Professor Alexander Alekseevich Bobrov (URL: http://bfnk. ru/personalities/bobrov-aleksandr-alekseevich)

The OBJECTIVE was to study the predisposing factors, pathogenic flora and clinical forms of lungs and pleura suppurative diseases in HIV-infected patients. MATERIAL AND METHODS. The article describes the etiology and clinical forms of lungs and pleura suppurative diseases in 237 HIV-infected patients. Features of damage to the lungs and pleura in these patients were determined. RESULTS. 46 % had empyema with bronchopleural fistula. At endoscopic examination, purulent and purulent-hemorrhagic tracheobronchitis were diagnosed in 27 %. CONCLUSION. Sputum culture or pleural exudate or the contents of a lung abscess cavity were used to determine the etiology of lungs and pleura suppuration in HIV infection. Klebsiella pneumoniae and Pseudomonas aeruginosa played an important role in the development of the disease.

The OBJECTIVE of the study was to evaluate the effectiveness of the use of «early» (up to 3 days) valve bronchial blocking in the complication of postoperative period in patients with bullous emphysema. MATERIAL AND METHODS. For the period from 2009 to 2017, 32 patients with bullous pulmonary emphysema had a long (more than 3 days) air leakage from the pleural cavity. Depending on the time of the valve bronchial blocker installation, the patients were divided into 2 groups: 1 group («late» blocking): the valve bronchial blocker was placed later than 3 days after the operation (11 patients); 2 group («early» blocking): the valve bronchial blocker was placed for 2–3 days from the operation (21 patients). RESULTS. During the first two days, air discharge through the pleural drainage was discontinued in 16 patients of the «early» blocking group and in 2 patients of the «late» blocking group (р=0.0022). The duration of air leakage in the «early» blocking group was 1.59 days less (44.91 %) than in patients of the «late» blocking group (р=0.0024). The positive blocking effect was fixed in 85.71 % (18) of the patients of the group with «early» blocking, which was 3.6 times higher than in the patients of the «late» blocking group (р= 0.04). The frequency of repeated intervention in the «early» blocking group was 3.81 times less than in the «late» blocking group (54.54 % vs. 14.28 %) (р=0.08). CONCLUSION. «Early» valve bronchoblocation (performed on the 2–3rd day of the postoperative period) had an indisputable advantage in comparison with bronchial blocking performed at the time of more than 3 days postoperative period, allowing reliably faster lung dilatation and eliminating air discharge through drainage from the pleural cavity, without resorting to repeated interventions, which was important, both for the surgeon and for the patient.

INTRODUCTION. Gastroduodenal bleedings often occurs among patients with cerebrovascular accident (CVA). The frequency, causes and treatment tactics for bleeding from the upper gastrointestinal tract (GIT) in this group of patients have not been sufficiently studied. There were no well established guidelines of treatment for this group of patients, that could be a reason for high mortality. The OBJECTIVE of the study was to improve the treatment outcome of gastroduodenal bleeding cases in patients with cerebrovascular accident (CVA) by using conservative and endoscopic methods that could be used to stop bleeding and developing tactics of treatment in this category of patients. MATERIAL AND METHODS. There were 105 patients with cerebrovascular accident (CVA) and signs of bleeding from the upper gastrointestinal tract in the study. Patients were admitted to the St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. Patients were divided into 2 groups, regarding the type of cerebrovascular accident (CVA): patients with ischemic stroke and patients with hemorrhagic stroke. All patients underwent esophagogastroduodenoscopy (EGD) during 2 hours from identifying the signs of bleeding. RESULTS. In this study, we analyzed medical files and records of patients with diagnosis of ischemic or hemorrhagic stroke, who were admitted to St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. During the observation of patients with diagnosis of ischemic or hemorrhagic stroke, 7483 patients and 1919 patients respectively were treated in the clinic. Among these patients, 58 patients were with diagnosis of acute stroke with ischemic type and 47 patients with acute hemorrhagic stroke in combination with bleeding from upper parts of a GIT. The frequency of the upper GI bleeding was 0.77 % (58 of 7483) in the group with ischemic type of stroke; in the group of patients with hemorrhagic stroke, gastroduodenal bleeding was diagnosed in 2.45 % (47 of 1919) cases. CONCLUSIONS. Endoscopic treatment of gastroduodenal bleeding in cases of ischemic and hemorrhagic stroke was the method of choice. The combined endoscopic hemostasis method was preferred. To achieve hemostasis in cases of superficial lesions of the mucous membrane of the upper gastrointestinal tract and acute ulcers of the gastroduodenal zone in combination with CVA, Argon plasma coagulation (APC) was effective. It was possible to combine APC with other methods of  endoscopic hemostasis that improved the results of treatment and reduced the risk of recurrent bleeding. If bleeding was from chronic ulcers of the stomach and / or duodenum, the method of clipping was effective in combination with APC and / or with injection method. When signs of recurrence of bleeding appeared, all patients with CVA should have undergone esophagogastroduodenoscopy (EGD) and hemostasis by endoscopic methods. All patients with CVA and gastroduodenal hemorrhages combination should have undergone anti-ulcer drug therapy.

