Outstanding surgeon, scientist, teacher and organizer of healthcare, founder of a large surgical school, Hero of Socialist Labor (1988), academician of the USSR Academy of Medical Sciences (1974), RAMS (1991) and RAS (1997), laureate of the USSR State Prize (1975), the State Prize of the Russian Federation (1992), Demidov Prize (2002) and the A. N. Bakulev Prize (2002), Professor Viktor Sergeevich Savelyev was born on February 24, 1928 in the village of Pakhotny Ugol of the Bondarsky district of the Tambov region in the family of Sergei Dmitrievich Savelyev, a wood sawmill worker, and Olga Kuzminichna, a housewife. In 1945, Viktor Sergeevich entered the 2^nd Moscow Medical Institute (now the Pirogov Russian National Research Medical University). After graduating in 1951, he studied in residency at the Department of Faculty Surgery, which was headed by the academician A. N. Bakulev, and was stayed at the department as an assistant. After defending his PhD thesis in 1955, he was appointed a teacher. In 1959, V. S. Savelyev successfully defended his doctoral dissertation, in 1961, he passed the academic title of Professor, in 1967, he was elected the head of the Department of Faculty Surgery. Viktor Sergeevich fully became the successor of A. N. Bakuleva and made the very great contribution to the development of domestic cardiac surgery. The works of V. S. Savelyev played a huge role in the formation and rapid development of vascular surgery. The clinic he headed has accumulated the world’s largest experience in the treatment of acute thrombosis and embolism of the main arteries. Viktor Sergeevich is rightfully one of the founders of modern Russian phlebology. He also made a significant contribution to the development of surgery of the stomach, intestines, bile ducts and pancreas. He was one of the first in the country to use organ-preserving operations on the stomach for complicated duodenal ulcer. Many of Viktor Sergeevich’s works were devoted to various aspects of postoperative management of patients, infusion therapy and parenteral nutrition, pathogenesis, diagnosis and treatment of sepsis. V. S. Savelyev and his students made a significant contribution to the development of abdominal endoscopy. V. S. Savelyev was a major organizer of domestic healthcare, for 34 years he held the post of the chief surgeon of the Ministry of Health of Russia. He was the Chairman of the Scientific Society of Surgeons of Russia (ROH), founder and president of the Russian Association of Phlebologists, editor-in-chief of journals «Thoracic and Cardiovascular Surgery» and «Phlebolymphology». Under his leadership and with his participation as the scientific consultant, 70 doctoral and 180 candidate dissertations were defended. He was the author and co-author of more than 500 scientific papers, including 24 monographs and manuals. The academician Viktor Sergeevich Savelyev died on December 25, 2013 and was buried in Moscow at the Troyekurovo Cemetery.

THE OBJECTIVE of the study was to study the causes and nature of traumatic brain injury in a metropolis and to form the principles of providing assistance to victims in a multidisciplinary hospital.

METHODS AND MATERIALS. The analysis of a sequential sample of 2017 case histories of patients admitted to St. Petersburg State Medical Institution “Mariinsky City Hospital” for urgent indications with injuries of the skin of the head, skull bones, brain of varying severity was carried out. They accounted for 69 % of the total number of injured patients (2,932 people) admitted with injuries to various parts of the body, including the head, from August 2021 to February 2022. We analyzed 114 case histories of patients treated in the intensive care unit (ICU). The mortality rate in this group was 36 % (41 out of 114 people). The work is illustrated by clinical observations with typical urban injuries, which were caused by icicles falling on the head, blocks of snow from the roofs of houses, incidents with personal mobility equipment on the sidewalks of the city, falls on ice and other causes.

RESULTS. Based on clinical examples, the causes and features of urban traumatic brain injury in a metropolis, criteria for sorting and routing patients admitted with signs of traumatic brain injury were considered.

The OBJECTIVE was to study the prevalence and nature of congenital and acquired anatomical features of the pulmonary vascular bed in patients with single ventricle and to evaluate their impact on staged hemodynamic correction.

