Deep vein thrombosis (DVT) and its associated post-thrombotic syndrome (PTS) represent a significant medical and social challenge, particularly in cases involving the iliofemoral venous segment. Approximately 70% of patients with proximal venous thrombosis experience complete occlusion or partial recanalization, leading to persistent venous outflow obstruction and progression of PTS. Current treatment methods, including endovascular desobstruction and venous stenting, show mixed clinical results, highlighting the need to study the risk factors affecting the efficacy of these interventions.
Objective: To evaluate the effectiveness and safety of endovascular treatment in patients with post-thrombotic proximal obstruction of the iliofemoral venous segment of varying lengths.
Materials and Methods: This retrospective study included 99 patients with PTS complicated by post-thrombotic obstruction of the iliofemoral venous segment who underwent venous stenting between 2016 and 2024. Patients were divided into two groups based on the length of the iliofemoral segment occlusion. Clinical assessment was conducted using the international CEAP classification and clinical questionnaires such as Villalta, VCSS, and CIVIQ-20. The primary outcomes of treatment effectiveness were reductions in scores on the Villalta, VCSS, and CIVIQ-20 scales, as well as confirmation of patency of the stented iliofemoral segment via ultrasound duplex scanning three months post-discharge.
Results: Technical success of stenting was achieved in all patients across both groups. Both groups showed statistically significant improvements in clinical scores (Villalta, VCSS, CIVIQ-20; p<0.001). In the early postoperative period, stent patency was 93.2% in Group I (localized occlusion) and 83.3% in Group II (extensive occlusion). Key risk factors for stent thrombosis in the early postoperative period were identified: occlusion involving more than one venous segment and peak blood flow velocity below 13 cm/s.
Conclusion: Endovascular stenting of the iliofemoral segment is an effective and safe treatment for patients with obstructive lesions and severe PTS. However, the risk of postoperative thrombosis remains high, particularly in cases of extensive obstructive lesions. Peak blood flow velocity within the stent zone is a significant prognostic factor for thrombosis, emphasizing the need for a personalized approach to patient management.

The continuing high rates of morbidity, hospitalization and mortality of the population with coronary heart disease, despite the search for new diagnostic and treatment methods, indicate the urgency of the problem to date. Patients with coronary heart disease require an individual comprehensive approach due to the nature and severity of atherosclerotic lesions, the presence of a potentially viable myocardium, and the volume and severity of its hibernation. The introduction of the method of stimulation of extracardial neoangiogenesis into clinical practice has significantly expanded the treatment options for patients with diffuse coronary artery disease. The article presents data on preoperative visualization of a viable myocardium in patients with severe atherosclerotic lesions of the coronary bed, as well as the dynamics of its recovery in the postoperative period, depending on the performed surgical revascularization method.
Materials and methods. The prospective, randomized study included data from 140 patients with coronary artery disease and diffuse coronary artery disease who underwent myocardial revascularization from 2016 to 2023 at the Department of Cardiovascular Surgery at the Moscow Institute of Thoracic and Cardiovascular Surgery. St. George’s Federal State Budgetary Institution “National Medical and Surgical Center named after N.I. Pirogov” of the Ministry of Health of the Russian Federation. Group I (n = 71) – complex revascularization; group II (n = 69) – isolated coronary bypass surgery. The results of gated-SPECT of the myocardium and echocardiography were evaluated early (10-14 days) and 6-12 months after surgery. Segmental analysis of changes in myocardial perfusion and contractility was performed. The main variants of perfusion-functional compliance were evaluated. The primary endpoint is a change in the volume of the hibernated myocardium during the entire follow-up period. Secondary endpoints are the dynamics of regional perfusion and contractility; changes in the left ventricular ejection fraction.
Results. The volume of the hibernated left ventricular myocardium in the early postoperative period decreased from 29[20;35]% to 17[10;25]% in group I (p<0.0001) and from 27[20;34]% to 18[10;26]% in group II (p<0.0001). In the long-term postoperative period (6-12 months), the volume of viable myocardium was 10[5;12]% (group I) and 21[14;25]% (group II) (p = 0.0002). Three degrees of hibernation were distinguished depending on the dynamics of contractility recovery: mild (complete restoration of the “sleeping” myocardium in the early postoperative period, moderate (complete recovery within 6-12 months), severe (partial improvement of contractility within 12 months). After 12 months, the left ventricular ejection fraction was 56[54;59]% (group I) and 53[51;57]% (group II) (p<0.0001).
Conclusion. The assessment of myocardial viability is an important criterion for choosing treatment tactics for patients with coronary artery disease, especially those with diffuse coronary artery disease. The addition of coronary bypass surgery to stimulate extracardial neoangiogenesis makes it possible to increase the restoration of the function of a larger volume of the hibernated myocardium and significantly improve the long-term results of complex treatment of patients.

