Habermas views modernity as "Unfinished project" ... The central issue continues to be rationality ... The utopian goal is to maximize rationalize so called by him "System" so and "Life world". Those. there is "System"- this is the state and the economy (they act strategically and rationally) And there is "Life World"- this is the private life of people and civil society (they are communicative and subject to morality).

Globalization has become a major problem for modern sociology. Giddens has a short definition of globalization: "I define it as action at a distance."... Or a more detailed definition: "Globalization is an intensification of social relations of a worldwide scale that connect distant locales in such a way that events occurring in one place are formed by what happens many miles away, and vice versa." Globalization by E. Giddens is interpreted as a natural continuation of the original tendencies of modernity. Globalization according to Giddens hasfive components:

At the end of last year, a department for endovascular diagnostic and treatment methods (a complex of intravascular interventions performed on blood vessels percutaneous access under the control of methods of radiation imaging). And now it has been done on the basis of the department - for the first time in the Moscow region! - a unique operation with a difficult name for nonmedicals: endoprosthetics of a saccular aneurysm of the aortic arch with a special stent graft. We talked about the new possibilities of Reutov healthcare with the head of the department of X-ray surgical methods of diagnosis and treatment of the Reutov Central City Clinical Hospital, the chief specialist of the Ministry of Health of the Moscow Region for X-ray endovascular diagnosis and treatment, Roman Goloshchapov-Aksenov.

- Roman Sergeevich, on December 27 last year, a department for endovascular diagnostics was opened at the Central City Clinical Hospital. How do you, one of the leading experts in this field, assess the significance of the event?

- It is impossible to imagine a modern multidisciplinary clinic today without such a department. This is a fundamentally new, actively developing area of ​​medicine, expanding the capabilities of diagnostic techniques to the active performance of medical operations that significantly improve the quality of life of patients. Such departments must be replicated, and X-ray surgical care should be brought as close as possible to the patient, so that the time interval from the onset of a life-threatening disease to the execution of the only possible efficient operation was minimal.

- What are the main advantages of this method?

- Minimal surgical intervention under local anesthesia, easy repeatability of procedures without a large additional risk for the patient, reduction in the time of hospital stay, which means lower treatment costs, improved quality of life for patients and high economic efficiency medical care... In addition, the operation can be offered to patients belonging to the high-risk group.

The main feature of X-ray endovascular surgery is that all operations, regardless of the disease, are performed inside the vascular bed, without incisions and under control x-rays, and the surgical access is carried out using a special needle. The terms of hospitalization of patients when performing planned intravascular surgeries often do not exceed one day. Thus, the quality of life of patients is preserved for high level... The methods of endovascular surgery are universal and have found application in almost all areas of medicine: cardiovascular surgery, cardiology, neurology, neurosurgery, urology, gynecology, oncology, liver surgery and gastrointestinal tract... X-ray endovascular surgeons restore vessel patency, as in the treatment of acute myocardial infarction or ischemic stroke.

- Roman Sergeevich, on October 2, at the Reutov Central City Clinical Hospital, an operation was performed to replace the saccular aneurysm of the aortic arch with a special stent-graft. What is the uniqueness?

- Firstly, until recently, the performance of such operations was impossible in any of the hospitals in the Moscow region, both at the municipal level and at the federal level. There are well-equipped military hospitals in the Moscow region, large federal centers, Regional Institute. Vladimirsky - MONIKI, however, to perform hybrid aortic surgery, not only modern equipment is needed, but also a team of highly qualified specialists - cardiovascular surgeons, specialists in X-ray endovascular diagnostics and treatment, as well as resuscitators.

- Explain, please, what is a "hybrid" operation?

- Hybrid surgery combines the capabilities of traditional surgery and endovascular surgery. It is performed by her cardiovascular surgeon and specialist in X-ray endovascular diagnosis and treatment. This modern technology is used for stenting of the aortic aneurysm - the largest arterial vessel human body, with the implantation of an artificial aortic valve without the use of artificial circulation. The technology of implantation of endoprostheses is no different from traditional stenting of arteries, only for insertion of the prosthesis into the vascular bed, not a point access to the arteries, but a surgical minimal incision is required. To install a special stent in the aortic arch, from which the arteries supplying the brain with blood, you must first perform a bypass operation of these arteries. The danger of aortic aneurysm lies in its rupture with a high risk of fatal outcome. The difference between a stent-graft and a conventional stent is that its cell is closed with a special vascular prosthesis, which, after stent implantation, covers the aneurysm and turns it off from the circulation. The peculiarity of the localization of the aneurysm in the aortic arch is that arteries that supply blood to the head and upper limbs depart from this segment of the aorta, and the overlap of the lumen of the latter, together with the aneurysm, can lead to stroke and ischemia of the upper limbs.

