The paper proposes and substantiates an arthroscopic classification of pathological processes in the hip joint associated with avascular necrosis of the femoral head (ANFH). In 2018–2022, the authors developed and advanced to the clinic “Method of minimally invasive two-stage decompression with bone alloplasty” (RF patent No. 2691543), which involved diagnostic and therapeutic arthroscopy of the hip joint as its first stage. The international ARCO classification (Association Research Circulation Osseous classification) was chosen as the prototype for the invention. The endoscopic view was recorded and compared with the data of radiological research methods (radiography, spiral CT and MRI). The revealed changes are characterized by the absence of pronounced pathological signs at stages 0, I according to ARCO, which testifies to the possibility of arthroscopic intervention only for the purpose of joint cavity drainage. Further development of necrosis is accompanied by the formation of cartilage flaps, cartilage defects, acetabular labrum tears, lysis of the ligament of the femoral head with the subsequent development of arthrosis, and, therefore, requires a combined approach.

Pain in patients with transitional lumbosacral vertebrae is managed with surgical and non-surgical treatment. The non-surgical treatment involves techniques of traditional oriental medicine, manual therapy, physiotherapeutic procedures, and pharmacological blockade. Surgical interventions include resection of the pseudarthrosis, minimally invasive endoscopic surgery, radiofrequency ablation, and interbody fusion. The paper presents immediate and, in some cases, long-term outcomes, the causes of unsatisfactory outcomes and complications. The relevance of the study stems from the high prevalence of lumbosacral transitional vertebrae in the population, and, moreover, the lack of unified, generally accepted algorithms in choosing individual treatment, based on the history of patients, their age, as well as concomitant dystrophic changes of the superior spinal motion segments.

The presacral, or pararectal, space is a potential site for the formation of various cysts and tumors, since it contains a variety of embryonic tissues. Magnetic resonance imaging is the principal method for the diagnosis of presacral cysts, and endoscopic ultrasonography is an auxiliary method. These masses are subject to surgical removal, even in cases of asymptomatic course. The paper presents the successful experience of treating 3 patients using various surgical approaches and describes their advantages and disadvantages.

Betalains are plant pigments synthesized in the cells of Caryophyllales (red beets, opuntia, etc.). They are involved in the inactivation of reactive oxygen species and free radicals. The paper summarizes the data on the physical-chemical and pharmacological properties of betalains. Betalains eliminate the consequences of oxidative stress, effectively correct metabolic disorders in diabetes mellitus and abdominal obesity, and reduce the risk of cardiovascular diseases. A betalain-enriched diet has a wide range of anticancer effects. Betalains protect brain dopaminergic neurons from oxidative damage and reduce the severity of neurodegenerative disorders in Alzheimer’s and Parkinson’s disease. However, betalains are not stable enough to resist degradation during processing and storage of plant raw materials. Therefore, developing non-damaging technologies for betalain-containing treatment is highly relevant.

The paper focuses on the assessment of factors affecting the health of medical personnel in forensic and pathology departments. Sanitary and hygienic working conditions in forensic medical institutions have specific features associated with microbial contamination, temperature and lighting conditions, air environment and other factors. Medical personnel was revealed to have high morbidity rate, caused by direct contacts with infected material. The paper summarizes current information on the disinfection, sanitary-hygienic and epidemic control measures as well as on the personnel infectious safety.

Objective. To study the effectiveness of high tibial osteotomy (HTO) in the treatment for 2–3 stage osteoarthritis of the knee.

Materials and methods. Over 2015–2022 period, 56 surgeries using HTO were performed in 49 patients with knee osteoarthritis of stages 2–3 at Vladivostok Clinical City Hospital No. 2. Biplanar osteotomy was performed above the tibial tuberosity. Locking compression plates were used for fixation. The results were assessed according to the Lysholm Knee Score and VAS.

Results. The follow-up results in 37 patients were monitored up to 5 years. Deformity correction was revealed in each case. The study indicated a persistent reduction in the mean values of the VAS scale from 1.1 to 2.7, as well as a significant improvement in the clinical and functional characteristics of the knee joint according to the Lysholm Knee Score. In 5 years after the procedure, the survival rate comprised 100%.

Conclusion. High tibial osteotomy is a complex procedure requiring long-term training and considerable experience of a surgeon, proper assessment of indications, meticulous preoperative planning, and adherence to surgical techniques. The HTO results demonstrate that a long-term delay in knee arthroplasty is feasible.

