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Trauma is one of the leading causes of disability and mortality in working-age population. Abdominal injuries comprise 20-30% of traumas. Uncontrolled bleeding is the main cause of death in 30-40% of patients. Among abdominal organs, spleen is most often damaged due to fragile structure and subcostal localization. In the last two decades, therapeutic management has become preferable in patients with abdominal trauma and stable hemodynamic parameters. In addition to clinical examination, standard laboratory tests and ultrasound, as well as contrast-enhanced CT of the abdomen should be included in diagnostic algorithm to identify all traumatic injuries and assess severity of abdominal damage. Development of interventional radiological technologies improved preservation of damaged organs. Endovascular embolization can be performed selectively according to indications (leakage, false aneurysm, arteriovenous anastomosis) and considered for severe damage to the liver and spleen, hemoperitoneum or severe polytrauma. Embolization is essential in complex treatment of traumatic vascular injuries of parenchymal abdominal organs. We reviewed modern principles and methods of intra-arterial embolization for the treatment of patients with traumatic injuries of the liver and spleen.

Objective: To evaluate the immediate results of ankle replacement with original prosthesis in a patient with severe post-traumatic deformation of the distal tibia.

Material and methods: When developing the original design of ankle prosthesis, we considered foreign analogues of classical and revision models of ankle prostheses taking into account their shortcomings. In this case, an integrated approach was used. Extensive work has been carried out to select materials for prosthetic components. Experimental work with mesenchymal stromal cells of bone marrow was aimed at testing cytotoxicity and biological compatibility. The staff of the department of designing biomechanical structures of the Research Institute of Bionics and Personalized Medicine of the Samara State Medical University carefully studied the proposed design of endoprosthesis using the Ansys software. After cadaver tests on full-scale models, we performed surgical intervention in a patient with severe post-traumatic deformity of the lower third of the left tibia.

Results: Our studies revealed convenience and certain advantages of intraoperative installation of original ankle prosthesis. Along with this, this clinical example indicated come features that must be taken into account in revision ankle replacement to avoid possible postoperative consequences.

Conclusion: Original ankle prosthesis makes it possible to replace the distal tibia and preserve limb function.

A 19-year-old patient after previous wedge resection of the right upper pulmonary lobe a year ago urgently admitted with recurrent right-sided spontaneous pneumothorax. According to standard management of spontaneous pneumothorax, we performed diagnostic thoracoscopy and drainage of the right pleural cavity with regular X-ray examinations. However, these measures were ineffective. The patient was scheduled for surgery, and we intraoperatively observed an unusual cause of pneumothorax. Thus, we present spontaneous pneumothorax following right upper lobe pulmonary sequestration. The uniqueness of this case is associated with unusual manifestation and non-standard localization of rare lesion. A few cases of pneumothorax in similar patients are described in the world literature. The key limiting factor in diagnosis of such defects (identification of aberrant vessel supplying abnormal lung parenchyma) is the lack of routine CT angiography in patients diagnosed with pneumothorax. That is why CT changes were interpreted as postoperative ones, and the true cause was established only during redo surgery. A thorough inspection of the pleural cavity and alertness regarding unusual appearance of the right upper pulmonary lobe made it possible to suggest a non-standard diagnosis, avoid complications (bleeding from afferent vessel) and perform adequate lung resection.

Objective: To study the effect of bariatric surgery on serum ghrelin in patients with morbid obesity.

Material and methods: We experimentally analyzed serum ghrelin in 96 rats. Of these, 84 rats underwent sleeve gastrectomy, and 12 rats comprised the control group (no surgery). We measured body weight and serum ghrelin using ELISA method after 1, 3, 7, 14, 21 and 30 days after surgery. Serum ghrelin was studied before and after bariatric surgery in 23 patients with morbid obesity.

Results: Baseline serum ghrelin was lower in larger rats and obese patients compared to normal body weight. We found no decrease in serum ghrelin after resection of fundal ghrelin-releasing part of the stomach.

Conclusion: Stomach volume changes after restrictive bariatric surgery (sleeve resection or gastroplication) are accompanied by mild increase in serum ghrelin. This increment is greater after more significant body weight loss after surgery. Similar researches will help to find new treatment strategies for pathological obesity.

Objective: To identify the factors associated with normal leukocyte count and C-reactive protein (CRP) in adults with acute appendicitis.

Material and methods: A retrospective cohort study included patients aged 18-60 years after surgeries for acute appendicitis. Convenience sampling was used to select medical records, and variables such as age, sex, weight, height, origin, self-medication, diabetes (DM2), high blood pressure (HBP), type of appendicitis, duration of illness, preoperative time, type of appendectomy, operative time, and hospital stay were analyzed. Patients were categorized into those with normal and abnormal inflammatory parameters. The SPSS version 28 software was used for analysis.

Results: We included 333 patients; 11.11% ones had normal inflammatory parameters. Both groups had mean age of approximately 33 years. Men comprised 56.76% and 57.43%in both groups, respectively. The abnormal group had shorter mean preoperative time, and catarrhal appendicitis was more common in the normal group. Multivariate analysis revealed that rural origin and self-medication were significantly associated with normal inflammatory parameters.

