Outstanding maxillofacial surgeon, scientist and teacher, one of the founders of the Russian dentistry and creator of the first large school of Soviet maxillofacial surgeons and dentists, corresponding member of the USSR Academy of Medical Sciences (1945), laureate of the USSR State (Stalin) Prize (1948), honored Scientist of the RSFSR (1963), Doctor of Medical Sciences, Professor Alexander Aleksandrovich Limberg was born on January 24 (February 6), 1894 in the family of the Limberg medical dynasty, famous in St. Petersburg – leading specialists in the field of dentistry and maxillofacial surgery. In 1916, A.A. Limberg graduated from the Vongle Dental School, and in 1919 – the Military Medical Academy and began to specialize in the field of maxillofacial surgery. In 1924, he was approved as head of the Department of Odontology (until 1936) of the State Institute of Medical Knowledge (2nd Leningrad Medical Institute (1930), Leningrad Sanitary and Hygienic Medical Institute (1947), since 1994 – St. Petersburg State Medical Academy named after I.I. Mechnikov). In January 1935, A. A. Limberg headed the first organized Department of Maxillofacial Surgery at the Leningrad Institute of Advanced Medical Training and directed it until the end of his life. From 1943 to 1945, he was the Professor at the Department of Maxillofacial Surgery at the Leningrad Pediatric Medical Institute, and from 1946 to 1956, he headed the Department of Surgical Dentistry at the Leningrad Medical Dental Institute. The name A. A. Limberg is closely connected with the organization and development of dentistry and maxillofacial surgery not only in Leningrad, but also in other regions of the USSR, in which, on the initiative of Alexander Alexandrovich, specialized departments and clinics were formed in medical institutes, as well as departments of maxillofacial surgery in regional hospitals. A. A. Limberg was the author and co-author of 150 scientific works, including 4 monographs, 2 textbooks on surgical dentistry, and individual chapters in 10 manuals. Under his leadership, 36 candidate and 9 doctoral dissertations were prepared. Corresponding Member of the USSR Academy of Medical Sciences, Professor A. A. Limberg died in December 1974 and was buried in Leningrad at the Bolsheokhtinskoye cemetery. The name of A. A. Limberg was assigned to the Department of Maxillofacial Surgery and Surgical Dentistry of the North-Western State Medical University (now St. Petersburg State Medical Academy) named after. I. I. Mechnikov in St. Petersburg.

The OBJECTIVE was to study the features of intraoperative and postoperative periods as well as the immediate results of extrapleural thoracoplasty among patients with destructive tuberculosis in combination with human immunodeficiency virus (HIV).

METHODS AND MATERIALS. A retrospective analysis of the results of extrapleural thoracoplasty for destructive pulmonary tuberculosis was performed in 46 patients with HIV infection and in 44 patients with tuberculosis without HIV infection. The groups were comparable in age and gender composition. The following variables were analyzed: the duration of the operation, the volume of blood loss, the volume of loss through drainage, the duration of postoperative drainage, the severity of postoperative pain syndrome, intra- and postoperative complications.

RESULTS. We noted that, despite the longer tuberculosis duration, the frequency of bacterial excretion, the prevalence of extensive drug resistance (XDR), immune dysfunctions, high prevalence of drug addiction and chronic viral hepatitis, the results of extrapleural thoracoplasty in patients with HIV infection did not significantly differ from the results of patients without HIV infection operated for destructive pulmonary tuberculosis. Postoperative complications were few, temporary and treatable, and there was no postoperative mortality.

CONCLUSION. Extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and HIV infection is not accompanied by severe, life-threatening complications. It also contributes to a significant reduction in destruction cavities in half of the operated patients. This operation does not make the course of HIV infection more difficult.

INTRODUCTION. One of the most formidable complications in thoracic surgery is bronchopleural fistula after pneumonectomy. Main bronchus stump reinforcement during surgery is used as method of prevention of this complication. The question of the preferred plastic material remains debatable.

The OBJECTIVE was to compare the results of myoplasty and diaphragmoplasty of the right main bronchus stump after pneumonectomy performed for destructive pulmonary tuberculosis.

METHODS AND MATERIALS. A retrospective study from 2015 to 2022 was conducted. The study included 30 patients who were divided into 2 groups. Group 1 included 19 patients who underwent diaphragmoplasty; group 2 included 11 patients who underwent myoplasty. Patients were comparable in terms of sex, age, functional indices, and features of the course and prevalence of the underlying disease. The short-term and long-term results of surgical treatment were compared.

