Vol 7, №1

Objective: To evaluate and compare the effectiveness of two methods of surgical treatment of hernias of the anterior abdominal wall – traditional hernioplasty with tissue tension and modern minimally invasive eTER- (endoscopic total extraperitoneal) hernioplasty.
Materials and Methods: The study included 60 patients with anterior abdominal wall hernias undergoing surgical treatment, of whom 38 (63.3%) were men and 22 (36.7%) were women. The average age of men was 50.2±11.3 years, while the average age of women was 48.1±9.6 years. All patients were randomized into two equal groups of 30 patients each. One group underwent traditional hernia repair, while the other underwent the eTEP procedure.
Results: Over 93% of patients who underwent eTEP hernioplasty reported a high level of satisfaction with the treatment results: painlessness, cosmetic results, and rapid recovery. In the traditional hernioplasty group, this figure was 70%. In Group 1, postoperative complications occurred in 8 patients (26.7%), including seromas, infiltrates, and local inflammatory reactions; in Group 2, they occurred in 2 patients (6.7%). During 6 months of observation, relapse was recorded in 5 patients (16.7%) in group 1, and in one case (3.3%) in group 2. Pain on the third day (as measured by the visual analog scale, VAS) was 1.7 times greater in patients in Group 1 (5.1 vs. 2.9, p<0.01). In Group 2, pain lasted an average of 3 days less (p<0.01). The recurrence rate in Group 1 was 20%, while in Group 2 this rate decreased to 3%, with a significant improvement in the blood flow to the anterior abdominal wall.
Conclusion: The study results convincingly demonstrate the high efficacy and safety of eTEP hernia repair compared to traditional methods for treating anterior abdominal wall hernias in elderly patients. eTEP hernia repair is characterized by fewer complications, a low recurrence rate, faster recovery, and significantly reduced postoperative pain.

Objective: Optimization of diagnostic methods and adequate selection of corrective surgical interventions for disorders of duodenal patency of the duodenum with combined complications of peptic ulcer disease.
Material and Methods: The examination and treatment results of 132 patients with ulcerative colitis and chronic duodenal ulcers (CDPU) were analyzed. A direct correlation was established between the duration of the ulcer history and the incidence of CDPU manifestations: the largest group of patients (46.9%) had a disease history of over 15 years. The diagnostic search was based on a comprehensive approach, including the assessment of clinical markers (the presence of bile in the stomach during FGDS – 94.8% of cases) and a step-by-step radiographic diagnostics: routine fluoroscopy of the stomach and duodenum; probe duodenography (under hypotension and without relaxation).
Results: Surgical tactics were determined based on a comprehensive intraoperative signs and a scoring assessment of the morphofunctional state of the gastroduodenal complex (according to N.A. Nikitin). In 20.5% of patients with compensated functional chronic duodenal ulcer disease, standard interventions (SPV, duodenolysis, Hofmeister-Finsterer resection) were deemed sufficient. In the remaining 79.5% of cases, the severity of duodenostasis required specialized corrective techniques: Strong’s procedure, duodenojejunostomy (DJ), or duodenal exclusion by Roux-en-Y gastrectomy. The overall postoperative complication rate was 15.2%. The complication rate depended on the type of primary intervention: With maintained duodenal passage (n=59), postvagotomy gastrostasis (5.1%) and early afferent loop syndrome (3.4%) were the most common complications. With duodenal exclusion (n=73), specific complications included Roux-en-Y stasis syndrome (4.1%) and anastomositis (4.1%).
Conclusion: Optimization of surgical tactics for comorbid duodenal ulcers and chronic duodenal ulcers is based on a multifactorial analysis of the pathogenesis of both diseases, their stages, and the severity of functional disorders. A comprehensive analysis of our clinical data indicates a shift toward individualized interventions with a focus on organ-preserving technologies, which significantly reduces the incidence of postoperative complications.

