The article covers the state of surgical care in the Russian Far East. Data of official statistics, reports of chief surgeons of the regions of the Far Eastern Federal District and employees of NMRC for Surgery named after A.V. Vishnevsky on visiting medical institutions of Primorskiy and Khabarovs territories as well as Jewish Autonomous Province in 2019 was used. A comparative analysis of the indicators of the organization of surgical care was done. A number of organizational problems were identified; a decrease in the quality and accessibility of surgical care for a number of diseases in the Far East was noted. Organizational solutions to reduce mortality in acute surgical diseases of the abdominal organs, possible ways of developing surgical care in the regions are proposed. The emphasis is on the feasibility of increasing the pace of implementation of minimally invasive surgical technologies, centralizing complex types of surgical interventions.

The review of studies of international and national researchers on the impact of matrix metalloproteinases (matrix metalloproteinases, ММРs) and their inhibitors (tissue inhibitors of metalloproteinases, TIMPs) on physiological and pathological processes in children with kidney diseases. It is shown that MMPs play a significant role in organogenesis, i.e. nephrogenesis. Thus, MMP-2, MMP-9 and TIMPs play a large role in basal membranes remodeling associated with epithelial structures in a developing kidney. Immunohistochemistry assay showed that MMP-2 was localized in structures of immature nephrons undergoing epithelial differentiation, MMP-9 – only in vascular structures included in immature glomeruli. Decreased activity of MMP and /or increased synthesis of TIMPs in nephrocytes contribute to the reduction of intercellular substance components catabolism and serve as a basis for glomerular fibrosis and renal interstitium. MMPs are the major group of proteases which regulate metabolism in extracellular matrix and serve as the most important parameters in tissue remodeling observed in acute and chronic inflammatory processes in kidneys. The literature review gives an opportunity to assess the importance of drug design preventing and delaying the progression of nephrosclerosis.

The review presents an analysis of the scientific literature on the assessment of the predictive value of hemodynamic parameters for predicting the immediate and long-term results of coronary artery bypass grafting (CABG). Modern options for hemodynamic and volumetric monitoring are considered, including transesophageal echocardiography, prepulmonary, transpulmonary thermodilution, as well as other methods based on estimation of pulse wave transit time. The information content of individual hemodynamic parameters is discussed to optimize the early diagnosis, prevention and intensive care of cardiovascular events associated with CABG. The scientific literature on stratification of the risks of postoperative complications and mortality based on the analysis of the predictive value of hemodynamic parameters is generalized. Variants of the integrated application of hemodynamic monitoring methods and artificial intelligence technologies for the development of automated systems for predicting the near and long-term results of CABG are analyzed.

Russia is one of the countries with high incidence rate of pulmonary tuberculosis. The existence of Mycobacterium tuberculosis under the persistent antibacterial therapy effect leads to a formation of drug resistant forms especially in immunodeficiency in persons with HIV-infection, the number of which is increasing every year. The use of combination of different types of collapse surgery in order to maintain a larger volume of normal pulmonary tissue enables to increase the number of cured patients. The results of literature review show a development and improvement of collapse surgery techniques. The application of different methods of compression of the affected part of the lung, collapse of destruction cavity and fixing the lung in a collapsed state are presented. The main reason for use of transplants in pulmonary tuberculosis collapse surgery is to create conditions for reparation and increase of efficacy of surgical treatment for destructive forms of pulmonary tuberculosis in cases in which for one reason or another it is impossible to perform a respective surgical operation.

Objective. The study objective it to analyze the dynamics of microbial content of burn wounds and to assess the markers of hospital-acquired infection (HAI) in different periods of hospitalization.

Methods: 617 microbiological samples from the surface of burn wounds of 515 patients in the period from the first to ninth days after the injury were analyzed. The presence of gramnegative bacteria Pseudomonas aeruginosa and Acinetobacter baumannii, multiresistant microorganisms and microbial associations was determined. Spectrophotometry was used to identify pathogens and plate method was used to assess microbial content of wounds.

Results: During treatment, there was change of pathogens associated with duration of stay in the hospital. With an increase in hospitalization, the degree of microbial contamination of wounds, the rate of gram-negative bacteria, multiresistant microorganisms, and microbial associations increased.

Conclusions: The greatest severity of all signs of nosocomial infection occurs on the 3–4th day of hospitalization in a burn care facility. This period can be considered ad a start of active contamination of burn wounds with nosocomial flora. To prevent this, it is necessary as early as possible, from 2–3 days after hospitalization to apply active strategy for treating burn wounds and closing burn surfaces. 

Objective: The study objective is to analyze biofilm formation in microorganisms isolated from patients of children’s hospital with severe purulent septic diseases.

