An outstanding surgeon, scientist, teacher and organizer of healthcare, academician of the USSR Academy of Medical Sciences (1945), Honored Scientist of the RSFSR (1934), founder of the largest surgical school in Siberia, Professor Vladimir Mikhailovich Mysh was born on January 4 (16), 1873 in St. Petersburg in the family of a lawyer. He received his secondary education in a classical gymnasium and entered the Imperial Military Medical Academy, which he graduated in 1895 with honors and was left for three years to improve at the Department of Surgery under the guidance of Professor N. A. Velyaminov. In 1898, V. M. Mysh defended his doctoral dissertation on the topic: «Herniae vaginales ingvinales in childhood» and was assigned to Kaluga, where he worked as the head of the Surgical Department in a Military hospital. In 1901, he was elected by competition to the position of professor of the Department of General Surgery with Desmurgy and the study of dislocations and fractures at the Medical Faculty of Tomsk University. In 1909, V. M. Mysh became the head of the Department of Faculty Surgery of Tomsk University, which he headed until 1931, and in 1922, he concurrently headed the Department of Urology created by him. He was the first in Russia and the third in the world to perform radical surgery for alveolar echinococcosis of the liver. In 1931, Vladimir Mikhailovich together with the staff of Tomsk State Medical University moved to Novosibirsk, where he continued to head the Department of Surgery, and in 1935, took an active part in the opening of Novosibirsk Medical Institute and the creation of the Department of Faculty Surgery in it. V. M. Mysh initiated the introduction of specialized urological care in Siberia and made a very great contribution to the development of neurosurgery. Academician V. M. Mysh created the largest surgical school in Siberia, from which famous professors came out: V. S. Levit, G. M. Mukhadze, M. S. Rabinovich, S. L. Schneider, B. I. Fuchs, K. N. Cherepnin, A. G. Savinykh, V. M. Galkin. Vladimir Mikhailovich was the author and co-author of 136 scientific papers, including 11 monographs and manuals on abdominal and thoracic surgery, oncology, urology, neurosurgery, diseases of bones and joints, general and plastic surgery. He was awarded two Orders of Lenin, the Order of the Red Banner of Labor, medals «For Valiant Labor in the Great Patriotic War of 1941–1945», «For Labor Valor». Academician V. M. Mysh died on December 31, 1947 and was buried at the Zaeltsovsky Cemetery in Novosibirsk. The surgical clinic of the State Institute for Advanced Training of Doctors and the Department of Faculty Surgery of NSMU were named after V. M. Mysh. He was listed in the gallery of Honorary Professors of the Novosibirsk State Medical Academy.

Introduction. In recent decades, the number of patients with coronary artery disease and diffuse coronary artery disease has significantly increased. Performing the full volume of myocardial revascularization in such patients is not always possible due to the nature of the lesion of the coronary bed, and the risk of shunt dysfunction in the early postoperative period remains high. Therefore, the use of ultrasound intraoperative flowmetry in coronary bypass surgery is especially necessary, but the issues of optimal indicators of graft patency remain unresolved.

The Objective was to evaluate the possibilities of using intraoperative ultrasound flowmetry in patients with diffuse coronary bed lesion.

Methods and Materials. The study included 188 patients with diffuse coronary bed lesion who underwent coronary bypass surgery at the St. George Thoracic and Cardiovascular Surgery Clinic, Pirogov National Medical and Surgical Center and the Center for Cardiology and Cardiovascular Surgery, Rostov-on-Don. Ultrasound Doppler flowmetry was performed in all patients, the following indicators were evaluated: the average volumetric blood flow rate (MGF – mean graft flow), the pulsation index (PI – pulsation index) and the percentage of diastolic volume filling (DF – diastolic filling). Coronaroshuntography was performed in 29 patients in the early postoperative period (within 2–6 hours after surgery). The comparison of angiographic data (slowing of blood flow through the shunt, stenosis, occlusion) with intraoperative parameters of ultrasound flowmetry was carried out.

Results. 405 primary intraoperative flowmetry samples were analyzed in 188 patients with diffuse coronary lesion. It was found that 19.7 % of intraoperative flowmetry indicators were less than the recommended values: 9.3 % of autoarterial and 25 % of autovenous shunts to the anterior descending artery; 20.8 % of autovenous shunts to the diagonal artery; 33.3 % – to the envelope and 21.9 % – to the right coronary artery. In 21 % of the observations, technical problems were identified (defect of proximal or distal anastomoses; bend of the conduit; dissection of the autoarterial shunt), which were eliminated; in other cases, no technical problems were identified. When comparing the data of intraoperative ultrasound flowmetry and shuntography in the early postoperative period, statistical differences were revealed in patients with normal patency of venous shunts and their dysfunction: MGF 53±18 (46–59) vs. 38±15 (29–47), p=0.014; PI: 3±1 (2–3) vs. 7±1 (6–8), p≤0.001; DF: 79±15 (64–91) vs. 48±17 (41–60), p=0.005. There are differences in the flowmetry of autoarterial shunts depending on the risk of their dysfunction: MGF 32±11 (28–44) vs. 20±5 (13–24), p=0.005; PI: 2±1 (1–4) vs. 7±2 (5–9), p≤0.001; DF: 70±12 (61–85) vs. 50±15 (45–64), p=0.005.

