Cerebrovascular pathology occupies a leading position among the causes of mortality and long-term recovery from disability in countries with different income levels, which indicates the need to find new strategic directions for the prevention of these diseases. Today, among the most common forms of cerebrovascular diseases are acute ischemic stroke and vascular cognitive impairment, in particular vascular dementia. In the pathogenesis of both of these conditions, damage to small vessels of the brain plays a significant role. The article is devoted to the analysis of literature data on the study of cerebrovascular diseases was conducted. Articles were selected from the database PubMed by searching for keywords: small vessel diseases, white matter hyperintensivity of the brain, lacunae, dilated perivascular spaces, brain atrophy, vascular cognitive impairment. Conclusion. The study of pathogenetic mechanisms for the development of cerebral microangiopathy or small vessel disease will allow developing directions in clinical and scientific research to find genetically based treatment and prevention strategies, which is extremely important for elderly patients.

In modern medicine, studying the mechanism of atherosclerotic plaque formation is one of the most important areas. As more knowledge about this process is accumulated, it becomes essential to analyze, reconsider and supplement existing theories about the pathogenesis of this condition. The analysis of literature sources has allowed us to identify 6 classical and 2 new theories that attempt to explain the possible origins of this disease, but these theories are not able to fully explain all aspects of the atherosclerosis process, as they focus on individual aspects according to their underlying assumptions. The aim of this review is not just to organize existing data but also to attempt to answer questions arising from studying specific aspects of atherosclerosis formation. As a consequence of the analysis it was found that systemic inflammation caused by factors such as bacteria and viruses, as well as active radicals of nitrogen oxide and oxygen can exacerbate this process, leading to accumulation and retention low-density lipoproteins in the inner lining of blood vessels. This inflammation leads to an increase in production of pro-inflammatory substances, which reduces the efficiency of transporting cholesterol from cells into the bloodstream and lymphatic systems. The organization of data obtained from this article can be used as a foundation for future experiments aimed at identifying so-called ‘control points’, developing new methods for monitoring and identifying biomarkers of atherosclerosis progression.

Aim. To evaluate the anatomical and functional feasibility and adequacy of performing intersystem anastomosis during bypass surgery of the vertebral artery with an vessel from the external carotid artery system. Material and methods. On the basis of ultrasound Dopplerography of 1,074 people, the dimensions and hemodynamic parameters of the external carotid and vertebral arteries, the calculation of the volumetric blood flow velocity and the diameter of the shunt sufficient to replenish blood supply in each individual case were studied. All the surveyed were divided into 4 age groups: 1) under 35 years old, 2) from 36 to 60 years old, 3) from 61 to 75 years old, 4) over 76 years old. Statistical analysis of the results was performed using IBM SPSS Statistics 20. Results. When forming a shunt with a diameter of 2.5–3.0 mm, the volume of replaced blood flow will be 134–194% of the initial values, with a diameter of 2.0 mm — 86%, with a diameter of 1.5 mm shunt — up to 48% of the volume blood flow for the vertebral artery. Conclusions. The study contributes to the development of new and improved existing methods of carotid spine bypass surgery based on data on the functional and morphometric features of these vessels in men and women of different age groups. Based on the calculations, the criteria for the sufficiency of the required diameter of the bypass vessel are justified. In most cases, the desired effect of surgical treatment can be achieved with a diameter of 2.0–2.5 mm shunts. In cases of small size of the required diameter, it is preferable to use an arterial autograft, and in cases of large size, a venous one. These features are relevant for performing reconstructive surgeries with a personalized carotid-spinal bypass approach.

