Objective: To compare the outcomes of mitral valve annuloplasty with support rings and that of the current technique employing an autopericardial strip in patients with degenerative diseases (patent RU2774033C1, June 14, 2022).

Materials and methods: The study included 105 patients with degenerative mitral valve disease who underwent surgery in our clinic from May 2010 to January 2020. Depending on the conduit type, the patients were divided into two groups. Group I included 53 patients who underwent mitral valve annuloplasty with an autopericardial strip. Group II included 52 patients who underwent annuloplasty with a support ring. Male patients predominated in both groups: 59.6% and 57.7%, respectively. The mean age of patients was 54.9 ± 9.5 years (36–78 years) in group I and 54.8 ± 10.05 years (32–70 years) in group II. In most cases, tri- and quadrangular resections of the P2 segment were performed, and in some cases, neochords were implanted to the A2 segment.

Results: There was 1 death in group II as a result of progressive cardiovascular and multiple organ failure while in group I no hospital mortality was reported. At the discharge, 81.1% of patients in group I and 59.6% of patients in group II had no mitral regurgitation.

Conclusions: The current technique of mitral valve annuloplasty with an autopericardial strip in patients with degenerative diseases allows for adequate stabilization of the annulus fibrosus and improves the surgical outcomes in selected patients. With our proposed method of mitral valve annuloplasty, the suitable strip length can be chosen for each patient.

Objective: To evaluate the effectiveness of endobronchial (EBUS) and endoscopic ultrasound (EUS) in cytomorphological verification of a malignant process using the transbronchial needle aspiration (TBNA) of the lymph nodes and mediastinal organs.

Materials and methods: In 2017–2019 we analyzed the cytological samples (standard and cell block) of 172 patients (115 males and 57 females) with an average age of 61 years (25–82 years) in the clinical diagnostic laboratory of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). Of them 111 were used for immunocytochemical analysis. The majority of the studies (77) were performed in patients with lung cancer in order to identify the stage of the disease. We used combined bronchoscopy under general anesthesia in the operating room with high-frequency ventilation and a rapid on-site evaluation (ROSE).

Results: We found the lymph node and mediastinal invasion in 140 (81%) patients who underwent EBUS-EUS TBNA. The non-diagnostic results were obtained in 32 (19%) patients. The combination of EUS and EBUS with TBNA showed the highest effectiveness in the mentioned clinical cases. The sensitivity, specificity, and accuracy of the cytologic analysis during EBUS and EUS with TBNA and no ROSE were 89%, 100%, and 90%, respectively. ROSE reduced the rate of non-diagnostic results and increased the sensitivity (96%), specificity (100%), and accuracy (97%) of the cytologic evaluation.

Conclusions: According to the obtained results, we recommend using EBUS-EUS TBNA modalities for morphological verification of the mediastinal lymph nodes as a routine invasive diagnosis component of the preoperative evaluation in patients with lung cancer.

Introduction: Computed tomography (CT) and CT angiography are standard imaging modalities for suspected acute intracerebral hemorrhage due to ruptured intracranial aneurysms. In this clinical setting, several protocols of computed tomography and CT angiography may be implemented. The standard CT angiography protocol is limited to intracranial vessels. The extended protocol may also include carotid and vertebral arteries and the aortic arch.

Objective: To define the CT angiography role in detection of extracranial carotid and vertebral artery disease and clinical significance of this method for patients with suspected acute intracerebral hemorrhages due to ruptured intracranial aneurysms.

Materials and methods: The study included 275 neurosurgical patients with acute nontraumatic intracranial hemorrhages due to ruptured intracranial aneurysms who were treated in Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) from September 2017 to August 2020. Computed tomography and CT angiography were performed in all patients. The scanned area included both intracranial and extracranial arteries (an arch-to-vertex angiogram) to detect extracranial carotid and vertebral artery diseases such as stenoses, occlusions, tortuosity, and hypoplasia.

Results: Atherosclerosis of internal carotid and vertebral arteries was diagnosed in 95 patients (34.5% of the total number of patients included in the study). In 13 (4.7%) patients these stenoses were hemodynamically significant. We identified a high frequency of tortuous carotid and vertebral arteries (122 cases, 44.3%) and vertebral artery hypoplasia (59 cases, 21.5%). The carotid and vertebral artery stenoses and congenital anomalies of vertebral arteries (however, not of carotid arteries) were associated with a higher incidence of unfavorable outcomes after endovascular treatment of intracranial aneurysms.