Objective: to identify a promising subgroup of patients in the group of patients with acute myocardial infarction and atrioventricular block of II–III degree for implantation of a permanent pacemaker at the earliest possible time.
Materials and methods: a retrospective non–randomized study was conducted, which included 124 patients with acute myocardial infarction in the anterior descending artery basin and atrioventricular block of II–III degree. All clinical cases meeting the criteria below were included from a continuous sample of 9687 patients with acute coronary syndrome treated in 2014–2024. Upon admission, all patients were sent to the X-ray room, where coronary angiography was performed, according to the results of which the anterior descending artery was visualized as an infarct-dependent artery and successful revascularization by stenting was performed. Despite the successful revascularization of the anterior descending artery, all patients retained atrioventricular blockade of the II–III degree, which served as the basis for temporary pacing through subclavian access, if there was no restoration of atrioventricular conduction within 14 days, then a permanent pacemaker was implanted. Depending on the type of atrioventricular block, the patients were divided into 2 groups. The AV-proximal group consisted of 58 patients with acute myocardial infarction in the anterior descending artery basin and proximal type of atrioventricular block of II–II degree, the AV-distal group consisted of patients with acute myocardial infarction in the anterior descending artery basin and distal type of atrioventricular block of II–III degree. Atrioventricular blockade of the II–III degree was considered distal with an elongation of the QRS complex of the electrocardiogram of more than 0.12 seconds, and proximal – respectively less than 0.12 seconds.
Results: The groups were comparable in all clinical and demographic indicators, with the exception of the frequency of coronary heart disease in the anamnesis, which was more common in the AV-distal group (49 (84.5%) and 64 (97%) in the AV-proximal and AV-distal groups, respectively, p = 0.007; error = 5.9 at 95% confidence interval [1,2;28,4]), and the frequency of AV-conduction recovery in the period up to 14 days from the moment of myocardial infarction, which was significantly higher in the AV-proximal group (48 (83%) and 5 (7.8%) in the AV-proximal and AV-distal groups, respectively, p = 0.001; Recovery = 58.56 with a 95% confidence interval [18.8; 182.8]), as well as the average time of temporary pacing before restoration of AV conduction or implantation of a permanent pacemaker was significantly less in the AV proximal group (7 [5;7] and 14 [14;14] in the AV proximal and AV is the distal, respectively, p = 0.03). When analyzing the complications of temporary pacing, no significant difference was obtained between the groups, except for the frequency of inflammatory skin phenomena in the puncture area and the location of the electrode for temporary pacing (3 (5.2%) and 12 (18.2%) in the AV-proximal and AV-distal groups, respectively, p = 0.01; inflammation = 4.0 [1,1;15]).
Conclusion: In patients with acute myocardial infarction in the anterior descending artery basin and distal type of atrioventricular blockade of II – III degree, who underwent successful endovascular revascularization, the chance of AV recovery in the period up to 14 days from the moment of acute myocardial injury is almost 60 times higher than if they had a proximal type of blockade (Recovery = 58.56 at 95% confidence interval [18.8; 182.8]), the risk of inflammatory skin phenomena in the puncture area and the location of the electrode for temporary pacing, which is 4 times higher in the group with distal type of AV block (inflammation = 4.0 [1.1;15]), which correlates with the time of temporary pacing. There is probably a need for more aggressive treatment tactics in patients with acute coronary syndrome in the anterior descending artery basin and distal type of atrioventricular blockade of II–III degree, consisting in early implantation of permanent sources of the rhythm driver from the moment of myocardial infarction.

The features of displaying an unchanged pericardium on CT scans performed in the standard examination mode for the thoracic cavity were studied. CT scan of signs of pericardial injury and features of their visualization were determined. It has been proven that CT of the chest cavity, performed in the standard scanning mode, allows diagnosing a bruised heart in case of gunshot wounds. The diagnostic effectiveness and prognostic value of the method are 87,5% and 53,2%, respectively.

Introduction. Multiple sclerosis (MS) is characterized by its course in patients of different genders. The described neurodegenerative and proinflammatory phenotypes of MS have different representation in men and women. The diversity of views on the influence of the location, size of demyelination foci and the degree of disability in patients with multiple sclerosis determines the importance of assessing these parameters by gender.
The aim of the study was to analyze gender characteristics in the location of demyelination zones, the relationship between morphological and quantitative features of focal changes and disability in patients with multiple sclerosis.
Materials and methods. A prospective analysis of magnetic resonance imaging data was performed in 103 patients (women – 54, men – 49; average age – 39±11.7) with relapsing-remitting multiple sclerosis during the period of persistent remission, who received outpatient care at the Kursk Regional Multidisciplinary Clinical Hospital in 2017-2024 using the consent criteria and correlation analysis.
Results. The presence of periventricular foci of demyelination in 72.2% of cases was recorded in women, while in men this figure was 97.9%, the differences are significant (p< 0.05). In the corpus callosum, demyelination foci were more often observed in men than in women – 46.2% versus 65.3% (p< 0.05). In the cervical spine, the demyelinating process was more pronounced in men (79.6%) compared to women (40.7%), which is statistically significant (p< 0.05). When assessing the severity of demyelination in the cerebellum, it was found that in men the proportion of foci was 46.9%, while in women this figure was 29.6% (p< 0.05). Correlation analysis using the Spearman criterion revealed a reliable effect of the number of foci on EDSS in the male population (p< 0.05). Correlation analysis revealed a moderate positive relationship between the sizes (min/max) and the disability indices of the connection in female patients (ρ = 0.397; p< 0.05).
Conclusion. In men, foci are localized more often periventricularly, in the cerebellum, corpus callosum and cervical spinal cord compared to women, which is comparable with the degree of disability. Women have a lesser degree of demyelinating process and a more favorable prognosis according to EDSS.

