Vol 14, No 1 (2025): Материалы Всероссийских форумов с международным участием

Cervical cancer currently ranks fourth in the structure of malignant oncological diseases in the world. Breast cancer is one of the most preventable and treatable forms of cancer if it is prevented by vaccination against human papillomavirus (HPV), detected at an early stage and effectively controlled. Russia is the leader among newly identified cases of breast cancer, as indicated by data for 2022, when 127 cases of the disease per 100,000 population [1]. According to the WHO Expert council, about 530,000 new cases of breast cancer are registered annually in the world. Russia is considered the leader among European countries in the number of detected cases between the ages of 29 and 34, as indicated by data from the Global Cancer Observatory [2, 3]. In 2020, WHO developed three strategies for the elimination of breast cancer. These include vaccination of at least 90% of girls against HPV under the age of 15, screening coverage of 70% of women using the highly effective test by the age of 35 and again by the age of 45, as well as treatment of at least 90% of precancerous and breast cancer. Detection of high–risk HPV is an effective screening tool recognized by large international randomized trials. Modern screening programs for the detection of breast cancer face two main problems that require immediate solutions: insufficient coverage of the female population and the need to improve diagnostic methods. Currently, the main focus is on increasing the number of women undergoing screening and optimizing breast cancer screening methods, the most promising of which is the detection of high-risk human papillomavirus (HPV) [4]. Effective screening requires not only a sensitive diagnostic method, but also a broad coverage of the female population by the existing program. However, the unavailability of medical facilities or the fear of diagnostic methods eventually set the task of creating a method of individual diagnostic methods without the direct intervention of a doctor. For this purpose, many vaginal secretion self-sampling test systems have been implemented, which have shown their effectiveness in cohort studies, having high predictive value and the greatest comfort for women.

Dysmenorrhea (algodismenorrhea, algomenorrhea) is a syndrome that occurs on the eve or during menstrual bleeding, the leading clinical manifestation of which is pain in the sacrum and lower back. Goal. To study the relevance of dysmenorrhea and its impact on the quality of life among women of different ages. Materials and methods. In this study, 280 respondents were surveyed, representing 2 age groups: 150 women (53.6%) from 16 to 20 years old and 130 women (46.4%) from 21 to 50 years old. Results. In order to differentiate the age for which the first episodes of dysmenorrhea are most characteristic, the respondents needed to indicate when the painful sensations were first recorded. At the age of 12, this syndrome was noted by 15 respondents (6.1%); from 12-14 years – 102 respondents (41.8%); from 15-17 years – 78 respondents (32%); from 17-25 years – 42 respondents (17.2%); after 25 years – 7 respondents (2.9%). The results show that dysmenorrhea is more likely to occur between the ages of 12 and 17. Conclusions. Dysmenorrhea remains one of the leading gynecological problems of women's health, 244 respondents noted the presence of pain syndrome. Girls between the ages of 16 and 20 experience menstrual pain in 92.6% of cases.

In the Kyrgyz Republic, the proportion of women with a birth interval of less than three years is increasing. Addressing the issue of short birth intervals requires identifying the practical aspects of non-compliance with the interdelivery interval, including ensuring universal access to high-quality, comprehensive, and detailed information about the optimal birth interval. Objective. To assess the knowledge and attitudes of postpartum women in Bishkek regarding the optimal birth interval. Materials and Methods. After obtaining written consent for participation in an anonymous study, we conducted an anonymous online survey among 98 postpartum women at Clinical Maternity Hospital No. 2 in Bishkek. Among them, 55 had a birth interval of less than 33 months, while 43 had an interval of 33 months or more. The collected data were processed using Microsoft Office Excel 2016. Results. 25% of respondents deliberately did not follow the recommended interdelivery interval. When asked about the duration of a safe birth interval, the majority of respondents (74%) stated that it should be three years. Conclusion. The reasons for short birth intervals are not only medical (e.g., not having the opportunity to consult a doctor regarding contraception) but also social (e.g., a woman's desire to give birth at a younger age, or the sex of the previous child—when a family has more daughters, women may try to conceive sooner to have a son).

