Vol 15 (2022): Памяти В.И.Булынина

Viktor Ivanovich Bulynin was born on October 12, 1932 in Leningrad, in a family of doctors. After graduating from high school, Viktor Ivanovich entered the Kuban Medical Institute. Two years later, in connection with the parents' move to Stavropol, Viktor Ivanovich, along with his older sister Lyudmila Ivanovna, who later was a wonderful surgeon who gave all his labor energy to surgery in the most difficult areas of the Stavropol Territory, transferred to the Stavropol Medical Institute. The institute years were spent not only at the student desk, but also in the experimental laboratory, where the surgeons of the circle regularly worked under the guidance of associate professor of the Department of Faculty Surgery Bulynin Ivan Ivanovich. By the end of the institute, Viktor Ivanovich already had a mock-up and an experimental sample of a device for stitching vessels without stopping blood flow. In 1957. after graduating from the medical faculty of the Stavropol Medical Institute, he was assigned to the Petrovsky district, where he worked as the head of the surgical department at the district hospital of the village of Gofitskoye, Stavropol Territory. Already in those years, Viktor Ivanovich usually performed cholecystectomies, gastric resections, nephrectomies and other operations of planned and emergency surgery and gynecology under local anesthesia. At the same time, he successfully reimplanted a limb torn off during agricultural work to a collective farmer, as the regional newspapers wrote about. In 1959, Viktor Ivanovich, on the advice of his father, a well-known surgeon in the Stavropol region at that time, went to Moscow to show vascular surgery specialists the vasoconstrictor device he had developed as a student. After meeting with Academician A.A. Vishnevsky, he was accepted to a workplace in the Department of Vascular Surgery of the A.V. Vishnevsky Institute of Surgery of the USSR Academy of Medical Sciences, and soon enrolled in the postgraduate course of the Institute.
Here he becomes a participant in the rapid development of heart surgery in those years and works a lot in the department of cardiac surgery under the supervision of Prof. N.K. Galankin. There he defended his PhD thesis in 1961 under the supervision of Prof. N.K. Galankin and Prof. I.I. Khozhainov on the topic "Circular suture of the aorta with a minimum time of cessation of blood flow". After graduating from graduate school, Viktor Ivanovich and his friend, a fellow graduate student, made several offers, including continuing to work in their specialty in Moscow, but the young doctors left to raise cardiac surgery in the republics of the USSR. Viktor Ivanovich is going to Kazakhstan, to Karaganda with the intention to put cardiovascular surgery there. Working as an assistant, and since 1964 as an associate professor of the Department of Hospital Surgery, he operates a lot in various fields of surgery, introduces heart sounding and angiography, begins heart surgery. In 1965, the first mitral valve stenosis operation was performed in Karaganda – mitral commissurotomy. The patient turned out to be a younger woman who, after recovery, presented Viktor Ivanovich with an album of illustrations of the Hermitage (it is still kept in the Bulynin family as a relic) with a gift inscription.
The first heart surgeries for pre-acquired defects coincided with the release of a film based on the novel by N.M.Amosov "Thoughts and Heart". The first screening of this film in Karaganda was announced by Viktor Ivanovich, who also led the discussion after it. Being a primary school student, Viktor Ivanovich's eldest son participated in this event as a spectator, after the film he commented on this event: "I was overwhelmed with pride for the success of Karaganda surgery and the first and only desire in choosing a profession appeared - to become a surgeon." Simultaneously with active surgical and academic work at the department, Viktor Ivanovich works as the Dean of the Faculty of Medicine.
