The basic principle of minimally invasive cardiac surgery is to minimize surgical trauma, reduce blood loss, achieve a cosmetic outcome, and lower the risk of infection. As a result, patients recover more quickly and their quality of life improves.
Despite this, coronary artery bypass grafting through a median sternotomy remains the gold standard for coronary revascularization surgery. This is due to the technical approach of minithoracotomy and its method’s reproducibility. The indications for minimally invasive coronary bypass grafting are the same as those for traditional sternotomy.
In some patients, coronary angiography reveals a coronary bed that is unsuitable for surgical revascularization. Furthermore, ongoing medical conservative treatment does not lead to expected success and is therefore ineffective. In these cases, we use the minimally invasive hybrid technique of extracardiac myocardial vascularization, known as “YurLeon”. With this approach, we first perform stenting on the necessary and accessible segment of the coronary artery. Next, we perform the YurLeon procedure through a minithoracotomy, which stimulates extracardiac vascularization of the heart.
This treatment method for CAD (coronary artery disease) is safe and effective, with good early clinical outcomes. It does not require extensive training, making it a reproducible and valuable option for coronary revascularization

Backgraund: hemorrhagic complications develop with a frequency of 2.0 to 10.5% of cases in the perioperative period in the group of patients with chronic limb threatening ischemia (CLTI). Identification of risk factors for hemorrhagic complications will reduce the frequency of their occurrence by planning surgical tactics and medical support for the patient, as well as associated complications.
Aims: identification and analysis of risk factors for bleeding in the perioperative period in patients with chronic limb threatening ischemia.
Methods: a retrospective analysis of the medical histories and outpatient records of 766 patients with chronic limb threatening ischemia who underwent surgical treatment (from 2006 to 2020) in order to identify hemorrhagic complications and possible risk factors for their development. All patients undergoing surgery for CLTI were included in the study. Exclusion criteria were: acute coronary syndrome, acute ischemia of the lower extremities, stroke, diabetes mellitus type I, severe purulentnecrotic lesions of the lower extremity requiring amputations. Observation period: in-hospital.
Results: 44 (5.74%) episodes of hemorrhagic complications in the early postoperative period. During the binary logistic regression, the most significant factors were: endovascular intervention with brachial and femoral access (p = 0.0001), hybrid intervention (p = 0.0001), duration of surgical intervention over 60 minutes (p = 0.001), triple antithrombotic therapy (p = 0.001), pronounced calcification of the vascular wall (p = 0.023).
Conclusions: identifying the most common risk factors for hemorrhagic complications through a comprehensive analysis of clinical, demographic and instrumental data, as well as studying their impact on the prognosis of patients with CLTI, makes it possible to develop a personalized approach to the treatment of such patients and prevent the development of these complications

The aim is to compare the efficacy and safety of rivaroxaban and apixaban in the treatment of deep vein thrombosis of the lower extremities in elderly and senile people suffering from chronic obliterating atherosclerosis of the arteries of the lower extremities.
Materials and methods. The results of treatment of 60 elderly and senile patients suffering from obliterating atherosclerosis of the arteries of the lower extremities, who developed deep vein thrombosis, were retrospectively studied. The patients were divided into 2 statistically homogeneous groups of 30 people each. The intergroup difference was the choice of the drug for long-term anticoagulant therapy. In the first group, anticoagulant therapy was performed with apixaban, and in the second group with rivaroxaban. The results of treatment were evaluated after one year by a control ultrasound and clinical examination to determine the degree of restoration of the deep vein lumen and the severity of venous outflow disorders. The frequency of hemorrhagic syndrome was recorded.
Results. After one year, effective recanalization (complete +partial) in the first group occurred in 24 (80%), and in the second — in 29 (96.7%), occlusion developed in 6 (20%) and 1 (3.3%) patients, respectively. Good one-year clinical results (degree of impairment is weak or absent) 18 (60%) patients were registered in the first group, and 24 (80%) patients in the second group. Poor results (the degree of impairment is medium and severe) were found in the first group of u12 (40%).and in the second group -in 6 (20%) patients. Hemorrhagic complications of anticoagulant therapy developed in 8 (13.2%) patients equally in both groups.
Conclusion. Revaroxaban is more effective than apixaban, and there are no differences between the drugs in terms of safety

Backgraund: the clinical significance of the genetic predisposition to pancreatic necrosis is rather uncertain and requires further study.
Aims: to study the clinical significance of polymorphisms of the ADH1B, CYP2C19 (CYP2C19*2, CYP2C19*3) genes in the blood in acute destructive pancreatitis.
Materials and methods: genetic polymorphism testing of the genes ADH1B, CYP2C19*2, CYP2C19*3 was performed in 72 Russian patients with pancreatic necrosis. All patients were admitted to the surgical hospital in an emergency. The diagnosis of destructive pancreatitis was made on the basis of clinical and ultrasound monitoring, laparoscopy data (14 patients — 19.4%), and was also confirmed during surgical intervention. Surgical aid was reduced to puncture and drainage sanitation of fluid formations in 36 patients (50%). The genetic study was conducted in the period from 2020 to 2022 inclusive in patients undergoing treatment in a surgical hospital.
Results: in the study group, polymorphisms of the ADH1B gene occurred with a frequency of 34.7%. Polymorphisms of the CYP2C19 gene were detected in 37.5% of cases. Polymorphisms of the CYP2C19*3 phenotype were not detected in all groups. 
Conclusions: it was found that an increase in the frequency of mutation of the ADH1B gene is associated with the formation of pancreatic abscess and purulent-necrotic pancreatitis, and the CYP2C19 gene is predominantly only pancreatic abscess

