Objective: to analyze the challenges associated with the morphological interpretation of histological specimens that simultaneously exhibit characteristic histological features of both ulcerative colitis (UC) with features of Crohn's disease (CD), and CD with features resembling UC (so-called " overlapping " forms).

Object and methods. Between 2019 and 2024, UC was diagnosed in 180 patients and CD in 120 patients. The average age of the patients was 48 ± 6 years. Diagnoses were established based on a combination of clinical-laboratory, endoscopic, and morphological data. A search was conducted for cases that posed diagnostic difficulties and whose characteristics were ambiguous and contained features of both UC and CD, resulting in 60 cases identified over a more than 5-year observation period. UC with features of CD was established in 58 cases (32.2%), and CD with features of UC in 2 cases (1.6%).

Results. 24 patients with UC had focal and segmental inflammation in colon. Among 13 patients with left-sided colitis, focal lesions in the form of chronic active inflammation were found in the periappendicular and cecal regions, and in 2 patients with UC, granulomas termed "cryptolytic" were found, associated with the destruction of crypts, which can be difficult to distinguish from granulomas in CD. In patients with UC, ileitis was detected in 18 patients, with the inflammatory process predominantly confined to the distal 1-2 cm of the ileum in most cases. Five patients exhibited ileitis without involvement of the cecum, and the inflammatory process was not related to a retrograde mechanism. In 2 patients with CD, the inflammatory process was isolated to the distal sections of the colon, and the diagnosis was established based on the presence of typical CD changes in the upper gastrointestinal tract and the development of severe anal-perianal complications and sacroiliitis.

Conclusion. Features typical for CD, such as relative or absolute integrity of the rectum, the presence of unaffected segments, and involvement of the ileum in the pathological process, can also be found in UC, especially in patients who have undergone treatment. The role of the pathologist is to determine the extent and severity of the disease, and to identify dysplasia or malignant transformation.

Aging is a systemic process affecting all tissues of the body. In this study, the choice of scientific interest fell on the paired gland, the key structure of the female reproductive system – the ovary.

Objective: to carry out a comparative analysis of the parameters of the thickness of the cerebral and cortical layers, as well as the protein membrane of the  ovaries  in women in adolescence,  the elderly and senile  age. 

Materials and methods. The analysis of the results of a study of 60 women with normal pelvic dimensions and without pathology of the reproductive system organs was carried out. Group I included 28 victims of adolescent age (16-20 years old), group II consisted of 29 elderly victims (56-74 years old), group III included 27 elderly victims (75-90 years old). The thickness of the cerebral and cortical layers, as well as the albumen of both ovaries, were determined in histological samples.

Results. A decrease in the thickness of the cortical and medulla and an increase in the thickness parameters of the albuminous membrane of both ovaries in the period from adolescence to old age were revealed. The thickness of the medulla of the right ovary is thinned by 3.76%, the left by 4.46%; the cortical substance of the right ovary by 29.9%, the left by 29.64% (p < 0,01). The thickness of the albumen of the right ovary, on the contrary, increases by 48.23%, of the left – by 50.21% (p <  0,01). From old age to senile age, there is a tendency to decrease the thickness of the cerebral and cortical matter of the ovary. The medulla is thinned by 0.95% on the right and 0.24% on the left (p > 0,05), the cortical substance – by 1.5% on the right and 1.21% on the left (p > 0,05). At the same time, the protein shell on the right becomes thicker by 14.08%, on the left – by  13.57% (p  < 0,01). 

Conclusion. The results obtained can become a conditional  "morphological standard" for certain age norms in the diagnosis of various diseases, as well as expand the understanding of changes in the morphological picture of a woman's ovaries with age.

Leiomyomatosis is a rare tumor of smooth muscle cells with uncertain malignant potential. The available literature describes mainly cases of leiomyomatosis of the uterine body, lungs, vessels, and peritoneum. There are data on isolated cases of cervical leiomyomatosis. Most often, leiomyomatosis is asymptomatic, however, there are localizations with the development of such clinical manifestations as infertility or respiratory failure. A clinical observation of a 61-year-old patient who was diagnosed with endometrioid carcinoma, for which videoendoscopic extirpation of the uterus with appendages was performed, is presented. During the examination of the surgical material, cervical leiomyomatosis was diagnosed in the cervix. This case is of interest due to the rarity of this pathology and the complexity of its diagnosis.