The OBJECTIVE of the study was to improve the results of treatment of patients with fluid collections in acute pancreatitis with a minimally invasive method. MATERIAL AND METHODS. Results of percutaneous-puncture interventions under ultrasound in 62 patients with acute pancreatitis in the presence of fluid clusters were analyzed. In the first day from the moment of the disease, 39 % of patients admitted during the second and the third days – 31 % and more than three days – 20 % of patients. RESULTS. Diagnostic punctures of fluid collections under ultrasound control were performed. In 49 (79 %) of 62 patients, the puncture was effectively transformed into percutaneous drainage. In 13 of 49 patients were further operated. Lethal outcomes after puncture-draining interventions were in 5 cases. Among 44 patients operated with a minimally invasive method of acute pancreatitis, recovery was noted in 24, recurrence of fluid collections – in 7, 13 patients were operated on. CONCLUSION. Thus, early diagnosis and timely implementation of conservative and minimally invasive methods of treatment contributed to improving the immediate results of treatment of patients with fluid collections in acute pancreatitis.

The OBJECTIVE was to evaluate the effectiveness of the method developed in the clinic for the treatment of umbilical hernias with simultaneous lifting of the abdominal wall and the urogenital perineum in women. MATERIAL AND METHODS. The treatment of 40 patients suffering from umbilical hernias, abdominal ptosis and stress urinary incontinence was analyzed. The patients were divided into 2 groups of 20 people. In the first group, treatment was carried out by supaponeurotic endoprosthesis replacement of the umbilical ring of the abdominal wall, and in the second group – with simultaneous lifting of the abdominal wall and the urogenital perineum. RESULTS. Integral indicators of the quality of life of patients in the second group were 1.3 times higher than in patients in the first group by physical component, and 1.2 times – by psychological component. CONCLUSION. The original technique was effective and pathogenetically supported.

The OBJECTIVE was to study the patency of the internal iliac artery and its effect to gluteus muscles blood supply and frequency of buttock claudication occurrence in the remote period after open infrarenal aortic aneurysm repair. MATERIAL AND METHODS. Examination of 37 patients after open infrarenal aortic aneurysm repair included collection of complaints, anamnesis, making CT scan with contrast and pelvic perfusion tomography. These methods allowed to assess the patency of the prosthesis and iliac arteries, calculate average blood flow rate in buttock muscles and frequency of buttock claudication occurrence depending on the lesion of the internal iliac arteries. RESULTS. Five-year patency of the internal iliac artery was 93 %. In case of passable internal iliac artery, the average blood flow rate in the ipsilateral buttock muscles was authentically higher than the same indicator in groups with stenotic or occlusive lesion of the internal iliac artery and its branches. In case of the disturbed internal iliac artery patency, the frequency of occurrence of the buttock claudication in the same side reached 50 %. CONCLUSION. High five-year internal iliac artery patency after open infrarenal aortic aneurysm repair attested the necessity of preservation the main blood flow in these arteries during the open infrarenal aortic aneurysm repair for the purpose of buttock claudication prevention. The CT scan allowed to evaluate the internal iliac artery patency and the average blood flow rate in the buttock muscles through perfusion tomography method which was necessary for differential diagnosis of the buttock claudication syndrome.

The OBJECTIVE of the study was to assess the current trends in the surgery of acute upper limb ischemia (AULI). MATERIAL AND METHODS. We performed the comparative analysis of clinical data and treatment results of 261 patients with AULI urgently treated between 2008 and 2018 years (main group) and 162 patients with AULI treated between 1975 and 1985 years (control group). RESULTS. For the past 30 years, there were the growing rate of AULI. In 92.7 % of cases, the main cause of AULI was embolism. The main disease leading to embolism became atrial fibrillation in 80.8 % of cases. For the past decades, there was a significant improvement of treatment results in patients with AULI: complete extremity blood flow supply was achieved in 95 % in main group vs 90.5 % in control group (p<0.05); postoperative mortality rate significantly decreased to 3.5 vs 8.8 % respectively (p<0.05). CONCLUSION. AULI continued to remain the actuality in modern vascular surgery.