Backgraund: Currently, among the adult population of most countries of the world, the growth of cholelithiasis (GI) and its complications continues, which reach 20% of the total number of cases. Regardless of age and concomitant diseases, minimally invasive laparoscopic cholecystectomy has become the gold standard of treatment for such patients, but after it is performed, various costs of surgical intervention arise; for example, in the long-term postoperative period, changes occur from the gastrointestinal tract, having a characteristic clinical and endoscopic picture.
Aims: The aim of the study was the pathomorphologic substantiation of clinical and functional changes of the upper gastrointestinal tract in the remote postoperative period after minimally invasive cholecystectomy.
Materials and methods: The data of 119 patients with chronic calculous cholecystitis were analyzed. The patients were divided into 3 groups: the first — treated in hospital without surgery, medically, the second — observed after cholecystectomy for a period from 8 months to 1 year and the third — for more than 3 years. A group of 50 volunteers who did not present any complaints was formed for comparison. The diagnosis of chronic calculous cholecystitis was made on the basis of clinical signs, laboratory and ultrasound examination. Endoscopic and then morphologic assessment of the mucosa of the upper digestive system by targeted mucosal biopsy with histologic examination was performed by means of fibrogastroscopy. In the obtained biopsy specimens the cells belonging to the diffuse endocrine system were recognized by immunohistochemistry.
Results: It was established that in patients after minimally invasive cholecystectomy in the postoperative period clinical, endoscopically confirmed inflammatory and atrophic processes of the digestive tract develop and they do not disappear.
Conclusions: Inflammation of the mucosa of the esophagus, stomach and duodenum leads to a decrease in the density of diffuse endocrine glands and impaired production of digestive peptides by them. Due to the lack of digestive peptides, a vicious circle is created that supports digestive disorders.

Aim. Improving the effectiveness of complex treatment of patients with acute pancreatitis by introducing a personalized approach.
Material and methods. The study analyzed the outcomes of surgical intervention in 126 patients with various clinical forms of acute pancreatitis. The subjects were divided into two groups: the first, prospective group, which included 62 patients, and the second, retrospective group, which included 64 patients. In most cases (70.6%, or 89 patients), acute pancreatitis was of biliary origin (due to cholelithiasis), in 22.2% (28 patients) of cases, this pathology was of alcoholic origin, and in 7.2% (9 patients) cases — post-traumatic.
Results. Complex conservative treatment was carried out in 28 (22.2%) cases, among them in 17 patients from the main group and 11 patients from the control group with acute pancreatitis of alcoholic and post-traumatic origin. Minimally invasive interventions of varying volume and nature (percutaneous-drainage, endoscopic and laparoscopic), both one-stage and two-stage combined interventions in the main group were used in 38 (30.2%) patients. Traditional open surgical interventions in general were performed in 60 (47.6%) patients, of which in 7 (11.3%) cases according to strict indications in patients of the main group, and in patients of the control group — in 53 (82.8%) observations. In 20 (12%) observations, the development of early complications was noted after both complex drug treatment and after various surgical interventions in patients from the main group. Death occurred in 4 (6.4%) cases. In the control group of patients, 44 (68.7%) patients developed early complications of various types. Death in the control group occurred in 9 (14.1%) cases.
Conclusion. Thus, the choice of tactics and method of treatment, conservative or surgical approach using modern minimally invasive technologies for acute pancreatitis, must be strictly personalized. This choice depends on the cause of the disease, its clinical form and stage of development, as well as the presence of complications.

Backgraund: The greatest challenge in diagnosis and selection of the optimal treatment method are Tillaux and triplane fractures. Computed tomography cannot to be a screening test for ankle injuries due to the high radiation exposure and limited availability on an outpatient basis. Sonographic examination is a safely method, does not require patient transportation, and allows damage in real time. Non-invasive methods are use to study regional blood supply.
Aims: Ultrasonic modifiers to developed for Tillaux and triplane fractures of the distal tibia in children with assessment of microcirculatory activity in the area of injury in the postoperative period.
Materials and methods: We performed a prospective, open-label study of patients aged 11 to 14 years with triplane and Tillaux fractures. The total number of patients is 70 people. Ultrasound examination of the ankle joint was performed in all patients. The mechanism of injury was assessed according to the Lauge-Hansen classification. laser Doppler flowmetry method was used over a period of 4 to 6 weeks. The rate of the regenerative process was assessed in 20 patients.
Results: These populations had criteria of homogeneity with little variation. The following ultrasonic damage modifiers were identified: isolated two-part triplane fracture with an intact or partially damaged anterior part of the distal tibiofibular syndesmosis, isolated Tillaux fracture with an intact or damaged anterior part of the distal tibiofibular syndesmosis, three- and four-part triplane fracture with partial damage or rupture of the anterior part of the distal tibiofibular syndesmosis, Tillaux fracture with an ipsilateral fracture of the fibula, complicated by a partial or complete rupture of the distal tibiofibular syndesmosis, a triplane fracture with an ipsilateral fracture of the fibula, complicated by a partial or complete rupture of the distal tibiofibular syndesmosis.
Conclusions: The known classification characteristics of typical fractures are supplemented by damage to soft tissue structures. The laser Doppler flowmetry method made it possible to assess the microcirculatory activity of the injury in the postoperative period.

