Objective. This study evaluated the long-term clinical and angiographic outcomes of coronary artery reconstruction for a diffusely diseased coronary artery without endarterectomy.

Material and Methods. We retrospectively reviewed 660 consecutive patients (mostly men (89.5%), mean age 68.3 ± 7.4 years) who underwent coronary artery bypass grafting in combination with coronary artery reconstruction between 2003 and 2016. 558 operated on patients (84.5%) were followed up for a mean of 94.3 ± 31.2 months.

Results. Long-term survival was 83.2% (95% confidence interval: 74.5–89.3); freedom from cardiac death was 97.4 ± 1.2%; and freedom from major adverse cardiac and cerebrovascular events was 64.7 ± 4.1%. Independent predictors of long-term mortality were age at surgery (< 70 years, p < 0.001), chronic obstructive pulmonary disease (p = 0.007), peripheral arterial disease (p = 0.002), diabetes mellitus (p = 0.013) and chronic kidney disease (p = 0.034). The arterial graft patency rate was 95.2%, and the vein graft patency rate was 75.4%.

Conclusion. Coronary artery bypass grafting in conjunction with coronary artery reconstruction without endarterectomy confers satisfactory long-term clinical outcomes with high probability of freedom from cardiac death and angina pectoris, good rates of angiographic patency of arterial grafts and favorable rates of vein graft patency.

Background. Prolonged air leak is the most common postoperative complication following lung resection. Despite the huge number of researches concerning this problem, no consensus exists regarding the choice of the appropriate method of pleural space drainage after thoracoscopic surgery.

Objective. To compare suction and water-seal regarding their influence on the incidence of prolonged air leak.

Material and Methods. This prospective randomized trial included sixty patients who underwent VATS lobectomies on different diagnoses in the Center for Thoracic Surgery, Clinical Hospital no. 122 (St. Petersburg) from September 2018 until May 2020. The open-label randomized controlled trial involved two groups: control group (water-seal drainage) and suction group. Each group consisted of thirty patients. Ten patients were discharged with a Heimlich valve.

Results. The incidence of prolonged air leak was 23%. Patients in the suction group had a higher duration of air leak than those in the control group (5.3 ± 1.3 vs 3.7 ± 0.9 days, р = 0.04). The number of air leak cases was slightly higher in the suction group (8 and 6 patients); however, the difference was not significant (р = 0.57). Both groups had no difference in the number of complications (р = 0.2). There were no cases of reoperation.

Discussion. The advantage of water-seal is a lower risk of parenchymal defects. Suction may increase holes in visceral pleura, cause hyperexudation, leading to prolonged duration of drainage. At the same time, the use of suction may decrease residual pleural spaces, match visceral and parietal pleura, which may decrease the duration of air leak. A lot of studies on this issue was performed, however, their results are contradictory.

Conclusion. Drainage of pleural space after VATS lobectomies may be safely performed with water-seal. In the case of increasing surgical emphysema or appearance of progressive dyspnea, suction should be applied

Background. The available data from clinical studies suggest the essential role of free radical processes in the pathogenesis of drug dependence syndrome. At the same time, there is a limited understanding of using markers of oxidative stress in laboratory monitoring and prediction of drug pathology.

Objective. To characterize changes in promising indicators of oxidative stress in patients with psychostimulant and opioid dependence syndrome.

Material and Methods. The total study population was divided into three groups of men aged 23–35: healthy controls (n = 20), patients with the opioid (n = 20) and psychostimulant (n = 20) dependence syndrome. Patients were analyzed for the oxidative stress markers while being in therapy for addiction syndrome aimed at treating mental disorders and detoxification.

Results. The study of antioxidant activity and blood plasma thiol groups did not reveal any significant differences between patients suffering from opioid and psychostimulant addiction. The values of the parameters mentioned above were maintained by 20–30% lower than the control indices throughout the entire study. The nature of changes in erythrocyte suspension parameters was not so unambiguous. Thus, patients with opioid dependence syndrome were characterized by a 91% increase in thiobarbituric acid (TBA)-reactive materials in the setting of a slightly altered state of the glutathione system parameters. Psychostimulant dependent patients revealed relatively low level of the products of biomolecule oxidative modifications in the erythrocytes that is 52% higher compared to the control values. It decreased during the therapy, but glutathione concentration reduction by 33% and an imbalance of glutathione metabolism were determined.