Abstract.

Introduction. Cervical cancer remains a serious medical problem, especially in developing countries where approximately 500 thousand new cases are registered annually. The main cause of the disease is long-term infection with human papillomavirus (HPV). Despite the importance of screening, many women avoid visiting doctors, which complicates early diagnosis. The development of urine analysis methods for HPV allows simplifying the detection process of cervical lesions by providing convenience and cost-effectiveness. Objective: To assess the relevance and effectiveness of using laboratory urine analysis for HPV as a screening method to detect precancerous and cancerous conditions of the cervix and reduce mortality rates. Materials and Methods: Based on VGKMP No. 1 under the Ministry of Health of the Russian Federation, we conducted research on the effectiveness of urine analysis for HPV to identify cervical pathologies. We evaluated the results from 30 patients divided into two groups based on PCR test systems used: HPV Quant 15 and HPV Quant 21 produced by DNA Technology, Russia. Results. The study showed that in the first group, full correspondence of results was observed in 22%, partial correspondence in 45%, and discrepancy in 33%. In the second group, partial correspondence was noted in 25% of patients, full correspondence in 33%, and discrepancies in 42%. The proportion of low virus titers in smears from the cervical surface among patients from Group 1 with discrepancies amounted to 58%, while high titers were 42%; 60% and 40% respectively for those examined in Group 2. Abnormalities during colposcopy in Group 1 were detected in 10 patients (55.55%). Among 12 patients with positive urine HPV tests, an abnormal picture was found in 8 (66.66%), increasing diagnostic sensitivity by 11.11% compared to the method of taking cervical samples. Among the 18 HPV-positive cervical samples, the first group showed abnormal cytology in 5 patients (27.77%). Four of the abnormal cytological samples (80%) had both positive HPV tests, with 2 being classified as ASC-US, 1 as LSIL, and 1 as HSIL. In Group 2, abnormal colposcopic findings were noted in 6 patients (50%). Out of 7 positive urine tests, 4 (57.14%) also revealed anomalies, enhancing the efficiency of colposcopic diagnostics by 7.14% when HPV status in urine was positive. In the second group, abnormal cytology was detected in 3 patients (25%), including 2 (28.57%) out of 7 HPV-positive urine tests showing ASC-US and LSIL. Conclusion. The results demonstrated a correlation between the presence of HPV DNA in urine and high concentrations of the virus in smears. The frequency of abnormalities during colposcopy and deviations in oncocytology with a positive urine HPV test turned out to be significant. This confirms the potential use of urine analysis for HPV as a possible screening method for preventing and detecting precancerous states of the cervix.

Cervical cancer (CC) is a malignant gynecological neoplasm and has long been ranked 5th (5.2%) in the structure of oncological morbidity in women, second only to 2 gynecological localizations and one of the leading causes of cancer mortality among young women. In the Russian Federation, according to 2018 data, 17,766 cases of the disease were identified, which is 22.3% more than in 2008 (13,807). In 2018, mortality from CC was 6,392, which puts this disease in 10th place in the structure of causes of cancer mortality in women. The peak incidence of CC, unlike other malignant neoplasms of the female genital tract, occurs at a younger age of 40 - 49 years (42.8 per 100 thousand of the corresponding population). Mortality rates from cervical cancer are steadily increasing, so there is a need to create new diagnostic methods that would allow determining changes in cervical tissues with high accuracy, for the early detection of pathological precancerous changes. TruScreen is a portable device for detecting cervical cancer, which was recognized by WHO in May 2019. This innovative scanner is capable of detecting cervical tissue damage, precancerous changes and cancerous processes with high accuracy in real time.

