Clinical practice in recent years has demonstrated a steady increase in the number of servicemen presenting with pain syndrome and functional disorders of the musculoskeletal system after combat surgical trauma. In a significant proportion of patients, these symptoms are delayed in onset: they may develop weeks, months, or even years after a gunshot injury and are often localized not strictly within the area of the initial trauma, but in other anatomical regions. In this regard, establishing a relationship between gunshot injuries and subsequent enthesopathy represents both a matter of scientific and practical interest and a clinically significant problem.

The present study is the first systematizing investigation of enthesopathy caused by the damaging factors of firearms. From a pathogenetic standpoint, it substantiates a new nosological entity that has not previously been considered and is not encoded by any of the existing terms: “gunshot enthesopathy”.

The article proposes the innovativeness of intraoperative bypass angiography in improving the results of coronary artery bypass grafting (CABG) at the stage of experience of the National Medical Research Center of the A.N. Bakulev Cardiovascular Surgery Center for 2023. The study involved 814 patients who were prescribed 1754 coronary bypass grafts. The main emphasis is on the detection and correction of bypass dysfunctions, such as occlusions, stenoses and kinks, which improves hemodynamics and long-term results of the surgery. The introduction of intraoperative bypass angiography in 2009 significantly reduced the number of dysfunctions, as a result of which this method is used in the CABG protocol. The results confirm the need for early diagnosis and correction of bypass grafts to prevent recurrent angina and rehospitalizations.

Purpose of the study: To evaluate the impact of simultaneous lower extremity artery reconstruction on the early and long-term outcomes in patients after open surgical treatment of infrarenal abdominal aortic aneurysms.

Materials and methods: The study included 163 patients with infrarenal AAA and hemodynamically significant lesions of the ilio-femoral and femoro-popliteal segments (TASC II types C and D) who underwent elective open surgical treatment between 1997 and 2022. The patients were divided into two groups: Group 1 (n = 66) – simultaneous open surgery: open surgical treatment of infrarenal abdominal aortic aneurysm with reconstruction of the lower extremity arteries (n = 66); Group 2 (n = 97) – isolated open surgical treatment of infrarenal abdominal aortic aneurysm (n = 97). The mean retrospective follow-up period was 7 years (range 5 to 15 years).

Results: Group 1 showed a significant increase in operative time (251±54 min vs. 197±35 min in Group 2; p = 0.001), aortic and arterial cross-clamp time (p<0.001), and a higher incidence of acute renal failure (10% vs. 3%; p = 0.05). In-hospital mortality did not differ significantly between the groups (9% vs. 3%; p = 0.1). In the long-term period (up to 15 years), Group 1 demonstrated significantly higher rates of primary patency (p = 0.001) and freedom from re-interventions (p = 0.001) compared to Group 2. The cumulative limb salvage rate and overall survival did not differ between the groups (p = 0.9).

Conclusion: Simultaneous reconstruction of the lower extremity arteries during open surgical treatment of infrarenal abdominal aortic aneurysms in carefully selected patients increases operative time and the rate of early postoperative complications but does not lead to a significant increase in in-hospital mortality. In the long term, this strategy provides significantly better primary patency and reduces the frequency of repeat interventions by ensuring adequate distal runoff.

Acute lower limb ischemia (ALLI) is a critical vascular condition associated with a high risk of amputation and mortality. The main etiological factors of ALLI include thrombosis and embolism, and the choice of optimal revascularization strategy plays a key role in clinical outcomes. Modern endovascular approaches, including catheter-directed thrombolysis, demonstrate effectiveness comparable to open surgery while being less invasive.

An important aspect of treatment optimization is the objective assessment of revascularization outcomes and prediction of clinical results. For this purpose, the TOPI (Treatment Of Peripheral Ischemia) scale was developed for angiographic evaluation of blood flow restoration. The aim of this study was to validate the TOPI scale for assessing the effectiveness of arterial revascularization and predicting outcomes in patients with acute lower limb ischemia following catheter-directed thrombolysis.

Materials and Methods: This prospective study included 69 patients with ALLI stages IIA–IIIA (according to the Saveliev–Zatevakhin classification) treated between 2016 and 2025. All patients underwent catheter-directed thrombolysis. Revascularization effectiveness was assessed using the TOPI scale (1–5 points) immediately after the procedure. Technical success, clinical outcomes, amputation rates, and perioperative complications were analyzed.

Results: Technical success of catheter-directed thrombolysis was achieved in 86.4% of patients. TOPI scores were distributed as follows: 5 points in 60.9% of cases, 4 points in 17.4%, 3 points in 11.6%, 2 points in 7.2%, and 1 point in 2.9%. The amputation rate was 7.2%, consistent with published data. Early postoperative mortality was 1.4%, associated with hemorrhagic stroke. Perioperative complications occurred in 5.8% of patients, mainly represented by access-site bleeding and pseudoaneurysm formation. A statistically significant association was observed between TOPI score and limb salvage (p<0.001): amputation occurred in 2.1% of patients with TOPI 4–5 and in 26.7% with TOPI 1–3.

Conclusion: The TOPI scale is a valid tool for objective assessment of revascularization effectiveness and outcome prediction in patients with acute lower limb ischemia following catheter-directed thrombolysis. A TOPI score ≥4 is associated with a high probability of limb salvage and may be used for risk stratification and optimization of treatment strategies.

Backgraund: Postoperative complications arising after operations for complicated and uncomplicated aneurysms of the infrarenal aorta are a complex surgical pathology with a high mortality rate.

Aims: To study the results of surgical treatment of complicated and uncomplicated aneurysms of the infrarenal aorta and evaluate the effectiveness of approaches to the diagnosis and treatment of postoperative complications.

Materials and Methods: The surgical treatment of 51 patients with abdominal aortic aneurysms was evaluated. Two groups of patients were identified: Group 1 (n = 21) – those admitted urgently with complicated aneurysms (rupture, dissection); Group 2 (n = 30) – those admitted electively and with uncomplicated aneurysms. According to MSCT angiography, the size of abdominal aortic aneurysms in elective patients was 57,8±3,7 mm, while in emergency patients, it reached 68,0±2,1 mm (p = 0,012). In both groups, linear and aortic-bifurcation grafting techniques were used for surgical treatment. Postoperatively, the diagnosis and treatment of complications were assessed.

Results: Aneurysmectomy with linear grafting was performed in 4 cases in patients in the first group (19%) and in 4 cases (13,3%) in the second group. Aneurysmectomy with bifurcation aortic grafting was recorded in 17 (81%) cases in the first group and 26 (86,7%) in the second. Of the 51% of postoperative complications observed in both groups, they were recorded 34,7% more often in the first group. The mortality rate was 36,2% higher (p<0,001), with a combined mortality rate of 21,6% (11 patients) in both groups.

