliche Ausbildung «Die Tscheljabinsker staatlicheMedizinakademie» des Ministeriums für Entwicklung des Gesundheitswesens und der Sozialverhältnisse

russischer Föderation,der Lehrstuhl für Onkologie, Strahldiagnostik und Strahltherapie

Der wissenschaftliche Betreuer: der Lehrstuhlleiter,korrespondierendes Mitglied russischer Akademie der Medizinwissenschaften, Professor,

Doktor der Medizinwissenschaften A.W. Waschenin

Im Jahr 2010 in Tscheljabinsker Gebiet erkrankt an Kehlkopfkrebs waren 219 Menschen,dabei 199Männer und 20 Frauen. [Tschissow W.I. , Starinsky W.W., Petrowa G.W. 2012].

Absolute Zahl von Gestorbenen an Kehlkopfkrebs betrug 130 Menschen, dabei 119 Männer und 11Frauen. [Tschissow W.I. , Starinsky W.W., Petrowa G.W. 2012].

Bei den vorbeugenden Untersuchungen ist die Erkrankung bei 4 % aller Beteiligten gefunden worden.Bei 32,2 % Patienten ist I-II Stadium der Erkrankung, bei 54,3 % Patienten ist III Stadium, bei

13,6 % Patienten IV Stadium festgestellt worden [Tschissow W.I., Starinsky W.W., Petrowa G.W. 2012].Die Sterblichkeit ab erstem Jahr nach Feststellung der Diagnose betrug 27,5 %.Beim größten Teil der Patienten wird ein derart lokalisierter Tumor nur an späten Stadien der Er-

krankung entdeckt, wodurch die Effizienz der modernen Behandlungsmethoden in großem Maße abge-schwächt wird.

Überwiegende Zahl der Erkrankungen an Kehlkopfkrebs im Vergleich zu den durch den Krebsverursachten Todesfällen weist auf die Möglichkeit der effizienten Behandlung derartig lokalisierter Tu-moren hin.

In jüngsten Jahren sind die neuen Methoden und methodologische Lösungen bei Behandlung derKrebskranken mit genannter Pathologie ins Leben gerufen worden.

148

Zu solchen Methoden zählen: operative Behandlung, Strahlenbehandlung.Bei der Anwendung der fortschrittlichen Behandlungstechnologien ist die modernediagnostische Ausrüstung erforderlich.Für die Feststellung der Diagnose und Prüfung von Effizienz der vorgenommenen Behandlung fin-

den folgende diagnostische Verfahren breite Anwendung:röntgenologische Computertomographie,Magnetresonanztomographie,Fiberlaryngoskopie,Ultraschalluntersuchung, die Positronen-

Emissions-Tomographie.Aber die häufige Anwendung der Computertomografie, Magnetresonanztomografie, Positronen-

Emissions-Tomographie. ist eingeschränkt durch die zulässige Strahlbelastung, Komplexität der Metho-diken, und Kostspieligkeit der Untersuchungen. Fiberlaryngoskopie ist eine invasive Methodik.

Das optimale Verfahren dabei ist die Ultraschallmonitoring.Die Ultraschalluntersuchung hat mehrere Vorteile: sie stellt keine Gefahr für die Ärzte dar,durchdringt nicht innere Organe,ist zugänglich, kann mehrmals wiederholt werden.Das Ziel: Einschätzung von Möglichkeiten der Ultraschalluntersuchung undDoppler — Farbenkartierung um individuelle Behandlung von Kehlkopfkrebskrankenzu ermöglichen.Die Ausrüstung und Methoden:die Ultraschalluntersuchungen wurden durchgeführt anhand von Scanner der Prüfklasse GE LO-

GIQ 9, mit dem linearen Mehrfrequenzsensor 10 MHz.Die Untersuchungen wurden durchgeführt zuerst im B — Modus, dann im Modus der Doppler —

Farbenkartierung. Die Kranken werden in der Rückenlage mit zurück geworfenem Kopf untersucht.Beim Husten die Untersuchung erfolgt im Sitzen.Die Vorbereitung der Untersuchung ist nicht erforderlich.Die Testergebnisse.Seit 2009 in der staatlich finanzierten Anstalt des Gesundheitswesens «Die

Tscheljabinsker klinische onkologischeBezirksgesundheitsfürsorgestelle» — Die klinische Uralstation derföderalen Staatverwaltung «das russische Wissenschaftszentrum für Röntgenradiologie» des Russland-sgesundheitswesen, in Abteilung Strahldiagnostik werden Ultraschalluntersuchungen an Kehlkopf durch-geführt.

Es sind 79 Untersuchungen durchgeführt worden. Durchschnittsalter der Patienten betrug 49 Jahre.Es waren überwiegend Männer (90 %).Die Querschnittsübersichten des Kehlkopfes gewähren ein erhöhtes Informationsniveau.Die Ultraschalluntersuchungen im B - Modus lassen sich eine Geometrie des Kehlkop-

fes,Beweglichkeit und Symmetrie der Echtstimmbänder, sowie das Vorhandensein, die Lage, die Anzahl,die Ausmaßen, Echogenität, die Homogenität des Tumors einschätzen, sowie Invasion in umgebendeStrukturen bestimmen.

Die Echtstimmbänder lassen sich in Form der feinen hyperechogenen Strukturen gut visualisieren,ebenso wie die Gleichgewichtsfalten mit etwas weniger ausgeprägter Echogenität.In Form vonhyperechogenem «Huf» wird der Schildknorpel visualisiert.Bei Visualisierung der Aryknorpel (Stellknorpel) kommen Schwierigkeiten auf.Die Untersuchung im Modus von Doppler — Farbenkartierung hilft prüfen, obeine pathologische, für die Tumoren charakteristische Durchblutung vorhanden ist.An 30 Kehlkopfkrebskranken wurde operative Behandlung durchgeführt (meistens bei Patienten im

III Stadium). In 28 Fällen die Daten der Ultraschalluntersuchung wurden durch morphologische Untersu-chung bestätigt.

Im ersten Falle wurde falsche Auslegung des Ergebnisses des Ultraschalltests festgestellt.Im ersten Falle wurde Unübereinstimmung der Daten von Ultraschalluntersuchung und morpholo-

gischem Aufbau festgestellt, was auf die diagnostische Probleme nach der Strahlbehandlung zurückzu-führen ist.

Die Durchführung der transkutanen Ultraschalluntersuchung des Kehlkopfes hat die Schwierigkei-ten der Differentialdiagnostik des bösartigen Tumors und postradialer Änderungen offenbart.

Für die Steigerung der Effizienz transkutaner Ultraschalluntersuchung des Kehlkopfes ist es erfor-derlich, vor der Speziellbehandlung die Ultraschalluntersuchung und Fiberlaryngoskopie für die Ein-schätzung von Dynamik durchzuführen.

Bilanz: Die eingeführte Methodik der transkutanen Ultraschalluntersuchung des Kehlkopfeshat sich als reiche Informationsquelle in großer Mehrprofilklinik erwiesen.

149

DIE ARBEIT DES KABINETTS DER ULTRASCHALLDIAGNOSTIKIN GROSSER MEHRPROFILKLINIK

D.N. Worgowa (acc.)Die staatlich finanzierte Lehranstalt für höchste berufliche Ausbildung «Die Tscheljabinsker staatliche

Medizinakademie» des Ministeriums für Entwicklung des Gesundheitswesens und der Sozialverhältnisserussischer Föderation,der Lehrstuhl für Onkologie, Strahldiagnostik und Strahltherapie

Der wissenschaftliche Betreuer: der Lehrstuhlleiter,korrespondierendes Mitglied russischer Akademie der Medizinwissenschaften, Professor,

Doktor der Medizinwissenschaften A.W. Waschenin

Aktualität. In der staatlich finanzierten Tscheljabinsker Anstalt des Gesundheitswesens «DieTscheljabinsker klinische onkologische Bezirksgesundheitsfürsorgestelle» -— wird heutzutage speziali-sierte medizinische Hilfe den Krebskranken mit differenzierter Lokalität des Tumors geleistet.

In Struktur der Gesundheitsfürsorgestelle sind eingebunden: 11 klinische Abteilungen, diagnosti-sche Abteilungen, die Beratungspoliklinik und die eng — spezialisierten Zentren.

Im Laufe der letzten 12 Jahren wurde eine Reihe von einmaligen für Russische Föderation zentra-len Behandlungsrichtungen entwickelt: Neutrontherapie, onkologische Ophthalmologie, onkologischeUrologie, Thermoradiotherapie, palliative Onkologie, fotodynamische Therapie, Antischmerztherapie.

Die Abteilungen der Gesundheitsfürsorgestelle enthalten 540 Bettstellen, von ihnen sind 320 Chi-rurgie -, 143 Radiologie -, 12 Reanimation -, 65 Chemotherapie — Bettstellen.

Die Poliklinikabteilung ist bestimmt für 400 Besuche pro Schicht.Auf Basis der Gesundfürsorgestelle agieren die klinischen Lehrstühle der staatlich finanzierten

Lehranstalt für höchste berufliche Ausbildung «Die Tscheljabinsker staatliche Akademie des Ministe-riums für Entwicklung des Gesundheitswesens und der Sozialverhältnisse», sowie technischer Lehrstühlean der Süduralstaatsuniversität.

Die staatlich geförderte Lehranstalt «Tschokod» nimmt die Abiturienten aus der Stadt Tschelja-binsk und aus dem Tscheljabinsker Gebiet auf.Die Abteilung für Strahldiagnostik bestehtaus 4 Kabinet-ten. Das Ziel der Untersuchung: die Analyse der Arbeit des Kabinetts für Ultraschalldiagnostik In Jahren2009 bis 2011. Die Ausrüstung und Methoden. GE Logiq 9 ist ein komplett digitales Ultraschallsystemfür Mehrzweckanwendung. Dieser Apparat ist sehr bequem zu betätigen. Erwähnungswert ist das Vor-handensein: Des graphischen Bildschirms 17'' mit Hochauflösung ohne Flimmereffekt, dessensorischen-Farbpaneels.

Automatische Optimierung jeden Modus, einschließlich B — Modus, Modus der Doppler –Farbkartierung, und Puls — Wellen Modus erspart die Zeit bei Untersuchungen, insbesondere bei der Ult-raschalldopplerographie, lässt Untersuchungen genauer und vollkommmener durchführen.

Automatisch vorgegebene Berechnungen für Doppler — Modus auch reduziert die Zeit der Unter-suchung. Die Speicherung der Aufnahme in Form von Kinoschleife in Archive gibt die Möglichkeit denZustand des Patienten kollegial zu besprechen und die Änderungen in Dynamik zu beobachten. Die Datenkann man sowohl auf CD als auch auf USB - Massenspeicher.

Die Ergebnisse der Untersuchungen. Ultraschalluntersuchungen werden durchgeführt an Patientender 1. chirurgischer Abteilung (bösartige Gebilden im Brustkorb), der 3. chirurgischen Abteilung (bösar-tige Neugebilden an der Milchdrüse), der. 4 chirurgischen Abteilung (bösartige Neugebilden am Hals undKopf), der 1. radiologischen Abteilung (

Strahlentherapie der Patientinnen mit bösartigen Neugebilden der Organe des kleinen Beckens), der6. onkologischen Abteilung (Chemotherapieabteilung), der poliklinischer Abteilung.

Die Häufigkeit der Untersuchungen für Rechenschaftsperiode hat gewachsen: sowohl als Gesamt-summe, als auch die Anzahl in einzelnen Lokalisationen.

Die meisten Patienten werden an Nieren, Nebennieren, Harnleitern untersucht, was mit der Not-wendigkeit der Einschätzung des Nierenzustandes verbunden ist (24 % für Jahre 2009–2011).Bei den amkleinen Becken untersuchten Patienten die meisten sind die Frauen, das ist zahlenmäßig der 2. Platz unterallen durchgeführten Untersuchungen (21,2 % in Jahren 2009–2011).

Die Untersuchungen werden sowohl für Erstdiagnostik und Einschätzung der Verbreitung des Pro-zesses als auch für Einschätzung der Dynamik der Behandlung durchgeführt.

Die meisten Patientinnen der 1. radiologischen Abteilung sind erkrankt an Gebärmutterhalskrebs.Für diese Patientinnen ist ein komplexer Ultraschallmonitoring entwickelt worden. Auf der 1. Etappe derUntersuchung der Erkrankten an der Gebärmutterhalskrebs wird als Übersichtsmaßnahme eine transab-

150

dominale Überprüfung der Organe des kleinen Beckens im B — Modus durchgeführt. Nach der naturmä-ßigen Füllung der Harnblase wird die Harnblase auf Möglichkeit der Invasion überprüft.

Auf der 2. Etappe der Untersuchung wird die transvaginale Ultraschallüberprüfung der Organe deskleinen Beckens nach der Entleerung der Harnblase durchgeführt.

Bei gezielter Untersuchung des Gebärmutterkörpers im B — Modus wird der Umfang ('m³),Konturen, Echogenität und Echostruktur des Gebärmutterhalses herausgefunden, über die Invasion

des Gebärmutterkörpers, methastatisches Befallen der Eierstocke die Klarheit verschafft.Im Doppler — Farbkartierung Modus wird das Vorhandensein und der Grad der Vaskularisation

bestimmt, im Modus der puls — wellen Dopplerometrie werden hemodynamische Parameter der Durch-blutung festgestellt:systologische Geschwindigkeit der Durchblutung (cm/s!c), diastologische Geschwin-digkeit der Durchblutung (cm/s!c),

Durchschnittsgeschwindigkeit der Durchblutung (sm/s!c), Resistenzindex und Pulsindex in Blutge-fäßen des Gebärmutterhalses. Die Untersuchung des ärmutterhalses wird so im Triplex - Modus durchge-führt.

Auf der 3. Etappe der Untersuchung der Erkrankten an Gebärmutterhalskrebs wird Ultraschall-überprüfung der Bauhöhlenorgane und der Organe des Retroperitoniums im B — Modusdurch den trans-abdominalen Zugang, auf leeren Magen, auf die Suche nach entlegenen Metastasen durchgeführt.Die Pa-tientinnen, denen die Gebärmutter samt Anhängseln entfernt wurde, wird die Ultraschalluntersuchungzum Ausschalten der Lymphkiste, sowie der Weiterentwicklung des Prozesses vorgeschrieben.

In Struktur der Untersuchung der Kleinbeckenorgane dominieren die sich wiederholenden Untersu-chungen der Patientinnen von 1. radiologischer Abteilung, was durch die Notwendigkeit der Kontrolleüber Effizienz der Therapie zu erklären ist. In 96–98 % Fällen

ist die transabdominale Untersuchung des kleinen Beckens durch die transvaginale Untersuchungergänzt worden.

Am dritten Platz sind die Untersuchungen der Bauchhöhle, was auf Ausspüren der Verbreitung desbösartigen Tumors und mit Differenzialdiagnostik der bösartigen und gutartigen Gebilde zurückzuführenist (17 % für Jahre 2009–2011).

In Struktur der Untersuchung der Bauchhöhlenorgane dominieren die sich wiederholenden Unter-suchungen der Patienten aus der 1. onkologischen Abteilung und aus der 1. radiologischen Abteilung,was auf die langfristige Behanglung zurückzuführen ist.

In Struktur der Untersuchung von Reproduktionssystem überwiegen Ultraschalluntersuchungen derMilchdrüsen. Schlussfolgerung: die Zahl der Ultraschalluntersuchungen wächst jährlich, sowohl in abso-luten Zahlangaben, als auch im prozentuellen Verhältnis.

ULTRASCHALLUNTERSUCHUNG DER ERKRANKTEN AN GEBÄRMUTTERHALSKREBSAUF AKTUELLER ETAPPE

D.N. Worgowa (acc.)

Die staatlich finanzierte Lehranstalt für höchste berufliche Ausbildung «Die Tscheljabinsker staatlicheMedizinakademie» des Ministeriums für Entwicklung des Gesundheitswesens und der Sozialverhältnisse

russischer Föderation,der Lehrstuhl für Onkologie, Strahldiagnostik und Strahltherapie

Der wissenschaftliche Betreuer: der Lehrstuhlleiter,korrespondierendes Mitglied russischer Akademie der Medizinwissenschaften, Professor,

Doktor der Medizinwissenschaften A.W. Waschenin

Aktualität. Eine aktuelle Aufgabe der onkologischen Gynäkologie und Radiologie besteht in Opti-mierung der Methoden bei Einschätzung des Zustandes der Tumoren während und nach der Behandlung.

Es gibt günstige und ungünstige Faktoren bei Diagnostik des Gebärmutterhalskrebses, wobei dieklinischen Daten und die Ergebnisse der morphologischen Untersuchung des Tumors berücksichtigt wer-den [1, 2, 3, 4, 5].

Zu den ungünstigen Faktoren zählen:Das junge Alter der Patientinnen,Die endophyte Form des Tumors- Das Eindringen der Metastasen in die Lymphenknoten,- Die bedeutende Größe des Tumors und die Tiefe des Hineinwachsens in Stroma- Die Invasion in den Körper der Gebärmutter

151

- Der metastatische Typ des Tumorwachstums, fassartiger Tumor des Kehlkopfhalses- Die niedrige Differenzierung des Tumors- Die Geburt, Abtreibungen in Anamnese später als vor 6 Monaten bis Entdeckungdes Ersttumors.- Das Vorhandensein der akuten Form venerischer Erkrankung auf Moment der Behandlung.- Die Daten, die bei Durchführung der Ultraschalluntersuchung herausgefunden werden, sind nicht

berücksichtigt worden.Die Ziele:1. Erstellen das Protokoll der Ultraschalldopplerographie der Gebärmutter.2. Erarbeiten die sonographischen Kriterien der Fortentwicklung des Gebärmutterhalskrebses.Die Ausrüstung und Methoden. Im Laufe der Arbeit wurden verwendet: Ultraschallscanner IMA-

GE POINT HX (HEWLETT PACKARD), mit dem Mehrfrequenzhohlraumsensor 5,0-7,5 MHz, sowieUltraschallscanner der Prüfklasse GE LOGIQ 9 mit Mehrfrequenzhohlraumsensor 5,0-8,0 MHz

Die Untersuchungen wurden auf Basis der staatlich finanzierten Anstalt des Gesundheitswesens«Die Tscheljabinsker klinische onkologische Bezirksgesundheitsfürsorgestelle» — die klinische

Uralstation der föderalen Staatsverwaltung «das russische Wissenschaftszentrum der Röntgenradiologie»des Russlandsgesundheitswesens. Es wurde die transabdominale und transvaginale Untersuchung derKleinbeckenorgane von 120 Gebärmutterkrebskranken durchgeführt

Testergebnisse:Es ist das Protokoll der Ultraschalldopplerographie des Gebärmutterhalses aufgenommen worden.Die transvaginale Ultraschalluntersuchung des Gebärmutterhalses wird bei entleerter Harnblase

durchgeführt.Bei gezielter Untersuchung des Gebärmutterhalses im Modus B werden der Volumen (cm³), Kon-

turen, Echogenität, Echostruktur des Gebärmutterhalses erfasst.Im Modus der Doppler — Farbkartierungkann man die Spezifik der Angiogenesis des Tumors untersuchen.

Im Modus der Doppler — Farbkartierung und im puls — welle Modus kann man die Parameter derDurchblutung des bösartigen Gebärmutterhalstumors zahlenmäßig bewerten, was für Diagnostik und Ein-schätzung der Effizienz von Behandlung notwendig ist.

Das Protokoll der Ultraschalldopplerographie des GebärmutterhalsesDie Benennung des Ultraschallsystems:Der Vorname und Familienname des Patienten:Geburtsdatum:Abteilung:Kartenummer:Diagnose:Untersuchungsdatum:Die Ultraschalldopplerographie des Gebärmutterhalses (die Behandlungsstufe)Der Gebärmutterhals: die Ausmaße, Echogenität, Homogenität,Konturen.Es wird die Anzahl von Gefäßen und der Grad der Vaskularization angegeben

SystologischeGeschwindigkeit,

cm/s.

DiastologischeGeschwindigkeit,

cm/s.

Durchschnittsgeschwindigkeit

cm/s.Der Resistenzindex Der Pulsindex

Schlussfolgerung:Der Vorname und Familienname des Arztes.In Zusammenhang mit der durchgeführten Untersuchung wurde der Verbesserungsvorschlag � 275

von 01.02.2012 «das Protokoll der Ultraschalldopplerographie desGebärmutterhalses» eingereicht.Es wurden sonographische Kriterien der Fortentwicklung des Gebärmutterhalses festgestellt:1. Die Vergrößerung des Umfangs des Gebärmutterhalses2. Das Entstehen der hypoechogenen Gebilden am Gebärmutterhals3. Das Entstehen der unebenen, undeutlichen oder hügeliger

152

Konturen des Gebärmutterhalses.4. Die Invasion in den Körper des Gebärmutterhalses5. Metastatisches Befallen der Eierstöcken6. Metastatisches Befallen der Lymphknoten im Retroperitonium.In Bezug auf erarbeitete Kriterien wurde Verbesserungsvorschlag � 276 von 01.02.2012 «Sonog-

raphische Kriterien des Wachstums des Gebährmutterhalses» eingereicht.Die Besprechung.Für die Optimierung der Therapie der Gebärmutterhalskranken, die nach verschiedenen Schemata

Behandelt werden, ist es zweckmäßig die sonographischen Kriterien der Entwicklung des Gebährmutter-halskrebses zu benutzen.

Die Durchführung der Ultraschalluntersuchung der Krebskranken in 1, 3 und 6 Monaten nach derBehandlung lässt die Ultraschallmerkmale der Krebsentwicklung aufdecken.

Die Behandlung der Patientinnen mit der Fortentwicklung des Gebärmutterkrebses wird optimiert:Ferner werden 2 Kursen der adjuvanten Chemotherapie durchgeführt werden.Die Bilanz:1. Das Protokoll der Ultraschalldopplerographie des Gebärmutterhalses hat eine wichtige wissen-

schaftspraktische Bedeutung.2. Die Anwendung des Protokolls ermöglicht es die Daten, die bei Untersuchung des Gebärmutter-

halses im B — Modus, im Modus der Doppler — Farbkartierung und im Modus der puls — wellenDopplerometrie gewonnen wurden, zu systematisieren.

3. Die erarbeiteten sonographischen Kriterien garantieren eine präzise Diagnostik der Entwicklungdes Gebärmutterkrebses zu jedem Zeitpunkt nach Behandlung im Modus der Realzeit.

4. Die erarbeiteten Merkmale sind in onkologischen Anstalten unterschiedlicher Niveaus bei Un-tersuchung und Behandlung der Gebärmutterhalskrebskranken zu verwenden.

Literatur:1. Radial oncology: organization, tactic, ways of development. — Moscow: publishing house

RAMN, 2003. — Pages 78–87.2. Grigsby, P.W. Lack of effect of tumor size on the prognosis of carcinoma of the uterine cervix

Stage IB and IIA treated with preoperative irradiation and surgery / P.W. Grigsby, C.A. Perez, K.S. Chaoet al. // Int. J. Radiat. Oncol. Biol. Phys. — 1999. — Vol. 45, � 3. — P. 645–651.

3. Naravan, K. Significance of tumor volume and corpus uteri invasion in cervical cancer patientstreated by radiotherapy / K. Naravan, R. Fisher, D. Bernshaw // Int. J. Gynecol. Cancer. — 2006. —Vol. 16, � 2. — P. 623–630.

4. Perez, C.A. Effect of tumor size on the prognosis of carcinoma of the uterine cervix treated withirradiation alone / C.A. Perez, P.W. Grigsby, S.M. Nene et al. // Cancer. — 1992. — Vol. 69, � 11. —P. 2796–2806.

5. Wu, Y.C. Power Doppler angiographic appearance and blood flow velocity waveforms in inva-sive cervical carcinoma / Y.C. Wu, C.C. Yuan, J.H. Hung et al. // Gynecol. Oncol. — 2000. — Vol. 79,� 2. — P. 181–186.

)"%'�0$!�+q,+�"*+',0"�!�1'4("1',+=J!%'$!>!�4q-&= —�!$&'J',,-/$q>1=(

"#(. "����� (����.)�3!&$231'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#

�+?!*3+ 1/'A%,+"-&/@ D%3231%%, 23/"/1%%

�������������������: 9��. /����$�� (���., . �. �.)

�+B!',./ F%)&% #."#!,'# 4&/1/13+&&G4 % '2$�!(,%.&G4 A/&#,%!4, .("�B+��%4 . '!$# '/-',/#&%! �4/5%/&+"-&/1/ ',+,2'+ A+5%!&,+, ?%)%B!'(/!, /$�!! '/',/#&%! )*/3/.-#, '/5%+"-&/!.)+%4/*!@',.%! % A'%D%B!'(/! )*/3/.-!.

*��z� 3+$/,G #.%"/'- '3+.&!&%! (+B!',.+ F%)&% A+5%!&,/. A/'"! 3+*%(+"-&/@ 5%',�(,/-4%%, (/,/3G4 .GA/"&#"+'- /3,/,/A%B!'(+# % 1!,!3/,/A%B!'(+# ,/&(/(%U!B&+# A"+',%(+ 4/B!./1/3!)!3.2+3+.

153

"����z����z ������� . �+ '!1/*&#U&%@ *!&- '3+.&!&%! (+B!',.+ F%)&% A+5%!&,/. '3+)"%B&G4% .%*+4% *!3%.+5%% 4/B% A/'"! 3+*%(+"-&/@ 5%',�(,/4%% A/ 3!)2"-,+,+4 A3/./*%4GD%''"!*/.+&%@ .+3%+$!"-&/ % &!/*&/)&+B&/, B,/ /$�#'&#!,'# %'A/"-)/.+&%!4 3+)"%B&GD /A3/'&%-(/. . /5!&(! (+B!',.+ F%)&%.

J����� ������ . �+ A/'"!*&%! 10 "!, . /,*!"!&%% 23/"/1%% �3!&$231'(/1/ /$"+',&/-1/ ("%&%B!'(/1/ 1/'A%,+"# .!,!3+&/. ./@& %4. �L. �+&*3G(+ .GA/"&!&/ $/"!! 100 5%',�(,/4%@.�,/$3+&/ 77 A+5%!&,/..

%* *!3%.+5%%

�/&,3/"-&+# 132AA+N = 25

�3,/,/A%B!'(%@ ��N = 40

¥�. — 35, �. — 5)

�!,!3/,/A%B!'(%@3!)!3.2+3

N = 37¥� — 36, F — 1)

�3!*&%@ ./)3+', ("!,) 68 (50–78) 75 (40–82) 65 (40–75)�244+ $+"/. A/ U(+"!�3+&/?'(% ($+""/.) 85 (75–90) 80 (70–90) 95 (85–100)

�3/*/"F%,!"-&/',-&+$"�*!&%# (*&!@) 60 (3–70) 53 (3–65) 45 (3–55)

�3,/,/A%B!'(+# % 1!,!3/,/A%B!'(+# A"+',%(+ .GA/"&#"+'- A/ /3%1%&+"-&G4 4!,/*%(+4, %)'!14!&,+ A/*.)*/U&/@ (%U(% *"%&&/@ 55 '4, /,',2A+# /, %"%/5!(+"-&/1/ 21"+ &+ 15–20 '4, ' /$#-)+,!"-&G4 '/D3+&!&%!4 +3,!3%% ileocolica. '!4 A+5%!&,+4 .GA/"&#"%'- +&,%3!?"�('&G! +&+-',/4/)G ' 4/B!,/B&%(+4%.

�"# %)2B!&%# (+B!',.+ F%)&% A+5%!&,/+ &+4% $G"+ .G$3+&+ % A3%4!&#"+'- 32''(+# .!3'%#/A3/'&%(+ «Medical Outcomes Study — ShortForm» (SF-36). �&(!,+ SF-36 .("�B+!, 36 ./A3/'/.,(/,/3G! /,3+F+�, 9 (/&5!A5%@ (U(+") )*/3/.-#: ?%)%B!'(2� 3+$/,/'A/'/$&/',-, '/5%+"-&2�+(,%.&/',-, ',!A!&- /13+&%B!&%# ?%)%B!'(/@ 3+$/,/'A/'/$&/',% % '/5%+"-&/@ +(,%.&/',%, A'%-D%B!'(/! )*/3/.-!, �&!31%B&/',- %"% 2,/4"#!4/',-, $/"-, /$�2� /5!&(2 )*/3/.-# % !1/ %)4!&!-&%# . ,!B!&%! A/'"!*&!1/ 1/*+.

�/"2B!&&G! 3!)2"-,+,G

1. PF — �%)%B!'(+# +(,%.&/',-2. RLHP — �/"- ?%)%B!'(%D A3/$"!4 . /13+&%B!&%% F%)&!*!#,!"-&/',%3. BP — �%)%B!'(+# $/"-4. GH — �$�!! ./'A3%#,%! )*/3/.-#5. VT — �%)&!'A/'/$&/',-6. SF — �/5%+"-&+# +(,%.&/',-7.RLE — �/"- �4/5%/&+"-&GD A3/$"!4 . /13+&%B!&%% F%)&!*!#,!"-&/',%8. MH — �'%D%B!'(/! )*/3/.-!

�/(+)+,!"% . A!3./@ 132AA! $G"% .GU!, B!4 ./ .,/3/@, % A3%$"%F+"%'- ( ,3!,-!@ ((/&-,3/"-&/@ 132AA!). �+4G4 &%)(%4 A/(+)+,!"!4 A/ $+""+4 . A!3./@ 132AA! $G"+ /5!&(+ F%)&!'A/-'/$&/',%, ./ .,/3/@ — ?%)%B!'(+# +(,%.&/',-.

PF RLHP RLE VT MH SF BP GH

�3,/,/A%B!'(%@ �� 78,5 70,1 83 62 81 75 80 74

�!,!3/,/A%B!'(%@ 3!)!3.2+3 60 66,1 80 64 78 74,5 79 64

�/&,3/"-&+# 132AA+ 97,3 83 82 69 84 82,1 84,8 77,4

154

$ ��� . �/',/.!3&GD 3+)"%B%@ &+ /'&/.+&%% +&(!,%3/.+&%# SF-36 4!F*2 (+B!',./4 F%)-&% A+5%!&,/. ' ���� % ���� &! .G#."!&/, /*&+(/ . '3+.&!&%% ' (/&,3/"-&/@ 132AA/@ (+B!',./F%)&% &%F!, . /'&/.&/4 )+ 'B!, /13+&%B!&%# ?%)%B!'(/@ +(,%.&/',% % 3/"% �4/5%/&+"-&GD A3/-$"!4 . /13+&%B!&%% F%)&!*!#,!"-&/',%.

�+B!',./ F%)&% A+5%!&,/. 2"2BU+!,'# ' 2.!"%B!&%!4 /$�!4+ 3!)!3.2+3+, )+ 'B!, '/(3+�!-&%# (/"%B!',.+ '+4/(+,!,!3%)+5%@ . 132AA! ���� % B+',/,G 4/B!%'A2'(+&%# . 132AA! ����.

�/'"!/A!3+5%/&&/! (+B!',./ F%)&% % 2*/."!,./3!&&/',- /, A3/.!*!&&/1/ "!B!&%# . &!4+-"/@ ',!A!&% )+.%'%, /, /F%*+&%@ A+5%!&,+. �+)�#'&!&%! A/.!*!&%#, /$3+)+ F%)&%, + ,+(F! 4!,/*G% A3%!4G 3!U!&%# % 2',3+&!&%# ,!D A3/$"!4, (/,/3G! 4/12, ./)&%(&2,- . A/'"!/A!3+5%/&&/4A!3%/*!, *+�, A/"/F%,!"-&G! 3!)2"-,+,G % A/)./"#�, $/"-&/42 "2BU! A3!/*/"!,- A'%D/"/1%B!-'(%@ % ?%)%B!'(%@ *%'(/4?/3, % $G',3!! +*+A,%3/.+,-'# . /$�!',.!.

�A%'/( "%,!3+,23G:1. �',3/.!3D/. �L�., �/4+U �L�., �2$/5(%@ �L�. �A!3+,%.&+# D%3231%# % ,/A/13+?%B!'(+#

+&+,/4%#. — �/'(.+, 2005. — �. 654–661, 662.2. �%&!"-&%(/., �L�. �,"+' +&+,/4%% B!"/.!(+, II ,/4. — �.: �!*%5%&+, 1979. — �. 75–81,

180–187, 193–197.3. �3/"/1%# / A/* 3!*+(5%!@ +(+*. ���� �L�. �/A+,(%&+. — �.: �����N�!*%+, 2005. —

�. 337–338.4. �+,.!!., �L�. �+( 4/B!./1/ A2)G3# // �"%&%B!'(+# /&(/23/"/1%# / A/* 3!*. �L�. �+,.!!.+.

— �.: !3*+&+, 2003. — �. 197–406.5. Pagano F., Bassi P., Galetti T.P. et al. Resultsofcontemporaryradicalcystectomyforinvasiveblad-

dercancer: Aclinicopathological study with an emphasis on the inadequacy of the tumor, nodes and me-tastases classification // J. Urol. — 1991. — Vol. 145. — P. 45–50.

6. Chang S.S., Cole E., Cookson M.S. et al. Preservation of the anterior vaginal wall during femaleradical cystectomy with orthotopic urinary diversion: technigue and results. / J. Urol. — 2002. —Vol. 168. — P. 1442–1445.

7. Gschwend J.E., May F., Paiss T. et al. High_dose pelvic irradiation followed by ileal neobladderurinary diversion: 'omplican and long_term results // Brit. J. Urol. — 1996. — Vol. 77 — P. 680–684.

8. Hautmann, R.E. Urinary diversion: ileal conduit to neobladder // J. Urol. — 2003. — Vol. 169,� 3. — P. 834–842.

9. Horenblas S., Meinhardt W., Ijzerman W., Moonen F.M. Sexuality preserving cystectomy andneobladder: initial results // J. Urol. — 2001. — Vol. 166. — P. 837–840.

10. Jiminez V.K., Marshall F.F. Surgery of bladder cancer // Campbells Urology, 8th ed. / WalshP.C., Retic A.B., Vaughan E.D., Wein A.J., eds. — Philadelphia: W.B. Saunders, 2002. — Chapter 79.

11. Lin D.W., Santucci R.A., Mayo M.E. et al. Urodynamic evaluation and long_term results of theorhotopic gastric neobladder in men // J. Urol. — 2000. — Vol. 164. — P. 356–359.

155

�"0!1!>+=�'1%'$-$!(={+^�40'/4;'&'J',,-^��!(!q&',+'J," «!�0&-/�+$!0»

"#$. "����� (����.), !#". $������� (����.)�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

�+?!*3+ /$�!@ D%3231%%

�������������������: ��H. ?���X (��., . �. �.)

"����z����z. «�',3G@ F%./,» — �,/ ("%&%B!'(%@ '%&*3/4, 3+).%.+��%@'# A3% /',3GD)+$/"!.+&%#D /31+&/. $3�U&/@ A/"/',% % )+$3�U%&&/1/ A3/',3+&',.+ % ,3!$2��%@ �(',3!&&/@D%3231%B!'(/@ A/4/�%. �*&/@ %) /'&/.&GD A3%B%& 3+).%,%# «/',3/1/ F%./,+» #."#�,'# /',3G!&!'A!5%?%B!'(%! ./'A+"%,!"-&G! )+$/"!.+&%# /31+&/. A%�!.+3!&%# (/',3G! ./'A+"%,!"-&G!A3/5!''G . B!3.!/$3+)&/4 /,3/',(!, F!"B&/4 A2)G3! % F!"B!.G./*#�%D A2,#D (��), A/*F!"2-*/B&/@ F!"!)! % *3.).

�+$/"!.+&%# F!"B!.G./*#�%D A2,!@ (F!"B&/(+4!&&+# $/"!)&- ' D/"!5%',%,+4% % $!) &%D,*%'(%&!)%# F!"B!.G./*#�%D A2,!@) )+&%4+�, /*&/ %) .!*2�%D 4!', '3!*% $/"!)&!@ /31+&/. A%-�!.+3!&%# 2 $!3!4!&&GD. � A3%4!32, /',3G@ D/"!5%',%, )+&%4+!, .,/3/! 4!',/ A/ B+',/,! '3!*%&!+(2U!3'(%D A/(+)+&%@ ( D%3231%B!'(/42 .4!U+,!"-',.2 [2].

�$#)+,!"-&G4 4!,/*/4 *%+1&/',%(% A+,/"/1%% F!"B!.G./*#�%D A2,!@ (���), A/ 4&!&%�3#*+ +.,/3/., #."#!,'# 2"-,3+).2(/./! %''"!*/.+&%! (���) /31+&/. $3�U&/@ A/"/',% (���) %)+$3�U%&&/1/ A3/',3+&',.+ [1, 2].

*��z���� . �A3!*!"!&%! 3/"% ��� ��� % )+$3�U%&&/1/ A3/',3+&',.+ A3% *%??!3!&5%-+"-&/@ *%+1&/',%(! &!/,"/F&/@ A+,/"/1%% ��� 2 $!3!4!&&GD.

J����� ������ . �3/.!*�& +&+"%) *%+1&/',%(% % "!B!&%# 86 A+5%!&,/(, A/',2A%.U%D' A/*/)3!&%!4 &+ &!/,"/F&2� D%3231%B!'(2� A+,/"/1%� /31+&/. $3�U&/@ A/"/',% % &+D/*%.-U%D'# &+ "!B!&%% . D%3231%B!'(/4 /,*!"!&%% �� «3��� %4. �LL�"24/.+» . A!3%/* ' %�"#2011 1. A/ ?!.3+"- 2012 1. '! $/"-&G! F!&�%&G ?!3,%"-&/1/ ./)3+',+ $G"% 3+)*!"!&G &+ 2132AAG. �'&/.&2� 132AA2 '/',+.%"% 42 $!3!4!&&G! F!&�%&G ' ("%&%(/@ «/',3/1/ F%./,+», (/&-,3/"-&2� 132AA2 — 42 F!&�%&G ' ("%&%(/@ «/',3/1/ F%./,+», $!) A3%)&+(/. $!3!4!&&/',%.

&�_��z�� . /'&/.&/@ 132AA! $!3!4!&&G! F!&�%&G &+$"�*+"%'- . ./)3+',! 18–40 "!,,'3!*&%@ ./)3+', — 28 "!,. A!3./4 ,3%4!',3! $!3!4!&&/',% A/',2A%"/ — 7 (16,7 %), .,/3/4 —22 (52,4 %), ,3!,-!4 — 13 (31,0 %) A+5%!&,/(. (/&,3/"-&2� 132AA2 .("�B!&G A+5%!&,(% . ./)-3+',! 20–43 "!,, '3!*&%@ ./)3+', — 31 1/*. /'&/.&/@ 132AA! $/"-&G! &+A3+."!&G ' *%+1&/)+4%:�/',3G@ +AA!&*%5%,» — 30 (71,4 %), «/',3G@ D/"!5%',%,» — 5 (11,9 %), «D3/&%B!'(%@ (+"-(2"�)-&G@ D/"!5%',%, . ',+*%% /$/',3!&%#» — 3 (7,1 %), «/',3+# (%U!B&+# &!A3/D/*%4/',-» — 1(2,4 %), «/',3G@ A+&(3!+,%,» — 3 (7,1 %) A+5%!&,(%. (/&,3/"-&/@ 132AA! $/"-&G! &+A3+."!&G '*%+1&/)+4%: «/',3G@ A+&(3!+,%,» — 5 (11,9 %), «/',3G@ +AA!&*%5%,» — 26 (57,1 %), «/',3G@ D/-"!5%',%,» —5 (11,9 %), «/',3+# 'A+!B&+# (%U!B&+# &!A3/D/*%4/',-» — 1 (2,4 %), «A3/$/*&+# #)-.+» — 2 (4,8 %), «D3/&%B!'(%@ (+"-(2"�)&G@ D/"!5%',%, . ',+*%% /$/',3!&%#» — 3 (7,1 %) A+5%-!&,(%.

�"# *%??!3!&5%+"-&/@ *%+1&/',%(% . (/4A"!('&/4 /$'"!*/.+&%% %'A/"-)/.+"/'- ������ % )+$3�U%&&/1/ A3/',3+&',.+. �3% ��� ��� A+,/"/1%# �� *%+1&/',%3/.+&+: . /'&/.&/@132AA! 2 6 (14,3 %) A+5%!&,/(, %) &%D 2 4 (66,7 %) A+,/"/1%# �� $G"+ 2',+&/."!&+ .A!3.G!, A3%�,/4: 2 2 (4,8 %) A+5%!&,/( — ���, D3/&%B!'(%@ (+"-(2"�)&G@ D/"!5%',%,; 2 2 (4,8 %) — ���,D3/&%B!'(%@ (+"-(2"�)&G@ D/"!5%',%, . ',+*%% /$/',3!&%#; 2 1 (2,4 %) — ���; 2 1 (2,4 %) —/',3G@ $!'(+4!&&G@ D/"!5%',%,. (/&,3/"-&/@ 132AA! A+,/"/1%# �� 2',+&/."!&+ 2 8 (19,1 %)A+5%!&,/(, %) &%D 2 4 (50 %) — .A!3.G!, A3% �,/4: 2 5 (11,9 %) A+5%!&,/( — ���, D3/&%B!'(%@(+"-(2"�)&G@ D/"!5%',%, . ',+*%% /$/',3!&%#; 2 1(2,4 %) — ���; 2 1(2,4 %) — /',3G@ (+"-(2-"�)&G@ ?"!14/&/)&G@ D/"!5%',%,; 2 1(2,4 %) — ���, /',3G@ (+"-(2"�)&G@ D/"!5%',%,.

�3% A3/.!*!&%% ��� )+$3�U%&&/1/ A3/',3+&',.+ A+,/"/1%# 4/B!.G./*#�%D A2,!@ (��)$G"+ .G#."!&+: . /'&/.&/@ 132AA! 2 7 (16,7 %), A+5%!&,/( %) &%D: 2 2 (4,8 %) — &!?3/A,/), 2 3(7,1 %) — *.2D',/3/&&%@ 23/',+), 2 2 (4,8 %) — 2.!"%B!&%! 3+)4!3/. A/B(%. (/&,3/"-&/@ 132A-A! A+,/"/1%# �� .G#."!&+ 2 5 A+5%!&,/( (11,9 %), %) &%D: 2 1 (2,4 %) — 4/B!(+4!&&+# $/"!)&-£23 (7,1 %) —&!?3/A,/), 2 1 (2,4 %) — 2.!"%B!&%! 3+)4!3/. A/B(%.

�+$/3+,/3&/ . /'&/.&/@ 132AA! A/.GU!&%! 23/.&# $%"%32$%&+ . (3/.% )+ 'B�, /$�!1/ $%-"%32$%&+ /,4!B!&/ 2 7 (16,7 %) A+5%!&,/(, %) &%D 2 2 (4,8 %), A/ *+&&G4 ���, 2',+&/."!&/ &+"%-B%! ���. �+ 'B�, A3#4/1/ $%"%32$%&+ A/.GU!&%! /,4!B!&/ 2 4 (9,5 %) A+5%!&,/(, )+ 'B�, &!A3#-

156

4/1/ — 2 3 (7,1 %). (/&,3/"-&/@ 132AA! A/.GU!&%! 23/.&# $%"%32$%&+ . (3/.% )+ 'B�, /$�!1/$%"%32$%&+ /,4!B!&/ 2 5 (11,9 %) A+5%!&,/(, %) &%D 2 1 (2,4 %), A/ *+&&G4 ���, 2',+&/."!&/ &+-"%B%! ���. �+ 'B�, A3#4/1/ $%"%32$%&+ A/.GU!&%! /,4!B!&/ 2 2 (4,8 %) A+5%!&,/(, )+ 'B�, &!-A3#4/1/ — 1 (2,4%), )+ 'B�, A3#4/1/ % &!A3#4/1/ — 2 (4,8 %).

'!4 $/"-&G4 (. )+.%'%4/',% /, 2',+&/."!&&/@ A+,/"/1%%) A3/./*%"/'- (/&'!3.+,%.&/!"!B!&%!. �/ A/(+)+&%#4 /A!3%3/.+&G: . /'&/.&/@ 132AA! — 7 (16,7 %) A+5%!&,/(, %) &%D: *%+1&/-',%B!'(+# �&*/.%*!/"+A+3/'(/A%# A3/.!*!&+ 2 1 (2,4 %) A+5%!&,(%, "+A+3/'(/A%B!'(+# +AA!&*�(-,/4%# — 2 2 (4,8 %), +AA!&*�(,/4%# — 2 4 (9,5 %) A+5%!&,/(; . (/&,3/"-&/@ 132AA! — 12 (28,6 %)A+5%!&,/(, %) &%D: *%+1&/',%B!'(+# .%*!/"+A+3/'(/A%# A3/.!*!&+ 2 1 (2,4 %) A+5%!&,(%, "+A+3/-'(/A%B!'(+# +AA!&*�(,/4%# — 2 4 (9,5 %), "+A+3/'(/A%B!'(+# D/"!5%',�(,/4%# — 2 7 (16,7 %)A+5%!&,/(.

$ ��� :1. ��� ��� % )+$3�U%&&/1/ A3/',3+&',.+ '"!*2!, 'B%,+,- 4!,/*/4 .G$/3+ *"# *%??!3!&-

5%+"-&/@ *%+1&/',%(% . A!3.G! B+'G A3% A/',2A"!&%% . ("%&%(2 2 $!3!4!&&GD ' A/*/)3!&%!4 &+�/',3G@ F%./,». �&.+)%.&G! % "2B!.G! 4!,/*G *%+1&/',%(% 2 $!3!4!&&GD '"!*2!, A3%4!&#,-A/'"! ���.

2. /'&/.&/@ % (/&,3/"-&/@ 132AA+D $/"-&G! ���, A/*,.!3F*!&&/@ ���, % A/.GU!&%!423/.&# $%"%32$%&+ &2F*+"%'- . */A/"&%,!"-&GD 4!,/*+D %''"!*/.+&%# *"# 2,/B&!&%# *%+1&/)+.

�A%'/( "%,!3+,23G:1. �+&,!4%3/.+, �L�. �!3!4!&&/',-, F!"B&G@ A2)G3- % "%A%*&G@ *%',3!''N'%&*3/4: *%+1&/-

',%(+ % A3%&5%AG "!B!&%# [!(',] / �L�. �+&,!4%3/.+, L�. �!,2D/. // �%&!(/"/1%#. 2005. — � 2.— �. 76–79.

2. �/.+"-'(+#, �L�. �',3G@ D/"!5%',%, % $!3!4!&&/',- // �*/3/.ª# �(3+¤&%. — 2010. — � 5.— �. 22.

J"0'J"0+%'�)+/","1+q$^+&4&>++

J#&. "������� (����.), '#". )��3�� (����.), +#". J������ (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#1 �+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

2 �+?!*3+ 4%(3/$%/"/1%%, .%32'/"/1%%, %442&/"/1%% % ("%&%B!'(/@ "+$/3+,/3&/@ *%+1&/',%(%

�������������������: 1 ���. ��%��� (��., . �. �.), 2 #��. ��%���� (��. �� ., . �. �.)

"����z����z. '"+.&/@ A"!#*! .G*+��%D'# 32''(%D 2B!&GD, 'G13+.U%D $/"-U2� 3/"- .%',/3%% /,!B!',.!&&/@ % 4%3/./@ 4!*%5%&'(/@ &+2(%, A/B!,&/! 4!',/ A3%&+*"!F%, �%(/"+��.+&/.%B2 �%3/1/.2. �L�. �%3/1/. — ,+"+&,"%.G@ A3/*/"F+,!"- A3/13!''%.&GD ,3+*%5%@ /,!-B!',.!&&/@ % )+32$!F&/@ 4!*%5%&G — './!@ 4&/1/13+&&/@ 4!*%5%&'(/@ % /31+&%)+,/3'(/-A!*+1/1%B!'(/@ *!#,!"-&/',-� .&!' &!/5!&%4G@ .("+* . 4!*%5%&'(2� &+2(2 % A3+(,%(2. �!&%-+"-&G@ +&+,/4, ,+"+&,"%.G@ �('A!3%4!&,+,/3, 3+)&/',/3/&&%@ ("%&%5%',ND%3231, ,!3+A!.,, /31+-&%)+,/3, /'&/./A/"/F&%( ./!&&/NA/"!./@ 4!*%5%&G, /*+3!&&G@ A!*+1/1, /& &!4+"/ '*!"+" % *"#3+).%,%# 4!*%5%&'(/1/ % /$�!1/ /$3+)/.+&%# . �/''%%. �&/1%! A/"/F!&%#, 4!,/*G % 3+)3+$/,(%�L�. �%3/1/.+ &! A/,!3#"% './!1/ )&+B!&%# % . &+U% *&%.

�L�. �%3/1/. — 3/*/&+B+"-&%( D%3231%% (+( &+2B&/@ 4!*%5%&'(/@ *%'5%A"%&G; /'&/./-A/"/F&%( /A!3+,%.&/@, 3!(/&',32(,%.&/@ % A"+',%B!'(/@ D%3231%%. &+',/#�!! .3!4# A3+(,%-(2��%! D%3231% %'A/"-)2�, &+ A3+(,%(! 4!,/*G, A3!*"/F!&&G! �L�. �%3/1/.G4. +(, &+A3%4!3,/31+&/'/D3+&#��!! &+A3+."!&%! . ,3+.4+,/"/1%% — $/"-&G4 A/ ./)4/F&/',% '/D3+&#�, $/"--U2� B+',- ',/AG, B,/ *+!, ./)4/F&/',- *+"-&!@U!1/ $"+1/A3%#,&/1/ A3/,!)%3/.+&%# ' %'A/"-)/-.+&%!4 &/.!@U%D /3,/A!*%B!'(%D A3%'A/'/$"!&%@. �'A/"-)2�,'# ,+(F! /'&/.&G! A/"/F!&%#4!,/*%(% �L�. �%3/1/.+ A/ A!3!'+*(! (/F%. �,/, 4!,/* #."#!,'# &! ,/"-(/ 4!,/*/4 A"+',%B!'(/@D%3231%%, &/ % 'A/'/$',.2!, '(/3!@U!42 )+F%."!&%� 3+&. � "!1(/@ 32(% .G*+��!1/'# 2B!&/1/ %.3+B+ '!1/*&# U%3/(/ .GA/"&#!,'# A!3!'+*(+ (/F%, (/',!@, 3%&/A"+',%(+ % *3. �B+',&%( 4&/1%D./@&, �L�. �%3/1/. /,(+)+"'# /, 3+&&%D +4A2,+5%@ A3% /1&!',3!"-&GD 3+&!&%#D (/&!B&/',!@ 'A/.3!F*!&%!4 (/',!@. �& 3+)3+$/,+" 2B!&%! / "!B!&%% /1&!',3!"-&GD 3+&, . ,/4 B%'"!, % . )+.%-'%4/',% /, './@',. A3%4!&!&&/1/ /32F%#. �L�. �%3/1/. 3+)3+$/,+" ./A3/'G /31+&%)+5%% ./!&&/-4!*%5%&'(/1/ *!"+, B,/ '+4G4 3!U+��%4 /$3+)/4 A/."%#"/ &+ 2'A!D% ./!&&/NA/"!./@ 4!*%5%&G

157

. 5!"/4. �& ,+(F! 3+)3+$/,+" % .&!*3%" . A3+(,%(2 (/',&/A"+',%B!'(%@ 4!,/* /A!3+5%% ',/AG.�4!&&/ �%(/"+@ �.+&/.%B .A!3.G! . 4%3! A3!*"/F%" A3/./*%,- A!3!'+*(2 (/',% ' /*&/1/ 4!',+&+ *321/!, �,+ /A!3+5%# &/'%, !1/ %4#. �A!3+5%# (/',&/@ A"+',%(% �%3/1/.+ ',+"+ %',/(/4 4%3/-./@ ./'',+&/.%,!"-&/@ D%3231%%. �L�. �%3/1/. .A!3.G! A3/.!" 3!)!(5%� (/"!&&/1/ '2',+.+; A3/-.!" % A/*3/$&/ /A%'+" A!3!.#)(2 (+F*/@ +3,!3%% A3% D%3231%B!'(%D .4!U+,!"-',.+D; 3+)3+$/,+"% /A%'+" 4!,/* A!3!3!)G.+&%# +D%""/./@ F%"G [2].

�L�. �%3/1/. .&!*3%" . 4!*%5%&'(2� A3+(,%(2 A3%&5%AG 1%1%!&G, . ,/4 B%'"! %'A/"-)/.+-&%! +&,%'!A,%(/.. �!(/,/3G! /,(3G,%# �L�. �%3/1/.+ 1!&%+"-&G % &! A/*.!3F!&G ./)*!@',.%#4.3!4!&%. &+',/#�!! .3!4# A/NA3!F&!42 ( D%4%B!'(%4 +&,%'!A,%(+4 /,&/'#, 1–5 %-&2� 'A%3,/-.2� &+',/@(2 @/*+. �,/ '3!*',./ &+32F&/1/ A3%4!&!&%# %'A/"-)2�, *"# /$3+$/,(% (/F% ./(3213+& A3% A!3!.#)(!, *"# /$3+$/,(% ''+*%&, A/.!3D&/',&GD 3+&. � 0,1–0,2 %-&G@ ./*&G@ 3+',./3D"/31!('%*%&+ %'A/"-)2�, (+( /*%& %) /'&/.&GD A3!A+3+,/. *"# A3/4G.+&%# 3+&, '"%)%',GD /$/-"/B!( % "!B!&%# 1&/@&GD 3+&, + 0,5 %-&G@ 'A%3,/./@ 3+',./3 D"/31!('%*%&+ %'A/"-)2�, *"# /$3+-$/,(% 32( D%3231+ % /A!3+5%/&&/1/ A/"#. �+"/ (,/ )&+!,, B,/ %D A!3.G4% ',+" A3%4!&#,- . D%323-1%% �L�. �%3/1/., B,/ �,/ /& .A!3.G! ..!" A/&#,%! / D%3231%B!'(/@ %&?!(5%% % 3+)*!"!&%% D%-3231%% &+ «13#)&2�» % «B%',2�». �L�. �%3/1/.2 A3%&+*"!F%, 1!&%+"-&/! A3!*A/"/F!&%! / ,/4,B,/ &+1&/%,!"-&G! /'"/F&!&%# )+.%'#, /, F%.GD ./)$2*%,!"!@. �B!&G@ .A!3.G! . %',/3%% 4!*%-5%&G A3!*A/"/F%" '2�!',./.+&%! $/"!)&!,./3&GD 4%(3//31+&%)4/. — «4%+)4/.»; '%',!4+,%)%-3/.+" % /A%'+" 4!',&G! '%4A,/4G /,*!"-&GD )+$/"!.+&%@: #)., /A2D/"!@, ./'A+"!&%#, '.%�!@ %,3+.4+,%B!'(%D A/.3!F*!&%@ [1]. A!3.G! . %',/3%% 4%3/./@ D%3231%% . 1841 1/*2 �L�. �%3/1/.A3%(+)+" %)/"%3/.+,- $/"-&GD 3/F!@ % 1+&13!&/@ %) /$�%D A+"+, 1/'A%,+"#, B!4 A3!13+*%" A2,-3+'A3/',3+&!&%� %&?!(5%%, '4!3,% % 'A+' F%)&% 4&/1%4 $/"-&G4. �L�. �%3/1/. /,(3G" ?+(, )+-3+)&/',% 1/'A%,+"-&GD %&?!(5%@ [4]. �3!13+*%,- A2,- 3+'A3/',3+&!&%� %&?!(5%@ 4/F&/ $G"/,+(F! ' A/4/�-� +&,%'!A,%(/.. G'/(/ 5!&# A3%&5%AG 1%1%!&G % '+&%,+3%%, )&+# / .G'/(%D/$!))+3+F%.+��%D './@',.+D D"/3&/@ ./*G, �L�. �%3/1/. %'A/"-)/.+" !� . (+B!',.! +&,%'!A,%(+,+ . D%3231%B!'(2� A3+(,%(2 .A!3.G! ..!" %'A/"-)/.+&%! */3/1/',/#�!@ . ,/ .3!4# @/*&/@ &+-',/@(%. ��! &! $G"+ '/)*+&+ ,!/3%# 1/'A%,+"-&GD )+3+F!&%@, !�! &! &+).+&G A/ %4!&+4 )+1+*/B-&G! 2$%@5G, A/A+*+��%! . 3+&G, + 2F! $G" /,(3G, A2,- $/3-$G '/ ',3+U&G4 .3+1/4 [1].

&+',/#�!! .3!4# A/'"!/A!3+5%/&&G! %&?!(5%% #."#�,'# /'&/.&/@ A3%B%&/@ )+$/"!.+!-4/',% % '4!3,&/',% . D%3231%%. �'/$/! )&+B!&%! A3/$"!4+ %&?!(5%% /$"+',% D%3231%B!'(/1/.4!U+,!"-',.+ A3%/$3!,+!, 2 /&(/"/1%B!'(%D $/"-&GD, . 3!)2"-,+,! '&%F!&%# )+�%,&GD ?+(,/-3/. /31+&%)4+ (+( %)N)+ /'&/.&/1/ )+$/"!.+&%#, ,+( % )+ 'B!, A3/./*%4/@ %442&/'2A3!''%.&/@,!3+A%%. �"# A+5%!&,/. '/ )"/(+B!',.!&&G4% /A2D/"#4% 1/"/.G % U!% .!3/#,&/',- 3+).%,%# %&-?!(5%/&&/1/ /'"/F&!&%# )&+B%,!"-&/ .GU!, B!4 A3% *321%D "/(+"%)+5%#D /A2D/"!@, B,/ /$2-'"/."!&/ +&+,/4%B!'(%4% % ?%)%/"/1%B!'(%4% /'/$!&&/',#4% *+&&/@ /$"+',% [2].

!34%& «?+(,/3 3%'(+» %4!!, /'/$/! )&+B!&%! . �A%*!4%/"/1%% % . (/&,!(',! %&?!(5%@/$"+',% D%3231%B!'(/1/ .4!U+,!"-',.+ /,&/'%,'# ( A+3+4!,32, (/,/3G@ %4!!, )&+B%42� &!)+.%-'%42� '.#)- ' 3+).%,%!4 %&?!(5%/&&/1/ /'"/F&!&%# A/'"! (/&(3!,&/@ /A!3+5%%. �+(,/3G 3%'(+/A3!*!"#�,'# A2,!4 4&/1/?+(,/3&/1/ +&+"%)+ . �A%*!4%/"/1%B!'(%D %''"!*/.+&%#D. � '/F+"!-&%�, ,!34%& «?+(,/3 3%'(+» B+',/ %'A/"-)2!,'# . D%3231%B!'(/@ "%,!3+,23! . $/"!! U%3/(/4'4G'"!, .("�B+# /'/$!&&/',% A+5%!&,+ %"% /A!3+5%%, (/,/3G!, D/,# % +''/5%%3/.+&G ' 3+).%,%!4%&?!(5%% /$"+',% D%3231%B!'(/1/ .4!U+,!"-',.+, A/ *+&&G4 /*&/?+(,/3&/1/ +&+"%)+, &! /$#)+-,!"-&/ #."#�,'# &!)+.%'%4G4% A3!*%(,/3+4% 3+).%,%# A/'"!*&!@.

*��z. �A3!*!"%,- ?+(,/3G 3%'(+ 3+).%,%# %&?!(5%/&&GD /'"/F&!&%@ /$"+',% D%3231%B!-'(/1/ .4!U+,!"-',.+ 2 A+5%!&,/. '/ )"/(+B!',.!&&G4% /A2D/"#4% 1/"/.G % U!%.

J����� ������ . �"# /A3!*!"!&%# ?+(,/3/. 3%'(+ 3+).%,%# %&?!(5%/&&GD /'"/F&!-&%@ /$"+',% D%3231%B!'(/1/ .4!U+,!"-',.+ 2 A+5%!&,/. '/ )"/(+B!',.!&&G4% /A2D/"#4% 1/"/.G% U!% A3/.!*!&/ 3!,3/'A!(,%.&/! %''"!*/.+&%! A+5%!&,/. D%3231%B!'(/1/ /,*!"!&%# �!"#$%&-'(/1/ /$"+',&/1/ ("%&%B!'(/1/ /&(/*%'A+&'!3+ (�����). �3/+&+"%)%3/.+&/ 85 %',/3%@ $/"!)&%A+5%!&,/. '/ )"/(+B!',.!&&G4% &/.//$3+)/.+&%#4% /$"+',% 1/"/.G % U!%, &+D/*%.U%D'# &+ "!-B!&%% . ����� . 2010–2011 1/*+D. '!4 A+5%!&,+4 (42FB%&G, '3!*&%@ ./)3+', 61,1 1/*+) &+ ?/-&! (/4$%&%3/.+&&/1/ "!B!&%# A/ A/./*2 /'&/.&/1/ )+$/"!.+&%# (3+( 1/3,+&%, #)G(+, 3/,/1"/,(% %*3.) A3/.!*!&+ ,3+D!/',/4%#. �"# %&*%.%*2+"-&/1/ A3/1&/)%3/.+&%# 3+).%,%# %&?!(5%/&&GD /'-"/F&!&%@ /$"+',% D%3231%B!'(/1/ .4!U+,!"-',.+ 2 A+5%!&,/. '/ )"/(+B!',.!&&G4% /A2D/"#4%1/"/.G % U!% % 3+)3+$/,(% 4+,!4+,%B!'(/@ 4/*!"% A3/1&/)+ 3+).%,%# %&?!(5%@ '?/34%3/.+&+�/$2B+��+#» 132AA+ %) 85 A+5%!&,/., (/,/3G4 A3/.!*!&+ ,3+D!/',/4%#. '! A+5%!&,G 3+)*!"!&G&+ 2 132AAG: I 132AA+ — «&!3!+"%)/.+&&/1/» 3%'(+ — 45 A+5%!&,/., 2 (/,/3GD .A/'"!*',.%% &!

158

3+).%"%'- %&?!(5%/&&G! /'"/F&!&%#; II 132AA+ («3!+"%)/.+&&/1/» 3%'(+) — 40 A+5%!&,/., 2 (/-,/3GD .A/'"!*',.%% 3+).%"%'- %&?!(5%/&&G! /'"/F&!&%#. G$3+& A/U+1/.G@ 4!,/* *%'(3%4%-&+&,&/1/ +&+"%)+ «Forwardstepwise». �"# '/)*+&%# 4+,!4+,%B!'(/@ 4/*!"% %'A/"-)/.+"% (/4A-�-,!3&2� A3/13+442 «StatisticaforWindows 6.0». �"# A/',3/!&%# A3/1&/',%B!'(/@ 4/*!"% %'A/"-)/-.+&G A/(+)+,!"%, A/"2B!&&G! A3% /$'"!*/.+&%% (+F*/1/ $/"-&/1/ */ 3+).%,%# %&?!(5%/&&/1/A3/5!''+.

&�_��z�� . � A+5%!&,/. '/ )"/(+B!',.!&&G4% /A2D/"#4% 1/"/.G % U!% B+�! *%+1&/',%-3/.+&+ 3-# ',+*%# /A2D/"% — 2 44,7 %, 2-# ',+*%# — 2 28,2%, 1-# ',+*%# — 2 12,9 %, 4-# ',+*%# —2 10,6 %. '!4 A+5%!&,+4 A3/.!*!&+ A"+&/.+# (62,35 %) %"% �(',3!&&+# (37,65 %) ,3+D!/',/4%#. �47 % A+5%!&,/. 3+).%"%'- %&?!(5%/&&G! /'"/F&!&%# . /$"+',% D%3231%B!'(/1/ .4!U+,!"-',.+.�2B!.2� ,!3+A%� */ /A!3+5%% A/"2B+"% 56,5 % A+5%!&,/., A/'"! /A!3+5%% — 2,35 %. �&,%$+(,!-3%+"-&2� ,!3+A%� A!3!* /A!3+5%!@ A/"2B+"% 18,8 % A+5%!&,/., A/'"! /A!3+5%% — 85,9 %. �+(-,/3+4% 3%'(+ 'B%,+"%: &+"%B%! $/"!! ,3!D '/A2,',.2��%D )+$/"!.+&%@ — 34,1 %; ./)3+', ',+3U!65 "!, — 28,2 %; (23!&%! — 20 %; '+D+3&G@ *%+$!, — 4,7 %; *"%,!"-&/',- /A!3+5%% $/"!! 2 B+'/.— 3,5 % % *3.

q��������. �) 4&/F!',.+ %)2B+!4GD A+3+4!,3/. &+4% $G" /A3!*!"!& 3#* (3%,!3%!., (/-,/3G! 4/12, $G,- %'A/"-)/.+&G *"# /A3!*!"!&%# .!3/#,&/',% 3+).%,%# %&?!(5%@ /$"+',% D%323-1%B!'(/1/ .4!U+,!"-',.+ 2 ,3+D!/',/4%3/.+&&GD A+5%!&,/. '/ )"/(+B!',.!&&G4% /A2D/"#4% 1/-"/.G % U!%: *"%,!"-&/! A3!$G.+&%! . ',+5%/&+3! A!3!* /A!3+5%!@, D3/&%B!'(%@ $3/&D%,, ./)3+',A+5%!&,+ ',+3U! 65 "!,.

�A%'/( "%,!3+,23G:1. � 200-"!,%� �L�. �%3/1/.+. — �+2B&G@ ?%"-4. — ����. — 2010.2. �+&13+4, �L�F. �2(/./*',./ A/ A3/?%"+(,%(! %&?!(5%@ . /$"+',% D%3231%B!'(/1/ .4!-

U+,!"-',.+ (�2(/./*',./ HICPAC) / �L�F. �+&13+4, L�. �/3+&, �L�. �%3'/& % *3. // �"%&%B!-'(+# 4%(3/$%/"/1%# % +&,%4%(3/$&+# D%4%/,!3+A%#. — 2003. — � 1, . 5. — �. 74–101.

3. �+'"!*%! �L�. �%3/1/.+ . ("%&%B!'(/@ % �('A!3%4!&,+"-&/@ D%3231%% &+ '/.3!4!&&/4�,+A! [�"!(,3/&&G@ 3!'23']. — �., 2010. — �!F%4 */',2A+: http://www.rsmu.ru.

4. �%(/"+@ �.+&/.%B �%3/1/.. — �+2B&G@ ?%"-4. — ����. — 2006.

&'q41]0"0-^+&4&>+%'�)!>!1'%',+=;!1],-^$',0&"1],!/>&-�'/�&+J'�0,!/+J�1",0"*++)"0'0'&"!,�)]w

!#0. "��3�� (��.)�+)+&'(/@ 1/'2*+3',.!&&/@ 4!*%5%&'(/@ +(+*!4%%

�+?!*3+ D%3231%%

�������������������: ;�Q. Q���������� (��.)

"����z����z. �%3231%B!'(/! "!B!&%! A/'"!/A!3+5%/&&GD 13GF (���) A!3!*&!@ $3�U-&/@ ',!&(% /',+!,'# /*&/@ %) &+%$/"!! +(,2+"-&GD A3/$"!4 '/.3!4!&&/@ D%3231%%, + '+4/ )+$/"!-.+&%! #."#!,'# /*&%4 %) '+4GD 3+'A3/',3+&!&&GD . D%3231%%. �3%4!B+,!"-&/, B,/ 2 3–19 % $/"--&GD A/'"! "+A+3/,/4%% )+(+&B%.+!,'# ��� [2]. �+ A/'"!*&%! *!'#,%"!,%! ' 3/',/4 B%'"+ D%323-1%B!'(%D .4!U+,!"-',. &+ /31+&+D $3�U&/@ A/"/',% ./)3/'"+ % B+',/,+ ��� . 9 3+) % &! %4!!,,!&*!&5%% ( '&%F!&%� [1]. &+',/#�!! .3!4# A3%4!&!&%! 3+)"%B&GD '%&,!,%B!'(%D 4+,!3%+"/.A3% 1!3&%/A"+',%(! #."#!,'# 4!,/*/4 .G$/3+. �3%4!&!&%! '%&,!,%B!'(%D A"+',4+''/.GD 4+,!-3%+"/. . (+B!',.! '!,B+,GD �&*/A3/3/,!)/. %) A/"%�',!3+ (*+(3/&), A/"%A3/A%"!&+ (4+3"!('), +,+(F! A"+',%& A/"%,!,3+?,/3�,%"!&+ (PTFE) A3%.!"/ ( )&+B%,!"-&/42 '&%F!&%� B+',/,G 3!5%*%-./. A3% ��� — */ 20–50 % [1]. �*&+(/ '2�!',.!&&/ 2.!"%B%"/'- (/"%B!',./ 3+&!.GD /'"/F&!-&%@ (��) . A/'"!/A!3+5%/&&G@ (A¦/) A!3%/* — 5–66 %. [2]. �/"%A3/A%"!&/.+# '!,(+ .A/"&! 2*/.-"!,./3#!, ,3!$/.+&%#4, A3!*�#."#!4G4 ( A3/,!)2 $3�U&/@ ',!&(% . /,"%B%! /, *321%D '%&,!,%B!-'(%D�&*/A3/,!)/., ,!4 &! 4!&!! '%&,!,%B!'(%@ 4+,!3%+" .G)G.+!, .G3+F!&&2� ./'A+"%,!"-&2�3!+(5%� '/ ',/3/&G /(32F+��%D ,(+&!@ ' A3!/$"+*+&%!4�(''2*+,%.&/N%&?%"-,3+,%.&/1/ (/4A/-&!&,+. A/'"!*',.%% ./)&%(+�, %&?%"-,3+,G, '!3/4G, A¦/ $/"-, D3/&%B!'(%@ $/"!./@ '%&*3/4.�/%'(% /A,%4+"-&/1/ 4+,!3%+"+ *"# A3/,!)%3/.+&%# $3�U&/@ ',!&(% .!*2,'# A/ '!@ *!&- . '+4GD3+)"%B&GD &+A3+."!&%#D ' 5!"-� A3/?%"+(,%(% 3+&!.GD /'"/F&!&%@. �3% "!B!&%% $/"-&GD .!&-,3+"-&/@ 13GF!@ %4A"+&,+, 4/F!, 3+'A/"+1+,-'# onlay, sublay, inlay, A3% �,/4 3!)2"-,+,G % ./)-

159

4/F&G! /'"/F&!&%# '2�!',.!&&/ 3+)"%B+�,'#. �'"/F&!&%! 3+&!./1/ A3/5!''+ /$3+)/.+&%!4 '!-3/4 ,+(F! 2.!"%B%.+!, 3%'( 3+).%,%# &+1&/!&%! A/'"!/A!3+5%/&&/@ 3+&G. �!3'A!(,%.&G4 4!,/-*/4, ."%#��%4 &+ ,!B!&%! 3+&!./1/ A3/5!''+ 4G 'B%,+!4 +*!(.+,&/! /3/U!&%! /)/&%3/.+&&/1/3+',./3+ . (/4$%&+5%% 4!',&G4 +&!',!,%(/4 ' 5!"-� A3/?%"+(,%(% 3+&!.GD /'"/F&!&%% % (2A%-3/.+&%# A/'"!/A!3+5%/&&/@ $/"%. �/�,/42, (+( ' A3+(,%B!'(/@, ,+( % &+2B&/@ ,/B(% )3!&%#, +(,2-+"-&G4 #."#!,'# A/%'( 3+5%/&+"-&GD4!,/*/. A3/?%"+(,%(% 3+&!.GD /'"/F&!&%@.

*��z���� . �"2BU!&%! 3!)2"-,+,/. D%3231%B!'(/1/ "!B!&%# $/"-U%D .!&,3+"-&GD 13GFA2,!4 3+)3+$/,(% 4!,/*/. A3/?%"+(,%(% 3+&!.GD /'"/F&!&%@.

J����������� . �+ A!3%/* ' 2011 A/ 2012 11. &+ $+)! ��� � 7 1. �+)+&% A3/,!)%32�-�+# 1!3&%/A"+',%(+ ' 2',+&/.(/@ (+,!,!3+ ��N���. A3!*$3�U%&&/@ ("!,B+,(! .GA/"&!&+38 A+5%!&,+4 A/ A/./*2 A/'"!/A!3+5%/&&GD .!&,3+"-&GD 13GF. �+)4!3G 13GF% /A3!*!"#"% '/-1"+'&/ ' ("+''%?%(+5%!@ ChevrelRath (2000). �+"G! — . 3 (7,89 %) '"2B+#D; '3!*&%! — . 6(15,78 %); $/"-U%! — . 15 (39,47 %); 1%1+&,'(%! — . 11 (28,94 %).

� 15 (39,47 %) A+5%!&,/. A3/,!) 3+)4!�!& . A/)%5%% onlay, 215 (39,47 %) $/"-&GD — 4!,/-*%(+ sublay, 2 8 (21 %) A+5%!&,/. — 4!,/*%(+ inlay. �'A/"-)/.+"%'- A/"%A3/A%"!&/.G! '!,(%.'!4 $/"-&G4 *"# A3/?%"+(,%(% 3+&!.GD /'"/F&!&%% % '&%F!&%# $/"!./1/ '%&*3/4+ . A/'"!-/A!3+5%/&&/4 A!3%/*! 2',+&/."!&G (+,!,!3G ��N��� . /$"+',% A3!*$3�U%&&/@ ("!,B+,(%, (/-,/3+# )+("�B+!,'# . '"!*2��!4: A/'"! A"+',%(% A!3!*&!@ $3�U&/@ ',!&(% .GU!2(+)+&&G4%'A/'/$+4% /',+."#"% *.+ A!3?/3%3/.+&&GD (+,!,!3+ ��N��� A+3+""!"-&/ 3+&!, (2*+ ../*%"'#/)/&%3/.+&&G@ 3+',./3 . (/4$%&+5%% 4!',&G4 +&!',!,%(/4.

� 11 A+5%!&,/. ' 1%1+&,'(%4% 13GF+4% (+,!,!3G '/D3+&#"%'- . ,!B!&%! 3 '2,/(, A3% �,/4-'244+3&+# */)%3/.(+ /)/&%3/.+&%# '/',+.%"+ 240 4".

� 15 $/"-&GD ' /$U%3&G4% 13GF+4% (+,!,!3G '/D3+&#"%'- 2 '2,/(, '244+3&+# */)%3/.(+/)/&%3/.+&%# '/',+.%"+ 160 4". /',+"-&GD '"2B+#D (+,!,!3G 2*+"#"%'- . ,!B!&%! A/"2,/3+ '2-,/(, */)%3/.(+ /)/&%3/.+&%# '/',+."#"+ /(/"/ 100 4".

&�_��z�� . � 35 (92 %) $/"-&GD '/ ',/3/&G 3+&G . A/'"!/A!3+5%/&&/4 A!3%/*! 'A!5%?%-B!'(%D /'"/F&!&%% &! &+$"�*+"/'-. �!,+"-&GD %'D/*/. &! $G"/. � ,3/%D A+5%!&,/. &+ 7–8-! '2-,(% '?/34%3/.+"/'- '!3/4+, (/,/3+# A2&(,%3/.+&+ A/* ���N(/&,3/"!4. �!5%*%./. 13GF &! .G#.-"!&/.

$ ���. +(%4 /$3+)/4, A/'"! A"+',%(% A!3!*&!@ $3�U&/@ ',!&(% +""/A"+',%B!'(%4 4+,!-3%+"/4 5!"!'//$3+)&/ /3/U!&%! /)/&%3/.+&&G4 3+',./3/4 . (/4$%&+5%% ' 4!',&G4 +&!',!,%(/4. A+3+A3/,!)&/! A3/',3+&',./. �3% &+"%B%% ?+(,/3/. 3%'(+ 3+).%,%# 3+&!.GD /'"/F&!&%@ '"!*2,A3%4!&%,- A3!*"/F!&&G@ 'A/'/$ ' 5!"-� 24!&-U!&%# B+',/,G ./)&%(&/.!&%# 3+&!.GD /'"/F&!-&%@, '&%F!&%# $/"!./1/ '%&*3/4+ . 3+&&!4 A/'"!/A!3+5%/&&/4 A!3%/*! % '/(3+�!&%# '3/(+ A3!-$G.+&%# . ',+5%/&+3!.

�A%'/( "%,!3+,23G:1. !3/&'(%@, �L�. �3%4!&!&%! &%(!"%*N,%,+&/.GD 'A"+./. A3% A"+',%(! A!3!*&!@ $3�U-

&/@ ',!&(% // !',&%( D%3. — 2000. — � 5. — �. 92–97.2. �!$3/.'(%@ L., /'(%& �L�., �"-B!&(/ �L�., �.+*5+,%"!,&%@ /AG, "!B!&%# A/'"!/A!-

3+5%/&&GD .!&,3+"-&GD 13GF // !',. D%3. — 1996. — � 2. — �. 105–108.

�!$&'J',,-'J'0!(-1'%',+=)'1!+(,-^&4;*!$ (!;q!&1+0'&"04&-)

"#,. ;��� 3�� (����.), >#$. )���z��� (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

�������������������: #��. Q���-���� (���., . �. �.)

"����z����z. �+).%,%!, A3/1&/), 'A/'/$G "!B!&%# % A3/?%"+(,%(% (!"/%*&GD 32$5/.A3!*',+."#�, '"/F&2� +(,2+"-&2� 4!*%(/N'/5%+"-&2� A3/$"!42. �+,/1!&!) (!"/%*&GD 32$5/.&! 2',+&/."!&. �,'2,',.2!, !*%&G@ A/*D/* ( /A3!*!"!&%� (3%,!3%!. �??!(,%.&/',% "!B!&%#./A3/' / ,+(,%(! "!B!&%# *+&&/@ &/)/"/1%% .G)G.+!, *%'(2''%�.

*��z. �/ *+&&G4 "%,!3+,23&GD %',/B&%(/. /5!&%,- '/.3!4!&&G! 'A/'/$G $/3-$G ' (!"/-%*&G4% 32$5+4%.

160

J���� �������. &/34+"-&/@ (/F! A3/5!''G '%&,!)+ % 3+'A+*+ &+D/*#,'# . *%&+4%B!-'(/4 3+.&/.!'%%, ,/ !',-, '(/"-(/ &/./1/ (/""+1!&+ '?/34%3/.+"/'-, ',/"-(/ F! ',+3/1/ A/*.!31-"/'- $%/"/1%B!'(/@ *!13+*+5%%. (!"/%*&/4 32$5! '%&,!) (/""+1!&+ )&+B%,!"-&/ A3!.GU+!,&/342 %4!&&/ )+ 'B!, 24!&-U!&%# A3/5!''+ 3+'A+*+ ($%/*!13+*+5%%). �/�,/42 "!B!&%! (!"/%*-&GD 32$5/. &+A3+."!&/ &+ 3+)32U!&%! 2F! '?/34%3/.+&&GD (/""+1!&/.GD ./"/(/&. �,/ 4/F!,$G,- */',%1&2,/ '"!*2��%4% 4!,/*+4%:

- /A!3+,%.&G@ 4!,/* (%''!B!&%! 32$5+);- "2B!.+# ,!3+A%#;- (/4A3!''%#;- '%"%(/&/.G! A"+',%&G %"% 1!"-;- "+)!3&+# /$3+$/,(+;- ��N*!',32(5%#;- %&�!(5%% (/3,%(/',!3/%*/.;- (3%/,!3+A%#;- 4+)!.+# ,!3+A%#;- (/4$%&%3/.+&&+# ,!3+A%#.�%3231%B!'(/! %''!B!&%!: A3% �,/4 'A/'/$! "!B!&%# (!"/%*/., B,/$G 4%&%4%)%3/.+,- A/-

.3!F*!&%!, /,'!B!&%� A/*.!31+!,'# 4%&%4+"-&/! (/"%B!',./ 4#1(%D ,(+&!@, + 3+&+ )+(3G.+!,'#,+(, B,/$G &! '/)*+.+,- %)"%U&!1/ *+."!&%# . (/F!. �"# �,/1/ %'A/"-)2�,'# 3+)"%B&G! "/'(2,-&G! 4!,/*%(%. �3/4! ,/1/, */"F&G $G,- %'("�B!&G .'! ./)4/F&G! %',/B&%(% ./'A+"!&%#, &+-A3%4!3, A/A+.U%! . 3+&2 ./"/'#&G! ?/""%(2"G, %&/3/*&G! A3!*4!,G, 1!4+,/4G. �+( 4/&/,!3+-A%# �,/, 4!,/* *+!, 3!5%*%.G . 70–90 % '"2B+!..

�2B!.+# ,!3+A%#: %)"2B!&%! A3%4!&#!,'# '+4/',/#,!"-&/ %"% . '/B!,+&%% ' D%3231%B!'(%42*+"!&%!4 *"# A3!*/,.3+�!&%# 3!5%*%./.. �*&+(/ 4/&/,!3+A%# (3+@&! &! �??!(,%.&+ % *+!, 3!5%-*%. A/B,% . 100 % '"2B+!.. �/"-U%! */)G %)"2B!&%# A/(+)G.+�, "2BU%! 3!)2"-,+,G, &/ A3% �,/4./)4/F&/ A!3!3/F*!&%! /A2D/"!@ B!3!) 15–30 "!,. .%*2 (+&5!3/1!&&/1/ *!@',.%# �,/, 4!,/* A3%-4!&#!,'# ,/"-(/ . '+4GD (3+@&%D '"2B+#D. �! A3%4!&#!,'# . /$"+',% 1/"/.G, "%5+, 132*%&G.

�/4A3!''%#: 4!D+&%B!'(%! (/4A3!''%/&&G! A/.#)(% %).!',&G (+( �??!(,%.&/! '3!*',./$/3-$G ' (!"/%*&G4% 32$5+4%. �/',/#&&+# (/4A3!''%# (20–40 44 3,. ',.) A3%4!&#!,'# 12–24 B+'+. '2,(% &+ A3/,#F!&%% 3–12 4!'#5!.. � /*&/@ ',/3/&G, /&+ A3/,%./',/%, 3/',2 32$5/./@ ,(+&%,4!D+&%B!'(% 2*!3F%.+# !! . /13+&%B!&&/4 A3/',3+&',.!, ' *321/@, '*+."%.+# '/'2*G 32$5+, $"/-(%32!, !1/ A%,+&%!, .G3+$/,(2 (/""+1!&+ % 3/', ?%$3/$"+',/., B,/ A3%./*%, ( /',+&/.(! !1/ 3/'-,+ % B+',%B&/@ 3!13!''%%.

�%"%(/&/.G! A"+',%&G % 1!"%: %'A/"-)2!,'# *"# "!B!&%# (!"/%*&GD 32$5/. ' A!3!4!&&G42'A!D/4. �D %'A/"-)2�, *"# A3!*/,.3+�!&%# (/&,+(,&/1/ *!34+,%,+ % 3+)3G./. (/F% 24 B+'+ .'2,(%. �%"%(/& &! A3/&%(+!, . (/F2, A3% �,/4 1!34!,%B&/ )+(3G.+!, 32$!5 % 2."+F&#!, !1/. �/-(+)+&/, B,/ '%"%(/& 2.!"%B%.+!, ,!4A!3+,232 . U3+4!, A/.GU+# +(,%.&/',- (/""+1!&+)G. +(F!'*+."%.+!, 4!"(%! (+A%""#3G, 24!&-U+# */',+.(2 4!*%+,/3/. ./'A+"!&%# %&1%$%32# '%&,!) (/"-"+1!&+ )+ 'B!, (%'"/3/*&/1/ 1/"/*+&%#. �/ ',+,%',%(! . 79 % '"2B+!. �3%,!4+ '/(3+�+!,'#, (!"/-%*&G@ U3+4 24!&-U+!,'#, )2* A3/D/*%,. �*&+(/ A/"&/1/ 3+''+'G.+&%# 32$5+ &! A3/%'D/*%,.