The OBJECTIVE was to compare the results of treatment of varicose veins of the lower extremities using minimally invasive methods in outpatient clinic. MATERIAL AND METHODS. The complex analysis of the treatment of 220 patients with varicose veins of the lower extremities was carried out. The approach to the choice of the volume of surgery was based on the data of ultrasound examination. The results of radiofrequency ablation and laser coagulation of subcutaneous veins were compared. RESULTS. CVI phenomena after EVLO were eliminated in 146 (95.4 %) patients, after RFA – in 62 (92.5 %). Differences in the frequency of obliteration were higher in the RFA group compared with EVLO (rxy=(0.772±0.02); p<0.01); differences in the ablation frequency were more significant after EVLO (rxy=(0.712±0.04); p<0.01), and differences in recanalization frequency were insignificant (rxy=(0.341±0.08); p<0.01). Thus, it was proven the equal efficacy of these methods in removing the vertical reflux in the surgical treatment FBVNC. In general, the efficiency estimated by recanalization frequency after EVLO and RFA was 92.7 %. CONCLUSION. Endovasal methods were highly effective and safe, could be successfully used for eliminating both vertical and horizontal pathological reflux in surgical treatment of FBVNC in outpatient clinic.

The OBJECTIVE was to determine the effect of anemia on the volume of blood loss during total hip arthroplasty in patients with end-stage renal disease. MATERIAL AND METHODS. The study was based on the data of 41 patients with pathology of hip joint who underwent primary hip replacement. In the group 1 – the group of comparison (n=20), there was no correction of anemia. In the group 2 – the main group (n=21), erythropoietin was applied 2 months before the operation, until the blood hemoglobin level exceeded 100 g/l, hematocrit – more than 30 %. RESULTS. In the first group of patients, there was the severe anemia: hemoglobin – (88.6±4.6) g/l, the number of red blood cells – (2.7±0.3·1012)/l, hematocrit – (27±2) %. In the second group, 2 months after using erythropoietin, hemoglobin level was (114.9±7.1) g/l, red blood cell count was (3.6±0.4·1012)/l, hematocrit was (33±2) %. Blood coagulation time before operation was (15.1±2.4) min in the first group, (8.7±1.8) min in the second group. Statistically significant difference was noted in blood loss: 59.2 %. In the first group, red blood cell mass transfusion was required in the volume of (554±205) ml for 18 patients (26 doses), plasma – in the volume of (641±67) ml for 20 patients (40 doses). In the second group, blood transfusion was performed for 3 patients in the volume of (321±116) ml. An inverse correlation between blood hematocrit, blood clotting time and blood loss was noted. The correlation coefficient was 0.9. CONCLUSION. The inverse correlation was indicated between the level of hematocrit, blood clotting time and blood loss. The use of erythropoietin in advance of reaching a blood hematocrit of >30 % could significantly reduce the risk of bleeding, reduce the amount of operating blood loss and reduce complications in the postoperative period.

The article describes the clinical experience of treatment of the victim using minimally invasive methods such as angiography and embolization. The applied treatment tactics made it possible to preserve the damaged parenchymal organ of the abdominal cavity and avoid performing other more traumatic surgical interventions (laparoscopy, laparotomy).

The article describes the observation of successful radical surgical treatment of a giant gastrointestinal stromal tumor of the cardiac stomach in the patient with concomitant pathology: type 2 diabetes mellitus, insulin-dependent, hypertensive disease of stage 3, severe anemia.

We present the clinical case of the patient with gastrointestinal stromal tumor of the duodenum (dGIST).The 34-year-old women had complaints of intermittent dull pain located in the upper abdomen. Clinical examination of the abdomen revealed a duodenum tumor. Resection of the anterior wall of the descending part of the duodenum with a tumor was performed. Histopathology reported that the removed neoplasm was represented by GIST of the duodenum. Immunohistochemistry reported that the tumor cells had an expression of DOG 1, Vim, CD117, CD 34.

The authors described the case of replantation of the right hand in the men of 28 years after a traumatic amputation. This injury was accompanied by damage to the main vessels, which could lead to acute blood loss, hemorrhagic shock and death. The complication after surgery in the form of suppuration of the wound and its effective treatment was shown. This clinical example demonstrated the possibility of limb replantation in traumatic amputations not only in specialized clinics, but also in General surgical hospitals. The basis of the success of the results of the operation was the phasing in the treatment, active monitoring of the replanted limb in order to early identifying possible complications in the postoperative period.

The objective was to present the case report of the patient with rare clinical finding – Saint`s triade. The examination diagnosed giant paraesophageal hernia (III type) with gastric torsion and cholelithiasis. The 72-years old woman was admitted to hospital with complaints of acute dysphagia. During the laparotomy operation, jejunal diverticulosis was also detected. The patient underwent crural repair, fundoplication, and cholecystectomy. The postoperative period was uneventful. She was discharged on the 14th day after surgery with recovery. The features of the presented case were the prevalence of the clinical picture of complicated hiatal hernia and the localization of diverticula in the jejunum. The clinical significance of the Saint`s triade was to assess the probability of this combination in identifying one of the components.

Currently, there are no clear indications for transfusion therapy in patients with liver cirrhosis. The article describes in detail the main clinical syndromes and pathophysiological mechanisms of chronic hepatitis, including the outcome of cirrhosis of the liver against the background of endotoxemia. The authors paid attention to the justification of the potential of transfusion therapy in this category of patients.