Introduction. Surgical site infection (SSI) incidence amounts to as much as 30% in patients after colorectal surgeries. Infectious complications after colorectal surgeries are characterised by the prevalence of deep forms of SSI with an unclear clinical presentation and difficulties in a timely diagnosis. An important aspect here is finding the earliest marker of the developing infectious complications and establishing its threshold value.

Materials and methods. This is a prospective study of outcomes of colon resection and construction of colon anastomoses in 135 patients. Patients were split in two groups depending on the method of anastomosis construction. The C-reactive protein level was recorded prior to surgery and on days 3, 5, and 7 postop.

Results and discussion. SSI was diagnosed in 32 patients (23.7%). Comparing the SSI incidence in different groups the authors established a statistically significant difference in favour of mechanical anastomosis; 9 patients (15.2%) against 23  patients (30.3%), р=0,0164. Statistically significant differences in CRP levels have been established between patients with SSI and patients without SSI at all the times the samples were taken postop. At the level of CRP higher than 100.5 mg/l (0.95 confidence range lower limit) the incidence of SSI increases significantly.

Conclusion. Mechanical anastomosis conclusively reduces the incidence of SSI in the postop period by 15.1%. The CRP level of higher than 100.5 mg/l from day 3 postop can be considered a reliable predictor for the development of SSI.

Introduction. The polyetiology and diversity of clinical manifestations of acute intestinal infections determine the difficulties of the differential diagnosis with acute surgical pathology of the abdominal organs.

This study aims to elucidate the causes of the erroneous diagnosis of surgical pathology of the abdominal organs which have symptoms similar to acute intestinal infections.

Materials and methods. The paper presents an analysis of 2940 medical records of patients hospitalised in the intestinal infections department of the Infectious Diseases Hospital No. 4 of Ufa with suspected acute intestinal infections. Among these in 42 patients following the clinical and laboratory examinations, the nature of the disease was established as a disorder requiring surgical treatment, and they were transferred  — urgently, more often than not  — to appropriate hospitals.

Results and discussion. The authors identified the earliest and most informative clinical, anamnestic and laboratory parameters aimed at making a timely differential diagnosis of acute intestinal infections with a variety of surgical pathology of the abdominal organs, primarily with acute appendicitis, intestinal tumours, somatic diseases of the gastrointestinal tract, haemorrhagic fever with renal syndrome and myocardial infarction.

Conclusion. When a non-infectious disease was diagnosed the authors carefully examined the results of general clinical tests, fecal panel, results of bacteriological and enzyme-linked immunosorbent assays of feces and vomit for pathogenic and opportunistic enterobacteria, rotaviruses, ultrasound and X-ray images of the abdominal organs.

Introduction. Appendicular infiltration is currently considered as a complication of acute appendicitis. The incidence rate of this disorder ranges between 0.2 and 5.8%. Despite a large number of studies dedicated to the issue of acute appendicitis and its complications, including appendicular infiltration, surgeons’ interest to this issue remains undiminished.

Materials and methods. The paper presents the results of a retrospective analysis of diagnosis and treatment of 57 patients admitted to MI CTH No. 8, Ufa, with a diagnosis of acute appendicitis complicated with appendicular infiltration in 2012-1017.

Results and discussion. In 32 (56.1%) patients, the infiltration was diagnosed during the surgery or diagnostic laparoscopy as an incidental find, the so-called ‘find-infiltration’. Of these, in 19 (33.3%) patients, the intraoperative find was evaluated as hard infiltration, in 13 (22.8%) — as soft. In 25 (43.9%) of patients admitted to the clinic with acute appendicitis, it was suspected that the infiltration had developed prior to surgery. Dynamic clinical and ultrasound examination in 11  patients left no doubt regarding the presence of infiltration. These patients were treated conservatively. In the remaining 14 patients, it was impossible to exclude acute appendicitis or infiltration and it was decided that diagnostic laparoscopy was indicated.

