Professor Semyon Semyonovich Girgolav was born on February 2 (14), 1881 in Tiflis (Tbilisi) in a large family of the hereditary honorary citizen of St. Petersburg Semyon Gavrilovich Girgolav. In 1899, he graduated from the Second St. Petersburg Classical Gymnasium with a silver medal and immediately entered the Imperial Military Medical Academy, from which he graduated with honors in 1904. Under the guidance of M. S. Subbotin, S. S. Girgolav prepared and in 1907 successfully defended his doctoral dissertation «Experimental data on the use of an isolated omentum in abdominal surgery». In 1912, Semyon Semyonovich was elected by the Conference of the Academy as a privatdozent of the general surgery clinic, and in 1914, he was confirmed as a senior assistant of the clinic. In the 1920/21 academic year, S. S. Girgolav introduced mandatory practical classes in general surgery for the first time in our country, where students studied and mastered the methods of asepsis and antiseptics, mastered the methods of examining patients with surgical diseases, methods of applying various bandages and transportation splints, techniques for temporary hemostasis, etc. In 1932, Semyon Semyonovich was appointed Deputy Director for the scientific part of the Leningrad Research Institute of Traumatology and Orthopedics (now the Russian Research Institute of Traumatology and Orthopedics named after R. R. Vreden). In the pre-war years, the main direction of scientific research of S. S. Girgolav and his staff in the hospital surgery clinic was the study of the regularities of the wound process and wound healing in surgical pathology. S. S. Girgolav applied much efforts and energy to the problems of traumatology. He developed the technique of a number of original surgical operations for acute fractures of long bones, the habitual dislocation of the shoulder joint. Semyon Semyonovich’s scientific heritage is great and multifaceted. He has published more than 140 scientific papers on general, military and thoracic surgery, traumatology, neurosurgery, surgical endocrinology and oncology, combustiology, pathology and therapy of frostbites and burns. Under the supervision of S. S. Girgolav, more than 20 doctoral and 45 candidate theses were prepared and defended. For outstanding services to the Motherland in peace and war, S. S. Girgolav was awarded two Orders of Lenin, three Orders of the Red Banner, the Order of the Red Banner of Labor, the Order of the Red Star, many medals and badges of honour. Academician Semyon Semyonovich Girgolav died on January 25, 1957 in Leningrad and was buried at the Bogoslovskoe Cemetery.

The OBJECTIVE was to study the features of changes in the blood coagulation system that contribute to the development of postoperative complications in patients depending on the stage of non-tumor mechanical jaundice at admission.

METHODS AND MATERIALS. A total of 537 patients with mechanical jaundice were examined and changes in the blood coagulation system were analyzed. Vascular-platelet hemostasis was characterized by the following tests: capillary resistance, the number of desquamated endothelial cells, the number of blood platelets. Plasma hemostasis was analyzed using activated partial thromboplastin time, plasma soluble fibrin level, thrombin time, prothrombin ratio, prothrombin index, and fibrinogen blood level. Then, XIIa-dependent fibrinolysis in the blood and the level of the fibrin D-dimer in the blood plasma were determined.

RESULTS. It was found that in the first stage of mechanical jaundice, with cholestasis, there were no changes in blood coagulation system that go beyond the normal limits. In the second stage, during cytolysis of hepatocytes, hyperbilirubinemia and hypertransaminasemia contribute to the activation of platelet first, and then plasma hemostasis. In the third stage (cholangitis), the death of endotheliocytes increases and there is a deficiency of blood coagulation factors due to their consumption and increased fibrinolysis.

CONCLUSION. In the stage of cholestasis in patients with non-tumors mechanical jaundice, the parameters of the coagulation system remain within the reference values. In the stage of cytolysis, as endotheliotoxicosis increases, platelet and plasma hemostasis begins to activate, which can lead to thrombosis and thromboembolism in vital organs. In the stage of cholangitis, further activation of plasma hemostasis causes hemorrhagic syndrome. The occurrence of the described disorders in blood coagulation system with the progression of MJ dictates the need to monitor the changes in the blood coagulation system and their correction for the prevention of intra-and postoperative complications.

INTRODUCTION. The problem of treating patients with peritonitis has always been and still remains relevant in surgery. Moreover, aspects of treating patients with tertiary peritonitis requiring repeated interventions are of particular importance. The OBJECTIVE of this work was to develop and evaluate the clinical effectiveness of a score-prognostic scale that allows to identify groups of patients with a high risk of persistent surgical infection in the abdominal cavity, in which a single intervention cannot be considered effective even despite the elimination of the primary surgical infection focus.