�+)!3&+# /$3+$/,(+: A3!%42�!',./ "+)!3&/@ ,!3+A%% . !! ,/B&/',%, 'A/'/$&/',% /,'!B!&%#,(+&% ' 4%&%4+"-&G4% A/.3!F*!&%#4% % "%(.%*+5%!@ ./'A+"!&%#. '! "+)!3&G! 2',3/@',.+%4!�, 'D/F%! 4!D+&%)4G *!@',.%# — ',%42"#5%# '/(3+�!&%# .G3+$/,(% (/""+1!&+ B!3!) &+13!.,A3/./(+5%# 4%(3/'/'2*%',/1/ ,3/4$/)+, '!"!(,%.&/! )+4!*"!&%! .G3+$/,(% (/""+1!&+. '! ?/3-4G "+)!3&/@ ,!3+A%% .G)G.+�, A/.,/3&/! A/#."!&%! (!"/%*&GD 32$5/. . 90 % '"2B+!..

��N*!',32(5%#: ��N*!',32(,%.&G@ 4!,/* U%3/(/ %'A/"-)2!,'# . &+',/#�!! .3!4#. �!-D+&%)4 !1/ './*%,'# ( ,/42, B,/ &!A/"&/5!&&+# . 4/3?/?2&(5%/&+"-&/4 +'A!(,! '/!*%&%,!"-&+#,(+&- (!"/%*&/1/ 32$5+ A/* ./)*!@',.%!4 ��NA3%$/3+ )+4!&#!,'# ,(+&-�, A/ ',3/!&%� % ?2&(-5%% $"%)(/@ ( &/34+"-&/@, B,/ A/*,.!3F*+!,'# *+&&G4% 1%',/"/1%B!'(/1/ %''"!*/.+&%#. �/"2-B!&&G! *+&&G! '.%*!,!"-',.2�, / .G'/(/@ �??!(,%.&/',% *+&&/1/ 4!,/*+ . "!B!&%% $/"-&GD '(!"/%*&G4% 32$5+4%.

�&�!(5%% (/3,%(/',!3/%*/.: (/3,%(/',!3/%*G A3%4!&#�,'# "/(+"-&/ (+( *"# A3/?%"+(,%-(% /$3+)/.+&%# (!"/%*/., ,+( % *"# "!B!&%# (!"/%*/. % ',+3GD 1%A!3,3/?%B!'(%D 32$5/. A2,!4.&2,3%32$5/.GD %&�!(5%@ (3%',+""%B!'(/@ '2'A!&)%%. &2,3%32$5/.G! %&�!(5%% '&%F+�, '%&-,!) (/""+1!&+ &! ,/"-(/ )+ 'B!, 21&!,!&%# *!"!&%# ?%$3/$"+',/., &/ % A/.GU!&%# (/&5!&,3+5%%(/""+1!&+)G. �/3,%(/',!3/%*G . A/"/.%&! '"2B+!. *+�, A/"/F%,!"-&G@ 3!)2"-,+,. �/"%B!',./

161

3!5%*%./. '/',+."#!, /(/"/ 30 %. �3% '/.4!�!&%% D%3231%B!'(/1/ "!B!&%# % 1/34/&+"-&GD %&�-!(5%@ �??!(,%.&/',- ./)3+',+!, */ 85 %.

�3%/,!3+A%# (A/.3!F*!&%! ("!,/( F%*(%4 +)/,/4): 4!D+&%)4 A/.3!F*!&%# ,(+&!@ (3%/1!-&/4 /$2'"/."!& A/3+F!&%!4 4%(3/5%3(2"#,/3&/1/ 32'"+ % 1%$!"-� 5%,/A"+)4G % /31+&!"" ("!-,/(, .G).+&&G4 .&2,3%("!,/B&G4 % .&2,3%'/'2*%',G4 /$3+)/.+&%!4 (3%',+""/. "-*+. / .3!4#/,,+%.+&%# . ("!,(+D A/.GU+!,'# (/&5!&,3+5%# �"!(,3/"%,/., B,/ A3% A/.,/3&/4 /D"+F*!&%%,(+&% '/A3/./F*+!,'# !�! $/"-U!@ (3%',+""%)+5%!@, 2'(/3#��!@ %D 1%$!"-. �+( 4/&/4!,/*(3%/,!3+A%# A/(+)+"+ A/"&/! %'B!)&/.!&%! (!"/%*/. % 1%A!3,3/?%B!'(%D 32$5/. ' /,'2,',.%!43!5%*%./. . 37 % 74 % '"2B+!., '//,.!,',.!&&/. '/B!,+&%% ' *321%4% 4!,/*+4% . 76–90 % — $!)3!5%*%./..

�+)!.+# ,!3+A%#: . )+.%'%4/',% /, 5!"% A3%4!&#�, 3+)"%B&G! 4+)% (+&,%$+(,!3%+"-&G!,&/34+"%)2��%! (3/.//$3+�!&%!, A/.GU+��%! %442&%,!, . /$"+',% 3+&G, )+4!*"#��%! %"%2'%"%.+��%! '%&,!) (/""+1!&+ % 3+)F%F+��%! 3+&!.2� '3!*2, % *3.).

�/4$%&%3/.+&&+# ,!3+A%# . '3+.&!&%% ' 4/&/4!,/*%(+4% *+!, 1/3+)*/ $/"!! �??!(,%.&G!3!)2"-,+,G % */(+)G.+!, &!/$D/*%4/',- '/B!,+&%# &!'(/"-(%D '/.3!4!&&GD 'A/'/$/. $/3-$G '(!"/%*+4%.

$ ��� . �/*./*# %,/1 % /5!&%. .GU!A!3!B%'"!&&G! 4!,/*G "!B!&%#, D/,!"/'- $G /'/$!&-&/ /,4!,%,- *.+ — �,/ ��N*!',32(5%# % (3%/,!3+A%#. �+ '!1/*&#U&%@ *!&- �,% 4!,/*%(% #."#-�,'# &+%$/"!! �??!(,%.&G4% 'A/'/$+4% $/3-$G ' (!"/%*&G4% 32$5+4%, + ,+(F! /,"%B+�,'# 4%-&%4+"-&G4 3%'(/4 3+).%,%# 3!5%*%./..

�&/1//$3+)%! 'A/'/$/. "!B!&%# (!"/%*&GD 32$5/. !�! 3+) */(+)G.+!, &+4, B,/ �,/ .!'-4+'"/F&G@ % ,32*/!4(%@ A3/5!'', (/,/3G@ &! .'!1*+ *+!, A/"/F%,!"-&G@ 3!)2"-,+,, &/ ,!4 &! 4!-&!! '/.3!4!&&G! &+2(+ % 4!*%5%&+ ',/#, &+ .!3&/4 A2,% 3+)3!U!&%# *+&&/@ A3/$"!4G.

�A%'/( "%,!3+,23G:1. �)!3'(+#, �L�. �2$5G (/F% % %D *!34+,/(/'4!,/"/1%B!'(+# (/33!(5%#. — ��$.: �'(2'',-

./ �/''%%, 2007.2. �+?/&/., �L. �%A!,3/?%B!'(%! % (!"/%*&G! 32$5G // �/'4!,/"/1. — 2012. — � 3 (53).

— �. 82–84.3. �+?3+&/. L., +1+&/. �L., �/3D2&/.+ �L�., �"+*-(/ L., �"+(' �L�., �/3*/.5!-

.+ L., �%'-4!&'(/.+ �L. ��N*!',32(,%.&G@ 4!,/* "!B!&%# A+5%!&,/. ' (!"/%*&G4% 32$5+4%// �"%&%B!'(+# *!34+,/"/1%# % .!&!3/"/1%#. — 2010. — � 6. — �. 41–43.

1'%',+';!1],-^!�0&-J+!>&",+%',,-J+`J�+'J"J+�1'$&-�+��!1]q!$",+'J0!&")!�)!�++

$#". ;����� (��.), '#". '������� (����.)

�!34'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%# %4. +(. �L�. +1&!3+�+?!*3+ &/34+"-&/@, ,/A/13+?%B!'(/@ % ("%&%B!'(/@ +&+,/4%%, /A!3+,%.&/@ D%3231%%

�������������������: 9��. ?�������� (0��. ��., ���., �. �. �.), W�8. ��������� (��., �. �. �.)

�',3+# �4A%!4+ A"!.3G A/NA3!F&!42 /',+!,'# +(,2+"-&/@ A3/$"!4/@ '/.3!4!&&/@ D%323-1%%. �,/ /$2'"/."!&/ .G'/(%4% A/(+)+,!"#4% "!,+"-&/',#4% % .G'/(%4 3%'(/4 ?/34%3/.+&%#D3/&%B!'(/@ �4A%!4G A"!.3G. �+ '!1/*&#U&%@ *!&- . "!B!&%% $/"-&GD ' ,/,+"-&G4% % '2$,/-,+"-&G4% /',3G4% &!'A!5%?%B!'(%4% �4A%!4+4% A"!.3G U%3/(/ %'A/"-)2!,'# ,/3+(/'(/A%#.�+A3/,%., 2 $/"-&GD ' /13+&%B!&&G4% �4A%!4+4% A"!.3G, (/1*+ &+1&/!&%! )+&%4+!, &!$/"-U/@2B+',/( A"!.3+"-&/@ A/"/',%, 3#* +.,/3/. %'A/"-)2!, A2&(5%/&&G@ 4!,/* "!B!&%# "%$/ A3/',/!*3!&%3/.+&%! A"!.3+"-&/@ A/"/',%, ./)*!3F%.+#'- /, .GA/"&!&%# ,/3+(/'(/A%%. �,/ /$�#'&#!,'#/$�!(,%.&G4% ,32*&/',#4%, .G).+&&G4% &!$/"-U%4% 3+)4!3+4% A/"/',% &+1&/!&%#; $"%)/',-�/B+1+ &+1&/!&%# ( *%+?3+14!, '3!*/',!&%�, A/*("�B%B&G4 '/'2*+4; 2*+"!&&G4 3+'A/"/F!&%!4A/"/',% 1&/@&%(+ /, A/.!3D&/',% 132*&/@ ("!,(%. �/,# /13+&%B!&&G! 1&/@&G! A"!.3%,G A3/,!-(+�,, (+( A3+.%"/, $/"!! $"+1/A3%#,&/, B!4 ,/,+"-&G! % '2$,/,+"-&G!, /*&+(/ A3% &!�??!(,%.-&/4 "!B!&%% 4/12, A3%./*%,- ( ',/@(/@ 2,3+,! ,32*/'A/'/$&/',% % ( "!,+"-&/42 %'D/*2.

*��z� &+U!1/ %''"!*/.+&%# ',+"+ /5!&(+ �??!(,%.&/',% %'A/"-)/.+&%# ,/3+(/'(/A%% ."!B!&%% $/"-&GD ' �,/@ A+,/"/1%!@.

162

J����� ������ . A!3%/* ' 1997 A/ 2011 11. . /,*!"!&%% ,/3+(+"-&/@ D%3231%% ���� 4 1. �!34% A3/D/*%"% "!B!&%! 233 (100 %) $/"-&GD ' /',3G4% /13+&%B!&&G4% &!'A!5%?%B!-'(%4% �4A%!4+4% A"!.3G (�����). "!B!&%% �,%D $/"-&GD 4G %'A/"-)/.+"% /A!3+,%.&2� ,/-3+(/'(/A%�.

�+)3+$/,+&&2� &+4% 4!,/*%(2 .GA/"&!&%# ,/3+(/'(/A%% $/"-&G4 ' ����� 4/F&/ '?/3-42"%3/.+,- '"!*2��%4 /$3+)/4: $/"-&G4 ' ����� A!3.G@ ,/3+(/5!&,!) '"!*2!, .GA/"&#,- .("%&%(/N+&+,/4%B!'(/4 «5!&,3!» A/"/',% &+1&/!&%#, A/'"! */',/.!3&/@ 3!&,1!&/"/1%B!'(/@,'/&/13+?%B!'(/@ % A2&(5%/&&/@ .!3%?%(+5%% 1&/@&%(+. /3+(/'(/A%B!'(%! 4+&%A2"#5%% &2F&/.GA/"&#,- A3!%42�!',.!&&/ . 4/&/A/3,+"-&/4 3!F%4!. �3% &+"%B%% $3/&D/A"!.3+"-&/1/ '.%�+% 3%1%*&/1/ "!1(/1/ '"!*2!, 2',+&+."%.+,- *.+ *3!&+F+.

�B+1% &+1&/!&%# 3+'A/"+1+"%'- . 3+)"%B&GD /,*!"+D A"!.3+"-&/@ A/"/',%, B,/ /A3!*!"#"//'/$!&&/',% ("%&%B!'(/@ +&+,/4%% A+,/"/1%B!'(/1/ A3/5!''+. �A%(+"-&/N.!3D2U!B&G! �����4G .',3!,%"% . 16 (7,1 %) '"2B+#D. 4 (1,9 %) $/"-&G4, 2 (/,/3GD &+1&/!&%! $G"/ &!$/"-U%D 3+)-4!3/. % "/(+"%)/.+"/'- &!A/'3!*',.!&&/ . .!3D2U(! (2A/"+ A"!.3+"-&/@ A/"/',%, A3%4!&%"%A2&(5%/&&G@ 4!,/* "!B!&%#. '! $/"-&G! .G)*/3/.!"%. � 12 (5.2 %) A+5%!&,/. &+1&/!&%! 3+'-A3/',3+&#"/'- .&%) */ 2-1/ 4!F3!$!3-#, % A2&(5%/&&/! "!B!&%! $G"/ &!�??!(,%.&/. �,%4 A+5%-!&,+4 4G .GA/"&%"% ,/3+(/'(/A%�.

�+)+"-&G! ����� &+$"�*+"% 2 102 (43,9 %) A+5%!&,/.. �,% 1&/@&%(% A3%"!1+"% ( *%+-?3+14+"-&/@ A"!.3!. 3 (1,4 %) $/"-&G4 ' &!$/"-U%4% A/"/',#4% &+1&/!&%# (*/ 100 4") 2'A!U&/A3%4!&%"% A2&(5%/&&G@ 4!,/* "!B!&%#. 99 (42,5 %) $/"-&G4 .GA/"&%"% ,/3+(/'(/A%�.

�!F*/"!.G! ����� 4G .',3!,%"% . 10 (4,2 %) '"2B+#D. � �,%D A+5%!&,/. 1&/@ '(+A"%.+"-'# 4!F*2 */"#4% "!1(/1/ % &! (/&,+(,%3/.+" ' A+3%!,+"-&/@ A"!.3/@. � 3 (1,4 %) $/"-&GD 2*+-"/'- */$%,-'# .G)*/3/."!&%# ' A/4/�-� A2&(5%/&&/1/ 4!,/*+ "!B!&%#. 7 (2,8 %) $/"-&G4 .G-A/"&%"% ,/3+(/'(/A%�.

�+3+4!*%+',%&+"-&G! ����� /$&+32F%"% . 10 (4,2 %) '"2B+#D. �3% ,+(/@ ("%&%B!'(/@+&+,/4%% A/"/',- 1&/@&%(+ (/&,+(,%3/.+"+ '/ '3!*/',!&&/@ A"!.3/@. 4 (1,9 %) $/"-&G4 2'A!U&/A3%4!&%"% A2&(5%/&&G@ 4!,/* "!B!&%#, + 6 (2,3 %) $/"-&G4 .GA/"&%"% ,/3+(/'(/A%�.

� 95 (40,6 %) B!"/.!( 4G &+$"�*+"% A3%',!&/B&/NA+3+(/',+"-&G! �����. � �,%D A+5%!&-,/. /B+1 &+1&/!&%# 3+'A/"+1+"'# &+ 3!$!3&/@ A"!.3!. � 11 (4,8 %) $/"-&GD ' 2'A!D/4 A3%4!&%"%A2&(5%/&&G@ 4!,/* "!B!&%#, /',+"-&G4 84 (35,8 %) $/"-&G4 .GA/"&%"% /A!3+,%.&2� ,/3+(/'(/-A%�.

&�_��z�� �����������. �"# /5!&(% �??!(,%.&/',% "!B!&%# .'!D A+5%!&,/. 3+)*!"%"%&+ *.! 132AAG.

I 132AA2 ./U"% 114 (48,9 %) B!"/.!( ' �����, . "!B!&%% (/,/3GD %'A/"-)/.+"% 3+)3+$/-,+&&2� &+4% 4!,/*%(2 .GA/"&!&%# /A!3+,%.&/@ ,/3+(/'(/A%%.

/ II 132AA2 ./U"% 119 (51,1 %) $/"-&GD, (/,/3G! A3/D/*%"% "!B!&%! . A!3%/*, (/1*+ 4!,/-*%(+ &+D/*%"+'- &+ ',+*%% 3+)3+$/,(%.

�3!*&## *"%,!"-&/',- 1/'A%,+"%)+5%% $/"-&GD . I 132AA! '/',+.%"+ 27,95 ± 0,96 (/@(/N*&#,./ II 132AA! 34,17 ± 1,38 (/@(/N*&#. I 132AA! %) 114 (100 %) A+5%!&,/. .G)*/3/.!"% 112 (98,25%)$/"-&GD. �'D/*/. . D3/&%B!'(2� �4A%!42 A"!.3G . I 132AA! &! $G"/. �4!3"% 2 (1,75 %) A+5%!&-,+. / II 132AA! %) 119 (100%) $/"-&GD .G)*/3/.!"% 102 (85,7%) $/"-&GD. �3/&%B!'(+# �4A%!4+A"!.3G '?/34%3/.+"+'- 2 13 (10,9%) $/"-&GD. �4!3"/ 4 (3,4 %) A+5%!&,+.

$ ��� . +(%4 /$3+)/4, . 3!)2"-,+,! .&!*3!&%# . ("%&%B!'(2� A3+(,%(2 ',+&*+3,%)%3/-.+&&/@ 4!,/*%(% .GA/"&!&%# ,/3+(/'(/A%% A/"2B!&/ '&%F!&%! '3/(/. 1/'A%,+"%)+5%% $/"-&GD '����� &+ 6,22 (/@(/N*&#, B,/ '/',+.%"/ 18,2 %. �/"%B!',./ .G)*/3/.!.U%D A+5%!&,/. 2.!"%B%-"/'- &+ 13,15 %, B%'"/ %'D/*/. . D3/&%B!'(2� �4A%!42 A"!.3G '&%)%"/'- &+ 10,9 %, "!,+"-&/',-'/(3+,%"+'- &+ 1,65 %.

�/"2B!&&G! D/3/U%! ("%&%B!'(%! 3!)2"-,+,G A/)./"#�, 3!(/4!&*/.+,- +(,%.&/! %'A/"--)/.+&%! A3!*"+1+!4/@ 4!,/*%(% .GA/"&!&%# ,/3+(/'(/A%% . "!B!&%! $/"-&GD ' /13+&%B!&&G4%/',3G4% &!'A!5%?%B!'(%4% �4A%!4+4% A"!.3G.

163

�&!>,!q+&!$",+'!0("1',,-^&'q41]0"0!$;"11!,,!/",>+!�1"�0+)+)!"&)0"*++"!&0-

,"!�,!$",++","0!J+%'�)+^�"&"J'0&!$

"#$. >������ (��.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�!"#$%&'(+# /$"+',&+# ("%&%B!'(+# $/"-&%5+

�,*!"!&%! '/'2*%',/@ D%3231%%

�������������������: ���. B��� ( �������� �����. ��-., ���.)

�/+3(,+5%# +/3,G (�/�) — �,/ .3/F*!&&/! '!14!&,+3&/! '2F!&%! +/3,G, 3+'A/"/F!&&/! ./$"+',% !! A!3!U!@(+ [2]. �+',/,+ �/�A/ *+&&G4 3+)"%B&GD +.,/3/. '/',+."#!, /, 6 % */ 14,2 %.'!D .3/F*!&&GD A/3/(/. '!3*5+ [5] % #."#!,'# /*&%4 %) &+%$/"!! 3+'A3/',3+&!&&GD .3/F*!&-&GD A/3/(/. '!3*!B&/ - '/'2*%',/@ '%',!4G. &+',/#�!! .3!4# %).!',&/ *.+ /'&/.&GD 'A/'/$+"!B!&%# (/+3(,+5%%: /,(3G,/! /A!3+,%.&/! % �&*/.+'(2"#3&/! .4!U+,!"-',./. 3+&'"�4%&+"-&+#$+""/&&+# +&1%/A"+',%(+ (����) #."#!,'# �??!(,%.&/@ % 4+"/%&.+)%.&/@ 4!,/*%(/@. �&+$!)/A+'&!! /,(3G,/@ (/33!(5%% A/3/(+ [1,7]. ,/ F! .3!4# /,4!B!&+ */./"-&/ .G'/(+# .!3/#,-&/',- 3!',!&/)+ A/'"! ����, (/,/3+# 4/F!, */',%1+,- 30 % % $/"!! [4], + ,+( F! ./)4/F&/',-?/34%3/.+&%# +&!.3%)4 . )/&! +&1%/A"+',%(% [6]. �!'4/,3# &+ A3/./*%4G!42"-,%5!&,3/.G! %'-'"!*/.+&%#£*/ &+',/#�!1/ .3!4!&% &! .G3+$/,+&/ B!,(%D (3%,!3%!. *"# /A,%4+"-&/1/ .G$/3+'A/'/$+ "!B!&%# �/� % /(/&B+,!"-&/ &! /A3!*!"!&/ 4!',/ 3!&,1!&D%3231%B!'(%D 'A/'/$/. . 2',-3+&!&%% *+&&/1/ A/3/(+. [2,3,6,8].

*��z. �3/.!',% +&+"%) /,*+"!&&GD 3!)2"-,+,/. % .G#.%,- +&+,/4%B!'(%! A+3+4!,3G,."%#��%! &+ /,*+"!&&G@ 3!)2"-,+, ���� �/�.

J����� ������ . �+ A!3%/* ' 2003 A/ 2010 1/* ���� �/� .GA/"&!&+ 51 A+5%!&,2./)3+', A+5%!&,/. '/',+."#" /, 1,5 4!'#5!. */ 35 "!, (. '3!*&!4 6,6 ± 6,1 1/*+). �3+*%!&, *+."!-&%# . /$"+',% ',!&/)+ A!3!U!@(+ +/3,G (/"!$+"'# /, 31 */ 103 44 3, ',. �/&,3/"- A3/./*%"'# A/*+&&G4 ("%&%B!'(/1/ /'4/,3+ ' %)4!3!&%!4 '%',!4&/1/ +3,!3%+"-&/1/ *+."!&%#, �D/(+3*%/'(/-A%%, 42"-,%'A%3+"-&/@ (/4A-�,!3&/@ ,/4/13+?%%.

&�_��z�� . �,*+"!&&G! 3!)2"-,+,G /5!&!&G 2 32 A+5%!&,/. (62,7 %). �3!*&%@ '3/( &+-$"�*!&%# 2,7 ± 1,8 1/*+. �!,+"-&GD %'D/*/. &! $G"/. �+5%!&,G $G"% 3+'A3!*!"!&G &+ 132AAG A/.!"%B%&! /',+,/B&/1/ 13+*%!&,+ . /$"+',% A!3!U!@(+ . /,*+"!&&/4 A!3%/*! A/'"! +&1%/A"+',%(%.�!3.+# 132AA+ — 21 A+5%!&, (65,6 %) ' /',+,/B&G4 13+*%!&,/4 *+."!&%# A/ *+&&G4 �D/(+3*%/-'(/A%% . &%'D/*#�!@ +/3,! &! $/"!! 20 44 3,. ',. ,/3+# 132AA+ — 6 A+5%!&,/.(18,8 %)' 13+*%!&-,/4 21–35 44 3,. ',. 3!,-# 132AA+ — 5 A+5%!&,/.(15,6 %) ' 13+*%!&,/4 $/"!! 35 44 3,. ',.

G#."!&/ *.+ +&+,/4%B!'(%D A+3+4!,3+ /$"+',% A!3!U!@(+, ."%#��%D &+ /,*+"!&&G@ 3!-)2"-,+, +&1%/A"+',%(%:

1. �3/,#F!&&/',- 2B+',(+ �/� — A/(+)+,!"- R1 (3%'. 1).2. �+'',/#&%! /, 2',-# "!./@ A/*("�B%B&/@ +3,!3%% (����) */ (/+3(,+5%% — A/(+)+,!"-

R2 (3%'. 2).

�%'. 1 �%'. 2

164

�"# '3+.&%,!"-&/1/ +&+"%)+ 2(+)+&&GD 132AA A/ A/(+)+,!"#4 R1 % R2 %'A/"-)/.+"% (3%,!-3%@ �F/&(%3+, A3!*&+)&+B!&&G@ *"# .G#."!&%# ,!&*!&5%@ %)4!&!&%# A3%)&+(+ A3% A!3!D/*! /,.G$/3(! ( .G$/3(! A3% '/A/',+."!&%% ,3!D % $/"!! .G$/3/(. G#."!&+ )&+B%4+# ,!&*!&5%#(p < 0,01) 2.!"%B!&%# A/(+)+,!"# R1 A3% A!3!D/*! /, A!3./@ 132AAG (/ .,/3/@, + )+,!4 ( ,3!,-!@.+(%4 /$3+)/4, 4/F&/ 2,.!3F*+,-, B,/ '2�!',.2!, A3#4+# (/33!"#5%/&&+# '.#)- 4!F*2 )&+B!-&%#4% 13+*%!&,+ . /$"+',% A!3!U!@(+ % )&+B!&%#4% R1: $/"-U%4 )&+B!&%#4 R1 '//,.!,',.2�,$/"-U%! )&+B!&%# 13+*%!&,+, 4+"G4 — 4+"G!. +(%4 F! /$3+)/4 .G#."!&+ )&+B%4+# ,!&*!&5%#(p < 0,01) 24!&-U!&%# A/(+)+,!"# R2 A3% A!3!D/*! /, A!3./@ 132AAG (/ .,/3/@, + )+,!4 ( ,3!,-!@.+(%4 /$3+)/4, 4/F&/ 2,.!3F*+,-, B,/ '2�!',.2!, /$3+,&+# (/33!"#5%/&&+# '.#)- 4!F*2 )&+B!-&%#4% 13+*%!&,+ % )&+B!&%#4% R2: $/"-U%4 )&+B!&%# R2 '//,.!,',.2�, 4+"G! )&+B!&%# 13+*%!&-,+, 4+"G4 — $/"-U%!.

�3+.&%,!"-&G@ +&+"%) '3!*&%D )&+B!&%@ A3/,#F!&&/',% A!3!U!@(+ (R1)% 3+'',/#&%# */ ���� (R2) . %''"!*2!4GD 132AA+D

�+%4!&/.+&%!A+3+4!,3+

�3!*&## .!"%B%&+ ± mÂ%&,!3.+" %)4!&!&%#] �/�??%5%!&,

�F/&(%3+Ã(3(0,01)=23

�&+B%4/',-3+)"%B%@

4!F*2132AA+4%�32AA+ 1 �32AA+ 2 �32AA+ 3

�3/,#F!&&/',-�/� (R1)

3,5 ± 1,04[1,5;5]

8,7 ± 0,9[7;10]

16,7 ± 0,9[13;22] S�4A=27 P < 0,01

�+'',/#&%#*/ ���� (R2)

16,8 ± 3,4[13;23,5]

9,2 ± 4,4[0,5;15]

2,0 ± 2,0[0;18] S�4A=25 P < 0,01

�+4!,%4, B,/ %&,!3.+"G %)4!&!&%# .!"%B%&G R1 . 132AA+D &! A!3!'!(+�,'#, ,/ !',- A+3+-4!,3 R1 4/F!, #."#,-'# '%"-&G4 %*!&,%?%(+,/3/4 132AAG, '"!*/.+,!"-&/, A/ )&+B!&%� R1 4/F-&/ ' .G'/(/@ ,/B&/',-� A3/1&/)%3/.+,- 23/.!&- 13+*%!&,+. ,/3/@ A+3+4!,3 R2 ,+(F! 4/F&/%'A/"-)/.+,- (+( %*!&,%?%(+,/3 132AAG, /*&+(/, ,/B&/',- %*!&,%?%(+5%% &!4&/1/ &%F!, B!4.A!3./4 '"2B+!. �!)2"-,+,G '3+.&%,!"-&/1/ +&+"%)+ 132AA A/ '3!*&%4 )&+B!&%#4 A/(+)+,!"!@ R1 %R2 A3!*',+."!&G &+ *%+13+44!.

+( (+( /$&+32F!&+ '%"-&+# A3#4+# (/33!"#5%/&&+# )+.%'%4/',- 4!F*2 R1 % 13+*%!&,/4 ./$"+',% A!3!U!@(+ (Y) ((/�??%5%!&, 3+&1/./@ (/33!"#5%% �A%34!&+ r = 0,9), % '%"-&+# /$3+,&+#(/33!"#5%/&&+# )+.%'%4/',- 4!F*2 R2 % Y (r = -0,8), ,/ 4GA/',3/%"% *.+ 3!13!''%/&&GD 23+.&!-&%#:

Y = 9,3 + 2,2 × R1((/�??%5%!&, *!,!34%&+5%% R = 0,87, ',+&*+3,&+# /U%$(+ ´ = 5,5).Y = 43,5 - 1,7 × R2((/�??%5%!&, *!,!34%&+5%% R = 0,68, ',+&*+3,&+# /U%$(+ ´ = 9,5).

165

� %'A/"-)/.+&%!4 *+&&GD 23+.&!&%@ 4/F&/ */',+,/B&/ D/3/U/ A3/1&/)%3/.+,- .!"%B%&213+*%!&,+ (Y) (+( A/ A+3+4!,32 R1, ,+( % A/ A+3+4!,32R2.

,/3/@ A+3+4!,3 R2 #."#!,'# $/"!! 132$G4 %*!&,%?%(+,/3/4. �*&+(/ A/ *+&&/@ .G$/3(!*/',/.!3&/ 4/F&/ 2,.!3F*+,-, B,/ !'"% R2 = 0, ,/ $/"-&/@ A/A+*+!, . ,3!,-� 132AA2.

�?/342"%32!4 A3/1&/',%B!'(%! (3%,!3%% /,&!'!&%# $/"-&/1/ ( 132AA! (1, 2, 3):�3%,!3%@ R1:!'"% R1�[0;5], ,/ $/"-&/1/ /,&/'%4 ( 132AA! 1;!'"% R1�[6;10], ,/ $/"-&/1/ /,&/'%4 ( 132AA! 2;!'"% R1>10, ,/ $/"-&/1/ /,&/'%4 ( 132AA! 3;�3%,!3%@ R2:!'"% R2 < 2, ,/ $/"-&/1/ /,&/'%4 ( 132AA! 3;!'"% R2�[2; 12], ,/ $/"-&/1/ /,&/'%4 ( 132AA! 2;!'"% R2 > 12, ,/ $/"-&/1/ /,&/'%4 ( 132AA! 1;�+B!',./ A3/1&/)+ 13+*%!&,+ A/ .GU!2(+)+&&G4 (3%,!3%#4 /5!&%.+"/'- A/ A+3+4!,3+4:

B2.',.%,!"-&/',-, 'A!5%?%B&/',-, A3/1&/',%B!'(+# 5!&&/',- % ,/B&/',-.

�5!&(+ A3/1&/)+ 3!)2"-,+,/. $+""/&&/@ +&1%/A"+',%(% �/�

�3%,!3%@ �2.',.%,!"-&/',- �A!5%?%B&/',-�3/1&/',%B!'(+# 5!&&/',- /B&/',-

A3/1&/)+�/"/F%,!"-&/1/3!)N,+

�,3%5+,!"-&/1/3!)N,+

R1*"# 13.1*"# 13.2*"# 13.3

100 %100 %100 %

100 %100 %100 %

100 %100 %100 %

100 %100 %100 %

100 %100 %100 %

R2*"# 13.1*"# 13.2*"# 13.3

100 %66,7 %100 %

81,2 %100 %100 %

91,3 %100 %100 %

100 %92,9 %100 %

93,8 %93,9 %100 %

$ ��� . �"# A3/1&/)%3/.+&%# /,*+"!&&/1/ 3!)2"-,+,+ ���� �/� 4/12, $G,- %'A/"-)/-.+&G ,+(%! A+3+4!,3G, (+( A3/,#F!&&/',- 2B+',(+ '2F!&%# % 3+'',/#&%! /, 2',-# ���� */�/�,A3%B!4 A3/,#F!&&/',- (/+3(,+5%% #."#!,'# $/"!! ,/B&G4 A3/1&/',%B!'(%4 A+3+4!,3/4. �+%-"2BU%! 3!)2"-,+,G 4/12, $G,- A/"2B!&G A3% A3/,#F!&&/',% 2B+',(+ (/+3(,+5%% 4!&!! 5 44 %3+'',/#&%% */ 2',-# ���� $/"!! 12 44. �!2*/."!,./3%,!"-&G! 3!)2"-,+,G $+""/&&/@ +&1%/A"+-',%(% �/� A3% 3+'A/"/F!&%% '2F!&%# . &!A/'3!*',.!&&/@ $"%)/',% /, 2',-# ���� 4/F&/ '.#-)+,- ' $/"-U!@ 3%1%*&/',-� ',!&(% +/3,G &+ �,/4 23/.&!.

�A%'/( "%,!3+,23G:1. �/(!3%# �L�., �"!(#& �L�. �2(/./*',./ A/ 3!&,1!&�&*/.+'(2"#3&/@ D%3231%% '!3*5+ % '/-

'2*/.. �: ����� %4. �. �. �+(2"!.+ ����, 2008. — . 2 — �. 215–236.2. �/(3/.'(%@, �L. �"%&%B!'(+# +&1%/"/1%#. — �.: �!*%5%&+, 2004. — . 1 — �. 612–625.3. �!3&#(, �L�. 3+&'"�4%&+"-&+# $+""/&&+# +&1%/A"+',%(+ % ',!&,%3/.+&%! 2 $/"-&GD '

(/+3(,+5%!@ % 3!(/+3(,+5%!@ +/3,G // �&1%/"/1%# % '/'2*%',+# D%3231%#. — 2001. — . 7, � 2. —�. 34–38.

166

4. Beekman R.H., Rocchini A.P., Dick M. et al. Percutaneous balloon angioplasty for native coarc-tation of the aorta // J. Am. Col. Cardiol. — 1987. — Vol. 10. — P. 1078–1084.

5. Campbell, M. Natural History of coarctation of the aorta. Brit Heart J 1970; 32 (5): 633–640.6. Egan M., Holzer, R.J. Comparing balloon angioplasty, stenting and surgery in the treatment of

aortic coarctation. Expert Rev Cardiovasc Ther. 2009. 11: 1401–1412.7. Fawzy, M. E., Awad, M., Hassan W. et al. Long-term outcome (up to 15 years) of balloon an-

gioplasty of discrete native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol. 2004.43: 1062–1067.

8. Forbes, T.J, Kim, D W, Du, W et al. Comparison of Surgical, Stent, and Balloon AngioplastyTreatment of Native Coarctation of the Aorta An Observational Study by the CCISC (Congenital Cardi-ovascular Interventional Study Consortium). J Am Coll Cardiol. 2011; 58 (25): 2664–2674.

41]0&"q$4)!$"=(+">,!�0+)"�(4�1')�,-J�)",+&!$",+'J�&+!�&'('1',++�"0!1!>+%'�)!>!>!&+q!,0"1],!>!+$'&0+)"1],!>!

�;&!�"4;!1],-^�$"&+)!q,!/;!1'q,]w,+�,+^)!,'%,!�0'/

w#$. >���� (����.)�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

�+?!*3+ /$�!@ D%3231%%

�������������������: ��H. ?���X (��., . �. �.)

�+'A3/',3+&!&&/',- .+3%(/)&/@ $/"!)&% '3!*% .)3/'"/@ A/A2"#5%% )+A+*&GD ',3+& '/',+.-"#!, /(/"/ 25 % [1]. +3%(/)&+# $/"!)&- '/A3/./F*+!,'# )&+B%,!"-&G4% A/(+)+,!"#4% .3!4!&&/@% ',/@(/@ 2,3+,G &!,32*/'A/'/$&/',% % ,3!$2!, )&+B%,!"-&GD ?%&+&'/.GD )+,3+,. �!'A2$"%(!�!"+32'- .+3%(/)&/ 3+'U%3!&&G! .!&G .',3!B+�,'# 2 20–25 % F!&�%& % 10–15 % 42FB%& [2]. &+32U!&%% 1!4/*%&+4%(% A3% .+3%(/)&/@ $/"!)&% .+F&2� 3/"- %13+�, A+,/"/1%B!'(%@ .!3,%-(+"-&G@, /$2'"/."!&&G@ &!'/',/#,!"-&/',-� ("+A+&/. A/.!3D&/',&GD .!&, % 1/3%)/&,+"-&G@'$3/', A3%B%&/@ (/,/3/1/ #."#!,'# &!*/',+,/B&/',- ("+A+&/. A!3?/3+&,&GD .!& [3].

*��z. �)2B%,- ,#F!',- ,!B!&%# (("%&%B!'(%! A3/#."!&%#) .+3%(/)&/@ $/"!)&% &%F&%D (/-&!B&/',!@ . )+.%'%4/',% /, ,%A+ A+,/"/1%B!'(/1/ '$3/'+.

J����� ������ . �+4% %)2B!&G A3/,/(/"G 2"-,3+).2(/./1/¥��) %''"!*/.+&%# ' *2A-"!('&G4 '(+&%3/.+&%!4 (��) 48 A+5%!&,/., &+D/*%.U%D'# &+"!B!&%% . 3��� %4. �"24/.+1. �%&'(+ . A!3%/* ' '!&,#$3# 2011 A/ +A3!"- 2012 11.

&�_��z�� . �!'/',/#,!"-&/',- A!3?/3+&,&GD .!& /A3!*!"!&+ 2 33 (68,7 %) A+5%!&,/., %)&%D F!&�%& — 15 (45,5 %), 42FB%& — 18 (54,5 %). �/ ("+''%?%(+5%% ���� %4!"% 4!',/ ("%&%-B!'(%! A3/#."!&%# 2 F!&�%&: �2 — 2 (13,3 %), �3 — 6 (40,0 %), �4 — 7 (46,8 %); 2 42FB%&: �2 —1 (5,5 %), �3 — 7 (38,8 %), �4 — 7 (38,8 %), �5 — 3 (16,6 %). �/ ./)3+',2: F!&�%& — 31–40 "!, —1 (6,6 %), 41–50 — 7 (46,8 %), 51–60 — 2 (13,3 %), 61–70 — 3 (20,0 %), 71–80 — 2 (13,3 %); 42FB%-&G: 21-30 "!, — 4 (22,2 %), 31–40 — 2 (11,1 %), 41–50 — 3 (16,8 %), 51–60 — 5 (27,7 %), 61–70 — 1(5,6 %),71–80 — 3 (16,6 %). � 2B!,/4 +&+4&!)+ *"%,!"-&/',% )+$/"!.+&%# ("+''%?%(+5%% A/ ����'//,.!,',./.+"/: 2 F!&�%& 1–5 "!, �3 — 2, �4 — 2; 6 — 10 "!,, �2 — 2, �3 — 1, �4 — 2; 11–15"!, �4 — 1; 16–20 "!, �3 — 2, �4 — 1; 26–30 "!, �3 — 1, �4 — 1. �3!*% 42FB%& �,% *+&&G! $G-"%: 1–5 "!, �2 — 1, �3 — 5, �4 — 2; 6–10 "!, �3 — 1, �4 — 3; 11–15 "!, — �4 — 1, �5 — 2; 16–20 "!, — �3 — 1, �5 — 1; 26–30 "!, �4 — 1.

�)/"%3/.+&&/, ,/"-(/ &!'/',/#,!"-&/',- /',%+"-&/1/ ("+A+&+ &+$"�*+"+'- 2 15 B!"/.!(,B,/ '/',+.%"/ 31,3 %. �/B!,+&%! A+,/"/1%B!'(/1/ 1/3%)/&,+"-&/1/ % .!3,%(+"-&/1/ '$3/'+ .G#.-"!&/ 2 26 (53,0 %)%)33 A+5%!&,/. '&!'/',/#,!"-&/',- A!3?/3+&,&GD .!&. �3% '/B!,+&%% &!'/',/#-,!"-&/',% A!3?/3+&,&GD .!& % /',%+"-&/1/ ("+A+&+ A/ ("+''%?%(+5%% CEAP $G"% '"!*2��%!("%&%B!'(%! A3/#."!&%# 2 /$'"!*/.+&&GD $/"-&GD: �2 — 2 (7,7 %), �3 — 8 (30,7 %), �4 — 13(50,0 %), �5 — 3 (11,6 %).

� 28 (84,9 %) B!"/.!( ' &!*/',+,/B&/',-� A!3?/3+&,&GD .!& &!'/',/#,!"-&G! A!3?/3+&,G.G#."!&G ,/"-(/ &+ 1/"!&%. �+"%B%! &!'/',/#,!"-&GD A!3?/3+&,&GD .!& % &+ $!*3!, % &+ 1/"!&%/,4!B!&/ 2 5 (15,1 %) $/"-&GD, .'! �,% A+5%!&,G %4!"% ,+(F! &!'/',/#,!"-&/',- /',%+"-&/1/("+A+&+ % '/1"+'&/ ("+''%?%(+5%% ���� /,&!'!&G (: �2 — 1 (20,0 %), �4 — 3 (60,0 %), �5 — 1(20,0 %) B!"/.!(.

167

$ ���. �+ ',!A!&- ,#F!',% ("%&%B!'(%D A3/#."!&%@ .+3%(/)&/@ $/"!)&% A/ ����, &+3+.&! '*321%4% ?+(,/3+4%, ,+(F! ."%#!, ?+(,/3 /*&/.3!4!&&/1/ &+"%B%# A+,/"/1%B!'(/1/ .!3,%(+"-&/1/% 1/3%)/&,+"-&/1/ '$3/'+. �'/$!&&/ �,/, +'A!(, ."%#!, &+ A3/13!'' .+3%(/)&/@ $/"!)&% A3% '/B!,+-&%% &!'/',/#,!"-&/',% A!3?/3+&,&GD .!& 1/"!&% % $!*3+ ' &!'/',/#,!"-&/',- /',%+"-&/1/ ("+A+&+.

�A%'/( "%,!3+,23G:1. �3G�+&/.%B L�., �/4+&/.%B �L., �/A+,- �L�. �5!&(+ ."%#&%# ?+(,/3/. 3%'(+ % .!&/)-

&/1/ 3!?"�('+ &+ A3/13!''%3/.+&%! .+3%(/)&/@ $/"!)&%. �(,2+"-&G! ./A3/'G 'A!5%+"%)%3/.+&-&/@ 4!*%5%&'(/@ A/4/�%, &/.G! &+A3+."!&%# . 4!*%5%&!. — �%&'(, 2010. — �. 111–114.

2. �+!U(/, �L�. �&1%/"/1%# % '/'2*%',+# D%3231%#: (23' "!(5%@. — �%&'(: ����. —�. 72–83.

3. �+!U(/ �L�., %D/& �L�. �3/&%B!'(+# .!&/)&+# &!*/',+,/B&/',- &%F&%D (/&!B&/',!@.�%&'(, 2008. — �. 25–26.

!�0'!�+,0'q�1"�0+,!/�4>1!$!/�0";+1],!�0]w�&+�'&'1!J')!�0'/>!1',+

"#>. >��_ (��.), &#(. ������� (��.), ,#�. ;������ (��.), �#�. >���� (��.)�3%*&!',3/.'(%@ 1/'2*+3',.!&&G@ 2&%.!3'%,!, %4. L�L�!.B!&(/

�+?!*3+ ,3+.4+,/"/1%%, /3,/A!*%% % ��

�������������������: 9�B. 8��-�0 (0��. ��., ���.. �. �. �.)

A!3%/* ',3!4%,!"-&/1/ 3+).%,%# ,!D&%(% A3%4!&!&%# 3+)"%B&GD &+(/',&GD ?%('+,/3/. .,3+.4+,/"/1%%, 4!,/*%(% %D 2',+&/.(%, A3% A!3!"/4+D 3+)"%B&/@ "/(+"%)+5%% A/',/#&&/ 2'/-.!3U!&',.2�,'#.

3+.4+,/"/1%B!'(/! /,*!"!&%! 3+'A/"+1+!, '(3/4&G4 /AG,/4 A3%4!&!&%# A"+',%& ' 21"/-./@ ',+$%"-&/',-� A3% "!B!&%% A!3!"/4/. (/',!@ 1/"!&% 3+)"%B&/@ "/(+"%)+5%%, &! ,3!$2��%D*"%,!"-&/@ &+32F&/@ %44/$%"%)+5%% 1%A'/.G4% A/.#)(+4%. �%',!4+ A"+',%& ' 21"/./@ ',+$%"--&/',-� /,&/'%,!"-&/ &/.G@ ,%A %4A"+&,+,/., ,3!$2��%D &/./1/ 4GU"!&%# . /,&/U!&%% /$�!-A3%&#,GD (/&5!A5%@ &+(/',&/1/ /',!/'%&,!)+ [1, 4].

�,+$%"-&+# ?%('+5%# A!3!"/4+, /'2�!',."�&&+# . D/*! D%3231%B!'(/1/ .4!U+,!"-',.+, A/-)./"#!, /$!'A!B%,- *.%1+,!"-&2� ?2&(5%� '2',+./., %'("�B+!, &+32U!&%! ,3/?%(% [3, 5]. �3+-�!&%! A!3!"/4+, ./'',+&/."!&%! A/"&/5!&&/@ ?2&(5%% (/&!B&/',% — /'&/.&+# )+*+B+ ,3+.4+,/-"/1+ A3% "!B!&%% A!3!"/4/. *"%&&GD ,32$B+,GD (/',!@ 1/"!&% 3+)"%B&/@ "/(+"%)+5%% [2].

*��z�����������. �/(+)+,- A/"/F%,!"-&G@ �??!(, A3% A3%4!&!&%% A"+',%& ' 21"/./@',+$%"-&/',- A3% "!B!&%% A!3!"/4/. (/',!@ 1/"!&% 3+)"%B&/@ "/(+"%)+5%%.

J����� ������ . &+U!@ $/"-&%5! A3/%)./*%"%'- /A!3+5%% A3% A!3!"/4+D ,%A+ 41— �2, �3; 41 — �1, �2, �3; 42 — �1, �2, �3, 1, 2, 3, �1, �2, �3; 43 — �1, �2, �3, �1, �2, �3A/ ("+''%?%(+5%% ��. �G /$"+*+!4 /AG,/4 A3%4!&!&%# A"+',%&G ' 21"/./@ ',+$%"-&/',-� 2 23$/"-&GD. �!&�%& — 10, 42FB%& — 13. /)3+', $/"-&GD: /, 24 */ 65 "!,.

/ .'!D /A!3+5%#D %'A/"-)/.+"+'- 4!,/*%(+ /,(3G,/@ 3!A/)%5%% (/',&GD /,"/4(/. % /'-,!/'%&,!) 4!,+""%B!'(/@ A"+',%&/@ ' 21"/./@ ',+$%"%)+5%!@.

'! /A!3+5%% A3/%)./*%"%'- A/* 'A%&&/4/)1/./@ +&!',!)%!@. �"# /A3!*!"!&%# (+B!',.+ 3!-A/)%5%% % 23/.&# A3/.!*!&%# .%&,/. %'A/"-)/.+"'# 3!&,1!&/13+?%# . ("+''%B!'(%D *.2D A3/!(-5%#D. �'&/.&/@ A3%&5%A /A!3+,%.&/1/ .4!U+,!"-',.+ — ./'',+&/."!&%# +&+,/4%B!'(/@ ?/34GA/.3!F*!&&/@ (/',% ' ?%('+5%!@ (/',&GD /,"/4(/. 4!,+""%B!'(/@ A"+',%&/@ ' 21"/./@ ',+$%"--&/',-� . �,+ 4!,/*%(+ )+("�B+"+'- . A/*1/,/.(% 4!',+ *"# A"+',%&G, A3%4!3(+ % 4/*!"%3/.+&%#A"+',%&G ' A/'"!*2��!@ 2',+&/.(/@ !� &+ (/',- % A3/$&/@ ?%('+5%!@ (/',&GD /,"/4(/.. �/'"!3!&,1!&/"/1%B!'(/1/ (/&,3/"#, A3/%)./*%"+'- ?%('+5%# .%&,+4%.

�3!*&!! .3!4# /A!3+5%% '/',+."#"/ 40 4%&2,. �/'"! /A!3+5%%, &+ (/&!B&/',- A3/%)./*%"/'-&+"/F!&%! �"+',%B&/1/ $%&,+ % &+1-! '2,(% A/'"! /A!3+5%% (/&!B&/',- 2("+*G.+"+'- &+ ./).GU!&-&/! A/"/F!&%!. �+ 2-! '2,(% 4G 3+)3!U+"% .',+.+,- $/"-&G4 % A!3!*.%1+,-'# &+ (/',G"#D $!) &+-132)(% &+ A3//A!3%3/.+&&2� (/&!B&/',-. �/A/"&%,!"-&/@ .&!U&!@ ?%('+5%% &! ,3!$2!,'#.

�&#,%! U./. .GA/"&#"% &+ 12–14-! '2,(% ' 4/4!&,+ /A!3+5%%, �"+',%B&/! $%&,/.+&%! A/'"!/A!3+5%@ &+ &%F&%D (/&!B&/',#D %"% A3%4!&!&%# 'A!5%+"%)%3/.+&&/1/ (/4A3!''%/&&/1/ ,3%(/-,+F+, */ 6 &!*!"-.

168

�3% .GA%'(! 3!(/4!&*/.+"% D/*-$2 ' (/',G"#4% $!) &+132)(% &+ (/&!B&/',- */ 2,5 4!'#5+,3!&,1!&/"/1%B!'(/! /$'"!*/.+&%! B!3!) 2,5–3,0 4!'#5+ *"# 3!U!&%# ./A3/'+ / ./)4/F&/',% A/"-&/@ &+132)(% &+ (/&!B&/',- % )+4!&G (/',G"!@ &+ ,3/',-.

+4$2"+,/3&GD 2'"/.%#D ./)4/F&/ A3%4!&!&%! 3+)"%B&GD ?%)%/A3/5!*23 (���, 13#)!"!-B!&%!, 2"-,3+).2(/.+# ,!3+A%#, ��N,!3+A%#, �"!(,3/',%42"#5%# 4GU5, % ,. *.), "!B!$&/@ 1%4&+-',%(%, &+A3+."!&&GD &+ 2(3!A"!&%# 4GU5 % 3+)3+$/,(2 *.%F!&%@ . '4!F&GD '2',+.+D &%F&%D(/&!B&/',!@.

�) .'!D /A!3%3/.+&&GD $/"-&GD %)2B!&G /,*+"!&&G! 3!)2"-,+,G ' 1"2$%&/@ */ 5 "!, 2 18$/"-&GD. �/3/U%! 3!)2"-,+,G ' A/"&/@ ./'',+&/."!&&/@ ?2&(5%!@ &%F&!@ (/&!B&/',% $G"% 2 15$/"-&GD. �*/."!,./3%,!"-&G! 3!)2"-,+,G (2 $/"-&GD — #."!&%# A/',,3+.4+,%B!'(/1/ *!?/34%-32��!1/ +3,3/)+ 1/"!&/',/A&/1/ '2',+.) — 2 3 $/"-&GD.

$ ��� :1. �3%4!&!&%! 4!,+""%B!'(%D A"+',%& ' 21"/./@ ',+$%"-&/',-� %'("�B+!, *"%,!"-&2� %

13/4/)*(2� .&!U&�� %44/$%"%)+5%� &%F&!@ (/&!B&/',%.2. �+&&## +(,%.%)+5%# A+5%!&,/. % 3+)3+$/,(+ *.%F!&%@ . '4!F&GD '2',+.+D A/)./"#!, %'-

("�B%,- 1%A/*%&+4%� % (/&,3+(,23G '2',+./..3. �/&',32(5%# A"+',%&G /$!'A!B%.+!, &+*�F&2� % ',+$%"-&2� ?%('+5%� /,"/4(/..4. �,+$%"-&+# ?%('+5%# /,"/4(/., !',!',.!&&G@ '3/( (/&'/"%*+5%% A!3!"/4/., (/'4!,%B!-

'(%@ �??!(, — /'&/.&G! */',/%&',.+ 4!,/*%(%, 2"2BU+��%D (+B!',./ F%)&% A+5%!&,/..

�A%'/( "%,!3+,23G:1. �/"(+ �L�., �+"+4+3B2( L., �2"+.%& �L�. % *3. �+U /AG, A3%4!&!&%# A"+',%& ' 21"/./@

',+$%"-&/',-� . "!B!&%% A!3!"/4/. // 3+.4+. �/&!5(%@ &+5%/&+"-&G@ 4!*%5%&'(%@ 2&%.!3'%-,!, %4. �/3-(/1/. — /4 11, � 2 — 2010. — �. 171–173.

2. #F!"/. �L�., �/&B+3/.+ �L�., �%32( �2&'%?. �!B!$&+# ,+(,%(+ A3% A/.3!F*!&%#D 1/"!-&/',/A&/1/ '2',+.+. �"1/3%,4 .G$/3+ 4!,/*+ "!B!&%# // 3+.4+. �/&!5(%@ &+5%/&+"-&G@ 4!*%-5%&'(%@ 2&%.!3'%,!, %4. �/3-(/1/. — /4 11, � 1. — 2010. — �. 93–97.

3. �!"&/(/. �L�., �!(3!!. �L�. �+(3G,G@ %&,3+4!*2""#3&G@ /',!/'%&,!) A3% "!B!&%% .G-'/(%D A!3!"/4/. $/"-U!$!35/./@ /',% // 3+.4+. �/&!5(%@ &+5%/&+"-&G@ 4!*%5%&'(%@ 2&%.!3-'%,!, %4. �/3-(/1/. — /4 11, � 3. — 2010. — �. 348–352

4. �&(%& �L�., �&(%& �L�. // �3+(,%B!'(+# ,3+.4+,/"/1%# !.3/A!@'(%! ',+&*+3,G *%+1&/-',%(% % "!B!&%#. — �/'(.+: �&%1+ A"�', 2002.

5. �!35!& �L�., +'%"+' �A%3%*/&, �?U%& �/32D % *3. �!,+""//',!/'%&,!) /(/"/-.&2,3%'2',+.&GD A!3!"/4/. (/',!@ 'A/&1%/)&G4% .%&,+4% ' $"/(%3/./B&G4% 'A%5+4% . A/F%-"/4 % ',+3B!'(/4 ./)3+',! // 3+.4+. �/&!5(%@ &+5%/&+"-&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4.�/3-(/1/. — /4 6, � 4 — 2005. — �. 427–431.

(+22'&',*+&!$",,-/�!(^!()$-�!1,',+w(&',+&!$",+=�1'$&"1],!/�!1!�0+�&+!�0&!/0!0"1],!/`J�+'J'�1'$&-

'#". '������� (����.), $#". ;����� (��.)�!34'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%# %4. +(+*. �L�L+1&!3+

�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

�������������������: W�8. ��������� (��., �. �. �.), ���. !������� (�. �. �.)

&+',/#�!! .3!4# /'&/.&G4 4!,/*/4, /$!'A!B%.+��%4 A/',/#&&/! 2*+"!&%! 1&/# 2 $/"--&GD /',3G4% &!'A!5%?%B!'(%4% �4A%!4+4% A"!.3G, #."#!,'# *3!&%3/.+&%! A"!.3+"-&/@ A/"/',%¥L�. �+F%&, 2004; L. �+(+3/., 2008; C.R. Schneider, M.W. Gaudereret. al., 2010). �+4% $G" A3/-+&+"%)%3/.+& /AG, *3!&%3/.+&%# A"!.3+"-&/@ A/"/',% 2 202 (100 %) $/"-&GD ' /',3G4% ,/,+"--&G4% �4A%!4+4% A"!.3G, A3/D/*%.U%4% "!B!&%! . A!3%/* 2005–2010 11. . /,*!"!&%% ,/3+(+"--&/@ D%3231%% ���� ���� 4 1. �!34%.

40 (19,8 %) &+%$/"!! ,#F!"G4 A+5%!&,+4 $G"/ .GA/"&!&/ A3/',/! *3!&%3/.+&%! /*&%4*3!&+F!4 A/ ��"+2. �',+"-&G4 162 (80,1 %) $/"-&G4 *3!&%3/.+&%! A"!.3+"-&/@ A/"/',% .GA/"-&#"% . D/*! /A!3+,%.&/@ ,/3+(/'(/A%%. �'A/"-)/.+"% &!'(/"-(/ ',+&*+3,&GD 'D!4 2',+&/.(%*3!&+F!@ . )+.%'%4/',% /, (/&(3!,&/@ ("%&%B!'(/@ '%,2+5%%.

�+)/./@ #."#"+'- ',+&*+3,&+# 'D!4+ 2',+&/.(% *3!&+F!@, (/,/3+# *+.&/ A3%4!&#!,'# . ,/-3+(+"-&/@ D%3231%%: *.+ $+)+"-&/N+A%(+"-&GD *3!&+F+ A3/./*%"% B!3!) ,/3+(/5!&,!)G, .GA/"-

169

&!&&G! 'A!3!*% % ')+*% . &%F&%D /,*!"+D A"!.3+"-&/@ A/"/',% % 3+'A/"+1+"% . &+A3+."!&%% /,*%+?3+14G ( (2A/"2 A"!.3G.

+(/! 3+'A/"/F!&%! *3!&+F!@ /$!'A!B%.+"/ 3+.&/4!3&2� �.+(2+5%� �(''2*+,+ % '$3/'./)*2D+ %) .'!D /,*!"/. A"!.3+"-&/@ A/"/',%. �,2 'D!42 *3!&%3/.+&%# %'A/"-)/.+"% . "!B!&%%111 (37,63 %) $/"-&GD.

15 (5,08 %) $/"-&G4, 2 (/,/3GD ./ .3!4# ,/3+(/'(/A%% $G"% /$&+32F!&G A3%)&+(% A"/D/@,!&*!&5%% "!1(/1/ ( 3!�('A+&'%%, 2',+&/.%"% '(./)&/@ *3!&+F.

�3% ,+(/4 'A/'/$! *3!&%3/.+&%# $G"+ %'("�B!&+ 4%13+5%# *3!&+F+, % ,+(/@ *3!&+F 4/F&/$G"/ "!1(/ )+4!&%,-, &! A3%$!1+# ( .GA/"&!&%� A/"&/5!&&/@ ,/3+(/'(/A%% . /,"%B%! /, $+)/./-1/ 4!,/*+ *3!&%3/.+&%#.

� 8 (2,71 %) A+5%!&,/. I 132AAG &+ ?/&! 3%1%*&/1/ "!1(/1/ %4!"/'- $/"-U/! (/"%B!',./1&/@&/N&!(3/,%B!'(%D '!(.!',3/. % ?%$3%&/)&/N1&/@&GD ?3+14!&,/., A/�,/42 %4 '(./)&/! *3!-&%3/.+&%! */A/"&#"% ..!*!&%!4 A!3!*&!1/ $+)+"-&/N+A%(+"-&/1/ *3!&+F+.

�D!4+ *3!&%3/.+&%# ,3!4# *3!&+F+4% $G"+ A3%4!&!&+ 2 28 (13,86 %) $/"-&GD. 3!,%@ *3!-&+F 2',+&+."%.+"% . '"2B+! /$&+32F!&%# A3%)&+(/. $3/&D/A"!.3+"-&/1/ '.%�+, B,/$G 23+.&#,-(/"%B!',./ ./)*2D+ .GD/*#�!1/ A/ '.%�2 % '$3+'G.+!4/1/ A/ *3!&+F+4.

�$GB&/ . A/'"!/A!3+5%/&&/4 A!3%/*! %'A/"-)/.+"% 3+)"%B&G! .+3%+&,G '/B!,+&%@ +(,%.-&/@ % A+''%.&/@ +'A%3+5%% (A/ A/(+)+&%#4). �(,%.&2� +'A%3+5%� %'A/"-)/.+"% A3% /,'2,',.%%"!1/B&/NA"!.3+"-&/1/ '.%�+ "%$/ A3% &!$/"-U/4 "!1/B&/NA"!.3+"-&/4 '//$�!&%%. �+''%.&/!*3!&%3/.+&%! A/ ��"+2 &+/$/3/, 'A/'/$',./.+"/ 1!34!,%)+5%% *!?!(,/. "!1/B&/@ ,(+&%.

�'"% . ,!B!&%! A!3.GD '2,/( A/'"!/A!3+5%/&&/1/ A!3%/*+ '/D3+&#"'# 4+''%.&G@ '$3/'./)*2D+ A/ *3!&+F+4, % "!1(/! &! %4!"/ ,!&*!&5%% ( 3+'A3+."!&%�, 4G 2',+&+."%.+"% 1-2 */A/"-&%,!"-&GD *3!&+F+.

�'"% (/""+A' "!1(/1/ '/D3+&#"'# ( (/&52 2-D '2,/(, .GA/"&#"% �&*/$3/&D%+"-&2� /(("�)%�.�3!*&## *"%,!"-&/',- 1/'A%,+"%)+5%% &+U%D A+5%!&,/. '/',+.%"+ 37,84 ± 1,13 (/@(/N*&#. �

17(8,41 %) $/"-&GD '?/34%3/.+"+'- D3/&%B!'(+# �4A%!4+ A"!.3G, 24!3"/ 22 (10,89 %) B!"/.!(+. 3!)2"-,+,! "!B!&%# 2*+"/'- */$%,-'# .G)*/3/."!&%# 2 163 (80,69 %) $/"-&GD.

+(%4 /$3+)/4, 4G '*!"+"% '"!*2��%! .G./*G:1. �3%4!&!&%! *%??!3!&5%3/.+&&/1/ A/*D/*+ ( .GA/"&!&%� *3!&%3/.+&%# 2 $/"-&GD '

/',3/@ ,/,+"-&/@ �4A%!4/@ A"!.3G A/)./"#!, */$%,-'# D/3/U%D ("%&%B!'(%D 3!)2"-,+,/. . A"+-&! '/(3+�!&%# .3!4!&% 1/'A%,+"%)+5%%, 2.!"%B!&%# (/"%B!',.+ A+5%!&,/. A/"&/',-� .G)*/3/-.!.U%D %, '//,.!,',.!&&/, '&%F!&%# '"2B+!. D3/&%)+5%% )+$/"!.+&%# % "!,+"-&/',%.

2. )+.%'%4/',% /, (/&(3!,&/@ ("%&%B!'(/@ '%,2+5%% &!/$D/*%4/ A3%4!&#,- 3+)"%B&G!'D!4G *3!&%3/.+&%#

3. �+)/./@ '"!*2!, 'B%,+,- 'D!42 ..!*!&%# *.2D $+)+"-&/N+A%(+"-&GD *3!&+F!@. �3% A"/-D/@ ,!&*!&5%% "!1(/1/ ( 3+'A3+."!&%� '"!*2!, 2',+&+."%.+,- '(./)&/@ *3!&+F. �+"%B%! U%3/(/-1/ $3/&D/A"!.3+"-&/1/ '.%�+ ,3!$2!, 2',+&/.(% */A/"&%,!"-&GD *3!&+F!@.

;+1"0'&"1],-'"0'&!�)1'&!0+%'�)+'�!&"�',+="&0'&+/;'(&",>!1',++�0!�- — �&!>,!q+�^!("1'%',+=

+&+�)"�+�0'J,-^!�1!�,',+/

+#$. '���z���� (��.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ D%3231%% �� % ���

�!"#$%&'(+# /$"+',&+# ("%&%B!'(+# $/"-&%5+

�������������������: ���. B��� (0��. ��., ���.)

"����z����z. �!3*!B&/N'/'2*%',G! )+$/"!.+&%# #."#�,'# .!*2�!@ A3%B%&/@ '4!3,&/',%./ 4&/1%D ',3+&+D 4%3+, %, A/ A3/1&/)+4 ��, %D */"# . ',32(,23!'4!3,&/',% $2*!, ./)3+',+,-, &/. /,"%B%! /, �(/&/4%B!'(% 3+).%,GD ',3+& . 3+).%.+��%D'# ',3+&+D, . ,/4 B%'"! % . ��, "�*% /,'!3*!B&/N'/'2*%',GD )+$/"!.+&%@ 24%3+�, &+ 15–20 "!, 3+&-U! [1]. �/1"+'&/ */("+*2 �� D3/-&%B!'(%4% /$"%,!3%32��%4% )+$/"!.+&%#4% +3,!3%@ &%F&%D (/&!B&/',!@ ',3+*+!, 5 % .)3/'"/-1/ &+'!"!&%#. �3%B!4, �,/, A/(+)+,!"-£*/',/.!3&/ )+.%'%, /, ./)3+',+ % .+3-%32!,'# /, 0,3 %¥'3!*% A+5%!&,/. */ 40 "!,) */ 7 %('3!*% A+5%!&,/. ',+3U! 60 "!,) [1]. �3!*% A+5%!&,/. ' A3/#.-"!&%#4% «A!3!4!F+��!@'# D3/4/,G» 7 % &2F*+�,'# . &!4!*"!&&/@ 3!(/&',32(,%.&/@ /A!3+5%%,

170

+ 4 % — . +4A2,+5%% A/3+F!&&/@ (/&!B&/',% [2]. �(("�)%32��%! )+$/"!.+&%# +3,!3%@ &%F&%D(/&!B&/',!@, #."#�,'# A3/$"!4/@ $/"-U/@ 4!*%(/N'/5%+"-&/@ )&+B%4/',%. �&,!3!' ( �,/@ A3/-$"!4! )&+B%,!"-&/ .G3/' . A/'"!*&%! 1/*G, ,+( (+( /,4!B+!,'# /,B!,"%.+# ,!&*!&5%# ( 2.!"%B!-&%� B%'"+ ,+(%D )+$/"!.+&%@ % /4/"/F!&%� (/&,%&1!&,+ $/"-&GD, ',3+*+��%D +,!3/'("!3/)/4'/'2*/. &%F&%D (/&!B&/',!@. �*&+(/, ',/%4/',- % A3/*/"F%,!"-&/',- "!B!&%#, ./).3+�!&%! (3+$/,! % (+B!',./ F%)&% A+5%!&,+ A/'"! .GA/"&!&&/@ +4A2,+5%% (/&!B&/',% B+',/ /',+�,'# )+A3!*!"+4% &+2B&GD %&,!3!'/.. �/ *+&&G4 "%,!3+,23G, (+B!',./ F%)&% ',+"/ 'B%,+,-'# 4!3/@�??!(,%.&/',% "!B!&%# . )&+B%,!"-&/4 (/"%B!',.! ("%&%B!'(%D %''"!*/.+&%@ [5]. � .'! F! /B!-.%*&G4 /',+!,'# ?+(,, B,/, &!'4/,3# &+ 2'A!D% 4!*%5%&G, (+( . &+U!@ ',3+&! ,+( % )+32$!F/4,B+',/,+ +4A2,+5%@&%F&%D (/&!B&/',!@ A/ A/./*2 (3%,%B!'(/@ %U!4%% A3/*/"F+!, /',+.+,-'# &+*/',+,/B&/ .G'/(/4 23/.&!. �3/5!'' +,!3/'("!3/)+ #."#!,'# D3/&%B!'(%4, /*&/@ %) 1%A/,!) !1/3+).%,%# #."#!,'# 3!+(5%# &+ A/.3!F*!&%# �&*/,!"%#, . 3!)2"-,+,! B!1/ 3+).%.+!,'# !1/ *%'?2&(-5%# % +*1!)%# "!@(/5%,/., B,/ .G)G.+!, *%'$+"+&' A3/- % +&,%,3/4$/,%B!'(%D ?+(,/3/. % .+)/+(-,%.&GD '2$',+&5%@. �3,!3%+"-&G! '/'2*G A/*.!31+�,'# $/"-U%4 1!4/*%&+4%B!'(%4 &+132)(+4,(/,/3G! /(+)G.+�,'%"-&/! 2*+3&/! *!@',.%! &+ �*/,!"%+"-&2� .G',%"(2. �3% *.%F!&%% (3/.%.*/"- �&*/,!"%# ./)&%(+!, &+A3+."!&&/! A/ (+'+,!"-&/@ 2'%"%! ,/34/F!&%#, &+A3#F!&%!4 '*.%-1+. !"%B%&+ �,+ A3#4/ A3/A/35%/&+"-&+ .#)(/',% (3/.% % /$3+,&/ A3/A/35%/&+"-&+ 3+*%2'2 '/-'2*+ . ,3!,-!@ ',!A!&%. �''"!*/.+&%# A/(+)+"%, B,/ .G'/(/! &+A3#F!&%! '*.%1+ /$3+,&/ A3/A/3-5%/&+"-&/ 3+'A3/',3+&!&&/',% 3+&&%D %&,%4+"-&GD A/.3!F*!&%@. �,% ?+(,G A3!*A/"+1+�, &+-"%B%! 4!D+&%)4+, ' A/4/�-� (/,/3/1/ 4/F&/ /$�#'&%,- A/.GU!&&G@ +,!3/1!&!) . )/&+D ' &%)-(%4 &+A3#F!&%!4 '*.%1+. 4!',! ' �,%4 �&*/,!"%@ 'A!5%?%B!'(% 3!+1%32!, &+ 5%("%B!'(2� *!-?/34+5%� 3+',#F!&%# [6]. �+@(" �!�!(% % '/+.,/3G .G*!"%"% A#,- $+''!@&/. 3+'A3/',3+&!&%#+,!3/'("!3/,%B!'(%D A/3+F!&%@. �/3/&+3&G! +3,!3%%, .!,.% *21% +/3,G, $3�U&+# +/3,+, $3�U-&+# +/3,+, (32A&G! .%'5!3+"-&G! +3,!3%%, % +3,!3%% &%F&%D (/&!B&/',!@ /'/$!&&/ A/*.!3F!&G+,!3/'("!3/)2. �"%&%B!'(%! A3/#."!&%# )+$/"!.+&%@ . $/"-U%&',.! '"2B+!.'.#)+&G ' "/(+"%)+-5%!@+,!3/'("!3/,%B!'(%D $"#U!( . �,%D '/'2*%',GD $+''!@&+D [7]. �/3/&+3&G! +3,!3%%, '/*!3-F+, 4&/1/ /,.!,."!&%@, A/*.!3F!&G '(32B%.+&%� A3% (+F*/4 '/(3+�!&%% '!3*5+, +,!3/'("!3/-,%B!'(%! $"#U(% 3+).%.+�,'# B+�! .'!1/ . 4!',+D $%?23(+5%@. �+5%!&,G ' A/3+F!&%!4 $3�U&/-1//,*!"+ +/3,G % +3,!3%@ &%F&%D (/&!B&/',!@ %4!�, &+%$/"!! .G'/(2� .!3/#,&/',- +,!3/'("!-3/,%B!'(/1/ A/3+F!&%# *321%D "/(+"%)+5%@ [7]. ��� . A3%./*#�!4 (+&+"! %4!!, /'/$2� '("/&-&/',- ( +,!3/'("!3/,%B!'(/42 A/3+F!&%�, D/,# &%(+(%D /,.!,."!&%@ ,+4 &!,. /"-(/ A3% '2F!-&%% A3/'.!,+ &+ 40 % 4/12, 3+).%,-'# '%4A,/4G, /*&+(/ .'"!*',.%! +&+,/4%B!'(/1/ '2F!&%# ���&! 'A/'/$&+ ( (/4A!&'+5%%, A/�,/42 '%4A,/4G 4/12, A/#.%,-'# % A3% 4!&-U!4 A/3+F!&%% [8].�3/./,/( . +3,!3%#D /$GB&/ "+4%&+3&/1/ D+3+(,!3+, $%?23(+5%# % *321%! 1!/4!,3%B!'(%!%)4!-&!&%# ."%#�, &+ "/(+"-&G! D+3+(,!3%',%(% (3/./,/(+, .G)G.+# ,23$2"!&5%�. �4!&&/ . /$"+',%$%?23(+5%@ %4!!,'# A/.GU!&&/! &+A3#F!&%! '*.%1+ % ,23$2"!&,&/',%, �,%4 4/F&/ /$�#'&%,-,/A/13+?%B!'(2� %)$%3+,!"-&/',- +,!3/'("!3/)+ [8].

*��z�����������. �A3!*!"!&%! ./)4/F&/',% A3/1&/)%3/.+&%# $/"-U%D % 4+"GD '/'2*%-',GD /'"/F&!&%@ 2 $/"-&GD ' *.2D',/3/&&%4 /(("�)%/&&/N',!&/,%B!'(/4 A/3+F!&%% +3,!3%@%&?3+%&1.%&+"-&/@ )/&G.

J����� ������ . �3/.!*!&3!,3/'A!(,%.&G@ +&+"%) %',/3%@ $/"!)&% A+5%!&,/. /,*!-"!&%# '/'2*%',/@ D%3231%% �!"#$%&'(/@ �$"+',&/@ �"%&%B!'(/@ �/"-&%5G. �&+"%) %',/3%@ $/-"!)&% 250 A+5%!&,/., 167 A+5%!&,/. ' *.2',/3/&&%4 A/3+F!&%#4% +3,!3%@ % 83 ' /*&/',/3/&&%4A/3+F!&%#4% +3,!3%@. �3!*&%@ ./)3+', '/',+.%" 59,2 ± Å"!,. �2FB%& — 230, F!&�%& — 20. 132AA! ' *.2',/3/&&%4 A/3+F!&%!4 +3,!3%@ A!3!&!'U%! �� 47(28,14 %), ',!&/(+3*%�. 132AA!' /*&/',/3/&&%4 A/3+F!&%!4 +3,!3%@ A!3!&!'U%! �� 15(12,45 %). *+&&2� 132AA2 ./U"%$/"-&G! ' *.2D',/3/&&%4 A/3+F!&%!4 +3,!3%@ &%F&%D (/&!B&/',!@. �/ *+&&G4 (/4A-�,!3&/@+&1%/13+?%% ' (/&,3+',&G4 2'%"!&%!4 /5!&%.+"'# D+3+(,!3 A/3+F!&%#+3,!3%@ %'/',/#,!"-&/',-*%',+"-&/1/ 32'"+. �+''4+,3%.+"%'- % 2B%,G.+"%'- ,/"-(/ 1!4/*%&+4%B!'(% )&+B%4G! ',!&/)G.

+$"%5+1

/."!B!&%! +3,!3%@ &%F&%D (/&!B&/',!@ A3% *.2',/3/&&!4 A/3+F!&%%

�+%&,!3!'/.+&&G! +3,!3%% �.2D',/3/&&!! A/3+F!&%! +3,!3%@�,!&/) �(("�)%#

1 2 3��� 14 (4,19 %) 5 (1,49 %)��� 9 (2,69 %) 790 (23,65 %)

171

�(/&B+&%! ,+$"%5G 1

��� 9 (2,69 %) 2 (0,59 %)3 $!35/.G! +3,!3%% 15 (4,49 %) 2 (0,59 %)2 $!35/.G! +3,!3%% 9 (2,69 %) 23 (6,88 %)1 $!35/.+# +3,!3%# 5 (1,49 %) 18 (5,38 %)

+$"%5+ 2

/."!B!&%! +3,!3%@ &%F&%D (/&!B&/',!@ A3% /*&/',/3/&&!4 A/3+F!&%%�+%&,!3!'/.+&&G! +3,!3%% �*&/',/3/&&!! A/3+F!&%! +3,!3%@

�,!&/) �(("�)%#��� 11 (13,2 %) 3 (3,6 %)��� 37 (44,6 %) 58 (69,9 %)��� 13 (15,6 %) 6 (7,2 %)3 $!35/.G! +3,!3%% 23 (27,71 %) 2 (2,40 %)2 $!35/.G! +3,!3%% 49 (59,03 %) 5 (6,0 %)1 $!35/.+# +3,!3%# 3 (3,61 %) 17 (20,5 %)

+$"%5+ 3

�3+.&%,!"-&G@ +&+"%) 132AA A/ '/',/#&%� *%',+"-&/1/ 32'"+

�/"%B!',./A/3+F!&&GD

+3,!3%@

�/"%B!',./ $/"-&GD . 132AA+D�/�??%5%!&,

�%U!3+

�3/.!&-)&+B%4/',%

3+)"%B%@�32AA+ 1(n = 83)

�32AA+ 2(n = 167)

3 +3,!3%% - 2 (1,2 %) 0,1 -2 +3,!3%% 5 (6,0 %) 23 (13,8 %) 2,4 P < 0,01�,/1/ 2–3 +3,!3%%: 5 (6,05 %) 25 (15,0 %) 2,2 P < 0,051 +3,!3%# 17 (20,5 %) 18 (10,8 %) 2,1 P < 0,05

+$"%5+ 4

�+'A3/',3+&!&&/',- '/A2,',.2��%D )+$/"!.+&%@ 2 $/"-&GD ' /*&/',/3/&&%4+,!3/'("!3/,%B!'(%4 /(("�)%/&&/N',!&/,%B!'(%4% A/3+F!&%!4 +3,!3%@ &%F&%D (/&!B&/',!@

�/A2,',.2��%! )+$/"!.+&%# �/"%B!',./ $/"-&GD�,!&/(+3*%# II–III ?. (" 34 (40,96 %)�,!&/) .!,.!@ *21% +/3,G 16 (19,27 %)�+D+3&G@ *%+$!, II ,%A+ 6 (7,22 %)

+$"%5+ 5

�+'A3/',3+&!&&/',- '/A2,',.2��%D )+$/"!.+&%@ 2 $/"-&GD ' *.2D',/3/&&%4+,!3/'("!3/,%B!'(%4 /(("�)%/&&/N',!&/,%B!'(%4% A/3+F!&%!4 +3,!3%@ &%F&%D (/&!B&/',!@

�/A2,',.2��%! )+$/"!.+&%# �/"%B!',./ $/"-&GD�,!&/(+3*%# II–III ?. (" 129 (77,24 %)�,!&/) .!,.!@ *21% +/3,G 160 (95,80 %)�+D+3&G@ *%+$!, II ,%A+ 24 (14,4 %)

&�_��z�� . �3% .GA/"&!&%% 3!(/&',32(,%.&GD /A!3+5%@ &+ $!*3!&&/NA/*(/"!&&/4 +3,!-3%+"-&/4 '!14!&,! &!A/'3!*',.!&&/ D/3/U%! 3!)2"-,+,G */',%1&2,G . 45,32 % '"2B+!., 3+&&%!,3/4$/)G U2&,/. $G"% . 10,33 % &+$"�*!&%@. �#,%"!,&## (242"#,%.&+# A3/D/*%4/',- U2&,/. ./$�!@ 132AA! '/',+.%"+ 43,51 %, A3% 91,56 % '/D3+&!&&GD (/&!B&/',!@. �/(+)+&/ &+"%B%! 3+)"%-

172

B%@ (p < 0,01) 4!F*2 132AA+4% A/ B%'"2 $/"-&GD, ' A/3+F!&%!4 2–3 +3,!3%@: . 132AA! ' *.2D',/-3/&&%4 A/3+F!&%!4 %D )&+B%4/ $/"-U!, B!4 . 132AA! ' /*&/',/3/&&%4 A/3+F!&%!4 +3,!3%@.�%'"/ $/"-&GD ' A/3+F!&%!4 /*&/@ +3,!3%% . 132AA! ' /*&/',/3/&&%4 A/3+F!&%!4 $/"--U!(p < 0,05), B!4 . 132AA! ' *.2D',/3/&&%4 A/3+F!&%!4 +3,!3%@ %&?3+%&1.%&+"-&/@ )/&G.

q��������. �,+,%',%B!'(% */(+)+&&/! A3!/$"+*+&%! $/"-&GD ' A/3+F!&%!4 2–3 $!35/.GD+3,!3%@ . 132AA! ' *.2D',/3/&&%4A/3+F!&%!4 +3,!3%@, + ,+(F!, $/"-U!! (/"%B!',./ $/"-&GD 'A!3!&!'!&&G4 ��, ',!&/(+3*%!@ &+A3#F!&%# II–III ?. ("., ',!&/)/4 .!,.!@ *21% +/3,G '.%*!,!"--',.2!, / .G3+F!&&/4, 42"-,%?/(+"-&/4 A/3+F!&%% +3,!3%@. �/"2B!&&G! *+&&G! A3% *+"-&!@-U!4 %''"!*/.+&%%, 4/12, $G,- %'A/"-)/.+&G *"# A3/1&/)%3/.+&%# 3+).%,%#'/'2*%',GD /'"/F&!-&%@ . 3+)"%B&GD $+''!@&+D 2 $/"-&GD ' *.2D',/3/&&%4A/3+F!&%!4 +3,!3%@ %&?3+%&1.%&+"-&/@)/&G.

�A%'/( "%,!3+,23G:1. �/''%@'(%! 3!(/4!&*+5%% «�%+1&/',%(+ % "!B!&%! $/"-&GD ' )+$/"!.+&%#4% A!3%?!3%-

B!'(%D +3,!3%@». — �., 2011.2. �+.3%"!&(/ �L. �(3G"!. �L�. �%3231%B!'(/! "!B!&%! $/"-&GD ' (3%,%B!'(/@ %U!4%!@

&%F&%D (/&!B&/',!@. — �., 2005. — 176 '.3. �/(3/.'(%@, �L. �"%&%B!'(+# +&1%/"/1%#. �2(/./*',./ *"# .3+B!@. — �.: �!*%5%&+,

2004. — . 1. — 808 '.4. Management of Periferal Arterial Disease. — 2010. — �. 235.5. TASC II Working Group Trans-Atlantic Inter-Society Consensus Management of Peripheral Ar-

terial Disease // International Angiology. — 2007. — Vol. 19, � 1. — P. 1–304.6. Ross, R. The Pathogenesis of atherosclerosis: a perspective for the 1990s. Nature. 1993. 62:801.7. DeBakey, M.E, Lawrie G.M, Glasser D.G. Paterns of atherosclerosis and their surgical signific-

ance.Ann Surg. 1985. 201: 115–131.8. Rutherford R.B, ed. Zarins C.K, Glagov S. Vascular surgery 4th edn. — Philadelphia: Sanders,

1995. — P. 204–221.

$1+=,+'&')","1+q"*++"&0'&+/,+�,+^)!,'%,!�0'/,"�!)"q"0'1+$,40&+�'&('%,!/>'J!(+,"J+)+$>!&+q!,0"1],!J

�!1!�',+++�&+!&0!�0"0+%'�)!/�&!;'4�"*+',0!$�J41]0+2!)"1],-J"0'&!�)1'&!q!J

>#". q������������ %4. +(+*. �L�. �!U+"(%&+

�!&,3 '/'2*%',/@ % 1%$3%*&/@ D%3231%%

�������������������: ���. !�� ��� ( ���., �. �. �.)

"����z����z. � $/"-&GD ' 42"-,%?/(+"-&G4 +,!3/'("!3/)/4 &!, /*&/)&+B&/1/ 4&!&%# .A3%/3%,!,! $+''!@&+ *"# 3!.+'(2"#3%)+5%%. �*&% +.,/3G A3%*!3F%.+�,'# 4&!&%# / A!3./&+B+"--&/@ 3!(+&+"%)+5%% (/3/&+3&GD +3,!3%@ (2, 3), ,+( (+( 3!(+&+"%)+5%# +3,!3%@ &%F&%D (/&!B&/',!@4/F!, A3%.!',% ( 2D2*U!&%� 5!&,3+"-&/@ 1!4/*%&+4%(%, *321%! 'B%,+�, 5!"!'//$3+)&G4 A3/-./*%,- 3!(+&+"%)+5%� +3,!3%@ . )/&! &+%$/"-U!@ %U!4%% (1).