Rationale: The research topic reflects the issues of steno-occlusive lesion of the femoral-popliteal segment and methods of surgical treatment.
Methods: The results of open operations on the femoral-popliteal segment in 141 patients were analyzed. Three study groups were formed: №1 (n = 53) – after remote endarterectomy (RE), №2 (n = 47) – after vein bypass (VBP), № 3 (n = 41) – after polytetrafluorethylene bypass (PTFE). The period of retrospective analysis corresponded to 3, 5 and 10 years of follow-up.
Results: After 3 years, the PP in RE and VBP was 78.4% and 80%, respectively, significantly lower in PTFE – 60,5% (p = 0,085). SP was 86,3%, 88,9%, and 76,3%, respectively. Freedom from reintervation is higher in RE – 54,5%, in bypass surgery groups 33,3% and 30,8%, respectively. The percentage of limb preservation was 94,1% vs 95,5% in the RE and VBP groups, 81,6% in PTFE (p = 0,02). The overall survival rate was 96,2%, 95,7% and 92,7%, respectively. After 5 years, the PP is 43,8% vs 46,3% vs 30,5%. SP is higher in the VBP group – 70,7%, compared with PTFE and RE – 58,3% and 66,6%, respectively. Freedom from reinterpretation is 44,4% vs 27,2% vs 28%, respectively. Limb preservation rates remained high in the RE and VBP groups – 87,5% vs 85%, in the PTFE group – 72,22% (p = 0,075). The survival rate was 90,56%, 87,23% and 87,8%, respectively. By the age of 10, there were no primary passable synthetic shunts. The PP of RE and VBP decreased to 22,2% and 26,3%, respectively (p = 0,006). SP is 53,3% vs 57,9% vs 41,2%, respectively. The frequency of limb preservation is 82,2% vs 76,3% vs 61,8%, respectively (p = 0,058). RE has the highest freedom from reintervation (p = 0,091). The survival rate was 84,9%, 80,8% and 82,9%, respectively.
Conclusion: The advantages of the remote endarterectomy have been revealed in comparison with bypass surgery, slightly inferior to vein bypass in primary patency, which confirms the importance of the method in arterial surgery and opens up new opportunities for reintervations.

Rationale. It is proved that the changes of ocular blood flow play an important role in the mechanism of primary open-angle glaucoma (POAG) development. The impact of occlusive-stenotic lesions of carotid arteries on POAG progression has been discussed in the course of the last ten years.
Objective: to study the characteristics of ocular blood flow and the changes of carotid arteries in patients with various stages of POAG.
Methods: 125 patients (210 eyes) with various stages of POAG, 65 eyes of them with early stage of POAG (1st group), 126 eyes with moderate stage (2nd group) and 19 eyes with advanced stage (3rd group) were examined. 20 healthy individuals (40 eyes) without ocular pathology and cardiovascular diseases constituted the control group. Ultrasound examination including Color Doppler imaging and pulse dopplerography were used for investigation of blood flow in ocular vessels in the retrobulbar region. The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA) and paraneural medial and lateral short posterior ciliary arteries (sPSA). According to the NASCET criteria, carotid stenosis is categorized.
Results: There was a statistically significant decrease of PSV, EDV in OA and the increase of RI in OA in eyes with advanced stage of POAG compared to control group and the 1st group (р< 0,05). The results showed significant decrease of EDV and the increase of RI in CRA, medial and lateral sPSA compared to control and the 1st group that might indicate reduced retinal and choroidal blood flow. Ultrasound examination of carotid arteries showed critical stenosis of internal carotid artery (ICA) on ipsilateral side in 7,9% and 31,5% of cases in the 2nd and the 3rd groups, respectively. The mild stenosis of ICA was detected in the most cases (90,8%) of early POAG.
Conclusion: Ultrasound examination with the assessment of blood flow is noninvasive, available and high-informative method for the diagnostics of pathological changes of blood flow in ocular vessels in patients with POAG.
Early detection of impaired local blood flow and the pathology of carotid arteries in patients with glaucoma might contribute to determine the patient care management.

Aim. Assessment of the quality of life in patients with varicose veins of the lower extremities using the VEINES-QoL/Sym questionnaire immediately before and 3 months after cyanoacrylate adhesive closure (CAC);
Materials and methods. The study included 690 patients with chronic venous disease (CVD) of class C2–C6 according to CEAP, who underwent CAC using the VenaSeal method. The patients were divided into several groups depending on their gender, age, BMI and educational level. The inclusion criteria were the presence of CVD C2–C6 CEAP classes, junctional incompetence of the truncal saphenous veins, the presence of axial reflux lasting more than 0.5 seconds, the absence of previous open surgical interventions and any types of endovenous ablation for varicose veins, the absence of a history of deep vein thrombosis of the lower extremities. The exclusion criteria were: the presence of advanced peripheral arterial disease, osteoarthritis of the hip and/or knee, sciatica. All patients, with their informed consent, were asked to answer the VEINES-QoL/Sym instrument questions on the day of the procedure and after 3 months. STATISTICA 10.0 software was used for statistical analysis. The results were statistically significant at p<0.05.
Results. Statistically significant improvement in the quality of life after the procedure was observed in all comparison groups differentiated by patients’ CEAP class, gender, BMI and educational level. The differences between the groups were statistically significant in all cases. The mean improvement in group C3 was 22 points, which is about 1.5 times more than in group C2 (+15 points). In the group of C4 patients, an improvement in the quality of life was noted by an average of 32 points, which is almost 2 times more than in C5 patients (+17 points). In the group of C6 patients, the quality of life improvement was noted at an average level of +12 points compared to the baseline. Statistically significant improvement in quality of life was observed in both groups of patients differentiated by gender (p<0.05). Meanwhile, there were no significant differences between these groups when comparing the initial values of the quality of life on the VEINES QoL/Sym scale. The improvement in the women’s group averaged +22 points, which is slightly lower than in the men’s group (+24 points). The improvement in the group of overweight patients averaged 23 points, which is higher than in the group of patients with a BMI<25 (13 points), p<0.05. Statistically significant improvement in the quality of life was also observed in all groups of patients differentiated by level of education. The improvement in the quality of life in the group of patients with secondary education averaged +32 points and did not significantly differ statistically from the group of patients with higher education (+17 points).
Conclusions. The VEINES-QoL/Sym questionnaire is a useful and convenient tool for assessing the quality of life of patients who have undergone intervention for varicose veins. The possibility of using the VEINES instrument depending on the variable criteria for dividing patients into groups is quite attractive and interesting. The structure of the studied parameters of the quality of life in the VEINES-QoL/Sym questionnaire indicates a predominant emphasis on clinical signs and symptoms as well as the physical component of health and less affects the psycho-emotional and social components. The VEINES-QoL/Sym measurement showed a statistically significant improvement in the quality of life of patients after glue ablation of varicose veins.

