Objective: To study and compare surgical risks and immediate effectiveness of surgical treatment in patients with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB).

Materials and methods: We examined immediate treatment outcomes of 1180 patients who underwent surgery for destructive MDRTB, pre-XDR-TB, and XDR-TB between 2011 and 2023. The patients were grouped: group 1 for patients with MDR-TB (744 cases) and group 2 for patients with pre-XDR-TB and XDR-TB (436 cases). Moreover, patients were further subdivided based on the extent of surgery.

Results: The complete clinical response, ie, cavity closure and elimination of bacilli (CV-, MBT-), was achieved in all 405 patients who underwent radical surgery, in 673 (97.1%) of 694 patients who underwent semiradical surgery, and only in 10 (12.3%) of 81 patients who underwent palliative surgery.

Conclusions: The immediate outcomes of surgical treatment for MDR-TB were superior in all parameters compared with those for pre-XDR-TB and XDR-TB; however, we found no significant differences when we evaluated treatment effectiveness in patients who underwent radical and semiradical surgery. 

Background: Although there is a significant incidence of spinal metastases and hematolymphoid tumors, the treatment strategy (decompression or decompression+stabilization surgery) for patients with impending spinal instability (Spinal Instability Neoplastic Score [SINS] values of 7-12) has not been clearly defined.

Objective: To examine the rationale of decompression or decompression+stabilization surgery in patients with impending spinal instability (SINS values of 7-12) due to spinal metastases and hematolymphoid tumors and to assess treatment results within the specified range of SINS values.

Materials and methods: The study included 92 patients with spinal metastases and hematolymphoid tumors who underwent surgery between January 1, 2014 and December 31, 2022 at the National Medical Research Center for Oncology (Rostov-on-Don, Russian Federation). The main inclusion criterion was SINS values of 7-12. All patients underwent palliative surgical treatment: either decompression and stabilization or decompression alone.

Results: Stabilization of the spinal column was performed in 71 (77%) patients; in 21 (23%) patients, the affected segment was not fixed during surgery. Patients who underwent decompression had a higher rate of postoperative complications, with an increase in postoperative instability of the affected segment being the most significant. As for patients who underwent decompression + stabilization we found a moderate positive correlation between the lesion level and the number of fixed segments (r = 0.33, P< .05) and a weak negative correlation between the residual height of the vertebral body and the number of fixed segments (r = −0.26, P< .05).

Conclusions: Stabilization in patients with impending spinal instability (SINS =  7-12) due to tumors is a more justified treatment strategy than decompression alone

Background: One-lung ventilation is used to improve surgical visualization and facilitate thoracoscopic manipulations; however, it induces ventilation/perfusion mismatch, exacerbating the inflammatory response that causes hypoxemia in the perioperative period. Opioid analgesics are the main analgesic drugs used during video-assisted thoracoscopic surgery (VATS), but their use is associated with adverse effects and higher risk of respiratory complications. Corrective measures to eliminate hypoxemia, reduce the inflammatory response, control pain, and minimize opioid-induced adverse effects are crucial in thoracic surgery.

Objective: To study the efficacy of dexmedetomidine in reducing lung damage and postoperative complications after VATS.

Materials and methods: We examined 100 patients who underwent lobectomy via a thoracoscopic approach. The patients were grouped based on anesthetic management: group 1 (n = 50) with intraoperative dexmedetomidine and group 2 (n = 50) without it. We determined the level of pro-inflammatory cytokines IL-6, IL-8, and TNF and calculated PaO₂/FiO₂ and A-aDO₂. We also assessed the postoperative pain intensity, need for trimeperidin promedol and tramadol, and incidence of postoperative complications.

