Professor Sergey Ivanovich Spasokukotskiy was born on June 10 (May 29 according to the old style) 1870 in Kostroma. In 1879 Sergey Spasokukotskiy began his study at the Yaroslav Provincial Gymnasium, after which he applied to the Faculty of Medicine of Moscow University in August 1888. After graduating from the Faculty of Medicine and receiving a diploma of doctor with honors in 1893, Sergey Ivanovich was left a supernumerary resident at the hospital surgical clinic. S. I. Spasokukotskiy is rightly considered one of the founders of surgical gastroenterology in Russia. In 1907 in St. Petersburg, he made a report «The breadth of indications for gastric resection in cancer and ulcer of it from the experience of 250 gastric operations and 29 resections». Problems of purulent surgery in the broadest sense have always been the focus of attention of Sergei Ivanovich, so there was a large purulent department in the clinic. In 1926, he was elected the Head of the Department and Clinic of Faculty Surgery of the II Moscow University. The works of Sergei Ivanovich and his students on hepatobiliary surgery, urology, neurosurgery were of great importance. Being since 1926 the head of the surgical sector of the Institute of Blood Transfusion, S. I. Spasokokotski has made a huge contribution to the development of domestic transfusiology. Under his guidance, the Faculty Surgery Clinic and the Blood Transfusion Institute Clinic developed blood transfusion indications for many pathological conditions. Spasokukotskiy had a high pedagogical skill, for which he earned great respect from students and young doctors, who always admired the Teacher ‘s personal example as a doctor, surgeon and scientist. Academician Sergei Spasokokotskiy died on November 17, 1943 and was buried in Moscow at the New Maiden Cemetery. For the best works in the field of surgery by the decision of the Government, there is a prize of his name.

The OBJECTIVE was to improve the results of surgical treatment of patients with discogenic radiculopathy by preoperative neuropsychological examination of patients with an increased risk of unsatisfactory outcome of the operation.

METHODS AND MATERIALS. Neuropsychological status of 77 patients with discogenic radiculopathy in the preoperative period was studied. For this purpose, we assessed the intensity of pain, levels of personal and situational anxiety and the presence and severity of depression. The obtained data were compared with postoperative results of quality of life assessment for the main parameters, which include the level of pain and adaptation to daily activities.

RESULTS. Data from neuropsychological tests were revealed, the presence of which in patients with discogenic pain syndrome suggests the risk of an unsatisfactory assessment of the operation performed by the patient. According to the long-term results of neurosurgical treatment, patients were divided into three groups: 1 – with a good result; 2 – patients with a number of preserved complaints, who rated the result of the operation as satisfactory; 3 – unsatisfactory outcome. In patients with unsatisfactory results of surgical treatment of discogenic radiculopathies with pain syndrome, patterns of psychological indices were found that were significantly associated with the outcome of treatment.

CONCLUSION. Conducting a neuropsychological examination prior to surgery with the identification of predictors of chronic discogenic pain and patient dissatisfaction with the results of treatment can influence the surgical tactics and optimize the process of further treatment.

The OBJECTIVE was the reduction in the frequency of specific complications of surgical treatment of patients with pathology of the thyroid and parathyroid glands using the original method of monitoring the neuro-functional activity of the recurrent laryngeal nerve.

METHODS AND MATERIALS. The research was conducted in two stages. At the first stage, the object of the topographic-anatomical study was 50 male and female corpses. The research, based on the fixed material, was focused upon the study of the anatomic special features of recurrent laryngeal nerves, their relations with neighboring structures, the study of peculiarities of recurrent laryngeal nerve syntopy and its neighboring structures to find the least traumatic way of incision during electroneurophysiological monitoring of activity. At the second stage, the object of the study was 60 patients with a benign pathology of the thyroid gland, who were operated on with the use of the original method of intra-operational visualization and control method over neuro-functional activity of recurrent laryngeal nerve.

