An outstanding Soviet and Russian pediatrician and pediatric surgeon, one of the founders of pediatric surgery in the USSR and the founder of the Leningrad Scientific School of Pediatric Surgeons, Doctor of Medical Sciences (1960), Corresponding Member of the USSR Academy of Medical Sciences (1963) and RAMS (1992), laureate of the USSR State Prize (1979), Honored Doctor and Honored Scientist of the RSFSR (1994), Professor (1962) Girey Alievich Bairov was born on May 2, 1922 in Alushta. In 1955, G. A. Bairov was the first in the Soviet Union to successfully operate on a newborn boy with esophageal atresia and tracheoesophageal fistula. In 1959, he was elected head of the Department of Pediatric Surgery with Orthopedics and Anesthesiology at the Leningrad Pediatric Medical Institute. In 1960, he defended his doctoral dissertation on the topic: «Fractures in the elbow joint in children». G. A. Bairov was a very versatile surgeon: he perfectly operated on newborns, children of different ages with various diseases of the chest and abdomen, performed urological, traumatological and orthopedic interventions, operated on the spine. In 1963, for outstanding achievements in the development of pediatric surgery, he was elected a corresponding member of the USSR Academy of Medical Sciences. For the development of methods of surgical treatment of congenital and acquired diseases of young children, he was awarded the State Prize of the USSR in 1979. G. A.Bairov was the author and co-author of about 400 scientific papers, including 20 monographs and textbooks, more than 40 inventions, rationalization proposals, new methods of surgical interventions. Under his direct supervision, 31 doctoral and 120 master’s theses were defended. Professor G. A. Bairov passed away on July 6, 1999 and was buried at the Smolensky cemetery in St. Petersburg.

The OBJECTIVE was to show the effectiveness of a new method for stopping nosebleeds in patients with nasopharyngeal cancer using endovascular superselective chemoembolization of the tumor arterial bed with HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin.
METHODS AND MATERIALS. The results of treatment of 94 patients who against the background of progressive growth of nasopharyngeal cancer and ongoing combined treatment in oncology centers experienced nosebleeds are presented. In all these patients, according to the results of examinations in cancer centers, no convincing source of nosebleeds was identified. In the conditions of Polenov Neurosurgical Institute, 94 patients underwent endovascular superselective chemoembolization of the vasculature of nasopharyngeal cancer. The embolizate was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50 mg). All patients were included in the study in the absence of contraindications and after signing a voluntary informed consent approved by the ethics committee. The selection of patients was carried out according to the following criteria: thorough morphological verification of the neoplasm; locally advanced process of III and IV stages (T2-4 N0-2M0); no history of other cancers; absence of individual hematogenous metastases; absence of competitive pathology in the stage of decompensation; age was over 18 years old. All patients underwent induction-simultaneous chemoradiotherapy (CRT) with the use of radiation therapy in the usual dose fractionation regimen.
RESULTS. The hemostatic effect was achieved in all 94 patients due to sequential superselective chemoembolization of the vasculature of the tumor itself with embolizate, which was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50mg). In the future, nosebleeds in these patients did not occur. The main sources of nosebleeds were the following branches of the external carotid artery: in 46.2 % of cases – the maxillary artery, in 37.6 % – the ascending pharyngeal artery, in 8.6 % – the occipital artery, in 5.4 % – the artery of the carotid node, in 2.2 % – other branches of the external and internal carotid arteries on one side or on both sides.
CONCLUSION. The method of endovascular superselective chemoembolization with doxorubicin of the vasculature of nasopharyngeal cancer complicated by nosebleeds developed and introduced into medical practice was the initial stage of the combined treatment of these neoplasms. A good hemostatic effect was achieved in all 94 patients.

INTRODUCTION. Drug-resistant tuberculosis with subtotal and total lesion of one of the lungs is the most common indication for pneumonectomy. This operation is accompanied by a high risk of postoperative complications, among which the most dangerous is pleural empyema with bronchopleural fistula. In this regard, the prevention of this complication is an extremely important task.
The OBJECTIVE was to study the results of using a diaphragmatic flap to prevent the development of right main bronchus stump insufficiency with bronchopleural fistula in patients with destructive pulmonary tuberculosis. METHODS AND MATERIALS. A retrospective study was carried out for the period from 2015 to 2019. The study included 13 patients who underwent right-sided pneumonectomy with diaphragmoplasty of the right main bronchus stump. Indications for diaphragmoplasty were: persistent bacterial excretion at the time of surgery, pre-existing bronchopleural fistula, intraoperative pleural contamination, progressive course of a specific process.
RESULTS. The postoperative period was smooth in 10 (77 %) patients. Postoperative complications developed in 3 (23 %) patients: in 1 (7.7 %) case, there was right main bronchus stump insufficiency with bronchopleural fistula and in 2 (15.3 %) cases, there were right main bronchus stump insufficiency without bronchopleural fistula. A satisfactory immediate result was achieved in 12 (92.3 %) patients.
CONCLUSION. The diaphragmatic flap is a reliable material for plasty of the right main bronchus stump in order to prevent the formation of bronchopleural fistula in destructive pulmonary tuberculosis.