*��z. �)2B%,- ."%#&%! 3!(+&+"%)+5%% 4+1%',3+"-&GD +3,!3%@ &%F&%D (/&!B&/',!@ &+ A/-(+)+,!"% .&2,3%'!3*!B&/@ 1!4/*%&+4%(% 2 A+5%!&,/. ' 42"-,%?/(+"-&G4 +,!3/'("!3/)/4 . A/-"/F!&%% "!F+ % A3% /3,/',+,%B!'(/@ A3/$!.

J����� ������ . %''"!*/.+&%! $G"% .("�B!&G 38 $/"-&GD ' 42"-,%?/(+"-&G4 +,!-3/'("!3/)/4, D3/&%B!'(/@ %U!4%!@ &%F&%D (/&!B&/',!@ (����) II$ – IV ',+*%% A/ ("+''%?%(+5%%�/(3/.'(/1/ ./)3+',/4 /, 52 */ 73 "!, (�! — 60,4). �%3231%B!'(% )&+B%4G! ',!&/)G A/*.)*/U&GD+3,!3%@ &+$"�*+"%'- 2 24 A+5%!&,/. (63 %), $!*3!&&GD +3,!3%@ 2 14 (36 %). '!4 A+5%!&,+4 A3/./-*%"+'- �&*/.+'(2"#3&+# 3!(+&+"%)+5%# '/ ',!&,%3/.+&%!4 A/3+F!&&GD +3,!3%@ ' */',%F!&%!42*/."!,./3%,!"-&/1/ +&1%/13+?%B!'(/1/ 3!)2"-,+,+. �/ /A!3+5%% .'!4 $/"-&G4 . A/"/F!&%% "!F+% A3% /3,/',+)! ' A/4/�-� ���N�� A3/./*%"/'- %)4!3!&%! (/&!B&/1/ *%+',/"%B!'(/1/ 3+)4!3+ %/$�!4+ A3+./1/ F!"2*/B(+ (��� ��, ��� ��), 3!1%',3%3/.+"+'- ?3+(5%# .G$3/'+ A3+./1/ F!"2-*/B(+ (� ��). $"%F+@U%@ '3/( A/'"! /A!3+5%% �,% F! A/(+)+,!"% 3!1%',3%3/.+"%'- . A/"/F!-&%% "!F+, + ,+(F!, (/1*+ A+5%!&, .A!3.G! .',+.+" A/'"! D%3231%B!'(/1/ "!B!&%#.

173

�!)2"-,+,G A3!*',+."!&G . .%*! 4!*%+&G (�!), 25-1/ % 75 A3/5!&,%"!@ (25 % – 75 %). �+)-"%B%# 'B%,+"% */',/.!3&G4% A3% p < 0,05.

&�_��z�� . �/(+)+,!"% .&2,3%'!3*!B&/@ 1!4/*%&+4%(% % � �� */ /A!3+,%.&/1/ "!B!-&%# . 1/3%)/&,+"-&/4 A/"/F!&%% '/',+.%"%: ��� �� — 3,2 '4 (2,9 % – 3,6 %), ��� �� —37,8 4" (28,5 % – 43,0 %), � �� — 56,3 % (49,0 % – 63,0 %). �3% /3,/',+,%B!'(/@ A3/$! *+&&G!A/(+)+,!"% '/',+.%"%: ��� �� — 3,2 '4 (2,8 % – 3,6 %), ��� �� — 33,0 4" (21,0 % – 41,0 %),� �� — 54,8 % (50,0 % – 58,0 %) % &! /,"%B+"%'- 4!F*2 '/$/@ (p > 0,05). �/'"! /A!3+5%% . 1/-3%)/&,+"-&/4 A/"/F!&%% ��� �� '/',+.%" 3,38 '4 (3,2 % – 3,5 %), ��� �� — 38,79 4" (30,0 % –44,0 %), � �� — 56,32 % (53,0 % – 63,0 %), A3% /3,/',+,%B!'(/@ A3/$! ��� �� '/',+.%"3,25 '4 (2,9 % – 3,5 %), ��� �� — 32,59 4" (26,0 % – 36,0 %), � �� — 55,24 % (50,0 % –58,0 %). *%&+4%(! A3% A!3!4!&! A/"/F!&%# ,!"+ *+&&G! A/(+)+,!"% ,+(F! &! %4!"% */',/.!3-&GD /,"%B%@ (p > 0,05).

�3% '3+.&%,!"-&/4 +&+"%)! A/(+)+,!"!@ .&2,3%'!3*!B&/@ 1!4/*%&+4%(% % � �� */ % A/'"!/A!3+5%% . A/(/! % A3% /3,/',+)! ',+,%',%B!'(% )&+B%4GD /,"%B%@ &! $G"/ .G#."!&/ (p > 0,05).

$ ��� . �/'"! 3!.+'(2"#3%)+5%% 4+1%',3+"-&GD +3,!3%@ &%F&%D (/&!B&/',!@ 2 A+5%!&,/.'���� &! A3/%'D/*%, )&+B%4GD %)4!&!&%@ A/(+)+,!"!@ .&2,3%'!3*!B&/@ 1!4/*%&+4%(% (+( .A/"/F!&%% "!F+, ,+( % A3% /3,/',+,%B!'(/@ A3/$!.

�A%'/( "%,!3+,23G:1. �.+"%+&%, L�. �'/$!&&/',% +/3,/(/3/&+3&/1/ U2&,%3/.+&%# 2 $/"-&GD '%',!4&G4 +,!-

3/'("!3/)/4. — �3D+&1!"-'(, 2007.2. �+#&*%&, �L�. �&?+3(, 4%/(+3*+ (+( A3%B%&+ "!,+"-&/',% A/'"! /A!3+5%@ A/ A/./*2

%U!4%% &%F&%D (/&!B&/',!@ // �&&+"G �������. — 1996. — GA. 5. — �. 36–40.3. Ameli, F.M. Predictors of surgical outcome in patients undergoing aortobifemoral bypass recon-

struction / F.M. Ameli, M. Stein, J.L. Provan et al. // J. Cardiovasc. Surg. — 1990. — Vol. 31, � 3. —P. 333–339.

!*',)"`22')0+$,!�0++��!1]q!$",+=)!11"��!^+&4&>+%'�)+^$J'x"0'1]�0$4;!1],-^�+,2+1]0&"0+$,-J04;'&)41'q!J1'>)+^

$#". +���� (����.)�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

�+?!*3+ ?,%)%/A2"-4/&/"/1%%

�������������������: ���. 6� ��� ( ���., �. �. �.)

"����z����z. A/'"!*&!! .3!4# .'! B+�! .',3!B+�,'# $/"-&G! %&?%"-,3+,%.&G4 ,2$!3-(2"!)/4 "!1(%D, .G*!"#��%! �� ' ��� % ,#F!"/ A/**+��%!'# (/&'!3.+,%.&/42 "!B!&%�. �,/'/)*+!, &!/$D/*%4/',- %)2B!&%# ./)4/F&/',% %'A/"-)/.+&%# (/4A"!('&GD A/*D/*/. . "!B!&%%,'/B!,+��%D +&,%$+(,!3%+"-&2� D%4%/,!3+A%� % (/""+A'/D%3231%B!'(%! .4!U+,!"-',.+.

*��z. �)2B!&%! �??!(,%.&/',% (/4A"!('&/1/ "!B!&%# $/"-&GD %&?%"-,3+,%.&G4 ,2$!3(2-"!)/4 "!1(%D, .G*!"#��%D �� ' ���.

J����� ������ . D/*! %''"!*/.+&%# A3/./*%"'# +&+"%) 4!*%5%&'(/@ */(24!&,+5%%�� «���� A2"-4/&/"/1%% % ?,%)%+,3%%»: %',/3%% $/"!)&!@, 4+,!3%+"G 3!&,1!&/"/1%B!'(%D, "+-$/3+,/3&GD, 'A%3/13+?%B!'(%D, $3/&D/'(/A%B!'(%D %''"!*/.+&%@, /A!3+5%/&&G! F23&+"G, (+-'+��%!'# 72 A+5%!&,/.: 38 ' .A!3.G! .G#."!&&G4 %&?%"-,3+,%.&G4 ,2$!3(2"!)/4 "!1(%D . ?+)!3+'A+*+, .G*!"#��%D �� ' ���, (/,/3G4 A3/./*%"/'- (/4A"!('&/! "!B!&%! ' A3%4!&!&%!4�(',3+A"!.3+"-&/@ ,/3+(/A"+',%(% % +&,%$+(,!3%+"-&/@ ,!3+A%% (/'&/.&+# 132AA+), % 34 A+5%!&-,+ ' .A!3.G! .G#."!&&G4 %&?%"-,3+,%.&G4 ,2$!3(2"!)/4 "!1(%D . ?+)! 3+'A+*+, .G*!"#��%D�� ' ���, (/,/3G! A/"2B+"% ,/"-(/ D%4%/,!3+A!.,%B!'(/! "!B!&%! ((/&,3/"-&+# 132AA+).

/'&/.&/@ 132AA! '//,&/U!&%! 4¦F — 28(73,7 %)/10(26,3 %); 3+'A3!*!"!&%! A/ ./)3+',2:*/ 20 "!, — 1 B!". (2,6 %), /, 21 */ 50 "!, — 34 B!". (89,5 %), /, 51 */ 63 "!, — 3 B!". (7,9 %). �/-(+"%)+5%# A+,/"/1%B!'(/1/ A3/5!''+: 'A3+.+ — 21(55,3 %), '"!.+ — 17(44,3 %); . '!14!&,+D S1,S2— 15(39,5 %), . S1,S2,S3 — 5(13,2 %), . S1,S2,S6 — 18(47,3 %).

(/&,3/"-&/@ 132AA! '//,&/U!&%! 4¦F — 23(67,6 %)/11(33,4 %); 3+'A3!*!"!&%! A/ ./)3+'-,2: */ 20 "!, — 1 B!". (2,9 %), /, 21 */ 50 "!, — 29 B!". (85,3 %), /, 51 */ 68 "!, — 4 (11,8 %). �/-(+"%)+5%# A+,/"/1%B!'(/1/ A3/5!''+: 'A3+.+ — 19 (55,9 %), '"!.+ — 15 (44,1 %); . '!14!&,+D S1,S2— 14 (41,2 %), . S1,S2,S3 — 4 (11,8 %), . S1,S2,S6 — 16 (47,0 %).

174

�/"-&G4 /'&/.&/@ 132AAG A3/./*%"+'- �(',3+A"!.3+"-&+# .!3D&!)+*&## ,/3+(/A"+',%(+ .'3/(% 2–4 4!'#5+ /, &+B+"+ D%4%/,!3+A!.,%B!'(/1/ "!B!&%#. � 28 $/"-&GD (73,7 %) $G"+ .GA/"-&!&+ '!4%3!$!3&+# .!3D&!)+*&## �(',3+A"!.3+"-&+# ,/3+(/A"+',%(+, 2 7 $/"-&GD (18,4 %) —./'-4%3!$!3&+#, 2 3 $/"-&GD (7,9 %) — *!.#,%3!$!3&+#.

/$!%D 132AA+D '/$"�*+"%'- %*!&,%B&G! /$�!A3%&#,G! A3%&5%AG D%4%/,!3+A%%.&�_��z�� . �!)2"-,+,G %''"!*/.+&%# /5!&%.+"%'- B!3!) 9 4!'#5!. /, &+B+"+ "!B!&%#.�+''+'G.+&%! %&?%"-,3+,%.&GD %)4!&!&%@ % 32$5!.+&%! (+.!3& /,4!B!&/ . /'&/.&/@ 132A-

A! 2 20 A+5%!&,/. (52,6 %), . (/&,3/"-&/@ 132AA! 2 8 A+5%!&,/. (23,5 %). �+''+'G.+&%! %&?%"-,-3+,%.&GD %)4!&!&%@, 24!&-U!&%! (+.!3& ' %',/&B!&%!4 %D ',!&/( % 2',3+&!&%! +(,%.&/',% ,2-$!3(2"!)&/1/ A3/5!''+ /,4!B!&/ . /'&/.&/@ 132AA! 2 11 A+5%!&,/. (29,0 %), . (/&,3/"-&/@ 132AA!2 9 A+5%!&,/. (26, 5%). �/D3+&!&%! +(,%.&/',% ,2$!3(2"!)&/1/ A3/5!''+ /,4!B!&/ . /'&/.&/@132AA! 2 5 A+5%!&,/. (13,1 %), . (/&,3/"-&/@ 132AA! 2 14 A+5%!&,/. (41,2 %), 24!3"% . /'&/.&/@132AA! 2 A+5%!&,+ (5,3 %), . (/&,3/"-&/@ 3 A+5%!&,+ (8,8 %). �+&'G &+ 3+''+'G.+&%! %&?%"-,3+-,%.&GD %)4!&!&%@ % 32$5!.+&%! (+.!3& . /'&/.&/@ 132AA! — 1,1, . (/&,3/"-&/@ — 0,3. �,&/U!-&%! U+&'/. — 3,67 > 1.

$ ��� . �!)2"-,+,G %''"!*/.+&%# A/(+)+"% $/"!! .G'/(2� �??!(,%.&/',- "!B!&%# $/"--&GD ' .A!3.G! .G#."!&&G4 %&?%"-,3+,%.&G4 ,2$!3(2"!)/4 "!1(%D . ?+)! 3+'A+*+, .G*!"#��%D�� ' ���, (/,/3G4 A3/./*%"/'- (/4A"!('&/! "!B!&%! ' A3%4!&!&%!4 3+&&!@ (B!3!) 2–4 4!'#5+/, &+B+"+ D%4%/,!3+A!.,%B!'(/1/ "!B!&%#) �(',3+A"!.3+"-&/@ .!3D&!)+*&!@ ,/3+(/A"+',%(% %+&,%$+(,!3%+"-&/@ ,!3+A%% A/ '3+.&!&%� ' $/"-&G4%, (/,/3G4 A3/./*%"/'- "%U- D%4%/,!3+-A!.,%B!'(/! "!B!&%!.

�A%'/( "%,!3+,23G:1. �1+!., �L�. �%3231%B!'(/! "!B!&%! $/"-&GD "!(+3',.!&&/N2',/@B%.G4 ,2$!3(2"!)/4

"!1(%D / �L�. �1+!., �L�. �"%!., �L�. �!*F%(/. // 2$!3(2"!) . �/''%%: �+,!3.VIII �/''. '�!)*+?,%)%+,3/.. — �., 2007. — �. 456.

2. �+A,!., �L�. � A3!*A/B,%,!"-&/',% ,/3+(/A"+',%(% A!3!* 3!)!(5%!@ "!1(%D 2 $/"-&GD,2$!3(2"!)/4 ' ��� / �L�. �+A,!. // �$. ,3. XI &+5. (/&13. A/ $/"!)&#4 /31+&/. *GD+&%#. — ��$.,2001. — �. 864.

3. �%""!3, �L�. �%3231%B!'(/! "!B!&%! $/"-&GD /',3/A3/13!''%32��%4 ,2$!3(2"!)/4 "!1(%D /�L�. �%""!3, �L. �%""!3, �L�. �%""!3 // �3/$"!4G ,2$!3(2"!)+. — 2004. — � 10. — �. 23–26.

$1+=,+'",0+!)�+(",0,!/0'&"�++,"0'%',+'�!�1'!�'&"*+!,,!>!�'&+!("4;!1],-^�)+x'%,!/,'�&!^!(+J!�0]w

"#&. +�z���� (����.)

�3!&$231'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#.�+?!*3+ 1/'A%,+"-&/@ D%3231%%, 23/"/1%%.

�������������������: W��. ����� (��., . �. �.)

�!4+"/.+F&/! )&+B!&%! . A+,/1!&!)! �&,!3+"-&/@ &!*/',+,/B&/',% A3% /',3/@ (%U!B&/@&!A3/D/*%4/',% . A/'"!*&%! 1/*G /,./*%,'# A3/5!''+4 './$/*&/N3+*%(+"-&/1/ /(%'"!&%#. '.#-)% ' �,%4 $/"-U/@ %&,!3!' A3!*',+."#!, A3%4!&!&%! +&,%/('%*+&,&GD A3!A+3+,/. A3% *+&&/4)+$/"!.+&%%.

*��z. �"2BU%,- 3!)2"-,+,G "!B!&%# $/"-&GD ' /',3/@ (%U!B&/@ &!A3/D/*%4/',-� (���). A/'"!/A!3+5%/&&/4 A!3%/*!.

J����� ������ . �$'"!*/.+&/ 48 $/"-&GD, A!3!&!'U%D /A!3+5%� . '.#)% ' ���. '!$/"-&G! $G"% 3+)*!"!&G &+ *.! 132AAG. 1-�, (/&,3/"-&2�, 1*! A3/./*%"/'- ,3+*%5%/&&/! "!-B!&%!, ./U"/ 20 A+5%!&,/.. 2-� (/'&/.&2�) 132AA2 '/',+.%"% 28 $/"-&GD % A/"2B+"% */A/"&%-,!"-&/ ./ .3!4# /A!3+,%.&/1/ .4!U+,!"-',.+ .&2,3%.!&&/ (+A!"-&/ «�!('/*®»– 0,2 41¦(1.

�3% A/',2A"!&%% . ',+5%/&+3, &+ 1-!, 3-% % 6-! '2,(% A/'"! /A!3+5%% /5!&%.+-"%'-¿"!@(/5%,+3&G@ %&*!(' %&,/('%(+5%% (���),'A/&,+&&+# D!4%"�4%&!'5!&5%# (��) % F!"!-)/%&*25%3/.+&&+# �� [.G'/,+ $G',3/@ .'AGU(% (�), '.!,/'244+ 4!*"!&&/@ .'AGU(% (��)]'G./3/,(% (3/.% A/ 4!,/*%(! �L�. �+D32*,%&/.+ (2002.). �3% /$'"!*/.+&%% 20 */&/3/. 2',+&/.-"!&G &/34+"-&G! )&+B!&%# ��: 'A/&,+&&+# '.!,%4/',- (��) — 0,75 ± 0,04 2L!., � — 1,49 ± 0,082L!., �� — 3,7 ± 0,37 2L!.; + ,+(F!��� -—1,06 ± 0,06 /,&. �*.

175

&�_��z�� . �3% A/',2A"!&%% . ',+5%/&+3 2 $/"-&GD /$!%D 132AA ��� . &!'(/"-(/ 3+)*/',/.!3&/ A3!.GU+" &/342 % '/',+."#" 6,49 ± 0,66 /,&. �* . 1-@ 132AA! % 7,04 ± 0,91 /,&. �* — ./2-@ 132AA!. �/(+)+,!"% �� 2 $/"-&GD 1-@ 132AAG¿�� — 2,05 ± 0,35 2L!., � — 6,18 ± 0,21 2L!.,��9,46 ± 1,65 2L!.; ./ .,/3/@ 132AA! �� —2,64 ± 0,48 2L!., � —5,37 ± 0,41 2L!., �� —9,97 ± 1,49 2L!.

�%'. 1. �/(+)+,!"% ���, ��: ��, �, �� A3% A/',2A"!&%% . ',+5%/&+3

1-! '2,(% A/'"! /A!3+5%% ��� . (/&,3/"-&/@ 132AA! '/',+.%" 10,26 ± 1,31, �� —2,13 ± 0,14 2L!., � — 4,76 ± 0,47 2L!., �� —10,7 ± 1,27 2L!. /'&/.&/@ 132AA!: ��� —8,54 ± 1,96, �� —1,7 ± 0,24 2L!., � —3,18 ± 0,37 2L!., �� — 7,09 ± 0,32 2L!.

�%'. 2. �/(+)+,!"% ���, ��: ��, �, �� &+ 1-! '2,(% A/'"! /A!3+5%%.

176

�+ 3-% '2,(% A/'"! /A!3+5%% . /'&/.&/@ 132AA! /,4!B+"/'- $/"!! .G3+F!&&/! % */',/.!3-&/! '&%F!&%! %)2B+!4GD A/(+)+,!"!@L (/&,3/"-&/@ 132AA! ��� '/',+.%" 8,54 ± 0,87,��1,84 ± 0,62 2L!., � 2,86 ± 0,36 2L!., ��9,01 ± 1,26 2L!. /'&/.&/@ 132AA! ��� - 3,09±0,71,��1,12 ± 0,19 2L!., �1,51 ± 0,22 2L!., ��6,34 ± 0,96 2L!.

0123456789

10

��� (/,&.�*)

�� (2L!.) � (2L!.) �� (2L!.)

�32AA+ 1�32AA+ 2

�%'. 3. �/(+)+,!"% ���, ��: ��, �, �� &+ 3-% '2,(% A/'"! /A!3+5%%.

�+ 6-! '2,(% A/'"!/A!3+5%/&&/1/ A!3%/*+%)2B+!4G! A/(+)+,!"% . /$!%D 132AA+D */',/.!3-&/ &! /,"%B+"%'-.

!B!&%! A/'"!/A!3+5%/&&/1/ A!3%/*+ . 5!"/4 $G"/ $/"!! $"+1/A3%#,&G4 . /'&/.&/@ 132A-A!, 1*! &+$"�*+"/'- $/"!! 3+&&!! (&+ 2,91 ± 0,37 '2,/() A/'"! /A!3+5%%, ./'',+&/."!&%! ?2&(5%%(%U!B&%(+ A/ '3+.&!&%� ' (/&,3/"-&/@ 132AA/@, . (/,/3/@ *+&&G@ A/(+)+,!"- '/',+.%"4,68 ± 0,42 '2,.

$ ��� . +(%4 /$3+)/4, A3%4!&!&%! A3!A+3+,+ «�!('/*®» 2 $/"-&GD ' (%U!B&/@ &!A3/D/-*%4/',-� A3!*2A3!F*+!, 3+).%,%! /(%'"%,!"-&/1/ ',3!''+, 'A/'/$',.2!, 24!&-U!&%� �&*/1!&&/@%&,/('%(+5%% % '&%F+!, .G3+F!&&/',-�&,!3+"-&/@&!*/',+,/B&/',% . A/'"!/A!3+5%/&&/4 A!3%/*!.

J!&2!1!>+%'�)!'!;!�,!$",+'�&+J',',+=)!J�!q+*+!,,-^�&!0'q!$(1=�1"�0+)+>&-��+{'$!(,!>!!0$'&�0+=(+"2&">J-

'#". )����� (��.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ D%3231%% �� % ���

�������������������: ���. ��$3�� ( ���., �. �. �.)

"����z����z. �+',/,+ 3+'A3/',3+&!&%# 1+',3/�)/?+1!+"-&/@ 3!?"�('&/@ $/"!)&% % .G'/-(+# .!3/#,&/',- ./)&%(&/.!&%# ,#F!"GD /'"/F&!&%@ /$2'"/.%"% )&+B%,!"-&G@ %&,!3!' ( *+&&/-42 )+$/"!.+&%�. �,%/"/1%% ���� /'&/.&+# 3/"- /,./*%,'# 4!D+&%',%B!'(/@ ,!/3%% !! ./)&%(-&/.!&%# — &+"%B%� +&+,/4%B!'(/1/ *!?!(,+ . .%*! 13GF% A%�!./*&/1/ /,.!3',%# *%+?3+14G.��/"/,G4 ',+&*+3,/4» . D%3231%B!'(/4 "!B!&%% 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G #."#-�,'# "+A+3/'(/A%B!'(%! +&,%3!?"�('&G! /A!3+5%% [5]. �!'4/,3# &+ /B!.%*&G! */',/%&',.+ "+-A+3/'(/A%B!'(%D /A!3+5%@, + %4!&&/: .G'/(+# ,/B&/',- % &%)(+# ,3+.4+,%B&/',-, '/(3+�!&%! (/-"%B!',.+ A/'"!/A!3+5%/&&GD /'"/F&!&%@ % 3+&&## +(,%.%)+5%# $/"-&GD, 3+&&!! ./'',+&/."!&%!

177

4/,/3&/N�.+(2+5%/&&/@ ?2&(5%% F!"2*/B&/N(%U!B&/1/ ,3+(,+, ./)4/F&/',- .GA/"&!&%# '%-42"-,+&,&GD /A!3+5%@; — /',+"+'- &!3!U!&&/@ A3/$"!4+ 3!5%*%./. 1+',3/N�)/?+1!+"-&/1/ 3!?-"�('+ % 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G . 3+&&!4 % A/)*&!4 A/'"!/A!3+5%/&&/4 A!3%/-*+D, B+',/,+ (/,/3GD */',%1+!, 18,4 % [7].

�+%$/"!! 3+'A3/',3+&!&&G4 &+ '!1/*&#U&%@ *!&- 'A/'/$/4 (/33!(5%% 13GF A%�!./*&/1//,.!3',%# *%+?3+14G #."#!,'# &+,#F&+# 1!3&%/A"+',%(+, )+("�B+��+#'# . 'U%.+&%% 4!F*2 '/-$/@ &/F!( *%+?3+14G ((323/3+?%#). �!*/',+,(/4 *+&&/@ 4!,/*%(% #."#!,'# ,/, B,/ ./ .3!4# (32-3/3+?%% A3/%'D/*%, &!%)$!F&+# (/4A3!''%# % &+,#F!&%! ,(+&!@ &/F!( *%+?3+14G, %D ./)4/F&+#%U!4%#, .A"/,- */ &!(3/)+, B,/ . *+"-&!@U!4 A3%./*%, ( A3/3!)G.+&%� &+"/F!&&GD U./. % 3!-5%*%.2 )+$/"!.+&%#.

�/%'( $/"!! �??!(,%.&GD 4!,/*%( A3%.!" ( %'A/"-)/.+&%� '%&,!,%B!'(%D %4A"+&,+,/. .A"+',%(! 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G. �2�!',.2��%! %''"!*/.+&%# A/*,.!3F*+�,�??!(,%.&/',- A3/,!)%32��%D A"+',%( 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G . A3/?%"+(,%(!3!5%*%./. )+$/"!.+&%# [2, 4, 6, 7].

�*&+(/, 4!,/*%(% "+A+3/'(/A%B!'(%D A3/,!)%32��%D /A!3+5%@ *+"!(% /, '/.!3U!&',.+ - ."%,!3+,23! A3%./*#,'# '"2B+% A3/"!F&!@ A%�!./*+, 4%13+5%% A3/,!)/. . A3/'.!, A/"GD /31+&/.[4, 6]. �+&&G! /'"/F&!&%# /$2'"/."!&G (+( &!*/',+,(+4% . 4!,/*%(+D /A!3+5%@, ,+( % './@',.+4%%'A/"-)2!4GD '%&,!,%B!'(%D A/"%4!3/.. �(,2+"-&/@ /',+!,'# A3/$"!4+ A/%'(+ /A,%4+"-&/1/'%&,!,%B!'(/1/ 4+,!3%+"+, /,.!B+��!1/ ,3!$/.+&%#4 %*!+"-&/1/ A3/,!)+. �('A!3%4!&,+"-&GD%''"!*/.+&%@, &+A3+."!&&GD &+ %)2B!&%! /'/$!&&/',!@ ,(+&!.GD 3!+(5%@ &+ %4A"+&,+,G . )/&!1+',3/N�)/?+1!+"-&/1/ A!3!D/*+, . "%,!3+,23! &! )+3!1%',3%3/.+&/; &!/$D/*%4 A/%'( '%&,!,%B!-'(%D %4A"+&,+,/., /$!'A!B%.+��%D &+*!F&2� A"+',%(2 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G' 4%&%4+"-&G4 (/"%B!',./4 /'"/F&!&%@.

*��z. �A3!*!"!&%# &+%$/"!! /A,%4+"-&/1/ % $!)/A+'&/1/ '%&,!,%B!'(/1/ %4A"+&,+,+ *"#A"+',%(% 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G A2,!4 .GA/"&!&%# �('A!3%4!&,+"-&GD A3/,!-)%32��%D /A!3+5%@ &+ "+$/3+,/3&GD F%./,&GD.

J����� � ����� �����������. �('A!3%4!&,+"-&/! %''"!*/.+&%! A3/.!*!&/ &+ 243+)&/A/"GD A/"/./)3!"GD (3/"%(+D, 4+''/@ 3,5–4,5 (1. D/*! �('A!3%4!&,+ 4/*!"%3/.+"+'- %4-A"+&,+5%# '%&,!,%B!'(%D A3/,!)/. &+ &/F(% *%+?3+14G A/)+*% A%�!./*+.�%./,&G! $G"% 3+)*!-"!&G &+ 2 132AAG A/ 12 /'/$!@ . (+F*/@ . )+.%'%4/',% /, .%*+ '%&,!,%B!'(/1/ %4A"+&,+,+, %'-A/"-)2!4/1/ *"# A3/,!)%3/.+&%# A%�!./*&/1/ /,.!3',%# *%+?3+14G.

1-# 132AA+ — 4%(3/A/3%',G@ A3/,!) (3+)4!3 A/3 10 4(4) %) A/"%,!,3+?"�/3/�,%"!&+(PTFE) — 2-@ ,%A %4A"+&,+,+ A/ ("+''%?%(+5%% A.G. Amid (1997);

2-# 132AA+ — 4/&/?%"+4!&,&G@ 4+(3/A/3%',G@ (3+)4!3 A/3 3–4 44) B+',%B&/ 3+''+'G-.+��%@'# /$"!1B!&&G@ (/4A/)%5%/&&G@ (50 % — A/"%A3/A%"!&, 50 % — 4/&/(3%") A3/,!) '2*!"-&G4 .!'/4 28 1¦42 — 1-@ ,%A %4A"+&,+,+ A/ ("+''%?%(+5%% A.G. Amid (1997).

�A!3+5%% .GA/"&#"%'- . '//,.!,',.%% ' 3+)3+$/,+&&/@ &+4% 4!,/*%(/@ A"+',%(% 13GFA%�!./*&/1/ /,.!3',%# *%+?3+14G (A+,!&, � 2438601 /, 10 #&.+3# 20121.). �A!3+5%% /'2�!',.-"#"%'- B!3!) "+A+3/,/4&G@ */',2A . "!./4 A/*3!$!3-! F%./,&/1/. �3/%)./*%"% A!3!'!B!&%! A%-�!./*&/N*%+?3+14+"-&/@ '.#)(%, F!"2*/B&/N*%+?3+14+"-&/@ '.#)(% '"!.+ % 'A3+.+ % B+',% F!-"2*/B&/N'!"!)!&/B&/@ '.#)(%, .G*!"!&%! &/F!( *%+?3+14G. �+,!4 &/F(% *%+?3+14G 'U%.+"%A/)+*% A%�!./*+ 2)"/.G4% U.+4%, "%&%% U.+ 2(3G.+"% A3/,!)/4 ' ?%('+5%!@ !1/ ( *%+?3+14!2)"/.G4% U.+4% A/"%A3/A%"!&/.G4% &%,#4% ' 2'"/.&G4 *%+4!,3/4 4–0. �%('%3/.+&&G@ A3/,!)2(3G.+"% 3+''!B!&&G4% "!./@ F!"2*/B&/N*%+?3+14+"-&/@ % F!"2*/B&/N'!"!)!&/B&/@ '.#)(+4% 'A/'"!*2��!@ %D ?%('+5%!@ ( A3/,!)2 2)"/.G4% U.+4%.

�%./,&G! $G"% .G.!*!&G %) �('A!3%4!&,+ &+ 7-!, 30-!, 90-!, 180-! '2,(% A/'"! /A!3+5%@.�/3?/"/1%B!'(/! %''"!*/.+&%! /'2�!',."#"% '3+)2 A/'"! .G.!*!&%# F%./,&GD %) �('A!-

3%4!&,+. GA/"&#"+'- '3!*%&&+# "+A+3/,/4%# % A3/./*%"+'- 4+(3/'(/A%B!'(+# /5!&(+ A/"/F!-&%# %4A"+&,+,+, /'/$!&&/',% /(32F+��!@ !1/ '/!*%&%,!"-&/,(+&&/@ (+A'2"G. �+,!4 %)."!(+"'#/31+&/(/4A"!(' (+$*/4%&+"-&G@ /,*!" A%�!./*+, (+3*%/N?2&*+"-&G@ /,*!" F!"2*(+, "!.+# */"#A!B!&%, ?3+14!&, *%+?3+14G) ' ?%('%3/.+&&G4 A3/,!)/4, 3+''!(+"+'- '/!*%&%,!"-&/N,(+&&+#(+A'2"+ % /5!&%.+"+'- A/*.%F&/',-, '4!�+!4/',-, '4/3�%.+&%! �&*/A3/,!)/.. �%',/"/1%B!'(%!'3!)G /(3+U%.+"% 1!4+,/('%"%&/4N�/)%&/4. �"# .G#."!&%# (/""+1!&/.GD ./"/(/& A3%4!&#"%/(3+'(2 A%(3/?2('%&/4 A/ +&N�%)/&2, *"# %*!&,%?%(+5%% �"+',%B!'(%D ./"/(/& %'A/"-)/.+"%/(3+'(2 F!"!)&G4 1!4+,/('%"%&/4 A/ !@1!3,2.

�/"2B!&&G! *+&&G! $G"% /$3+$/,+&G 4!,/*+4% 4!*%5%&'(/@ ',+,%',%(%. �5!&(2 */',/-.!3&/',% A/"2B!&&GD *+&&GD A3/%)./*%"% ' %'A/"-)/.+&%!4 (3%,!3%# �+&&+ — �%,&%. �"#

178

/5!&(% 3+)"%B%@ */"!.GD A/(+)+,!"!@ %'A/"-)/.+"% D%N(.+*3+, �%3'/&+. �+)"%B%# 'B%,+"%'- */'-,/.!3&G4% A3% p < 0,05.

&�_��z�� � ����������. �&,3+/A!3+5%/&&GD /'"/F&!&%@ . 132AA+D &! )+3!1%',3%3/-.+&/. A/'"!/A!3+5%/&&/4 A!3%/*! A/'"! %4A"+&,+5%% (/4A/)%5%/&&/1/ A3/,!)+ /'"/F&!-&%@ .G#."!&/ &! $G"/. �3% %'A/"-)/.+&%%%4A"+&,+,+ %)PTFE /'"/F&!&%# . A/'"!/A!3+5%/&-&/4 A!3%/*! ./)&%("% . 3 '"2B+#D (25 %). /*&/4 &+$"�*!&%% $G"/ /$&+32F!&/ '4!�!&%!�&*/A3/,!)+ &+ 90-! '2,(% �('A!3%4!&,+, % . 2 &+$"�*!&%#D — '%1+3//$3+)&+# *!?/34+5%#A3/,!)+ &+ 90-! % 180-! '2,(%.

�/3?/"/1%B!'(+# (+3,%&+ . )/&! %4A"+&,+5%% �&*/A3/,!)/. &+ 7-! '2,(% �('A!3%4!&,+ '.%-*!,!"-',./.+"+ / 3+).%,%% 13+&2"#5%/&&/@ ,(+&%: /,4!B+"'# /,!( ,(+&!@, 4+(3/?+1+"-&+# 3!+(-5%#, 3/', (+A%""#3/., A3/"%?!3+5%# ?%$3/$"+',/., '%&,!) % '/)3!.+&%! (/""+1!&/.GD ./"/(/&. ,(+&#D /(32F+��%D A3/,!) %) PTFE, /,4!B+"+'- $/"!! .G3+F!&&+# "%4?/1%',%/5%,+3&+# %&-?%"-,3+5%#, (/"%B!',./ "!@(/5%,/. */',%1+"/ 1510 ± 12,6("./442, 4+(3/?+1/. &+'B%,G.+"/'- */1389 ± 21,7 ("./442, . ,/ .3!4#, (+( A3% %'A/"-)/.+&%% (/4A/)%5%/&&/1/ �&*/A3/,!)+ 3!1%',3%3/-.+"%'- '2�!',.!&&/! $/"!! &%)(%! )&+B!&%#: "!@(/5%,/. &+'B%,G.+"/'- 551 ± 24,4 ("./442 , 4+(-3/?+1/. — 914 ± 26,1 ("./442.

�+ 30-! '2,(% �('A!3%4!&,+ /',3G! ./'A+"%,!"-&G! %)4!&!&%# ./(321 %4A"+&,+,/. )+(/&/-4!3&/ % A/'"!*/.+,!"-&/ '4!&#"%'- 24!&-U!&%!4 A"/�+*% %&?%"-,3+5%% % /,!(+, A3/%'D/*%"+,3+&'?/34+5%# 13+&2"#5%/&&/@ ,(+&% . )3!"2� ./"/(&%',2� '/!*%&%,!"-&2� ,(+&-. /(321 (/4-A/)%5%/&&/1/ �&*/A3/,!)+ &+ *+&&/4 '3/(! /,4!B+"+'- $/"!! .G3+F!&&+# 4+(3/?+1+"-&+# 3!+(-5%# 286 ± 7,8 ("./442, B!4 . )/&! %4A"+&,+5%% A3/,!)+ %) PTFE, 1*! %D (/"%B!',./ '/',+."#"/124 ± 5,9 ("./442. �,/, ?+(, 4G '.#)G.+!4 ' A3/5!''/4 3!)/3$5%% 3+',./3%4/1/ (/4A/&!&,+ (/4-A/)%5%/&&/1/ 4+,!3%+"+. �'/$!&&/',-� A3/,!)+ %) PTFE $G"/ %)$G,/B&/! /$3+)/.+&%! 4+(3/?+-1/., %D (/"%B!',./ */',%1+"/ &+ *+&&/4 '3/(! 2991 ± 26,2 ("./442£. ,/ .3!4# (+( ./(321 (/4A/)%-5%/&&/1/ A3/,!)+ %D &+'B%,G.+"/'- 1653 ± 13,7 ("./442.

� 90-4 '2,(+4 �('A!3%4!&,+ /,4!B+"/'- *+"-&!@U!! 24!&-U!&%! ("!,/B&/',%, A3!/$"+-*+��%4% /',+.+"%'- ?%$3/$"+',G, &!$/"-U/! (/"%B!',./ '/'2*/.. �3/%'D/*%"+ ',+$%"%)+5%#A3/5!''/. '/)3!.+&%# '/!*%&%,!"-&/@ ,(+&% % %&(+A'2"#5%# A3/,!)/., ./'A+"%,!"-&G! %)4!&!&%#/,'2,',./.+"%. �/"-U/! (/"%B!',./ %&/3/*&/1/ 4+,!3%+"+ �&*/A3/,!)+ %) PTFE )&+B%,!"-&/ ',%-42"%3/.+"/ ?%$3/$"+',%B!'(2� 3!+(5%� % $/"!! %&,!&'%.&/! 3+).%,%! '/!*%&%,!"-&/@ ,(+&%./(321 �&*/A3/,!)+, B,/ A3%.!"/ ( ?/34%3/.+&%� 132$/@ &!3+.&/4!3&/@ '/!*%&%,!"-&/,(+&&/@(+A'2"G ./(321 %4A"+&,+,+.

�+ 180-! '2,(% A/'"!/A!3+5%/&&/1/ A!3%/*+ ./(321 (/4A/)%5%/&&/1/ %4A"+&,+,+ % A3/,!)+%) PTFE /A3!*!"#"+'- )3!"+# '/!*%&%,!"-&/,(+&&+# (+A'2"+, A3!*',+."!&&+# . /'&/.&/4 2A/3#-*/B!&&G4% (/""+1!&/.G4% % �"+',%B!'(%4% ./"/(&+4%, 3+'A/"/F!&&G4% A+3+""!"-&/ 4+,!3%+"2�&*/A3/,!)+; ("!,/B&G@ (/4A/&!&, $G" A3!*',+."!&, . /'&/.&/4, )3!"G4% ?%$3/$"+',+4%, !*%-&%B&G4% "!@(/5%,+4% % 4+(3/?+1+4%. �/.GU!&&+# ,(+&!.+# '/.4!',%4/',- % A/3/)&/',- (/4A/-)%5%/&&/1/ A3/,!)+ 'A/'/$',./.+"+ ?/34%3/.+&%� A/"&/5!&&/1/ �"+',%B&/1/ 32$5+, A3% �,/4'!,B+,G@ A3/,!) % '/!*%&%,!"-&+# ,(+&- /$3+)/.G.+"% !*%&/! 5!"/!. PTFE-�&*/A3/,!) A/(+)+"'!$# (+( $/"!! %&!3,&G@ 4+,!3%+", &+ .'!D '3/(+D �('A!3%4!&,+ 1%1+&,'(%D ("!,/( %&/3/*&GD ,!". /(32F+��%D %4A"+&,+, ,(+&#D .G#."!&/ &! $G"/; ./(321 %4A"+&,+,+ /$3+)/.+"+'- )3!"+# '/-!*%&%,!"-&+# ,(+&- $!) #."!&%@ D3/&%B!'(/1/ ./'A+"!&%#. �*&+(/ &%)(+# A/3/)&/',- A/"%,!,-3+?"�/3/�,%"!&/./1/ 4+,!3%+"+ A3!A#,',./.+"+ .3+',+&%� ?%$3/$"+',/. % ./"/(/& . A3/,!), B,/A3%./*%"/ ( '"+$/@ ?%('+5%% . ,(+&#D % 'A/'/$',./.+"/ !1/ *!?/34+5%% % '4!�!&%�.

$ ��� . �+%$/"!! /A,%4+"-&G4 %4A"+&,+,/4 *"# A3/,!)%3/.+&%# *!?!(,/. A%�!./*&/1//,.!3',%# *%+?3+14G #."#!,'# (/4A/)%5%/&&G@ A3/,!), A/'(/"-(2 2F! ( 30-4 '2,(+4 A/'"!/A!3+-5%/&&/1/ A!3%/*+ &+*!F&/ ?%('%32!,'# ( *%+?3+14! A3/3+',+��!@ !1/ '/!*%&%,!"-&/@ ,(+&-�$!) ,!&*!&5%% ( '4!�!&%� % 4%13+5%% . A%�!./* % F!"2*/(. �4A"+&,+5%# (/4A/)%5%/&&/1/A3/,!)+ '/A3/./F*+!,'# &+%$/"!! $"+1/A3%#,&G4 ,!B!&%!4 3+&!./1/ A3/5!''+ % A3%./*%, ( ?/3-4%3/.+&%� $/"!! ,/&(/1/ % �"+',%B&/1/ 32$5+.

�3/,!) %) PTFE '("/&!& ( '4!�!&%� % *!?/34+5%% . A/'"!/A!3+5%/&&/4 A!3%/*!, A/-'(/"-(2 ,/"-(/ %&(+A'2"%32!,'# ' ?/34%3/.+&%!4 ./(321 A3/,!)+ 132$/1/ % 3%1%*&/1/ 32$5+, &!A3/3+',+!, '/!*%&%,!"-&/@ ,(+&-�.

�A%'/( "%,!3+,23G:1. �/',!.'(/@, �L�. �$/'&/.+&%! % /5!&(+ �??!(,%.&/',% &/.GD 4+,!3%+"/. % 4!,/*/. .

"!B!&%% A/'"!/A!3+5%/&&GD .!&,3+"-&GD 13GF: +.,/3!?. *%'. … *N3+ 4!*. &+2( / �L�. �/',!.-'(/@. — ��$., 2008. — 16 '.

179

2. �+"%4/., �L. �+A+3/'(/A%B!'(+# (/33!(5%# 13GF A%�!./*&/1/ /,.!3',%# % 3!?"�('-�)/?+1%,+ / �L. �+"%4/., L�. �+&/., �L�. �+A,3+(%A/., L. �G"/.+ // �&*/'(/A%B!'(+# D%323-1%#. — 2006. — � 6. — �. 14–19.

3. �2$/.+, �L�. �/3?/"/1%B!'(+# D+3+(,!3%',%(+ ,(+&!./@ 3!+(5%% A3% %4A"+&,+5%% '!,B+-,GD A3/,!)/.: +.,/3!?. *%'. … *N3+ 4!*. &+2( / �L�. �2$/.+. — �., 2008. — 23 '.

4. �'A+&/., �L�. �!)2"-,+,G A3%4!&!&%# "+A+3/'(/A%B!'(%D ?2&*/A"%(+5%@ 3+)"%B&/1/ ,%-A+ / �L�. �'A+&/., �L. �A%', �L�. �/F+D4!,/. // �&*/'(/A%B!'(+# D%3231%#. — 2009. — � 1 —�. 186–187.

5. �2B(/., �L. �3GF% A%�!./*&/1/ /,.!3',%# *%+?3+14G / �L. �2B(/., L�. �%"%4/&/.— �.: �!*A3+(,%(+, 2003. — 172 '.

6. �,+3/*2$5!., L�. �"%F+@U%! % /,*+"!&&G! �&*/'(/A%B!'(%! 3!)2"-,+,G D%3231%B!'(/1/"!B!&%# ���� % ���� / L�. �,+3/*2$5!., L�. �+2"%&, �L�. �2A3%#&/., �L�. �/,&%(/.+,�L�. �!"/2'/.+, �L�. �!3!,32D%& // �"-4+&+D %&',%,2,+ D%3231%% %4. �L. %U&!.'(/1/ — 2012.— . 7, � 1. — �. 125–126.

7. �%,+3-#&, �L�. �%+?3+14/(323/A"+',%(+ ' %'A/"-)/.+&%!4 '!,B+,GD �('A"+&,+,/. A3%4+"/%&.+)%.&/4 D%3231%B!'(/4 "!B!&%% 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G / �L�. �%,+3--#&, �L�. �%)%!., �L�. �/.+"!. // �"-4+&+D %&',%,2,+ D%3231%% %4. �L. %U&!.'(/1/ — 2012. — 7, � 1. — �. 123–124.

�0&4)04&"(!&!�,!�0&",��!&0,-^�&!+�x'�0$+/>. )&"�,!=&�)"+1'%';,!�(+">,!�0+%'�)"=0")0+)"�&+,+^q"�'&+!( 2007–2012 >>.

$#+. )����� (��.)�3+'&/#3'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4. A3/?. L�. /@&/N�'!&!5(/1/

�+?!*3+ ,3+.4+,/"/1%%, /3,/A!*%% % �� ' (23'/4 �� %4. A3/?. �L�. �/*&#&'(/1/

�������������������: ��9. _��-���� (0��. ��., ��., �. �. �.)

�!2("/&&G@ 3/', ,3+.4+,%)4+ /,4!B+!,'# ./ .'!4 4%3!. !D&/1!&&G! % A3%3/*&G! (+,+',-3/?G, ./!&&G! (/&?"%(,G . 50–60 % '"2B+!. A3%./*#, ( '/B!,+&&G4 % 4&/F!',.!&&G4 A/.3!F-*!&%#4 '%',!4 % /31+&/. B!"/.!(+. �3!*% �,%D 3+&!&%@ /'/$/@ ,#F!',-� % './!/$3+)%!4 .G*!"#-�,'# +.,/*/3/F&G! A/3+F!&%#, */"# (/,/3GD . /$�!@ ',32(,23! '4!3,!@ */',%1+!, 25 %. �/*/$-&G! ,3+.4G, (+( A3+.%"/, #."#�,'# '/B!,+&&G4%, ' A/.3!F*!&%!4 2–3 % $/"!! +&+,/4%B!'(%D /$-"+',!@ ,!"+ (�4%3&/. �L�. % �3�(/. L�., 2005; �3�'/. �L�., 2009; AnupindiM. Et al., 2008; Hou-genH. Et al., 2000) [1–3, 8].

+F&/! )&+B!&%! *"# $"+1/A3%#,&/1/ %'D/*+ A3% "!B!&%% 4&/F!',.!&&GD % '/B!,+&&GD 3+-&!&%@ A3% +.,/4/$%"-&GD (+,+',3/?+D %4!!, .G$/3 .3!4!&% /(+)+&%# % /$�!4+ D%3231%B!'(%D.4!U+,!"-',.. �/(3+�!&%! '3/(/. */',+.(% 3+&!&/1/ . A3/?%"-&/! /,*!"!&%!, &+"%B%! .G'/(/-,!D&/"/1%B&GD '3!*',. *%+1&/',%(% % "!B!&%#, 5!"!&+A3+."!&&/! %)2B!&%! A/13+&%B&GD '/',/#-&%@ #."#!,'# /'&/./A/"+1+��%4 . 2'A!U&/4 %'D/*! *"# A+5%!&,+.

*��z���� . G#."!&%! /A,%4+"-&GD 3!)2"-,+,/. "!B!&%# 3+&!&GD ' ,#F!"G4% '/B!,+&&G4%,4&/F!',.!&&G4% % (/4$%&%3/.+&&G4% 3+&!&%#4% A3% +.,/*/3/F&GD A3/%'U!',.%#D &+ �,+A! /(+)+-&%# (.+"%?%5%3/.+&&/@ 4!*%5%&'(/@ A/4/�% &+ A3%4!3! ���� ��� � 7 1. �3+'&/#3'(+.

q��������������:1) %)2B%,- ',32(,232 % D+3+(,!3 ,#F!"GD 3+&!&%@ A3% +.,/*/3/F&GD A3/%'U!',.%#D . )+.%-

'%4/',% /, ,#F!',% .!*2�!1/ A/.3!F*!&%# )+ A!3%/* ' 2007 A/ 2012 11.;2) /A3!*!"%,- A/'"!*/.+,!"-&/',- *%+1&/',%B!'(%D % D%3231%B!'(%D .4!U+,!"-',. 2 3+&!-

&GD ' ,#F!"G4% 4&/F!',.!&&G4%, '/B!,+&&G4% % (/4$%&%3/.+&&G4% 3+&!&%#4% A3% +.,/*/-3/F&GD A3/%'U!',.%#D . )+.%'%4/',% /, ,#F!',% .!*2�!@ ,3+.4G )+ A!3%/* ' 2007 A/ 2012 11.;

3) /A3!*!"%,- /A,%4+"-&G@ 'A/'/$ *%+1&/',%(% % ,+(,%(% "!B!&%# A+5%!&,/. ' ,#F!"G4%4&/F!',.!&&G4%, '/B!,+&&G4% % (/4$%&%3/.+&&G4% 3+&!&%#4% A3% +.,/*/3/F&GD A3/%'U!',-.%#D . )+.%'%4/',% /, ,#F!',% .!*2�!@ ,3+.4G.

J����������� �����������. �!,3/'A!(,%.&/, A/ *+&&G4 %',/3%@ $/"!)&!@, A3/+&+-"%)%3/.+&G 3!)2"-,+,G "!B!&%# 30 3+&!&GD A3% +.,/*/3/F&GD A3/%'U!',.%#D ' ,#F!"G4% 4&/-F!',.!&&G4%, '/B!,+&&G4% % (/4$%&%3/.+&&G4% A/.3!F*!&%#4%, (/,/3G4 $G"+ /(+)+&+ (.+"%-?%5%3/.+&&+# 4!*%5%&'(+# A/4/�- . ���� ��� � 7 1. �3+'&/#3'(+ )+ A!3%/* ' 2007 A/ 2012 11.'! A/',3+*+.U%! . ./)3+',! /, 18 */ 45 "!, 42FB%&G, A3+(,%B!'(% )*/3/.G! "�*% */ 3+&!&%#¥'3!*&%@ ./)3+', 25,6 ± 3,2 1/*+).

180

'!4 A/',2A%.U%4 3+&!&G4 . /,*!"!&%! ,3+.4+,/"/1%% % /3,/A!*%% ���� ��� � 7 A3/./-*%"% '(3%&%&1/./! ("%&%(/N"+$/3+,/3&/! % %&',324!&,+"-&/! /$'"!*/.+&%!. �/"2B!&&G! *+&&G!3!,3/'A!(,%.&/ /$3+$/,+&G 4!,/*/4 .+3%+5%/&&/@ ',+,%',%(% ' A/4/�-� (/4A-�,!3&GD A3/-13+44 «����L-7.0» % «STATISTICA-6.0» (�Æ'1/Ç/ft/Windows-XP).

&�_��z�� . �.,/*/3/F&G! 3+&!&%# D+3+(,!3%)/.+"%'- $/"-U%4 4&/1//$3+)%!4 '/B!,+&%@,3+.4%3/.+&&GD +&+,/4%B!'(%D /$"+',!@ ,!"+. �+�! &+$"�*+"/'- '/B!,+&%! A/.3!F*!&%@ 1/"/.G% (/&!B&/',!@ — 14 (46 %) B!". /3+(/+$*/4%&+"-&G! 3+&!&%# .G#."!&G . 2 (6,6 %) '"2B+#D.3+.4+ (/&!B&/',!@ /,4!B+"+'- 2 25 (83,3 %) A/',3+*+.U%D; 3+&!&%! 1/"/.G — 2 6 (20 %); 132*%— 2 9 (30 %), A&!.4/,/3+(' *%+1&/',%3/.+& 2 6 (20 %) 3+&!&GD, 1!4/,/3+(' — 2 5 (16,6 %)), F%./-,+ — 2 12 (40 %), U!% % ,+)+ — A/ 5 (33,3 %) 3+&!&GD. �+&!&%! A/)./&/B&%(+ *%+1&/',%3/.+&/ .2 (6,6 %) '"2B+#D.

� 25 (83,3 %) 3+&!&GD ' A/.3!F*!&%#4% /A/3&/N*.%1+,!"-&/1/ +AA+3+,+ . 12 (48 %) '"2B+#D.G#."!&G A!3!"/4G (/',!@ 1/"!&%, . 4 (16 %) — A!3!"/4G $!*3+ % . 9 (36 %) — A!3!"/4G (/',!@.!3D&!@ (/&!B&/',%. �/.3!F*!&%# 4+1%',3+"-&GD '/'2*/. (/&!B&/',!@ /,4!B!&G . 8 (32 %) '"2-B+#D. �+�! .',3!B+"/'- A/.3!F*!&%! $!*3!&&/@ +3,!3%% — 5 (62,5 %) B!"/.!(.

�+&!&%# B!3!A+ .',3!B+"%'- 2 7 (23,3 %) 3+&!&GD. 6 (85,7 %) '"2B+#D /,4!B+"+'- )+(3G,+#B!3!A&/N4/)1/.+# ,3+.4+, . 1 (14,3 %) — /,(3G,+# B!3!A&/N4/)1/.+# ,3+.4+. � 6 (85,7 %) B!".,3+.4+ 1/"/.G '/A3/./F*+"+'- '/,3#'!&%!4, 2 1 (14,3 %) — 2U%$/4 1/"/.&/1/ 4/)1+.

�+%$/"!! ,#F!"G4% A/.3!F*!&%#4% 2 3+&!&GD ' '/B!,+&&/@ +.,/*/3/F&/@ ,3+.4/@ #."#-"%'- A/.3!F*!&%# F%./,+. �/ U(+"! AIS A/.3!F*!&%# F%./,+ '/',+."#"% 3,5 ± 0,5 $+""+.

�"%&%B!'(%! A3/#."!&%# 2 3+&!&GD ' '/B!,+&&G4% 4&/F!',.!&&G4% +.,/*/3/F&G4% 3+&!-&%#4% 3+)"%B+"%'- . )+.%'%4/',% /, ,#F!',% .!*2�!1/ A/.3!F*!&%#.

� .'!D 3+&!&GD /,4!B+"+'- 1%A/,/&%# (�� 90/60 44 3,. ',.) % ,+D%(+3*%# (���113,3 ± 22,4 2*¦4%&). �&!4%# 4+('%4+"-&/ .G3+F!&&/@ $G"+ A3% .!*2�!4 A/.3!F*!&%% F%./,+:1!4/1"/$%& — 76,3 1¦", �3%,3/5%,G — 3,8*1012¦". �3% .!*2�!4 A/.3!F*!&%% B!3!A+, &+/$/3/,,/,4!B+"+'- 1!4/(/&5!&,3+5%#: 1!4/1"/$%& — 140 1¦", �3%,3/5%,G — 5,2*1012¦". �&,/('%(+5%/&-&G@ '%&*3/4 /,4!B+"'# 2 .'!D, &/ $/"!! .'!1/ $G" .G3+F!& 2 3+&!&GD ' .!*2�%4 A/.3!F*!&%!4F%./,+, 132*% % (/&!B&/',!@ ("!@(/5%,G — /, 16,1*109¦" */ 20,6*109¦").

$%/D%4%B!'(/4 +&+"%)! (3/.% A3% A/',2A"!&%% A3+(,%B!'(% ./ .'!D 132AA+D .G3+F!&&GD%)4!&!&%@ &! .G#.%"%. �%U- A3% .!*2�!4 A/.3!F*!&%% F%./,+ /,4!B+"/'- A/.GU!&%! +4%"+)G*/ 144,2 44/"-¦" % (3!+,%&%&+ */ 153,5 4(4/"-¦", + ,+(F! 1%A!31"%(!4%# ' A/.GU!&%!4 23/.&#1"�(/)+ /, 8,6 */ 20,9 44/"-¦".

�'&/.&G4 %&',324!&,+"-&G4 4!,/*/4 %''"!*/.+&%# #."#"+'- 3!&,1!&/13+?%# A/.3!F*!&-&GD /$"+',!@ ,!"+.

�!B!$&/N*%+1&/',%B!'(+# ,+(,%(+ . A3!*/A!3+5%/&&/4 A!3%/*! )+.%'!"+ /, ,#F!',% '/',/#-&%# 3+&!&/1/, +&+,/4%B!'(%D A/.3!F*!&%@ % &!/$D/*%4/',%, A/ F%)&!&&G4 A/(+)+&%#4, A3/.!-*!&%# ,/1/ %"% %&/1/ D%3231%B!'(/1/ .4!U+,!"-',.+.

�3% /A3!*!"!&%% D%3231%B!'(/@ ,+(,%(% &+ /'&/.+&%% /5!&(% ,#F!',% '/',/#&%# % A/.3!-F*!&%@ %'A/"-)/.+"% (+( ,3+*%5%/&&2� ,+(,%(2: /*&/4/4!&,&/! 2',3+&!&%! .'!D A/.3!F*!&%@ .D/*! D%3231%B!'(/@ /A!3+5%% 2 16 (53,3 %) 3+&!&GD, ,+( % ,+(,%(2 �,+A&/1/ 2',3+&!&%# A/.3!F-*!&%@: 2 14 (46,7 %) 3+&!&GD.

�G"% A3/.!*!&G +&+"%) A3/*/"F%,!"-&/',% D%3231%B!'(%D /A!3+5%@, D+3+(,!3%',%(% ("%-&%B!'(%D A/(+)+,!"!@, 3+).%,%# /'"/F&!&%@ % B+',/,G "!,+"-&/',% . )+.%'%4/',% /, .G$3+&&/@D%3231%B!'(/@ ,+(,%(%. G#."!&/, B,/ �,+A&G@ "!B!$&/N*%+1&/',%B!'(%@ +"1/3%,4 % ,+(,%(+ A/-)./"%"% '/(3+,%,- A3/*/"F%,!"-&/',- A3!*/A!3+5%/&&/@ A/*1/,/.(% ' 52,2 ± 4,6 */ 41,9 ± 3,84%&. � A3/*/"F%,!"-&/',- D%3231%B!'(%D /A!3+5%@, .GA/"&!&&GD . A!3.G! B+'G A/'"! 3+&!&%#,$G"+ 4!&-U! . 2 3+)+ ('/ 130 */ 73 4%&). +(%4 /$3+)/4, %'A/"-)/.+&%! �,+A&/@ "!B!$&/-*%+1&/',%B!'(/@ ,+(,%(% A/)./"#!, '/(3+,%,- A3/*/"F%,!"-&/',- A3!*/A!3+5%/&&/@ A/*1/,/.(%% D%3231%B!'(%D /A!3+5%@, .GA/"&!&&GD . A!3.G! B+'G A/'"! 3+&!&%#, % 24!&-U%,- ,#F!',- /A!-3+5%/&&/@ ,3+.4G.

$ ��� :1. �,32(,23+ 3+&!&%@ A3% +.,/*/3/F&GD A3/%'U!',.%#D )+ A!3%/* ' 2007 A/ 2012 11.

. 1. �3+'&/#3'(! D+3+(,!3%)2!,'# 4&/1//$3+)%!4 '/B!,+&%@ ,3+.4%3/.+&&GD +&+,/4%B!'(%D /$-"+',!@ ,!"+. �+�! &+$"�*+!,'# '/B!,+&%! A/.3!F*!&%@ 1/"/.G % (/&!B&/',!@ — 46 % /$'"!*2!-4GD. 3+.4+ (/&!B&/',!@ /,4!B+"+'- 2 83,3 % A/',3+*+.U%D, 3+&!&%! 1/"/.G — 2 20 %, 132*% —2 30 %, F%./,+ — 2 40 %, U!% % ,+)+ — A/ 33,3 % 3+&!&GD. �+&!&%! A/)./&/B&%(+ *%+1&/',%3/.+-&/ . 6,6 % '"2B+#D.

181

2. �!B!$&/N*%+1&/',%B!'(+# ,+(,%(+ . A3!*/A!3+5%/&&/4 A!3%/*! )+.%'%, /, ,#F!',% '/-',/#&%# 3+&!&/1/, +&+,/4%B!'(%D A/.3!F*!&%@ % &!/$D/*%4/',%, A/ F%)&!&&G4 A/(+)+&%#4, A3/-.!*!&%# ,/1/ %"% %&/1/ D%3231%B!'(/1/ .4!U+,!"-',.+. �+ '!1/*&#U&%@ 4/4!&,, &+ /'&/.+&%%/5!&(% ,#F!',% '/',/#&%# % A/.3!F*!&%@, %'A/"-)2!,'# (+( /*&/4/4!&,&+# ,3+*%5%/&&+# ,+(,%(+(53,3% &+$"�*!&%@), ,+( % ,+(,%(+ �,+A&/1/ 2',3+&!&%# A/.3!F*!&%@ (46,7% &+$"�*!&%@).

3. .%*2 4!&-U!@ A3/*/"F%,!"-&/',% A3!*/A!3+5%/&&/@ A/*1/,/.(% % D%3231%B!'(%D /A!-3+5%@, .GA/"&!&&GD . A!3.G! B+'G A/'"! 3+&!&%#, 4!&-U!@ ,#F!',% /A!3+5%/&&/@ ,3+.4G ,+(-,%(+ A/�,+A&/1/ .!*!&%# A+5%!&,+ ' ,#F!"/@ '/B!,+&&/@ ,3+.4/@ #."#!,'# $/"!! /A,%4+"-&/@.

�A%'/( "%,!3+,23G:1. �1+*F+&#& L., �+,+"%& �L., �3+.5/. �L�. % '/+.,. �'&/.&G! +'A!(,G 4!F1/'A%,+"--

&/@ ,3+&'A/3,%3/.(% A+5%!&,/. ' A/"%,3+.4/@, &+D/*#�%D'# . (3%,%B!'(/4 '/',/#&%% // �$�.3!+&%4+,/". — 2006. — . 2, � 5–6. — �. 35–39.

2. �1+*F+&#& L., �+,+"%& �L., �3+.5/. �L�. �'&/.&G! A3%&5%AG /31+&%)+5%% % ,+(,%(%4!*%5%&'(/@ ,3+&'A/3,%3/.(% A/',3+*+.U%D ' A/"%,3+.4/@ // !',&. ,3+.4+,/". % /3,/A!*. %4.�L�. �3%/3/.+. — 2009. — � 1. — �. 7–12.

3. �3+,%�!., �L. �3%&5%AG ,3+&'A/3,%3/.(% A+5%!&,/. . (3%,%B!'(/4 '/',/#&%% // �/'.4!*. F23&. — 2008. — � 3. — �. 6–10.

4. �/("+* 4%&%',3+ ,3+&'A/3,+ �/''%% �1/3# �!.%,%&+. — 2009.5. �!"-?+&*, �L�. �&,!13+"-&G! '%',!4G /5!&(% ,#F!',% '/',/#&%# $/"-&GD A3% A/"%,3+.-

4! // !',&. %&,!&'. ,!3+A. — 2004. — � 1. — �. 58–65.6. �?3!4!&(/, �L. % '/+.,. �$!'A!B!&%! $!)/A+'&/',% �.+(2+5%% A+5%!&,/., &+D/*#�%D'# .

(3%,%B!'(%D '/',/#&%#D // �"%&. +&!',!)%/". % 3!+&%4+,/". — 2004. — . 1, � 3. — �. 113–114.7. �%B%&, L. �!(/,/3G! +'A!(,G /31+&%)+5%% /(+)+&%# 4!*%5%&'(/@ A/4/�% A/',3+*+.-

U%4 ' '/B!,+&&/@ ,3+.4/@ (*/("+*). — 7-# !F!1/*&+# .G!)*&+# '!''%# �����. — 2006.8. Teichman P.G., Donchin Y., Kot R.J. International aeromedical evacuation // N. Engl. J. Med.

— 2007. — Vol. 356, � 3. — P. 262–270.9. Shirley, P.J. Transportation of the critically ill and injured patient // Update in Anaesthesia. —

2004. — Issue 18. — Article 2: Page 1. http://www.nda.ox.ac.uk/wfsa/html/u18/u1802_01.htm.10. Warren J., Fromm R.E., Jr. Orr R.A. et al. Guidelines for the inter- and intrahospital transport

of critically ill patients // Crit. CareMed. — 2004. — Vol. 32, � 1. — P. 256–262.

�&!2+1")0+)"";(!J+,"1],!/��"'%,!/;!1'q,+

�#". )����� (���.)

�!.!3/N)+A+*&G@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4. �L�. �!B&%(/.+�+?!*3+ ?+(2"-,!,'(/@ D%3231%%

�������������������: ?��. B����� ( ���.)

"����z����z. �!'4/,3# &+ '/.3!4!&&G@ A3/13!'' . 4!*%5%&'(/@ &+2(!, A3/$"!4+ A/'"!-/A!3+5%/&&/1/ 'A+!B&/1/ A3/5!''+ $3�U&/@ A/"/',% % +$*/4%&+"-&/@ 'A+!B&/@ $/"!)&% /',+!,-'# /*&/@ %) +(,2+"-&GD A3/$"!4 /$�!@ D%3231%%. �%'"/ $/"-&GD A3/*/"F+!, 2.!"%B%.+,-'# A3/-A/35%/&+"-&/ (/"%B!',.2 /A!3+,%.&GD .4!U+,!"-',., + 'A+!B&G! /'"/F&!&%# )+&%4+�, /*&/ %)A!3.GD 4!', . ',32(,23! A/'"!/A!3+5%/&&/@ "!,+"-&/',% [1].

�3+�!&%# (+( 4/3?/"/1%B!'(%@ '2$',3+, $/"!)&% 3+).%.+�,'# 2 +$'/"�,&/1/ $/"-U%&',.+$/"-&GD, A!3!&!'U%D /A!3+5%� &+ /31+&+D $3�U&/@ A/"/',%, . ,/ .3!4# (+( ("%&%B!'(%! !! A3/-#."!&%# &+$"�*+�,'# 2 20–64 % /A!3%3/.+&&GD, #."##'- /'&/.&G4 /'"/F&!&%!4 'A+!B&/1/ A3/-5!''+. �/'"!/A!3+5%/&&G! 'A+@(% .G)G.+�, )&+B%,!"-&/! B%'"/ '!3-!)&GD /'"/F&!&%@, &+%$/-"!! B+',/! % 13/)&/! %) (/,/3GD — /',3+# 'A+!B&+# (%U!B&+# &!A3/D/*%4/',-, '/',+."#��+# $/-"!! 40 % '3!*% 3+)"%B&GD .%*/. A3%/$3!,!&&/@ &!A3/D/*%4/',% (%U!B&%(+, "!,+"-&/',- A3%�,/4 */',%1+!, 8–19 %. �3/4! ,/1/, 'A+@(% /,&/'#, ( &+%$/"!! .!3/#,&/@ A3%B%&! A/'"!/A!3+5%-/&&GD $/"!@ . F%./,! % *%'?2&(5%% A%�!.+3!&%# A+5%!&,/. /A!3%3/.+&&GD &+ /31+&+D $3�U-&/@ A/"/',%.. �/&'!3.+,%.&+# ,!3+A%# �� 4+"/�??!(,%.&+, + /'&/.&/@ 4!,/* "!B!&%# ,+(%D $/"--&GD — /A!3+,%.&/! .4!U+,!"-',./ — #."#!,'# . ,/ F! .3!4# 1"+.&/@ A3%B%&/@ 3+).%,%# +$*/4%-&+"-&/@ 'A+!B&/@ $/"!)&%, % &! ,/"-(/ &! A3%./*%, ( ',/@(/42 .G)*/3/."!&%�, &/ 'A/'/$',.2!,A/.,/3&G4 3!5%*%.+4, B+',/,+ (/,/3GD */',%1+!, 50 % [1, 4, 6]. .%*2 &!2,!U%,!"-&GD 3!)2"-,+-

182

,/. "!B!&%# /'/$!&&/ +(,2+"-&G4% ',+&/.#,'# ./A3/'G A3/?%"+(,%(% 3+).%,%# 'A+!B&/1/ A3/-5!''+ A/'"! /A!3+5%@ &+ /31+&+D $3�U&/@ A/"/',%.

�!D+&%)4 3+).%,%# .&2,3%$3�U%&&GD '3+�!&%@ &+ &+',/#�%@ 4/4!&, D/3/U/ %).!',!&,B,/ A/)./"#!, .!',% 5!"!&+A3+."!&&G@ A/%'( '3!*',., ."%#��%D &+ /,*!"-&G! ).!&-# A+,/1!&!)+.�&/1/�,+A&/',- A3/5!''+ ?/34%3/.+&%# 'A+@(% A3!*/',+."#!, U%3/(%! ./)4/F&/',% *"# A3/?%-"+(,%(% !1/ 3+).%,%#, B,/ A3%.!"/ ( A/#."!&%� /13/4&/1/ (/"%B!',.+ A3!.!&,%.&GD '3!*',., (/-,/3G! A/ './!42 ?2&(5%/&+"-&/42 '/',/#&%� 4/F&/ 3+)*!"%,- &+ *.! 132AAG:

- %'A/"-)2!4G! *"# A!3.%B&/@ A3/?%"+(,%(% 'A+!B&/1/ A3/5!''+, (/1*+ A+5%!&,2 D%3231%-B!'(/! .4!U+,!"-',./ .GA/"&#!,'# .A!3.G!, % 'A+!B&G@ A3/5!'' . $3�U&/@ A/"/',% /,'2,',.2!,;

- A3%4!&#!4G! *"# .,/3%B&/@ A3/?%"+(,%(%, (/1*+ D%3231%B!'(/! .4!U+,!"-',./ .GA/"&#-!,'# A3% &+"%B%% 'A+!B&/1/ A3/5!''+ . $3�U&/@ A/"/',%.

�3%&5%AG A!3.%B&/@ A3/?%"+(,%(% /A3!*!"#�,'# A+,/1!&!)/4 3+).%,%# 'A+!B&/1/ A3/5!'-'+. �A!3+5%/&&+# ,3+.4+ %"% %&?!(5%/&&G@ A3/5!'' .!*2, ( A/.3!F*!&%� 4!)/,!"%#, B,/ '"2F%,A3%B%&/@ 3+).%,%# ./'A+"%,!"-&/1/ A3/5!''+ . $3�U%&!. �/'"!*&%@ A3%./*%, ( &+32U!&%� !!?%$3%&/"%,%B!'(%D './@',., B,/ .G3+F+!,'# . '&%F!&%% . A!3%,/&!+"-&/@ F%*(/',% (/"%B!',.+,(+&!./1/ +(,%.+,/3+ A"+)4%&/1!&+, /'&/.&/1/ (/4A/&!&,+ ?%$3%&/"%,%B!'(/@ '%',!4G. �,/A3%./*%, ( ,/42, B,/ . $3�U&/@ A/"/',% ?%$3%& *!A/&%32!,'# . (/"%B!',.+D, (/,/3G! A3!.GU+-�, 'A/'/$&/',- *!13+*+5%%. �'"% ?%$3%&, A/ (+(%4N"%$/ A3%B%&+4 &! 3+''+'G.+!,'#, ,/ &+ 3 '2-,(% .&2,3% 'A+@(% A/#."#�,'# ?%$3/$"+',G, (/,/3G! &+B%&+�, A3/*25%3/.+,- (/""+1!&/.G! ./-"/(&+, ',+$%"%)%32��%! 'A+@(2. �+ �,/@ ',+*%% &% ./'',+&/."!&%! +(,%.&/',% '%',!4G ?%$3%-&/"%)+, &% A!3%',+"-,%(+ (%U!B&%(+ 2F! &! . '/',/#&%% 3+)/3.+,- '/!*%&%,!"-&/,(+&&/! '3+�!-&%!. �'D/*# %) .GU!'(+)+&&/1/ ',+&/.%,'# #'&G4, B,/ /(+)+,- ."%#&%! &+ ?/34%3/.+&%! 'A+!B&/-1/ A3/5!''+ ./)4/F&/ "%U- */ 3-%D '2,/( A/'"! /A!3+,%.&/1/ .4!U+,!"-',.+. �+*+B!@ A!3.%B&/@A3/?%"+(,%(% 'A+!B&/1/ A3/5!''+, (+( '"!*2!, %) A+,/1!&!)+, #."#!,'# A3/.!*!&%! 4!3/A3%#,%@,&+A3+."!&&GD &+ "%(.%*+5%� ./'A+"%,!"-&/1/ A3/5!''+, 3+&&!! ./'',+&/."!&%! ,(+&!./1/ +(,%-.+,/3+ 4!)/,!"%# $3�U%&G, (/,/3/! 'A/'/$',.2!, ./'',+&/."!&%� !! ?%$3%&/"%,%B!'(/@ +(,%.-&/',%, + ,+(F! 3!+(,%.+5%� ?2&(5%% F!"2*/B&/N(%U!B&/1/ ,3+(,+ */ 3-D '2,/( A/'"! /A!3+5%%.[2, 3, 5].

�"# */',%F!&%# 2(+)+&&GD 5!"!@ &!/$D/*%4/ 4&/1/(/4A/&!&,&/! ./)*!@',.%! &+ $3�U%-&2. �&/ .("�B+!, . '!$# $!3!F&/! /$3+�!&%! ' ,(+&#4% ./ .3!4# /A!3+5%%, A3!*/,.3+�!&%! .G-'2U%.+&%# '!3/)&/@ /$/"/B(%, 3+'U%3!&%! A/(+)+&%@ *"# "+A+3/'(/A%B!'(%D .4!U+,!"-',. — ,/!',- 4!3G, &+A3+."!&&G! &+ 4%&%4%)+5%� A/.3!F*!&%# $3�U%&G. �"# "%(.%*+5%% ./'A+"%,!"--&/1/ A3/5!''+ % ./'',+&/."!&%# A!3%',+"-,%(% %'A/"-)2!,'# .&2,3%$3�U&/! ..!*!&%! "!(+3',-.!&&GD A3!A+3+,/., ./)*!@',.2��%D &+ 3+)"%B&G! ).!&-# A+,/1!&!)+ 'A+!B&/1/ A3/5!''+: +&,%-$%/,%(/., ?%$3%&/"%,%(/., +&!',!,%(/., ���, %442&/4/*2"#,/3/.. �+&&## �??!(,%.&+# "%(.%-*+5%# ./'A+"!&%# $3�U%&G ./)4/F&+ A3% /$3+$/,(! A3/,%././'A+"%,!"-&G4% A3!A+3+,+4% .'!@!! A/.!3D&/',%. �"# �,%D 5!"!@ 3+)3+$/,+& 'A/'/$ %&'2??"#5%% $3�U&/@ A/"/',% "!(+3',.!&-&G4 +�3/)/"!4. �2,- 4!,/*+ )+("�B+!,'# . '"!*2��!4: "!(+3',.!&&+# '4!'- . F%*(/@ ?/34! A/-*+!,'# . +AA+3+, *"# .G'/(/B+',/,&/@ %&'2??"#5%%, . (/,/3/4 /$3+�+!,'# . +�3/)/"-, % . ,+(/4.%*! A/ .!3D&!42 '(./)&/42 *3!&+F2 A/*+!,'# . $3�U&2� A/"/',-. �+."!&%! % '(/3/',- ..!*!&%#+�3/)/"#, 3+''B%,+&&G! �4A%3%B!'(%, /$!'A!B%.+�, A/"&/5!&&2� /$3+$/,(2 4+('%4+"-&/ $/"--U/@ A/.!3D&/',% $3�U%&G, .("�B+# ,32*&/*/',2A&G! 4!',+, )+./3/,G % (+34+&G. �$3/' ./)*2D+% �(''2*+,+ /'2�!',."#"'# B!3!) &%F&%! *3!&+F%. �3% &+"%B%% "/(+"-&/1/ ./'A+"%,!"-&/1/ A3/-5!''+ ./)4/F&/ A3/.!*!&%! "/(+"-&/@ %&'2??"#5%% "!(+3',.!&&/1/ +�3/)/"# &!A/'3!*',.!&&/ ./$"+',- %&?!(5%/&&/1/ A3/5!''+, *"# B!1/ A3!*2'4/,3!&G 3+)"%B&G! .+3%+&,G *3!&%3/.+&%#$3�U&/@ A/"/',%. D/*#�%@ . '/',+. +�3/)/"# (%'"/3/* 2"2BU+!, /('%1!&+5%� % .+'(2"#3%)+-5%� $3�U%&G, B,/ 'A/'/$',.2!, "2BU!@ .'+'G.+!4/',% "!(+3',.!&&GD .!�!',., /$3+)2!, (%'"/-3/*&2� A3/'"/@(2 4!F*2 "%',(+4% $3�U%&G, A3!A#,',.2# !! '"%A+&%� . A/'"!/A!3+5%/&&/4A!3%/*!. �/',+. +�3/)/"# A/*/$3+& %) '/.4!',%4GD "!(+3',.!&&GD A3!A+3+,/., /$"+*+��%D A3/-,%././'A+"%,!"-&G4, +&,%$+(,!3%+"-&G4, ?%$3%&/"%)%32��%4, 1!A+,/A3/,!(,%.&G4, %442&/-4/*2"%32��%4 './@',.+4%: &/./(+%&, +&,%$%/,%( U%3/(/1/ 'A!(,3+ *!@',.%#, 1%*3/(/3,%)/&,?23+5%""%&, ?%$3%&/"%)%&, %442&/?+&, (%'"/3/*. /)4/F&+ % %&+# (/4$%&+5%# "!(+3',.!&&GD'3!*',., )+.%'#�+# /, (/&(3!,&/@ '%,2+5%%. ���� A3/./*#, B!3!) 8–12 B+'/. A/'"! )+.!3U!&%#/A!3+5%%. �+ '2,(% — 3 '!+&'+, .'!1/ 3–5 '2,/(.

���� #."#!,'# �??!(,%.&G4 'A/'/$/4 '+&+5%% $3�U&/@ A/"/',%, 'A/'/$',.2!, /$3+$/,-(! .'!@ A/.!3D&/',% $3�U%&G, 3+)3G.2 ?%$3%&/.GD 'A+!(, ./'',+&/."!&%� ?%$3%&/"%,%B!'(/@?2&(5%% $3�U%&G % ?2&(5%% ��, ,/ !',- A3/?%"+(,%(! 3+).%,%# 'A+!B&/1/ A3/5!''+ [5, 7].

183

*��z. �5!&%,- �??!(,%.&/',- 4!,/*+ ���� . $3�U&2� A/"/',- . 3+&&!4 A/'"!/A!3+5%-/&&/4 A!3%/*! *"# A!3.%B&/@ A3/?%"+(,%(% 3+).%,%# 'A+!B&/1/ A3/5!''+.

J����� ������ . �+ *!'#,%"!,&%@ A!3%/* 4!,/* ���� $G" A3%4!&!& 2 133 A+5%!&-,/.. �) &%D 70 B!"/.!( &+D/*%"%'- &+ "!B!&%% A/ A/./*2 3+)"%,/1/ A!3%,/&%,+, 63 — /13+&%B!&&/-1/. $/"-U%&',.! '"2B+!. 3+).%,%! A!3%,/&%,+ (+( "/(+"-&/1/, ,+( % 3+)"%,/1/ $G"/ /$2'"/."!&/*!',32(,%.&G4% ?/34+4% +AA!&*%5%,+ (34 % 42 % '//,.!,',.!&&/). �,*+"!&&G! 3!)2"-,+,G A3/-'"!F!&G 2 118 $/"-&GD. �"# +&+"%)+ /,*+"!&&GD 3!)2"-,+,/. A+5%!&,G "%$/ A3%1"+U+"%'- . ("%-&%(2, 1*! A3/%)./*%"'# %D /'4/,3, "%$/, A3% &!/$D/*%4/',%, /&% 1/'A%,+"%)%3/.+"%'- *"# /$'"!*/-.+&%#. '"2B+#D, (/1*+ A+5%!&,G F+"/$ &! A3!*�#."#"%, +&+"%) 3!)2"-,+,/. /13+&%B%.+"'# $!'!*/@.

�/',/#&%! A+5%!&,/. /5!&%.+"/'- A/ ,3!D$+""-&/@ '%',!4!:- D/3/U!! ((/1*+ A+5%!&,G F+"/$ A3+(,%B!'(% &! A3!*�#."#"%);- 2*/."!,./3%,!"-&/! ((/1*+ F+"/.+"%'- &+ A!3%/*%B!'(2� $/"- . F%./,!, ,3!$/.+.U2�

A3%!4+ 4!*%(+4!&,/)&GD A3!A+3+,/.);- &!2*/."!,./3%,!"-&/! ((/1*+ A/ A/./*2 $/"!@ . F%./,! A3%D/*%"/'- "!B%,-'# . ',+5%/&+-

3! /*%& %"% &!'(/"-(/ 3+)).&�_��z�� �����������. �&+"%)%32# /,*+"!&&G! 3!)2"-,+,G "!B!&%# 61 A+5%!&,+ A/'"!

/A!3+5%@ A/ A/./*2 3+'A3/',3+&!&&/1/ A!3%,/&%,+, '"!*2!, /,4!,%,-, B,/ 2 72 % '/',/#&%! $G"//5!&!&/ (+( «D/3/U!!», 2 23 % — (+( «2*/."!,./3%,!"-&/!», 2 5 % A+5%!&,/. /,*+"!&&G! 3!)2"--,+,G $G"% &!2*/."!,./3%,!"-&G4%.

�3% %''"!*/.+&%% /,*+"!&&GD 3!)2"-,+,/. "!B!&%# 57 $/"-&GD /13+&%B!&&G4 A!3%,/&%,/4.G#'&%"/'-, B,/ A/*+."#��!! $/"-U%&',./ (97 % B!"/.!() F+"/$ &! A3!*�#."#!,. �./! A+5%!&,/.A3!*�#."#�, F+"/$G &+ A!3%/*%B!'(2� $/"- . F%./,!, ,3!$2��2� A3%!4+ "!(+3',.!&&GD'3!*',. . +4$2"+,/3&GD 2'"/.%#D.

$ ��� . +(%4 /$3+)/4, 2B%,G.+# &!%)$!F&/',- ?/34%3/.+&%# 'A+!( . $3�U&/@ A/"/',%A/'"! D%3231%B!'(%D /A!3+5%@£A3/.!*!&%! A!3.%B&/@ A3/?%"+(,%(% A3!*',+."#!,'# .!'-4+ 5!"!-'//$3+)&G4. �!,/* .G'/(/B+',/,&/@ %&'2??"#5%% "!(+3',.!&&/1/ +�3/)/"# . $3�U&2� A/"/',-. 3+&&!4 A/'"!/A!3+5%/&&/4 A!3%/*! % A/"2B!&&G! 3!)2"-,+,G'.%*!,!"-',.2�, /$ �??!(,%.&/-',% /A%'+&&/@ 4!,/*%(% % A/)./"#�, 3!(/4!&*/.+,- !1/ *"# A!3.%B&/@ A3/?%"+(,%(% 3+).%,%#'A+!B&/1/ A3/5!''+.