RESULTS. The frequency of the three different variants of topographic-anatomical position of recurrent laryngeal nerve depends on the side of the body. The safest, stable and the fastest one to be found is the left recurrent laryngeal nerve. Postoperative unilateral paresis of the larynx, diagnosed in 4 of 60 patients, is regarded as postischemic. Two-sided paresis of the larynx was diagnosed in 1 patient.

CONCLUSION. This method allows to minimize the development of severe intraoperative complications, to reduce the frequency of postoperative paralysis and paresis of the larynx. Intra-operative visualization of recurrent laryngeal nerves is especially necessary during the repeated surgeries with postoperative scar transformations with wrong syntopy of neck organs and vascular-nerve structures, which makes it possible to minimize the number of postoperative paralyses and paresis of larynx and to get positive effect without carrying out the intubation of trachea among patients with postoperative paralysis of larynx or stenosis, and to avoid more serious damage of larynx or trachea in case of intubation.

The OBJECTIVE of the study was to compare the results of using the longitudinal – cross-linking method of sternum osteosynthesis with other methods (single wire stitches, 8-shaped wire stitches) for cardiosurgery patients.

METHODS AND MATERIALS. The study included 3,150 patients, which were operated on in Samara cardiology dispensary named after V. P. Poliakov from 2012 to 2018. Patients were divided into 2 groups. Group 1 (1397 patients, operated on from 2012 to 2014) used single wire stitches or 8-shaped wire stitches for sternum osteosynthesis. Group 2 (1753 patients, operated from 2015 to 2018) used the longitudinal -cross-linking method of sternum osteosynthesis. The incidence of instability of the sternum without infection, superficial postoperative wound infection, deep sternal infection and hospital mortality were evaluated.

RESULTS. Groups (1–68 % of men, average age (59.4±9,9) years; 2–68 % of men, average age 62.3±8.5) were significantly different in obesity patients (25.6 & 29.3 %, p=0.02), amount of smokers (50.5 & 64.2 %, p<0.001) and amount of urgent cases (3 & 10 %, p<0.001). The incidence of sternal instability without infection was less in group 2 (0.64 & 0.29 %; OR, 2.29; 95 % CI, 0.76 to 6.8; p=0.1). The amount of deep sternal infection was significant less in group 2 (1.6 & 0.6 %; OR, 2.53; 95 % CI, 1.2 to 5.2; p=0.009). The hospital mortality was 3.9 % in group 1 and 2.96 % in group 2 (OR, 1.34; 95 % CI, 0.9 to 1.9; p=0.1).

CONCLUSION. The longitudinal-cross-linking method of sternum osteosynthesis is the available method that can significantly reduce the incidence of deep sternal infection in cardiosurgery.

The OBJECTIVE of the study was to assess the changes in blood supply of the bronchus stump following lung resection with lymph node dissection.

METHODS AND MATERIALS. Bronchial microcirculation was studied in 8 patients during pneumonectomy of the wall of the main bronchus using laser Doppler flowmetry method. In this paper, we present our observations of postoperative necrotic ischemic bronchitis after lobectomy with associated formation of bronchopleural fistula of the main bronchus and the failure of the stump of the lobular bronchus.

RESULTS. Mobilization of the bronchus decreased microcirculation rate to (3.3±0.3) conventional units (c. u.), or to 74.5 %; lymphatic dissection further reduced microcirculation rate to (2.6±0.2) c. u., or to 60.2 %. An additional twisted suture was found to worsen ischemia. The normalized value of the amplitude decreased during the second minute of the dissection of the bronchus, indicating hypoxia. A 61-year-old patient with diabetes showed damage to the wall of the main bronchus 0.6 cm in size 7 days after undergoing the right lower lobectomy with lymphatic dissection. On the 19th day after the same procedure, the same patient developed an insolvency of the stump of the lower lobe bronchus, which was classified as a manifestation of ischemia. Postoperative ischemic bronchitis can occur in a true ischemic or an ulcerative necrotic form, and it can be diagnosed using a macroscopic picture in the context of fibrobronchoscopy. It occurs in (2.5–3.2) % of patients who underwent lung resections for cancer with lymphatic dissection.