Rationale: Surgical decision-making when planning suture surgery of the supraspinatus tendon of the shoulder joint is further complicated by the fact that many ruptures do not correspond to the final clinical picture.
Aim: retrospective results of arthroscopic suture surgery of the supraspinatus tendon of the shoulder joint, taking into account the extent of the damage.
Materials and methods: a total of 83 cases were examined. The patients were divided into 2 groups according to the type of rupture: massive and small. Assessment was carried out before the operation according to the DASH (Disabilities of the Arm, Shoulder and Hand) scales, VAS (Visual Analogue Scale), and then at the terms of 1, 6, 12 months after the operation and the degree of dystrophy according to the Goutalier classification in the T1 MRI weighted mode before surgery. and then 3, 6, 12 months after surgery.
Results: the difference between the groups divided by the type of gap in the indicator, the classification according to Gutallier as well as the VAS score and the DASH questionnaire was detected and tracked across all control points. There was no evidence of a deterioration in the outcome relative to age.
Discussion: Despite the fact that no data on the age factor have been identified, it should still be paid attention.
Conclusion: when predicting the results of surgery, attention should be paid to the size of the rupture and the age of the patient

The changes occurring in the immediate postoperative period after various operations on the damaged spleen in patients of different age groups were studied. It was found that the choice of surgery for spleen injury depends on age indicators: in young and middle–aged patients, it is autolyentransplantation, in older patients, splenectomy. Forced splenectomy in patients of the older age group helps to prevent changes in the immunoglobulin profile

Rationale: Pilonidal sinus (PS), or the more common name in Russia, epithelial coccygeal duct, is an acquired disease in which there are fistulas on the skin of the intergluteal region. During mass examinations, PS occurs in 3–5% of healthy people with an incidence of 26 cases per 100 thousand. people with a predominance of male population. Cosmetic results of surgical treatment are not always satisfactory — 13–17% may develop hypertrophic scars, wound healing time can be up to 70 days and, accordingly, the period of temporary disability increases.
Objective:to evaluate the cosmetic effect of surgical treatment of pilonidal sinus, wound healing time and periods of temporary disability.
Methods:A prospective single-center randomized study (n = 100 patients) with PS without abscess (L05.9) was conducted at the State Budgetary Healthcare Institution Research Institute-KKB No. 1, Department of Purulent Surgery from January 2019 to January 2021. In the main group (n = 50), excision of the pilonidal sinus was performed with plastic closure of the wound defect of the sacrococcygeal region according to RU patent No. 2751821 dated July 19, 2021; in the control group (n = 50), excision of the PS was performed with suturing using the Bascom II method.
Results:When analyzing the results, the groups were homogeneous by gender, age, and BMI. There was no significant difference in wound healing time (p = 0.913). The period of temporary disability in the control group was shorter and amounted to 18 days (p<0.001). The cosmetic effect of the operation according to the POSAS scale after 1 and 6 months, both from the doctor and from the patient, was better expressed in the main group (p<0.001).
Conclusion: The developed method is simple in technical execution and reliable, which allows it to be used in routine practice and does not require special (plastic) training of the surgeon.

Background: Despite the many existing methods of local impact on wounds, the search for new means of stimulating healing remains relevant. Certain prospects are associated with the use of a high-intensity erbium (Er:YAG) laser capable of not only sanitizing the wound surface, but also influencing the regeneration processes.
Aim: To evaluate the wound healing properties of a high-intensity Er:YAG laser in the treatment of patients with long-term non-healing wounds and when exposed to a complicated wound process in an experiment.
Materials and methods: In this work, the effect of erbium laser treatment of long-term non-healing wounds in patients with diabetes mellitus, venous and arterial insufficiency, as well as experimental wounds in rats was evaluated. During the study, visual changes in wound defects were analyzed in dynamics, planimetry was performed, bacteriological, cytological studies were performed, as well as morphological analysis using light and electron microscopy.
Results: The use of the Er:YAG laser in two modes accelerated the purification and epithelialization of wound defects. The regeneration stimulation regime promoted the growth of granulation tissue, and the cytological picture confirmed signs of active healing. Bacterial growth was absent in most wounds by the end of the observation period. According to morphological analysis, Er:YAG laser radiation increased the functional activity of fibroblasts, as well as stimulated collagen synthesis and angiogenesis.
Conclusions: The results of the clinical and experimental study confirm the wound healing properties of the Er:YAG laser. The radiation parameters and the possibility of laser operation in a stimulating mode can improve the results of wound treatment of various origins.