- A bit uncomfortable. Tell me, was the operation successful?

- Yes, the very next day the 64-year-old patient could get up. Currently, the patient's condition is satisfactory, he is preparing for discharge. As for the operation itself, the first stage was bypass grafting of the arteries of the aortic arch; it was performed by Doctor of Medical Sciences, Professor Roman Komarov, an employee of the clinic of aortic and cardiovascular surgery of the First Moscow State medical university them. THEM. Sechenov. I performed the stenting of the aortic arch.

- Will similar operations be carried out in the Reutov Central City Clinical Hospital in the future?

- Hybrid technologies are expensive. To date, only about 50 transcatheter aortic valves have been implanted in Russia; stenting of the aortic arch is rare, and a few more operations have been performed to stent an aneurysm of the abdominal aorta. In Europe and the United States, every patient diagnosed with aortic aneurysm is considered a candidate for aortic stenting or a hybrid option. surgical treatment... In the countries of the European Union, this technology is financially supported by the state, and in Germany and France there are also special federal programs. I hope that our clinic will be included in such a program.

Some statistics
Myocardial infarction: in 98.5% of cases, it is possible to stop the pathological process of the necrocardiac muscle with the timely use of X-ray surgery methods.
Ischemic stroke: mortality decreases from 40% to 27.2% with the timely administration of a thrombolytic drug into the thrombosed intracerebral artery.
Critical ischemia lower limbs: in 91% of cases it is possible to avoid amputation due to X-ray endovascular restoration of blood flow through the arteries of the lower leg.
Uterine fibroids: in 99% of cases, recovery can be achieved by blocking blood flow through the uterine arteries and avoiding removal of the uterus or myomatous nodes.

A video footage from RTV about the aortic stenting operation, the first in the history of the Moscow region, which was performed in Reutov, is possible.

Holders of the patent RU 2289415:

The invention relates to medicine, in particular to gynecology, and for the treatment of uterine fibroids. For this, after selective catheterization, 100 mg of Actovegin in 2.5 ml is injected into both uterine arteries, and then the embolisate is immediately introduced. The method provides a painless course of the postembolization period and a decrease in the manifestations of the postembolization syndrome.

The invention relates to medicine, in particular to gynecology, and for the treatment of uterine fibroids, mainly nodular forms, using the technique of uterine artery embolization (UAE).

Uterine fibroids are among the most common benign tumors of the female genital organs, often detected in women of reproductive age. According to average statistical data, its frequency after 30 years reaches 25-50%. Approximately 1/3 of all visits to gynecological clinics are diagnosed with this tumor (Kulakov V.I., Adamyan L.V., 2000). In 53.3-63.5% of uterine fibroids are diagnosed at the age of 40-50 years; is more common among women engaged in mental work - 60.1%, in contrast to women engaged in manual labor - 9.4% (Gilyazutdinova Z.Sh., 2004). According to the literature, the incidence of uterine fibroids in young women is currently increasing. The problem of treating patients with uterine myoma is relevant in modern gynecology in view of the high frequency of this pathology, as well as its negative influence on the reproductive system and general state woman's health.

Currently, the treatment of uterine fibroids is carried out by a conservative, surgical and combined method. Conservative therapy is to appoint medications(neuroleptics, immunomodulators, general somatic and hormonal), physiotherapeutic, balneological treatment methods. Modern hormone therapy has a large arsenal drugs, the use of which inhibits the growth and reduces the size of uterine fibroids, but after discontinuation of treatment, relapses of the disease are usually observed. Surgical remains the main treatment for uterine fibroids. The significance of the problem is emphasized by the fact that hysterectomy remains the most frequent gynecological operation worldwide (52-94% of patients). The volume of surgical intervention can be radical: hysterectomy, and conservative: myomectomy. However, removal of the uterus leads to the development of posthysterectomy syndrome, and removal of myomatous nodes in 30% of cases leads to a relapse.

As mentioned earlier, in recent years there has been a "rejuvenation" of uterine fibroids, in connection with which there is a need to preserve the generative function of a woman.

Modern diagnostics, the choice of an adequate method for the treatment of uterine fibroids, as well as the evaluation of the results are relevant at the present time.

