Background: Staged hybrid coronary revascularization (HCR) is an effective treatment method for patients with CAD. At the moment, the optimal procedure for performing the surgical and endovascular stages of intervention within the framework of HCR in patients with atherosclerotic lesions of the coronary artery (CA) has not been determined.
Purpose: To compare the immediate and longterm results of staged HCR in the scope of coronary artery bypass grafting (CABG) with previous CA stenting and PCI followed by CABG.
Methods: On a retrospective basis, the study included 97 patients with CAD who underwent staged HCR at the Pirogov Center (Moscow, Russia) from 2014 to 2020. In group I, 48 patients underwent CABG followed by PCI (CABG+PCI); in group II, 49 patients first underwent coronary artery stenting, then CABG (PCI+CABG). The average time interval between the 1st and 2nd stages of breastfeeding was 87.5±10.6 days, the total observation period was 36.9±5.8 months.
Results: The CABG+PCI cohort showed slightly better 3year outcomes compared to the PCI+CABG cohort in terms of relapse of myocardial ischemia (20.1% vs. 24.5%, p = NS) and TLR (18.5% vs. 22.3 %, p = NS). The number of registered cases of VGF in patients of groups I and II was similar — 23.1% versus 24.0% (p = NS). The incidence of MI, stroke, death from all causes did not differ significantly in both groups and was 3 (6.3%), 2 (4.2%) and 3 (6.1%), and 3 (6.1%), 3 (6.3%) and 2 (4.1%) cases in cohorts I and II, respectively (p = NS). The overall proportion of MACE after 36.9±5.8 months of followup was 16.7% versus 16.3% in patients with CABG+PCI and PCI+CABG (p = NS).
Conclusion: The approach to HCR with CABG performed as the first stage before PCI shows slightly greater effectiveness and provides similar safety compared to the “PCI before CABG” strategy

Objective: To identify risk factors for unfavorable outcome in newborns operated on for congenital pathology of the aortic arch. Materials and methods of research: Data from the results of treatment of 79 patients with congenital pathology of the aortic arch were analyzed and the effectiveness of the therapy was assessed. All patients underwent an examination with the study of obstetric and gynecological history, life history and illness, with an assessment of existing complaints after birth and their changes over time. The obtained clinical, echocardiographic and laboratory parameters were analyzed and compared. The following surgical methods were used for surgical correction of congenital pathology of the aortic arch: resectionof coarctation with plastic surgery of the aortic arch with native tissues, resection of aortic coarctation with the imposition of an extended end-to-end anastomosis, hybrid version. The results of the performed operations and complications were evaluated.
Results: Factors such as the development of small ejection syndrome before surgery, the emergency nature of the intervention, and reduced left ventricular ejection fraction (less than 35%), increased heart rate, had a significant association with an unfavorable outcome. Signs of moderate significance that were associated with an unfavorable outcome of surgical treatment were the following clinical and hemodynamic preoperative parameters: increased respiratory rate, reduction of diastolic pressure in the lower extremities and reduction LV EDC. Anthropometric data and reduction of systolic pressure in the lower extremities had a weak connection with mortality.
Conclusions: The most significant factors of unfavorable outcome before surgery in newborns with congenital pathology of the aortic arch, those operated with the use of artificial blood circulation are: increased heart rate, decreased LV EF. Low anthropometric indicators of the child (weight, height, body surface area) are also have an impact on the outcome. Index of the end-diastolic size of the left ventricle as a factor reflecting his anatomically determined ability to produce a systemic blood flow it is important when choosing an option for surgical.

