Year 2022 Vol. 30 No 6




Federal State Budgetary Institution "Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies" of the Federal Medical and Biological Agency of Russia 1, Moscow,
FSBEI 72 Central polyclinic of the Ministry of Emergencies of Russia 2, Moscow,
Remsi Diagnostics Rus LLC 3, St. Petersburg,
Russian Federation

To evaluate the results of surgical treatment of patients (n=87) with substernal goiter. The main emphasis was done on the application of multislice spiral three-dimensional computed tomography reconstruction
With the volume of the retrograde component of the thyroid gland up to 100 cm3, it is preferable to perform the operation through the cervical approach, even without crossing the prethyroid muscles, with the volume from 100 to 150 cm3 - cervical access with the intersection of the prethyroid muscles, and with the retrograde component more than 150 cm3 - combined access.
The main risk factor for the expansion of surgical access from cervical to combined is the volume of the retrograde component of the thyroid gland more than 150 cm3. The use of the ultracision «Harmonic» Scalpel «Neurosan-400» complex, the magnifying optics by an operating surgeon during surgery can improve the safety of surgery and significantly reduces the risk of intraoperative complications, primarily: bleeding, recurrent laryngeal nerve injury, identification of inadvertently removed parathyroid glands.
Preoperative (3-4 days) X-ray endovascular occlusion of the thyroid arteries allows significantly reducing the arterial blood flow to the gland, followed by a decrease of its volume, which leads to a reduction of intraoperative blood loss, facilitates the operation technique, to shorten the actual operating time.
For the safe and effective treatment of patients with substernal goiter, the clinic should have a multidisciplinary team of specialists for surgery.

Keywords: journal goiter, multispiral computed tomography, combined operative access, X-ray endovascular occlusion
p. 501-509 of the original issue
  1. Ivanov JuV, Solov’ev NA, Chudnyh S.M. Sovremennye aspekty diagnostiki zabolevanij shhitovidnoj zhelezy. Lechashhij Vrach. 2004;(6):26-28. (In Russ.)
  2. Welman K, Heyes R, Dalal P, Hough S, Bunalade M, Anikin V. Surgical Treatment of Retrosternal Goitre. Indian J Otolaryngol Head Neck Surg. 2017 Sep;69(3):345-50. doi: 10.1007/s12070-017-1151-0
  3. Gostimsky AV, Karpatsky IV, Matveeva ZS, Shudaev IR, Selikhanov BA. Diagnosis and Choice of Surgical Tactics in Cervical Abroad Zoba. Tauride Medical and Biological Bulletin. 2020;23(2):52-58. doi: 10.37279/2070-8092-2020-23-2-52-58. (In Russ.)
  4. Kacprzak G, Karas J, Rzechonek A, Blasiak P. Retrosternal goiter located in the mediastinum: surgical approach and operative difficulties. Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):935-37. doi: 10.1093/icvts/ivs339
  5. Rolighed L, Rønning H, Christiansen P. Sternotomy for substernal goiter: retrospective study of 52 operations. Langenbecks Arch Surg. 2015 Apr;400(3):301-6. doi: 10.1007/s00423-015-1288-9
  6. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011 Sep;260(3):892-99. doi: 10.1148/radiol.111102067.
  7. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2009 Nov;19(11):1159-65. doi: 10.1089/thy.2009.02748.
  8. Anakin V, Velman K, Asadi N, Dalal P, Reshetov I, Beddow E. Zagrudinny zob in thoracic surgical practice.Surgery. Journal named after NI Pirogov. 2021;(12):20-26. doi: 10.17116/hirurgia202112120 (In Russ.)
  9. McKenzie GA, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg. 2014 Jul;19(1):139-43. doi: 10.1093/icvts/ivu094
  10. Chen X, Xu H, Ni Y, Sun K, Li W. Complete excision of a giant thyroid goiter in posterior mediastinum. J Cardiothorac Surg. 2013 Nov 7;8:207. doi: 10.1186/1749-8090-8-207
  11. Sakkary MA, Abdelrahman AM, Mostafa AM, Abbas AA, Zedan MH. Retrosternal goiter: the need for thoracic approach based on CT findings: surgeon’s view. J Egypt Natl Canc Inst. 2012 Jun;24(2):85-90. doi: 10.1016/j.jnci.2012.04.002
  12. Ivanov YuV, Istomin NP, Soloviev NA, Zlobin AI, Popov DV. Diagnosis and peculiarities of surgical treatment of girdle thyroid lesions. Surgeon. 2010;(4):69-73. (In Russ.)
Address for correspondence:
115682, Russian Federation,
Moscow, Orekhovy Blvd, 28
Federal Scientific and Clinical Center
for Specialized Types of
Medical Care and Medical Technologies
of the Federal Medical-Biological Agency of Russia,
tel.: +7 926 520 70 62,
Zlobin Alexander I.
Information about the authors:
Ivanov Yury V., MD, Professor, Honored Doctor of the Russian Federation, Head of the Department of Surgery, Federal State Budgetary Institution «Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies» FMBA of Russia, Moscow, Russian Federation,
Lomakin Ivan A., surgeon, Federal State Budgetary Educational Institution “72 Central Polyclinic” of the Ministry of Emergency Situations of the Russian Federation, Moscow, Russian Federation.
Kolbenev Evgeniy I., Department of Radiation Diagnostics, Ramsey Diagnostics Rus LLC, Radiologist. Moscow, Russian Federation.
Epifantsev Evgeniy A., Surgeon, Department of Surgery, Federal State Budgetary Institution «Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies», FMBA of Russia, Moscow, Russian Federation.
Zlobin Aleksandr I., PhD, Surgeon, Department of Surgery, Federal State Budgetary Institution «Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies», FMBA of Russia, Moscow, Russian Federation



