Outstanding traumatologist-orthopedist, scientist, teacher and health care organizer, founder of a large school of traumatologists and pediatric orthopedists, academician of the USSR Academy of Medical Sciences and the Russian Academy of Medical Sciences, vice-president of the USSR Academy of Medical Sciences, chief traumatologist and chairman of the Academic Council of the USSR Ministry of Health, Honored Scientist of the RSFSR, laureate of the USSR State Prize, Professor Mstislav Vasilievich Volkov was born on June 1, 1923 in Vladivostok. In 1940, he entered the 2nd Moscow Medical Institute, at the beginning of the Great Patriotic War, he joined the people’s militia, served as a signalman, and after demobilization in 1945, he continued his studies at the Institute, after which he studied in a clinical residency, and then in graduate school at the Department of Pediatric Surgery and Orthopedics under the direction of Professor S. D. Ternovsky. In 1952, he defended his candidate’s thesis «Peculiarities of amputation limb stump in children», and in 1961 – his doctoral thesis «Tumors and dysplasia of bones in children». From 1961 to 1984, M. V. Volkov headed the Central Institute of Traumatology and Orthopedics named after N. N. Priorov and at the same time headed the Clinic of pediatric bone pathology and adolescent orthopedics of this Institute. Mstislav Vasilievich made a huge contribution to the development of traumatology and orthopedics. Under his leadership, 48 doctoral and 50 candidate dissertations were prepared, in which the most pressing problems and numerous specific issues of traumatology, adult and pediatric orthopedics were studied. The results of these studies have become widespread in the practical activities of specialized hospitals in the Soviet Union. M. V. Volkov was the author and co-author of 33 inventions. The Volkov-Oganesyan repositioning-compression and hinge-distraction devices have received the greatest popularity and widespread implementation in practice. For 18 years, Mstislav Vasilievich was the chief traumatologist-orthopedist of the USSR Ministry of Health. He has published over 350 scientific papers, 17 monographs and manuals, many of which have been translated into English, French and German. Academician M. V. Volkov died on December 11, 2001 and was buried at the Vostryakovskoye cemetery in Moscow.

INTRODUCTION. The Nottingham prognostic index (NPI) is a tool that, based on quantitative histological features of the tumor, allows optimal treatment tactics for patients suffering from breast cancer (BC). The level of estrogen and progesterone receptors (ER/PR), as well as the expression of HER-2/neu receptors are important parameters in the molecular evaluation of this tumor. The OBJECTIVE was to calculate the NPI in newly diagnosed patients with BC and to compare the prognostic efficacy of molecular markers (ER, PR) and Nottingham prognostic index. METHODS AND MATERIALS. The study included 125 patients with early BC. The Nottingham prognostic index was calculated based on the data of pathomorphological conclusions, and the levels of molecular markers were obtained by immunohistochemical analysis. Prognostic efficacy of molecular markers and Nottingham prognostic index was compared. RESULTS. According to immunohistochemical analysis, ER-positive tumors were detected in 66 (53%) patients, PRpositive – in 55 (44%) patients, a high level of expression of HER-2/neu receptors was registered in 22 (18%) cases. The mean NPI was 4.99±1.23. We found out that molecular markers corresponding to an excellent prognosis and by the Nottingham prognostic index were assigned to the moderate prognostic group. No statistically significant results was observed between the Nottingham prognostic index and molecular markers that would help in assessing the prognosis (p>0.05). CONCLUSION. In breast cancer, the Nottingham prognostic index is the best tool for prognosis determination than immunohistochemical markers.

INTRODUCTION. The severe acute respiratory syndrome-related coronavirus-2 (SARS-Cov2) virus is able to interfere with the interaction of angiotensin-converting enzyme with its receptor. Pronation can affect not only the state of gas exchange during Coronavirus disease 2019 (COVID-19), but also blood circulation, as well as the exchange of vasoactive substances. Hemocirculation disorders are essential in the pathogenesis of severe COVID-19.

The OBJECTIVE was to assess the level of vascular biomarkers in patients with pneumonia caused by SARS-CoV-2 during proning against the background of various respiratory support

METHODS AND MATERIALS. The study included 3 groups of patients depending on respiratory support. The first group consisted of 16 patients who received respiratory support with oxygen at a flow of 5–7 liters per minute. The second group included 15 patients who underwent non-invasive lung ventilation. The third group of 16 patients underwent invasive lung ventilation. Blood tests of endothelin-1, B-natriuretic hormone were performed using an enzyme immunoassay kit. The amount of nitrite (NO₂) and nitrates (NO₃) was determined by the method based on the enzymatic conversion of nitrate to nitrite with the participation of the enzyme nitrate reductase. The reaction recorded the colorimetric concentration of nitrite using the azo dye formed in the Griess reaction.

RESULTS. In patients with respiratory oxygen support during pronation, a decrease in the blood level of brain natriuretic peptide was detected. During the prone position maneuver in patients on mechanical ventilation, the concentration of nitrites increased. In an intergroup comparison, in patients of group 3 relative to groups 1 and 2, NO₂ and NO₃ indicators changed against the background of proning.