METHODS AND MATERIALS. To achieve the goal, a correlation was evaluated between a number of factors and the likelihood of relaparotomy in a retrospective group consisting of 111 patients with secondary peritonitis. Based on the achieved data, score-prognostic scale for assessing the severity of peritonitis was developed, which allowed to formulate an algorithm of surgical tactics, which was used in the treatment of 109 patients. A group of 34 people with a high risk of tertiary peritonitis development was allocated from the number of patients – of which 20 patients had a total number of 39 planned surgical interventions.

RESULTS. The use of the developed scale led to an increase in the total number of surgical interventions, however, reducing postoperative mortality by 1.7 times (p = 0.001) mainly due to improved survival rates in the group of patients with severe forms of peritonitis.

CONCLUSION. The obtained results allowed to recommend the developed integral prognostic scale for assessing the severity of peritonitis for use in clinical practice.

RELEVANCE. The early diagnosis and correction of enteral insufficiency syndrome influence the treatment outcomes in patients with abdominal sepsis and multiple organ failure.

The OBJECTIVES was to improve the effectiveness of diagnosis and correction of enteral insufficiency syndrome in patients with generalized peritonitis using the express assessment scale of the severity of enteral insufficiency and the treatment algorithm based on this.

MATERIALS AND METHODS. The express assessment scale of the severity of enteral insufficiency syndrome was developed along with the treatment algorithm depending on the detected degree for systematic approach to the management of patients with generalized peritonitis. The study included 39 patients with generalized peritonitis (GP) who had received treatment in the Surgery Department of Samara Regional Clinical Hospital named after V. D. Seredavin in the period of 2019–2020. A computational program was created for quick severity evaluation of enteral insufficiency syndrome and choosing the best treatment strategy.

RESULTS. When comparing the severity of enteral insufficiency in patients immediately after the first operation and in 96 hours, a positive dynamics was registered: the number of patients with III degree of severity of enteral insufficiency syndrome decreased from 19 to 4 people, and the number of patients with I degree of severity of enteral insufficiency syndrome changed from 3 to 29 people, this indicated the stabilization of the condition of patients with GP (p<0.05). The statistically significant reduction in the number of points in the limits of each severity was evaluated as the proof of clinical efficacy of the algorithm applied for the enteral insufficiency syndrome correction (p<0.05).

CONCLUSION. Due to the correct choice of the treatment algorithm according to the identified severity of enteral insufficiency syndrome, the regression of clinical signs of generalized peritonitis was registered in all patients on the 5th postoperative day (96 hours after surgery).

The OBJECTIVE of this work was to develop a classification of complications of local cold injury.

METHODS AND MATERIALS. The study is based on the results and analysis of the treatment of 132 patients with local cold injury of the II–IV degree of the lower extremities. The victims were hospitalized in the regional center for thermal trauma on the basis of the «City Clinical Hospital № 1» in the period from 2018 to 2019. Post-traumatic complications were detected in 54 patients (40.1 %), of which 32 developed early and 22 patients developed late complications. The remaining 78 patients after discharge from the hospital did not seek medical help again and were under the supervision of a polyclinic surgeon.

RESULTS. In the course of the study, it was found that in 32 out of 132 patients in the early period of local cold injury of the lower extremities, sensitivity disorders, muscle weakness, convulsions, impaired coordination of movements, graft rejection, wound suppuration and suture failure, stump necrosis were detected in the affected segments of the extremities. 22 victims developed late complications of local cold injury: trophic ulcers of the stumps of the feet, osteomyelitis with the formation of sequesters, gangrene of the stumps of both feet. As a result of the study and pathogenetic interpretation of the consequences of cryoinjury, a new classification of complications of local cold injury was formed and the criteria for the forms of «cold extremity» were identified.

CONCLUSION. Post-traumatic complications were detected in almost half of the victims with local cold injury (54 patients, 40.1 %). Thus, in the early stages of cryoinjury, 32 patients were found to have impaired sensitivity of the affected limb, muscle weakness, convulsions, and impaired coordination of movements; 4 (12.5 %) had treatment complicated by graft rejection; 5 (15.5 %) had wound suppuration and suture failure; 2 (6.25 %) had stump necrosis. In the late period, complications of local cold injury were registered in 22 patients. Of these, 12 (55 %) patients were found to have trophic disorders; osteomyelitis was detected in 8 (36 %) patients; in 2 (9 %) — gangrene of the distal segment of the affected limb.