Thrombosis of the superficial veins of the lower extremities (thrombophlebitis) is a common pathology, especially in patients with varicose veins. Various methods from anticoagulant therapy to surgical intervention have been proposed and used to treat such patients, but there are still controversial points about their choice.
Aim: to compare the results of surgical treatment of patients with ascending varicothrombophlebitis of the main subcutaneous veins of the lower extremities by radiofrequency ablation and crossectomy.
Materials and methods. The study included the results of treatment of 24 patients (6 (25%) men and 18 (75%) women, the average age of patients was 54±15 years) with varicose veins of the lower extremities class C2-C5 (according to CEAP) and thrombosis of the great saphenous vein and its tributaries. Group I — patients after radiofrequency ablation (n = 12), group II — patients after crossectomy (n = 12). In the postoperative period, the clinical condition and quality of life were assessed according to the CIVIQ-2 questionnaire, control ultrasound examinations were performed 1, 3, 7, 14 days, 1 month and 1 year after surgery.
Results. In the postoperative period, no recurrence of the disease was detected in any of the groups, p>0.005. Lymphorrhea was noted in group II in 16.6% of cases (n = 2), in I this complication was not detected. p<0.005 Parasthesia in patients of group I was detected in 8.3% of cases (n = 1), in Group II in 25% of observations (n = 3), p<0.005. Indicators of the pain factor according to the CIVIQ-2 questionnaire in group I: 1.73±0.93, in group II: 2.8±1.05, p<0.005. In group I, the average bed day was 1.4±0.2 and the duration of disability was 4.9±0.2, in group II — 6.1±1.3 and 13±1.2, respectively (p<0.005).
Conclusion. Surgical methods of treatment of patients with varicose veins of the lower extremities complicated by ascending thrombophlebitis are effective and safe in terms of prevention of venous thrombembolism. Endovenous radiofrequency ablation, being a less traumatic method, avoids general anesthesia, significant cosmetic defects, the development of lymphorrhea, paraesthesia and other complications, especially in obese patients, as well as reduces the time of hospitalization and postoperative rehabilitation

Background. The need to evaluate the results of complex treatment with standard methods in patients with chronic surgical soft tissue infection in the hospital for further comparison with other treatment methods.
Objective. To analyze the results of complex treatment of patients with chronic surgical infection in a hospital setting.
Materials and methods. The case histories of 80 patients with trophic ulcers of the lower extremities in the hospital from 2018 to 2023 were retrospectively studied. The clinical and demographic indicators of patients, the results of duplex scanning of the vessels of the lower limbs, the duration of treatment in a hospital setting, the nature and area of the wound, as well as its contamination were analyzed.
Results. The average age of the patients was 67.65±12.49 years. Gender distribution: women — 52 (65%), men — 28 (35%). The duration of the disease, namely the appearance of TJ in patients before admission to the hospital, averaged 4-5 weeks. The maximum duration of the disease before admission was 8 weeks. The duration of hospitalization averaged 9.1±3.1 bed days. The minimum period of hospitalization was 6 bed days, the maximum was 13 bed days.
Conclusions. The traditional comprehensive treatment of patients with a venous etiology in the hospital is carried out in order to cleanse the affected foci, stop the inflammatory process and further continue the healing process already on an outpatient basis. It is obvious that further progress in the treatment of patients with this pathology will be associated with the widespread introduction of fundamentally new approaches

The purpose of the study — to evaluate the long–term results of calculating IOL in patients with an anterior radial keratotomy in the anamnesis. Introduction. In recent years, there has been an increase in the number of cataract patients who had previously undergone radial keratotomy. There is no single IOL calculation tactic for this group of patients. The risk of not getting into the target refraction after surgery remains very high. Patients and methods. The results of calculating the optical strength of IOL in 13 patients (16 eyes) with a history of radial keratotomy in the period from January 2021 to April 2023 were analyzed. The calculation of IOL was carried out using the formulas Hoffer-Q, HAIGIS, Barret TrueK with keratometry data Tomey OA 2000 and Verion. Based on the obtained values, the optical power of the IOL was determined by selecting a results close in value within the limits of the diopter, preference was given to IOL with greater optical strength. Results. In the long–term period (6 months — 2 years) uncorrected visual acuity averaged 0.56 ±0.06, visual acuity with correction - 0.69±0.06. The refractive index of the eye averaged -0.45±0.2 dptr. Conclusions. The calculation of the optical power of the IOL using the formulas Hoffer-Q, HAIGIS, Barret TrueK gives high functional results without applying corrections

Rationale: Rheumatoid arthritis is a prevalent severe immunoinflammatory disease which defines its medical and socioeconomical significance. In 2020 olokizumab — biological product developed and produced in Russia — was registered by Ministry of Health of the Russian Federation for treatment of rheumatoid arthritis. Olokizumab is a humanized monoclonal antibody (IgG4-cappa type) specifically inhibiting interleukin-6 (IL-6). Product efficacy and safety were confirmed in recent international phase 3 clinical trials which included 2444 patients over 18 years old with moderate and severe rheumatoid arthritis (CREDO 1, CREDO 2, CREDO 3). There is limited data on use of olokizumab in rheumatoid arthritis in Russian Federation in routine practice.
Objective: To describe the first experience with olokizumab use in the Department of rheumatology of Pirogov National Medical and Surgical center in patients with rheumatoid arthritis.
Materials and methods: The product was given to 17 patients with RA — 14 women and 3 men aged 20 to 75 years old, with typical clinical features they had polyarthritis with morning stiffness, joint tenderness and swelling on examination, increased ESR and CRB according to test results. Most patients had severe or moderate rheumatoid arthritis and functional disorders, 7 out of 17 patients had extraarticular manifestations. The patients were followed-up for 12 weeks. The response evaluation was based on pain assessment by the patient, tender joint count, swollen joint count (based on evaluation of 28 joints), patient global assessment of disease activity, CRP, ESR and DAS28-CRP index.
Results: Olokizumab use resulted in reduction of pain intensity in 88% of patients. There was a trend to reduction and normalization of CRP, especially in patients with initially high RA activity. After 12 weeks the DAS-CRP and the percentage of patients with severe and moderate disease activity reduced. After 12 weeks the percentage of patients with low activity was 58.8%, and with moderate activity was 41.2%.
Conclusion: The olokizumab therapy led to positive results both in naïve patients and in those previously treated with biologics. The rapid reduction of acute-phase reactants was accompanied by positive changes in articular syndrome. Longer observation is required for more detailed description of olokizumab efficacy and safety