A steady increase in the incidence of cervical malignancy (cervical cancer) and the rejuvenation of the age group of patients actualize the need to optimize preventive programs and methods of early detection of the disease. Special attention is paid to the annual increase in the number of newly diagnosed pathologies among women of reproductive age (21-35 years). According to the statistics of the Voronezh Region, in 2023, 242 patients with newly diagnosed ZNO were registered, and 50% of them had the disease detected at stage I. This pathology remains a significant factor in female mortality: mortality in the first year after diagnosis reaches 12.7% in the Russian Federation, demonstrating a steady negative trend. The persistence of human papillomavirus (HPV), especially highly oncogenic types (HPV-16 and HPV-18), is recognized as a key factor in the development of breast cancer. Despite the possibility of preventing breast cancer through timely diagnosis of precancerous conditions, the problem is compounded by low coverage of screening programs and insufficient effectiveness of preventive examinations. The article discusses regional statistical data and modern cytological screening strategies, including two-stage diagnosis. An analysis of 3 years of data (270,748 women were examined) revealed an HPV-positive status in 15.63% of the surveyed. Distribution by serotypes: 29.7% — types 16/18; 44.4% — 2-3 serotypes; 8.4% — 4 or more serotypes. These data confirm the importance of HPV screening in the prevention of breast cancer, and combined diagnosis (PAP test and HPV typing) has proven effective in reducing morbidity and mortality. The successful implementation of screening requires the combined efforts of medical professionals, health authorities and the public.

The problem of diagnosis and treatment of fetal and neonatal haemolytic disease (FHD) caused by Rhesus-isoimmunisation has not lost its relevance to date, despite a well-organised system of immunoprophylaxis, and remains one of the causes of perinatal mortality and disability. Perinatal mortality due to foetal haemolytic disease (FHD) in our country reaches 15-16 ‰.According to the current clinical recommendations of the Ministry of Health of the Russian Federation ‘Rhesus-isoimmunisation. Haemolytic disease of the fetus’ 2024, after intrauterine transfusion of washed red blood cells to the fetus, abdominal delivery is preferable, which avoids additional traumatisation and distress of the fetus during labour. However, modern studies suggest that the choice of the method of delivery should be based on obstetric indications. Objective. To demonstrate the possibility of choosing the method of delivery based on obstetric indications in pregnant women with GBP after multiple VPKs. Materials and Methods. Two clinical examples of the course of pregnancy complicated by Rh-isoimmunisation are presented. Labour histories, anamnesis data, clinical, laboratory and instrumental investigations were analysed. Results. Two observations of Rh-isoimmunisation complicated by GBP were described in the presented clinical cases, which necessitated fourfold MIC in both pregnant women. The method of delivery did not affect the outcome of labour, both children were born in satisfactory condition. Conclusion. Current management of pregnant women with Rh-isoimmunisation tends to intrauterine EMOLT transfusions at a later date in order to reduce perinatal complications associated with prematurity. In addition, compensation of intrauterine anaemia on the eve of delivery makes it possible to choose the method of delivery based on the obstetric situation.

Breast cancer, like HIV infection, represents global challenges for healthcare. The combination of HAART (highly active antiretroviral therapy) and chemotherapeutic treatment poses risks of increased toxicity due to drug interactions and comorbidities. The relevance of this topic stems from the need to optimize treatment regimens to reduce toxicity and improve patient survival rates. Objective: To analyze current data on cross-toxicity in HIV-infected patients with breast cancer undergoing HAART and chemotherapy. Materials and Methods. The literature review utilized data from clinical studies focused on breast cancer treatment in the context of HIV therapy. Research was conducted using epidemiological data from the WHO and UNAIDS websites, as well as PubMed and eLibrary databases. Results. The study revealed that the risk of increased cross-toxicity during HAART and antitumor drug use depends on pharmacokinetic and pharmacodynamic interactions. Modern evidence-based online tools for assessing pharmacokinetic interactions and cross-reactions between antiretroviral and cytotoxic anticancer drugs enable the development of personalized treatment plans aimed at mitigating risks associated with these drug combinations. Conclusion: Addressing the issue of increased toxicity during antitumor treatment and HIV therapy is a critical healthcare challenge that requires a personalized approach.