The relevance of the polytrauma problem remains at a high level, and the latest statistics confirm this. In peacetime, the main causes of multiple and combined injuries are traffic accidents, traumatic injuries, and criminal accidents. Recently, great success has been achieved at the state level in solving this complex medical and social problem, primarily in organizing medical care for patients with polytrauma. Regional trauma systems have been created, a network of trauma centers has been deployed, appropriate logistical support has been provided to hospitals, and a large practical training base on polytrauma has been developed. However, there are still a number of clinical and organizational problems, theoretical and practical controversial issues. First of all, this is a debatable question about the terminology of polytrauma. Polytrauma surgery is a uniform organization and a strict algorithm of therapeutic and diagnostic measures. This necessitates the creation of a differentiation and a unified scale for assessing the severity and condition of patients, regulating the timing of surgical intervention, and defining clear indications for multi-stage surgical treatment of the wounded. There is a need for a well-established mechanism for routing patients with polytrauma and subsequent traumatic illness, a multidisciplinary approach in their treatment, and the creation of a special department for multiple and combined injuries based on all Level I trauma centers. A separate and very important issue is the training of specialists in the field of injury surgery. Solving these problems will certainly have a positive impact on both the organization of medical care and the effectiveness of treatment for this category of patients. Therefore, the purpose of this work is to identify problems affecting the provision of medical care to patients with polytrauma and possible solutions.

The article presents data on the diagnostic accuracy of the DWI MRI method in the initial assessment of the prevalence of lymphomas. The study included 81 patients with different types of lymphomas. DV MRI was performed in all patients before the start of therapy and after the initial PET/CT examination. As a result of the work performed, the diagnostic accuracy is 91.31%, sensitivity — 93.48%, specificity — 88.32%, positive predictive value — 91.48%, negative predictive value — 90.91%, positive likelihood ratio 7.95, negative likelihood ratio 0.74. The area of the ROC curve was 0.9481. The most accurate results were found in patients with stages 1 and 2 of the disease. The data obtained indicate the high diagnostic value of the DWI MRI method in the primary assessment of the prevalence of the disease. At the same time, there are cases confirming, unfortunately, the limitation of the diagnostic capabilities of the method when assessing groups of lymph nodes located near the heart region, or when assessing the objective involvement of the bone marrow in the pathological process, which in turn may affect the primary the staging of the process and, consequently, the choice of therapy regimen, which directly affects the outcome of the disease. Based on the analysis, it can be concluded that the PET/CT method is the best for detecting tumor lesions in patients with lymphomas, at the same time, the DWI MRI method can be used to assess the prevalence of the disease in the absence of the possibility of using PET/CT scan with FDG.

Cardiac surgery patients often require allogeneic platelet transfusions. The blood service produces several types of donor platelet concentrates (РС), the methods of obtaining and additional processing of which directly affect the functional state of the cells and their clinical effectiveness. Pathogen reduction РC reduces the risk of transmission of infections (bacteria, viruses), but its effect on clinical effectiveness in cardiac surgery has not been sufficiently studied. Currently, there are no large randomized studies on this topic. Purpose of the study. To compare the effectiveness of the clinical use of different types of donor platelet concentrates in adult cardiac surgery patients. Material and methods. A retrospective randomized controlled trial was conducted. Adult cardiac surgery patients who received one or more РC units were eligible for inclusion. Exclusion criteria included patients with the presence of factors that could affect post-transfusion platelet growth: sepsis, febrile fever, РC transfusion resistance. The primary endpoint was an increase in the number of circulating peripheral blood platelets at 1 and 24 hours. The secondary endpoint was the need for repeat transfusions. The t test was used to compare continuous variables. Results. The study included 162 patients who were divided into groups that received either pathogen-reduced (group 1) or leukoreduced (group 2). There were no statistically significant differences between the groups. Discussion. In both groups, the number of platelets after 24 hours exceeded the initial level. However, the absolute increase in platelet count after 1 and 24 hours in group 1 was lower by 17 and 15%, respectively. In order to take into account the individual characteristics of patients, the method of adjusted platelet growth was used. After 1 hour and 24 hours indicated the effectiveness of replacement therapy, but in the first group it was lower than in the second. Lower platelet growth rates in the first group were not accompanied by a shortening of the interval between transfusions. Conclusions. Pathogen-reduced РC transfusions are associated with lower APT and SPT at 1 and 24 hours. However, a decrease in these indicators does not lead to a decrease in the interval between transfusions and an increase in the frequency of transfusions. The results obtained above may indicate equal clinical effectiveness of both types of РC.