Conclusion. Diagnostic laparoscopy is the leading method for diagnosis of this complication that helps determine a treatment strategy. Surgical strategy was strictly differentiated  — at the infiltration stage  — conservative, at the abscess stage — surgical; abscess cavity dissection and draining was recommended. Appendectomy was considered acceptable in technically uncomplicated situations. All the patients following the resolution of appendicular infiltration and dissection of periappendicular abscess should receive the recommendation to have appendectomy 3–4 months after discharge

Introduction. Surgical treatment of patients with spinal injuries with traumatic spinal canal stenosis is an important and widely discussed problem of contemporary vertebrology. Injuries to the spine in the incidence structure of isolated or combined injuries occupy a special place due to their high social and clinical significance. Long-term outcomes of traumatic disease in patients with combined trauma to the thoracic and lumbar spine are studied, as before, by ever larger groups of researchers in connection to the new generations of spinal fixation devices being introduced.

Materials and methods. 111 patients with various thoracolumbar spine injuries treated surgically were included in the study. In 40 patients, the post-traumatic stenosis was treated with the use of ligamentotaxis and transpedicular osteosynthesis. Thll–Thl2, Th12–L1 and L1–L2 were the most frequent localisations of the level of injury in the study group.

Results and discussion. The immediate treatment outcomes observed were as follows — good in 33 (82.5%) cases, satisfactory in 6 (15.0%), unsatisfactory — in 1 (2.5%). Long-term outcomes with follow-up longer than a year were recorded in 27 (67.5%) patients with good outcomes in 20 (74.1%) and satisfactory in 7 (25.9%).

Conclusion. A correct stabilisation with metal systems makes it possible to verticalize the patient quickly and shorten the rehabilitation period in all patients including those of active working age, as well as minimize the risks in the long term.

Introduction. Hip and knee arthroplasty are the two of the most frequently used methods of surgical treatment. The techniques of drug support in the perioperative period, as well as the rehabilitation component, are of primary importance. However, due to the increase in number of operations the number of complications is also growing. At the same time, surgical approaches to the treatment of bilateral knee OA are still not sufficiently studied. The literature describes intervals between arthroplasty operations on knee joints from 3 months to 5 years. The epidemiological and pathogenetic aspects of functional recovery in bilateral knee OA patients are also in need of further research.

Materials and methods. Authors analysed outcomes in 124 patients with gonarthrosis treated with arthroplasty. 32 patients underwent arthroplasty of the contralateral joint. The outcomes were evaluated with the KSS score and X-ray imaging at 1, 3 and 6 months postop.

Results and discussions. In the first month after the operation functional recovery was noted due to the relief of pain, recovery of the muscle tone and regional hemodynamics in the area of the knee joint. It was also noted that the recovery of function in the period from month 1 to month 3 in patients with bilateral gonarthrosis occurs less intensively due to decompensation of the contralateral joint.

Conclusion. The study demonstrates the recovery of function in patients in the postoperative period. There is, however, the issue of functional decompensation in the opposite limb, which in turn reduces the effectiveness of motor rehabilitation and leads to the need for endoprosthetic replacement of the second joint.

Introduction. There are various osteoplasty methods aimed at managing the challenge of jaw atrophy. When the scope of the osteoplasty is extensive it is not always possible to prepare an appropriate amount of bone tissue without additional surgeries. In some cases there is a lack of intraoral bone tissue sources for this kind of operations. Using extraoral sources of bone tissue is not always justified; it is invasive and patients take longer to recover and return to work. Using alternative sources of bone biomaterials might help establish a less invasive osteoplasty protocol.

Goal. To demonstrate the efficiency of alveolar ridge osteoplasty with the application of laminar technique and using various combinations of autograft and allograft tissues.

Materials and methods. To achieve the goal set we have examined and treated fourteen patients (N=14) surgically. All patients presented a clinical picture of severe atrophy in dentoalveolar segments 3 and 4, knife-edged ridge, Cawood and Howell class IV–V. Depending on the combination of autograft and allograft biomaterials patients were split into three study groups and one control group.