Purpose of the study. Improving methods for preventing the development of dysphagia after laparoscopic fundoplication in patients with hiatal hernia.
Material and methods. A comprehensive analysis of diagnostic data and results of surgical treatment of 140 patients with a diagnosed hiatal hernia (HH) was carried out. According to the study design, the patient cohort was stratified into two groups. The control group consisted of 67 patients who underwent traditional open surgery. The main group included 73 patients who underwent videolaparoscopic correction of the НН using developed methods for the prevention of postoperative dysphagia.
Results. In the control group (n = 67), surgical correction of the НН was carried out through a classic laparotomy approach using standard surgical techniques. In the main group (n = 73), in 68 (93.2%) cases, various modifications of videolaparoscopic fundoplication with posterior crurorrhaphy were used. Only 5 (6.8%) patients, according to strict indications, underwent laparotomy operations with Nissen fundoplication in a clinical modification, also with posterior crurorrhaphy. In order to prevent dysphagia of varying severity, the mesh prosthesis was covered with a strand of omentum. Also, during videolaparoscopic Nissen fundoplication, the formation of a soft cuff was used using a Blackmore probe to dose the degree of tension of the fundoplication. Analysis of postoperative complications demonstrated significant differences between the study groups regarding the incidence of dysphagia. In the main group, dysphagia of varying intensity was recorded in only 4 patients, which amounted to 5.5% of the total number of observations. In the control group, this complication occurred much more often – in 13 patients (19.4%).
Conclusion. Thus, the obtained statistical data convincingly demonstrate the clinical effectiveness of the developed set of preventive measures in preventing the development of mechanical dysphagia in the postoperative period.

Rationale: The modern trend of Russian and world herniology is to shift the emphasis towards endoprosthetics of the abdominal wall with lightweight prostheses that do not significantly affect the quality of life of patients after surgery. However, the disadvantage of lightweight meshes is their insufficient strength due to the weak strength of the connective tissue of the abdominal wall during their implantation. The connective tissue capsule around the prosthesis cannot always sharply reduce the intra-abdominal pressure that occurs in some cases of relapse of the disease. A promising example of this problem is the use of bone marrow cells that stimulate tissue regeneration processes, which ensures a shorter period of formation of strong connective tissue.
Objective: to experimentally study the effect of bone marrow cells on the course of the wound process after subcutaneous implantation of a lightweight polypropylene prosthesis on aponeurosis of the rectus abdominis muscles.
Materials: The experimental study was performed on 30 rabbits divided into two groups of 15 animals. Subcutaneous implantation of a lightweight polypropylene prosthesis for aponeurosis of rectus abdominis muscles was performed in both groups. The animals in the first group were not injected with bone marrow cells. In the second group, after implantation of the prosthesis, bone marrow cells were taken from the crest of the rabbit ilium using a 2.5 ml spinal puncture needle. Then bone marrow cells of 0.5 ml were injected under the center of the prosthesis and in the area of its four corners to the places from which the process of implant rejection begins. On the 3rd, 7th, 14th, 21st, and 30th days after surgery, a section of the rabbit’s anterior abdominal wall was excised along with the implanted prosthesis and a standard histological examination was performed.
Results: The inflammatory reaction in the first group lasted 7 days, in the second – 3 days. The peak of the fibroblastic reaction occurred in the first at 14, in the second at 7 days. Durable connector.
Conclusion: the introduction of bone marrow cells into the implantation zone of a lightweight polypropylene prosthesis makes it possible to optimize the reparative processes in the wound.

The aim of the study is to evaluate and improve the modern diagnostic capabilities and treatment results of patients with DBTC with the formation of its stricture.
Materials and methods. A study was conducted with the participation of 17 patients treated at the State Clinical Hospital in Vladimir from 2013-2023 with DPC complicated by the presence of benign stricture of the sigmoid colon on the background of DBTC. According to emergency indications, 6 (36%) patients with a clinical picture of acute colonic obstruction were hospitalized. In 11 (64%) cases, strictures of the sigmoid colon against the background of DBTC occurred, detected at the outpatient stage. In differential diagnosis with CRC, the level of cancer markers CA19-9, REA was determined, and histological verification was performed. In 6 (36%) patients, the colonic obstruction had an obstructive character. In 2 (12%) cases, partial colonic obstruction was diagnosed, which resolved after conservative treatment. In 3 (18%) cases of obstructive intestinal obstruction, fibrocolonoscopy was performed after its resolution. Laparoscopic interventions were not performed.
Results: In 7 (42%) cases, against the background of ultrasound signs of colon diverticulosis, a narrowed area in the intestinal wall and signs of colonic obstruction were determined. Fibrocolonoscopy with biopsy was performed in 8 (47%) patients. An increase in the level of CA 19-9, REA has not been registered. In 12 (71%) cases, abdominal MSCT with intravenous contrast was performed. In 4 (24%) patients, there was a CT scan of the stricture of the sigmoid colon with phenomena of colonic obstruction. In 8 (47%) cases, a section of the sigmoid colon with signs of stenosis without intestinal obstruction. Surgical treatment was performed in 100% of cases. Obstructive resection of the sigmoid colon according to Hartmann was performed in 3 (17.6%) patients. In 14 (82.3%) patients, sigmoid colon resection was performed with the imposition of primary colonic anastomosis. LGE with the imposition of primary anastomosis was performed in 4 (23.5%) cases. There were no fatalities. Insolvency was diagnosed in 1 (5.8%) patient after sigmoid colon resection for DBTC. Suppuration of the postoperative wound occurred in 1 (5.8%) patient. 1 (5.8%) patient developed bilateral polysegmental pneumonia in the postoperative period.
Conclusion: Acute colonic obstruction caused by stenosis or stricture of the colon on the background of BTK is a late and relatively rare complication of it. The main method of accurate diagnosis of DBTC with the formation of intestinal stricture is fibrocolonoscopy with biopsy and morphological examination of the stenosis zone, CT of the abdominal cavity with contrast. The only radical method of treatment for this category of patients is surgical intervention. The use of modern diagnostic methods allows you to choose the most optimal amount of surgical aid. Endoscopic stenting is regarded as a “bridge” to planned intestinal resection with the possibility of applying primary colon anastomosis.