Methods: The ability to biofilm formation was studied in microorganisms isolated from 32 patients aged from 1 to 15 y.o. with sepsis, acute hematogenous osteomyelitis, peritonitis, and pneumonia in intensive care unit of regional general children’s hospital. Blood, phlegm, bronchial and oropharyngeal washings, wound fluid, peritoneal fluid served as specimens.

Results: All tested strains have the ability to biofilm formation; moreover, the majority of them formed moderate biofilms.

Conclusion: The common spread of biofilm infections can be related to the most important factors of preservation and distribution of microorganisms in health facilities which significantly limit preventive and therapeutic measures. 

Objective: Analysis of ultrastructure of a biomineral of hip bones (HB) in white rats in alimentary obesity caused by excessive refined palm oil (PO) intake as well as developing a method for correction of detected changes using Garcinia cambogia extract (GCE).

Methods: 216 male rats (juvenile, pubertal, and senile) were used. Animals received PO at a dose of 30 g/kg a day and GCE at a dose of 0.25 g/kg a day 6 weeks later after the start of PO intake. The ultrastructure of PO biomineral was analyzed by X-ray scattering technique.

Results: When juvenile rats took PO, the sizes of crystallites were 4.35% larger than control figures by the 60th day, and coefficient of micro-texturing was 4.72% lower. In pubertal rats, these deviations were 6.14 and 5.05%; in senile rats, they were 5.68 and 7.43%, respectively. When administrating GCE, in juvenile rats, the sizes of crystallites were 3.82% lower than values of group without correction by the 60th day, and coefficient of micro-texturing was 4.67% higher. In pubertal rats, these deviations accounted for 5.52 and 8.03%; and in senile rats, they were 4.34 and 5.56%, respectively.

Conclusion: Consumption of PO at a dose of 30 g/kg a day is accompanied by destabilization of HP biomineral in white rats. Administration of GCE at a dose of 0.25 g/kg a day reduces the effect of PO on the ultrastructure of HB biomineral from 30 to 60 days in juvenile and pubertal rats, in senile rats – from the 60th day. 

Objective: To identify the features of chronic gastroduodenal pathology in children with atopic dermatitis (AD) complicated by secondary mycotic infection.

Methods: The examination of mucous membrane micro-biocenosis of stomach and duodenum was performed in 64 children aged 3–16 years with diseases of gastrointestinal tract and AD complicated by fungal infection. 45 out of 64 patients, having been under medical supervision, had a combined damage of skin and gastrointestinal tract with Candida fungi. In-depth clinical and mycological study was performed represented by esophagogastroduodenoscopy with biopsy of intestine mucous membrane. The detection of circulating candida antigens in blood serum was conducted with method of amperometric enzyme biosensor. Helicobacter pylori were detected using urease test.

Results: Children with AD combined with secondary mycotic infection had a damage of the upper parts of gastrointestinal tract and skin with Candida fungi in 70.3% of cases. Gastroduodenitis accounted for 66.7%; peptic ulcer disease was 33.3% in the structure of gastrodudenal pathology. Candida albicans fungi were plated in 80 % of cases; all children had a candida antigen in the blood serum.

Conclusions: Children with AD, complicated by mycotic infection, and chronic gastrodudenal pathology should be examined for candidiasis of upper parts of gastrointestinal tract. If there is a candidiasis they should be prescribed with systemic antimycotics and dietary adjustment. 

Objective. The study objective is to assess the efficacy of preventive care for thromboembolic complications after endoprosthetics of large joints depending on patients’ compliance.

Methods: Prospective clinical examination of 686 patients aged 50–70 years, who underwent the endoprosthetics of knee and hip joints. Preventive care for thrombosis and embolism was performed according to three regimens: 1) monotherapy with parenteral low molecular weight heparins, 2) therapy with low molecular weight heparins converted to indirect anticoagulants, 3) administration of oral anticoagulants.

Results: 376 patients (54.8%) fully complied with the medical recommendations. The rest 310 patients (45.2%), non-compliant patients, ignored medical prescriptions: refusal to take anticoagulants, spontaneous replacement of anticoagulants with antiplatelet agents, not taking medications as prescribed. Among compliant patients, deep vein thrombosis of lower extremities was registered in 9 cases (2.4%); among non-compliant patients, it was registered in 13 cases (4.2%).

Conclusions: Deep vein thrombosis of lower extremities was registered significantly more often in non-compliant patients. To increase the efficacy of the prevention care for thromboembolic complications after endoprosthetics of large joints, more attention should be paid to explanatory work, explaining to patients the nature and negative consequences of compliance violations. 

