Vol 22, No 2 (2025)

In patients with emergency abdominal surgical pathology (EASP), purulent-inflammatory wound complications (PIWC) after emergency relaparotomy (ERLT) “on demand” develop in 30–65 % of cases. ERLT is performed in the first phase of wound healing (3-7 days), during this period of time, inflammatory processes are clearly expressed in the wound: the wound is oversaturated with inflammatory mediators (prostaglandins, inflammatory cytokines, chemokines) leading to vascular contraction and increased permeability of the vascular wall, local acidosis, increased catabolism, migration of leukocytes into the wound, and wound ischemia is increased due to the compressive effect of the sutures. These components of the first phase of wound healing, during relaparotomy by removing sutures, significantly increase the risk of infection and complicate the treatment tasks. The aim of this study is to improve the treatment outcomes of patients with EASP after ERLT by using improved methods of treating PIWC. Materials and methods: Clinical studies were conducted on 129 patients with various types of EASP who underwent ERLT, of which 87 were retrospective (comparison group) and 42 were prospective (main group). The results showed that in the main group, the use of improved methods of treating PIWC based on closed prolonged irrigation of wounds with antibiotics and antiseptics, with anaerobic flora, additional insufflation of the wound with oxygen, allow earlier elimination of anaerobic non-clostridial flora (ANF), replacement of mixtures of facultative anaerobic bacteria with a monoculture, and avoidance of nosocomial infection. Compared to the comparison group, the updated algorithm for treating suppurating wounds reduced the time of the possibility of applying secondary sutures by (6 ± 1) days, reduced the duration of hospitalization by (10 ± 2) days, and mortality by (4.5 ± 0.5) %. Conclusions. The proposed improved methods of closed treatment of PIWC after ERLT allow to avoid complications from the wound (phlegmon, eventration), statistically significantly reduce the duration of hospitalization and mortality.

According to the Russian Ministry of Health, diabetes mellitus currently accounts for 3.3 % of the Russian population. The most dangerous consequences of the global diabetes epidemic are systemic vascular complications, in particular, lesions of the peripheral vessels of the lower extremities. A necessary condition for stopping infectious and trophic processes in case of obstruction of limb vessels is the restoration of the main blood flow. In recent years, preference has been given to endovascular revascularization methods. The aim of the work is to demonstrate a clinical observation and evaluate the effectiveness of endovascular transluminal balloon angioplasty (TLBA) for the correction of TASC D leg lesions in a patient with diabetic foot syndrome (DFS), as well as to analyze the literature data on the use of this technique in lower extremity vascular lesions. Material and methods. The clinical part of the work was carried out on the basis of the surgical departments of the State Healthcare Institution City Clinical Hospital of Emergency Medical Care No. 25 of Volgograd. Traditional research methods were used to diagnose lower extremity vascular lesions: duplex scanning of the lower extremity vessels, selective angiography of the arteries of the left lower extremity. The information bases were the following data: PubMed, CyberLeninka, Google Scholar, Medline, eLIBRARY and the Russian Diabetes Registry of 2021. Results. A review of studies devoted to the study of the possibilities of lower extremity revascularization in the treatment of patients with diabetic foot syndrome shows that TLBA in patients with critical limb ischemia to preserve it costs the state 4–7 times less than amputations and subsequent stages of prosthetics and rehabilitation. Reconstructive surgeries give positive results of limb revascularization in 70–80 %. The article presents a clinical observation demonstrating the possibility and effectiveness of endovascular balloon angioplasty as one of the options for endovascular correction in purulent-necrotic lesions of the foot in a patient with diabetic foot syndrome against the background of TASC D leg artery lesions. Conclusion. Transluminal balloon angioplasty against the background of critical ischemia of the leg arteries in patients with diabetes mellitus can be considered as the operation of choice for limb salvation.

The variability in the size of the branches of the lower jaw determines the relevance of assessing the proportionality of its main parts. In intravital conditions, X-ray methods of examination occupy a special place in diagnosis. Purpose. To determine the main vertical parameters of the mandibular branch and its components in physiological occlusion of permanent teeth. Material and methods. An analysis of 74 sets of radiographs, including orthopantomograms and teleradiographs of people with signs of physiological occlusion, was carried out. The mandibular branch was conditionally divided by a line running through the distal occlusal point into two sections, the upper occlusal articular and the lower occlusal gonional. Results and discussion. In the course of the analysis of radiographs of people with physiological types of occlusion, it was found that the height of the mandibular branch averaged (61.28 ± 1.24) mm. The ratio of the upper part to the lower part was 1.97 ± 0.07. The relative ratio in the range from 1.8 to 2.1 allowed us to distinguish 3 groups. The first group included radiographs in which the relative indicator corresponded to the mean values (1.8–2.1). The second group included radiographs with a reduced ratio of parts of the mandibular branch (less than 1.7). In the third group, the ratio of parts of the mandibular branch exceeded 2.2. Conclusion. On average, the height of the upper occlusal articular part of the branch was twice the size of the lower occlusal gonional part, which can be used both in the clinic of orthodontics and maxillofacial surgery when planning operations to model the branch of the lower jaw.