West Kazakhstan Marat Ospanov Medical University 1,
Military Institute of Air Defense named T.J. Begeldinov 2, Aktobe,
Republic of Kazakhstan

Objective. To study the relationship of polymorphisms (rs1800629) of the tumor necrosis factor alpha gene, (rs16944) of the interleukin-1 gene, (rs1800795) of the interleukin-6 gene, (rs1800896) of the interleukin-10 gene with the development of acute pancreatitis in the Kazakh population.
Methods. The material for the study was DNA samples isolated from the peripheral blood of 96 unrelated patients with acute pancreatitis (44 men and 52 women) of Kazakh nationality. The assessment of the severity of the disease was based on the analysis of clinical and laboratory criteria. The control group included 108 (64 men and 44 women) unrelated Kazakh volunteers. Genotyping of polymorphisms (rs1800629) of the TNF-α -308 G/A gene, (rs16944) of the IL-1β -511 C/T gene, (rs1800795) of the IL-6 -174 G/C gene, (rs1800896) of the IL-10 -1082 gene A/G was carried out by real-time PCR.
Results. The genotypes of the studied polymorphisms in the control group were in accordance with the Hardy–Weinberg distribution (p>0,05). An analysis of the association of the studied genotypes with the risk of developing the disease found that the homozygous genotype -308A/A TNF-α -308 was associated with an increased risk of developing acute pancreatitis (OR=10,557, 95% CI 0,561-198,681; p=0,033). There were no significant differences in the distribution of genotypes (rs16944) of the IL-1β gene, (rs1800795) of the IL-6 gene, (rs1800896) of the IL-10 gene between patients with acute pancreatitis and control subjects (p>0,05).
Conclusion. Subjects carrying the -308A/A TNF-α, genotype have an increased risk of developing acute pancreatitis in the Kazakh population.

Keywords: àcute pancreatitis, tumour necrosis factor, Interleukin-1b, Interleukin-6, Interleukin-10, genetic polymorphism
p. 510-518 of the original issue
  1. Chen Y, Xie CL, Hu R, Shen CY, Zeng M, Wu CQ, Chen TW, Chen C, Tang MY, Xue HD, Jin ZY & Zhang XM. Genetic Polymorphisms: A Novel Perspective on Acute Pancreatitis. Gastroenterol Res Pract. 2017;2017:5135172. doi: 10.1155/2017/5135172
  2. Rodriguez-Nicolas A, Jiménez P, Carmona FD, et al. Association between Genetic Polymorphisms of Inflammatory Response Genes and Acute Pancreatitis. Immunol Invest. 2019;48(6):585-96. doi: 10.1080/08820139.2019.1576729
  3. Park JW, Choi JS, Han KJ, Lee SH, Kim EJ, Cho JH. Association of a genetic polymorphism of IL1RN with risk of acute pancreatitis in a Korean ethnic group. Korean J Intern Med. 2018 Nov;33(6):1103-10. doi: 10.3904/kjim.2017.133
  4. Jarkenov TA, Skipenko OG, Zhumabaev MN,. Zairova ST, Akataev NA, Yessenbaev DB, Mukushev MM Nurmanov, KZh, Balshambaev ME. The Association of Tumor Necrosis Factor-α Gene Polymorphism with the Severity of Acute Pancreatitis: a Systematic Review. Novosti Khirurgii. 2020 May-Jun; 28(3):309-17. doi: 10.22416/1382-4376-2017-27-3-27-33 (In Russ.)
  5. Liu Y, Dan G, Wu L, Chen G, Wu A, Zeng P, Xu W. Functional effect of polymorphisms in the promoter of TNFAIP3 (A20) in acute pancreatitis in the Han Chinese population. PLoS One. 2014 Jul 22;9(7):e103104. doi: 10.1371/journal.pone.0103104. eCollection 2014.
  6. Bishehsari F, Sharma A, Stello K, Toth C, O’Connell MR, Evans AC, LaRusch J, Muddana V, Papachristou GI, Whitcomb DC. TNF-alpha gene (TNFA) variants increase risk for multi-organ dysfunction syndrome (MODS) in acute pancreatitis. Pancreatology. 2012 Mar- Apr;12(2):113-8. doi: 10.1016/j.pan.2012.02.014
  7. Samgina TA, Bushueva OIu, Ivanov VP, Solodilova MA, Nazarenko PM, Polonikov AV. Sviaz’ promotornogo polimorfizma -308G>A gena faktora nekroza opukholi s tiazhest’iu techeniia ostrogo pankreatita u russkoi populiatsii zhitelei Kurskoi oblasti. Eksperim i Klin Gastroenterologiia. 2014;(9):17-20. (In Russ.)
  8. Özhan G, Yanar HT, Ertekin C, Alpertunga B. Polymorphisms in tumour necrosis factor alpha (TNFalpha) gene in patients with acute pancreatitis. Mediators Inflamm. 2010;2010:482950. doi: 10.1155/2010/482950
  9. Park JW, Choi JS, Han KJ, Lee SH, Kim EJ, Cho JH. Association of a genetic polymorphism of IL1RN with risk of acute pancreatitis in a Korean ethnic group. Korean J Intern Med. 2018 Nov;33(6):1103-10. doi: 10.3904/kjim.2017.133
  10. Chi DZ, Chen J, Huang DP. Influence of interleukin-1β and interleukin-6 gene polymorphisms on the development of acute pancreatitis. Genet Mol Res. 2015 Feb 3;14(1):975-80. doi: 10.4238/2015.February.3.5.
  11. Samgina T.A., Zhivotova G.A., Nazarenko P.M., Polonikov A.V. The role of cytokine genetic polymorphism in development of acute pancreatitis: analysis of intergenic and environmental interactions. Russian Journal of Gastroenterology. doi: 10.22416/1382-4376-2017-27-3-27-33
  12. Jiang BZ, Tang L, Xue H, Liu DP. Role of IL-10 gene polymorphisms in the development of acute pancreatitis. Genet Mol Res. 2016;15(2):10.4238/gmr.15027743. doi: 10.4238/gmr.15027743
  13. Jiang S, Ni M, Zhang Y, Wu Y, Lu X. Association of IL-10 polymorphisms with acute pancreatitis. Int J Clin Exp Med. 2016;9(12):23702-706.
  14. Li D, Li J, Wang L, Zhang Q. Association between IL-1β, IL-8, and IL-10 polymorphisms and risk of acute pancreatitis. Genet Mol Res. 2015;14(2):6635-6641. doi: 10.4238/2015.June.18.6
  15. Bao XB, Ma Z, Gu JB, Wang XQ, Li HG, Wang WY. IL-8 -251T/A polymorphism is associated with susceptibility to acute pancreatitis. Genet Mol Res. 2015;14(1):1508-1514. doi: 10.4238/2015.February.20.6
Address for correspondence:
030019, Republic of Kazakhstan,
Aktobe, Maresev st. 68,
West Kazakhstan Medical
University named after Marat Ospanov,
Department of Surgical Diseases No1,
tel.: +7 7132 544297,
Dzharkenov Timur A.
Information about the authors:
Jarkenov Timur A., MD, Professor of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
Sakhanova Svetlana K., MD, Associate Professor, Head of the Scientific and Practical Center, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
Zhumabaev Marat N, Ph.D., Associate Professor, Head of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
Zairova Saule T, PhD, Head of the Psychological Service security, Military Institute of Air Defense Named T.J. Begeldinov, Aktobe, Republic of Kazakhstan.
Mukushev Manas M , PhD, Associate Professor of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
Nurmanov Kairat Z, Assistant of the Department of Surgical Diseases No. 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.