METHODS AND MATERIALS. The study was a retrospective cohort study based on the study of the experience of surgical treatment of patients with a single ventricle from 2005 to 2022. 208 patients, 95 females and 113 males met the inclusion criteria. Depending on the type of the first stage of correction, all patients were divided into three groups: 1 – patients after the Norwood operation (n=84), 2 – patients after the isolated systemic-to-pulmonary shunts (n=74), 3 – patients after pulmonary artery band or those who did not need the first stage of surgical treatment (n=50).

RESULTS. From all patients who survived the Stage-I (158 patients), 47 (30 %) patients underwent 72 reconstructive interventions on the pulmonary arteries: 8 % – before Stage-II, 46 % – at Stage-II, 17 % – between stages II and III, 11 % – at Stage-III and 18 % – after Stage-III. When comparing freedom from stenosis of the pulmonary arteries, statistically significant differences were found between groups of patients (p=0.005), with the least freedom from stenosis in group 1 (after the Norwood operation) and the greatest freedom from stenosis in group 3 (after pulmonary artery band or without first stage of correction).

CONCLUSIONS. Patients with a functionally single ventricle are at risk of developing pulmonary artery stenosis throughout the entire period of staged hemodynamic correction and after its completion. The identified narrowing needs immediate correction, since a long-term existing narrowing can lead to hypoplasia of the pulmonary vascular bed and become an obstacle to the timely Fontan completion. More extensive use of tomographic imaging techniques is recommended in order to fully assess the degree of narrowing.

The objective was to estimate the risk and predictors of intraoperative transition from a single-stent technique of correction of bifurcation lesions of the coronary arteries to a double-stent technique.

METHODS AND MATHERIALS. The study included 49 patients (35 men – 71.4 % and 14 women – 28.6 %) with acute coronary syndrome, whose coronary angiography revealed non-stem bifurcation lesions of the coronary arteries. The patients were operated with single- (Provisional) and double- (Culotte and TAR) stent techniques. Three patients had two bifurcation lesions at once. Thus, 52 bifurcations were included in the study. The average age of patients was 62±8 years. The lateral branch was affected in 34.6 % of cases. A blood clot in the bifurcation area was visualized in 15.4 % of cases. The study is a prospective analytical one. Statistical data processing was carried out using the chi-square test. The statistically significant value was considered p<0.05.

RESULTS. In Y-type bifurcation, kissing dilation was performed in 50% of cases, and stent implantation into the lateral branch - in 23.8% of cases (47.6% of cases where kissing dilation was performed). In T-type bifurcation, kissing dilation was required in 33.3% of cases, and the transition to double-stent technique was required in 11.1% of cases (33.3% of cases where kissing dilation was performed (p=0.610)). With the initially affected lateral branch, kissing dilation was required in 88.2 % of cases, and stenting of the lateral branch was required in 47.1 % of cases (53.3% of cases where kissing dilation was performed). With an intact lateral branch, kissing dilation was required in 26.5 % of cases, the second stent was needed in 8.8 % of cases (33.3% of cases where kissing dilation was performed (p<0.001)). In the presence of a blood clot in the bifurcation area, the need for kissing dilation appeared in 75% of cases, and the need for double-stent technique – in 12.5% of cases (20% of cases where kissing dilation was performed).

CONCLUSIONS. When using the Provisional techniques, the kissing dilation was required in 47.1 % of cases. Expansion of the scope of surgical intervention to double-stent technique was required in 21.6 % of cases.

The OBJECTIVE of the research was to study the patency of coronary shunts from the radial artery in the presence of morphological changes in its wall in the period from 40 to 52 months after surgery.

METHODS AND MATERIALS. Fragments of 110 radial arteries taken from 103 patients for coronary artery bypass grafting in the period from 2018 to 2021 were subjected to histological examination. To assess the functional state of the shunts in the period from 40 to 52 months after surgery, computed tomography of the coronary arteries (CTCA) with contrast was performed in 66 patients.

RESULTS. Histological examination revealed such changes in the radial artery wall as edema of one layer of the artery or all three layers, proliferation of the subendothelial layer of the inner coat, intimal fibrosis, partial obstruction of the artery lumen by a massive accumulation of agglutinated erythrocytes, as well as occlusion of the radial artery. Occlusion of the shunt from the radial artery in the period of 41–42 months was detected in 2 patients who underwent computed tomography of the coronary arteries.