One of the fundamental tasks of experimental oncology today is to detail the necessary characteristics of the tumor process, which will help to most accurately determine specific targets for targeted therapy and increase its effectiveness. It has been found that tumor cells under certain conditions have the ability to create limited basal membrane high-permeability, matrix-rich vasculogenic mimicry channels, supporting the growth of tumor tissue and its metastasis. They become the main suppliers of energy substrates. Vasculogenic mimicry correlates with a high degree of tumor malignancy and is more common in patients with an unfavorable course of the disease, making the study of this phenomenon on experimental models a relevant and promising direction for modern scientists. The mechanism of vasculogenic mimicry is not completely understood, but a stable connection between its initiation and hypoxic conditions of the tumor microenvironment is noted. It is under these conditions that the expression of genes responsible for the epithelial-endothelial transition of tumor cells, the production of matrix metalloproteinases increases. Dynamic monitoring of tumor progression in experimental models, serial sections of biomaterial can be carried out thanks to the use of trepanobiopsy - a modern, minimally invasive method that is distinguished by sufficient informativeness, availability, and mobility of equipment, allowing to maintain the viability of laboratory animals.

Introduction. Hydronephrosis associated with uropelvic junction anomalies (N13.0) is a pathological condition leading to progressive urinary outflow obstruction and renal tissue atrophy, which can result in chronic kidney failure and various complications. Early diagnosis and timely intervention are crucial for preventing complications such as urinary tract infections, pyelonephritis, and renal hypertension. The aim of this study is to analyze the clinical presentation and symptoms of hydronephrosis caused by uropelvic junction anomalies, as well as to review modern diagnostic and treatment methods, including surgical intervention. The study utilizes data from relevant scientific publications, prenatal ultrasound screenings, and clinical observations, which help in developing effective patient management algorithms. Hydronephrosis in (N13.0) can be asymptomatic or present with symptoms such as urinary tract infections, abdominal pain, hematuria, and elevated blood pressure. In severe cases, progression of kidney failure and development of urosepsis are observed, requiring surgical correction. Treatment includes conservative observation with regular monitoring and surgical intervention when indicated. Early diagnosis and timely surgical intervention are essential measures to prevent irreversible renal tissue changes and preserve kidney function.

Peritoneal carcinomatosis (PC) is the most common and unfavorable variant of gastric cancer progression after radical treatment.

Artificial intelligence (AI) is rapidly transforming various fields of medicine, and oncology is no exception. Thanks to its ability to analyze vast amounts of data, identify hidden patterns, and provide accurate predictions, Artificial intelligence is opening new horizons in the diagnosis, treatment, and prevention of cancer. Today, artificial intelligence is revolutionizing oncology by offering new tools to combat cancer. It can analyze medical images for early and accurate diagnosis, develop personalized treatment plans considering the patient’s genetics, and predict recurrence risks. Artificial intelligence also optimizes radiation therapy and assists in monitoring treatment effectiveness. These capabilities make artificial intelligence a powerful ally for physicians in the fight against oncological diseases.

The treatment of soft tissue sarcoma (SMT) has gone through a long and difficult development path — from amputation operations to complex and extensive interventions aimed at preserving organs. However, regardless of the type of surgery performed, the problem of relapses still remains relevant. Goal. To analyze recurrent soft tissue sarcoma using a clinical case example. Materials and methods. In 2011, patient D. independently discovered a neoplasm in the middle third of her right shin, and after a few months the formation disappeared. 10 years later, an education in the same field appeared. Results. In May 2022, a recurrence occurred in the area of the postoperative scar. In March 2023, another recurrence of the soft tissue area of the right shin. In August 2024, a recurrent lesion was detected in the inguinal-femoral region. Conclusions. Information about these rare cases of recurrent lesions in soft tissue sarcoma contributes to an in-depth understanding of the dynamics of malignant tumors and helps to develop more effective and personalized approaches to the treatment of patients with this pathology.

The complexities of preoperative N-stage gastric cancer (RV) create prerequisites for an irrational approach to treatment planning. A possible option for improving the accuracy of preoperative assessment of the condition of regional lymphocollectors in Russian railways is the development and use of prognostic models.

Choriocarcinoma is a rare, typically very aggressive malignant tumor that develops from trophoblastic cells. There are two main types of choriocarcinoma: gestational (associated with pregnancy) and nongestational (outside of pregnancy). The gestational form occurs only in women and is typically linked to pregnancy, whereas the nongestational form affects both sexes. In this case, choriocarcinoma is a type of germ cell tumor that most commonly arises from the cells that form the human reproductive system. In men, it typically develops at a young age and affects the testes.