Belarusian Medical Academy of Postgraduate Education 1,
Medical Centre «NeoMediñal» 2, Minsk,
Republic of Belarus

Objective. To analyze and systematize the results of ultrasound scan in patients with acute complications of diverticular disease of the colon.
Methods. The results of ultrasound scan of the intestine were analyzed in 57 patients who complained of acute abdominal pain, flatulence and stool abnormalities, who had diverticular disease of the colon. Of these, 31 (54,4%) were women and 26 (45,6%) were men. In 49 (86%) patients, diverticula were located in the left side of the colon, in 6 (10,5%) patients, diverticula were located in the right side of the colon and 2 (3,5%) patients, diverticula were found all over colon.
Result. A preliminary ultrasound classification of acute complications of diverticular disease of the colon according to the severity of the course (4 degrees) has been developed. The first degree indicates an inflamed diverticulum with/without pericolitis, with/without abscess ≤2 cm in diameter regardless of localisation in relation to the mesenteric and anti-mesenteric margins. The second degree indicates an inflamed diverticulum with an abscess >3 cm in diameter or with a diverticulum perforation along the mesenteric margin, as well as with an abscess >2cm and with a perforation along the anti-mesenteric margin. The third degree is characterized by focal or generalized purulent peritonitis. The fourth degree - development of faecal peritonitis.
Conclusion. Ultrasound is safe, non-invasive, easy and affordable, It allows at once visualize not only the entire gastrointestinal tract, but also other organs and systems, in parallel interpret both clinical and ultrasound data, classify patients into outpatient and inpatient depending on the severity of complications of diverticular disease of the colon.