Objectives. To evaluate clinical, laboratory, and instrumental features of diagnosis and treatment in patients with ST-segment elevation myocardial infarction (STEMI) and SARS-CoV-2 infection (COVID-19). Material and methods. The retrospective case-control study included 114 patients (57 pairs adjusted by gender, age, comorbidity and diagnosis of STEMI) who underwent coronary angiography (CAG). According to the temporary routing regulations for the pandemic in the Sverdlovsk region, in each pair one of the patients had been hospitalized with COVID-19 (group 1) at the Central City Hospital, Verchnya Pyshma, and the other person without COVID-19 (group 2) had been admitted to LLC Medical Association «Novaya Bolnica», Yekaterinburg. July to December 2020 medical records data were processed. Results. Patients with COVID-19 underwent PCI significantly later from the onset of symptoms, 607.0 (340.0–870.0) minutes versus 350.0 (190.0–450.0), p < 0.001. There were no difference in anatomy and the number of affected coronary arteries between the study groups. Massive coronary thrombosis was equally common in both groups, both with COVID-19 in 57.9% of cases and without COVID-19 in 56.1%, p = 0.849. Stenting attempts in the COVID-19 group were slightly less frequent and performed in 89.5% cases, while in patients without COVID-19 stenting occurred in 96.5% cases, p = 0.232. The optimal stenting result as TIMI 3 blood flow was obtained slightly less in the NCVI group: 94.2% versus 98.2% in patients without COVID-19, p = 0.067. COVID-19 positive subjects with STEMI required more days of hospitalization: 13.0 (10.0–18.0) versus 8.0 (8.0–8.0) in the group without COVID-19, p < 0.001. Conclusions. The manifestations of an infectious disease in cases of COVID-19 and STEMI comorbidity negatively affected the time from the onset of symptoms to the initiation of reperfusion therapy and caused a significantly longer duration of hospitalization. At the same time, timely routing decisions at the regional level to ensure the availability of primary PCI for all patients with STEMI, regardless of the presence of an infectious disease, allowed acceptable intervention results to be achieved in the vast majority of patients in both groups.

A group of men with hypertension (HT) was examined. The patients were divided into three groups: those with paroxysmal atrial fibrillation (AF), those with persistent AF, and those with coronary artery disease (CAD) (2–3 FC angina).When analyzing the parameters of the renin-angiotensin-aldosterone system, it was revealed that patients with GB and AF are more likely to have high–grade arterial hypertension (AH) (up to 50%), and in patients with GB and CHD — normorenin hypertension (60%). Among patients with high-RH hypertension, significantly higher renin values were noted in the group with persistent AF and coronary artery disease. Against the background of taking antihypertensive therapy (b-blockers and BAR), the level of aldosterone was within the normal range in all examined patients. The high level of angiotensin II in the group of persons with high-renin AH and AF requires further study. Hypokalemia was detected only in patients with hypertension and paroxysmal AF in 13.4% of cases. It should be noted that a low level of K⁺ from 3.5 to 3.9 mmol/L was detected in 34.2% of patients with paroxysmal AF and in 30% of patients with persistent AF. No correlation was found between the renin-angiotensin-aldosterone system and the K⁺ level.