Purpose: To conduct a clinical and morphological analysis of the case of death as a result of sepsis, the cause of which was Brody's abscess.

Material and methods. An analysis of the fatal outcome of a 54–year-old patient who occurred in a hospital of a medical organization where he received medical care for a disease – a new coronavirus infection. The complex of clinical, laboratory and instrumental diagnostic methods could not explain the progressive deterioration of the severity of the patient's condition and the onset of death.

Results. During the autopsy, an abscess of the proximal epiphysis of the left humerus was found with the spread of the inflammatory process to the soft tissues of the breast, the parietal pleura with the development of purulent fibrinous pleurisy, left-sided pneumonia, purulent fibrinous pericarditis, hematogenous purulent meningitis.

Conclusion. The authors of the article have established a causal cause of death from Brody's abscess, which makes it possible to expand the diagnostic search in the case of sepsis with an unclear primary focus.

Relevance. In the last decade, preoperative rehabilitation has attracted considerable attention from both domestic and foreign specialists, however, its effectiveness and impact on the early recovery of patients with osteoarthritis of the knee joint after primary arthroplasty causes many contradictions and remains controversial.

Objective. To analyze the scientific literature and evaluate the results, potential advantages and disadvantages of using available and modern methods of preoperative rehabilitation in preparation for primary arthroplasty in patients with osteoarthritis of the knee joint.

Materials and methods. In the course of this study, data was searched using Scopus, Web of Sciеnce, Pubmed, and RSCI databases for the period from 2009 to 2024.

Results. As a result of the analysis, the key methods of preoperative rehabilitation used during the preparation for total knee arthroplasty were identified, and the effect of these methods on the restoration of functional parameters in patients, changes in pain and the duration of hospital stay after surgery was studied in comparison with the standard program of preparation for total knee arthroplasty.

Conclusion. During the study, it was revealed that preoperative rehabilitation before total knee replacement can significantly reduce the duration of hospital stay, however, convincing evidence of improvement in postoperative functional parameters has not been established. To determine the real effectiveness of preoperative rehabilitation, clinical studies are needed to study the effect of comprehensive preoperative rehabilitation programs on the pathogenetic aspects of osteoarthritis, clinical symptoms and functional parameters in the postoperative period.

Relevance. Liver trauma is one of the most common abdominal injuries. The purpose is to review the evidence and present the current level of diagnosis, tactics and treatment of blunt liver trauma.

Materials and methods. The results of clinical studies in liver trauma have been analyzed. Literature was searched in PubMed electronic search engines (https://pubmed.ncbi.nlm.nih.gov), eLibrary (https://elibrary.ru) by keywords: "liver trauma", "management liver trauma", "diagnosis liver trauma". 134 publications were selected for analysis.

Results. Historically, most patients with liver trauma were cured promptly using techniques such as liver suturing, liver resection, ligation of the hepatic artery, atrioval shunts. Conservative management was practically not used. Consequently, mortality was high and reached almost 90% in patients with severe trauma, including damage to the main hepatic vessels. The introduction of such techniques as perigepathic packaging and direct suturing of damaged vessels significantly improved the prognosis of patients. The widespread use of conservative therapy in patients with stable hemodynamics, the management of which is based on instrumental assessment, carefully selected diagnostic imaging of the nature of liver injury, instrumental dynamic observation using operative X-ray angiology and endoscopy, in a hybrid operating room, contributed to the improvement of treatment results.

Conclusion. In recent decades, conservative therapy has been performed in 80–86% of cases in patients with stable hemodynamics. The use of minimally invasive interventions such as angiography and embolization, a combination of percutaneous drainage and endoscopic methods for injury to vascular and biliary structures can be considered as the main method of treating post-traumatic complications.