Keywords: diverticular disease, colon, ultrasound, complication, classification
p. 518-527 of the original issue
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  7. Frush DP, Applegate K. Computed tomography and radiation: understanding the issues. J Am Coll Radiol. 2004 Feb;1(2):113-19. doi: 10.1016/j.jacr.2003.11.012
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  10. Laméris W, van Randen A, Bipat S, Bossuyt PM, Boermeester MA, Stoker J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008 Nov;18(11):2498-511. doi: 10.1007/s00330-008-1018-6
  11. Laméris W, van Randen A, van Gulik TM, Busch OR, Winkelhagen J, Bossuyt PM, Stoker J, Boermeester MA. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum. 2010 Jun;53(6):896-904. doi: 10.1007/DCR.0b013e3181d98d86
  12. Êoushnerou AI, Hadzhi-Ismail IA, Vorobej AV, Rudenko SI. Ul’trazvukovaja diagnostika oslozhnennoj divertikuljarnoj bolezni obodochnoj kishki. Zdravoohranenie. 2021;(6):63-71. (n Russ.)
  13. Andeweg CS, Felt-Bersma R, Verbon A, Stoker J, Boermeester M, Bleichrodt R. Summary of the practice guideline on diverticulitis in the colon: diagnostics and treatment in specialty care. Ned Tijdschr Geneeskd. 2013;157(15):A6124. [Article in Dutch]
  14. Andeweg CS, Mulder IM, Felt-Bersma RJ, Verbon A, van der Wilt GJ, van Goor H, Lange JF, Stoker J, Boermeester MA, Bleichrodt RP; Netherlands Society of Surgery; Working group from Netherlands Societies of Internal Medicine, Gastroenterologists, Radiology, Health echnology Assessment and Dieticians. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg. 2013;30(4-6):278-92. doi: 10.1159/000354035
  15. Trubacheva JuL, Orlova LP, Moskalev AI, Skridlevskij SN, Belov DM, Shahmatov DG, Achkasov SI. Ultrasound diagnosis of chronic paracolic inflammatory mass in diverticular disease. Hirurgija. Zhurn im. N.I. Pirogova. 2020;9:14-19. doi: 10.17116/hirurgia202009114 (In Russ.)
  16. Êoushnerou AI, Hadzhi-Ismail IA, Vorobej AV, Rudenko SI. Comprehensive Ultrasound Diagnosis of Sigmoid Diverticulitis. Ros Zhurn Gastrojenterologii, Gepatologii, Koloproktologii. 2021;31(4):45-54. doi: 10.22416/1382-4376-2021-31-4-45-54 (In Russ.)
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Address for correspondence:
223041, Republic of Belarus,
Minsk region, Minsk district, a/g Lesnoy-1.
Belarusian Medical Academy of Postgraduate Education, Department of Surgery,
Tel. +375 44 7514263,
Haji Ismail Ismail Abbas
Information about the authors:
Koushnerou Alexandr I., MD, Professor, Medical Center «NeoMedical», Minsk, Republic of Belarus.
Haji-Ismail Ismail Abbas, PhD, Associate Professor, Belarusian Medical Academy of Postgraduate Education, Department of Surgery, Minsk, Republic of Belarus.
Varabei Aliaksandr V., MD, Professor, Corresponding Member of the National Academy of Sciences of the Republic of Belarus, Minsk, Republic of Belarus.
Rudenka Svetlana I., PhD, Ðhysician (ultrasound) at the NeoMedical Medical Center, Minsk, Republic of Belarus.



EE "Gomel State Medical University", Gomel,
Republic of Belarus

Methods. The study was performed on 240 male laboratory rats after preliminary modeling of alloxan diabetes mellitus, paw ischemia by ligation of the femoral artery, formation of a trophic ulcer by intradermal injection of 0.6 ml of 10% calcium chloride. The developed wound dressings were used in all animals, which were divided into four groups. A clinical assessment of the wound was carried out, the sampling of granulation tissue was performed on the third, seventh and 14th days. Histological material was stained with hematoxylin-eosin and trichrome MSB according to the standard method. A semi-quantitative histological evaluation was used to assess reparative processes.
Results. When applying a wound dressing without an antibacterial agent (first group), there is abundant infiltration with neutrophils, coagulation necrosis during the entire observation period. The presence of immature granulation tissue by day 14 indicates the absence of regeneration in the ulcer. The addition of gentamicin to dressing reduces inflammatory responses. Granulation tissue matures by the 7th day. Signs of epithelialization in the edges of wounds with the absence of inflammation are noted by the 14th day. With the addition of gentamicin and methyluracil to dressing, the presence of granulations was noted by the 7th day, and complete epithelization of wounds by the 14th day.
Conclusion. The addition of gentamicin and methyluracil to the composition of wound dressings statistically significantly (p<0.0001) stimulates regeneration in ulcers compared to the control group and wound dressings without gentamicin and methyluracil, and also reduces inflammatory reactions in the defect zone, stimulates the growth of granulations and their transformation into collagen (p<0.0001), which is an objective criterion for early healing.

Keywords: trophic ulcer, diabetes mellitus, wound dressing, hydrogel
p. 528-539 of the original issue
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Address for correspondence:
246000, Republic of Belarus,
Gomel, st. Lange, 5,
Gomel State Medical University,
Department of Surgical Diseases No. 1
with a Course of Cardiovascular Surgery,
tel. mob.: +375 29 6837629,
Silvistrovich Victoria I.
Information about the authors:
Silvistrovich Victoria I., assistant of the Department of Surgical Diseases No. 1 with a course of cardiovascular surgery, Gomel State Medical University, Gomel, Republic of Belarus.
Lyzikov Aleksey An., MD, Professor, Head of the Department of Surgical Diseases No. 1 with a Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
Kaplan Mark L., PhD Candidate of Medical Sciences, Associate Professor of the Department of Surgical Diseases No. 1 with a Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.
Osipov Boris B., PhD, Associate Professor of the Department of Surgical Diseases No. 1 with a Course of Cardiovascular Surgery, Gomel State Medical University, Gomel, Republic of Belarus.



Polenov Neurosurgical Research Institute, branch of Federal State Budgetary Institution “Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation 1, Saint Petersburg,
Multidisciplinary Clinic Named after N.I. Pirogov 2, Saint Petersburg,
Russian Federation