The analysis of the results of treatment of 88 victims with gunshot wounds of the pancreas (pancreas) at the stages of providing qualified and specialized medical care in medical organizations of the Russian Ministry of Defense from 2023 to 2024 was carried out. In 76% of cases, combined wounds to the abdomen and other areas of the body were observed, isolated wounds in 24%, while injury only to the pancreas was noted in 3.4%, in all other cases (96.4%) simultaneously with the pancreas, there were injuries to other organs of the abdominal cavity. A feature of pancreatic gunshot wounds is the early (immediately after the injury) infection of the damaged organ with the development of acute traumatic pancreatitis (OTP) by 3–5 days with purulent complications characteristic of it, which occurred in 64,8% of cases. In order to prevent the development of complications, drug and surgical prophylaxis were performed. The essence of the latter was to observe the principle of minimal activity in relation to the pancreatic tissue, maximum activity in relation to drainage of the injury zone. The best results were obtained with the use of VAC drainage of parapancreatic and retroperitoneal tissue, which provided effective removal of pancreatic and purulent (with the development of phlegmon and abscess) secreted and lysing necrotic tissues. As a result of the treatment tactics used, the mortality rate for pancreatic gunshot wounds decreased from 28.6% in the first follow-up period to 15.2% in the second, with a total mortality rate of 21.6%.

Rationale. In recent years, there has been increasing evidence of a high incidence of arterial hypertension (AH) among patients with ankylosing spondylitis (AS). Timely diagnosis and prevention require the development of methods for predicting the development of AH in patients with AS. Objective. To develop prognostic criteria for the development of AH in patients with AS using neural network technology. Material and methods. A total of 202 people were examined. Group 1 included 28 people with AH, Group 2 included 60 patients with AS without AH, Group 3 included 45 patients with AS and AH, and Group 4 included 69 people in the control group. The subjects underwent 24-hour blood pressure monitoring, complete blood count, determination of C-reactive protein and cholesterol, and a study of gene polymorphism: AGT (T704C), AGT (C521T); ACE (I/D); NOS3 (T789C), AGTR1 (A1166C). Results. As a result of the conducted logistic analysis, six parameters were identified that formed the basis of the model for predicting the high risk of hypertension in patients with AS. The structure of the multilayer perceptron included indicators of the presence of a burdened heredity for hypertension, carriage of the AGT and ACE gene polymorphisms, AS activity, the level of C-reactive protein and cholesterol. The accuracy of the model prediction was 95.2%, sensitivity — 88.9%, area under the curve (AUC) = 0.959 [95% CI 0.893–0.988], p < 0.001). To facilitate the use of the model, an online calculator was developed to identify the high risk of hypertension in patients with AS. Conclusion. The model for predicting the development of hypertension in patients with AS is highly informative and functional.

Relevance. Antibiotic resistance (ABR) is one of the major threats to public health worldwide. In abdominal surgery, a complex clinical task is the treatment of secondary peritonitis, which, on the one hand, is accompanied by a high risk of developing abdominal sepsis, on the other hand, is associated with a wide range of microorganisms with different levels of ABR. Aims. To study the etiological structure and prevalence of resistance to ABP in pathogens of secondary peritonitis. Material and methods. A retrospective analysis of 120 cases of hospitalization of patients with secondary peritonitis in the period from 2021 to 2023 in the Regional State Autonomous Healthcare Institution “City Clinical Hospital No. 3 named after B.I. Alperovich” (Tomsk) was carried out. 139 isolates were studied based on the results of bacteriological examination of the contents of the abdominal cavity. Results. Representatives of the order Enterobacterales (E. coli, K. pneumoniae, P. mirabilis) prevailed in the structure of secondary peritonitis pathogens. Mixed infection, represented by a combination of K. pneumoniae with other pathogens, mainly E. faecalis, E. coli and P. aeruginosa, was detected in 22.5% of cases. Among the identified pathogens, K. pneumoniae and E. coli isolates characterized by an unfavorable ABR profile to cephalosporins, penicillins and fluoroquinolones were of concern. Conclusions. The etiological structure of secondary peritonitis is represented by a wide range of pathogens characterized by different levels of ABR. The main etiological role belongs to gram-negative bacteria. The causative agents of secondary peritonitis are characterized by different levels of ABR to the main groups of antibiotics used in clinical practice. The obtained data may be useful for the formation of local tactics of empirical antibacterial therapy.