Objective: A comprehensive analysis of factors influencing the choice of surgical tactics in the correction of early complications after laparoscopic cholecystectomy.
Materials and Methods: Between 2015 and 2025, data from 70 patients who underwent laparoscopic cholecystectomy and presented with signs of early postoperative complications were analyzed. Of these, 24 (34.3%) were men and 46 (65.7%) were women. The study group included 40 patients in whom complications were corrected using relaparoscopic surgery and modern laparoscopic instruments. The control group included 30 patients who underwent traditional treatment using open surgery and conservative therapy.
Results: Relaparoscopy resulted in clinical recovery in 95% of patients in the study group, shortening the duration of hospitalization and the inflammatory response. The most common complications were: bile leakage (14 cases, or 20%), abscesses and infiltrates (9 cases, or 12.8%), bile peritonitis (7 cases, or 10%), and intra-abdominal bleeding (6 cases, or 8.6%). Dynamic monitoring of liver biochemical parameters (ALT, AST, bilirubin) and inflammatory markers (GGT, interleukin-6, D-dimer, procalcitonin) showed statistically significant improvement in patients in the study group as early as 3–5 days after relaparoscopy, while in the control group, changes were less pronounced and delayed. A direct relationship was established between the level of intraoperative complexity according to the Cuschieri scale and the frequency of postoperative complications: with low complexity, complications were observed in only 16.6% of cases, while with high complexity, their frequency reached 88.5%.
Conclusion: Early diagnosis of complications based on clinical observation, ultrasound, and laboratory parameters significantly reduces the risk of severe complications. Relaparoscopy is the preferred method for correcting most early complications after laparoscopic cholecystectomy due to its high efficacy, safety, and minimal invasiveness. The use of the Cuschieri intraoperative complexity scale allows for an objective assessment of the risk of complications and the prognosis of the postoperative course.

Objective: To determine clinical and echocardiographic predictors of myocardial ischemia in non-obstructive coronary arteries (INOCA) in patients with stable angina/ischemia equivalents.
Materials and Methods: The study was conducted between January 2025 and January 2026 inclusive among 100 patients with stable angina or ischemic equivalents. The average patient age was 61.22±10.24 years, and 53% were women (n=53). The average body mass index was 28.90±3.99 kg/m². Based on the results of coronary angiography, patients were divided into three groups: with obstructive coronary artery disease (CAD), with INOCA, and with intact coronary arteries.
Results: The INOCA phenotype (n=40) was characterized by a higher proportion of women (OR 3.95; 95% CI 1.50–10.42), a lower pre-test probability of obstructive CAD (46.04±14.76% vs. 64.28±10.87%, p<0.001), a higher LV ejection fraction (63.01±4.02% vs. 58.16±5.02%, p<0.001), preserved left ventricular systolic function, and a tendency toward more pronounced signs of diastolic dysfunction. A positive response to nitroglycerin was less common (OR 0.36; 95% CI 0.14–0.95) than in obstructive CAD. The most favorable echocardiographic profile was observed in the group of intact coronary arteries. This confirms the distinction between “non-obstructive ischemia” (INOCA) and no coronary pathology. Patients with intact coronary arteries (n=25) compared with the obstructive CAD group (n=35) were younger (54.52±12.41 vs. 66.49±7.16 years; p<0.001) and had a lower body mass index (BMI) (26.95±3.54 vs. 29.01±3.04 kg/m²; p=0.023). The pre-test probability of obstructive CAD in the intact arteries group was significantly lower (24.18±8.37% vs. 64.28±10.87%; p<0.001).
Conclusion: A combination of clinical data, standard echocardiography, and nitrate testing can be used for pre-coronary angiography stratification of INOCA probability and optimization of patient management in the presence of persistent symptoms. It is also important to consider functional verification of the ischemic mechanism for subsequent mechanism-based patient management.

Objective: To study patients’ adherence to drug therapy after recurrent myocardial infarction and evaluate its impact on the incidence of cardiovascular events.
Materials and Methods: A prospective study included 53 patients discharged after recurrent myocardial infarction (RMI). Follow-up was conducted for 12 months, assessing adherence at 1, 3, 6, and 12 months across five classes of medications: acetylsalicylic acid, P2Y12 inhibitors, statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE inhibitors/ARBs), and beta-blockers.
Results: At discharge, all patients received acetylsalicylic acid, P2Y12 inhibitors, and statins. 92.5% took ACE inhibitors/ARBs, 94.3% – β-blockers. After 12 months, the proportion of patients taking 4-5 classes of drugs decreased from 81.1% to 35.8% (p < 0.001). The most pronounced decrease was noted for P2Y12 inhibitors (from 100% to 34.0%), β-blockers (from 94.3% to 47.2%), and ACE inhibitors/ARBs (from 92.5% to 50.9%). The MACE rate in the low/partial adherence group (grades 0–3 at month 6) was 3.3 times higher than in the high adherence group (40.0% vs. 12.1%; p=0.018; OR=3.30; 95% CI 1.14–9.58). Factors that reduced adherence included age 70 years and older (p=0.022), rural residence (p=0.022), financial difficulties (p<0.001), and lack of relatives’ support (p=0.008).
Conclusion: In patients following a recurrent myocardial infarction, adherence to drug therapy declines during the first year. This is particularly noticeable with regard to the second antiplatelet agent and neurohormonal modulators. Poor adherence increases the risk of adverse outcomes threefold. The identified sociodemographic factors indicate the need to develop targeted support programs to improve the effectiveness of secondary prevention.