Coronary heart disease (CHD) occupies a dominant place among the cardiovascular causes of death in the Russian Federation and around the world. In some patients with coronary heart disease, complete surgical revascularization is difficult due to diffuse damage to the coronary bed, small vessel diameter, pronounced calcification of the artery walls, distal stenotic-occlusive lesion, high risk of complications and severity of the clinical condition due to other concomitant diseases. The effectiveness of treatment of such patients still remains low. The effectiveness of treatment of such patients still remains low. In order to overcome this problem, Academician of the Russian Academy of Sciences Yu.L.Shevchenko developed and introduced into clinical practice the technique of surgical stimulation of extracardial myocardial vascularization «YurLeon». Currently, there are various modifications to improve the results of patient treatment.
Aim: to compare the results of coronary bypass surgery, supplemented by the YurLeon II and YurLeon III.
Materials and methods. The retrospective study included 180 patients with diffuse coronary artery disease (127 men (71%), 53 women (29%) aged 50 to 70 years, average age — 65.6±4.65 years) who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic of the Federal State Budgetary Institution «National Medical and Surgical Center named after N.I. Pirogov» Ministry of Health of the Russian Federation. Patients were divided into three groups: Group I (n = 60) — after coronary artery bypass grafting (CABG) (control group); group II (n = 60) — after CABG supplemented by the YurLeon II; Group III (n = 60) — after CABG, supplemented by the YurLeon III. The clinical condition of patients, echocardiography data, gated-SPECT and quality of life indicators (questionnaire SF-36) were evaluated.
Results. In the long-term postoperative period, in groups II and III, compared with group I, there was a statistically significant decrease in the functional class of angina pectoris (1 [1-2], 1 [1-2] versus 2[2-2], p<0.05); increased left ventricular ejection fraction (59[54-62]% (group II), 59[55-63]% (group III) compared to the control group — 50 [47-53]%, p<0.05). According to myocardial scintigraphy, there was a decrease in the «Summed Rest Score» (4[3-7] points (group II), 4[2-8] points (group III) versus 11[6-18] points (group I), p<0.05); a decrease in the «Summed Thickening Score» (8[5-11] points (group II), 7 [5-8] points (group III) compared to the control — 10 [8-14] points, p<0.05). The studied patients 12-36 months after surgery differed in terms of quality of life (SF-36): PF (74[66-80] points (group I), 86[80-92] points (group II), 84 [78-90] points (group III), p<0.05); RP (76 [70-82] points (group I), 90[85-95] points (group II), 92[88-96] points (group III), P<0.05); BP (80 [75-85] points (group I), 90[85-95] points (group II), 92[86-98] points (group III), P<0.05); PH (46[42-50] points (group I), 58[54-62] points (group II), 60 [56-64] points (group III), p<0.05).
Conclusion. Coronary bypass surgery, supplemented by surgical stimulation of extracardial vascularization, in the patients with coronary artery disease and diffuse coronary artery disease improves the clinical condition of patients, their quality of life, increases the left ventricular ejection fraction, its perfusion and allows for additional blood supply to the myocardium in the long-term postoperative period.

Objectives: comparison of the results of surgical intervention with and without aortic arch dilation in patients with acute type I aortic dissection. Patients and methods: The study included 157 patients (from 2011 to 2021) with acute type I aortic dissection. The average age of patients in the general group was 51 [49.8–65.0] years, the most part of patients were men n = 127 (81%). The patients were divided into 2 groups: group 1 included 104 (66.2%) patients who underwent surgery only on the ascending section (supracoronary prosthetics of the ascending aorta and Bentall DeBono surgery); in the group 2, n = 53 (33.8%) patients with prosthetics of the ascending aorta in combination with interventions on the aortic arch, of which n = 14 (8.9%) patients with complete prosthetics of the aortic arch according to the “elephant trunk” type. After pseudorandomization (PSM), 70 patients with acute aortic dissection of type I aorta were included in the analysis. 35 (50%) patients underwent surgery on the ascending aorta (group Asc. A) 35 (50%) patients underwent extended surgery (group Asc. A+arch), including 26 (37.1%) — on the ascending aorta and hemiarch, 9 (12.9%) — on the ascending aorta and total arch.
Results: Statistically significant differences were revealed in group II (Asc. A+arch) with a longer time of surgery, time of the CPB, cross clamp time of the aorta and less hypothermia, also in this group, perfusion through the right subclavian artery was statistically significantly more often performed and less often perfusion of the left common femoral artery. In the postoperative period, complications were assessed in patients in both groups: cardiac arrhythmias, acute respiratory and heart failure, acute kidney injury, bleeding, multiple organ failure syndrome and 30day mortality. There were no statistically significant differences between the groups. There were no statistically significant differences between the groups. In comparing groups of patients with intervention only on the ascending aorta and with the extension of the intervention to the arch, no statistically significant difference in mortality was revealed (17.1% vs. 5.7%. p = 0.1572). The hospital mortality after PSM was 11.4%.
Conclusion: This study showed possibility of expansion scope of surgery with prosthetics of the aortic arch without increasing the risk of death

Rationale: The possibility of surgical intervention in patients with claudication determines the direction of treatment. At the same time, some patients are not characterized by a benign course of peripheral arterial disease. This work is based on clarifying the results of reconstructive treatment of patients with PAD at the stage of critical ischemia and in the case of stage IIb according to Pokrovsky — Fontaine.
Objective: analyze early postoperative complications and find an answer to the question: “Is stage IIb reconstruction justified in patients with PAD?” Method: The study involved 237 patients who underwent reconstructive interventions for peripheral arterial disease. Of these, 136 patients were operated on at the CLI stage (critical limb ischemia — critical ischemia), and 101 patients received surgical assistance at the stage of claudication. The results of surgical interventions were prospectively assessed during the first 30 days after surgery and retrospectively analyzed. The primary end point was the development of complications (segment thrombosis, bleeding, surgical site infection).
Results: Patients treated surgically for stage CLI were more likely to experience early postoperative complications (thrombosis, infection, bleeding, and amputation). This is probably due to the more significant degree of arterial damage (multilevel damage) and the choice of surgical interventions.
Conclusion: The group of patients operated on at the stage of critical ischemia had a greater number of complications, therefore, in the case of an unfavorable development with a pronounced reduction in walking distance, the focus of tactical approaches should be changed towards active tactics, without waiting for the development of critical ischemia.