�A%'/( "%,!3+,23G:1. �"%!., �L�. �/4A"!('&G@ A/*D/* . "!B!&%% % A3/?%"+(,%(! 'A+!B&/@ $/"!)&% $3�U&/@

A/"/',%: +.,/3!?. *%'. … *N3+ 4!*. &+2(. — �., 2009. — 31 '.2. !3$%5(%@, �L�. �3%4!&!&%! 1!"# (+3$/('%4!,%"5!""�"/)G *"# A3/?%"+(,%(% 'A+@(//$-

3+)/.+&%# . $3�U&/@ A/"/',%: +.,/3!?. *%'. … (+&*. 4!*. &+2(. — ��$.: ����N�, 2004. — 20 '.3. �!$3/.'(%@, L. �'"/F&!&%# . D%3231%% F%./,+. — �.: ���, 2006. — 445 '.4. �!&B!.'(%@, �L�. �A+!B&+# $/"!)&-. — �.: �!*%5%&+, 1989. — 192 '.5. �!(4+)/., �L�. �A+!B&+# $/"!)&- /31+&/. $3�U&/@ A/"/',% : *%'. … *N3+ 4!*. &+2(. —

�., 2004. — 195 '.6. �%"!&(/ �L�., �+)+3!. �L�., �/3'+( �L�. �+)3+$/,(+ 4!,/*+ .G'/(/B+',/,&/@ %&'2??"#-

5%% "!(+3',.!&&/1/ +�3/)/"# *"# "!B!&%# A!3%,/&%,+ % A3/?%"+(,%(% 'A+!B&/1/ A3/5!''+ .$3�U&/@ A/"/',% // !',&%( D%3231%% %4. �L�. �3!(/.+. — 2009. — � 5. — �. 47–51.

7. �%"!&(/ �L�., �+)/&/. �L�., �/3'+( �L�. �!B!&%! A!3%,/&%,+ ' %'A/"-)/.+&%!4 .G'/(/-B+',/,&/@ %&'2??"#5%% "!(+3',.!&&/1/ +�3/)/"# . $3�U&2� A/"/',-: A/'. *"# .3+B!@. — ��$.,2000. — 17 '.

!*',)"$1+=,+=�!�40�0$4w{'/�"0!1!>++,"!0("1',,-'&'q41]0"0-�!�1'!(,!�!�4(+�0!/&'$"�)41=&+q"*++J+!)"&("

$#(. )������!"#$%&'(+# /$"+',&+# ("%&%B!'(+# $/"-&%5+

�������������������: ���. B��� ( ���., �. �. �.)

"����z����z. �3/$"!4+ ."%#&%# '/A2,',.2��!@ A+,/"/1%% &+ /,*+"!&&G! 3!)2"-,+,G A/-'"! 3!.+'(2"#3%)+5%% /*&/@ %) (/3/&+3&GD +3,!3%@ (��) %)2B!&+ &!*/',+,/B&/, +, 4/F!, $G,-,%4!&&/ �,% )+$/"!.+&%# #."#�,'# A3%B%&/@ &%)(/1/ (+B!',.+ F%)&% % '4!3,&/',% A+5%!&,/. ./,*+"!&&/4 A!3%/*! A/'"! /A!3+,%.&/1/ .4!U+,!"-',.+?

184

*��z. �)2B%,- ."%#&%! '/A2,',.2��!@ A+,/"/1%% &+ /,*+"!&&G! 3!)2"-,+,G A/'"! 3!.+-'(2"#3%)+5%% /*&/@ %) ��.

J����� � ����� . �3!*4!,/4 *+&&/1/ %''"!*/.+&%# ',+"/ %)2B!&%! 3/"% '/A2,',-.2��!@ A+,/"/1%% 2 190 A+5%!&,/. A/'"! /A!3+,%.&/1/ .4!U+,!"-',.+ &+ /*&/@ %) ��, .GA/"-&!&&GD ' ?!.3+"# 2004 A/ *!(+$3- 2009 1/*+ . /,*!"!&%#D (+3*%/D%3231%% % 3!&,1!&/D%3231%%��� &+ ',+&5%% �!"#$%&'(.

�3%,!3%#4% .("�B!&%# . %''"!*/.+&%! #."#"/'- &+"%B%! 2 A+5%!&,/., A/ *+&&G4 (/3/&+-3/+&1%/13+?%%, 1!4/*%&+4%B!'(% )&+B%4/1/ ',!&/)+ ($/"!! 60 % *%+4!,3+ '/'2*+) /*&/@ %) ��.

�3!%42�!',.!&&/! $/"-U%&',./ A+5%!&,/. '/',+.%"% 42FB%&G: %) 190 A+5%!&,/. — 16542FB%& % 25 F!&�%&, ./)3+', $/"-&GD (/"!$+"'# /, 27 */ 75 "!, ('3!*&%@ ./)3+', 53,6 ± 1,1). �,!&-,%3/.+&%! �� $G"/ .GA/"&!&/ 90 A+5%!&,+4, (/3/&+3&/! U2&,%3/.+&%! $!) %'(2'',.!&&/1/ (3/./-/$3+�!&%# 100 $/"-&G4. /,*+"!&&/4 A!3%/*! A/'"! /*&/'/'2*%',/@ 3!.+'(2"#3%)+5%% 4%/(+3*+4G A/"2B%"% '.!*!&%# / 115 A+5%!&,+D, /&% $G"% 3+)*!"!&G &+ 2 132AAG: 1-# 132AA+ — 52 B!"/.!(+A/'"! (/3/&+3&/1/ U2&,%3/.+&%# % 2-# 132AA+ — 63 A+5%!&,+ A/'"! ',!&,%3/.+&%# ��.

&+U!4 %''"!*/.+&%% 4G '3+.&%"% *.! 132AAG $/"-&GD A/ '"!*2��%4 '/A2,',.2��%4)+$/"!.+&%#4: A/3+F!&%! *321%D ��, +3,!3%+"-&+# 1%A!3,!&)%# (��), %)$G,/B&+# 4+''+ ,!"+¥��) % /F%3!&%!, A/',%&?+3(,&G@ (+3*%/'("!3/) (���), &+32U!&%! 3%,4+ '!3*5+ (���), D3/-&%B!'(%! /$',32(,%.&G! )+$/"!.+&%# "!1(%D (����), '+D+3&G@ *%+$!, (��) 2-1/ ,%A+, .+3%(/)&/!3+'U%3!&%! .!& &%F&%D (/&!B&/',!@ (� &¦(), +,!3/'("!3/) +3,!3%@ &%F&%D (/&!B&/',!@ (��&¦() % +,!3/'("!3/,%B!'(/! A/3+F!&%! '/&&GD +3,!3%@ (����).

&�_��z�� �����������. � %'A/"-)/.+&%!4 4&/1/?2&(5%/&+"-&/1/ &!A+3+4!,3%B!'(/1/(3%,!3%# �%U!3+ 4G '3+.&%.+"% A3/5!&,&G! */"% $/"-&GD . 2 132AA+D, %4!��%D ,/ %"% %&/!'/A2,',.2��!! )+$/"!.+&%!.

�/A2,',.2��%!)+$/"!.+&%#

�3/5!&,&G! */"% $/"-&GD�&+B!&%!(3%,!3%#�%U!3+

�&+B%4/',-3+)"%B%@

�32AA+ 1¥�2&,. ��)

n = 52

�32AA+ 2¥���)n = 63

����������. )" 42 (80,8 %) 48 (76,2 %) 0,2 �!, 3+)"%B%@"> 46 (88,5 %) 54 (85,7 %) 0,8 �!, 3+)"%B%@

+J0��������� 44 (84,6 %) 54 (85,7 %) 1,1 �!, 3+)"%B%@

�+) 30 (57,7 %) 34 (54,0 %) 0,1 �!, 3+)"%B%@,&� 13 (25,0 %) 16 (25,4 %) 0,5 �!, 3+)"%B%@^!q1 2 (3,4 %) 8 (12,7 %) 2,0 P < 0,05�( 17 (14,1 %) 26 (41,3 %) 3,3 P < 0,01

$&$��� 40 (76,9 %) 47 (74,6 %) 0,7 �!, 3+)"%B%@

""��� 32 (61,5 %) 37(58,7 %) 0,3 �!, 3+)"%B%@"��" 4 (7,7 %) 11 (17,5 %) 1,5 �!, 3+)"%B%@

�/(+)+"%, B,/ ',+,%',%B!'(% */',/.!3&G4 #."#!,'# /,'2,',.%! 3+)"%B%@ 4!F*2 132AA+4% .3+'A3!*!"!&%#D A/ .'!4 A+3+4!,3+4, (3/4! ���� % ��.

�G"/ .G#."!&/, B,/ 2 $/"-&GD ' �� &¦( &+%$/"!! B+',/ .G#."#�,'# /F%3!&%!, ���, ����,����, + ���� % ��� .G#."#�,'# ,/"-(/ 2 ,!D $/"-&GD, 2 (/,/3GD !',- �� &¦(.

� A+5%!&,/. ' ���� B+',/ .G#."#�,'# /F%3!&%!, ���, ���, ����, ��, �� &¦(, + ����.G#."#�,'# ,/"-(/ 2 ,!D $/"-&GD, 2 (/,/3GD !',- ����.

� .'!D $/"-&GD ' � &¦( A3%'2,',.2!, ��.�"# .G#."!&%# '.#)% 4!F*2 '/A2,',.2��%4% )+$/"!.+&%#4% %'A/"-)/.+"% 4!,/* 3+&1/./@

(/33!"#5%% �A%34!&+.

�3. �� �� �� ��� ��� ���� �� � &¦( �� &¦( �����3. �����F%3 0,4��� 0,3���

185

���� 0,3 0,4�� 0,3� &¦( 0,7�� &¦( 0,9 0,3���� 0,3 0,4 0,8 0,25

�%"-&G! (/33!"#5%/&&G! '.#)% .G#."!&G 4!F*2 '"!*2��%4% A/(+)+,!"#4%: �� % � &¦(,r = 0,7; ��� % �� &¦(, r = 0,9; ���� % ����, r = 0,8.

�+ /'&/.+&%% .G#."!&&GD (/33!"#5%/&&GD '.#)!@ '?/342"%3/.+"% (3%,!3%%, A/ (/,/3G44/F&/ %*!&,%?%5%3/.+,- '/',/#&%! '/'2*/. (� &¦(, �� &¦(, ����):

�3%,!3%@ 1: �'"% �� = 1, ,/ � &¦( = 1.

�+'A3!*!"!&%! $/"-&GD . 132AA+D (� &¦( = 1 % � &¦( = 0). '//,.!,',.%% ' (3%,!3%!4 (�� = 1)

�32AA+�/"%B!',./ (A3/5!&,&G! */"% $/"-&GD)

�3%,!3%@ .GA/"&!& (�� = 1) �3%,!3%@ &! .GA/"&!& (�� = 0)

� &¦( = 1 87 (100 %) 0 (0 %)

� &/ = 0 13 (46,4 %) 15 (53,6 %)

�+3+(,!3%',%(% A3/1&/)+:1. �2.',.%,!"-&/',- — .!3/#,&/',- .G#."!&%# � &¦( A/ �� = 1: � = 100 %2. �A!5%?%B&/',- — .!3/#,&/',-, B,/ � &¦( = 0 (&!,) A/ �� = 0:� = 53,6 %3. �3/1&/',%B!'(+# 5!&&/',- A/"/F%,!"-&/1/ 3!)2"-,+,+ — .!3/#,&/',- ,/1/, B,/ $/"-&G! '

�� = 1 A/A+*2, . 132AA2, 1*! � = 1. � = 87 %4. �3/1&/',%B!'(+# 5!&&/',- /,3%5+,!"-&/1/ 3!)2"-,+,+ — .!3/#,&/',- ,/1/, B,/ $/"-&G! '

�� = 0 A/A+*2, . 132AA2, 1*! � = 0. � = 100 %5. /B&/',- A3/1&/)+ — .!3/#,&/',- $!)/U%$/B&/1/ A3/1&/)+: = 88,7 %

�3%,!3%@ 2: �'"% ��� = 1, ,/ �� &¦( =1

�+'A3!*!"!&%! $/"-&GD. 132AA+D (�� &¦( = 1 % �� &¦( = 0). '//,.!,',.%% ' (3%,!3%!4 (��� = 1)

�32AA+�/"%B!',./ (A3/5!&,&G! */"% $/"-&GD)

�3%,!3%@ .GA/"&!& (��� = 1) �3%,!3%@ &! .GA/"&!& (��� = 0)

�� &¦( = 1 64 (92,8 %) 5 (7,2 %)

�� &¦( = 0 0 (0 %) 46 (100 %)

�3%,!3%@ 3: �'"% ���� = 1, ,/ ���� = 1

�+'A3!*!"!&%! $/"-&GD . 132AA+D (���� = 1 % ���� = 0). '//,.!,',.%% ' (3%,!3%!4 (���� = 1)

�32AA+�/"%B!',./ (A3/5!&,&G! */"% $/"-&GD)

�3%,!3%@ .GA/"&!& (���� = 1) �3%,!3%@ &! .GA/"&!& (���� = 0)

���� = 1 10 (66,7 %) 5 (33,3 %)

���� = 0 0 (0 %) 100 (100 %)

186

�5!&(+ A3/1&/)+ 3+).%,%# '/'2*%',/@ A+,/"/1%%. /,*+"!&&/4 A!3%/*! A/'"! 3!.+'(2"#3%)+5%%&+ /*&/@ %) �� A/ '/A2,',.2��%4 )+$/"!.+&%#4

�/B!,+&%! )+$/-"!.+&%@

�2.'

,.%,

!"-&

/',-

�A!

5%?%

B&/'

,-

�3/1&/',%B!'(+# 5!&&/',-

/B&/',-A3/1&/)+�/"/F%,!"-&/1/

3!)2"-,+,+�,3%5+,!"-&/1/

3!)2"-,+,+

� &¦( % �� 100 % 53,6 % 87 % 100 % 88,7 %

�� &¦( % ��� 92,8 % 100 % 100 % 90,2 % 95,7 %

���� % ���� 66,7 % 100 % 100 % 95,2 % 95,7 %

$ ��� :1. �/'"! 3!.+'(2"#3%)+5%% 4%/(+3*+ 2 .'!D A+5%!&,/. ' (3%,%B!'(%4% 4/&/A/3+F!&%#4%

�� /,4!B+"/'- 2"2BU!&%! '+4/B2.',.%#, % 24!&-U+"'# �� ',!&/(+3*%%.2. �) %''"!*/.+&%# .%*&/, B,/ ���� % ��� .G#."#�,'# 2 A+5%!&,/. ' �� &¦(; ���� .G#.-

"#!,'# 2 $/"-&GD ' ����; �� — 2 A+5%!&,/. ' � &¦(.3. �%"-&G! (/33!"#5%/&&G! '.#)% $G"% .G#."!&G 4!F*2 '"!*2��%4% A/(+)+,!"#4%: �� %

� &¦(; ��� % �� &¦(; ���� % ����.4. �/A2,',.2��%! )+$/"!.+&%# */"F&G $G,- *!,+"-&/ A3/"!B!&G, B+',/ %4!&&/ /&% #."#-

�,'# 1"+.&/@ A3%B%&/@ A"/D/1/ '+4/B2.',.%# A+5%!&,/. . /,*+"!&&/4 A!3%/*! A/'"! /*&/'/'2-*%',/@ 3!.+'(2"#3%)+5%% 4%/(+3*+.

�A%'/( "%,!3+,23G:1. ���. �%+1&/',%(+ % "!B!&%! ',+$%"-&/@ ',!&/(+3*%%. �/''%@'(%! 3!(/4!&*+5%% (.,/-

3/@ A!3!'4/,3) // �+3*%/.+'(2"#3&+# ,!3+A%# % A3/?%"+(,%(+. — 2008. — �3%"/F!&%! 4.2. �&,!3.!&5%/&&G! 4!,/*G "!B!&%# %U!4%B!'(/@ $/"!)&% '!3*5+ / A/* 3!*. �L�. �/(!3%%,

�L�. �"!(#&+, �. �/"/4$/, �L�. �2)%+U.%"%. — �.: �)*+,!"-',./ ����� %4. �L�. �+(2"!.+����, 2002. — 417 '.: 5.. %".

3. �!3&#.'(%@ �L�., �'%!. �L�., /3/&%&+ �L. % *3. // �+3*%/"/1%#. — 2004. — . 44, � 5.— �. 30–35.

4. �/.%( �L�., �/&/.+ L�. �2(/./*',./ A/ %''"!*/.+&%� (+B!',.+ F%)&% . 4!*%5%&!. —2-! %)*+&%! / A/* 3!*. +(+*. ���� �L�. �!.B!&(/. — �.:��� «���� �!*%+ �32AA», 2007. —320 '.

5. The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardi-ology. Guidelines on the management of stable angina pectoris: executive summary // Eur. Heart. J. —2006. — Vol. 27 — �. 1341–81.

^+&4&>+%'�)!'1'%',+'^&!,+%'�)!/�'&('%,!/,'(!�0"0!%,!�0+��!J!{]w+�)4��0$',,-^�'14(!%)!$�'&(*"

J#+. )���3 (����.), +#�. ����3���� (����.), "#2. ������� (����.)

�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,���� «�+3*%/"/1%#»

�������������������: ���. Q����� (. �. �.)

"����z����z. �3+(,%B!'(% *"# .'!D &/)/"/1%B!'(%D ?/34 )+$/"!.+&%@ '!3*5+ ?%&%U&/@A3#4/@ #."#!,'# D3/&%B!'(+# '!3*!B&+# &!*/',+,/B&/',- (���), A3/$"!4+ (/,/3/@ &/'%, 1"/-$+"-&G@ '/5%+"-&/N�(/&/4%B!'(%@ D+3+(,!3. �!'4/,3# &+ ,/, B,/ ,3+&'A"+&,+5%# '!3*5+ #."#!,'#�??!(,%.&G4 '3!*',./4 "!B!&%# ��, B%'"/ */&/3/. &! A3!.GU+!, 25–30 % /, &!/$D/*%4/@ A/-,3!$&/',%. �*&%4 %) 'A/'/$/. 3!U!&%# �,/@ A3/$"!4G #."#!,'# %'A/"-)/.+&%! 3+)"%B&GD 4!,/-*/. 4!D+&%B!'(/@ A/**!3F(% (3/.//$3+�!&%#, . B+',&/',% ���.

187

*��z. �$/$�%,- /AG, "!B!&%# D3/&%B!'(/@ '!3*!B&/@ &!*/',+,/B&/',% A/'3!*',./4 4!,/-*/. .'A/4/1+,!"-&/1/ (3/.//$3+�!&%# ' %'A/"-)/.+&%!4 %'(2'',.!&&GD F!"2*/B(/. '!3*5+ A/,%A2 /$D/*+ "!./1/ (LVAD) % /$/%D F!"2*/B(/. (BiVAD), A3/+&+"%)%3/.+,- 3!)2"-,+,G "!B!&%#. 3+&&!4 % A/)*&!4 A/'"!/A!3+5%/&&/4 A!3%/*!.

J����� ������ �����������. �+,!3%+"/4 *"# %''"!*/.+&%# A/'"2F%"% 3!)2"-,+,G"!B!&%# 16 A+5%!&,/., (/,/3G4 .GA/"&!&+ /A!3+5%# %4A"+&,+5%% '%',!4 LVAD % BiVAD. '!$/"-&G! &+D/*%"%'- &+ ',+5%/&+3&/4 "!B!&%% . ���� «�+3*%/"/1%#» (1. �%&'() ' 2008 1. A/2011 1. �!,/*+4% %''"!*/.+&%# 3!)2"-,+,/. D%3231%B!'(/1/ "!B!&%# A/'"2F%" 3!,3/'A!(,%.&G@+&+"%) %',/3%@ $/"!)&% *+&&GD A+5%!&,/., ',+,%',%B!'(+# /$3+$/,(+ *+&&GD A/'3!*',./4 SPSSStatistics 15.0.

�!)2"-,+,G %''"!*/.+&%#. A!3%/* ' 2008 1. A/ 31.10.2011 . ���� «�+3*%/"/1%#» $G"/A3/%).!*!&/ 16 /A!3+5%@ A/ %4A"+&,+5%% ���. � 50 % A+5%!&,/. (8 B!"/.!() $G" %'A/"-)/.+&"!./F!"2*/B(/.G@ /$D/* (LVAD), 2 *321/@ A/"/.%&G– /$D/* /$/%D F!"2*/B(/. (BiVAD). �'-&/.&2� B+',- A+5%!&,/. '/',+."#�, 42FB%&G (14 A+5%!&,/., 87,5 %). �+ */"� F!&�%& A3%D/-*%,-'# 12,5 % (2 A+5%!&,(%). �3!*&%@ ./)3+', . %''"!*2!4/@ (/1/3,! '/',+.%" 45,1 1/*+.

�3%)&+(% A!B!&/B&/NA/B!B&/@ &!*/',+,/B&/',% (A/.GU!&%! 23/.&!@ /$�!1/ $%"%32$%&+,4/B!.%&G, (3!+,%&%&+) %4!"% 4!',/ 2 13 A+5%!&,/. (81,25 %). �"%&%B!'(+# (+3,%&+ «)+',/@&GD»A!B!&% % A/B(% 3+).%"+'- 2 8 (50 %) A+5%!&,/., U!',% %) &%D A/,3!$/.+"'# $%.!&,3%(2"#3&G@/$D/* (37,5 %).

�"# /5!&(% ?2&(5%% '!3*5+ % !! %)4!&!&%# A/'"! %4A"+&,+5%% VAD-'%',!4 $G"% A3/+&+-"%)%3/.+&G 3!)2"-,+,G ,3+&',/3+(+"-&/@ ���(+3*%/13+?%% */ /A!3+5%% % . A/'"!/A!3+5%/&&/4A!3%/*!. �!3!* /A!3+5%!@ 2 .'!D A+5%!&,/. /,4!B+"%'- ���(+3*%/13+?%B!'(%! A3%)&+(% ,!34%-&+"-&/@ ��: &%)(+# � �� (. '3!*&!4 15,8 ± 3,4 %), .G'/(%! )&+B!&%# ��� �� (77,3 ± 4,1 44),��� �� (266 ± 15,4 4"), ��� �� (316 ± 27,5 4").

,!B!&%! A!3.GD 4!'#5!. A/'"! /A!3+5%% /,4!B+!,'# ,!&*!&5%# ( 2"2BU!&%� &+'/'&/@?2&(5%% '!3*5+ 2 .'!D A+5%!&,/.. �+"-&!@U+# &!/*&/3/*&/',- *%&+4%(% 4/F!, $G,- '.#)+&+ (+(' 3+)"%B&G4% (/4A!&'+,/3&G4% ./)4/F&/',#4% '!3*5+ (A3% *"%,!"-&/@ �('A"2+,+5%% ���¥'.GU! 6 4!'#5!.) /,4!B+!,'# 2D2*U!&%! ���(+3*%/13+?%B!'(%D A/(+)+,!"!@), ,+( % ' �,%/"/1%-!@ ��.

�!'4/,3# &+ '/A/',+.%4G! %'D/*&G! ���(+3*%/13+?%B!'(%! A/(+)+,!"% '!3*5+ 2 A+5%!&-,/. ' ���� % ����, *+"-&!@U+# %D *%&+4%(+ . A/)*&!4 A/'"!/A!3+5%/&&/4 A!3%/*! '2�!',-.!&&/ 3+)"%B+!,'#: . ,!B!&%! A!3.GD 3-D 4!'#5!. &+$"�*+!,'# 2.!"%B!&%! �, + ,+(F! '&%F!&%!���, ���, ��� &!)+.%'%4/ /, �,%/"/1%% ��. �/)*&!! (B!3!) 6 4!'#5!.) A/"/F%,!"-&G! %)4!&!-&%# *+&&GD ��� '!3*5+ /,4!B+!,'# ,/"-(/ 2 A+5%!&,/. ' ����, . ,/ .3!4# (+( 2 A+5%!&,/. '���� /B!.%*&/ 2D2*U!&%! &+'/'&/@ ?2&(5%% '!3*5+ ('4. ,+$"%52 1).

+(%4 /$3+)/4, A3/1&/) 2 $/"-&GD ' ���� $/"!! $"+1/A3%#,&G@, B!4 2 A+5%!&,/. '����.

+$"%5+ 1

�%&+4%(+ ���(+3*%/13+?%B!'(%D A/(+)+,!"!@ �� A/'"! %4A"+&,+5%% VAD-'%',!4. )+.%'%4/',% /, �,%/"/1%% ��

�+3+4!,3���N��

���� �����/ /A!3. 1–3 4!' 3–6 4!'. �/ /A!3. 1–3 4!'. 3–6 4!'.

�,% 15,1 ± 2,1 24,9 ± 3,05 43 ± 6,36 17,5 ± 1,37 34,3 ± 5,4 24,5 ± 3,62

���, 44 76,6 ± 4,45 63,25 ± 4,53 53 ± 4,9 79,5 ± 2,13 70,8 ± 2,2 74 ± 3,9

���, 4" 289 ± 54,9 211,9 ± 29,3 126 ± 9,1 321 ± 21,3 220 ± 25,1 276,5 ± 35

���, 4" 246,6 ± 48,4 156,1 ± 28,2 71,2 ± 14 261,3 ± 16 147 ± 24,1 199 ± 5,8

�/1%B&G4 A/*,.!3F*!&%!4 A/"/F%,!"-&/@ *%&+4%(% ���N�� A/(+)+,!"!@ 3+$/,G '!3*5+#."#!,'# '&%F!&%! �� �� A/'"! /A!3+5%% (' %'D/*&/1/ 3–4-1/ ("+''+ */ 1–2-1/ . ,!B!&%! 6 4!'#-5!.).

D/*! 3+$/,G $G"+ .G#."!&+ (/33!"#5%# 4!F*2 &+"%B%!4 A3!*U!',.2��%D /A!3+5%@ %A/(+)+,!"!4 '4!3,&/',%: 24!3"/ 57,1 % A+5%!&,/. ' D%3231%B!'(%4 .4!U+,!"-',./4 &+ '!3*5! .+&+4&!)!, '3!*% A+5%!&,/. $!) .4!U+,!"-',.+ "!,+"-&/',- &! /,4!B+!,'# (Spearman’s: r-0,545, p-

188

0,029). 3+&&!4 A!3%/*! /'"/F&!&%# ./)&%("% 2 12 A+5%!&,/. (75 %): (3/./,!B!&%# — 9 (50 %),,3/4$/�4$/"%B!'(%! (. ,/4 B%'"! ����) — 4 (22,2 %), ��� — 2 (11,1 %), *321%! (1!&!3+"%)/-.+&&+# %&?!(5%#, 1!4/33+1%B!'(%@ 5%',%,) — 3 (16,7 %).

�'"/F&!&%# . A/)*&!4 A/'"!/A!3+5%/&&/4 A!3%/*! ('/ '3/(/4 &+$"�*!&%# $/"!! 35 '2,/()&+$"�*+"%'- 2 7 A+5%!&,/. (58,3 %): "/(+"-&+# %&?!(5%# — 7 (70 %), ,3/4$/) ��� — 2 (20 %),���� — 1 (10 %).

�$�+# '4!3,&/',- — 4 A+5%!&,+ (25 %), A3%B!4 .'!4 �,%4 $/"-&G4 $G"% %4A"+&,%3/.+&GBiVAD-'%',!4G. �'&/.&G4% A3%B%&+4% '4!3,% #.%"%'-: ���� — 2 A+5%!&,+, ��� — 2. 3+&'-A"+&,+5%# '!3*5+ A3/%).!*!&+ 8 A+5%!&,+4 (50 %).

�3!*&## A3/*/"F%,!"-&/',- �('A"2+,+5%% ��� — 207,5 (± 64) *&#; %) B%'"+ )+.!3U%.U%D�('A"2+,+5%� (12 A+5%!&,/.) — 216 (15–620 '2,/() *&!@.

�$�+# A3/*/"F%,!"-&/',- ?2&(5%/&%3/.+&%# ��� '/',+.%"+ 3325 '2,/( ($/"!! 9 "!,), .,/4 B%'"! LVAD — 2215 , BiVAD — 1110 '2,/()

$ ��� :1. G$/3 ,%A+ /$D/*+ /A3!*!"#!,'# ("%&%B!'(%4 '/',/#&%!4 A+5%!&,+, . B+',&/',% .G3+-

F!&&/',-� A3+./F!"2*/B(/./@ &!*/',+,/B&/',% (2 A+5%!&,/. ' %4A"+&,%3/.+&&G4% BiVAD %LVAD-'%',!4+4% ?3+(5%# .G$3/'+ �� %'D/*&/ '/',+."#"+ 24,9 ± 2,8 % % 33,6 ± 2,7 % '//,.!,',-.!&&/); + ,+(F! $%/D%4%B!'(%4% A/(+)+,!"#4% (3/.% (*//A!3+5%/&&G@ 23/.!&- /$�!1/ $%"%32-$%&+ A3% "!./F!"2*/B(/./4 /$D/*! '/',+."#" 24,7 4(4/"-¦", A3% $%.!&,3%(2"#3&/4 — 494(4/"-¦"; + ��� — 0,87 4" /' /1,73 42 (. A!3./4 '"2B+!) % 0,46 4" /' /1,73 42 (./ .,/3/4), B,/ A/*-,.!3F*!&/ A3% ',+,%',%B!'(/@ /$3+$/,(!.

2. �??!(,%.&/',- %'A/"-)/.+&%# ��� A/*,.!3F*+!,'# ,!&*!&5%!@ ( 2"2BU!&%� &+'/'&/@?2&(5%% '!3*5+ (3!1%',3%32!4/@ ' A/4/�-� ,3+&',/3+(+"-&/@ ���N(+3*%/13+?%%) (+( 2 A+5%-!&,/. ' LVAD, ,+( % 2 A+5%!&,/. ' BiVAD-'%',!4+4%.

3. �+"%B%! A3!*U!',.2��!@ /A!3+5%% &+ '!3*5! #."#!,'# &!$"+1/A3%#,&G4 A3/1&/',%B!-'(%4 ?+(,/3/4 . /,&/U!&%% 1/'A%,+"-&/@ "!,+"-&/',%: 24!3"/ 57,1 % A+5%!&,/. ' D%3231%B!-'(%4 .4!U+,!"-',./4 &+ '!3*5! . +&+4&!)!, '3!*% A+5%!&,/. $!) .4!U+,!"-',.+ "!,+"-&/',- &!/,4!B+!,'# (Spearman’s: r — 0,545, p — 0,029).

4. �??!(,%.&/',- %'A/"-)/.+&%# VAD-'%',!4 A3%$"%F+!,'# ( ,+(/./@ A3% ,3+&'A"+&,+5%%'!3*5+: (242"#,%.&+# .GF%.+!4/',- '/',+."#!, 0,71 (A3% A!3!'+*(! '!3*5+ — 0,82). �,/ '.%*!-,!"-',.2!, / A!3'A!(,%.&/',% %'A/"-)/.+&%# 3+)"%B&GD 'A/'/$/. ���.

�A%'/( "%,!3+,23G:1. �24+(/., L�. �'(2'',.!&&/! '!3*5!. — �., 2003. — �. 216–296.2. The next decade in mechanical assist: advances that will help the patient and the doctor Pavan

Atluri, Michael A. Acker and Mariell Jessup, Current Opinion in Cardiology. 2011. 26: 256–260.3. Current State of Ventricular Assist Devices, Marco Caccamo & Peter Eckman & Ranjit John,

Curr Heart Fail Rep (2011). 8: 91–98.

�&'+J4{'�0$"$,40&+$',,!>!�'&+2'&+%'�)!>!)"0'0'&"�!�&"$,',+w�(&4>+J+��!�!;"J+$$'(',+=

1')"&�0$',,-^$'{'�0$

+#$. J��������� (����.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ '!',3%&'(/1/ *!"+, 2D/*+ )+ $/"-&G4% % 4!&!*F4!&,+�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

�������������������: #��. Q���-���� (���).

"����z����z. �+,!,!3%)+5%# A!3%?!3%B!'(%D .!& &+ '!1/*&#U&%@ *!&- #."#!,'# /*&/@ %)&!/,�!4"!4GD B+',!@ "!B!$&/1/ A3/5!''+, /$!'A!B%.+��!@ *"%,!"-&G@ */',2A ( .!&/)&/@ '%',!-4!, 'A/'/$',.2��!@ $G',3/42 % ,/B&/42, �??!(,%.&/42 ..!*!&%� */)G A3!A+3+,+. �3!%42�!',-.+4% #."#!,'# �(/&/4%# .3!4!&% 4!*%5%&'(/1/ A!3'/&+"+, /,"%B&G@ % 2*/$&G@ .!&/)&G@ */',2A,+ '+4/! 1"+.&/! '/D3+&#!,'# ?%)%B!'(+# % A'%D/"/1%B!'(+# (/4?/3,&/',- A+5%!&,+.

*��z�����������. �3/.!',% '3+.&%,!"-&G@ +&+"%) /$�!1/ $"+1/A/"2B%# % ',!A!&% 2*/.-"!,./3!&&/',% ',/3/&+4% F%)&!*!#,!"-&/',%.

189

J����� � ����� �����������. %''"!*2!4/@ .G$/3(! 2B+',./.+"/ 35 B!"/.!((17 42FB%& % 18 F(&�%&) %) ���� % ���� � 15. �) &%D (+A!"-&%5G ',+.%"% 20, .&2,3%.!&&G@A!3%?!3%B!'(%@ (+,!,!3 — 10, A/*("�B%B&G@ (+,!,!3 — 5. �/ ./)3+',&/42 '/',+.2 A3!/$"+*+"%A+5%!&,G . ./)3+',! /, 23 */ 78 "!,. �''"!*2!4+# 132AA+ %4!"+ 3+)"%B&G! )+$/"!.+&%#. �/"-&G!$G"% A3/+&(!,%3/.+&G ' A/4/�-� &!'A!5%?%B!'(/1/ /A3/'&%(+ SF-36, (/,/3G@ '/',/%, %)36 ./A3/'/., '132AA%3/.+&&GD . ./'!4- U(+":

1.�%)%B!'(/! ?2&(5%/&%3/.+&%!2. �/"!.+# *!#,!"-&/',-3. !"!'&+# $/"-4. �$�!! )*/3/.-!.5. �%)&!'A/'/$&/',-6. �/5%+"-&/! ?2&(5%/&%3/.+&%!7. �4/5%/&+"-&/! ?2&(5%/&%3/.+&%!8. �'%D%B!'(/! )*/3/.-!.�/(+)+,!"% /, (+F*/@ U(+"G '/',+."!&G ,+(%4 /$3+)/4, B,/ B!4 .GU! )&+B!&%! A/(+)+,!"#

¥/, 0 */ 100), ,!4 "2BU! /5!&(+ A/ %)$3+&&/@ U(+"!. �) &%D ?/34%32�,'# *.+ A+3+4!,3+: A'%D/-"/1%B!'(%@ % ?%)%B!'(%@ (/4A/&!&,G )*/3/.-#.

&�_��z�� �����������. D/*! %''"!*/.+&%# $G"/ .G#."!&/, B,/ '3!*% %''"!*2!4GD4!,/*%( &+%$/"!! 2*/."!,./3%,!"-&G! A/(+)+,!"% A/ U(+"+4 $G"% A3% %'A/"-)/.+&%% .&2,3%-.!&&/1/ A!3%?!3%B!'(/1/ (+,!,!3+, ,. !. *+&&+# 4!,/*%(+ &! A/(+)+"+ )&+B%,!"-&GD /,("/&!&%@ A/A'%D/"/1%B!'(/42 % ?%)%B!'(/42 (/4A/&!&,+4 )*/3/.-#. / .,/3/4 '"2B+! %'A/"-)/.+"/'- ..!-*!&%! A3!A+3+,/. B!3!) ',+&*+3,&G! (+A!"-&%5G. �,/4 %''"!*/.+&%% $G"/ /,4!B!&/ &+32U!&%!?%)%B!'(/1/ ?2&(5%/&%3/.+&%#, $/"!./@ *%'(/4?/3, &%F! 2*/."!,./3%,!"-&/@ &/34G, F%)&!-'A/'/$&/',- $G"+ '&%F!&+, A'%D/"/1%B!'(%@ 23/.!&- )&+B%,!"-&/ &%F! &/34G. '"2B+! ' %'-A/"-)/.+&%!4 A/*("�B%B&/1/ (+,!,!3+ A/(+)+,!"% A/ .'!4 U(+"+4 &! 2*/."!,./3%,!"-&G!.

$ ��� . �+&&/! %''"!*/.+&%! A/(+)+"/ A3!%42�!',./ A!3%?!3%B!'(/1/ .&2,3%.!&&/1/ (+-,!,!3+ A/ '3+.&!&%� ' *321%4% 4!,/*%(+4% A/ U(+"+4: ?%)%B!'(/! ?2&(5%/&%3/.+&%!, 3/"!./!?2&(5%/&%3/.+&%!, $/"-, F%)&!'A/'/$&/',-, '/5%+"-&/! ?2&(5%/&%3/.+&%!, A'%D/"/1%B!'(/!)*/3/.-!. +(%4 /$3+)/4, %&?2)%/&&+# ,!3+A%# A/'3!*',./4 A!3%?!3%B!'(/1/ .&2,3%.!&&/1/ (+-,!,!3+ — &!/,�!4"!4+# B+',- '/.3!4!&&/1/ "!B!$&/1/ A3/5!''+. �*/$',./ . !F!*&!.&/@ 3+$/,! 'A!3%?!3%B!'(%4% (+,!,!3+4% #."#!,'# &! 4+"/.+F&G4 ?+(,/3/4 A/ &!'(/"-(%4 A3%B%&+4. /-A!3.GD, �,/ �(/&/4%# .3!4!&% 4!*%5%&'(/1/ A!3'/&+"+, $!)/A+'&/',- A+5%!&,/. % '3!*&!1/ 4!-*%5%&'(/1/ A!3'/&+"+. /N.,/3GD, &!/13+&%B!&&/! ?%)%B!'(/! ?2&(5%/&%3/.+&%! A3% D/3/U!@?%('+5%%, $!) &!/$D/*%4/',% B+',/@ )+4!&G. N,3!,-%D, /*&/(3+,&+# A/',+&/.(+ (+,!,!3+ A/)./-"%, %)$!F+,- 4&/1/(3+,&GD, &! 2*/$&GD *"# A!3'/&+"+ % $/"!)&!&&GD *"# A+5%!&,+ 4+&%A2"#-5%@. �3!*% %''"!*2!4GD 4!,/*%( �� — 4!,/*%(+, /$"+*+��+#)&+B%,!"-&G4 23/.&!4 A'%D/"/-1%B!'(/1/ % ?%)%B!'(/1/ 2*/$',.+ *"# A+5%!&,+.

^+&4&>+%'�)!'J!('1+&!$",+'^&!,+%'�)!/�!%'%,!/,'(!�0"0!%,!�0+

J#$. !����� (����., �. �. �.), w#+. "���� (��.), (#". %������� (��.), (#'. >������ (��.)

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ A+,/"/1%B!'(/@ ?%)%/"/1%%

�������������������: #��. ����� ( ���., �. �. �.)

"����z����z ���� . �3/&%B!'(+# A/B!B&+# &!*/',+,/B&/',- (���) /',+!,'# /*&/@ %).+F&!@U%D A3/$"!4 '/.3!4!&&/@ 4!*%5%&'(/@ &+2(%, B,/ '.#)+&/ ' $/"-U%4 (/"%B!',./4 /'-"/F&!&%@ �,/@ A+,/"/1%%, )+,3+1%.+��%4% .'! /31+&G % '%',!4G B!"/.!B!'(/1/ /31+&%)4+. �3%%)2B!&%% ��� 2 B!"/.!(+ (+3,%&2 )+$/"!.+&%# )+B+',2� */A/"&#�, '/A2,',.2��%! )+$/"!.+&%#,*!@',.%# &+)&+B+!4GD "!(+3',.!&&GD '3!*',. % *321%D 4!,/*/. "!B!&%# (.("�B+# )+4!',%,!"--&2� A/B!B&2� ,!3+A%�), B,/ *!"+!, )+,32*&%,!"-&G4 %''"!*/.+,- ��� %)/"%3/.+&&/. '.#)% '�,%4, +(,2+"-&G4 A3!*',+."#!,'# 3+)3+$/,(+ �('A!3%4!&,+"-&/@ 4/*!"% ���, 4+('%4+"-&/ A3%-$"%F!&&/@ ( ("%&%B!'(%4 2'"/.%#4, B,/ A/)./"%, %''"!*/.+,- A+,/?%)%/"/1%B!'(%! % A+,/D%4%-B!'(%! +'A!(,G ���, '/.!3U!&',./.+,- &+ �,/@ /'&/.! A3%&5%AG % 4!,/*G *%+1&/',%(% % "!B!-&%#. "%,!3+,23! A3!*',+."!&/ &!'(/"-(/ .+3%+&,/.'/)*+&%# 4/*!"!@ ���. �!(/,/3G! %) &%D

190

'.#)+&G ' A/.3!F*!&%!4 %&,!3',%5%# % ("2$/B(/.L�,/ 4/*!"- 'A/&,+&&/ 3+).%.+��!1/'# ./"B+-&/B&/1/ &!?3%,+ 2 &/./)!"+&*'(%D 4GU!@ 1%$3%*&/@ "%&%% F1 % 4GU!@ "%&%@ MRL/lpr, BXSB[3]. � &!(/,/3GD "%&%@ 4GU!@ A3/5!'' ',+3!&%# ,+(F! 4/F!, %'A/"-)/.+,-'# *"# '/)*+&%# 4/*!-"% ���, ,L(. ' ./)3+',/4 A3/13!''%32!, &!?3/'("!3/) % '&%F!&%! '(/3/',% ("2$/B(/./@ ?%"-,-3+5%% [3]. �3/4! ,/1/, %'A/"-)2�,'# 3+)"%B&G! .+3%+&,G A/3+F!&%# '/'2*/. % 1"/4!32"#3&/@4!4$3+&G, . B+',&/',%, (3G'G '/ 'A/&,+&&/@ 1%A!3,!&)%!@ .'"!*',.%! +&/4+"%% . 3+).%,%% 1"+*-(/4GU!B&/@ ,(+&%, "%&%# (3G' Buffalo/mna ' %*%/A+,%B!'(%4 &!?3/,%B!'(%4 '%&*3/4/4 %)N)+A/.3!F*!&%# A/*/5%,/.. ��*+ /,&/'%,'# % 42,+&,&+# "%&%# (3G' MunichWistarFrömter ' *!?%5%-,/4 &!?3/&/. [3]. �"# %''"!*/.+&%# 1!&!,%B!'(%D /'&/., . ,/4 B%'"! % ���, A3%4!&#�, 1!&&/-%&F!&!3&G! 4/*!"%, ,+(%! (+( A!3.%B&+# A/*/5%,N'A!5%?%B!'(+# 4/*!"- ?/(+"-&/-'!14!&,+3&/1/ 1"/4!32"/'("!3/)+, (/,/3+# A/)./"#!, '!"!(,%.&/ 24!&-U%,- (/"%B!',./ A/*/5%-,/. . &!?3/&! )+ 'B!, ,/1/, B,/ /&% %)&+B+"-&/ '/*!3F+, 3!5!A,/3G ( ../*%4/42 A/*/5%,-'A!5%?%B!'(/42 ,/('%&2 [3]. � 4GU!@ ' '%&*3/4/4 �"-A/3,+ (42,+5%!@ . 1!&!, (/*%32��!4 .G-3+$/,(2 5!A!@ (/""+1!&+ 4 ,%A+) B!3!) 4 &!*!"% /, 3/F*!&%# 3+).%.+!,'# 1"2D/,+ % ���. �4!�,'#4!,/*%(% A/ '/)*+&%� %442&%,!, — %&*25%3/.+&&GD 4/*!"!@ ���, %4%,%32��%D IgA &!?3/-A+,%� % &!?3%, A3% A23A23! �!&"#@&N�!&/D+. � (3G' *"# &%D %'A/"-)2�,'# %&�!(5%% 4GU%&GD+&,%,%4/5%,+3&GD 4/&/("/&+"-&GD +&,%,!" B!3!) D./',/.2� .!&2. �%U- A/.,/3&G! %&�!(5%%4/12, A3%.!',% ( %&,!3',%5%+"-&/42 &!?3/'("!3/)2 % A3/13!''%3/.+&%� ���, B,/ /A3!*!"#!,'"/F&/',- A3% '/)*+&%% �,/@ 4/*!"% [3]. �!?3/'("!3/)+ % ��� 2 �('A!3%4!&,+"-&GD F%./,&GD4/F&/ */$%,-'#, A3%4!&## ,/,+"-&/! %"% "/(+"-&/! /$"2B!&%!, .G).+. 3+*%+5%/&&2�&!?3/A+-,%�, B,/ /A+'&/ *"# �('A!3%4!&,+,/3+ % ,3!$2!, 'A!5%?%B!'(/1/ /$/32*/.+&%#. �3% *"%,!"-&/4&+)&+B!&%% (3G'+4 5%("/'A/3%&+ � (7,5 41¦(1 . *!&- . ,!B!&%% 28 *&!@) 3+).%.+!,'# 5%("/'A/3%-&/.+# &!?3/A+,%# % &!?3/'("!3/), /*&+(/ 3+).%.+!,'# ,#F!"+# %442&/'2A3!''%#, B,/ /'"/F&#!,-'# '/A2,',.2��!@ %&?!(5%/&&/@ A+,/"/1%!@, �,/ *"# &+U!@ 4/*!"% &!F!"+,!"-&/ [3]. �!*/',+,-(% �,%D 4/*!"!@ . ,/4, B,/ A3%/$3!,!&%! ,+(%D F%./,&GD ,3!$2!, )&+B%,!"-&GD 4+,!3%+"-&GD)+,3+,, '3/( 3+).%,%# ��� '"%U(/4 $/"-U/@ (/, A/"21/*+ */ 2 "!,), + ,+(F! '2�!',.!&&/ A/.3!-F*+�,'# *321%! /31+&G % '%',!4G. �"# '/)*+&%# 4/*!"% ��� 4G %'A/"-)/.+"% 4!,/* D%3231%B!-'(/1/ 2*+"!&%# 5/6 A/B!B&/@ ,(+&%, . '.#)% ' !1/ &!$/"-U/@ ',/%4/',-�, /,'2,',.%!4 ,3!$/.+&%@( /A3!*!"!&&/@ "%&%% 4GU!@, + ,+(F! $G',3/,/@ 3+).%,%# ���. �/ &+U!42 4&!&%�, �,/ &+%$/-"!! */',2A&G@, $G',3G@ % A3/',/@ 4!,/* '/)*+&%# 4/*!"% ���.

*��z ���� . �/)*+,- +*!(.+,&2� ("%&%B!'(%4 2'"/.%#4 �('A!3%4!&,+"-&2� 4/*!"-���.

J����� ������ . �+$/,+ A3/./*%"+'- &+ 90 $!"GD &!"%&!@&GD (3G'+DN'+45+D, 4+''/@200–250 1, ./)3+',/4 5–6 4!'#5!., &+D/*#�%D'# &+ '/*!3F+&%% . 2'"/.%#D .%.+3%#, &+ ,%A/./43+5%/&!. �"# '3+.&!&%# $G"+ '/)*+&+ 132AA+ (/&,3/"-&GD F%./,&GD, (/,/3G4 A3/%)./*%"+'-,/"-(/ '3!*%&&+# "+A+3/,/4%#. (/&,3/"-&/@ 132AA! F%./,&GD $G"/ A3//A!3%3/.+&/ 60 F%./,-&GD. '! 4+&%A2"#5%% ' �('A!3%4!&,+"-&G4% F%./,&G4% .GA/"&#"%'- . '//,.!,',.%% ' A3+.%-"+4% 124+&&/1/ /,&/U!&%# ( F%./,&G4, 4!,/*%B!'(%4% 3!(/4!&*+5%#4% A/ %D .G.!*!&%� %)/AG,+ % �.,+&+)%%, 3!1"+4!&,%3/.+&&G4% «�3+.%"+4% A3/.!*!&%# 3+$/, ' %'A/"-)/.+&%!4 �('A!-3%4!&,+"-&GD F%./,&GD» (�3%(+) �� ���� � 775 /, 12.08.1977) % A/"/F!&%#4% �!"-'%&'(/@�!("+3+5%% �� (1997).

�%/D%4%B!'(%! 4!,/*G. �/&5!&,3+5%� 4/B!.%&G, 4/B!./@ (%'"/,G % (3!+,%&%&+ . 'G./-3/,(! /A3!*!"#"% �&)%4+,%B!'(%4 (/"/3%4!,3%B!'(%4 4!,/*/4 % (%&!,%B!'(%4 4!,/*/4 $!) *!-A3/,!%&%)+5%% &+ +AA+3+,! «Roki-6T» (�/''%#, �+&(,N�!,!3$231) ' %'A/"-)/.+&%!4 3!+(,%./.?%34G «Human» (�!34+&%#). �!)2"-,+,G .G3+F+"% *"# 4/B!.%&G % 4/B!./@ (%'"/,G . 44/"-¦",*"# (3!+,%&%&+ — . 4(4/"-¦".

�,+,%',%B!'(2� /$3+$/,(2 A/"2B!&&GD 3!)2"-,+,/. A3/./*%"% ' %'A/"-)/.+&%!4 A+(!,+A3%("+*&GD A3/13+44 «Statisticav. 6.0 forWindows», 1*! � — '3!*&!! +3%?4!,%B!'(/! )&+B!&%!A3%)&+(+, m — ',+&*+3,&+# /U%$(+ '3!*&!1/. �3/.!3(+ */(+)+,!"-',.+ 1%A/,!)G %'A/"-)/.+"'#&!A+3+4!,3%B!'(%@ (3%,!3%@ — U (U �+&&+ — �%,&%).

&�_��z�� . �3G'+4 .GA/"&#"+'- 4!,/*%(+ '/)*+&%# 4/*!"% D3/&%B!'(/@ A/B!B&/@ &!*/'-,+,/B&/',%, )+("�B+��+#'#, . *.2D�,+A&/4 /A!3+,%.&/4 .4!U+,!"-',.!. �&+B+"+ A3/%)./*%,'#A3+./',/3/&&## &!?3�(,/4%#, )+,!4 B!3!) 7 '2,/( ' 4/4!&,+ A!3./@ /A!3+5%% '"!*2!, .,/3+# —A3/%)./*%,'# (/+12"#5%# �"!(,3/&/F/4 2/3 A/.!3D&/',% "!./@ A/B(%. �3/&%B!'(+# A/B!B&+# &!-*/',+,/B&/',- 3+).%.+"+'- B!3!) 21 '2,(%. �%./,&GD )+ 6–8 B+'/. */ /A!3+5%% /13+&%B%.+"% .A%�!, )+ 2–3 B+'+ */ /A!3+5%% — . A%,-!. �!3.G@ �,+A /A!3+5%% )+("�B+"'# . A3+./',/3/&&!@&!?3�(,/4%%. 2'"/.%#D 4+'/B&/1/ �?%3&/1/ &+3(/)+, 'A/&,+&&/1/ *GD+&%# (3G'+ 3+'A/"+1+"+'-

191

&+ /A!3+5%/&&/4 ',/"%(! ' A/*/13!./4 . A/"/F!&%% &+ 'A%&! ' ?%('+5%!@ (/&!B&/',!@. G',3%-1+"/'- /A!3+5%/&&/! A/"! (A!3!*&## $3�U&+# ',!&(+), /A!3+5%/&&/! A/"! /$3+$+,G.+"/'- +&,%-'!A,%(/4 «�2,+'!A,», A/'"! B!1/.GA/"&#"+'- '3!*%&&+# "+A+3/,/4%#. �"%&+ 3+)3!)+ '/',+."#"+/, 3 */ 4 '4. �/'"! �,/1/ . $3�U&2� A/"/',- ../*%"%'- 2–3 '+"?!,(%, '4/B!&&G! ./*&G4 0,05 %-&G4 3+',./3/4 D"/31!('%*%&+ ' 5!"-� /,13+&%B!&%# /A!3+5%/&&/1/ A/"# /, /(32F+��%D ,(+&!@.�/'"! /,13+&%B!&%# /A!3+5%/&&/1/ A/"#, *&/4 /A!3+5%/&&/1/ A/"# #."#"+'- A3+.+# A/B(+, ',!&-(+4% — $/(/.+# ',!&(+ $3�U&/@ A/"/',% % ,+4A/&G. �+,!4 3+''!(+"+'- A!B!&/B&/NA/B!B&+#'.#)(+lig. hepatorenale (&! .'!1*+ A3%'2,',.2!,), .'(3G.+"+'- A3!*A/B!B&+# ?+'5%# fascia prerenalis,A/B(+ .G.%D%.+"+'- &+ A/B!B&/@ &/F(! . .!&,3+"-&/4 &+A3+."!&%%, % . �,/, 4/4!&, ./(321 A/-B!B&/@ &/F(% A3/./*%"+'- "%1+,23+ %) U!"(+ � 3, % )+,#1%.+"+'-. �+"/F!&%! "%1+,23G A/.,/3#-"/'- ' 5!"-� A3!*/,.3+�!&%# !� '"2B+@&/1/ '/'(+"-)G.+&%# ("%1%3/.+&%! �"!4!&,/. A/B!B&/@&/F(% A/ /,*!"-&/',% &! A3!*',+."#!,'# ./)4/F&G4 %)N)+ %D 4!"(%D 3+)4!3/.). �/'"! �,/1/ A3/-%)./*%"/'- /,'!B!&%! A3+./@ A/B(% *%',+"-&!! &+"/F!&&GD "%1+,23, "%1+,23G /$3!)+"%'- ' /'-,+."!&%!4 (/&B%(/. . 3–4 44, "/F! A/B(% &! 2U%.+"/'-, A3/%)./*%"'# (/&,3/"- 1!4/',+)+, %)$3�U&/@ A/"/',% A/ 'B!,2 %)."!(+"%'- ,+4A/&G, % $3�U&+# A/"/',-, (/F+ % A/*(/F&+# ("!,B+,-(+ A/'"/@&/2U%.+"%'- &+1"2D/ /,*!"-&G4% 2)"/.G4% U.+4% U!"(/4 � 3. �+,!4 2$%3+"+'-�?%3&+# 4+'(+, F%./,&/! /,.#)G.+"/'- % A!3!./3+B%.+"/'- &+ F%./,, &+D/*#'- &+ A/*/13!.+!4/4/A!3+5%/&&/4 ',/"%(! */ A/#."!&%# *.%1+,!"-&/@ +(,%.&/',%, A/'"! B!1/ A!3!&/'%"/'- . ("!,(2% 2("+*G.+"/'- &+ B%',2� $/"-U2� '+"?!,(2 ' 5!"-� &!*/A2�!&%# (/&,+(,&/1/ %&?%5%3/.+&%#A/'"!/A!3+5%/&&/@ 3+&G. ,/3+# /A!3+5%# .GA/"&#"+'- B!3!) 7 '2,/( A/'"! A!3./@ % )+("�B+-"+'- . (/+12"#5%% A/B!B&/@ A+3!&D%4G �"!(,3/&/F/4. �/'"! '3!*%&&/@ "+A+3/,/4%%, ' /*&/.3!-4!&&G4 '&#,%!4 &!*!"!@ 3+&!! &+"/F!&&GD U./., .'(3G.+"+'- A3!*A/B!B&+# ?+'5%#, *+"!! 4GA3/%)./*%"% (/+12"#5%� 2/3 A"/�+*% A/B(% U+3%(/.G4 �"!(,3/*/4 +AA+3+,+ ��� 200-1 «�/-"%,/4-1» (2',+&/.(% — 3!F%4 — 3!)+&%!, 4/�&/',- — 7,0 (4+('%424 — 10,0). �G &! %'A/"-)/-.+"% A!3!.#)(% .!,.!@ A/B!B&/@ +3,!3%% % A3/',2� 3!)!(5%� A/B!B&/@ A+3!&D%4G, ,+( (+( �,/2'"/F&#!, /A!3+5%�. �+,!4 A3/%)./*%"'# (/&,3/"- 1!4/',+)+, %) $3�U&/@ A/"/',% A/ 'B!,2 %)-."!(+"%'- ,+4A/&G, % $3�U&+# A/"/',-, (/F+ % A/*(/F&/NF%3/.+# ("!,B+,(+ A/'"/@&/ 2U%.+-"%'- &+1"2D/ /,*!"-&G4% 2)"/.G4% U.+4% U!"(/4 � 3.

��� 3+).%.+"+'- B!3!) 21 '2,(%, (3%,!3%#4% 3+).%,%# ��� '"2F%"% )&+B%4/! A/.GU!&%!. 'G./3/,(! (/&5!&,3+5%% 4/B!.%&G, (3!+,%&%&+, 4/B!./@ (%'"/,G. �!)2"-,+,G A3!*',+."!&G .,+$"%5! 1.

+$"%5+ 1

�/(+)+,!"% �&*/1!&&/@ %&,/('%(+5%% � ± m

�32AAG / A/(+)+,!"% �/F&//A!3%3/.+&&G! (n = 60) ��� (n = 90)

�/B!.%&+, 44/"-¦" 5,98 ± 0,33 10,28 ± 0,803 < 0,001

�3!+,%&%&, 4(4/"-¦" 95,28 ± 3,55 168,49 ± 10,093 < 0,001

�/B!.+# (%'"/,+, 4(4/"-¦" 76,34 ± 5,86 99,25 ± 7,433 < 0,001

�3%4!B+&%!: 3 —A/(+)+,!"- )&+B%4/',% 3+)"%B%@ 4!F*2 132AA+4% A/ (3%,!3%� �+&&+ — �%,&%.

$ ��� :1. 3!)2"-,+,! +&+"%)+ A3%.!*!&&GD . "%,!3+,23! .+3%+&,/. '/)*+&%# 4/*!"% ��� 4G /A-

3!*!"%"% 3#* (3%,!3%!. .G$/3+ 4/*!"% ���, +*!(.+,&/@ ("%&%B!'(%4 2'"/.%#4. �,/ ./)4/F-&/',- .G$/3+ &!"%&!@&GD F%./,&GD, (+( '"!*',.%!, A3/',/,+ % *!U!.%)&+ 4!,/*+, + ,+(F! '(/-3/',- 3+).%,%# ���. '.#)% ' �,%4 4G .G$3+"% 4!,/* D%3231%B!'(/1/ 2*+"!&%# 5/6 A/B!B&/@,(+&%. �& &+%$/"!! */',2A&G@ % $G',3G@, ��� 3+).%.+!,'# B!3!) 4–5 &!*!"-.

2. �+4% $G"/ A3//A!3%3/.+&/ 90 $!"GD &!"%&!@&GD (3G'N'+45/.. �"# '3+.&!&%# $G"+ '/)-*+&+ 132AA+ (/&,3/"-&GD F%./,&GD %) 60 (3G', (/,/3G4 A3/%)./*%"+'- ,/"-(/ '3!*%&&+# "+A+-3/,/4%#.

3. �*!(.+,&/',- '/)*+&&/@ 4/*!"% A/*,.!3F*!&+ "+$/3+,/3&G4% *+&&G4%.

�A%'/( "%,!3+,23G:1. �23(+"%&, �L�. �2(/./*',./ A/ �('A!3%4!&,+"-&/@ D%3231%% / �L�. �23(+"%&, L�. �/3-

'(%@, �L�. �+""!3. — �., 2010. — 176 '.

192

2. Santos, L.S. Surgical reduction of the renal mass in rats: morphologic and functional analysis onthe remnant kidney / L.S. Santos, E.W. Chin, et al. // Acta Cir Bras. — 2006. — Vol. 21, � 4. — �. 252–257.

3. Yang, H. Models of chronic kidney disease / H. Yang, Y. Zuo, �.B. Fogo // Drug Discov TodayDis Models. — 2010. — Vol. 7, � 1–2. — �. 13–19.

4. �!$3/.+, �L�. �,+,%',%B!'(%@ +&+"%) 4!*%5%&'(%D *+&&GD. �3%4!&!&%! A+(!,+ A3%-("+*&GD A3/13+44 STATISTICA / �L�. �!$3/.+. — �.: �!*%+ �?!3+, 2006. — 312 '.

&!1]",0+;+!0+)!$*'2"1!��!&+,!$!>!&=("$1'%',++!�0&!>!+^&!,+%'�)!>!^!1'*+�0+0"

"#!. ������� (����.), "#J. 2����_�� (����.)

�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ /$�!@ D%3231%%

�������������������: ��H. ?���X (��., . �. �.)

"����z����z��� . �%'"/ $/"-&GD ' /',3G4 % D3/&%B!'(%4 D/"!5%',%,/4 ' (+F*G4 1/-*/4 2.!"%B%.+!,'# [1]. �,/ /$2'"+."%.+!, &!/$D/*%4/',- A/%'(/. ./)4/F&/1/ 2"2BU!&%# 3!)2"--,+,/. A3/./*%4/1/ "!B!&%#. �+ '/.3!4!&&/4 �,+A! B3!).GB+@&/ +(,2+"-&G4 #."#!,'# %)2B!&%!+&,%$%/,%(/3!)%',!&,&/',% 4%(3//31+&%)4/., .G'!.+!4GD %) F!"B%, + ,+(F! %)2B!&%! A3/./*%-4/@ +&,%$%/,%(/A3/?%"+(,%(% % +&,%$%/,%(/,!3+A%% . ',+5%/&+3! [2]. �%3/(/! %'A/"-)/.+&%!A3!A+3+,/. 5!?+"/'A/3%&/./1/ 3#*+ &! .'!1*+ A/)./"#!, 3!U%,- A3/$"!4G +&,%$%/,%(/A3/?%-"+(,%(% % +&,%$%/,%(/,!3+A%% 2 ,+(%D $/"-&GD.

*��z �����������. �A3!*!"%,- +&,%$%/,%(/3!)%',!&,&/',- 4%(3//31+&%)4/. F!"B% %)F!"B&/1/ A2)G3# ( A3!A+3+,+4 5!?+"/'A/3%&/./1/ 3#*+ A3% /',3/4 % D3/&%B!'(/4 D/"!5%',%,!.

J����� ������ . 3+$/,2 .("�B!&G 55 $/"-&GD, &+D/*%.U%D'# &+ "!B!&%% . �� «3-#��� %4. �L. �"24/.+» 1. �%&'(+ /, '!&,#$3# 2011 1. */ '!&,#$3# 2012 1., (/,/3G4 $G"% .GA/"&!-&G 4%(3/$%/"/1%B!'(/! %''"!*/.+&%! F!"B% % F!"B&/1/ A2)G3#.

&�_��z�� . �''"!*2!42� 132AA2 '/',+.%"% 55 $/"-&GD ' /',3G4 D/"!5%',%,/4 (��) %D3/&%B!'(%4 D/"!5%',%,/4 (��): 46 (83,6 %) F!&�%& % 9 (16,4 %) 42FB%&. /)3+', $/"-&GD /, 36"!, */ 82 "!,, ,32*/'A/'/$&/1/ ./)3+',+ — 14 (25,5 %). �+,/4/3?/"/1%B!'(%: 21 (38,2 %) — ��,34 (61,8 %) — ��. / .'!D '"2B+#D /,4!B+!,'# '/.A+*!&%! ("%&%B!'(/1/ % A+,/4/3?/"/1%B!'(/1/*%+1&/)+. 47 (85,5 %) '"2B+#D A3/./*%"+'- "+A+3/'(/A%B!'(+# D/"!5%',�(,/4%# (���), . 8(14,5 %) — �� ' *3!&%32��%4% /A!3+5%#4% %) "+A+3/,/4&/1/ */',2A+. � 8 (17,4 %) $/"-&GD /,-4!B+"%'- /'"/F&!&%# /'&/.&/1/ *%+1&/)+: D/"!*/D/"%,%+) — 21 (38,2 %) '"2B+!., ',3%(,23+ ,!3-4%&+"-&/1/ /,*!"+ D/"!*/D+ — 2 (3,6 %), 3!+(,%.&G@ A+&(3!+,%, — 1 (1,8 %), %) &%D 4!D+&%B!-'(+# F!",2D+ &+$"�*+"+'- 2 17 (30,9 %) $/"-&GD. � 36 (65,5 %) A+5%!&,/. *%+1&/',%3/.+&+ '/A2,-',.2��+# A+,/"/1%#: %U!4%B!'(+# $/"!)&- '!3*5+ — 11 (20 %) '"2B+!., +3,!3%+"-&+# 1%A!3,!&-)%# — 27 (49,1 %), '+D+3&G@ *%+$!, — 7 (12,7 %).

%''"!*2!4/@ 132AA! $+(,!3%/D/"%# .G#."!&+ 2 28 (50,9 %) A+5%!&,/.. � 10 (35,7 %) A+5%-!&,/. B2.',.%,!"-&/',- ( +&,%$%/,%(+4 5!?+"/'A/3%&/./1/ 3#*+ /,'2,',./.+"+. A/"2B!&&GD"+$/3+,/3&GD *+&&GD 2 18 A+5%!&,/. /A3!*!"#"+'- B2.',.%,!"-&/',- ( +&,%$%/,%(+4 1-1/, 2-1/,3-1/ A/(/"!&%@ 5!?+"/'A/3%&/./1/ 3#*+. �3% +&+"%)! $+(A/'!./. /,4!B!&/, B,/ ( 5!?+"/'A/3%-&+4 A!3./1/ A/(/"!&%# $G"% B2.',.%,!"-&G 6 (33,3 %) $/"-&GD, A3% �,/4 .'! $+(,!3%%, .G'!#&-&G! %) F!"B% �,%D A+5%!&,/., ,+(F! $G"% B2.',.%,!"-&G ( A3!A+3+,+4 .,/3/1/ % ,3!,-!1/ A/(/-"!&%@. � 9 (50 %) 3!)2"-,+,/. A/'!./. %4!"+ 4!',/ B2.',.%,!"-&/',- ( 5!?+"/'A/3%&+4 .,/3/1/A/(/"!&%#, A3% �,/4 /&% $G"% ,+(F! B2.',.%,!"-&G ( 5!?+"/'A/3%&+4 3-1/ A/(/"!&%#. �2.',.%-,!"-&/',- ( +&,%$%/,%(+4 5!?+"/'A/3%&/./1/ 3#*+ ,3!,-!1/ A/(/"!&%# .G#."!&+ 2 12 (66,6 %)$/"-&GD, % ,/"-(/ 2 3 %) &%D $+(,!3%% $G"% &!B2.',.%,!"-&G ( A3!A+3+,+4 A!3./1/ % .,/3/1/ A/-(/"!&%@. �3% A/'!.+D B2.',.%,!"-&/',- ( +&,%$%/,%(+4 B!,.!3,/1/ A/(/"!&%# 5!?+"/'A/3%&/./-1/ 3#*+ &! /A3!*!"#"+'- A/ ,!D&%B!'(%4 A3%B%&+4.

$ ��� . �!"!'//$3+)&/',- "!B!&%# /',3/1/ % D3/&%B!'(/1/ D/"!5%',%,+ +&,%$%/,%(+4%5!?+"/'A/3%&/./1/ 3#*+ '"!*2!, (/&,3/"%3/.+,- A/',/#&&G4 4/&%,/3%&1/4 . (/&(3!,&/4 "!B!$-&/4 2B3!F*!&%%. �!(/4!&*2!4G! A3/,/(/"G *"# ,+(/1/ A3/?%"# $/"-&GD ,+(F! A/*"!F+, A!3!-'4/,32 ' 2B!,/4 4/&%,/3%&1+ % */"F&G $/"!! U%3/(/ .("�B+,- A3!A+3+,G *321%D 132AA +&,%-$%/,%(/..

193

�A%'/( "%,!3+,23G:1. �!',!3!&(/ �L�., �%D+@"2'/. �L., �23/.+ L�., �/(/&/. �L�., �+"(%)/. �L�. �!B!&%!

(+"-(2"!)&/1/ D/"!5%',%,+ % !1/ /'"/F&!&%@ // �%3231%#. — 2003. — � 10. — �. 41–45.2. �%(/&/., �L. �3%4!&!&%! 'A/3/$+(,!3%&+ . (/4A"!('&/4 "!B!&%% /',3/1/ D/"!5%',%,+

2 A+5%!&,/. A/F%"/1/ % ',+3B!'(/1/ ./)3+',+: +.,/3!?. *%'. ... (+&*. 4!*. &+2( : 14.00.27 / �%(/&/.�!,3 "+*%4%3/.%B. — �3!&$231, 2009. — 24 '.

$-;!&J'0!("0&'�","*++�&+0&"$J"0+%'�)+^!;!1!%'%,-^+$,40&+J!q>!$-^>'J"0!J"^4;!1],-^$�!�0!=,++)1+,+%'�)!/

�4;)!J�',�"*+++4J'&',,!/(')!J�',�"*++"#2. ������� (����.)

�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ &!3.&GD % &!@3/D%3231%B!'(%D $/"!)&!@

�������������������: ���. ?������� (���.)

"����z����z. �/.3!F*!&%# 5!&,3+"-&/@ &!3.&/@ '%',!4G . /$�!@ ',32(,23! ,3+.4+,%)4+'/',+."#�, /(/"/ 30–40 % , + '3!*% A3%B%& %&.+"%*%)+5%% .GD/*#, &+ A!3./! 4!',/ (�%D,!3-4+& �L�. ' '/+.,., 2001). �+',/,+ B!3!A&/N4/)1/.GD ,3+.4 '/',+."#!, . '3!*&!4 2–4 '"2B+# &+1 000 B!"/.!( . 1/* (�+""+(#& �L�. ' '/+.,., 2003).

*��z. �A3!*!"%,- /A,%4+"-&G@ 4!,/* ,3!A+&+5%% A3% ,3+.4+,%B!'(%D /$/"/B!B&GD %.&2,3%4/)1/.GD 1!4+,/4+D 2 $/"-&GD . '/',/#&%% ("%&%B!'(/@ '2$(/4A!&'+5%% % 24!3!&&/@ *!-(/4A!&'+5%%.

J����� ������ �����������. �+$/,+ /'&/.+&+ &+ +&+"%)! 3!)2"-,+,/. D%3231%B!-'(/1/ "!B!&%# $/"-&GD &+ $+)! .)3/'"/1/ &!@3/D%3231%B!'(/1/ /,*!"!&%# ��� ��� 1. �%&'(+' 1.01.2009 A/ 31.01.2011.

�3/.!*!&/ 3!,3/A3/'A!(,%.&/! %''"!*/.+&%! 132AA $/"-&GD ' (/',&/NA"+',%B!'(/@ ,3!A+-&+5%!@ B!3!A+ (���) % *!(/4A3!''%.&/@ ,3!A+&+5%!@ B!3!A+ (��). �/"-&G!, (/,/3G4 A3/./-*%"% ���, '/',+.%"% /'&/.&2� 132AA2 (n = 36); . (/&,3/"-&2� 132AA2 ./U"% $/"-&G! ' .GA/"-&!&&/@ �� (n = 36).

�3%,!3%#4% .("�B!&%# $/"-&GD . %''"!*/.+&%! #."#"%'-: &+"%B%! 2 $/"-&/1/ .&2,3%B!-3!A&/1/ ,3+.4+,%B!'(/1/ /B+1+ (/$/"/B!B&G!, .&2,3%4/)1/.G! 1!4+,/4G, /B+1% 2U%$+ % 3+)4/)-F!&%# 4/)1+ % %D '/B!,+&%! 4!F*2 '/$/@); &! $/"!! 72 B+'/. (3 '2,/() A/'"! A/"2B!&%# ,3+.4G;23/.!&- '/)&+&%# */ "!B!&%# $/"-U! 10 $+""/. A/ ��� (U(+"! (/4 �"+)1/). �3%,!3%#4% %'("�-B!&%# $/"-&GD %) %''"!*/.+&%# $G"%: A3/#."!&%# .G3+F!&&/1/ /,!(+ % &+$2D+&%# 4/)1+ ./ .3!4#.GA/"&!&%# /A!3+5%%, &+"%B%! *.2D',/3/&&%D 1!4+,/4, .*+."!&&G! A!3!"/4G, &+"%B%! ,#F!"/@'/B!,+&&/@ ,3+.4G.

&�_��z�� �����������. D/*! %''"!*/.+&%# /5!&%.+"/'- (/"%B!',./ (/@(/N*&!@ A3/-.!*!&&GD . $/"-&%5!. %''"!*2!4/@ 132AA! /&/ '/',+.%"/ 16,81 ± 8,62 *&#. (/&,3/"-&/@ —18,08 ± 7,42 *&# ( 3 > 0,05).

�3/./*%"+'- /5!&(+ A/'"!/A!3+5%/&&/1/ '/',/#&%# $/"-&GD . /$!%D 132AA+D. %''"!*2!-4/@ 132AA! (/"%B!',./ $/"-&GD . #'&/4 '/)&+&%% (15 $+""/. A/ ���) '/',+.%"/ 15 B!".(41,66 %), . '/',/#&%% /1"2U!&%# (11–14 $+""/.) — 19 B!" (52,77 %), . '/A/3! (9–10 $+""/.) —2 B!". (5,55 %). ��� A/'"! /A!3+,%.&/1/ "!B!&%# '/',+.%"/ +1,08 ± 1,54 $+""+ ( %'D/*&/42 '/-',/#&%�. (/&,3/"-&/@ 132AA! 3+'A3!*!"!&%! $/"-&GD A/ 23/.&� '/)&+&%# .G1"#*!"/ '"!*2�-�%4 /$3+)/4: /1"2U!&%! — 20 B!". (66,66 %), #'&/! '/)&+&%! — 16 B!". (44,44 %). ��� A/'"!/A!3+,%.&/1/ "!B!&%#: +1,8 ± 1,32$+""+ ( %'D/*&/42 '/',/#&%� (3 < 0,05).

�3+.&%.+"/'- (/"%B!',./ 3!/A!3+5%@: . %''"!*2!4/@ 132AA! — 8 (22,22 %), . (/&,3/"-&/@132AA! — 4 (11,11 %) (3 > 0,05).

�5!&%.+"/'- (/"%B!',./ "!,+"-&GD %'D/*/.. �&/ '/',+.%"/ A/ 2 B!"/.!(+ (5,55 %) . (+F*/@132AA!.

$ ��� . �/"!! 5!"!'//$3+)&G4 4!,/*/4 /A!3+,%.&/1/ "!B!&%# 2 $/"-&GD ' �� . '/',/#-&%% ("%&%B!'(/@ '2$(/4A!&'+5%% % 24!3!&&/@ *!(/4A!&'+5%% '"!*2!, A3%)&+,- A3/.!*!&%!���. �,4!B+!,'# "2BU!! ./'',+&/."!&%! $/"-&GD, (/,/3G4 A3/./*%"+'- ���. �,/, .%* /A!-3+,%.&/1/ "!B!&%# #."#!,'# �(/&/4%B!'(% .G1/*&G4 (&! ,3!$2!,'# A/.,/3&/@ 1/'A%,+"%)+5%%$/"-&GD, '/(3+�+�,'# 3+'D/*G &+ A3/.!*!&%! A"+',%(% (/',&/1/ *!?!(,+). �,+,%',%B!'(% */',/-.!3&GD 3+)"%B%@ A/ A3/*/"F%,!"-&/',% "!B!&%#, (/"%B!',.2 3!/A!3+5%@£"!,+"-&/',% 4!F*2/$!%4% 132AA+4% .G#."!&/ &! $G"/.

194

�A%'/( "%,!3+,23G:1. �"+&5, �. �!*%(/N$%/"/1%B!'(+# ',+,%',%(+. — �., 1999. — 462 '.2. �/&*3+,-!., �L�. �!/,"/F&+# &!@3/,3+.4+,/"/1%#. — �., 2009. — 190 '.3. �!$!*!. L., �3G"/. L. �!/,"/F&+# &!@3/D%3231%#. — �., 2000. — �. 103–266.4. �!$!*!. L., �!$!*!. �L. �!/,"/F&+# D%3231%# ��. — �., 2008. — 522 '

^+&4&>+%'�)!'1'%',+'�"*+',0!$�(+1"0"*+!,,!/)"&(+!J+!�"0+'/

+#�. ����3���� (����.), J#+. )���3 (����.), "#2. ������� (����.)�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

���� «�+3*%/"/1%#»

�����������������������. Q����� (. �. �.)

"����z����z. ',32(,23! /$�!@ '4!3,&/',% &+'!"!&%# �!'A2$"%(% �!"+32'- "%*%32�-�2� A/)%5%� )+&%4+�, $/"!)&% '!3*!B&/N'/'2*%',/@ '%',!4G (53,8 %), &/.//$3+)/.+&%# (13,4 %)% .&!U&%! A3%B%&G (10,3 %).

�3+(,%B!'(% *"# .'!D &/)/"/1%B!'(%D ?/34 )+$/"!.+&%@ '!3*5+ ?%&%U&/@ A3#4/@ #."#!,'#D3/&%B!'(+# '!3*!B&+# &!*/',+,/B&/',- (���), A3/$"!4+ (/,/3/@ &/'%, 1"/$+"-&G@ '/5%+"-&/-�(/&/4%B!'(%@ D+3+(,!3. �/ 9 % .'!D '"2B+!. ��� '/',+."#!, ���� [1]. �� (/"%B!',./ .G#.-"!&&GD $/"-&GD ���� '/',+."#!, 1,34 &+ 100 ,G'. B!". �3/1&/) *+&&/1/ )+$/"!.+&%# .!'-4+'!3-�)!&. �+( A3+.%"/, &+',2A+!, A3/13!''%32��!! 2D2*U!&%! F!"2*/B(/.GD ?2&(5%@ %, (+('"!*',.%! �,/1/, '4!3,- /, &!*/',+,/B&/',% &+'/'&/@ ?2&(5%% %"% &+32U!&%@ 3%,4+. A!3.G!A#,- "!, )+$/"!.+&%# 24%3+!, */ 70 % $/"-&GD. ,!34%&+"-&/@ ',+*%% ���� /A,%4+"-&G4 'A/-'/$/4 "!B!&%# #."#!,'# D%3231%B!'(/! "!B!&%!. �/ .G$/3 A3%4!&#!4/@ 4!,/*%(% (A"+',%-(+¦A3/,!)%3/.+&%! 4%,3+"-&/1/ ("+A+&+, (+3*%/3!'%&D3/&%)%32��+# ,!3+A%# "%$/ %D '/B!,+&%!)&! %4!!, /A3!*!"!&&GD ("%&%(/N"+$/3+,/3&GD (3%,!3%!. [2].

*��z. �3/.!',% '3+.&%,!"-&G@ +&+"%) %'A/"-)2!4GD 4!,/*%( D%3231%B!'(/1/ "!B!&%# ('/-B!,+&&/! "%$/ %)/"%3/.+&&/! A3%4!&!&%! (/33!(5%@ ?2&(5%/&+"-&/@ &!*/',+,/B&/',% 4%,3+"--&/1/ ("+A+&+ % (+3*%/3!'%&D3/&%)%32��!@ ,!3+A%%) 2 A+5%!&,/. ' ����.

�+*+B%:1) ("%&%(/N1!4/*%&+4%B!'(+# /5!&(+ &!A/'3!*',.!&&GD 3!)2"-,+,/ .(/33!(5%% 4%,3+"-&/@

&!*/',+,/B&/',% (A"+',%(+��, A3/,!)%3/.+&%! ��);2) A3/+&+"%)%3/.+,- �??!(,%.&/',- (+3*%/3!'%&D3/&%)%32��!@ ,!3+A%% . 3+&&!4 A/'"!-

/A!3+5%/&&/4 A!3%/*!;3) /5!&%,- 3!)2"-,+,G A3%4!&#!4GD 4!,/*%( . A/)*&!4 A/'"!/A!3+5%/&&/4 A!3%/*!;4) A3/.!',% '3+.&%,!"-&G@ +&+"%) %'A/"-)2!4GD 'A/'/$/. D%3231%B!'(/1/ "!B!&%#.J����� � ����� . %''"!*/.+&%! .("�B!&/ 170 A+5%!&,/., A3//A!3%3/.+&&GD .

���� «�+3*%/"/1%#» ' 2002 A/ 2011 11. �!,/*/4 %''"!*/.+&%# #."#!,'# A3/'A!(,%.&G@ +&+"%)$+)G *+&&GD, 'A!(,3+ .GA/"&!&&GD /A!3+5%@ ' 2B!,/4 A3/.!*!&&GD %''"!*/.+&%@ (���, ���-(+3*%/13+?%# % ,. *.), ',+,%',%B!'(+# /$3+$/,(+ *+&&GD A/'3!*',./4 SPSS Statistics 15.0.

&�_��z�� . �3!*&%@ ./)3+', A+5%!&,/. '/',+.%" 44,5 1/*+, '//,&/U!&%! 42FB%& % F!&-�%& — 9:1. �G"/ .GA/"&!&/ 170 /A!3+5%@ A/ (/33!(5%% ����, %) &%D: %)/"%3/.+&&+# (/33!(5%#&!*/',+,/B&/',% 4%,3+"-&/1/ ("+A+&+ (94; 55,3 %); (+3*%/3!'%&D3/&%)%32��+# ,!3+A%# (��)(28; 16,5 %); (/33!(5%# &!*/',+,/B&/',% �� . '/B!,+&%% ' �� (24; 14,1 %); *321%! .4!U+,!"-',-.+ (24; 14,1 %).

+$"%5+ 1

�'D/*&G! ���NA/(+)+,!"% "!./1/ F!"2*/B(+ (��)

�/(+)+,!"- �� + �� �� �� P���, 44 76 74 71 0,17���, 44 66 66 63 0,5�, % 28 25 29 0,22���, 4" 317 311 271 0,02���, 4" 244 239 204 0,03

195

+(%4 /$3+)/4, &+$"�*+!,'# ',+,%',%B!'(% */',/.!3&+# 3+)&%5+ 4!F*2 %'D/*&G4% A/(+)+-,!"#4% ��� % ���.

A/'"!/A!3+5%/&&/4 A!3%/*! &+$"�*+!,'# */',/.!3&/! 2"2BU!&%! &+'/'&/@ ?2&(5%%'!3*5+, B,/ A/*,.!3F*+!,'# '&%F!&%!4 ���, ��� % 2.!"%B!&%!4 �. �*&/1/*%B&+# .GF%.+!-4/',- — 85 ± 0,04 %, 4-"!,&## — 39 ± 0,08 %.

$ ��� :1. &+',/#�!! .3!4# /,'2,',.2�, /*&/)&+B&G! (3%,!3%% *"# .G$/3+ ,+(,%(% D%3231%B!-

'(/1/ "!B!&%# ����.2. �+"%B%! �"!(,3%B!'(/@ *%''%&D3/&%% (�����) #."#!,'# &!/$D/*%4G4, &/ &!*/',+,/B-

&G4 A3!*%(,/3/4 ,+(,%(% D%3231%B!'(/1/ .!*!&%# A+5%!&,/. ' ����.3. �+$"�*+!,'# ',+,%',%B!'(% */',/.!3&/! (3 < 0,001) '&%F!&%! 23/.&# 4%,3+"-&/@ 3!123-

1%,+5%% A3% %)/"%3/.+&&/@ (/33!(5%% 4%,3+"-&/@ &!*/',+,/B&/',%, + ,+(F! A3% '/B!,+&%% '��.

4. �/'A%,+"-&+# "!,+"-&/',- '/',+.%"+ 2,7 % (4 A+5%!&,+): ',+,%',%B!'(% )&+B%4/@ 3+)&%5G. 23/.&#D 1/'A%,+"-&/@ "!,+"-&/',% 4!F*2 .%*+4% .4!U+,!"-',.+ A3% (/33!(5%% 4%,3+"-&/@&!*/',+,/B&/',% &! /,4!B+!,'#. �/'A%,+"-&+# "!,+"-&/',- A3% %)/"%3/.+&&/@ �� 3+.&+ 0.