Previous cases of unique clinical case of extragenital liver involvement with choriocarcinoma in a 36-year-old male. This disease presentation is rare, which complicated both the diagnostic process and the selection of treatment methods. The patient was admitted to the hospital with signs of rapidly developing multiple organ failure, which led to the diagnosis being confirmed post-mortem through histological and immunohistochemical studies. Autopsy material was analyzed, and accompanying medical documentation was reviewed, along with all 11 cases of liver choriocarcinoma published in the international literature to date.

В современной хирургии важное значение имеют методы гемостаза и улучшения регенерации тканей. Особенно это важно при операциях на печени в связи с анатомическими особенностями сосудистого русла этого органа. Цель. Изучить эффективность гемостаза при ранениях печени с использованием препарата «Фибриностат» и низкоинтенсивного лазерного излучения (НИЛИ). Материалы и методы. Опыты проведены на 16 белых крысах, у которых моделировали рану (0,5х0,3х0,2 см) на левой доле печени. Вскрытие проводили через 28 суток после операции и оценивали состояние раневой поверхности с последующей микроскопией места раны печени. Результаты. Результаты показали, что все животные хорошо перенесли операции. На 3-и сутки после вмешательства у крыс не наблюдалось выпота, признаков кровотечения и гематом. В группе с «Фибриностатом» наблюдалась выраженная инфильтрация гранулоцитами, тогда как в группе, подвергшейся воздействию низкоинтенсивного лазерного излучения, она была выражена меньше. В более поздние сроки наблюдались различия в макрокартине печени — в группе с «Фибриностатом» преобладал адгезивный процесс. Заключение. Таким образом, «Фибриностат» продемонстрировал хорошие гемостатические, а в сочетании с низкоинтенсивным лазерным излучением регенераторные свойства печеночной ткани.

Fractures in children are frequent injuries that require a comprehensive approach to treatment.

Repositioning - restoration of anatomical integrity and correct bone position - is an important part of fracture treatment and has a significant impact on further recovery and functional status of the limbs [2].

The aim of the study was to analyse the types of injuries that required repositioning in childhood.  The study was carried out on the basis of the trauma centre of the DOKB in Belgorod. The study group included 227 cases of various types of repositioning in the course of a particular injury. The age and sex of the patients in the study group, the localization of the injury and the type of repositioning, the need for hospitalisation and recurrence were analysed. The study group included 161 (70.9%) boys and 66 (29.1%) girls.

The largest number of cases was associated with fractures of the upper extremities. In the majority of cases 71 (34.6%) were injuries of both forearm bones.

 The most frequent injuries were sustained in the age period from 6 to 12 years - 155 cases (68.3%). This is the age when the child has little or no parental control and self-control is far from perfect.

 Closed reposition as a method of treatment for injuries in children and adolescents is a priority, but in our study, in 7 cases (3.1%), repeated repositioning was necessary - open repositioning was performed after closed repositioning.

A perforated ulcer is a serious complication of peptic ulcer disease that requires emergency surgical treatment. It is logical to assume that the results of treatment and the mortality rate among patients in this group are influenced by many factors, including the timing of hospitalization. In 2023, the proportion of patients diagnosed with a perforated ulcer who were admitted to the hospital later than 24 hours after the onset of the disease in different regions of the Russian Federation ranged from 21% to 39.4%. The purpose of the study. To conduct a mortality analysis taking into account the duration of hospitalization among patients diagnosed with perforated gastric and duodenal ulcers admitted to GBUZ VOKB No. 1 for 2020-2023. Materials and methods. We studied 48 medical records of patients diagnosed with perforated ulcer who were hospitalized in GBUZ VOKB No. 1 for 2020-2023, of which 15 were fatal. Results. During the systematization of the material, two groups were identified: those with hospitalization up to 24 hours from the onset of the disease (early) and later than 24 hours (late hospitalization). The subjects of comparison of the two groups are: mortality rate, causes of death. The result of the analysis is a direct relationship between the duration of hospitalization and the mortality rate. Conclusion. In the case of a perforated ulcer, the timing of hospitalization is an important factor that determines the clinical picture, decompensation of concomitant pathology, and the presence of complications, which affects the risk of death.

