Professor Gavriil Abramovich Ilizarov was born on June 15, 1921 in the town of Bialowiez in the Bialystok Voivodeship of the Polish Republic. Gavriil was able to go to school only at the age of 11, but his level of education allowed him to pass the exams for the elementary grades, and he was enrolled immediately in the fourth grade. He graduated from the eight-year school with excellent marks and in 1938 continued his studies at the medical faculty in the city of Buinaksk, Dagestan ASSR. In 1939, Gavriil Abramovich entered the Crimean State Medical Institute, after graduating from which in 1944 he worked as a doctor in Polovinskaya and then Kosulinskaya district hospitals of the Kurgan region. At this time, Ilizarov came up with a brilliant idea for the treatment of complex fractures of long tubular bones with the fixation of their fragments with a special metal controlled device instead of blind and static plaster immobilization. In 1955, G. A. Ilizarov was appointed head of the Traumatological and Orthopedic department of the Kurgan Regional Hospital for the Disabled of the Great Patriotic War, where he began to apply his invention. The first official scientific recognition of G. A. Ilizarov received his dissertation «Transosseous compression osteosynthesis by the author’s apparatus (experimental and clinical study)» in September 1968 in Perm. In 1966, on the basis of the 2^nd city hospital of Kurgan, the problem laboratory of the Sverdlovsk Research Institute of Traumatology and Orthopedics was organized, the head of which was Gavriil Abramovich, and in 1969 the laboratory was transformed into a branch of the Leningrad Research Institute of Traumatology and Orthopedics named after R. L. Vreden and its director was appointed G. A. Ilizarov. Since 1982, the triumphant introduction of the Ilizarov method into the practice of leading foreign countries began, and the press gave the author the enthusiastic title of «Michelangelo in orthopedics». Gavriil Abramovich successfully engaged in public activities, was elected deputy of the district and regional Councils of Workers‘ Deputies, deputy of the Supreme Soviet of the RSFSR, People’s Deputy of the USSR. For his great achievements in medical science and outstanding services to the national and world health care, G. A. Ilizarov was awarded the highest state awards, academic and honorary titles of the USSR and many foreign countries. Academician Gavriil Abramovich Ilizarov died suddenly of heart failure on July 24, 1992 in Kurgan and was buried in the central alley of the new Riabkovskое cemetery in Kurgan.

The OBJECTIVE was to study the nature of blebbing formation of peripheral blood leukocytes in patients with diabetic foot syndrome, the effect of treatment on this process.

METHODS AND MATERIALS. The data of treatment of patients of the Department of Purulent Surgery of the City Clinical Hospital No 6, Izhevsk, 2019–2020 (clinic of the Department of General Surgery of Izhevsk State Medical Academy) were analyzed. 2 groups of patients with diabetic foot syndrome n1 (Meggit – Wagner 1–2) and n2 (Meggit – Wagner 0) were formed. The blebbing formation of neutrophils and lymphocytes, parameters of integral leukocyte indices, data of the scale of the general assessment of neuropathy and the Michigan screening test, indices of planimetry of ulcerative defects were studied.

RESULTS. It was revealed that the blebbing formation of neutrophils and lymphocytes in the studied groups was different, which was reflected in a decrease in these indices in the n1 group and an increase in the n2 group. Integral indices revealed a decrease in immunoreactivity and nonspecific reactivity. In the dynamics of treatment, there was an improvement in the data of the scale of general neuropathy and the Michigan screening test.

CONCLUSION. The studied indices of blebbing formation correspond to the indices of the leukocyte integral indices, the diagnostic scales for neuropathy, reflect the severity of the wound process. The study of blebbing provides objective data on the dynamics of the immune status of patients with diabetic foot syndrome, which allows improving treatment results.

The OBJECTIVE was to assess the incidence, diagnostic abilities and surgical tactics in case of benign tumors of the large bronchi and trachea.