CONCLUSION. Ischemia of the bronchial wall during its mobilization plays a significant role in the etiology of bronchopleural fistula. Lymphatic dissection worsens microcirculation of the bronchial wall. Ischemic necrotic bronchitis can lead to formation of the bronchopleural fistula outside of the stump. High-risk patients require additional coverage of the bronchus stump with muscle or fat tissue.

The OBJECTIVE was to determine the possibility of using chromatography-mass spectrometry to select causal treatment for patients with pleural empyema.

METHODS AND MATERIALS. The analysis of the results of examination and treatment of 207 patients with pleural empyema for the period from 2017 to 2018 was done. All patients underwent bacteriological examination, twenty patients from them underwent chromato-mass-spectrometric examination of pleural exudate.

RESULTS. Patients were transferred to a specialized thoracic hospital from other medical institutions, where they received a course of empirical antibacterial therapy and drainage of the pleural cavity was performed. Bacteriological examination of the contents of the pleural cavity was positive in 112 (54.1 %) patients. The leading pathogens were gram-negative bacteria isolated from the contents of the pleural cavity in 45 % of patients with closed and 63.5 % – open pleural empyema. Polyantibiotic-resistant stocks of P. aeruginosa (30.4 %), K. pneumoniae (19.6 %) and A. baumannii (12.5 %) prevailed, which remained sensitive to polymyxin and, in some cases, to amikacin. In 25 (22.3 %) patients, micromycetes of the genus Candida were found. No growth of anaerobic microflora was detected. Chromato-mass-spectrometric examination of pleural exudate revealed markers of 30 taxa of bacteria, viruses and fungi that exceeded the norm by more than two times. Markers of gram-negative bacteria were not detected. The proportion of anaerobic microorganisms was 76.6 %, with the highest concentration found for bacteria of the genus Clostridium and Eubacterium.

CONCLUSION. The choice of causal treatment for patients with pleural empyema is difficult due to the negative culturing from the contents of the pleural cavity in 45.9 % of patients, as well as the discordance between the results of bacteriological and chromato-mass-spectrometric studies. Diagnostic methods for detecting pathogens of pleural empyema require further improvement.

The OBJECTIVE was improving the results of diagnostics and assessment of the severity of patients with mechanical jaundice (MJ) at various stages of its development.

METHODS AND MATERIALS. The basis of clinical and laboratory research was the data of 537 patients who were admitted during the period from 2010 to 2019. Principles of separation at the stage of the course of mechanical jaundice of non-tumor Genesis.

RESULTS. Analysis of clinical and laboratory studies showed characteristic signs of various complications of cholelithiasis, accompanied by mechanical jaundice. Then, on this basis, specific symptoms characteristic of each stage of mechanical jaundice of non-tumor Genesis were determined.

CONCLUSION. The course of mechanical jaundice, which develops with complications of cholelithiasis, has a phase-stage character, beginning with extrahepatic cholestasis, then-joining hepatocytolysis and ending with cholangitis. Initially, cholestasis and cytolysis are functional, which is confirmed by biochemical tests, so these processes are labile and reversible. This makes it possible to effectively use biliary decompression methods and infusion therapy with detoxification during treatment. Cholangitis is characterized by destructive morphological manifestations, so it is verified by specific clinical symptoms and laboratory tests characteristic of inflammatory-septic reactions and progresses to sepsis. Differentiation of stages of mechanical jaundice allows to personify surgical and conservative treatment of such patients.