In 1971, Viktor Ivanovich defended his doctoral dissertation on "Clinical forms of pulmonary hypertension in patients with mitral stenosis". The scientific consultants of this work were well-known professors I.K.Galankin, L.D.Krymsky, F.L.Gektin. Immediately after defending his doctoral dissertation, Viktor Ivanovich is elected to the post of head of the Department of Hospital Surgery. The first students of Viktor Ivanovich were subsequently well-known doctors: Prof. D.I.Bogomolov, the personal physician of the President of Kazakhstan Nursultan Abishevich Nazarbayev S.E.Tokpanov, Prof. Departments of General Surgery of the Moscow Medical University named after I.M.Sechenov, A.N.Afonasyev, etc.
In 1975, V.I. Bulynin took the position of head of the Department of Hospital Surgery of the Voronezh State Medical Institute by competition. The arrival to the management coincided with the transition of the clinic to a new standard building of the regional clinical hospital, where 10 specialized surgical departments were deployed in good conditions on 500 - hundred beds, including the interregional heart surgery center for 60 beds. Having a good command of various sections of surgery, Viktor Ivanovich energetically put into practice dozens of new operations for Voronezh (more than 60 names in total). Viktor Ivanovich was a polyvalent surgeon, but he gave special preference to cardiac and vascular surgery. Cardiosurgery, surgery of large vessels under Professor V.I. Bulynin has reached the level corresponding to world standards in Voronezh. The organization of kidney transplantation and microsurgery services is associated with the name of Viktor Ivanovich.
Professor V.I. Bulynin was a member of many European Associations of surgeons, a member of the Presidium of the All-Russian Society of Surgeons, an honorary citizen of Voronezh. All the years of his stay in Voronezh, he headed the Regional Scientific and Practical Society of Surgeons. He is the author of more than 30 inventions, 4 monographs; 34 dissertations were defended under his leadership, 6 collections of works on various sections of surgery were published. V.I. Bulynin created a school of vascular, cardio, gastrourgeons and surgeons of other specialties in Voronezh. After the untimely death of Viktor Ivanovich in 1998, the work of his beloved professor was continued by his students. In the memory of them and everyone who knew him, Viktor Ivanovich remains a charming, intelligent, athletic, cheerful and wise man, a wonderful professional who gave all his strength to people and his beloved surgery.
Viktor Ivanovich was an avid traveler. He visited many countries of the world, where he got acquainted with people's lives, as well as new achievements in medicine, especially surgery, his stay in the USA, in private and public clinics, where he took part in operations, was especially interesting.
Every person has dreams that are destined or not destined to come true in life. Such dreams of Viktor Ivanovich were the sections of transplantology. Viktor Ivanovich managed to transplant kidneys and return severed limbs to patients, as well as transplant various tissues of his own to patients using microsurgery during his lifetime, which he was very proud of. Thanks to the efforts of the doctors of the cardiac surgery center and their Moscow colleagues, it was possible to realize his dream of a heart transplant. But the dream of transplanting the liver, pancreas and other abdominal organ complexes is worse – it has not yet been realized for various subjective and objective reasons. But there is hope that this dream will be realized by the hands of Viktor Ivanovich's students. The name of V.I.Bulynin is associated with the formation of a new Voronezh Surgical School, whose students head key positions in practical healthcare and medical education.
Viktor Ivanovich was a versatile person who was constantly in contact with representatives of the creative intelligentsia – he was friends with the famous Russian family of sculptor I.P.Dikunov, writer G.N.Troepolsky, talantlev engineers, Lenin Prize laureate I.I. Poyarkov, G.V.Sukhodolsky, composer M. I. Nosarev, architect P.P. Danilenko, editor R.A. Khodeev, prof. chemist Goncharov E.G., Davydov O.M. and many others.
This friendly contact made it possible to create subjects and programs at the junction of specialties that are so necessary not only for medicine, but also for other spheres of life of residents of the Voronezh region. Representatives of various age groups of Voronezh residents gratefully remember Viktor Ivanovich Bulynin.

