The article is devoted to academician of the USSR Academy of Medical Sciences A. N. Bakulev-the founder of cardiovascular surgery in the USSR and the first director of the Research Institute of thoracic surgery (since 1961, cardiovascular surgery), who made a significant contribution to the development of issue of stomach and esophageal cancer, x-ray contrast diagnostics and puncture treatment of brain abscesses, ways of treatment of bullet wounds of the skull, spine, brain.

Objective. In this paper, we show the work of the emergency surgical department on the example of a large repurposed multidisciplinary hospital, also its necessity even for infectious hospitals not accepting patients with acute surgical pathology.

Methods and Materials. The work of surgical department of Pavlov First Saint Petersburg State Medical University repurposed for COVID-19 patients was analyzed. About 1500 COVID-19 patients were hospitalized during 4-month period.

Results. All patients undergoing surgery were in severe condition (at intensive care unit). Most common surgery in abdomen was diagnostic laparoscopy. Spontaneous bleedings of different localization occurred in these patients, what required endovascular and endoscopic treatment. We observed only Clavien – Dindo 1-degree postoperative complications. Mortality rate was high and amounted to 75 %.

Conclusion. The work of surgical department in an infectious hospital for the treatment of a new coronavirus infection is extremely difficult. An infectious hospital should have a 24-hour diagnostic service (US, CT, MRI). Patients severity and the working conditions necessitate the availability of the trained surgical personnel. Given the high risks of bleedings in patients with COVID-19, it is necessary to have a 24-hour endoscopy and endovascular surgery departments with the ability to perform diagnostic and therapeutic interventions. 

The objective of the study was to compare the order of admission and distribution in hospitals of the incoming flow of victims with explosive peacetime injuries (based on the analysis of terrorist acts in Minsk on April 11, 2011 and in St. Petersburg on April 3, 2017).

Methods and Materials. We analyzed the organization of inpatient medical care for 2 groups of victims who applied for medical care to hospital health organizations on the day of the terrorist attack. The first group – 195 victims of the explosion in the subway of Minsk. The second group – 55 victims of the explosion in the subway of St. Petersburg. 

Results. The order of admission of victims to the healthcare organization in both groups was similar, as was the number of requests for medical care within 1.5 hours from the time of the first treatment (72.7 and 63.6 %, p>0.05). In both groups, there were identical indicators of the victims aimed at inpatient treatment (80.5 and 83.6 %, p>0.05), and cases when the profile of the hospitalization department was crucial for the nature of medical care (74.5 and 76.1 %, p>0.05). The victims of both groups hospitalized in hospital healthcare organizations had identical indicators of subsequent transfers to other medical institutions or to other departments.

Conclusion. The first 1.5 hours after the first call to hospitals after explosions in the subway are the most stressful, which may require limiting medical care only to emergency operations. Up to 20 % of the victims had no serious injuries and were referred for outpatient treatment. 

The objective was to develop a methodology for predicting death in patients with burn injury using regression analysis methods.

Methods and Materials. The analysis of the results of treatment of 330 burned with a shock injury, hospitalized in the Department of Anesthesiology and Resuscitation of the Department of Thermal Lesions of Saint-Petersburg I. I. Dzhanelidze research institute of emergency medicine in the period 2013–2019.

Results. In the course of the study, 52 indicators were identified that characterized the condition of the victim with burn injury in the dynamics of treatment measures. To build a predictive model, only statistically significant parameters (p<0.05) were used, which were used to build a model of logistic regression. The final algorithm included 18 predictors. The model allows predicting a positive outcome of treatment and the likelihood of a fatal outcome with an accuracy of 93 and 87 % respectively.

Conclusion. The use of a multivariate mathematical model made it possible to develop a method for predicting a fatal outcome, taking into account the peculiarities of the pathogenesis of burn disease and the principles of therapeutic measures in the first three days after injury. The use of linear regression analysis using new indicators of thermal injury in a retrospective cohort of 330 patients allowed us to achieve a high predictive value. 