5. �/*%B&+# .GF%.+!4/',- A/'"! D%3231%B!'(/1/ "!B!&%# '/',+.%"+ 85 %, . ,/ .3!4# (+(A3% 4!*%(+4!&,/)&/@ ,!3+A%% &! A3!.GU+!, 45 %.

6. %* (/33!(5%% 4%,3+"-&/@ &!*/',+,/B&/',% (A"+',%(+¦A3/,!)%3/.+&%!) */',/.!3&/ &!."%#!, (3 = 0,145) &+ .GF%.+!4/',- . /,*+"!&&/4 A!3%/*!.

7. #F!',- ��� A/ �� NYHA ',+,%',%B!'(% /*&/)&+B&/ (long-rank test 3 = 0,001) #."#!,'#&!$"+1/A3%#,&G4 A3/1&/',%B!'(%4 ?+(,/3/4 . /,&/U!&%% .GF%.+!4/',% . /,*+"!&&/4 A!3%/*!,B,/ /$2'"+."%.+!, &!/$D/*%4/',- './!.3!4!&&/1/ D%3231%B!'(/1/ .4!U+,!"-',.+.

�A%'/( "%,!3+,23G:1. �!35!&, �L�L�3/&%B!'(+#'!3*!B&+#&!*/',+,/B&/',-: �A%*!4%/"/1%B!'(%! +'A!(,G /

�L�. �!35!&, �L�. �/)"/. // �!*%5%&+. — 2004. — � 4. — �. 107–109.2. The EuroHeart Failure survey programme a survey on the quality of care among patients with

heart failure in Europe. Part 1: patient characteristics and diagnosis / J.G. Cleland [et al.] // Eur. Heart. J.— 2003. — � 24(5). — P. 442–463

!�!;',,!�0+)1+,+)++1";!&"0!&,-^�!)"q"0'1'/)&!$+�&+!�0&!JJ'q',0'&+"1],!J0&!J;!q'

!#!. ���3���, ,#". ;�����

�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ /$�!@ D%3231%%

�!)!&,!3%+"-&G@ ,3/4$/) #."#!,'# /*&%4 %) ,#F!"!@U%D '/',/#&%@ . &!/,"/F&/@ +$*/4%-&+"-&/@ D%3231%%. �+',/,+ 4!)!&,!3%+"-&/1/ ,3/4$/)+ '/',+."#!, 0,05–7,6 % /, /$�!1/ B%'"+ .'!/',3GD D%3231%B!'(%D )+$/"!.+&%@ [2, 3]. �!'4/,3# &+ '/.3!4!&&/! 3+).%,%! /,!B!',.!&&/@ 4!-*%5%&G, "!,+"-&/',- A3% *+&&/@ A+,/"/1%% */',%1+!, 65–100 % [1, 4].

�+%$/"!! B+',/ .',3!B+!,'# /(("�)%# 4!)!&,!3%+"-&GD +3,!3%@, (/,/3+# '/',+."#!, 88–97 % '"2B+!., A3% �,/4 ,3/4$/) 4!)!&,!3%+"-&GD .!& .',3!B+!,'# . 2–15 % '"2B+!.. �3% �,/4'%&*3/4 /',3/@ +$*/4%&+"-&/@ %U!4%% &! .'!1*+ &/'%, /(("�)%/&&G@ D+3+(,!3. �3% &!(/,/3GDA+,/"/1%B!'(%D '/',/#&%#D, '/A3/./F*+��%D'# '%&*3/4/4 1%A!3(/+12"#5%% (,3/4$/?%"%#,�3%,3!4%# % ,L*.) % %)4!&!&%!4 ',!&(% '/'2*/. (+,!3/'("!3/), �&*+3,!3%%, % ,L*.), ./)4/F&/ ?/3-4%3/.+&%! A3%',!&/B&/1/ ,3/4$+, &! A/"&/',-� )+(3G.+��!1/ A3/'.!, '/'2*+. +( F!, /',3+#4!)!&,!3%+"-&+# &!*/',+,/B&/',- 4/F!, $G,- '"!*',.%!4 5!&,3+"%)+5%% (3/.//$3+�!&%# A3%U/(!, ,#F!"/@ %&,/('%(+5%%, + ,+( F! A3% *!(/4A!&'+5%% D3/&%B!'(/@ '!3*!B&/@ &!*/',+,/B&/-',% )+ 'B!, (/4A!&'+,/3&/1/ +&1%/'A+)4+ .%'5!3+"-&GD +3,!3%@ % .!&.

�A!3+,%.&/! "!B!&%! 4!)!&,!3%+"-&/1/ ,3/4$/)+ . ',+*%% %&?+3(,+ (%U!B&%(+ ' ("%&%(/@A!3%,/&%,+, (+( A3+.%"/£&! /(+)G.+!, �??!(,+. �3% �,/4 /',+�,'# &!3!U�&&G4% */ (/&5+ ./A3/-'G 3+&&!@ *%+1&/',%(% *+&&/@ A+,/"/1%% ' 5!"-� 3+&&!1/ A3%4!&!&%# ,+(%D /A!3+5%@, (+( 3!)!(-5%# (%U!B&%(+ 3+)"%B&/1/ /$��4+, ,3/4$/N�4$/"�(,/4%#, 3!(/&',32(,%.&G! .4!U+,!"-',.+ &+$3GF!!B&GD '/'2*+D % *3. [5]. '! .GU!A!3!B%'"!&&G! ?+(,/3G /A3!*!"#�, +(,2+"-&/',- %)2B!-

196

&%# ./A3/'/. 3+&&!@ ("%&%(/N"+$/3+,/3&/@ % %&',324!&,+"-&/@ *%+1&/',%(% *+&&/@ A+,/"/1%% %/A3!*!"!&%# 3+5%/&+"-&/@ ,+(,%(% .!*!&%# $/"-&GD.

*��z� %''"!*/.+&%# #."#"'# +&+"%) B+',/,G .',3!B+!4/',% /',3/1/ 4!)!&,!3%+"-&/1/,3/4$/)+ % A/%'( ("%&%(/N"+$/3+,/3&GD A/(+)+,!"!@ *"# 3+&&!@ *%+1&/',%(% % /A3!*!"!&%# A3/-1&/)+ )+$/"!.+&%#.

J����� ������ �����������. /'&/.2 3+$/,G A/"/F!& +&+"%) 3!)2"-,+,/. "!B!-&%# 76 $/"-&GD ' ("%&%(/@ /',3/1/ 4!)!&,!3%+"-&/1/ ,3/4$/)+, A3/D/*%.U%D "!B!&%! . ������� � 1 1. �!"#$%&'(+ ' 2006 A/ 2011 1/*G. �''"!*/.+&%! &/'%, 'A"/U&/@, 3!,3/'A!(,%.&G@ D+-3+(,!3. �"# /A3!*!"!&%# ("%&%(/N"+$/3+,/3&GD A/(+)+,!"!@, ."%#��%D &+ ,!B!&%! % A3/1&/) )+-$/"!.+&%#, .'! $/"-&G! $G"% 3+)*!"!&G &+ 2 132AAG: /'&/.&2� % 132AA2 '3+.&!&%#. /'&/.&2�132AA2 $G"% .("�B!&G 8 $/"-&GD ' $"+1/A3%#,&G4 %'D/*/4. 132AA2 '3+.&!&%# $G"% .("�B!&G68 A+5%!&,/., 2 (/,/3GD )+$/"!.+&%# )+.!3U%"/'- "!,+"-&G4 %'D/*/4. �/1"+'&/ A/"2B!&&G4*+&&G4, A/(+)+,!"- "!,+"-&/',% '/',+.%" 89,5 %. '!4 A+5%!&,+4 . A3/5!''! ',+5%/&+3&/1/ "!-B!&%# $G"% A3/%).!*!&G ("%&%B!'(/! % "+$/3+,/3&/! /$'"!*/.+&%#, /$)/3&+# 3!&,1!&/13+?%#$3�U&/@ A/"/',%, 2"-,3+).2(/./! %''"!*/.+&%! /31+&/. $3�U&/@ A/"/',%. +(F! A3%4!&#"%'-*%+1&/',%B!'(%! /A!3+5%% ("+A+3/'(/A%#, "+A+3/,/4%#). �3% ?/342"%3/.(! ("%&%B!'(/1/ *%+1-&/)+ %'A/"-)/.+"%'- '/.3!4!&&+# ("+''%?%(+5%# % ��� 10.

�,+,%',%B!'(2� /$3+$/,(2 *+&&GD /'2�!',."#"% 4!,/*+4% .+3%+5%/&&/@ ',+,%',%(% ' %'-A/"-)/.+&%!4 A3/13+44&/1/ A+(!,+ MS Excel-2010. �/',/.!3&/',- 3+)"%B%@ 4!F*2 A/"2B!&&G4%A/(+)+,!"#4% /5!&%.+"% ' A/4/�-� &!A+3+4!,3%B!'(%D 4!,/*/. ',+,%',%(%: �32'(+"+ — �/""!-'+, �+&&+ — �%,&% %  2. �3/.!&- )&+B%4/',% $G" A3%&#, 4!&!! 5 %.

&�_��z�� . �3% '3+.&!&%% . /'&/.&/@ 132AA! */"# 42FB%& '/',+.%"+ 37,5 %, + */"# F!&-�%& — 62,5 %. �3% �,/4 . 132AA! '3+.&!&%# */"# 42FB%& (42,6 %) % F!&�%& (52,4 %) $G"+ */',/-.!3&/ $"%)(+ A/(+)+,!"#4 . /'&/.&/@ 132AA! (3 > 0,05). �3!*&%@ ./)3+', A+5%!&,/. . /'&/.&/@132AA! '/',+.%" 62,8 � 3,5 1/*+, + . 132AA! '3+.&!&%# — 74,6 � 1,8 1/*+ (3 > 0,05).

�3% '3+.&!&%% *+&&GD '3/(% 1/'A%,+"%)+5%% . /'&/.&/@ 132AA! '/',+.%"% 52,4 � 14,9 B+'+,. 132AA! '3+.&!&%# - 43,7 � 4,9 B+'+ (3 > 0,05). �3% *!,+"-&/4 +&+"%)! '3/(/. 1/'A%,+"%)+5%%$/"-&GD /$!%D 132AA $G"% A/"2B!&G '"!*2��%! 3!)2"-,+,G (,+$". 1).

+$"%5+ 1

�+',/,+ 1/'A%,+"%)+5%% $/"-&GD /$!%D 132AA . )+.%'%4/',%/, ("%&%B!'(/@ ',+*%% 4!)!&,!3%+"-&/1/ ,3/4$/)+

�"%&%B!'(%! ',+*%%�'&/.&+# 132AA+(n = 8) �32AA+ '3+.&!&%# (n = 68)

�$'. % �$'. %

- A!3.G! 12 B 4 50* 41 60,3

- 13–24 B 1 12,5 6 8,8

- 25–48 B - - 7 10,3

- A/)F! 48 B 3 37,5* 12 17,6�3%4!B+&%!: * — 3 < 0,05 — */',/.!3&/! /,"%B%! A/(+)+,!"!@ . /$!%D 132AA+D.

�3% +&+"%)! A/"2B!&&GD *+&&GD . ',+*%% %U!4%% . /'&/.&/@ 132AA! 1/'A%,+"%)%3/.+&/50 % $/"-&GD, + . 132AA! '3+.&!&%# 60,3 % A+5%!&,/. (3 < 0,05). ',+*%% %&?+3(,+ (%U!B&%(+$G"% 1/'A%,+"%)%3/.+&G 12,5 % $/"-&GD /'&/.&/@ % 8,8 % A+5%!&,/. 132AAG '3+.&!&%# (3 > 0,05). '3/(% $/"!! 24 B+'/. /, &+B+"+ )+$/"!.+&%# $G"% 1/'A%,+"%)%3/.+&G 37,5 % A+5%!&,/. /'&/.-&/@ % 27,9 % $/"-&GD 132AAG '3+.&!&%#. �/, !'"% 2 A+5%!&,/. 132AAG '3+.&!&%# ("%&%(2 4!)!&-,!3%+"-&/1/ ,3/4$/)+ /'"/F&#" A!3%,/&%,, ,/ . /'&/.&/@ 132AA! %4!"% 4!',/ .!&/)&G@ ,3/4$/)%"% ("%&%(+ '2$(/4A!&'%3/.+&&/@ D3/&%B!'(/@ +$*/4%&+"-&/@ %U!4%% $!) &!(3/)+ ',!&(% (%-U!B&%(+, B,/ /(+)G.+"/ '2�!',.!&&/! ."%#&%! &+ %'D/* )+$/"!.+&%#.

� A3%B%&+4, /A3!*!"#��%4 .G'/(2� "!,+"-&/',- A3% /',3/@ +$*/4%&+"-&/@ %U!4%%,4/F&/ /,&!',% /'/$!&&/',% A+,/4/3?/"/1%%, (/,/3G! A/)./"#�, .G*!"%,- &!'(/"-(/ ("%&%B!-'(%D .+3%+&,/. *+&&/@ A+,/"/1%%.

197

+$"%5+ 2

�"%&%(/N4/3?/"/1%B!'(%! .+3%+&,G % /'"/F&!&%# /',3/@ 4!)!&,!3%+"-&/@ &!*/',+,/B&/',%2 $/"-&GD /$!%D 132AA

�"%&%(/N4/3?/"/1%B!'(%! .+3%+&,G�'&/.&+# 132AA+ (n = 8) �32AA+ '3+.&!&%# (n = 68)

�$'. % �$'. %�!14!&,+3&G@ ,3/4$/) �� 2 25 %* 1 1,5 %3/4$/) �� 1 12,5 %* 50 73,5 %3/4$/) ��� 1 12,5 % 8 11,8 %3/4$/) �� % ��� 1 12,5 5 7,4 %3/4$/) 4!)!&,!3%+"-&GD.!& 2 25 % 3 4,4 %�',3+# 4!)!&,!3%+"-&+# %U!4%# 1 12,5* 1 1,5 %�!3%,/&%, - - 44 64,7 %

�'"/F&!&%#N&!1/'A%,+"-&+# A&!.4/&%# - - 7 10,3 %- ���� - - 16 23,5 %

�3%4!B+&%!: �� — .!3D&## $3GF!!B&+# +3,!3%#; ��� — &%F&## $3GF!!B&+# +3,!3%#; * — 3 < 0,05 —*/',/.!3&/! /,"%B%! A/(+)+,!"!@ . 132AA+D.

�&+"%) A/"2B!&&GD *+&&GD '.%*!,!"-',.2!, / ,/4, B,/ '3!*% A+5%!&,/. ' $"+1/A3%#,&G4%'D/*/4 A3!/$"+*+"% ("%&%B!'(%! '"2B+% '!14!&,+3&/1/ ,3/4$/)+ .!3D&!@ $3GF!!B&/@ +3,!3%%(25 %) % ,3/4$/)+ 4!)!&,!3%+"-&GD .!& (255) (3 < 0,05). ,/ F! .3!4# '3!*% $/"-&GD ' "!,+"-&G4%'D/*/4 A3!.+"%3/.+"% '"2B+% ,3/4$/)+ .!3D&!@ $3GF!!B&/@ +3,!3%%, (/,/3G@ $G" *%+1&/',%-3/.+& . 73,5 % '"2B+!. (3 < 0,05). �+',/,+ .',3!B+!4/',% ,3/4$/)+ &%F&!@ $3GF!!B&/@ +3,!3%% %!1/ '/B!,+&%# ' ,3/4$/)/4 .!3D&!@ $3GF!!B&/@ +3,!3%% &! %4!"+ */',/.!3&/@ 3+)&%5G . /$!%D132AA+D % */"# ,+(%D $/"-&GD '/',+.%"+ . /'&/.&/@ 132AA! 25 %, + . 132AA! '3+.&!&%# — 19,2 %¥3 < 0,05). ,/ F! .3!4# . 132AA! '3+.&!&%# /,4!B+"% */',/.!3&/ &%)(2� B+',/,2 .',3!B+!4/',%,3/4$/)+ 4!)!&,!3%+"-&GD .!& (4,4 %), '!14!&,+3&/1/ ,3/4$/)+ .!3D&!@ $3GF!!B&/@ +3,!3%%(1,5 %) % /',3/@ +$*/4%&+"-&/@ %U!4%% (1,5 %) (3 < 0,05).

� 5!"-� A/%'(+ &+%$/"!! )&+B%4GD A3/1&/',%B!'(%D (3%,!3%!. "+$/3+,/3&GD 4!,/*/. %'-'"!*/.+&%#, (/,/3G! 4/12, $G,- %'A/"-)/.+&G *"# 3+&&!@ *%+1&/',%(% /',3/@ 4!)!&,!3%+"-&/@%U!4%% % /A3!*!"!&%# A3/1&/)+ )+$/"!.+&%#, $G" A3/.!*!& '3+.&%,!"-&G@ +&+"%) 3#*+ "+$/3+,/3-&GD A/(+)+,!"!@ (3/.%. �3% '3+.&!&%% A/(+)+,!"!@ /$�!1/ +&+"%)+ (3/.% . /$!%D 132AA+D 23/.!&-1!4/1"/$%&+ % (/"%B!',./ �3%,3/5%,/. &! %4!"% */',/.!3&GD /,"%B%@, B,/ %'("�B+!, ./)4/F&/',-%'A/"-)/.+&%# *+&&GD (3%,!3%!. *"# /A3!*!"!&%# ,!B!&%# % %'D/*+ )+$/"!.+&%#. � A+5%!&,/. '$"+1/A3%#,&G4 %'D/*/4 23/.!&- "!@(/5%,/. &! A3!.GU+" 10 D 109¦", */"# A+"/B(/#*!3&GD &!@,3/-?%"/. $G"+ 4!&!! 10 % A3% &/34+"-&/4 '/*!3F+&%% "%4?/5%,/. % 4/&/5%,/. (3/.% (3 < 0,05). ,/F! .3!4# 2 A+5%!&,/. ' "!,+"-&G4 %'D/*/4 /,4!B+"% )&+B%,!"-&G@ "!@(/5%,/) (15,8�0,45 × 109¦"),A+"/B(/#*!3&G@ &!@,3/?%""!) (20,4� 0,9 %) % 4/&/5%,/) (1,6 �0,08 × 109¦").

�3% +&+"%)! $%/D%4%B!'(%D A/(+)+,!"!@ (3/.% 2 $/"-&GD ' $"+1/A3%#,&G4 %'D/*/4 /,4!-B+"% &!)&+B%,!"-&/! A/.GU!&%! 23/.&# 4/B!.%&G (13,7 � 1,5 44/"-¦"), (3!+,%&%&+ (185,4 � 13,2),$%"%32$%&+ (24,4 � 1,6 4(4/"-¦") % +4%"+)G (3/.% (128,8 � 16,4 !*¦") (3 < 0,05). �3% �,/4 23/.!&-(+"%# (3,9�0,3 44/"-¦"), &+,3%# (133,4�6,4 44/"-¦") % /$�!1/ $!"(+ (3/.% (61,2 � 2,3 1¦") 2 $/"--&GD �,/@ 132AAG '//,.!,',./.+" &/34!. /,"%B%! /, �,/1/ 2 $/"-&GD ' "!,+"-&G4 %'D/*/4 &+-$"�*+"% 1%A!3(+"%!4%� (5,9 � 0,09 44/"-¦"), 1%A!31"%(!4%� (10,5 � 0,5 44/"-¦"), 1%A/A3/,!%&!-4%� ( 55,5 � 1,3 1¦"), 2.!"%B!&%! 23/.&# 4/B!.%&G (20,3 � 0,6 44/"-¦"), (3!+,%&%&+ (259,8 � 10,44(4/"-¦"), $%"%32$%&+ (48,6 � 2,3 4(4/"-¦") % +4%"+)G (3/.% (231,6 � 7,7 !*.) (3 < 0,05). �''"!*/-.+&%! 23/.&# (3!+,%&?/'?/(%&+)G (740 � 20,5 !*.), "+(,+,*!1%*3/1%&+)G (100,4 � 35,4) % �!"/B&/@?/'?+,+)G (303 � 6,8 !*.) 2 $/"-&GD 132AAG '3+.&!&%# 2(+)G.+�, &+ %D )&+B%,!"-&/! A/.GU!&%!. ',+*%% %&?+3(,+ (%U!B&%(+, B,/ A/)./"#!, %'A/"-)/.+,- *+&&G! A/(+)+,!"% *"# *%+1&/',%(%&!(3/)+ (%U!B&%(+ A3% /',3/@ +$*/4%&+"-&/@ %U!4%%.

�3% +&+"%)! A/(+)+,!"!@ (/+12"/13+44G A3/,3/4$%&/.G@ %&*!(' . /'&/.&/@ 132AA! '/',+-.%" 83,6 %, + . 132AA! '3+.&!&%# — 67,4 % (3 < 0,05). ,/ F! .3!4# +(,%.%3/.+&&/! B+',%B&/!,3/4$/A"+',%&/./! .3!4#, 23/.!&- /$�!1/ ?%$3%&/1!&+, +(,%.%3/.+&&/! .3!4# 3!(+"-5%?%(+5%%&! %4!"% */',/.!3&GD /,"%B%@ . /$!%D 132AA+D, B,/ &! A/)./"#!, %'A/"-)/.+,- %D *"# /A3!*!"!-&%# ,!B!&%# % A3/1&/)+ A3% /',3/4 4!)!&,!3%+"-&/4 ,3/4$/)!.

198

q��������. �3% /',3/@ 4!)!&,!3%+"-&/@ &!*/',+,/B&/',% ,!B!&%! % %'D/* )+$/"!.+&%#)+.%'%, /, 23/.&# /(("�)%% '/'2*/., &+"%B%# /'"/F&!&%@, *+.&/',% )+$/"!.+&%# % '3/(/. &+B+"++*!(.+,&GD "!B!$&GD 4!3/A3%#,%@. �/'A%,+"%)+5%# $/"-&GD . ',+*%% %U!4%%, 3+&&## *%+1&/-',%(+ /',3/1/ 4!)!&,!3%+"-&/1/ ,3/4$/)+ % +(,%.&+# D%3231%B!'(+# ,+(,%(+ A/)./"#�, '&%)%,-A/(+)+,!"- "!,+"-&/',% '/ 100 */ 66,7 %. �3% �,/4 3%'( &!$"+1/A3%#,&/1/ ,!B!&%# )+$/"!.+&%#2.!"%B%.+�, ,+(%! ?+(,/3G, (+( ./)3+', A+5%!&,/. ',+3U! 70 "!,, '3/(% 1/'A%,+"%)+5%% $/"!!6 B+'/. /, &+B+"+ )+$/"!.+&%# % &+"%B%! ("%&%B!'(%D A3%)&+(/. A!3%,/&%,+.

�"# 3+&&!@ *%??!3!&5%+"-&/@ *%+1&/',%(% /',3/@ 4!)!&,!3%+"-&/@ &!*/',+,/B&/',% .',+*%% %U!4%% % ',+*%% &!(3/)+ 4/F&/ %'A/"-)/.+,- "+$/3+,/3&G! (3%,!3%% /$�!1/ +&+"%)+(3/.%, + %4!&&/: &+"%B%! .G3+F!&&/1/ "!@(/5%,/)+, A+"/B(/#*!3&/1/ &!@,3/?%""�)+ % 4/&/5%,/-)+. �3/4! ,/1/, &!(3/,%B!'(%! %)4!&!&%# (%U!B&%(+ '/A3/./F*+!, 1%A!3(+"%!4%#, .G'/(%@ 23/-.!&- +)/,%',GD U"+(/. % 1"�(/)G (3/.%, + ,+(F! A/.GU!&%! 23/.&# +4%"+)G, (3!+,%&?/'/(%&+-)G, "+(,+,*!1%*3/1!&+)G % �!"/B&/@ ?/'?+,+)G (3/.%. �''"!*/.+&%! *+&&GD A/(+)+,!"!@ . *%-&+4%(! A/)./"#!, &! ,/"-(/ /5!&%,- ,#F!',- '/',/#&%#, &/ % /A3!*!"%,- &+%$/"!! .!3/#,&G@ A3/-1&/) )+$/"!.+&%#. �&+B%,!"-&/! A/.GU!&%! 23/.&# �,%D A/(+)+,!"!@ 2(+)G.+!, &+ &+"%B%! &!(3/-,%B!'(/@ ',+*%% 4!)!&,!3%+"-&/1/ ,3/4$/)+ % !1/ /'"/F&!&%# % /,3+F+!, .G'/(%@ 3%'( 3+).%,%#"!,+"-&/1/ %'D/*+.

�A%'/( "%,!3+,23G:1. �+.!"-!. L�., �A%3%*/&/. �L. �',3G! &+32U!&%# 4!)!&,!3%+"-&/1/ (3/.//$3+�!&%#.

— �.: �!*%5%&+, 2004. — 232 '.2. �+.!"-!., L�. �2(/./*',./ A/ &!/,"/F&/@ D%3231%% /31+&/. $3�U&/@ A/"/',%. — �.:

3%+*+N�, 2004. — 640 '.3. �+!U(/, �L�. �',3G! &+32U!&%# $3GF!!B&/1/ (3/.//$3+�!&%# - �,%/"/1%#, ?+(,/3G

3%'(+, 3+'A3/',3+&!&&/',- // �&1%/"/1%# % '/'2*%',+# D%3231%#. — 2004. — � 4. — �. 99–113.4. �3%1/3#&, �L�. �$*/4%&+"-&+# D%3231%#. — �.: ���, 2006. — 672 '.5. �/(3/.'(%@ �L., �*%& L�. �',3+# 4!)!&,!3%+"-&+# &!A3/D/*%4/',-. �"%&%B!'(+# +&-

1%/"/1%#: 32(. A/* 3!*. �L. �/(3/.'(/1/. — �.: �!*%5%&+, 2004. — . 2. — �. 626–645.

&'>','&"*+!,,-/>+�0!>','q>,!/,-^&",�!($1+=,+'J&"q1+%,-^��!�!;!$J'�0,!>!1'%',+=

". $. ���������

�3!&$231'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ ?+(2"-,!,'(/@ D%3231%%, (+?!*3+ 1%',/"/1%%, 5%,/"/1%% % �4$3%/"/1%%

�������������������: ��?. ��0��� ( ���., �. �. �.),���. /������� ( ���., 0. �. �. ;B, 0��. ��., �. -. �.)

"����z����z. �3/$"!4+ "!B!&%# 1&/@&/N./'A+"%,!"-&GD )+$/"!.+&%@ 4#1(%D ,(+&!@ .'.#)% ' ./)3+',+&%!4 %D B+',/,G, ,#F!',-� ,!B!&%#, A3/13!''%32��%4 ./)3+',+&%!4 +&,%$%/,%-(/2',/@B%.GD % +&,%$%/,%(/)+.%'%4GD U,+44/. 4%(3/$/. A3/*/"F+!, /',+.+,-'# '"/F&/@,,32*&/@ % +(,2+"-&/@ [1, 2, 3]. �/�,/42 /',+!,'# .+F&G4 A/%'( &/.GD 4!,/*/. % '3!*',. 4!',&/1/"!B!&%#. +(%4 ,3!$/.+&%#4 /$"+*+!, 3+)3+$/,+&&G@ A3/?!''/3/4 �L�. �2)/.G4 % A3/?!''/3/4�L�. �"%?'/&/4 . ���� �� «�3!&$231'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#» �%&%-',!3',.+ )*3+.//D3+&!&%# % '/5%+"-&/1/ 3+).%,%# �/''%@'(/@ �!*!3+5%%» A3!A+3+, 4%"%+5%" —A3/'#&/! 4+'"/ [3]. A/'"!*&%! 1/*G )&+B%,!"-&/ A/.G'%"'# %&,!3!' %''"!*/.+,!"!@ ( %)2B!&%�3/"% % )&+B!&%# &/&+A!A,%*/. '2A3+/A,%B!'(%D % A+3+.!&,3%(2"#3&GD #*!3 1%A/,+"+42'+ (?%"/-1!&!,%B!'(% $/"!! *3!.&%D &!@3/'!(3!,/3&GD 5!&,3/. /31+&/. &!3.&/@ '%',!4G) . /$!'A!B!&%%A3/5!''/. +*+A,+5%% % (/4A!&'+5%% &+32U!&&GD ?2&(5%@ B!"/.!(+ [4].

*��z �����������. �('A!3%4!&,+"-&/N4/3?/"/1%B!'(% /$/'&/.+,- ("%&%B!'(2� �??!(-,%.&/',- 4!',&/1/ A3%4!&!&%# 4%"%+5%"+ . "!B!&%% 1&/@&GD 3+& &%F&%D (/&!B&/',!@ ' 2B!,/4+*+A,%.&/@ 3/"% 1%A/,+"+4%B!'(/@ &/&+A!A,%*!31%B!'(/@ &!@3/'!(3!5%% . 3!A+3+,%.&GD 1%',/-1!&!)+D.

J����� � ����� . �('A!3%4!&,+"-&G! %''"!*/.+&%# A3/.!*!&G &+ 72 "+$/3+,/3&GD$!'A/3/*&GD (3G'+DN'+45+D 4+''/@ 230–280 1, &+ (+?!*3! 1%',/"/1%%, 5%,/"/1%% % �4$3%/"/1%%���� �� �3��� �%&)*3+.'/53+).%,%# �/''%%.

199

� (3G' 4/*!"%3/.+"'# 1&/@&/N./'A+"%,!"-&G@ A3/5!'' )+*&%D (/&!B&/',!@, . ,/4 B%'"! A3%%&?%5%3/.+&%% 36 (3G' S. aureus ' +&,%"+(,/?!3%&/./@ +(,%.&/',-� (����+) % 36 F%./,&GD4%(3/$&G4 U,+44/4 ',+?%"/(/((+ $!) +&,%"+(,/?!3%&/./@ +(,%.&/',% (����-). �/*/AG,&G4(3G'+4 A/'"! 2*+"!&%# ./"/'#&/1/ A/(3/.+ % /$3+$/,(% (/F% &+',/@(/@ @/*+ % 'A%3,/4 . ',!3%"--&GD 2'"/.%#D .&2,3%4GU!B&/ . /$"+',- $!*3+../*%"'#1 4" .).!'% '2,/B&/@ (2"-,23G ',+?%"/(/(-(+ (2 4"3*. 4%(3/$&GD ,!") % 0,25 4" 25 % 3+',./3+ '2"-?+,+ 4+1&%# — /'&/.&+# '!3%# % (/&,3/"--&G! '!3%% %&?%5%3/.+&&G! ����+ % ����-. 3+$/,! $G"% %'A/"-)/.+&G 42)!@&G! 4%(3/$G,A/"2B!&&G! . �&',%,2,! ("!,/B&/1/ % .&2,3%("!,/B&/1/ '%4$%/)+ �3� ��� (*%3!(,/3 — B"!&N(/3.��� �L. �2D+3%&). �/'"! A/"2B!&%# �('A!3%4!&,+"-&/@ 4/*!"% 1&/@&/N./'A+"%,!"-&/1/ /B+1+ &+7 *!&- A3/%)./*%"+'- !1/ D%3231%B!'(+# /$3+$/,(+ . /$�!4!, /$!'A!B%.+��!4 2*+"!&%! &!F%)&!-'A/'/$&GD ,(+&!@. �A!3+,%.&/! .4!U+,!"-',./ A3/./*%"/'- A/* +&!',!)%!@.

�+"!! 2 (3G' /'&/.&/@ '!3%% . 4!',&/4 "!B!&%% 3+& %'A/"-)/.+& 4%"%+5%" (!F!*&!.&/ &+3+&2 &+&/'%"/'- 0,3 4" 4%"%+5%"+, &+("+*G.+"+'- 4+3"!.+# A/.#)(+).

A!3./@ (/&,3/"-&/@ '!3%% �('A!3%4!&,/. %''"!*/.+& D+3+(,!3 ,!B!&%# 1&/@&/-./'A+"%,!"-&/1/ A3/5!''+ $!) "!B!$&/@ (/33!(5%%.

/ .,/3/@ (/&,3/"-&/@ '!3%% "!B!&%! 1&/@&/N./'A+"%,!"-&/1/ /B+1+ /'2�!',."#"/'- 1 %3+',./3/4 *%/('%*%&+, + )+,!4 /$"!A%D/.G4 4+'"/4.

(+F*/@ '!3%% .)#,/ A/ 24 (3G'G (12 (3G' %&?%5%3/.+&G S. aureus ����+ % 12 (3G' S.aureus ����-).

� A/*/AG,&GD F%./,&GD . *%&+4%(! ,!B!&%# 3+&!./1/ A3/5!''+ /5!&%.+"/'- A3/,%././'-A+"%,!"-&/! % 3!A+3+,%.&/! ./)*!@',.%! 3+)"%B&GD 'A/'/$/. "!B!&%#. �/4%4/ 2B!,+ ("%&%B!-'(%D *+&&GD, A3/./*%"% 1%',/"/1%B!'(%! %''"!*/.+&%# &+ 3, 7 % 14 *!&- "!B!&%# A/'"! )+$/#(3G'. �"# A3/.!*!&%# %''"!*/.+&%@ F%./,&G! .G./*%"%'- %) /AG,+ A2,!4 %&1+"#5%% "!,+"-&/@*/)G �?%3+. GA/"&#"'# )+$/3 4+,!3%+"+ *"# 1%',/"/1%B!'(/1/ %''"!*/.+&%#, ,(+&% ?%('%3/.+"%. 10 % 3+',./3! &!@,3+"-&/1/ ?/34+"%&+. �$�!(,G %''"!*/.+&G &+ '.!,//A,%B!'(/4 23/.&!. �/-"2B!&&G! *+&&G! $G"% /$3+$/,+&G &+ �� ' A/4/�-� A3/13+44G «�,+,%',%(+ 6.1».

'! �('A!3%4!&,G .GA/"&#"%'- ' '/$"�*!&%!4 «�3+.%" A3/.!*!&%# 3+$/, ' %'A/"-)/.+-&%!4 �('A!3%4!&,+"-&GD F%./,&GD» '/1"+'&/ A3%(+)2 �� ���� � 755 /, 12.08.1977. % �!-*!3+"-&/42 )+(/&2 �� «� )+�%,! F%./,&GD /, F!',/(/1/ /$3+�!&%#» /, 01.12.1999.

&�_��z�� �����������. �''"!*/.+&%#, A3/.!*!&&G! &+ 72 $!"GD $!'A/3/*&GD (3G'+D'+45+D, '.%*!,!"-',.2�, / .G'/(/@ �??!(,%.&/',% A3%4!&!&%# 4%"%+5%"+ . "!B!&%% 1&/@-&GD 3+& 2 (3G'. �3/(% )+F%."!&%# 1&/@&GD 3+& 2 (3G' /'&/.&/@ '!3%% /AG,/., "!B!&&GD4!',&/ 4%"%+5%"/4(10,3 ± 0,2 '2,.), 4!&-U! +&+"/1%B&GD 2 F%./,&GD, 2 (/,/3GD A3%4!&#"% 1 %3+',./3 *%/('%*%&+, + )+,!4 /$"!A%D/./! 4+'"/4 (16,4 ± 0,4 '2,.).

�%',/"/1%B!'(%@ +&+"%) %''"!*/.+&&GD /$�!(,/. 2 F%./,&GD, (/,/3G! &! A/*.!31+"%'- "!-B!$&/@ (/33!(5%%, A/(+)+", B,/ . 5!"/4 4/3?/"/1%B!'(%! %)4!&!&%# . 3+&!./@ /$"+',% A/"&/-',-� 2("+*G.+"%'- . (+3,%&2 /$�!%).!',&/1/ ,!B!&%# 3+&!./1/ A3/5!''+ (+"-,!3+5%# ,(+&!.GD',32(,23, �(''2*+5%#, A3/"%?!3+5%# 4+"/*%??!3!&5%3/.+&&GD ("!,/( % 3!/31+&%)+5%# 32$5+).�'A/"-)/.+&%!4 4%"%+5%"+ . /'&/.&/@ '!3%% �('A!3%4!&,+, . '3+.&!&%% '/ .,/3/@ (/&,3/"-&/@'!3%!@, 2',+&/."!&/ $/"!! .G3+F!&&/! 2'%"!&%! "!@(/5%,+3&/@ % 4+(3/?+1+"-&/@ 3!+(5%%, $G-',3!! &+ 2$G"- U!" ./'A+"%,!"-&G@ A3/5!''. �G"/ 2',+&/."!&/, B,/ A3%4!&!&%! *+&&/1/ ./)*!@-',.%# &+ 3+&!./@ *!?!(, �('A!3%4!&,+"-&GD F%./,&GD A/)%,%.&/ ."%#"/ &+ D/* 3!A+3+,%.&GDA3/5!''/. . 4/*!"%32!4/@ 3+&!./@ /$"+',%. �3!F*! .'!1/, �,/ (+'+"/'- D+3+(,!3+ % ,!B!&%# +"--,!3&+,%.&/@ % �(''2*+,%.&/@ ?+) ./'A+"!&%#.

�'A/"-)/.+&%! . (+B!',.! "!B!$&/1/ '3!*',.+ 4%"%+5%" '/)*+.+"/ $/"!! $"+1/A3%#,&G! 2'-"/.%# *"# A/'"!*2��!@ *%??!3!&5%3/.(% 13+&2"#5%/&&/@ ,(+&% % A3/*/"F+��!1/'# .+'(2"/1!-&!)+, B,/ . %,/1! A3%./*%"/ ( �??!(,%.&/42 )+F%."!&%� 3+&!./@ /$"+',%. �3/%'D/*%"/ �,/ 1"+.-&G4 /$3+)/4 )+ 'B!, /A,%4%)+5%% 3!A+3+,%.&GD A3/5!''/.: 1) A/'"!*/.+,!"-&/! )+4!�!&%! 3+&!-./1/ *!?!(,+ 4+"/*%??!3!&5%3/.+&&/@ '/!*%&%,!"-&/@ ,(+&-�, '/)*+��%@ +*!(.+,&G! 2'"/.%#*"# �A%,!"%)+5%% 3+&G )+ 'B!, (+4$%+"-&GD ("!,/B&GD �"!4!&,/. �A%*!34%'+ % !1/ *!3%.+,/.;2) 3+).%,%! . '+4/@ 13+&2"#5%/&&/@ ,(+&% (/'/$!&&/ . '"/! .!3,%(+"-&/ /3%!&,%3/.+&&GD 1!4/-(+A%""#3/.) ,/&(%D (/""+1!&/.GD % �"+',%B!'(%D ?%$3%""; 3) ?/34%3/.+&%# A/.!3D&/',&/1/ 1/-3%)/&,+"-&/1/ '"/# (/""+1!&/.GD ./"/(/&, B!3!*2��%D'# ' ?%$3/$"+',+4%, &+ 13+&%5! ' "!@(/-5%,/3&/N&!(3/,%B!'(%4% 4+''+4%. �+&&G! ?+(,G '/ .'!@ /B!.%*&/',-� A/(+)G.+�, ,/, B,/ A3%-4!&!&%! 4%"%+5%"+ . D/*! "!B!$&/@ (/33!(5%% 3+&!./1/ A3/5!''+ '2�!',.!&&/ +(,%.%)%32�, 3!-A+3+5%� '/!*%&%,!"-&/@ ,(+&%, ,!4 '+4G4 '/)*+.+# +*!(.+,&G! 2'"/.%# *"# 3!+"%)+5%% ,(+&!- %/31+&/'A!5%?%B!'(%D A/,!&5%@ . D/*! 3!A+3+,%.&GD 1%',/1!&!)/.. �'A/"-)/.+&%! A3!*"/F!&&/-1/ "!B!$&/1/ '3!*',.+ A3%./*%"/ ( '/(3+�!&%� '3/(/. 3!A+3+5%% 3+&!./1/ *!?!(,+.

200

�''"!*/.+&%# ,+(F! A/(+)+"%, B,/ 2 �('A!3%4!&,+"-&GD F%./,&GD A3/%'D/*%, 2'%"!&%!?2&(5%/&%3/.+&%# 1%A/,+"+4/N1%A/?%)+3&/@ &!@3/'!(3!,/3&/@ '%',!4G (����).

+(, B!3!) 3 '2,/( /, &+B+"+ �('A!3%4!&,+ A3/%'D/*%, */',/.!3&/! ./)3+',+&%! 3+)4!3/.#*!3, #*3GU!( % 5%,/A"+)4G «'.!,"GD» (?2&(5%/&+"-&/ +(,%.&GD) &!@3/'!(3!,/3&GD ("!,/(¥���) '2A3+/A,%B!'(%D % A+3+.!&,3%(2"#3&GD #*!3 1%A/,+"+42'+. �,% F! '3/(% &+$"�*!&%@ .2'"/.%#D %&?%5%3/.+&&GD 3+& S. aureus c +&,%"+(,/?!33%&/./@ +(,%.&/',-� (����+) 4G /,4!-,%"% #."!&%# )+*!3F(% ($"/(%3/.(%) .G'./$/F*!&%# &!@3/'!(3!,+ . /$�%@ (3/./,/( &+ 23/.&!+('/.+)+"-&GD (/4A"!('/. &!@3/1%A/?%)+. �,4!B!&G A3/5!''G 2"-,3+',32(,23&GD &+32U!&%@(/3,%(/,3/A/5%,/. +*!&/1%A/?%)+. �('A!3%4!&,+"-&/ 4/*!"%32!4G@ *!?!(, ,(+&!@ &+ ?/&! %&-?%5%3/.+&%# A3%./*%, &! ,/"-(/ ( +(,%.%)+5%% 1%A/,+"+4%B!'(/@ &/&+A!A,%*!31%B!'(/@ &!@3/-'!(3!5%%, &/ % ( *!?%5%,2 +*+A,%.&GD &/&+A!A,%*/., + ,+(F! 21&!,!&%� 1%A/,+"+4/-1%A/?%)+3&/@ +*3!&/(/3,%(+"-&/@ '%',!4G (/'/$!&&/ &+ ',+*%% 14 '2,/( �('A!3%4!&,+). �"-,3+-',32(,23&G@ +&+"%) ��� '2A3+/A,%B!'(%D % A+3+.!&,3%(2"#3&GD #*!3, 1%A/,+"+42'+ . �,% '3/(%&+$"�*!&%@ A/(+)+" '!3-!)&G! A/.3!F*!&%# /31+&!"" '%&,!)+ &!@3/'!(3!,+ (*%'(/4A"!('+5%#�&*/A"+)4+,%B!'(/1/ 3!,%(2"24+ % *%(,%/'/4 (/4A"!('+ �/"-*F%, 2.!"%B!&%! "%A/'/4).

+(%4 /$3+)/4, A/"2B!&&G! ?+(,G !�! 3+) A/*,.!3F*+�, 3!)2"-,+,G, 3+&!! A/"2B!&&G! ."+$/3+,/3%% (+?!*3G 1%',/"/1%%, 5%,/"/1%% % �4$3%/"/1%% �3!&$231'(/@ 1/'2*+3',.!&&/@ 4!-*%5%&'(/@ +(+*!4%% / ,/4, B,/ 3+&!./@ A3/5!'' 3+)"%B&/@ "/(+"%)+5%%, /'"/F&!&&G@ %&?%5%-3/.+&%!4, 4/F!, A3/,!(+,- &+ ?/&! 3+)$+"+&'%3/.(% A3/*2(5%% % .G'./$/F*!&%% 124/3+"-&GD?+(,/3/. 5!&,3+"-&/1/ (1%A/,+"+4%B!'(/1/) ).!&+ &!@3/�&*/(3%&&/@ 3!12"#5%%, B,/, $!)2'"/.&/,/13+&%B%.+!, 3!+"%)+5%� %D +*+A,/1!&&/1/ ."%#&%# &+ 1%',/"/1%B!'(%! ',32(,23G [4].

$ ��� . �!',&/! A3%4!&!&%! 4%"%+5%"+ /A,%4%)%32!, ?+)G 3!A+3+,%.&GD 1%',/1!&!)/. .1&/@&GD 3+& &%F&%D (/&!B&/',!@.

�/)%,%.&/! *!@',.%! 4%"%+5%"+ . "!B!&%% �('A!3%4!&,+"-&/1/ 1&/@&/N&!(3/,%B!'(/1/A3/5!''+ (/33!"%32!, ' &/34+"%)+5%!@ 1%A/,+"+4%B!'(/@ &/&+A!A,%*!31%B!'(/@ &!@3/'!(3!5%%,'2�!',.!&&/ &+32U!&&/@ . 2'"/.%#D %&?%5%3/.+&%# 3+&!.GD *!?!(,/. A!3'%',!&,&G4% U,+4-4+4% $+(,!3%+"-&GD A+,/1!&/.. �,% *+&&G! '.%*!,!"-',.2�, / 3+).%,%% +*+A,%.&/1/ /,.!,+ 1%-A/,+"+4/N1%A/?%)+3&/@ &!@3/'!(3!,/3&/@ '%',!4G (+( .!*2�!1/ 5!&,3+"-&/1/ ).!&+ 3!12"#5%%("!,/B&/1/ % ,(+&!./1/ 1/4!/',+)+.

�A%'/( "%,!3+,23G:1. ��2(, �L. �!B!&%! 1&/@&/N./'A+"%,!"-&GD)+$/"!.+&%@ &%F&%D (/&!B&/',!@ // �/''%@-

'(%@ $%/,!3+A!.,%B!'(%@ F23&+". — 2007. — � 2. — �. 20.2. �/$5/., �L. �3%4!&!&%! '%',!4G A/"#3%)/.+&&/@ '.!,/,!3+A%% . (/4A"!('! "!B!&%#

$/"-&GD ' 1&/@&G4% 3+&+4% // �(,2+"-&G!./A3/'G '/.3!4!&&/@ D%3231%%: '$/3&%(, A/'.#�!&-&G@ 60-"!,%� '/ *&# 3/F*!&%# A3/?!''/3+ �L�. %&&%(+. — �3+'&/#3'(, 2008. — �. 305–308.

3. �2)/. �L�., �,+*&%(/. �L�., �2)/.+ �L�. �A,%4%)+5%# 3!A+3+,%.&/@ 3!1!&!3+5%% ,(+&!@.— �.: �!*%5%&+, 2012. — 199 '.

4. �,+*&%(/. �L�., �2D+3%& �L. �%A/,+"+4%B!'(+# &!@3/'!(3!5%# % ',32(,23&/N?2&(5%/-&+"-&G@ 1/4!/',+) A3/- % �2(+3%/, (4/3?/"/1%B!'(%! /'&/.G 3!+(,%.&/',%, A"+',%B&/',% % 3!1!-&!3+5%%). — �3!&$231, 2012. — 295 '.

&'q41]0"0+^�&4&>�%,+^$0&4%",]�&+0&4;,!J42")0!&�;'q�1�((=0"�!q"J"0)!$�/$">�0,!�0�

"#$. ������� (���., �. �. �.), "#,. J���� (����.), =.$. >�����z�� (����.)

�2(/.%&'-(%@ *!3F+.&%@ 4!*%B&%@ 2&�.!3'%,!,�+?!*3+ +(2U!3',.+ � 1�&!(/"/1�¤ ) (23'/4 *%,#B/¤ ,+ A�*"�,(/./¤ 1�&!(/"/1�¤

����������@���: ���. ����@`� (0��. ��., ���., �. �. �.)

�3/.!*!&/ ("�&�(/N"+$/3+,/3&! /$',!F!&&# 82 F�&/( �) $!)A"�**#4 ,+ 22 )*/3/.%D .+1�,&%DF�&/(, �/ ',+&/.%"% (/&,3/"-&2 132A2L�+ &+#.&/',� .,/3%&&/¤ $!)A"�*&�',� */4�&2�B2 B+',(2 )+-@4+"+ $!)A"�*&�',- ,32$&/1/ A/D/*F!&&#. �A!3+,%.&� .,32B+&&# A!3!*2.+"% 3/).%,(2 A!3.%&&/¤A/)+4+,(/./¤ .+1�,&/',� 2 40 %, ) &%D 20 % — "+A+3/'(/A�¤. ��'"# A3/.!*!&&# "+A+3/,/4�@ A/)+4+-,(/.+ .+1�,&�',- 'A/',!3�1+"+'# 2 13 .%A+*(+D, "+A+3/'(/A�@ — 2 5 .%A+*(+D, ,/42 4!,/*/4 A3/?�-"+(,%(% A/)+4+,(/.%D .+1�,&/',!@ A/.%&&+ $2,% './¯B+'&+ *�+1&/',%(+ ,+ )+',/'2.+&&# "+A+3/'-(/A�B&%D /A!3+5�@ A3% .,32B+&&#D &+ /31+&+D 4+"/1/ ,+)2.

201

&'q41]0"0-^+&4&>+%'�)+^$J'x"0'1]�0$4�',{+,�0&4;,-J2")0!&!J;'��1!(+=+$,'J"0!%,!/;'&'J',,!�0]w

"#$. ������� (���., �. �. �.), "#,. J���� (����.), =#$. >�����z��� (����.)�2(/.%&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

�+?!*3+ +(2U!3',.+ % 1%&!(/"/1%% ' (23'/4 *!,'(/@ % A/*3/',(/./@ 1%&!(/"/1%%

�������������������: ���. ������ (0��. ��., ���.)

"����z����z. �/"%B!',./ $!'A"/*&GD $3+(/. ' (+F*G4 1/*/4 2.!"%B%.+!,'# % &+ *+&&/4�,+A! (/"!$"!,'# /, 10 */ 15 %, B,/ A3%/$3!,+!, &! ,/"-(/ 4!*%5%&'(/!, &/ % '/5%+"-&/-*!4/13+?%B!'(/! % �(/&/4%B!'(/! )&+B!&%!. �,B+',% �,/ '.#)+&/ ' ,!4, B,/ A/'"!*&%! *!'#,%"!-,%# 2',/@B%./ '/D3+&#!,'# ,!&*!&5%# ( 2.!"%B!&%� (/"%B!',.+ F!&�%&, F!"+��%D .A!3.G! 3/-F+,- . ./)3+',! 30–35 "!,, B+',%B&/ ' '/5%+"-&/N�(/&/4%B!'(%4% ?+(,/3+4% [3].

',32(,23! $!'A"/*&/1/ $3+(+ /'&/.&/! 4!',/ A3/*/"F+!, )+&%4+,- ,32$&/-A!3%,/&!+"-&G@ ?+(,/3. �+',/,+ �,/1/ ?+(,/3+ $!'A"/*%# */',%1+!, 18–73 %. �3%B%&+4% !1/ ./)-&%(&/.!&%#, (+( A3+.%"/, #."#�,'# %&?!(5%%, A!3!*+��%!'# A/"/.G4 A2,!4, /A!3+,%.&G! .4!-U+,!"-',.+ &+ /31+&+D 4+"/1/ ,+)+ % $3�U&/@ A/"/',% [1, '. 29–31].

&!4+,/B&+# $!3!4!&&/',- .',3!B+!,'# A3%4!3&/ . 2 % .'!D $!3!4!&&/',!@ % 4/F!, . *+"--&!@U!4 A3%.!',% ( $!'A"/*%� % A/.,/3&/@ .&!4+,/B&/@ $!3!4!&&/',%. !3/#,&/',- &/34+"-&/@$!3!4!&&/',% % 3/*/. '/',+."#!, /(/"/ 50 %, A/.,/3&/@ .&!4+,/B&/@ $!3!4!&&/',% — /(/"/20 %, $!'A"/*%# — /(/"/ 30 % [2, '. 34–36]. �3% *+&&/@ ?/34! $!'A"/*%# 3!(/&',32(,%.&/-A"+',%B!'(%! /A!3+5%% &+ 4+,/B&GD ,32$+D &!*/',+,/B&/ �??!(,%.&G. �3% /,'2,',.%! 3+)3G.+4+,/B&/@ ,32$G *%+1&/',%B!'(%! % "!B!$&G! 4!3/A3%#,%# &+A3+."!&G &+ A3/?%"+(,%(2 /'"/F-&!&%@ % '/D3+&!&%! ?!3,%"-&/',%. �'&/.&/@ "!B!$&/N*%+1&/',%B!'(%@ 4!,/* — "+A+3/'(/A%#.�+A+3/,/4%� .GA/"&#�, A3% ,#F!"/4 '/',/#&%% $/"-&/1/ % &!./)4/F&/',-� .GA/"&%,- "+A+3/-'(/A%B!'(2� /A!3+5%� B!3!) cA+!B&G@ A3/5!'' [4]. �'(2'',.!&&G@ ,32$&G@ +$/3, — .G*+."%.+-&%! A"/*&/1/ #@5+ B!3!) $3�U&/! /,.!3',%! 4+,/B&/@ ,32$G. �,/ */./"-&/ A3/',+# 4+&%A2"#5%#,(/,/3+#, /*&+(/, '/A3/./F*+!,'# $/"-U%4 (/"%B!',./4 /'"/F&!&%@. �%'( 3!5%*%.+ .&!4+,/B&/@$!3!4!&&/',% .*./! .GU!, B!4 A/'"! *321%D /A!3+5%@ A/ A/./*2 ,32$&/@ $!3!4!&&/',%. �/"--U%&',./ +.,/3/. &! 3!(/4!&*2�, %'A/"-)/.+,- �,/, 4!,/*, D/,# '2�!',.2�, *+&&G! / ,/4, B,/B+',/,+ &/34+"-&/@ $!3!4!&&/',% A/'"! %'(2'',.!&&/1/ ,32$&/1/ +$/3,+ */',%1+!, 92 % [3].

*��z. �!"-� &+U!1/ %''"!*/.+&%# $G"/ /A3!*!"%,- */"� .&!4+,/B&GD $!3!4!&&/',!@ .',32(,23! $!'A"/*%# % ."%#&%! /A!3+,%.&GD .4!U+,!"-',. &+ ./)&%(&/.!&%! .&!4+,/B&/@ $!3!-4!&&/',%.

J����� � ����� . �"# 3!+"%)+5%% A/',+."!&&/@ 5!"% &+4% A3/.!*!&/ ("%&%(/-"+$/3+,/3&/! /$'"!*/.+&%! ' A/'"!*2��!@ ',+,%',%B!'(/@ /$3+$/,(/@ *+&&GD 82 F!&�%&, (/,/-3G! $G"% 3+)*!"!&G &+ 2 132AAG: I 132AA+ (/'&/.&+#) — 60 F!&�%& ' $!'A"/*%!4 3+)"%B&/1/ 1!-&!)+, II 132AA+ ((/&,3/"-&+#) — 22 3/F+.U%! F!&�%&G, &! F+"2��%!'# &+ $!'A"/*%!.

&�_��z�� �����������. �'&/.&2� 132AA2 '/',+."#"% F!&�%&G ' A!3.%B&G4 % .,/3%B-&G4 $!'A"/*%!4. /)3+', F!&�%& (/"!$+"'# /, 22 */ 39 "!, (. '3!*&!4 30,05 ± 0,45 1/*+). �/ 30"!, "!B%"%'- A/ A/./*2 $!'A"/*%# 34 A+5%!&,(% (56,67 ± 6,40 %), A/'"! 30 "!, — 26(43,33 ± 6,40 %). �3/*/"F%,!"-&/',- $!'A"/*%# $G"+ /, 1 */ 17 "!, (. '3!*&!4 6,95 ± 0,45 1/*+).

�"%&%B!'(/! /$'"!*/.+&%! A+5%!&,/( .("�B+"/ ,�+,!"-&/! %)2B!&%! F+"/$ % +&+4&!',%B!-'(%D *+&&GD. '! A+5%!&,(% A3/U"% (/4A"!('&/! ("%&%(/N"+$/3+,/3&/! /$'"!*/.+&%!, (/,/3/!.("�B+"/ /$�!! ("%&%B!'(/! /$'"!*/.+&%!, %''"!*/.+&%! 23/.&# A/"/.GD 1/34/&/., 2"-,3+).2-(/./@ 4/&%,/3%&1, /A3!*!"!&%! % /5!&(2 ,!',/. ?2&(5%/&+"-&/@ *%+1&/',%(% 3!A3/*2(,%.&/@'%',!4G, % $G"% '/4+,%B!'(% )*/3/.G4%.

(/&,3/"-&2� 132AA2 .D/*%"% '/4+,%B!'(% )*/3/.G! F!&�%&G, (/,/3G! &! F+"/.+"%'- &+$!'A"/*%! % 2 (/,/3GD 2F! $G"% *!,%. �) &%D /*%& 3+) )+$!3!4!&!"% % 3/*%"% 9 F!&�%&(40,9 ± 10,48 %), *.+F*G — 9 F!&�%& (40,9 ± 10,99 %): 2 5 F!&�%& (22,7 ± 8,93 %) $!3!4!&&/',-)+(/&B%"+'- &/34+"-&G4% 3/*+4% *.+F*G, 2 3 F!&�%& (13,6 ± 7,31 %) A!3.+# $!3!4!&&/',- )+(/-&B%"+'- 3/*+4%, .,/3+# — %'(2'',.!&&G4 +$/3,/4, 2 1 F!&�%&G (4,6 ± 4,47 %) — *.24# %'(2'',-.!&&G4% +$/3,+4%. �/"!! *.2D 3+) )+$!3!4!&!"% 4 F!&�%& (18,2 ± 8,23 %): 3/*G /*%& 3+) $G"% .*.2D '"2B+#D, *.+F*G — . /*&/4 '"2B+!, +$/3,G *.+F*G $G"% . +&+4&!)! .'!D F!&�%&, '+4/A3/-%)./"-&G! .G(%*GU% — . +&+4&!)! 2 *.2D F!&�%&. /)3+', F!&�%& (/"!$+"'# /, 20 */ 39 "!, (.'3!*&!4 30,9 ± 0,45 1/*+). +&+4&!)! D3/&%B!'(%@ +*&!('%, $G" 2 3 F!&�%& (13,6 ± 7,31 %), &+-32U!&%# 4!&',32+"-&/1/ 5%("+ — . 1 (4,6 ± 4,47 %). � /',+"-&GD F!&�%& &! $G"/ &%(+(%D )+$/-"!.+&%@ (+( '/ ',/3/&G A/"/.GD /31+&/., ,+( % '/ ',/3/&G *321%D /31+&/. % '%',!4 /31+&%)4+.

202

�!3.%B&/! $!'A"/*%! $G"/ 2 22 F!&�%& (36,7 ± 6,22 %), A3%B!4 F!&'(/! $!'A"/*%! ,32$&/-1/ A3/%'D/F*!&%# 2 F!&�%& ' A!3.%B&/@ $!'A"/*%!4 $G"/ . 9 '"2B+#D (40,9 ± 10,48 %). �A!3+,%-.&G! .4!U+,!"-',.+ ("+A+3/,/4%%) &+ /31+&+D 4+"/1/ ,+)+ A3!*U!',./.+"% A!3.%B&/42 $!'A"/-*%� . 4 '"2B+#D (44,4 %).

,/3%B&/! $!'A"/*%! *%+1&/',%3/.+"+'- . 38 '"2B+#D (63,3 ± 6,22 %). �!&'(/! $!'A"/*%!,32$&/1/ A3/%'D/F*!&%# A3% .,/3%B&/4 $!'A"/*%% $G"/ . 31 '"2B+! (81,6 ± 6,29 %). /*&/4'"2B+! *+&&+# ?/34+ $!'A"/*%# '/B!,+"+'- ' $!'A"/*%!4, '.#)+&&G4 ' /,'2,',.%!4 /.2"#5%%, ./.,/3/4 — ' F!&'(%4 $!'A"/*%!4 *321/@ A3%3/*G (�&*/4!,3%/)/4). �3% F!&'(/4 $!'A"/*%% ,32-$&/1/ A3/%'D/F*!&%# ./'A+"%,!"-&G! )+$/"!.+&%# F!&'(%D A/"/.GD /31+&/. $G"% . +&+4&!)! 223 F!&�%& (60,5 ± 7,93 %): 2 ,3!D /,4!B!&/ &+"%B%! (%',/)&GD /$3+)/.+&%@ #%B&%(/., 2 /*&/@ —4%/4G 4+,(% % A/"%A+ �&*/4!,3%# . � /*&/@ F!&�%&G /$&+32F!&/ ,/"-(/ (%',/)&G! /$3+)/.+-&%# #%B&%(/., 2 .,/3/@ — A/"%A �&*/4!,3%#. /*&/4 '"2B+! . +&+4&!)! $G"/ A3/.!*!&/ ',!3%"%-)+5%� 4+,/B&GD ,32$ A3% (!'+3!.+ '!B!&%#.

&!4+,/B&+# $!3!4!&&/',- $G"+ 2 18 F!&�%& ' .,/3%B&G4 $!'A"/*%!4 ,32$&/1/ 1!&!)+(47,4 ± 8,10 %): . 10 '"2B+#D (55,5 %) &+$"�*+"+'- /*&+ .&!4+,/B&+# $!3!4!&&/',-, . 1 '"2B+! /*-&+ .&!4+,/B&+# $!3!4!&&/',- A/'"! %'(2'',.!&&/1/ +$/3,+; . 6 — A/'"! /A!3+,%.&GD .4!U+-,!"-',. &+ /31+&+D 4+"/1/ ,+)+, %) (/,/3GD 2 /A!3+5%% $G"% "+A+3/'(/A%B!'(%4%; 2 8 F!&�%&(45,5 %) — *.! .&!4+,/B&G! $!3!4!&&/',%, %) (/,/3GD . 3 '"2B+#D A3/./*%"/'- "+A+3/'(/A%B!'-(/! "!B!&%! A3!*G*2�!@ .&!4+,/B&/@ $!3!4!&&/',%, . 5 — "+A+3/,/4%#. �!3./@ .&!4+,/B&/@$!3!4!&&/',% A3!*U!',./.+"% "+A+3/,/4%% . 4 '"2B+#D (40 %), .,/3/@ — 2 5 (62,5 %). �+A+3/'(/-A%B!'(%! /A!3+5%% A3!*U!',./.+"% A!3./@ .&!4+,/B&/@ $!3!4!&&/',% . 2 '"2B+#D (20 %), .,/3/@— 2 3 (37,5 %). �'(2'',.!&&G! +$/3,G $G"% . +&+4&!)! 2 2 F!&�%& (5,3 ± 3,63 %), %'(2'',.!&&G@+$/3, % &/34+"-&G! 3/*G — 2 6 F!&�%&. �+4/A3/%)./"-&G! .G(%*GU% $G"% . 3 F!&�%&(7,7 ± 4,30 %) A3% &+"%B%% &/34+"-&GD 3/*/. . +&+4&!)!. +&+4&!)! "%U- 2 3 F!&�%& ' .&!4+,/-B&/@ $!3!4!&&/',-� 2',+&/."!&/ &+"%B%! *321/@ A+,/"/1%% '/ ',/3/&G F!&'(%D A/"/.GD /31+-&/. — �,/ (%',+ #%B&%(+, A/"%A �&*/4!,3%# % '!*"/.%*&+# 4+,(+.

$ ��� .1. � F!&�%& ' A!3.%B&/@ $!'A"/*%!4 A/B,% . /*%&+(/./4 (/"%B!',.! .',3!B+"%'- F!&'(/!

$!'A"/*%!, '.#)+&&/! ' /,'2,',.%!4 /.2"#5%%, ,32$&/1/ A3/%'D/F*!&%# % *321/@ A3%3/*G (23/1!-&%,+"-&G! %&?!(5%% % �&*/4!,3%/)). �3% A!3.%B&/4 $!'A"/*%% ,32$&/1/ A3/%'D/F*!&%# B+',/,+/A!3+,%.&GD "+A+3/,/4&GD .4!U+,!"-',. '/',+.%"+ 44,4 %.

2. �3% &+"%B%% .,/3%B&/1/ $!'A"/*%# */4%&%32��2� */"� )+&%4+"/ $!'A"/*%! ,32$&/1/A3/%'D/F*!&%# (81,6 %), A/ (/"%B!',.2 */',/.!3&/ /,"%B+"/'- /, $!'A"/*%# ,32$&/1/ A3/%'D/F-*!&%# A3% A!3.%B&/4 $!'A"/*%% (3 < 0,05).

3. �A!3+,%.&G! .4!U+,!"-',.+ A3!*U!',./.+"% 3+).%,%� A!3.%B&/@ .&!4+,/B&/@ $!3!4!&-&/',% 2 40%, %) &%D 20 % — "+A+3/'(/A%%, A3% .,/3%B&/@ .&!4+,/B&/@ $!3!4!&&/',% "+A+3/,/-4%% — 62,5 %, "+A+3/'(/A%% — 37,5 %, A/�,/42 "+A+3/'(/A%B!'(%! /A!3+5%% &! 4/12, $G,-!*%&',.!&&G4 4!,/*/4 "!B!&%# .&!4+,/B&/@ $!3!4!&&/',%.

4. �/'"! A3/.!*!&%# "+A+3/,/4%@ .&!4+,/B&+# $!3!4!&&/',- &+$"�*+"+'- . 13 '"2B+#D(59,1 ± 11,13 %), "+A+3/'(/A%@ — . 5 '"2B+#D (22,7 ± 12,3 %) (3 < 0,05), A/�,/42 4!,/*/4 A3/?%"+-(,%(% .&!4+,/B&GD $!3!4!&&/',!@ */"F&/ $G,- A3%4!&!&%! "+A+3/'(/A%B!'(%D /A!3+5%@ A3%%&GD .4!U+,!"-',.+D &+ /31+&+D 4+"/1/ ,+)+.

�A%'/( "%,!3+,23G:1. !&5(�.'-(%@ �L�., �!12"/.%B B.�., �!4!&�( �L�. �+A+3/'(/A�B&! "�(2.+&&# 1/',3%D )+-

A+"-&%D A3/5!'�. A3%*+,(�. 4+,(% � A!"-.�/A!3%,/&�,�. �) )+',/'2.+&&#4 /)/&/,!3+A�¤ // �*!'. 4!*.F23&+". — 2001. — � 2 (64). — �. 29–31.

2. �/"!'&%(, L�. �/4A"!('&G@ 4!,/* "!B!&%# D3/&%B!'(/1/ '+"-A%&1///?/3%,2 / L�. �/-"!'&%(, L�. �/"/,+ // �!*%+,3%#, +(2U!3',./ % 1%&!(/"/1%#. — 2005. — � 3. — �. 34–36.

3. �/"!'&%(, L�. �!+$%"%,+5%# 3!A3/*2(,%.&/@ ?2&(5%% F!&�%&, ',3+*+��%D D3/&%B!'-(%4 '+"-A%&1//?/3%,: *%'. ... (+&*. 4!*. &+2(. : 14.01.01 / L�. �/"!'&%(. — �%!., 2006.

4. �2"+(/. L�., �*+4#& �L., �%&$+!. �L�. �A!3+,%.&+# 1%&!(/"/1%# D%3231%B!'(+# �&!3-1%#. — �.: ������, 2000.

203

�&!>,!q+&!$",+'!�1!�,',+/$�!�1'!�'&"*+!,,!J�'&+!('$$+('&"q$+0+=,�$��,'2&!�"0++4;!1],-^

��&'(�!1">"'J!/J41]0+J!("1],!/",'�0'q+'/$&'";+1+0"*+!,,!�$!��0",!$+0'1],!J�'&+!('

=#!. 0���3����� (����.), �#�. ;������ (����.), �#+. J������ (����.),"#!0���"����� (����.), &#�. +������ (����.), 1#&. %����� (����.)

�/',/.'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�!&,3+"-&+# &+2B&+# %''"!*/.+,!"-'(+# "+$/3+,/3%#

�+?!*3+ )*/3/./1/ /$3+)+ F%)&% % *%!,/"/1%% ��� % ���

�������������������: 6��. W������� (��. �. �.), ���. W������� (���.)

"����z����z. �!'/4&!&&/! )&+B!&%! *"# %'D/*/. /A!3+,%.&GD *!@',.%@ %4!!, &! ,/"-(/,!D&%(+ % (+B!',./ /A!3+,%.&/1/ .4!U+,!"-',.+, &/ % 3!+$%"%,+5%/&&G! 4!3/A3%#,%#, . ,/4 B%'-"! % (2A%3/.+&%! $/"!./1/ '%&*3/4+ . A/'"!/A!3+5%/&&/4 A!3%/*! [1]. �&/1/ %''"!*/.+&%@ A/-'.#�!&/ A3%4!&!&%� 42"-,%4/*+"-&/@ +&!',!)%% *"# /$!'A!B!&%# +*!(.+,&/@ &/5%5!A,%.&/@)+�%,G ' 2B!,/4 ).!&-!. A+,/1!&!)+ $/"!./1/ '%&*3/4+, B,/ A3!*A/"+1+!, (/4$%&%3/.+&&/! %'-A/"-)/.+&%! *.2D % $/"!! +&+"-1!,%(/. ' 3+)&G4 4!D+&%)4/4 *!@',.%# [5!&,3+"-&G@ +&+"1!,%( '&!',!3/%*&G4 A3/,%././'A+"%,!"-&G4 A3!A+3+,/4 (���)] [2, 3]. �/3+F!&%# ,2$2"/-%&,!3',%5%+"-&/@ ,(+&% A/B!(, . ,/4 B%'"! % D3/&%B!'(/1/ D+3+(,!3+, %&*25%3/.+&&G! A3%�4/4���, %4!��%! ,+(F! &+).+&%! «���N&!?3/A+,%#», &+ */1/'A%,+"-&/4 �,+A! *!"+�, *+&&GDA+5%!&,/. $/"!! .!3/#,&/@ 132AA/@ A/ 3+).%,%� #,3/1!&&/1/ A/3+F!&%# A/B!( ' A/'"!*2��%41!4/*%+"%)/4 . ./'',+&/.%,!"-&/4 A!3%/*!, A/'(/"-(2 *+F! A3% (/3/,(/4 (23'! &+)&+B!&%#��� . *+"-&!@U!4 ./)4/F&/ 3+).%,%! A/B!B&/@ &!*/',+,/B&/',%, B,/ '2�!',.!&&/ 4/F!, A/-."%#,- &+ ,!B!&%! 3!+$%"%,+5%/&&/N./'',+&/.%,!"-&/1/ A!3%/*+ [4–7]. �F%*+,- A/*/$&/1/ /'-"/F&!&%# 4/F&/ A3+(,%B!'(% 2 (+F*/1/ *!'#,/1/ A+5%!&,+. +(, . �.3/A! /',3+# A/B!B&+# &!*/'-,+,/B&/',-, '.#)+&&+# ' A3%�4/4 ���, '/',+."#!, */ 15,6 % '"2B+!. [8]. +.',3+"%@'(/4 %''"!-*/.+&%% 31 654 A+5%!&,/., &+D/*#�%D'# &+ 1!4/*%+"%)!, . 10,2 % '"2B+!. A3%B%&/@ 23!4%% #.-"#"'# A3%�4 +&+"-1!,%(/. [9]. �"/2A/,3!$"!&%! ��� . +&+4&!)! &+ A3/,#F!&%% F%)&% A+5%!&,+4/F!, '/A3/./F*+,-'# 3+).%,%!4 D3/&%B!'(/1/ ,2$2"/N%&,!3',%5%+"-&/1/ &!?3%,+, B,/ A/.GU+-!, 3%'( . *+&&/@ 132AA! 3+).%,%# A/B!B&/@ &!*/',+,/B&/',% % 4/F!, /'"/F&%,- ,!B!&%! A/'"!-/A!3+5%/&&/1/ A!3%/*+, ,!4 $/"!! A3% &+)&+B!&%% ' 5!"-� +&+"-1!)%% ��� . '/',+.! 42"-,%-4/*+"-&/@ +&!',!)%%. �''"!*/.+&%# "!(+3',.!&&/@ &!?3/A+,%% . �/''%% 4+"/B%'"!&&G % B+',//13+&%B%.+�,'# /A%'+&%!4 /,*!"-&GD ("%&%B!'(%D '"2B+!.. �3/4! ,/1/, /,'2,',.2�, (3%,!3%%,A/)./"#��%! /,&!',% A+5%!&,/. ( 132AA! 3%'(+ A/ 3+).%,%� ���N&!?3/A+,%% ' 2B!,/4 "!(+3-',.!&&/1/ +&+4&!)+ A+5%!&,/. % */',2A&GD 4!,/*/. "+$/3+,/3&/@ *%+1&/',%(%, . B+',&/',% /'/-$!&&/',!@ 4/B!./1/ '%&*3/4+ [10].

*��z. �)2B%,- .)+%4/'.#)- 4!F*2 ("%&%(/N�A%*!4%/"/1%B!'(%4% /'/$!&&/',#4% A/,3!$-"!&%# ��� &+ */1/'A%,+"-&/4 �,+A! % "+$/3+,/3&G4% *+&&G4% *"# .G#."!&%# 132AA 3%'(+ A/3+).%,%� ���N&!?3/A+,%% 2 A+5%!&,/. ' A3!*A/"+1+!4G4 A3%�4/4 (/4$%&+5%% +&+"-1!,%(/. .3!+$%"%,+5%/&&/N./'',+&/.%,!"-&/4 A!3%/*!.

J����� ������ . �+ $+)! ����� ���� ���� �/''%% /$'"!*/.+&/ 200 A+5%!&,/.',+5%/&+3+ A/ 'A!5%+"-&/ 3+)3+$/,+&&/@ +&(!,!. �5!&!&G A/(+)+,!"% +&,3/A/4!,3%% (3/',, .!',%&*!(' 4+''G ,!"+, /$D.+, ,+"%%), *+&&G! +&+"%)/. $%/D%4%B!'(/1/ %''"!*/.+&%# (3/.% % !��"!(,3/"%,/., /$�!1/ +&+"%)+ (3/.%, /$�!1/ +&+"%)+ 4/B%, "%A%*/13+44G, 1"%(!4%% (3/.%, +,+(F! 3+''B%,+&+ '(/3/',- ("2$/B(/./@ ?%"-,3+5%% A/ ?/342"! MDRD. /$'"!*/.+&&/@ 132AA!%) 200 B!"/.!( (43 % —42FB%&G, 57 — F!&�%&G) ,/"-(/ 6 % /,3%5+"% 2A/,3!$"!&%! ���.�3!*&%@ ./)3+', '/',+.%" 58,86 ± 14,8 1/*+. � 5!"-� .G#."!&%# 3%'(+���N&!?3/A+,%% A+5%!&-,G 3+)*!"!&G &+ ,3% 132AAG A/ '244+3&/@ */)! ���, A3%&#,/@ A+5%!&,/4 )+ .3!4# F%)&%: 1-#132AA+ — $/"!! 1 (1; 2-# 132AA+ — /, 0,5 (1 */ 1 (1; 3-# 132AA+ — 4!&!! 0,5 (1. �"# /$3+$/,(%*+&&GD A3%4!&#"+'- A3/13+44+ Statistica 6.0.

&�_��z�� �����������. A!3./@ 132AA! )&+B%,!"-&/ B+�! .',3!B+"+'- +3,!3%+"-&+#1%A!3,!&)%# (84 %) . /,"%B%! /, .,/3/@ % ,3!,-!@ 132AA, 1*! B+',/,+ +3,!3%+"-&/@ 1%A!3,/&%% '/-',+.%"+ 41 % % 61% '//,.!,',.!&&/. �32AAG '2�!',.!&&/ &! 3+)"%B+"%'- A/ A/(+)+,!"#4 %&*!('+4+''G ,!"+ (1-# 132AA+ — 30,85 ± 6,4 (1¦42; 2-# 132AA+ — 30,73 ± 12,18 (1¦42; 3-# 132AA+ —28 ± 11,3 (1¦42), /$D.+,2 ,+"%% (1-# 132AA+ — 99,77 ± 21,5; 2-# 132AA+ — 93,56 ± 15,58; 3-# 132AA+— 99,23 ± 15,93 '4), ���, A/(+)+,!"#4 "%A%*/13+44G (���� % ,3%1"%5!3%*G *"# 1-@ 132AAG —

204

4,03 ± 1,18 44/"-¦" % 2,36 ± 1,01 44/"-¦", '//,.!,',.!&&/; *"# 2-@ 132AAG — 3,45 ± 0,68 44/"-¦" %1,8 ± 0,68, '//,.!,',.!&&/ % *"# 3-@ 132AAG — 3,5 ± 1,27 44/"-¦" % 1,94 ± 0,57 44/"-¦", '//,.!,',-.!&&/), /$�!1/ +&+"%)+ (3/.% (+&!4%% .',3!B+"%'- . 132AA+D /$'"!*/.+&&GD . 15 %, 10 % % 15 %,'//,.!,',.!&&/ . 132AA+D 1, 2 % 3), 1"%(!4%% (3/.% % B+',/,! '/A2,',.2��!@ D3/&%B!'(/@ A+,/"/-1%% '/ ',/3/&G F!"2*/B&/N(%U!B&/1/ ,3+(,+. �3!*% )+$/"!.+&%@ /31+&/. A%�!.+3!&%# B+�!.',3!B+"'# ,+(/@ *%+1&/), (+( D3/&%B!'(%@ 1+',3%,. �+',/,+ .G#."!&%# A/ 132AA+4 1, 2 % 3 '//,-.!,',.!&&/ '/',+.%"+ 46 %, 44 % % 30 %. �*&+(/, /$3+�+!, &+ '!$# .&%4+&%! ,/, ?+(,, B,/ . A!3-./@ 132AA! )&+B%,!"-&/ B+�! . /$�!4 +&+"%)! 4/B% &+$"�*+"%'- /,("/&!&%# /, &/34G (3 < 0,01).+(, A3/,!%&23%# .',3!B+"+'- . 23 % '"2B+!., ,/1*+ (+( ./ .,/3/@ % ,3!,-!@ 132AA! — . 4 % % 1 %'"2B+!., '//,.!,',.!&&/; "!(/5%,23%# . ,3% 3+)+ B+�! /,4!B!&+ A3% A3%�4! ��� . (/"%B!',.!$/"!! 1 (1 (1-# 132AA+ — 30 %, 2-# 132AA+ — 11 %, 3-# 132AA+— 10 %). �!4+,23%# 2 A+5%!&,/.,3!*(/ A3%&%4+��%D ���, . /$�!4 +&+"%)! &! .',3!B+"+'- '3!*% /$'"!*/.+&&/@ 132AAG $/"--&GD, ,/1*+ (+( ./ .,/3/@ % ,3!,-!@ 132AA! '/',+.%"+ 8 % % 23 %, '//,.!,',.!&&/.

$ ��� . �3% *"%,!"-&/4 2A/,3!$"!&%% A+5%!&,+4% ���, . ,/4 B%'"! % $!) &+)&+B!&%#.3+B+, . /$�!4 +&+"%)! 4/B% B+�! .',3!B+�,'# %)4!&!&%# . .%*! A3/,!%&23%%, 1!4+,23%% % "!@-(/5%,23%%, B,/ '//,.!,',.2!, +&+"/1%B&G4 %)4!&!&%#4 A3% 3+).%,%% D3/&%B!'(/1/ ,2$2"/-%&,!3',%5%+"-&/1/ &!?3%,+ — D3/&%B!'(/1/ ���NA/3+F!&%# A/B!(. �+5%!&,G D%3231%B!'(/1/',+5%/&+3+ ' /,"%B&G4% /, &/34G A/(+)+,!"#4% . /$�!4 +&+"%)! 4/B% 4/12, 3+''4+,3%.+,-'# (+(132AAG 3%'(+ A/ 3+).%,%� A/B!B&/@ &!*/',+,/B&/',%. �+&&/! /$',/#,!"-',./ '.%*!,!"-',.2!, /&!/$D/*%4/',% %)2B!&%% "!(+3',.!&&/1/ +&+4&!)+ F%)&% A+5%!&,+ ' .G#."!&%!4 A/,3!$"!&&/@ )+1/*G F%)&% */)G ��� % /5!&(% %)4!&!&%@ 4/B!./1/ '%&*3/4+ 2 A+5%!&,/. ' A3!*A/"+1+!4/@A/,3!$&/',-� . 42"-,%4/*+"-&/@ +&!',!)%% . A/'"! /A!3+5%/&&/4 A!3%/*!. �/'(/"-(2 . *+&&/@132AA! .!3/#,!& 3%'( #,3/1!&&/1/ A/.3!F*!&%# A/B!(.

�A%'/( "%,!3+,23G:1. �+24/. L�., �!4!&/. �L�., �!&*!"- �L�., �+42%"/.+ �L�., !3,(%& �L�. �,3+,!1%# .!-

*!&%# A/'"!/A!3+5%/&&/1/ $/"!./1/ '%&*3/4+: ?/(2' &+ 42"-,%4/*+"-&2� +&!',!)%� /// Consi-lium medicum. — 2010. — /4 12, � 8. — �. 1–2.

2. Kehlet H., Dahi J.B. The value «muitimodal» or «balanced analgesia» in postoperative painTreatment // Anesth. Anaig. — 1993. — Vol. 77, � 5. — P. 1048–1056.

3. Kavanagh B.P., Sandler A.N et al. Muitimodal analgesia before thoracic surgery does not reducepostoperative pain Treatment // J. Anesth. — 1994. — Vol. 73, � 2. — P. 184–189.

4. �%U(%&, �L�. �&+"-1!,%B!'(+# &!?3/A+,%#: '(3G,+# 213/)+ // �/.G! �.-�$. .3+B!$&G!.!*/4/',%. — 2003. — � 2. — �. 28–31.

5. �3-!., �L�. 2$2"/%&,!3',%5%+"-&G@ &!?3%, . A3+(,%(! %&,!3&%',+ // �/.G! �.-�$. .3+-B!$&G! .!*/4/',%. —2002. — � 1. — �. 22–26.

6. �/"!'&%( �L�., �2*+3 �L�., !"%B(/ �L�., �,!A+&/.+ �L�. 2$2"/%&,!3',%5%+"-&G@&!?3%,: *%+1&/',%(+ % "!B!&%! // �%',!5,./ "�(2.+&&#. �%',!5,./ "!B!&%#. — 2001. — � 2. —�. 15–19.

7. Abdel-Kader Kh., Palevsky P. Acute kidney injury in the elderly // Clin. Geriatr. Med. — 2009.— Vol. 25, � 3. — �. 331–358.

8. Delmas, P.D. Non-steroidal anti-inflammatory drugs and renal function // Br. J. Rheumatol. —1995. — Vol. 34, � 1. — �. 25.

9. Chang S.H., Mathew T.H., McDonald S.P. Analgesic nephropathy and renal replacement thera-py in Australia: trends, comorbidities and outcomes // Clin. J. Am. Soc. Nephrol. — 2008 — Vol. 3. —�. 768–776.

10. �2*+3!.+ �L�., �+,�U%& �L�., �.!,(/. �L�. �"%&%(/N�A%*!4%/"/1%B!'(%! +'A!(,G "!-(+3',.!&&/@ &!?3/A+,%%, %&*25%3/.+&&G! A3%!4/4 &!',!3/%*&GD A3/,%././'A+"%,!"-&GD A3!-A+3+,/. // �+2B&+# 4G'"- �+.(+)+. — 2012 — � 2. — �. 189–194.

205

,"&4x',+=�&!$'(',+=q$4)!$!>!�+>,"1"�!(",,-J"�$�4;!1],-^�>'J!&&">+%'�)+J+,�41]0!J

�40"J',"1],!/1!)"1+q"*++

"#". 0������ (����.), +#'. '����� (��.), "#,. �������� (����.)

�3+'&/#3'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4. A3/?. L�. /@&/N�'!&!5(/1/�+?!*3+ ,/A/13+?%B!'(/@ +&+,/4%% % /A!3+,%.&/@ D%3231%%

�+?!*3+ &!.3/"/1%% % &!@3/D%3231%% ' (23'/4 ���

�������������������: ���. /�������� ( ������ �������, ���., �. �. �.),#�8. W���X ( ���., �. �. �.), ��8. Q�$�� (. �. �.)

