Professor Nikolay Nikolaevich Blokhin was born on April 21 (May 4), 1912 in the county town of Lukoyanov, Nizhny Novgorod province in the family of a doctor. After graduating from high school in 1929, Nikolay Nikolaevich entered the medical Faculty of Nizhny Novgorod University. In June 1934, N. N. Blokhin graduated with honors from the surgical department and received a diploma from the Gorky Medical Institute. For excellent studies and great abilities for research work, Nikolay Nikolaevich was enrolled in a postgraduate course at the Department of Hospital Surgery. After medical practice, N. N. Blokhin returned to the hospital surgery clinic, continued his research and operated a lot. At the beginning of the Great Patriotic War, a front-line evacuation hospital for a thousand beds № 2816 was deployed in Gorky, Nikolai Nikolaevich was appointed the leading surgeon. In 1947, N. N. Blokhin was appointed deputy director of the Gorky Research Institute of Reconstructive Surgery, Traumatology and Orthopedics for the scientific part, and in March 1948 – director of this Institute. In December 1948, Nikolai Nikolaevich was awarded the academic title of professor. On January 29, 1960, N. N. Blokhin was elected a full member of the USSR Academy of Medical Sciences, and in the evening of the same day, the Minister of Health of the USSR S. V. Kurashov proposed to elect Nikolai Nikolaevich as the president of the Academy. In 1977, the Cancer Research Center of the USSR Academy of Medical Sciences was renamed the All-Union Cancer Research Center of the USSR Academy of Medical Sciences, and N. N. Blokhin was appointed its general director. More than 100 doctoral and PhD theses were defended under his leadership. Many of his students became prominent oncologists in Russia and neighboring countries. The multifaceted, bright and fruitful activity of Nikolai Nikolaevich was repeatedly awarded with high awards of the Soviet Union. On May 16, 1993, Academician Nikolai Nikolaevich Blokhin died and was buried at the Novodevichy Cemetery in Moscow. In the same year, the name of N. N. Blokhin was assigned to the Russian Cancer Research Center of the Russian Academy of Medical Sciences. 

The OBJECTIVE was to estimate the left ventricular stroke volume calculated using the Reuleaux triangle formula, and compare with the parameters obtained from measurements in the left ventricle outflow tract. 

METHODS AND MATERIALS. A prospective cross-sectional study of the dimensions of the left ventricular outflow tract (LVOT), the aortic valve, and the velocity-time integral (VTI) was carried out, followed by calculation of the left ventricular stroke volume in the LVOT and aortic valve in 36 patients receiving renal replacement therapy.  

RESULTS. The sizes of anatomical structures were determined in 36 patients. The average value of the LVOT area was calculated – 3.8 cm2, the average value of the area of the aortic valve (AV) opening was 2.8 cm2, the AV area according to the circle formula – 3.14 cm2, the AV area according to the Reuleaux triangle formula – 2.8 cm2. The mean value of the VTI in the LVOT was 21 cm; the VTI on the AV was 26.9 cm. The stroke volume (SV) in the LVOT was 70.85 ml, the SV on the AV by the area of the AV opening was 70.9 ml, the SV on the AV according to the circle formula – 76.5 ml, SV for AV according to the Reuleaux triangle formula – 68.72 ml. In a comparative analysis of the results of mathematical calculations, it was revealed that, in comparison with the SV in LVOT, the discrepancy between the results was more than 30 % when using the circle formula (χ2=4.1, p=0.04), in comparison with the Reuleaux triangle formula (13.8 % versus 4.1 %, respectively).  

CONCLUSION. Parameters of the left ventricular stroke volume calculated with the Reuleaux triangle formula matches to the reference values selected in the study, calculated for the left ventricular outflow tract. 

INTRODUCTION. The heterogeneity of the population of patients with perforated ulcers determines the need for a targeted research of the results of their treatment, including taking into account the level of comorbidity.

OBJECTIVE. To study the results and develop a predictive model of surgical treatment of perforated ulcers, taking into account the comorbid status of patients.

METHODS AND MATERIALS. The results of treatment of 194 patients with perforated ulcers of the stomach and duodenum were studied. Stratification of patients was carried out taking into account the Charlson-Deyo comorbidity index. The construction of prognostic models was carried out using binary logistic regression.

RESULTS. Depending on the level of comorbidity, during a posteriori comparisons, the incidence of postoperative complications in the third group (46.7%, 28/60) was statistically significantly higher compared to the first (22.8%, 13/57) and second groups (16.9%, 13/77) (χ2 = 15.908, p<0.001).