Objective. To improve the results of surgical treatment of patients with urogenital-colonic, small-colonic and large-intestinal-vaginal fistulas of diverticular origin by improving the diagnostic program and surgical tactics. Materials and methods. A study was conducted with the participation of 82 patients treated at the State Clinical Hospital in Vladimir from 2012-2022 with DPC complicated by the formation of fistulas. There were 38 (46.3%) patients with internal intestinal fistulas, of which 22 (57.9%) were men and 16 (42.1%) were women. The mandatory diagnostic program included: general clinical studies, ultrasound of the abdominal cavity, pelvis, in women transvaginal ultrasound, CT of the abdominal cavity with intravenous contrast enhancement and MRI of the pelvis, cystoscopy, FCS, irrigography, including simultaneous fistulography through an external fistula opening.
Results. The clinical picture of a colovesical fistula was found in 19 (50%) cases, sigmo-vaginal in 14 (36.8%), and ileo-sigmoid in 5 (13.2%) cases. Abdominal ultrasound was performed in all patients (n-82), transvaginal ultrasound in 23 (28%), and ultrasound in 38 (46.3). Irrigoscopy was performed in 68 (82.9%) patients. Cystoscopy was performed in 19 (23.2%) cases. FCS was performed in 68 (82.9%) patients. MSCT in 77 (93.9%) cases. Dissection of the fistula, resection of the sigmoid colon according to Hartmann with the removal of a single-stem colostomy with planar resection and suturing of the bladder wall was performed in 6 (7.3%) patients. LGE was performed in 28 (34.1%) patients. Sigmoid colon resection with primary colonic anastomosis and the imposition of an interventional colostomy was performed in 9 (11%) patients. In 23 (28%) cases, sigmoid colon resection was performed with primary anastomosis without removal of the interventional stoma, in 10 (12.2%) patients with external intestinal fistulas, and 13 (15.9%) with sigmovesical fistula. In 5 (6.1%) cases, resection of the sigmoid colon was performed with resection of the small intestine bearing the fistula, with the imposition of small and large intestinal anastomoses. Complications occurred in 6 (7.3%) cases (Table 5).
Conclusion: The treatment of diverticular colon disease complicated by the formation of fistulas is one of the most urgent and time-consuming tasks. The incidence of this complication is 15.7%. The most severe category of patients are patients with external colon fistulas, since their occurrence was facilitated by previous surgical interventions for complications of DBTC. The only radical method of treatment for this category of patients is only surgical intervention. Given the need to involve related specialists in the treatment of internal DBTC fistulas, the strategy for the diagnosis and treatment of this difficult category of patients should be multidisciplinary. And the method of performing surgical intervention in this case should be strictly personalized.

Rationale: The search for new ways to stop bleeding in severe liver injuries is an urgent task of modern surgery, due to the technical complexity of known hemostasis methods, the high frequency of postoperative complications and the need for relaparotomies.
Objective: To improve the results of treatment of patients with severe traumatic liver injuries.
Methods: A randomized controlled clinical trial was conducted, including 70 patients with severe traumatic liver injuries. In the main group (n = 35), the original “Method of hemostasis in severe traumatic liver injuries” was used (patent Russian Federation 2792914). The control group (n = 35) uses traditional surgical techniques of hemostasis.
Results: The groups were comparable in terms of the main demographic indicators, the degree of liver damage, and the combination of injuries. In the main group, complications were biliary — 31.4%, inflammatory, requiring relaparotomy — 5.7%, liver failure — 11.4%, there were no recurrence of bleeding, relaparotomy — 2 was performed. In the control group, complications were biliary — 40.0%, inflammatory, requiring relaparotomy — 28.6%, liver failure — 31.4%, recurrent bleeding — 8.6%, relaparotomy — 19.
Conclusion: The original method of hemostasis allows to improve the results of treatment of patients with severe liver injuries, by reducing the frequency of postoperative complications and the need for relaparotomies. The effectiveness of the technique is based on the absence of direct contact of gauze tampons with the liver, which prevents them from sticking to the wound surface, impregnation with biological fluids and, accordingly, secondary infection