The issues of determining the methods of orthodontic treatment with and without tooth extraction remain relevant to this day. A special place is occupied by methods with the removal of the first premolars, and the orientation to the position of the Bimler stess-axis is perhaps the only criterion for determining the method of extraction therapy. However, we have not found any information about the position of the Bimler line, taking into account the individuality of the dentition-jaw system. Purpose. To determine the location of the upper first premolars relative to the Bimler stess-axis in different trusal variants of the dentoalveolar arches and latitudinal parameters of the chin protrusion. Material and methods. The study was retrospective, with distribution into groups that took into account variants of physiological protrusion and incisor retrusion, as well as latitudinal variants of the chin protrusion, along the posterior protrusion of which the Bimler strass axis passed. Using the computer program PowerPoint, a circle was inscribed on the photo of the teleradiograph, which passed through the anterior and posterior occlusal points and the upper point of the articular head. From the center of the circle to the posterior convexity of the contour of the chin symphysis, the Bimler strass axis was drawn. The position of the first upper premolars relative to the landmark was visually assessed. Results and discussion. It was noted that with the protrusive position of the incisors, in people with physiological occlusion, there was a displacement of the first premolars anterior to the Bimler stress axis. At the same time, the location of the first upper premolars behind or on the Bimler line, in people with retrusin-type arches, is not a contraindication to extraction treatments. The width of the chin protrusion influenced the position of the Bimler stress axis. Conclusion. In the course of the study, it was found that in the mesotrusal type of dental arches, in people with wide chin variants, the location of the Bimler stress axis behind the upper premolars is not a sign of their mesial displacement relative to the structures of the skull. The same is noted for the protrusive type of arches, regardless of the width of the chin protrusion. The data obtained can be decisive in the diagnosis of anomalies and the choice of extraction and non-extraction methods of treatment.

The purpose. The objective of this study is to evaluate the efficacy and safety of forming an antireflux sleeve from the round ligament of the liver in obese patients after longitudinal gastrectomy (LG) in the prevention of gastroesophageal reflux disease (GERD) compared with standard LG with cruroraphy. Material and methods. A prospective study (2018–2023) included 82 obese patients (BMI ≥35 kg/m²) with confirmed GERD. The primary cohort (n = 42) was administered GERD with the formation of an antireflux cuff from the round ligament of the liver and posterior cruroraphy; the control group (n = 40) received only GERD with cruroraphy. The assessment encompassed a range of methodologies, including clinical (GSRS, SF-36 questionnaires), instrumental (FEGDS, pH-metry, fluoroscopy), and the Clavien-Dindo classification of complications. Statistical analysis was performed using the Mann-Whitney and χ² criteria. Results. Efficiency. After a 12-month period, a complete disappearance of GERD symptoms was observed in 92.9 % of patients in the primary cohort, as compared to 85% in the control group (p = 0.033). The recurrence of gastroesophageal reflux disease (GERD) was observed to occur in 2.4 % (1/42) of the subjects in the study, as compared to 15 % (6/40) of the subjects in the study. Complications. In the main group, 2.4 % of mild complications (bleeding) were registered, while in the control group, 5 % of cases required repeated surgical interventions (e.g., gastric bypass, teres-plasty). Instrumental data. In the primary cohort, Index DeMeester registered at 7.1 (compared to 9.3 in the control group), while the proportion of time spent with a pH below 4 was recorded at 1.7 % (versus 1.38 %). Quality of life. The GSRS questionnaire revealed a statistically significant improvement in the "reflux syndrome" scale among the primary cohort (p = 0.004). The SF-36 demonstrated a significant improvement in the "General health" (77 versus 67 points) and "Social functioning" (100 versus 88) scales. Conclusion. The antireflux cuff, fabricated from the round ligament of the liver, has been demonstrated to reduce the risk of Gastroesophageal Reflux Disease (GERD) recurrence, enhance quality of life, and is deemed safe in patients post-Procedure Related to the Liver (PR). The method has the potential to become a standard in bariatric surgery for patients with obesity and concomitant GERD.

Introduction. The causes of upper mono- and paraparesis leading to disability are often stroke, myopathy and trauma, the frequency of which increases with age. It is necessary to evaluate the results, features and prospects of using the innovative method of exoskeleton habilitation and rehabilitation in elderly patients. Objective: to demonstrate the possibilities of using the modification of the passive exoskeleton of the upper limbs "EXAR-34" in complex habilitation and rehabilitation of older patients with upper flaccid para- and monoparesis. Materials and methods. The experience of using the EXAR-34 exoskeleton using the anatomical parameterization method in 2 women and 2 men aged 63-86 years with upper flaccid para- and monoparesis of various etiologies is summarized. Goniometry and neurological status examination were used. Results. The design features of the modification of the upper limb exoskeleton of the EXAR series, to be used in elderly patients with upper mono- and paraparesis, are revealed and described. It is demonstrated how, as a result of exoskeleton habilitation and rehabilitation, all patients of the discussed category in a short time managed to steadily increase the volume of abduction and flexion in the shoulder-scapular joints compromised by pathology from the level of significant to insignificant limitation, which significantly improved their quality of life. The concept is outlined and an assessment is given of the positive and negative aspects of the use of passive exoskeletons in a complex of habilitation and rehabilitation measures for mono- and paraparesis in elderly and old people. The expansion of indications is substantiated and the conditions for using a passive exoskeleton in spastic paraplegia are determined. The pathogenetic effects and pathophysiological mechanisms of the influence of the EXAR series exoskeletons on neuromuscular transmission are revealed. Conclusions. The first experience of using the EXAR-34 passive upper limb exoskeleton in older patients with upper flaccid para- and monoparesis indicates good tolerance of the exoskeleton and pronounced habilitation and rehabilitation effects. The expansion of indications for the use of the EXAR-34 exoskeleton is possible due to a group of patients with post-stroke complications in the form of spastic paraplegia, after preliminary botulinum toxin therapy.