Conclusion. Intraoperative ultrasound flowmetry is a safe and effective tool for assessing blood flow through conduits during coronary bypass surgery in patients with coronary artery disease and diffuse coronary bed lesions. According to our study, to predict the normal patency of shunts in the early postoperative period, it is advisable to use targets MGF above 28 ml/min for internal thoracic artery and 65 ml/min for venous shunts, PI less than 5.0 for all types of conduits, DF above 60 % for autoarterial shunt, and more than 68 % for autovenous graft.

The Objective was to evaluate the effects of the concentration of blood hemoglobin, total serum protein and albumin on skin graft engraftment frequency.

Methods and Materials. The study included 186 patients with full-thickness skin burn more than 5 % of total body surface area who were treated in five different burn departments of the Russian Federation. Depending on the readiness of the wounds, all performed surgical treatments were divided into four groups: 1) simultaneous skin graft after tangential necretomy; 2) simultaneous skin graft after radical necretomy; 3) skin graft for granulation wounds; 4) skin graft for a long time existing pathologically (hyper)granulation. Venous blood was taken from all the patients 12 hours before and 12–24 hours after skin graft. The concentration of blood hemoglobin, total serum protein and albumin was determined in the obtained samples. The evaluation of skin graft engraftment frequency was carried out by a combined method on the 7th day after skin graft. The data obtained were processed using descriptive and nonparametric statistics.

Results. The concentration of total serum protein (p=0.001) and albumin (p=0.000) had a significant impact on the skin grafting results. This relationship was most pronounced during skin grafting on granulating wounds and after radical necretomy. The data obtained were identical for meshed and non-meshed skin grafts. Decrease in hemoglobin concentration did not lead to a degradation of skin grafts (p=0.068) in any of the study groups. According to the results of the laboratory parameters ranking, it was found that maintaining the concentration of total serum protein more than 6 g/dL allows 1.3 times to improve the results of skin grafting, and albumin concentrations more than 3.5 g/dL – 1.4.

Conclusion. During the study, we were unable to confirm the existence of a relationship between the concentration of blood hemoglobin and the results of skin graft engraftment by any of the statistical analysis methods in any of the study groups. Accordingly, the inability to transfuse erythrocytes to a patient with anemia below 9–8 g/dL cannot be considered as an absolute contraindication for early surgical treatment of burned patients. Apparently, the concentration of total serum protein and albumin has a much greater effect on the skin grafting results. Trigger values of total serum protein can be recognized as 6 g/dL (albumin – 3.5 g/dL), which provides good results of engraftment in at least 90 % of operated patients. 

The Objective was to improve medical and diagnostic care for patients with obstructive jaundice of tumor genesis.

Methods and Materials. Retrospective analysis of the treatment results of 309 patients with obstructive jaundice of tumor genesis. We studied the results of endoscopic transpapillary and/or percutaneous transhepatic antegrade endobilliary minimally invasive surgical interventions of 307 (99.3 %) patients. We carried out the analysis of complications, reasons and possible elimination path. A new, more effective method of trepan-biopsy of tumors of the pancreatic head and distal choledochus and devise for it implementation were developed (patent № 2722655, 2747591).

Results. Minimally invasive decompression interventions at the first stage of treatment of patients with obstructive jaundice of tumor genesis reduced the percentage of fatal postoperative complications to 1.3 %. The first results of the application of the developed trepan-biopsy method showed their high efficiency, reliability and safety.

Conclusion. The differentiated approach to the choice of the method of decompression of the biliary tract at the first stage is important for improving the results of treatment. The use of the method of simultaneous puncture transhepatic billioduadenal drainage with trepan-biopsy of tumors of the pancreatic head and distal choledochus is, as it seems to us, a new, promising adjustment in solving the problem of morphological verification of tumors of the hepatopancreatoduodenal zone and reducing the time of diagnosis and treatment of patients with obstructive jaundice of the tumor genesis.

The objective of the work was to study the efficacy of minimally invasive endoscopic treatment of esophageal varices (EV) in children with extrahepatic portal hypertension (EHPH).

