Venous trophic ulcers affect approximately 1% of the working-age population of industrialized countries, which gives rise to massive direct and indirect healthcare expenditure. Today, irreversible injury to the microcirculatory bloodstream caused by impaired venous outflow from the lower extremities is regarded as the main cause of venous trophic ulcers, which explains the high recurrence rate of venous trophic ulcers even after surgical management of pathological changes in the superficial, deep and perforating veins of the lower extremities. In other words, it is necessary to restore adequate skin covering with a normally functioning microcirculatory bloodstream in order to heal and prevent the venous trophic ulcer recurrences. That is why the complex systemic and local conservative therapy is required for the treatment of venous trophic ulcers, even after an apparent radical surgical intervention. The local treatment pathogenetically substantiated and adapted to the phase of the wound process combined with the compression therapy plays a crucial role in the treatment of venous trophic ulcers and prevention of ulcer recurrences. The reason for this is a change in the paradigm of chronic wound treatment due to clinical confirmation of the wound wet healing theory, expansion of the coatings line focused on different phases of the wound process, as well as the study of growth factor capabilities. The latter can be immobilized in wound coatings, incorporated into various ointments or used in an injection form. The epidermal growth factor (EGF) is the most studied one among the growth factors used to restore skin and soft tissues. It is included in the combination ointment (human recombinant epidermal growth factor + silver sulfadiazine) formulation, which improves tissue trophism and regeneration. This publication is devoted to the features of the use of this drug to treat venous trophic ulcers, with discussion of clinical case reports.

The aim of the review is to analyze the clinical efficacy of modern methods of treatment of patients with varicose veins of the lower extremities from the standpoint of a differentiated approach to determining treatment tactics, taking into account the individual characteristics of the pathogenesis and variants of the clinical course of the disease. The literature review presents a brief history of the development of methods for the treatment of patients with varicose veins of the lower extremities. An analysis of the clinical efficacy and long-term results of phlebectomy, scleroobliteration, endovenous laser obliteration, radiofrequency ablation, endovenous steam ablation, mechanochemical ablation, and the use of the adhesive agent cyanoacrylate was carried out. The analysis showed that there is currently no universal method of treatment for patients with varicose veins. There is no unified approach to the choice of treatment tactics, the problem of personalization of treatment taking into account the individual characteristics of the pathogenesis and variants of the clinical course of the disease has not been solved. With all the variety of nominally existing treatment methods, recurrence of varicose veins develops in 15.0–70.0% of patients. Currently, the majority of patients with varicose veins are treated using combined phlebectomy, an alternative to which is endovascular laser obliteration, as well as sclerosurgery. Of particular interest are the few studies of the individual features of the pathogenesis of primary varicose veins, in order to determine the criteria for predicting the variants of the clinical course, for the development of a differentiated approach to the choice of treatment tactics.

Nowadays, vitamin K antagonists (VKA) remain the anticoagulants of choice for patients with implanted inferior vena cava (IVC) filters, while the use of direct oral anticoagulants (DOACs) is controversial. Aim of the review – the study aimed to compare the efficacy and safety of DOACs and VKAs in patients with IVC filters. A systematic search for the relevant papers was performed in Medline (Pubmed) and the Cochrane Library according to the PRISMA guidelines. The inclusion criteria for the analysis were as follows: comparative studies of any design that enrolled patients with verified venous thromboembolism (VTE) who underwent IVC filter implantation and received long-term therapy with DOACs or VKAs with reported numbers of thrombotic and hemorrhagic complications within a follow-up of ≥3 months. The primary endpoints were VTE recurrence and major bleeding. Secondary endpoints included deep vein thrombosis (DVT), IVC thrombosis or filter occlusion, pulmonary embolism (PE), clinically relevant non-major (CRNM) bleeding, any bleeding, and all-cause mortality. Meta-analysis was performed using a random or fixed-effect model depending on the identified heterogeneity. As a result of the literature search was performed in July 2024 and identified 189 references, of which four articles were selected for full-text analysis after screening and excluding 174 irrelevant papers. The final qualitative analysis and quantitative synthesis included two retrospective cohort studies of 302 patients comparing rivaroxaban and warfarin. There were no significant differences between rivaroxaban and warfarin according to the prespecified endpoints. Rivaroxaban is the only DOAC studied in patients with IVC filters. Anticoagulation with rivaroxaban is not less effective and safe than with warfarin after IVC filter implantation.

Chronic venous diseases are the most common vascular diseases of the lower extremities, negatively affecting all components of the quality of life in the modern society. Due to their high prevalence, the prevention and treatment of chronic venous diseases are one of the priorities of national healthcare systems in industrially developed countries. In recent years, numerous experimental and clinical studies have uncovered an important role of vascular inflammation and endothelial dysfunction in the pathogenesis of chronic venous diseases, which determine not only a wide range of vein-specific symptoms, but are also the main drivers of pathological remodelling of the vein wall and its valve apparatus, followed by the development of varicose syndrome and more severe chronic venous insufficiency. Modern knowledge of the pathogenesis of chronic venous diseases enables us to identify several priority strategies aimed at managing the basic pathophysiological mechanisms of the development and progression of the disease. Pharmacotherapy with phlebotropic drugs is one of them. Some of these drugs are able to inhibit the vein-specific inflammation, improve the microcirculatory bed regulation, increase the vein tone and contractility and, as a result, have a positive effect on the clinical signs of chronic venous disease. This review presents the mechanism of action of a phlebotropic drug that is new to the Russian Federation. It is a combination of Ruscus aculeatus extract (Ruscus extract) with hesperidin methyl chalcone (HMC) and ascorbic acid. Studies showed a high level of evidence of clinical efficacy and safety of this drug for the treatment of patients with various forms of chronic venous diseases. Due to the unique features of its mechanisms of action, the optimal focus groups for its use may include patients of different age groups with early-stage disease, in which vein-specific symptoms predominate, and patients with chronic venous oedema.