Conclusion: Severe complications of surgical treatment of abdominal aortic aneurysms include dynamic intestinal obstruction, abdominal compartment syndrome, acute kidney injury, and ischemic colitis, which are most common in complicated cases. A comprehensive preoperative examination, including CT angiography, adherence to intraoperative revascularization procedures, intra-abdominal pressure monitoring, postoperative colonoscopy, and timely reoperation using vacuum systems in the postoperative period enable successful management.

Rationale: Diabetic foot syndrome remains one of the leading causes of non-traumatic amputations worldwide, with the neuroischemic form characterized by the most severe course and unfavorable prognosis. Despite the development of revascularization techniques, the incidence of major amputations reaches 40–60%, and postoperative mortality remains high. There is an urgent need to optimize the management of these patients to overcome the consequences of ischemia and postreperfusion complications, making the search for effective integrated approaches critical for modern surgery.

Objective: To evaluate the long-term treatment outcomes of patients with HNO SDS and peripheral circulatory impairment treated with local negative pressure therapy. Materials and Methods: Treatment of patients with HNO SDS associated with critical lower limb ischemia (CLLI) has been a key focus of the Department of Cardiovascular Surgery at the Vascular Center of Rostov State Medical University (RostSMU) for over 30 years. Over the past years, the clinic has treated over a thousand patients with this condition. A multidisciplinary approach involving various specialists (endocrinologists, cardiologists, cardiovascular and endovascular surgeons, orthopedists, microbiologists, and pharmacologists) enables us to achieve the shortand long-term treatment outcomes presented in this study. A comparative analysis of data from 65 patients was conducted, divided into two groups: a study group (n = 33), which utilized a developed protocol with vacuum therapy after revascularization, and a control group (n = 32), which received standard treatment.

Methods: The methodology included assessment of transcutaneous oximetry, hospital stay, wound healing, and limb survival rates (Kaplan-Meier scale).

Results: This study presents for the first time a rigorous three-stage treatment algorithm, in which local negative pressure well-pressure therapy (NPWT) is considered not as an additional method, but as a mandatory element integrated into a unified approach immediately after the restoration of main blood flow and necrosectomy. Early use of vacuum therapy in the post-revascularization period has been shown to significantly improve microcirculation (confirmed by TcpO2TcpO2 data) and block the cascade of purulent-necrotic complications more effectively than standard methods. In the study group, high amputations were avoided (0 cases), while in the control group, 5 high amputations at the femur level were performed (19.23%). The total number of amputations (including minor) in the control group was 38.46% versus 7.14% in the study group (p = 0.0043). The average duration of inpatient treatment in the study group was reduced to 11.73±0.23 days compared to 16.39±0.51 days in the control group (p = 0.000001). Complete healing of defects in the study group was faster: on average, 33.94 days versus 44.85 days in the control group (p = 0.01332). On the 5th day after the second stage of treatment, the TcpO2 level in the study group was significantly higher (35.32 mmHg) than in the control group (31.01 mmHg).

Conclusion: The authors conclude that integrating local negative pressure therapy into a rigorous algorithm after revascularization significantly improves the prognosis: 100% preservation of limb weight-bearing function was achieved in the study group (versus 84.37% in the control group). This method not only accelerates wound cleansing and granulation but also prevents a cascade of complications leading to repeated disabling surgeries.

Backround. Breast cancer (BC) remains the leading oncological disease among women worldwide and in Russian, as well. In early-stage breast cancer (T1–3N0M0), sentinel lymph node biopsy (SLNB) is a mandatory diagnostic procedure for accurate surgical staging. However, SLNB may result in lymphorrhea, formation of lymphoceles, and, more rarely, upper limb lymphedema, which are among the most common complications of surgical treatment of breast cancer. According to various authors, postoperative lymphorrhea after SLNB occurs in 5–93% of cases as a result of impaired lymph transport through the lymphatic vessels. The main clinical problem of this condition is associated with uncontrolled and unpredictable lymphatic flow in the axillary region, arising during interventions in the regional lymphatic drainage area. To date, there is no unified approach to the effective prevention and treatment of postoperative lymphorrhea. Thus, preventive measures aimed to reduce postoperative lymphorrhea in patients with early-stage breast cancer remain an unresolved issue in oncologic surgery and research in this area is highly relevant.

Aim. To develop and comparatively evaluate the effectiveness of an intraoperative lipofilling technique and its combination with latex tissue glue for the prevention of lymphorrhea in patients with early-stage breast cancer after lumpectomies and sentinel lymph node biopsy.

Materials and methods. This single-center prospective randomized controlled study included 120 patients with early-stage breast cancer. Between September 1, 2024, and March 31, 2025, all patients underwent lumpectomy with sentinel lymph node biopsy. Patients were allocated into three groups: Group A included 40 patients who underwent layered wound closure in the axillary region; Group B included 42 patients who received autologous fat transplantation into the axillary region; Group C (control group) consisted of 38 patients who underwent autologous fat transplantation combined with the application of latex tissue to the wound surface. In the postoperative period, ultrasound examination of the axillary soft tissues was performed to assess the presence of fluid.

Results. A statistically significant difference in the number of aspiration procedures was observed when comparing two study groups with the control group (RR = 5.26; 95% CI 1.23–22.48; p = 0.012 and RR = 3.68; 95% CI 1.09–12.40; p = 0.032, respectively). In the control group, the risk of aspiration puncture was more than five times higher compared with Group A (RR = 5.26).

Discussion. The study demonstrated high effectiveness of lipofilling, both as a standalone technique and in combination with a latex tissue glue, in the prevention of postoperative lymphorrhea.

Rationale: One of the main causes of exudative complications in surgical practice is the difficulty of ensuring reliable hemostasis. The problem of preventing wound exudative complications during endoprosthetics of the anterior abdominal wall leaves many questions for discussion, and requires the search for new hemostatic agents and techniques to solve this problem. To date, there are a large number of tools for local hemostasis, however, work reflecting their use in endoprosthetics of the anterior abdominal wall is extremely rare. The introduction of this group of drugs into practice will significantly improve the surgical arsenal of preventive measures and reduce the number of local bleeding, seromas and hematomas.

Objective: to evaluate the effectiveness of the use of a hemostatic drug in conditions of simulated local bleeding in the area of the anterior abdominal wall endoprosthesis.

Methods: The experimental part of the work was performed on 64 male Wistar rats. A randomized scheme was formed for dividing experimental animals into two equal groups: the main and the control. During the surgical intervention, all animals underwent the implantation of an Esfil mesh endoprosthesis with simultaneous modeling of a bleeding lesion. In the individuals of the main group, the drug Statin Palm was used for hemostasis, whereas in the control group the drug was not used. The material was collected on days 1, 2, 3 and 10 after surgery. Using an overdose of ether anesthesia, tissue samples of the anterior abdominal wall were taken with complete capture of the muscle layer and the implant. For histological analysis, staining of sections using the Zerbino and Lukasevich method was used, which made it possible to carry out a differentiated assessment of the age of fibrin deposits and analyze the effect of a hemostatic agent on the dynamics of the reparative process.