'.#)% ' ,!4, B,/ /*&/@ %) 1"+.&GD )+*+B D%3231%B!'(/1/ "!B!&%# &!,3+.4+,%B!'(%D .&2,-3%4/)1/.GD (3/./%)"%#&%@ . /',3G@ A!3%/* #."#!,'# 'A+'!&%! ',./"+ 1/"/.&/1/ 4/)1+ /, /',3/./)&%(U!@ (/4A3!''%% % *%'"/(+5%%, . &+U!@ ("%&%(! .'!4 $/"-&G4, A/',2A%.U%4 ' 1!4/33+1%-B!'(%4 %&'2"-,/4 A2,+4!&+"-&/@ "/(+"%)+5%% (��) ',+"% %''"!*/.+,- +(2',%B!'(%! ',./"/.G!.G).+&&G! A/,!&5%+"G (���), *"# /$�!(,%.&/@ /5!&(% ?2&(5%/&+"-&/1/ '/',/#&%# ',./"/.GD',32(,23.

J����� ������ . �+ $+)! &!@3/'/'2*%',/1/ 5!&,3+ ��� )+ A!3%/* 2011–2012 11. /$-'"!*/.+&+ 132AA+ $/"-&GD ' 1!4/33+1%B!'(%4 %&'2"-,/4 A2,+4!&+"-&/@ "/(+"%)+5%% (��)(n = 29). '!4 $/"-&G4 *+&&/@ 132AAG A3/.!*!&/ %''"!*/.+&%! ��� (&!@3/4%/+&+"%)+,/3��!@3/4%+&» ���-4-01). �,%42"#5%# A/*+.+"+'- /,*!"-&/ &+ A3+./! % "!./! 2D/, B%'"/ 2'3!*&!-&%@ — 2000, *"%,!"-&/',- ',%42"+ — 0,1 4', %&,!&'%.&/',- — 100 *�. �)2B+"%'- '"!*2��%! A+-3+4!,3G: "+,!&,&/',% I, III, V (/4A/&!&,/., %&,!3.+"G I–III, III–V, I–V, +4A"%,2*G I % V (/4A/-&!&,/., /,&/U!&%# +4A"%,2* I/V.

&�_��z�� �����������. � .'!D /$'"!*2!4GD $/"-&GD ' 1!4/33+1%B!'(%4 %&'2"-,/4 ��%4!"%'- &+32U!&%# A3/./*%4/',% ).2(/./1/ '%1&+"+ &+ 23/.&! ',./"+ 1/"/.&/1/ 4/)1+ (2.!"%B!-&%! +$'/"�,&GD "+,!&,&/',!@, '&%F!&%! +4A"%,2*). �*&+(/ A/ '2�!',.2��%4 3!(/4!&*+5%#4*"# /$�!(,%.&/@ /5!&(% '/',/#&%# ',./"/.GD ',32(,23 &+ A/&,/N4!)!&5!?+"-&/4 23/.&! . A!3-.2� /B!3!*- '"!*2!, /$3+�+,- .&%4+&%! &+ )&+B!&%! /,&/'%,!"-&GD "+,!&,&/',!@ — 4!FA%(/.GD%&,!3.+"/.. �3% �,/4, B,/$G %'("�B%,- A!3%?!3%B!'(%@ (&!.3+"-&G@) (/4A/&!&, % /5!&%,- %'-,%&&/ ',./"/.G! &+32U!&%#, A3%5!"-&/ %''"!*/.+"%'- ',./"/.G! 4!FA%(/.G! %&,!3.+"G III–V %I–V. G#."!&/, B,/ 2 9 $/"-&GD ' 1!4/33+1%B!'(%4 %&'2"-,/4 �� %4!"/'- 2.!"%B!&%! 4!FA%(/-.GD %&,!3.+"/. III–V % I–V, . ,/ .3!4# (+( 2 20 A+5%!&,/. &+32U!&%# A3/.!*!&%# ).2(/./1/ '%1-&+"+ A3/#."#"%'- ,/"-(/ . 2.!"%B!&%% +$'/"�,&GD "+,!&,&/',!@ % +4A"%,2* ((/,/3G! % */ '"2-B%.U!1/'# (3/./%)"%#&%# 4/1"% $G,- /B!&- .+3%+$!"-&G), + 4!FA%(/.G! %&,!3.+"G $G"% . A3!-*!"+D &/34G.

�+&&G! A/"2B!&&G! A3% %''"!*/.+&%% ��� 2 $/"-&GD ' 1!4/33+1%B!'(%4 %&'2"-,/4 A2-,+4!&+"-&/@ "/(+"%)+5%%, 4/12, $G,- A/"!)&G A3% /,$/3! $/"-&GD &+ /A!3+,%.&/! "!B!&%!.

�A%'/( "%,!3+,23G:1. �23/., �L�. �%3231%B!'(/! "!B!&%! .&2,3%B!3!A&GD (3/./%)"%#&%@ 4!,/*/4 A2&(5%/&-

&/@ +'A%3+5%% % "/(+"-&/1/ ?%$3%&/"%)+: +.,/3!?. *%'. … *N3+ 4!*. &+2(. — �., 2008. — 48 '.2. �&!)*%5(%@, L. G).+&&G! A/,!&5%+"G 4/)1+ . ("%&%B!'(/@ A3+(,%(! / L. �&!)*%5-

(%@. — �.: ���A3!''N%&?/34, 2003. — 264 '.3. �+U-#&, L�. �%3231%B!'(/! "!B!&%! 1!4/33+1%B!'(/1/ %&'2"-,+: +.,/3!?. *%'. … *N3+

4!*. &+2( / L�. �+U-#&. — �., 2009. — 49 '.4. �"?%4/., �L. �&+"%) 3+)"%B&GD 4!,/*/. "!B!&%# 1%A!3,!&)%/&GD .&2,3%4/)1/.GD 1!-

4+,/4 / �L. �"?%4/., �L�. �A%3%&, L. �+(!!. % *3. // �!.3/"/1%B!(%@ .!',&%(. — 2008. —. XL. — GA. 3. — �. 95–98.

5. �!&(/., �L�. �2&(5%/&+"-&+# *%+1&/',%(+ &!3.&GD $/"!)&!@ / �L�. �!&(/., �L�. �/&(%&.— �., 2004. — 488 '.

6. �3G"/., L. �%3231%# 1%A!3,!&)%.&GD .&2,3%4/)1/.GD 1!4+,/4 / L. �3G"/.,L�. �+U-#&, �L�. �23/. // �!4/33+1%B!'(%@ %&'2"-,: A3+(,%B!'(/! 32(/./*',./, �.: �����-�!*%+, 2005. — �. 99–118.

7. �3G"/., L. G$/3 4!,/*+ D%3231%B!'(/1/ "!B!&%# 1%A!3,!&)%.&GD 1!4+,/4 /L. �3G"/., L�. �+U-#& // �!@3/D%3231%#. — 2005.— � 2. — �. 10–16.

206

8. �+3%$!(#&, �L�. �%3231%B!'(/! "!B!&%! 1!4/33+1%B!'(/1/ %&'2"-,+ / �L�. �+3%$!(#&. —�., 2009. — 287 '.

9. �(./35/.+, L�. �!4/33+1%B!'(%@ %&'2"-, / L�. �(./35/.+, L. �3G"/.. — �., 2005. —160 '.

10. �2'"%&+, �L�. �%??2)%/&&/- % A!3?2)%/&&/N.).!U!&&+# 4+1&%,&/N3!)/&+&'&+# ,/4/-13+?%#: ./)4/F&/',% % A!3'A!(,%.G / �L�. �2'"%&+, �L�. �4+3/.+, �L. �3/,!&(/.+ // �3%"/F!-&%! ( F23&+"2 &!.3/"/1%% % A'%D%+,3%% %4. �L�. �/3'+(/.+ «�&'2"-,». — 2006. — � 17. —�. 28–36.

�&"$,+0'1],"=!*',)"&'q41]0"0!$+��!1]q!$",+="11!�1"�0+%'�)!>!J"0'&+"1"�&+,"1!�',++)!,*'$!/)!1!�0!J-

4;!1],-^&")!J,+�,'"J�41=&,!>!!0('1"�&=J!/)+x)+

q#J. 0������ (��.)

�+)+&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�!'A2$"%(+&'(%@ ("%&%B!'(%@ /&(/"/1%B!'(%@ *%'A+&'!3

�������������������: 9�8. 8�������� ( ���., �. �. �.)

������������������: 9�;. �*������ ( ���., �. �. �.)

"����z����z. �2$"%(+5%% A/'"!*&%D "!, '.%*!,!"-',.2!, / &!2("/&&/4 3/',! )+$/"!.+!-4/',% (/"/3!(,+"-&G4 3+(/4 ./ .'!4 4%3!. ',32(,23! '4!3,&/',% /, /&(/"/1%B!'(%D )+$/"!.+-&%@ . $/"-U%&',.! 3+).%,GD ',3+&, . ,/4 B%'"! . �/''%%, (/"/3!(,+"-&G@ 3+( )+&%4+!, .,/3/!4!',/. �'&/.&+# */"# (*/ 50 %) "!,+"-&GD %'D/*/. A3% *+&&/4 )+$/"!.+&%% A3%D/*%,'# &+ "%5',+3B!'(/1/ ./)3+',+. �+"%B%! 2 ,+(%D $/"-&GD '/A2,',.2��%D )+$/"!.+&%@, + ,+(F! ./)3+',&+#+',!&%)+5%# #."#�,'# /'&/.&G4% A3/1&/',%B!'(%4% ?+(,/3+4% &!$"+1/A3%#,&/1/ %'D/*+ D%323-1%B!'(/1/ .4!U+,!"-',.+.

*��z��������������������. �/%'( /A,%4+"-&/1/ 'A/'/$+ &+"/F!&%# (/&5!./@ (/"/-',/4G 2 $/"-&GD (/"/3!(,+"-&G4 3+(/4 A/'"! $3�U&/NA3/4!F&/',&/@ �(',%3A+5%% A3#4/@(%U(%.

J����� � ����� . �+,!3%+" 3+$/,G /'&/.G.+!,'# &+ A3/'A!(,%.&/N3!,3/'A!(,%.&/4+&+"%)! 3!)2"-,+,/. D%3231%B!'(/1/ "!B!&%# 151 $/"-&/1/ 3+(/4 &%F&!+4A2"#3&/1/ /,*!"+ A3#-4/@ (%U(% /'"/F&!&&G4% '/A2,',.2��%4% '/4+,%B!'(%4% )+$/"!.+&%#4% % %)$G,/B&/@ 4+''/@,!"+ (�� > 25 (1¦42, A3% �,/4 .'! A+5%!&,G &! %4!"% A/,3!$&/',% . D%3231%B!'(/4 "!B!&%%/F%3!&%#) &+D/*%.U%D'# &+ "!B!&%% . ���� �� � (1. �+)+&-) ' 2005 A/ 2012 1/*G. '!4 $/"--&G4 .GA/"&!&/ /A!3+,%.&/! "!B!&%! . /$�!4! $3�U&/NA3/4!F&/',&/@ �(',%3A+5%% A3#4/@(%U(% ' &+"/F!&%!4 A/',/#&&/@ (/&5!./@ (/"/',/4G. �) *+&&/@ 132AAG . %''"!*/.+&%! $G"%/,/$3+&G A+5%!&,G, (/,/3G! '//,.!,',./.+"% '"!*2��%4 (3%,!3%#4 .("�B!&%#:

- 1%',/"/1%B!'(%@ A/*,.!3F*!&&G@ 3+( A3#4/@ (%U(%;- ./)3+', > 45 "!,;- ./)4/F&/',- A3/.!*!&%# A"+&/./1/ /A!3+,%.&/1/ .4!U+,!"-',./ ' A3!*/A!3+5%/&&/@ "2-

B!./@ ,!3+A%%�+ /'&/.+&%% *+&&GD A3!*/A!3+5%/&&/1/ /$'"!*/.+&%# ' A/4/�-� 4/*%?%5%3/.+&&/@

$3%,+&'(/@ U(+"G *"# (/"/3!(,+"-&GD /A!3+5%@ (Cr –POSSUM) [12, 17, 20] *"# (+F*/1/ A+5%!&,+$G" 3+''B%,+& A/(+)+,!"- A3/1&/)%32!4/@ A/'"!/A!3+5%/&&/@ "!,+"-&/',% % A/'"!/A!3+5%/&&GD/'"/F&!&%%. �+&&+# U(+"+ 2B%,G.+!, ."%#&%! 6 ?%)%/"/1%B!'(%D (./)3+',, &+"%B%! '!3*!B&/@&!*/',+,/B&/',%, '%',/"%B!'(/! +3,!3%+"-&/! *+."!&%!, B+',/,+ '!3*!B&GD '/(3+�!&%@, 23/.!&-1!4/1"/$%&+ % 23/.!&- 4/B!.%&G A"+)4G (3/.%) % 6 D%3231%B!'(%D ( /$�!4 /A!3+5%%, &+"%B%!%&?!(5%/&&GD A3/5!''/. . $3�U&/@ A/"/',%, ',+*%# (/"/3!(,+"-&/1/ 3+(+, '3/B&/',- D%3231%-B!'(/1/ .4!U+,!"-',./) A+3+4!,3/. &+ ,!B!&%! A!3%/A!3+5%/&&/1/ A!3%/*+. �'"/F&!&%! $G"%3+)*!"!&G &+ D%3231%B!'(/! % &!D%3231%B!'(/!. �%3231%B!'(%4% 'B%,+"% &!'/',/#,!"-&/',- (/-"/',/4%B!'(%D U./., (3/./,!B!&%!, &+1&/!&%! . A+3+(/"/',/4%B!'(/@ /$"+',%, �.!&,+35%#, A3/-"+A' ',/4G. � &!D%3231%B!'(%4 /,&/'%"% 3+).%,%# /31+&&GD *%'?2&(5%%.

�"# .G#."!&%# B+',/,G A/'"!/A!3+5%/&&GD /'"/F&!&%@ /, ./)3+',+ .'! /A!3%3/.+&&G!-$/"-&G! 3+)*!"!&G &+ '"!*2��%! 132AAG (,+$". 1). �+U2 132AA2 %) 151 $/"-&GD '/',+.%"% 64(42,38 %) 42FB%&G % 87 (57,61 %) F!&�%&.

207

+$"%5+ 1

�+'A3!*!"!&%! A+5%!&,/. ' 3+(/4 A3#4/@ (%U(% A/ ./)3+',&G4 132AA+4% A/"/./@ A3%&+*"!F&/',% ('/1"+'&/ ("+''%?%(+5%% ��)

�/" �/ 45"!,¥4/"/*/@)

�/ 45–59¥'3!*&%@)

�/ 60–74¥A/F%"/@)

75 % $/"!!¥',+3B!'(%@) '!1/

�2F'(/@ 4 12 30 18 64�!&'(%@ 1 21 41 24 87�,/1/ 5 33 71 42 151 (100 %)

� 111 (73,51 %) A+5%!&,/. &+ 4/4!&, A/',+&/.(% *%+1&/)+ (/"/3!(,+"-&/1/ 3+(+ %4!"%'-'/A2,',.2��%! )+$/"!.+&%# (,+$". 2). �) &%D 21 (13,90 %) 3+&!! &! A/"2B+" A+,/1!&!,%B!'(/@/$/'&/.+&&/@ ,!3+A%%, % . *//A!3+5%/&&/4 A!3%/*! A3/./*%"/'- (/33%1%32��+# 4!*%(+4!&,/)-&+# ,!3+A%#. �) 19 (12,58 %) $/"-&GD, A/',2A%.U%D . ',+5%/&+3 ' +&!4%!@ 3+)"%B&/@ ',!A!&% .G-3+F!&&/',%, 9(5,96 %) . A3!*/A!3+5%/&&/4 A!3%/*! A/,3!$/.+"/'- 1!4/,3+&'?2)%#. �3/,%./#)-.!&&2� ,!3+A%� ' 2B!,/4 �&*/'(/A%B!'(%D A3%)&+(/. 2 3 (1,9 %) A+5%!&,/.,3!$/.+"/'- A3/./-*%,- *//A!3+5%/&&/4 A!3%/*!.

+$"%5+ 2

�'&/.&G! '/A2,',.2��%! )+$/"!.+&%#

�/A2,',.2��!! )+$/"!.+&%! �/"%B!',./A+5%!&,/. %

�U!4%B!'(+# $/"!)&- '!3*5+ 128 84,76 %�+D+3&G@ *%+$!, 9 5,96 %�+$/"!.+&%# '/'2*/. &%F&%D (/&!B&/',!@ 21 13,91 %�3/&%B!'(%! )+$/"!.+&%# "!1(%D 42 27,81 %�+$/"!.+&%# 5!&,3+"-&/@ &!3.&/@ '%',!4G 6 3,97 %�3,!3%+"-&+# 1%A!3,!&)%# 44 29,13 %�&!4%# 19 12,58 %�).!&&+# $/"!)&- F!"2*(+ % ��� 3 1,98 %

�) 151 $/"-&/1/ 144(95,36 %) A/"2B%"% A3!*/A!3+5%/&&2� "2B!.2� ,!3+A%� (%) &%D32 $/"-&GD — *%',+&5%/&&2� 1+44+N,!3+A%� . 3+)/./@ */)! 2 �3 */ '244+3&/@ /B+1/./@ */)G38–42 �3; %112 A+5%!&,/. — '3!*&!?3+(5%/&&2� *%',+&5%/&&2� 1+44+N,!3+A%� . 3+)/./@ */)! 5�3 */ '244+3&/@ /B+1/./@ */)G 25 �3). � /',+"-&GD A+5%!&,/. %4!"%'- A3/,%./A/(+)+&%# *"#A3/.!*!&%# "2B!./@ ,!3+A%%: &+"%B%! 3+'A+*+��!@'# /A2D/"%, (3/./,!B!&%! %) /A2D/"%% /',3+#(%U!B&+# &!A3/D/*%4/',-

� 80 (52,98 %) $/"-&GD$G"+ II ',+*%# /A2D/"!./1/ A3/5!''+ (T3-4N0-3M0); 2 47(31,12 %) —III ',+*%# (T1-4N1-3M0). �/"-&GD' I ',+*%!@ (T1-2N0M0) $G"/ 18 (11,9 %) A+5%!&,/. % ' IV ',+*%!@(T1-4N0-3M1) — 6 (3,97 %).

�/ 4/3?/"/1%B!'(/42 ',3/!&%� A3!/$"+*+"+ +*!&/(+35%&/4+ 3+)"%B&/@ ',!A!&% *%??!-3!&5%3/.(% 2 120 (79,47,75 %) $/"-&GD. �!*%??!3!&5%3/.+&&G@ 3+( .G#."!& 2 29 (19,2 %) $/"--&GD. �!"+&/4+ A3#4/@ (%U(% — 2 2 (1,3 %) A+5%!&,/..

'//,.!,',.%% ' A3%4!&#.U%4%'# . ("%&%(! 4!,/*+4% ?/34%3/.+&%# (/&5!./@ (/"/',/4G)+ +&+"%)%32!4G@ 7-"!,&%@ A!3%/*, (/,/3G@ . 5!"/4 /,3+F+!, A/%'(% A2,!@ /A,%4%)+5%% 'A/'/-$/. '/)*+&%# % A3/?%"+(,%(% /'"/F&!&%@ %'(2'',.!&&/1/ )+*&!1/ A3/D/*+, &+4% $G"% .G*!"!&G2 132AAG $/"-&GD, A3+./4!3&/',- '3+.&!&%# (/,/3GD $G"+ A/*,.!3F*!&+ %D '/A/',+."!&%!4 A/5!"/42 3#*2 &+%$/"!! .+F&GD A+3+4!,3/..

1-� 132AA2 ((/&,3/"-&2�) .("�B!& 101 $/"-&/@, (/,/3/42 A/'"! $3�U&/-A3/4!F&/',&/@�(',%3A+5%% A3#4/@ (%U(% &+("+*G.+"% (/"/',/42 ("+''%B!'(%4 'A/'/$/4 A//$�!A3%&#,/@ 4!,/*%(!, (/,/3+# )+("�B+!,'# . A/'"/@&/4 A/*U%.+&%% .G./*%4/@ (%U(% ( A!-3!*&!@ $3�U&/@ ',!&(%.

�/ 2-@ 132AA! (/'&/.&/@ ) /,&!'!&/ 50 A+5%!&,/., (/,/3G4 &+ (/&!B&/4 �,+A! /A!3+5%% $G-"+ '?/34%3/.+&+ (/"/',/4+ ' %'A/"-)/.+&%!4 +""/A"+',%B!'(/1/ 4+,!3%+"+.

�!,/*%(+ &/./1/ 'A/'/$+ &+"/F!&%# (/"/',/4G '/',/%, . '"!*2��!4. �/'"! .GA/"&!&%#/'&/.&/1/ �,+A+ $3�U&/NA3/4!F&/',&/@ �(',%3A+5%% A3#4/@ (%U(% . "!./@ $/(/./@ /$"+',%

208

F%./,+ ?/34%32!,'# ,/&&!"- *"# .G.!*!&%# ',/4G. �/$%"%)/.+&&G@ 2B+',/( /$/*/B&/@ (%U(%.G./*#,B!3!) ,/&&!"-. �+"!! '/ ',/3/&G $3�U&/@ A/"/',% /,*!"-&G4% U.+4% ( ',/4! A/*U%.+-�, +""/A"+',%B!'(%@ 4+,!3%+", '/)*+.+# 4+&F!,(2 &+ .&2,3%$3�U&/@ B+',% .G.!*!&&/@ (%U(%.�/"/'(% '!,(% ?%('%32�, 2)"/.G4% U.+4% A/ /(32F&/',% (/"/',/4%B!(/@ 3+&G ( A+3%!,+"-&/@$3�U%&! '/ ',/3/&G $3�U&/@ A/"/',%. �3/,%./A/(+)+&%!4 ( A3%4!&!&%� *+&&/1/ 'A/'/$+ (/-"/',/4%% #."#!,'# &+"%B%! %&?%5%3/.+&&/1/ .GA/,+ . $3�U&/@ A/"/',%.

&�_��z�� . �+&&%! A/'"!/A!3+5%/&&G! /'"/F&!&%# . /$"+',% (/&5!./@ (/"/',/4G 2$/"-&GD (/&,3/"-&/@ 132AAG &+$"�*+"%'- . 19 (18,81 %) '"2B+#D (,+$". 3).

�+%$/"!! 13/)&G4% %) &%D #.%"%'-: )+./3/, ,/&(/@ (%U(% ./(321 .G.!*!&&/@ ',/4G (1 A+-5%!&,), 3!,3+(5%# ',/4G (2 A+5%!&,+), &!(3/) ',!&(% .G.!*!&&/@ (%U(% (2 A+5%!&,+) % A!3?/3+-5%# ',!&(% (%U(% (1 A+5%!&,). '! �,% /'"/F&!&%# A/,3!$/.+"% A/.,/3&/1/ /A!3+,%.&/1/ "!B!-&%#. �!,+"-&GD %'D/*/. &! $G"/.

�3% %)2B!&%% /,*+"!&&GD 3!)2"-,+,/. (/&,3/"-&/@ 132AAG$G"/ /,4!B!&/ ./)&%(&/.!&%!14 /'"/F&!&%@ . /$"+',% (/"/',/4G 2 101 /A!3%3/.+&&GD $/"-&GD, A3/'"!F!&&G! . '3/(% /,3 4!'#5!. */ 5 "!, A/'"! 3+*%(+"-&/1/ .4!U+,!"-',.+. �+( .%*&/ %) ,+$"%5G 4, &+%$/"-U%@2*!"-&G@ .!' . ',32(,23! /'"/F&!&%@ A/'"! .GA%'(% %4!"% '"!*2��%!: A+3+(/"/',/4%B!'(%!13GF% — 7 (6,9 %), .GA+*!&%! (%U(% (A3/"+A') — 4 (3,9 %).

(+B!',.! %""�',3+5%% A3%./*%4 ("%&%B!'(%@ A3%4!3. �/"-&/@ �. 64 "!, A/',2A%" .���� �� � ' *%+1&/)/4 «3+( &%F&!+4A2"#3&/1/ /,*!"+ A3#4/@ (%U(%». �3% ?%$3/(/"/&/'(/-A%%: /A2D/"- A3#4/@ (%U(%, &%F&%@ A/"�' (/,/3/@ &+ 3+'',/#&%% 3 '4 /, +&+"-&/1/ F/4+, /A2-D/"- 5%3(2"#3&/ A/3+F+!, (%U(2. �/3?/"/1%#: 24!3!&&/ *%??!3!&5%3/.+&&+# +*!&/(+35%/&/-4+. �/'"! A3/.!*!&%# A3!*/A!3+5%/&&/@ "2B!./@ ,!3+A%% $/"-&/42 A3/.!*!&+ /A!3+5%# �(',%3-A+5%# A3#4/@ (%U(% ' &+"/F!&%!4 A/',/#&&/@ (/"/',/4G ,3+*%5%/&&G4 4!,/*/4. �/'"!/A!3+-5%/&&G@ A!3%/* A3/,!(+" $!) /'"/F&!&%@. �3% (/&,3/"-&/4 /'4/,3! $/"-&/1/ B!3!) 6 4!'#5!..G#."!&+ A+3+(/"/',/4%B!'(+# 13GF+ $/"-U%D 3+)4!3/.. �+&&/! /'"/F&!&%! A/,3!$/.+"/ A/-.,/3&/1/ /A!3+,%.&/1/ .4!U+,!"-',.+

/'&/.&/@ 132AA! $/"-&GD A3% (/&,3/"-&GD /$'"!*/.+&%#D . 3+&&%!, $"%F+@U%! % /,*+-"!&&G! '3/(% 'A!5%?%B!'(%D A+3+(/"/',/4%B!'(%D /'"/F&!&%% &! /,4!B!&/.

$ ��� . �3%4!&!&%! 3+)3+$/,+&&/1/ 'A/'/$+ (/"/',/4%% A3%.!"/ &! ,/"-(/ ( '2�!',.!&-&/42 2"2BU!&%� &!A/'3!*',.!&&GD 3!)2"-,+,/. "!B!&%#, &/ % ( */',/.!3&/42 '/(3+�!&%� B%'"+3+&&%D % A/)*&%D A+3+(/"/',/4%B!'(%D /'"/F&!&%@ A/ '3+.&!&%� ' ,3+*%5%/&&G4% 4!,/*+4%.�,/ '/)*+!, 3!+"-&G! A3!*A/'G"(% *"# A/"&/5!&&/@ 3!+$%"%,+5%% 3+*%(+"-&/ /A!3%3/.+&&GD$/"-&GD 3+(/4 A3#4/@ (%U(%.

'! .GU!%)"/F!&&/! *+!, /'&/.+&%! 'B%,+,- 3+)3+$/,+&&2� &+4% 4!,/*%(2 % ,!D&%(2 ?/3-4%3/.+&%# A/',/#&&/@ (/"/',/4G 4!,/*/4 .G$/3+ A3% .GA/"&!&%% 3+*%(+"-&GD D%3231%B!'(%D.4!U+,!"-',. A/ A/./*2 3+(+ &%F&!+4A2"#3&/1/ /,*!"+ A3#4/@ (%U(%.

!�!;1+$!�0�'&"(+)"*�� HELICOBACTER PYLORI$���1=!�'&"*�/,!J4�'&�!(�4^$!&+^,"�'&2!&"0+$,4$+&"q)4

x14,)"0"($","(*=0+�"1!�)+x)+

�#$. %�������, �#$. )�������� (����., �. �. �.)�+5�/&+"-&%@ 4!*%B&%@ 2&�.!3'%,!, �4!&� �L�. �/1/4/"-5#

�+?!*3+ D�3231�¤ � 2

�!,/� 3/$/,% ¯*/'"�*F!&&# 4/F"%./',� )+',/'2.+&&# +&,%$�/,%(�., �/ .%(/3%',/.2�,-'# 2'D!4+D $+)%'&/¤ ,!3+A�¤ $+(,!3�+"-&/1/ A!3%,/&�,2 A3% D!"�(/$+(,!3N+'/5�-/.+&%D A!3?/3+,%.&%D.%3+)(+D *.+&+*5#,%A+"/¤ (%U(% (���), ) 4!,/� !3+*%(+5�¤ Helicobacter pylori (HP) .A�'"#/A!3+5�@&/42 A!3�/*� $!) */*+,(/./1/ A3%)&+B!&&# ("+'%B&%D 'D!4 !3+*%(+5�@&/¤ ,!3+A�¤.

�$',!F!&/ 264 D./3%D, A3//A!3/.+&%D ) A3%./*2 A!3?/3+,%.&/¤ .%3+)(% ���. �./3%4 A�*B+' /A!3+5�¤ .%(/&2.+"+'- $�/A'�# '"%)/./¤ +',3+"-&/1/ .�**�"2 U"2&(+, $�/A,+,% &+A3+."#"%'- &+$+(,!3�/"/1�B&! */'"�*F!&&# ) 4!,/� .%#."!&&# Helicobacter pylori. �./3� ) A/)%,%.&%4 3!)2"-,+-,/4 $+(,!3�/"/1�B&/1/ */'"�*F!&&# $2"% 3/)*�"!&� &+ *.� 132A%: A!3U�@ A/./*%"+'- ',+&*+3,&++&,%$+(,!3�+"-&+ ,!3+A�# A�'"#A!3?/3+,%.&/1/ A!3%,/&�,2 ,+ +&,%'!(3!,/3&+ ,!3+A�#, 2 *321�@132A� */*+,(/./ )+',/'/.2.+"% 3!(/4!&*/.+&2 (/&'!&'2'+4% !3+*%(2�B2 �� ,!3+A��. �/&,3/"-!?!(,%.&/',� A3/.!*!&/¤ !3+*%(+5�¤ HP )*�@'&�.+"% B!3!) 4–6 ,%F&�.. �3% A!3.%&&/42$+(,!3�/"/1�B&/42 */'"�*F!&&� $�/A,+,�. &+#.&�',- HP .%#."!&/ 2 91 D./3%D (40,08 %).

209

�3% (/&,3/"-&/42 */'"�*F!&&� 2 A!3U/¤ 132A� !3+*%(+5�# */'#1&2,+ 2 44 A+5%!&,/.(84,62 %), . *321/¤ 2 39 A+5%!&,/. (84,79 %). �+',/,+ 3/).%,(2 A/$�B&%D !?!(,�. +&,%$+(,!3�+"-&/¤,!3+A�¤ 2 D./3%D A!3U/¤ 132A% '("+"+ 26,92 %, . *321/¤ — 78,26 %.

!�!;',,!�0+`&"(+)"*++ HELICOBACTER PYLORI$�!�1'!�'&"*+!,,!J�'&+!('4;!1],-^

��'&2!&"0+$,!/=q$!/�'14()"+($',"(*"0+�'&�0,!/)+x)+

�#$. %�������, +#$. )�������� (����., �. �. �.)

�+5%/&+"-&G@ 4!*%5%&'(%@ 2&%.!3'%,!, %4. �L�. �/1/4/"-5+�+?!*3+ D%3231%% � 2

�3/.!*!&%! �??!(,%.&/1/ (23'+ �3+*%(+5%/&&/@ ,!3+A%%, A/ *+&&G4 4&/1%D +.,/3/., #."#-!,'# /$#)+,!"-&G4 2'"/.%!4 2'A!U&/1/ "!B!&%# D!"%(/$+(,!3N+''/5%%3/.+&&/@ #).!&&/@ $/"!)&%*.!&+*5+,%A!3',&/@ (%U(% (���) [3]. �!(/4!&*/.+&&G! �++',3%D,'(%4% (/&'!&'2'+4% '/.3!-4!&&G! 'D!4G +&,%$+(,!3%+"-&/@ ,!3+A%% /$!'A!B%.+�, .G'/(2� B+',/,2 ($/"!! 80 %) �3+*%(+-5%% Helicobacter pylori (��). �*&+(/ A3%4!&!&%! (/4$%&+5%% &!'(/"-(%D +&,%$%/,%(/. .!*�, (3+).%,%� A/$/B&GD 3!+(5%@, B,/ B+',/ '"2F%, /'&/.+&%!4 *"# A3!(3+�!&%# ,!3+A%% [1]. �,/ /'/-$!&&/ +(,2+"-&/ . '"2B+#D A/'"!/A!3+5%/&&/@ ,!3+A%% A+5%!&,/. ' A!3?/3+,%.&/@ #)./@ F!"2*(+% ���, ,+( (+( &+"%B%! 2 &%D A!3%,/&%,+ ,3!$2!, A3/.!*!&%# (23'+ +&,%$+(,!3%+"-&/@ ,!3+A%%+&,%$%/,%(+4% U%3/(/1/ 'A!(,3+ *!@',.%#. �/A/"&%,!"-&/! &+)&+B!&%# A3!A+3+,/. *"# �3+*%(+-5%% �� 2'%"%.+!, /,3%5+,!"-&/! ."%#&%! +&,%$+(,!3%+"-&/@ ,!3+A%% &+ 4%(3/?"/32 (%U!B&%(+% )&+B%,!"-&/ 2.!"%B%.+!, ',/%4/',- "!B!&%# $/"-&/1/. �3/4! ,/1/, . A/'"!*&%! 1/*G A3% A3/.!-*!&%% �3+*%(+5%/&&/@ ,!3+A%% /*&/@ %) A3/$"!4, (/,/3+# '2�!',.!&&/ ."%#�, &+ 3!)2"-,+,G"!B!&%#, ',+"+ 3!)%',!&,&/',- �� ( +&,%$+(,!3%+"-&G4 A3!A+3+,+4. �!)%',!&,&G! U,+44G ,#F!-"!! A/**+�,'# �3+*%(+5%% % '&%F+�, �??!(,%.&/',- '/.3!4!&&GD 3!F%4/. "!B!&%# [5].

+(%4 /$3+)/4, . &+',/#�!! .3!4# &+)3!"+ &!/$D/*%4/',- A/%'(+ &/.GD +"-,!3&+,%.&GDA3!A+3+,/. % 'D!4 �3+*%(+5%% ��.

�+%$/"!! B+',/ . +&,%$+(,!3%+"-&/@ ,!3+A%% A!3%,/&%,/. A3% A!3?/3+,%.&/@ #).! F!"2*(+% ��� A3%4!&#�, +&,%$%/,%(% 5!?+"/'A/3%&/./1/ 3#*+, ?,/3D%&/"/&G % '%&,!,%B!'(%! A!&%-5%""%&G. /,"%B%! /, *321%D 4%(3//31+&%)4/. �� in vitro B2.',.%,!"!& ( $/"-U%&',.2 +&,%-4%(3/$&%D A3!A+3+,/. [2]. ��! . 1988 1. . './%D %''"!*/.+&%#D C.A.M. Mcnulty % J.C. Dent A/(+-)+"% B2.',.%,!"-&/',- HP in vitro ( $/"-U%&',.2 5!?+"/'A/3%&/. % ?,/3D%&/"/&/. [4].

A3/?!''%/&+"-&/@ "%,!3+,23! &! .',3!B+�,'# *+&&G! /$ �??!(,%.&/',% +&,%$%/,%(/.,%'A/"-)2!4GD . $+)%'&/@ ,!3+A%% A!3%,/&%,/. A3% A!3?/3+,%.&GD #).+D F!"2*(+ % ��� . (+B!'-,.! A3!A+3+,/. *"# �3+*%(+5%% HP.

*��z���� . �''"!*/.+&%! ./)4/F&/',% %'A/"-)/.+&%# +&,%$%/,%(/., A3%4!&#!4GD . $+-)%'&GD 'D!4+D ,!3+A%% A!3%,/&%,+ A3% D!"%(/$+(,!3N+''/5%%3/.+&&GD A!3?/3+,%.&GD #).+D F!-"2*(+ % ���, *"# �3+*%(+5%% �� . A/'"!/A!3+5%/&&/4 A!3%/*! $!) */A/"&%,!"-&/1/ &+)&+B!&%#("+''%B!'(%D 'D!4 �3+*%(+5%/&&/@ ,!3+A%%.

J����� ������ �����������. �+ A!3%/* ' 2004 A/ 2012 1/*G &+4% /$'"!*/.+&/ 264$/"-&GD, A3//A!3%3/.+&&GD A/ A/./*2 A!3?/3+,%.&/@ #).G F!"2*(+ % ���. D/*! /A!3+5%% A3/-./*%"'# )+$/3 $%/A'%@&/1/ 4+,!3%+"+ '"%)%',/@ /$/"/B(% +&,3+"-&/1/ /,*!"+ F!"2*(+. �%/A'%@-&G@ 4+,!3%+" &+A3+."#"% &+ $+(,!3%/"/1%B!'(/! %''"!*/.+&%! &+ A3!*4!, %&?%5%3/.+&%# ��.

�"# A3/.!3(% �??!(,%.&/',% +&,%$%/,%(/., A3%4!&#!4GD . ',+&*+3,&/@ +&,%$+(,!3%+"--&/@ ,!3+A%% A!3%,/&%,+, . (+B!',.! A3!A+3+,/. *"# �3+*%(+5%% �� . %''"!*/.+&%! $G"/ .("�B!-&G 98 A+5%!&,/. ' A/"/F%,!"-&G4% 3!)2"-,+,+4% 4%(3/$%/"/1%B!'(/1/ %''"!*/.+&%# &+ &+"%B%!��. �2FB%& $G"/ 78 (79,59 %), F!&�%& — 20 (21,41 %), '3!*&%@ ./)3+', '/',+.%" 34,2 ± 2,4 1/*+.

A/'"!/A!3+5%/&&/4 A!3%/*! A+5%!&,G $G"% 3+)*!"!&G &+ *.! 132AAG. �!3./@ 132AA![52 $/"-&GD (53,06 %)] A3/./*%"+'- +&,%$+(,!3%+"-&+# ,!3+A%#, &+A3+."!&&+# &+ $/3-$2 ' A!3%-,/&%,/4, $!) */A/"&%,!"-&/1/ &+)&+B!&%# A!3/3+"-&/@ +&,%D!"%(/$+(,!3&/@ ,!3+A%%.

�+%$/"!! B+',/ &+)&+B+"% +&,%$%/,%(% 5!?+"/'A/3%&/./1/ 3#*+ (5!?,3%+('/&, 5!?/A!3+-)/&, 5!?,+)%*%4, 5!?!A%4). '"2B+#D &+B+"+ ,!3+A%% ' A!&%5%""%&/./1/ 3#*+ +&,%$%/,%(/. &+-)&+B+"% «)+�%��&&G!» A!&%5%""%&G (+4/('%5%""%&¦("+.2"+&+,, +4A%5%""%&¦'2"-$+(,+4, A%A!-3/5%""%&¦,+)/$+(,+4%). '"2B+#D ,#F�"GD ?/34 3+)"%,/1/ 1&/@&/N?%$3%&/)&/1/ A!3%,/&%,+ */-A/"&%,!"-&/ &+)&+B+"'# +&,%$%/,%( 132AAG ?,/3D%&/"/&/. (5%A3/?"/('+5%& %"% 1+,%?"/('+-5%&) .&2,3%.!&&/. �&,%$+(,!3%+"-&+# ,!3+A%# A3/./*%"+'- &+ A3/,#F!&%% 7–10 *&!@. �3/4! ,/-

210

1/, .'! A+5%!&,G A/"2B+"% +&,%'!(3!,/3&2� ,!3+A%� A3!A+3+,+4% %&1%$%,/3+4% A3/,/&&/@ A/4-AG (/4!A3+)/", A+&,/A3+)/").

�+5%!&,+4 .,/3/@ 132AAG [46 $/"-&GD (46,94 %)], (3/4! /A%'+&&/@ .GU! 'D!4G ,!3+A%%,' 4–7-D '2,/( A/'"!/A!3+5%/&&/1/ A!3%/*+ &+)&+B+"+'- A!3/3+"-&+# +&,%D!"%(/$+(,!3&+# ,!3+A%#'/1"+'&/ (/&'!&'2'+4 �++',3%D,-1 (1996), �++',3%D,-2 (2000) % �++',3%D,-3 (2005), (/,/3+#.("�B+"+ +4/('%5%""%& (1 000 41 *.+ 3+)+ . '2,(%) ± ("+3%,3/4%5%& (500 41 *.+ 3+)+ . '2,(%) &+A3/,#F!&%% 14 *&!@. �3%,!3%!4 &+B+"+ +&,%D!"%(/$+(,!3&/@ ,!3+A%% $G"/ ./'',+&/."!&%! (%-U!B&/@ A!3%',+"-,%(% % 2*+"!&%! (%U!B&/1/ )/&*+.

�!3!) 4–6 &!*!"- A/'"! /(/&B+&%# (23'+ +&,%$+(,!3%+"-&/@ ,!3+A%% *"# (/&,3/"# �??!(-,%.&/',% A3/.!*!&&/@ �3+*%(+5%% �� A+5%!&,+4 /$!%D 132AA .GA/"&#"% ?%$3/1+',3/*2/*!&/-'(/A%� ' $%/A'%!@ '"%)%',/@ /$/"/B(% +&,3+"-&/1/ /,*!"+ F!"2*(+ *"# *+"-&!@U!1/ A3/.!*!&%#4%(3/$%/"/1%B!'(/1/ %''"!*/.+&%#.

&�_��z�� �����������. �3% A!3.%B&/4 $+(,!3%/"/1%B!'(/4 %''"!*/.+&%% $%/A,+,/.&+"%B%! HP .%#."!&/ 2 107 A+5%!&,/. (40,07 %).

�3% (/&,3/"-&/4 /$'"!*/.+&%% B!3!) 4–6 &!*!"- A/'"! )+.!3U!&%# (23'+ +&,%$+(,!3%+"--&/@ ,!3+A%% (#.%"/'- 98 A+5%!&,/.) A/"/F%,!"-&G@ 3!)2"-,+, $+(,!3%/"/1%B!'(/1/ %''"!*/.+&%#&+ &+"%B%! �� $G" A/"2B!& 2 8 A+5%!&,/. (15,38 %) A!3./@ 132AAG. �3+*%(+5%# �� */',%1&2,+ 244 A+5%!&,/. (84,62 %)�,/@ 132AAG. �3!*% A+5%!&,/. .,/3/@ 132AAG A/"/F%,!"-&G@ 3!)2"-,+,$+(,!3%/"/1%B!'(/1/ %''"!*/.+&%# $G" A/"2B!& . 15,21 % '"2B+!. (7 B!"/.!(), + �3+*%(+5%# $G"+*/',%1&2,+ '//,.!,',.!&&/ 2 39 A+5%!&,/. (84,79 %). �+)&%5+ 4!F*2 3!)2"-,+,+4% %''"!*/.+&%! .*.2D 132AA+D ',+,%',%B!'(% &!*/',/.!3&+ (3 > 0,05). +(%4 /$3+)/4, */A/"&%,!"-&/! &+)&+B!&%!("+3%,3/4%5%&+ . (/4$%&+5%% ' +4/('%5%""%&/4 ' 5!"-� �3+*%(+5%% �� . A/'"!/A!3+5%/&&/4A!3%/*! &! %4!!, '2�!',.!&&GD A3!%42�!',. A/ '3+.&!&%� '/ ',+&*+3,&/@ ,!3+A%!@ A!3%,/&%,+.

�/1"+'&/ (3%,!3%#4 (/&'!&'2'+ �++',3%D,-2 (2000), A3!A+3+,, %'A/"-)2!4G@ *"# �3+*%(+-5%% ��, 'B%,+!,'# �??!(,%.&G4 A3% 2'A!U&/@ �3+*%(+5%% $/"!! B!4 . 80 % '"2B+!.. �3%4!&!&%!' 5!"-� �3+*%(+5%% �� +&,%$%/,%(/., %'A/"-)2!4GD *"# ,!3+A%% A!3%,/&%,+, . (/4$%&+5%% ' %&-1%$%,/3+4% A3/,/&&/@ A/4AG . 3+&&!4 A/'"!/A!3+5%/&&/4 A!3%/*! $!) */A/"&%,!"-&/1/ &+)&+-B!&%# ,3+*%5%/&&GD *"# �3+*%(+5%% �� +&,%$%/,%(/. A/"&/',-� /,.!B+!, �,/42 (3%,!3%�(84,62 %).

�/$/B&G! �??!(,G +&,%$+(,!3%+"-&/@ ,!3+A%% % B+',/,+ %D 3+).%,%# 2 A+5%!&,/. /$!%D132AA /,/$3+F!&G . ,+$"%5! 1.

+$"%5+ 1

�/$/B&G! �??!(,G +&,%$+(,!3%+"-&/@ ,!3+A%%�/$/B&G! �??!(,G +&,%$+(,!3%+"-&/@,!3+A%%

1-# 132AA+ 2-# 132AA+N % n %

�+32U!&%# ',/3/&G ��� 0 0 4 8,69�!"2*/B&/N(%U!B&G! 3+'',3/@',.+ 6 11,53 12 26,09�%'$+(,!3%/) 4 7,69 7 15,21+1%&+"-&G@ (+&*%*/) 2 3,84 6 13,04�!4+,/"/1%B!'(%! &+32U!&%# 2 3,84 2 4,35�!A+,/,/('%B&G@ �??!(, 0 0 5 10,86�$�+# B+',/,+ 3!+(5%@ 14 26,92 36 78,26

�+32U!&%# '/ ',/3/&G ��� A3/#."#"%'- . .%*! 1/"/.&/@ $/"%, '"+$/',% % 1/"/./(32F!-&%#. �!"2*/B&/N(%U!B&G! 3+'',3/@',.+ A3/#."#"%'- ,/U&/,/@, 3./,/@, A/&/'/4. �!4+,/"/1%-B!'(%! &+32U!&%# (24!3!&&G! �/)%&/?%"%# % ,3/4$/5%,/A!&%#) &+$"�*+"%'- 2 A+5%!&,/., A/-"2B+.U%D +4/('%5%""%&, (/,/3G@ 4/F!, /(+)G.+,- ,/('%B!'(/! ."%#&%! &+ /31+&G (3/.!,./-3!&%#. �!A+,/,/('%B&G@ �??!(, ("%&%B!'(% A3/#."#"'# . A/.GU!&%% 23/.&# ,3+&'+4%&+) (3/-.% % &+$"�*+"'# A3!%42�!',.!&&/ 2 A+5%!&,/., A/"2B+.U%D ("+3%,3/4%5%&. +(%4 /$3+)/4, 2A+5%!&,/. A!3./@ 132AAG /,4!B+"/'- )&+B%,!"-&/! 24!&-U!&%! B+',/,G 3+).%,%# A/$/B&GD3!+(5%@ (26,92 % A+5%!&,/. A!3./@ 132AAG A3/,%. 78,26 % A+5%!&,/. .,/3/@ 132AAG)¥� = 0,0001).

$ ��� . &+',/#�!! .3!4# . '.#)% ' 3+'A3/',3+&!&%!4 3!)%',!&,&/',% �� ( +&,%$%/,%(+4% .G'/(/@ B+',/,/@ /'"/F&!&%@ ',+&*+3,&GD 'D!4 +&,%D!"%(/$+(,!3&/@ ,!3+A%% &+)3!"+ &!/$D/-*%4/',- A/%'(+ &/.GD +"-,!3&+,%.&GD 'D!4 �3+*%(+5%% ��. �3%4!&!&%! /$�!A3%&#,GD 'D!4 +&-

211

,%$+(,!3%+"-&/@ ,!3+A%% $+(,!3%+"-&/1/ A!3%,/&%,+ . 3+&&!4 A/'"!/A!3+5%/&&/4 A!3%/*! &!2',2A+!, A/ �??!(,%.&/',% �3+*%(+5%% �� */A/"&%,!"-&/42 &+)&+B!&%� ',+&*+3,&/1/ +&,%D!"%-(/$+(,!3&/1/ "!B!&%# (84,62 % A3/,%. 84,79 %). �/A/"&%,!"-&/! &+)&+B!&%! ',+&*+3,&GD 'D!4�3+*%(+5%/&&/@ ,!3+A%% A/'"! A3/.!*!&%# +&,%$+(,!3%+"-&/1/ "!B!&%# A!3%,/&%,+, .G).+&&/1/A!3?/3+5%!@ 1+',3/*2/*!&+"-&/@ #).G, 2.!"%B%.+!, B+',/,2 A/$/B&GD 3!+(5%@ &+ 51,34 %.

�A%'/( "%,!3+,23G:1. �%3/*F/., �L�. �/$/B&G! *!@',.%# �3+*%(+5%/&&/@ ,!3+A%% Helicobacter Pylori / �%3/-

*F/. �L�., �U+&(2"/.+ �L�., �/@4+,/.+ �L�., �!14+,/.+ �L�. // �"%&%B!'(+# 4!*%5%&+. — 2007.— � 6. — �. 47–50.

2. ¬!3$+(/., �L�. �!B!&%! )+$/"!.+&%@, +''/5%%3/.+&&GD ' %&?!(5%!@ Helicobacter pylori /¬!3$+(/. �L�., �+U&%(/. L�., �/3&%!&(/ �L�. // �!B+�%@ .3+B. — 2010. — � 7. — �. 6–11.

3. Meiferthemer, P. Current concept in the management of Helicobacter pylori infection: the Maas-tricht III Consensus Report / Meiferthemer P., Megraud F., O’Morain C. et al. // Gut. — 2007. — 56. —P. 772–781.

4. McNulty, C. A. M. Susceptibility of Campylobacter pylori to twenty-one antimicrobal agents /McNulty C. A. M., Dent J. C. // Eur. J. Clin. Microbiol. Infect. Dis. — 1988. — V. 7. — P. 566–569.

5. Wong, W.M. Lansoprazol, levofloxacin and amoxicillin triple therapy vs. quadruple therapy assecond-line treatment of resistant Helicobacter pylori infection / Wong W.M., Gu Q., Chu K.M., et al. //Aliment Pharmacol. Ther. — 2006. — Vol. 23, � 3. — P. 421–427.

)!J�1')�,-/�!(^!($(+">,!�0+)'+1'%',++�+,(&!J"(+";'0+%'�)!/�0!�-

"#$. %������ (��., �. �. �.)

2"-'(%@ 1/'2*+3',.!&&G@ 2&%.!3'%,!,, 4!*%5%&'(%@ %&',%,2,�+?!*3+ D%3231%B!'(%D $/"!)&!@ � 2

"����z����z. �%&*3/4 *%+$!,%B!'(/@ ',/AG (���) /A3!*!"!& �!F*2&+3/*&/@ 3+$/B!@132AA/@ (+( «%&?!(5%#, #).+ %¦%"% *!',32(5%# 1"2$/(%D ,(+&!@, '.#)+&&+# ' &!.3/"/1%B!'(%4%&+32U!&%#4% % '&%F!&%!4 4+1%',3+"-&/1/ (3/./,/(+ . +3,!3%#D &%F&%D (/&!B&/',!@ 3+)"%B&/@',!A!&% ,#F!',%». /'&/.2 �,/@ ?/342"%3/.(% $G"/ A/"/F!&/ /A3!*!"!&%! �� [2]. +(%4 /$-3+)/4, ��� A3!*',+."!& 1"+.&G4 /$3+)/4 1&/@&/N*!',32(,%.&G4% A/3+F!&%#4% &%F&%D (/&!B-&/',!@. �+'A3/',3+&!&&/',- ��� . $/"-U%&',.! A/A2"#5%@ '/',+."#!,, A/ /5!&(+4 �('A!3,/., 4–10 % /, .'!D A+5%!&,/. ' �� [1].

*��z. �3/+&+"%)%3/.+,- 3!)2"-,+,G *%+1&/',%(% % "!B!&%# $/"-&GD ' '%&*3/4/4 *%+$!,%-B!'(/@ ',/AG.

J����������� �����������. /F/1/./4 /,*!"!&%% 2"-'(/@ /$"+',&/@ ("%&%B!-'(/@ $/"-&%5G )+ A!3%/* 2008–2011 11. &+D/*%"%'- &+ "!B!&%% ' 3+)"%B&G4% ',+*%#4% *%+$!,%-B!'(/@ +&1%/A+,%% &%F&%D (/&!B&/',!@ 66 B!"/.!(. /)3+', A+5%!&,/. /, 40 */ 86 "!,. �2FB%&— 36 (54,5 %), F!&�%& — 30 (45,5 %). �3/*/"F%,!"-&/',- )+$/"!.+&%# '/',+."#"+ /, 1 1/*+ */30 "!,. #F�"+# ',!A!&- �� .G#."!&+ 2 42 B!"/.!(, '3!*&## — 2 19, "�1(+# — 2 5. '! $/"-&G!%4!"% '/A2,',.2��2� A+,/"/1%�: ���, 1%A!3,/&%B!'(2� $/"!)&-, +,!3/'("!3/).

&�_��z�� �����������. '!4 $/"-&G4 A3/./*%"'# (/&,3/"- "+$/3+,/3&GD A/(+)+,!"!@,+ %4!&&/: /$�%@ +&+"%) (3/.%, 4/B%, $%/D%4%B!'(%! +&+"%)G (3/.% ($%"%32$%& % !1/ ?3+(5%%,4/B!.%&+, (3!+,%&%&, �"!(,3/"%,G), '%',!4+ 1!4/',+)+ (,3/4$/5%,G, A3/,3/4$%&/.G@ %&*!(',���), ���, (/&'2"-,+5%# /?,+"-4/"/1+ ' /'4/,3/4 1"+)&/1/ *&+, (/&'2"-,+5%# '/'2*%',/1/ D%-3231+. �!12"#3&/ A3/./*%"+'- (/33!(5%# 1"%(!4%% %&'2"%&+4% (/3/,(/1/ % A3/"/&1%3/.+&&/1/*!@',.%# &! 3!F! 4–6 3+) . '2,(% */ ',+$%"%)+5%% 23/.&# 1"�(/)G (3/.% . A3!*!"+D 7–10 44/"-¦",,+(F! 3!12"#3&/ .GA/"&#"'# /'4/,3 $/"-&GD �&*/(3%&/"/1/4 ' 5!"-� (/33!(5%% %&'2"%&/,!3+-A%%.

�"# *%&+4%B!'(/@ /5!&(% '/',/#&%# (3/./,/(+, .G#'&!&%# +&+,/4%B!'(/@ "/(+"%)+5%%/(("�)%@ % ',!&/)/., + ,+(F! 3!U!&%# ./A3/'+ / ./)4/F&/',% A3/.!*!&%# �&*/.+'(2"#3&GD .4!-U+,!"-',. A3/./*%"/'- *2A"!('&/! '(+&%3/.+&%! +3,!3%@ &%F&%D (/&!B&/',!@. �3% &!*/',+,/B-&/@ %&?/34+,%.&/',% A/'"!*&!1/ . +"1/3%,4 *%+1&/',%(% 4G .("�B+"% 3!&,1!&/(/&,3+',&2�+&1%/13+?%� (���) (+( &+%$/"!! */',/.!3&G@ 'A/'/$ .G#."!&%# ./)4/F&GD A/3+F!&%@ +3,!3%@&%F&%D (/&!B&/',!@. �B%,G.+# ./)4/F&G@ 3%'( 3+).%,%# A/',4+&%A2"#5%/&&GD /'"/F&!&%@,

212

&!?3/,/('%B!'(/! ./)*!@',.%! &!(/,/3GD (/&,3+',&GD .!�!',., + ,+(F! %&.+)%.&/',- ���, .G-A/"&#,- A/'"!*&��, &+ &+U .)1"#*, '"!*2!, ,/"-(/ A+5%!&,+4 ' A3!*A/"+1+!4/@ ./)4/F&/',-��&*/.+'(2"#3&GD /A!3+,%.&GD .4!U+,!"-',.. �*&+(/ A3% A3/.!*!&%% ��� . *%+1&/',%B!'(%@+"1/3%,4 &!/$D/*%4/ .("�B+,- ,+(F! 3+).!3&2,/! %''"!*/.+&%! '%',!4G 1!4/',+)+ % 1+',3/*2/-*!&/'(/A%� (.G#."!&%! #).!&&GD *!?!(,/.).

�!B!&%! *+&&/@ 132AAG $/"-&GD .("�B+"/ . '!$# ./)*!@',.%! &+ .'! A+,/1!&!,%B!'(%! ).!-&-# '%&*3/4+ *%+$!,%B!'(/@ ',/AG, ' /$#)+,!"-&/@ (/33!(5%!@ 23/.&# 1"%(!4%% % +3,!3%+"-&/1/*+."!&%#. � 5!"-� (/33!(5%% &+32U!&%@ '.!3,G.+��!@ '%',!4G &+)&+B+"%'- '"!*2��%! 132AAGA3!A+3+,/.: +&1%/A3/,!(,/3G, *!)+13!1+&,G % 3!/"%,%(% — +5!,%"'+"%5%"/.+# (%'"/,+, A!&,/(-'%?%""%&, ("/A%*/13!"-, 1!A+3%& % &%)(/4/"!(2"#3&G! 1!A+3%&G, &! ,3!$2��%! A/',/#&&/1/"+$/3+,/3&/1/ 4/&%,/3%&1+ '%',!4G 1!4/',+)+, 'A+)4/"%,%(% — A+A+.!3%&, *3/,+.!3%&. �"# "!-B!&%# *%+$!,%B!'(/@ &!@3/A+,%% &+4% A3%4!&#"%'- A3!A+3+,G .%,+4%&/. 132AAG % &%(/,%&/-.+# (%'"/,+.

'D!42 "!B!&%# &+4% ,+(F! $G"/ .("�B!&/ A3%4!&!&%! +(,%.+,/3+ ("!,/B&/1/ 4!,+$/"%)-4+ — +(,/.!1%&+. �*&+(/ A3% &+)&+B!&%% *+&&/1/ A3!A+3+,+ '"!*2!, A/4&%,- / */)/)+.%'%4/',%�??!(,+. �+4% %'A/"-)/.+"+'- '"!*2��+# 'D!4+ ..!*!&%# A3!A+3+,+: .¦. %&?2)%# . ,!B!&%!10 *&!@ A/ 1 000–2 000 41 (%&?2)%/&&G! ?"+(/&G 4 %"% 8 41¦4" A/ 250 4").

�!/,�!4"!4G4 (/4A/&!&,/4 "!B!&%# #."#"/'- A3%4!&!&%! +&,%$%/,%(/. U%3/(/1/ 'A!(,3+*!@',.%# (%&1%$%,/3)+�%�!&&G! A!&%5%""%&G, 5!?+"/'A/3%&G II–III A/(/"!&%#, ?,/3D%&/"/&G,"%&(/)+4%*G), A3% .G'/(/4 3%'(! A3%'2,',.%# . 3+&! +&+�3/$&/@ ?"/3G (1"2$/(+# 3+&+ %"% %U!-4%#) — */$+."#,- . 'D!42 "!B!&%# 4!,3/&%*+)/". �*&+(/, 2B%,G.+# U%3/(/! 3+'A3/',3+&!&%!+&,%$%/,%(/3!)%',!&,&GD (. ,/4 B%'"! .&2,3%$/"-&%B&GD) 4%(3//31+&%)4/., A3% '%&*3/4! *%+-$!,%B!'(/@ ',/AG 5!"!'//$3+)&/ A3/./*%,- "!B!&%! A/* (/&,3/"!4 $+(,!3%/"/1%B!'(/1/ %''"!-*/.+&%# 3+&!./1/ /,*!"#!4/1/. �3% .!3%?%(+5%% . 3+&! 13%$/., B+�! *3/FF!@ (3+)"%B&G! .%*GCandida), &!/$D/*%4/ &+)&+B!&%! +&,%4%(/,%B!'(%D A3!A+3+,/. ((+'A/?2&1%&, ?"2(/&+)/" % *3.).

�3!*% */A/"&%,!"-&GD 4!,/*/. "!B!&%# &+4% A3%4!&#"%'- 1%A!3$+3%B!'(+# /('%1!&+5%#¥���) — *"# 2"2BU!&%# 4%(3/5%3(2"#5%%, '&%F!&%# ,(+&!./@ 1%A/('%%; .¦. /)/&/,!3+A%# —' 5!"-� *!,/('%(+5%%, /('%1!&+5%%, %442&/4/*2"#5%% % 2"2BU!&%# 3!/"/1%B!'(%D './@',. (3/-.%, A"+)4!?!3!), ��� +2,/(3/.%, A3%4!&!&%! $%/"/1%B!'(% +(,%.&GD A!3!.#)/B&GD 4+,!3%+"/.,��N(+.%,+5%# 3+&.

�,+A&G! &!(3�(,/4%% ,2AG4 % /',3G4 A2,!4 4G A3/%)./*%"% A/ *!4+3(+5%/&&/@ "%&%% '4+('%4+"-&G4 �+F!&%!4 &!'(/4A3/4!,%3/.+&&GD ,(+&!@.

�3% &!�??!(,%.&/',% (/&'!3.+,%.&/@ ,!3+A%%, &+"%B%% +&+,/4%B!'(%D ./)4/F&/',!@, /,-'2,',.%% A3/,%./A/(+)+&%@, + ,+(F! %).!',&GD +&+,/4%B!'(%D "/(+"%)+5%#D /(("�)%@ % ',!&/)/.&+4% A3%4!&#"%'- �&*/.+'(2"#3&G! .4!U+,!"-',.+, &+A3+."!&&G! &+ 3!.+'(2"#3%)+5%� '/'2*/.A/3+F!&&/@ (/&!B&/',%. �%F! A3%./*%4 .%*G % (/"%B!',./ �&*/.+'(2"#3&GD .4!U+,!"-',. 212 A+5%!&,/. ' ���. � �,%D $/"-&GD B3!'(/F&+# $+""/&&+# +&1%/A"+',%(+ % ',!&,%3/.+&%! .G-A/"&#"%'- &+ '!14!&,+D '"!*2��%D +3,!3%@: A/.!3D&/',&/@ $!*3!&&/@ (3), A/*(/"!&&/@ (2), A!-3!*&!@ (2) % )+*&!@ (5) $/"-U!$!35/.GD. '!4 A+5%!&,+4 A3/./*%"/'- (/4A"!('&/! A+,/1!&!,%-B!'(% /$/'&/.+&&/! 4!*%(+4!&,/)&/! "!B!&%!. �&/ .("�B+"/ ',3/1%@ A/',!"-&G@ 3!F%4, +&,%-,3/4$/5%,+3&2� ,!3+A%� (("/A%*/13!"-, )%",, A"+.%(', �1%,3/4$, + ,+(F! +'A%3%& 100 41¦'2, A/-',/#&&/), A3%4!&!&%! *+.#�!@ A/.#)(% . 4!',! %&�!(5%%. � .'!D $/"-&GD &+',2A%"/ )&+B%,!"--&/! ("%&%B!'(/! 2"2BU!&%!, B,/ .G3+F+"/'- . )+F%."!&%% 3+&!.GD *!?!(,/. . '2�!',.!&&/ $/-"!! (/3/,(%! '3/(%.

$ ��� :1. �/&,3/"- 1"%(!4%% % 23/.&# +3,!3%+"-&/1/ *+."!&%# #."#�,'# /'&/.&G4% (3%,!3%#4%

A3/?%"+(,%(% 3+).%,%# '%&*3/4+ *%+$!,%B!'(/@ ',/AG.2. +"1/3%,4 *%+1&/',%(% C�C &!/$D/*%4/ .("�B+,- *2A"!('&/! '(+&%3/.+&%! +3,!3%@

&%F&%D (/&!B&/',!@ %, A3% &!/$D/*%4/',%, ��� (+( &+%$/"!! %&?/34+,%.&G! 4!,/*%(%.3. �/4A"!('&/! "!B!&%! A+5%!&,/. ' ��� .("�B+!, 4&/1/(/4A/&!&,&/! ./)*!@',.%! &+

?+(,/3G 3%'(+ 3+).%,%# '!3*!B&/N'/'2*%',GD )+$/"!.+&%@, D%3231%B!'(/! % (/&'!3.+,%.&/! "!-B!&%! 3+&!.GD *!?!(,/..

4. /'',+&/."!&%! 4+1%',3+"-&/1/ (3/./,/(+ *+F! A/ /*&/@ %) $!35/.GD +3,!3%@ A3%./*%,( '2�!',.!&&/42 2'(/3!&%� )+F%."!&%# #).!&&/N&!(3/,%B!'(%D *!?!(,/..

�A%'/( "%,!3+,23G:1. �!F*2&+3/*&/! '/1"+U!&%! A/ *%+$!,%B!'(/@ ',/A!. — 2000.2. �+5%/&+"-&G! ',+&*+3,G /(+)+&%# A/4/�% $/"-&G4 '+D+3&G4 *%+$!,/4. — �., 2002.

213

;"1"1"&("�-�4-��,'�'�"�"&&'21w)��,'J('4�!&-0-,(-1"&-

�#�. x�����Ê+3+Ë+&*G 4!4"!(!,,�( 4!*%5%&+ 2&%.!3'%,!,�

�+"+"+3 D%3231%# (+?!*3+'G

�.,/3"+3 Ì)*!3�&�Í !4*!2 ,ÎF�3%$!"!3�&! FÏ1�&! /,G3GA Ð2GÐN&!'!A+Ë+3 3!?"�('�&(/33!5%#"+2*GÍ F+Í+ �&*/'(/A%#"GÐ Î*�' Ñ'G&Ë+&. �2G3 &!'!A+Ë+3 3!?"�('�&*!, $�3&!U!(/33!(5%# F+'+Ë+&&+& (!@�& FÎ&! +UGÐ ,Ï3*!1� /A!3+5%#*+& (!@�&1� 3!5%*%. (!)�&*!,&!'!A+Ë+323!,3/.!)%(+"-*� '!14!&,,�Í !(� F+Ð,G Ð+3+4+NÐ+3'G 1%*3/1!"-*� $/"�',!3*�Ð+"GA,+',G32 Î*�'�& Ð/"*+&Ë+&*+ F+Ð'G &Î,%F!"!31! F!,(!&.

&'q41]0"0-1'%',+=�4q-&,!�J!%'0!%,+)!$!>!&'21w)�"4('0'/

�#�. x����� (%&,.)

�+3+1+&*%&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ *!,'(/@ D%3231%%

�������������������: #�/. ������ (0��. ��., ���., �. �. �.)

"����z����z. �2)G3&/N4/B!,/B&%(/./@ 3!?"�(' (���) D+3+(,!3%)2!,'# 3!,3/13+*&G4)+$3/'/4 4/B% . .!3D&%! 4/B!.G! A2,% %) 4/B!./1/ A2)G3#L��� '/',+."#!, 25–30 % /, .'!D A/-3/(/. % )+$/"!.+&%@ 4/B!.G*!"%,!"-&/@ '%',!4G 2 *!,!@ [1]. A+,/1!&!)! 3!?"�('+ "!F%, .3/-F*!&&+# &!*/',+,/B&/',- 23!,3/.!)%(+"-&/1/ '!14!&,+ (��) % .,/3%B&G! %)4!&!&%# ("+A+&&/1/4!D+&%)4+ )+ 'B!, ./'A+"!&%# 4/B!.G*!"%,!"-&/@ '%',!4G [2]. �/ *+&&G4 +.,/3/., . *!,'(/@23/"/1%B!'(/@ A3+(,%(! $/"!! 75 % '"2B+!. ��� /$2'"/."!&G &!*/',+,/B&/',-� �� /31+&%B!-'(/1/ 1!&!)+, + /',+"-&G! 25 % — .,/3%B&/1/ 1!&!)+[3]. �!B!&%! ��� . )+.%'%4/',% /, ?/34G:(/&'!3.+,%.&/! (A3% .,/3%B&/@ &!*/',+,/B&/',% �� &+ ?/&! %&?!(5%% 4/B!.GD A2,!@) % /A!3+-,%.&/! [3]. � ,3+*%5%/&&G4 /,(3G,G4 /A!3+,%.&G4 4!,/*+4 (/33!(5%% ��� /,&/'#,: .&!A2)G3-&G!, .&2,3%A2)G3&G! 4!,/*G D%3231%B!'(/1/ .4!U+,!"-',.+, + ( $/"!! '/.3!4!&&G4 4!,/*+4/,&/'#, �&*/'(/A%B!'(2� (/33!(5%�.

*��z�����������. �5!&(+ &!A/'3!*',.!&&GD % /,*!"!&&GD 3!)2"-,+,/. "!B!&%# A2)G3-&/N4/B!,/B&%(/./1/ 3!?"�('+ 2 *!,!@.

J����� � ����� . �+,!3%+"/4 *"# %''"!*/.+&%# A/'"2F%"% ("%&%B!'(%! &+$"�*!&%#3!)2"-,+,/. "!B!&%# 55 *!,!@ ' ���, &+D/*%.U%D'# . /,*!"!&%% /$�!@ D%3231%% ���� 1 �+3+-1+&*G . A!3%/* 2005–2012 11. �) &%D 10 *!,#4 (1-# 132AA+) 2',3+&!&%! 3!?"�('+ A3/%).!*!&/ ,3+-*%5%/&&G4 /A!3+,%.&G4 .4!U+,!"-',./4: 7 — 5%',/&!/',/4%# A/ �/�&2, 3 — A/ �/"%,+&/-�!&*$!,,!32. 25 *!,#4 (2-# 132AA+) 2',3+&!&%! 3!?"�('+ A3/.!*!&/ �&*/'(/A%B!'(/@ %&'2??"#-5%!@ «�/"%4!3 �%*3/1!"» . A/*'"%)%',G@ '"/@ 2',-# 4/B!,/B&%(+ A/ 4!,/*%(! «Double-hit» A2-,!4 '/)*+&%# $/"�'/. &+ /*&/@ A"/'(/',% (3%'2&/( 1).

20 *!,#4 (3-# 132AA+) �&*/'(/A%B!'(+# (/33!(5%# A3/./*%"/'- A2,!4 '/)*+&%# $/"�'/.&+ A3/,%./A/"/F&GD A"/'(/',#D (�&*/'(/A%B!'(+# (/33!(5%# A2)G3&/N4/B!,/B&%(/./1/ 3!?-"�('+ 2 *!,!@. �/"/F%,!"-&/! 3!U!&%! &+ A/"2B!&%! %&&/.+5%/&&/1/ A+,!&,+ � 2011/11.75.1/, 11.11.2011). �A/'/$ /'2�!',."#�, '"!*2��%4 /$3+)/4: A3% A3/.!*!&%% 5%',/'(/A%% A/*.%)2+"-&G4 (/&,3/"!4 A!3.G@ .(/" %1"G ' %&'2?"#5%!@ +""/%4A"+&,+,+ A3/%)./*#, . .!3D&!4A/"�'! %&,3+423+"-&/1/ /,*!"+ 4/B!,/B&%(+ . A/*'"%)%',G@ '"/@ &+ 12 B+'+D . 1"2$%&! 0,5–1,0 '4 */ '/A3%(/'&/.!&%# '?/34%32��!1/'# $/"�'+ ' &%F&!@ ',!&(/@ 4/B!,/B&%(+ A/ &+-A3+."!&%� «'.!3D2N.&%)»; *+"!! .,/3/@ .(/" A3/./*#, '&+32F% &+ 0,3 '4 *%',+"-&!! /, 2',-#&+ 6 B+'+D A/ &%F&!@ 12$!, */ '/A3%(/'&/.!&%# '/ ',!&(/@ .!3D&!@ 12$G 2',-# (3%'2&/( 2). +-(%4 /$3+)/4, '?/34%3/.+&&G! $/"�'G . %&,3+423+"-&/4 /,*!"! 4/B!,/B&%(+ % 2 .D/*+ .2',-# 4/B!,/B&%(+ 2*"%&#�, % '2F%.+�, A2)G3&G@ /,*!" 4/B!,/B&%(+ A2,!4 '/)*+&%# S-/$3+)&/@ ?/34G.

214

�%'. 1. �!,/*%(+ Double-hit. 1. �',-! 4/B!-,/B&%(+. 2. �/B!,/B&%(. 3. �/"%4!3N1%*3/-1!"-. 4. �1"+

�%'. 2. �&*/'(/A%B!'(+# (/33!(5%# ���A/ A3!*"/F!&&/42 'A/'/$2. 1. �',-! 4/B!-,/B&%(+. 2. �&,3+423+"-&G@ /,*!" 4/B!-,/B&%(+. 3. �/"%4!3N1%*3/1!"-. 4. �1"+

�+'A3!*!"!&%! *!,!@ A/ ./)3+',2, A/"2, ',/3/&! % ',!A!&% 3!?"�('+ A3!*',+."!&G . ,+$"%-5! 1.

+$"%5+ 1

�+'A3!*!"!&%! *!,!@ ' ���

�,!A!&- ��� �/" % ./)3+', *!,!@0–3 "!, 4–7 "!, 8–12 "!,

�3+./',/3/&&%@ 3!?"�('I ',!A!&- 1 (�)II ',!A!&- 4 (�) 3 (�)III ',!A!&- 4 (�)

�!./',/3/&&%@ 3!?"�('I ',!A!&- 1(�) 6 (�)II ',!A!&- 10 (�)III ',!A!&- 7 (�)

�.2D',/3/&&%@ 3!?"�('I ',!A!&- 5 (�)II ',!A!&- 6 (�)III ',!A!&- 4 (�) 4 (�)

�+( .%*&/ %) ,+$"%5G 1, ��� B+',/ .',3!B+!,'# 2 *!./B!( — 32 (58,2 %). G#."#!4/',- A/-3/(+ . $/"-U%&',.! '"2B+!. (87,3 %) A3/%'D/*%, . ./)3+',! /, 4 */ 12 "!,.

&�_��z�� �����������. �'&/.&G4% (3%,!3%#4% /5!&(% 3!)2"-,+,/. "!B!&%# ��� #.%-"%'-: *"%,!"-&/',- A3/./*%4/@ /A!3+5%%, '/',/#&%! 3!$!&(+ . 3+&&!4 A/'"!/A!3+5%/&&/4 A!-3%/*!, *"%,!"-&/',- &+D/F*!&%# *!,!@ . ',+5%/&+3!, A/(+)+,!"% +&+"%)/. (3/.% % 4/B%, &+"%B%!%"% /,'2,',.%! /$/',3!&%% A%!"/&!?3%,+, + ,+(F! 3!5%*%.+ ���. �+4% A3/.!*!& +&+"%) .GA/"-&!&&GD /A!3+,%.&GD (/33!(5%% ���, (/,/3G! A3!*',+."!&G . ,+$"%5! 2.

+$"%5+ 2

�!,/*G .GA/"&!&&GD /A!3+,%.&GD .4!U+,!"-',. ��� 2 *!,!@

%*G/A!3+,%.&GD.4!U+,!"-',.

�,!A!&- ��� '!1/

I II III IV �$'. %�$'. % �$'. % �$'. % �$'. %

�3!,!3/&!/5%',/',/4%#A/ �/�&2 4 57 3 43 7 100

�3!,!3/&!/5%',/',/4%#A/ �/"%,+&/N�!&*$!,,!32 1 33 2 67 3 100

�&*/'(/A%B!'(+# (/33!(5%#��� 5 20 12 48 8 32 25 100

�&*/'(/A%B!'(+# (/33!(5%#��� A/ A3!*"/F!&&/42 'A/'/-$2

2 10 3 15 9 45 6 30 20 100

215

�) A3!*',+."!&&/@ ,+$"%5G .%*&/, B,/ . /'&/.&/4 ,3+*%5%/&&G! /A!3+5%% A3/./*%"%'-A3% II % III ',!A!&%, (/1*+ �&*/'(/A%B!'(/! 2',3+&!&%! $G"/ A3%4!&!&/ 2 7 *!,!@ ' I ',!A!&-����, B,/ 1/./3%, / ./)4/F&/',% A3%4!&!&%% A/'"!*&!1/ 4!,/*+ 2F! &+ 3+&&%D ',+*%#D )+$/"!-.+&%#.

�!,3/'A!(,%.&/! % A3/'A!(,%.&/! %)2B!&%! '3+.&%,!"-&GD 3!)2"-,+,/. (/33!(5%% ��� A/-(+)+"/, B,/ *"%,!"-&/',- ,3+*%5%/&&GD /,(3G,GD /A!3+5%% '/',+.%"+ . '3!*&!4 1,5–2 B+'+, + A3%�&*/'(/A%B!'(/@ (/33!(5%% !! *"%,!"-&/',- '/',+.%"+ 20–30 4%&. 3+&&!4 A/'"!/A!3+5%/&&/4A!3%/*! *!,% 1-@ 132AAG +(,%.%)%3/.+"%'- "%U- &+ 7–8-! '2,(% (%)N)+ $/"!./1/ '%4A,/4+ % &+"%-B%# 23!,!3+"-&/1/ % 4/B!./1/ (+,!,!3/.); A/'"! (/33!(5%% 1%*3/1!"!4 *!,% +(,%.%)%3/.+"%'- 2F!&+ 2-! '2,(% A/'"! 2*+"!&%# 4/B!./1/ (+,!,!3+. �/"!./@ '%4A,/4 2 *!,!@ 1-@ 132AAG &+$"�*+"'#*/ 3–4 '2,/(, 2 *!,!@ 2-@ % 3-@ 132AA !1/ ./.'! &! $G"/, *!,% /$!)$/"%.+"%'- /*&/(3+,&/ A/'"!.G.!*!&%# %) &+3(/)+. '3!*&!4 $/"-&G! 1-@ 132AAG . &+D/*%"%'- ',+5%/&+3! 10–12 '2,/(, ,/1*+(+( A/'"! �&*/'(/A%B!'(/@ (/33!(5%% *"%,!"-&/',- &+D/F*!&%# . ',+5%/&+3! '/',+."#"+ . '3!*-&!4 4 '2,/(.

"+$/3+,/3&GD +&+"%)+D (4+(3/- % 4%(3/1!4+,23%#) A/'"! ,3+*%5%/&&GD /A!3+5%% A/"&+#'+&+5%# 4/B% */',%1&2,+ . '3!*&!4 &+ 14-! '2,(% A/'"! /A!3+5%%, A/'"! �&*/'(/A%B!'(/@ (/33!(-5%% — &+ 7-! '2,(%.

�!5%*%.G /$/',3!&%# /$',32(,%.&/1/ A%!"/&!?3%,+ . /,*+"!&&/4 A!3%/*! A3+(,%B!'(%@/,4!B+"%'- 2 .'!D *!,!@ A/'"! ,3+*%5%/&&GD /A!3+5%%, A/'"! �&*/'(/A%B!'(/@ (/33!(5%% 2 *!,!@2-@ 132AAG .,/3%B&G@ /$',32(,%.&G@ A%!"/&!?3%, &+$"�*+"'# "%U- 2 3 (12 %) *!,!@. � *!,!@3-@ 132AAG /$',32(,%.&G@ A%!"/&!?3%, &! &+$"�*+"'#. �+ (/&,3/"-&/4 /$'"!*/.+&%% B!3!)6 4!'#5!. 3!5%*%.G ��� A/'"! /A!3+5%% A/ �/�&2 $G"% 2 1 (14 %); A/'"! /A!3+5%% A/ �/"%,+&/-�!+&*$!,,!32 2 1 (33 %); A/'"! �&*/'(/A%B!'(/@ (/33!(5%% . 1-@ 132AA! 2 3 (12 %); 2 3-@ 132AAG$/"-&GD *+F! A3% A3/.!*!&%% (/33!(5%% 2 *!,!@ ' 4-@ ',!A!&-� ��� 3!5%*%./. &! &+$"�*+"/'-.!3%?%5%3/.+&&G@ 3!5%*%., (+( A/'"! ,3+*%5%/&&GD /A!3+5%@ (2 *!,!@) % �&*/'(/A%B!'(/@ (/3-3!(5%% (3 *!,!@) 2',3+&#"% ..!*!&%!4 «�/"%4!3 �%*3/1!"#» A/ A3!*"/F!&&/42 &+4% 'A/'/$2, ,+((+( A3% �,/4 '?/34%3/.+&&G! $/"�'G . �� 4/B!,/B&%(+ % 2 .D/*+ . 2',-# 4/B!,/B&%(+ 2*"%-&#�, % '2F%.+�, A2)G3&G@ /,*!" 4/B!,/B&%(+ A2,!4 '/)*+&%# S-/$3+)&/@ ?/34G, '/)*+.+# +*!(-.+,&G@ +&,%3!?"�('&G@ ("+A+&&G@ 4!D+&%)4.

+(%4 /$3+)/4, 2',3+&!&%! ��� 2 *!,!@ (&!)+.%'%4/ /, ./)3+',+ % ',!A!&%) */"F&/ &+B%-&+,-'# ' �&*/'(/A%B!'(/@ (/33!(5%%, &!/*&/(3+,&/! %'A/"-)/.+&%! *+&&/@ 4+&%A2"#5%% % /,'2,-',.%! �??!(,+ #."#!,'# +$'/"�,&G4 A/(+)+&%!4 ( �&*/'(/A%B!'(/@ (/33!(5%% A/ A3!*"/F!&&/42&+4% 'A/'/$2 %"% A3/.!*!&%� ,3+*%5%/&&/@ /A!3+5%%.

$ ��� :�3+.&%,!"-&G@ +&+"%) 3!)2"-,+,/. /A!3+,%.&GD .4!U+,!"-',. A/(+)+", B,/ (/33!(5%�

��� 2 *!,!@ &!/$D/*%4/ &+B+,- ' �&*/'(/A%B!'(/@ (/33!(5%%.�,(3G,G! ,3+*%5%/&&G! 4!,/*G 23!,3/5%',/&!/',/4%% ,3+.4+,%B&G, + ,+(F! &! ?%)%/"/-

1%B&G. �3% /,'2,',.%% A/"/F%,!"-&/1/ �??!(,+ A/.,/3&G! /A!3+5%% B3!.+,G (3/./,!B!&%!4,32$5/.G4 ',!&/)/4 )/&G /A!3+5%% % *321%4% /'"/F&!&%#4%.

�/33!(5%# ��� ,3+*%5%/&&G4 /A!3+,%.&G4 4!,/*/4 A3/./*%,'# . $/"-U%&',.! '"2B+!.A3% II–III ',!A!&%, ,/1*+ (+( �&*/'(/A%B!'(2� (/33!(5%� 4/F&/ A3/./*%,- % A3% I ',!A!&%.

�!/*&/(3+,&/! %'A/"-)/.+&%! �&*/'(/A%B!'(/@ (/33!(5%% % /,'2,',.%! �??!(,+ /, *+&&/1/.%*+ "!B!&%# #."#!,'# +$'/"�,&G4 A/(+)+&%!4 ( '/)*+&%� +&,%3!?"�('&/1/ ("+A+&&/1/ 4!D+-&%)4+ A2,!4 '/)*+&%# $/"�'/. 1%*3/1!"!4 &+ A3/,%./A/"/F&GD A"/'(/',#D %"% A3/.!*!&%� ,3+-*%5%/&&/@ /A!3+5%%.

�A%'/( "%,!3+,23G:1. �+&%"/.+, L�. "%#&%! �&*/'(/A%B!'(/@ (/33!(5%% 3!?"�('+ &+ ?2&(5%/&+"-&/! '/-

',/#&%! &%F&%D 4/B!.GD A2,!@ / L�. �+&%"/.+, L. �+&%"/. // �!,'(+# D%3231%#. — 2007. —� 2. — �. 20–22.

2. Wong, M.Y. Endoscopikorrecsion. Curr. Opin. Urol. 2008. Jul; 11(4): 367–372.3. Spencer B.A., Wood B.J., Dretler S.P. Helical CT and ureteral colic. Urol. Clin. North. Am.,

2003, Vol. 27, � 5. P. 231–241.

216

;1+�"/x+'&'q41]0"0-!�'&"*++)!&!,"&,!>!x4,0+&!$",+=,"&";!0"w{'J�'&(*'�+�)4��0$',,-J)&!$!!;&"{',+'J

;'q)"&(+!�1'>++

�#0. `������� (���.), +#w. "�������� (���.), q#J. (����� (���.), 0#). &3���� (����.)