Introduction. Over the past decades, due to the constant conduct of local wars and armed conflicts, gunshot fragmentation and mine explosion wounds have become dominant in injury surgery. Modern combat gunshot injury is characterized by combined and multiple injuries of various anatomical areas, a high frequency of purulentseptic complications, persistent disability and high mortality. Despite the improvement of modern means of armor protection, there is no tendency to decrease the category of penetrating pelvic wounds with damage to the rectum, which can be attributed to extremely severe both in the course of the pathological process and difficult to diagnose, which requires further study of this pathology.
Objective: to study the frequency and localization of rectal wounds, features of diagnosis and treatment at the stage of providing qualified surgical care, options and sequence of surgical interventions, early complications.
Materials and methods: a prospective analysis of the provision of surgical care for rectal wounds to patients admitted to advanced medical organizations and to the surgical hospital of FGKU “1602 EKG” of the Ministry of Defense of the Russian Federation from the area of a Special military operation was carried out. At the same time, medical documentation was studied, including primary medical records, protocols of performed surgical interventions of previous stages of medical care. The analyzed group of wounded belongs to the same age group, with the same conditions of military service, life and nutrition, which increases the representativeness of the results obtained.
Results: The rectal injury Scale (AAST) was used in the work. The degree of injury was determined either based on the data from the protocols of surgical interventions of previous stages of medical care, or intraoperatively when performing programmatic relaparotomies. The vast majority of the wounded (86.4%) were admitted to the stage of providing qualified medical care in the first day from the moment of injury. The proportion of shrapnel wounds (88.2%) prevailed over bullet wounds (11.8%). In the absolute majority of cases, the localization of the inlet was located in the gluteal region (61.7%). The multiple nature of the injuries, combined with injuries to other organs and systems, was recorded in 87.6% with intraperitoneal injuries, in 85.5% with extraperitoneal localization. At the same time, damage to the small intestine (23.1%) and pelvic bones (19.0%) was most often noted in combination with injury to the intraperitoneal rectum, colon (15.2%), with extraperitoneal localization, respectively, the bladder (54.1%), pelvic bones (27.3%). The tactics of simultaneous surgical treatment were used everywhere in 48.3%, and multi–stage surgical treatment in 51.7%. In the surgical treatment of rectal wounds of both localizations, in 92.0% of cases, the formation of an unloading stoma was performed. In 8.0% of cases, the discharge stoma did not form, the operation ended with suturing of the rectal wound. In 0.8% of cases, the failure of the distal stump of the rectum was noted, in 3.4% — the development of intrathase phlegmon. There have been cases of late diagnosis of isolated rectal wounds of extraperitoneal localization, due to poor clinical data, short periods of stay at the stages of medical evacuation. In 1.7% of cases, the onset of death was noted against the background of progression of intrathase phlegmon, sepsis, and multiple organ failure.
Conclusion: rectal wounds, especially those of extraperitoneal localization, occupy not a leading, but an important place in the structure of combat surgical trauma. Timely detection of damage to the rectum, determination of optimal surgical tactics, allows you to avoid or reduce the risk of purulent septic complications. The main tactical tasks for rectal wounds should be considered: stopping passage through the rectum, washing the distal colon, draining the cellular spaces of the pelvis in case of extraperitoneal injuries

Rationale: Coccygeal sinus in mass population survey is observed in 0.5-1% of people under 30–35 years of age. Currently a large number of surgery modifications are proposed, but the results of treatment do not satisfy surgeons and coloproctologists; 6–30% of operated patients have early postoperative complications, from 5 to 24% — recurrences of the disease; 6–17% — hypertrophic scars. Therefore, the search for solutions aimed at their prevention is relevant and timely.
Purpose: Improving the surgical treatment results of patients with coccygeal sinus without clinical manifestations and in remission by developing a method of surgery, optimizing the treatment of patients in the preoperative and postoperative periods.
Materials and methods: The blood supply and innervation of the sacrococcygeo-gluteal region were studied in 15 troupes. The data of examination and treatment of 156 patients with the pathology studied in this work are presented. The observed patients were divided into two groups of equal age, gender composition, and pathology. The comparison group (control group) consisted of 78 patients who underwent traditional excision of the coccygeal sinus and wound suturing with Donati vertical mattress sutures. When choosing a treatment method for 78 patients of the main group, the topographic-anatomical relationship of the coccygeal-sacral-gluteal region structures, the peculiarities of its blood supply, and the predisposition to pathological scar formation were taken into account. Preoperative preparation of patients has been improved. Modifications of operations and therapeutic measures have been developed aimed at improving blood supply to the wound area and preventing pathological scarring.
Results: In the early postoperative period, 17 (21.8%) complications were detected in patients of the control group, and 4 (5.1%) complications in the main group. The long-term results of treatment were traced in the period from 6 months to14 years. Recurrence of the disease occurred in 11 (14,1%) patients in the control group, in the main group — in 2 (2,5%) operated patients. In 18 (81,8%) out of 22 (28,2%) patients with a tendency to pathologic scar formation it was possible to prevent its development by carrying out anti-scarring therapy.
Conclusions: In the treatment of patients with coccygeal sinus without clinical manifestations and in remission, a thorough preoperative preparation aimed at the destruction of microbial flora in the area of the proposed surgical intervention is necessary. The methods of surgery are proposed, taking into account the topographic-anatomical structure of the coccygeal-sacroiliac-gluteal region. Formation of the intergluteal fold along the entire length after suturing the wound provides better care for it. The use of intradermal suture does not disrupt the blood supply in the area of the wound edges, prevents the wicking properties of the suture material. The use of physiotherapeutic and medications in the postoperative period improves blood supply in the wound, increasing the regenerative processes of tissues. The proposed predictors of pathologic scar formation allowed to determine the group of patients with predisposition to its development and to carry out timely therapy for them, obtaining a good functional and cosmetic effect.