The OBJECTIVE was to evaluate methods for the prevention of gastrointestinal bleeding in patients after endovascular surgery on the arteries of the lower extremities for critical ischemia.
METHODS AND MATERIALS. The study included 188 patients treated in the vascular surgery department of A. A. Polyantsev General Surgery Clinic of Volgograd State Medical University for obliterating atherosclerosis of the arteries of the lower extremities in the period from 2017 through 2021.
RESULTS. There was a relationship between the indicator that the patient indicated independently – the number of painkillers taken per day to reduce pain, and erosive and ulcerative lesions of the stomach and duodenum in both groups. The increasing number of operations with critical lower extremity ischemia (СLEI) and the expected decrease in the number of amputations indicates the increased capabilities of vascular and X-ray endovascular surgeons in preserving the extremity and ultimately the life of patients with decompensated forms of obliterating lesions of the extremities. This group of patients had a large number of perioperative complications from various organs and systems, including a high probability of gastrointestinal bleeding.
CONCLUSION. An increased risk group for the occurrence of gastrointestinal bleeding (GIB): patients with repeated reconstructions, surgical corrections of complications or amputations at various levels, as well as taking anticoagulants in therapeutic dosage. Long-term routine prevention of acute erosive and ulcerative lesions of the stomach and duodenum, gastrointestinal bleeding with proton pump inhibitors is not acceptable for this group of patients. It is necessary to have a complex effect on the factors of aggression – the exclusion of the use of NSAIDs, total eradication.

The OBJECTIVE was to evaluate long-term results of the use of «closed» techniques of surgical treatment of pilonidal disease.
METHODS AND MATERIALS. The study included 147 patients who underwent excision of the pilonidal sinuses according to Karydakis – 28 and excision of the pilonidal sinuses with mobilization of the gluteal fascia – 89, laser obliteration using Filac Fistula Probe – 30 patients. To assess the long-term results, a questionnaire survey of patients, a face-to-face examination and ultrasound of the soft tissues of the postoperative scar area, statistical data processing were carried out.
RESULTS. By primary intention, wounds healed in 91.4 % of patients. Complications were observed in 10 (8.5 %) patients: postoperative wound seromas – 8, wound hematoma – 1, postoperative wound suppuration – 1. After mobilization of the gluteal fascia, recurrence of the disease was established in 4 (4.4 %) patients, after obliteration with the use of laser energy and Filac Fistula Probe – in 4 (13.3 %) patients. No relapse was diagnosed after Karydakis procedure.
CONCLUSIONS. Operations using «closed» techniques are effective methods of surgical treatment of pilonidal disease. At the same time, there is a low percentage of complications, relapses of the disease and a short period of rehabilitation.

The OBJECTIVE of the study was to analyze the results of treatment of patients with lightning scrotal gangrene (Fournier’s gangrene).
METHODS AND MATERIAL. The work is based on the analysis of the results of treatment of 31 patients with Fournier’s gangrene aged 32 to 82 years. In 19 (61.3 %) patients, the most probable nosological causes of Fournier’s gangrene were diseases of the anorectal zone, in 10 – pathology of the urogenital sphere. In 2 patients, Fournier’s gangrene developed as a result of a closed injury (1) and a gunshot wound (1) of the perineum and scrotum. A limited (slowly progressing) form of the disease was observed in 18 (58.1 %) patients, a common form with a lightning (9) and rapidly progressing (4) course – in 13 (41.9 %). 6 (19.3 %) patients suffered from diabetes mellitus of varying severity. In all patients, the clinical manifestations of the disease and laboratory parameters were characterized by the phenomena of generalized surgical infection with signs of systemic inflammatory response syndrome and endotoxicosis. In 93.5 % of patients, causative microflora was represented by various associations of both facultative-anaerobic and obligateaerobic gram-negative and obligate-facultative anaerobic gram-positive microorganisms. The growth of anaerobic gramnegative non-clostridial flora was also obtained.
RESULTS. Out of 31 patients, 6 (19.3 %) patients died who had a common form of FG with a lightning and rapidly progressing clinical course in the format of systemic inflammatory response syndrome and systemic endotoxicosis with an outcome in organ-system dysfunction. The causes of death were: septic shock (in 1), progressive systemic endotoxicosis (sepsis) with the outcome of multiple organ failure (in 3) and pulmonary embolism (in 2).
CONCLUSION. Multidisciplinary approach to solving organizational and therapeutic and tactical tasks with the participation of doctors of related specialties, active surgical tactics in the format of «aggressive surgery», providing for the widest possible excision of necrotic and non-viable tissues, performed in combination with programmed (stage-by-stage) sanitation necrectomy, pathogenetically justified correction of violations of the homeostasis system, rational antibacterial therapy, a comprehensive system of local wound treatment and plastic replacement of lost integumentary tissues are priority ways to optimize the results of treatment of patients with Fournier’s gangrene.