Backgraund: In recent decades, the number of patients with acute mechanical jaundice has increased significantly. Routine use of endoscopic retrograde cholangiopancreatography improved the results of treatment of patients with obstructive jaundice.
Aims: The aim of this study is to identify risk factors for the development of acute pancreatitis after ERCP, as well as to analyze the relationship with individual anatomical features and intraoperative characteristics.
Materials and methods: The data of 402 patients without cholangitis clinic and without increased amylase levels at the time of hospitalization were analyzed according to laboratory examination data. The patients were divided into 2 groups: the first – those observed after ERCP without complications, the second – patients who developed an acute pancreatitis clinic.
Results: In the examined sample, 9.7% of cases of acute pancreatitis were detected, which is a fairly average indicator. The results of the comparative analysis indicated a combination of the influence of factors of anamnesis, anatomy and actions of endoscopists during the ERCP manipulation.
Conclusions: The data obtained prove that the correct actions of the attending physician, consideration of risk factors and the experience of the endoscopist play a leading role in the results of treatment of patients with obstructive jaundice.

Gunshot wounds to the abdomen are one of the most complex sections of military field surgery. The natural reaction of the body to this type of injury is the development and progressive course of widespread gunshot peritonitis. Multi-stage surgical sanitation and adequate drainage of the abdominal cavity using VAC systems are the main controlled technologies that determine the outcome of treatment of patients with this severe complication.
Aim. To evaluate the effectiveness of programmed relaparotomies with staged sanation and the use of vacuum-assisted (VAL) and vacuum-instillation laparostomy (VIL) techniques in the treatment of widespread peritonitis in penetrating gunshot wounds of the abdomen with damage to internal organs.
Materials and methods. A comparative analysis of the treatment results was performed for 118 patients with gunshot injuries to abdominal organs complicated by widespread peritonitis, who underwent multi-stage surgical treatment using various types of VAC therapy for drainage of the abdominal cavity.
Results. The first relaparotomy according to the program was performed in 75.7% of patients after 24 hours, in 24.3% – after 36-48 hours. The number and interval between subsequent repeated sanitations were determined individually. Each stage included revision, sanitation of the abdominal cavity by multiple lavage with antiseptic solutions and installation of VAC systems. An analysis of 213 cultures from the abdominal cavity was performed. In 82.2% of the wounded, intra-abdominal complications (prolonged necrosis of the intestinal segment, perforation of acute ulcers, failure of intestinal sutures and previously applied anastomoses, adhesive intestinal obstruction, developing limited purulent leaks and necrosis, the presence of foreign bodies of gunshot origin) were effectively eliminated during programmed relaparotomies. The use of abdominal cavity drainage techniques using VAC systems (VIL, VAL) ensured faster decontamination during the treatment of gunshot peritonitis, which made it possible to reduce the number of program sanitizations and decrease the risk of complications by 32%. There were no fatal outcomes.
Conclusion. The method of laparostomy with programmed sanation of the abdominal cavity, supplemented by the installation of a drainage VAC system (VAL, VIL) – made it possible to reduce the number of relaparotomies performed by increasing the time intervals, promptly eliminate complications of the wound process and even more effectively treat gunshot peritonitis.

When analyzing 586 medical records of patients of the Pirogov Center who underwent hip arthroplasty in the first half of 2024, it was found that during treatment (the average hospitalization period in a surgical hospital is 7.0±0.1 days), the average hemoglobin concentration decreases to 108.0±1.5 g/l in women and 121.9±1.8 g/l in men. The need for blood transfusion developed in 2.2% of women and 0.4% of men, 1 patient underwent hardware reinfusion of autologous red blood cells. 6.7% of patients received tranexamic acid and 2.7% – iron preparations.
It is advisable to include the use of blood components, reinfusion and other patient blood management technologies in clinical guidelines and the standard of medical care for adults with coxarthrosis.

The aim of the research was to develop a technique that improves the results of surgical treatment of dislocations of the femoral head component of the hip endoprosthesis.
Materials and methods: The study included 64 patients who suffered from head dislocation after hip arthroplasty. For the treatment of patients of the first group, a technique was used in which the installation and fixation of the anti-luxation ring (“visor”) was performed screws to the existing cup or polyethylene insert of the endoprosthesis, which leads to the closure of the spherical head of the endoprosthesis in the pelvic component, which makes it impossible to separate them, thereby preventing dislocation of the endoprosthesis head for a long time. Patients of the second group were treated with other surgical methods.
Results and conclusion: Patients of the two groups were followed up for 24 months after the revision surgery. In the first group (26 patients), 2 cases of complications occurred – relapse of dislocation (7.7%). In the second group(38 patients), repeated dislocation occurred in 6 (15.8%); in one case, fubular neuritis occurred.
The developed technology, in which the device is fixed to the already installed parts of the endoprosthesis, will avoid a larger volume of surgery associated with the removal of well-fixed components of the endoprosthesis. If the surgeon, during a revision operation associated with dislocation of the head of the endoprosthesis, considers it possible to preserve the stably fixed components of the endoprosthesis, the method of choice may be the use of the proposed anti-luxation device.