Objective. Evaluation of clinical results and technical features of percutaneous full-endoscopic transforaminal subannular removal of large median hernias of the «protrusion» type of the lumbar spine.
Methods. The patients (n=27) with large median hernias of the lumbar spine have been operated (2016-2019 and the results of percutaneous full-endoscopic transforaminal discectomy for large median herniations have been analized. To evaluate the results of surgical treatment used the ODI questionnaire, VAS scale and McNab.
Results. The assessment was made before surgery, the next day, after 1, 6 12 and 24 months after surgery,The average severity of preoperative radicular axial and back pain according VAS after surgery decreased from 7,8±1,4 and 5,2±1,2 to 1,6±1,2 (in average 6,3, 95% CI (confidence interval) : from 5,6 to 7,0; t=19,00; p<2,2×1016) and 3,6±1,4 (in average 1,1, 95% CI: from 0,2 to 2,0; t=2,411; p=0,0233) the next day; to 1,8±1,4 (in average 5,9, 95% CI: from 5,1 to 6,8; t=15,12; p=2,2×10−14) and 3,6±1,4 (in average 1,2, 95% CI: from 0,5 to 1,8; t=3,677; p=0,0011) after 1 month; to 1,5±1,2 (in average 6,2, 95% CI: from 5,5 to 6,9; t=17,60; p=5,9×10−16) and 2,8±1,4 (in average 2,3, 95% CI: from 1,5 to 3,0; t=6,332; p=1,1×10−6) after 6 months; to 1,5±1,2 (in average 6,3, 95% CI: from 5,7 to 7,0; t=20,26; p<2,2×10−16) and 2,8±1,4 (in average 2,4, 95% CI: from 1,7 to 3,2; t=6,653; p=4,7×10−7) after 12 months and 1,6±1,2 (in average 5,7, 95% CI: from 5,0 to 6,5; t=15,87; p=6,9×10−15) and 2,0±1,2 (in average 3,3 áàëëà, 95% CI: from 2,6 to 4,0; t=9,991; p=2,2×10−10) 24 months after surgery, respectively, According to the McNab scale, 10 (37,0%) patients rated the treatment results “excellent”, 15 (55,6%) “good”, 2 (7,4%) satisfactory. The average ODI improved from 65,2±6,4 to 19,2±2,8 (in average 47,9, 95% CI: from 44,4 to 51,4; t=28,04; p<2,2×10−16) after 1 month; to 14,6±2,2 (in average 50,3, 95% CI: from 46,9 to 53,6; t=30,91; p<2,2×10−16) after 6 months; to 15,4±2,3 (in average 50,9, 95% CI: from 47,6 to 54,1; t=32,15; p<2,2×10−16) after 12 months and to 14,4±2,2 (in average 51,4, 95% CI: from 48,7 to 54,2; t=38,05; p<2,2×10−16) 24 months after surgery, respectively.
Conclusion. Percutaneous full-endoscopic transforaminal subannular removal of large median herniations of the “protrusive” type of the lumbar spine is consided to be a safe and effective method; avoiding excessive unnecessary resection of the bone structural elements of the spine and the risks of neurological complications associated with traction of dural sac and roots of the spinal cord; reducing the recurrence risk of such herniations and avoiding spinal fusion; facilitating early postoperative activation and recovery of the patient.

Keywords: endoscopic transforaminal discectomy for large median disc herniations
p. 540-551 of the original issue
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  20. Kondo M, Oshima Y, Inoue H, Takano Y, Inanami H, Koga H. Significance and pitfalls of percutaneous endoscopic lumbar discectomy for large central lumbar disc herniation. J Spine Surg. 2018 Mar;4(1):79-85. doi: 10.21037/jss.2018.03.06
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  26. Meredzi AM, Gulyaev DA, Singaevskiy SB, Prishvin AP. Percutaneous transforaminal endoscopic discectomy for the upper lumbar disc herniation. Ros Neirokhirurg Zhurn im prof. AL Polenova. 2017;9(4):22-29. (In Russ.)
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Address for correspondence:
19101, Russian Federation, St. Petersburg,
«Russian Research Neurosurgical Institute Named after prof, A. L. Polenov» - a Branch of the Federal
State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, Mayakovsky st., 12
tel. +79967992946
Belyakov Yury V.
Information about the authors:
Mereji Amir M., Neurosurgeon, PhD, Senior Researcher, Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Proftssor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation, Multidisciplinary Clinic Named after N.I. Pirogov, Saint Petersburg, Russian Federation.
Orlov Andrey Y., Neurosurgeon. MD, Head of the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» named after V.A. Almazov Ministry of Health of the Russian Federation, Russia, St. Petersburg, Russian Federation, Multidisciplinary Clinic Named after N.I. Pirogov, Russia, St. Petersburg, Russian Federation.
Nazarov Alexander S. Neurosurgeon, PhD, Senior Researcher at the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Head of the Department of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
Belyakov Yury V., Neurosurgeon, Researcher at the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor, A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
Kudziev Andrey V., Neurosurgeon, Researcher in the Research Laboratory of Neurosurgery of the Spine and Peripheral Nervous System, Russian Research Neurosurgical Institute Named after Professor A. L. Polenov a Branch of the Federal State Budgetary Institution «NMRC» Named after V.A. Almazov Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation.
Lalayan Tigran V., Neurologist, PhD, Associate Professor of the Department of Neurology and Manual Medicine, Faculty of Postgraduate Education of the First SSMU Named after Academician I.P. Pavlov, St. Petersburg, Russian Federation.
Singaevskiy Sergey B., Surgeon, MD, Chief Physician of the Multidisciplinary Clinic Named after N.I. Pirogov, St. Petersburg, Russian Federation.
Smirnov Pavel V., Neurologist of the Multidisciplinary Clinic Named after N.I.Pirogov. St. Petersburg, Russian Federation.




