Russian surgical journal

2025 marks the 215th anniversary of the birth of one of the greatest representatives of Russian medicine, Nikolai Ivanovich Pirogov. His contribution to Russian and world medicine cannot be overestimated. Dedication, amazing hard work, and a life   dedicated to serving the Motherland and people make Pirogov a unique person in the history of medicine and culture in general. His scientific discoveries, social activities, and deep reflections on life, death, and immortality are timeless. Pirogov lived a difficult but truly outstanding life full of scientific insights, hard work and difficult relations with the authorities. His memoirs are "Questions of Life. The diary of an old doctor" became the spiritual testament of a practicing surgeon. Pirogov's scientific and practical activities were innovative and in many ways revolutionary. Pirogov's works are a combination of scientific precision, humanism and philosophical depth. Nikolai Ivanovich Pirogov, a great Russian scientist, surgeon, founder of topographic surgical anatomy, military field   surgery, organizer and reformer of pedagogy and public education, became and remains an inspiration for doctors today. Pirogov managed to overcome the limitations of his time, maintaining faith in science, God and man. His contribution to world medicine remains invaluable, and his life is an example of dedication, wisdom and dedication.

The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with incisional ventral hernias. The multicenter, non-randomized, controlled clinical study included 67 patients of both sexes who were operated on using a laparoscopic approach using the LapIPOM technique for a primary ventra hernia. The duration of observation ranged from 12 to 94 months. In the main group, 31 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 36 patients who were treated with anti-adhesive collagen coated meshes (Parietene composite, Parietex Composite, Symbotex). The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were two recurrences of hernias observed in patients included in the study. There were slightly more ad hesions in the fluoropolymer-coated mesh group. The quality of life of patients in the study groups did not differ. In laparoscopic LapIPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with incisional ventral hernias.

The effectiveness of medical care for people over the age of 60 differs significantly from that among younger cohorts of the population in all countries and on all continents of the world. This is important in the examination of centenarians with acute surgical diseases of the abdominal cavity, taking into account the ambiguity of the data provided by many specialists on patients with so-called acute abdomen for practical surgical activity. Information about the results of medical care for centenarians with acute cholecystitis is particularly interesting. To evaluate the results of the examination and treatment of centenarians hospitalizefor acute cholecystitis in multidisciplinary medical organizations where geriatric care is licensed. Results of the examination and treatment of 79 patients of the St. Petersburg State Medical University "War Veterans Hospital" in 2015–2022 for acute cholecystitis are presented. All patients are long–lived, their age exceeded 90 years. Information about each patient was stereotypically entered into a data base (Xl-format) under certain headings reflecting typical algorithms of clinical activity. The digital parameters of each of the headings were subjected to a targeted statistical analysis, taking into account generally recognized criteria for evaluating the results and   quality of medical care provided to patients with acute cholecystitis. When analyzing the examination features and treatment results of patients of the so-called age cohort of the population, it was found that acute cholecystitis is not a rare pathology observed in centenarians; cases of calculous forms of the disease prevail in patients of older age groups; diagnosis of acute cholecystitis in centenarians is characterized by certain difficulties; performing operations due to acute cholecystitis in patients over 90 years of age is associated with significant the risk of postoperative complications, which, in turn, leads to high mortality rates. Centenarians with acute cholecystitis make up a special group of patients for whom it is advisable to provide medical care in multidisciplinary medical organizations, specialists who have the necessary competencies in gerontology and geriatrics.

The technique of radical prostatectomy has already been developed in detail, tested and widely used by oncourologists in the treatment of patients with prostate cancer. In this disease, this surgical intervention is considered an operation of choice. Despite the achieved validity of standardization measures in the implementation of radical prostatectomy, the results of its implementation in medical organizations with ambiguous capabilities and licensed permits for the participation of their employees in the process   of providing medical care to the male population of different subjects of the Russian Federation may differ significantly. This is especially evident when evaluating the activities of medical organizations specialists in large administrative centers of cities with a population of more than 1 million. The purpose of the study to evaluate in comparison the effectiveness of the implementation of radical prostatectomy in patients with prostate cancer by specialists of oncourological departments of medical organizations with an ambiguous status in the regulation of administration in the provision of oncourological medical services. The results of the implementation   of the radical prostatectomy in 2010–2023 in the medical institutions of two subjects of the Russian Federation (Kuban and St. Petersburg) have been studied. The indicators of the male population in these regions are comparable. The clinical data on the effective ness of radical prostatectomy in 2,591 patients of Krasnodar Regional Clinical Hospital No. 1 and 1,178 men hospitalized for RCT in   St. Luke's Clinical Hospital of St. Petersburg were evaluated. It is taken into account that in matters of organization of planning and implementation of the volume of urological care for men, these medical institutions differ in the level of authority in the administration of regional urology services. There were no significant differences in the examination data of patients from both the Head Medical Institution of the region (Krasnodar Regional Hospital) and St. Luke's City Specialized Hospital of St. Petersburg (in terms of age parameters, features of the clinical course of the oncological process, completeness of the examination, and other characteristics). The parameters of the effectiveness of surgical treatment of prostate cancer patients in the analyzed medical organizations in providing medical care to the majority of patients were regarded as positive (87.9 and 95.9 % respectively) It is obvious that the implementation of radical prostatectomy in urban specialized hospitals in administrative centers of regions with a million inhabitants with a   minimum frequency of negative consequences of surgical interventions with a positive effect on the course of the oncological process   is possible not only in purely Head multidisciplinary medical organizations., as it is practiced in the regions of Russia with a relatively small population. In the administrative centers of the so-called million-plus regions, their medical staff consists of qualified specialists using scientifically based individual approaches in urology, with sufficient experience, and with proper technical equipment (including and modern surgical robotic complexes), the performance of radical prostatectomy is permissible in medical institutions that are not formally affiliated with the Main institutions of the regions, but are certified and accredited for oncourologic al activities. Taking into account the high incidence of prostate cancer in men, as well as the priority of using surgical methods in providing medical care to patients with this disease, in specialized medical organizations in Russian megacities with a well-developed healthcare management system, It is advisable and acceptable to carry out radical prostatectomy outside the head medical regions by employees of regional scientific and production institutions with methodological control over achieving the proper quality and safety of medical activities of the Main and Leading specialists of Regional Health Authorities in the field of medical specialty (urology).