Objective: To assess the clinical and demographic features, the structure of organ and cardiovascular involvement, as well as the nature of therapy and disease activity dynamics in patients with systemic lupus erythematosus (SLE) at the hospital stage.
Materials and Methods: A retrospective analysis of 137 case histories of patients with systemic lupus erythematosus (SLE) was conducted. They were hospitalized in the rheumatology departments of the Shifobakhsh National Medical Center of the Republic of Tajikistan (Dushanbe) and the Sughd Regional Clinical Hospital named after S. Kutfidinov (Khujand) between 2021 and 2024. The diagnosis was verified according to the current classification criteria of ACR 1997, SLICC 2012, and/or EULAR/ACR 2019.
Results: The majority of patients were women of reproductive age (90.5%, median age 36.7 years), with a female-to-male ratio of 9.5:1. Most patients had multiple organ involvement at presentation: 59.1% were diagnosed with lupus nephritis, and 68.6% had hematological disorders. The prevalence of arterial hypertension and dyslipidemia reached 56.9% and 36.5%, respectively, and 6.6% had already suffered a stroke or myocardial infarction. Factors associated with cardiovascular complications in systemic lupus erythematosus were identified: older age, disease duration greater than 5 years, lupus nephritis, antiphospholipid antibodies, persistent lupus activity (SLEDAI ≥ 6), overweight, and dyslipidemia. Despite a decrease in the median SLEDAI-2K score from 14 to 7 points during hospital therapy, only 33.6% of patients achieved the target (SLEDAI ≤ 5).
Conclusion: Systemic lupus erythematosus (SLE) in hospitalized patients presents with a high incidence of multiorgan damage and significant cardiovascular and comorbid burden. The identified clinical and metabolic factors indicate the need for early risk assessment and more aggressive cardioprotective strategies.

Objective: To study the features of ventricular electrical systole parameters (Q-T interval duration and dispersion) in elderly patients with arterial hypertension (AH) and comorbid cardiac pathologies.
Materials and Methods: For the study, the cohort of participants was divided into two groups. The first group consisted of 40 healthy young and elderly individuals, 20 in each. The second group included 126 elderly patients (60–74 years old), who were further divided into three subgroups: those with stage II–III hypertension (n=42), those with AH and coronary heart disease (CHD) (n=44), and those with AH and chronic heart failure (CHF) (n=40).
Results: In patients with hypertension, the Q-T interval was increased by 1.2 times compared to apparently healthy elderly individuals (470.1 ms versus 388.4 ms). The corrected Q-Tc interval was 1.3 times higher (537.4 ms versus 426.5 ms). In patients with hypertension and coronary artery disease or with hypertension and heart failure, the Q-T interval was increased by 26.2 ms (from 470.1 to 496.3 ms) compared to those with hypertension alone. The corrected Q-Tc interval also increased by 28.8 ms (566.2 ms versus 537.4 ms). In patients with hypertension and CHF, the Q-T interval was statistically significantly longer by 56.3 ms (526.4 vs. 470.1 ms) than in patients with hypertension and coronary artery disease. Analysis of the corrected Q-T interval also showed a significant increase of 70.8 ms in patients with hypertension and CHF (608.2 vs. 537.4 ms).
Conclusion: Increased Q-Tc dispersion in elderly patients with hypertension and chronic heart failure indicates myocardial electrical instability. This condition is associated with an increased risk of ventricular arrhythmias and sudden cardiac death.