�',3+D+&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#�+?!*3+ '!3*!B&/N'/'2*%',/@ D%3231%% ���

�!*!3+"-&G@ 5!&,3 '!3*!B&/N'/'2*%',/@ D%3231%%

�������������������: W��. !��������� (0��. !b��q 1)

*��z. �3+.&%,!"-&G@ +&+"%) �??!(,%.&/',%/A!3+5%@(/3/&+3&/1/ U2&,%3/.+&%# (��) &+3+$/,+��!4 '!3*5! '%'(2'',.!&&G4 (3/.//$3+�!&%!4 (��) $!) (+3*%/A"!1%%.

J����������� . �&+"%) 3!)2"-,+,/. 2 254 /A!3+5%@ (/3/&+3&/1/ U2&,%3/.+&%# $/"--&GD, &+D/*%.U%D'# &+ "!B!&%% . ����� 1. �',3+D+&% �� A3!"# 2009 1. A/ %�&- 2011 1. �,+,%-',%B!'(+#/$3+$/,(+ *+&&GD A3/%)./*%"+'- ' A/4/�-� A3/13+44G Microsoft Exel.

&�_��z�� �����������. �� ' �� $!) (+3*%/A"!1%% (��) $G"/ .GA/"&!&/ 2 874 $/"--&GD. �) &%D 42FB%& — 648 (74 %), F!&�%& — 226 (26 %). �3!*&%@ ./)3+', 56,8 1/*+. ��� .+&+4&!)! 2 638 $/"-&GD. � < 35% — 2 122 $/"-&GD. �,!&/(+3*%# III-IV �� — 2 716 $/"-&GD.��� — 2 25 $/"-&GD. �3!*&## A3/*/"F%,!"-&/',- /A!3+5%% — 171 4%&. 3!4# �� — 73 4%&.�+'D/* �3%,3/5%,+3&GD (/4A/&!&,/. (3/.% —45,6 4" /A!3+5%#. �3!$G.+&%! . ',+5%/&+3! A/'"!/A!3+5%% — 8,6 (/@(/¦*&#. �/'A%,+"-&+# "!,+"-&/',- — 7. �'"/F&!&%#: ���� —4, ��� —13,(3/./,!B!&%! —7, &!',+$%"-&/',- 132*%&G —18, ',!3&+"-&+# %&?!(5%# —7. �3%B%&+ '4!3,%:��� — 6, ���� — 1.

q��������. �/3/&+3&/! U2&,%3/.+&%! ' �� $!) (+3*%/A"!1%% #."#!,'# */',+,/B&/ $!)/-A+'&G4 4!,/*/4 "!B!&%# ���. �+)132)(+ '!3*5+ '&%F+!, A/,3!$&/',- 4%/(+3*+ . (%'"/3/*!, B,/A/)./"#!, A3%4!&#,- 3+)"%B&G! 'A/'/$G /'2U!&%# )/&G +&+',/4/)+, + ,+(F! &! "%4%,%32!, D%-3231+ A/ .3!4!&% &+ /'&/.&/4 �,+A! . A/"-)2 2"2BU!&%# (+B!',.+ 3+$/,G. �+&&+# ,!D&/"/1%# 4/-F!, %'A/"-)/.+,-'# D%3231/4 '/ «'3!*&%4%» 4+&2+"-&G4% &+.G(+4%. �'A/"-)/.+&%! �� A3% '/-$"�*!&%% '//,.!,',.2��%D A3/?%"+(,%B!'(%D 4!3 (%&,3+/A!3+5%/&&/! ��� +/3,G) &! /,3+F+!,-'# &+ (/"%B!',.! �4$/"%B!'(%D /'"/F&!&%@. �+&&+# 4!,/*%(+ 4/F!, $G,- 3!(/4!&*/.+&+ *"#A3%4!&!&%# . A/.'!*&!.&/@ A3+(,%(! (+( *"# "!B!&%# $/"-&GD '/ ',+$%"-&G4% ?/34+4% ���, ,+(% A3% /',3/4 (/3/&+3&/4 '%&*3/4!.

(+,"J+)"$+(!$!>!�!�0"$">!��+0"1],-^$!q;4(+0'1'/^+&4&>+%'�)!/+,2')*++J=>)+^0)",'/

++^",0+;+!0+)!&'q+�0',0,!�0+q" 1994–2011 >!(-

"#J. =������ (����.)�3!&$231'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#

�+?!*3+ 1/'A%,+"-&/@ D%3231%%, 23/"/1%%

�������������������: /�?. B����� (��., �. �. �.)

�+ A/'"!*&%! 1/*G /,4!B+�,'# '4!&+ ("�B!.GD ./)$2*%,!"!@ 1&/@&GD )+$/"!.+&%@ 4#1(%D,(+&!@ % %)4!&!&%! %D B2.',.%,!"-&/',% ( ,3+*%5%/&&/ A3%4!&#!4G4 +&,%$%/,%(+4.

�!B!&%! 1/'A%,+"-&/@ D%3231%B!'(/@ %&?!(5%% A3!*',+."#!, /A3!*!"!&&2� '"/F&/',-.'"!*',.%! A/.GU!&&/@ +13!''%.&/',% $/"-&%B&GD U,+44/. % %D .G3+F!&&/@ +&,%$%/,%(/3!)%-',!&,&/',%, % A/,/42 ,3!$2!, (/4A"!('&/1/ A/*D/*+, '/',+."#��%4% (/,/3/1/ #."#�,'#:

• �A!3+,%.&/! "!B!&%!• �3!&%3/.+&%! % "+.+F /B+1+• �&,%$+(,!3%+"-&+# ,!3+A%#• �442&/4/*2"%32��+# ,!3+A%#• �!)%&,/('%(+5%/&&+# ,!3+A%#• �2,3%,%.&+# A/**!3F(+• �/&,3/"- 1"%(!4%%• �!'A%3+,/3&+# A/**!3F(+

217

• �3/?%"+(,%(+ ',3!''N#).• �!4/*%&+4%B!'(+# A/**!3F(+• �%4A,/4+,%B!'(/! "!B!&%! &+U!4 %''"!*/.+&%% 4G 2*!"%"% /'&/.&/! .&%4+&%! ("�B!./42 (/4A/&!&,2 "!B!&%#

1/'A%,+"-&/@ D%3231%B!'(/@ %&?!(5%% 4#1(%D ,(+&!@ — +&,%$+(,!3%+"-&/@ ,!3+A%%.�/,/42 5!"-� &+U!1/ %''"!*/.+&%# #.%"+'- /5!&(+ *%&+4%(% .%*/./1/ '/',+.+ ./)$2*%,!-

"!@ &/)/(/4%+"-&/@ D%3231%B!'(/@ %&?!(5%% 4#1(%D ,(+&!@ % %D B2.',.%,!"-&/',% ( +&,%$%/,%-(+4 )+ A!3%/* ' 1994 A/ 2011 1/*G.

�+4% $G" A3/%).!*!& +&+"%) 3!)2"-,+,/. $+(,!3%/"/1%B!'(/1/ /$'"!*/.+&%# 2 794 $/"-&GD,,!B!&%! )+$/"!.+&%# 2 (/,/3GD /'"/F&%"/'- 3+).%,%!4 1&/@&/N./'A+"%,!"-&GD /'"/F&!&%@.

%*/./@ '/',+. 1/'A%,+"-&GD ./)$2*%,!"!@ $G" A3!*',+."!&: ',+?%"/(/((+4% — A3!%42-�!',.!&&/ (/+12"+)/A/)%,%.&G4% (34 %), �&,!3/$+(,!3%#4% (30 %), �&,!3/(/((+4% (15 %), (/+12-"+)/&!1+,%.&G4% ',+?%"/(/((+4% (6 %), ',3!A,/(/((+4% (5 %) % A'!.*/4/&+*+4% (10 %).

�3% +&+"%)! B+',/,G .G#."!&%# 3+)"%B&GD ./)$2*%,!"!@ A/ 1/*+4 .G#."!&/ A/.GU!&%!�,%/"/1%B!'(/@ 3/"% (/+12"+)/A/)%,%.&GD ',+?%"/(/((/. — ' 29,2 % */ 44,1 %. �+',/,+ .G*!"!-&%# ',3!A,/(/((/., (/+12"+)/&!1+,%.&GD ',+?%"/(/((/. % A'!.*/4/&+* '2�!',.!&&/ &! 4!&#"+'-.�,4!B!&+ ,!&*!&5%# ( '&%F!&%� B+',/,G .G*!"!&%# �&,!3/$+(,!3%@ — ' 42,9 % */ 23,3 %¥. 2005 1.) % *+"-&!@U%4 A/.GU!&%!4 */ 31,7% (. 2011 1.). �+('%4+"-&+# B+',/,+ .G#."!&%# �&-,!3/(/((/. $G"+ .G#."!&+ . 1997 1. — 25,1%, (/,/3+# . *+"-&!@U!4 '&%)%"+'- */ 10,6 % (2010 1.).

218

�/B!,'# /,4!,%,- /'/$!&&/',% *%&+4%(% )+3+F+!4/',% &/)/(/4%+"-&G4% ./)$2*%,!"#4%.��! 10–15 "!, &+)+* ,3% B!,.!3,% '"2B+!. 1/'A%,+"-&/@ D%3231%B!'(/@ %&?!(5%% 4#1(%D ,(+&!@$G"% .G).+&G �&,!3/$+(,!3%#4%, % 4!&!! A/"/.%&G '"2B+!. — ',+?%"/(/((+4%, A3!%42�!',.!&-&/ (/+12"+)/A/)%,%.&G4%. 2000–2005 1/*+D �,%/"/1%B!'(+# 3/"- ',+?%"/(/((/. % �&,!3/$+(,!-3%@ $G"+ /,&/'%,!"-&/ 3+.&/5!&&/@. A/'"!*&%! 1/*G .!*2�+# 3/"- . �,%/"/1%% &/)/(/4%+"--&GD %&?!(5%@ A3%&+*"!F%, (/+12"+)/A/)%,%.&G4 ',+?%"/(/((+4 — ,3% B!,.!3,% '"2B+!., % .4!&-U!@ ',!A!&% �&,!3/(/((+4 — /(/"/ A/"/.%&G .'!D '"2B+!. 1/'A%,+"-&/@ D%3231%B!'(/@ %&-?!(5%% 4#1(%D ,(+&!@.

�'&/.&G! %)4!&!&%# +&,%$%/,%(/3!)%',!&,&/',% &/)/(/4%+"-&GD ./)$2*%,!"!@, .G*!"!&-&GD ' 1994 1. A/ 2011 1., )+("�B+"%'- . A/.GU!&%% 23/.&# 3!)%',!&,&/',% ',+?%"/(/((/. ( /('+-5%""%&2 (' 28 % */ 62 %) % 1!&,+4%5%&2 (' 16 % */ 36 %). �!)%',!&,&/',- 1/'A%,+"-&GD �&,!3/-$+(,!3%@, '.#)+&&+# ' A3/*2(5%!@ $!,+N"+(,+4+) 3+'U%3!&&/1/ 'A!(,3+, )+ 2005–2011 11. 2.!"%B%-"+'- ' 13 % */ 28 %. '! 1/'A%,+"-&G! A'!.*/4/&+*G $G"% A/"%+&,%$%/,%(/3!)%',!&,&G.

4!',! ' ,!4 '/D3+&#!,'# .G'/(%@ 23/.!&- B2.',.%,!"-&/',% .'!D ./)$2*%,!"!@ ( '/.3!-4!&&G4 132AA+4 +&,%4%(3/$&GD A3!A+3+,/.: ?,/3D%&/"/&+4 (/, 80 */ 96 %), 4+(3/"%*+4 (74–87 %), (+3$+A!&!4+4 (100 %). �+ A!3%/* ' 1994 A/ 2011 1/*G &! $G"/ .G#."!&/ &% /*&/1/ .&!-$/"-&%B&/1/ %"% 1/'A%,+"-&/1/ .+&(/4%5%&3!)%',!&,&/1/ ',+?%"/(/((+.

����� ������

����� ������

����� ������

������������

������������

������������

��������!

��������!

0% 20% 40% 60% 80% 100%

"��������!

#���� �!

$������ �!

��������

�+ /'&/.+&%% A/"2B!&&GD *+&&GD $G"% '*!"+&G '"!*2��%! .G./*G:� A/'"!*&%! 1/*G /,4!B+!,'# 2.!"%B!&%! B+',/,G .G*!"!&%# 1/'A%,+"-&GD ',+?%"/(/(-

(/., %4!!,'# ,!&*!&5%# ( '&%F!&%� B+',/,G .G*!"!&%# �&,!3/$+(,!3%@. �+',/,+ .G*!"!&%# $/"--&%B&GD U,+44/. ',3!A,/(/((/., �&,!3/(/((/. % A'!.*/4/&+* '2�!',.!&&/ &! 4!&#!,'#.

��',/@B%./',- 1/'A%,+"-&/@ ?"/3G ( ,3+*%5%/&&/ A3%4!&#!4G4 132AA+4 +&,%$%/,%(/.)&+B%,!"-&/ 2.!"%B%"+'-.

�G#."!& .G'/(%@ 23/.!&- ./'A3%%4B%./',% &/)/(/4%+"-&/@ ?"/3G ( '/.3!4!&&G4 132A-A+4 +&,%$+(,!3%+"-&GD A3!A+3+,/..

�!)2"-,+,G A3/.!*!&&/1/ &+4% 4%(3/$%/"/1%B!'(/1/ 4/&%,/3%&1+ A/4/12, /A,%4%)%3/.+,-A3/.!*!&%! +&,%$+(,!3%+"-&/@ ,!3+A%% % 2"2BU%,- 3!)2"-,+,G "!B!&%# $/"-&GD D%3231%B!'(/@%&?!(5%!@ 4#1(%D ,(+&!@.

�"# A3/.!*!&%# ',+3,/./@ �4A%3%B!'(/@ +&,%$+(,!3%+"-&/@ ,!3+A%% A3% 1/'A%,+"-&GD %&-?!(5%#D 4#1(%D ,(+&!@ 4G 3!(/4!&*2!4 ?,/3D%&/"/&G, 4+(3/"%*G %"% (+3$+A!&!4G.

�A%'/( "%,!3+,23G:1. �'/$!&&/',% D%3231%B!'(/@ %&?!(5%% 4#1(%D ,(+&!@ / �+*!!. �L�., �!3&/.+ �L�., �%31%-

)/.+ �L�., �2D+3%& �L. // �%3231%#. — 2001.— � 7. — �. 42–44.

219

2. �+*!!., �L�. �!(/,/3G! �,%/"/1%B!'(%! +'A!(,G D%3231%B!'(/@ %&?!(5%% 4#1(%D ,(+&!@/ �+*!!. �L�. // �&&+"G ,3+.4+,/"/1%% % /3,/A!*%%. — 2001. — � 2. — �. 61–63.

3. �+*!!., �L�. �,%/A+,/1!&!,%B!'(%! /'/$!&&/',% D%3231%B!'(/@ %&?!(5%% 4#1(%D ,(+&!@/ �+*!!. �L�., /"(/. �L., �!4%& �L�. // !3,%(+"-: �3!&$231'(%@ &+2B&G@ .!',&%(. — 2001. —� 2. — �. 30.

4. �+*!!., �L�. �'/$!&&/',% �4A%3%B!'(/@ �,%/,3/A&/@ ,!3+A%% D%3231%B!'(/@ %&?!(5%%4#1(%D ,(+&!@ / �+*!!. �L�., +3+'!&(/ L�., �,+*&%(/. �L�. // !)%'G V �/''%@'(/@ (/&?. «�/-.3!4!&&G! A3/$"!4G +&,%4%(3/$&/@ D%4%/,!3+A%%». — �/'(.+, 2003. — �. 41.

5. �4A%3%B!'(+# +&,%$+(,!3%+"-&+# ,!3+A%# . "!B!&%% D%3231%B!'(/@ %&?!(5%% 4#1(%D,(+&!@ / �+*!!. �L�., +3+'!&(/ L�., �,3!"-5/. �L�., �!"/("/(/. �L., /"(/. �L., �!4%& �L�.// �$. ,32*/. IV &+2B&/NA3+(,%B!'(/@ (/&?. .3+B!@ �3%./"F'(/N�3+"-'(/1/ ./!&&/1/ /(321+ «�(-,2+"-&G! ./A3/'G ./!&&/@ % A3+(,%B!'(/@ 4!*%5%&G». — �3!&$231, 2003. — �. 305–306.

�')*+= 4. +,,!$"*++$!�'&"0+$,!/0'^,+)'

ORTHONYXIA AND �RYOSURGERY — NEW METHODSOF TREATMENT INGROWN TOENAIL

I.V. Gor

Chelyabinsk state medical academyDepartment of topographic anatomy and operative surgery

Scientific adviser: M.V. Shirobokova (ass.)

Actuality. Ingrown toenail is one of the frequent causes of surgical intervention in the ambulatoryconditions (0,5–10 % in the structure of ambulatory surgical aid). It’s possible to count 3–10 % amongprimary out - patients, this index doesn’t depend on social status. Treatment ingrown toenail bringsdura-tion incapacity for work (sick list is written for 15–18 days) (1, 6).

Ethiology.Ingrown toenail is pathologic complex, it’s conditioned by a number of reasons, mani-festing a set of morphological and functional changing of nails toes, matrices and soft tissues. Clinicalresearchers confirm that ingrown toenails came across with female more often than with mail (coefficientreaches 1,4). Besides the cosmetic and emotional disorders, ingrown toenail accompanied distinct painsyndrome, long — term inflammation in the ingrowth nail plate, infection and sluggish suppuration,changing the axis of walking up right. Subsequently often have pains and strains of joints. There’re warpsin some cases, developing near the nail plate, keratomas, hemangiomas and other neoplasms (1, 2, 3).

Ingrowing of the lateral or medial edge initially causes bolster finger in the form of redness, somenail fold’s swilling, moderate pain wnen walking (I degree of damage). Subsequently, increases redness,edema and infiltration of nail fold, ulceration starts to develop of purulent inflammation (II degree ofdamage). Appearance of pyogenic granulema suggests III degree of damage (2).

There’s not consensus about the ethiology and pathogenesis of this condition. According to mostauthors’ opinion, the main cause ingrowing of toenails is infringement of their normal growth and ana-tomic disproportion between nail plate, nail fold and nail bed.

Additional factors are fatigue, static and dynamic overloads, wearing tight shoes, violation offood hygiene and improper cutting the nail plate (angle briefly clipped nail begins to put pressure onthe base of nail fold, soft tissues begin to sag, hung on the nail plate, but no opposite (in a number ofrecent papers reported that the nail plate doesn’t grow in the width, therefore plane can’t ingrow in thefold itself (1, 6, 7).

Purpose: Estimate the literature the effectiveness of two modern methods of treatment ingrowntoenail — Orthonyxia and Cryosurgery.

Materialsand results.Ingrown toenail is treated orthopedic, conservative, and surgical methods. Thehistory of the surgical method starts with the removal operation of ingrown toenail, G. Duputren proposedin 1847. This method is still being performed very often, operation is very traumatic. The nail regrowthonly in 5 months, support function of the foot is all the while inadequate. The main disadvantage of the

220

Duputren operation- frequent relapses (70–90 %). Also known the marginal resection operation the num-ber of relapses reaches 60 %.

Orthonyxia is considered prospective treatment option (it’s kind of conservative method). It’s usedfrom the middle of the last century, when it became a need for integrating interdisciplinary approach tosolve the problem of ingrown toenail.

J. Harrer and collaborators compared results of orthonyxia and surgical treatment for ingrown toe-nails. In the group of patients in which treatment was used orthonyxia was less pronounced pain syn-drome. Patients had begun to wear ordinary shoes, didn’t miss work time, whereas in the surgical inter-vention’s group patients last in average of 14,7 work days. The authors conclude that orthonyxia with aspecial staples is a cost effective alternative to the surgical method.

On the base of nail health center under the auspices of the National Alliance of dermatologists andcosmetologists was examined the effectiveness of a combination of orthonyxia and outdoor antibiotictherapy (baneotsin was used as a medicament. It contains two antibacterial components — bacitracin andneomycin). During the research all the patients were divided into 2 groups. The first group received as anantibacterial external treatment 3 times a day (n = 20). The second group used a powder of baneotsin(n = 10). Clinical effectiveness of the proposed method amounted to 95 % in the first group and 90 % inthe second one. Complete recovery was observed in 28 of 30 patients.

As a result of orthonyxia the following transformations are observed:- Changing the shape of nail and nail bed — they become more feat.- Constant decompression of nail fold is achieved by staples, with an insignificant change in the

form of nail.- Lateral fold becomes suspectible to the use of medicines, its blood becomes supply improves,

which promotes regeneration and wound healing in this area.Wire staples, plastic and metal plates are used for the orthonyxia. They’re fixed to the edge of nail

plate. The concept of the lever and the elastic force underlies the correction effect. The staples is fixedwith a special glue, that creates a firm connection effect, so the loss staple is very rare. Due to constantelastic force, nail is lifted at the edges. Stretching should be balanced and moderate, on the one hand toensure the effective discharge of the lateral folder, and the other hand avoid damage of the nail plate,when it’s separated from the skin. To keep an uniform tensile force, clip is removed and put in every 6–7weeks, producing its «activation».

Among the new treatment methods of ingrown toenail cryosurgery released special features. It’sstudied and implementation in practice has been going on 50 years.

On the base of clinic � 1 in Kirov cryotherapy was used in 17 patients with complicated forms ofingrown toenail. First group included 10 patients with acute inflammation as a felon (II degree). Secondgroup included 7 patients with inflammatory granulation (III degree). The first group used single cryothe-rapy with exposure of 30–45 seconds to reach the freezing depth of 1,5–2 mm of tissue in the area of in-flammation. In the second group the exposure depended on the square of tissue. In all cases, treatmentwas achieved positive clinical effect, a full recovery and a reduction in the average time up to 10, 1 daysof disability (in traditional methods of treatment 12 days).

O.M. Anesoglyan investigated the effectiveness of the method of cryosurgery in 82 patients. As aresult, a simple ingrown toenail without complications, 22 patients after cryodestruction all frozen tissueis rejected by the 20th day. In patients with severe purulent inflammation (26 people) and the rejection ofhealing cryonecrosis held a little longer - up to 30 days, as used deeper cryotherapy. 34 patients with in-grown toenails complicated by chronic inflammation and other complications in 5 of the patients in thisgroup dealt with the fingertip amputation due to recurrence of hemangioma folder. Cryonecrosis’ rejec-tion after cryodestruction tumor pathological tissue nail folder occurred at 30–45 day. Total recurrent in-grown nail was observed in two patients operated by cryosurgery. All of them were stated in the first yearafter cryodestruction.Relapses occurred in connection with the underestimation of the depth of pathologi-cal changes and exercise is not enough intensive cryodestruction. In 4 patients, immediately after thaw-ing, freezing zone swabs were taken for bacteriological seeding. In all cases, the colony-forming organ-isms in smears weren’tfound.

T.R. Sonnex and R.P.R. Dawber studied 44 patients with ingrown toenails, which were treated withcryosurgery. As a result, 28 patients (63,6 %), there was a full recovery without relapse.

At the moment, the cryosurgical treatment ingrown nail have a lot of modifications, depending onthe severity of the disease. But the principle of the method does not change the same. Deep freeze localpathological tissues using special tools as a refrigerant liquid nitrogen with a temperature minus 196'Scauses gradual necrosis, detachment from the whole body on a clear demarcation line, drying it, and

221

mummification of the growth of new epithelium under cryonecrosis and spontaneous rejection ruinedcold tissue volume in 1–3 weeks, depending on its size. Cryosurgery is called the most physiological andgentle way to eliminate pathological tissues. Insensitive to cryodestruction of biological tissues and mi-croorganisms exist. Cryosurgical impact relatively painless, often it does not involve a violation of theintegrity of the covers, not only without bloodshed, but also has a hemostatic effect.

Conclusions: 1) In the treatment by surgery is not enough to remove the nail plate or part withoutroot and matrix, as well as the soft tissues of the lateral shift relative to the folder ingrowing nail edge. 2)Both methods - Cryosurgery and Orthonyxia meet modern requirements of Orthopaedic surgery (minimaltrauma, minimally invasive, short treatment time, no recurrence, satisfactory cosmetic results).

TRANSPHARYNGEAL ACCESS TO THYROID AND PARATHYROID GLANDSAND ORIGINAL DEVICE FOR ITS REALIZATION

A.A. Smirnov (postgraduate), S.U. Mandjaeva (stud.)

The Northwestern I.I. Mechnikov state medical universityThe department of topographic anatomy and operative surgery

Scientific adviser: E.M. Trunin (head of the dep., prof.)

Relevance.Recent years, surgery has been developed being based on the principle of maximumpossible reduction of invasiveness. So, less traumatic minimally invasive accesses are gradually replacingtraditional accesses. Such type of accesses significantly reduce surgical trauma and blood loss, facilitatethe postoperative period, shorten hospital stay, minimize pain and emotional distress, and therefore therisk of stress, which causes cardiovascular disease decompensation in somatic burdened patients. Allthese factors will undoubtedly improve health outcomes and quality of life of these patients. An importantfactor is a good cosmetic result, which is the maximum possible reduction of the scar size, or even ab-sence of the scar at all in the skin [1, 2]. This is often a deciding factor while selecting the type of accessfor patients, whose appearance determines their professional competence.

This transpharingeal access to the thyroid and parathyroid glands was developed to minimize thecosmetic defect and operative trauma [3].

The absence of an anatomically closed cavity in the neck makes it difficult to form an operativespace needed for transluminal interventions by gas insufflation, as fascial sheath impedes significant ex-pansibility of the tissues.Gas insufflation can sometimes cause massive subcutaneous emphysema of theneck and mediastinum, that can lead to compression of the large vessels and airways, circulatory prob-lems, and hypoxia. Therefore, for proposed access a mechanical lift method using the original device foroperational space creation was invented (Fig. 2) [3].

The purpose of the study.Creation of the minimally invasive transpharyngeal access to the thyroidand parathyroid glands, and its complex anatomical and surgical evaluation.

Description of the surgical intervention.A flexible endoscope with working part diameter 5 mm andhaving the instrument channel is introduced into pharyngeal cavity through the mouth. Then 5cm abovethe pharyngoesophageal narrowing a 5 mm long incision is performed in the posterior-lateral wall of thepharynx using electrosurgical knife introduced through the instrument channel of the endoscope. Thenthrough this 5 mm opening the device for the operational space creation is introduced in the lateral peri-pharyngeal space. Device for the operational space creation consists of hinged shoulders and levers sys-tem, which are the edges of the triangular prism formed by opening up the device (Fig. 1a). Then maxi-mum possible disclosure of the device is performed (Fig. 1b), that makes it possible to create an operativespace bounded laterally by posterior-medial surface of the thyroid gland lobe, medially by the pharynxand behind by prevertebral layer of the cervical fascia proper and the deep neck muscles placed under thisfascia. After that, the proximal part of the device is disconnected and removed from the pharynx and flex-ible endoscope is introduced into the operational space created (Fig. 1c).

222

Figure 1. Principal stages of the transpharyngeal access to the thyroid and parathyroid glands (a — inser-tion of the folded device for operational space creation into lateral peripharyngeal space; b — device isopened and operational space is created; c - a flexible endoscope is introduced into the operational spaceand operative actions on the thyroid and parathyroid glands are performed)

Having performed the necessary operating activities, device for operational space creation is foldedand removed from the pharynx. The defect of the pharyngeal wall is closed with instruments introducedthrough the instrumental channel of the endoscope.

Materials and methods.Topographic-anatomic study was conducted on 55 corpses of both sexes(men — 31, women — 24), age varied from 29 to 85 years.

Anatomical objects were divided into three groups according to the standard features of the neck.The first group included the bodies with short thick neck type, and the second with a middle intermediatetype of neck and a third type with a long thin neck. While determining the constitutional type of the neckthe technique of anthropometric measuring of the neck designed by Y.V. Maleev was used [4, 5].

After Kocher collar incision superior and inferior thyroid arteries are identified, recurrent laryngealnerve, parathyroid glands, are marked with dark ligature. Then Kocher access is sutured.

Then transpharyngeal access is performed. The device for the operational space creation is insertedinto the lateral peripharyngeal space down and its maximum opening is produced.

For qualitative evaluation of the proposed access, an endoscope was used to visualize previouslymarked anatomical structures.

Figure 3. The distal part of the endoscope goes out of the incision in the lateral peripharyngeal space(1 — left lobe of the thyroid gland is moved medially and downwards, 2 — the distal part of the flexibleendoscope, 3 — larynx, 4 — sternohyoid muscle)

Figure 2. Device for operational spacecreation in the middle phase of its dis-closure (1 — front radial shoulder,2 — longitudinal shoulder, 3 — lever,4 — frame of the device)

223

To assess adapted criteria of the minimally invasive surgical approaches in patients with varioustypes of constitutional neck [6] the following quantifying criteria of operational access assessment weremeasured: wound depth, the endoscopic angle of operational action (EAOA), that was assessed in twoways: as the angle between two lines formed by the opening in pharyngeal wall and two extreme points ofaccessibility zone (Ò1), and the angle between the extreme positions of the distal part of a flexible endos-cope (Ò2); observation axis, disclosure degree of device for operational space creation, and the criteriathat are directly related to it: the volume of operational space (VOS) and accessibility zone (AZ).

Results.The estimation of this criteria studied showed that for a short thick type of the neck EAOAÒ1 has a minimum value, while it has the maximum value of EAOA Ò2, on the contrary, long thin necktype has a maximum value of EAOA Ò1 and minimal value of EAOA Ò2. In middle intermediate type ofthe neck EAOA Ò1 and EAOA Ò2 values are in the middle value in a specified range (Fig. 4). In any typeof neck EAOA value is sufficient for operating activities using a flexible endoscope.

BETA1 ������BETA2 ������

&�� '��

25

35

45

55

65

75

85

"������(��� ��!( ������)��*!( + �!(�����(

BETA1 � ���BETA2 � ���

&�� '��

25

35

45

55

65

75

85

"������(��� ��!( ������)��*!( + �!(�����(

Figure 4. Dependence of the EAOA Ò1 andEAOA Ò2 values (right and left sides) of the constitutionaltype neck (in degrees)

224

--��������--��� ���

&�� '��

14,5

15,5

16,5

17,5

18,5

19,5

20,5

"������(��� ��!( ������)��*!( + �!(�����(

Figure 5. Dependence of VOS (cub. cm) on constitutional type of the neck.

Assessment of the volume of operational space has shown that for any type of neck VOS wasenough for manipulation performing (Fig. 5).

Thus, the developed method of operation through transpharyngeal access makes it possible toper-form operational actions on the thyroid and parathyroid glands using a flexible endoscope within any typeof the neck.

Conclusions.1. Transpharyngeal access to the thyroid and parathyroid glands using a device for operational

space creationand a flexible endoscope, creates sufficient conditions for the surgical procedures for anytype of the neck.

2. This access allows good visualization of the most important anatomic structures of the anteriorneck region with any type of the neck.

3. The use of the proposed device for operational space creation of the original design while per-forming the transpharyngeal access does not require carbon dioxide insufflation, that makes it possible toavoid complications associated with it.

4. Transpharyngeal access to the thyroid and parathyroid glands anatomically and surgically possi-ble and cosmetically reasonable.

�A%'/( "%,!3+,23G:1. �2(+&/., �L. �+B+"-&G@ /AG, 4%&%*/',2A&/@ �&*/D%3231%B!'(/@ "/$�(,/4%% �%,/-

.%*&/@ F!"!)G / �L. �2(+&/., �L�. �2(+&/. // �&*/'(/A%B!'(+# D%3231%#. — 1999. — � 2. —�. 72.

2. �2(+&/., �L. �&*/D%3231%# �%,/.%*&/@ F!"!)G %) 4%&%*/',2A+ / �L. �2(+&/.,�L�. �2(+&/. // �&*/'(/A%B!'(+# D%3231%#. — 2001. — � 4. — �. 21–23.

3. �!U!&%! / .G*+B! A+,!&,+ � 2011139072 /, 06.08.2012 «�A/'/$ /A!3+5%% &+ /31+&+D U!%% 2',3/@',./ *"# '/)*+&%# /A!3+5%/&&/1/ A3/',3+&',.+ A3% !1/ /'2�!',."!&%%». �.,/3G:�L�. 32&%&, �L�. �4%3&/., �L�. �%3(%'.

4. �+"!!., �L. /A/13+?/N+&+,/4%B!'(/! /$/'&/.+&%! /A!3+,%.&GD .4!U+,!"-',. . A!-3!*&!@ /$"+',% U!%: 3+5%/&+"%)+5%# D%3231%B!'(%D A/*D/*/.: +.,/3!?. *%'. … *N3+ 4!*. &+2( /�L. �+"!!.. — /3/&!F, 2010. — 48 '.

5. �+"!!., �L. �%3231%B!'(+# +&+,/4%# �%,/.%*&/@ F!"!)G . '.#)% ' ,%A/.G4% /'/$!&-&/',#4% U!%: +.,/3!?. *%'. … (+&*. 4!*. &+2( / �L. �+"!!.. — /3/&!F, 1999. — 23 '.

6. �32*(/., �L�. �'&/.G 4%&%4+"-&/ %&.+)%.&/@ D%3231%% / �L�. �32*(/.. — �(+,!3%&-$231, 2007. — 58 '.

225

�'&$-/!�-0"40!"&0'&+"1],!/&')!,�0&4)*++;+24&)"*++!�"�&+)"&!0+(,!/`,("&0'&`)0!J++

�#$. +������������� %4. +(+*. �L�. �!U+"(%&+

�!&,3 '/'2*%',/@ % 1%$3%*&/@ D%3231%%

�������������������: ���. !�� ��� ( ���., �. �. �.)

"����z����z. �+3/,%*&+# �&*+3,!3�(,/4%# #."#!,'# '!1/*&# /*&/@ %) &+%$/"!! B+',/ .G-A/"&#!4GD '/'2*%',GD 3!(/&',32(5%@. �,/ /$2'"/."!&/ &! ,/"-(/ $/"-U/@ B+',/,/@ A/3+F!&%#$%?23(+5%% '/&&/@ +3,!3%%, '/',+."#��!@ 65–70 % .'!D /(("�)%32��%D A/3+F!&%@ .!,.!@ *21%+/3,G, &/ % .G'/(/@ �??!(,%.&/',-� (+3/,%*&/@ �&*+3,!3�(,/4%% . (/33!(5%% 4/)1/./1/ (3/./-,/(+, A3!*/,.3+�!&%% 5%3(2"#,/3&GD 3+'',3/@',. % 3+).%,%# /',3GD &+32U!&%@ 4/)1/./1/ (3/-.//$3+�!&%# [1, 2, 3, 4, 5, 6, 7, 8, 9].

3!)2"-,+,! %''"!*/.+&%# ACAS $G"/ 2',+&/."!&/, B,/ (+3/,%*&+# �&*+3,!3�(,/4%# A/(+)+-&+ 2 $/"-&GD ' +'%4A,/4&G4% ',!&/)+4% $/"!! 60 % .&2,3!&&!@ '/&&/@ +3,!3%% [10, 11, 12, 13, 14].

�3% +&+"%)! B+',/,G /(("�)%/&&GD A/3+F!&%@ .!,.!@ *21% +/3,G B+�! .'!1/ A/3+F+�,'#$%?23(+5%# /$�!@ '/&&/@ +3,!3%% (���) % A3/('%4+"-&G@ /,*!" .&2,3!&&!@ '/&&/@ +3,!3%%¥��). �+32F&+# '/&&+# +3,!3%# (���) A/3+F+!,'# 3!F!, B!4 .&2,3!&&## '/&&+# +3,!3%# (��).�!4/*%&+4%B!'(% )&+B%4/! A/3+F!&%! ��� A3% /(("�)%% %"% A3!*!"-&/4 ',!&/)! �� .',3!B+-!,'# . 27–53 % '"2B+!..

�/ 4&!&%� 3#*+ +.,/3/., A3% /(("�)%% .&2,3!&&%D '/&&GD +3,!3%@ &+32F&+# '/&&+# +3,!-3%# $!3!, &+ '!$# */ 30 % 4/)1/./1/ (3/./,/(+. /'',+&/."!&%! +*!(.+,&/1/ 4+1%',3+"-&/1/ (3/-./,/(+ A/ ��� A3% !! ',!&/)! %"% /(("�)%% 2 $/"-&GD ' '/'2*%',/N4/)1/./@ &!*/',+,/B&/',-�A3%./*%, ( 2"2BU!&%� (3/./'&+$F!&%# 4/)1+ B!3!) '%',!4&G! +&+',/4/)G, B,/ . './� /B!3!*-A3%./*%, ( '&%F!&%� A3/#."!&%@ &+32U!&%# 4/)1/./1/ (3/.//$3+�!&%# [3, 4].

�+3/,%*&+# �&*+3,!3�(,/4%# (����), .GA/"&#!4+# A/ %).!',&G4 4!,/*%(+4, A3!*A/"+1+!,3!U!&%! *.2D )+*+B:

1) ./'',+&/."!&%! A3/D/*%4/',% +3,!3%% A2,!4 2*+"!&%# $"#U(% %) 2',-# '/&&GD +3,!3%@;2) A3/?%"+(,%(+ 3!',!&/)+ % ,3/4$/)+ . )/&! 3!(/&',32(5%% A2,!4 3+'U%3!&%# 2',-# ��

)+A"+,/@ %) '/$',.!&&GD ,(+&!@ %"% '%&,!,%B!'(%D 4+,!3%+"/. [1, 2, 11, 13]. &+',/#�!! .3!4# %).!',&G *.! /'&/.&G! 4!,/*%(% (+3/,%*&/@ �&*+3,!3�(,/4%%: �.!3'%-

/&&+#, A3% (/,/3/@ $"#U(+ 2*+"#!,'# %) /,'!B!&&/@ /, 2',-# .&2,3!&&!@ '/&&/@ +3,!3%% 4!,/*/4!! .G./3+B%.+&%#. /'',+&/."!&%! A3/'.!,+ +3,!3%% /'2�!',."#!,'# A2,!4 !! A/.,/3&/1/ .U%.+-&%# . A3!F&!! 2',-!. �"+''%B!'(+# �&*+3,!3�(,/4%# .GA/"&#!,'# A2,!4 A3/*/"-&/@ +3,!3%/,/-4%% &+* +,!3/'("!3/,%B!'(/@$"#U(/@'./'',+&/."!&%!4 3+''!B!&&/@ ',!&(%+3,!3%%+2,/- %"%'%&,!,%B!'(/@ )+A"+,/@.

�'&/.&/@ A3/$"!4/@ D%3231%% '/&&GD +3,!3%@ #."#�,'# 3!',!&/)G, (/,/3G!, A/ *+&&G4-3+)"%B&GD +.,/3/., 3+).%.+�,'# 2 0,5–4,9 % . 3+&&!4 A/'"!/A!3+5%/&&/4 A!3%/*! % 2 7,9–29 %$/"-&GD — . /,*!"!&&G! '3/(% &+$"�*!&%# (Hertzer N.P., 1994; Schnyder et al., 2002 % *3.).

�3% �,/4, A/ 4&!&%� /*&%D +.,/3/., &!, */',/.!3&GD /,"%B%@ . B+',/,! 3!',!&/)/. A3% %'-A/"-)/.+&%% 3+)"%B&GD 4!,/*%( (+3/,%*&/@ �&*+3,!3�(,/4%% (�/(3/.'(%@ �L., Katz M.). �321%!/,*+�, A3!*A/B,!&%! �.!3'%/&&/@ 4!,/*%(! /A!3+5%% .'"!*',.%! 4!&-U!1/ B%'"+ 3+&&%D % A/)*-&%D 3!',!&/)/. [15, 16, 17].

&+',/#�!! .3!4# /'&/.&G4 4!,/*/4 "!B!&%# $/"-&GD ' +,!3/'("!3/,%B!'(%4 A/3+F!&%!4'/&&GD +3,!3%@ #."#!,'# (+3/,%*&+# �&*+3,!3�(,/4%#. �'&/.&/@ A3/$"!4/@ D%3231%% '/&&GD+3,!3%@ #."#�,'# 3!',!&/)G. �!(/,/3G! +.,/3G /,*+�, A3!*A/B,!&%! �.!3'%/&&/@ 4!,/*%(! /A!-3+5%% .'"!*',.%! 4!&-U!1/ B%'"+ 3+&&%D % A/)*&%D 3!',!&/)/..

*��z�����������. �)2B%,- ./)4/F&/',- %'A/"-)/.+&%# +2,/+3,!3%+"-&/@ 3!(/&',32(-5%% $%?23(+5%% /$�!@ '/&&/@ +3,!3%% . D%3231%% $3+D%/5!?+"-&GD +3,!3%@ A/ /3%1%&+"-&/@4!,/*%(!.

J����������� . �+4% A3!*"/F!&+ 4!,/*%(+ A"+',%(% '/&&/@ +3,!3%% A/'"! �&*+3,!-3�(,/4%% %) �� A2,!4 +2,/+3,!3%+"-&/@ 3!(/&',32(5%% $%?23(+5%% ���. �3%/3%,!,&+# 'A3+.-(+ � 2011139454 /, 29.09.2011. �+&&G@ 4!,/* /'2�!',."#!,'# '"!*2��%4 /$3+)/4. �/* 4!',&/@A3/./*&%(/./@ +&!',!)%!@ %"% �&*/,3+D!+"-&G4 &+3(/)/4 3+)3!)/4 A/ 4!*%+"-&/@ A/.!3D&/',%-(%.+,!"-&/@ 4GU5G .G*!"#�, $%?23(+5%� /$�!@ '/&&/@ +3,!3%%, .&2,3!&&�� '/&&2� +3,!-3%�, .G*!"#�, &+ %*!&,%B&/4 3+'',/#&%% &+32F&2� '/&&2� +3,!3%� ' 4/$%"%)+5%!@ .!3D&!@

226

�%,/.%*&/@, #)GB&/@, "%5!./@ % )+,G"/B&/@ +3,!3%@. �+3/,%*&G@ 1"/42' /,'!A+3/.G.+�, %'4!�+�, (&%)2 % ()+*% $%?23(+5%% /$�!@ '/&&/@ +3,!3%%. �+32F&2� '/&&2� +3,!3%� /,'!(+�,A/* 21"/445° /, 2',-# ' 2B+',(/4 /$�!@ '/&&/@ +3,!3%%, A/'"! �,/1/ .GA/"&#�, A3/*/"-&2� +3-,!3%/,/4%� A/ A!3!*&!@ 4!*%+"-&/@ A/.!3D&/',% .&2,3!&&!@ '/&&/@ % )+*&!N"+,!3+"-&/@ A/-.!3D&/',% &+32F&/@ '/&&/@ +3,!3%%. �3% �,/4 +3,!3%/,/4%# &+32F&/@ % .&2,3!&&!@ '/&&GD +3-,!3%@ /$3+�!&G *321 ( *3212 . /*&/@ A"/'(/',%. �/* .%)2+"-&G4 (/&,3/"!4 .GA/"&#�, A/'"!*/-.+,!"-&2� �&*+3,!3�(,/4%� %) .&2,3!&&!@ % &+32F&/@ '/&&GD +3,!3%@. �+.!3U+��!! ./'',+-&/."!&%! A3/'.!,+ +3,!3%@ A3/./*#, A2,!4 'U%.+&%#%D ',!&/( *321 ' *321/4 A/ ,%A2 $/( . $/(:4!F*2 .&2,3!&&!@ % &+32F&/@ '/&&G4% +3,!3%#4% &%,-� A/"%A3/A%"!& 6/0 ' *.24# %1"+4%, '/-D3+&## A3% �,/4 5!"/',&/',- .'!D .!,.!@ &+32F&/@ '/&&/@ +3,!3%%. �/. &+B%&+�, ' *%',+"-&/1/(3+# +3,!3%/,/4%B!'(%D /,.!3',%@ .&2,3!&&!@ % &+32F&/@ '/&&/@ +3,!3%@ % )+(+&B%.+�, &+ /$-�!@ '/&&/@ +3,!3%%.

�+4% A3//A!3%3/.+& 21 A+5%!&, ' 42"-,%?/(+"-&G4 +,!3/'("!3/)/4 . ./)3+',! /, 59 */ 80"!, (68 "!,); 42FB%& — 14 (67 %), F!&�%& — 7 (33 %); '3!*&%@ ./)3+', A+5%!&,/. 63 ± 3 1/*+.�3/,#F!&&/',- +,!3/'("!3/,%B!'(/@ $"#U(% . .&2,3!&&!@ '/&&/@ +3,!3%% '/',+."#"+ . '3!*&!4:32 ± 5 44. '!4 A+5%!&,+4 */ /A!3+5%% % A!3!* .GA%'(/@ %) /,*!"!&%# .GA/"&#"% '- 42"-,%'A%-3+"-&+# (/4A-�,!3&+# ,/4/13+?%# ' (/&,3+',%3/.+&%!4 $3+D%/5!?+"-&GD +3,!3%@ % 2"-,3+).2-(/./! *2A"!('&/! '(+&%3/.+&%! ' 5.!,&G4 (+3,%3/.+&%!4 A/ /$�!A3%&#,/@ ',+&*+3,&/@ 4!,/*%-(! ' 5!"-� /5!&(% 3+).%,%# 3!',!&/)/. /A!3%3/.+&&GD +3,!3%@ */ /A!3+5%%, A!3!* .GA%'(/@ %)/,*!"!&%#, + ,+(F! . '3/(% /, 3 4!'. */ 1 1/*+.

&�_��z�� . 3+&&!4 A/'"!/A!3+5%/&&/4 A!3%/*! /'"/F&!&%@ &! &+$"�*+"/'-. �,*+-"!&&G! 3!)2"-,+,G %)2B!&G 2 15 A+5%!&,/. . '3/(% /, 6 4!'. */ 1 1/*+. )/&! .4!U+,!"-',. (+-(%DN"%$/ *!?/34+5%@ (',!&/)/., +&!.3%)4) &! .G#."!&/. �"2B+!. /'"/F&!&%@ %"% 3!5%*%./.'%4A,/4/. 4/)1/./@ &!*/',+,/B&/',% . $+''!@&! 3!(/&',32%3/.+&&/@ +3,!3%% &! *%+1&/',%3/-.+&/.

$ ��� . �3!*"/F!&&G@ 4!,/* A"+',%(% 3+'U%3#!, ./)4/F&/',% +2,/+3,!3%+"-&/@ 3!(/&-',32(5%% A3% �&*+3,!3�(,/4%% %) '/&&GD +3,!3%@ % A/)./"#!, 24!&-U%,- B+',/,2 %'A/"-)/.+&%#3+'U%3#��%D )+A"+, . )/&! /A!3+5%%.

�A%'/( "%,!3+,23G:1. /"/'!.%B, �L�. �,*+"�&&G! 3!)2"-,+,G D%3231%B!'(/1/ "!B!&%# /(("�)%.&/N',!&/,%-

B!'(%D A/3+F!&%@ $3+D%/5!?+"-&GD +3,!3%@ / �L�. /"/'!.%B, L�. �3!4!!., �L�. �!3&/. //�23&. &!.3/"/1%% % A'%D%+,3%% %4. �L�. �/3'+(/.+. — 2003. — GA. 9. — C. 200.

2. �+.3%"!&(/, �L. �"%F+@U%! 3!)2"-,+,G D%3231%B!'(/1/ "!B!&%# *.2',/3/&&%D /(("�-)%/&&/N',!&/,%B!'(%D A/3+F!&%@ '/&&GD +3,!3%@ / �L. �+.3%"!&(/, �L. �2("%&, �L�. �(3G"!.// �&1%/"/1%# % '/'2*%',+# D%3231%#. — 2006. — . 12, � 1. — �. 97–102.

3. �/(%&, �. �. �!(/&',32(,%.&+# D%3231%# '/&&GD +3,!3%@ 2 A+5%!&,/. ',+3U! 70 "!, /�L�. �/(%&, �L�. �"!D%&, �L�. �%3!!. // �&1%/"/1%# % '/'2*%',+# D%3231%#. — 2007. — . 13,� 3. — �. 115–118.

4. Aleksic, N. Changes in internal carotid blood flow after CEA evaluated by transit-time flowme-ter / N. Aleksic, V. Matoussevitch, J. Hecknkamp // European Journal of Vascular and Endovascular sur-gery. — 2006. — Vol. 31, � 1. — P. 14–17.

5. Dahl, T. Data quality of surgery for carotid artery stenosis. Are the national vascular registriesreliable? / T. Dahl, K. Rudjord, M. Altreuther // European Journal of Vascular and Endovascular surgery.— 2006. — Vol. 31, � 4. — P. 381–385.

6. Goldstein, L.B. Comparison and meta-analysis of randomized trials of endarterectomy for symp-tomatic carotid artery stenosis / L.B. Goldstein, V. Hasselblad, D.B. Matchar, D.C. McCrory // J. Neurol-ogy. — 1995. — V. 45. — P. 1965–1970.

7. Halm, E.A. Revisiting the appropriateness of carotid endarterectomy / E.A. Halm, M.R. Chassin,S. Tuhrim, L.H. Hollier, A.J. Popp // Stroke. — 2003. — Vol. 34, � 6. — P. 1464–1471.

8. Hendrikse, J. Effect of carotid endarterectomy on primary collateral blood flow in patients withsevere carotid artery lesions / J. Hendrikse, D.R. Rutgers, C.J. Klijn, B.C. Eikelboom, J. van der Grond //Stroke. — 2003. — Vol. 34, � 4. — P. 1650–1654.

9. Johna, S. Carotid endarterectomy for severe asymptomatic carotid stenosis: a perioperative expe-rience at a community hospital / S. Johna, F. Gaw, R. Berten, J. Miro // J. Surg. — 2000. — Vol. 66,� 11. — P. 1046–1048.

10. �+3$+3+U, �L�. 3+&'A"+&,+5%# +/3,+"-&GD ('!&/("+A+&/. '!3*5+ (("%&%(/N%442&/-"/1%B!'(/! %''"!*/.+&%!): +.,/3!?. *%'. … (+&*. 4!*. &+2( / �L�. �+3$+3+U. — �., 1972. — 18 '.

227

11. Endarterectomy for asymptomatic carotid artery stenosis: Executive Committee for the Asymp-tomatic Carotid Atherosclerosis Study // JAMA. — 1995. — Vol. 273. — P. 1421–1428.

12. Fisher, M. The NASCETACAS plaque project / M. Fisher, A. Martin, �. Cosgrove, J. Norris //Stroke. — 1993. — Vol. 24, � 12. — P. 24–25.

13. Halliday, A.W. The asymptomatic carotid surgery trial (ACST): Rationale an design /A.W. Halliday, D. Thomas, A. Mansfield // Eur. J. Vasc. Surg. — 1994. — Vol. 8. — P. 703–710.

14. Lepore, M.R.J. Influence of NASCET/ACAS trial eligibility on outcome after carotid endarte-rectomy / M.R.J. Lepore, W.C. Sternbergh, K. Salartash, B. Tonnessen, S.R. Money // J. Vasc. Surg. —2001. — Vol. 34, � 4. —P. 581–586.

15. �/(3/.'(%@, �L. �3+.&%,!"-&G@ +&+"%) /,*+"!&&GD 3!)2"-,+,/. (+3/,%*&/@ �&*+3,!-3�(,/4%% . )+.%'%4/',% /, 4!,/*%(% /A!3+5%% / �L. �/(3/.'(%@, �L�. �2&5!.%B, �L�. �!"/#35!.// �&1%/"/1%# % '/'2*%',+# D%3231%#. — 2005. — . 11, � 1. — �. 93–101.

16. Katz, M.M. The use of patch angioplasty to alter the incidence of carotid restenosis followingthrombendarterectomy / M.M. Katz, G.T. Jones, J. Degenhardt // J. Cardiovasc. Surg. — 1987. —Vol. 28, � 2. — P. 2–8.

17. Raithel, D. Carotid eversion endarterectomy a better thehnic then the standart operation? /D. Raithel // J. Cardiovasc. Surg. — 1997. — Vol. 5, � 5. — P. 471–2.

�&"$,+0'1],"=^"&")0'&+�0+)"!0("1',,-^&'q41]0"0!$"1]0'&,"0+$,-^$"&+",0!$`1')0&!)"&(+!�0+J41=*++

�&"$!>!�'14(!%)"$#$. )��3���� (��.), '#�. 1������ (��., �. �. �.)

�/',/.'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ .&2,3!&&%D $/"!)&!@ � 1

�!&,3 (+3*%/"/1%% % '!3*!B&/N'/'2*%',/@ D%3231%%�,*!"!&%! D%3231%B!'(/1/ "!B!&%# '"/F&GD &+32U!&%@ 3%,4+ '!3*5+

% �"!(,3/(+3*%/',%42"#5%%

�������������������: ���. _�������� (0��. ��., ���., �. �. �.)

"����z����z. �/'"! ..!*!&%# . A3+(,%(2 '%',!4 �"!(,3/(+3*%/',%42"#5%% (���) ' %'-A/"-)/.+&%!4 ,3+&'.!&/)&/1/ �"!(,3/*+ . 1959 1. A3%/3%,!,&/@ "/(+"%)+5%!@ %4A"+&,%3/.+&%#��� #."#"+'- .!3D2U(+ A3+./1/ F!"2*/B(+ (��). �"%&%B!'(%! %''"!*/.+&%# CTOPP, DanishStu-dy, DAVID, MOST, A/'.#�!&&G! %)2B!&%� /,*+"!&&GD 3!)2"-,+,/. %4A"+&,%3/.+&%# ��� . /$-"+',- .!3D2U(% ��, A/(+)+"% &!/*&/)&+B&G! 3!)2"-,+,G. � /*&/@ ',/3/&G, ��� .!3D2U(% ��#."#!,'# �??!(,%.&G4 4!,/*/4 )+�%,G /, ("%&%B!'(% )&+B%4GD $3+*%+3%,4%@, ' *321/@, — A3%-./*%, ( 4&/1/B%'"!&&G4 &!1+,%.&G4 A/'"!*',.%#4: �"!(,3%B!'(/@ % 4!D+&%B!'(/@ +'%&D3/&%%"!./1/ F!"2*/B(+ (��), 3!4/*!"%3/.+&%� '!3*5+, '%',/"/N*%+',/"%B!'(/@ *%'?2&(5%% ��,?2&(5%/&+"-&/@ &!*/',+,/B&/',% 4%,3+"-&/1/ ("+A+&+ (��), A/.GU!&%� 3%'(+ 3+).%,%# F%)&!-213/F+��%D &+32U!&%@ 3%,4+ '!3*5+ % *3. [1, 2]. 3!)2"-,+,! %''"!*/.+&%# MOST $G"/ A/(+)+-&/, B,/ *!'%&D3/&%)+5%# F!"2*/B(/., /$2'"/."!&&+# A/',/#&&/@ ��� �� 2 A+5%!&,/. ' ("%&%-B!'(% )&+B%4/@ *%'?2&(5%!@ '%&2'/./1/ 2)"+ % &/34+"-&/@ *"%,!"-&/',-� (/4A"!('+ QRS, A/-.GU+!, 3%'( 1/'A%,+"%)+5%@ A/ A3%B%&! '!3*!B&/@ &!*/',+,/B&/',% % ��, *+F! . '"2B+! '/D3+-&!&%# '%&D3/&&/',% +,3%/.!&,3%(2"#3&/1/ (�) A3/.!*!&%# [3]. �',+&/."!&/, B,/ /,&/'%,!"-&/!A3!%42�!',./ A3!*'!3*&/@ ',%42"#5%% &+* *.2D(+4!3&/@ 2 A+5%!&,/. ' *%'?2&(5%!@ '%&2'/./1/2)"+ /$2'"/."!&/ A/$/B&G4% �??!(,+4% +'%&D3/&&/@ �"!(,3%B!'(/@ +(,%.+5%% �� A/* ./)*!@-',.%!4 ',%42"#5%% .!3D2U(% ��, % 4/F!, $G,- .G3+F!&&G4 . )&+B%,!"-&/ $/"-U!@ ',!A!&% 2A+5%!&,/. '/ '&%F!&&/@ ?2&(5%!@ �� % '!3*!B&/@ &!*/',+,/B&/',-� [4, 5]. A/'"!*&%! 1/*G3+)3+$/,+&/ 4&/F!',./ (/&?%123+5%@ �&*/(+3*%+"-&GD �"!(,3/*/. *"# A3!*/,.3+�!&%# %D *%'-"/(+5%%, + ,+(F! ',+"/ ./)4/F&G4 A3/.!*!&%! ��� *321%D /$"+',!@ '!3*5+ $!)/A+'&G4 'A/'/-$/4 . /,&/U!&%% A/3/1+ ',%42"#5%%, +*!(.+,&/1/ '!&'%&1+ % ./)4/F&/@ A!3?/3+5%% ',!&(% F!-"2*/B(+ [6]. �,%42"%3/.+&%! 4%/(+3*+ F!"2*/B(/. A/ '%',!4! �%' — �23(%&-! .G)G.+!, '%&-D3/&&G! +(,%.+5%� % '/(3+�!&%! F!"2*/B(/. % A3!A#,',.2!, '&%F!&%� ?2&(5%% "!./1/ F!"2-*/B(+ [7]. 2000 1. Deshmukh % '/+.,. A/(+)+"% ./)4/F&/',- A3/.!*!&%# A/',/#&&/@ '!"!(,%.&/@',%42"#5%% A2B(+ �%'+ 2 A+5%!&,/. ' ?%$3%""#5%!@ A3!*'!3*%@ % &/34+"-&/@ *"%,!"-&/',-�(/4A"!('+ QRS % */(+)+"%, B,/ ',%42"#5%# A!3!1/3/*(% A2,!4, $"%)(%4 ( &/34+"-&/@ +(,%.+5%%'%',!4G �%' — �23(%&-! %4!!, A3!%42�!',./ A/ '3+.&!&%� ' +A%(+"-&/@ ��� �� [8, 9].

228

+(%4 /$3+)/4, +(,2+"-&G4 #."#!,'# %)2B!&%! F!"2*/B(/./1/ +'%&D3/&%)4+, . ,/4 B%'"!A3% ��� .!3D2U(% ��, % !1/ A+,/"/1%B!'(/1/ ."%#&%# &+ '/(3+,%,!"-&2� ?2&(5%� 4%/(+3*+./)4/F&/',- A3%4!&!&%# ',%42"#5%% +"-,!3&+,%.&/@ A+3+1%'%+"-&/@ /$"+',% 2 A+5%!&,/. ' 3+)-&/@ ',!A!&-� &+32U!&%@ � A3/./*%4/',% U%3/(/ &! 3+''4+,3%.+"+'- % A/�,/42 #.%"+'- 5!"-�%''"!*/.+&%#.

*��z�����������. �&+"%) A3!%42�!',.+ A/',/#&&/@ +"-,!3&+,%.&/@ ��� . /$"+',% *%'-,+"-&/@ A/35%% A2B(+ �%'+, &+B+"-&/1/ 2B+',(+ '%',!4G �%'+ — �23(%&-! ' ?%)%/"/1%B!'(/@+(,%.+5%!@ F!"2*/B(/. . '3+.&!&%% '+A%(+"-&/@ ���.

J����� � ����� . %''"!*/.+&%! $G"% .("�B!&G53 A+5%!&,+ ' &+32U!&%#4% �-A3/.!*!&%# . ./)3+',! 48–72 "!,, (/,/3G4 A3/.!*!&+ A/',/#&&+# ��� ' A/)%5%/&%3/.+&%!4 �"!(-,3/*+ . �� . +"-,!3&+,%.&GD )/&+D. �+)4!�!&%! �"!(,3/*+ . A+3+1%'%+"-&/@ /$"+',% .GA/"&!&/18 A+5%!&,+4 ' A/',/#&&/@ $3+*%?/34/@ ��, 12 A+5%!&,+4 — ' A/',/#&&/@ ,+D%?/34/@ �� .'/B!,+&%% ' 3+*%/B+',/,&/@ +$"+5%!@ �N'/!*%&!&%#, + ,+(F! 23 $/"-&G4 — ' �N$"/(+*/@ II–II',!A!&%.

�%A/"#3&G! �&*/(+3*%+"-&G! �"!(,3/*G +(,%.&/@ ?%('+5%% (MEDTRONICCAPSUREFIX-NOVUS, BIOTRONIKSELOXSR60, VITATRONCRYSTALLINEACTFIX) ,3+*%5%/&&G4 */',2A/4'"!.+ ../*%"%'- ' A/4/�-� 'A!5%+"-&G4 /$3+)/4 %)/1&2,/1/ ',%"!,+ % */',+."#��!@ '%',!4G.�/* (/&,3/"!4 3!&,1!&/'(/A%% �"!(,3/* A/)%5%/&%3/.+"'# . .G./*&/4 ,3+(,! ��, )+,!4 A3/./-*%"'# */ .!3D&!'!A,+"-&/@ /$"+',%, (/"-5+ ,3%(2'A%*+"-&/1/ ("+A+&+. �"# /5!&(% "/(+"%)+5%%)/&G %&,!3!'+ A3/./*%"/'- ',%42"#5%/&&/! (+3,%3/.+&%! 4&/1/A/"#3&G4 *%+1&/',%B!'(%4 (+-,!,!3/4, (/,/3G@ ../*%"'# B!3!) $!*3!&&2� .!&2 % A/)%5%/&%3/.+"'# 2 *%',+"-&/@ A/35%% A2B(+�%'+ (3%'. 1).

�"# /A3!*!"!&%# /A,%4+"-&/@ ,/B(% A/',/#&&/@ ',%42"#5%% . /$"+',% A2B(+ �%'+ A3/./-*%"+'- .3!4!&&+# 4/&/A/"#3&+# ',%42"#5%# (+4A"%,2*+ %4A2"-'+ 5, A3/*/"F%,!"-&/',-� %4-A2"-'+ 0,5 4'). �3% */',%F!&%% ',+$%"-&/@ ',%42"#5%% F!"2*/B(/. ' 2)(%4 (/4A"!('/4 QRS,A3/%)./*%"+'- ?%('+5%# �"!(,3/*+, 3!1%',3%3/.+"+'- $%A/"#3&+# �&*/(+3*%+"-&+# �"!(,3/13+4-4+ A2B(+ �%'+, %)4!3#"%'- A/3/1 ',%42"#5%%, +4A"%,2*+ )2$5+ R, U%3%&+ (/4A"!('+ QRS % .!"%-B%&+ %&,!3.+"+ St-QRS. �3%,!3%#4% (/&,3/"# 4!',/A/"/F!&%# �"!(,3/*+ '"2F%"%: &+%$/"!! 2)-(%@ QRS (/4A"!(' A3% (/&,3/"-&/@ ',%42"#5%%, B!,(+# $%A/"#3&+# �&*/(+3*%+"-&+# �"!(,3/-13+44+ A2B(+ �%'+, ,%A%B&+# 3!&,1!&/"/1%B!'(+# "/(+"%)+5%# �"!(,3/*+, /',3G@ A/3/1 ',%42"#-5%% ¼ 2,0 A3% *"%,!"-&/',% %4A2"-'+ 0,5 4'. ,!B!&%! .'!1/ .3!4!&% /A3!*!"!&%# /A,%4+"-&/-1/ 4!',/&+D/F*!&%# �"!(,3/*+ A3/./*%"'# 4/&%,/3%&1 ��� . 12 /,.!*!&%#D.

�%'. 1. �%U!&- *"# ?%('+5%% �"!(,3/*+ (*%',+"-&+# A/35%# A2B(+ �%'+, &+B+"-&G@ 2B+',/('%',!4G �%'+ — �23(%&-!).��� %'A/"-)/.+"+'- ' 3!F%4+4%: VVIR, DDD, DDDR, DVI, DDDRLV.

�"# */',%F!&%# A/',+."!&&/@ 5!"% %''"!*/.+&%# .'!4 A+5%!&,+4 A/'"! %4A"+&,+5%% ���B!3!) 6, 12 % 24 4!'#5+ A3/./*%"/'- �D/(+3*%/13+?%B!'(/! %''"!*/.+&%!, ' /A3!*!"!&%!4 � .*%&+4%(!. �"# '3+.&!&%# A/"2B!&&GD 3!)2"-,+,/. A3/./*%"'# +&+"%) *+&&GD (/&,3/"-&/@ 132A-AG, (/,/32� '/',+.%"% 70 A+5%!&,/. ' +A%(+"-&/@ ',%42"#5%!@, . ./)3+',! 46–74 "!,. �/ ("%&%-B!'(%4 D+3+(,!3%',%(+4 $/"-&G! (/&,3/"-&/@ 132AAG */',/.!3&/ &! /,"%B+"%'- /, A+5%!&,/.

229

/'&/.&/@ 132AAG %''"!*/.+&%#. �+'B!, A/(+)+,!"!@ /'2�!',."#"'# A3/13+44&G4 /$!'A!B!&%!4Statistica 6.0.

&�_��z�� . �3% /5!&(! ��� . *%&+4%(! /,4!B+"/'- 2"2BU!&%! 4/3?/"/1%% (/4A"!('+QRS . 132AA! A+5%!&,/. ' +"-,!3&+,%.&/@ ��� A/ '3+.&!&%� ' 132AA/@ +A%(+"-&/@ ���. �%3%-&+ (/4A"!('+ QRS /5!&%.+"+'- A3% )+A%'% ��� &+ '(/3/',% )+A%'% 100 44¦'. �)4!3!&%# A3/./*%-"%'- */ ',%42"#5%% % A3% (+F*/@ A/'"!*/.+,!"-&/',% "/(+"%)+5%% ',%42"#5%%. �3!*&## *"%-,!"-&/',- (/4A"!('+ QRS 3+''B%,G.+"+'- (+( '3!*&%@ A/(+)+,!"- . ,3!D (/4A"!('+D . /,.!*!&%%' &+%$/"!! U%3/(%4 (/4A"!('/4 QRS. �+ .3!4# &+$"�*!&%# A+5%!&,/. A/'"! ��� +"-,!3&+,%.-&/@ A+3+1%'%+"-&/@ /$"+',% '3!*&## A3/*/"F%,!"-&/',- QRS '/',+.%"+ 124 ± 28 4', B,/ $G"/4!&-U! *"%,!"-&/',% QRS A3% +A%(+"-&/@ ��� (168 ± 244') % $/"-U! %'D/*&/1/ QRS(91 ± 33 4'). �/3/1 ',%42"#5%% . +"-,!3&+,%.&/@ /$"+',% 2 .'!D A+5%!&,/. &+D/*%"'# . *%+A+)/&!0,8 ± 0,3 A3% *"%,!"-&/',% %4A2"-'+ 0,5 4', . ,!B!&%! &!*!"% A/'"! %4A"+&,+5%% /',+.+"'# &%)-(%4, B!3!) 6 4!'#5!. . '3!*&!4 /A3!*!"#"'# . *%+A+)/&! 1,0 ± 0,6 . �!3!) 12–24 4!'#5+ . '3!*&!4$G" 0,95 ± 0,5 . �4A!*+&' 5!A% $G" &+ 23/.&! 580 ± 105 �4. �4A"%,2*+ )2$5+ R . �&*/(+3*%+"--&/44/&/A/"#3&/4 /,.!*!&%% $G"+ /A3!*!"+&+ 6,45 4. �3+.&%.+"+'- '/(3+,%,!"-&+# ?2&(5%#�� A3% +A%(+"-&/@ % A+3+1%'%+"-&/@ ���.

�3+.&%,!"-&G@ +&+"%) A/"2B!&&GD *+&&GD �D/(+3*%/13+?%B!'(/1/ %''"!*/.+&%# A/)./"%"2',+&/.%,-, B,/ 4!FF!"2*/B(/.+# )+*!3F(+ . 132AA! A+5%!&,/. ' .GA/"&!&%!4 +A%(+"-&/@ ���$G"+ '2�!',.!&&/ .GU! . '3+.&!&%% ' 132AA/@ $/"-&GD ' +"-,!3&+,%.&/@ ',%42"#5%!@(47,2 ± 19,2 4' % 34,2 ± 18,4 4', '//,.!,',.!&&/). �+)"%B%# A/ A/(+)+,!"#4 ?3+(5%% .G$3/'+ $G"%&!)&+B%,!"-&G4% % '/',+.%"% 50,4 ± 8,2 % A3% +A%(+"-&/@ ��� % 53,1 ± 8,1 % . '"2B+! +"-,!3&+-,%.&/@ /$"+',%. �,!A!&- 4%,3+"-&/@ 3!1231%,+5%% A3% A+3+1%'%+"-&/@ ',%42"#5%% 1,2 ± 0,8 4',B,/ /(+)+"/'- '2�!',.!&&/ &%F! A/(+)+,!"!@ +A%(+"-&/@ ',%42"#5%% (1,9 ± 0,9 4').

$ ��� . '3!*&!/,*+"!&&/4 A!3%/*! A/',/#&&+#��� ' A+3+1%'%+"-&G4 A/)%5%/&%3/.+-&%!4 A3+./F!"2*/B(/./1/ �"!(,3/*+ #."#!,'# A3!*A/B,%,!"-&/@ +"-,!3&+,%./@ +A%(+"-&/@ �"!(-,3/(+3*%/',%42"#5%%. �3% &+$"�*!&%% )+ A+5%!&,+4% . ,!B!&%! 12–24 4!'#5!. 2',+&/."!&/, B,/A/3/1% )+D.+,+ % B2.',.%,!"-&/',% A3% A+3+1%'%+"-&/@% +A%(+"-&/@ �"!(,3/(+3*%/',%42"#5%%A3+./1/ F!"2*/B(+ '/A/',+.%4G. �3% A/',/#&&/@ �"!(,3/(+3*%/',%42"#5%% A+3+1%'%+"-&/@ /$-"+',% */',%F%4G &/34+"-&+# 4/3?/"/1%# (/4A"!('+ QRS ' 24!&-U!&%!4 ',!A!&% 4!FF!"2*/B-(/./@ *%''%&D3/&%%. '! �,/ A/)./"#!, 3+''4+,3%.+,- +"-,!3&+,%.&2� A+3+1%'%+"-&2� /$"+',-(+( A3%/3%,!,&G@ 4!,/* ?%)%/"/1%B!'(/@ ��� 2 A+5%!&,/. ' A3%)&+(+4% '!3*!B&/@ &!*/',+,/B-&/',%, "!./F!"2*/B(/./@ *%'?2&(5% % '/D3+&&G4 .&2,3%F!"2*/B(/.G4 A3/.!*!&%!4 A3% A/(+-)+&%#D ( F!"2*/B(/./@ ���.

�A%'/( "%,!3+,23G:1. Lamas G.A., Lee K.L., Sweeney M.O. et al. MOST Investigators Ventricular pacing or dual

chamber pacing for sinus node dysfunction N Engl J Med 2002; 346: 1854–1862.2. Sharma A.D., Rizo-Patron C., Hallstrom A.P. et al. DAVID Investigators Percent right ventricu-

lar pacing predicts outcomes in the DAVID Trial Heart Rhythm 2005;2:830-834.3. Sweeney M.O., Prinzen F.W. A new paradigm for physiologic ventricular pacing. J Am Coll

Cardiol 2006; 47: 282–288.4. Victor F., Mabo P. et al. A randomized comparison of permanent septal versus apical right ven-

tricular pacing: short-term results. J Cardiovasc Electrophysiol 2006; 17: 238–42.5. De Cock C.C., Giudici M.C., Twisk J. Comparison of the haemodynamic effects of right ventri-

cular outflow-tract pacing with right ventricular apex pacinga quantitative review. Europace 2003; 5:275–278.

6. Yee R., Klein G.J., Krahn A.C., Skanes A.C. Selective site pacing: tools and training. PacingClin Electrophysiol 2004; 27 :894–6.

7. Occhetta E., Bortnik M., Magnani A. et al. Prevention of ventricular desynchronization bypermanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a cros-sover, blinded, randomized study versus apical right ventricular pacing. J Am Coll Cardiol 2006; 47:1938–45.

8. Deshmukh P., Casavant D.A., Romanyshyn M., Anderson K. Permanent, direct His-bundle pac-ing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 2000;101: 869–77.

9. Lu F., Iaizzo P.A. et al. Isolated Atrial Segment Pacing: An Alternative to His Bundle PacingAfter Atrioventricular Junctional Ablation (J Am Coll Cardiol 2007; 49: 1443–9.

230

J!(+2+)"*++��!�!;!$�1"�0+)+�"^!$-^>&-�

�#$. 1������� (����.), (#�. ����������� (����.), 0#;. 0������ (����.)

�3/*&!&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,1-# (+?!*3+ D%3231%B!'(%D $/"!)&!@

�������������������: ��W. #������� (��., . �. �.)

"����z����z. �+32F&+# 13GF+ #."#!,'# /*&%4 %) '+4GD 3+'A3/',3+&!&&GD D%3231%B!-'(%D )+$/"!.+&%@. �/ *+&&G4 4&/1%D +.,/3/., 3–4 % &+'!"!&%# &+U!@ ',3+&G #."#�,'# 13GF!&/-'%,!"#4%, A3%B!4 &+ */"� A+D/.GD % $!*3!&&GD 13GF A3%D/*%,'# */ 85 % [4].

�(,2+"-&/',- A3/$"!4G D%3231%B!'(/1/ "!B!&%# A+D/.GD 13GF 2'212$"#!,'# !�� .G'/(/@B+',/,/@ %D 3!5%*%./.; ,+(, A3% %'A/"-)/.+&%% ("+''%B!'(%D 'A/'/$/. A"+',%(% A3/',GD 13GF 3!-5%*%. &+$"�*+!,'# . 3–15 % '"2B+!. [2] �*&+(/ A3% +2,/A"+',%(! '"/F&GD ?/34, '/',+."#��%D$/"!! 40 % .'!D A+D/.GD 13GF, 3!5%*%.G )+$/"!.+&%# ./)&%(+�, . 45,5–63,7 % &+$"�*!&%@ [1].

�/ A/'"!*&!1/ .3!4!&% 'B%,+"/'-, B,/ A!3.%B&G4% . 132AA! 4!',&GD A3%B%& ?/34%3/.+&%#13GF% #."#�,'# &+"%B%! *!?!(,+ %"% 3+',#F!&%# A/A!3!B&/@ ?+'5%%. &+',/#�!! .3!4#, A/ A/-'"!*&%4 *+&&G4 "%,!3+,23G, 'B%,+!,'#, B,/ A+D/.+# 13GF+ #."#!,'# '"!*',.%!4 &+32U!&%#',32(,23G '/!*%&%,!"-&/@ ,(+&%.

�'&/.&/@ A3%B%&/@ ./)&%(&/.!&%# 3!5%*%./. 13GF #."#!,'# &!*/',+,/B&/! 2(3!A"!&%!)+*&!@ ',!&(% A+D/./1/ (+&+"+. �!5%*%.&G! 13GF% . /'&/.&/4 .',3!B+�,'# A/'"! &+,#F&GD 'A/-'/$/. A"+',%(% (�%3+3+ — �A+'/(2(/5(/1/, �+3,G&/.+). �+%$/"!! B+',/ .',3!B+!,'# &!$/"-U/@*!?!(, . )+*&!@ ',!&(!, B!3!) (/,/3G@ .GD/*%, 13GF!./@ 4!U/(. �!F! .',3!B+!,'# A/"&/! 3+)32-U!&%! )+*&!@ ',!&(%, (/,/3/!, (+( A3+.%"/, '/B!,+!,'# ' 3+)32U!&%!4 %"% '"+$/',-� A+D/./@'.#)(% [3].

�B%,G.+# �,% *+&&G!, 4/F&/ 2,.!3F*+,-, B,/ !*%&',.!&&G4 ./)4/F&G4 4!,/*/4 "!B!&%#13GF #."#!,'# &!&+,#F&+# A"+',%(+, (/,/3+# 'B%,+!,'# A+,/1!&!,%B!'(% /$/'&/.+&&/@.

*��z. �/.!3U!&',./.+&%! '2�!',.2��%D 'A/'/$/. A"+',%(% A+D/.GD 13GF % '&%F!&%! .!-3/#,&/',% 3!5%*%./. % *321%D A/'"!/A!3+5%/&&GD /'"/F&!&%!: A+3!',!)%@, *%)23!,%B!'(%D 3+'-',3/@',., A/"/./@ *%'?2&(5%%, +'!A,%B!'(/1/ A!3%/',%,+ "/$(/./@ (/',%. �+)3+$/,+,- 4/*%?%-(+5%% /A!3+5%@, *+��%! ./)4/F&/',- 4/*!"%3/.+,- 1!3&%/A"+',%(2, . )+.%'%4/',% /, ',32(,23GA3%"!1+��%D ,(+&!@.

J����� ������ �����������. �G" A3/.!*�& +&+"%) "!B!&%# 94 A+5%!&,/. ' A+D/./-4/U/&/B&G4% 13GF+4%, %) &%D 10 ' 3!5%*%.&G4% 13GF+4%, /A!3%3/.+&&GD . A!3%/* ' 2008 A/2010 11., &+D/*%.U%!'# &+ $+)! . �� «1134 � � ��».

'! A+5%!&,G $G"% /A!3%3/.+&G A/* 'A%&+"-&/@ +&!',!)%!@, ,. (. �,/, 'A/'/$ /$!'A!B%.+!,A/"&/5!&&/! /$!)$/"%.+&%! % 3!"+('+5%� 4GU5, A/)./"#!, A3% &!/$D/*%4/',% .GA/"&#,- *.2D-',/3/&&!! .4!U+,!"-',./.

�'&/.&+# B+',- A+5%!&,/. — ' A3/',G4% 13GF+4% — $G"+ A3//A!3%3/.+&+ 4!,/*/4 &!&+-,#F&/@ 1!3&%/A"+',%(% A/ �2"*+@'2 (Shouldice) . '/$',.!&&/@ 4/*%?%(+5%%.

�3!*"+1+!4G@ 'A/'/$ /'2�!',."#!,'# '"!*2��%4 /$3+)/4. +( (+( A/A!3!B&+# ?+'5%# A3%-'2,',./.+"+ ,/"-(/ 2 30 % A+5%!&,/., A3%B�4 $G"+ (3+@&! %',/&B!&+ % 3+)./"/(&!&+, A3%&#,/3!U!&%! /,(+)+,-'# /, !� %'A/"-)/.+&%# . (+B!',.! A"+',%B!'(/1/ 4+,!3%+"+.

�!3.G@ % .,/3/@ 3#*G &!A3!3G.&/1/ U.+ &+("+*G.+�,'# A//B!3�*&/ 4!F*2 A/A!3!B&/@4GU5!@ F%./,+ % A+D/./@ '.#)(/@ % .&2,3!&&!@ (/'/@ 4GU5!@ F%./,+ % A+D/./@ '.#)(/@. 3!,%@3#* &!A3!3G.&/1/ U.+: A+D/.+# '.#)(+ A/*U%.+!,'# ( +A/&!.3/)2 &+32F&/@ (/'/@ 4GU5G F%./,+ '?/34%3/.+&%!4 *2A"%(+,23G. �3%B�4 &+*(/',&%5+ "/$(/./@ (/',% &! 2B+',.2!, . ?/34%3/.+&%%&!A3!3G.&/1/ U.+, B,/ /$2'"/."%.+!, /,'2,',.%! A/'"!/A!3+5%/&&/1/ ./'A+"!&%# &+*(/',&%5G.

�'"% $G"/ &!./)4/F&/ A3/.!*!&%! /A!3+5%% A/ �2"*+@'2 (%)N)+ 3+)./"/(&!&%# ,(+&!@ A/-A!3!B&/@ ?+'5%% % 4GU5) %'A/"-)/.+"'# 'A/'/$ A"+',%(% )+*&!@ ',!&(% A/ �+''%&% ' &+"/F!&%-!4 &!A3!3G.&/1/ U.+. �+&&G@ 4!,/* %4!!, './% A3!%42�!',.+ A!3!* 2)"/.G4% U.+4%, ,+( (+( &!/',+."#!, A3/4!F2,(/. % &! 3+)./"/(&#!, 4GU!B&/N+A/&!.3/,%B!'(%@ '"/@.

'"2B+! )&+B%,!"-&/1/ 3+'U%3!&%# A+D/./1/ (/"-5+ % )&+B%,!"-&/1/ *%',3/?%B!'(/1/ %)-4!&!&%# '/!*%&%,!"-&/@ ,(+&% . 3!5%*%.&GD 13GF+D %'A/"-)/.+"'# '!,B+,G@ +""/,3+&'A"+&,+, '!1/ *2$"%(+,23/@, (/,/3G@ '/)*+!, *.2D23/.&!.G@ (+&+" ./(321 '!4!&&/1/ (+&+,%(+. �%('+5%#+""/,3+&'A"+&,+,+ A3/%)./*%,'# ',!F(+4% A/ .'!42 (/&,232.

&�_��z�� �����������. �'"/F&!&%@ . 3+&&%@ % A/)*&%@ A/'"!/A!3+5%/&&G@ A!3%/* &!&+$"�*+"/'-. �3!*&## *"%,!"-&/',- 1/'A%,+"%)+5%% '/',+.%"+ 5–7 *&!@. �,*+"!&&G! 3!)2"-,+,G

231

/A!3+5%% A3/'"!F!&G . '3/(% /, 1/*+ */ *.2D "!,. �!5%*%./. &! &+$"�*+"/'-. '! 3+$/,+��%!'/D3+&%"% './� 'A!5%+"-&/',-. �,'2,',./.+"% A/'"!/A!3+5%/&&G@ *%'(/4?/3,, $/"%, A+3!',!-)%%. �A3/' /A!3%3/.+&&GD &! .G#.%" &+32U!&%@ A/"/./@ ?2&(5%%.

$ ��� :1. �'/.!3U!&',./.+&&G@ 'A/'/$ &!&+,#F&/@ 1!3&%/A"+',%(% A/ �2"*+@'2 (Shouldice) #.-

"#!,'# &+*!F&/@ 4!3/@ A3/?%"+(,%(% +'!A,%B!'(/1/ ./'A+"!&%# &+*(/',&%5G, A3!A#,',.2!, 3+'-D/F*!&%� ,(+&!@, &+*!F&/ 2(3!A"#!, )+*&�� ',!&(2 A+D/./1/ (+&+"+ % A/)./"#!, 2"2BU%,- /,-*+"!&&G! 3!)2"-,+,G "!B!&%#.

2. )+.%'%4/',% /, ',!A!&% %)4!&!&%# ',32(,23G A3% 2(3!A"!&%% )+*&!@ ',!&(% A+D/./1/(+&+"+ A/ �+''%&% 3!(/4!&*2!,'# A3%4!&#,- &!A3!3G.&G@ U/., (/,/3G@ A3!*2A3!F*+!, 3+)./-"/(&!&%! +A/&!.3/)+.

3. �/B!,+&%! A"+',%(% A+D/./1/ (+&+"+ 4!',&G4% ,(+&#4% ' A3%4!&!&%!4 *2$"%(+,23G '!,-B+,/1/ '%&,!,%B!'(/1/ 4+,!3%+"+ /$!'A!B%.+!, &+*!F&2� 4!D+&%B!'(2� A3/B&/',- *+&&/@ /$"+'-,% % A3/,%./',/%, ./)*!@',.%� .&2,3%$3�U&/1/ *+."!&%#. �'A/"-)/.+&%! 2'/.!3U!&',./.+&&GD'A/'/$/. A"+',%(% A/)./"#!, %)$!F+,- 3!5%*%./. A+D/.GD 13GF % 'A/'/$',.2!, ',/@(/42 %)"!B!-&%� %D. �!,/*%(% 4/12, $G,- A3!*"/F!&G *"# U%3/(/1/ %'A/"-)/.+&%#.