Introduction. Relapses is an important criterion that is used to determine the effectiveness of any treatments of varicose veins of the lower extremity (VVLE). However, only a few studies in the literature are devoted to the distant outcomes of endovenous laser coagulation (EVLC) using the 1470 nm laser.
Aim. To identify anatomical variants of VVLE relapses after EVLC using the 1470 nm laser, study the frequency of relapses, and determine the factors affecting the risk of relapses.
Materials and methods. A total of 358 EVLC with 78 sonographic recurrences were performed during a 5-year observation period. EVLC was performed using the 1470 nm laser system, and radial light guides with a 400-μm-diameter. At 1, 3, 6, 12, 24, 36, 48, 60 months after EVLC, a follow-up ultrasound examination was carried out. A visual detection of varicose vein was classified as a clinical recurrence. Patients without visually detected varicose tributaries and trunk, but with recanalized sections of the great saphenous vein (GSV) trunk, an incompetent GSV trunk in the lower leg, tributaries and perforators of the operated extremity were considered to be sonographic recurrences. Statistical analysis was performed with IBM SPSS 22 statistic software package (USA). The analysis of variance test (ANOVA) was used to determine the statistical significance of observed differences in mean value, and Pearson's chi-squared (χ2) test in Fisher's exact solution to determine frequencies. Differences were considered statistically significant at p < 0.005.
Results. The main anatomical variants of sonographic recurrences included incompetent ostial tributaries (n = 20), segmental recanalization of femoral perforator GSV trunk (n = 21), perforators in the upper third leg (n = 10), perforators in the middle and lower third leg (n = 22).
Discussion. Endovascular laser obliteration of the intact anterior accessory great saphenous vein (AAGSV) needs further studies. It is not recommended to ligate perforators with a diameter < 3.5 mm, while coagulation of perforators that have direct drainage to the great or small saphenous vein trunk with a high energy flow needs further studies.
Conclusion. The most of sonographic VVLE recurrences occur within 1 to 4 years after endovascular laser treatment and are associated with the development of valve insufficiency in previously intact saphenous and/or perforator veins followed by segmental recanalization of the obliterated GSV trunk.

Introduction. Comparability of the outcomes of treatment of patients with thrombophlebitis of varicose veins using surgical intervention and medical therapy, a wide range of drugs have become the basis for conducting this study.
Aim. To evaluate the effectiveness of the use of micronized purified flavonoid fraction in comparison with the isolated use of diosmin in patients with superficial varicothrombophlebitis in outpatient surgical practice.
Materials and methods. From 2021 to 2022, a prospective study of the treatment results of 82 patients (from 42 to 68 years old, average age: 54.3 ± 12.34 years) with a diagnosis of superficial vein thrombophlebitis was conducted. To relieve inflammation as soon as possible and accelerate recanalization, a direct oral thrombolytic was prescribed. The patients were divided into two groups. The main group (44 patients) took a drug consisting of diosmin 900 mg (90%) and flavonoids in terms of hesperidin 100 mg (10%). In the comparison group (38 people), unmicronized diosmin was taken at a dosage of 600 mg.
Results and discussion. Thrombophlebitis of superficial veins was more often localized in the basin of the great saphenous vein (47 patients (57.3%)). On the 30th day after the start of treatment, there was no progression of the thrombotic process. In the main and control groups, the symptoms of thrombophlebitis (a feeling of tightness under the skin and local soreness in the area of varicose veins) were eliminated in 34 (77.3%) of the main group and 22 (57.9%) patients of the comparison group. There was a decrease in the signs of chronic venous insufficiency from 73.7 to 36.4%, as well as a statistically large proportion of patients with complete or partial recanalization (70.5 vs 44.5% in the control group).
Conclusion. The results of the study show that the micronized purified flavonoid fraction has advantages over non-micronized diosmin in reducing the severity of symptoms, significantly reducing the signs of chronic venous insufficiency and improving quality.