In the Republican perinatal center, there was a premature newborn girl who had a combination of various risk factors in the antenatal and postnatal period. From birth, the child was in the intensive care unit, required intensive care. Against the backdrop of positive dynamics, at the 4th week of life, the child’s condition worsened noticeably, signs of pneumoperitoneum appeared. After emergency laparocentesis, it took several days to stabilize the condition. Laparotomy was performed in a deferred order, in which isolated perforation of the posterior wall of the stomach was detected. The scope of the operation was limited to suturing the opening, since no other changes from the small and large intestine were detected. In the postoperative period, the child’s condition remained severe for a long time, was in the neonatal intensive care unit. The child was discharged home with recovery after 3 months.

The OBJECTIVE of the study was to evaluate the severity of submucosal fibrosis in patients with esophageal achalasia, its influence on technical and clinical success of peroral endoscopic myotomies (POEM), and their results.

METHODS AND MATERIALS. The study included 116 patients with esophageal achalasia who underwent POEM in the Clinic of the Pavlov First Saint Petersburg State Medical University from June 2015 to March 2019. The mean age of patients was 50 years. It included 42 men and 74 women. This research was based on the retrospective analysis of video recordings of 116 POEM that were performed on patients with esophageal achalasia at the Endoscopy Department at the Pavlov First Saint Petersburg State Medical University.

RESULTS. The mean operation time was 89.6 minutes. During the operation, changes in the esophageal mucosa were recorded in all patients, which were classified according to the esophageal mucosa in achalasia (EMIA), and during creating the tunnel, the severity of submucosal fibrosis (SMF) was evaluated according to the three-stage classification (SMF from 0 to 3 stage). We found out that SMF-1 occurred in 20 patients, SMF-2 occurred in 44 patients and SMF-3 occurred in 48 patients; we identified a new group of severe submucosal fibrosis – 3b that accompanied in our study by the highest 25 % frequency of mucosal perforation during surgery.

CONCLUSION. The submucosal fibrosis of various SMF grades was determined intraoperatively in the majority of the patients and affected the POEM duration and complications.

The OBJECTIVE was to study the course and results of treatment of lung abscesses in HIV-infected patients.

METHODS AND MATERIALS. We analyzed the case histories of 199 patients with lung abscesses who treated in the Department of thoracic surgery of St. Petersburg Pokrovskaya Municipal Hospital in the period from 2012 to 2018. The 1st group included 121 HIV-infected patients, and the 2nd group – 78 patients with HIV-negative status.

RESULTS. Patients from the 1st group were younger than patients from the 2nd group (p <0.05). Lung abscesses without sequestration were detected in 105 (86.8 %) patients in the 1st I group and 65 (83.3 %) in the 2nd group. Lung abscesses with sequestration (gangrenous abscesses) was diagnosed in 16 (13.2 %) HIV-infected and 13 (16.7 %) uninfected patients. There were no differences between surgical methods of treatment and outcomes (p>0.05). The mortality rate in the 1st group was 9.1 %, and in the 2nd – 12.8 %.

CONCLUSION. General surgical methods for treating lung abscess are equally effective in patients with HIV-negative status and HIV-positive status. Lung abscesses in HIV-positive and HIV-negative patients have a similar etiology, clinical symptomatology, courses and outcome.

Thymolipoma is a rare benign pathological tumor of the anterior mediastinum and accounts for about 2–9 % of thymus tumors. Tumor is usually represented as soft tissue consisting of adipose and thymic tissues. Because of the asymptomatic presentation, patients are often diagnosed with a large tumor. Gigantism of the tumor due to long-term and progressive compression of adjacent organs and anatomical structures of this region can lead to dysfunction, and in some cases, to a complete block of their activity, which is fraught with a fatal outcome. Preoperative diagnosis is always a difficult task due to the lower sensitivity of CT scans and biopsies. The main method of treatment is radical surgical excision. The article presents a clinical case of a 51-year-old patient with a giant tumor of the left hemithorax with a long-term asymptomatic presentation, who was diagnosed with thymolipoma after surgical excision and final histopathological examination.

This is the case report of successful treatment of the patient with acute stroke and tandem lesion of the intra- and extracranial divisions of the internal carotid artery.