CONCLUSION. Statistical analysis of the obtained results revealed that the presence of such morphological changes in the radial artery wall as alteration, exudation and proliferation does not statistically significantly affect the timing of adequate functioning of the shunt.

The OBJECTIVE was to evaluate the effectiveness of the original technique for assessing the reparative potential of the anterior abdominal wall in the prevention of complications from the laparotomic wound in abdominal gunshot injury.

METHODS AND MATERIALS. The comparative assessment of the results of surgical treatment of 145 victims with abdominal gunshot injury, which were divided into 2 groups, was made. The retrospective group included 92 patients who underwent a standard approach to the prevention of infectious complications in the surgical area: perioperative administration of antibiotics, daily dressings, as well as laboratory monitoring of acute phase parameters and instrumental assessment of tissue condition (ultrasound). The prospective group was formed from 53 patients in whom, as part of the prevention of the infectious process, the original method for assessing the reparative potential of the tissues of the anterior abdominal wall was used (priority certificate for the invention ¹ 2023109198 dated 04/12/2023). The studied groups were comparable in terms of the main clinical criteria: the age of the victims, the severity of injuries, and the structure of surgical interventions.

RESULTS. Suppuration of the laparotomic wound was noted in 22 patients in the retrospective group and in 4 in the prospective group, which accounted for 23.9 % and 7.5 % of their number (p=0.014). Eventration was observed in 11 patients in the retrospective group and in one patient in the prospective group (11.9 % and 1.9 %, p=0.05).

CONCLUSION. The use of the original technique for assessing the reparative potential of the tissues of the anterior abdominal wall makes it possible to reduce the incidence of complications from the laparotomic wound in abdominal gunshot injury.

The OBJECTIVE was choose an informative, convenient and accessible in clinical practice index for assessing the level of endogenous intoxication associated with a bacterial infection.

METHODS AND MATERIALS. In the groups of patients with surgical inflammatory bacterial diseases (104 people), with intracellular non-bacterial infection (254 people), and in healthy people (94 people), the degree of LII correlation according to Kalf-Kalif (as a "standard" of indices) was compared with more simple and easy-to-calculate indices: LII according to Ostrovsky, simplified LII according to Ostrovsky ¬ without taking into account plasma cells (sLII according to Ostrovsky), the blood leukocyte shift index according to Yabluchansky, the Harkavy index and the Krebs index.

RESULTS. Within all groups of observations, the closest correlation with LII according to Kalf-Kalif was established for LII according to Ostrovsky, slightly less for LII according to Ostrovsky. The latter was chosen for further study due to the possibility of calculation based on the data of the 5diff automatic blood cell analyzer. Compared with the group of healthy people (1.34 (0.93; 1.59)) sLII according to Ostrovsky did not increase in the group of patients with intracellular non-bacterial infections (1.21 (0.82; 1.49)), moderately increased in subgroup of urological and gynecological patients with chronic local inflammatory processes (2.35 (1.49; 2.99)) and was many times higher in subgroups with acute inflammatory and destructive diseases of the abdominal organs (7.64 (2.05; 11.77 )), sepsis (8.58 (2.96; 13.29)) and septic shock (7.34 (4.07; 9.48)).

CONCLUSION. The calculation of LII according to Ostrovsky or its simplified version without taking into account plasma cells (neutrophils + immature granulocytes)/(lymphocytes + monocytes + eosinophils + basophils) is appropriate and easily applicable in wide clinical practice for assessing a bacterial infection and the development vector of an infectious process.

Venous thromboembolic complications (VTC) occupy one of the central positions in the structure of complications associated with a new coronavirus infection. Characterized by high epidemiological thresholds, as well as an atypical clinical picture, they determine the search for new approaches to early diagnosis and active treatment. Surgical treatment of pulmonary embolism, in itself, is an extremely controversial method of reperfusion of the pulmonary arterial bed basin. If we talk about pulmonary embolism associated with the new coronavirus infection, then we have not found a single described clinical case in the literature available to us. The article presents the first experience of complex treatment of subacute pulmonary embolism that developed against the background of COVID-19. The obtained treatment results demonstrate the need to develop a unified treatment protocol at the intersection of interdisciplinary areas, which will help to find answers to the post.