Venous thromboembolic events (VTE) are regarded as side effects from anabolic androgenic steroids (AAS), however, systematic data on this matter are missing. The aim of this study was to evaluate the effects related to testosterone and AAS abuse on the risk of VTE in healthy individuals who use medications without medical reasons. A systematic literature search via PubMed was performed in March 2024. The analysis included studies of any design which described the development of venous thrombosis and specifically deep vein thrombosis (DVT), pulmonary embolism (PE), splanchnic vein thrombosis, and cerebral sinus thrombosis in healthy individuals taking AAS or testosterone medications in the absence of medical indications. The generated search query retrieved 537 references, of which 14 full-text articles containing descriptions of 15 clinical cases were included in the analysis. VTE were observed in men aged 18 to 56 years (mean age 28 ± 12 years) using various AAS at different doses and combinations. VTE were represented by cerebral sinus venous thrombosis (n = 6, 40%), PE with or without concomitant DVT (n = 5, 33.4%), retinal vein thrombosis (n = 2, 13.3%) and arterial thrombosis combined with PE (n = 2, 13.3%). Among additional risk factors, deficiencies of natural anticoagulants (n = 2, 13.3%), hyperhomocysteinemia (n = 1, 7%), and high levels of hemoglobin or hematocrit (n = 2, 13.3%) were identified. The therapy resulted in the following outcomes: death (n = 1, 7%), residual neurological deficit (n = 3, 20%), thrombosis progression with vena cava filter occlusion and development of inferior vena cava syndrome (n = 1, 7%), complete recovery (n = 8, 53%), no long-term results were provided on 2 patients. The risk of developing VTE in patients who abuse AASs cannot be assessed, as the literature contains only descriptions of sporadic cases among which venous thrombosis in atypical locations prevail, therefore, prospective cohort studies are needed to clarify this matter.

Despite the rapid development and rapid spread of minimally invasive techniques in the surgical treatment of chronic venous diseases in recent years, the relapse rate, taking into account the postoperative period, continues to remain high. Currently, there is no unified algorithm for surgical treatment of patients with recurrent varicose veins of the lower extremities. Therefore, discussion of surgical tactics taking into account the individual clinical and anatomical form of disease relapse is an urgent problem. The article provides a review of modern domestic and foreign literature on the incidence, etiology, pathogenesis, diagnosis and surgical treatment options for recurrent varicose veins of the lower extremities. The modern classifications REVAS and PREVAIT, used to assess the recurrence of varicose veins of the lower extremities, are presented. Modern hypotheses about the main reasons leading to its occurrence are reflected in detail. An analysis of the relapse rate after the use of various methods of surgical correction of the primary disease was carried out. The review provides characteristics of both classical and modern methods for correcting recurrent varicose veins of the lower extremities. The role of ultrasound duplex angioscanning of the veins of the lower extremities is emphasized as an optimal diagnostic method that makes it possible to accurately identify the main pathomorphological and hemodynamic causes of the development of relapse of the disease. Surgical interventions for relapse should be performed only in specialized departments and by highly qualified surgeons. When surgically treating recurrent varicose veins of the lower extremities, it is necessary to correct the venous blood flow in all parts of the muscular-venous pump, and not be limited to simple removal of varicose veins.

Pelvic congestion syndrome (PCS) is not a rare and poorly studied disease. However, the current state of PCS pharmacotherapy is characterized not only by insufficient study of this issue, but also by the presence of conflicting views. The results of key publications prove that the main trend in PCS treatment is associated with invasive methods. At the same time, pharmacotherapy is a successful solution leading to the relief of the main symptoms in most patients with PCS. The current review is based on the analysis of data from known scientific literature and clinical guidelines. It covers various aspects of conservative treatment of patients with PCS and focuses on pharmacotherapy. This publication aims to summarize the known data related to drug correction of PCS, based on evidence-based medicine. The review presents information related to the history of the selection of pharmacotherapy, including combinations of drugs of various groups with the appointment of analgesics, hormonal, psychotropic, venoactive drugs and selective vasoconstrictors. An objective analysis of each of the indicated pharmacological groups of drugs is presented with an assessment of subsequent prospects, including not only known therapeutic agents, but also those not previously used in the therapy of PCS. The drug of choice in the arsenal of the attending physician are vasoactive drugs based on diosmin with the largest evidence base in MPFF. In the presence of severe pain syndrome, short-term administration of analgesics is advisable. The presence of anxiety-depressive disorders, as well as severe CPP, can serve as an indication for taking psychotropic drugs. Further research is needed to expand the potential of pharmacotherapy for patients with PCS.

Delated periorbital veins causing cosmetic discomfort are one of the most common reasons why patients seek treatment at clinics specializing in aesthetic phlebology. The etiology and pathogenesis of the expansion of once-normal veins on the lower and upper eyelids, as well as in the temporal region have not been established. The potential risk factors include various injuries, invasive cosmetic procedures, intake of female sex hormones, exposure to unfavourable environmental conditions, natural skin ageing, heavy sports activities, and sudden body weight loss. It should be noted that dilated periorbital veins can not only cause aesthetic discomfort, but also induce spontaneous haemorrhages into nearby soft tissues. Initially, dilated periorbital veins were treated using various sclerotherapy options or radiofrequency coagulation with a hair-thin electrode. In recent years, owing to the advent of latest laser platforms, especially neodymium activated yttrium-aluminum-garnet (Nd:YAG) ones, percutaneous laser coagulation (PLC) has become the first-choice technique for treating dilated facial veins. The modern long-pulsed Nd:YAG lasers generate 1064 nm laser radiation, which ensures the achievement of target veins located at different depths under the skin's surface, and also demonstrates high affinity towards haemoglobin and its derivatives. In other words, Nd:YAG lasers are the optimal option to treat dilated facial veins, including those in the periorbital region, in patients with any skin phototypes. The multi-application XEO (Cutera) platform designed for photo and laser therapy is the most successful representative of Nd:YAG lasers. The case reports presented in this article highlight the successful treatment of dilated periorbital veins.