Rationale: Antigens of the blood group systems MNSs, Duffy, Kidd, Lutheran, Lewis, Kell (Kpa, Kpb) and P1PK are immunogenic, cause the production of irregular antibodies and corresponding difficulties in the selection of donor red blood cells. Objective: to create a cohort of regular donors, phenotyped according to the antigens of the above blood group systems.
Methods: From 2014 to 2023 in the blood transfusion department of the Okrug Clinical Hospital (Khanty-Mansiysk). We examined 830 regular donors with a donation frequency of more than 3 times a year. Along with the ABO and Rh phenotypes, antigens of the MNSs, Duffy, Kidd, Lutheran, Lewis, Kell (Kpa, Kpb) and P1PK blood group systems were determined. Red blood cells were phenotyped in gel cards using an IH-100 analyzer (Biorad, Switzerland). The prevalence of phenotypes was compared with literature data on the prevalence of similar phenotypes in Caucasians using the chi-square method at a significance level of 0.05.
Results: In Khanty-Mansiysk, the M+N-S-s+ phenotype is 9.2% more common (p<0.01) and the M+N+S+s+ phenotype is 11.1% less common (p<0.01). The Le (a-b-) phenotype among donors is 9.1% more common than in the comparison group (p<0.001). These donors should be aware of the increased risk of coronary artery disease in individuals with the Lewis null phenotype. Fya and Fyb antigens were detected in 71% and 76% of cases, respectively. The Duffy null phenotype, Fy(a-b-), was found in 4 donors. The frequency of occurrence of Jka and Jkb antigens was 82.4% and 64.3%, respectively. 41 donors with the rare Kidd null phenotype were identified. For the Lutheran blood group system, the frequencies of Lua and Lub antigens were 2.0% and 98%, respectively. Phenotype P1 among donors is 16% less common than in the comparison group (p<0.001).
Conclusion: For the first time, the frequency of phenotypes of six additional blood group systems in donors from Khanty-Mansiysk was studied. Compared to literature data, the following phenotypes are more common in Khanty-Mansiysk: M+N-S-s+, Le(a-b-), Fy(a-b-), Jk(a-b-) and less commonly – phenotypes M+N+S+s+ and P1. The effectiveness of selecting blood from donors with a known extended erythrocyte phenotype for the prevention of transfusion reactions caused by irregular antibodies remains to be assessed

Rationale: In 2021, a mandatory change in the study of markers of infections in blood donors (refusal of confirmatory studies, etc.) at the Republican Blood Transfusion Station (RPSK, Ufa) was combined with a significant increase in the blood donors deferrals.
Objective: to compare the frequency and structure of donor deferrals due to the detection of infection markers in 2021 and 2022. Null hypothesis: unchanged order of donor examination in 2021 and 2022. will lead to the maintenance of an increased proportion of donor deferrals.
Methods: Based on the results of the work of the RSPK in 2020–2022 and using the
method of continuous observation, we compared the number of primary and repeat donors, their donations and the number of people diverted from donation after identifying markers of blood-borne infections. The results were assessed using descriptive and inductive statistics at a significance level of 0.05.
Results: In 2021, the part of donors deferred due to infection markers increased significantly: first time — by 1.2% (p<0.001), repeat — by 0.7% (p<0.001). In 2022, the part of both primary and repeat donors deferred due to infection markers did not differ from the same indicator in 2021. At the same time, the frequency of HIV deferrals based on a confirmatory test at the AIDS center has not changed.
Conclusion: The more donations a donor makes, the higher his risk of getting into the examination process with an error in the pre-analytical (wrong blood in tube), analytical (low specificity) and post-analytical (clerical error) stages of laboratory screening of donor blood. The Russian blood service needs to abandon the donors deferrals based on a single positive result of a single screening of markers of blood-borne infections

The surgical management of patients with abdominal aortic aneurysm (AAA) and concomitant severe cardiovascular diseases can be tough and are the subject of controversy among cardiovascular surgeons. It has been shown that concomitant lesions increase the morbidity and mortality in a postoperative period among high-risk patients. Due to the lack of clear recommendations regarding the treatment modality and timing of the surgical management are the cause of disagreements between treatment providers. Coronary artery disease (CAD) and carotid artery stenosis (CAS) are common in patients with abdominal aortic aneurysms. In this group patients, aortic cross-clamping may have a detrimental effect on cardiac function and can cause a stroke whereas coronary artery bypass graft surgery before aneurysmectomy (staged operation) carries the risk of the perioperative aneurysm rupture. Some authors advocate performing a staged approach: aortic surgery after thorough preoperative preparation and the second stage is carotid and coronary artery revascularization. Others recommend performing coronary artery and carotid artery revascularization first. In addition to this, there are disagreements about the timing of the aortic surgery as a second stage. Taking into account the risks of the staged approach some authors advocate a combined one-stage approach. This article also summarizes non-standard approaches to the treatment of patients with coexistent AAA and cardiovascular diseases. Due to the small number of articles on this topic, small sample size and various statistical methods in the available studies, it is not possible to propose the most optimal treatment modality. Randomized controlled studies with higher sample sizes should be conducted to determine an optimal treatment.