Fracture and migration of fragments of a Kirchner wire is a rare but potentially dangerous complication after treatment of clavicle injuries. In the presented clinical case, the fracture of the Kirchner wire occurred 2 months after the fixation of the sternoclavicular joint. The fragment of the Kirchner wire migrated into the anterior mediastinum, penetrated into the ascending aorta with the formation of an anterior mediastinal hematoma and right-sided hemothorax. The fragment of the Kirchner wire was successfully extracted during the operation through median sternotomy. In this case, the Kirchner wire did not damage other structures and was extracted without the use of cardiopulmonary bypass.

Tracheal cancer accounts for less than 0.2 % of the total number of oncological diseases. The medical literature describes isolated cases of metastatic lesions of the trachea and bronchi from distant organs. Metastasis of kidney cancer is observed most often in the absence of early detection of the tumor. We present a case of successful treatment of intraluminal metastasis of kidney cancer into the trachea.

The presented case contains a successful surgical correction of venous stasis of an autograft that occurred in the early postoperative period during the delayed reconstruction of the left breast with a free TRAM flap in a patient after radical surgical treatment of stage 3A pT2N2M0 breast cancer. Using the microsurgical technique, two venous anastomoses were sequentially applied, which made it possible to keep the transplanted flap completely viable and, thus, to ensure a successful outcome of the reconstructive surgery.

This review is devoted to new trends in esophageal surgery due to the introduction of ERAS (Enhanced Recovery After Surgery). Currently, the absence of a single regulation for the surgical treatment of patients with esophageal diseases requires the search for new directions and research in this area. However, any innovations always cause alertness among surgeons, which is associated with a high risk of postoperative complications and an increase in the mortality rate. The article discusses new reports proving the ineffectiveness of many established principles of treatment, and also demonstrates the importance of a multidisciplinary approach to the treatment of such patients.

In 2023, the 120^th anniversary of the birth of the famous surgeon, prominent scientist, talented teacher, Professor A.Ya. Ivanov will be celebrated. Graduated from the Odessa Medical Institute in 1926, he worked as a surgeon in hospitals of the Ukrainian SSR, and then in Leningrad. During the Great Patriotic War – senior surgeon of the hospital in besieged Leningrad, and since 1943 – the chief surgeon of the army of the 3^rd Ukrainian Front. After the war, Anatoly Yakovlevich’s entire career was connected with the Department of General Surgery of the Leningrad Sanitary and Hygienic Medical Institute, where he made the way from assistant (1947), associate professor (1951), professor (1957) to head of the department (1960). From 1956 to 1973, A.Ya. Ivanov simultaneously held the position of director (rector) of the Leningrad Sanitary and Hygienic Medical Institute. He proved himself as a high-class surgeon, organizer of the scientific and pedagogical process. Under his leadership, new areas of work of the clinic were created, in particular, one of the first vascular surgery departments in the country was opened. It should be noted the breadth of A. Ya. Ivanov’s horizons and the variety of the studied scientific issues. Under his leadership, 3 doctoral and 20 candidate dissertations were defended, he was the author of more than 100 scientific papers. He was awarded orders and medals of the USSR. He died on August 26, 1988, and was buried at the Bolsheokhtinskoye Cemetery in St. Petersburg.

In 1923, the outstanding doctor, scientist and teacher, corresponding member of the Russian Academy of Medical Sciences, Professor Nikolai Vasilyevich Putov, turns 100 years old. Under his leadership, the Research Institute of Pulmonology successfully served as the country’s leading institution on the relevant problem and became one of the leading medical research centers in the Soviet Union. Headed by him Department of Hospital Surgery ¹ 1 of the First Leningrad Medical Institute named after Academician I. P. Pavlov was a leader in university and postgraduate teaching of surgery and surgical science. N. V. Putov was the extraordinary teacher, he had the excellent understanding of issues of universal human culture. He was known and appreciated, people were proud of the friendship with him not only in Leningrad – St. Petersburg, but also in Russia and abroad.