Introduction. Due to the growing number of polyantibiotic-resistant strains of microorganisms, the issue of improving the tactics oflocal treatment of soft tissue wounds without the use of antibiotic therapy is gaining more and more urgency in surgery.
Aim. To study the dependence of the antiseptic effect of chitosan-based wound dressings on the degree of their biodegradation and to evaluate the prospects for the use of such dressings for the treatment of purulent wounds.
Materials and methods. The object of the study was wound dressings with incorporated antiseptic polyhexanide (PH) based on chitosan of two types: unstabilized (Ch-H-PH) and stabilized by cross-linking with glutaric aldehyde (Ch-H-GA-PH). The antimicrobial activity spectrum was investigated in vitro by disk-diffusion method using test cultures of Staphylococcus aureus and Escherichia coli. The directionality of biodegradation was studied by scanning electron microscopy.
Results and discussion. Stabilized Ch-H-GA-PH samples had prolonged antimicrobial action due tolonger biodegradation times (max – 36–48 h; p ≤ 0.05), while Ch-H-PH samples due to high hydrophilicity of the material biodegraded early and realized the full antimicrobial potential within 24 hours (max – 12 h; p ≤ 0.05). The obtained results correlated with the data provided in the foreign researchers’ publications on the investigation of the properties of biopolymer materials used as matrix carriers for drugs, and in terms of addressing the search for strategies to combat poly-antibiotic resistance in surgical practice.
Conclusion. Application of wound dressing s of antiseptic type of action on the basis of chitosan with different parameters of biodegradation will allow to realize a programmed approach to treatment of purulent wounds of soft tissues in a personalized way depending on a specific clinical situation.

Introduction. Acute paraproctitis is an acute inflammation of the peri-rectal tissue, caused by the spread of the inflammatory process from the anal crypts and anal glands. One of the typical complications of treatment of all forms of acute paraproctitis is relapse of the disease. An extensive literature is devoted to this issue; it is this problem that encourages surgeons to persistently search for more rational methods of treatment. The rate of these complications ranged from 9.9% to 50%. Postoperative wound healing after opening paraproctitis is protracted, in some cases requiring repeated surgical interventions. The use of modern antiseptic solutions and dressings in the intraoperative and postoperative periods should improve the immediate results of treatment.
Aim. To study the effectiveness of the use of the wound healing agent Chitokol-KDA in the treatment of patients with acute paraproctitis.
Materials and methods. A prospective comparative randomized study was conducted in the department of coloproctology and the specialized advisory center of the Clinics of Samara State Medical University in 2024. The study included 105 patients who underwent autopsy of acute purulent paraproctitis in an inpatient setting. In the main group (n = 51), the wound healing agent Chitokol-KDA was used as an addition to treatment. In the control group (n = 54), no additional means were used during dressing.
Results and discussion. From the data obtained on the use of the wound-healing agent Chitokol-KDA, it follows that it reduces the intensity of the pain syndrome by the 3 days, and also accelerates the healing time and epithelialization of wounds (t = 2.17, p = 0.032), but does not affect the timing of the appearance of granulations (t = 0.88, p = 0.38).
Conclusion. The use of the wound-healing agent Chitokol-KDA reduces pain in the postoperative period, accelerates wound healing and does not affect the incidence of perirectal fistulas.

Introduction. In Russia, more than 5 million people suffer from venous ulcers. According to general studies, in more than 10% of cases, venous ulcers lead to permanent disability in patients. Currently, there is a growing interest in the use of photodynamic therapy (PDT), which has already proven its effectiveness in various fields of medicine.
Aim. To improve treatment outcomes in patients with venous trophic ulcers by incorporating photodynamic therapy into complex treatment.

Materials and methods. A prospective comparative study was conducted in 213 patients with CEAP C6. In the main group (n = 100), treatment was carried out using photodynamic therapy. The control group (n = 113) received standard treatment for venous ulcers.
Results. The bacteriological study revealed significant statistical differences in the reduction in the level of bacterial contamination in patients of the main group compared to the control group. A comparison of the standard treatment of venous ulcers and the treatment method using PDT for the entire period of treatment showed that the use of PDT in the complex treatment of venous ulcers reduces the time for clearing ulcers by 1.75 times, accelerates the appearance of granulation tissue by 1.66 times, and accelerates healing by 1.87 times (p < 0.05).
Discussion. The introduction of new medical technologies into clinical practice helps to improve the results of treatment of venous ulcers. The use of PDT in the treatment of venous ulcers has demonstrated high clinical effectiveness.
Conclusion. The results of the study convincingly show that photodynamic therapy accelerates reparative processes in the ulcer, improves the state of the microbial background, and, accordingly, accelerates the rate of epithelization of the trophic ulcer.

