№4, 2025, volume 21

Objective: to evaluate the dynamics of intestinal wall perfusion in adhesive acute intestinal obstruction and to determine the critical period of reversibility of ischemic changes. Material and methods. The study was performed in 50 rats in an acute experimental setting. Chronic adhesive disease was induced 30 days prior to the main experiment. Animals were divided into a control group (laparotomy without adhesions) and four experimental groups with adhesive disease: sham group (without obstruction), group A (strangulation for 1 hour), group B (24 hours), and group C (48 hours). Microcirculation was measured using non-contact laser Doppler flowmetry with vibration noise suppression; the M1 parameter (first spectral moment reflecting blood flow intensity, TPU) was evaluated. Statistical analysis was performed using STATISTICA 10.0 with parametric and non-parametric tests. Results. Peritoneal adhesions were found to reduce basal perfusion by 10.5% (0.95±0.05 vs 0.85±0.06 TPU; p=0.0256). Initiation of strangulation resulted in a sharp decrease in M1 by approximately three-fold within the first 10 minutes (to 0.34±0.09 TPU). Perfusion recovery after obstruction resolution depended on ischemia duration: at 1 hour, 68% of baseline level was recovered; at 24 hours, 24%; at 48 hours, no recovery was observed (p=0.567), indicating development of the irreversible "no-reflow" phenomenon. Conclusion. After strangulation, perfusion levels progressively decreased until the development of "biological zero" of microcirculation. The critical period of ischemia reversibility in adhesive strangulation is in the range of 24–48 hours.

Objective: to present the results of intravitreal application of the new anti-Ang-2 and anti-VEGF-A drug faricimab in the treatment of neovascular age-related macular degeneration (AMD) using three clinical cases. Patients with newly diagnosed neovascular AMD received intravitreal faricimab (Vabismo) at a dose of 6 mg (0.05 ml of solution) every 4 weeks in the amount of 4 "loading" injections, further tactics depended on the dynamics and activity of the disease. The use of faricimab in the treatment of neovascular AMD is due to its effect on two mechanisms of pathogenesis: faricimab independently binds and neutralizes both angiopoietin-2 (stabilizes blood vessels, reduces vascular permeability and reduces inflammation) and VEGF-A (reduces vascular permeability and inhibits neovascularization). In the cases we considered the use of faricimab in clinical practice for the treatment of neovascular AMD has demonstrated high efficacy, long-term stabilization of the achieved results, and the absence of adverse events.

Objective: to evaluate the effectiveness of the original method of calcaneal osteotomy in treatment of pes planovalgus severe forms in children. Material and methods. The study included 90 patients with flat feet (mean age was 11,5±0,7 years). The 50 children of a similar age without static foot deformities were the comparison group. The patients of the experimental group were operated by using the modified method of treatment pes planovalgus, which includes interfacet osteotomy of the calcaneus with simultaneous correction of the soft-tissue component of the deformity. The postoperative follow-up period was 1,1±0,8 years. The effectiveness of the method was analyzed by use a clinical and instrumental score scale developed specifically for this pathology. Results. Complex clinical and instrumental assessment showed excellent results in 74,7% cases, good – 16,5%, fair – 8,2% and poor – in one child (0,6%). Conclusion. The use of the interfacet osteotomy of the calcaneus in the author's modification provides the best conditions for achieving good anatomical and functional results in treatment of the severe pes planovalgus in children.

A rare clinical case of recurrent laryngopharyngeal fibromyxoma detected 24 months after primary resection is presented. Histologically confirmed tumor recurrence was accompanied by symptoms of upper airway obstruction and phonation and swallowing disorders. Observation emphasizes the exceptional rarity of this localization and the tendency of fibromyx to relapse, which requires a radical surgical approach and long-term oncological monitoring. There is a need for increased alertness of otorhinolaryngologists and oncologists due to the risk of malignancy, even histologically benign mixes with their atypical localization.

The clinical picture and diagnostic features of bettolepsy are described. The development of this condition in middle-aged men with excess body weight and chronic obstructive pulmonary disease is typical. A special feature of the clinical case under consideration was the combination of cough syncope with cicatricial-granulation stenosis of the upper third of the trachea, which complicated the diagnostic search.

Objective: to determine the efectiveness of dynamic electrical stimulation on the functional state of the masticatory muscles in patients with temporomandibular joint pain dysfunction syndrome. Material and methods. The study involved 60 people aged 25 to 60 years with temporomandibular joint pain dysfunction syndrome, who were divided into two groups of 30 people. Patients of the frst group underwent dynamic electrical nerve stimulation in the area of pain complaints, and patients of the second group also in the projection of the trigeminal nerve exit on the face. Elec-tromyographic examination of the masticatory muscles and completion of the McGill pain questionnaire as modifed by V.V. Kuzmenko et al. before and after exposure to dynamic electrical nerve stimulation were performed by all patients. Results. All patients showed a signifcant improvement in the condition of the masticatory and temporal muscles according to electromyography p<0.001 in all measurements, the inclusion of additional zones did not afect the improvement in the condition. According to the pain questionnaire, the treatment results improved in both groups (p<0.001), M±m=10.7±0.89 points and M±m=5.87±0.81 points before and after treatment in the group1, M±m=10.83±0.86 and M±m=5.73±0.65 points before and after treatment in the group 2. When comparing results between groups, there were no signifcant diferences. Conclusion. Dynamic electrical neurostimulation has a positive clinical efect on the functional state of the masticatory and temporal muscles after just one session.