Aim. To analyze modern methods of diagnostics of coronary heart disease (CHD) among young patients, as well as to evaluate the effectiveness and safety of non-invasive cardiac imaging technologies. The work is aimed at identification of optimal approaches to diagnostics, which can improve the prognosis and quality of life of this category of patients.
Materials and Methods. literature analysis, comparative analysis and synthesis of
data on the latest diagnostic technologies. Special attention is paid to coronary computed tomography angiography (CT-angiography) and magnetic resonance imaging (MRI), in comparison with traditional methods such as electrocardiography and exercise testing.
Results. CT-angiography and MRI have high diagnostic value, especially in cases of atypical course of CHD in young patients, when traditional methods may be ineffective. These methods allow not only to reveal the presence of coronary artery stenoses, but also to estimate structural and functional changes of myocardium, which is important for early detection and prevention of CHD.
Conclusion. Integration of noninvasive imaging methods into clinical practice can significantly improve IBS diagnostics in young patients. It is necessary to take into account individual features of each patient, as well as potential risks and limitations of each method. The results of the study can serve as a basis for the development of new clinical recommendations and improvement of existing protocols for the management of patients with CHD

The prevalence of intracranial aneurysms (IAs) in the general population is about 2–6%; their frequency as a cause of subarachnoid hemorrhage, according to various sources, is estimated at 10-38%. Endovascular intervention is the first-line treatment for both ruptured and unruptured IA, which is associated with a lower incidence of surgical complications and mortality compared with open neurosurgery. Endovascular specialists performing therapeutic interventions for IA need to have specialized theoretical and practical training, since the specific structure of the vascular bed, the delicacy of the anatomical region and the variability of the nature of the lesion determine the extremely high cost of error. In addition, interventions on intracranial vessels are performed independently by residents and interns least often. Printing three-dimensional models allows you to plan surgical intervention more accurately; carry out the selection of consumables for a specific vascular pathology; use the model as a guide during surgery. Moreover, it is a unique educational tool that enhances training in surgical and endovascular techniques through realistic anatomical representation and tactile experience. Three-dimensional modeling is a promising, actively developing area. Further research is required, aimed both at improving the method of making models and at reducing its cost, which will contribute to the wider use of this technology in the foreseeable futu

Varicose veins of the lower extremities are a common clinical problem nowadays. It can cause discomfort, pain, swelling, thrombosis, bleeding, ulceration, can have a negative impact on the physical, psychological, and social components of the quality of life of patients and even lead to disability. And the treatment of such patients is associated with the risk of relapse.
Despite the successes of modern medicine in the diagnosis and treatment of patients with varicose veins of the lower extremities, this pathology remains the most common, there is still no accurate understanding of the etiology and pathogenesis, there are problems of improving treatment results that require continued research

The decision of the question about the terms of radical surgical treatment of patients with mechanical jaundice, the scope and methods of preparation for surgery, including the expediency of preliminary drainage of biliary tract, largely depends on the patient’s condition at the time of diagnosis. The present review is devoted to modern approaches of investigation and evaluation of liver functional state as one of the most important criteria for surgical tactics determination. Modern methods of investigation and evaluation of the liver functional state are considered

Rationale: According to world data, radicular syndrome causing neurological disorders is 83.2 cases per 100,000 population per year, with a subsequent increase in prevalence after 40 years of age. If conservative treatment of cervical disc herniations is ineffective, surgical treatment is required. The gold standard of surgical treatment is an anterior cervical discectomy with fixation (ACDF). However, there is no consensus on the choice of the optimal material for fixation in the modern medical community.
Purpose: To review the literature sources devoted to interbody fixation of the cervical segment during discectomy, to improve the results of these operations.
Materials and Methods: We used PubMed (http://www.ncbi.nlm.nih.gov/pubmed), Elibrary (http://elibrary.ru), and the archives of the journals “Neurosurgery” and “Spine Surgery” to search for relevant publications.
Results: The data of the world literature on methods and materials for fixation of the cervical spine during discectomy were analyzed. We reviewed the methods of cervical segment stabilization with autograft from the iliac crest, segment fixation with a plate, interbody cages made of titanium and PEEK with and without filling with osteoconductive materials, and considered early models of biodegradable cages made of lactide polymer. According to the data obtained, the choice of material and method for fixation of the cervical segment remains an open question. The most frequent complications are related to graft migration and subsidence.
Conclusion: Taking into account the obtained data and the urgency of the problem in the Russian Research Center of Surgery named after academician B.V. Petrovsky together with the Kurchatov Institute are developing a biocompatible biodegradable device/cage for cervical spine stabilization during cervical spine surgeries. At present, medical and technical requirements for the polymer device have been formed, and a search for suitable materials is underway