Laparoscopic Sleeve Gastrectomy is the most common weight loss surgery and at the same time one of the safest. However, like any other surgery, it carries significant risks and complications. One of these complications isliver abscess. This article presents a clinical case of a 36-year-old patient who developed multiple liver abscesses one month after laparoscopic sleeve gastrectomy. The patient’s medical history, surgery details, postoperative course, symptoms and diagnostic tests are described. Liver abscess is a rare but very serious complication after sleeve gastrectomy. The etiology of this complication is still a subject of debate. We can only assume that the most likely causes ofliver abscess are intra-abdominal bleeding with hematoma formation and its subsequent infection or failure of the stapler suture line in the early postoperative period. Computed tomography with intravenous contrast is the preferred method for diagnosing this complication, especially in patients with fever, rapid heartbeat, and abdominal pain. Currently, the most effective and safe method for treating localized purulent liver diseases is percutaneous puncture and drainage of the abscess under ultrasound or CT navigation, followed by intravenous antibiotics for 4-6 weeks. This treatment strategy has proven its effectiveness in many studies. Our clinical case was no exception. The purpose of this article is to raise awareness among surgeons about this rare complication and emphasize the importance of early diagnosis and treatment.

In Russia, more than 70,000 new cases of breast cancer are registered annually. Vacuum aspiration biopsy (VAB) is a minimally invasive method for diagnosing the genesis of focal breast pathology, which is also used for therapeutic purposes for the complete removal of benign neoplasms. High efficiency and favorable clinical outcomes have allowed VAB to gain wide popularity in clinical practice, due to which the method has been widely developed. However, like any surgical intervention, the VAB procedure may be accompanied by complications, the main share of which are hemorrhagic. Generalization and systematization of information on the development of the VAB technique, prevalence and risk factors of complications, as well as methods of their prevention and timely elimination. Scientific publications cited in this literature review were selected from the Pubmed database of medical and biological publications (National Center for Biotechnology Information (NCBI), USA), the Clinical Key database (Elsevier Corporation, the Netherlands), Web of Science Citation Indexing Database (Clarivate, USA), Google Scholar (CIF), and the scientific electronic library elibrary.ru (Russia). The information presented in the article can become a theoretical basis for future research aimed at increasing safety, further development and improvement of the VAB technique.

Introduction. Conservative therapy for hemorrhoids is one of the most discussed and controversial in coloproctology. Considering the high prevalence of this disease, the use of effective pathogenetical and symptoms relieve pharmacotherapy remains especially relevant.
Aim. To compare the effectiveness of complex therapy and monotherapy for chronic hemorrhoids.
Materials and methods. A prospective observational study was conducted on the effects of different approaches with the use of the Venarus and Venaproct Alium to the treatment of patients with hemorrhoids (“VITA”). The complex therapy group was treated with standardized dosages of systemic bioflavonoids hesperidin 100 mg and diosmin 900 mg, and sodium alginate rectal suppositories for topical use. The monotherapy control group received only therapy with Venarus. The study was conducted from June 20, 2023 to May 31, 2024 and included 80 patients with chronic hemorrhoids. The dynamics of hemorrhoids symptoms, the quality oflife, adherence to the therapy, the frequency of repeated disease exacerbations was compared depending on treatment approaches.
Results. Conservative pharmacotherapy was effective in both groups, however, in the complex therapy group, the effect of decreased symptoms of “blood discharge during defecation” and “presence of enlarged external hemorrhoids” was more pronounced. Statistically significant differences between groups recorded at 14 days (p = 0.009) for the symptom “blood discharge during bowel movements” and 85% of patients receiving complex therapy had no complaints about the presence of enlarged external hemorrhoids by the 14th day (p < 0.001) and 87% by the 30th day of treatment (p < 0.001).
Discussion. Pharmacotherapy of hemorrhoids, given the prevalence of symptoms of bleeding and prolapse of nodes, should be aimed at their effective elimination. The combination of systemic and topical therapy for hemorrhoids offers an integrative approach that can significantly improve the treatment effect.
Conclusion. Considering the absence of differences in patient adherence to the treatment, the effect of complex therapy compared to monotherapy of hemorrhoids symptoms decrease, indicates the advisability of using complex treatment with the Venarus and Venaproct Alium.

Introduction. Patients with chronic proctologic diseases can postpone the planned surgery in time of pandemic. However the patients are very concerned about delays in treatment.
Aim. To study the features of care provision to the patients with proctologic diseases based on the chronic hemorrhoids treatment in terms of pandemic.
Materials and methods. Changes in material base of medical centers and clinics, the results of their activities based on the analysis of initial visits, minimally invasive interventions and hemorrhoidectomies in terms of pandemic were analyzed.
Results. The number of people who applied to coloproctologists in the analyzed time periods 2019 and 2020 was the same, 3771 and 3775 people respectively, while the number of visits to commercial clinics has increased by 13% and to municipal clinics by 10.6%. Minimally invasive interventions have been performed by 27.6%less often in the municipal clinics and by 6.9% more often in the commercial clinics. 91 hemorrhoidectomies were carried out in 2020 which is 51.1%less compared to the same period in 2019.
Discussion. According to the results of initial visits analysis, outpatient proctologic care did not undergo any changes during the pandemic in the city. But worsening of epidemic situation has caused the decrease in the number of patients in April-May 2020. The decrease of minimally invasive interventions in the municipal clinics was observed in the same period. For 7 months of the pandemic the number of hemorrhoidectomies has decreased from 178 to 91 operations compared to the same period in 2019, the number of interventions corresponded to the needs of the population.
Conclusion. Maintaining of sufficient level of care for patients with proctologic diseases in time of pandemic became possible due to collaborative activities of medical facilities of various ownership forms.