In recent years, with the development of endovascular surgery, the method of uterine artery embolization (UAE) has found wide application in the treatment of uterine fibroids. UAE is a minimally invasive non-surgical organ-preserving procedure that is a sufficient alternative to surgical treatment.

UAE has been used since 1979 to stop severe postpartum and post-traumatic uterine bleeding... In 1990, Jacques Ravina, using uterine artery embolization for the preoperative preparation of women with uterine fibroids in the presence of hypervascularized tumors, noted that in some patients, as a result of the manipulation, the main symptoms were stopped and surgical treatment was not required. In September 1995, Jacques Ravina published an article for the first time in The Lancet on the treatment of uterine fibroids using UAE. Currently, the EAA method is widely used in medical institutions in the USA, Europe, Asia and the Middle East. In 1996, UAE received FDA approval in the United States, and in 1998, by order of the Ministry of Health of the Russian Federation, it was included in the list of permitted endovascular interventions. More than 300,000 UAE procedures have been performed in Europe and the United States. Currently, all over the world, including the leading clinics of our country, more than 100,000 embolizations are performed annually.

In the pathogenesis of uterine fibroids, as is known, neoangiogenesis, which is activated during tumor growth, plays an important role. As the myometrium hypertrophy and the tumor mass grows in the capillary network of the myometrium adjacent to the myomatous nodes, the architectonics of the capillary network characteristic of normal myometrium completely disappears - its loop-mesh pattern, the capillary network becomes shapeless, chaotic, irregularity of the filling of blood vessels appears, they appear stasis, capillaries often acquire a tortuous course. The angioarchitectonics of the capillary network of the "intact" myometrium in some cases retains its normal appearance (Savitsky G.A., Savitsky A.G., 2003).

Vessels of the peripheral plexus, a chaotic vascular network surrounding the myoma along the periphery, is represented by arc and radial arteries that bend around the node and send a weakly expressed feeding capillary network into the tumor. Myoma vessels have a diameter of up to 0.5 mm, which is several times larger than the diameter of the arteries of the normal myometrium. During UAE, injected particles of polyvinyl alcohol (PVA) of a certain size (300-700 microns) with the blood flow migrate only to the peripheral branches of the uterine arteries of the corresponding diameter and accumulate in them, causing segmental vascular occlusion. Wherein distal parts the vascular bed of the unchanged myometrium remains passable and after a short period of time begins to be supplied with blood through the collateral vessels, which contributes to the gradual elimination of organ tissue ischemia. Of great importance in this mechanism are the anastomoses between the ovarian branches of the uterine artery and the ovarian arteries proper, extending from the aorta. The capillary ramifications of the myomatous nodes themselves do not have anastomoses at the end sections, therefore, the PVA particles entering them lead to persistent blockage of the supplying vessels, which determines the selective effect of endovascular intervention and its effect only on the myoma itself (Dobrokhotova Yu.E., Kapranov S.A. ., Bobrov B.Yu., Alieva A.A., Grishin I.I.). After the introduction of embolization particles, the myoma loses its blood supply and is replaced connective tissue- fibrosis, which leads to a significant reduction and / or disappearance of fibroids and its manifestations.

The closest analogue of the proposed method is a method of treating uterine fibroids by selective embolization of the uterine arteries, proposed by Jacques Ravina (Ravina J.H., Arterial embolization to treat uterine myomata. Lanset 1995; 346: 671-672). Under local anesthesia of the skin in the upper third of the thigh by transfemoral access under the control of X-ray television, alternate catheterization of the uterine arteries is performed, after which an angiogram is performed, followed by the introduction of embolizing particles of polyvinyl alcohol (PVA) into the myoma vessels, which leads to complete occlusion of the vascular bed and the great artery.

Catheterization of the uterine arteries is always carried out from both sides, since the blood supply of even one node can be carried out from different vessels, utero-ovarian anastomoses different types(B. Yu. Bobrov, S. A. Kapranov, Yu. E. Dobrokhotova, I. A. Krasnova, N. A. Shevchenko, D. D. Alieva, V.B. Aksenova. Endovascular surgery of the heart and blood vessels, pp. .198).