The OBJECTIVE of the study was to analyze the experience of performing thyroidectomy (TE) in patients with amiodarone-induced thyrotoxicosis (AmIT) at our centre.

METHODS AND MATERIALS. The study included 12 patients with AmIT who underwent TE. Medical records were analyzed to assess the features of the AmIT and indications for TE. We also studied the operation protocols and postoperative follow-up data. Intraoperative, early and long-term postoperative complications were recorded. The long-term TE results were evaluated by the dynamics of the left ventricular ejection fraction (LVEF) based on the echocardiography data.

RESULTS. The main indications for TE included the resistance of thyrotoxicosis to medication and worsening of the cardiac pathology. No cases of thyrotoxicosis progression or thyrotoxic crisis were registered during the operation. The vocal cord paresis developed in one case, completely restored in a year. Blood loss was minimal in all cases. Other intraoperative complications were absent. Not a single death was registered in the early postoperative period. At this period, a short paroxysm of atrial fibrillation resolved on its own was registered in patient with arrhythmogenic right ventricular dysplasia. A patient with biventricular chronic heart failure of a high functional class died 39 days after the operation due to a massive pulmonary thromboembolism. The long-term results of TE were evaluated in eight patients. In four out of five patients with initially reduced LVEF, it increased. In three patients with initially normal LVEF, it did not change.

CONCLUSION. Thyroidectomy is an effective and safe treatment in patients with AmIT, including those with the persistent thyrotoxicosis and severe cardiac pathology. The success is possible when the preparation of patients for the intervention is carried out by a team of specialists experienced in treating of such patients.

A new approach for thymectomy in case of mediastinal shifting is proposed. Parasternal access provides optimal conditions for performing an adequate thymectomy, does not require single lung ventilation and could be used after previously performed pneumonectomy.

INTRODUCTION. Chest wall tumors represent a variety of morphological forms and variants of lesions. According to different authors, primary malignant tumors of the chest wall account for 0.2–2 % of all malignant neoplasms. Of them, soft tissue sarcomas constitute about 45 %. Metastatic tumors of the chest wall occur much more frequently and most commonly develop from malignant tumors of the mammary, prostate and thyroid glands, lungs, kidneys and ovaries.

MATERIALS AND METHODS. The standard of the treatment of primary and metastatic tumors of the chest wall is combination or comprehensive therapy. In some cases, preoperative care allows to create a more favorable environment for performing surgical treatment being considered the best option for chest wall tumors. The choice of a technique for the replacement of the post-resection chest wall defect is of special importance to preserve the physiological chest volume, to restore chest rigidity, to prevent paradoxical respiration and to seal the pleural cavity.

RESULTS. There are different surgical techniques for skeleton reconstruction. A wide range of materials used for a skeleton reconstruction include bone tissues obtained from patient’s own body (bone autoplasty, autografts), polymeric mesh (polypropylene, polytetrafluoroethylene (Gore-Tex), bone cement (polymethyl methacrylate), stainless steel and titanium constructions as well as titanium bars and rib clips (STRATOS). In spite of a large number of techniques for sternal reconstruction described in the literature, searching for new materials and ways of their usage appears relevant.

CONCLUSION. Our clinical case studies demonstrate that modern reconstructive techniques combined with careful surgical planning allow to perform radical surgery with a successful outcome preventing serious postoperative complications.

An overview of the clinical observation of a patient with the consequences of severe traumatic brain injury, with a tracheoesophageal fistula is presented. The article discusses a staged multidisciplinary approach to treatment.

Placentoid transformation (in English publications – placental transmogrification) extremely rare lung disease, characterized by formation of villous structures, which look like chorionic villus with pulmonary emphysema. We report the first case of 28 y. o. patient with giant placentoid transformation and chronic obstructive pulmonary disease. We used extracorporeal membrane oxygenation support for surgical management and it let the oxygen-dependent patient to return to normal life.

Aortic injury in closed chest trauma takes the second place in the structure of mortality in closed injuries. The type of aortic injury is a crucial factor in determining the optimal timing of the operation. For many years, the treatment strategy was reduced to immediate surgical intervention. The mortality rate in open operations is still high. The widespread introduction of endovascular technologies and aortic endoprosthetics has significantly reduced mortality and reduced the number of severe postoperative complications. With the advent of new endoprostheses, the possibilities of treatment have increased even more and its results have improved for various aortic injuries. A case of successful treatment of a patient with traumatic dissection and pseudoaneurysm of the thoracic aorta by endoprosthetics is presented.