Rationale: Cole osteotomy is performed in patients having a cavus deformity with the apex of the deformity in a plantigrade foot. We invented a new approach in cavus foot surgery: removing the navicular bone and wedgeshaped osteotomy of the cuboid bone. We retrospectively reviewed and compared the clinical and radiographic results of 16 feet (16 patients) that underwent Cole midfoot osteotomy, and 11 feet (11 patients) that underwent removing of the navicular bone ande midfoot. Correction of the deformity at this midfoot level improves foot and ankle stability by creatin wedgeshaped osteotomy of the cuboid bone (2020–2023). Objective: to compare clinical results of two methods of surgical treatment of the cavus foot: removal of the navicular bone with osteotomy of the cuboid bone and osteotomy of Cole.
Methods: The patients had two etiologies (idiopathic pes cavus and CharcotMarieTooth disease). In the first group dorsal and slightly laterally based transverse wedge osteotomy through the navicular bone medially and the cuboid bone laterally was performed, in the second group — removal of the navicular bone and wedgeshaped osteotomy of the cuboid bone. Patients were under routine clinical followup. We evaluated clinical and radiographic results.
Results: Mean clinical followup was 15.7 months (range, 6–36 months). The mean preoperative and postoperative talo–first metatarsal angles on lateral radiographs were 29,9 and 8,7, respectively (р<0,05) after the Cole osteotomy and 27,2 and 5,4, respectively (P , .05) after the navicular bone removal. The mean postoperative calcaneal pitch angle changes were 10,8 on the lateral radiograph (р<0,05) after the Cole osteotomy and 15,6 after the navicular bone removal (р<0,05). At final followup, all patients were independently active, had plantigrade feet,and were able to wear conventional shoes. The mean American Orthopaedic Foot and Ankle Society questionnaire score was 38.8 preoperatively and 79.5 postoperatively (р<0,05) in the first group and 37,4 preoperatively and 83,5 postoperatively р<0,05) in the second group. One patient after the Cole osteotomy did not have full bony union.
Conclusions: removing the navicular bone and wedgeshaped osteotomy of the cuboid bone is a safe procedure to correct adult pes cavus deformity with the apex in midfoot, and has similar results as Cole osteotomy.

Background: understanding the patterns of development of post-radiation pseudoprogression is an actual task in the treatment of patients with vestibular schwannomas, since it allows not only to justify the selection of patients for radiosurgical treatment, but also to optimize their subsequent follow-up in order to assess the immediate and long-term results of treatment.
Aims: to study for post-radiation dynamics of changes in the volume of vestibular schwannomas depending on the observation time after stereotactic radiosurgery.
Material and methods: the study included 541 patients: the ratio of men to women was 1:3, the median follow-up was 55 months. The average age was 48.2 years (18–80). The mean initial volume of vestibular schwannomas was 4.1 cm3 (0.1–14.5). The dynamics of changes were assessed by volumetric comparison on a workstation equipped with Leksell Gamma Plan 10.1 software. An analysis of the dynamics of changes in the volume of schwannomas after radiosurgery was carried out on the basis of the initial tumor volume, the maximum magnitude of the change in volume and the time it was achieved, and the tumor volume at the time of the last observation. Analysis of changes in the volume of schwannomas was carried out at intervals of 12 months after radiosurgery.
Results: In 59.7%, vestibular schwannomas progressively decreased after radiosurgery, and post-radiation pseudoprogression occurred in 40.3% of cases. Typical pseudoprogression is characterized by development after irradiation and has either a short course with an early (11.7 months) peak increase in tumor volume and complete reverse development after 24–36 months, or a protracted course with a late (38.1 months) peak (p<0. 0001) and complete reverse development after 60–72 months. Atypical development of pseudoprogression after progressive tumor reduction requires a differential diagnosis with tumor recurrence, which requires a control MRI after 12 months to assess the dynamics of further changes in tumor volume. Re-enlargement of a vestibular schwannoma after previous pseudoprogression most likely corresponds to tumor recurrence.
Conclusion: post-radiation pseudoprogression of vestibular schwannomas is a frequent phenomenon with a different course — short and protracted. Monitoring of patients with prolonged pseudoprogression requires MRI for at least 6 years after radiosurgery to reliably assess the treatment outcome. Atypical development of pseudoprogression after progressive reduction requires differential diagnosis with tumor recurrence.