СONCLUSION. The increased invasiveness of respiratory support in patients with COVID-19 when performing prone positioning is associated with changes in blood levels of nitrites and nitrates.

The OBJECTIVE was to improve the results of treatment of patients with fractures of the head of the radius by improving the algorithm for choosing a treatment method depending on the type of fracture.

METHODS AND MATERIALS. The authors presented a new classification in which all fractures of the head of the radius were divided into 7 types, each of which corresponds to the optimal treatment method. Based on the proposed classification, the algorithm for choosing the treatment method for patients with fractures of the head of the radius of various types was proposed and tested in clinical practice. The result of treatment of 104 patients with an average age of 43.5±14.1 years with 106 different fractures of the head of the radius was evaluated. Of these, 65 patients with 67 fractures (group 1) were treated according to the algorithm proposed by the authors, and 39 patients with 39 fractures (group 2) were treated contrary to this algorithm.

RESULTS. The results of treatment for more than 6 months in both groups were evaluated on the Mayo Elbow Performance Score (MEPS). In the group 1, excellent results were obtained in 51 (76.1 %), good – in 13 (19.4 %), satisfactory – in 2 (3.0 %), bad – in 1 (1.5 %) cases. In the group 2, excellent results were obtained in 9 (23.1 %), good – in 14 (35.9 %), satisfactory – in 9 (23.1 %), bad – in 7 (17.9 %) cases. Thus, in the group 1, the treatment results were significantly better than in the group 2 (at p<0.0001). With the analysis of the long-term results of treatment depending on the type of fracture, it was found that significantly (at p<0.05) the best results of surgical treatment for all types of fractures were also obtained in patients of group 1.

CONCLUSION. The obtained results of the clinical trial confirm the effectiveness of the proposed algorithm for choosing method for the treatment of patients with fractures of the head of the radius.

INTRODUCTION. The venous drainage disorder from the remaining lung after lobectomy is a life–threatening complication. Usually, thrombosis is considered to be the cause of pulmonary vein obstruction, but in some cases, it can be explained by an unintentional intraoperative ligation or crossing of segmental and subsegmental pulmonary veins.

METHODS AND MATERIALS. From 2003 to 2022, authors observed 7 patients who had injury of the pulmonary veins of the remaining part of the lung during lobectomies.

RESULTS. In all cases, there were anatomy variants of the pulmonary venous bed that were different from the classical one. Cross-section of pulmonary vein of the remaining part of the lung was diagnosed intraoperatively in 2 patients (29 %), and therefore, the volume of the planned resection was expanded. 3 patients were re–operated (43 %, 2 completive pneumonectomies – right- and left-sided, 1 wedge lung resection). Conservative therapy and active observation were performed in 2 patients (29 %). The rate of mortality was 29 % (2 cases).

CONCLUSIONS. The knowledge of the most common anatomy variants of the pulmonary venous bed and a certain alertness about the possibility of the development of venous plethora of the remaining lung during surgery and in the postoperative period will prevent or diagnose the complication in time. CT angiography can help with this.

The OBJECTIVE was to analyze the results of treatment and improvement of surgical management of hemothorax following blunt chest injury.

METHODS AND MATERIALS. Of 398 patients with blunt chest trauma, 84 (21.1 %) had hemothorax. Patients were divided into 4 groups: small hemothorax (<300 ml) – 43 people (51.1 %); medium (300 to 1000 ml) – 27 (32.1 %), large (1000 to 1500 ml) – 10 (11.9 %); and total (>1500 ml) – 4 (4.8 %).The causes were household injuries – in 50 cases (59.5 %) and transport injuries – in 20 cases (23.8 %).

RESULTS. Medium, large and total hemothorax was diagnosed by chest X-rays. Computed tomography was performed in case of severe concomitant injuries, clotted hemothorax and unclear diagnosis. In the Group 1, hemothorax was diagnosed by computed tomography scans only in 12 cases (27.9 %), by ultrasound examination – in 4 cases (9.3 %). Medium and large hemothorax at late admission was removed by pleural puncture in 5 cases. Pleural drainage was performed in 24 patients. Thoracoscopy was performed in 53 patients. In 32 patients (60%) of Groups 1 and 2, thoracoscopy ended only with a revision of the pleural cavity and blood removal. The clotted hemothorax was removed during thoracoscopy in 15 patients of Groups 2, 3 and 4. With total hemothorax, 2 patients underwent thoracotomy for ongoing bleeding. Thoracotomy was performed in 3 patients of Groups 1 and 2 for ruptures of the lung and diaphragm. The cause of hemothorax could be rib fractures in 75 patients (90.4 %), lung rupture in 49 patients (59 %) with hemopneumothorax, damage to the diaphragm in 3 (3.6 %) cases. Surgical hemostasis for ongoing bleeding was required in 7 (8.4%) cases. Thoracoscopy for residual hemothorax after drainage of the pleural cavity was performed in four (4.8%) patients.