Conclusion. The course of the opioid dependence syndrome is characterized by a pronounced intensification of free radical processes while the common trait for psychostimulant abusers is significant changes in the antioxidant defense system. Therefore, in the first case, it is most justified to conduct a laboratory assessment of indicators of oxidative damage, and in the second one, it is also advisable to determine the markers of the state of individual links of the antioxidant system.

Background. Pain syndromes developing as a result of degeneration of the lumbar segments of the spine constitute a significant problem in modern vertebrology. The results of the application of preoperative diagnostic provocative tests are contradictory, and therefore the mixed effectiveness of puncture surgical techniques is recorded.

Objective. To develop an algorithm for the clinical and instrumental diagnosis of non-compression lumbar pain syndromes to optimize the use of puncture surgical techniques.

Material and Methods. The study included 923 patients who underwent provocative diagnostic techniques on the intervertebral disk (IVD) and the arched joints (AJ) between 2012 and 2017. Taking into account clinical and instrumental data, the following are made: in group I (n=246) – laser IVD nucleoplasty, in group II (n = 287) – laser denervation of FJ, in group III (n = 390) – simultaneous use of laser exposure to IVD and AJ. We analyzed the dynamics of the level of pain in the lumbar spine and lower extremities according to The Visual Analogue Scale and quality of life according to The Short Form-36 (SF-36) questionnaire.

Results. When performing provocative diagnostic tests, the minimum number of adverse effects was recorded: 3.2% in group I, 2.4% in group II, and 2.1% in group III. After puncture methods of surgical treatment, a significant persistent decrease in the severity of preoperative pain was observed both in the lumbar spine (p = 0.002, p = 0.005 and p = 0.004, respectively) and in the lower extremities (p = 0.003, p = 0.001 and p = 0.005, respectively) A significant improvement in the physical and psychological components of health was also established in group I (p = 0.02 and p = 0.01, respectively), in group II (p = 0.01 and p = 0.03, respectively) and group III (p = 0.03 and p = 0.02, respectively).

Conclusion. In the presence of neuroimaging parameters of IVD according to C. Pfirrmann III–IV and protrusion size 4–6 mm, minimal degenerative changes in the AJ according to A. Fujiwara I–II and D. Weishaupt I–II, as well as a positive disruption test, it is possible to perform laser nucleoplasty. In case of detection of neuroimaging data of IVD according to C. Pfirrmann I–II and protrusion size less than 4 mm, moderately pronounced degenerative changes in the AJ according to A. Fujiwara II–III and D. Weishaupt II–III, as well as positive paraarticular stimulation of AJ, laser denervation of AJ is recommended. When determining, according to neuroimaging data, moderate degenerative changes in IVD according to C. Pfirrmann over III and protrusion size 4–6 mm, as well as degeneration of AJ according to A. Fujiwara more than II and D. Weishaupt more than II, positive of samples and paraarticular stimulation of AJ, it is advisable to perform simultaneous surgical intervention in the volume of laser IVD nucleoplasty and laser denervation of AJ.

Background. Liver lesions are increasingly found in a huge number of patients. Ultrasound (US) is the method of choice in liver lesion characterization. The limitations of traditional US techniques are well known. Multiparametric ultrasound (MPUS) includes multiple facets of the US examination, and their combination can significantly improve the diagnostic capabilities of the method.

Objective. To evaluate the capabilities of MPUS in the differential diagnosis of liver tumors.

Material and Methods. A retrospective analysis included 172 patients with morphologically confirmed liver tumors. All patients underwent an MPUS examination.

Results. Traditional US techniques have a rather low specificity in the differential diagnosis of liver neoplasms: the sign of “contour clarity” was typical for hemangiomas, hepatocellular adenomas (HCA), liver metastases and was recorded in 82, 100, 96% cases, respectively; heterogeneous echostructure was noted in all nosological entities, groups of hepatocellular carcinomas (HCC), liver metastases and HCA were characterized by foci of various types of echogenicity. Specific symptoms were discovered in patients with liver metastases (32%) and focal nodular hyperplasia (FNH) (96%). Intratumoral blood flow was recorded in 34 (19.7%) cases. The study of spectral characteristics was possible only in 11 (6.4%) patients. Statistically significant differences in contrast-enhanced US parameters “contrasting onset in focus” were found between the groups “FNH & hemangioma” (р < 0.000046), “FNH & HCA” (р < 0.006293), “MTS & FNH” (р < 0.028125), “FNH & HCC” (р < 0.024933), “maximum fill-in time” – “FNH & hemangioma” (р < 0.012590), “FNH & HCC” (р < 0.007983), “MTS & HCC” (р < 0.000243). Statistically significant differences in the wash-out time were obtained in “MTS & HCC” and “MTS & HCA” groups.