Results and discussion. Positive outcomes for the treatment administered were observed in 13 out of 14 patients. Complications were determined by the lack of soft tissue, exposure of the graft or its suppuration. All the patients in all the groups underwent a control CT which confirmed the bone tissue growth at the area of the augmentation performed.

Conclusion. Using the bone biomaterial allograft in combination with autograft bone makes it possible to get good clinical results in all the groups observed. This method may be a method of choice eliminating the additional invasive procedure of bone transplant harvesting; it does, however, require further, more detailed research.

Introduction. In this study, we analysed the results of applying various surgical methods in the combined treatment of inflammatory diseases of bones and joints.

Materials and methods. The work was based on data from a multi-dimensional cohort study using non-concurrent (historical) control. A retrospective study included the analysis of medical records covering the period of 2009–2016 (1059 patients). A prospective study consisted in analysing the effectiveness of modern surgical methods in the combined treatment of inflammatory diseases of bones and joints in patients hospitalised to the Septic Surgery Department of the G.G. Kuvatov Republican Clinical Hospital (Ufa, Russia) in 2017–2018 (285 patients).

Results and discussion. An analysis of the authors’ own data revealed that injuries (73.21%) and infectious complications after receiving surgery on bones and joints (15.03%) are the most common causes of osteomyelitis. In most cases, the following list of measures is optimal for diagnosing suspected osteomyelitis of various etiologies: X-ray, general clinical tests supplemented by the fistulography or CT of the affected area prior to surgery, as well as the examination of surgical material after surgery. The use of modern methods for surgical debridement and surgical repair of bone defects in the combined treatment of patients with chronic osteomyelitis can significantly reduce the relapse rate. It is recommended that patients with osteomyelitis be treated at large in-patient surgical facilities, which include a specialised department for the treatment of surgical infections and corresponding support services.

Conclusion. Apparently, there is no one most optimal method for treating osteomyelitis. The optimal effect in the treatment of osteomyelitis is achieved through a personalised set of therapeutic measures using the following methods: laser vaporisation, negative-pressure wound therapy, ultrasonic cavitation in the focus of inflammation, as well as surgical repair of the post-trepanation bone defect or wound.

The original concept of tumour stem cells (TSC) has been questioned ten years after TSCs in glioblastoma (GBM) had been described for the first time. Our understanding of cell heterogeneity in malignant brain tumours has become more complex. The improvements in our knowledge of tumour stem cells also impact on pre-clinical research and clinical practice. Chemoresistance is one of the key obstacles to success in treating malignant tumours; it results in tumour recurrence and metastatic spread. GBM relapse is almost universal, and its prognosis remains uncertain despite significant advances in treatment over the last decade. Tumour stem cells, glioblastoma stem cells (GSC) in particular, are highly resistant to chemotherapy, radiation therapy and immune recognition. GBM shows significant intratumoural phenotypic and molecular heterogeneity containing a population of tumour stem cells that contributes to the division of tumour cells supporting the resistance to treatment. TSCs are defined functionally by their ability for self-renewal and differentiation; they present a most diverse hierarchy of cells making up the tumour. The critical role of TSCs in glioblastoma pathogenesis makes the research into their molecular and phenotypic characteristics is a therapeutic priority.

Introduction. Fibromuscular dysplasia (FMD) is an idiopathic, non-atherosclerotic, non-inflammatory disease of arteries. Careful research into this disorder showed that FMD has been found in every arterial bed in the body; the most common arteries affected are renal arteries and extracranial sections of carotid and vertebral arteries. The clinical presentation is determined by the localization of the vasculature affected and the stenosis severity. Today FMD is a very rare disease with the incidence of 4 per 1000 people. The diagnosis today is difficult and may take a long time. According to the latest European Society of Cardiology guidelines renal artery balloon angioplasty is indicated for patients with FMD; if a good angiographic result is achieved (no dissection, TIMI 3 flow) no renal artery stenting required. The treatment success depends on the early diagnosis.

Materials and Methods. This paper presents a clinical case of renal artery stenosis caused by fibromuscular dysplasia that was treated successfully with balloon angioplasty without stenting.