Healthcare Institution «Brest Regional Clinical Hospital», Brest,
Republic of Belarus

Objective. To improve the results of treatment of esophageal perforations by using the current minimally invasive video-assisted thoracoscopic technologies.
Methods. The patients (n=54) underwent the treatment: 41 (75.9%) men and 13 women (24.1%). The average age of patients was 52 years. The causes of perforations are as follows: spontaneous rupture of the esophagus − 21 (38.9%); foreign body of the esophagus - 9 (16.7%); cancer − 2 (3.7%); iatrogenic damage - 5 (9.3%); cardiodilatation with achalasia of the cardia - 2 (3.7%); bougie stricture of the esophagus with reflux esophagitis − 1 (1.9%); swelling of the scar-altered esophagus due to chemical burn of the esophagus - 14 (25.9%). The average time from the initial clinical manifestations to surgery was 24 hours. The discrepancy between the primary diagnosis and the final one was revealed in 23 (42.6%) patients. All patients (n=54) were operated on. 47 (87%) patients were discharged in satisfactory condition, 7 (13%) died.
Results. Pre-operative factors affecting the tactics of surgery: «coincidence of the primary diagnosis with the main one»; «diagnosis» and «distance from incisors to esophageal perforation» was determined. The best treatment results in the groups using the «controlled fistula» method were obtained. Thus, in the upper and middle thoracic regions, the optimal method was to fix the drainage at the site of esophageal perforation, in the lower thoracic region - the installation of a T-shaped drainage system.
Conclusion. The method of choosing surgical treatment depends on the correct primary diagnosis, the level of perforation and the main cause of esophageal perforation. In the absence of «compromised» esophagus in the treatment of its perforation, minimally invasive thoracoscopic intervention provides the best results by reducing the duration of rehabilitation, improving the quality of life and reducing mortality rate. The conducted clinical study made it possible to improve the treatment outcomes of patients with esophageal perforation in various pathologies.

Keywords: esophageal perforation, T-shaped drainage system, fixation of the transpleural tube, extirpation of the esophagus.
p. 552-561 of the original issue
  1. Axtell AL, Gaissert HA, Morse CR, Premkumar A, Schumacher L, Muniappan A, Ott H, Allan JS, Lanuti M, Mathisen DJ, Wright CD. Management and outcomes of esophageal perforation. Dis Esophagus. 2022 Jan 7;35(1):doab039. doi: 10.1093/dote/doab039
  2. Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, Ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019 May 31;14:26. doi: 10.1186/s13017-019-0245-2. eCollection 2019.
  3. Zhu J, Zhu SB, Xi EP. Puncture of the anterior wall of the pericardium by a fish bone from an oesophageal perforation. Eur Heart J. 2022 Jul 7;43(26):2531. doi: 10.1093/eurheartj/ehac258
  4. DeVivo A, Sheng AY, Koyfman A, Long B. High risk and low prevalence diseases: Esophageal perforation. Am J Emerg Med. 2022 Mar;53:29-36. doi: 10.1016/j.ajem.2021.12.017
  5. Mure?an M, Mure?an S, Balmo? I, Sala D, Suciu B, Torok A. Sepsis in acute mediastinitis – a severe complication after oesophageal perforations. A review of the literature. J Crit Care Med (Targu Mures). 2019 May 13;5(2):49-55. doi: 10.2478/jccm-2019-0008. eCollection 2019
  6. Kassem MM, Wallen JM. Esophageal Perforation And Tears. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jan 17]. Available from:
  7. Biancari F, D’Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, Saarnio J, Lucenteforte E. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg. 2013 May;37(5):1051-59. doi: 10.1007/s00268-013-1951-7
  8. Aiolfi A, Ferrari D, Riva CG, Toti F, Bonitta G, Bonavina L. Esophageal foreign bodies in adults: systematic review of the literature. Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1171-78. doi: 10.1080/00365521.2018.1526317
  9. Watkins JR, Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin. 2018 Nov;28(4):541-54. doi: 10.1016/j.thorsurg.2018.07.002
  10. García-Moreno V, Maiocchi K, Gómez-Quiles L, Villarin-Rodríguez A, Aliaga-Hilario E, Martínez-Hernández A, Abdelkader N, López E, Escrig-Sos J, Laguna-Sastre JM. Treatment of esophageal perforation: A review of our experience at a tertiary referral hospital spanning the past 19 years. Rev Gastroenterol Mex (Engl Ed). 2022 Oct-Dec;87(4):405-10. doi: 10.1016/j.rgmxen.2021.11.014
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  12. Wright CD, Mathisen DJ, Wain JC, Moncure AC, Hilgenberg AD, Grillo HC. Reinforced primary repair of thoracic esophageal perforation. Ann Thorac Surg. 1995 Aug;60(2):245-48; discussion 248-9. doi: 10.1016/0003-4975(95)00377-w
  13. El-Sourani N. Esophageal perforation: diagnosis, management and decision-making - a retrospective tertiary centre study. Turk J Surg. 2021 Dec 31;37(4):342-346. doi: 10.47717/turkjsurg.2021.5289. eCollection 2021 Dec.
  14. Loske G, Scharsack E, Gobrecht O. Emergency endoscopic negative pressure therapy of a long oesophageal perforation in eosinophilic esophagitis with a single-lumen nasogastric tube-like open-pore film drain. Endoscopy. 2022 May;54(5):E247-E248. doi: 10.1055/a-1493-1805
  15. Panneerselvam K, Samuel R, Sealock RJ. Esophageal Perforation Successfully Treated With EVT. ACG Case Rep J. 2022 Jan 12;9(1):e00711. doi: 10.14309/crj.0000000000000711. eCollection 2022 Jan
  16. Eroglu A, Aydin Y, Ulas AB. Minimally Invasive and Endoscopic Approach to Esophageal Perforation. Eurasian J Med. 2022 Feb;54(1):101-106. Published online 2022 Feb 1. doi: 10.5152/eurasianjmed.2022.21135
  17. Stathopoulos P, Zumblick M, Wächter S, Schiffmann L, Gress TM, Bartsch D, Seitz G, Denzer UW. Endoscopic vacuum therapy (EVT) for acute esophageal perforation: Could it replace surgery? Endosc Int Open. 2022 Feb 24;10(5):E686-E693. doi: 10.1055/a-1781-0827. eCollection 2022 May.
  18. Kumar A, Singla V, Pulle MV, Asaf BB, Puri HV, Bishnoi S. Multidisciplinary, minimally invasive approach for oesophageal perforations with delayed presentation. J Minim Access Surg. 2022 Jul-Sep;18(3):353-59. doi: 10.4103/jmas.JMAS_28_21
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Address for correspondence:
224027, Republic of Belarus,
Brest, 7 Meditsinskaya str.,
Brest Regional Clinical Hospital,
Department of Thoracic Surgery,
tel.: +375298054971,
Ignatsiuk Aliaksandr N.
Information about the authors:
Ignatyuk Alexander N., Applicant of the Department of General Surgery of the Educational Establishment «Grodno State Medical University», Surgeon of the Department of Thoracic Surgery of the Educational Institution «Brest Regional Clinical Hospital», Brest, Republic of Belarus.
Karpitsky Alexander S., MD, Professor, Chief Physician of the ME «Brest Regional Clinical Hospital», Brest, Republic of Belarus.