Methods and Materials. Eighty children aged 3 to 17 years of age with EHPH included in this study. The patients were divided into three analysis groups. The group I (n=14) included children with EHPH who had not previously undergone any surgical interventions and endoscopic ligation of EV was performed against the background of acute bleeding or after medical hemostatic treatment. The group II (n=37) included patients who had undergone the endoscopic treatment of EV after an unsatisfactory outcome of previously performed surgical interventions. The group III included 29 children who underwent only azygos-portal disconnection procedures. We performed the comparative analysis of the severity of EV before and after sessions of the endoscopic treatment of EV, as well as the analysis of the frequency of recurrent bleedings in comparison groups.

Results. According to the research results, recurrent gastroesophageal hemorrhages were noted in 44.4 % of cases in the group I. In the group II, 37 patients underwent a total of 68 sessions of the stage endoscopic treatment of EV. According to the control endoscopic examinations, there was a significant reduction in the risk of bleeding from EV between ligation sessions (p=0.001) of the endoscopic treatment of EV. During the follow-up period, in the group II, recurrent bleedings from EV were noted in 6 (16.2 %) patients. Whereas in 10 (34.5 %) children of the group III, recurrent gastroesophageal hemorrhages were noted in the postoperative period. The analysis showed a significant correlation of the presence of «red flags» with recurrent episodes of bleedings in children of the group II after the endoscopic treatment of EV (r=0.32 p=0.05). Analysis of the causes of recurrent gastroesophageal bleedings in children of the group III did not reveal significant differences in such parameters as the degree of EV and «red flags».

Conclusion. Thus, the endoscopic treatment of EV is a safe and effective method of secondary prevention of bleedings from EV. The question concerning the primary prevention of gastroesophageal hemorrhages require further study.

The article presents the latest trends of the diagnosis and treatment of tracheobronchial amyloidosis. Constriction of the bronchus due to amyloid deposits requires immunohistochemistry for protein typing. The only way of major airways recanalization is endoscopic surgical treatment. It is described the experience of treating four patients with tracheobronchial amyloidosis, in one of whom, a rare form of amyloidosis – lung amyloidoma developed.

The Objective was to pay attention to the rare combination of a true aneurysm of the inferior phrenic artery and the syndrome of compression of the celiac trunk, its open decompression and elimination of aneurysms in three patients.

Methods and Materials. From September 2018 to December 2022, in 5 patients with celiac trunk compression syndrome (three men; mean age 49.4 years, from 18 to 72 years) out of 182, according to MSCT angiography and during surgery, an aneurysm of the right inferior phrenic artery was detected in two and left for three. These arteries originated from the post-stenotic moderately dilated part of the celiac trunk.

Results. On average, its diameter at the site of stenosis was 1.9 mm and the degree was 58 %, the trunk was 8.6 mm and the aneurysm was 6.8 mm, and its length was 8 mm. In 4 cases, the aneurysm originated from the ostium of this artery and in one case, 5 mm from it, without involvement of the celiac trunk. All 5 aneurysms were concentric sac-shaped, including a funnel-shaped variant in two of them. Three out of 5 patients successfully underwent open decompression of the celiac trunk and immediately resection of the aneurysm in two with the imposition of a lateral suture and ligatures on the artery, respectively, and exclusion in one with a purse-string suture.

Conclusion. An aneurysm of the inferior phrenic artery originating from the celiac trunk may be one of the specific manifestations of its long-term significant diaphragmatic compression. With such a combination of lesions, the expediency of decompressing the celiac trunk and removing the aneurysm from the bloodstream, regardless of its size, should be considered.

Introduction. Coronary heart disease and aortic valve stenosis still occupy a leading position among cardiovascular diseases. Against the background of an increase in life expectancy, patients with a combined pathology of the heart are increasingly appearing. Without surgical treatment, such patients have an unfavorable prognosis of life with a high mortality rate. Simultaneous surgical correction of coronary heart disease and aortic valve stenosis is a treatment method that can improve the prognosis and prolong the life of a patient. At the same time, combined interventions remain higher-risk operations compared to isolated aortic valve replacement and isolated coronary artery bypass grafting.

The Objective was to evaluate the effect of incomplete and complete myocardial revascularization on the immediate results of surgical correction of combined pathology of the aortic valve and coronary arteries.

Methods and Materials. For the period from 2017 until June 2022, 62 aortic valve replacement operations in combination with coronary artery bypass grafting were performed in the cardiac surgery department of the Leningrad Regional Clinical Hospital. The operated patients were divided into two groups. The group 1 included (n=32) patients who underwent aortic valve replacement and complete myocardial revascularization. The group 2 included patients (n=30) who underwent aortic valve replacement and incomplete myocardial revascularization.

Results. Postoperative periods in both groups, according to the structure of early postoperative complications, are generally similar. The mortality rate in both groups did not exceed the predicted mortality rate and corresponded to the data of various literary sources.