In a comparative analysis, a prognostic model taking into account the comorbid status of the patient predicted the development of postoperative complications and mortality with the greatest accuracy.

CONCLUSION. Taking into account the comorbid status of patients with perforated ulcer makes it possible to predict with greater accuracy the development of postoperative complications of III-V degree according to Clavien-Dindo.

The OBJECTIVE was to improve the treatment of victims with liver injury in blunt abdominal trauma by using minimally invasive methods of diagnosis and treatment.  

METHODS AND MATERIALS. We analyzed the treatment results of 76 patients with blunt liver injuries using traditional treatment and 78 patients who were treated with the developed new algorithm. In the second group, patients with ultrasound signs of liver injuries and stable hemodynamics (BP>90 mm Hg) underwent MSCT with intravenous contrast. In the absence of ongoing bleeding signs, conservative treatment was carried out; if they were detected, angiography with selective angioembolization was performed.  

RESULTS. There were no statistically significant differences in gender, age, mechanism and severity of injury (according to the ISS, Tsibin, VPH-P scales) and severity of the condition (VPH-SP) between the patients of the groups. More than half (52.3 %) of the victims of the main group were treated without abdominal surgery. By using the proposed algorithm in patients with stable hemodynamics, laparocentesis gave way to less traumatic and more accurate methods of diagnosing intra-abdominal bleedings. All laparotomies in the main group were performed for other abdominal injuries. In the victims of both groups, video laparoscopy was diagnostic in nature. One patient of the main group with liver injury of IV degree according to the AAST scale with ongoing intraparenchymatous and intraperitoneal bleeding underwent endovascular hemostasis.  

CONCLUSION. The use of non-operative and minimally invasive treatment of hemodynamically stable patients with liver ruptures in isolated and combined blunt abdominal trauma allowed to reduce the number of the performed diagnostic video laparoscopies by 24 %, laparotomies by 29 %, and completely abandon laparocentesis as a diagnostic method, reduce mortality rate by 4.6% and the duration of inpatient treatment of surviving patients for 4 days. 

The OBJECTIVE of the study was to demonstrate the results of treatment of children with large foreign bodies of the esophagus and stomach. The article presents five clinical observations of large foreign bodies (LFBs) of the esophagus and stomach. In three children, LFBs was localized in the esophagus – a toothbrush, a metal pendant, multiple magnetic balls. In two children, in the stomach – a tablespoon and Chupa-Chups stick. In four children, LFBs from the esophagus and stomach was removed during esophagogastroduodenoscopy. A tablespoon was removed from the stomach by laparotomy – gastrotomy, after unsuccessful attempts to remove it endoscopically, under general anesthesia. Endoscopic removal of the esophageal and gastric LFBs presents certain difficulties, therefore, the removal of the LFBs should be performed by an experienced qualified specialist. 

Left mesenteric-parietal (paraduodenal) hernias are a rare cause of abdominal pain or acute intestinal obstruction in children (1–2 % of all cases).  

The most common internal hernias can be detected as incidental findings during laparotomy or autopsy. Since the strangulated mesenteric-parietal hernia has no pathognomonic symptoms, which greatly complicates the diagnosis and can lead to a significant deterioration of the patient’s condition up to death with total involvement of the intestinal tube. This article presents a clinical case of diagnosis and treatment of impaired left mesenteric-parietal hernia in a boy of 9 years old. The clinical picture was noteworthy, which was accompanied by intense abdominal pain against the background of error in the dietary.  

During X-ray examination, it is valuable to assess the passage of contrast agent along the upper gastrointestinal tract, which also allows us to assess the location of the duodenum and the initial parts of the jejunum. The example of the described case demonstrates the effective diagnostic tactics, features of the intraoperative picture and surgical treatment of a patient with left mesenteric-parietal hernia. 

The OBJECTIVE was to evaluate the efficacy and safety of hemorrhoidectomy with lateral ultrasound dissection in patients of older age groups.  

METHODS AND MATERIALS. A comparative analysis of the immediate and long-term results of treatment in two groups of geriatric patients suffering from III–IV stages of hemorrhoids was carried out. The main included 27 patients who underwent hemorrhoidectomy using the original technique of lateral ultrasound dissection in the «cutting» mode. The control group consisted of 33 patients who underwent traditional Milligan–Morgan hemorrhoidectomy using electrocoagulation. To assess the traumaticity degree of interventions using light microscopy, pathomorphological changes in remote hemorrhoids were studied, and the dynamics of the wound process was traced.  