Objective. To evaluate the effectiveness of CT-guided thoracic biopsy in the diagnosis of lung and mediastinal malignancies.

Materials and methods. A retrospective analysis of 32 cases of CT-guided transthoracic biopsy was performed. Lung and mediastinal masses suspicious for malignancy with a size of more than 2.0 cm in the area available for manipulation were the indication for Cor-biopsy with additional examination of impression smears. A step-by-step procedure involved CT positioning of the object, marking by the radiation therapy program, and performing the procedure. The cytological and histological materials were evaluated and compared.

Results. The analysis of manipulations performed in 32 patients with lung masses (75±7.7%) and mediastinal masses (25±7.7%) proved the technical effectiveness of the procedure, which lasted 37±9 minutes. The diagnosis was confirmed by cytological analysis of impression smears in 81.3±6.9% of cases, and using histological methods – in 71.9±8% (p>0.05). The agreement between the results obtained by both methods was 53.1±8.8%. Immunohistochemical analysis of the material was performed in 69.6±9.6% of patients. Procedural complications (pneumothorax and hemoptysis) were observed in 21.9±7.3% of patients. Cytological examination allowed the results of a planned histological and immunohistochemical analysis to be foreseen with a high degree of probability.

Conclusion. CT-guided transthoracic puncture is a highly effective method of diagnosing lung and mediastinal malignancies, which allows their morphological characterization to be done in 81% of cases.

Objective. To evaluate the actual diet of children with type I diabetes in order to develop recommendations for nutrition correction.

Materials and methods. An observational study of actual diet of the case-control type was conducted in a group of children with type I diabetes mellitus (DM1; n=47) and a comparison group of conditionally healthy children living in Omsk Oblast (n=43). Actual nutrition was studied by analyzing the frequency of food consumption reported by parents in interviews.

Results. The level of energy consumed with food in the group of children with DM1 accounted for 1929 kcal. It corresponded to physiological needs and was consistent with the comparison group. However, consumption of fats was higher than recommended, while that of carbohydrates was, on the contrary, lower. Energy from added sugars and saturated fats was at twice the recommended levels. Protein intake was adequate to physiological needs, but the proportion of animal proteins was greater in the group of children with diabetes. The author noted excessive consumption of fats and shortage of omega-3 fatty acids. The amount of carbohydrates in the diet of children with DM1 was lower than the physiological needs, but did not differ from the comparison group, the consumption of simple sugars was greater in children from the comparison group. There were no differences in consumption of minerals and vitamins, with the exception of vitamin A, which was greater in the diet of children with DM1. The amounts of vitamin A, D, beta-carotene, vitamin B9 and iodine were lower than recommended. An excess of sodium and phosphorus in the diet and calcium imbalance were also revealed.

Conclusion. Nutrition of children with type I diabetes is considered to be improper. The nutrition imbalances are similar in both groups. When consumption of carbohydrates is insufficient, an excess of simple sugars is noted. Priority micronutrients for correction are vitamins A and D, folates, iodine.

Aim. To evaluate the potential for detecting of gene allelic polymorphism for chickenpox in adults.

Materials and methods. The examination involved 201 conscripted soldiers of Caucasian race, aged between 18 and 24, who were born in and served in Zabaykalsky Krai. Determination of gene polymorphism was carried out via polymerase chain reaction. Genomic DNA was extracted from whole blood leukocytes using DNA-Express reagent. IBM SPSS Statistics 25.0 (International Business Machines Corporation, License No. Z125-3301-14, USA) was used for statistical processing of the results.

Results. IL-10(G1082A) obtains the highest predictive value for chickenpox, while TLR9(T1237C) – the lowest. More commonly, chickenpox affects adults with IL-10(C819T), IL-10(G1082A) and TLR9(A2848G). TLR9(T1237C) is insignificant for chickenpox. TT and TC IL-10(G1082A), GA and AA TLR9(A2848G), AG and GG IL-10(C819T) are activators of chickenpox. AA IL-10(G1082A), CC IL-10(C819T), AA TLR9(A2848G) are chickenpox protectors. Android app was created for prognosis and early diagnosis of chickenpox in adults.

