Johann Friedrich August von Esmarch was one of the most eminent surgeons of the German school of the nineteenth century. Esmarch's tourniquet is used daily around the world to stop bleeding, Esmarch's bandage scissors for cutting large bandages, Esmarch's transport splint, Esmarch's circle irriga, Esmarch's knife, etc. However, these inventions are only a few of the many significant innovations of this outstanding surgeon, scientist, organizer and teacher. Esmarch is rightfully considered one of the founders of military field surgery and disaster medicine, he also owns the idea of exsanguination of a limb during operations, the introduction into anesthesiology practice of the method of extending the lower jaw to combat asphyxia (“Esmarch’s technique”), as well as the creation of a prototype anesthesia mask and design of the chloroform anesthesia device. He was the first to introduce the principle of medical triage of the wounded, described intracranial epidermoid tumors, was a pioneer in the use of cryotherapy and popularized the rules of asepsis and antisepsis in military field surgery. Over 40 years of practice, Esmarch has conducted more than 20000 major operations. In addition to his surgical abilities, he was recognized as an unusually astute diagnostician. Thanks to Esmarch's initiative, a network of "Samaritan Courses" was organized in Germany to train civilians in first aid. Its coat of arms, presented in 1887 by Emperor Wilhelm I, depicted the coat of arms of the Esmarch family, the Samaritan cross and a bloodless hand with Esmarch's bandage. A truly appropriate set of heraldic symbols for such an outstanding person who has done so much for surgery in general, and for the humane and effective treatment of the wounded in particular.

Pathological adhesion formation in the abdominal cavity following surgical interventions remains an unresolved problem, leading to intestinal obstruction, chronic pain, and infertility. Despite existing preventive methods, an effective solution has not yet been found. Gene therapy approaches represent promising developments that target key molecular mechanisms of fibrosis and inflammation. Experimental studies demonstrate the potential of this direction. Suppression of transforming growth factor β (TGF-β) reduces fibroblast activation. Activation of antifibrotic factors decreases collagen deposition and stimulates fibrinolysis. Gene editing modulates inflammation and angiogenesis. Thus, gene therapy could become a breakthrough in preventing adhesive disease but requires further research to address immunogenicity, controlled long-term efficacy, and other safety concerns.

This article provides an overview of current surgical options for treating peripheral arterial disease of the lower extremities, including those in comorbid patients with multifocal atherosclerosis and abdominal aortic aneurysms. The article presents data from large randomized trials comparing early and late outcomes of lower extremity vascular revascularization. The article analyzes outcomes of various approaches to abdominal aortic aneurysms reconstruction, including small abdominal aortic aneurysms in high-risk patients. The literature data are illustrated by a clinical example from our own practice. A case of successful open surgical reconstruction is described: aortobifemoral bypass grafting in a patient with generalized atherosclerosis and infrarenal aortic aneurysm with a 6-month follow-up period.

Inguinal hernias are one of the most common surgical pathologies requiring operative intervention. One of the most crucial aspects is the choice of surgical technique, especially for patients with a history of multiple abdominal surgeries. The authors present a clinical case of a recurrent inguinal hernia in a patient with a history of multiple open abdominal surgeries. The patient had previously undergone Lichtenstein hernia repair, laparotomy for fecal peritonitis, scheduled abdominal lavages, resection of the colon with ileostomy formation. The patient underwent extended totally extraperitoneal (e-TEP) repair. The authors suggest that extended totally extraperitoneal repair (e-TEP) may be recommended for patients with inguinal hernias who have a history of anterior inguinal canal repair and/or open abdominal surgeries.

A review of scientific publications on the results of the use of modern technologies in the implementation of radical surgical treatment of patients with prostate cancer has been conducted. Taking into account the development of science and the acquisition of appropriate experience by surgeons, increasing the capabilities of technical equipment for medical organizations, radical prostatectomy is currently associated with an improvement in the functional results of its use in oncourological practice. The treatment of patients using innovative surgical technologies is guaranteed to be accompanied by a reduction in the severity of surgical trauma and minimization of the risks of complications after it. Performing radical prostatectomy with the so-called traditional (open) access is considered the “gold standard” for the treatment of patients with malignant tumors of the prostate gland. However, the development of laparoscopic and robotic technologies, as the experience of specialists from medical organizations that provide care to patients with oncourological pathology, allows us to be optimistic about the advantages of minimally invasive technologies in terms of improving the quality of examination and treatment of patients with prostate cancer.