Conclusions: The optimal CT angiography protocol for acute nontraumatic intracranial hemorrhage should focus on the arteries of the head and neck (up to the aortic arch). This protocol shows higher detection rate of concomitant anomalies of carotid and vertebral arteries. These findings are important for planning and successful performance of endovascular treatment for intracranial aneurysms. 

Background: Little is written about substantiated clinical and biometric indications for dynamic stabilization, rigid fixation, and their combinations in patients with two-level degenerative disease of the cervical intervertebral discs (IVD).

Objective: To study the risk factors for poor outcomes of two-segment interventions (total disk arthroplasty, TDA; anterior cervical discectomy and fusion, ACDF; and their combination) in patients with two-level degenerative diseases of the cervical IVD; to develop a custom clinical and instrumental assessment strategy for future interventions.

Materials and methods: We retrospectively analyzed the outcomes in 118 patients with a two-level degenerative disease of the cervical IVD, who underwent TDA (n = 37), ACDF (n = 41), and their combination (n = 40) from 2005 to 2015. After this analysis, we built a mixed effects logistic regression model to identify and assess the impact of various risk factors on poor clinical outcomes in each intervention.

Results: TDA correlated with favorable outcomes in patients with cervical lordosis over 12 °; I–III grade IVD changes according to Pfirrmann scale; I–II grade facet joints (FJ) changes according to Pathria criteria; no FJ tropism; segmental movements amplitude > 8 °; interbody space height ≤ 6 mm, and with no central spinal stenosis/spine interventions. Favorable ACDF outcomes may be achieved in patients with cervical lordosis ≥ 7 °; more than III grade IVD changes according to Pfirrmann scale; more than II grade changes in FJ according to Pathria criteria; segmental movements amplitude ≤ 8 °; interbody space height < 6 mm. FJ tropism, central spinal stenosis, and history of spine interventions do not affect ACDF outcomes.

Conclusions: An individual approach to TDA, ACDF, and their combination as well as comprehensive preoperative clinical and instrumental assessment in patients with a two-level degenerative IVD disease contribute to the effective resolution of existing neurological symptoms, which reduced the pain severity in the cervical region and upper limbs, improve the patients’ functional status and quality of life in the late postoperative period, and reduce the number of postoperative complications and reinterventions.

Background: In some parts of the world, the incidence of postburn pathologic scars reaches 16%. One should understand reconstructive surgery techniques and prioritize scar prevention during burn wound treatment. Inadequate wound management affects scar tissue formation and may cause pathologic scarring. Optimal timing of skin restoration operations reduces the risk of postoperative complications.

Objective: To demonstrate that the surgical removal of fibrotic dermis and granulation tissue is feasible to reduce the incidence of pathologic scarring.

Materials and methods: We studied treatment results in 57 patients with deep burns who were divided into 2 groups based on surgical treatment types before autologous skin grafting. Group 1 underwent total excision of granulation tissue, removal of fibrotic dermis, and excision of wound edges on day 27–31 after the injury. On day 22–28 postburn, group 2 had tangential excision of granulation tissue, removal of the upper skin layers only (the fibrotic dermis preserved), and then autologous skin grafting. The patients were followed up postoperatively at 1, 6, 12 months. During the examinations we assessed the formed scar tissue and perfusion of the burn injuries. Types and features of the scar tissue were identified by histologic examination of biopsy tissues.

Results: We identified statistically significant differences between the analyzed patient groups based on the perfusion values measured by laser Doppler flowmetry and found a relationship between surgical approaches, wound perfusion, and the incidence of pathologic scarring.

Conclusions: When early debridement is unfeasible, the preferred surgical approach for deep burns is a staged wound cleansing from necrotic tissue followed by total removal of granulation tissue and fibrotic dermis, and finally autologous skin grafting. This approach prevents pathologic scarring.

Introduction: Retrograde intrarenal surgery (RIRS) alongside percutaneous surgery is gaining a leading position in the nephrolithiasis treatment. According to 2022 EAU Guidelines, RIRS is one of the basic surgical modalities to treat 10-20 mm kidney concrements. Turning concrements into dust, holmium laser is the most effective and safest method for concrement disintegration.