Relevance. The problem of tissue regeneration in diabetic foot syndrome has currently become particularly relevant due to the multipolarity of the mechanisms of trophic disorders, their tendency to recur, the expansion of the affected areas when using traditional treatment methods, resistance to drug treatment methods, deterioration of patients' quality of life, as well as due to the significant expenditure of time and effort required for treatment. All these factors lead to significant economic costs in the management of patients in this cohort.

The aim of the study: to develop new combined methods of surgical treatment of tissue defects in patients with complicated forms of diabetic foot syndrome.

Materials and methods. The paper presents an original approach to solving one of the urgent problems of modern surgery of complications of diabetes mellitus, to the treatment of pathological processes of soft tissues of the lower extremities.

Conclusions. At the stages of the entire study period, rapid wound healing was registered regardless of the initial clinical data and patient's medical history. There was also a decrease in the inflammatory response and active restoration of damaged tissues.

Aim: to evaluate the effectiveness of using virtual reality to restore motor function in patients in the acute period of ischemic stroke.

Material and methods. We studied 207 patients in the acute period of ischemic stroke, who were divided into two groups by randomization: study group – 105 patients, comparison group – 102 patients. All patients received all necessary standardized therapy. Patients in the study group additionally received classes using the ReviVR device. Efficacy was assessed using the NIHSS, FMA-LE, and BBS scales.

Results. On all scales studied, patients in the study group demonstrated better results in relation to the comparison group, both in terms of the final result and in terms of the level of change in indicators during the rehabilitation process. The use of virtual reality made it possible to reduce disability on the NIHSS scale to 7.0 (4.0; 9.0) points, which is better than the results of the comparison group – 9.0 (5.0; 13.0) points with a high level of significance p < 0.001. The increase in motor function according to FMA-LE in the study group was higher and amounted to 21.0 (15.0; 24.0) points versus 18.0 (7.0; 22.0) points in the comparison group with a significance level of p = 0.002. The study group also showed better results on the BBS scale – 26.0 (17.0; 34.0) versus 18.0 (5.0; 29.0) points with a significance level of p < 0.001.

Conclusion. The use of virtual reality together with standardized therapy in the acute period of ischemic stroke is effective in restoring motor function of the affected lower limb, improving balance and reducing general disability in general.

Topicality. One of the risk factors for the progression of the fibrotic process in the liver in triple superinfection with HIV/HBV/HCV may be the order of entry of viral pathogens into the human body, as well as the time interval between the entry of different pathogens. The aim of the study was to assess the effect on the course of liver fibrosis in HIV/HBV/HCV superinfection of the sequence of pathogens entering the human body and the time between superinfection.

Materials and methods. 97 people with a verified diagnosis of HIV/HBV/HCV superinfection were subjected to a retrospective analysis depending on the timing of pathogen intake, the severity of liver fibrosis and antiviral therapy. Among the examined, 80% were men. The age category of 18-44 years included 84% and the remaining patients were in the category of 45–49 years. All patients received antiviral therapy. Liver fibrosis was assessed using dynamic liver elastography.

Outcomes. The most favorable from the point of view of the progression of liver fibrosis was the primary HIV infection with an interval of 1–5 years between infection with hepatitis B and C viruses. The predominance of the progressive course of the fibrotic process in the liver occurred in cases where the first pathogen was HBV, and the interval between superinfection with another virus (HIV, HCV) exceeded 10 years. In cases not included in this category of patients, a HCV viral load above 1,700,000 copies/ml may be a risk factor for triple superinfection.

Findings. 1. In HIV/HBV/HCV superinfection, a high risk of progressive liver fibrosis is associated with situations when: the first superinfecting pathogen is HIV at an interval of 1–5 years before superinfection with hepatitis B and/or C viruses; the first superinfecting pathogen is HBV with an interval of more than 10 years prior to HIV and/or HCV superinfection. 2. In HIV/HBV/HCV superinfection, in the absence of a priority for superinfection, a HCV viral load of more than 1700000 copies/ml may be a risk factor for advanced liver fibrosis. A rational regimen for antiretroviral therapy in triple superinfection with HIV/HBV/HCV is a combination of nucleotide inhibitors of HIV and HBV reverse transcriptase and HIV protease inhibitors.