Purpose of the study. To evaluate the severity of liver fibrosis, the level of serum markers of fibrosis and their prognostic value in HCV patients and patients with mixed infection (HCV and herpes infection). Material and methods. The article presents the results of the study of changes in the level of serum markers of liver fibrosis in patients with mono-infection with HCV genotypes 1, 2, 3 and mix-infection HCV and herpes co-infection in three stages of the study in dynamics during treatment with antiviral drugs and their prognostic possibilities. A number of important biochemical parameters were evaluated state of liver morphology and function: ALT, AST, GGT, cholinesterase, alkaline phosphatase, total protein, total bilirubin and blood glucose. In both study groups at the stages of observation all biochemistry indices after treatment were registered within the limits of normal values. The study was conducted in the laboratory of the State Budgetary Institution of the Russian Center for AIDS and IZ of the Republic of Bashkortostan, Ufa, where 46 people with HCV participated, two study groups: with mono-infection with CHC and with mix-infection (HCV and herpes infection — HPV-1, VEB, CMV). Results and discussion. According to the data of the study in group 1 of patients with HCV with expressed fibrosis and cirrhosis of the liver all biochemical indices after antiviral therapy were set within the limits of normal values, in group 2 of patients with mix-infection and expressed fibrosis and cirrhosis after antiviral and specific anti-herpetic therapy a part of indices — total protein, total bilirubin, alkaline phosphate, CE, GGT, blood glucose — tended to normalization, ALT and AST indices did not come to normal. Correlation analysis of indices of fibrosis stage by indirect elastometry method revealed a reliable relationship with the values of indirect markers of liver fibrosis, the degree of thrombocytopenia. Conclusions. In patients with mix-infection (HCV and herpetic infection) with identical course of HCV, more pronounced inflammatory and fibrotic processes in liver tissue, more rapid rates of fibrosis prevailed compared to patients with mono-infection with HCV, which is reflected in fibroеlastometry data and indices of indirect markers of liver fibrosis (biochemical indices), as quite informative and available in clinical practice.

Presarcopenia is the initial stage of sarcopenia, a common aging process associated with loss of muscle mass in the elderly and senile. Like presarcopenia, type 2 diabetes mellitus is an age-associated disease. Degenerative changes in skeletal muscle are a common pathogenetic factor in the two diseases. A reflection of muscle tissue functioning may be the value of the neutrophin BDNF, the expression of which increases in muscle after physical activity and also depends on the volume of muscle mass. Purpose of the study. To determine the diagnostic significance of BDNF biomarker in the diagnosis of presarcopenia in patients with type 2 diabetes mellitus. Material and methods. A one-stage single-center cross-sectional study of patients over 60 years old hospitalized in the endocrinology department of Bujanov State Clinical Hospital due to decompensation of carbohydrate metabolism was carried out. During hospitalization, the SARC-F questionnaire was used to detect sarcopenia syndrome; patients with more than 4 points were included in the main phase of the study to detect sarcopenia according to the EWGSOP 2 consensus. 88 patients were randomly selected and divided into 2 equal groups with and without presarcopenia. Sera were obtained from these patients for determination of BDNF levels by ELISA method. Statistical processing was performed using SPSS Statistics 23 program package. Results. During the study period, 232 patients were examined, of whom 147 (63% of the total number of patients, men 35 (24%), women 112 (76%), mean age 70 ± 8 years), presarcopenia was detected in 87 people (59% of the number of patients). From them 88 people were randomly selected and divided into 2 equal groups with and without presarcopenia. Patients with presarcopenia had lower BDNF levels than those without presarcopenia, with values of 5.4 ± 1.6 and 7.2 ± 1.7, respectively. When comparing the indices using Student’s t-criterion in Welch’s modification, statistically significant differences were established (p = 0.0001). When performing correlation analysis, both direct correlations of BDNF level and dynamometry of the right hand (rxy = 0.38; p = 0.0001), left hand (rxy = 0.37; p = 0.003), SPPB-test (rxy = 0.212; p = 0.048), phase angle (rxy = 0.407; p = 0.0001), as well as inverse correlations of SARC-F (rxy = –0.222; p = 0.038), ASMM (rxy = –0.236; p = 0.027), iASMM (rxy = –0.246; p= 0.021), COE (rxy = –0.348; p = 0.001). To determine the diagnostic significance of VDNF level, its dividing value was found by ROC-curve method, allowing to diagnose presarcopenia in patients with type 2 diabetes mellitus. The area under the ROC-curve corresponding to the relationship between the prediction of presarcopenia and BDNF level was 0.826 ± 0.046 with 95% CI: 0.735–0.917. The resulting prognostic model was statistically significant (p < 0.001). The threshold value of BDNF at the cut-off point was 6.71. A high risk of presarcopenia was predicted when BDNF was equal to or exceeded this value. The sensitivity and specificity of the method were 81.8 and 75%, respectively. Conclusions. Thus, the study shows that plasma BDNF protein is directly related to the risk of presarcopenia, which emphasizes the possibility of using this marker for the diagnosis of presarcopenia.