There are alimited number of publications in both domestic and foreign literature on the treatment of wounds in patients after anal canal and perineal surgery. This remains a serious problem, since even uncomplicated wound healing after general proctological operations can take up to 45 days, and the frequency of chronic non-healing wounds reaches 34%. This significantly reduces the quality oflife of patients and increases the cost of treatment. The biological laws governing wound healing, regardless of their etiology, are generally the same and include the following phases: inflammation, tissue regeneration (proliferation) and scar formation. However, in the perineal area, wound healing is complicated by microbial contamination by intestinal flora, which can prolong the healing time. But systemic administration of antibiotics after anal canal surgery is not required routinely. The most important role is played by the use oflocal forms of ointment forms. Taking into account microbial contamination, pronounced postoperative pain syndrome and abundant wound discharge, combined healing-stimulating drugs with antimicrobial, dehydrating andlocal analgesic activity are of the greatest interest as ointments. One of these drugs is a combined ointment with antimicrobial, regenerating, anti-inflammatory andlocal anesthetic properties, which has proven effective in the treatment of purulent wounds, contributing to faster healing and reducing pain without significant side effects. The article presents a clinical example of the use of a combination ointment based on ofloxacin, methyluracil, lidocaine hydrochloride for the treatment of wounds after hemorrhoidectomy.

Osteoarthritis of the knee joints and varicose veins of the lower extremities are two common diseases that quite often occur in combination in patients. What pathology is primary? This is an important issue for specialists, since specialized treatment is provided in different surgical departments and often without correction of the venous outflow there is no possibility of surgical treatment of the knee joint. Based on the literature and personal experience, we have established a possible connection between these two diseases with an attempt to determine which of them will be the root cause. The literature analysis was carried out using Elsevier, PubMed, eLibrary, PLOS and Cyberleninka databases. Articles containing the keywords: osteoarthritis, gonarthrosis, varicose veins, lower extremities, knee joint, venous congestion were analyzed. English and Russian full-text articles, literature reviews, systemic reviews, meta-analyses, cohort studies, and traditional reviews with a search depth of no more than 35 years were studied. It has been established that the most widespread theory is one that identifies varicose veins of the lower extremities as the root cause of osteoarthritis of the knee joint. In our opinion, both diseases should not be considered as the root cause. The presence of one pathology may aggravate the clinical picture of another. Having conducted a single-center randomized prospective study in 40 patients with varicose veins of the lower extremities, we found that 24 of them, with clinical manifestations of osteoarthritis of the knee joint, were diagnosed with clinical classes of varicose veins C3–C5 according to CEAP.

Introduction. Acute aortic dissection type A is still considered one of the most formidable conditions in urgent surgery. The occurrence of malperfusion significantly worsens the results of treatment, leading to an increase in the incidence of complications and mortality. Patients who have undergone reconstructive interventions in the acute period require dynamic observation due to the development of aortic remodeling, leading in some cases to repeated dissection.
Aim. To improve the results of surgical treatment of patients with acute type A aortic dissection and malperfusion.
Materials and methods. From 2006 to 2021, 117 patients with acute type A aortic dissection and malperfusion were treated at the Interregional Clinical and Diagnostic Center of the Ministry of Health of the Republic of Tatarstan, Kazan, 107 of whom received surgical treatment.
Results. The following factors had a statistically significant impact on survival: aortic rupture with hemotamponade, myocardial infarction, anastomotic bleeding, renal and coronary malperfusion. The right coronary artery, brachiocephalic trunk, common carotid, renal and common iliac arteries had a significant effect (p < 0.05) on the occurrence of malperfusion with a true lumen narrowing degree of at least 60%. Remodeling of the aorta and its branches requiring correction occurred in every 5th (17%) case.
Discussion. The introduction of new predictors of unfavorable outcome is an urgent problem; their dissemination and implementation makes it possible to modernize existing treatment methods. The problem of aortic remodeling in patients after acute dissection is the most pressing in modern aortic surgery, because repeated acute aortic syndrome against the background of the previous development of a more malignant disease.
Conclusions. In the acute period, it is necessary to carefully assess the presence of risk factors and the degree of narrowing of the true branches of the aorta in order to reduce thelevel of complications and mortality. To prevent acute aortic syndrome, it is necessary to monitor pathological remodeling of the aorta.

During pregnancy, the rate of vulvar varicose veins (VVVs) is 4 to 22%. It is commonly believed that VVVs is mostly asymptomatic during pregnancy in the prevailing majority of cases, that’s why little attention is paid to the symptomatic forms, especially in cases where VVVs mimic the soft tissue formation or are accompanied by inflammatory events. The article presents two clinical cases of atypical manifestations of VVVs in pregnant women. The key complaints included itching, burning sensation and swelling in the vulva, changes in the volume of vaginal discharge, which were initially considered as manifestations of vulvovaginal candidiasis (VVC) and combined with bacterial vaginosis. However, the symptoms were not relieved after local and systemic therapy with natamycin in the first case and repeated courses of local therapy with neomycin combined with ternidazole and nystatin accompanied by the systemic use of metronidazole in the second case. The examination findings showed VVVs in both pregnant women. The use of phlebotropic therapy with diosmin 600 mg resulted in a reduction in itching severity, a decrease in swelling, and disappearance of burning sensation. No negative effects of diosmin on the course of pregnancy and childbirth, or the well-being of newborns were observed. Both cases clearly demonstrate the impact of atypical VVV symptoms on the overdiagnosis of infectious and inflammatory diseases of the vulva, and inadequate choice of pharmacological therapy associated with that, ultimately leading to the persistence of complaints, decreased quality of life in pregnant woman and increased risk of side and adverse effects during treatment. It seems appropriate to consider the probability of contribution of VVVs when pregnant women complain about itching, burning sensation and swelling of the vulva, especially in the absence of positive laboratory results of vaginal candidiasis and/or bacterial vaginosis and in the presence of persistently recurring symptoms on antifungal, antibacterial and antiinflammatory therapy. The use of diosmin as a trial therapy appears promising if there is a high probability that such symptoms originate from venous diseases.