Introduction. For diseases such as stricture and obliteration of the urethra, urethral hypospadias, reconstructive operations are required. The buccal mucosa is the material most commonly used for these operations. The search for alternative materials, carried out in order to reduce trauma and complications in the donor area, is an urgent area of modern urology. Tissue engineered constructions (TEC) can be used as such material.

Objective. Justification of the possibility of applying a TEC based on the biodegradable polymers and seeded with autologous buccal epithelium (BE) cells as an implantable material for urethroplasty in an experiment.

Methods and Materials. TEC based on poly-L-lactide-caprolactone (PLC) and poly-L-lactide-glycolide (PLG) seeded with BCs was created. Rabbits (n=12) underwent a biopsy of the oral mucosa, BCs were isolated, cultured and PLC-PLG scaffold was seeded with cells. TECs seeded with autological BCs were used on the model of acute trauma of rabbit urethra for replacement urethroplasty.

Results. The results were evaluated after 12 weeks, according to the histological examination, there was a repair of the urethral mucosa. According to the data of retrograde urethrography, no impaired urethra patency was detected.

Conclusion. TEC (PLK-PLG) seeded with autologous BCs ensured the maintenance of the rabbit urethral lumen which is necessary for adequate urination. This TEC could be recommended for the further clinical studies. 

The Objective of the study was to identify the clinical features of newborns and infants with perforation of the stomach, and to justify the possibility of organ-preserving operations even with extensive gastric necrosis.

Methods and Materials. The results of treatment of 32 newborns with stomach perforation was analyzed: not only the risk factors that cause this condition, but diagnostic methods and variants of surgical treatment. All patients with extensive necrosis of the stomach wall underwent an atypical resection within healthy tissues, a gastric «tube» was formed on the drainage probe with a significant decrease of organ volume. In cases of the local damage of the gastric wall, the perforated area was sutured after the excision of the edges of the defect.

Results. Mortality rate was 36.5 % (n = 12). The cause of death in 5 children (15 %), in 3 to 8 days after surgery, was multiple organ failure syndrome. In 7 patients (22 %), a fatal outcome occurred due to the severe post-intensive care syndrome at the age of 3 to 12 months of life.

Conclusion. The mechanism of perforations of the stomach in newborns and infants is multifactorial. All children with stomach perforation need preoperative preparation. The operation of choice for the stomach perforation is an organpreserving surgery. The function of the stomach is restored in all children after extensive resection of the stomach. 

A Peroral Endoscopic Myotomy was performed on the patient with the persistent dysphagia despite preceding Heller myotomy combined with partial fundoplication, relaparotomy, fundoplication wrap reconstruction, gastrostomy and left-sided thoracoscopy with the drainage of the thoracic abscess. The use of intraoperative High-Resolution Manometry during Endoscopic Peroral Myotomy helped to reveal the reasons for the failure of previous treatment and to address the dysphagia.

The Objective was to improve the results of diagnostics of the severity of patients with complications of cholelithiasis, occurring in the form of mechanical jaundice, against the background of comorbidity.

Methods and Materials. 537 patients admitted in the clinic of hospital surgery of Kabardino-Balkar State University named after H. M. Berbekov in the period from 2010 to 2019 were examined. The terms of admission to the hospital were different. 25 (4.6 %) people were admitted in a short period of time up to 6 hours. A day after the onset of the disease – 82 (15.3 %) people. More than half – 277 (51.6 %) people were hospitalized a week after the onset of the disease. We analyzed the data of comorbidity scales of CIRS, Kaplan–Feinstein and Mary Charlson Index, as well as biochemical criteria reflecting the severity of calculous cholecystitis, jaundice and concomitant diseases.

Results. As a result of their analysis and comparison, we found that comorbidity in patients of this kind is the main aggravating factor and worsens the пeneral condition as the stages of jaundice develop.