A rare case of catheter-induced infectious endocarditis of the right heart chambers complicated by embolism of the left pulmonary artery and its successful surgical treatment is presented. We performed the operation to remove a foreign body and vegetations from the superior vena cava and the right atrium, embolectomy from the left main branch of the pulmonary artery, chemical sanitation of the right chambers of the heart and pulmonary artery under extracorporeal circulation.

We presents the clinical case of splenosis of the abdominal cavity, simulating carcinomatosis. Radiation methods (ultrasound, computed tomography, positron emission tomography) revealed multiple soft tissue tumors in the right iliac region, pelvis, bed of the removed spleen. The patient underwent a splenectomy 23 years ago for a spleen injury. Laparoscopy was performed, tumor formations in the right iliac region and pelvis were removed. Histological examination confirmed the diagnosis of splenosis.

A clinical case of gangrenous pyoderma is described, as well as the difficulty of differential diagnosis and treatment of this disease. We carried out a literature review of the materials of foreign and domestic authors describing the course of gangrenous pyoderma using search engines PubMed, Google Scholar, BioMed Central (55 articles).

The objective of this article was to analyze current researches on the peculiarities of performing coronary artery bypass grafting in patients who primarily underwent intraluminal angioplasty and stenting due to acute coronary syndrome. Despite the priority of stenting in patients with acute coronary syndrome (ACS), there is still a significant number of unresolved issues in this category of patients, especially when these patients, previously stenting due to ACS, undergo coronary artery bypass grafting due to a repeated ACS case. The tactics of management and preparation of patients who were admitted for repeated CABG after preliminary stenting are still not clear, and therefore, a significant number of unresolved issues remains when performing CABG against the background of repeated ACS cases with a previously compromised vascular bed and the presence of chronic inflammation in the coronary arteries. Questions about the perioperative and postoperative complications in this category of patients remain open. We analyzed the latest works and researches about that problem using such systems as NLM, Google Scholar and Elibrary. Due to the current situation of mass use of stenting, a number of questions remain open (the time of cancellation of double disaggregation therapy, the need for shunting the previously stented vessel, the possibility of performing a combined method of treatment for ACS). There is a very little information on the need to bypass the previously stented coronary artery at an earlier date than indicated in the European recommendations.

The definition of a sentinel lymph node is a technique that appeared at the middle of the 20th century. For a number of malignant neoplasms, the definition of a sentinel lymph node is standard procedure, but for highly differentiated thyroid cancer, the data is conflicting. The role of prophylactic central compartment lymph node dissection in the clinical N0 stage is not established. Sentinel lymph node detection seems to be the possible way to reduce the risk of persistence and recurrence of highly differentiated thyroid cancer.

Intraoperative identification of healthy parathyroid and parathyroid adenomas facilitate a favorable outcome of surgical treatment of patients with parathyroid diseases and various hyperparathyroidism’s forms. In doing so, it is important to preserve the entire parathyroid tissue, since unintentional damaging, removal or devascularization leads to the most common development of complication – hypoparathyroidism, which occasionally becomes permanent. Although, in case of surgical treatment of patients with hyperparathyroidism, the removal of the whole pathologically altered tissue is needed in order to avoid the persistence and recurrence hyperparathyroidism, as confirmed by intraoperative and postoperative parathyroid hormone examination. Up to recent time, surgeons could had relied only on pre-surgical localization of hyperfunctioning parathyroid glands, thorough knowledge of front neck anatomy and personal experience, which wasn’t always reliable to recognize the parathyroids intraoperatively and differentiate the healthy parathyroid tissue from adenoma. To solve these problems, the auxiliary navigation and visualization methods, based on application of radiopharmaceutical and fluorescent agents, tropic to parathyroid tissue, are being actively implemented to endocrine surgery nowadays. The comparative characteristic of modern methods for intraoperative visualization of the parathyroid glands, based on the worldwide literature data, is represented in this article.