Results: During one-lung ventilation, patients from group 1 had higher PaO₂/FiO₂ values (P = .025). The A-aDO₂ value was higher in group 2 (P = .006). After surgery, we found differences in the content of TNF and IL-8 (P < .001). Twenty-four hours after surgery, we recorded a more significant prevalence of the studied cytokines in group 2 (P < .001). There were no significant differences in the pain dynamics on the first postoperative day (P > .05). Opioid analgesics were less needed in group 1 than in group 2 (P < .001). The incidence of postoperative complications did not differ significantly.

Conclusions: Dexmedetomidine in thoracic surgery improves the oxygenation and reduces the percentage of intrapulmonary shunting by inhibiting the release of pro-inflammatory cytokines. In the postoperative period, dexmedetomidine reduces the need for opioid analgesics, but does not affect the pain level or incidence of complications.

Background: Various physical phenomena come into use in medicine; however, to date, universal physical methods have not been developed to optimize the course of the wound healing at all treatment stages. In combustiology, the first stage of burn treatment is debridement; then it is important to create an optimal biological environment, normalize blood circulation, suppress pathogenic flora, and stimulate proliferative processes in the wound.

Objective: To determine the effectiveness of low-temperature argon plasma (LTAP) and ultrasonic cavitation in deep burn wound treatment based on clinical observations and cytological findings.

Materials and methods: We studied impression smears from burn wounds of 36 patients with deep burns of various etiologies who were treated using LTAP and ultrasonic cavitation in the Thermal Injuries Unit at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine (Saint Petersburg, Russian Federation) between 2022 and 2023.

Results: We found that cytogram findings in the study area changed from the inflammatory type to the regenerative-inflammatory one on day 3-7 when LTAP and ultrasonic cavitation were used, while such change in the control area was observed only after 10 days of treatment. Thanks to the use of LTAP and ultrasound after necrosectomy for deep dermal burns, the wound preparation for autologous skin grafting takes less time than it does with standard methods of local burn wound care. Ultrasonic cavitation should be used in cases of severe exudation and slough, whereas LTAP should be used when reparative processes in a burn wound slow down.

Conclusions: Burn wound treatment using ultrasonic cavitation and LTAP enables to prepare the wound surface for autologous skin grafting with a high engraftment rate. The procedure allows to effectively and atraumatically debride the wound and suppress pathogenic microflora. Further research is planned in patients with large deep burn wounds. 

Introduction: Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system accompanied by neurodegeneration contributing to cognitive dysfunction. Cognitive impairment occurs in 40%-65% of patients with MS and can manifest even in the early stages of the disease.

Objective: To evaluate cognitive dysfunction features in patients with MS.

Materials and methods: The study included patients with MS (n=30; age, 40.8±9.74 years; disease duration, 9.67±6.96 years; Expanded Disability Status Scale [EDSS] score, 4.76±2.11) and healthy individuals (n=30; age, 40.3±12.24 years). Cognitive impairment was assessed using the Montreal Cognitive Assessment Scale (MoCA) and the Paced Auditory Serial Addition Test (PASAT).

Results: Cognitive impairment in the group of MS patients was found in 73.3% of the cases. The mean MoCA, PASAT-3, and PASAT-2 scores of MS patients were 13.56%, 24.31%, and 29.48% lower than those in the control group, respectively. In women, the cognitive level in MS patients remains higher than in men. Analysis of the PASAT-3 and PASAT-2 results in MS patients did not reveal any statistically significant differences between the groups of patients aged 18-35 years and those aged 36-44 years and the groups of patients aged 18-35 years and those aged 45-59 years. The results of the MoCA and hearing tests in patients with higher and secondary education were not statistically significant. We found an inverse relationship between EDSS and PASAT-2 (R= −0.49; P< .05), EDSS and PASAT-3 (R= −0.37; P< .05). The most severe cognitive impairment was observed with high EDSS (7.5-9).

Conclusions: We have identified features of cognitive functions in MS. Follow-up and therapy of MS patients require cognitive dysfunction assessment using appropriate scales.