Objective: To analyze the comparative results of nephrectomy indicators in cases of severe and mild paranephritis, without pyonephrosis and nephroureterectomy, depending on the nosology and type of kidney damage (benign diseases, space-occupying lesions, donor kidneys).
Materials and Methods: An analysis of 803 case histories of patients who underwent nephrectomy using various methods was conducted. The effectiveness of these methods was also assessed depending on the clinical situation.
Results: Surgical success rates in patients with severe paranephritis were worse than in patients with mild paranephritis. In the group of patients who underwent nephrectomy without regard to pyonephrosis or nephroureterectomy, we found no significant differences in outcomes across all groups. Nephrectomy outcomes for donor nephrectomy were statistically more favorable than those for nephrectomy for benign kidney disease and neoplasms (except for surgical duration). Nephrectomy for renal neoplasms, compared with nephrectomy for benign diseases, had advantages in the following indicators: the length of the incision for kidney removal (on average by 3.6 cm, p<0.0001), the volume of blood loss (on average by 46.8 ml, p<0.0001), stay in intensive care (p<0.0001), the consumption of narcotic analgesics (p<0.0001), complications after surgery (p<0.0006) and the number of hospital days after surgery (p<0.0001). In the retroperitoneoscopic donor nephrectomy group, age (by an average of 6.8 years; p=0.0053), weight (by an average of 5.4 kg; p=0.0282) and height (by an average of 4.7 cm; p=0.0230) differed statistically significantly compared to the laparoscopic access group.
Conclusion: The presented scientifically based approach enables specialists performing organ-removal surgeries for various benign and malignant kidney pathologies to effectively diagnose and select the optimal surgical treatment method depending on the specific situation, as well as the clinic’s capabilities.

Objective: To study the efficacy and safety of combined cardio-nephroprotective therapy in patients with chronic kidney disease stages 3-4.
Materials and Methods: The prospective study included 158 patients with chronic kidney disease stages C3a–C4, estimated glomerular filtration rate of 15–59 ml/min/1.73 m², type 2 diabetes mellitus and/or chronic heart failure. Participants were divided into two groups: the first (n=79) received sodium-glucose cotransporter-2 inhibitors (SGLT2i): dapagliflozin or empagliflozin 10 mg/day, in combination with atorvastatin 40 mg/day; the second group (n=79) received standard therapy.
Results: In the combination therapy group, the glomerular filtration rate stabilized (Δ +0.9 ml/min/1.73 m²; 95% CI -0.5; 2.3). In the control group, on the contrary, its decrease was observed (Δ -2.3 ml/min/1.73 m²; 95% CI -3.8; -0.8; р=0.014). A decrease in the urine albumin to creatinine ratio by 47.6% (р<0.001) was also recorded. Global longitudinal strain of the myocardium improved: from 15.8% to 17.2% (р<0.001). In the combination therapy group, 73.4% of patients achieved the target low-density lipoprotein cholesterol level of less than 1.8 mmol/L. In the control group, this figure was achieved in only 39.2% of patients (р<0.001). Combination therapy reduced the risk of cardiorenal outcomes by 60% (relative risk 0.40; 95% CI 0.16–0.98; P=0.047) and was characterized by a favorable safety profile without an increase in the incidence of serious adverse events.
Conclusions: The use of SGLT2i in combination with high-intensity statin therapy in patients with chronic kidney disease stages 3-4 has a significant nephro- and cardioprotective effect, promotes effective correction of the lipid profile and has a favorable safety profile.

Objective: To study the efficacy and safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with malignant tumors of the hepatopancreatoduodenal zone and associated peritoneal carcinomatosis.
Materials and Methods: The study included 17 patients with malignant neoplasms of the hepatopancreatoduodenal zone and peritoneal carcinomatosis. From 2021 to 2025, they underwent laparoscopic PIPAC using standard chemotherapy regimens alongside systemic therapy.
Results: All patients underwent 51 PIPAC procedures, an average of three sessions per patient. The majority of participants were men (82.3%), with a mean age of 59 years. ECOG performance status (PEG) of 0-1 was 94.1%. The primary diagnosis was pancreatic cancer in 88.2% of cases. All patients had previously undergone complete cytoreduction. Peritoneal lesions primarily manifested as low to moderate PCI levels, with no lesions larger than 5 cm. The average session duration was 98.6 minutes, blood loss was 110 ml, and hospital stay was 1.85 days; no complications or fatalities were recorded. According to the PRGS scale, after three procedures, a complete pathological response was observed in 29.4% of patients, regression in 35.3%, stabilization in 29.4%, and progression in 5.9%. With ≥2 PIPAC sessions, the pathological response rate reached 90%.
Conclusion: Pressurized intraperitoneal aerosol chemotherapy for patients with peritoneal hepatopancreaticoduodenal carcinomatosis has demonstrated good tolerability, a high pathological response rate, and significant tumor regression. This method is effective as an adjunct to systemic chemotherapy, improving local disease control and increasing patient survival.