UAE causes fibroid ischemia, resulting in acute hypoxia and necrotic changes in tissues. This leads to the appearance of painful sensations of varying intensity, bleeding from the vagina, an increase in body temperature, weakness, malaise, dysfunction Bladder and intestines, changes in blood counts, that is, to the development of "postembolization syndrome" (Yu. E. Dobrokhotova, S. A. Kapranov, B. Yu. Bobrov, A. A. Alieva, I. I. Grishin, gynecologist, 2, 2005, 44-49). Depending on the severity of his symptoms, anesthetic, infusion, anti-inflammatory, antibacterial therapy is performed.

The purpose of the invention: to reduce these complications due to a preliminary increase in the parenchymal blood flow of the myomatous uterus before the UAE, which contributes to a better embolization due to the penetration of PVA particles into the previously spasmodic capillaries of the myoma and, accordingly, a decrease in ischemic areas in it and an improvement in blood supply in healthy tissues of the myometrium, which prevents the development of gross morphological changes in the uterus, leading to postembolization complications. To achieve the effect of increasing parenchymal blood flow, we used Actovegin in a solution for injection of 200 mg / 5 ml, which was divided into equal shares and injected at 100 mg / 2.5 ml into each uterine artery, while counting on the improvement of blood circulation, which is provided by Actovegin , as well as on its metabolic effect in the myometrium, namely, the activation of aerobic oxidation processes, an increase in oxygen utilization by tissues, an activation of enzymes of the antioxidant defense system, an increase in tissue tolerance to hypoxia.

Modified EMA technique.

The method is carried out as follows:

Under local anesthesia, the femoral artery is punctured in the upper third of the right thigh;

A pig-tail catheter is passed to a level slightly below the renal arteries and pelvic angiography is performed to clarify the anatomy of the uterine arteries;

A Roberts catheter (COOK) or "cobra" is inserted into the contralateral uterine artery and selective catheterization of the uterine artery is performed under the control of radiotelevision;

A contrast agent is injected and subsequent angiography to visualize the vessels of the uterus;

100 mg (2.5 ml) of Actovegin is injected into the uterine artery;

An embolisate is introduced, for example, such as polyvinyl alcohol (PVA 500, COOK: 500-710 microns) mixed with a contrast agent in an amount necessary to completely stop antegrade blood flow through the artery;

A Roberts catheter is inserted into the ipsilateral artery and the above manipulation is performed on the opposite side.

This technique: the introduction of Actovegin 2.5 ml / 100 mg on each side - was effective regardless of the size and location of the fibroids.

Since 2004, we have been carrying out embolization of the uterine arteries to treat uterine fibroids; since 2005, UAE has been carried out in our modification using Actovegin.

Treatment by the UAE method in a modified by us technique using Actovegin was carried out in 11 patients, 20 patients made up the control group, who underwent standard UAE. UAE was performed in patients with the following types of uterine fibroids:

A general increase of 6 to 15 weeks of the pregnant uterus;

The presence of one node and with multiple nodes;

In combination with adenomyosis;

Intermuscular arrangement of nodes and nodes with centripital and subserous growth;

The presence of a node with a power failure in it.

The course of the postembolization period after standard UAE was characterized by various postembolization symptoms: abdominal pain, hyperthermia up to 38 ° C and higher; violation of the gastrointestinal tract; symptoms of an acute abdomen; menorrhagia; leukocytosis.

When performing UAE using a modified technique with Actovegin, a favorable course of the postembolization period was achieved: pain was insignificant or absent; an increase in body temperature not higher than 37.0-37.5 ° C; dysfunction of the gastrointestinal tract was not noted; discharge from the genital tract is scanty and noted only in 2 patients; the number of leukocytes was up to 8.0 to 11.5 * 10 ^ 9 / l, the hospital stay after UAE was 1-2 days.

Patients, both experimental and control groups, were under dynamic observation: examination, ultrasound of the pelvic organs were carried out after 1, 3, 6, 9 months. A decrease in the size of uterine fibroids occurred in the same way in both groups.

Thus, with the use of a new modified UAE technique using Actovegin, an almost painless course of the postembolization period was noted. The use of the above technique provided a significant reduction in the manifestations of postembolization syndrome while maintaining the effectiveness of this manipulation in terms of reducing the size of myoma and its manifestations.

Clinical examples.

Patient 3., 47 years old. Case history No. 919. DS: Uterine fibroids, enlargement up to 8 weeks of pregnant uterus with centripital node growth (node ​​size up to 5.0 cm in d).