Aim. Improving the results of treatment of patients with chronic cologenic stasis by applying a differentiated approach to treatment.
Materials and methods. The study analyzed the results of complex treatment of 194 patients with various stages of chronic cologenic stasis (CCS). Patients with CCS were divided into 3 groups depending on the stage of the disease. The CCS group included 21 (10.8%) patients in the compensated stage, 119 (61.4%) patients in the subcompensation stage, and 54 (27.8%) patients in the decompensated stage of CCS. In 19 cases (9.8%), CCS was accompanied by various pathologies that led to its development and were combined with insufficiency of the bauhinium valve.
Results. The study found that complex conservative treatment was effective in 25 cases (12.9%): in 21 cases (100%) with a compensated stage and in 4 cases (3.4%) with a subcompensated stage of constipation that arose against the background of dolichosigma. At the same time, 169 patients (87.1%) with CCS in the sub and decompensation stage had pronounced anatomical, physiological and morphological changes in the colon; conservative treatment for at least 6 months was ineffective. In these cases, taking into account the duration of constipation and other factors, surgical interventions of varying scope and nature were performed.
In the longterm period after conservative treatment, good results were achieved in 11 cases (73.3%), satisfactory results were observed in 4 cases (26.7%), and there were no unsatisfactory results. In turn, after surgical intervention, good results were recorded in 92 cases (76.0%), satisfactory — in 18 cases (14.9%), however, in 11 cases (9.1%) unsatisfactory results were observed, among which developed recurrence of colostasis.
Conclusion. Thus, the choice of treatment method in patients with chronic coronary syndrome, whether a conservative or surgical approach, is determined strictly individually. It depends on the cause of the disease, its stage and duration of constipation, the severity of anatomical, physiological and morphological changes in the colon, as well as the presence of complications caused by constipation.

Goal. To study changes in cellular immunity indicators in patients with penetrating gunshot wounds of the pelvis in the immediate postoperative period.
Materials and methods. The study included 40 female patients from the civilian population who were treated for penetrating gunshot wounds of the pelvis received as a result of local hostilities. All patients were female, the average age was 36±4 years. Two clinical groups were formed. In the first (A), the wounded were selected in the number of 20 (50%) people, whose time interval did not exceed 60 minutes, in the second (B) — 20 (50%) wounded, whose time interval exceeded 60 minutes. To achieve this goal, a study of laboratory parameters characterizing cellular immunity was conducted: the total number of leukocytes in peripheral blood, lymphocytes (%), determining changes in subpopulations of both Tlymphocytes and Blymphocytes. The number of mature T lymphocytes (CD3+); T helper cells (CD4+); cytotoxic T cells (CD8+); natural killers (CD16+); B cells (CD20+) was calculated.
Results. As a result of the study, it was found that changes in the cellular link of the immune system in gunshot wounds of the pelvis depend on the time elapsed from the moment of injury to the beginning of surgical intervention. At the same time, if surgical intervention was performed up to one hour from the moment of injury, changes in the subjects occurred later and recovered earlier compared to the group of wounded who underwent surgical intervention later than one hour from the moment of injury.

Rationale: Wounds that do not progress through normal phases and remain in an unregulated inflammatory state are reclassified from acute to chronic. One of the serious consequences of complicated wound healing is the development of gross pathological scars, which sharply impair the quality of patients life, reduce mobility, and worsen treatment results. Such patients require longterm observation and antiscar therapy for the entire period of healing and scar formation.
Goal: Improving the results of treatment of extensive granulating wounds in patients through the use of a set of intraoperative and postoperative measures to stimulate healing and prevent wound healing disorders, followed by dynamic monitoring using computer, including remote technologies.
Materials and methods: Subject of the study: 98 patients aged 30 to 65 years of both sexes. The study group included 50 patients who underwent necrectomy with autodermoplasty and complex intra and postoperative stimulation of healing. The second group (control) consisted of 48 patients who underwent traditional surgical intervention to a standard extent. The effectiveness analysis was carried out using anauthor’s PC program. Outpatient observation with remote monitoring enabled in the «Scar Diary» application.
Results: In the study group, intensive dynamics of subsidence of signs of inflammation was noted, the median of which was 4 days, while in the control group the median was 7 days. The median reduction of the inflammatory process was 5.0 and 10, and epithelization in the groups was 7.0 and 10.0 days, respectively.
Conclusion: Carrying out intraoperative complex treatment of wounds and postoperative use of cold plasma flow can reduce the incidence of complications, reduce wound healing time, shorten the length of hospital treatment and the recovery period. The use of remote and modern computer technologies is certainly effective and convenient for assessing the dynamics of healing and improving the quality of patient management in the postoperative and recovery period

Coronary heart disease is currently one of the main causes of mortality, temporary and permanent disability of the population in the developed countries of the world. The problem of treating such patients is currently aggravated by an increase in cases of detection of diffuse lesions of the coronary bed, when the usual tactics of complete direct revascularization becomes impossible. In this regard, the attention of cardiac surgeons is directed to the development of new treatment methods. In such conditions, the issue of preoperative diagnosis of the viable myocardium becomes especially relevant, which can significantly affect the choice of surgery tactics aimed at the complete restoration of myocardial perfusion of the left ventricle

Coronary heart disease plays a leading role in mortality from circulatory system diseases. In most cases, atherosclerotic process is underlying stenotic lesions of the coronary arteries. Current methods of CHD treatment, in particular, optimal medical therapy and surgical procedures (coronary bypass surgery and percutaneous coronary interventions), in some cases, are not able to ensure complete myocardial revascularisation. In this respect, a number of investigators are searching for new methods to solve this problem. One of the directions of the search is inducing of noncoronary collateral circulation development. This review discusses modern concepts of myocardial collateral blood supply, physiological aspects of the process of vascular network regeneration, contains data on intra and extracardiac sources of blood flow, existing approaches to functional evaluation of certain collaterals, principles of stimulation of indirect myocardial revascularisation (based on the example of YurLeon technique).