The purpose: to evaluate the morphological features of the course of reparative processes in patients with diabetic foot syndrome (DFS) due to the use of collagen wound coatings.
Material and methods. The paper presents a comparative retrospective analysis of the histological material of wound tissues of 112 DFS patients. Morphological examination of the material was carried out using a microscope “Micros MC 50”, a lens “WF EWF 10x/18”. The studied material is divided into two groups: the main one is 62 micro-preparations of the wound tissue of DFS patients, collagen wound coatings (“Green Oak”, RF) were used in the complex treatment of wound defects; The control group consisted of 60 micro–preparations of wound tissues of DFS patients, local treatment of wound defects consisted of daily dressings with antiseptics and ointments.
Results and discussion. Analysis of the obtained results showed that the use of collagen wound coatings affects each phase of the reparative process of chronic wounds of DFS patients, contributes to a faster transition from the alternativeexudative stage of inflammatory reaction in proliferative and epithelial phase; collagen absorbs wound exudate, performing a drainage function, contributing to acceleration of wound cleansing processes, reduces inflammatory reaction, normalizes the functioning of microcirculatory vessels, stabilizing blood supply in the area of wound defect and reducing hypoxia, leads to the activation of reparative processes; the use of collagen wound coatings activates the process of leukocyte migration, significantly increases the number of macrophages, promoting increased expression of proinflammatory cytokines, speeds up the process of angiogenesis, migration and proliferation of fibroblasts – granulation tissue in the wounds undergoes a maturation process much faster than the group of patients, treated with daily bandages with antiseptics and ointments.
Conclusion. The use of collagen wound coatings in the complex treatment of patients with purulent necrotic DFS forms can significantly accelerate the course of each phase of the reparative process in wound defects due to the influence of this technique granulation tissue is able to pass the process of maturation in a shorter period of time, allowing to reduce the time of preparation for plastic closure from 20–22 to 12–16 days.

Aims: To compare the etiological structure of pathogens in patients with purulent wounds in hospitals in Grodno and Vitebsk.
Methods: The analysis of the results of microbiological studies in patients with purulent wounds who were treated at the Municipal Clinical Hospital of Emergency Medicine of Grodno and the Vitebsk Regional Clinical Hospital in 2016-2023 was performed. A complex of bacteriological studies has been carried out. The species was determined on the ATB Expression BioMerieux biochemical analyzer (France).
Results: The analysis of the seeded microflora in patients with purulent wounds in hospitals in Grodno and Vitebsk showed that the leading role as an etiological factor is occupied by representatives of the genus Staphylococcus, the family Enterobacteriaceae, P. aeruginosа and A. baumannii. K. pneumoniae is the leader among enterobacteria. Сoagulase-negative staphylococci and enterobacteria are more common in Grodno, and P. aeruginosа and A. baumannii are more common in Vitebsk. ESKAPE pathogens predominate in Vitebsk.
Conclusion: In different regions of the Republic of Belarus, there are individual differences in the species structure of pathogens of purulent processes of soft tissues, however, in general, there is a general tendency for the growth of the most dangerous pathogens of the “ESKAPE pathogen” group for patients. This indicates a gradual decrease in the effectiveness of antibiotic therapy, which dictates the need to search for new means of combating such microorganisms, one of the variants of which may be metal nanoparticles.

Atrial fibrillation (AF) is one of the most prevalent forms of arrhythmia, affecting approximately 1–2% of the population. Its prevalence is expected to notably increase in the coming decades due to an aging population. AF negatively impacts quality of life and cardiac function, increasing mortality risk. Catheter ablation has become a key method for treating AF, particularly for achieving pulmonary vein isolation (PVI). While traditional radiofrequency ablation remains widespread, recent years have seen increasing attention towards the single-shot cryoballoon ablation technique.
This article provides an analysis of contemporary approaches to the diagnosis and cryoballoon ablation of AF, examining data on the application of new cryoballoon systems. Emphasis is placed on comparing Arctic Front and PolarX technologies, including differences in components and application methods. Various ablation approaches are described, including the direct approach, «hockey stick» method, pull-down, and pull-away techniques, focusing on their clinical efficacy and risk reduction of phrenic nerve injury.
Key differences between cryoablation systems that influence clinical outcomes are investigated. The article concludes on the importance of re-evaluating skills and practices when introducing new technologies, to achieve the highest efficiency and safety in treating AF patients. Further research and continuous professional development are deemed essential for improving treatment outcomes and understanding new catheter ablation technologies.

Ferrum deficiency is one of the most common causes of anemia syndrome, it is a common comorbid age–associated pathology in clinical practice. Clinical manifestations of anemia are known, but latent ferrum deficiency can also negatively affect the clinical picture, aggravating the manifestations of the main pathological process. The negative role of tissue ferrum deficiency on cardiomyocyte metabolism is undeniable. Depending on the mechanism of pathological changes at the tissue and cellular level, there are three different variants of iron deficiency heart failure. The need to correct ferrum deficiency has already been noted in clinical guidelines for the treatment of chronic heart failure, which indicates the clinical significance of this problem for cardiac patients. However, there are few research on the effects of ferrum deficiency on other cardiovascular diseases. The study of the pathogenetic mechanisms of the linkage between ferrum deficiency conditions and such a common pathology as arrhythmias may contribute to changing the management tactics of cardiac patients in order to improve clinical outcomes.