Introduction. The capacity to execute mini percutaneous nephrolithotomy (PCNL) as a day case procedure in the treatment on renal stones measuring between one and two centimetres is being assessed in this study. Mini-PCNL has been employed more and more in the treatment on renal stones with favourable results in terms on stone clearance and low morbidities.
Aim. To find a reliable replacement for E.S.W.L. and R.I.R.S in treating small renal stones that is safe, efficient, and reliable with the shortest post-operative stay period.
Materials and methods. Seventy patients underwent surgery for kidney stones that ranged in size from 1 to 2 cm and had densities greater than 1000 H.U. They were split into two groups: group B received mini-PCNL and group A received regular PCNL. Both procedures were carried out while the patients was in the prone position. In group A, we fragmented the material with an electrohydraulic lithotripter and removed the resulting fragments using forceps. In contrast, group B employed a 30 w Quanta Holmium laser in dusting mode (0.5 j and 15 Hz) with 550 um laser fibre and relied on our exit plan for the double-J stent implantation, which avoided the necessity for a nephrostomy tube.
Results. Operation duration was significantly longer in mini-PCNL group (p < 0.001). Intraoperative extravasation and its severity were non-significantly less frequent in mini-PCNL group (p > 0.05). All patients operated with mini-PCNL underwent double j stent, while the other group included only two patients who necessitated double J insertion insertion, and the remaining 33 patients depended on the insertion on a nephrostomy tube together with a ureteric catheter.
Conclusion: Mini-PCNL is a dependable day case method that is safe for treating tiny kidney stones. Larger sample size studies could be required to confirm mini-PCNL as a day case technique.

According to WHO there is an annual increase in the number of ostomy patients, whose number is 100–150 people per 100,000 population. As of 2019, there were more than 3,000 ostomy patients living in the Samara region of the Russian Federation. This leads to an increase in risk factors for complications, the most common of which is the formation of parastomal hernias. After two years or more, parastomal hernias are diagnosed in at least 50% of stomached patients andlead to a marked deterioration in the quality of life. The purpose of this review is to analyze the modern definition of the concept of parastomal hernia, epidemiology, risk factors, existing classifications, diagnostic methods, conservative and surgical treatment, as well as prevention of parastomal hernia. Currently there are no specific methods for the conservative treatment of parastomic hernias. Modern surgical methods for treating ostomy patients can be divided into three groups: stoma transposition, autogernioplasty and allogernioplasty. But there is no single choice of an algorithm for their surgical correction. Therefore, the development of new treatment methods, as well as modifications of existing ones, continues to be relevant. In the analysis of possible ways to prevent the development of parastomal hernia, the importance of focusing on this problem at all stages of medical rehabilitation has been established. During the pre-operative preparation, it is important to choose the correct location of the future stoma, as well as to determine the access to the intervention. It is necessary to appropriately approach the choice of the method of elimination and observe the principles of intestinal stoma formation, as well as to use a mesh implant. It is important to provide detailed information to the patient in the early postoperative period and to develop the number of specialized offices for stoma patients.

Violation of mesenteric circulation and intestinal damage are life-threatening conditions that require early diagnosis and, if necessary, prompt surgical intervention. Currently, the diagnosis of these conditions remains a difficult task due to the nonspecific nature of clinical symptoms andlimitations of existing diagnostic tools. The aim of the study is to study the potential of intestinal fatty acid binding protein (I-FABP) as a biomarker of mesenteric circulatory disorders and intestinal damage. The article discusses the structure and function of I-FABP, its expression and distribution in the small intestine, the mechanisms of release of I-FABP. Clinical studies of I-FABP levels in patients with these conditions are analyzed, assessing the accuracy of diagnosis and potential thresholds. The results of this study show that I-FABP has significant potential as a biomarker of OMI, intestinal ischemia and intestinal damage. Elevated levels of I-FABP have been observed in patients, and the diagnostic accuracy of I-FABP appears to be superior to other currently used biomarkers. However, further research is needed to determine optimal thresholds and establish standardized I-FABP measurement protocols. Thus, the introduction of I-FABP as a biomarker into clinical practice may lead to earlier diagnosis and improved outcomes in patients with intestinal ischemia.

