INTRODUCTION. At present, the advantages of surgical treatment over conservative methods in patients with hemodynamically significant stenosis of the carotid arteries are actively discussed. Nowadays, the main discussion issues are the time from the beginning of the stroke to the operation and the criteria for selecting patients for surgical intervention. In recent years, neurophysiological methods for studying spontaneous and evoked brain activity, which are able to identify functional disorders that have important prognostic significance, have become the most relevant.

OBJECTIVE. To study the dynamics of spectral-coherent parameters of EEG and somatosensory evoked potentials in patients with ischemic atherothrombotic stroke of different severity, who were performed carotid endarterectomy on the heart attack side in an acute period.

METHODS AND MATERIALS. We examined 105 patients with ischemic stroke who underwent carotid endarterectomy in the acute period, analyzed the dynamics of spectral, coherent characteristics of EEG and amplitude-latency parameters of somatosensory evoked potentials in the postoperative period.

RESULTS. The dynamics of power spectra, intra-hemispheric EEG, latency and amplitude of somatosensory evoked potentials and clinical parameters were compared.

CONCLUSION. It is shown that significant suppression of alpha activity power on the side of both hemispheres, decrease of intra-hemispheric coherence and amplitude of N20-P23 on the side of clinically intact hemisphere in the period up to 3 weeks after surgery determines a longer recovery of neurological deficit in the postoperative period. 

OBJECTIVE was to evaluate the immediate results of treatment of patients with mediastinal tumors.

METHODS AND MATERIALS. We treated 240 patients (123 man, 117 woman) with mediastinal tumors. Age range were from 13 to 73 year old. The anterior mediastinum tumors were located in 201 cases, the posterior mediastinal tumors were located in 38 cases. All patients were operated. Video endoscopic technologies were used in 128 cases.

RESULTS. Tumor removal was supplemented other operations in 20 cases. Using video thoracoscopic operations, we had six cases of conversion. One patient died during the initial anesthesia due to the increase in tumor compression of the mediastinal structures. There were post operation complications with 21 (8.75 %) patients. Fatal outcome in the early postoperative period was in 6 (2.5 %) patients.

CONCLUSION. The tactics of treating patients with mediastinal tumors should be individual and depend on the results of the examination, the localization of the tumor and its connection with the surrounding structures. 

OBJECTIVE of the study was to analyze the main problems and try to find the ways to improve the esophageal stenting for malignant stenosis with regard to our experience.

METHODS AND MATERIALS. Palliative esophageal stenting for malignant dysphagia realized in 103 patients with observing all the patients till the fatal outcome.

RESULTS. Early complications were observed in 9 patients (8.7 %) among which were: perforation of esophagus – 1 (0.97 %), minor bleeding – 2 (1.9 %), stent migration – 6 (5.8 %). Elimination of dysphagia as an immediate clinical effect was achieved in all of 103 patients (100 %) among all of early complications included. Delayed sequelae were found in 40 patients (38.8 %) among which were recurrent dysphagia because of tissue in-/overgrowth – 27 (26.2 %), stent migration – 2 (1.9 %), different kinds of esophageal fistulae – 5 (4.9 %), major bleeding – 6 (5.8 %). The most severe life-threatening complications developed at 109 days after stent placement. The mean survival rate was 131 days (from 12 till 546 days).

CONCLUSION. Immediate clinical effect of stenting was achieved in 100 % of cases and delayed clinical effect was in 73.8 % of patients. Chemoradiotherapy conduces to increase the mean survival rate and, at the same time, to increase the most severe delayed life-threatening complications after esophageal stenting

OBJECTIVE was to evaluate the results of transcatheter arterial chemoembolization (TACE) in the treatment of patients with hepatocellular carcinoma (HCC) on advanced liver cirrhosis (LC) and intermediate stage (B) according to BCLC classification (Barcelona Clinic Liver Cancer classification).

METHODS AND MATERIALS. We evaluated results of TACE in 54 patients. Of them, 12 (22 %) had stage A of cirrhosis and 42 (78 %) – stage B of cirrhosis according to the Child-Pugh score. Nine (17 %) patients matched stage A4 and 45 (83 %) – stage В according to BCLC classification. The TACEs was performed according to the conventional practice with using Lipiodol + gelfoam (n=40) and with a drug-eluting beads (n=14) from 1 to 16 (average 6) times. The Doxorubicin was used as a first-line therapy in all cases.

RESULTS. After TACE, two patients died of liver failure (3.7 %). According to the m-RECIST, complete response to treatment was observed in 9 (16.5 %), partial response – in 13 (24 %), stabilization – in 19 (35.5 %) and progression – in 13 (24 %) patients. At present, 22 (41 %) patients are alive for 1 to 51 (average 16.2) months. 32 patients (59 %) died between 2 to 62 months: 13 (24 %) – from HCC progression, 19 (35 %) – from liver failure. The 1– 2–3-year survival rate was 75–44–15 %; only one patient survived > 5 years. The median survival rate was (22.0±3.0) months, overall survival rate according to Kaplan – Meier was 26 months.