Aim. To study the results of arthromedullary bypass (AMB) in arthroscopic treatment of gonarthrosis at 5 years after the intervention. Material and methods. 152 patients aged 42 to 80 years with osteoarthritis of the knee joint participated in the study. 67 control patients underwent arthroscopy of the joint only, 85 patients underwent additional AMB. Treatment efficacy was also compared in subgroups of patients selected for similar clinical and demographic factors. Outcomes were assessed over 60 months using the Lequesne and WOMAC indices, and the frequency of anti-inflammatory medication was noted. Results. Significant joint improvement was noted after 3 months and was maintained throughout the follow-up period. The incidence of joint stiffness, swelling, and nighttime joint pain decreased by 58, 69, and 75% in bypassed patients, respectively, and by 28, 25, and 54% in controls, respectively, (p < 0.01). Medication was required in 32% of control patients and 13% of AMB patients (p<0.05). Bypass surgery had a 17% higher success rate compared to controls (p < 0.05). In the matched subgroup with AMB, the reduction in the incidence of joint stiffness, edema and nocturnal pain after 5 years was 82, 74 and 83%, respectively, versus 35, 35 and 61% in controls (p < 0.01–0.05).. In the control group, 32% of patients required analgetics and NSAIDs, while only 5% did in the bypass group (p < 0.05). The success rate for bypass surgery was 35% higher than in the control subgroup (p < 0.05). Conclusion. The use of AMS in the treatment of gonarthrosis rapidly improves the condition of the affected joints, maintains a long-term five-year effect, and reduces the risk of invasive surgical interventions.

Аdvancements in medicine over recent decades, encompassing both therapeutic and diagnostic fields, have led to an increasing proportion of elderly individuals within the general population. As a consequence, there has been a rise in the frequency of medical consultations among this demographic. Nevertheless, contemporary literature reveals that the outcomes of surgical intervention in patients with atherosclerotic lesions of the peripheral arteries, specifically concerning the extracranial segments of the carotid arteries, remain under-explored. The aim of this study is to determine the impact of patient age on surgical treatment outcomes for individuals with atherosclerotic involvement of the carotid arteries. Material and Methods. This study assessed the treatment results of 63 patients who received surgical treatment at the Petrovsky сenter for Surgery. The cohort included both male and female patients (28 males and 35 females), age of over 75 years. All patients presented with hemodynamically significant symptomatic stenosis of the carotid arteries. The study results were derived from a retrospective analysis of a database. Results. Early postoperative outcomes (intraoperative; during the first 7–10 days post-surgery, while patients were hospitalized); and long-term postoperative outcomes (evaluated at six months post-operation). During the intraoperative period, complications developed in two patients: one case (1.56%) of non-ST elevation myocardial infarction (resolved without subsequent myocardial damage as confirmed by follow-up investigations) and one case (1.56%) of ischemic stroke. We reviewed existing literature regarding the frequency and types of major complications following carotid endarterectomy, finding no statistically significant differences relative to our findings (p > 0.05). At the six-month follow-up mark, 37 patients were assessed. Long-term outcome evaluations recorded the occurrence of non-ST elevation myocardial infarction, ischemic stroke, worsening of arterial hypertension, and mortality rates. One fatal outcome was recorded, as well as a progression of arterial hypertension in 8 patients, determined by increased frequency and dosage of antihypertensive medications. Conclusions. 1. The surgical outcomes for patients over the age of 75 with atherosclerotic lesions of the carotid arteries do not differ significantly from younger patients. 2. The presence of comorbid conditions and the severity of the patient’s initial state are the main predictive factors for the occurrence of complications. 3. Advanced age should not be regarded as a contraindication for surgical intervention.