Plastic replacement of osteochondral defect of the chest wall after surgical treatment of osteomyelitis of the sternum and ribs is a complex and topical issue in surgery. Often, an extensive post-resected defect of the sternum and ribs is combined with instability of the frame of the chest wall and thoracoabdominal hernia, which leads to physiological and socio-psychological maladaptation of the patient. The case of successful replacement of an extensive chest wall defect in combination with a ventral hernia in a patient after combined treatment of breast cancer complicated by osteomyelitis of the sternum and ribs is presented. TiNi- reinforcing rib prostheses and TiNi-mesh were used to create the frame of the chest wall and hernioplasty. 5-year follow-up did not reveal a recurrence of osteomyelitis and ventral hernia, implant displacement and instability of the frame of the chest wall. The method of reconstruction of an extensive thoracoabdominal defect using bioadaptive implants from TiNi is safe and effective in patients at the final stage of surgical treatment of osteomyelitis of the chest wall including in combination with ventral hernia. Thanks to the developed technology, an excellent functional result was achieved.

A clinical case of surgical treatment of renal cancer with tumor thrombosis of the inferior vena cava is presented. A rare operation was performed – nephrectomy and resection of the retrohepatic part of the inferior vena cava with a thrombus.

This study was aimed to analyze the most common diagnostic and therapeutic errors in orthopaedic oncological diseases. Bone tumors usually do not have characteristic symptoms, especially in the early stages of disease development. Therefore, they can often mimic benign tumors and non-tumor diseases. Careful history taking, detailed clinical and X-ray examinations in a timely manner are essential diagnostic tools for patients with bone sarcomas. Moreover, a correct analysis of clinical and radiological findings with regard to the dynamic relationship between them can help make more accurate diagnosis at the first doctor’s visit. Subsequent X-ray examinations performed in oncological centers using special methods such as spiral CТ, MRI, PET/CT with mandatory morphological verification of the diagnosis enable us to make a more precise diagnosis and to provide an objective assessment of pathological processes. The most common diagnostic and therapeutic errors that occur in orthopaedic oncological diseases were analyzed. In 35 % of cases, diagnostic or tactical errors were made by general practitioners. In 15 % of cases, the errors were associated with a latent course of disease and 12 % of cases were wrongly diagnosed as a benign neoplasm.

The function of the respiratory parenchyma remaining after lung resection is one of the determining factors of the immediate result of the operation and the postoperative quality of life. A number of studies have been conducted to objectify the preoperative prognosis of the functional safety limit of thoracic interventions using a variety of methods and formulas. Unfortunately, until now, there is no convincing data on the correctness of at least one of the proposed methods for predicting respiratory function. The process of rehabilitation of postoperative ventilation function in the lungs is affected not only by the volume of parenchymal resection, but also by the area of resection, the method and trauma of access, the severity of emphysema, intraoperative trauma of mediastinal structures, postoperative progression of pulmonary fibrosis, etc., and video assisted surgery and segmental resections do not provide an obvious functional advantage in the long term after operations. During the first year after anatomical resection of the lung, functional indicators usually improve. Reasons (or reason) of such improvements are not always clear and may be associated with compensatory growth of the pulmonary parenchyma in a number of patients.

Injuries of abdominal and retroperitoneal major veins, especially in combination with pelvic fractures, are accompanied by high mortality and require further improvement of treatment tactics. The objective of the study was to analyze the data from Russian and foreign literature for improving the treatment of patients with injuries of the major abdominal veins, including pelvic bone fractures, by General surgeons. The article considers treatment options for patients with damage to major abdominal veins, describes the methods of temporary and final hemostasis, features of temporary prosthetics and vascular suture, and considers indications for endovascular interventions. CONCLUSION. Indications for endovascular methods of treatment of injuries of abdominal and retroperitoneal major veins are expanded. For general surgeons, knowledge of rational approaches and methods of temporary and final hemostasis is necessary to save the life of the sufferer.

A review of the manual for physicians «Mediastinitis» published in 2020, written by the famous Russian surgeon and scientist Professor Mikhail Mikhailovich Abakumov, is presented. The manual is based on the study of pathogenesis and practical experience in the diagnosis and treatment of patients with various forms of mediastinitis at the Sklifosovsky Research Institute for Emergency Medicine for 40 years. Sections of the manual include the history of the problem, terminology and classification issues, pathogenesis, clinical presentation and diagnosis, surgery and postoperative treatment of mediastinitis. The manual is intended for a wide range of surgeons who may be involved in acute mediastinitis diagnosis and treatment.