CONCLUSION. TACE is a relatively safe and effective treatment in patients with HCC on advanced LC and intermediate stage (B). 

THE OBJECTIVE was to report our experience of endovascular treatment in patients with acute thromboembolic occlusion of the superior mesenteric artery (SMA).

METHODS AND MATERIALS. 13 patients with acute thromboembolic occlusion of the SMA underwent endovascular intervention. There were 4 (31 %) men and 9 (69 %) women. The average age was 76±9 years. The time from the beginning of the disorder to intervention and mechanical reperfusion of the SMA ranged from 4 to 65 hours, averaging (22±17) hours. Initial leukocytosis was (16.5±5.8)·10/9 l (from 9.2 to 28.8·10/9 l). Various endovascular manipulations were applied to achieve artery reperfusion: mechanical recanalization, balloon angioplasty, aspiration thrombectomy and stenting.

RESULTS. Complete recovery of antegrade blood flow through the SMA and its main branches was achieved at all 13 (100 %) patients. Laparotomy was executed at 4 (31 %) patients, thus the intestinal necrosis after endovascular intervention developed in 3 (23 %) cases. The lethal outcome was 46 %. The main reason for a lethal outcome was reperfusion syndrome (4 patients, 31 %).

CONCLUSION. Endovascular methods of treatment of patients with acute thromboembolic occlusion of the SMA can be considered as the first step in medical algorithm. They allow to save intestinal viability in most patients. Reperfusion syndrome was the main reason for a lethal outcome. The development of methods for the prevention and treatment of reperfusion syndrome in acute thromboembolic occlusion of the SMA has to become the basis for successful treatment of these patients. 

THE OBJECTIVE was to compare the efficacy and rate of complications in patients of groups with uncovered and covered colorectal stents.

METHODS AND MATERIALS. The study included 102 patients who were admitted for emergency with symptoms of malignant colon obstruction, who were randomly installed covered and uncovered SEMS from December 2012 to September 2017.

RESULTS. Clinical success was achieved with uncovered stents in 98 % of cases and 96 % with covered stents (relative risk (RR) 1.02). 95 % confidence interval (CI) 0.954–1.092). The incidence of complications in the group of uncovered stents was 9.8 %, in the group of covered stents – 3.9 % (RR 0.938, CI 0.841–1.046); the frequency of recurrences of obstruction did not significantly different between groups. The median duration of cumulative stent patency was 181 days in the group of uncovered stents and 218 days in the group of covered stents (p=0.427), the difference was statistically insignificant.

CONCLUSION. The use of double covered and double uncovered stents is equally effectively and safely for patients with malignant colorectal obstruction. The frequency of reobstructions did not exceed 4 % and did not differ in the groups of covered and uncovered stents. The choice of the type of stent should be determined individually depending on the clinical situation.

OBJECTIVE. We wanted to relate the perfusion index (M) in burn wound in the period of treatment with the development of the type of pathological scar tissues of different origin during the convalescence period. METHODS AND MATERIALS. We studied burn wounds and scars in 25 patients with thermal trauma in the postoperative period and the convalescence period during the year. We determined the values of perfusion of burn wounds with help of laser Doppler flowmetry, which were diagnostically significant for predicting the outcome of treatment of burn wounds. RESULTS. If the perfusion index was lower than 4.0 PU and higher than 10 PU, then a high risk of developing the pathological type of scar tissue was predicted. If the perfusion index was between 4.0 and 10 PU, then a minimal risk of developing the pathological type of scar tissue was predicted. CONCLUSION. The perfusion index is an important criterion for choosing early preventive measurements and specialized treatment of burn wounds to reduce probable developing the pathological scars and, as a result, obtaining good cosmetic and functional effects. Based on the results of the study, we developed the diagnostic algorithm for predicting the development of various types of scar tissue. Keywords: deep burns, predicting the type of scars, scars, microcirculation, laser Doppler flowmetry, burn wound, outcome of treatment of burn wounds

We report the clinical case of aortic valve replacement for severe aortic insufficiency in patient who previously was subjected to coronary bypass grafting, with functioning grafts, including internal thoracic artery graft. The procedure was performed from the upper ministernotomy with peripheral (femoral) cardiopulmonary bypass.

One of the most serious complications of sternomediastinitis after coronary artery bypass surgery is bleeding from coronary artery grafts. The result of successful treatment of the patient with purulent sternomediastinitis complicated by bleeding from the graft is presented. The choice of the method of stopping such bleeding is grounded.

Small intestinal obstruction is a very rare complication of gallstone disease. It occurs when large stones are found in the gallbladder for a long time, which penetrate into the lumen of the duodenum through the cholecysto-duodenal fistula. Obstruction is more often observed in the terminal part of the ileum. The clinic is atypical and has a two-phase character. At the beginning of the disease, the clinic resembles acute cholecystitis, and then the clinical picture of acute intestinal obstruction develops. With the viability of the small intestine, the enterolithotomy is the optimal operation.