Keywords: perforated ulcer, late hospitalization, mortality.

The arterial blood supply of the liver is a crucial aspect of surgical anatomy, significantly influencing the strategy of surgical interventions. The variability of the vascular system is determined by embryonic development and can substantially complicate surgical manipulations, increasing the risk of intraoperative injuries and postoperative complications. Understanding anatomical variations of the hepatic arteries is essential for successful surgical planning, particularly in transplantation, oncology, and reconstructive surgery. Objective. To analyze anatomical variations in the arterial blood supply of the liver and their impact on surgical strategies in various types of operations. Materials and Methods. A literature review was conducted, including an analysis of anatomical and clinical studies on hepatic artery variations and their significance in liver, pancreatic, and biliary surgery. Results. It was found that the most widely used classifications (Michels, Hiatt) allow for the systematization of hepatic artery variations. Vascular anomalies influence techniques in liver transplantation, pancreaticoduodenal resection, gastrectomy, and gastric fundoplication. The use of modern imaging techniques, including MSCT angiography and 3D reconstruction, enables the identification of variations during preoperative planning, reducing the risk of complications.. Conclusion. Anatomical variations of hepatic arteries have clinical significance in surgical planning and require an individualized approach. The use of advanced diagnostic methods contributes to improved surgical outcomes.

Bladder injury is one of the most severe injuries to the organs of the genitourinary system and occupies a special place in the problem of injury (1-3% of cases among injuries to other organs). Based on the anatomical structure and localization of the bladder, we can say that it is a hollow muscular organ located in the intraperitoneal space and thus protected from external influences, and therefore injury. Goal. to analyze a non-traumatic rupture of the bladder using the example of a clinical case. Materials and methods. In the course of this study, a clinical case of the urology department at the Tver Emergency Hospital was analyzed. Results. At the time of the examination, the patient noted abdominal pain, most pronounced in the lower regions (suprapubic region). An ultrasound examination and a CT scan were performed, which revealed a large amount of fluid in the abdominal cavity. After examination by the therapist and the surgeon, a preliminary diagnosis was made – "Closed abdominal injury, intraperitoneal rupture of the bladder," after which it was decided to urgently close the rupture with drainage of the abdominal cavity. Conclusions. Intraperitoneal bladder injury is a rather dangerous injury that can be accompanied by a number of complications. The complexity of the clinical picture makes diagnostic examination difficult.

. The most common pathology of the thyroid gland is macrofollicular and microfollicular colloid goiter, malignant neoplasms, thyroiditis, as well as benign neoplasms of the thyroid gland (adenoma, angioma, lymphoma). Surgical methods are often used to treat thyroid pathology.
  Objective: to study the basic approaches to surgical treatment of thyroid diseases.
  Materials and methods: a review of data in PubMed, ScienceDirect, eLIBRARY was performed using the keywords "endocrinology", "thyroidectomy", "hemithyroidectomy", "thyroid gland", "thyroid cancer", "intraoperative neuromonitoring". Of the initially identified 56 sources, 15 were included in the review.
  Results: total and subtotal thyroidectomy, hemithyroidectomy are the most common surgical interventions. Current guidelines recognize hemithyroidectomy as an acceptable method of initial treatment for cytologically indeterminate nodules and papillary thyroid carcinoma. According to the recommendations of the American Thyroid Association and the National Comprehensive Cancer Network, if thyroid nodules less than 4 cm in size are detected without concomitant signs of malignancy, it is advisable to consider hemithyroidectomy. Recently, active surveillance of papillary thyroid microcarcinomas smaller than 100 mcg in the absence of signs of malignancy and metastases to the lymph nodes has become an increasingly acceptable treatment method.
  Conclusion: the choice of surgical tactics depends on the nature of the thyroid disease, the prevalence of the pathological process and should take into account the capabilities of modern surgery and the patient's wishes.