OBJECTIVE. Relapses of diabetic foot ulcers are an urgent problem of outpatient surgery, however, risk factors for relapse, as well as the definition of relapse itself remain a subject of discussion. The presented study investigates the frequency of relapses of ulcerative foot defects in diabetes mellitus, the risk factors for their development and treatment outcomes, based on the definition of relapse as the development of a repeated defect in the same place as the healed defect.
METHODS AND MATERIALS. The data of 1714 patients with foot ulcers (2213 ulcerative defects) from 01.2012 to 01.2017 were studied. Patients were divided into two groups: with relapses (n=239, 13.9%) and without them (n=1475). Risk factors for relapse, characteristics of patients and ulcerative defects, and treatment outcomes were evaluated.
RESULTS. Relative risk for relapse: type 1 diabetes mellitus (1.36); Charcot foot (1.65); history of amputation of the great toe (1.35); severe polyneuropathy (1.25); neuropathic foot (1.37). Relapses/single ulcer (%): superficial lesion 72.8/63.3 (р<0.01); primary healing: 61.1/52.7 (p=0.025); healing after surgery (amputations excluded): 4.2/4.5 (ns); amputations: 7.1/6.6 (ns) of which major 5.9/20.6 (p=0.01); non-healing (%): 11.7/5.5 (р=0.001); loss of follow-up (%): 15.9/30.7 (р=0.0001). Median duration of the treatment (days) of relapses/single ulcer: conservative 147/114; healing after surgery (amputations excluded) 241/170; after amputation 286/182. Revascularization in relapses – 7 (100%), with single ulcers – 66 (59.5% of patients with critical ischemia).
CONCLUSION. 5-years relapse rate was 13.9 %. Patients with Charcot foot, postoperative deformities and with neuropathic form of diabetic foot syndrome are more prone for foot reulceration. Recurrent ulcers are characterized with longer duration of the treatment however their primary healing rate is higher compared with single ulcer group. The results of the study were significantly influenced by the high frequency of loss of follow-up in both groups.

The OBJECTIVE was to promote the official introduction into clinical practice of the term «fibrinothorax» as a separate nosological unit and a special form of exudative pleurisy. This term reflects the essence and timing of the pathological process in the pleural cavity and defines a specific set of necessary therapeutic and diagnostic measures.
METHODS AND MATHERIALS. 67 patients with fibrinothorax of different volumes were examined and treated. Two methods of pleural cavity sanitation were used: operative (thoracoscopic) and «closed» with the use of proteolytic enzymes.
RESULTS. Among 67 patients, the leading cause of fibrinothorax was nonspecific (para- and metapneumonic) pleurisy – 48 (72 %) patients. In 7 (10 %) cases, fibrinothorax was established, which complicated the course of pleurisy of tuberculous etiology. In 6 (9 %) cases, pleural effusion was a transudate, in which, against the background of repeated punctures and long periods of fluid accumulation in the pleural cavity, partial delineations in the form of fibrinothorax formed. Carcinomatous pleurisy was diagnosed in 6 (9 %) patients of the study group. Pleural cavity sanitation through the use of proteolytic enzymes was performed in 49 (73 %) of 67 patients. Thoracoscopic sanitation with biopsy for fibrinothorax was performed in 18 (27 %) patients. This material formed the basis of the concept of diagnosis of fibrinothorax and optimization of treatment.
CONCLUSION. The introduction of the term «fibrinothorax» into clinical practice, reflecting the essence of this pathological condition, contributes to the formation of a treatment and diagnostic algorithm aimed at the sanitation of the pleural cavity in optimal ways.

The OBJECTIVE was to improve the results of pancreatoduodenal resection by reducing the incidence of pancreatoenteroanastomotic leak and postoperative pancreatitis with a «soft» pancreatic stump.
METHODS AND MATERIALS. A new method for the formation of pancreatoenteroanastomosis has been developed and implemented: precision wirsungojejunoanastomosis with additional wide atraumatic peritonization of the pancreatic stump cutoff with the loop of the small intestine. From February 2016 to March 2018, this method was tested in 18 patients.
RESULTS. Pancreatoenteroanastomotic leak of class A was noted in 2 (11.1 %) patients, was transient, asymptomatic, did not require additional medical measures and did not extend the duration of the postoperative period. There were no pancreatoenteroanastomotic leak of classes B and C, pancreonecrosis of the stump, lethal outcomes. Objectively worst statistical results were obtained in the comparison group.
CONCLUSION. The formation of the small intestine anastomosis with a «soft» pancreatic stump according to the proposed method for pancreatoduodenal resection reduces the incidence of postoperative pancreatitis of the stump and pancreatoenteroanastomotic leak.