Objective: To determine surgical possibilities of holmium laser lithotripsy for single and multiple unilateral nephrolithiasis using disposable flexible ureterorenoscopes.

Materials and methods: We performed 124 interventions from October 2021 to October 2022 using LithoVue flexible ureterorenoscope in patients with nephrolithiasis, of them 70 males and 54 females with the mean age being 54 (27–74) years. Patients were divided into 2 groups: group I (56 patients) with a single renal concrement, group II (68 patients) with multiple concrements (2 to 7 pieces). The concrement size ranged from 5 to 20 mm. The density of kidney concrements on computed tomography (CT) was 214 to 1,620 HU. LightTrail 230 μm and 270 μm reusable laser fibers were chosen for Auriga XL holmium laser crushing mode. Laser operating settings were as follows: frequency 8 Hz, pulse energy 1,200 mJ (LightTrail 230 µm) and frequency 12 Hz, pulse energy 1,800 mJ (LightTrail 270 µm). These are the maximum setting values for the specific laser fibers.

Results: Average time of 1 concrement disintegration (V = 1 cm³) was 28.3 minutes. Concrement disintegration time was 21.4 ± 6.7 minutes (group I) and 42.3 ± 9.4 minutes (group II). Intervention time was 27.4 ± 8.3 minutes (group I) and 54.6 ± 12.4 minutes (group II). In-hospital stay was 2.5 ± 1 days (group I) and 3 ± 1 days (group II). The rate of surgical success according to CT scans was 92.6% (group I) and 88.2% (group II). Two patients in group I and 5 patients in group II required reintervention. One patient (1.8%) in group I and 3 patients (4.4%) in group II developed an acute pyelonephritis (Clavien-Dindo classification, grade II). In the remaining patients the complications did not exceed Clavien-Dindo grade I. There were no equipment-related issues in the perioperative period.

Conclusions: As a safe and effective procedure with low complication rate, fast postoperative recovery, and short hospital stay, RIRS can be used as a method of choice for disintegration of kidney concrements up to 20 mm in size.

Background: Investigating various postnatal parameters of cerebral hemispheres is of great practical value.

Objective: To study gender differences in hemispheric parameters and interhemispheric interactions in preadolescent children.

Materials and methods: The retrospective study assessed archived brain magnetic resonance images of 60 eight-year-old boys and 60 eight-year-old girls. The analyzed parameters were as follows: 1) hemispheric length; 2) hemispheric width; 3) hemispheric height; 4) width-longitudinal index of a hemisphere; 5) altitude-longitudinal index of a hemisphere; 6) length of frontal lobes; 7) length of parietal lobes; 8) length of occipital lobes; 9) length of temporal lobes. Quantitative indicators were assessed for normal distribution using the Kolmogorov–Smirnov test. Source data were accumulated and arranged in Microsoft Excel 2016 spreadsheets. Statistica 10.0 was used for the statistical analysis. The results were considered statistically significant with P < 0.05.

Results: The analysis of cephalometric indicators suggests sex-related variation in the cerebral hemispheres. Based on the obtained data we can identify morphometric parameters of interhemispheric variability that may act as one of the morphometric criteria for the brain asymmetry. The study results can be widely used for neuroimaging.

Conclusions: We determined cephalometric reference values for various cerebral hemispheres parts in preadolescent children.

Introduction: Testicular torsion is the most urgent case in pediatric andrology that requires emergency care due to the high sensitivity of testicular tissue to hypoxia.

Objective: To determine statistically significant parameters indicating diagnostic significance of some ultrasonographic testicular torsion symptoms in children.

Materials and methods: Ultrasonography was performed in 202 children with testicular torsion (main group) and 449 patients (control group) aged from 2 months to 17 years 11 months and 28 days. During statistical processing we determined the mean values, their standard deviation, sampling errors, significance of differences in the mean values, correlation coefficient and did ROC analysis. For an objective ultrasonographic assessment of testicular shape, we implemented the coefficient of rounding – k_o = (testicular length – testicular thickness) / testicular length – and the parameter Δk_o calculated as the difference between k_o for the affected side and the contralateral one.