RESULTS. The incidence of postoperative complications in the main and control groups was 7 % and 27 % (p=0.09). When assessing the dynamics of the intensity of the pain syndrome within 5 days after the intervention, significantly lower indicators were found in patients who underwent hemorrhoidectomy with lateral ultrasound dissection, which made it possible to significantly reduce the doses of analgesics. A comparative analysis of pathomorphological changes showed statistically differences in the extent of the coagulation necrosis zone, which was significantly less in patients of the main group.  

CONCLUSION. The use of hemorrhoidectomy with lateral ultrasound dissection in geriatric patients reduces the incidence of complications and the intensity of the pain syndrome, as well as speed up their rehabilitation. 

This article presents the clinical observation of the diagnosis and treatment of type II endoleak – complications in the late postoperative period following endoprosthetics of an aneurysm of the infrarenal abdominal aorta in a 64-year-old patient. On the regular follow-up MSCT-angiography, the growth of aneurysmal sac was detected with no obvious signs for the presence of endoleak. During selective angiography of superior mesenteric artery, the path of blood reflux into the isolated aneurysm cavity from the trunk of the inferior mesenteric artery was well visualized. Embolization of the inferior mesenteric artery was performed. Rare anatomical variant of blood supply to the splenic angle and descending colon was revealed. This clinical case describes an effective method for eliminating type II endoleak. 

The article presents a clinical case of a patient with a histologically confirmed cyst of the canal of Nuck, similar at the preoperative stage according to anamnestic, instrumental, objective data with an endometrioid cyst of the inguinal canal.

The article presents a case of successful surgical treatment of pulmonary embolism in a patient with a high risk of early cardiac death on the background of paradoxical embolism complicated by acute cerebrovascular accident. Cryptogenic acute cerebrovascular accident in combination with severe progressive right ventricular failure on the background of pulmonary embolism causes serious difficulties in making decisions regarding treatment tactics in these patients. Intracardiac localization of thromboemboli, threatened by the development of recurrent pulmonary embolism, as well as paradoxical embolism, requires immediate implementation of a differential diagnostic complex aimed at verifying the pathophysiological mechanism of the disease, which largely determines the effectiveness of the treatment. The analysis of the available literature data, given in the work, as well as the analysis of the clinical case, make it possible to develop a tactical algorithm in this group of patients and to determine the indications for open heart surgery.

We presented the case history of a 71-year-old patient who underwent sternotomy and aortic valve replacement, which was complicated by the development of poststernotomy mediastinitis. A good result was noted in the treatment with vacuum-assisted dressings at the stage of wound cleansing, followed by plasty of the anterior chest wall with a skinsubcutaneous-fascial-muscular flap on the superior epigastric artery. 

Classical aortic valve replacement is often fraught with negative outcomes for patients. When replacing the aortic valve with a mechanical valve prosthesis, the patient is associated for life with the use of indirect anticoagulants, which often leads to hemorrhagic and thrombotic complications. In the case of replacement of the aortic valve with a biological prosthesis, a fairly frequent complication is early calcification and, consequently, a high frequency of dysfunctions of the biological prosthesis. In addition, mechanical and biological prosthetics of heart valves are quite expensive, which creates a serious economic load on the healthcare institution. But in the last decade, the technique of neocuspidization of the aortic valve with autopericardial flaps has been introduced into wide cardiac surgical practice, which is a clear alternative to prosthetics of heart valves.

We described a clinical observation of the use of early rehabilitation (Fast-Track protocol) in two-stage revision hip arthroplasty in a patient with a periprosthetic femoral fracture complicated by the development of a deep paraprosthetic infection. 

Despite certain successes in the treatment of epilepsy, primarily associated with the active development of pharmacology, in 30% of cases, there is a resistant course, especially focal forms of temporal lobe epilepsy. Mesial temporal sclerosis (MTS) is one of the most common causes of drug-resistant epilepsy. Conservative treatment could help only in 90–92 % of cases. In other cases, surgical treatment is required for improving the quality of life of such patients. However, the percentage of surgical care for epilepsy remains low. Structured information on clinical signs, diagnostic techniques, approaches to surgical treatment and its outcomes should contribute to understanding the problem among specialists. Data on the effectiveness of operations in patients with drug-resistant epilepsy can help in timely hightechnology care for patients with mesial temporal lobe epilepsy. 