Over the years, surgical treatment techniques for patients with coronary heart disease (CHD) have undergone changes. This literature review examines the relevance of surgical treatments, the history of the development of methods for stimulating extracardiac blood supply, and the cell technologies used in patients with coronary artery disease. Particular attention is paid to the development of a surgical and biotechnological technique called «YurLeon», developed by academician Y.L. Shevchenko. Early intervention methods have become relevant due to the rapid development of cellular technologies, allowing for significant improvement and expansion of methods for stimulating vasculogenesis

Treatment of patients with atherosclerosis of the lower limbs with an outcome in critical ischemia despite the achievements of modern medicine is a complex process. Critical limb ischemia (CLI) is often accompanied by multi-level artery lesions, which necessitates complex multi-storey arterial reconstructions to rescue limbs. The results of open and endovascular operations are not always optimal. Hybrid Interventions allow you to instantly restore blood flow in several segments, increasing the chances of limb recovery and reducing surgical risks in somatic heavy patients. This overview article presents a comparative analysis of hybrid interventions in patients with critical lower limb ischemia with an emphasis on multi-level artery lesions

Classical Hodgkin lymphoma is considered a potentially curable cancer, however, relapsed and refractory disease is observed in approximately 10–30% of patients after the first-line treatment. The choice of further therapy approach is complex because efficacy of traditional second-line chemotherapy regimens is limited. Immune checkpoint inhibitors (PD-1-inhibitors) are a highly effective option in relapses and refractory classical Hodgkin lymphoma at present. This article presents a comprehensive review of studies demonstrating feasibility and safety of PD-1-inhibitors as a bridge for autologous stem cell transplantation, enabling to achieve a durable response to treatment

In recent years, much attention has been paid to the treatment of wounds of various etiologies. In the modern world, we are faced with an increasing number of gunshot wounds (up to 68% in the structure of modern combat surgical injuries), with the largest percentage (53%) being limb injuries. Against the background of massive tissue destruction and large blood loss, high risk of general and local infectious complications, primary surgical treatment becomes the key point of treatment. Compliance with the correctness of all its stages (dissection of the wound, removal of foreign bodies, excision of nonviable tissues, wound drainage, wound closure) allows you to prevent the development of complications and create favorable conditions for wound healing. But often in our work, after cleansing the wound, we are faced with the problem of the duration of wound healing and lengthening of all phases of the wound process. One of the available and effective methods that stimulate the reparative process, in our opinion, is laser therapy. In this review article, we reviewed the literature on the mechanisms of biological action and the use of laser technologies in the treatment of wounds of various etiologies, including gunshot wounds

The article discusses the issues of reducing the physical activity of students. Statistical studies by domestic and foreign authors on the causes of physical inactivity among students in higher educational institutions, the risks of diseases as a result of a sedentary lifestyle and ways to overcome it are analyzed

A case of ICA aneurysm is presented, all possible pathogenesis mechanisms that led to the formation of an aneurysm are analyzed. In the analysis of the clinical case, mathematical modeling confirmed the assumption of the relationship between biomechanical conditions in the aneurysm area, regardless of etiology

The rationale for the study. The study of long-term results, errors, dangers and complications of endovascular embolization in gastroduodenal bleeding.
The purpose of the study. The probability of migration of the embolizing coil from the target vessel after stopping gastroduodenal bleeding.
Methods. The patient is 76 years old, with a clinic of gastrointestinal bleeding caused by the migration of an embolizing coil installed 5 years ago into the gastroduodenal artery with active ulcerative bleeding. Verification of the diagnosis using EGDS, MSCT, and selective angiography.
Results. The treatment used endoscopic extraction of the migrated coil in combination with conservative treatment of peptic ulcer disease. The result is recovery.
Conclusion. There is a possibility of migration of embolizing coils. This complication is rare. Currently, it is necessary to develop recommendations to eliminate this complication. In this regard, the expediency of such clinical observations is obvious. Surgical tactics in each case should be individual

There is an increase in the number of victims with damage of the main arteries due to the escalation of armed conflicts.
The frequency of vascular injuries varies from 2–3% in peacetime and increases in war up to 6–17%.
The outcome of all cases of vascular injuries in 48.9% to 68.7% is the formation of traumatic arteriovenous fistulas (AVF) and false aneurysms.
This article describes clinical cases of successful treatment of traumatic (gunshot) arteriovenous fistulas of the extremities using endovascular technologies and hybrid techniques