Aeromedical evacuation of casualties, wounded, and sick patients in local and global military conflicts has a significant impact on the outcome and return time of such personnel. This role of aviation is difficult to overestimate. However, the risks associated with air transportation must also be considered. The main problem is that the requirements for such transportation haven't been clearly defined yet, as well as there aren't any general recommendations outlining the indications, contraindications, possible timing, and conditions for such evacuation. The only exception is the recommendations published in 2003 [1], which concern the air travel of patients with various acute and subacute conditions on civilian aircraft. Such recommendations are applicable not only to personnel transportation but also to the evacuation of people from natural disaster zones, terrorist threats, and other emergency situations. Based on this, it should be noted that the development of standards for medical support for aeromedical evacuation of patients with the most common types of surgical pathology is urgent and requires resolution in the near future.

Background. Chordal rupture is a rare complication of various diseases and conditions, occurring both primary and secondary. This condition can lead to acute mitral regurgitation and death of the patient, it is necessary to keep in mind a number of diseases and conditions that can cause this complication or be a risk factor. Purposes. It nesessary to analyze the causes of tendon chord detachment, identify the most frequent and the rarest of them. Determine the association of comorbidities with tendon chord detachment. Material and methods. Literature data were summarized and analyzed. Literature search was carried out in Scopus and Pubmed databases. Conclusions. Chordal rupture remains a complication of a large number of diseases. At present, chordal rupture occurs predominantly as a complication of degenerative mitral valve diseases in elderly patients, which correlates with the global trend. The role of rheumatic heart disease and infectious endocarditis as causes of chordal rupture has decreased, but still remains significant.

The clinical case of a patient participating in a special military operation who underwent orthotopic heart transplantation at the Federal State Budgetary Institution “NMIC TIO named after V.I. Shumakov” of the Ministry of Health of the Russian Federation. This patient has secondary dilated cardiomyopathy accompanied by chronic heart failure, stage IIB according to the Vasilenko-Strazhesko classification, with severe physical activity restriction — NYHA functional class III. The presented case describes the successful integration of the military medical service with civilian healthcare institutions to provide high– tech medical care to a participant in a special military operation. The performed orthotopic heart transplantation using the bicaval method led to an improvement in the patient’s prognosis and quality of life.

The article describes apical hypertrophic cardiopathy, its etiology and pathogenesis. A clinical case of a patient with apical hypertrophic cardiomyopathy is presented. The features of the course of the disease, modern approaches to assessing the prognosis are described. The issues of differential diagnosis are considered.

Purulent-septic complications in patients with type 2 diabetes mellitus (DM) do not tend to decrease and vary from 15 to 49%. About 50% of all patients with DM are at risk. Objective: to describe a rare case of purulent leptomeningitis in a patient with type 2 DM. Material and methods. A comparison of data based on the results of clinical analysis and autopsy was carried out. Histological material is stained with hematoxylin and eosin. Results. A 62-year-old patient who died at home lived alone. From the outpatient card records (last visit to a therapist on July 22, 2024), the diagnosis was: DM, type 2: diabetic macromicroangiopathy. The patient’s immune reactivity index (IRI) is within normal limits and is 7.1. The lymphocyte index is reduced to 0.2. The patient died on 10/28/2024 with symptoms of multiple organ failure. Due to the statement of death, the body was sent for autopsy. Examination of the brain reveals vascular congestion with small thrombi, the pia mater is diffusely infiltrated with polymorphonuclear leukocytes. Perivascular and pericellular edema of the brain is determined. Interlobular and periductal sclerosis, subatrophic and atrophic changes in the insular apparatus are detected in the pancreas. The vessel walls are hyalinized and sclerosed. Conclusion. In the presented case, the determining factor in the development of purulent leptomeningitis and the onset of death of the patient was diabetes. Despite the fact that several months before death, the IIR was within normal values, the lymphocyte index was significantly reduced.