Due to the high mortality rate from oncological diseases, the world medical community continues to work on methods of treatment and prevention of complications associated with the treatment of malignant neoplasms. However, not enough attention is paid to the active study of some scientifically based ways to fight cancer. One of such effective and little-studied methods of influencing the processes of carcinogenesis is the effect on the body of increased oxygen pressure. In this regard, the analysis of scientific and research works devoted to the study of the mechanism of action and the possibility of using hyperbaric oxygenation in patients with malignant neoplasms was carried out. The results of experimental and clinical studies, during which the use of hyperbaric oxygen therapy in oncology was evaluated, are described and structured. In the course of studying the literature data, it was revealed that exposure to increased oxygen pressure leads to activation of apoptosis of tumor cells, a decrease in their proliferation and aggressiveness. In the postoperative period, the indicators of hemogram, water-electrolyte balance, acid-base state improve. Combined use with polychemotherapy helps to overcome chemotherapeutic resistance, reduce the toxic and cytostatic effects of chemotherapy drugs on the body. And the combination with radiation therapy allows the use of hyperbaric oxygenation both as a method of increasing the sensitivity of tumor cells to radiation, and as a preventive and therapeutic effect on delayed radiation lesions. Thus, the use of high oxygen pressure therapy in the complex treatment of malignant tumors leads to an increase in the quality and life expectancy of patients with neoplasms. At the same time, it is possible to use both a method of supporting basic polychemotherapy and /or radiation therapy, and a method of preventing the development and treatment of complications. However, due to the insufficiency of the conducted clinical studies, this method needs extensive multidisciplinary discussion and study both in domestic medicine and in foreign practice

A significant increase in the number of so-called «deferred» patients for whom planned operations were postponed to a later date after the acute phase closer to the post-pandemic phase of COVID-19 creates serious problems for the health care system of various countries, forcing surgeons to take a more proactive strategy to treat these patients and prevent them further growth. It is known that currently, according to various estimates, the world has accumulated 28 million deferred operations during the peak period of the COVID-19 pandemic. There is also the problem of providing routine surgical care to patients who have had an asymptomatic form of the new SARS-CoV-2 coronavirus infection. Until today, the degree of safety of patients, medical personnel who have undergone asymptomatic or symptomatic forms of COVID-19 remains insufficiently clear. Most researchers believe that the selection of patients for planned surgical interventions should be based on a comprehensive, comprehensive assessment of the condition of patients who have undergone COVID-19, and operations should be performed in compliance with anti-epidemic measures, the use of personal protective equipment by medical personnel and patients

The discovery of the laser in 1960 was preceded by a long period of scientific research. The combination of achievements in quantum physics and radio engineering allowed Theodore Maiman to launch the first, completely new light source on May 16, 1960 — a laser. Laser devices have undergone a number of significant changes over a long time, and the range of their applications has expanded. Today lasers are actively used in various areas of medical practice. Lasers have indications and contraindications. Lasers are used to correct a large number of aesthetic problems, depending on the optical, thermos-physical properties of the tissue and the target chromophore. Laser therapy has advantages over traditional treatment methods: precision, minimal invasiveness and fast recovery time after the procedure.
The review article presents in detail the history of laser technologies, describes the currently existing types of laser devices actively used by dermatologists and phlebologists in their practice. The study of this issue is relevant because this method of treatment is in constant development and improvement.

Objective: to study the frequency of lower limb amputations in combination with severe damage to the contralateral lower limb in wounds and injuries; optimal surgical tactics in domestic and foreign military field surgery.
Material and methods: the analysis of 36 domestic and foreign open sources of literature on the material of past military conflicts was carried out. It was found that limb tears in combination with severe multiple injuries and bone fractures ranged from 3.4 to 5.6%.
Results: The preliminary results of the study showed the need to solve the problem of choosing the optimal surgical tactics when combining lower limb detachment and severe damage to the contralateral lower limb.
Conclusion: The frequency of amputations in the world is steadily increasing due to an increase in the number of victims with high-energy injuries, including as a result of armed conflicts characterized by the use of explosive ordnance. The treatment of wounded with severe multiple and combined injuries with the presence of an amputation defect is a big problem both in choosing the method of osteosynthesis of the damaged limb, and in the indications and timing of prosthetics

After surgical intervention on the face, the issue of identification of a citizen who has changed his appearance is being updated. To ensure effective law enforcement in this area, it is necessary to develop a methodology for the criterion assessment of significant changes in appearance as a result of injuries, mutilations and medical procedures

A clinical case of a 75-year-old patient with ihd and multivessel diffuse coronary artery atherosclerosis is presented. The risk of surgical treatment is extremely high — reduced lvef — 34%, copd, paroxysmal form of atrial fibrillation, history of cancer, old age. a gentle operation was performed — an isolated bypass of the anterior interventricular artery from a minimally invasive approach, supplemented by a technique for stimulating extracardial myocardial vascularization.

Antithrombotic therapy in patients with unstable angina is considered mandatory. However, in patients with concomitant cirrhotic portal hypertension, complicated by previously occurring variceal esophagogastric bleeding, the prescription of anticoagulants and antiplatelet agents negatively affects the effectiveness of hemostatic measures in case of recurrent hemorrhage and can lead to poor outcome.
Case report demonstrates result of TIPS procedure, supplemented by embolization of inflow tracts to the esophagogastric varices in a patient with an endoscopically established high risk of variceal re-bleeding against the background of coronary heart disease with unstable angina. Achieving effective portal decompression made it possible to prescribe the patient antithrombotic therapy, subsequently perform coronary stenting and continue the necessary therapy with a good long-term outcome in the course of both diseases.
Of total number of 307 patients with complicated portal hypertension who underwent TIPS procedure in Surgical clinic of Rostov State Medical University in 2007-23, in 27 patients portosystemic shunt intervention was performed against the background of the need for antithrombotic therapy due to comorbid pathology.