Conclusion. Our observation data showed that the mortality rate in the early postoperative period, in combined operations, does not depend on the completeness of revascularization in combined operations of coronary artery bypass grafting and aortic valve replacement. It is necessary to perform as complete myocardial revascularization in combined operations as technically feasible and appropriate in a clinical situation.

Introduction. Contrast-induced nephropathy (CIN) is a complication that occurs after contrast medium (CM) administration. The existing risk scales for possible CIN include chronic kidney disease and do not take into account stenotic changes in the renal artery with normal serum creatinine levels.

The Objective was to study the frequency of CIN in patients with acute and chronic coronary occlusion (CCO) after endovascular recanalization in the presence of hemodynamically significant renal artery damage with initially normal creatinine levels.

Methods and Materials. The study included 38 patients with acute coronary syndrome (control group) and 67 patients with CCO and hemodynamically significant renal artery stenosis (main group). Stenting of one of the renal arteries was performed in 25 patients out of 67 patients before planned coronary revascularization.

Results. The incidences of CIN were significantly higher than the calculated one in patients with CCO and renal artery stenosis. In the group of patients with pre-stenting of the renal arteries, there was a decrease in cases of CIN.

Conclusions. Renal artery stenosis with normal creatinine levels is an additional risk factor for CIN.

Ischemic stroke is one of the most common causes of disability and mortality worldwide. Occlusive-stenotic lesion of the extra- and intracranial carotid arteries, which developed acutely and led to acute cerebrovascular accident, is a prognostically unfavorable factor. The appearance of endovascular technologies has revolutionized the salvation of this category of patients; however, they are sometimes powerless in the fight against nature. The article presents a case of tandem and bilateral lesions of the extra- and intracranial internal carotid artery, the successful result of treatment of which became possible only due to the development of spontaneous recanalization.

A rare clinical observation of a 46-year-old patient with primary esophageal melanoma is presented. We demonstrate the difficulties of verifying the disease, taking into account the complex morphological picture of the tumor, anatomical features. The possibilities of modern combined treatment of this category of patients are also shown. For the first time, a case of primary esophageal melanoma with a family history of esophageal cancer is described.

Gallbladder duplication is a rare abnormality of the biliary system. When a pathology develops in a doubled gallbladder, there can be difficulties in diagnosis and surgical treatment. Apart from the ultrasound investigation, other imaging methods are of great importance for more accurate diagnostics: computed tomography, magnetic resonance tomography, magnetic resonance cholangiopancreatography and endoscopic ultrasonography. The article presents a literature review and demonstrates our own clinical case of laparoscopic cholecystectomy in the patient with gallbladder duplication.

On the seventh day after the operation, the patient was diagnosed with the new coronavirus infection. On the fifth day from the onset of the viral disease and on the 12th day after the operation, the signs of a “cytokine storm” were appeared, the volume of lung damage increased from 6 to 50 %, and the phenomena of respiratory failure increased. Immunosuppressive therapy (high doses of glucocorticoids, interleukin blockers) was prescribed. The condition was stabilized. On the 20th day after the operation and the 13th day from the start of the diagnosis of the new coronavirus infection, there were signs of peritonitis, which required laparoscopic sanitation and drainage of the abdominal cavity for widespread serous peritonitis without a primary focus. On the 26th day after hemicolectomy and the 19th day from the onset of coronavirus infection, the extraperitoneal opening of the retroperitoneal phlegmon on the left was performed. On the 61st day after hemicolectomy and the 68th day from the onset of coronavirus infection, the extraperitoneal opening of the phlegmon of the retroperitoneal space on the right was performed. On the 78th day, he was discharged from the hospital in a satisfactory condition.

The results of treatment of gastroduodenal bleedings in the Russian Federation leave much to be desired. According to the chief surgeon and endoscopist of the Russian Federation, Academician A. Sh. Ramishvili [2], operative mortality in the treatment of gastroduodenal bleedings is 19 %, and only in 32 % of cases, bleeding was stopped endoscopically. The article analyzes the problems in the treatment of gastroduodenal bleedings. The main problem is organizational. Strict implementation of national clinical recommendations by surgeons and endoscopists is necessary for high-quality care for patients with gastroduodenal bleedings (1). Special conditions should be created in hospitals to help patients with gastroduodenal bleedings. These are the presence of a surgical team, intensive care unit, blood transfusion department or cabinet, 24-hour endoscopy (department or cabinet) equipped with modern digital endoscopes and all the tools to stop bleedings. It is necessary to treat not the bleeding but the patient with bleeding. For this purpose, it is necessary to use drug antisecretory therapy after endoscopic treatment. It is very important that surgeons and endoscopists equally understand the complexity of the problem – the treatment of gastroduodenal bleedings.