Conclusion. We found out that a common biochemical tests as for characterizing changes of the hepatocyte in nontumor obstructive jaundice, and for evaluating the degree of impact of comorbidity are the content of blood alkaline phosphatase, creatine phosphokinase and transaminases. Intoxication syndrome in patients with cholangitis and comorbidity so negatively affect all organs and systems of the body that it can lead to inoperability. 

The Objective was to evaluate the effectiveness of original physiotherapeutic methods in the treatment of patients with acute spread purulent peritonitis.

Methods and Materials. We done a treatment approach analysis of 72 patients with peritonitis after programmed sanitation of the abdominal cavity. The control group included 42 patients with standardized treatment regimen. The main group consisted of 35 patients. Their treatment included low-intensity laser radiation of the abdominal cavity, electrical stimulation of the duodenum according to the original methods. We evaluated dynamic changes of the blood parameters, endogenous intoxication markers, the functional status of the liver, kidneys, and intestines.

Results. The use of original physiotherapeutic methods in the treatment of patients with acute peritonitis leads to a significant improvement in clinical and laboratory data. The functional status of the liver, kidneys and intestine restored rapidly. Mortality rate decreased from 28.7 to 17.1 % (χ2=1.392, p=0.238), hospital stay decreased by 5.7 hospital days (p<0.05).

Conclusion. The treatment regimen for severe peritonitis leads to a relatively rapid relief of the inflammatory process in the abdominal cavity, as well as the restoration of the functional status of the liver, kidneys and intestine. It largely determines the correction of homeostatic indicators, including reducing the severity of endogenous intoxication. 

In the presented clinical observations, in one patient, acute massive pulmonary embolism developed on the 2nd day after the extended surgical intervention in the colon; in the second case, it developed on the 18th day after the extensive surgical aid against pancreatic necrosis. Clinical predictors of a high risk of death of thromboembolism and the technical impossibility of using another treatment method were the basis for systemic administration of tissue plasminogen activator. The direct result of systemic thrombolysis was the clinical recovery of patients. The hemorrhagic complication diagnosed in one of the observations was in the form of moderate bleeding from a vessel of the gastroenteroanastomosis region. Bleeding was stopped with the minimally invasive endoscopic clipping.

Surgical treatment of oncological diseases with concomitant somatic pathologies is a complex issue. In situations when concomitant somatic pathology also requires a surgical approach, the determination of adequate treatment tactics is most relevant. Delayed surgical treatment of cancer increases the risks of progression and generalization of the process; surgical treatment of a tumor against the background of decompensated concomitant pathology potentially entails risks of an unfavorable outcome. With a combination of oncological and somatic diseases, the definition of treatment algorithms today is one of the primary tasks.

This paper presents a clinical observation of one-stage surgical treatment of lung cancer and severe aortic stenosis, provides a brief literature review on this topic. 

Currently, the age of primiparous women is increasing, but the risk of cancer, which is sometimes found during gestation, is also increasing. This article discusses the problems of diagnosis and treatment of cancer during pregnancy, which occurs under the guise of gestational complications. Two cases of malignant neoplasms first discovered during pregnancy are described. The first observation illustrates cholangiocarcinoma in a 37-year-old multiparous, and the second is a case of colorectal cancer in a 40-year-old primiparous. The timely identification of such women is an important challenge of the outpatient, which in the future can help maintain the quality of life of the mother and child.

We report the case of treatment of a 30-year-old woman with an impaired passage in the duodenojejunal segment of the gastrointestinal tract due to Ladd’s syndrome. Occlusion of the superior mesenteric artery was developed as a result of incomplete rotation of midgut in dysembryogenesis. Mesenteric blood circulation was compensated by collaterals formed in the antenatal period. Ladd’s operation was performed to treat acute intestinal failure, the duodenojejunal passage was restored. The patient was discharged on the 11th postoperative day in a good condition with the main diagnosis «Ladd’s syndrome». In the presented case report, the impaired passage in the gastrointestinal tract in the middle age patient was traced from childhood. Detailed examination of medical history, correct interpretation of MSCT findings allowed to form an accurate diagnosis and perform effective surgical treatment. 