Conclusion. Conventional US should be used as basic screening, follow-up and navigation in the neoplastic biopsy. Contrast-enhanced US within MPUS is currently a well-established technique which allows a more precise and confident diagnosis of liver tumors.

We report the clinical case of treating a female patient with a giant dumbbell neurinoma arising from the Th1 nerve root. For the treatment of neoplasm, a hybrid surgical tactic was chosen, including Th1 hemilaminectomy, mobilization of the dorsal part of the tumor and video-assisted thoracoscopy in order to remove its intrathoracic mass. The patient developed no neurological complications after surgery. A gross total tumor resection was documented by control computed tomography. Thus, well-coordinated work of the multidisciplinary surgical team provided good oncological and functional results in the treatment of a giant neurinoma with extension into the thoracic cavity.

Structural and functional cardiovascular abnormalities associated with single ventricle physiology are particularly challenging in terms of perioperative management. The modified Fick principle is considered to be one of the most effective tools for evaluating a patient’s clinical status as well as the parameters of respiratory and hemodynamic support.

The availability of a stoma after Hartmann’s procedure significantly limits the patient’s ability to work and worsens the quality of his/her life, as it partially isolates him/her from society. Performing plastic colon surgeries is challenging due to the active formation of intestinal adhesions and low rectal stump. At present many different devices, equipment, operating methods, and techniques have been proposed for reconstructive surgery on the colon. However, the issues of access to the surgical area, providing constant visual control, both at the stage of isolation for the short stump of the rectum in the narrow pelvis and in formation process of low colorectal anastomosis, are not covered in the scientific publications.

New possibilities of modern medical science open up prospects for instrumental and laboratory diagnostics of many pathological conditions, unknown or not previously diagnosed in the practice of an orthopedist. These include bone marrow edema. Not only orthopedic traumatologists, but also rheumatologists, neurosurgeons, general practitioners, rehabilitation therapists, morphologists, and many others today face this concept in a variety of definitions, concepts of etiology, pathogenesis, and clinical recommendations for treatment.

The authors performed a systematic review by using four open resources: electronic scientific library (elibrary), PubMed, SciVerse (Science Direct), and Scopus.

The complexity of pathology lies in the fact that in each specific case, the development of treatment tactics requires a personal interpretation of the entire variety of data obtained and a case by case approach.

A significant increase in arthrosis and arthritis causes not only conservative but also other various methods of surgical treatment. Minimal invasiveness, less trauma compared to traditional surgical methods of treatment, the ability to carry out treatment on the principle of one-day surgery determine their greater demand.

The paper presents a review of literature data on the features of anesthesia in elderly patients who underwent arthroscopic surgery on the lower extremities.

The paper analyzes the life and professional journey of Nikolai F. Melnikov-Razvedenkov, an outstanding scientist, doctor, and professor, as a reflection of Russian history from the end of the 19th century till the first quarter of the 20th century. The study identifies the role of Nikolai F. Melnikov-Razvedenkov in the development of medical science and the establishment of medical education in the Kuban region. The analysis was conducted with the involvement of archival records, personal correspondence, and scientific works of Nikolai F. Melnikov-Razvedenkov. To solve research problems, the authors used historical descriptive, comparative historical, problem-based chronological, biographical methods, and the method of monographic description. It is shown that the scientist’s fate mirrors the cultural and historical era experienced by the country. The authors define the exclusive role of Nikolai F. Melnikov-Razvedenkov in the establishment of the Kuban Medical Institute. His life path helped reveal the inviolability of medical ethics based on mercy, dedication to the profession, and willingness to serve people. Even in the situation of social upheaval Nikolai F. Melnikov-Razvedenkov found the meaning of his life in scientific work and helping people. His example will allow the modern generation of doctors to gain a greater understanding of the essential purpose of their work.