Objective: To study changes in the expression of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor 2 (HER2) and the proliferative marker Ki-67 between primary tumors and recurrent/metastatic lesions in patients with breast cancer.
Materials and Methods: A prospective analysis of data from 42 patients with recurrent breast cancer followed at the Russian Cancer Research Center of the Ministry of Health and Social Development of the Republic of Tajikistan (2018–2024) was conducted. All patients underwent immunohistochemistry (IHC) testing of both the primary tumor and the recurrent or metastatic lesion. ER, PR, HER2 status, and Ki-67 levels were compared between paired samples.
Results: The data demonstrated statistically significant discordance in biomarker expression. The proportion of ER-positive tumors decreased from 66.7% to 57.1% (κ=0.569, p<0.001), and PR-positive tumors from 59.5% to 40.5% (κ=0.377, p=0.0014) in relapse. HER2 status did not change significantly: the proportion of HER2-positive tumors was 26.2% versus 28.6% (κ=0.152, p=0.203). The proportion of tumors with high Ki-67 levels increased: 66.7% compared to 69.0% (κ=0.401, p=0.0006). A significant change in molecular subtype (based on ER/PR/HER2) was observed in 23.8% of patients (10 of 42), with the most common transformation being progression from the luminal B (HER2-) subtype to triple-negative cancer.
Conclusion: The study demonstrates that receptor status (ER, PR, HER2) and proliferation level (Ki-67) often change as breast cancer progresses. This biological evolution of the tumor is critical for therapy selection. The results support the need for mandatory biopsy and repeat immunohistochemical testing of recurrent and metastatic lesions. This helps clarify the tumor’s biological characteristics and determine the most effective, personalized treatment.

Objective: To study the nature and frequency of breast cancer recurrence, taking into account the clinical, morphological and molecular biological characteristics of the tumor.
Materials and Methods: A comparative analysis of data from 208 breast cancer patients was conducted, divided into two groups: a study group (104 patients with verified recurrence) and a control group (104 patients with no signs of recurrence over a follow-up period of ≥5 years). The analysis included a detailed examination of parameters such as age, menstrual status, tumor histology, TNM stage, grade of differentiation (G), and molecular subtypes (ER, RP, HER2, and Ki-67).
Results: The average age in the relapse group was 48.7 years, while in the control group it was 50.1 years. In the control group, there was a significant predominance of patients aged 50–59 years (55.8% versus 37.5%; p<0.001). In the relapse group, locally advanced stages (IIIA–IIIC – 66.3%) and metastatic stages (IV – 10.6%) were diagnosed more often. Poorly differentiated tumors were also detected significantly more often (G3: 41.3% versus 14.4%, p<0.001). Analysis of molecular subtypes revealed that aggressive forms of breast cancer were more common in the study group: luminal B HER2-negative (40.4%), HER2+ non-luminal (12.5%), and triple-negative breast cancer (10.6%). In the control group, luminal A subtype predominated (43.3%; p<0.001). Histological tumor type and menopausal status did not independently influence prognosis.
Conclusion: The risk of breast cancer recurrence depends on many factors. The most important are the extent of the disease at advanced stages (III-IV), low cell differentiation (G3), aggressive molecular subtypes (HER2 and triple-negative), and young patient age. These data justify the need for personalized risk stratification to optimize adjuvant therapy strategies.