METHODS AND MATERIALS. Benign tumors of the large bronchi and trachea were diagnosed in 29 (6.3 %) of patients among 445 patients with benign bronco-pulmonary tumors. The diagnosis was made due to X-ray and endoscopic studies. Lung resections were performed in 5 (17.2 %) patients. RESULTS. Clinical symptoms were non-specific. In 10 (35.7 %) cases, the disease was diagnosed during X-ray examination. Computed tomography revealed pulmonary changes caused by bronchial narrowing in 5 patients (17.2 %).
The biopsy taken during bronchoscopy detected the histological form of the tumor in 16 (55 %) patients. The exact morphological type of the tumor was identified after its removal. More often, they were polyps (48.3 %), papillomatosis (20.7 %), chondromas (10.3 %), in single cases – teratomas, sclerosing hemangioma, adenoma, mucoepidermoid tumor, histiocytoma, inflammatory pseudotumors. In 24 (82.8 %) patients, tumors were removed during bronchoscopy by electrosurgical or argonoplasmic destruction methods. The repeated surgery for a recurrence was required in 5 (17.2 %) patients in terms of (8.3±4.7) months, three times for two patients. In three cases, we performed lobectomy; in one case, we performed lobectomy with wedge resection of the intermediate bronchus. Pneumonectomy was made in two patients: one patient suspected of cancer after tumor biopsy, the other – complicated with lung gangrene. The latter patient died of pneumonia of the single lung. The mortality rate was 3.4 %.

CONCLUSION. In presence of non-specific pulmonary symptoms resistant to therapy, it is necessary to rule out benign bronchial tumors using X-ray and endoscopy. Most formations can be removed during bronchoscopy. In case of irreversible lung changes or impossible endoscopic removal, we should use surgery.

INTRODUCTION. Bariatric operations lead to changes in body composition. The desired fat loss may be accompanied by decrease of muscle mass, thus raising the risk of sarcopenia.

The OBJECTIVE was to evaluate the long-term results of surgical treatment of morbid obesity and concomitant comorbid conditions, as well as a decrease of muscle mass in the pre - and long-term postoperative period.

METHODS AND MATERIALS. This prospective randomized controlled blind trial included the results of treatment of 241 patients. Patients were divided into 2 groups depending on the type of surgical treatment. The first group consisted of 116 people who underwent RYGB; the second group included 125 patients who underwent OAGB/MGB. 83 patients from the first group and 95 patients from the control group at the preoperative stage and 24 months after the operation randomly underwent bioelectrical impedance with the determination of skeletal muscle mass (SMM) and skeletal muscle mass index (SMMI)=SMM/Height². The calculated SMMI index for men normally corresponds to >10.76 kg/m²; moderate sarcopenia SMMI=8.51–10.75 kg/m²; the SMMI index of ≤8.5 kg/m² corresponds to severe sarcopenia. For women, this index is normally ≥6.76 kg/m²; moderate – 5.76–6.75 kg/m²; severe sarcopenia ≤5.75 kg/m². Bioelectrical impedance were performed on a «AVS-01 Medass» bioelectrical impedance body composition analyzer (Russia). 

RESULTS. The difference in changes in the results of anthropometric indicators, as well as laboratory indicators of diabetes compensation within 24 months in both groups was statistically insignificant (p>0.05). According to bioelectrical impedance data, the incidence of sarcopenia in patient groups was as follows: the initially normal ratio of muscle mass to the square of growth in meters, i.e. normal SMMI in 71 (85.5 %) patients in the group with RYGB, and in 78 (85.7 %) patients in the group with OAGB/MGB. Moderate sarcopenia was detected in 12 (14.5 %) patients with RYGB and 13 (14.3 %) patients with OAGB/MGB. 24 months after the operation, SMMI was distributed as follows – Norm in 59 (71.1 %) patients of the study group and 47 (51.6 %) patients in the control group. Moderate sarcopenia was found in 16 (19.3 %) patients in the group of patients with RYGB, and in 29 (31.9 %) cases in the group of patients with OAGB/MGB. Severe sarcopenia was observed in 8 (9.6 %) patients of the first group and 15 (16.5 %) patients of the second group (p=0.0001).