Chronic viral hepatitis B (CHB) is a significant global health problem. The biological characteristics of the hepatitis B virus, which causes this disease, significantly impede the achievement of complete virus elimination in most patients. In this regard, the rational choice of drugs and antiviral therapy regimens is crucial for increasing life expectancy and improving the quality of life in patients with CHB. The purpose of this literature review is to identify current approaches and trends in etiotropic therapy for CHB.

Materials and methods. The review uses data published in domestic and foreign scientific journals, clinical guidelines, regulatory documents, and Internet resources.

Results. Currently, the most effective means of etiotropic therapy for CHB are interferons (standard interferon alpha, pegylated interferons alpha-2a and alpha-2b), as well as first-line nucleoside/nucleotide analogs (entecavir, tenofovir) and second-line analogs (lamivudine, telbivudine, adefovir). The choice of a specific drug is determined by the patient's clinical condition, preferences, availability, and cost of treatment. Despite certain limitations of current etiotropic therapies for CHB, their use can significantly increase patients' life expectancy and improve their quality of life.

Epidural pneumocysts are a rare but significant cause of severe low back pain in patients. A clinical case of diagnosis and treatment of this disease, which often remains poorly studied in the literature, is presented. It should be noted that descriptions of nerve root compression by a gas bubble are found in both domestic and foreign publications, but they are rare, which makes the problem relevant and interesting for the medical community.

An observation from practice is given tuberculous constrictive pericarditis, which has been occurring for a long time with symptoms of polyserositis without identifying of etiology. The recurrent course of the disease, the constant accumulation of effusion in the abdominal and pleural cavities was the basis for the diagnosis: "compressive pericarditis complicated by calcification of unknown genesis and of constant patronage of cardiologists. Considering the tuberculous process suffered more than 10 years ago, to exclude the tuberculous etiology of polyserositis, the patient underwent pericardial resection. According to the results of microbiological examination of the surgical material, the tuberculous nature of pericarditis was established, however, according to the results of histological examination, no foci of necrosis and granuloma elements were found. The clinical case demonstrates the complexity of the diagnosis of tuberculous constrictive pericarditis with the phenomena of pronounced polyserositis, which was detected only as a result of diagnostic surgery: partial excision of the pericardium.

This article discusses the etiology of sporadic and hereditary forms of medullary thyroid cancer (MTC), diagnostic criteria that allow the most accurate and accurate diagnosis and differentiate it from similar symptoms, morphological changes in MTC, which is one of the least studied due to the peculiarities of its histogenetic genesis and low frequency of treatment of the population with this a problem. MTC is often diagnosed at the time of planned hospitalization of patients for problems in a related area, but not directly related to thyroid cancer. In this article, clinical manifestations presented in a specific clinical case are investigated, markers of immunohistochemical studies are determined. This case is interesting and unusual for the duration of the patient's treatment, as well as successful surgical interventions that were aimed at removing multiple metastases. To date, the number of referrals from patients with minimal structural and functional changes in the thyroid gland is small, which indicates that the disease is often diagnosed at a later date. In the minds of a certain percentage of the population, the idea of a possible self-healing of the body is firmly fixed, which is often decisive with the progression of the disease (especially with a sharp jump in progress, for example, after a general somatic decrease in the immune response after infectious diseases, hypothermia, radiation exposure). This article is indicative in this matter – it clearly demonstrates the need for timely vigilance and care for the body, timely medical examination of the population and attentive attitude in particular to the thyroid gland.

The article provides a brief overview of the frequency, prevalence of use, and results of video capsule endoscopy in patients with various indications after undergoing CT/MRI enterography or barium sulfate enterography. A clinical case is presented where a patient with symptoms of gastrointestinal bleeding underwent video capsule endoscopy, revealing a small bowel tumor, followed by surgical treatment. This non-invasive technique enables obtaining more accurate data for decision-making regarding further treatment strategies.