To date, ventricular extrasystole is one of the most common types of arrhythmias and occurs in 5% of healthy individuals of young age and up to 50% in Holter monitoring in the same group of individuals. The treatment of ventricular extrasystole is a complex and multicomponent task, including long-term selection of antiarrhythmic therapy, or requiring multistage RFA, which increases the probability of complications in the patient, as well as, in some cases, does not lead to sufficient effectiveness in the long term, leading to deterioration of the patient’s condition. It is proved that in patients with severe concomitant pathology, such as ischemic heart disease, myocardial infarctions, CHF, in the presence of frequent LES, the patient’s life prognosis worsens, and may also lead to the development of life-threatening arrhythmias, in particular, ventricular fibrillation. Therefore, we present a case of RFA in a patient with frequent polymorphic VES and reduced LV ejection fraction due to a long coronary history.
Aim. To demonstrate a clinical case of successful treatment of polymorphic left ventricular extrasystole in an ischemic patient using one-stage radiofrequency treatment of the dominant arrhythmia focus.
Methods. The patient underwent radiofrequency exposure using the CARTO 3 navigation system (Biosense Webster Inc, USA). Bipolar substrate mapping of the left ventricle with standard settings (normal tissue >1.5 mV and scar tissue <0.5 mV) was performed, which was supplemented with parallel activation mapping of two extrasystolic morphologies and stimulation mapping of extrasystoles. RFA was performed using a ThermoCool SmartTouch© catheter. Exposures were performed with exposure power parameters of 50 W, the exposure cutoff was a stable ablation time of 60 sec, and the RF catheter was irrigated with isotonic NaCl solution at a solution delivery rate of 30 ml/min during exposure application.
Results. At the moment of admission the patient had 12 thousand polymorphic ventricular extrasystoles predominantly of 2 morphologies. After surgical intervention on the next day of discharge the patient had no ventricular extrasystoles according to ECG and Holter monitoring data. Conclusion. According to the results of the clinical case the efficacy of performing a one-stage ablation of ventricular extrasystole of two morphologies when acting on the dominant source in an ischemic patient was demonstrated. In the presence of persistent absence of extrasystole in the future, this will facilitate the selection of antiarrhythmic therapy and improve the long-term prognosis of the patient’s life.

The article presents clinical cases of acute myocarditis disguised as acute coronary syndrome; approaches to differential diagnosis and treatment tactics, using modern management algorithms

Recurrent gastrointestinal bleeding represents a serious problem in urgent surgery due to the difficult diagnostics of the source of bleeding and high mortality. The literature describes isolated cases of bleeding from neoplasms of the small intestine. Today in clinical practice there is not a single method that has 100% diagnostic value. A rare clinical case of preoperative diagnosis of the source of recurrent intestinal bleeding using contrast-enhanced computed tomography is reviewed. This clinical case highlights the difficulties and possibility of objective preoperative diagnosis of the source of bleeding in the jejunum, using a method that is not mandatory for this purpose, which can improve patient treatment outcomes

Introduction: Femoral neck fractures usually occur in older patients as a result of a decrease in the strength of bone tissue as the body naturally ages. In women, femoral neck fractures are detected twice as often as in men. For older people, a hip fracture is a serious injury because, due to age-related changes and existing chronic diseases, bone structures are characterized by a significantly lower ability to regenerate. Complications from prolonged immobilization and staying in bed after injury become life-threatening for an elderly patient. Nowadays, the most effective treatment for femoral neck fractures is endoprosthetics. Replacement of the hip joint with artificial implants ensures early getting out of bed, can significantly shorten the rehabilitation period and restore the supporting function of the lower limb.
Aim: to demonstrate the successful experience of treating a long-lived patient with fractures of the proximal femur, taking into account a differentiated approach to the choice of surgical tactics. 
Materials and methods: to write the article, data from the medical documentation of the trauma hospital, data from instrumental research and the results of dynamic observation were used. A search was also conducted in the open electronic scientific databases PubMed of the US National Electronic Medical Library and the databases of the Russian scientific electronic library elibrary using keywords and phrases: femur fracture, proximal part, surgical treatment.
Results: as a result of osteosynthesis of the Gamma-3 fracture of the right femur and endoprosthetics of the left hip joint, the patient achieved early activation and the ability to move independently.
Conclusions: The use of intramedullary osteosynthesis reduces the length of hospital treatment, improves the quality of life of patients and returns the opportunity to restore motor activity from the first days after surgery. The described clinical case reflects the importance of a differentiated approach to planning surgical treatment, taking into account the somatic status of patients

The biography of Professor Alexander Ilyich Kliorin, his contribution to the development of Russian pediatrics, science, education, scientific and social activities and military healthcare is presented.

In 2023, the 120th anniversary of the birth of the outstanding surgeon Professor Ivan Demyanovich Zhitnyuk was celebrated. He has passed a difficult life path from a worker in railway workshops to Major General m/s, head of the Department of Surgery for Advanced Training of Doctors No. 2 of the Military Medical Academy named after S.M. Kirov. A student of Professor S.P. Fedorov, he worthily, at all stages of his professional activity, represented the school of the great surgeon and scientist