Introduction: Total anomalous pulmonary venous return (TAPVR) is a congenital heart defect in which there is no direct connection between pulmonary veins and the left atrium. Hospital mortality in patients with TAPVR, depending on the anatomical type of the defect, ranges from 14% to 35%. Without surgical correction, children with obstructive TAPVR die in the neonatal period. The mortality rate of children with nonobstructive TAPVR reaches 80% by the first year of life.

Objective: To evaluate the capabilities of transthoracic echocardiography (TTE) and cardiac computed tomography (CT) in TAPVR diagnosis and surgical planning of its correction.

Materials and methods: The study included 17 children with an initial diagnosis of TAPVR. The age of the patients was 28.5 (11; 91) days. All the infants underwent TTE; 15 patients underwent cardiac CT, and 4 patients, cardiac catheterization with conventional angiography. We evaluated and compared the capabilities of these methods in the diagnosis and determination of the TAPVR type and concomitant anomalies. All data were compared with conventional angiography findings and intraoperative data. The interval between TTE, cardiac CT, and angiography or open surgery was less than 5 days.

Results: The accuracy of TTE in diagnosing TAPVR was not significantly inferior to that of cardiac CT (88% vs 100%); erroneous results of TTE were found in 2 patients with heterotaxy syndrome (right isomerism). Both methods showed 100% diagnostic efficiency in determining the TAPVR type. The accuracy of TTE in diagnosing obstructive TAPVR was 81.2%, whereas that of cardiac CT, 94%. There was no statistically significant difference in diagnostic efficiency between CT and TTE in the diagnosis of TAPVR and its obstructive forms.

Discussion: Our findings demonstrate the high efficiency of TTE in diagnosing TAPVR, determining its anatomical type, and identifying obstructive forms. This method has limited diagnostic capabilities in determining TAPVR in patients with heterotaxy syndrome and other congenital anomalies of the atria. Cardiac CT has proven to be a highly accurate tool in diagnosing TAPVR and determining obstructive forms and associated heart anomalies.

Conclusions: In children with isolated TAPVR and normal arrangement of the organs (situs solitus) with good acoustic window, TTE is the initial and final tool for surgical planning of TAPVR correction. In children with TAPVR and concomitant heart defects, heterotaxy syndrome and other atrial anomalies, TTE should be supplemented by cardiac CT. Cardiac CT in children with TAPVR is an alternative to invasive cardiac catheterization with conventional angiography and should be a preferred diagnostic tool. Conventional angiography should be used in children with TAPVR for assessment of functional, not anatomical characteristics of the defect. 

Background: Early necrosectomy with immediate or delayed skin grafting is the gold standard in treatment of burn injuries. Despite all advances in active surgical treatment of burn patients, the optimal time of necrosectomy as well as methods and timing of skin grafting remain the subject of debate among burn surgeons. Reliability and practicality of methods to determine the viability of affected skin tissues act as a limiting factor to advances in surgical strategies for early treatment of burn injuries.

Objective: To improve methods of early surgical treatment of patients with deep burns using biological dressings.

Materials and methods: Our study analyzed treatment outcomes of 34 patients (age, 18 to 60 years) diagnosed with third-degree burn wounds of different localizations involving 5%-20% of body surface area (according to ICD-10). Group 1 included 18 (53%) patients who underwent skin grafting right after surgical removal of necroses; biological dressings (Chitopran) were applied. Group 2 comprised 16 (47%) patients who also underwent early surgical treatment (autografting), but autografts were covered with synthetic dressings (Voskopran).

Results: We found that in group 1 the average time to engraftment after skin grafting followed by Chitopran application was 5.0 (5.0-6.0) days. In group 2, the average time to engraftment after skin grafting followed by Voskopran application was 6.0 (6.0-6.3) days. The statistical data demonstrated that biological dressings had an advantage over synthetic ones in terms of time to engraftment.

Conclusions: We can conclude that biological dressings have an advantage over synthetic ones in surgical treatment of partial thickness and deep burn wounds. 