The article presents a clinical case of the development of the pro-arrhythmogenic effect of lappaconitine hydrobromide in the form of monomorphic ventricular tachycardia in a 68-year-old female patient. Upon admission, there were complaints of a constant feeling of heaviness in the sternum and shortness of breath, episodes of dizziness and unsteadiness when walking, interruptions in the work of the heart, occurring with minor physical exertion. The patient has a history of type 2 myocardial infarction (two years ago), during inpatient treatment ventricular tachycardia was recorded, due to which amiodarone was prescribed. At the outpatient stage, amiodarone was replaced with lappaconitine hydrobromide. Three days before the current hospitalization, during Holter ECG monitoring, frequent ventricular extrasystoles, episodes of unstable and stable ventricular monomorphic tachycardia were recorded. The detected arrhythmia was assessed as a proarrhythmogenic effect of lappaconitine hydrobromide, due to which this drug was discontinued and amiodarone was prescribed. During echocardiography on the second day of hospitalization, diffuse myocardial hypokinesia was detected, a decrease in the left ventricular ejection fraction to 48%. During the treatment, an improvement in well-being was noted: chest discomfort, shortness of breath, and attacks of palpitations did not bother. One month after hospitalization, outpatient echocardiography showed an increase in the left ventricular ejection fraction to 54%. The presented case draws the attention of practicing physicians to the need to monitor the effectiveness and safety of antiarrhythmic therapy, especially in patients with organic myocardial damage.

Postoperative ventral hernia is one of the most common pathologies in surgical practice. Despite the fact that the number of laparoscopic operations in abdominal surgery is growing, the use of traditional laparotomic access remains high, after which postoperative ventral hernias develop in 3–19% of cases. The presented article, using a clinical case as an example, demonstrates the effectiveness of eliminating a giant postoperative ventral hernia with a combination of abdominal wall separation techniques (endoscopic Ramirez and transverse abdominis muscle release (TAR)).

This article describes the objectives and structure of the Combat Surgical Trauma Research Laboratory. It describes the research conducted by the laboratory’s staff during 11 missions to Afghanistan and their participation in providing care to the wounded during counterterrorism operations in the North Caucasus. The results of the research and their practical implementation are presented.

The work presents the life and work of Professor P.A. Herzen. It is noted that he was an outstanding “master” of Soviet and world medicine, one of the founders of domestic oncology and cardiovascular surgery, who enriched Soviet healthcare with a number of new ideas and surgical techniques of a high theoretical and practical level. The scientist’s life path was complex, multifaceted, interesting, and his services to Russian medicine were enormous. The vibrant life of Pyotr Alexandrovich occurred in the first half of the 20th century — an era of change and two world wars. Following the will of his great grandfather, P.A. Herzen decided to return to his homeland. In 1897 he came to Russia. When trying to start working in his specialty in his historical homeland, he encountered enormous difficulties. Without a diploma from a Russian university, without truly knowing the Russian language and without a Russian passport, P.A. Herzen turned to Professor V.F. for advice. Luginin, an old friend of his family. V.F. Luginin P.A. Herzen was helped to overcome all obstacles and in 1898 P.A. Herzen graduated from Moscow University. From 1898 to 1920 P.A. Herzen worked at the Old and New Catherine Hospital. Here he worked his way up from resident to professor. Describing the creative path of P.A. Herzen, we tried to imagine the complex interaction of factors that determined such a remarkable result — Pyotr Alexandrovich’s significant contribution to world medical science.