Objective: To study the adaptive hemodynamic responses of miners from different high-altitude regions of the Tien Shan during long-term work in an ultra-high-altitude mine.
Materials and Methods: The study involved 87 healthy male miners aged 20 to 33. They were divided into four groups based on their initial region of residence (low altitude 760 meters or mid-altitude 1800 meters) and length of service at the Kumtor gold mine (3600–4200 meters).
Results: Analysis of baseline hemodynamic parameters at rest revealed statistically significant differences between the groups in heart rate (HR) and stroke volume (SV) (F(3,83)=8.94, p<0.001) and SV (F(3,83)=4.12, p<0.01). HR in group 3 (natives of mid-mountain areas with long-term experience) was significantly lower than in groups 1 and 4 (p<0.01), and SV in group 3 was significantly higher than in group 4 (p<0.05). Total peripheral vascular resistance (TPVR) in Group 4 was significantly higher than in Group 3 (p<0.05). In low-altitude residents, both new arrivals (Group 4) and those with 3 years of experience (Group 1), the predominant strategy was characterized by tachycardia (both at rest and under exertion), a significant increase in TVR, and a cardiac output dependent primarily on heart rate rather than stroke volume. On the contrary, among those native to the midlands, especially those with long work experience (group 3), a more economical profile was observed: lower HR, higher SV.
Conclusion: The duration of stay in high-altitude conditions is a critically important factor determining the nature of the body’s hemodynamic adaptation to ultra-high-altitude hypoxia during physical exertion.

Objective: To evaluate the thermoregulatory responses of miners in high-altitude quarries in Kyrgyzstan depending on the season, altitude, and the nature of their physical activity.
Materials and Methods: The field study was conducted during the winter and summer seasons at the Kumtor (elevation 4,200 m) and Makmal (elevation 3,000 m) open pit mines. Forty-eight workers participated in the study. The following parameters were measured: body and skin temperature (at seven points), moisture loss, subjective temperature perception, and weather conditions.
Results: It was found that during cold periods, physical exertion leads to a significant decrease in average skin temperature (to 25.16°C) while maintaining a stable body temperature. During the warm season, the differences between these parameters are smoothed out. A regression analysis revealed that the subjective sensation of cold and moisture loss during the winter, particularly at Kumtor, are strongly correlated with air temperature (determination coefficient R²=0.97), wind speed, and physical exertion level.
Conclusion: High-altitude conditions, especially during the cold season, create significant thermal stress on miners, requiring the development of individual work schedules, acclimatization measures, and thermal protection. The study emphasizes the need to consider climate factors in occupational safety and health in the mining industry. This is especially relevant in the context of global climate change.

Objective: To evaluate the hepatoprotective properties of hepacholetol during two-month intoxication with CC14 in white rats.
Materials and Methods: This study is devoted to an experimental investigation of the complex essential oil preparation hepacholetol. To evaluate its hepatoprotective properties, 40 adult mongrel rats weighing 210–230 g were used in the experiments.
Results: The obtained results demonstrate that hepacholetol, administered intragastrically for 2 months at doses of 0.01 and 0.02 g/kg body weight, exhibits effective hepatoprotective properties against the background of carbon tetrachloride intoxication. This is confirmed by improvements in cytolytic syndrome markers (ALT, AST) and cholestasis (ALP), whose activity decreases by 26.3%, 16.6%, and 30%, and by 22.2%, 25.4%, and 34.27%, respectively, compared to control animals. The test product significantly (p≤0.05) reduces cholesterol, bilirubin, and LDL levels, and improves phospholipid and HDL levels. In a comparative analysis, hepacholetol is as effective as the well-known hepatoprotector Carsil, and in some respects, it outperforms it.
Conclusion: Thus, the complex ether-oil agent hepacholetol improves intrahepatic metabolic processes, thereby protecting liver cells from the toxic effects of the hepatotoxic agent carbon tetrachloride, an example of which is a decrease in the activity of markers of cytolytic syndrome, cholestasis and improved lipid and bilirubin metabolism with underlying toxic hepatitis.