Conclusion: The prevalence of normal inflammatory parameters in acute appendicitis patients was 11.11%. Rural origin, self-medication, shorter preoperative time, and catarrhal appendicitis were significantly associated with normal inflammatory parameters in this context.

Objective: To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients.

Material and methods: A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m².

Results: The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique (p=0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing.

Conclusion: Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.

Objective: To study the diagnostic value of fluorescent lymphography for sentinel lymph node biopsy in breast cancer.

Material and methods: The cohort study, conducted at 4 specilized centers between June 2019 and March 2024, included 333 patients with cT1-4 N0-1M0 breast cancer. 50 patients received neoadjuvant systemic therapy, 14 of them had single metastases, confirmed by cytological or histological methods, which clinically completely regressed after systemic treatment. Immediately before the operation, 1 ml (5mg) of indocyanine green was injected subareolarly or subcutaneously into the tumor projection. Fluorescence imaging was performed using various devices for ICG navigation in the open surgical field - MARS, IC-Flow, Stryker SPY-PHI, IC-GOR. In 78 patients after sentinel lymph node biopsy standard axillary lymphadenectomy was performed.

Results: Detection level was 99.1%. The average number of sentinel lymph nodes was 3.4. Metastatic lesions of sentinel lymph nodes were detected in 54 of 330 patients (16.4%). The average number of metastatic lymph nodes was 1.6; in 90.7% of cases metastases to 1-2 lymph nodes were registered. Intraoperative morphological examination revealed metastases only in 59% of cases. No systemic adverse events were recorded. The false-negative error rate in the group of patients who underwent axillary lymphadenectomy was 6.6%. The overall accuracy of fluorescent lymphography for sentinel lymph node biopsy in breast cancer was 94%.

Conclusion: The SLNB technique using fluorescence lymphography is safe and highly accurate as a stand-alone method.

We present a 36-year-old woman with small pelvis lipoma spreading to the gluteal region through the greater sciatic foramen. Resection of lipoma was performed via two accesses (lower median laparotomy and semilunar incision in the gluteal region). The tumor was the content of sciatic hernia that is extremely rare. Combination of surgical approaches can provide favorable outcomes in these patients.

Objective: To improve the results of treatment of deep vein thrombosis of the upper extremities sing endovascular technologies.

Material and methods: We analyzed safety and effectiveness of treatment in 24 patients with deep vein thrombosis of the upper extremities. All ones were divided into 2 homogeneous groups by 12 people each. In the first group, conventional anticoagulation was performed. In the second group, we used additional regional catheter thrombolysis with alteplase and, if necessary, venous stenting or balloon angioplasty for residual stenosis. Patients received apixaban at baseline and throughout 6 postoperative months. After 12 months, we performed ultrasound and clinical examination to identify deep vein patency and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. The quality of life of patients was studied using the SF-36 questionnaire.

Results: In the first group, we observed complete vein recanalization in 25% of cases, partial - in 33%, minimal - in 41% of cases; in the second group - 83.3% and 16.7% of patients, respectively. In the first group, clinical manifestations of venous outflow disorders were absent in 25% of patients, mild disorders - 25%, moderate - 8.3%, severe - 41.7% of patients. In the second group, venous outflow was not impaired in 83.7% of patients, mild violations occurred in 16.7% of patients. In the first group, physical health was equal to 44.2±1.7 scores, psychological health - 49.3±2.3 scores; in the second group - 69.3±5.7 and 71.3±5.4 scores, respectively.

Conclusion: Endovascular treatment improved postoperative outcomes.

Objective: To justify the optimal method for determining indocyanine green plasma disappearance rate (PDR_ICG).

Material and methods: We analyzed PDR_ICG in intensive care units. Indocyanine green was administered intravenously at a dose of 0.25 mg/kg. PDR_ICG was analyzed simultaneously by using of three methods: 1) PDD (PiCCO2 LiMON device), 2) SBS with analysis of plasma samples on precise spectrophotometer, 3) SBS with analysis of plasma samples on simple experimental photometer.

Results: PDD method was used for 346 PDR_ICG tests in 256 patients. Of these, 14.3% of measurements were erroneous. Paired tests using PDD and SBS methods were performed in 299 cases. SBS method resulted erroneous data in 0.6% of cases. Certain correlation (r=0.79, p<0.001) was found between the reference method (SBS with spectrophotometry) and the PDD method. Bland-Altman plot for these two methods showed that proportional bias of mean difference was caused by extremely high PDR_ICG of the PDD method (for example, more than 30%/min). Comparison of two SBS variants (spectrophotometer and experimental photometer) revealed good correlation (r=0.91, p<0.001).

Conclusion: SBS method for measuring PDR_ICG ensures accurate results under mechanical interferences in patients with impaired capillary blood flow. This eliminates the need for redo measurement. Duplication of the PDD and SBS methods is recommended when repeating the test is not possible (organ donors).