02/01/05: UAE was carried out in the following way: selective catheterization of the uterine arteries was performed by transfemoral access, followed by the introduction of 2.5 ml / 100 mg of Actovegin under fluoroscopic control and the immediate introduction of PVA-500 (COOK). In the p / o period, the pain symptom was absent, the body temperature was kept at normal values, in the blood test L - 5.3 * 10 ^ 9 / l, fibrinogen was normal. Ultrasound control on the day of discharge on the 3rd day - reduction of the node size from 5.0 cm to 3.2 * 3.0 cm. Follow-up for 9 months: node size 2.5 * 2.2 cm, normalization menstrual cycle, improvement of general well-being.

Patient U., 26 years old. Case history No. 11099. DS: Multiple uterine fibroids increase up to 15 weeks of the pregnant uterus. Chronic anemia II Art. Ultrasound examination and gynecological examination revealed many nodes located in all layers and on all surfaces of the uterus. 10/20/05: UAE according to our modified method with Actovegin: transfemoral access was used for selective catheterization of the uterine arteries, followed by the introduction of 2.5 ml / 100 mg of Actovegin under fluoroscopic control and immediately the introduction of PVA-500 (COOK). P / o period with a slight pain syndrome (relief by a single injection of tramadol and no-shpa), t up to 37.3 ° C, on the first day - weakness, dizziness against the background of normal blood pressure, in the blood test L - 11.5 * 10 ^ 9 / l, fibrinogen - 2.68. Ultrasound after 3 days: reducing the size of the uterus up to 13 weeks.

Patient 77., 37 years old. Case history No. 11427. DS: Uterine fibroids 8 weeks, malnutrition of the node. Received 25.10.05, with complaints of pulling pain in the lower abdomen. According to the ultrasound and examination, the patient revealed a malnutrition of the myomatous node (interstitial node 4.3 * 3.5 cm along the left uterine rib). On day 1, the patient was injected intravenously with 200 mg of Actovegin in 200.0 physical doses. solution; 2.0 2% papaverine; 400.0 5% glucose solution; 100.0 metrogyl; 0.1 doxycycline in 200.0 physical solution. A day later, 10/27/05, against the background of the disappearance of pain, UAE was performed according to a modified method with Actovegin: selective catheterization of the uterine arteries was performed by transfemoral access, followed by the introduction of 2.5 ml / 100 mg of Actovegin under fluoroscopic control and immediately the introduction of PVA-500 (COOK). In the n / a period, the ongoing therapy was continued. Pain syndrome- insignificant, rectal suppositories "diclofenac" were used once a day, body temperature at normal numbers, in the blood test L - 7.1 * 10 ^ 9 / l, fibrinogen - 3.26. Ultrasound of 10/29/05: node 3.5 * 2.8 cm, clear contours. Extract on October 29, 05 - on the 2nd day after the EMA.

Conclusion.

First proposed, developed and used in clinical practice original modification of uterine artery embolization in the treatment of uterine fibroids. The method of uterine artery embolization with the preliminary administration of Actovegin allows achieving a more favorable course of the postembolization period: painless course or with minor painful sensations; reduction of the postoperative bed-day; reducing the number of medications used without compromising the effectiveness of the manipulation performed and its immediate and long-term results of treatment.

A method of treating uterine fibroids by embolization of the uterine arteries, characterized in that after selective catheterization, 100 mg of Actovegin in 2.5 ml is injected into both uterine arteries, and then the embolisate is immediately introduced.

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The invention relates to medicine, namely to production technology medicines, and can be used in pharmacology for the preparation of preparations based on the dry blood of antler deer - pantogematogen "dry" for external use.

On May 21–23, 2017, the Russian New University (RosNOU) took part in the XXI Annual Session of the National Scientific and Practical Center for Cardiovascular Surgery (NNSPCSSH) named after A. N. Bakulev of the Ministry of Health of the Russian Federation.

The session included a meeting "Sociology and jurisprudence in health care" and a scientific and practical seminar "Criminal legal risks of medical practice in cardiovascular surgery: prevention and prevention of negative legal consequences", organized jointly by RosNOU, N. Bakulev NSPCSSH, Association "Law in Health Care" and the Moscow Region Bar Association.

The chairmen of the meeting "Sociology and jurisprudence in health care" were the dean of the law faculty of RosNOU Alexei Tyrtyshny and the head of the Center for medico-legal support of medical workers, senior researcher at the Department of Contemporary Sociology, Moscow State University. M.V. Lomonosova Tatiana Semina.