Results: When using the hemostatic drug Statin Palma, a reduction in the intensity of exudative processes and the absence of exudative formations were noted. In the control group, 25% of the animals exhibited exudative complications (seromas) by the tenth day of the experiment, caused by ongoing bleeding. In addition to its primary hemostatic effect, the hemostatic drug Statin Palma also positively influences the acceleration of reparative processes in the implantation area. This is evidenced by the faster maturation and transformation of fibrin into its mature form, which was observed as early as the second day of the experiment in the group treated with Statin Palma.

Conclusion: The use of Statin palm in patients with active bleeding is effective in improving the quality of hemostasis during endoprosthetics of the anterior abdominal wall complicated by bleeding. This technique will reduce the number of exudative complications in the postsurgical period and improve wound healing processes.

Background. Fractures of long tubular bones account for up to 49.8% of all musculoskeletal injuries and are associated with a high risk of complications, including nonunion, refracture and chronic osteomyelitis. There is still no unified approach to the timing and extent of metal osteosynthesis.

Objective. To evaluate the effectiveness of the developed two-plane osteosynthesis technique in the treatment of femoral fractures and in the prevention of long-term complications.

Materials and Methods. A retrospective analysis of 126 medical records of patients with femoral fractures treated at the The Clinical Hospital of emergency medical care (before Bishkek Scientific Center of Traumatology and Orthopedics) from 2019 to 2024 was performed. All patients underwent surgery using the authors’ two-plane osteosynthesis technique. Clinical examination, biplanar radiography and, when indicated, computed tomography were used. Consolidation time, complication rate, length of hospital stay and anatomical-functional outcomes were assessed.

Results. The most common long-term complications were nonunion (49%), refracture (28%) and delayed union (23%). The leading causes of injury were road traffic accidents (48.3%) and domestic trauma (45.3%). The two-plane osteosynthesis provided anatomically accurate reduction and stable fixation, as demonstrated by clinical cases. The mean hospital stay was 8 days, pain relief was achieved by day 3, and normalization of clinical and laboratory parameters by day 5. The anatomical-functional outcome index ranged from 3,7 to 4,0 points, indicating good treatment results.

Conclusions. The two-plane osteosynthesis technique is an effective method for treating femoral fractures, reducing the need for repeated surgery, accelerating rehabilitation and decreasing the risk of long-term complications.

Optical coherence tomography is an additional diagnostic test for studying the structure of pterygium. Angiographic mode allows visualization of the vascular network and its angioarchitecture. A limited number of studies have previously been published on the role of this test in the follow-up of patients with pterygium surgery. Sutureless tissue fixation using two-component autologous fibrin glue reduces conjunctival trauma, accelerates epithelialization, and shortens the patient recovery period. Therefore, it is important to study the feasibility of using angiography in the postoperative follow-up of these patients.

The aim of the study was to fix changes in perilimbal vessels in the early and late postoperative periods following pterygium removal using various methods using adhesive fixation and to explore the potential of using optical coherence tomography (anterior segment angiography) in predicting treatment outcomes.

During the study, all patients diagnosed with primary and recurrent pterygium underwent angiographic (Angio Retina) scanning of the pterygium removal site before surgery, as well as in the early and late postoperative periods, and vascular density was calculated.

The study allowed us to explore the structural features of the vascular network and demonstrated gradual remodeling of the vascular pattern in the postoperative period. Vascular density before and after pterygium removal was higher in patients with recurrent pterygium. The increase in density in the postoperative period was associated with gradual restoration of episcleral vessels in the surgical area. After 6 months of follow-up, initial signs of pterygium recurrence were observed in two cases, manifested by corneal neovascularization, as documented by OCT angiography.

Background: The problem of postoperative pain management is a priority in modern surgery. At least 30% of patients suffer from severe pain in the early postoperative period, which worsens their psychoemotional state and complicates early resuscitation and rehabilitation. Physical inactivity, in turn, is a cause of postoperative complications, prolonged hospital stays, and increased treatment costs.

Objective: To evaluate the effectiveness of existing and newly proposed methods of pain relief in patients undergoing transabdominal preperitoneal grafting (TAPP).

Material and methods: A total of 160 patients with inguinal hernias were surgically treated using the TAPP technique. The patients were divided into 4 groups: the first (n = 40) – postoperative pain relief was performed according to the generally accepted scheme: intramuscular administration of non-steroidal anti-inflammatory drugs (NSAIDs); the second (n = 40) – pain relief was achieved using the transverse plane of the abdomen block (Transversus Abdominis Plane, TAP block); the third (n = 40) – block of the ilioinguinal and iliohypogastric nerves (IIN block); the fourth (n = 40) – a new method of intraoperative precision blockade of the nerves of the inguinal region (patent No. 2836327 dated March 12, 2025). The severity of the pain syndrome was assessed using a visual analogue scale (VAS).

Results: It was established that a new method of intraoperative precision blockade of the inguinal nerves in the form of a single injection of 7.5% ropivacaine anesthetic in a volume of 10 ml. during TAPP plasty of the inguinal canal, allows for a reduction in postoperative pain by 98% compared to other types of pain relief.

Conclusion: It has been established that the proposed technique of intraoperative precision blockade of the nerves of the inguinal region is a more effective and safe method of pain relief in patients undergoing laparoscopic plastic surgery of the inguinal canal.

Rationale: Intervertebral disc herniation (IVDH) in the lumbar spine is the most common cause of pain in the lower extremities and associated disability. More than 10% of such patients require surgical intervention. Despite advances in surgical techniques, recurrence of IHD occurs at a rate of 0.5 to 25%. Recurrence of IHD leads to the development of pain syndrome, neurological deficit, disability, repeat surgery, and increased burden on the healthcare system.

Objective: to analyse the frequency and causes of recurrence of intervertebral disc herniation after microdiscectomy performed in our department, which will improve the results of surgical treatment and reduce the number of recurrences.

Methods: A retrospective study was conducted involving 644 patients who underwent microsurgical discectomy in the lumbar spine at the same level due to intervertebral disc herniation in the spinal surgery department of the Petrovsky Research Centre for Surgery between 2012 and 2020. Of these, 89 people (13.8%) developed a recurrence of intervertebral disc herniation (first group), while the rest of the patients did not develop a recurrence (second group).