Экспериментальный остеоартрит может быть инициирован различными методами. Наиболее часто в практике используется химическая индукция с применением монойодацетата натрия (МИА). Предпринята попытка сравнительной оценки синовита на ранних стадиях развития изменений в суставах в эксперименте с применением синовиальной жидкости пациента и МИА. Необходимо оценить и сравнить рентгенологические и морфологические изменения, возникающие при введении монойодацетата (МИА) и синовиальной жидкости человека с остеоартритом начальных стадий в коленный сустав крыс. Эксперимент проводили на 20 самцах крыс линии Wistar весом 180–250 г. Сформировано четыре группы по пять животных (группы K, S, M, MS). Группе контроля (группа K) в оба коленных сустава делали инъекцию стерильного 0,9 % раствора хлорида натрия в объеме 10 мкл. Группе S в правый коленный сустав вводили 10 мкл синовиальной жидкости пациента с II стадией остеоартрита коленного сустава. В левый коленный сустав крыс вводили стерильный 0,9 % раствор хлорида натрия в объеме 10 мкл. Животным из группы M в правый коленный сустав вводили 10 мкл раствора MИА в дозе 2 мг на 10 мкл, в левый коленный сустав 0,9 % раствор хлорида натрия в объеме 10 мкл. Животным из группы MS в правый коленный сустав вводили 10 мкл раствора MИA, в левый – синовиальной жидкости. Рентгенологическое исследование проводили на 10, 25, 46 сут соответственно дням эвтаназии. В дальнейшем изготавливались гистологические препараты коленных суставов крыс с оценкой гистопатоморфологических признаков качественно и с использованием шкалы Hagen. В группах M и MS выявлены дегенеративно-дистрофические изменения в коленных суставах: отек и воспаление, сужение суставной щели, появление остеофитов, явления остеопороза, которые достигали максимума к 46 сут. В группе К, по рентгенологическим данным, суставная ткань осталась интактна. Наибольшие изменения обнаружены в суставах у крыс, которым вводился MИА, с заметным прогрессированием воспалительных и деструктивных процессов на 25 и 46 сут. При сравнении рентгенологических данных, полученных в ходе эксперимента, выявлено, что максимальные изменения с течением времени наблюдаются в коленных суставах крыс с внутрисуставным введением МИА. В ранние сроки эксперимента не выявлено рентгенологических изменений суставов в группе контроля, а также в суставах, в которые выполнялась инъекция синовиальной жидкости. Изменения в суставах после введения синовиальной жидкости, развивающиеся к концу четвертой недели, отличаются от изменений суставов с введенным МИА, а результаты рентгенологического исследования не отображают полной картины изменений, выявляемых при патоморфологическом исследовании, что не позволяет правильно диагностировать артрит и подобрать терапию в максимально ранние сроки.

The rates of instability of the endoprosthesis components after arthroplasty of the joints differ significantly. Aseptic instability of the implant is the cause of revision total hip arthroplasty in 20–80 % of cases. Aseptic instability of one or both components of the endoprosthesis was the main cause of revision knee joint interventions in 17 % of cases. At the same time, the proportion of aseptic loosening of the hip joint endoprosthesis in the structure of primary revisions reaches 50.3 %, and in the structure of repeated revisions it ranks second in frequency after infectious complications, reaching 20 %. Literature data was searched in the open electronic databases of scientific literature PubMed and Library. The search was carried out by keywords and phrases. In some cases, aseptic instability of hip and knee arthroplasty is not such, since an in-depth microbiological examination can reveal the growth of low-virulent microflora. Unjustified simultaneous re-arthroplasty leads to an increase in the number of complications of this operation, in particular, periprosthetic infection. There are few works in the available literature devoted to the study of the spectrum of microflora and the definition of treatment tactics for such patients. There is an obvious need for scientific research to study the intraoperative differential diagnosis of periprosthetic infection in patients with the so-called aseptic instability of knee and hip arthroplasty in accordance with the principles of evidence-based medicine. The review analyzes publications devoted to the study of modern aspects of studying the treatment features of patients diagnosed with aseptic instability of hip and knee implants.

In recent decades, resection interventions for complications of peptic ulcer of the stomach and duodenum have been a backup option for surgical care. Vagotomy with gastric drainage surgery can be performed as a less traumatic intervention in severe comorbid condition. The purpose of this work is to analyze a clinical case of surgical treatment of combined complications of duodenal ulcer occurring against a background of combined abdominal and severe concomitant pathology. The patient underwent stem vagotomy with pyloroplasty according to Finney, cholecystectomy with drainage of the stump of the cystic duct according to   Halsted – Pikovsky. The postoperative period was complicated by suture failure, traumatic bleeding from the duodenum, which was successfully supervised by conservative measures and endoscopic procedures. Minimally invasive endoscopic and surgical technologies should be used to treat life-threatening complications of duodenal ulcer in patients with severe comorbid background. The long-term results of treatment of a patient with a complicated course of peptic ulcer disease, combined surgical and severe concomitant pathology, presented in this clinical case, allow us to confirm the correctness of the choice of organ-preserving surgical tactics.