About 600 thousand new cases with an established diagnosis of osteoarthritis are registered annually in Russia. The total number of patients can reach about 15 million. At the same time, there is a tendency for the incidence to increase from 32.2 to 35.7 cases per thousand population. Literature data was searched in the open electronic databases of scientific literature PubMed and Library. The search was carried out by keywords and phrases. Over the past 20 years, there has been an impressive increase in the number of patients with this disease – by 260 %. When examining the age structure, it should be noted that there are quite significant differences in morbidity rates. Currently, when talking about osteoarthritis, close attention is paid to the multifactorial nature of the disease. Undoubtedly, mechanical action plays a crucial role in triggering the pathological process. On the other hand, the metabolic syndrome should be considered equally important in the development of the disease, its presence can potentiate the risk of developing osteoarthritis by more than two times. Thus, the prevalence of osteoarthritis and the steady increase in morbidity, as well as the aggravation of its course in the presence of concomitant diseases, lead to the need for a special approach to patients with comorbid conditions and their further study.

Total hip arthroplasty is currently the treatment of choice for end-stage hip osteoarthritis. However, joint replacement with an implant is often associated with the development of intraoperative and postoperative complications, and fatal outcomes following total hip arthroplasty are not uncommon. Objective – to analyze the incidence and structure of mortality at various time points after total hip arthroplasty using conventional statistical methods and the Kaplan – Meier method. The study included 507 patients aged 19 to 87 years who underwent total hip arthroplasty at the Department of Traumatology and Orthopedics of North-Western State Medical University named after I.I. Mechnikov between 2015 and 2018. The data were processed using Microsoft Excel and the R software environment. Long-term outcomes and patient survival after total hip arthroplasty were evaluated using the non-parametric Kaplan – Meier method. Among the 233 patients (46.0 % of the total cohort) who remained under observation for 7 to 10 years after total hip arthroplasty, the mortality rate was 36 cases (15.5 %). The highest number of deaths was recorded in the first year following surgery (4.29 %), with a gradual decline to 0.43 % by the eighth year. The leading causes of death were acute myocardial infarction and acute cerebrovascular accident (each accounting for 27.8 % of cases), followed by malignant neoplasms and COVID19 (each 13.9 %), and pulmonary embolism (11.1 %). The Kaplan – Meier analysis, which takes into account information on censored observations, shows mortality rates of 8.9 % for 8–10 years after total hip arthroplasty, while 7.4 % of patients died in the first five years after hip arthroplasty. Most deaths occurred within the first five years after surgery, consistent with the literature. A significant limitation of the study was the high proportion of patients lost to follow-up, which limited the completeness of long-term outcome evaluation and underscores the need for unified registries and postoperative monitoring systems. Long-term outcomes of total hip arthroplasty show a high mortality rate. Mortality indicators vary depending on the statistical analysis method used. The most objective results are obtained through registry-based analysis, which confirms the need for organized long-term follow-up of patients after surgery.