Results: Men had a 1.474 times higher risk of recurrence than women. Patients with diabetes mellitus had a 1.654 times higher risk of recurrence than patients without diabetes. Smoking patients had a 2.023 times higher risk of recurrence. Patients with severe MDD degeneration (grade 4 and 5) had a recurrence risk 4.651 times higher than those with less severe MDD degeneration. In patients with protrusion, the risk of recurrence was 2.324 times higher than in patients with sequestered hernia; also, among patients with extrusion, the risk of recurrence was 2.516 times higher than with sequestered hernia. With paramedian hernia, the risk of recurrence is 5.271 times higher than with central hernia; in addition, in patients with foraminal hernia, the risk of recurrence is 6.460 times higher compared to central hernia.

Conclusion: Male gender, type 2 diabetes mellitus, smoking, IV–V degree intervertebral disc degeneration according to the Pfirrmann classification, protrusion and extrusion of the intervertebral disc, paramedian and foraminal location are noted as independent preoperative risk factors for the development of intervertebral disc herniation recurrence. In order to reduce the frequency of recurrence and revision surgery, it is important to minimise the influence of modifiable risk factors. Patients with risk factors that cannot be modified should be aware of the high risk of recurrence.

Voluntary blood donation remains a necessary component of effective healthcare for many diseases and injuries. Blood component donors are at very high risk of developing iron deficiency. Standard blood donation results in a donor losing up to 250 mg of iron. For women of reproductive age, this amount is equivalent to half of all iron stores reduced by physiological blood loss.

Objective. To assess the impact of iron therapy on the physical and mental health of female donors with iron deficiency.

Materials and Methods. A prospective study was conducted at the clinic of the Department of Faculty Therapy. It included 30 female blood donors aged 20-56 years (Q2 = 41) with no health complaints and diagnosed latent iron deficiency (83.33% of cases, n = 25) or iron deficiency anemia (16.67% of cases, n = 5). Latent iron deficiency was diagnosed when the ferritin level dropped below 30 ng/ml, iron deficiency anemia – when the ferritin level dropped below 30 ng/ml and hemoglobin level dropped below 120 g/l. When one of the iron deficiency states was detected, blood donation was suspended and therapy with iron (II) sulfate orally at a dosage of 200 mg (as elemental iron) per day was prescribed. Before therapy, on the 30th day and on the 60th day of drug administration, quality of life was assessed using the validated Russian version of the SF-36 “Quality of Life Assessment” questionnaire, ferritin levels were determined, and the relationship between these indicators over time was assessed.

Results. Before the start of iron therapy, the median ferritin concentration in female blood donors with iron deficiency states was – 16.4 [13.25; 30] ng/ml. According to the SF-36 results, the median score for the physical component of health was 54.58 [47.3; 58.9] points, and for the mental component of health, 44.9 [39.8; 54.6]. After 30 days of therapy, an increase in ferritin to 43 [32.4; 57.77] ng/ml, p<0.05) and an improvement in quality of life in terms of physical (53.33 [48.32; 56.51], p<0.05) and mental health (50.21 [44.23; 55.22], p<0.05) were achieved. After 60 days of therapy, the median ferritin was 48 [38.9; 78.275], p<0.05), and there was a tendency toward improvement in quality of life indicators (physical component – 56.32 [51.24; 57.57], p<0.05; mental component – 51.53 [45.85; 55.87], p<0.05).

Conclusion. Laboratory improvement during therapy for iron deficiency conditions in female donors is accompanied by an improvement in quality of life indicators (as assessed using the SF-36 scale).

The treatment of colitis of the “switched-off” colon is becoming increasingly important, both medically and socially and economically, in patients with abdominal gunshot trauma, significantly delaying the possibility of performing reconstructive surgeries aimed at eliminating the stoma and restoring colonic continuity with fecal passage.

Materials and Methods: to determine the predictors of the development of diversion colitis and its severity in 42 patients with stomas following abdominal gunshot trauma, a retrospective and prospective comparative controlled study of the diagnostic and surgical treatment outcomes during the rehabilitation phase was conducted in a multidisciplinary hospital. Patients in the study (n = 20) and control (n = 22) groups underwent clinical and endoscopic examinations, computed tomography, and morphological examination of mucosal biopsies from the switched-off colonic areas, including bacterial analysis.

Results: Clinical manifestations of diversion colitis were detected in 64.2% of patients. It was established that predictors of its occurrence were pathomorphological processes in the intestine and zones of gunshot injury alteration in the phase of purulent-septic complications of the course of traumatic disease in the wounded. Three degrees of colitis severity in stoma patients were distinguished: minimal (19.1%), moderate (38.2%), significant (42.7%), objectified by morphological and bacteriological results, which are the basis for the diagnostic algorithm of instrumental studies. Patients of the main group underwent preoperative preparation for 10-14 days to correct the disturbed microbiocenosis. The terms of reconstructive and restorative surgeries aimed at eliminating stomas and restoring gastrointestinal continuity ranged from 2 to 12 months. The total number of complications in the study group was 11.7%, in the control group 29.3%. The average hospital stay in the study group was up to 25 days, while in the control group it was over 90 days, taking into account the treatment of purulent-septic complications.

Conclusion: the pathogenesis of diversion colitis in patients with gunshot abdominal trauma is ischemic in nature and is associated with a disruption of the microflora in the dysfunctional colon. Its diagnosis should be based on the results of MSCT, FCS, morphological and bacteriological studies. Surgical rehabilitation of wounded patients with a functional stoma for more than 6 months requires specific preparation, including correction of the microbiome and intestinal motility.

In modern military conflicts, limb injuries prevail in the structure of sanitary losses, which constitute the absolute majority of combat surgical pathology. Gunshot wounds inflicted by modern high-energy wounding projectiles are characterized by a large amount of damage to the tissues of the extremities, which determines the occurrence of severe purulent-septic complications, leading to long treatment periods, severe disability of the wounded and a significant decrease in their quality of life.

Objective: to analyze the cause and frequency of purulent-septic complications and the effectiveness of the treatment of gunshot injuries of the extremities by negative pressure in victims with mine-explosion injury in a military conflict.

Materials and methods: the results of complex treatment of 148 wounded men with combat injuries of the limbs, accompanied by extensive tissue defects from 50 cm2 to 140 cm2, complicated by a progressive inflammatory process (phlegmons, abscesses, osteomyelitis), were analyzed. Specialized medical care was performed in a multidisciplinary hospital and included secondary surgical treatment of wounds, staged osteosynthesis and PST amputations, VAC therapy, and the use of epidermal growth factor preparations.