Objective: To identify diagnostic difficulties and determine optimal surgical tactics for rare forms of distal duodenal obstruction of tumor origin.
Materials and Methods: The authors describe a clinical case. Patient A., 53, with chronic duodenal obstruction, was observed.
Results: Based on radiographic data from a gastric and duodenal contrast study, a diagnosis of “decompensated arterio-mesenteric duodenal compression syndrome” was made, but the exact cause of the distal duodenal obstruction at the level of the ligament of Treitz was not determined. Only during surgery was the true cause of the disease discovered—a small jejunal tumor in the area of the ligament of Treitz, measuring 3.0 x 2.5 cm. Following an intraoperative rapid biopsy, which revealed adenocarcinoma, a radical tumor resection with lymph node dissection and side-to-side duodenojejunostomy was performed. The postoperative period was uneventful, and the patient was discharged home in satisfactory condition. He is currently under the care of an oncologist and undergoing adjuvant chemotherapy.
Conclusion: Intraoperative finding: the true cause of the distal duodenal obstruction was identified as a small jejunal tumor located in the area of the ligament of Treitz.

Objective: To describe rare clinical cases of congenital vaginal agenesis in sexually active women in urological practice.
Materials and Methods: This retrospective study presents two clinical cases. The first is a 31-year-old patient, S., with congenital vaginal agenesis consistent with Mayer-Rokitansky-Küster-Hauser syndrome. The second is a 19-year-old patient, N., who underwent surgery to create and expand an artificial vagina from a segment of small intestine. Both patients were observed and treated at the Republican Scientific and Clinical Center of Urology.
Results: In clinical practice, extremely rare cases are encountered in which, due to congenital vaginal agenesis, the urethra is used for sexual intercourse. This anatomical adaptation is accompanied by significant urological complications and requires a comprehensive medical approach, including consideration of surgical correction. In the second case, after the formation of an artificial vagina from a segment of the small intestine, dilation was performed, which ensures the achievement of the main functional effect – improving the quality of the woman’s sexual life. Mayer-Rokitansky-Küster-Hauser syndrome (vaginal agenesis, Müllerian agenesis) is a rare congenital anomaly of the Müllerian ducts, characterized by aplasia of the uterus and upper two-thirds of the vagina, while the ovaries, female phenotype, and 46,XX karyotype remain normal. The incidence is 1 case per 4,000–5,000 female births, ranking it second among the most common causes of primary amenorrhea after hypogonadotropic hypogonadism. The etiology of the disease is multifactorial, but genetic factors with an autosomal dominant inheritance pattern predominate. Clinically, the syndrome manifests as primary amenorrhea in adolescents, despite normal puberty and the development of secondary sexual characteristics. The goal of treatment is to create a functional neovagina to solve the problem of absolute uterine factor infertility.
Conclusion: Despite significant advances in this field, important questions remain unresolved, such as etiology and pathogenesis, long-term consequences of immunosuppression after transplantation, and optimization of psychological rehabilitation.

Objective: To study issues of epidemiology, modern diagnostic methods and comprehensive approaches to the treatment of echinococcosis of the brain.
Materials and Methods: The review article analyzed literary sources from the PubMed, Scopus, Web of Science and eLibrary databases, found 752 sources, from which 36 articles were selected during the analysis process, examining the chosen topic, mainly over the past 8 years.
Results: The epidemiological and epizootological situation for echinococcosis in the world remains unfavorable. According to the analysis of scientific literature, the incidence of echinococcosis is recorded in 6-12.8 cases per 100 thousand among the residents of Tajikistan; among the residents of Russia – 0.39-3.0; among the residents of Algeria – 3.4; among the residents of Kuwait – 3.6; among the residents of Kazakhstan – from 5.0 to 6.3; among the residents of Morocco – 6.5-7.8; among the residents of China – 8.7; among the residents of Uzbekistan – from 2.3 to 9.0; among the residents of Jordan – 15; among the residents of Tunisia – 16.5; among the residents of Kyrgyzstan – from 3.6 to 21.2. In Central Asian countries, approximately 58% of the population is at risk of contracting echinococcosis. Cerebral echinococcosis is a rare form of echinococcosis, with an overall incidence ranging from 0.2% to 5.0%. This disease is most commonly diagnosed in children aged 2 to 10 years (21.1%) and in young adults aged 11 to 30 years (54.9%). Computed tomography and magnetic resonance imaging (MRI) are effective in diagnosing cerebral echinococcosis. The standard neurosurgical treatment for cerebral echinococcosis is removal of the cyst with its capsule intact.
Conclusion: Currently, given the likelihood of further spread of the invasion and an increase in the incidence of the disease among people, the issues of timely detection of patients in the early stages of the disease, clinical prognosis, selection of optimal surgical tactics, prevention of postoperative complications and chemotherapy, as well as relapses of the disease and dispensary observation are relevant.