CONCLUSION. Surgical management for traumatic hemothorax should be differentiated depending on its volume, the associated injuries, the time from injury to the start of treatment, and the developed complications.

INTRODUCTION. Rectal prolapse is a common condition, in which there are conflicting opinions about the optimal surgical treatment.

The OBJECTIVE was to improve the results of surgical treatment of rectal prolapse by developing a new method of surgical intervention using domestic implants and lasers.

METHODS AND MATERIALS. The clinical part of the research covered the period from 2013 to 2023; in total, the results of operations in 102 patients with rectal prolapse of II–III degree were analyzed.

RESULTS. The article presents the first clinical results of the proposed method of rectopexy in rectal prolapse of II–III degree. Due to the use of laser technologies and composite material on top of a mesh prosthesis, the new method made it possible to achieve stable hemostasis in the area of surgery, as well as to prevent the development of a local adhesive process and scar deformation in the area of fixation of the intestine with a prosthesis.

CONCLUSION. In general, the developed version of rectopexy made it possible to reduce the frequency of long-term postoperative complications requiring additional surgical measures or (and) significantly affecting the quality of life of patients from 34.0 to 10.2 %, which ensured the improvement in the proportion of achieved good results of operations from 34.0 to 69.4 % and the reduction in the frequency of unsatisfactory results from 24.5 to 8.2 %.

The OBJECTIVE was to estimate the effectiveness of endobiliary interventions performed in the antegrade version in the correction of biliary tract pathology in patients who underwent surgery on the biliary tract, upper part of the gastrointestinal tract and after unsuccessful endoscopic treatment.

METHODS AND MATERIAL. Treatment results of 63 patients with biliary tract pathology using antegrade endobiliary interventions in complicated cases for endoscopic support were analyzed. In 44 (70.0 %) cases, the PTBD was carried out as the first stage. Correction of biliary duct pathology in one stage was carried out in 19 (30.0 %) cases. At the second stage, the antegrade correction of biliary tract pathology was carried out in 43 (97.7 %) patients. In addition, lithoextraction was carried out in 5 (11.6 %) cases, lithotripsy in 4 (32.5 %) cases, laser vaporization of stricture in 2 (4.6 %) cases. The conversion to laparotomy was required in 1 (2.3 %) case. Cholecystectomy at the third stage was performed on 36 (57.1 %) patients.

RESULTS. Specific problems were noted in 8 (12.7 %) patients. In the postdecompression phase in mechanical jaundice, «rapid» decompression syndrome developed in 4 (8.5 %) cases. Amylasuria, increased liver function test results appeared in 5 cases. Fluid accumulation under the right lobe of the liver was observed at the third stage after cholecystectomy in 1 patient. Signs of cholangitis after endobiliary interventions were in 3 patients. Failure of antegrade resolution of biliary tract pathology was reported in 1 case due to device failure. Postoperative lethality was 1.6 %.

CONCLUSION. In complicated for retrograde resolution of the biliary tract pathology under the endoscopic navigation, the antegrade method under the radial navigation is quite effective method of the biliary tract pathology correction.

The preduodenal portal vein, being an extremely rare anomaly that occurs with a frequency of 3:1000, is clinically manifested mainly in childhood by signs of intestinal obstruction due to duodenal compression. In adults, this anomaly is asymptomatic, but has surgical importance, increasing the risk of damage to the preduodenal vein during operations on the biliary tract and duodenum. The preduodenal portal vein is usually associated with other intestinal obstruction, such as external (annular pancreas, malrotation), internal (atresia, membrane and stenosis), as well as with cardiovascular abnormalities, reverse location. Recently, we treated a patient with a preduodenal portal vein, which stimulated a revision of the disease process including diagnosis, association with other anomalies and surgical treatment.

An observation of a rare complication of a hiatal hernia is presented – migration of the stomach with an antireflux cuff into the mediastinum with the development of acute gastric dilation, necrosis of the gastric wall in a 51-year-old woman. The effectiveness of stage-by-stage treatment of severe intrapleural complications of recurrent hiatal hernia accompanied by sepsis and multiple organ failure is shown.

The literature review considers the characteristics of local complications in the classifications of acute pancreatitis, as well as analyzed the effectiveness of modern methods of their diagnosis. Understanding the morphology of changes occurring in the pancreas and parapancreatic tissue in acute pancreatitis is of great importance, as it often determines the tactics of surgical treatment. Modern diagnostic methods for local complications of acute pancreatitis, such as contrast-enhanced ultrasound, endoscopic ultrasound, computed tomography, magnetic resonance imaging and cholangiopancreatography are highly informative, but the effectiveness of their use depends on the duration of the disease and the type of local complications, which makes to apply the differentiated approach to their use.

Every year more and more pancreatic lesions are accidentally detected. Besides genetic predisposition and environmental factors, chronic pancreatitis is by far the greatest risk factor for pancreatic malignancy. Currently, there are no screening methods for early detection of pancreatic cancer and its differential diagnosis with chronic pancreatitis. Precise characterization of pancreatic lesions is crucial in deciding whether to use active surgical tactics or dynamic observation, which surgery to perform.