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer mortality worldwide. The effectiveness of its standard treatment in some cases remains poor.

We report a case of a patient with Barcelona Clinic Liver Cancer stage C cryptogenic HCC whose life duration was 26 months after diagnosis.

A 46-year-old woman, a former smoker, presented with elevated alpha-fetoprotein and a left liver lobe mass diagnosed as HCC. Pulmonary nodules (presumably metastatic) were previously found and remained stable. The left lobe of the liver was resected. Intrahepatic recurrence developed 1.5 months later. Lenvatinib+pembrolizumab therapy was prescribed and later switched to olaparib following the detection of somatic and germline BRCA1 mutation. The patient underwent a liver transplant and was prescribed a combination of tacrolimus and everolimus, later supplemented with extracorporeal photopheresis. Pulmonary nodules that were found to be metastases were treated with radiation therapy. A lethal outcome occurred 21.3 months after the transplant.

The first literature review related to this case report discusses the problem of neoadjuvant immune checkpoint inhibitor therapy prior to a liver transplant. More than 100 patients have been described in 40 articles and 113 patients, in 2 multicenter studies. Although 16.7%-27.7% of patients developed rejection, such approach may be effective in downstaging the disease. 

Malignant sinonasal tumors are rare and account for 1% of all neoplasms. Most of these carcinomas are poorly differentiated or undifferentiated tumors. Due to overlapping features, both young and experienced physicians encounter difficulties in their diagnosis. We present 2 cases of 2 tumors of the sinonasal tract, which belong to small round blue cell tumors: sinonasal small cell neuroendocrine tumor and esthesioneuroblastoma.

Calcification of the lower extremities arteries is an unfavorable factor for vascular surgery. Extensive lesions of the femoral segment are an indication for femoropopliteal bypass surgery. Calcification of the femoral arteries complicates the construction of a proximal anastomosis because it precludes clamping the arteries. In addition to technical difficulties in the construction of an anastomosis, significant calcification increases the risks of bleeding and embolic complications and the duration of surgery. In cases of total calcification of the femoral and iliac arteries, balloon occlusion during the construction of an anastomosis makes it possible to occlude the arteries without clamping, which reduces the risks of perioperative complications. We report a case of femoropopliteal bypass surgery in a patient with total calcification of the iliofemoral segment and occlusion of the superficial femoral artery.

Introduction: Hydatidiform mole with a normally developing fetus is a rare case associated with an increased risk of bleeding, preterm birth, preeclampsia, congenital anomalies, and intrauterine fetal death.

Case report: We report a case of a twin pregnancy with a hydatidiform mole and a normal fetus. The pregnancy was conceived via in vitro fertilization. The complete hydatidiform mole was diagnosed during the first screening. We extended the pregnancy until 38 weeks’ gestation. Thanks to the control of beta-human chorionic gonadotropin levels and dynamic ultrasound monitoring, the woman successfully gave birth. 

Introduction: The main disadvantage of bioprosthetic valves is the susceptibility of their leaflets to structural changes, leading to bioprosthetic valve dysfunction requiring a repeated surgical intervention. This group of patients is characterized by high comorbidity, which increases the risk of hospital mortality during repeated interventions. At the same time, low left ventricular ejection fraction (LVEF) is the main independent predictor of adverse outcomes. Transcatheter valve-in-valve implantation can be an alternative to an open intervention in patients with high surgical risk. However, this technique is often associated with prosthesis-patient mismatch due to a smaller effective orifice area of a bioprosthetic valve, as well as with the high incidence of intraventricular conduction disorders and/or the need for a pacemaker, preventing the LVEF recovery even in the late period after the procedure.