CONCLUSIONS. Bariatric bypass surgery results in significant changes in body composition 24 months after surgery. Bioelectrical impedance allows to effectively detect these changes. The desired weight loss is associated with a significant decrease in skeletal muscle mass, mineral mass. Thus, patients after bypass surgery are at risk of sarcopenia. Sarcopenia is more pronounced in patients after OAGB/MGB than after RYGB.

The OBJECTIVE was to analyze the results of endoscopic transsphenoidal removal of neoplasms of the chiasmalsellar region in children.

MATERIALS AND METHODS. We studied 23 patients aged 3 to 17 years who underwent endoscopic transsphenoidal removal of neoplasms of the chiasmal-sellar region. Neurological, ophthalmological, endocrine disorders and otorhinolaryngological pathology were evaluated. Neuroimaging data (MRI and CT), results of laboratory tests were studied. In addition, the analysis of surgical treatment including intraoperative and early postoperative complications was performed.

RESULTS. In 39.1 % of cases, neoplasms of supraparainfracellar localization were diagnosed. In 34.8 % of patients, the size of the neoplasms did not exceed 2 cm. In 1 patient, the volume of neoplasm was 53.7 cm³. According to the type of pneumatization, the sellar type prevailed. Сonch type was observed in 1 child. Hemostatic material «Surgicel Fibrillar» was used more often (86.9 %). Plastic surgery of the skull defect was carried out on a floor-by-floor basis with «Tachocomb» plates (62.5 %). Total tumor removal was achieved in 75 % of children. The majority of neoplasms were represented by craniopharyngioma – 30.43 %. In the early postoperative period, there was a significant regression of neurological disorders – by 69.6 %, as well as ophthalmological – by 34.8 % and endocrine – by 37.8 %. There were no cases of nasal liquorrhea and epistaxis in children.

CONCLUSION. Our study demonstrated the success of removing neoplasms in children from 3 years old, regardless of the size of the nasal cavity and pneumatization of the sphenoid sinus. It is possible to use endoscopic transsphenoidal access in children to remove the neoplasms of the chiasmal-sellar region of more than 5 cm, since the risk of intra – and postoperative complications is minimized.

The article describes the stages of diagnostics and treatment of a child with the stomach and jejunum trichobezoars, starting from the regional hospital and ending with a children’s medical republican institution. The operation, which was performed 2 days after the child’s hospitalization, consisted in enterotomy, gastrotomy and the trichobezoars extraction. The postoperative period was uneventful. The significant difficulty in trichobezoars recognition in children requires the development of an action algorithm at all stages of the diagnostic process.

The OBJECTIVE was to evaluate the informative value of various methods for determining the volume of blood loss during early surgical excision with simultaneous skin grafting with split grafts in patients with full thickness burns.

MATERIAL AND METHODS. Our study included 10 patients with burns more than 20 % TBSA. In these patients, from the 2^nd to the 5^th day after the burn, fascial surgical excision with simultaneous skin grafting with perforated split grafts was performed. To assess the volume of operative blood loss, we used visual, empirical (B. S. Vikhriev; 1986, I. V. Chmyrev; 2011, T. A. Housinger; 1993, T. Janezic; 1997) and calculated (J. B. Gross; 1983, P. G. Budny; 1993, G. D. Warden; 1982) methods. The obtained data were processed by the generally accepted methods of nonparametric statistics.

RESULTS. The minimum volume of blood loss was ascertained by visual assessment. We observed the maximum losses in the same patients when using calculated methods. In 5 out of 10 patients, the difference between the minimum and maximum results obtained using different methods exceeded 1000 %.