Reverse shoulder arthroplasty is currently a common operation, despite this, debates continues about various aspects of the biomechanics of reverse endoprosthesis. In particular, there is no consensus in the medical literature about the function of the subscapularis muscle. Several clinical and biomechanical studies have been conducted to analyze its role in joint stability and influence on range of motion. Some results suggest that the subscapularis muscle improves joint stability but may limit joint range of motion.

The article reviews the literature on the occurrence of trigeminal neuralgia, its surgical treatment, and the history of the development of other methods. Modern diagnostic methods, treatment tactics, determination of the effectiveness of treatment methods. Methods of assessing the quality of life the impact of a particular treatment method on the quality of life of patients. The analysis of the effectiveness of treatment methods is given. Application of questionnaires and comparative analysis of the results to determine the quality of life before and after the treatment of trigeminal neuralgia.

Treatment of thoracoabdominal wounds is an urgent task of injury surgery in peacetime and wartime. Accounting for at least a third of all chest and abdominal wounds, this pathology is accompanied by high mortality, as well as significant risks of postoperative complications. Approaches to the treatment of such patients have undergone changes from a period of absolutely conservative management to damage control tactics and multi-stage surgical treatment. The experience of providing assistance to the wounded in the second half of the 20th century made it possible to improve anesthesiological care, provide a deep understanding of the course of traumatic illness and the role of anti-shock therapy and, ultimately, the formation of an integrated therapeutic approach with a differentiated choice of surgical tactics. The article summarizes the data on modern methods of diagnosis of thoracoabdominal wounds, including at the stages of medical evacuation. The frequency of organ damage in related areas is given and the opinions of researchers are relative.

The coronavirus pandemic has shown the global medical community that effective treatment of acute respiratory disease requires a lot of effort. Scientists and clinicians have managed to develop diagnostic and treatment algorithms, identify patients with a high risk of thrombotic complications and death. This required studying the pathogenesis of the disease, which is based on two conditions: coagulopathy and inflammation. Therefore, during the pandemic, laboratory studies of inflammation and blood clotting parameters were conducted to search for markers of thrombotic complications and markers that signal a deterioration in the condition. Expanding the boundaries of knowledge in laboratory research will allow for more advanced complex treatment and reduce potential complications of coronavirus infection.

Peripheral nerve injuries are a common complication of bullet, highexplosive and mine blast wounds of the upper and lower extremities. Understanding the multifactorial spectrum of pathogenetic mechanisms of nerve fiber damage and choosing the appropriate time parameters for providing the necessary surgical care are necessary for specialized treatment of this complex traumatic process. The article discusses the pathophysiological factors of traumatic damage to peripheral nerves, presents the most appropriate classification of injuries and wounds of the peripheral nervous system, the preferred timing of surgical intervention. Considering that severe trauma of peripheral nerves leads to loss of ability to work and frequent disability of military personnel, it is necessary to know the pathophysiological factors that influence the choice of timely and adequate surgical care for a fast recovery and to prevent the complications.

In recent decades, endovascular surgery has been developing by leaps and bounds, this technique performs operations on almost all vascular basins of the body. However, despite all the advantages and effectiveness of endovascular procedures, these interventions are not without complications. One of the most common complications is distal embolism, which is a well-known, but little-studied complication. It is a significant problem that worsens the outcome of the intervention and increases the risk of serious complications, including acute arterial thrombosis and limb ischemia. Timely recognition and effective treatment of this complication is of great importance for preventing the development of ischemia and preserving the patient’s limb. However, there is currently no consensus on the best treatment for acute complications of distal embolism during endovascular interventions for peripheral artery diseases. In this article, we analyze our clinical experience in the detection, diagnosis and treatment of distal embolism. The assessment of risk factors, methods of prevention and tactics of treatment of these complications was carried out. The observations and data obtained emphasize the importance of early diagnosis of distal embolisms and allow us to develop recommendations for improving clinical practice. The article will be useful for both specialists in the field of angiosurgery and doctors of other specialties involved in the treatment of vascular diseases of the lower extremities.

The article presents a clinical observation of a 35-year-old female patient with the diagnosis: Late postpartum hemorrhage. Hematometra with a pulsating vessel in the uterine cavity. 15th day after the first term delivery. Underlying disease: stage 1 anemia (hemoglobin concentration 93 g / l). Embolization of the uterine arteries was performed. Blood transfusions were not performed. The postoperative period was uneventful. The patient was discharged home in a satisfactory condition on the 5th day after the operation. Hemoglobin concentration at discharge was 92 g / l. It is concluded that organ-preserving surgery of uterine artery embolization can be an effective method for reducing perioperative blood loss in patients with secondary postpartum hemorrhage.

The article presents a clinical observation of a patient with large benign prostatic hyperplasia, complicated with the presence of chronic urinary retention and detrusor atony. These changes in the lower urinary tract led to the development of acute urinary retention – an emergency condition requiring immediate drainage of the bladder. After additional examination methods, the patient underwent endovascular embolization of prostatic arteries. Subsequently, the second stage of treatment was transurethral resection of the prostate gland.