�A%'/( "%,!3+,23G:1. �32$&%( L., �/'!. �L�., �+#)%,/. �L�., �+3?!&,-!. �L�. �/.3!4!&&G! 4!,/*G "!B!&%#

$3�U&GD 13GF. — �%!.: �*/3/.-!, 2001. — �. 2–5.2. �!3�1%&+, �L�. �A/'/$ "!B!&%# A+D/.GD 13GF // �%3231%#. — 1999. — � 12. — �. 53–54.3. �1%!. L�., �#*/. �L., /'(3!'!&'(%@ �L�. �,"+' /A!3+,%.&/@ D%3231%% 13GF. — �/'(-

.+: �!*A3+(,%(+N�, 2003. — �. 121–122.4. �!$3/.'(%@ L., �"-$+U%3 �/D+4!* /4. �%3231%# 13GF F%./,+ % �.!&,3+5%@. —

�%4?!3/A/"-: �%)&!'N�&?/34, 2002. — �. 191–192.

$"&�",0�1"�0+)+�&!J'�+,+�&+,"=$,!�0�)+x)!$!���^$!$!�,!&+*�

�#&. ,������ (���., �. �. �.), !#J. J����� (����.), (#&. q��z����� (����.)�2(/.%&'-(%@ *!3F+.&%@ 4!*%B&%@ 2&�.!3'%,!,

�+?!*3+ +(2U!3',.+ � 1�&!(/"/1�¤ ) (23'/4 *%,#B/¤ ,+ A�*"�,(/./¤ 1�&!(/"/1�¤

����������@���: ���. ����@`� (0��. ��., ���., �. �. �.)

�/.&%@ 3/)3%. A3/4!F%&% ) 2,./3!&&#4 (%U(/./NA�D./.%D &/3%5- A3%)./*%,- */�&.+"�*%)+5�¤, .+F(%D 4/3+"-&%D A!3!F%.+&- F�&(%, &!3�*(/ */ 3/)A+*2 '�4Ó¤. /42 .'� ,3+.4% �A�'"#A/"/1/.� 3/)3%.% A3/4!F%&% �V ',2A!&# A/.%&!& )+U%.+,% D�3231, #(%@ 4+¯ */'.�* A/*�$&%D/A!3+5�@. �&U/42 .%A+*(2 &!/$D�*&! ,3%.+"! A3/,%)+A+"-&! "�(2.+&&# &/3%5� ) A/*+"-U%4 A3/-.!*!&&#4 3!(/&',32(,%.&/NA"+',%B&%D /A!3+5�@.

�! *%."#B%'- &+ ,!, �/ A3/.!*!&+ D./3�@ 3!(/&',32(,%.&+ A"+',%(+ A3/4!F%&% U"#D/4A!3!4��!&&# (/.)+�B/1/ (%U(/./1/ ("+A,# )+ �/$"!4 «)+',+3�"+» ()+A3/A/&/.+&+ �/$"!4 2 19023/5�), *+&%@ .%A+*/( */.�. ¤¤ +(,2+"-&�',-.

$"&+",0�1"�0+)+�&!J'�,!�0+�&+,"1+%++)+x'%,!�$1">"1+{,!>!�$+{"

+#&. ,������ (���., �. �. �.), !#J. J��� � (����.), (#&. q��z����� (����.)�2(/.%&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,

�+?!*3+ +(2U!3',.+ % 1%&!(/"/1%% ' (23'/4 *!,'(/@ % A/*3/',(/./@ 1%&!(/"/1%%

�������������������: ���. ������ (0��. ��., ���., �. �. �.)

"����z����z. �/"&G@ A/'"!3/*/.G@ 3+)3G. A3/4!F&/',% ' /$3+)/.+&%!4 (%U!B&/-."+1+"%�&/1/ '.%�+ A3%./*%, ( %&.+"%*%)+5%%, ,#F!"G4 4/3+"-&G4 A!3!F%.+&%#4 F!&�%&G,&!3!*(/ ( 3+'A+*2 '!4-%. �/�,/42 .'! ,3+.4G % A/'"!3/*/.G! 3+)3G.G A3/4!F&/',% IV ',!A!&%*/"F!& )+U%.+,- D%3231, %4!��%@ /AG, A/*/$&GD /A!3+5%@. A3/,%.&/4 '"2B+! &!/$D/*%4/*"%,!"-&/! A3/,%././'A+"%,!"-&/! "!B!&%! ' A/'"!*2��%4 A3/.!*!&%!4 3!(/&',32(,%.&/-A"+',%B!'(%D /A!3+5�@ &+ A3/4!F&/',% [1, '. 93–96; 4, '. 76–79; 5, '. 62–65].

232

*��z���� . �!"-� 3+$/,G $G"/ A3/.!*!&%! 3!(/&',32(,%.&/NA"+',%B!'(/@ /A!3+5%% $/-"-&/@ '/ ',+3G4 A/'"!3/*/.G4 3+)3G./4 A3/4!F&/',% IV ',!A!&%, A/'"! A3!*.+3%,!"-&/1/ A3/-.!*!&%# '+&+5%% ."+1+"%�+ 4!',&G4% +&,%'!A,%(+4%.

J����� � ����� . �+ /A!3+,%.&/! "!B!&%! . 1%&!(/"/1%B!'(/! /,*!"!&%! 2)"/./@("%&%B!'(/@ $/"-&%5G A/',2A%"+ $/"-&+# �. 1982 1/*+ 3/F*!&%# ' *%+1&/)/4 «',+3G@ A/'"!3/-*/.G@ 3+)3G. A3/4!F&/',% IV ',!A!&%». �+)3G. A3/%)/U!" A/'"! A3/.!*!&&GD 3/*/. . /*&/@ %)��� /$"+',% % /'"/F&!&&/1/ A/'"!3/*/./1/ A!3%/*+, ' /$3+)/.+&%!4 ."+1+"%�&/NA3#4/(%U!B-&/1/ '.%�+.

(+B!',.! A3!*/A!3+5%/&&/@ A/*1/,/.(% $/"-&/@ A3/.!*!&+ *.2D�,+A&+# '+&+5%# ."+1+-"%�+ '/.3!4!&&G4% 4!',&G4% +&,%'!A,%(+4%. �/ *+&&G4 "%,!3+,23G, A3!*"/F!&&G@ (/4A"!(',!3+A%% A3/#.%" .G'/(2� �??!(,%.&/',- A3% "!B!&%% %&?!(5%/&&GD ./'A+"%,!"-&GD )+$/"!.+-&%@ ."+1+"%�+ [2, '. 78–81; 3, '. 53–55].

�/"-&/@ $G"+ A3/.!*!&+ /A!3+5%# — 3!(/&',32(5%# A3/4!F&/',% A2,!4 A!3!4!�!&%# '(/-"-)#�!1/ (%U!B&/1/ "/'(2,+ A/ �/$"�. �,/, 'A/'/$ /A%'+"% �/$"- (Noble, 1902) % �!&1!3, %�%U (Mengert and Fish, 1955). �3%4!&!&%! !1/ A/(+)+&/ A3% 3+)3G.+D +&2'+ % A3#4/@ (%U(% *"%-&/@ .'!1/ &!'(/"-(/ '+&,%4!,3/. [6, '. 568–572].

&�_��z�� �����������. �/* A3/.!*!&&/@ 3!(/&',32(,%.&/NA"+',%B!'(/@ /A!3+5%%.�/"-&+# &+ /A!3+5%/&&/4 ',/"! &+D/*%,'# . "%,/,/4%B!'(/4 A/"/F!&%%. �+ 4#1(%! ,(+&% A/ $/(+4,&+ 2 '4 .GU! 4!',+ ?/34%3/.+&%# )+*&!@ 'A+@(% A/"/.GD 12$ &+("+*G.+!4 )+F%4G �"%'+. 3!,%@)+F%4 &+("+*G.+!4 A/ '3!*&!@ "%&%%, &!'(/"-(/ .GU! .!3D&!1/ (3+# *!?!(,+ A3/4!F&/',%. �3%3+).!*!&%% $/(/.GD )+F%4/. .%*!& 13!$!&- 32$5/./ %)4!&�&&GD ,(+&!@, (/,/3G@ A3!*',+."#!, '/-$/@ 13+&%52 4!F*2 A3/'.!,/4 ."+1+"%�+ % A3#4/@ (%U(%. �,/, 13!$!&- 3+''!(+�, ' A/4/�-�'(+"-A!"#. �3/5!'' 3+''!B!&%# 4/F&/ /$"!1B%,-, !'"% A3!*.+3%,!"-&/ %&?%"-,3%3/.+,- ,(+&% ?%-)%/"/1%B!'(%4 3+',./3/4. �+ 3+''!B!&&G! (3+# ()+*&�� ',!&(2 ."+1+"%�+ % A!3!*&�� ',!&(2 A3#-4/@ (%U(%) &+("+*G.+!4 )+F%4G �"%'+, /,*!"#!4 %D *321 /, *321+ */',+,/B&/ U%3/(/ A/ $/(+4 % .A3/('%4+"-&/4 &+A3+."!&%%. �+''!B!&%! ,(+&!@ A3/./*#, $"%F! ( '"%)%',/@ ."+1+"%�+ *"# A3!*2-A3!F*!&%# A/.3!F*!&%# A3#4/@ (%U(%. �3% ,+(/4 3+''!B!&%% ,(+&!@ &+D/*%4 (/&5G A/.3!F*�&-&/1/ +&+"-&/1/ '?%&(,!3+ &+ (/,/3G! &+("+*G.+!4 )+F%4G �"%'+, A/*,#1%.+# %D (A!3!*%.

�&+"-&G@ (+&+" 3!(/&',32%32!4 A/'"! A/"&/1/ 2*+"!&%# 32$5/./ %)4!&�&&GD ,(+&!@ %�/'.!F!&%#» 3+''!B!&&GD (3+!. '"%)%',/@ ."+1+"%�+ % A3#4/@ (%U(%. �,!&(2 A3#4/@ (%U(% )+-U%.+!4 2)"/.G4% (*!('/&, '%&,%") U.+4%, (/,/3G4% )+D.+,G.+�, .'! '"/% ',!&(%, )+ %'("�B!&%-!4 '"%)%',/@.

�"# %*!+"-&/1/ '/A/',+."!&%# (3+!. '"%)%',2� /$/"/B(2 '"!*2!, A3!*.+3%,!"-&/ ..!3&2,-. A3/'.!, A3#4/@ (%U(%. �"!*2��%@ '"/@ 2)"/.GD U./. &+("+*G.+!4 A/.!3D A!3./1/ % A3/*/"-F+!4 &!'(/"-(/ *+"-U! ..!3D /, A!3./1/.

�"!*2��%4 �,+A/4 A3/./*%4 3!(/&',32(5%� '?%&(,!3+. �+F%4+4% �"%'+ A/*,#1%.+�,(A!3!*% (/&5G '?%&(,!3+. �D '/A/',+."#�, ' A/4/�-� ./'-4%/$3+)&/1/ U.+, )+D.+,G.+# '/!*%-&%,!"-&2� ,(+&-, (/,/3+# /(32F+!, '?%&(,!3 % A!3%4%)%@. .!*!&&G4 . A3/'.!, A3#4/@ (%U(%2(+)+,!"-&G4 A+"-5!4 /A3!*!"#!4 �??!(,%.&/',- &+"/F!&%# U./..

*+"-&!@U!4 A2B(% "!.+,/3/. % /',+,(% A/A!3!B&/@ 4GU5G A3/4!F&/',% '/A/',+."#!42)"/.G4% U.+4%.

�+ )+.!3U+��!4 �,+A! /A!3+5%% A3/./*#, A"+',%(2 A3/4!F&/',%. �"%)%',2� ."+1+"%�+ %(/F2 A3/4!F&/',% )+U%.+�, .$"%)% &+32F&/1/ (/"-5+ )+*&!1/ A3/D/*+. �%).!*!&&2� ',!&(2A3#4/@ (%U(% 2)"/.G4% U.+4% A/ *21! ?%('%32�, ( (/F! A3/4!F&/',%.

�/'"!/A!3+5%/&&G@ A!3%/* % )+F%."!&%! 3+&G A3/D/*%"/ $!) /'"/F&!&%@. �+ 10-! '2,(%A/'"! /A!3+5%% $/"-&+# .GA%'+&+ */4/@. �,2" % 1+)G 2*!3F%.+!,.

$ ��� . �!'4/,3# &+ ,/, B,/ A3/.!*!&&+# $/"-&/@ 3!(/&',32(,%.&+# A"+',%(+ A3/4!F&/-',% A2,!4 A!3!4!�!&%# '(/"-)#�!1/ (%U!B&/1/ "/'(2,+ A/ �/$"� «2',+3!"+» (A3!*"/F!&+ �/$-"!4 . 1902 1/*2), *+&&G@ '"2B+@ */(+)+" !! +(,2+"-&/',-. �,'2,',.%! %&?!(5%% /$!'A!B%"% &+*-"!F+�+# A3!*/A!3+5%/&&+# A/*1/,/.(+ % A/'"!/A!3+5%/&&G@ 2D/*.

�"# %'("�B!&%# . *+"-&!@U!4 A/'"!3/*/.GD ."+1+"%�&/NA3#4/(%U!B&GD '.%�!@ .'! ,3+-.4G % A/'"!3/*/.G! 3+)3G.G A3/4!F&/',% IV ',!A!&% */"F!& )+U%.+,- D%3231, %4!��%@ /AG,A/*/$&GD /A!3+5%@.

�A%'/( "%,!3+,23G:1. �+3+&/.'-(+, �L�. �2B+'&� ("�&�(/N"+$/3+,/3&� /'/$"%./',� &!'A!5%?�B&%D �&?!(5�@&%D

)+D./3�.+&- A�D.% / �L�. �+3+&/.'-(+, �L�. */.%B!&(/ // �!*�+,3�#, +(2U!3',./ ,+ 1�&!(/"/1�#.—2011. — . 73, � 5. — �. 93–96.

233

2. �+*)%&'(%@, L�. �.2D�,+A&+# ,!3+A%# .+1%&+"-&GD %&?!(5%@ / L�. �+*)%&'(%@, �L�. �3*%-#&5, �L�. �!,.!3,+(/.+, �L�. �%'2&/ // �(2U!3',./ % 1%&!(/"/1%#. — 2011. — � 5. — �. 78–81.

3. �+*)%&'(%@, L�. �3/?%"+(,%(+ A/'"!/A!3+5%/&&GD /'"/F&!&%@ 2 F!&�%& ' *%'$%/)/4."+1+"%�+ / L�. �+*)%&'(%@, �L�. �3*%#&5, �L�. �32U+&#& // �(2U!3',./ % 1%&!(/"/1%#. —2008. — � 5. — �. 53–55.

4. �,3%F+(/., �L�. �3/?%"+(,%(+ % A3!.!&,%.&+# ,!3+A%# %&?!(5%/&&/N./'A+"%,!"-&GD/'"/F&!&%@ .&2,3%4+,/B&/@ D%3231%% / �L�. �,3%F+(/., �L�. �+.G*/., �L. �2*+&/. // �%&!(/-"/1%#. — 2005. — � 4. — �. 76–79.

5. %D/4%3/. �L�., �"!@&%( �L�. �+(,!3%+"-&G@ .+1%&/): &!(/,/3G! +'A!(,G �,%/"/1%%, A+-,/1!&!)+, ("%&%(%, *%+1&/',%(% % "!B!&%# / �L�. %D/4%3/., �L�. �"!@&%( // �%&!(/"/1%#. —2004. — . 6, � 2. — �. 62–65.

6. �%3U, �L�. �A!3+,%.&+# 1%&!(/"/1%#. �,"+' / �%3U �L�., �!)!3 �., �("! �L�.; A!3. '+&1". �/* 3!*. L�. �2"+(/.+, �L. �!*/3/.+. — �.: ����� ��������, 1999. — �. 568–572.

J'0!(`,(!$',!q,!/1"q'&,!/)!">41=*++�!()!�,-^$',$1'%',++$"&+)!q,!/;!1'q,+$',,+�,+^)!,'%,!�0'/

w#$. ����� (����.), '#�. ���������� (����.)

�!"/32''(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,1-# (+?!*3+ D%3231%B!'(%D $/"!)&!@

�������������������: ���. ��� ( ���., �. �. �.)

"����z����z. &+',/#�!! .3!4# '+4/@ B+',/@ '/'2*%',/@ A+,/"/1%!@ #."#!,'# .+3%(/)-&+# $/"!)&- .!& &%F&%D (/&!B&/',!@ (���), *"# (/,/3/@ D+3+(,!3&G 3/', B%'"+ )+$/"!.U%D %,!&*!&5%# ( ./)&%(&/.!&%� )+$/"!.+&%# 2 "%5 4/"/*/1/ ./)3+',+. �+)&//$3+)&G! A3/#."!&%# �,/-1/ )+$/"!.+&%# % !1/ /'"/F&!&%@ /31+&%B!'(/1/, ?2&(5%/&+"-&/1/ % �',!,%B!'(/1/ D+3+(,!3+ '2-�!',.!&&/ '&%F+�, ,32*/'A/'/$&/',- % 2D2*U+�, (+B!',./ F%)&%.

/'&/.! "!B!&%# 1!4/*%&+4%B!'(%D &+32U!&%@ A3% ��� "!F%, 2',3+&!&%! A+,/"/1%B!-'(%D 3!?"�('/. ,/(+ (3/.% (1/3%)/&,+"-&/1/ % .!3,%(+"-&/1/) % .G("�B!&%! %) (3/./,/(+ A+,/-"/1%B!'(% %)4!&!&&GD 2B+',(/. .!&/)&/@ '%',!4G &%F&%D (/&!B&/',!@. � �,/@ 5!"-� /$GB&/A3%4!&#�,'# D%3231%B!'(%! .4!U+,!"-',.+ [1–3]. &+',/#�!! .3!4# &+3#*2 ' ,3+*%5%/&&G4%D%3231%B!'(%4% /A!3+5%#4% . "!B!&%% ��� .'! B+�! %'A/"-)2�,'# 4+"/%&.+)%.&G! 4!,/*G, ((/,/3G4 /,&/'#,'#: 3+)"%B&G! .+3%+&,G ?"!$/'("!3/)%3/.+&%#, (3%/�(',3+(5%# .!&, 3+*%/B+'-,/,&+# % "+)!3&+# (/+12"#5%#. �/4%4/ .G'/(/@ �??!(,%.&/',%, '/A/',+.%4/@ ' 3!)2"-,+,+4% D%-3231%B!'(/1/ "!B!&%#, &!'/4&!&&G4% A3!%42�!',.+4% �,%D 4!,/*%( #."#�,'# 4!&-U+# ,3+.4+-,%B&/',-, ./)4/F&/',- .GA/"&!&%# . +4$2"+,/3&GD 2'"/.%#D % D/3/U%@ �',!,%B!'(%@ 3!)2"-,+,[4]. �&*/.!&/)&+# "+)!3&+# (/+12"#5%# (���) — 4!,/* /$"%,!3+5%% 4+1%',3+"-&GD A/*(/F&GD.!& A2,!4 .&2,3%'/'2*%',/1/ ,!34%B!'(/1/ ./)*!@',.%# "+)!3&G4 %)"2B!&%!4 — A3%4!&#!,'# .("%&%B!'(/@ A3+(,%(! . ,!B!&%! A/'"!*&%D *!'#,% "!, [5]. �!"-� ��� #."#!,'# ?%$3/)&+#,3+&'?/34+5%# .!&, A3%./*#�+# ( ',/@(/42 .G("�B!&%� %D %) A+,/"/1%B!'(/1/ (3/./,/(+. �"#A!3.GD +AA+3+,/. ' *"%&/@ ./"&G 0,81 4(4, A3%4!&#.U%D'# *"# �&*/.!&/)&/@ (/+12"#5%% . '+-4/4 (/&5! A3/U"/1/ .!(+, D3/4/?/3/4N4%U!&-� #."#"'# /('%1!4/1"/$%&. G*!"#��!!'# A3%A/1"/�!&%% "+)!3&/@ �&!31%% .&2,3% '/'2*+ ,!A"/ A3%./*%"/ ( "/(+"-&/42 «(%A!&%�» (3/.% '/$3+)/.+&%!4 A2)G3-(/. A+3+, (/,/3G! . './� /B!3!*- /'2�!',."#"% ,!34%B!'(/! A/.3!F*!&%!.!&/)&/@ ',!&(%, &+B%&+# ' �&*/,!"%#. �/.3!F*!&%! .&2,3!&&%D '"/!. ',!&(% .!&G /$!'A!B%.+"/2'"/.%# *"# ?/34%3/.+&%# /(("�)%/&&/1/ ?%('%3/.+&&/1/ A3/,#F!&&/1/ ,3/4$+ ' A/'"!*2��%4?%$3/)&G4 A!3!3/F*!&%!4 .!&G % A3!(3+�!&%!4 A+,/"/1%B!'(/1/ (3/./,/(+. �,/ ,+( &+)G.+!-4G! 1!4/1"/$%&/.G! %"% �N"+)!3G. &+',/#�!! .3!4# .'! $/"-U!! 3+'A3/',3+&!&%! A/"2B+�,"+)!3&G! +AA+3+,G ' *"%&/@ ./"&G 1,56 4(4 — W-"+)!3G (./*&G!), A3% (/,/3GD /'&/.&/! ./)-*!@',.%! %)"2B!&%# A3%D/*%,'# &+ ./*&2� '/',+."#��2� ',!&(% .!&.

7���������������$ )+("�B+"+'- . /5!&(! ("%&%B!'(/@ �??!(,%.&/',% % �(/&/4%B!'(/@ 5!"!-'//$3+)&/',% 4!,/*+ "+)!3&/@ (/+12"#5%% A/*(/F&GD .!& &%F&%D (/&!B&/',!@ A3% "!B!&%% ���.

J����� ������ �����������. �3/.!*!& ',+,%',%B!'(%@ +&+"%) D%3231%B!'(/1/ "!-B!&%# 139 A+5%!&,/. ' .+3%(/)&/@ $/"!)&-� &%F&%D (/&!B&/',!@, &+D/*%.U%D'# &+ "!B!&%% .A"+&/./4 D%3231%B!'(/4 /,*!"!&%% �� «10-# ��� 1. �%&'(+» ' +A3!"# 2011 1/*+ A/ 4+3, 2012 1/-*+. �A!3+5%% .GA/"&#"%'- ' A3%4!&!&%!4 "+)!3&GD ,!D&/"/1%@. �'A/"-)/.+"'# +AA+3+, «�!*%/-

234

"+N�&*/» (���� ��-50 %'A/"&!&%! 4) ' '/B!,+&%!4 *"%& ./"& 1,064 % 1,34 4(4. �!F%4 ./)*!@-',.%# /A3!*!"#!,'# *.24# ?+(,/3+4%: 4/�&/',-� %)"2B!&%# % '(/3/',-� %)."!B!&%# '.!,/./*+ %).!&G. �/.4!',&/ *.+ �,%D ?+(,/3+ /A3!*!"#"% */)2 "+)!3&/1/ %)"2B!&%#, ./)*!@',.2��2� &+ .!-&G. �!,/*/4 ��� /$3+$+,G.+"%'- 4+1%',3+"-&G! ',./"G $/"-U/@ A/*(/F&/@ .!&G (��) %4+"/@ A/*(/F&/@ .!&G (��). �/(/.G! 3+'U%3!&&G! .!,.% &+ $!*3! % 1/"!&% % A!3?/3+&,&G!&!'/',/#,!"-&G! .!&G (/+12"%3/.+"%'- B!3!) A3/(/"G ' ,24%&%'5!&5%!@.

'! A+5%!&,G /$'"!*/.+&G +4$2"+,/3&/ A/ /$�!A3%&#,/@ 4!,/*%(!, + ,+(F! %4 */ /A!3+-5%% A3/%)./*%"+'- 2"-,3+).2(/.+# *%+1&/',%(+: *2A"!('&/! %"% ,3%A"!('&/! '(+&%3/.+&%! .!-&/)&/@ '%',!4G &%F&%D (/&!B&/',!@.

/$�!4 /A!3+,%.&/1/ "!B!&%# /$#)+,!"-&/ .("�B+"+'- (3/''�(,/4%#. �3% &!./)4/F&/',%A3/.!*!&%# '.!,/./*+ . 3!,3/13+*&/4 &+A3+."!&%%, 4+1%',3+"-&+# .!&+ .G*!"#"+'- . /$"+',% 4!-*%+"-&/@ "/*GF(%, % +&,!13+*&/ A3/./*%"'# '.!,/./* */ '+?!&/?!4/3+"-&/1/ '!14!&,+. �3% %)-."!B!&%% '.!,/./*+ A/*+.+"/'- %4A2"-'&/! %)"2B!&%! 4/�&/',-� 22 , A3% *"%&! ./"&G 1,344(4. �(/3/',- %)."!B!&%# '.!,/./*+ .+3-%3/.+"+ . )+.%'%4/',% /, *%+4!,3+ �� (A/ *+&&G4���) /, 0,5 */ 1 '4 . '!(2&*2. �+3(%3/.+&&G! $/(/.G! 3+'U%3!&&G! .!,.% % A!3?/3+&,&G! &!'/-',/#,!"-&G! .!&G (/+12"%3/.+"%'- A2&(5%/&&G4 4!,/*/4 %1"/@ 18G "+)!3&G4 %)"2B!&%!4 '*"%&/@ ./"&G 1,064 4(4 ' A3!*.+3%,!"-&/ .GA/"&!&&/@ ,24%&%'5!&5%!@. /,*!"-&GD '"2B+#DA3% .+3%('+D 3+)4!3/4 /, 1,5 '4 % $/"!! .GA/"&#"/'- %D 2*+"!&%! A/ �+3+,2. �,&/'%,!"-&G4A3/,%./A/(+)+&%!4 ( .GA/"&!&%� ��� �� $G"/ &+"%B%! !! A3/'.!,+ (A/ *+&&G4 ���) $/"!!1,1 '4. ,+(%D '%,2+5%#D .GA/"&#"+'- /A!3+5%# ��$(/((+. �/'"! /A!3+5%% /'2�!',."#"/'- ,21/!$%&,/.+&%! (/&!B&/',%. 3#*! '"2B+!. .GA/"&#"%'- /*&/4/4!&,&G! /A!3+5%% &+ /$!%D &%F&%D(/&!B&/',#D.

�/ *+&&/@ 4!,/*%(! .GA/"&!&/ 139 /A!3+5%@ 2 133 A+5%!&,/.. �/ 4!F*2&+3/*&/@ ("+''%-?%(+5%% CEAP .'! A+5%!&,G ' .+3%(/)&/@ $/"!)&-� 3+'A3!*!"%"%'- '"!*2��%4 /$3+)/4: 126(94,7 %) — ',+*%# �2–C3, 6 (4,5 %) — �4; 1 — �5. �3!*&%@ ./)3+', A+5%!&,/. '/',+.%" 46 ± 2,31/*+. �!&�%& /(+)+"/'- $/"-U! 84 (60,4 %).

�+5%!&,G $G"% 3+)*!"!&G &+ *.! 132AAG: 1-# 132AA+ (.GA/"&!&+ (3/''�(,/4%#, ��� ��,�� A3%,/(/. % A!3?/3+&,/.) — 97 A+5%!&,/., %) (/,/3GD 48 &+D/*%"%'- . ',+5%/&+3! «/*&/1/*&#»; 2-# 132AA+ (.GA/"&!&+ (3/''�(,/4%#, ��� ��, �� A3%,/(/. % A!3?/3+&,/., */A/"&!&&+#/A!3+5%!@ �+3+,+) — 33 A+5%!&,+, A3%B!4 . ',+5%/&+3! «/*&/1/ *&#» "!B%"/'- 19 A+5%!&,/.. (+B!',.! (/&,3/"-&/@ 132AAG $G"% .)#,G A+5%!&,G, "!B!&%! ��� (/,/3GD A3/./*%"/'- A/,3+*%5%/&&/@ D%3231%B!'(/@ 4!,/*%(!: (3/''�(,/4%#, /A!3+5%# ��$(/((+, 2*+"!&%! $/(/.GD .!,-.!@ A/ �+3+,2, "%1%3/.+&%! A!3?/3+&,&GD .!& A/ �/(!,,2.

�,+,%',%B!'(+# /$3+$/,(+ *+&&GD A3/./*%"+'- ' A/4/�-� A3/13+44&/1/ /$!'A!B!&%# IBMSPSS Statistics 19.0.

&�_��z�� �����������. '!4 A+5%!&,+4 /A!3+,%.&G! .4!U+,!"-',.+ .GA/"&#"%'- &+'"!*2��%@ *!&- A/'"! A/',2A"!&%#. �'/$!&&/',!@ A3!*/A!3+5%/&&/@ A/*1/,/.(% &! $G"/. �$!)-$/"%.+&%! — 'A%&&/4/)1/.+# +&!',!)%# (���), . 3!*(%D '"2B+#D — &+3(/) %"% 4!',&+# %&?%"-,-3+,%.&+# +&!',!)%#.

�3/.!*!&+ ',+,%',%B!'(+# /$3+$/,(+ *+&&GD. �3!*&%@ '3/( A3!$G.+&%# A+5%!&,/. . ("%&%-(!: A+5%!&,G, "!B!&%! (/,/3GD A3/./*%"/'- ' %'A/"-)/.+&%!4 "+)!3/,!3+A%%, — 5,81 ± 2,86 *&!@.�+)*!"-&/ A/ 132AA+4 A/"2B!&G '"!*2��%! *+&&G!: 1-# 132AA+ — 7,27 ± 1,6 *&!@, . ',+5%/&+3!�/*&/1/ *&#» — 2,78 ± 0,6; 2-# 132AA+ — 7,45 ± 1,92 *&#, . ',+5%/&+3! «/*&/1/ *&#» — 2,47 ± 0,7;(/&,3/"-&+# 132AA+ — 6,88 ± 2,79 *&!@. �/',/.!3&/',-: p < 0,05.

A/'"!/A!3+5%/&&/4 A!3%/*! *"# /$!)$/"%.+&%# A3%4!&#"'# (!,/3/"+( (3 % — 1.0 4",/*%&N*.+ 3+)+ .&2,3%4GU!B&/. �+5%!&,+4 3+)3!U+"/'- .',+.+,- &+ '"!*2��%! '2,(% ($/"!! 3+&-&!! .',+.+&%! )+A3!�+"/'- %)N)+ ���). �) 3+&&%D A/'"!/A!3+5%/&&GD /'"/F&!&%@ '"!*2!, /,4!-,%,- 2 ,3!D $/"-&GD &+"%B%! �(D%4/)/. A"/�+*-� */ 1'42. 3/4$/)/. 1"2$/(%D .!&, &+1&/!&%@ &!/,4!B+"/'-. �/',/#&%! .'!D A+5%!&,/. A/'"! "+)!3&/@ (/+12"#5%% .!& $G"/ 2*/."!,./3%,!"-&G4,B,/ A/)./"#"/ A!3!./*%,- %D &+ +4$2"+,/3&/! "!B!&%! &+ 3–4-! '2,(% A/'"! /A!3+5%%. �"!*2!,/,4!,%,-, B,/ '3!*% 8 A+5%!&,/. %4!"% 4!',/ '%"-&G! 1/"/.&G! $/"% (A/'"!*',.%# ���).

$ ��� . �'A/"-)/.+&%! "+)!3&/@ (/+12"#5%% A/*(/F&GD .!& A3% ��� A/(+)+"/ !! .G'/-(2� ("%&%B!'(2� �??!(,%.&/',-, �(/&/4%B!'(2� 5!"!'//$3+)&/',- % D/3/U2� A!3!&/'%4/',-A+5%!&,+4%.

�A%'/( "%,!3+,23G:1. �!.B!&(/ �L�., �,/@(/ �L�., �G,(%& �L�. �'&/.G ("%&%B!'(/@ ?"!$/"/1%%. — �.:

�!*%5%&+, 2005. — 311 '.

235

2. �!.B!&(/ �L�., �,/@(/ �L�., �+)+@U.%"% �L. �+)!3&+# D%3231%# .+3%(/)&/@ $/"!)&%.— �., 2011.

3. �23 �L�., �3%U%& �L�., �23 �L�. 3/?%B!'(%! #).G &%F&%D (/&!B&/',!@. — �%&'(:�'/$&G, 2008. — 148 '.

4. �/(/"/. �L�., �#*/. �L., �,/@(/ �L�. �&*/.!&/)&+# "+)!3&+# (/+12"#5%# . "!B!&%% .+-3%(/)&/@ $/"!)&%. — �.: �!*A3+(,%(+N�, 2007. — 220 '.

5. Navarro L., Min R.J., Bone �. Endovenous laser: a new minimally invasive methods of treat-ment of varicose veins — preliminary observations using an 810 nm diode laser // Dermatol. Surg. —2001. — Vol. 27 (2). — P. 117–122.

41]0&"�0&4)04&,"=^"&")0'&+�0+)"+qJ',',+/$)41]0'�!(�'14(!%,!/�'1'q-�&+&'q')*++!&>","

�!�1'$!q('/�0$+=,+q)!+,0',�+$,!>!1"q'&,!>!+q14%',+=

"#". ����z�� (���., �. �. �.)

�3/*&!&'(%@ 1/'2*+3',.!&&G@ 4!*%5%&'(%@ 2&%.!3'%,!,�+?!*3+ /A!3+,%.&/@ D%3231%% % ,/A/13+?%B!'(/@ +&+,/4%%

"����z����z. &+',/#�!! .3!4# . $/"-U%&',.! ',3+& 4%3+ &+$"�*+!,'# %&,!&'%.&/!.&!*3!&%! "+)!3&/1/ %)"2B!&%# . $%/"/1%B!'(%D %''"!*/.+&%#D % . A3+(,%B!'(/@ 4!*%5%&!. �&%-(+"-&G! './@',.+ "+)!3&/1/ "2B+ /,(3G"% U%3/(%! ./)4/F&/',% !1/ A3%4!&!&%# . 3+)"%B&GD /$-"+',#D: D%3231%%, ,!3+A%% % *%+1&/',%(!. �"%&%B!'(%! &+$"�*!&%# A/(+)+"% �??!(,%.&/',- "+)!-3+ 2"-,3+?%/"!,/./1/, .%*%4/1/ % %&?3+(3+'&/1/ 'A!(,3/. *"# 4!',&/1/ A3%4!&!&%# &+ A+,/"/-1%B!'(%@ /B+1 % *"# ./)*!@',.%# &+ .!'- /31+&%)4 [1, 2, 3, 4]. �*&+(/, &!'4/,3# &+ '3+.&%,!"-&/$/"-U/@ '3/( A3%4!&!&%# *+&&/1/ 4!,/*+, %4!�,'# "%U- !*%&%B&G! 3+$/,G, A/(+)G.+��%! �?-?!(,%.&/',- &%)(/%&,!&'%.&/1/ "+)!3&/1/ %)"2B!&%# &+ 2"-,3+',32(,23&/4 23/.&!.

*��z �����������. �)2B%,- &+ 2"-,3+',32(,23&/4 23/.&! %)4!&!&%#, A3/%'D/*#�%! .(2"-,! A/*F!"2*/B&/@ F!"!)G A3% 3!)!(5%% /31+&+ .'"!*',.%! ./)*!@',.%# &%)(/%&,!&'%.&/1/"+)!3&/1/ %)"2B!&%#.

J����������������. �+,!3%+"/4 *"# 3!U!&%# A/',+."!&&GD . &+',/#�!4 %''"!*/.+-&%% )+*+B% A/'"2F%"% 10 $!"GD $!'A/3/*&GD (3G'N'+45/. 4+''/@ 200 13+44/., (/,/3G! '/*!3-F+"%'- &+ ',+&*+3,&/4 3+5%/&! A%,+&%# . .%.+3%% '/ './$/*&G4 */',2A/4 ( A%�! % ./*!. �A!3+-5%� 3!)!(5%% A/*F!"2*/B&/@ F!"!)G .GA/"&#"% ' '/$"�*!&%!4 A3+.%" +'!A,%(% % +&,%'!A,%(%A/* .&2,3%4GU!B&G4 (+"%A'/"/.G4 &+3(/)/4 %) 3+'B!,+ 0,5 41¦(1. !3D&%4 '3!*%&&G4 3+)3!)/4.'(3G.+"% $3�U&2� A/"/',-. 3+&2 .G./*%"% '!"!)�&(2 % A/*F!"2*/B&2� F!"!)2. �3/%)./*%"%4/$%"%)+5%� % 3!)!(5%� *%',+"-&/@ B+',% F!"!)G A/ 4!F*/"-(/.G4 A3/4!F2,(+4 ' '/D3+&!&%-!4 (3/./'&+$F!&%# '!"!)!&(% (3+)4!3 3!)!5%32!4/1/ 2B+',(+ — 1,5 '4). �2"-,� F!"!)G 2U%.+"%*.24# �N/$3+)&G4% U.+4% (A/"%A3/A%"!& 6/0) % A/132F+"% . $3�U&2� A/"/',-. �A!3+5%/&&2�3+&2 &+ A!3!*&!@ $3�U&/@ ',!&(! A/'"/@&/ 2U%.+"%.

�/'"! .GA/"&!&%# 3!)!(5%% A/*F!"2*/B&/@ F!"!)G F%./,&G4 /AG,&/@ '!3%% �('A!3%4!&-,+ B!3!) /A!3+5%/&&2� 3+&2 A!3!*&!@ $3�U&/@ ',!&(% ./)*!@',./.+"% &%)(/%&,!&'%.&G4 "+)!3-&G4 %)"2B!&%!4 &+ (2"-,� /31+&+ . ,!B!&%! 5 4%&2,. �$"2B!&%! A3/%)./*%"% ' A/4/�-� "+)!3-&/1/ +AA+3+,+ «�/*&%(-1». (+B!',.! %',/B&%(+ %)"2B!&%# %'A/"-)/.+"% &!A3!3G.&G@ A/"2A3/-./*&%(/.G@ "+)!3 (3+'&/@ /$"+',% 'A!(,3+ (Ô = 0,67 ± 0,02 4(4; � = 20 4 ,). �A!3+5%/&&2� 3+&2&+ A!3!*&!@ $3�U&/@ ',!&(! A/'"/@&/ 2U%.+"%. A/'"!/A!3+5%/&&/4 A!3%/*! �,%4 F%./,&G4A3/./*%"% !F!*&!.&/ . ,!B!&%! 5 *&!@ (/&,+(,&G4 'A/'/$/4 B!3!) A!3!*&�� $3�U&2� ',!&(2/$"2B!&%! "+)!3/4 ' 2(+)+&&G4% .GU! A+3+4!,3+4% . /$"+',% A3/!(5%% (2"-,% A/*F!"2*/B&/@F!"!)G. �"/,&/',- 4/�&/',% %)"2B!&%# &+ A/.!3D&/',% (/F% '/',+."#"+ 25,5 4,¦'4² % /A3!*!-"#"+'- A/ ?/342"!: P = 4W/0,01 Õd², 1*! P — A"/,&/',- 4/�&/',% %)"2B!&%# &+ A/.!3D&/',% (/F%¥4,¦'4²); W — 4/�&/',- %)"2B!&%# &+ *%',+"-&/4 (/&5! '.!,/./*+ (20 4,); Õ — 3,14; d — *%+-4!,3 '.!,/./1/ A#,&+ (*%+4!,3 &+'+*(%) &+ (/&5! %)"2B+,!"# (10 44). �321%! .%*G ,!3+A%% &!/'2�!',."#"%.

'!D F%./,&GD .G./*%"% %) �('A!3%4!&,+ &+ 7 '2,(% A/'"! /A!3+5%%.J���� �����������. �"!(,3/&&/N4%(3/'(/A%B!'(/! %)2B!&%! A3/./*%"% . /$3+)5+D

,(+&% A/*F!"2*/B&/@ F!"!)G, ?%('%3/.+&&GD 1 %-&G4 3+',./3/4 B!,G3!D/(%'% /'4%# &+ 0,1 �$2?!3! �%""/&%1+, 3� 7,4 A3% +4 º� . ,!B!&%! 2 B+'/.. �/'"! *!1%*3+,+5%% . 'A%3,+D ./'D/*#�!@

236

(/&5!&,3+5%% % +5!,/&! /$3+)5G )+"%.+"% . '4!'- �A/&N+3+"*%,. �) A/"2B!&&GD $"/(/. &+ 2"-,-3+4%(3/,/4! �-7000ULTRA (USA) 1/,/.%"% A/"2,/&(%! '3!)G, (/,/3G! /(3+U%.+"% 4!,%"!&/-.G4 '%&%4. �3!A+3+,G %)2B+"% . '.!,/./4 4%(3/'(/A! % .G$%3+"% 2B+',/( *"# *+"-&!@U!1/ %)2-B!&%# 2"-,3+',32(,23&GD %)4!&!&%@. �+,!4 %)1/,+."%.+"% 2"-,3+,/&(%! '3!)G, (/,/3G! (/&,3+-',%3/.+"% 2 %-&G4 3+',./3/4 23+&%"+5!,+,+ &+ 50 % 4!,+&/"! % 5%,3+,/4 '.%&5+ A/E.S. Reynolds. �3!A+3+,G %)2B+"% . �"!(,3/&&/4 4%(3/'(/A! JEM-100 CX A3% 2.!"%B!&%#D 4,8 —36000 . )/&! % .&! )/&G 3!)!(5%% A/*F!"2*/B&/@ F!"!)G.

&�_��z�� �����������. /AG,&/@ '!3%% �('A!3%4!&,+, 1*! /A!3+,%.&/! .4!U+,!"-',./*/A/"&#"/'- ./)*!@',.%!4 &%)(/%&,!&'%.&/1/ "+)!3&/1/ %)"2B!&%#, . 2B+',(+D A/*F!"2*/B&/@F!"!)G, 3+'A/"/F!&&GD .&! )/&G 3!)!(5%%, /$3+�+"+ &+ '!$# .&%4+&%! 1!,!3/1!&&/',- +5%&2'/.. ("!,(+D /*&%D +5%&2'/. &+$"�*+"/'- '(/A"!&%! 4&/1/B%'"!&&GD )3!"GD )%4/1!&/.GD 13+&2" .)/&! +A%(+"-&/1/ A/"�'+ ' A3%)&+(+4% )+*!3F(% .G*!"!&%# '!(3!,+ . A3/'.!, 5!&,3/+5%&/)&/1/A3/,/(+, / B!4 (/'.!&&/ 4/1"+ '.%*!,!"-',./.+,- 3!*2(5%# 4%(3/./3'%&/(. ("!,(+D *321%D+5%&2'/. '/*!3F+"%'- 4&/1/B%'"!&&G! 13+&2"G A3/)%4/1!&+, &!)3!"G! 13+&2"G % (/&*!&'+5%/&-&G! .+(2/"%. +(+# F! (+3,%&+ &+$"�*+"+'- % . A3!*!"+D /*&/1/ +5%&2'+. �*3+ +5%&+3&GD ("!,/(/,"%B+"%'- /.+"-&/@ %"% /(321"/@ ?/34/@, &!1"2$/(%4% %&.+1%&+5%#4% #*!3&/@ /$/"/B(%, ' A!-3%?!3%B!'(/@ (/&5!&,3+5%!@ 4!"(/)!3&%',/1/ (/&*!&'%3/.+&&/1/ D3/4+,%&+. �*3GU(% $G"%(32A&G4%, ' A3!%42�!',.!&&/ 13+&2"#3&G4 (/4A/&!&,/4, A/3G U%3/(%!, /,B!,"%.G!. �%,/D/&-*3%% $G"% /.+"-&/@ %"% 2*"%&!&&/@ ?/34G, B+',/ 1%A!3,3/?%3/.+&&G!, ' 4&/1/B%'"!&&G4%(3%',+4%, 4+,3%('/4 24!3!&&/@ �"!(,3/&&/@ A"/,&/',%. � 4%,/D/&*3%#4% B+',/ ,!'&/ (/&,+(,%-3/.+"% )3!"G! 13+&2"G )%4/1!&+. �3+&2"#3&+# �&*/A"+)4+,%B!'(+# '!,- $G"+ 4/�&/ 3+).%,+,A3!*',+."!&+ 4&/F!',.!&&G4% A"/,&/2A+(/.+&&G4% A+3+""!"-&G4% 4!4$3+&+4% ' $/"-U%4B%'"/4 '.#)+&&GD 3%$/'/4. �/4A"!(' �/"-*F%, (+( A3+.%"/, &+D/*%"'# . +(,%.&/4 '/',/#&%%, '4&/1/B%'"!&&G4% 4!"(%4% 1"+*(%4% .!)%(2"+4% % (/&*!&'+5%/&&G4% .+(2/"#4% 3+)"%B&/1/3+)4!3+. G#."#"%'- !*%&%B&G! *.2#*!3&G! % «,!4&G!» ("!,(%. 4!F*/"-(/./4 A3/',3+&',.!&+$"�*+"% A3/"%?!3+5%� 1!4/(+A%""#3/..

)/&! 3!)!(5%% . 3!)2"-,+,! ./)*!@',.%# "+)!3&/1/ %)"2B!&%# (3+'&/@ /$"+',% 'A!(,3+ &+-$"�*+"/'- 3+)3+',+&%! '/!*%&%,!"-&/@ ,(+&% ' A3!/$"+*+&%!4 (/""+1!&/.GD ./"/(/&, B+',/ /$-"+*+��%D A/.GU!&&/@ �"!(,3/&&/@ A"/,&/',-�. �"!,/B&G! �"!4!&,G .G#."#"%'- 3!*(/. �(+-)+&&G! 4/3?/"/1%B!'(%! A3%)&+(% '.%*!,!"-',./.+"% / $/"!! $G',3/4 '/)3!.+&%% 13+&2"#5%/&-&/@ ,(+&% A/* ./)*!@',.%!4 "+)!3+ % ,3+&'?/34+5%% !! . '/!*%&%,!"-&2� ,(+&-. �5%&+3&G!("!,(% . A3!*!"+D /*&/1/ +5%&2'+ /,"%B+"%'- .G3+F!&&/@ 1!,!3/1!&&/',-� 5%,/A"+)4+,%B!'(/1/4+,3%('+. /)3+',+"/ B%'"/ «,!4&GD» ("!,/(, . 2–3 3+)+ A/ '3+.&!&%� ' (/&,3/"-&/@ 132AA/@.�.!"%B!&%! B%'"+ «,!4&GD» ("!,/( . A/*F!"2*/B&/@ F!"!)! &+$"�*+!,'# A3% !! A/.GU!&&/@?2&(5%/&+"-&/@ +(,%.&/',%, (/1*+ %*!, ',%42"#5%# .G$3/'+ '!(3!,+. «!4&G!» ("!,(% #."#�,'#"%$/ 3!)!3.&G4%, A/)F! .',2A+��%4% . ?+)2 '%&,!)+ '!(3!,+, "%$/ ,!4%, . (/,/3GD '%&,!) A%�!-.+3%,!"-&GD ?!34!&,/. )+&%4+!, $/"!! *"%,!"-&G@ '3/( [5]. �+3#*2 ' «,!4&G4%» % «'.!,"G4%»("!,(+4% .G#."#"%'- «A3/4!F2,/B&G!». /)3+',+"/ (/"%B!',./ *.2#*!3&GD +5%&+3&GD ("!,/(,A3%B!4 (+( «'.!,"GD» ,+( % «,!4&GD». �*3+ $/"-U%&',.+ ("!,/( A3%/$3!,+"% 2*"%&!&&2� ?/3-42, '/*!3F+"% (32A&/!, �('5!&,3%B&/ 3+'A/"/F!&&/! #*3GU(/, ' A3!%42�!',.!&&/ 13+&2"#3&G4(/4A/&!&,/4, U%3/(%! /,B!,"%.G! A/3G . #*!3&/@ /$/"/B(!. #*3+D /,*!"-&GD +5%&+3&GD ("!-,/( )&+B%,!"-&/ 2.!"%B%.+"/'- (/"%B!',./ #*3GU(/./1/ 4+,!3%+"+. �%,/D/&*3%% A+&(3!+,/5%-,/. % ("!,/( '/!*%&%,!"-&/@ ,(+&% /,"%B+"%'- 4&/1/B%'"!&&G4% (3%',+4%, 4+,3%('/4 24!3!&-&/@ �"!(,3/&&/@ A"/,&/',%. �,4!B+"/'- &+$2D+&%! 4+,3%('+ 4%,/D/&*3%@ % A3%/$3!,!&%! &+-32F&/@ 4!4$3+&/@ /31+&!"" ./"&%',GD /B!3,+&%@, B,/ 'A/'/$',.2!, 2.!"%B!&%� A/.!3D&/',&/@A"/,&/',% /31+&!"". �+�! /$&+32F%.+"%'- 1%A!3,3/?%3/.+&&G! ?/34G. �"%&+ 4%,/D/&*3%@ .'3!*&!4 '/',+."#"+ 7,033 ± 0,077 × 10Ø74, U%3%&+ — 3,786 ± 0,037 × 10Ø7 4. �3% �,/4 A3/%'D/*%"/*/',/.!3&/! (p < 0,001) 2.!"%B!&%! *"%&G 4%,/D/&*3%@ &+ 28,2 % % U%3%&G &+ 22,2 % A/ '3+.&!-&%� ' (/&,3/"-&/@ 132AA/@. �/*/$&G! ',32(,23&G! %)4!&!&%# 4%,/D/&*3%@ 2(+)G.+�, &+ ./)-3+',+&%! %D ?2&(5%/&+"-&/@ +(,%.&/',%. �3+&2"#3&+# �&*/A"+)4+,%B!'(+# '!,- $G"+ '%"-&/ 3+)-.%,+, 5%',!3&G !! ' 4&/1/B%'"!&&G4% '.#)+&&G4% 3%$/'/4+4% A3+(,%B!'(% 3+.&/4!3&/ A"/,&/)+A/"&#"% .'� 5%,/A"+)42 (+( . $+)+"-&/4 /,*!"! ("!,/(, ,+( % . +A%(+"-&/4. / 4&/1%D ("!,(+D&+$"�*+"+'- *!13+&2"#5%# 13+&2"#3&/@ �&*/A"+)4+,%B!'(/@ '!,%, + 4!F*2 !! 5%',!3&+4% .G#.-"#"/'- 4&/F!',./ './$/*&GD 3%$/'/4. �,% 4/3?/"/1%B!'(%! A3%)&+(% #."#�,'# A/(+)+,!"!4 +(-,%.+5%% $%/'%&,!)+ (+( ,3+&'A/3,&/1/ $!"(+, ,+( % *"# '/$',.!&&GD &2F* ("!,/(. «'.!,"GD»("!,(+D 5%',!3&G 13+&2"#3&/@ �&*/A"+)4+,%B!'(/@ '!,%, (+( A3+.%"/, $G"% 3+'U%3!&&G4%, .A3/4!F2,/B&GD — . 4!&-U!@ ',!A!&%, + . «,!4&GD» A3!*',+."!&G A"/,&/ 2A+(/.+&&G4% A+3+"-

237

"!"-&G4% 4!4$3+&+4%. �/4A"!(' �/"-*F% $G" A3!*',+."!& ',/A(/@ 2A"/�!&&GD 5%',!3& %(32A&G4% .+(2/"#4% ' �"!(,3/&&/N'.!,"G4 '/*!3F%4G4. �+3+(,!3&/, B,/ . /,"%B%! /, A3!*G*2-�%D 132AA, . A3%4!3&/ /*&/@ ,3!,% «'.!,"GD» +5%&+3&GD ("!,/( (+( . A3!*!"+D /*&/1/ +5%&2'+,,+( % . 3+)&GD +5%&2'+D A3!/$"+*+"% &!)3!"G! 13+&2"G )%4/1!&+ % 13+&2"G A3/)%4/1!&+. �,/ /$-',/#,!"-',./ 2(+)G.+"/ &+ A3!/$"+*+&%! ',+*%% '/)3!.+&%# '!(3!,+ &+* &+(/A"!&%!4. �3% �,/4&!)3!"G! 13+&2"G )%4/1!&+ %4!"% &!,%A%B&G@ .%*, /$2'"/."!&&G@ D+3+(,!3/4 3+'A3!*!"!&%#'!(3!,+ . 13+&2"+D. /',+"-&GD +5%&+3&GD ("!,(+D .G#."#"%'- A3!%42�!',.!&&/ )3!"G! 13+&2-"G )%4/1!&+ %&,!&'%.&/ B!3&/1/ 5.!,+, (/,/3G! 4!',+4% ,!'&/ (/&,+(,%3/.+"% *321 ' *321/4 %"/(+"%)/.+"%'- $/"-U!@ B+',-� . +A%(+"-&/4 /,*!"! (',+*%# &+(/A"!&%# % .G*!"!&%# '!(3!,+).�!&,3/+5%&/)&G! A3/,/(% /,"%B+"%'- 4&/1/B%'"!&&G4% 4%(3/./3'%&(+4% % /,B!,"%.G4% '/-!*%&%,!"-&/N,(+&&G4% (/4A"!('+4%. �,4!B+"+'- A3/"%?!3+5%# /',3/.(/./@ ,(+&%.

$ ��� . +(%4 /$3+)/4, . 3!)2"-,+,! ./)*!@',.%# ���� . )/&! 3!)!(5%% A/*F!"2*/B&/@F!"!)G /,4!B+!,'# 2'(/3!&%! '/)3!.+&%# 13+&2"#5%/&&/@ ,(+&% ' A/'"!*2��!@ ,3+&'?/34+5%!@. )3!"2� '/!*%&%,!"-&2� ,(+&-. �+)!3&/! ./)*!@',.%! ',%42"%32!, A3/"%?!3+5%� 1!4/(+A%""#-3/. . 4!F*/"-(/./4 A3/',3+&',.!. �!)(/ ./)3+',+�, 3!A+3+,%.&G! A3/5!''G . +5%&+3&GD ("!,-(+D, 4/3?/"/1%B!'(%4 A/(+)+,!"!4 (/,/3GD #."#!,'# )&+B%,!"-&/! 2.!"%B!&%! B%'"+ *.2#*!3&GD% «,!4&GD» ("!,/(. '//,.!,',.%% ' �,%4 A/.GU+!,'# $%/'%&,!,%B!'(+# +(,%.&/',- . ("!,(+D, /B!4 '.%*!,!"-',.2!, +(,%.+5%# #*!3&/1/ +AA+3+,+, 13+&2"#3&/@ �&*/A"+)4+,%B!'(/@ '!,% % 4%,/-D/&*3%@. �'%"%.+�,'# A3/5!''G (+,+$/"%)4+, &+$"�*+!,'# $/"!! .G3+F!&&G@ +''%&D3/&%)4 '!(-3!,/3&/1/ 5%("+ . +5%&2'+D. �,%42"%32!,'# A3/"%?!3+5%# /',3/.(/./@ ,(+&%. �/N.%*%4/42, "+-)!3&/! %)"2B!&%! ',%42"%32!, /$3+)/.+&%! «,!4&GD» ("!,/( ,/"-(/ . A+,/"/1%B!'(% %)4!&!&&/@,(+&% A/*F!"2*/B&/@ F!"!)G, . ,/ .3!4# (+( . %&,+(,&/@ ,(+&% (/"%B!',./ «,!4&GD» ("!,/( /'-,+!,'# &+ 23/.&! (/&,3/"#.

�A%'/( "%,!3+,23G:1. �2@"%&, L�. �%)(/%&,!&'%.&G! "+)!3G . D%3231%%: 3!+"-&/',- % A!3'A!(,%.G /

L�. �2@"%&, �L�. �3!D/., L�. �3G(/. // �&&+"G D%3231%%. — 2003. — � 2. — �. 8–10.2. �2&+!., �L. �%)%(/N,!D&%B!'(%! /'&/.G &%)(/%&,!&'%.&/@ "+)!3&/@ ,!3+A%%. — ISBN

978-3-8484-1368-3, LAP, 2012.— 296 '.3. �/'(.%&, �L. �%',!4&G@ +&+"%) �??!(,%.&/',% 2A3+."!&%# $%/"/1%B!'(%4% '%',!4+4%

&%)(/�&!31!,%B!'(%4 "+)!3&G4 %)"2B!&%!4: +.,/3!?. *%'. ... *N3+ $%/". &+2(. — 2"+, 2008. —38 '.

4. �!B%A23!&(/, �L�. �!D+&%)4G *!@',.%# % $%/"/1%B!'(%! �??!(,G &%)(/%&,!&'%.&/1/"+)!3&/1/ %)"2B!&%# / �L�. �!B%A23!&(/ [% *3.] // �!*%5%&'(%! &/./',%. — 2008. — � 12. —�. 17–21.

5. �!34#(/., �L�. �"-,3+',32(,23&G@ +&+"%) '!(3!,/3&/1/ 5%("+ A/*F!"2*/B&/@ F!"!)G /�L�. �!34#(/., �L�. �/*/"-'(%@, �L�. %,/.+. — �.: �!*%5%&+, 1973. — 239 '.

238

���������

�')*+= 1. +�0!&+%'�)!',"�1'(+',#+. �+&!>!$"

Alekhina D.D. Pirogov's ideas and modern angiosurgery ……………………………………………….. 3

Barysheva V.O., Koryakova O.E., Oselkova Y.O. The scientific activity of N.I. Pirogov in our days …. 5

Bojchuk Yu.D., Udovenko �L�., �ucheruk �.S., Scherbak I.N.Humanistic ideas in pedagogical heritage of N. Pirogov ……………………………………………...... 10

Chikisheva A.A. The reflection of the legacy of Pirogov N.I. in the activity of surgeonsof the Chelyabinsk medical academy …………………………………………………………………... 13

Dubanova K.U., Peskova T.V. Nikolai Ivanovich Pirogov — a great man ……………………………. 15

Eremin A.O. N.I. Pirogov — the founder of the theory of aseptic and antiseptic ……………………… 16

Isakova A.A., Tretyakova V.Y., Barysheva V.O. The historical heritage of N.I. Pirogovin the field of asepsis and antisepsis ……………………………………………………………………. 18

Jukova A.D. Twins ……………………………………………………………………………………... 20

Lukyanova K.�., Yuldybaev N.U., Israelyan D.K. Pedagogical views of Pirogov N.I. ………………. 21

Markina �.Y., Tarasova I.S. Creation of the military field surgery …………………………………… 22

Martemyanova Y.V., Kosovskaya V.V., Barysheva V.O. From Pirogov’s «ice anatomy»to Ivanov’s magnetic resonance anatomy ……………………………………………………………… 23

Matveyeva E.S., Tarasova I.S. Role of Administration in Formation of Domestic Medicine …………. 28

Medvedenko I.V., Sinyova K.S. National surgical armaments ………………………………………… 31

Mukhanov M.L. Pirogov — surgeon and educator …………………………………………………….. 32

Pirogova M.Y. Meaning of life as viewed by the outstanding scientist ………………………………... 34

Ponomareva A.D. N.I. Pirogov’s Achievements in the development of anesthesiology ………………. 35

Shlepotina N.M. Remember and appreciate our great teachers ………………………………………... 37

Shlepotina N.M., Sinyova K.S. The role of activity of Russian doctors associationin memory of N.I. Pirogov at the end of XIX — beginning of XX centuries ………………………….. 39

Shmakova V.V. The formation of field surgery in the course of the Russian military history ………… 41

Verein K.V., Kotlovanova O.V. Pirogov's contribution to venerology development ………………….. 43

Zaharova D.A., Fleisher I.S., Barysheva V.O. Innovations of N.I. Pirogovin the field of vascular surgery …………………………………………………………………………. 45

!D+ �L. �2*-$+ 3!?/34+,/3+ ………………………………………………………………………. 46

/"12)/. �L. �L�. �%3/1/. % !1/ «�+B+"+» . ./!&&/NA/"!./@ D%3231%% ……………………….. 48

239

GA3%5(%D �L�., �!3#$%&+ �L., �%&%B(%& �L�., �!.B!&(/ �L�.�/"- �(/"/1%B!'(%D ,3%11!3/. . ?/34%3/.+&%% % 3+).%,%% ���NA+,/"/1%% ……………………. 50

�!3+'%4/.+ �L�. �L�. �%3/1/. — A!3./A3/D/*!5 A3%4!&!&%# +&!',!)%% &+ ,!+,3! ./@&G …… 55

�/"/.+&- L�. �',/3%B!'(%! +'A!(,G ./!&&/NA/"!./@ D%3231%% ………………………………… 58

�/.+"-B2( �L�., �)!.2"-'(+# �L., �+"%(/. �L. G*+��%@'# +&+,/4 �L�. �%3/1/. —?2&*+,/3 �%!.'(/@ +&+,/4%B!'(/@ U(/"G …………………………………………………………. 59

�/3#(/.+ �L�., �234+,/.+ �L�., �234+,/. �L�., �'!"(/.+ �L�., �+3GU!.+ L�.,�3%&B%@ �L�. �/.3!4!&&+# «�!*#&+# +&+,/4%#» …………………………………………………... 63

�2B!32( �L�., �/@B2( �L�. �3/#."!&%# 124+&%)4+ . A!*+1/1%B!'(%D .)1"#*+D �L�. �%3/1/.+ .. 70

�!*.!*!&(/ �L. �&+B!&%! A!*+1/1%B!'(/1/ &+'"!*%# �L�. �%3/1/.+ …………………………… 72

�!*.!*!&(/ �L. �L�. �%3/1/. — A!3.//,(3G.+,!"- /A!3+,%.&/1/ .4!U+,!"-',.+A/* �?%3&G4 &+3(/)/4 . �/''%% …………………………………………………………………….. 73

�/3/)/. �L. �'/$!&&/',% D%3231%B!'(/1/ /$!'A!B!&%# A+3,%)+&'(/1/ *.%F!&%#. 1/*G !"%(/@ �,!B!',.!&&/@ ./@&G ………………………………………………………………. 75

�!45!.+ �L., �/$3GU!. �L�. /'A%,+&&%(% «�%3/1/.5+» — &+U% 2B%,!"# …………………… 77

�/&/4+3!&(/ �L�., �/&/4+3!&(/ �L�. «�!*#&+# +&+,/4%#» �L�. �%3/1/.+ —A3//$3+) ,/A/13+?%B!'(/@ +&+,/4%% % "2B!./@ *%+1&/',%(% …………………………………….. 78

�231%&+ �L�. �',/3%# 3+'A3/',3+&!&%# (23!&%# '/ .3!4!& �%3/1/.+ % */ &+U%D *&!@ ……….. 81

�+',3G1%&+ L�., �+A/F(/.+ �L., �/&*3+, �L., �/3!"- �L.�(,2+"-&/',- A!*+1/1%B!'(/1/ &+'"!*%# �%(/"+# �.+&/.%B+ �%3/1/.+ …………………………. 83

�!&B!&(/.+ �L. �4A2,+5%# — &+'"!*%! �%(/"+# �.+&/.%B+ �%3/1/.+ ………………………… 85

�"!@U!3 �L�., �+D+3/.+ �L�. «�%5/ .3+B+» (+( %',/3%B!'(/! &+'"!*%!�%(/"+# �.+&/.%B+ �%3/1/.+ ………………………………………………………………………... 88

¬!3$+( �L�., �/@B2( �L�. �*!# /$�!B!"/.!B!'(/1/ ./'A%,+&%#. A!*+1/1%B!'(/4 &+'"!*%% �L�. �%3/1/.+ ………………………………………………………….. 90

�')*+= 2. �!$&'J',,-'"��')0-","0!J+++�"0","0!J++

Chekushkin A.A., Yunyashina Y.V. Change in the morphological structure of the adrenal cortexin experimental hemorrhagic shock …………………………………………………………………….. 93

Divisenko A.S. The analysis of the reasons of a lethality in hospitals of Chelyabinsk regionon materials of autopsiyny examinations ……………………………………………………………….. 94

Divisenko A.S. Divergence of the clinical and pathoanatomical diagnosis as criterionof quality of work of medical institutions ………………………………………………………………. 96

Kokovina T.A., Shichipitsyna A.S., Zamyatina K.I. Tumors of salivary glandson total operational material ……………………………………………………………………………. 98

Zarkov S.I., Sinyova K.S. Reasons of adverse trauma outcome ……………………………………… 101

240

�3,�4!. �L�. /A/13+?/N+&+,/4%B!'(+# D+3+(,!3%',%(+ /A!3+,%.&/1/ */',2A+A3% 3+)&GD +&,3/A/4!,3%B!'(%D A+3+4!,3+D A+5%!&,/( ' 3+(/4 ,!"+ 4+,(%. 2'"/.%#D +&+,/4%B!'(/1/ �('A!3%4!&,+ ………………………………………………………… 102

+@&!3 �L�. �&,3/A/4!,3%B!'(%! D+3+(,!3%',%(% F!&�%& */ % A/'"! (/33!(5%%%)$G,/B&/1/ .!'+ ……………………………………………………………………………………. 105

"+*%B!&(/ �L�. �+)!3&+ A/"#3%4!,3�# #( 4!,/* *%?*�+1&/',%(%4/3?/"/1�B&%D )4�& A!3!*4�D23/./¤ )+"/)% ………………………………………………………. 108

�+$/3 �L�., �+32�+( �L�. �'/$"%./',� +"-,!3+,%.&%D )4�&A!B�&(%A3% !('A!3%4!&,+"-&/42 '%&*3/4� 1/',3/1/ 2U(/*F!&&# "!1!&- ……………………………… 111

�!&+*&�(/.+ �L�. �'/$"%./',i ("Æ&Æ(% ,+ *Æ+1&/',%(% D./3/$% �!&!,3Æ! ………………………. 112

�34+(/.+ �L�., %4/&%& �L�., �&%1!3!. �L�. �3%B%&&/N'"!*',.!&&+# '.#)-4!F*2 ("%&%B!'(%4 ,!B!&%!4 &!,3+.4+,%B!'(%D .&2,3%4/)1/.GD (3/./%)"%#&%@% /'/$!&&/',#4% ',3/!&%# 5!&,3+"-&GD A!3?/3%32��%D +3,!3%@ 1/"/.&/1/ 4/)1+ …………. 114

��",%(/.+ L�. �/3?/4!,3%B!'(%! A/(+)+,!"% '!*+"%�&/1/ &!3.+2 42FB%& )3!"/1/ ./)3+',+ …………………………………………………………………………. 115

�/4+3 �L�., �3/&/.%5(+# �L�., �/@(/ �L�. �!(/,/3G! +'A!(,G2'A!U&/1/ A3!A/*+.+&%# +&+,/4%% . 'A/3,%.&/4 .2)! (&+ A3%4!3! �����) …………………. 118

�2)&#5/.+ L�., �3GU,/?�( �L�., �+U(+.!5 �)L�. �"-,3+',32(,23&G# +'+$"Æ.+'5i5!" &#@3/&ý 1Æ',+4Æ&�31ÆB&+1+ #*3+ �2 1ÆA+,+"+42'+ A+52(+ A+'"# '2$,+,+"-&+@,3G55+5ÆD.Æ"Æ&&+@ iU�4ii 1+"+Ù&/1+ 4/)12 ………………………………………………………… 119

�+.3�. �L�., �"�@&%( �L�. �,+&/."!&&# ,/A/13+?�¤ A3%.2U&%D '"%&&%D )+"/)2 A"/*�. ,3!,-/1/ ,3%4!',32 .&2,3�U&-/2,3/$&/1/ 3/).%,(2 …………………………………… 123

�!34/&,/. �L�. �&*%.%*2+"-&+# %)4!&B%./',- &+*A/B!B&%(/.GD +3,!3%@:/, B+',&/1/ ( /$�!42 ……………………………………………………………………………….. 128

�+"G1%&+ �L�. �3/!(5%/&&+# +&+,/4%# ',32(,23 1/"/.&/1/ 4/)1+A3% /$�!4&GD A/3+F!&%#D …………………………………………………………………………. 130

��)- �L., ��"/.2' �L�. �/3?/4!,3%B&+ /5�&(+ ',32(,23% &!23+F!&/¤ ',�&(%*.+&+*5#,%A+"/¤ (%U(% 2 ',+,!./&!)3�"%D �23�. ………………………………………………… 134

�#$5!.+ �L�., �.,2U(/ �L�., �+"%&/.'(%@ �L�. �/3?/"/1%B!'(%! %)4!&!&%# &%F&!1/ .!(+2 $/"-&GD %&./"�5%/&&G4 �(,3/A%/&/4 ………………………………………………………… 136

�!*/'/. �L�. �/3?/4!,3%B!'(+# D+3+(,!3%',%(+ +"-.!/"#3&GD /,3/',(/. .!3D&!@ B!"�',%2 .)3/'"/1/ B!"/.!(+ A3% 3+)"%B&/@ ?/34! !1/ "%5!./1/ B!3!A+ ……………………………….. 138

�!3&/2' L. �'/$!&&/',% 4/3?/"/1%B!'(/@ *%+1&/',%(% D3/&%B!'(/1/ ,/&)%""%,+. ?+)! ("%&%B!'(/@ 3!4%''%% ……………………………………………………………………… 140

�')*+= 3. ")04"1],-'�&!;1'J-)1+,+%'�)!/^+&4&>++

Devyatkina O.A. «Superlymph» treatment of diabetic foot syndrome at patientswith insulin-independent diabetes (type II) …………………………………………………………… 143

Dyachkova E.Y., Milyukova D.Y. The utilization of osteotropic material «Collost»for filling bone defects ………………………………………………………………………………... 145

241

Markina �.Y. Epidemiology of breast cancer among women of fertile agein the Chelyabinsk region …………………………………………………………………………….. 146

Worgowa D.N. Die Spezifik der Durchführung transkutaner Ultraschalluntersuchungder Erkrankten an Kehlkopfkrebs auf aktueller Etappe ………………………………………………. 147

Worgowa D.N. Die Arbeit des Kabinetts der Ultraschalldiagnostikin großer Mehrprofilklinik ……………………………………………………………………………. 149

Worgowa D.N. Ultraschalluntersuchung der Erkrankten an Gebärmutterhalskrebsauf aktueller Etappe …………………………………………………………………………………… 150

�*%"/. �L�. �+B!',./ F%)&% A+5%!&,+ A/'"! 2*+"!&%# 4/B!./1/ A2)G3# —'/.3!4!&&G@ .)1"#* …………………………………………………………………………………. 152

�"�D%&+ �L., +"�(!.%B �L�. �+,/"/1%# F!"B!.G./*#�%D A2,!@ 2 $!3!4!&&GD' A/*/)3!&%!4 &+ «/',3G@ F%./,» …………………………………………………………………. 155

�"%A+&+D/. �L�., �"%U%&+ �L�., �%D+@"/.+ �L�. �+,!4+,%B!'(%@ +&+"%) . D%3231%% ……… 156

�"%U!. �L. �!)2"-,+,G D%3231%B!'(/1/ "!B!&%# $/"-&GD .!&,3+"-&/@ 13GF!@A3% 4!',&/@ %4A"+&,+5%% (+,!,!3+ ��N��� …………………………………………………….. 158

�/$3GU!. �L�., �/.+"-B2( �L. �/.3!4!&&G! 4!,/*G "!B!&%# (!"/%*&GD 32$5/.¥/$)/3 "%,!3+,23G)…………………………………………………………………………………… 159

�3%,/( L�., �"/.%(/.+ �L�. �!B!&%! $/"-&GD /',3G4% /13+&%B!&&G4% �4A%!4+4% A"!.3G' %'A/"-)/.+&%!4 ,/3+(/'(/A%% …………………………………………………………………… 161

�+'&%(/. �L. �3/1&/)%3/.+&%! /,*+"!&&GD 3!)2"-,+,/. $+""/&&/@ +&1%/A"+',%(%(/+3(,+5%% +/3,G &+ /'&/.+&%% +&+,/4%B!'(%D A+3+4!,3/. ……………………………………. 163

�/"#( �L. �"-,3+).2(/.+# *%+1&/',%(+ ' *2A"!('&G4 '(+&%3/.+&%!4A3% /A3!*!"!&%% A+,/"/1%B!'(/1/ 1/3%)/&,+"-&/1/ % .!3,%(+"-&/1/ '$3/'+ 2 $/"-&GD' .+3%(/)&/@ $/"!)&-� &%F&%D (/&!B&/',!@ ……………………………………………………... 166

�3/)+ �L�., �+&+'!&(/ �L�., �/3*%#& �L�., �+@*!@ �L�. �',!/'%&,!) A"+',%&/@' 21"/./@ ',+$%"-&/',-� A3% A!3!"/4! (/',!@ 1/"!&% …………………………………………... 167

�"/.%(/.+ �L�., �3%,/( L�. �%??!3!&5%3/.+&&G@ A/*D/* ( .GA/"&!&%�*3!&%3/.+&%# A"!.3+"-&/@ A/"/',% A3% /',3/@ ,/,+"-&/@ �4A%!4! A"!.3G …………………... 168

�4!"-#&/.+ �L. �%"+,!3+"-&/! +,!3/'("!3/,%B!'(%! A/3+F!&%# +3,!3%@ $!*3+,1/"!&% % ',/AG — A3/1&/) %'D/*+ "!B!&%# % 3%'(+ '%',!4&GD /'"/F&!&%@ …………………... 169

�!@*"%5 �L�. "%#&%! 3!(+&+"%)+5%% +3,!3%@ &%F&%D (/&!B&/',!@&+ A/(+)+,!"% .&2,3%'!3*!B&/@ 1!4/*%&+4%(% . 1/3%)/&,+"-&/4 A/"/F!&%%% A3% /3,/',+,%B!'(/@ A3/$! 2 A+5%!&,/. ' 42"-,%?/(+"-&G4 +,!3/'("!3/)/4 ………………. 172

�.+&/. L�. �5!&(+ �??!(,%.&/',% %'A/"-)/.+&%# (/""+A'/D%3231%B!'(%D .4!U+,!"-',.2 $/"-&GD ' %&?%"-,3+,%.&G4 ,2$!3(2"!)/4 "!1(%D …………………………………………….. 173

�"-#'/. �L�. "%#&%! +&,%/('%*+&,&/@ ,!3+A%% &+ ,!B!&%! A/'"!/A!3+5%/&&/1/ A!3%/*+2 $/"-&GD ' (%U!B&/@ &!A3/D/*%4/',-� ………………………………………………………… 174

�+"%&%&+ �L�. �/3?/"/1%B!'(/! /$/'&/.+&%! A3%4!&!&%# (/4A/)%5%/&&GD A3/,!)/.*"# A"+',%(% 13GF A%�!./*&/1/ /,.!3',%# *%+?3+14G …………………………………………. 176

242

�+'%4/. L�. �,32(,23+ */3/F&/N,3+&'A/3,&GD A3/%'U!',.%@ 1. �3+'&/#3'(+% "!B!$&/N*%+1&/',%B!'(+# ,+(,%(+ A3% &%D )+ A!3%/* 2007–2012 11. …………………………... 179

�/,(/. �L�. �3/?%"+(,%(+ +$*/4%&+"-&/@ 'A+!B&/@ $/"!)&% ………………………………….. 181

�/B&!.+ L�. �5!&(+ ."%#&%# '/A2,',.2��!@ A+,/"/1%% &+ /,*+"!&&G! 3!)2"-,+,GA/'"! /*&/'/'2*%',/@ 3!.+'(2"#3%)+5%% 4%/(+3*+ ……………………………………………… 183

�2*/U �L�., �!,3+U!.%B �L�. �%3231%B!'(/! "!B!&%! D3/&%B!'(/@ '!3*!B&/@&!*/',+,/B&/',% ' A/4/�-� %'(2'',.!&&GD F!"2*/B(/. '!3*5+ ……………………………….. 186

�!*.!*!&(/ �L. �3!%42�!',.+ .&2,3%.!&&/1/ A!3%?!3%B!'(/1/ (+,!,!3+A/ '3+.&!&%� ' *321%4% 'A/'/$+4% ..!*!&%# "!(+3',.!&&GD .!�!',. ………………………… 188

�'%(/. �L., �1!!. �L�., �!3!A+&/. �L�., �3%&B%@ �L�. �%3231%B!'(/! 4/*!"%3/.+&%!D3/&%B!'(/@ A/B!B&/@ &!*/',+,/B&/',% …………………………………………………………... 189

�+."/.!5 �L�., �3+&52)/.+ �L�. �/"- +&,%$%/,%(/. 5!?+"/'A/3%&/./1/ 3#*+. "!B!&%% /',3/1/ % D3/&%B!'(/1/ D/"!5%',%,+ ………………………………………………….. 192

�+3?�&/.+ �L�. G$/3 4!,/*+ ,3!A+&+5%% A3% ,3+.4+,%B!'(%D /$/"/B!B&GD% .&2,3%4/)1/.GD 1!4+,/4+D 2 $/"-&GD . '/',/#&%% ("%&%B!'(/@ '2$(/4A!&'+5%%% 24!3!&&/@ *!(/4A!&'+5%% ………………………………………………………………………... 193

�!,3+U!.%B �L�., �2*/U �L�., �+3?!&/.+ �L�. �%3231%B!'(/! "!B!&%! A+5%!&,/.' *%"+,+5%/&&/@ (+3*%/4%/A+,%!@ ………………………………………………………………… 194

�"!U+(/. �L�., �+3D+,/.+ �L�. �'/$!&&/',% ("%&%(% % "+$/3+,/3&GD A/(+)+,!"!@ (3/.%A3% /',3/4 4!)!&,!3%+"-&/4 ,3/4$/)! ……………………………………………………………. 195

�32*&%(/. �L. �!1!&!3+5%/&&G@ 1%',/1!&!) 1&/@&GD 3+& A/* ."%#&%!43+)"%B&GD 'A/'/$/. 4!',&/1/ "!B!&%# …………………………………………………………….. 198

�!4!&#( �L., �2D%&+ �L�., �3/D/"-'(+# �L. �!)2"-,+,G D%3231%B!'(%D .4!U+,!"-',.2 F!&�%& ' ,32$&G4 ?+(,/3/4 $!'A"/*%# % .&!4+,/B&/@ $!3!4!&&/',-� ……………………. 200

!3!U!&(/.+ �L�., �23"+B(/ �L�., �+3B!&(/ �L�., !3N�(/A#& �L�., �'4+%"/. �L�.,�!&5/.+ �L�. �3/1&/)%3/.+&%! /'"/F&!&%@ . A/'"!/A!3+5%/&&/4 A!3%/*!. .%*! 3+).%,%# ��� — &!?3/A+,%% 2 $/"-&GD ' A3!*A/"+1+!4/@42"-,%4/*+"-&/@ +&!',!)%!@ . 3!+$%"%,+5%/&&/N./'',+&/.%,!"-&/4 A!3%/*! ………………. 203

%4/&%& �L�., �34+(/.+ �L�., �&%1!3!. �L�. �+32U!&%# A3/.!*!&%# ).2(/./1/ '%1&+"+A/ *+&&G4 ��� 2 $/"-&GD ' 1!4/33+1%B!'(%4 %&'2"-,/4 A2,+4!&+"-&/@ "/(+"%)+5%% …… 205

/@B2!. �L�. �3+.&%,!"-&+# /5!&(+ 3!)2"-,+,/. %'A/"-)/.+&%#+""/A"+',%B!'(/1/ 4+,!3%+"+ A3% &+"/F!&%% (/&5!./@ (/"/',/4G 2 $/"-&GD 3+(/4&%F&!+4A2"#3&/1/ /,*!"+ A3#4/@ (%U(% ………………………………………………………… 206

�!4/*+&/. �L., �/"/'/.%B �L. �'/$"%./',� !3+*%(+5�¤ Helicobacter pylori. A�'"#/A!3+5�@&/42 A!3�/*� 2 D./3%D &+ A!3?/3+,%.&2 .%3+)(2 U"2&(+,+ *.+&+*5#,%A+"/¤ (%U(% ………………………………………………………………………….. 208

�!3*+(/. �L. �/4A"!('&G@ A/*D/* . *%+1&/',%(! % "!B!&%%'%&*3/4+ *%+$!,%B!'(/@ ',/AG ……………………………………………………………………. 211

�2+D$+!. �L�. �+"+"+3*+ËG Ð2GÐN&!'!A+Ë+3 3!?"�('�& !4*!2 Ð/3G,G&*G"+3G ....................... 213

243

�&1%&/!. �L., �3'"+&+"%!. �L�., �F+?+3/. �L�., �+U%*/.+ L�.�"%F+@U%! 3!)2"-,+,G /A!3+5%% (/3/&+3&/1/ U2&,%3/.+&%# &+ 3+$/,+��!4 '!3*5!' %'(2'',.!&&G4 (3/.//$3+�!&%! $!) (+3*%/A"!1%% ……………………………………………. 216

�(/."!.+ �L�. �%&+4%(+ .%*/./1/ '/',+.+ 1/'A%,+"-&GD ./)$2*%,!"!@ D%3231%B!'(/@%&?!(5%% 4#1(%D ,(+&!@ % %D +&,%$%/,%(/3!)%',!&,&/',% )+ 1994–2011 1/*G ……………….. 216

�')*+= 4. +,,!$"*++$!�'&"0+$,!/0'^,+)'

Gor I.V. Orthonyxia and cryosurgery — new methods of treatment ingrown toenail ……………….. 219

Smirnov A.A., Mandjaeva S.U. Transpharyngeal access to thyroid and parathyroid glandsand original device for its realization …………………………………………………………………. 221

�1&+,!&(/ �L. �!3.G@ /AG, +2,/+3,!3%+"-&/@ 3!(/&',32(5%% $%?23(+5%% ���A3% (+3/,%*&/@ �&*+3,!3�(,/4%% ………………………………………………………………….. 225

�/3U2&/. L., �!.%5(+# �L�. �3+.&%,!"-&+# D+3+(,!3%',%(+ /,*+"!&&GD 3!)2"-,+,/.+"-,!3&+,%.&GD .+3%+&,/. �"!(,3/(+3*%/',%42"#5%% A3+./1/ F!"2*/B(+ ……………………. 227

�%,.%&!5 �L., �.%3*�(!.%B �L�., !"%B(/ L�.�/*%?%(+5%% 'A/'/$/. A"+',%(% A+D/.GD 13GF ………………………………………………… 230

��5/.%B �L�., �/@'%( �L�., ��&-(!.%B �L�. +3�+&, A"+',%(% A3/4!F%&%A3% &+#.&/',� (%U(/./NA�D././¤ &/3%5� …………………………………………………………… 231

�+.B2( �L., �A%3%*/&/. �L�. �!,/* �&*/.!&/)&/@ "+)!3&/@ (/+12"#5%%A/*(/F&GD .!& . "!B!&%% .+3%(/)&/@ $/"!)&% .!& &%F&%D (/&!B&/',!@ ……………………… 233

�,!&-(/ �L�. �"-,3+',32(,23&+# D+3+(,!3%',%(+ %)4!&!&%@. (2"-,! A/*F!"2*/B&/@ F!"!)G A3% 3!)!(5%% /31+&+A/'"! ./)*!@',.%# &%)(/%&,!&'%.&/1/ "+)!3&/1/ %)"2B!&%# ……………………………………. 235

���������0�����

����������� ����� II ������������������������������������������������������� ����� �

������������������»

�/* 3!*+(5%!@ A3/?!''/3+ �L. �2(%B!.+

ISBN 978-5-94507-171-1

�)*+,!"-',./ «�!"#$%&'(+# 1/'2*+3',.!&&+# 4!*%5%&'(+# +(+*!4%#»454048, 1. �!"#$%&'(, 2". /3/.'(/1/, 64

!". (351) 262-77-98

�/*A%'+&/ . A!B+,- 20.11.2012. �,A!B+,+&/ . �� «�������».�/34+, 60 × 84/8. �24+1+ /?'!,&+#. �+3&%,23+ Times New Roman cyr.

�'". A!B. ". 28,37. �!B+,- &+ 3%)/13+?!. %3+F 150 50. �+(+) 1519.454092, 1. �!"#$%&'(, 2". �3+'&+#, 42; ,!".: 230-67-37; 727-74-50