Conclusion. Genes GA, AA IL-10(G1082A, and TT, CT IL-10(C819T), as well as AG, GG TLR9(A2848G) predispose to chickenpox, and gene AA TLR9(A2848G) reduces the probability of developing the disease. Considering that, the main prognostic markers for chickenpox in adults are polymorphisms of genes IL-10(G1082A), TLR9(A2848G), IL-10(C819T), the developed diagnostic model allows for the prediction and early diagnosis of the disease.

Objective. To assess factors in COVID-19-associated lethal outcomes and to identify gaps in the quality of inpatient medical care.

Materials and methods. An analysis of expert opinions (reports of medical care quality) was carried out using a random sample of 116 medical histories of COVID-19-associated lethal outcomes from various hospitals in Primorsky Krai for the period from June 2020 to August 2021.

Results. The highest mortality was observed among patients aged 60–79 (53.4%) and 80–96 (30.2%). The lethal outcome occurred, on average, on the 12.8 ± 1.3 day of illness. Concomitant chronic pathologies of various organs and systems was observed in 96.5% of the deceased, with the majority of such patients having had comorbidities of three or more body systems (55.2%). Discrepancies in clinical and pathoanatomic diagnoses were noted in nine cases (7.8%) and were related to the structure of the clinical diagnosis and the reassessment of COVID-19 complications. The immediate cause of death in 84.5% of patients was acute respiratory distress syndrome.

Conclusion. Elderly and senile patients with comorbid diseases are at highest risk of severe and lethal COVID-19 outcome. The difficulty of managing such patients is associated with the complexity of diagnosis, interpretation of critical conditions, and selection of appropriate therapy.

Objective. To evaluate the nature of changes in body fat composition in cirrhotic patients of various somatotypes.

Materials and methods. The data of 46 cirrhotic patients and 20 volunteers were analyzed. Anthropometric examination was carried out according to methodological requirements with assessing the body composition of patients by means of bioimpedance analysis using ABC-01 Medass system (NTC Medass, Russia). Somatotypes were determined according to the Heath–Carter method. Ranks for the somatotype scale were assigned as endomorphy scores increased. Spearman rank correlation was used to identify the relationships between the variables. Differences between continuous variables were determined using the Mann–Whitney test. Statistical analysis was performed using Statistica 10 (StatSoft Inc., USA).

Results. Child–Pugh scores for men and women were 9 (7.3–11.8) and 7 (6–9), respectively. Body fat percentage (BFP) of cirrhotic patients accounted for 27.7% (23.3–33) in men and 41.2% (33.6–46.3) in women. In healthy volunteers, the BFP was 21.9% (13.9–26.3) in men and 32.7% (29.3–41.6) in women. Assessment of the relationships between liver cirrhosis severity and body fat was characterized by a correlation coefficient of r = -0.47528 (p-value < 0.001). A significant negative correlation was determined between the liver cirrhosis severity according to Child–Pugh scores and somatotypes (r = -0.30536, p = 0.03905).

Conclusion. The results of this study emphasize the correlation between somatotypes and changes in BFP in patients with liver cirrhosis of various degrees of severity. The sum of Child–Pugh scores and endomorphic indicators demonstrated the inverse relationship, which must be taken into account when developing mathematical models of the personalized prognosis of liver cirrhosis.

Aim. To investigate specific features of regional blood flow in the liver of young people with vitamin B₁₂ deficiency anemia (VBDA).

Materials and methods. A total of 64 patients diagnosed with VBDA with the median age of 38 years and 95% confidence interval [26; 49] were examined. Hemodynamic parameters of the liver and central circulation were assessed using pulsedwave Doppler ultrasound with color and power imaging. Statistical data was processed by Statistica 25.0.

Results. At the onset of VBDA, the revealed hemodynamic disorders are primarily associated with a 13.8% decrease in the ratio of the linear velocity of the portal flow and the diameter of the portal vein, which leads to liver blood stagnation. A long medical history of VBDA is associated with the venous collector of hepatic hemodynamics and a decrease in the volume values (16.8%) against the background of increased peripheral vascular tone of hepatic vessels (23.5%). A correlation between the indicators of regional blood flow in the liver and the type of central hemodynamics was revealed, being most pronounced in severe VBDA and the hypokinetic hemodynamics type.

Conclusion. Assessment of the regional blood flow of the liver was found to be an effective method for diagnosing the state of target organs in VBDA and for verifying the predictors of VBDA severity.