The form factor of an ultrasound device with a wireless sensor has become firmly established in the standards for equipping medical institutions in recent years. In the Russian science literature there is a limited number of works on the practical application of such systems and a description of their advantages and disadvantages. It is important to evaluate the capabilities of a wireless ultrasound device in diagnosing urgent conditions.

Purpose of the study: to compare the effectiveness, advantages and ease of use of wireless ultrasound diagnostic sensors in relation to stationary devices. A comparative analysis of the wireless ultrasonic sensor "Uprobe-C5PL" (Sonostar, China) with stationary devices "DC-70" (Mindray, China), "CX-50" (Philips, Netherlands), "Logic E9" (GE, USA). A total of 40 patients were studied. The comparison was carried out based on the following characteristics: comparison of measured organ sizes, identification of pathological conditions, consistency of results between several medical experts, ergonomic characteristics and ease of use.

Results: there was no statistically significant differences (Mann– Whitney U test with Bonferroni correction, p > 0.05) and a strong correlation (r = 0.99; p < 0.01) between the measured values of organ sizes and pathological structures. The wireless sensor showed the highest diagnostic sensitivity – 91.7% and accuracy – 97.5% in detecting free fluid in the main cavities. A high agreement of results between expert was revealed (Kappa-Cohen coefficient, K = 0.836).

Conclusion. The wireless ultra-sound sensor is not inferior to stationary devices in identifying free fluid and other pathological conditions within the framework of urgent studies. At the same time, the wireless form factor increases ease of use in confined spaces due to the mobility of the diagnostician and the autonomy of the device. When routinely examining a large number of patients, a wireless sensor is less convenient and informative than high-end devices.

Currently, autologous organ transplantation continues to be widely implemented in various countries. Its relevance is due to the large number of patients with diffuse liver damage. Liver autotransplantation is an effective and only radical operation for end-stage diffuse liver lesions, such as alveococcosis, cholangiocellular carcinoma and metastatic liver cancer.

Purpose of the study. To evaluate the results of the clinical implementation of liver autotransplantation technologies in the State Autonomous Healthcare Institution of the Republican Clinical Hospital.

Materials and methods. Since 2023, 4 operations for liver autotransplantation have been performed in the State Autonomous Healthcare Institution of the Russian Clinical Hospital. One patient was selected to describe the clinical case.

Research results. The operation for autologous liver transplantation in a patient with alveococcosis of the left lobe of the liver was performed successfully on December 4, 2023. On day 45, the patient was discharged for outpatient observation in satisfactory condition.

Conclusion. The complexity of liver transplantation and resection due to the lack of donor organs and the high risk of rejection forces the introduction of new, more effective methods, one of which is liver autotransplantation, which does not require immunosuppressive therapy, which reduces the risk of developing purulent-inflammatory complications in the postoperative period.

Relevance. The education system plays a crucial role in the formation of professional orientation in the learning process. The digital transformation of education has become an integral part of the development of our society. One of the effective tools in the context of the activation of digital didactics to improve the quality of educational services is the introduction of modern distance learning technologies.

Aim. Creation of a multimedia electronic manual dedicated to teaching the discipline "Propaedeutics of internal diseases" on the topic "Thermometry".

Materials and methods. The multimedia electronic manual "Thermometry" developed at the Propaedeutic Therapy Department in Samara State Medical University contains theoretical material on the methodology and technique of measuring body temperature. The manual provides illustrative material with illustrations and description of the main types of fevers, describes the grades of fever, provides a detailed description of the rules for the registration of a temperature chart and provides an example of a filled temperature chart. The presented multimedia electronic manual contains a set of tests and clinical cases for self-monitoring of students' knowledge with references.

Conclusion. The multimedia electronic manual "Thermometry" developed at Samara State Medical University can increase the efficiency of learning the material, which will help to improve the formation of professional competencies among students, while examining patients of various profiles, making correct diagnosis and management strategy.