Objective: To investigate the potential of pressurized intraperitoneal aerosol chemotherapy (PIPAC) as a palliative treatment option for patients with peritoneal metastatic disease.
Materials and Methods: This review covers recent advances in the use of PIPAC in the treatment of pancreatic cancer, including the pharmacokinetic characteristics of the method, the drugs used, clinical outcomes and safety profile.
Results: Pancreatic cancer is one of the most aggressive malignancies, making its prognosis poor when it spreads to the peritoneum. Tumor spread to the peritoneum limits the effectiveness of standard therapies and systemic chemotherapy. Therefore, alternative locoregional treatments are needed. PIPAC is an innovative method involving laparoscopic administration of chemotherapy drugs as an aerosol into the abdominal cavity. This allows for increased local drug concentrations and reduced systemic toxicity. The authors emphasize the importance of further prospective studies to clarify indications and optimize treatment protocols, ensuring longer-term disease control with an acceptable toxicity profile.
Conclusion: Pressurized intraperitoneal aerosol chemotherapy holds significant potential for the palliative treatment of pancreatic cancer, particularly when tumors extend into the peritoneum. However, further studies are needed to confirm its efficacy before this method can be implemented into clinical practice. It is also important to develop clear, multidisciplinary protocols for patient selection.

Objective: To analyze the evolution of surgical tactics for liver abscesses, systematize modern indications for various treatment methods, and present the concept of a step-up approach as the safest and most effective strategy.
Materials and Methods: An analysis of literary sources on the topic of surgical tactics for liver abscesses was conducted from the PubMed, Cochrane Library, eLibrary and CyberLeninka databases for the period from 2020 to 2026.
Results: Modern meta-analyses demonstrate the high efficacy of percutaneous catheter drainage (PCD), reaching 91.3%. This exceeds the results of needle aspiration, which reach 88.2%. PCD promotes faster clinical improvement, an average of 1.9 days, and significantly reduces the recurrence rate over six months (relative risk 0.44). An analysis of national databases revealed the following rates of use of various treatment methods: CCD – 38.8%, needle aspiration – 13.5%, open surgery – 6.7%, and 35.3% of patients receiving drug therapy alone. Mortality in modern studies has been reduced to 3.3%. A step-up approach is actively used, according to which treatment begins with the least invasive methods. Open surgery is performed only if these are ineffective.
Conclusion: The current treatment strategy for liver abscesses is based on the use of minimally invasive techniques, among which catheter drainage has proven superior to needle aspiration. This staged approach minimizes surgical invasiveness and reduces complication rates and mortality. Further advances are driven by improved navigation technologies, consideration of antibiotic resistance, and individualized treatment strategies.

Objective: To explore current diagnostic and risk stratification methods, as well as treatment strategies, including drug and radiofrequency ablation, in Wolff-Parkinson-White syndrome.
Materials and Methods: This literature review included articles published in international databases (PubMed, Scopus, Web of Science, eLIBRARY), primarily over the past ten years, devoted to the diagnosis, risk stratification, and treatment of Wolff-Parkinson-White syndrome. Particular attention was paid to the challenges of managing patients with multiple accessory pathways and the limitations of noninvasive risk assessment methods.
Results: Wolff-Parkinson-White syndrome is a congenital electrophysiological disorder caused by the presence of accessory atrioventricular connections. These abnormal pathways can cause supraventricular tachyarrhythmias, primarily atrioventricular reciprocating tachycardia, and in some cases, atrial fibrillation with a high risk of sudden cardiac death. Patients with associated congenital heart defects and genetic syndromes, for whom the risk of life-threatening arrhythmias is significantly higher, deserve special attention. Further genetic research, improved mapping and ablation methods, and the development of clinical guidelines tailored to individual risk will contribute to improved treatment outcomes for this patient population.
Conclusion: Wolff-Parkinson-White syndrome is a well-studied but clinically diverse pathology that requires an individualized approach. In the century since its first description, our understanding of the disease’s mechanisms has significantly improved, and the introduction of catheter ablation has radically altered the prognosis. However, unresolved issues remain: the management of asymptomatic patients, the prognostic value of non-invasive tests, and the optimal treatment strategy for multiple accessory atrioventricular connections.