Due to the lack of specific symptoms of colon lipoma, the disease is often complicated by invagination, bleeding, or colonic obstruction. The article presents a clinical case of successful treatment of complicated lipoma of the hepatic flexure of the colon.

We tried to analyze current data and trends in the surgical treatment of pulmonary embolism.

Surgical treatment of pulmonary embolism is a safe and effective procedure, but still is an unpopular tactic and it often remains in reserve treatment. It is necessary to conduct more large-scale studies in order to consolidate firm positions in the treatment of this cohort of patients with embolectomy, which will make it possible to further improve the prognosis and survival in patients with massive PE. 

Surgery, as well as almost all sections of medicine, has always been a man’s affair. Valentina Pavlovna Kleshchevnikova (1919–2009), one of the few women who became a professor of surgery, stood out in the mid-20th century galaxy of surgeons. October 2019 marks the 100th anniversary of her birth. Having started her professional career during the Great Patriotic War in a military hospital, she gained experience and knowledge in many areas of surgery. Professor Sergey Vladimirovich Heinatz, her mentor and teacher, had extensive experience in esophageal surgery and while still working in Khabarovsk made – one of the first in the country – esophagoplasty resection with one-stage esophagoplasty. Professor V. P. Kleshchevnikova, a promising surgeon, was also involved in the development of this very difficult field of surgery. It was the material that formed the basis for the candidate’s and later doctoral dissertation of a young, but already experienced specialist. After defending her thesis, V. P. Kleshchevnikova, a young doctor of medical sciences, was elected by competition to head the Department of Hospital Surgery at Petrozavodsk State University (Petrozavodsk). For a long time almost all the leading surgeons of Petrozavodsk and the Republic of Karelia were her students or students of the Department headed by V. P. Kleshchevnikova – someone listened to her lectures, someone worked with her in the clinic or had the honor to «get» Valentina Pavlovna as a mentor or opponent for the defense of the thesis. In Saint Petersburg, at the Mariinsky Hospital, and later at Petrozavodsk State University, a prominent and very bright part of Professor Kleshchevnikova’s surgical and scientific career took place. She was a worthy representative of the pleiad of the most brilliant surgeons, and if we take female surgeons, she was probably the most outstanding surgeon.

The article is dedicated to the 60th anniversary of the birth of the outstanding representative of the St. Petersburg medical school and thoracic surgery of the country, the talented scientist and teacher, doctor of medical sciences, professor Petr Kazimirovich Yablonskiy. P. K. Yablonskiy is the founder of many progressive endeavors in medicine: the study of the fundamental principles of respiratory transplantation implemented in the world’s first successful simultaneous allotransplantation of the trachea (1991) and the first successful bilateral lung transplantation in the Russian Federation; the creation of the Russian school of interventional pulmonology and the St. Petersburg school of breast endovascular surgery; the development and implementation for the first time in world practice of the concept of using robot-assisted operations in the treatment of patients with pulmonary tuberculosis. Significant scientific potential and high organizational capabilities allowed P. K. Yablonskiy to lead and actively develop the Center for Intensive Pulmonology and Thoracic Surgery on the basis of the multidisciplinary city hospital; the Department of Hospital Surgery, and then the Faculty of Medicine of St. Petersburg University; St. Petersburg Research Institute of Phthisiopulmonology. The great experience in clinical medicine and the organization of public health contributed to his appointment as the chief freelance specialist – the thoracic surgeon of the Ministry of Health of the country, and also allowed him to head the Association of Thoracic Surgeons and the National Association of TB specialists, created by him.

The article is dedicated to the 85th birthday of the famous scientist, honored worker of science of the Russian Federation, honored worker of science of the Republic of Mordovia, honored doctor of the Republic of Mordovia, laureate of State prize, head of the scientific-pedagogical surgical school, doctor of medical Sciences professor Piksin Ivan Nikiforovich. I. N. Piksin is the author of fundamental studies of the biomedical effects of quantum radiation at the molecular, cellular and organismal levels in patients with acute destructive diseases of the lungs, purulent-septic diseases, lactational mastitis and other pathologies. The team of the scientific-pedagogical school led by I. N. Piksin explores the problems of diagnosis and treatment of gastroduodenal bleeding, mechanical jaundice, pancreatitis, suppurative diseases of the lung and pleura, surgical diseases of the heart, blood vessels, prevention of complications of limb injuries, diabetes and diabetic foot care, pediatric orthopedics. Under the leadership of I. N. Piksin, new minimally invasive technologies have introduced: transthoracic drainage and rehabilitation therapy of purulent cavities of the lung and pleura, percutaneous and transhepatic cholecystocholangiography, diagnostic and treatment interventions in space-occupying lesions of the abdomen and thyroid gland, ultrasound techniques of diabetes in acute destructive pancreatitis and others. He is considered as one of organizers of higher medical education system in the region. The professor is actively working on improvement in training of medical and scientific personnel for various regions of the Russian Federation.