Kartagener Syndrome (CS) is a rare autosomal recessive disease that is a part of primary ciliary dyskinesia (PCD), and is characterized by a triad of syndrome including bronchiectasis, polysinusitis and a complete mirror arrangement of the internal organs of the chest and abdominal cavities (situs inversus). In most patients, bronchiectasis in the lungs develops from the first years of life and progresses in time. The tardy diagnostic leads to a poor prognosis of the disease and adduce the development of persistent violations of the function of external respiration. Most often, patients with CS are observed by physicians and pulmonologists from early childhood, since respiratory infections often require annual hospitalization in specialized medical institutions due to abnormalities of the ciliary epithelium of the respiratory tract. However, to date, there are no generally accepted recommendations for the management and treatment of patients in this category. This article describes the case of a newly diagnosed CS in an older patient undergoing surgical treatment for gastric cancer. Despite the pronounced concomitant pathology on the part of the bronchopulmonary system, the perioperative period in the patient proceeded relatively satisfactorily and did not entail an increase in the length of hospitalization.

Bowen’s disease is the oncological process, which is rarely found in coloproctologist practice. Early verified diagnosis is ensured of possibility of full checkup and differential diagnostic. Surgery is radical and effective treatment of a perianal skin cancer. We report about the clinical case that describes successful treatment of perianal Bowen’s disease.

The final reconstructive treatment of complex pelvic injury in a patient with combined trauma in the acute period of traumatic disease is presented. Indirect reposition, limited access, stable functional osteosynthesis were performed, which allowed to obtain a good anatomical and functional outcome.

The Objectivewas to discuss various aspects (organizational, diagnostic, therapeutic and socio-ethical) of care for patients with surgical complications of lung cancer and the role of thoracic surgeon in the management of these patients. Different problematic issues of the management of patients with surgical complications of lung cancer (pneumothorax, pulmonary hemorrhage, paracancrotic abscess, pleural empyema) directed to the department of general thoracic surgery are presented. Various aspects of the management of patients with surgical complications of lung cancer are considered: organizational, diagnostic, therapeutic, social and ethical. The implementation of the presented aspects requires the training of specialists: thoracic surgeons in oncology and the technique of interventions, taking into account the principles of oncological radicalism, oncologists in the features of infectious postoperative complications. Improving the treatment and diagnostic approach in this category of patients will extend the life of those of them in whom radical surgical, chemotherapeutic and radiation treatment is impossible. Recognition of patients as palliative does not mean the cessation of emergency measures to save them from life-threatening complications. The problem can be solved with the participation of thoracic surgeons, oncologists, healthcare organizers. 

 

To date, the main way to stop dysphagia for patients with unresectable esophageal cancer is stenting. Being widely accepted and effective, this technique, however, allows for oral nutrition only for an average of 3–4 months and is accompanied by the development of a wide range of complications. Recent Russian and foreign publications in the field show that evaluation of the effectiveness of the stenting technique, including analysis of possibility of complications development, is important for practical application. To improve long-term outcomes, the potential trends in the method evolution have already been identified. The stents coated with radioactive isotopes of iodine are among of the actively used novelties. Application of 3D printing for the manufacture of custom-tailored stents, as well as the inclusion of chemotherapeutic agents in the coating of self-expanding metal stents seem promising approach. The search for a «perfect stent» continues under paradigm of personalization.

Currently, the timely diagnosis and treatment of gastric cancer is one of the most actual problems of both abdominal surgery and oncology. Despite the decline in the incidence of stomach cancer remains one of the leading causes of death in many countries. The necessary stage of radical surgical treatment based on the typical representation of angioarchitectonics of the celiacomesenteric pool is lymph node dissection D2. The need for precision skeletal arterial trunks in the surgical treatment of gastric cancer in order to achieve radical surgery carries significant surgical risks. Vascular anatomy of the upper floor of the abdominal cavity is variable. After analyzing the information from different sources, the value of variability of celiacomesenteric pool in the surgical treatment of gastric cancer was estimated.