Severe acute panreatitis is a life-threatening disease with mortality rates of about 15%. With the development of infected necrotizing pancreatitis, complicated by the development of organ failure, the mortality rate is 35.2%. Due to the fact that acute pancreatitis is a highly variable pathological process, leading to a wide range of clinical outcomes, predicting the severity of the disease and early identification of patients at risk of developing severe complications is critical to optimize treatment outcomes for this disease. Currently, there are no uniquely accurate and practically available laboratory tests to predict the severity of patients with acute pancreatitis. The review presents literature data on the terminology and classifications of the severity of acute pancreatitis, taking into account the possibilities of their practical application. Information on clinical scale systems for assessing the severity of acute pancreatitis with an assessment of their effectiveness in predicting various treatment outcomes is presented in detail. The characteristics and capabilities of various laboratory markers in the assessment of organ failure and diagnosis of systemic complications of acute pancreatitis are presented. Currently, for the best assessment of the severity of acute pancreatitis, it is necessary to use a multidisciplinary clinical examination of patients and a combination of various predictive tools.

Despite the improvement of endovascular technologies, the method of choice for multi-vascular lesions of the coronary arteries today remains coronary bypass surgery. However, in a range of patients, it is possible to perform hybrid revascularization – a technique with minimal injury that preserves good long-term results similar to those of coronary bypass surgery. The review analyzes current data from the world literature and current trends in the choice of the revascularization method.

Georgy Savvovich Chepcheruk was born on September 8, 1942 in the village of Gremyache, Rivne region of the Ukrainian SSR. After graduating from elementary school in 1955, he studied at the Dubna Medical School in the Rivne region until 1958. Then, for two years, he worked as the head of the feldsher-midwife station. In 1960, he was drafted into the ranks of the Soviet army. He began his service as a paramedic of an artillery regiment, from where, in 1962, he entered the Military Medical Academy named after S. M. Kirov. He graduated from the Academy in 1968 with a GOLD MEDAL. After graduating from the Academy, he served for 4 years as the head of the medical service of a submarine in the Red Banner Black Sea Fleet. In 1972, having successfully passed the entrance exams, he entered the postgraduate course at the Department of Hospital Surgery of the Military Medical Academy named after S. M. Kirov. In 1976, he defended his PhD dissertation on the subject: «Clotted hemothorax and early fibrinothorax after pneumonectomy». He held positions from teacher to deputy head of the department. From 1984 to 1987, he served in the Democratic Republic of Afghanistan as an adviser to the chief surgeon of the Central Military Hospital in Kabul. In 1988, he defended his doctoral dissertation on the subject: «Pathogenetic bases for the prevention and treatment of pleural empyema». From 1989 to 1994 – Deputy Head of the Department of Hospital Surgery. From this position in 1994, he retired from the ranks of the Armed Forces continuing to work in civil healthcare on the basis of the hospital of the Ministry of Internal Affairs of St. Petersburg until 2018. Georgy Savvovich devoted all his main activities in medicine to thoracic surgery. The results of his practical and scientific activity of many years were published in more than 170 scientific papers, 7 monographs and guidelines for physicians. Georgy Savvovich was a «pioneer» in the use of direct-acting fibrinolytic therapy in thoracic surgery as an alternative to surgical treatment in such pathological conditions as fibrinothorax, pleural empyema, clotted hemothorax.

The article introduced selected fragments of the "Manual for Teaching Surgery" by Professor of the St. Petersburg Medical and Surgical Academy I.F. Bush (1771-1843), devoted to the teaching about arterial aneurysm, into scientific circulation. For the first time in Russian literature, I.F. Bush defined aneurysm, divided aneurysm into true, false, mixed and arteriovenous, singled out spongy aneurysm (hemangioma), described the etiology, clinic, diagnosis, outcome, prognosis and surgical treatment of aneurysm, as well as indications and contraindications for surgery, possible complications and postoperative care. It should be noted that the teaching about arterial aneurysm is presented with a deep knowledge of the subject and literature about it at the beginning of the 19^th century, which indicates the great personal clinical experience of the author and his students (V.V. Pelikan, I.V. Buyalsky, etc.) in this section of surgery. It was concluded that the teaching about arterial aneurysm, comprehensively presented by I.F. Bush in 1807-1831, should be considered the beginning of Russian angiology and vascular surgery.