CONCLUSION. Most of the methods used in burn surgery for determining the volume of surgical blood loss are insufficiently representative. To determine the optimal tactics for surgical treatment of patients with severe burns, it is necessary to create formulas for assessing the volume of blood loss, which will take into account laboratory parameters, features of surgical treatment, hydrobalance indicators, anthropometric data and other variables with high predictive value.

The OBJECTIVE was to study the efficiency and tolerability of minimally invasive surgical methods of treatment in women with bladder pain syndrome (BPS).

METHODS AND MATERIALS. 110 women with a confirmed diagnosis of BPS participated in this study, their age was 19 to 78 years (mean age (44.7±3.3) years). The treatment was divided into 3 consecutive stages. The first line of treatment included behavioral and pharmacotherapy, the second line was hydrodistension of the bladder and the third line of treatment was intravesical botulinum therapy (intravesical injections of botulinum toxin type A at 20 points of the bladder wall, 5 U in each pint, total dose was 100 U). The method of performing bladder hydrodistension consisted of the maximum filling of the urinary bladder at a pressure of 100 cm of water column, exposure time was 2 min, the procedure was repeated twice with an interval of several minutes. The examination of the patients was carried out before treatment and one month after the start of treatment measures at each stage of treatment. Patients were transferred to the next line of therapy if the previous stage was ineffective. Improvement of the patient’s quality of life by at least 1 point according to the QoL questionnaire was used as a criterion for the effectiveness of treatment.

RESULTS. Conservative treatment was effective only in 21 (19.1 %) of 110 treated patients. The remaining 89 patients underwent bladder hydrodistension, the positive results of that were in 46 (51.6 %) patients. Botulinum therapy was effective in 41 (95.3 %) of 43 treated patients with BPS refractory to previous lines of treatment. The effectiveness of minimally invasive methods of treatment was increased in patients with a lower initial bladder capacity, higher stage of cystoscopic changes in the bladder wall and severity of clinical manifestations of the disease. The tolerability of the treatment was satisfactory.

CONCLUSION. The results of the study showed high efficiency and good tolerability of minimally invasive methods of treatment in women with BPS.

The OBJECTIVE of the study was to analyze the results and to introduce our experience of the laparoscopic pyeloplasty regarding the stricture of the pyeloureteral segment.

METHODS and MATERIALS. Our study represents results of treatment of 114 patients who had surgical treatment during the years 2013–2018. In that period, we made 114 primaries and 9 secondaries laparoscopic pyeloplasties with transperitoneal access. In this account, there were 43 men aged from 19 to 64 years, average age was (34.9±3.7), and 71 women aged from 19 to 77 years, average age was (39.2±4.2). All patients underwent ultrasound examination of the kidneys on the day of discharge and 3-5 days after stent extraction. Control examination, which included history taking, examination, clinical and biochemical blood analyses, clinical urine analysis and ultrasound of the kidneys were performed after 3 months. Plain and excretory urography were performed 6 and 18 months after surgical intervention. 

RESULTS. Operative removal of the stricture of the pyeloureteral segment was successful in 105 (92.2 %) out of 114 cases. 9 patients (7.8 % of the total number of operated patients) underwent repeated laparoscopic pyeloplasty. Duration stay after primary laparoscopic pyeloplasty was from 3 to 5 days, on average (3.9±0.7) days. Postoperative period after secondary pyeloplasty was without complications, the bed-day was from 3 to 6 days, on average (4.3±0.6) days.

CONCLUSION. Our opinion is that the optimal method for surgical treatment of patients with primary and secondary strictures of the pyeloureteral segment is laparoscopic pyeloplasty. This kind of surgery has a favorable security profile and optimal postoperative results. Considering the possible causes of relapse of the stricture of the pyeloureteral segment, we came to the conclusion that the frequency of relapse is mainly connected with selected suture material, which determines the severity of scar changes.