Results: purulent-septic complications were diagnosed in 82.4% of cases. Soft tissue injuries were noted in 44.7%, of which 67.8% of the injured were the main group, 32.2% – the control group. Gunshot fractures of bones were diagnosed in 55.3% of the victims. The treatment of the subjects of the main group was carried out in compliance with the principles of “damage control” and traumatological gradation of stage-by-stage osteosynthesis. The treatment results of the victims of both groups were characterized by an increase in the average duration of fracture consolidation. The healing time of extensive gunshot wounds of the extremities in the main group was 17.9% faster than in the control group. The average duration of inpatient treatment for the wounded in the main group was 2.7 times less than in the control group, and amounted to 21.7±14.3 and 84.5±29.7 days, respectively.

Conclusion: multi-stage surgical and traumatological tactics for extensive wound defects of the soft tissues of the limb and gunshot fractures of long tubular bones should include: full surgical treatment, drainage, extra-focal osteosynthesis with rod devices. Medical care for victims with explosive and gunshot injuries should be based on the principles of multi-stage surgical treatment (damage control and medical resources).

Rationale. Abdominal injuries, particularly in the pelvic region, remain a serious problem, especially in wartime. Studies show that such injuries account for a significant proportion of combat injuries, and their severity is particularly high in the pelvic region. In women, pelvic gunshot wounds are often associated with serious complications and even death. The more time that passes between injury and surgery, the higher the risk of complications. The traumatic morbidity that develops after a gunshot wound is also related to macronutrient levels in the body, especially calcium. Although the problem has been widely studied, there are still questions that need to be answered.

Objective. To track and analyze the changes in blood calcium levels in women who received a gunshot wound to the pelvis in the first days after surgery.

Methods: The study analyzed the consequences of penetrating pelvic gunshot wounds in 35 women who were injured in localized combat operations. The average age of the patients was 35±5 years. In the process of the study the level of total calcium in blood was studied: free, ionized, bound to proteins, as well as undissociated complexes with citrate and phosphate. For the study of blood calcium level data, venous blood was collected, which was further analyzed on an automatic analyzer «Indiko Plus, Thermo Fisher Scientific». To assess the relationship between the indicators, the χ2 test of agreement was used. Statistical significance was determined by r value: 0,01–0,29: weak positive relationship; 0,30–0,69: moderate positive relationship; 0,70–1,00: strong positive relationship.

Results. The study showed that postoperative blood calcium levels increase in the first 24 hours as a result of traumatic shock. Patients who received care sooner (group A) had lower calcium levels than those who received care later (group B). Calcium levels returned to normal more quickly in group A. Three days after surgery, Group B patients’ calcium levels began to rise due to an increase in hormones that regulate metabolism. Complete recovery of calcium levels in group B occurred 17-19 days after surgery.

Conclusions. It was found that intracellular calcium levels increased after surgery compared to the initial value. The peak of this increase was observed on the third day after surgery, when calcium levels were 23% higher than preoperatively. By the fifth day after surgery, calcium levels began to decrease in group A, and in contrast, calcium levels peaked in group B. Importantly, intracellular calcium levels were significantly higher than normal, indicating enhanced cellular damage due to elevated calcium levels.

Backgraund: The renoprotective activity of angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists (ARBs), beta-blockers (BBs), and diuretics has been proven, preventing kidney damage in patients with hypertension (HTN) and chronic kidney disease (CKD). However, the protective effects of calcium channel blockers (CCBs) in patients with hypertension and CKD have not been clearly defined.

Aims: To compare the effect of the third-generation CCB lercanidipine and the second-generation CCB amlodipine on the dynamics of the levels of urinary markers of tubulointerstitial damage, neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1), in patients with arterial hypertension (AH) of varying severity and CKD with stage C2 and C3a during 6 months of treatment.

Materials and methods: A total of 77 patients (21 men and 56 women, aged 40 to 78, mean age 57.0±9.9 years) with essential and nephrogenic hypertension and C2,C3a stage CKD were examined. They were divided into 2 groups according to the severity of hypertension: patients with stage 2 hypertension (SBP not higher than 179 mmHg) and with stage 3 hypertension (SBP 180 mmHg and higher). To compare the nephroprotective effect of CCBs of two generations, subgroups of patients prescribed amlodipine or lercanidipine were identified in each of these categories. The nephroprotective effect of the drugs was assessed by changes in the urinary levels of biomarkers NGAL, KIM-1 and albumin initially and after 6 months of antihypertensive treatment using standard methods and commercial reagent kits for ELISA diagnostics.

Results: The decrease in the concentration of NGAL and KIM-1 in urine during antihypertensive therapy with amlodipine in patients with stage 2 and 3 hypertension combined with CKD was 65.6% (p<0.001) and 54.3% (p<0.001) for KIM-1, and 58.5% (p<0.001) and 65.8% (p<0.001) for NGAL compared with baseline, respectively. The dynamics of these biomarkers in patients receiving lercanidipine was similar and was characterized by a significant decrease in KIM-1 by 60.8% (p<0.001) and 67.6% (p<0.001), and NGAL by 80.5% (p<0.001) and 65.8% (p<0.001), respectively, from baseline values. Moreover, the degree of reduction in urinary NGAL concentration was 17.2% (p = 0.042) higher with lercanidipine therapy. A 25.7% (p = 0.017) reduction in albuminuria from baseline was observed in patients with stage 2 hypertension after 6 months of treatment with lercanidipine.

Conclusions: In groups of patients with hypertension and CKD who took amlodipine and lercanidipine for 6 months, a significant decrease in urinary excretion of KIM-1 and NGAL was observed. However, the decrease in urinary NGAL concentration was more pronounced with lercanidipine therapy. A decrease in albuminuria was observed with the administration of lercanidipine in patients with stage 2 hypertension. 

The scientific rationale for incorporating game-based technologies into the speech therapy of patients with mild aphasia is based on the necessity of bridging the gap between “clinical” speech recovery and the functional use of language in everyday communication. A primary challenge for this population is the acute awareness of their own deficit, which often triggers “speech negativism” and social withdrawal. Traditional exercises are frequently perceived by intellectually intact patients as monotonous and devoid of communicative purpose, which diminishes rehabilitation potential and motivation. According to the activity theory of A.N. Leontiev and L.S. Vygotsky, gaming is a powerful stimulus for activating higher mental functions. The implementation of tabletop communicative games (e.g., Alias, Codenames, Crocodile) requires the patient to move beyond the simple reproduction of learned words toward the operational resolution of complex cognitive tasks: the activation of associative fields, the use of verbal search strategies (synonymy, antonymy), the inhibition of inadequate speech responses, and the retention of multi-component instructions.

Aim.To analyze the effectiveness of game-based technologies in group speech therapy sessions for patients with mild forms of aphasia and to justify their significance for improving speech function and social adaptation during the second stage of rehabilitation.