The study of intraoperative energy consumption is an important indicator of assessing the formation of critical incidents of patients, «the adequacy of patient protection from operational stress». For their prevention, intensive therapy is prescribed, aimed at restoring metabolic losses that have developed under the influence of operational stress.
To investigate this problem, a pilot study was conducted on the basis of the University Clinical Hospital №1 named after S.R. Peacemakers (Saratov, Russia) in order to determine the possibility of dynamic assessment of energy consumption during traumatic surgical interventions. Energy consumption was studied in three surgical oncological patients who underwent abdominalthoracic interventions under combined anesthesia. According to the monitoring data of the anesthesia device CARETATION 650, based on the data of O2, CO2, MVeexp, barometric pressure, O2 consumption and CO2 elimination were determined, energy consumption was calculated. The above parameters and indicator were recorded at 6 stages of surgical intervention (combined anesthesia, the beginning of the operation, the traumatic stage (abdominal, thoracic), the end of the operation, the end of anesthesia). Critical incidents were noted during anesthesia and surgery. In this work, semantic analysis methods were used to summarize the data of scientific publications published in the scientometric databases Pubmed (PubMed Central® (PMC) is a free fulltext archive), Web of Science, Scopus, RSCI.
According to the results of the research, it was noted the need to determine ASA based on background, concomitant diseases, the general condition of the patient, the estimated complexity of anesthesia and the traumatic nature of surgery, for continuous perioperative monitoring it is necessary to analyze the parameters of O2 consumption and CO2 elimination, energy consumption indicators.
It was revealed that, depending on the critical incidents that have arisen, the indicators of gas exchange and energy exchange differ in each of the presented clinical cases

Methods. A clinical case of surgical treatment of patient P., 39 years old, with a history of surgery in October 2021 for Mirizzi syndrome type 4 is presented. A cholecystectomy was performed with an «end-to-end» anastomosis of the common bile duct on a T-shaped drainage. The postoperative period proceeded without early complications, however, the patient noted the preservation of jaundice of the skin, periodic darkening of urine. A month after the operation, according to magnetic resonance cholangiopancreatography data, an extended stricture from the upper third of the common hepatic duct was revealed. Upon admission to the Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine in February 2022, the patient was fully examined, among the features — the level of total bilirubin was 206.2 mmol/l. The first stage was antegrade biliary decompression by percutaneous transhepatic external drainage of the biliary tract. Subsequently, taking into account the data of multispiral computed tomography-fistulography and multispiral computed tomography of the abdomen, a topographic and anatomical model was built in real time using augmented reality technology. Reconstructive surgery was planned and performed. Among the features, it should be noted a significant reduction in the time for determining and differentiating anatomical vascular and biliary structures in the liver gates against the background of a pronounced adhesive process when using AR. The reconstructive stage ended with the formation of a hepatic-eunoanastomosis on the loop of the small intestine in comparison with an inter-intestinal anastomosis.

Rationale. Os acromiale is a variant of nonunion of the apophysis of the acromial process, occurring in 6–8% of cases in the adult population. Symptomatic os acromiale may be accompanied by pain and decreased muscle strength during active sports.
Target. The main goal is to develop an effective method for of treatment of symptomatic os acromiale in athletes.
Materials and methods. A technique for surgical treatment of unstable os acromiale in athletes has been proposed, including mobilization of a free bone fragment of the acromion, formation of bone tunnels using a double-barreled guide for parallel drilling of bone canals and osteosynthesis using two cannulated screws.
Conclusion. Thus, our proposed technique allows us to achieve reliable fixation of an unstable fragment of the acromial process without the use of additional grafts with simultaneous correction of the shape of the acromial process of the scapula to prevent the subsequent development of impingement syndrome and disruption of the congruence of the acromioclavicular joint.

Mine blast injuries of the upper limb are difficult to classify, which makes every reconstructive surgery after such injuries unpredictable. A clinical observation of a 24-year-old patient who was wounded in the left forearm by a shell fragment is presented. After a complete diagnosis, surgical intervention was performed in the volume — transposition of m. brachioradialis to the common extensors of the fingers, tendon plasty of the radial extensors of the hand. Neurolysis of the median nerve. Due to the lack of standard algorithms for the treatment of such injuries, even careful preoperative planning cannot guarantee a favorable outcome. We are deeply convinced that such reconstructive interventions need a multidisciplinary strategy, and also need high technological support of the operation theater.

A brief biography of Immanuel Kant is given, and the influence of the scientist’s philosophical works on the development of medical theory and education is shown

This review article provides information about the life path, discoveries and influence on the world medicine of the famous Russian researcher and physician Professor Alexander Alexandrovich Maximow. The article is dedicated to the 150th anniversary of the great scientist.

Sergey Sergeyevich Yudin, at the height of the Great Patriotic War in 1943, in his work “How to reduce postoperative mortality among those wounded in the stomach in the war?”, described in detail the method of forming a suspended enterostomy proposed by him to eliminate persistent paresis of the small intestine. This operation was performed in more than 12% of the wounded in the abdomen and received wide support from military field surgeons. Until the mid-60s, it remained the main method in the arsenal of surgeons for resolving persistent paresis of the small intestine in peritonitis and intestinal obstruction