RESULTS. Complicated course of the postoperative period was observed in 6 (31.6 %) patients in group 1 and in 5 (45.5 %) patients in group 2. Satisfactory immediate result in group 1 was achieved in 17 (89.5 %) patients, in group 2 – in 8 (72.7 %). In the remote period, the result of complex treatment of TB patients in group 1: successful treatment – 13 (68.5 %), ineffective treatment – 2 (10.5 %), loss to follow-up – 2 (10.5 %), lethal outcome – in 2 (10.5 %); in group 2: successful treatment – 8 (72.7 %), ineffective treatment – in 3 (27.3 %).

CONCLUSIONS. Right-sided pneumonectomy in patients with destructive pulmonary tuberculosis with drug-resistant mycobacteria is accompanied by a high risk of main bronchus stump failure. The diaphragm and chest wall muscles are reliable materials for strengthening the main bronchus stump.

The OBJECTIVE was to retrospectively study the results of treatment of mediastinal bronchogenic cysts (MBC), to present a case of the formation of a cystobronchial fistula after a transbronchial cyst puncture.

METHODS AND MATERIALS. MBC were diagnosed in 11 (20 %) of 55 patients with various mediastinal cysts. The diagnosis was confirmed by computed tomography data, in one case by a transbronchial puncture. All patients were operated on.

RESULTS. MBC was asymptomatic in 8 cases (72.7 %). Neoplasm in the mediastinum was detected during fluorographic examination in 5 patients, with CT in 6 cases. The dimensions of the cysts according to CT data were 45.5±15.2mm and 39.3±17.5mm, respectively. MRI was performed in two patients due to comorbid pathology of the spine. A 60-year-old patient underwent a transbronchial biopsy with biopsy forceps for diagnostic aim, as a result of which the cyst cavity was opened, infected, and a cystobronchial fistula with a diameter of 2 mm was formed with constant coughing up the purulent contents of the cyst. After anti-inflammatory, antibacterial therapy, after a month and a half, the cyst was removed by thoracotomy due to a pronounced periproccess. Video-assisted thoracoscopic cystectomy was performed for 9 patients. One patient was underwent conversion to thoracotomy due to the adhesive process after a previously performed lobectomy. Exudative pleurisy developed from postoperative complications in one case.

CONCLUSION. The main method of diagnosing MBC is computed tomography. The ultrasound-guided transbronchial needle puncture of a cyst can be used to clarify the diagnosis under antibiotic prophylaxis, but can lead to infection of the cyst. Thoracoscopic excision of MBC should be considered the first-line therapeutic option due to the risk of complications and the presence of clinical manifestations.

The OBJECTIVE was to study the 5-year results of dynamic intraligamentous stabilization compared with early knee anterior cruciate ligament (ACL) repair.

METHODS AND MATERIALS. We carried out the study and statistical analysis of the treatment of 72 patients (47 men and 25 women), average age 30.9±8.5 years (min. 18 max, 45 years), with injury duration from 3 to 21 days (aver-age – 10.6±5.0 days) with ACL injury, activity level on the Tegner scale before injury not lower than 5 (1–9), average value 5.8±0.9 points. In group I (39 patients), with arthroscopic diagnosis and detection of separation from the femur with preservation of the synovial membrane, DIS was performed; in group II (control. 33 patients), early ACL repair was performed.

RESULTS. Pain syndrome according to VAS after 12 months was 1.1±0.8 and 1.3±1.0 points (p=0.340). Patient satisfaction with the operation after 12 months in group I was 8.0±0.8 points, in group II – 7.4±0.8 (p=0.003). Tegner test at 12 months after surgery in group I was 6.5±0.9 points, in group II was 6.3±0.8 (p=0.014). Results on the Lysholm scale at 12 months: 91.1±2.2 and 88.6±3.5 points (p=0.001). During the dynamic study for 5 years, relapses of anteromedial instability of the knee joint were detected in 10 patients, which amounted to 13.9%, while in 4 patients in group I (10.3%), in group II in 6 patients (18.2%).

CONCLUSION. Dynamic intraligamentous stabilization, in comparison with early anterior cruciate ligament plastic, shows a more rapid recovery of the level of physical activity in the next year after surgery; and in the long-term period, in terms of the number of relapses of instability, the results are no worse, which may influence changes in the algorithm for choosing surgical treatment.