An observation from practice is given – surgical treatment of a patient with advanced tuberculosis of a single lung and a pronounced lung displacement. Patient A., 47 years old, after 3 months from the left pneumonectomy for fibrocavernous tuberculosis complained of dyspnea at rest, and dysphagia, underwent CT scan, which showed a pronounced displace ment of a single right lung with tuberculoma to the left. At the first stage of the surgery, the overstretched section of a single lung with tuberculoma was resected, the displaced lung was put back and a hernial orifice was strengthened with a mesh implant. At the second stage, the extrapleural thoracoplasty was made with resection of I–IV ribs from the side of pneumonectomy to reduce the volume of the left hemithorax and prevent relapse of mediastinal hernia. As a result, the patient stopped dyspnea and dysphagia, radiographically a single right lung was visualized in the right hemithorax.

Pancreatic pleural fistula is one of the rare and difficulty verifying complication of chronic pancreatitis. We present a rare medical case of a patient with chronic pancreatitis complicated by pancreatic pleural fistula with the formation
of multiple lung abscesses. At the same time, the success of the treatment of the patient was due to the staged treatment and the participation of a multidisciplinary team of specialists.

The article provides an example of successful simultaneous surgical treatment of a patient with a thrombotic complication after endovascular intervention (Endovascular aneurysm repair, EVAR) in the long-term postoperative period (2 years) in the presence of concomitant gastric cancer, detected during a follow-up examination before planned surgery.

An observation from practice was devoted to the experience of an interdisciplinary approach in the diagnosis and surgical treatment of a patient with complicated course of Crohn’s disease against the background of the formation of a stricture of the terminal ileum, an enterovesical fistula, the penetration into the mesentery of the sigmoid colon.

In cases when there is a need to visualize the posterior part of the tibia and talus, the subtalar joint and the possibility of performing osteosynthesis or arthrodesis, the most optimal is the posterior surgical approach. The article presents a demonstration of successful arthrodesis of the ankle joint using an LCP plate with angular stability of screws from the posterior surgical approach in a patient with renal osteodystrophy receiving renal replacement therapy. The result of treatment according to the AOFAS scale 4 months after the operation was 70 points, the severity of pain according to the VAS was 1/2 point. Clinical and radiological characteristics were assessed as satisfactory, taking into account the severity of the deformity and the severity of osteoporosis against the background of concomitant pathology.

The main idea of this article is based on the uncertainty of the current recommendations, according to which a temporary shunt (TS) during carotid endarterectomy (CEE) can be used selectively, routinely, and even completely abandon its use. This statement is supported by the low level of evidence (class B) of the conclusion that indications for the use of TS are established only on the basis of a decrease in retrograde pressure in the internal carotid artery (ICA) and/or indicators of cerebral oximetry. Thus, the low efficiency of these procedures makes it possible not to use them at all.

Esophageal anastomoses leakage is a serious and urgent problem of surgical complications with high mortality rates. With the development of endoscopic technologies, minimally invasive methods of treatment are widely introduced into clinical practice with the development of endoscopic technologies in various non-standard situations, including esophageal anastomoses leakage. Stenting is one of the methods of choice in this case. However, the indicators of their effectiveness differ significantly across studies. A retrospective analysis of the stenting results in this severe complication demonstrates many factors influencing the success of esophageal stent implantation. Stents are often selected without due regard to their characteristics, which may affect the results of implantation. One of the most frequent and unfavorable outcomes of stenting is stent migration, which significantly affects the prognosis of the treatment. In this regard, in Russian practice, stenting, as a method of treating for esophageal anastomoses leakage, is introduced only in some institutions. However, many complications can be avoided at present due to the development in endoscopy and the constant improvement of stent designs. The objective of this review was to highlight the main advantages and problems
of stenting in esophageal anastomoses leakage today.

Ivanov A. I., Popov V. A., Burmistrov M. V. Endoscopic stenting for esophageal anastomoses leakage (review of literature). Grekov’s Bulletin of Surgery. 2021;180(3):87–93. (In Russ.)