Results and discussion: Testicular torsion was more common in children above 12 years of age (84.7%). The k_o was 0.160 ± 0.007 in the group of children with testicular torsion and 0.037±0.003 in the control group (t = 16.92, p >> .001). The ROC analysis proved the Δk_o to be highly informative: AUC was 0.886. The Δk_o was 0.130 ± 0.008 for patients with favorable treatment outcomes and 0.19 ± 0.01 (p < 0.001) for those with unfavorable outcomes. In most cases (71), the whirlpool sign was visualized with preserved blood flow. In such a case, the probability of the favorable treatment outcome was 74.6%. The whirlpool sign visualization was significantly less common (31 cases) without Doppler ultrasonography; favorable treatment outcomes were achieved in 54.8%. Of 22 patients with the undetected whirlpool sign, favorable treatment outcomes were possible only in 40.9%.

Conclusions: The coefficient of rounding k_o can be used as an auxiliary criterion for the early diagnosis of testicular torsion. With Δk_o = 0.08, the sensitivity of the parameter in respect of testicular torsion is 79.2%, and specificity is 85.7%. With Δk_o = 0.16, the specificity of the parameter is almost 100% with a 45.0% decrease of the sensitivity. Whirlpool sign detection using color Doppler ultrasonography is a positive prognostic factor.

Background: Russian state policy for health protection, rehabilitation, and health improvement requires studying regional mortality rates, including those related to COVID-19.

Objective: To assess differences in COVID-19-related mortality between the regions of the same federal district.

Materials and methods: Mortality data are sourced from death records in the Unified State Register of Civil Status Acts. The data were analyzed using unweighted arithmetic means, specific indicators, and standard deviation (the mean ± standard deviation). To eliminate the distortion by an age factor in mortality rates comparison, we replaced the age structure of the individual region’s population with that of Russia through indirect standardization of mortality rates. We used K-means clustering to group the regions by COVID-19-related mortality rates.

Results: In 2021 Russia had 2,446,922 deaths, i.e. 648,615 (36.1%) and 163,645 (7.2%) cases more compared to 2019 and 2020, respectively. Of the total number, 17.3% of cases (424,252) had COVID-19 as a primary cause of death: nearly three times more than in 2020 (144,691 COVID-19-related deaths). Based on the average sizes of all individual age groups related to the respective region, nonstandardized and standardized COVID-19-related mortality rates were 265.30 ± 103.16 and 279.28 ± 91.07 per 100,000 persons in 2021, respectively. The cluster analysis showed that the largest number of regions (28 regions in 8 federal districts) comprised the third cluster with an average mortality rate of 276.26 ± 15.16 per 100,000 persons. The first cluster with an average mortality rate of 406.43 ± 29.26 per 100,000 persons included 12 regions in 7 federal districts. The second сluster included 21 regions (341.49 ± 18.16 per 100,000 persons) in 6 federal districts, the fourth cluster – 17 regions (196.73 ± 25.05 per 100,000 persons) in 6 districts, and the fifth cluster – 7 regions (87.22 ± 12.42 per 100,000 persons) in 5 districts.

Conclusions: There is no common explanation for the COVID-19-related mortality differences not only between the regions of the same country but also between countries. This lack of understanding gets worse because one should also separate the pandemic’s health factors from social, psychological, and economic ones. The government should play a more important role in healthcare management, reform payment systems, and eliminate private financial intermediaries used to pay for medical services.

Restrictions: The Unified State Register of Civil Status Acts data, which consisted of preliminary death certificates, may differ from the data of the Federal State Statistics Service, which became available to researchers later in 2022.

Objective: Long-standing gastroesophageal reflux disease is the most common cause of a cicatricial stricture of the esophagus. The treatment of this pathology involves a wide range of methods including conservative and surgical options. Surgeons can encounter technical difficulties in case of concomitant neck and chest pathology.

Clinical case: We report a case of a decompensated cicatricial stricture of the esophagus with concomitant paraesophageal hiatal hernia, refractory gastroesophageal reflux disease, and nontoxic multinodular goiter (166.9 cm³). Selecting the optimal management for such patients is often a challenge. Staged treatment significantly improves postoperative quality of life, but the increased length of hospital stay can negatively impact patient compliance.

Objective: To determine the role of and indications for peroral cholangioscopy using the SpyGlass system in the differential diagnosis of biliary tract lesions and in case of biliary strictures, based on the literature data analysis and our own experience.