Materials and Methods. This study is a descriptive observation of the effectiveness of game-based technologies within the second stage of inpatient speech rehabilitation for patients with mild aphasia of cerebrovascular etiology. The program integrated gaming methods into the traditional correctional process using adapted board games and role-playing scenarios. Patients were divided into two groups: a control group (traditional methods, n = 10) and an experimental group (game-based technologies, n = 10). The observation period lasted 14 days of inpatient care. Qualitative and quantitative assessments were conducted preand post-treatment using the Wasserman Scale and the Hospital Anxiety and Depression Scale (HADS).

Results. Data analysis confirmed the positive impact of game-based technologies on both speech function and social adaptation. Quantitative assessment via the Wasserman Scale showed positive dynamics in both groups; however, HADS scores revealed significantly more pronounced improvement in the experimental group compared to the control.

Qualitative assessment demonstrated a significant reduction in the frequency of paraphasias and word-finding latencies in the experimental group. Patients exhibited increased speed and accuracy in lexical retrieval within specified categories, particularly during Alias and Codenames. Role-playing and spontaneous speech showed improvements in sentence construction and a decrease in mistakes, with patients utilizing more complex syntactic structures. The volume of utterances increased, and the coherence and logical flow of monologues improved. Role-playing also facilitated the ability to maintain prolonged dialogue and provide elaborated responses. Furthermore, gaming technologies significantly increased motivation, reduced the fear of errors, and helped patients feel more socially confident.

Conclusion. For successful speech rehabilitation of patients with mild motor aphasia, the use of game-based technologies is recommended as an integral part of the intervention to expand creative, motivational, and communicative potential. Results indicate the restoration of inner speech through the establishment of stable semantic anchors, the refinement of categorical apparatus, and the expansion of active.

Rationale: In most surgical procedures, the need for blood transfusions is relatively rare. Despite this, tests for red blood cell phenotype and irregular anti-erythrocyte antibodies are widely used. The need for a more targeted approach to immunohematological testing in potential recipients of donor blood is discussed.

Objective: To identify patterns in the frequency of immunohematological testing and blood transfusions in a multidisciplinary hospital.

Methods: A retrospective study, using electronic medical records, examined immunohematological testing and blood transfusions performed in patients in 23 inpatient departments of the Pirogov Center in 2025.

Results: In 23 inpatient departments of the Pirogov Center, 11,841 patients were assigned immunohematological testing, 516 (4.4%) of whom received blood transfusions. The ratio of blood group determinations to red blood cell recipients varied between departments, ranging from 1.0 to 164.4, with an average of 45.9±50.5. Variability in this ratio is due to both the use of patient blood management and the active transfer of patients between departments for preoperative preparation and rehabilitation.

Conclusion: A “blood group determination to red blood cell recipient ratio” coefficient is proposed and discussed, which can be used as a benchmark for similar studies.

The aim of this study was to assess how well the problem of gunshot injury to the enthesis has been developed in the contemporary scientific literature, based on a systematic bibliometric analysis. A structured search was conducted in PubMed, OpenAlex, Web of Science/Scopus, Google Scholar, eLIBRARY.ru, and CyberLeninka using keywords related to gunshot trauma, enthesis/enthesopathy, and periarticular tissues, followed by merging and comparison of the retrieved publication sets. It was found that, despite tens of thousands of publications devoted to gunshot injuries and thousands of papers addressing enthesopathies and the enthesis, the indexed databases contain no clinical studies that simultaneously consider gunshot damage to the tendon–bone attachment zone as an independent object of analysis. Combined queries linking the terms “gunshot” and “enthesopathy/enthesis” yielded zero results in PubMed, and the few records identified in open bibliographic systems proved, upon verification, to be unrelated to the clinical problem (paleopathology, archaeology). These findings indicate that “gunshot enthesopathy” is currently a “blank spot” in the scientific literature, and that its establishment as a distinct clinico morphological category requires primary description and the development of appropriate terminology, classification, and an etiopathogenetic concept.

False peripheral aneurysms represent a significant challenge in vascular surgery, as they can remain subclinical for extended periods and manifest only at the stage of complications, including rupture and thrombosis. Unlike true aneurysms, which involve a protrusion of the blood vessel wall, a pseudoaneurysm does not involve damage to the entire wall structure. Instead, blood escapes from the site of injury and is contained by a wall formed from the surrounding tissues. Timely diagnosis and treatment of false aneurysms are essential. All patients with penetrating limb injuries should undergo routine ultrasound duplex scanning (USDS). In elective cases with suspected false aneurysm and no significant hematoma, MSCT angiography is indicated. In the presence of a hematoma or signs of active bleeding, urgent selective angiography is required to determine the subsequent treatment strategy.

Conclusion. Post-traumatic false peripheral aneurysms pose a serious threat due to the risk of rupture and thrombosis. The key diagnostic algorithm includes: routine vascular USDS for all patients with limb injuries, MSCT angiography for elective cases without hematoma, and selective angiography in cases of active bleeding. Timely imaging prevents long-term complications and dictates the optimal management strategy.

Parathyroid carcinoma (PC) is a rare malignant neoplasm that accounts for less than 1% of all cases of primary hyperparathyroidism (PHPT). The detection of early-stage PC is steadily increasing likely due to expanded screening of serum calcium levels. Surgical intervention is the primary and only effective treatment for primary tumor as well as for recurrent and metastatic PC. However, the optimal extent of the primary surgical procedures remains unclear. There are no specific biomarkers for PC currently. The issue of preoperative PC diagnosis remains unresolved. Topical diagnosis of these neoplasms is increasingly important, however, in practice such methods have certain limitations. In particular, ultrasound requires special training of specialists. This review presents current advances in preoperative diagnosis of PC and examines their advantages and limitations.

The aim of this study is to comprehensively analyze and summarize current domestic and international experience in treating purulent-necrotic complications of diabetic foot syndrome (DFS). The objectives of the study include exploring the mechanisms of interdisciplinary collaboration, comparing the effectiveness of this approach with traditional methods, and substantiating the feasibility of implementing integrated models of healthcare delivery. The relevance of this problem is determined by the high epidemiological significance of diabetes mellitus (DM) in the Russian Federation, where the number of patients has exceeded 7.5 million, as well as the increasing incidence of purulent-necrotic complications. This study includes a systematic review of the scientific literature on innovative DFS treatment methods. Particular attention is paid to the high rate of disability and the frequency of major amputations. The traditional discrete (fragmented) patient routing model has proven ineffective: the risk of limb amputation in DFS remains 10–30 times higher than in the general population. This necessitates a transition to systemic teamwork within an interdisciplinary approach. The study’s results can serve as a basis for developing new clinical guidelines and improving existing protocols for managing patients with diabetic foot syndrome.

Rationale: gunshot peritonitis, which occurs immediately at the time of injury, differs significantly from peritonitis of other etiology in terms of the mechanism of its development. The accelerated dynamics of the course of various phases of peritoneal inflammation and the early manifestation of enteral insufficiency syndrome are the key points in the progression of diffuse peritonitis after a gunshot injury.