The article is devoted to the description of a clinical case of neurological complications of foam sclerotherapy. The goal is to familiarize doctors with a fairly serious complication of the procedure, most often performed for cosmetic purposes. Stroke and transient ischemic attacks have been reported as “isolated cases” following sclerotherapy. Visual disturbances and complaints of headaches and migraines are much more common (0.1–1%). The main causes of these disorders are either gas embolism, which occurs immediately after the procedure, or paradoxical thromboembolism, which is recorded some time after sclerotherapy. The main cause of disorders is congenital heart disease, atrial or ventricular septal defect, however, total screening before the procedure is considered inappropriate. It is recommended to limit the volume of foam injected to 10 ml and carefully collect anamnesis. A history of heart disease with a right-to-left shunt is an absolute contraindication to the procedure. A clinical case is described with a 39-year-old patient who had previously unde rgone foam sclerotherapy sessions for cosmetic reasons. During the third session of sclerotherapy, the patient developed signs of acute cerebrovascular accident, which required hospitalization and treatment in the neurological department. Congenital heart disease has not been previously detected. Subsequently, with the treatment, all neurological disorders completely regressed. Conclusions. Doctors should be aware of the possibility of developing the serious complication described in the article, which, under unfavorable circumstances and lack of timely medical care, can lead to disability of the patient. If this complication develops, it is necessary to refer the patient to a neurologist as soon as possible to establish a diagnosis and begin therapy.

This narrative literature review is dedicated to the issue of individual risk assessment and prevention of postoperative VTE in patients undergoing lower limb varicose vein surgery. The registry-based CAPSIVS trial showed that the detection frequency of any forms of VTE after modern minimally invasive superficial vein surgery reaches 3.4%, of which only 0.5% are symptomatic. The current clinical guidelines regulate the individual risk assessment of postoperative thrombosis using the Caprini Risk Score (CRS). The first validation study resulted in a proposal of evidence-based approach to the phlebological patient stratification into risk groups according to the Caprini scores with 0–6 scores indicating the low risk, 7–10 scores – the moderate risk and 11 scores or more –the high risk, which differs significantly from approaches in other medical specialties. At the same time, the pharmacoprophylaxis may be appropriate in the groups of moderate and high risk, especially when simultaneous varicose tributary ablation and perforating vein interventions increasing the risk of VTEC 6–11 times are performed. The duration of pharmacoprophylaxis of postoperative venous thrombosis is essential to its efficiency, which should not be less than 7 days for the moderate VTE risk group and reach 30 days for the high VTE risk group. A single injection of parenteral anticoagulants on the day of surgery has been shown to be associated with an 8.8% incidence of postoperative thrombosis. The risk of postoperative thrombosis in patients with VTE in their past medical history, including prior varicothrombophlebitis is increased by 4.2 times, which requires that secondary pharmacoprophylaxis be prescribed for at least 30 days, and in some cases up to 3-6 months. At this stage, there is sufficient evidence to support the use of the Caprini Risk Score to assess the risk of postoperative VTE and prescribe adequate pharmacological prophylaxis in varicose vein surgery treatment.

The mortality rate associated with postoperative eventration remains quite high at the moment. At the same time, recurrent eventrations are common. Despite the improvement of surgical techniques and suture materials, the incidence of eventrations does not decrease. The presence of previous oncological diseases in the patient significantly worsens the course of the wound process due to changes in the immune status and prevailing catabolic processes. One of the reasons that causes eventration in a high percentage of cases is suppuration of the postoperative wound. Given the polyetiology of this pathology, for the prevention of eventrations and for their effective treatment, a comprehensive approach is needed, including both an impact on the general somatic status of the patient (elimination of hypoproteinemia, normalization of bowel function, etc.), and an impact on the wound process in order to form high-quality scar tissue. This article presents a clinical case of a patient with wound eventration that developed in the postoperative period. The complexity of the case is due to previous oncological pathology and impaired reparative processes that developed as a result of hypoproteinemia. This clinical observation demonstrates the relevance of searching for new methods of influencing the course of the wound process, the possibility of using cellular concentrates of autologous blood to stimulate regeneration. The possibilities of stimulating the wound process by using platelet autoplasma are considered, in order to accelerate wound healing, it can be used in outpatient practice, both for the management of postoperative patients admitted for follow-up care after the inpatient stage, and as an independent treatment for chronic wounds.

Varicose veins of the lower extremities is a chronic disease with primary veins extention of the subcutaneous veins of the lower extremities. According to various estimates, the prevalence of varicose disease reaches 60% of the adult population in different regions. The steadily progressing nature of the disease, as well as the importance of timely comprehensive treatment, requires a constant search for new optimal approaches to the treatment of varicose veins. The “gold” standard for the treatment of varicose veins with reflux along the main saphenous veins is endovasal laser ablation (EVLA), which in some cases has effectively replaced combined phlebectomy. The method has proven itself to be relatively safe, while effective and providing the opportunity to carry out treatment on an outpatient basis. However, it is not always possible to carry out thermal methods of obliteration of the main saphenous veins, and in such situations the best choice for treatment is ultrasound-guided foam sclerotherapy (UGFS) of the main saphenous veins. Despite thelong coexistence of both methods, there is no convincing data of treating patients with EVLA and UGFS. More than 50 russian and foreign articles from the open access were analyzed. Thelack of comparisons in the Russian articles and the contradictory nature of research results in foreign sources allow us to conclude that this issue requires further research and detailed study to determine the indications and the optimal treatment tactics using EVLA or UGFS.