Vol 18, No 1 (2025)

Background. The concept of comprehensive treatment of burns is based on active surgical tactics aimed at removing necrotic tissues and restoring the integrity of the skin at earlier terms, which is essential for the prevention of purulent-septic complications of burn disease. Timely diagnosis of the development of infectious septic complications and immunodeficiency conditions based on the immune status monitoring is an urgent task of comprehensive, including surgical, treatment of patients with extensive burns.

Aim. To evaluate the effectiveness of surgical treatment in patients with extensive burns based on a comprehensive analysis of the immunological study results.

Materials and methods. The single-center retrospective non-randomized study included 100 patients with an average burn area 47.7±1.5% of the body surface (b.s.). Of these, deep burns averaged 16.5±1.7% b.s. All patients underwent comprehensive treatment based on clinical recommendations in the field of surgery (combustiology), including surgical necrectomy, local drug treatment of burn wounds using modern wound coverings and skin grafting to close wounds. The immune status was monitored in 100 patients using flow cytometry, turbidimetry and chemiluminescence techniques starting from the moment of admission to the Burn Center; in 55 of them the immune status was monitored in dynamics on the 10th and 30th days of treatment. The immune status parameters of 30 donors were used to compare the patients’ data.

Results. Reliably significant (p<0.05) alternative changes were identified in 15 key immune markers: leukocytes, band neutrophils, total lymphocytes, blood leukocyte shift index, leukocyte intoxication index, CD4+/CD8+, CD21+, CD64+, HLA-DR+ monocytes, HLA- DR+ lymphocytes, CD25+, CD16+, CD56+, IgG and IgM. Complex treatment of burn disease, prevention and treatment of its complications, resulted in a consistent normalization of the immune status in 43 (78%) patients in 40.8 ± 2.9 days after the burn injury; these patients had been exposed to timely removal of non-viable tissue, their burn wounds had been prepared for plastic closure using modern wound dressings and water-soluble ointments, autodermoplasty had been performed as early as possible. Simultaneously, positive changes in key immune markers with relief of endogenous intoxication and infectious-inflammatory reaction, normalization of antimicrobial potential in general allowed effectively continuing surgical treatment to restore the skin.

Conclusions. The results obtained based on the first used multiparametric panel of immune markers do not only emphasize the importance of active surgical tactics in providing specialized medical care to victims with extensive burns, but also allow for its timely correction at various stages of complex treatment in severely burned patients.

This paper describes a clinical case of a patient with megaduodenum; the condition was detected in adulthood, it developed due to congenital duodenal malformation.

A 43-year-old female patient visited A.V. Vishnevsky National Medical Research Center with complaints of nausea and vomiting after eating, which brought her relief. These signs occasionally bothered the patient throughout her life. Based on the examination performed, the patient was diagnosed with a giant duodenal diverticulum and surgical intervention (laparoscopic diverticulectomy) was planned.

The obtained intraoperative data evidenced a presenting congenital megaduodenum associated with the duodenum bulb critical stenosis. During the surgical intervention, a duodenotomy was performed, which implied a step-by-step excision of the mucosal-submucosal fold of the duodenal wall with scar tissue at its base with duodenoplasty according to the original technique.

The article describes the difficulties of diagnosing the condition and the original surgical treatment option. A brief review of the literature comparing clinical outcomes of patients with a similar nosology is provided.

Jejuno-gastroplasty has its own history, directly related to the history of gastric surgery, being its continuation and variety. However, for almost 80 years, for a number of historical reasons and the dominant conservative approach it has not been properly developed in our country, due to the "technical complexity". The staff of A.V. Vishnevsky National Research Scientific Surgical Center has accumulated the experience of more than 350 operations using the jejunum segment on the vascular pedicle, during primary and reconstructive operations on the stomach. The accumulated experience of the Center allowed us to develop the principles of jejuno-gastroplasty as an alternative option for reconstructing the digestive tract after gastric resection and gastrectomy.

Introduction. The high incidence of blunt liver injuries, general and postoperative mortality necessitate a search for optimal treatment options of the condition.

Аim. To conduct a systematic literature review and meta-analysis and compare various treatment options for patients with blunt liver injury.

Methods. A systematic search for non–randomized studies was conducted from 01 October 2015, a systematic search for randomized studies was conducted without time limits, until February 29, 2024.

Results. There is a clear trend towards non-surgical management of hemodynamically stable or stabilized patients, and in case of hemodynamic instability, the use of liver tamponade followed by angioembolization.

Conclusion. A larger number of well-planned randomized clinical trials are required to concretize the surgical approach to patients with liver injury.