The paper presents a clinical case of successful treatment for fourth-grade achalasia of cardia using video laparoscopic esophagocardiomyotomy with esophagocardiogastroplasty according to T.A. Suvorova. The surgery involves a peculiar process – the triangular-folded anterior wall of the stomach is sutured to the edges of the formed defect in the muscular layer of the esophagus and cardia. In the early and late postoperative period, patients did not have complications, dysphagia and regurgitation. In a year, contrast fluoroscopy of the esophagus and esophagoscopy revealed reduction in the esophagus length and width, free inflow of contrast into the stomach, absence of reflux esophagitis; the endoscope was freely moving throughout the esophagus.

The paper presents a rare clinical case of a 36-year-old female patient with primary hyperparathyroidism (PHPT) and an ectopic parathyroid adenoma (EPA) in the mediastinum. Ectopic parathyroid adenoma in the mediastinum is found in 1–2% of cases. This is an extremely rare atypical localization as compared with many other possible uncommon locations. Thoracoscopic resection of the adenoma was performed. Pathohistological examination of the postoperative specimen confirmed the preliminary diagnosis. The specimen revealed typical parathyroid adenoma. On the seventh day after surgical treatment the patient was discharged in satisfactory condition.

Prevailing complications of radical prostatectomy include rectal injuries and urethrorectal fistulas. Their surgical treatment is highly invasive with 25% recurrence rate. The most commonly used techniques include the York-Mason procedure and transperineal fistuloplasty using local tissue or gracilis muscle flap of thigh. In addition, endoscopic vacuum-aspiration therapy has been used to treat failed anastomoses of digestive tract since 2006. The therapy involves continuous active aspiration through a monoporous foam material of the required size fixed to the aspiration tube. The paper presents a clinical case of successful treatment of urethrorectal fistula by means of a vacuum-aspiration system, which enables the fistula to be completely separated and urethral and anal continence to be preserved. On the 45th day after radical prostatectomy, the cystoscopy and rectoromanoscopy detected closure of the defect; independent urination was restored. 6 months later, independent defecation came back. Relapse-free period for the underlying disease and its complications comprised 32 months.

The paper presents a clinical case of endovascular treatment for a patient affected by acute myocardial infarction combined with acute ischemic stroke. The study emphasizes a role of early diagnosis of ischemic stroke in timely detection of cerebral embolism in large vessels during the postoperative period. Treatment strategy is analyzed along with the effectiveness of intravascular thrombectomy that significantly reduces mortality and disability of patients with acute cerebrovascular disease.

Nikolau syndrome is a rare post-injection complication with unclear etiology and pathogenesis, characterized by the development of acute local pain syndrome, localized erythematous rash, livedoid and hemorrhagic skin lesions with foci of ischemic necrosis. The paper presents a clinical case of Nikolau syndrome induced by intramuscular administration of diclofenac solution as an analgesic after hip replacement. The analysis of the causes, clinical picture and stages of treatment of post-injection complication was carried out.

The present study involves an analysis of treatment results of the severe burn patients of the Burn Unit, Far Eastern District Medical Center in 2020–2022. The paper describes a clinical case of comprehensive intensive treatment of a patient with major burn injury (80% body surface area burned). The study indicates a vital importance of the fastest evacuation of severely burned patients to a special care unit and adequate intensive therapy to be carried out during transportation. This enables an invasive surgical approach to be adopted, including effective early removal of necrotic tissues, leading to a reduction in the number of complications and improvement of treatment outcomes. The recovery of patients with major burn injury highly correlates with total availability of medication and instruments, individual management of patients, and active rehabilitation measures.

This article presents a clinical case of diffuse large B-cell lymphoma in a teenager, who had laboratory and clinical signs of acute kidney injury in the onset of the disease. The presented case is characterized by the late manifestation of the disease in the absence of classical tumor markers. The diagnosis was verified only following a repeat spine MRI. This case may be relevant for pediatricians, pediatric oncologists and hematologists, pediatric nephrologists.

To the 65^th anniversary of the thoracic department of the Primorsky Regional Tuberculosis Dispensary

The paper reviews the main stages of the sixty-five-year history of the Thoracic Surgical Department of Primorsky Krai TB Dispensary. During this time, the department has handled all the difficulties of establishing the TB service, turning it to a platform for mastering new technologies in close cooperation with leading research institutions of Russia. Due to high professionalism and considerable efforts of managers, doctors and whole staff, the department is rapidly developing in the field of practical medical care and scientific work. All these historical chapters are inextricably interlinked with people whose respectful work and personal talents serve as an example for new generations of specialists.