Objective: To demonstrate the role of transluminal balloon valvuloplasty in staged surgical treatment of bioprosthetic aortic valve dysfunction. Case report: We present our experience of successful staged surgical treatment of biodegenerative dysfunction of a biological prosthetic aortic valve using balloon valvuloplasty followed by “open” repeated valve replacement in a patient at very high cardiovascular risk.

Conclusions: This staged approach may be justified in patients with extremely low LVEF to minimize risks and improve surgical outcomes.

Cor triatriatum dexter is a rare congenital heart anomaly in which the right atrium is divided into 2 chambers by a membrane. Clinical manifestations vary depending on the degree of the right atrium separation and the presence of concomitant anomalies. We report a case of asymptomatic cor triatriatum dexter diagnosed during transthoracic echocardiography. The diagnosis was confirmed by transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Transthoracic echocardiography is a sensitive primary diagnostic tool for such congenital heart disease as cor triatriatum dexter. 

We discuss main challenges of much-debated endovascular treatment in patients with “false” bifurcation stenoses of the left main coronary artery. There are no convincing literature data on the rationale of planning complete bifurcation stenting using 2 stents and clear indications for this procedure. We highlight the importance of studying the effectiveness and safety of the complex routine use of various intravascular imaging during the left main coronary artery percutaneous coronary intervention. We analyzed observations in which a “false” bifurcation lesion can only be considered an ostial stenosis, which will affect the stenting strategy. We focus on the development of universal algorithms for performing endovascular interventions, including those using intravascular imaging which role at each stage of surgery should be additionally studied. 

This article aims to review the literature regarding assessment of the gut microbiota effect on kidney stone formation. We sought to determine whether several specific gut bacteria or a wider number of members of the gut microbiota are responsible for this association based on the literature data. We conducted an extensive literature search (publications on kidney stones and gut microbiota dated 2013-2023) in PubMed, Cochrane CENTRAL, and Web of Science Core Collection.

A large number of earlier studies were focused on physical and chemical properties of crystals formed by kidney stones. In recent years as diagnostic technologies advance, there has been a tendency to study the association of the gut microbiota and the development of other unrelated diseases. Studies have emerged showing the gut microbiota effect on the development of urolithiasis, which suggests that stone formation can be prevented or caused by changing the structure of the gut microbiome. However, further research is needed to identify which genera or types of the gut microbiota break down oxalate and reduce the risk of kidney stone formation. 

Leakage of intestinal anastomoses remains an issue in view of the increasing number of patients who need reconstructive interventions in different parts of the gastrointestinal tract. Researchers around the world are actively looking for methods of strengthening intestinal anastomoses. The literature presents various approaches to sealing intestinal anastomoses in experimental animals using allografts, biological sealants, polymer film materials, etc. This article classifies and analyzes innovative methods of strengthening intestinal anastomoses to prevent their leakage. We also describe a concept of developing polymer membranes for interventions on hollow organs and our experience in this field of work and making of medical devices at the premises of a university research laboratory. 

Toxoplasmosis of the brain is a pressing issue in the practice of neurologists and neurosurgeons. Most patients with cerebral toxoplasmosis are persons with AIDS. However, toxoplasmic encephalitis can develop in patients with any immunodeficiency conditions that lead to reactivation of toxoplasmosis infection in the central nervous system. Although cerebral toxoplasmosis is not a neurosurgical pathology, patients sometimes require neurosurgical interventions: diagnostic biopsy and lesion removal. Moreover, literature shows cases of removal of brain lesions initially mistaken for a brain tumor, which, as a rule, occurs when the patient’s HIV status is unknown and the severity of their condition does not allow for a comprehensive additional examination.

This article reviews Russian and foreign publications on neurosurgical interventions in patients with cerebral toxoplasmosis. 

The article discusses the problem of colonic anastomotic leakage in patients who underwent resection for colorectal cancer. We describe risk factors for colonic anastomotic leakage and diagnostic approaches. Particular attention is given to noninvasive early diagnosis of anastomotic leakage using laboratory tests with specific biochemical markers.