Objective: to study the literature data and conduct a comparative analysis of the currently used methods of treatment of enteral insufficiency syndrome, which improves the outcome of treatment of patients with gunshot wounds of the abdominal cavity.

Result: an analysis of articles, reviews, and studies in the modern scientific medical literature on the problem of the progressive course of gunshot peritonitis has been performed to identify the leading links in its pathogenesis and the severe course of the traumatic disease, the debut of which is the «phenomenon of mutual aggravation» against the background of massive primary alterations of organs and tissues, traumatic endotoxicosis, and maladaptation syndrome. Later, when a traumatic disease manifests, its «leading link in pathogenesis» changes with the appearance of enteral insufficiency syndrome, against the background of intestinal paresis, which inevitably leads to the translocation of bacteria and toxins into the abdominal cavity and systemic bloodstream. This becomes a fundamental source of endogenous intoxication, closing the «vicious circle» in the pathogenesis of abdominal sepsis. When providing surgical and intensive care for gunshot peritonitis, intraoperative nasointestinal drainage of the small intestine, followed by enterosorbtion and antibacterial therapy, becomes the basis for the treatment of enteral insufficiency. However, this technique has been criticized in the foreign literature, pointing out the danger of its use and the rejection of its use in common peritonitis.

Conclusion: having analyzed the available data published in recent years and during previous terrorist attacks and local armed conflicts, despite such serious discrepancies between native and foreign authors on the issue of nasointestinal intubation of the small intestine in peritonitis and enteral insufficiency syndrome, we believe that the complete and categorical rejection of this technique for gunshot wounds of the abdomen is premature and unacceptable.

Poststernotomy mediastinitis is a rare but severe complication of cardiac surgery with high mortality; the outcome largely depends on the timeliness of diagnosis and initiation of etiotropic therapy.

Description of the observation. A 60-year-old patient who had undergone coronary artery bypass grafting with the use of the left internal thoracic artery developed postoperative wound soaking on the third day after surgery, without overt signs of sternal instability or pronounced purulent discharge. However, a rapid increase in C-reactive protein levels and leukocyte formula shift were observed, accompanied by significant changes in additional biomarkers (ESId, presepsin, and HLA-DR expression on monocytes). These findings served as a basis for early chest CT imaging, which confirmed the diagnosis of sternomediastinitis, leading to the activation of surgical management (staged mediastinal debridement, vacuum-assisted therapy, and subsequent sternal reconstruction using metallic implants).

Conclusion. This case demonstrates that an extended monitoring protocol of inflammatory biomarkers and immune status enables early suspicion of mediastinitis before the development of classical local manifestations and allows timely adjustment of treatment strategy.

Relevance. Resuscitative thoracotomy remains a controversial procedure in civilian multidisciplinary hospitals due to low survival rates with indiscriminate use and limited experience among surgical teams. However, for penetrating chest injuries with traumatic cardiac arrest, timely RT can achieve survival rates of 15–35%.

Aim. Resuscitative thoracotomy is an effective intervention for massive hemorrhage and traumatic cardiac arrest in a multidisciplinary hospital setting.

Case Description. We report a clinical case. Patient В., a 27-year-old male, was admitted 30 minutes after sustaining a stab-incised wound to the left chest. On admission: BP 65/46 mm Hg, HR 146 bpm, MFS-CA (Military Field Surgery – Condition on Admission) 43 points, subtotal left hemothorax per eFAST (extended Focused assessment with sonography in trauma). Indications for emergent thoracotomy were established. Bulau drainage was performed, and the patient was transferred to the operating room (15 minutes post-admission). Traumatic circulatory arrest developed during transfer to the operating table. Resuscitative thoracotomy was performed via left 5th intercostal space. The bleeding source was a completely transected left internal mammary artery. Interventions included aortic cross-clamping, direct cardiac massage, artery ligation, and suturing of the S4 segment wound in the upper lobe of the left lung. Spontaneous circulation was restored 13 minutes after aortic clamping. Total blood loss was 3500 mL. The patient was discharged on day 22 in satisfactory condition without neurological deficit.

Conclusion. This case demonstrates the effectiveness of the resuscitative thoracotomy protocol in a multidisciplinary hospital when strict temporal criteria and interdisciplinary coordination are adhered to.

This article presents a clinical case of a mine blast shrapnel wound to the chest organs, including the heart, with the fragment lodged in the interventricular septum. The patient, in stable condition, underwent surgery three weeks after the injury. Intraoperatively, in addition to a metal fragment, a fragment of clothing was found in the heart. The foreign bodies were removed. The postoperative period and rehabilitation were uneventful.

Some historical and statistical information related to penetrating wounds of the heart, including those of non-metallic nature, is presented, and aspects of diagnosis and treatment tactics are highlighted.

Pericardial calcification (“armored heart”) is a variant of chronic fibrous pericarditis with calcification of the pericardial layers. The true prevalence of chronic fibrous pericarditis in the population is unclear due to the lack of a specific clinical picture, as well as, as a rule, a combination of pericardial calcification with other cardiac pathologies, which are the reason for seeking medical help. The literature describes the main factors that lead to calcification of the pericardial layers (tumors, tuberculosis, autoimmune diseases, radiation therapy, myocardial infarction, etc.). In case of an active inflammatory process in the pericardium, a competent collection of complaints and anamnesis, as well as physical examination data, lead to a suspicion of this pathology already during the initial examination. However, when the process becomes chronic and a specific clinical picture is absent, and therefore certain instrumental diagnostic methods may not be prescribed, the resulting pericardial calcification may come as a surprise to the surgeon on the operating table. A case report of severe pericardial calcification in a patient with coronary artery disease undergoing coronary artery bypass grafting is presented.

Background. Aortic dissection following cardiac surgery represents a significant clinical challenge, necessitating individualized indications for ascending aorta replacement. Traditional diameter thresholds (≥5.5 cm) are insufficient for predicting dissection risk.

Objective. To demonstrate the importance of comprehensive risk assessment for aortic dissection in post-cardiac surgery patients through analysis of two clinical cases.

Material and Methods. Two cases of type A aortic dissection developing in the late postoperative period after aortic valve replacement and coronary artery bypass grafting are presented. Retrospective analysis of dissection predictors was performed: aortic diameter and morphometry, arterial hypertension, bicuspid aortic valve, atherosclerosis.

Results. In both patients, aortic dissection occurred with ascending aorta diameter <5.5 cm. Risk factors included uncontrolled arterial hypertension, atherosclerosis, and aortic morphological features (elongation, increased curvature). Timely diagnosis and reconstructive interventions resulted in favorable outcomes.

Conclusion. Aortic diameter should not be the sole criterion for prophylactic replacement decisions. Multiparametric risk assessment is required, including aortic morphometry, body surface area indexing, vascular wall evaluation, and strict blood pressure control.