Tatyana Vasilievna made a presentation "Trends in modern healthcare: burnout of a doctor - cardiovascular surgeon", saying that one of the reasons for emotional burnout is the unsettled legal relationship in conflicts between doctors and patients.

Presentations at the meeting were also made by:

- Romanovsky Georgy Borisovich, Head of the Department of Criminal Law, Penza State University, report "Legal Foundations of Telemedicine";

- Elena Vladimirovna Kuntz, Head of the Department of Criminal Law and Criminology, Chelyabinsk State University, report " State of the art defects rendering medical care»;

- Bokeria Leo Antonovich, director of the N.N.Bakulev NSPCSSH, Vladimir Yuryevich Semyonov, chief physician IKiSKh NTs SSH named after A.N.Bakulev, Stupakov Igor Nikolaevich, Deputy Director of NSPCSSH named after A.N.Bakulev on general issues, Yurlov Ivan Aleksandrovich, surgeon NNSPCSKh named after A.N.Bakulev, Vinokurov Alexander Vladimirovich leading researcher of the training department specialists and continuing education of the N.N.Bakulev NSPCSSH with reports on the topic "The concept professional development and professional standard “doctor - cardiovascular surgeon” ”;

- Osipova Nadezhda Gennadievna, Dean of the Faculty of Sociology, Moscow State University named after M.V. Lomonosov with the report "Sociology, jurisprudence and health care: the formation of an interdisciplinary categorical apparatus";

- Goloshchapov-Aksyonov Roman Sergeevich, Head of the Department of X-ray Endosurgical Diagnostics and Treatment of the Central City clinical hospital of the city of Reutov, Lakunin Konstantin Yuryevich, Chief Physician of the Central City Clinical Hospital of the city of Reutov, Pigolkin Yury Ivanovich, Head of the Department of Forensic Medicine of the Moscow State Medical University named after I.M. ;

- Tyrtyshny Alexey Alexandrovich, dean of the Faculty of Law of RosNOU, Pomazkova Svetlana Ivanovna, Head of the Department of Civil Law Disciplines of RosNOU with reports on "Conciliation procedures for the settlement of disputes between doctors and patients."

In his report, Aleksey Aleksandrovich made the main emphasis on the need to introduce into the practice of medical care the institution of pre-trial settlement of disputes, based on the experience of foreign countries, but reflecting the realities of modern Russian healthcare.

The dean of the Faculty of Law of RosNOU spoke about the essence of the concept of conciliation (mediation) procedures and the experience of their application. According to him, in Russia, mediation procedures for resolving disputes apply only to private law relations, and public law relations are prohibited from mediating dispute settlement.

Examples of judicial practice testify to the possible settlement of disputes in the administrative order, which is a weighty argument in the issue of introducing the institution of pre-trial settlement of disputes. The nature of some cases allows for an alternative way of resolving disputes such as mediation in the future. For example, in the matter of reimbursement technical means rehabilitation, independently acquired at the patient's own expense.

The report examined the legal risks of introducing the institution of conciliation procedures, analyzed the factors that can reduce the risks, as well as the directions of the implementation of the institution of social ombudsman and mandatory pre-trial resolution of disputes. According to the dean of the Law Faculty of RosNOU, such areas include the resolution of medical disputes using online platforms, cooperation of insurance organizations, medical, patient and legal communities, professionalization of the institution of reconciliation.

Alexey Alexandrovich Tyrtyshny paid special attention to the creation of the Council for the professional qualifications of non-medical personnel - lawyers, personnel officers, IT specialists at the Association of Cardiovascular Surgeons and the League of Nation's Health - for the direct implementation of the institution of pre-trial settlement of disputes in the provision of medical care in cardiovascular surgery.

Svetlana Pomazkova, Head of the Department of Civil Law Disciplines of RosNOU, made a presentation “Reasonable risk and the limits of its legitimacy. Medical risk ". According to Svetlana Ivanovna, one of the most important conditions the legitimacy of the risk is the direction of the riskier's actions to achieve a socially useful goal - improving the patient's health. The report noted that the patient has a right to be informed about the diagnosis, the methods of care and the associated risk. The head of the Department of Civil Law Disciplines of RosNOU also spoke about the assessment of harm caused to the life and health of the patient, as well as about cases when the harm is not illegal.

The so-called "principle of general tort" is enshrined in civil law, according to which any harm is illegal. The exception is infliction of harm by lawful actions, infliction of harm with the consent of the victim and infliction of harm in a state of extreme necessity.

Text - Daria Rozhkova