Objective. The study objective is to assess the effectiveness of bone cysts treatment by parietal resection of a bone cyst with plastic reconstruction with bone replacement materials.

Methods: We have analyzed surgical treatment of 13 patients aged from 6 to 16 years with the diagnosis “solitary bone cyst”. As bone replacement material we used “Osteomatriks” (9 cases), (2 cases) and Chronos (2 cases). Surgical operations were performed in the active stage of cyst in eight patients and in the passive stage – five patients. To assess the results of treatment we used radiological criteria C.S. Neer et al. (1973).

Results: Recovery was registered in 11 cases, residual cavity – in 1 case, relapse – in 1 case.

Conclusions: Parietal resection with plastic reconstruction with bone replacement materials is a quite effective method of treatment of solitary cysts in children. In this case “Osteomatriks” can be an alternative to more expensive and less available materials. 

Objective. The study objective is to analyze the results of blunt abdominal trauma treatment in children and adolescents with an emphasis on the possibilities of minimally invasive surgery.

Methods: The results of treatment of 129 patients aged from 3 to 17 with injured internal organs due to blunt abdominal trauma were retrospectively analyzed.

Results: Medical therapy was effective in 74.6% of cases. Surgery was limited to a laparoscopy access in 13 cases (10.7%), open surgery was required to 18 patients (14.7%). One fatal outcome associated with the massive blood loss was registered.

Conclusions: The algorithm of treatment of blunt abdominal traumas, used over the last years and including laparoscopy in hemodynamically stable patients, allowed avoiding laparotomy in 85.3% of cases. 

Objective: To summarize the experience of endoscopic surgical treatment of patients with adrenal neoplasms.

Methods: The results of treatment of 80 patients (64 women and 16 men) with adrenal neoplasm were retrospectively analyzed in Medical Center, Far Eastern Federal University, from 2014 to 2019.

Results: Andrenalectomies were performed via three accesses: laparoscopic (49 cases), retroperitoneoscopic (22 cases) and laparoscopy-assisted (6 cases). Three cases required conversion. 70 benign and 10 malignant neoplasms were removed. Complications, including one death, developed in four cases.

Conclusions: Minimally invasive andrenalectomy is safer and more preferable than open surgery due to reduced duration of hospital stay, decreased rate of complications, degree of pain syndrome, extent of blood loss and need for opioid analgesics. 

Objective. The study objective is to assess the results of chemical angioplasty results in patients after clipping of ruptured aneurism of cerebral arteries complicated by cerebral vasospasm.

Methods: We have examined 18 patients aged from 24 to 66 y.o. with subarachnoid hemorrhage caused by aneurism rupture, who after cerebral vessels clipping received the treatment of cerebral vasospasm by chemical angioplasty with nimodipine.

Results: The number of chemical angioplasty sessions ranged from 1 to 9. In three cases, there was a fatal outcome pathogenetically not associated with subarachnoid hemorrhage. Most of discharged patients had no deficit in the level of consciousness; only one patient was transferred to rehabilitation stage with its low level (10 points, Glasgow coma scale). Lindegaard ratio decreased on average from 3.8 to 2.7 after the completion of chemical angioplasty.

Conclusions: Chemical angioplasty with nimodipine allows reducing the development rate of significant vasospasm complications after subarachnoid hemorrhage. 

Objective: The objective is to analyze the results of endoscopic submucosal dissections (ESDs) of large intestine tumors performed in one clinic.

Methods: Data on 207 ESDs in large intestine for 2007–2019 were analyzed. The duration and speed of surgical operation, the number of en block resections and curable resections, and the level of complications and change of results within gain in experience were assessed.

Results: According to locations, tumors are divided as follows: right-sided – 48, left-sided – 71, rectal – 88. The average speed of submucosal dissection was 13.5 mm2/min.; the average time taken for dissection of one square centimeter of a tumor was 12.5 min. The conversion to loop assistance was required in 35 cases, conversion to a laparoscopic resection – in two cases. According to criteria of endoscopic radical operations, 170 (82.1%) cases were considered curable. As experience of operations was gaining, despite the increase in number of tumors of right-sided location, the speed of ESDs was significantly increased, and the number of perforations and conversions to loop assistance was not changed.

Conclusions: ESD is an effective method of large intestine tumor removal; however, during the training period, a professional should gain an experience in at least 100 operations. 

Objective: To assess the efficacy of hemorrhoidectomy with Milligan-Morgan technique in the author’s modification.

Methods: Results of surgical treatment of 558 patients aged 21–72 years with complicated hemorrhoids of III–IV stage were analyzed. The group of clinical comparison (207 patients) was operated according to standard scheme, the main group (351 patients) – according to author’s technology with modified technique for treating the hemorrhoid bolus using betamethasone.