Results and discussion. Protracted process of diagnosing this disease may result in deteriorating quality of life and poor outcomes such as difficult-to-control hypertension and its sequelae, TIA, stroke, aneurism dissection or rupture. It is worth pointing out that FMD diagnosis may be incidental when imaging is performed for other reasons, or when there is a systolic murmur at arteries in an asymptomatic patient who does not have classic atherosclerosis risk factors. According to the latest guidelines endovascular treatment is indicated for patients with FMD to manage the hypertension; this has proven very effective in improving quality of life.

Introduction. Idiopathic macular hole (IMH) is a frequent disorder of the posterior segment of the eye that impacts on visual functions leading to the reduction of visual acuity and the manifestation of metamorphopsia. In the majority of cases the basic treatment technique for IMH is a three-port transconjunctival guillotine vitrectomy. In the key of the further development of vitrectomy the latest and most interesting is the use of ultrasonic energy for vitreous fragmentation. Members of staff of the Department of Ophthalmology with the Course of Additional Professional Education of Bashkir State Medical University jointly with the Department of Microsurgical Equipment of CJSC Optimedservice have built a 25G ultrasonic vitrectomy system with the mechanism of action that turns the vitreous body into easy-to-remove emulsion with the use of ultrasound.

Materials and methods. This paper presents a clinical case of idiopathic macular hole successfully treated with the method of 25G subtotal ultrasonic vitrectomy.

Results and discussion. The data obtained through comprehensive ophthalmological examination and supported by fundus-camera, OCT and OCTA images made it possible to make a diagnosis of vitreomacular traction syndrome, idiopathic macular hole, J. D. Gass stage 3. 25G subtotal ultrasonic vitrectomy was performed on the universal ophthalmic surgery system Optimed Profi (Optimedservice, Russia) with intraoperative OCT-controlled internal limiting membrane staining and peeling, and apposition of the macular hole edges with gas tamponade. A good outcome, both anatomical and functional, was achieved; IMH has closed and a positive visual acuity dynamic has been recorded.

Conclusion. We can thus conclude that 25G subtotal ultrasonic vitrectomy with ILM peeling and gas tamponade is an effective IMH treatment method that ensures high visual functions.

Introduction. Glioblastoma multiforme (GBM) is the most common and aggressive form of primary malignant brain tumour in adults associated with a poor prognosis. Exosomes have been shown to be useful non-invasive biomarkers for the diagnosis and prognosis of tumours, GBM included. Exosomes play a role of biological carriers which can perform various tasks through various signalling pathways of carcinogenesis, such as PI3K/AKT, SOX2, PTEN, ERK and STAT3.

Materials and methods. Exosomes were isolated from blood plasma taken from patients diagnosed with GBM prior to surgical resection.

Results and discussion. Plasma exosomes from patients with GBM had spherical shape and varied in size from 40 to 100 nm matching the exosomes’ morphological characteristics. The combination of ultrafiltration and double ultracentrifugation makes it possible to extract exosome examples from plasma without the presence of contaminating particles over 100 nm in size; the shape and size of these vesicles match the characteristics of exosomes isolated from other biological fluids.

Conclusion. The experimental protocol for the extraction of exosomes from GBM patients’ plasma described here proves effective as a method used to ensure the purity of exosomes. Applying this method offers further opportunities for research into the role of exosomes in GBM pathogenesis. Equally this method can be used in research involving other human pathologies.

Chronic mesenteric ischaemia constitutes a condition characterised by a decreased abdominal blood flow, which is caused by the obstruction of visceral arteries. This short communication paper presents a clinical case of endovascular treatment in a patient with the obstruction of the celiac trunk, superior and inferior mesenteric arteries. Intestinal blood supply was provided through collaterals from the system of internal iliac veins via the inferior mesenteric artery, the arc of Riolan. This clinical case confirmed that percutaneous transluminal angioplasty and stenting of the visceral arteries is the method of choice in the surgical treatment of abdominal angina.