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients with previously implanted stents require a precise interventional approach. Coronary artery spasm and suboptimal stent deployment are key factors determining both angiographic and clinical outcomes of percutaneous coronary intervention (PCI).

We present a clinical case of treatment of patient T., 50 years old, admitted with the clinical picture of NSTE-ACS 3 years after previous stenting of the right coronary artery (RCA) and the circumflex branch of the left coronary artery (CXL). Coronary angiography revealed occlusion of the RCA stent in the middle and distal thirds. After recanalization and balloon angioplasty, severe spasm of the artery was recorded, significantly distorting its true diameter. Intravascular ultrasound (IVUS) showed insufficient expansion of the previously implanted stent and suboptimal compliance of its size with the vessel diameter. After intracoronary 100 mcg nitroglycerin and IVUS navigation, stenting of the RCA and posterior interventricular branch (PIV) was performed with three drug-eluting stents, followed by postdilation with a non-compliant balloon. Control IVUS confirmed optimal expansion of the stents along their entire length; final antegrade blood flow TIMI 3.

Conclusion. The combined use of intracoronary vasodilators and IVUS allows for differentiation of the causes of previously implanted stent occlusion, appropriate device size selection, elimination of angiographic artifacts caused by coronary spasm, and optimal PCI outcomes. This observation confirms the feasibility of routine intravascular imaging in complex reoperations.

A clinical case of surgical treatment of a 50-year-old patient with acute type A aortic dissection complicated by severe cerebral malperfusion and extension of the dissection into the brachiocephalic arteries is presented. Multislice CT revealed dissection of the brachiocephalic trunk with false lumen thrombosis, stenosis of the right common carotid artery, critical stenosis and false lumen thrombosis of the left common carotid artery, as well as involvement of the left subclavian artery. Given the high risk of perioperative cerebral ischemia, the operation was initiated with branch-first reconstruction of the brachiocephalic arteries using a trifurcated graft. After restoration of controlled cerebral perfusion, replacement of the ascending aorta and aortic arch was performed under adaptive cerebral perfusion. Cardiopulmonary bypass time – 232 min, cross-clamp – 101 min, and circulatory arrest – 36 min. The postoperative course was complicated by respiratory and renal failure requiring hemodialysis. The patient was discharged on postoperative day 30 in satisfactory condition.

Giant intracranial neoplasms compressing and extending into various compartments of the cerebrospinal fluid (CSF) system of the brain contribute to alterations in CSF dynamics, which may affect clinical outcomes in the early postoperative period. Our report describes a case of ventriculoperitoneal shunt overdrainage following resection of a giant petroclival meningioma, as well as the specific features of patient management in such a condition.

The article discusses clinical observations of the treatment of two patients using ICG navigation to remove the residual stump of the cystic duct with remaining calculi after a previous laparoscopic cholecystectomy (LCE). These clinical observations represent successful outcomes of surgical treatment of the residual stump of the cystic duct with calculi using modern techniques for imaging the biliary tract, which help to avoid anatomical damage in the surgical area.

This article presents a clinical case of an 83-year-old patient with biliary ileus at the duodenal level (Bouvier’s syndrome), which is a rare localization of an gallstone duodenal obstruction. The article highlights the challenges in timely diagnosis and surgical management, which were influenced by the patient’s complaints and anamnesis, as well as the results of physical and instrumental examinations, that lead to the suspicion of gastrointestinal bleeding. The diagnosis of acute duodenal obstruction syndrome was the basis for surgical intervention, including laparotomy, duodenotomy, and gallstone extraction to resolve the intestinal obstruction.

Relevance: Cystic pulmonary hypoplasia (CPH), or congenital malformation of the respiratory tract of the lungs (RTL) accounts for more than half of all detected lung malformations in children and is often complicated by the addition of chronic infectious diseases of the respiratory system, including mycobacterial origin (tuberculosis, mycobacteriosis of the lungs). Diagnosis of both congenital lung defects and associated respiratory infection is often difficult.

Aim: To demonstrate an integrated approach to treatment and long-term results of a rare case of a combination of congenital malformation of the respiratory tract of the lungs (cystic hypoplasia of the lower lobe of the right lung) manifested in adolescence with mycobacteriosis of the lungs caused by M.kansasii.

Materials: the medical history of a teenage patient with a combination of mycobacterial infection and congenital malformation of the respiratory tract was studied.

Results: The patient underwent a video-assisted thoracoscopic (VATS) lower lobectomy of the right lung with removal of a conglomerate of bronchopulmonary lymph nodes. There were no complications during the operation or in the postoperative period. The drains were removed on the 6th day. Specific antimycobacterial therapy and courses of broad-spectrum antibiotics were performed before and after surgery. 7 months after the operation, a follow-up clinical and X-ray examination showed a favorable course of the long-term postoperative period and positive X-ray dynamics.

Conclusion: This clinical observation demonstrates the high effectiveness of treatment of a child with a complicated course of combined pathology «CPH+RTL» due to the use of an integrated approach – a course of specific etiotropic therapy and timely surgical intervention.

Rationale: Pigmentary glaucoma (PG), which develops against the background of pigment dispersion syndrome (PDS), is a significant medical and social problem in ophthalmology. A key feature of PG is that it affects young people of working age (20 to 40 years old). The social significance of PG is exacerbated by the high risk (35% to 50%) of asymptomatic PDS transforming into clinically significant glaucomatous optic neuropathy within 4 to 10 years. Without timely treatment, this leads to irreversible vision loss during the most active period of life.

Objective: Based on an analysis of long-term clinical observations of patients with pigmentary glaucoma, to evaluate the effectiveness of selective laser trabeculoplasty (SLT) and a combination of SLT with laser iridectomy (LI) in achieving stable normalization of intraocular pressure and preventing the progression of glaucomatous optic neuropathy.

Results: The combined use of SLT and laser iridectomy ensures lasting normalization of intraocular pressure and stabilization of visual functions. Repeated courses of SLT demonstrate a long-term hypotensive effect and allow control of disease progression over. The use of laser techniques significantly increases the chances of preserving visual function in patients with pigmentary glaucoma, especially in young working-age individuals.

Conclusion: The presented clinical observations confirm the high effectiveness of modern laser techniques–SLT and LI–in the treatment of pigmentary glaucoma.

The biography of an outstanding Russian therapist, hematologist, and creator of sternal puncture and lymph node aspiration biopsy techniques is presented. His contribution to the development of medicine, science, and education is highlighted.

The article presents a brief biography of Academician G.A. Sofronov and reflects his contribution to the development of general and military toxicology, as well as to chemical safety. The main stages of the scientist’s research and organizational activities, his role in the formation of scientific schools and personnel training are highlighted.