Fulminant liver failure (FLF) is a life-threatening condition. The mortality rate among patients with developed fulminant liver failure reaches 70 %. Performing liver transplantation from a posthumous donor for fulminant liver failure, the mortality rate, according to various sources, reaches 25.4 – 38.1 %. Up to 25 % of patients with acute liver failure die on the cadaveric liver waiting list without receiving a transplant. In presented clinical case, a 16-year-old patient developed fulminant liver failure in the absence of chronic diseases. Despite the syndromic therapy, hepatic, kidney and cardiovascular failure progressed. The developed depression of consciousness and respiratory failure required the transfer of the patient to artificial ventilation. Coma and multiple organ failure were diagnosed. As a result of interdepartmental cooperation, the patient urgently underwent liver transplantation from a cadaveric donor. The postoperative period proceeded without complications. On the 36th day, the patient was discharged in satisfactory condition for the outpatient stage of treatment. To date, liver transplantation is the only effective and radical treatment for fulminant liver failure.

Anatomical lung resection is the standard treatment for primary lung tumors. In patients with metastatic lung lesions, wedge resection may be feasible for subpleural lesions, but reliable localization by thoracoscopy may be difficult for deeply located nodules. Wedge resection via thoracotomy may be unfeasible. We present the first observation in Russian literature of successful thoracoscopic anatomical subsegmentectomy in a patient with a solitary lung metastasis from breast cancer in the upper lobe of the right lung.

Secondary malignant cardiac tumors are extremely rare cases, however, since the expansive growth of the tumor quickly leads to the development of life-threatening conditions. There is still no unified treatment strategy for this type of myocardial damage, and the prognosis is unfavorable due to the progression of the disease. This clinical case represents the experience of surgical treatment of melanoma metastasis with involvement of the right atrium.

Conservative treatment of severe and moderately severe acute pancreatitis (AP) with a focus on reducing suppurative complications poses a challenging task. The early initiation of enteral nutrition plays a crucial role in improving AP treatment outcomes. This case presentation illustrates an original method of duodenal drainage and intestinal tube feeding.

A case of a patient with moderately severe acute pancreatitis and a relatively high risk of a fatal outcome is presented. Positive therapeutic effects were achieved through the innovative method of selective feeding with duodenal isolation. Percutaneous drainage of the abdominal cavity under ultrasound control for enzymatic peritonitis, coupled with early artificial feeding, successfully prevented infection and the development of multiorgan failure.

The developed method of duodenal content aspiration and early jejunal tube feeding has demonstrated both effectiveness and safety.

Anomalies of the appendix are rare malformations that are most often diagnosed intraoperatively and do not have a specific clinical picture. The article describes a clinical case in a 6-year-old 4-month-old boy who was admitted to the hospital with symptoms of appendicitis. According to urgent indications, diagnostic laparoscopy was performed, during which two phlegmonously altered appendixes were identified. The diagnosis was « Acute phlegmonous appendicitis of two appendixes. Loose periappendicular infiltrate. Congenital developmental pathology: Tubular doubling of the caecum dome with appendixes ». Laparoscopic appendectomy was performed. Thus, this article describes the rare clinical case of tubular doubling of the caecum dome with phlegmonously altered appendixes.

INTRODUCTION. Severe pain syndrome is a significant complication of the postoperative period. Despite the prevalence of laparoscopic surgical interventions for colorectal cancer, there is still a lack of commonly agreed strategies to provide the most effective perioperative analgesia in such patients. Multimodal analgesia is a modern method of anesthesia that affects multiple components of the pathogenesis of pain syndrome. Proposed as a gold standard for open colorectal surgeries, thoracic epidural anesthesia as a component of multimodal analgesia does not show the same beneficial results in laparoscopic colorectal intervention.

The OBJECTIVE was to compare different techniques of local anesthesia and to identify the most perspective method of local anesthesia as a part of a multimodal analgesia in terms of effectiveness and affordability in daily practice.

METHODS AND MATERIALS. A review of the current scientific literature was conducted in order to search and assess the usability of different local anesthesia techniques.

CONCLUSION. Infiltration of a local anesthetic solution into the trocar wound area is the most uncomplicated and affordable method of anesthesia, comparable in efficacy with other methods of locoregional anesthesia, which can potentially be a promising component of multimodal analgesia in colorectal oncosurgery.

The concept of «postoperative (surgical) complication» implies a new pathological condition caused by surgical intervention, arising during its implementation and within 30 days later, having a clinical manifestation and requiring correction of treatment tactics. Based on this definitional approach, the classification of negative events associated with the operation, taking into account the involvement of the anatomical and functional structures of the body (local, regional and systemic) is presented. Another ranked feature is the syndromic characteristic of manifestations, which involves ordering problems depending on the leading cause of their formation of central or peripheral origin, including infectious and inflammatory nature, disorders in the hemostatic system and other variable (different) situations. This approach allows to plan and implement measures for the prevention and treatment of complications in practice. The logic of the pathophysiological understanding of their symptoms facilitates the prediction and early diagnosis of perioperative incidents.