Various types of treatment for triple-negative breast cancer are considered. On the example of a clinical case, the role of regional chemotherapy in the treatment of this pathology is reflected. The effectiveness of combined systemic and regional chemotherapy in the treatment of early stages of triple-negative breast cancer was evaluated.

At present, due to the growing number of elderly and senile patients, as well as among patients of surgical hospitals, and an increase in the number of them with geriatric syndromes, science is facing new ways of treating and rehabilitating these patients of different age groups.

The purpose of this study is to determine the risk markers for the development of senile asthenia in emergency surgical pathology in older age groups. Ignoring the signs of senile asthenia in a patient can cause postoperative complications or even lead to death. For this reason, when an elderly patient with an emergency surgical pathology is admitted to the hospital, it is necessary to carry out the necessary types of examinations as quickly as possible and evaluate the values of the markers obtained at the same time, reflecting the degree of possibility of both the actual operation and the degree of its success if it is carried out.

Accordingly, it can be concluded that a timely and accurate assessment of the risk markers for the development of senile asthenia in emergency surgical pathology will improve the effectiveness of surgical interventions, as well as the postoperative condition of elderly and senile patients.

Considering this fact, it is necessary to develop and develop methods of prevention that prevent the deterioration of the condition of patients who have senile asthenia syndrom

Goal: to improve the results of oral floor cancer treatment if surgical treatment is not possible.

Materials and methods: a clinical case of combined radiation treatment of a patient with St III T3N1M0 oral floor cancer is presented. PHI No. X: highly differentiated squamous cell carcinoma. A treatment plan was developed: stage 1 chemoradiation: 3 courses of intra-arterial chemotherapy (Selective (super selective) embolization (chemoembolization) of tumor vessels in the left and right facial and left lingual arteries (cisplatin 150 mg), with a daily infusion of 5-fluorouracil 4000 mg, with an interval of 21 days). Stage 2 - volumetrically modulated radiation therapy (VMAT) to the area of the primary tumor (oral floor mucosa) and regional metastasis pathways (60 Gy to regional lymph flow zones, 50 Gy to oral cavity). Stage 3 - intracanular radiation therapy. The single dose per primary site was 3GR per fraction, 2 times a day, 6 hours apart to the 21Gr SOD, 7 fractions.

Results: complete tumor regression was observed after treatment. On PET/CT 48 months after the treatment of pathological accumulation of RPH, characteristic of the tumor process was not detected.

Conclusion: Chemoradiation treatment, in combination with brachytherapy, can be considered as an equal alternative to the surgical treatment of patients with oral floor mucosal cancer.

Introduction. Currently, an important problem in the surgical treatment of malignant neoplasms of the oral mucosa is the determination of tactics in the use of the most effective locoregional flap to eliminate the resulting defect.

The aim of the study. Determination of the tactics of surgical treatment with simultaneous reconstruction in patients with malignant neoplasms of the oral mucosa.

Methods. From 2017 to 2022, the Voronezh Regional Clinical Oncology Dispensary has accumulated experience in surgical treatment of 53 patients (aged 45 to 67 years) with a verified diagnosis of cancer of the oral mucosa. The histological variant corresponded to squamous keratinizing and non-keratinizing cancers of different degrees of differentiation. With Tis and T1, surgical treatment consisted of removing the tumor and then replacing the defect using split skin flaps. The presence of metastases in the cervical lymph nodes or their absence determined the tactics of performing cervical dissections with defect replacement using a flap of the anterior neck muscles and the nodding muscle. The use of a musculoskeletal flap from the pectoralis major muscle to replace a defect in the bottom of the oral cavity in T3 and recurrent tumors after chemoradiotherapy was combined with Krail surgery on the affected side.

The results of the study. Complete engraftment of the replaced flap was noted in all patients. Necrosis of the skin fragment of the flap was noted in 4 observations, in cases of the use of a flap from the anterior neck muscles, a flap from the pectoralis major muscle, which did not lead to the loss of the flap. It is worth noting that patients with necrosis of the skin fragment had severe concomitant diseases, such as diabetes mellitus and cardiosclerosis. Flap epithelialization was observed 7-10 days after surgery. During the follow-up period from 6 months to 5 years, continued growth was detected in two observations, relapse - in 3 cases. Postoperative mortality was 3%.