Materials and methods: Peroral cholangioscopy is mainly used for the differential diagnosis of biliary tract lesions. During peroral cholangioscopy, we carefully consider gross signs of damage to the bile duct mucosa: abnormal capillary vascular pattern, granulation tissue and other types of proliferation, palpatory characteristics of the wall. Morphology should also be verified during image-guided intraductal forceps biopsy.

Results: Peroral endoscopy of the biliary tract significantly increases the effectiveness of differential diagnosis between various types of biliary strictures.

Direct examination of the bile duct mucosa with optical forceps biopsy and morphological verification increases the sensitivity and specificity of stricture type determination up to 83.3%–96% and 90.9%–99%, respectively. The diagnostic value of peroral cholangioscopy in the diagnosis of malignant and benign biliary tract lesions exceeds the effectiveness of endoscopic retrograde cholangiopancreatography, even with fluoroscopy-guided verification of ducts.

Conclusions: Peroral cholangioscopy with its enormous potential plays an important role in management of patients with various diseases of the bilio-pancreatoduodenal area, including biliary strictures. We formulated key indications for peroral cholangioscopy based on the literature data analysis and our own experience with this technique in patients with bile duct pathology, including nondifferentiated biliary strictures.

Currently, purulent-inflammatory diseases of the abdominal organs are the prevalent causes of complications and mortality. Treatment of these diseases complicated by peritonitis is one of the urgent problems in modern clinical medicine. Experiment is important for testing new treatment methods. This article provides a systematic analysis of the current in vivo models of the purulent peritonitis, which are used to test the options for surgical treatment and combinations of antibacterial drugs. We describe the most common models as well as rare simulations of specific peritonitis. It should be noted that despite the wide use of minimally invasive techniques, the literature has few reports on simulation of peritonitis through the laparoscopic approach.

This article is part 2 of our review assessing diagnostic modalities. In the first part, we analyzed the ultrasonography capabilities to detect abdominal adhesions. The second part assesses the effectiveness of MRI and CT.

MRI and CT modalities are much less commonly used in detecting adhesions than ultrasonography. MRI has approximately the same prognostic capabilities as ultrasonography in detecting adhesions between the viscera and the abdominal wall, and it additionally detects adhesions between the abdominal organs. Yet, MRI is significantly more time-consuming and highly dependent on the radiologist experience. Like ultrasonography, MRI determines the extent of adhesions but not the type.

Native CT does not visualize abdominal adhesions, though its findings in artificial pneumoperitoneum are superior in diagnostic value to those of ultrasonography and MRI, so this modality should be considered.

Background: Caused by the degenerative spine disease (DSD), the pain syndrome in the lumbosacral spine and lower extremities represents a socioeconomic problem. Nowadays, minimally invasive methods of treatment, in particular, epidural injections (EI), are commonly used.

Objective: To do a literature review on translaminar EIs and their mechanism of action in treating patients with radicular and vertebrogenic pain symptoms arising from the DSD.

Materials and methods: We analyzed the most recent literature data in which the efficacy of epidural corticosteroid injections for DSD was evaluated.

Conclusions: Translaminar EIs with corticosteroids are effective in relieving symptoms in the short term (up to 6 months) and delaying the surgery, but the evidence of their long-term benefits is yet to be found.

In this article we describe a rare clinical condition of stress cardiomyopathy (takotsubo cardiomyopathy) for which we, despite controversy and lack of data, identified the main pathogenic pathways (including the direct toxic effect of catecholamines on the myocardium, catecholamine-mediated myocardial stunning, and microcirculation disorders). After the systematic review, we identified the distinct pathology features of this condition and new diagnostic strategies.

Colorectal cancer ranks third after breast cancer in terms of incidence and second after lung cancer in terms of mortality.

Management of rectal cancer requires a multidisciplinary approach, with the surgical management playing the main role. There are currently three resective techniques that complement the traditional open surgery: laparoscopic surgery, robotic surgery, and transanal total mesorectal excision.

Rectal cancer in elderly patients is particularly hard to diagnose and treat surgically due to multiple comorbidities and limited functional reserve. Treatment of such patients may be associated with poorer outcomes after both open and minimally invasive surgery.

This article reviews the current state of advances in minimally invasive surgery for rectal cancer in general and in elderly patients in particular.