Psoriatic spondyloarthritis is a rare and poorly studied group of non-infectious autoimmune inflammatory lesions of the spine, belonging to the group of axial spondyloarthritis. There are no systematic data on the diagnosis and course of spondylitis in patients with psoriasis in the literature. The aim of the study is to present the results of the clinical course and features of the diagnosis of chronic spondylitis in patients with psoriasis and to systematize the literature data on the issue under consideration. The clinical part of the study included six patients successively operated on in the period from 2018 to 2021. The diagnosis of gouty spondylitis and aseptic chronic spondylitis was suspected according to the CASPAR questionnaire (Classification Criteria for Psoriatic ARthritis, 2006) and established on the basis of the ASDAS (Ankylosing Spondylitis Disease Activity Score) and BASDAI (Bath Ankylosing Spondylitis Activity Index). The features of clinical, laboratory, radiation and histological manifestations of the disease were studied. All patients underwent vertebral trephine biopsy with hemotoxylin-eosin staining and Romanovsky – Giemsa examination. The literature was systematized using the medical literature databases PubMed, Google Scholar, eLIBRARY. The search depth was from 2013 to 2023. The average age of patients was 37.8±5.2 years with a psoriasis duration of 14.3±75 years. The average value for five signs of the CASPAR questionnaire was 3.5±0.4. According to the ASDAS-CRP and BASDAI indices, moderate disease activity was noted – 2.6±0.3 (Mmin – 1.8, Mmax – 3.1) and 2.5±0.4 (Mmin – 1.6, Mmax – 2.8), respectively, which was confirmed by a moderate increase in CRP – 8.2±2.4 mg/l (Mmin – 5.7, Mmax – 14.2). When analyzing the quality of life and functioning of the spine, patients complained of significant pain (VAS 5–6 points) and difficulty sitting, lifting objects and standing), which corresponded to moderate disorders according to the ODI and SF 36 questionnaires. In three (50 %) of six patients, radiographic signs of damage to the sacroiliac joints were detected. Traditional histological examination of biopsy material revealed dystrophic changes in bone tissue with a nonspecific leukocyte reaction. A more indepth histological examination and staining of the preparation according to Romanovsky – Giemsa revealed clusters of mast cells characteristic of psoriasis. The presence of psoriasis, vertebrogenic pain syndrome, exceeding 3.5 points according to the CASPAR criteria and detection of signs of spondylitis, aseptic spondylitis and/or sacroiliitis in MRI allow us to suspect psoriatic spondyloarthritis. In this group of patients, according to the BASDAI and ASDAS indices, markers of the systemic inflammatory response, there was moderate activity. Staining biopsy material according to Romanovsky – Giemsa in destructive processes in the spine allows not only to exclude granulomatous, oncological and pyogenic etiology of the disease, but also to suspect psoriatic spondyloarthritis and select individual treatment for the disease.

The aim of this study was to present the long-term outcomes of surgical treatment for chronic plantar fasciitis that is refractory to conservative therapy, using the method of radiofrequency denervation. Randomized and multicenter studies indicate that percutaneous radiofrequency ablation helps reduce operative time and improve postoperative recovery outcomes in patients with chronic heel pain syndrome. However, there are currently no standardized guidelines for the surgical management of plantar fasciitis. This article presents the results of surgical treatment in a female patient operated on at the St. Petersburg Research Institute of Phthisiopulmonology during the period from 2024 to 2025. The results demonstrate the absence of pain recurrence. No postoperative complications were observed. Radiofrequency denervation of the medial calcaneal branch of the tibial nerve under ultrasound guidance may be considered an effective and minimally invasive method for the surgical treatment of plantar fasciitis refractory to conservative therapy.

Tuberculosis of the musculoskeletal system in children is currently a rare pathology. Low incidence contributes to insufficient alertness on the part of both pediatricians and surgeons and orthopedic traumatologists. In this regard, ostitis and spondylitis of tuberculous etiology, even in the presence of a phthisiatric anamnesis (active tuberculosis of the respiratory organs, a history of tuberculosis, changes in tuberculin tests, social and medical risk factors, etc.) are diagnosed already at the stage of bone tissue destruction. With late diagnosis and without timely assistance for spinal tuberculosis in children and adolescents, in 100 % of cases, disability occurs, the degree of which increases with age. The purpose of this demonstration is to attract the attention of specialists in various fields to the problem of the development of severe complications of tuberculosis in children with untimely diagnosis of the disease and the absence of etiotropic therapy. Clinical observation: child B., 5 years old, from an asocial family. During the examination, a diagnosis of tuberculosis of the intrathoracic lymph nodes in the consolidation phase was established. The child's mother refused inpatient treatment. A year later, tuberculous spondylitis C5-Th1, complicated by abscess, was diagnosed. The development of the disease was facilitated by low alertness of general practitioners in terms of the development of extrapulmonary tuberculosis in a child with several risk factors for the disease, the passive position of the child's parents, their refusal of etiotropic therapy in inpatient settings, and the absence of stable, regulated relationships between employees of medical organizations and social services.