Conclusion. With the prevalence of the tumor process of the corresponding Tis and T1 - defect replacement is possible with the use of split skin flaps. In T2, the use of a skin-muscle flap from the anterior muscles of the neck is justified. In case of T3 and recurrent tumors of the bottom of the oral cavity with the Krail operation, it is advisable to use a skin-muscle flap from the pectoralis major muscle. Taking into account the small number of complications and fully restored oral functions in remote observations, the rehabilitation of patients can be regarded as satisfactory.

Objective: Comparison of efficacy and toxicity of low-power and high-power brachytherapy used in monotherapy in patients with localized prostate cancer of low - and intermediate-risk progression groups.

Materials and methods. The study enrolled 226 patients with localized prostate cancer in the low-risk and intermediate-risk progression groups. All patients underwent brachytherapy from 2010 to 2018. 88 patients received treatment in the volume of high-dose brachytherapy (BT-AMD) using a micro-source of 192Ir in the form of 2 fractions of 15 Gy with an interval of 2-4 weeks at the Voronezh Regional Clinical Oncological Dispensary. 100 patients received treatment in the volume of brachytherapy with the use of 125I micro-sources (BT-NMD) in the standard mode to a total focal dose of 145 Gy on the basis of the Federal State Budgetary Institution "Russian Scientific Center of X-ray Radiology." The median follow-up was 46 months. All patients gave written informed consent.

Results. PSA-specific survival was 96.3% in the BT-AMD group and 92.7% in the BT-NMD group. In the BT-AMD group, as well as in the BT-NMD group, 1 case of bone metastases was observed, which was 1.1% and 0.7%, respectively. Lymph node involvement was not observed in the BT-AMD group, 1 case (0.7%) was recorded in the BT-NMD group. In the BT-NMD group, 6 patients with intermediate risk of progression experienced local tumor recurrence. In 5 of 6 patients, initial PSA from 10 ng/mL to 20 ng/mL. BT-NMD showed a higher incidence of early genitourinary (HU) and gastrointestinal (GI) toxicity than BT-AMD (p < 0.001). The frequency of late HU toxicity was not significantly different in the groups. Higher results from the preservation of erectile function (EF) in BT-AMD - 74%, in the BT-NMD group - 66.7% (p < 0.001).

Conclusion. Comparable results were obtained compared to BT-NMD in patients in the low and intermediate risk progression groups. Early HU toxicity was reported more frequently in patients undergoing BT-NMD. Late HU toxicity was not different in the groups.

The sequence of using treatment options for patients with recurrent refractory Hodgkin's lymphoma is presented. The phasing and effectiveness of each stage of treatment is shown on the example of a clinical case. The effectiveness of using the drug Opdivo, which potentiates the immune response of the body by blocking the connection between PD-1 programmed cell death receptors and its ligands, has been shown, which has allowed for many years to stabilize the process in a patient with recurrent refractory Hodgkin's lymphoma in a common stage.

About 300 thousand coronary artery bypass grafting (CABG) operations are performed annually in the world. The most common complication accompanying such operations is postoperative cognitive dysfunction (POCD) [2]. The incidence of cognitive dysfunction after CABG with cardiopulmonary bypass (CB) can reach 86% [4][5]. In the course of this study, using the Mini-Mental State Examination (MMSE), a perioperative assessment of the dynamics of the cognitive status of 30 middle-aged patients with coronary heart disease (CHD) who underwent CABG with CB and cardioplegia. The duration of cardiopulmonary bypass and the duration of myocardial anoxia were chosen as the studied intraoperative triggers for changes in the perioperative cognitive status. According to our results, the dynamics of MMSE tests has a negative correlation with all the studied triggers (p < 0.05). Thus, the duration of CI and myocardial anoxia can be used as prognostic criteria that allow assessing the risks of developing POCD already in the early postoperative period, which makes it possible to start correcting this condition in a timely manner.