Bochdalek hernia (HB) is a congenital defect of the diaphragm, which in the neonatal period can lead to a lifethreatening cardio-respiratory distress syndrome. Bochdalek hernias rarely unnoticed until adulthood. When diagnosing HB, a radical method of treatment is surgery, which avoids complications such as perforation and necrosis of migrated organs from the abdominal cavity. To date, standard approaches for performing surgical intervention have not been defined. Reconstruction of the diaphragm is possible from both the abdominal and thoracic cavities. This paper presents a clinical case of thoracoscopic reconstruction of giant diaphragmatic HB in the adult.

А clinical case of septic shock treatment with new approved for clinical use hemoperfusion columns Efferon LPS of multi-purpose action, which are capable of removing LPS and cytokines from the blood, is presented. A 75-year-old patient 8 hours after surgery for widespread peritonitis, which developed due to obturation intestinal obstruction and rupture of the cecum, in a state of septic shock (SOFA 10, sympathomimetic support with norepinephrine 0.56 μg/kg per minute) underwent in addition to the treatment 2 sessions of hemoperfusion (120 minutes each) with an interval of two days. The next day after the first session of hemoperfusion, blood pressure returned to normal. Over the next 5 days, impaired organ functions gradually recovered (SOFA dynamics from 10 to 1 point) and the level of procalcitonin in the blood decreased from 98 to 5 ng/ml. A decrease in the concentration of IL-6 in the blood was noted: from 1686 to 1388 pg/ml after the first session, from 692 to 411 pg/ml after the second and up to 350 pg/ml on the following days. The content of CD14⁺ blood monocytes also decreased: from 0.13·10⁹/l to 0.03·10⁹/l after the first session and from 0.30·10⁹/l to 0.18·10⁹/l after the second. The patient was in intensive care for 8 days and was discharged from the hospital after 24 days. The use of hemoperfusion column for the adsorption of cytokines and LPS in an extremely severe patient with septic shock was safe. One of the effects of using the column was the removal of LPS-activated CD14⁺ monocytes and CD14⁺ granulocytes from the blood, which helped to reduce systemic inflammation and the severity of multiple organ disorders.

Three clinical cases of endoscopic and traditional surgical treatment of patients with a rare pathology – colon lipoma are presented. The diagnosis was established by colonoscopy and biopsy with histological examination. In one observation, the lipoma was removed endoscopically, in two cases, by open surgery. The postoperative period was uneventful, within 12–24 months, there was no recurrence of the disease. The presented cases show the possibility and effectiveness of both endoscopic and open surgical methods for the treatment of patients with colonic lipoma.

The recommended drugs for the treatment of COVID-19 are, on the one hand, experimental in nature, but at the same time, they have many side effects that cause long-term complications in organs and systems, including osteoarticular. Based on the analysis of modern domestic and foreign literature, to determine the effect of not only the new coronavirus infection COVID-19, but also the drugs used to treat it, on the human osteoarticular system. In the course of the study, a scientific search was made for publications in the electronic databases PubMed, MedLine and e-Library for the period from January 2000 to October 2021 for the main keywords. Due to successive “waves” of the COVID-19 pandemic, the number of patients receiving non-specific therapy, including corticosteroids, will increase in the coming years. Preliminary data on COVID-19 and similar trends during the Sars-COV-1 epidemic of 2003 show that the pathogenesis of Sars- Cov-2 and its treatment with high doses of corticosteroids may increase the risk of osteonercosis in patients, which will inevitably lead to an increase in orthopedic diseases in patients not only the middle age group, but also young patients in the near future. Currently, studies are required aimed at risk stratification, studying the pathogenesis of damage to the musculoskeletal system after COVID-19 and the effectiveness of preventive and therapeutic measures in such patients.

Combined anterior and posterior approaches are required in spinal tumor surgery and considered highly invasive. Anatomical and physiological features of the surgical intervention area should be taken into consideration as well. Thus, these criteria reflect the severity of intraoperative complications during the surgical treatment of spinal tumors. The authors reviewed the scientific literature on the frequency and nature of complications in surgical interventions for spinal tumors.The most significant risk factors for intraoperative complications have been considered, the main of which are: the proximity of the location of the main vessels and viscera, the development of postoperative liquorrhea, as well as surgical site infection. Based on the studied information, we presented the methods of prevention and surgical tactics options in complications.