Results: When using the author’s technique, a more significant decrease in postoperative pain syndrome severity was achieved: injection analgesics were not required already in a day, and after 6 days the pain syndrome was stopped in all cases. Only three patients (0.9%) demonstrated an acute urinary retention up to two days. The group of clinical comparison maintained a longterm (up to three months) pain syndrome; postoperative urinary retention was registered in 38 cases (18.4%); 9 patients (4.3%) developed blood loss in the area of surgical intervention.

Conclusions: Suggested technique of surgical treatment for hemorrhoids is quite effective, simple and can be implemented in any surgical inpatient facility. 

The development of urinary disorders with the formation of infravesical obstruction in a patient with prostate adenoma for 10 years is described on the basis of clinical case with the use of uroflowmonitoring. It is shown that forty-eight-hour uroflowmonitoring allows obtaining enough data to determine urinary structure and hence the functional state of the lower urinary tract.

Objective: The objective is to determine the features of formation of the functional state of the central nervous system (CNS) and cognitive abilities in children and adolescents of the school age.

Methods: The study included 300 school children of general education institution of Orenburg. Functional state of CNS was evaluated with variational chronoreflexometry. Cognitive availabilities have been studied with proof-reading test, Landolt ring.

Results: From 7–11 y.o. to 16–17 y.o., there was an increase by 1.5 times in parameters of CNS functional state. Students aged from 7–11 y.o. by 12–15 y.o. demonstrated decrease in processing speed by 1.5 times due to increase of cognitive activity to 1.8 times. From 12–15 y.o. by 16–17 y.o., on the contrary, there was an increase of information processing speed by 1.3 times and decrease of cognitive activity by 2.9 times.

Conclusions: The detected features of formation of CNS functional state and cognitive abilities in children and adolescents can be taken into account in when organizing personality-oriented training in educational institutions in order to maintain and increase the level of mental performance and academic performance of students. 

Objective: The objective is to analyze the organization of independent activity of students (IAS) as a part of training of pediatric students in a medical higher educational institution, to structure and to improve pedagogical techniques and to manage this activity.

Methods: The study object was a management of clinical training for future professionals of the training program “Pediatrics” in Institute of pediatrics, PSMU.

Results: The structure of IAS studying at clinical bases of Institute of Pediatrics includes three interconnected components: motivation and goal setting, independent activity and its management. The organization of IAS as a part of training of pediatric students in a medical higher educational institution was assessed. Pedagogical settings conducive to the development of professional competences in IAS of a medical higher educational institution exemplified by studying clinical disciplines of the specialty «Pediatrics».

Conclusions: The efficacy of rational organization of IAS includes, primarily, formation of self-developing personality of a future professional able to solve urgent problems in their field, organize process of self-education. 

A brief overview of problem relevance of rare (orfan) diseases in pediatrics and experience of Department of Pediatrics No. 1 of Irkutsk State Medical University on implementation of academic discipline of choice “Orfan diseases” into an academic process of the specialty 31.05.02 “Pediatrics”, relating to the variable part of block 1 «Disciplines (modules)».

Clinical case of extrahepatic biliary obstruction of acquired false liver cyst having occurred in a woman aged 52 years old after laparoscopic cholecystectomy. Stage of diagnosis of biliary unit, surgical treatment and the course of postoperative period are presented.

The article presents a clinical case of intestinal epithelial dysplasia (tufting enteropathy), a rare disease which relates to congenital diarrheas, has a particular clinical presentation and is life-threating. The diagnosis was confirmed by histological examination and electronic microscopy of mucous membrane of small intestine. Additional evidence is substantiated for the existence of prenatal markers of intestinal epithelial dysplasia represented as polyhydramnios and intrauterine dilatation of fetal intestinal loops. These symptoms are considered to be a clinical hallmark of sodium and chloride diarrheas and are described in single cases in enteropathy called a microvillus inclusion disease.

A case of combined duodenal trauma in the 11-year-old patient is described. Complications of pre-operative and intraoperative diagnosis as well as complicated postoperative period are emphasized to be a cause of high mortality risk in this pathology. The disconnection of proximal and distal parts of duodenum was performed; anastomoses were placed between the common bile and pancreatic ducts and small intestine, and gastroenteroanastomosis was performed on a short loop. Follow-up traced for 10 months: recovery.

A clinical case of successful surgical treatment of a patient with a giant cervical retrosternal nontoxic goiter with severe cardiac pathology is presented. Thyroidectomy from cervical access without sternotomy was performed. At the follow-up examination 5 months after the operation, instrumental and clinical signs of disease relapse were not detected.