Federal State Budgetary Institution National Ilizarov Medical Research Centre for Traumatology and Orthopaedics of the RF Ministry of Health, Kurgan,
Russian Federation

Objective. Purpose of this article – to study the charateristic features of the structural rearrangement of the main components of the ankle joint in diabetic neuroosteoarthropathy complicated by chronic osteomyelitis using histopathological semi-quantitative assessment of osteomyelitis.
Methods. Analysis of the data of pathohistological studies of the operating material (bone-and-cartilaginous fragments of the ankle with adjacent soft tissues) of 30 patients with the established diagnosis of diabetic neroosteoarthropathy complicated by chronic osteomyelitis. Light microscopy of paraffin-embedded sections using immunohistochemical evaluation of marker of neutrophilic granulocytes CD15 was performed.
Results. The pronounced destruction of the articular cartilage and subchondral bone was revealed in all the patients. The articular cartilage structure disturbance was noted both on the side of the articular surface (synovial pannus, active chondroclasts), and on the side of the subchondral zone (destruction of the basophilic section, the calcified cartilage zone). Fragments of cartilage and bone were distributed in the articular cavity and in the synovium. The synovium was hypertrophied, hypervascularized with inflammatory infiltration. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical detection of CD15-positive neutrophils made it possible to identify signs of the active stage of chronic osteomyelitis in 8 patients, those of subacute course – in 16 patients, weakened chronic osteomyelitis (remission) – in 6 patients. An increased number of osteoclasts, intense destruction of the subchondral bone plate and a pronounced inflammatory infiltrate with the content of 5 or more neutrophils were observed in patients with an active inflammatory stage of chronic osteomyelitis. A positive correlation was found between the inflammatory stage of chronic osteomyelitis and the severity of inflammatory infiltration and osteonecrosis.
Conclusion. The combination of signs – pronounced destruction of the articular cartilage, subchondral bone, hypertrophy of the synovial membrane, bone and cartilaginous fragments in the joint cavity and in the synovial membrane, fragments of bone tissue in the cartilage is a diagnostic histological criterion for the chronic stage of diabetic neroosteoarthropathy. The histopathological semi-quantitative assessment of osteomyelitis and the immunohistochemical determination of CD15 increase the accuracy of the pathological diagnostics of the inflammatory phases of chronic osteomyelitis in diabetic foot syndrome.

Keywords: histology, the ankle (joint), diabetic äèàáåòè÷åñêàÿ neroosteoarthropathy, osteomyelitis, diagnostics
p. 562-571 of the original issue
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Address for correspondence:
640014, Russian Federation,
Kurgan, st. M. Ulyanova, 6,
National Medical Research Center
for Traumatology and Orthopedics
Named after Academician G.A. Ilizarov,
tel. +7 905 850-67-89,
Stupina Tatyana A.
Information about the authors:
Stupina Tatyana A., MD (Biol), Senior Researcher, Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
Migalkin Nikolai S., Researcher. Laboratory of Morphology, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
Mezentsev Igor N., Pathologist, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.
Sudnitsyn Anatoly S., PhD, Orthopedic Surgion, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russian Federation.




Kursk State Medical University, Kursk,
Russian Federation

The main cause of the development of trophic ulcers is the insufficiency of the venous system of the lower extremities. Venous trophic ulcers (VTU) occupy up to 80% of the structure of trophic lesions of the skin and soft tissues. This pathology is more common in elderly and senile people, when the incidence of the lesion reaches 5% in the population. Without a doubt, in order to achieve complete and rapid healing, surgical treatment is necessary, which would eliminate the etiological factor of the development of VTU. However, in most cases, surgical correction of venous insufficiency is not feasible. Conservative treatment should be multidirectional, and recently more and more attention has been paid to physiotherapy methods of influence. The analysis of the literature data confirms the possibility of using various types of physiotherapeutic methods of exposure as additional therapy for patients suffering from trophic ulcers of mainly venous etiology. It was found that the combination of methods based on various physical factors of influence has the most favorable effect on the healing of VTU. It is not possible to talk about the preferential effectiveness of any one method of physiotherapy, since the studies of individual authors are not identical, which does not allow them to be compared. Thus, we consider further research in this direction to be promising, since these studies will optimize the treatment process and improve the quality of life of patients with VTU.