One of the rare neoplasms of the pyramid of the temporal bone is an endolymphatic sac tumor (ELST). The progression of the disease is characterized by an increase in neurological symptoms, including sensorineural hearing loss, facial nerve paresis, and headache. Neurosurgical tactics differ from standard methods of treating tumors because of the histoanatomical characteristics of ELST. This article describes a case of successful treatment of an endolymphatic sac tumor. Microsurgical removal of ELST is a best treatment, whereas radiosurgery has limited possibilities. This method used in the postoperative period with residual volumes of pathological tissue or tumor recurrence. We use retrolabyrinthine access with subtotal petrosectomy with neuronavigation and neurophysiological monitoring. Embolization of the vessels feeding the tumor was not performed before operation. Autohemotransfusion system, named Cell-Saver, and hemostatic materials were used intraoperatively. This method is safety and effectiveness, providing a relatively small amount of blood loss, complete decompression of intracranial structures, including the bulbar group of cranial nerves, partial - the VII and VIII pairs, which, however, was accompanied by regression of neurological symptoms and a satisfactory degree of resection of the tumor. This tactic can be recommended for the treatment of endolymphatic sac tumor, since there are lower risks of relapses and surgical complications for the patient.

Arrosive bleeding of pancreatonecrosis is a rare, however, life-threatening condition due to the lack of a clear arteriographic localization of the source. Most bleeding occurs against the background of infected pancreatic necrosis, as well as pseudocysts of the pancreas, which are formed due to the destruction of the ductal system. The most common causes of hemorrhagic complications of pancreatic necrosis are pseudoaneurysms of vessels involved in the blood supply of the pancreas, with their breakthrough into the free abdominal cavity, retroperitoneal space, into the lumen of the gastrointestinal tract, as well as arrosias of pancreatic vessels involved in the infiltrative inflammatory process. The literature describes isolated cases of endovascular embolization in the treatment of arrosive parapancreatic bleeding in the presence of a round-the-clock angiographic service in a surgical hospital on duty. Today there is no specific management tactics in clinical practice for patients with erosive bleeding from pancreatic cysts, which underlines the urgency of the problem. The observation of intraoperative arrest of arrosive parapancreatic bleeding in a surgical hospital on duty, devoid of round-the-clock angiographic service, is demonstrated. It highlights the difficulties in surgically identifying the source of bleeding and possible solutions.

The article presents a clinical observation of patient N., 74 years old, with a history of surgery in August 2023 for cholelithiasis. During the surgical intervention, a number of complications were noted that required repeated operations and drainage of the common bile duct. In the postoperative period, drainage migrated with a clinical picture of biliary peritonitis. Relaparotomy, choledocholithotomy, lithoextraction, and redrainage of the common bile duct according to Kehr were performed. Due to the dislocation of the Kehr drainage, a drainage was installed in the subhepatic space, through which persistent external bile leakage was maintained. The patient underwent multi-stage endoscopic surgical treatment, as a result of which the passage of bile into the duodenum was restored. The external biliary fistula closed. The patient’s quality of life improved.

Grounding: Breast cancer (BC) ranks first in the structure of oncological diseases in women. Their share among the working age is 60%. Fifteen years ago, the main surgical method of treating BC was mastectomy. This operation led to the disability of a woman, affecting the decrease in her social adaptation, and caused colossal psychological damage.
Purpose: to substantiate, on the basis of clinical observations, the indications for the reconstruction of the nipple-areolar complex (NAC) by the method of free autotransplantation in patients with breast cancer, to evaluate the safety of this technique. To compare the aesthetic results of autotransplantation of the NAC with delayed reconstruction of the NAC.
Materials and methods: Clinical examples of 3 patients who underwent surgical treatment for BC in 2021–2022 are given. All underwent simultaneous reconstruction of the mammary gland with replantation of the NAC. Preoperative measurements included the distance from the sternal notch to the nipple (in cm), the distance from the nipple to the inframammary sulcus (in cm), the width of the base of the mammary gland (in cm), and the diameter of the NAC (in mm). The degree of ptosis was classified according to the classification systems of Regnault and Brink.
Results: Three clinical cases.
Conclusion: The technique of NAC autotransplantation in patients with breast cancer necessarily requires an intraoperative urgent histological examination of the submammary area and its subsequent planned histological examination. One-stage NAC autotransplantation is a safe and reliable method for patients for whom mastectomy with NAC preservation is contraindicated and is indicated in cases where the presence of tumor cells is excluded after an urgent histological examination of the submammary area.

The article describes the main milestones of the life, professional and creative path of academician M.I. Perelman. His clinical, scientific and research activities, which cover a wide range of surgical problems, are presented. His significant contribution to the study of the problems of thoracic surgery and phthisiology is noted.

Total endoprosthetics of the temporomandibular joint (TMJ) is an important area in the treatment of patients with severe joint pathologies, including ankylosis, arthritis, arthrosis, injuries and congenital anomalies. The article examines the historical aspects of the development of this technique, starting with the first mentions of TMJ pathologies in ancient times and ending with modern prosthetics technologies such as CAD/CAM.
The authors describe the evolution of approaches to the treatment of joint dysfunctions, including the use of various materials such as metals, silicone, Teflon and polymers. Special attention is paid to their advantages and disadvantages, including biocompatibility, durability and side effects.
The paper presents the key stages of the development of endoprosthetics methods: from the removal of the affected joint to the development of modular implants. The results of using materials such as Silastic, Proplast and Teflon, as well as the impact of these technologies on the state of bone structures and the overall function of the joint are considered.

Until 1874, all attempts in Russia to perform transperitoneal removal of the uterus (hysterectomy) affected by myomatous nodes or a malignant tumor ended in death. The main cause of the adverse outcomes was bleeding from the surgery area and peritonitis. The first, successful hysterectomy in Russia, which ended with the recovery of the patient, was performed on 08/22/1874 by an employee of the Medical Surgical Academy, virtuoso surgeon Nikolai Vladimirovich Ekk. N.V.Ekk reported on the patient at a meeting of the Society of Russian Doctors in St. Petersburg on 05/02/1877 (Protocol No. 14).