Keywords: venous trophic ulcer, phototherapy, electrotherapy, magnetotherapy, hyperbaric oxygen therapy, negative pressure therapy, ultrasound therapy.
p. 572-582 of the original issue
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Address for correspondence:
Kursk, st. Karl Marx, 3,
«Kursk State Medical University» of the Ministry
of Health of Russia, Department of Operative Surgery and Topographic Anatomy,
tel.: +7 951 072-32-02,
Terekhov Alexey G.
Information about the authors:
Grigoryan Arsen Y., PhD, Associate Professor, Associate Professor of the Department of Operative Surgery and Topographic Anatomy, KSMU of the Ministry of Health of Russia, Kursk, Russian Federation.
Terekhov Aleksey G., Full-Time Postgraduate Student of the Department of Operative Surgery and Topographic Anatomy, Assistant of the Department of Surgical Diseases No. 1, KSMU of the Ministry of Health of Russia, Kursk, Russian Federation.



EÅ «Gomel Regional Clinical Oncological Dispensary» 1,
EE «Gomel State Medical University» 2, Gomel,
Republic of Belarus

Melanoma accounts for about 10% of all diagnosed skin cancers. However, its aggressive course, due to the high ability for regional and distant multiple metastasis, leading to high mortality rates and makes the issue of treatment relevant. Understanding of molecular biology and immunological characteristics of the tumor contributed to the emergence of targeted drugs (BRAF, MEK inhibitors) and immuno-oncological drugs (Checkpoint inhibitors as a type of f immunotherapy - blockers CTLA-4 (cytotoxic T-lymphocyteassociated protein 4), PD-1 (programmed death 1) and its ligands (PD-L1). They block proteins that stop the immune system from attacking the cancer cells and made it possible to enhance tumor response to treatment and significantly improve patient outcomes. Currently, the main approach in systemic treatment is not to stimulate the immune response, but to remove factors that inhibit its development, the so-called immune checkpoint inhibitors. The worst prognosis in patients with metastatic melanoma, the overall 5-year survival rate previously was 9-20%; at present, the use of current systemic therapy gives a chance of about 50% of patients to live for 5 or more years. The systemic treatment of metastatic melanoma has improved considerably with the introduction of new, targeted substances and immune checkpoint inhibitors.

Keywords: melanoma, metastases, systemic therapy, targeted therapy, immunotherapy
p. 583-591 of the original issue
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Address for correspondence:
246012, Republic of Belarus,
Gomel, Meditsinskaia st., 2,
Gomel State Medical University,
Department of Oncology,
tel. office: +375 232 491154,
mob.: +375 29 7309039,
Nesterovich Tatyana N.
Information about the authors:
Ganusevich Olga N., Oncologist-Surgeon of the Oncological Department of General Oncology and Rehabilitation of the Institution «Gomel Regional Clinical Oncological Dispensary», Gomel, Republic of Belarus.
Nesterovich Tatyana N., Assistant of the Department of Oncology of the Educational Institution «Gomel State Medical University», Gomel, Republic of Belarus.
Fedorkevich Igor V., Oncologist-Surgeon, Head of the Oncological Department of General Oncology and Rehabilitation of the Institution «Gomel Regional Clinical Oncological Dispensary», Gomel, Republic of Belarus.



Irkutsk State Medical University 1,
Irkutsk Scientific Centre of Surgery and Traumatology 2, Irkutsk,
Russian Federaration

The authors report the case of recurrent anematizing digestive bleeding in a 58-year-old woman who suffered from von Willebrand disease (VWD) and factor VIII deficiency. The hemorrhagic syndrome arose from a vascular malformation of the jejunum wall – Dieulafoy’s Lesions, a relatively rare pathology of the gastrointestinal tract, associated with high lethality. Convoluted arteries without signs of vasculitis were the contributor of hemorrhage. It is not improbable that Dieulafoy’s Lesions is a congenital malformation, since it develops in patients aged from 20 weeks to 94 years. Ulcers of the posterior wall of the upper third of the stomach was described. .. Such ulcers, located distal to the duodenojejunal junction, occur in no more than 1% of case reports. Intraluminal capsule and/or two-balloon jejunoscopy provides detection of the hemorrhage origin and localization. In the reported case, a bleeding vessel was found by means of selective contrasting of the upper mesenteric artery, which detected extravasation into the lumen of the first jejunum loop. Endovascular occlusion was technically impossible. After laparotomy esophagogastroduodenoscopy with manual intraabdominal assistance was performed. Two defects of the mucous membrane closed by a red blood clot appeared in 39-35 cm from the ligament of Treitz. Intestinal resection was performed in 2/3 according to A.V. Melnikov. Histological examination verified the diagnosis. In the presented case report, complex hematological pathology complicated the disease course. Intensive replacement therapy allowed bringing the VIII and von Willebrand factors to normal levels. In consequence, the surgical intervention without excessive bleeding.was performed.

Keywords: recurrent intestinal bleeding, Dielafua lesion, von Willebrand disease, mesenteriography, intestinal resection
p. 592-596 of the original issue
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Address for correspondence:
664003, Russian Federation,
Irkutsk, Krasnoe Vosstanie st., 1,
Irkutsk State Medical University,
Department of Hospital Surgery.
tel. +7 902 51 11 027,
Grigoriev Evgeny G.
Information about the authors:
Panasyuk Alexandr I., Surgeon, Assistance of the Department of Hospital Surgery, Irkutsk Regional Hospital, Irkutsk State Medical University, Irkutsk, Russian Federaration
Grigoryev Eugene G., MD, Professor, Irkutsk Scientific Centre of Surgery and Traumatology, Scientific Coordinator, Irkutsk State Medical University, Head of the Department of Hospital Surgery. Irkutsk, Russian Federaration
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