Relevance. Benign prostatic hyperplasia remains one of the most common urological diseases and a leading cause of lower urinary tract symptoms in older men. The expanding range of endoscopic, laser, and ultra-minimally invasive interventions requires a structured overview of their historical development and current clinical role.

Aim. To analyze the evolution of surgical treatment for benign prostatic hyperplasia from open adenomectomy and transurethral resection of the prostate to contemporary laser and ultra-minimally invasive techniques.

Materials and Methods. A narrative review of the literature, recommendations of the European Association of Urology and the American Urological Association, and key meta-analyses was performed. Technical features, advantages, limitations, and the current clinical role of the methods were assessed.

Results. Surgical treatment for benign prostatic hyperplasia evolved from open procedures to transurethral resection of the prostate, which long remained the gold standard, and subsequently to bipolar resection and laser techniques, particularly holmium laser enucleation of the prostate, thulium laser enucleation of the prostate, and photoselective vaporization of the prostate. More recently, ultra-minimally invasive approaches, including prostatic urethral lift, water vapor thermal therapy, robotic waterjet ablation, prostatic artery embolization, and a temporarily implanted nitinol device, have expanded the therapeutic armamentarium by reducing invasiveness and better preserving sexual function. However, these methods generally provide less pronounced functional improvement and may be associated with higher retreatment rates.

Conclusion. Current surgical treatment for benign prostatic hyperplasia is based on personalized selection according to prostate size and anatomy, symptom severity, comorbidities, and patient preferences. Transurethral resection of the prostate remains a key clinical benchmark; laser enucleation offers comparable efficacy with lower invasiveness, and ultra-minimally invasive therapies broaden the options for tailored care.

Relevance. Epilepsy and sleep disorders are comorbid conditions combined by complex bidirectional pathophysiological relationships. Sleep disorders in patients with epilepsy often go undiagnosed, and existing reviews rarely integrate data on the role of antiepileptic drugs in modulating this relationship.

Aim. To systematize and actualize the results of modern clinical and preclinical studies on the relationship between the mechanisms of epilepsy and sleep disorders, to evaluate the role of antiepileptic in modulating these processes, and to justify the need for expanding diagnostic approaches.

Materials and Methods. A literature search was conducted in PubMed, Google Scholar, eLibrary.ru, and CyberLeninka databases for the period from 2016 to 2026. Inclusion criteria were original research and systematic reviews in Russian and English covering epilepsy, sleep disorders, and the pharmacology of antiepileptic drugs. Search queries included relevant keyword combinations. After the selection procedure, 40 eligible publications were chosen for analysis.

Results. The analysis confirmed a bidirectional relationship between sleep and epilepsy: sleep deprivation and fragmentation of its structure act as powerful triggers of seizures, while interictal epileptiform activity and seizures themselves disrupt the architecture of sleep. Different classes of antiepileptic drugs have different effects on the sleep-wake cycle: they normalize the structure of sleep by suppressing epileptiform activity, or excessively depress the REM sleep phase and cause daytime sleepiness.

Conclusion. The choice of antiepileptic therapy should be carried out taking into account the chronobiological profile of the drug and an individual assessment of the patient's sleep characteristics. The presented review highlights the problem of dissomnia disorders in patients with epilepsy through the prism of the pharmacodynamics of antiepileptic drugs, and assesses the relationship between various forms of epilepsy and their characteristic sleep disorders. Understanding the mechanisms linking epilepsy and sleep will help improve seizure control and improve the quality of life for patients with epilepsy.

Relevance. Obsessive–compulsive disorder has been increasingly linked to autonomic nervous system dysregulation, which may confer elevated cardiovascular risk. Heart rate variability is a non-invasive marker of sympathovagal balance and autonomic flexibility. However, comprehensive heart rate variability assessment incorporating nonlinear indices in young, drug-naïve obsessive–compulsive disorder patients remains limited.

Aim. To compare time-domain, frequency-domain, and nonlinear heart rate variability parameters between patients with obsessive–compulsive disorder and healthy controls.

Materials and methods. The present cross-sectional comparative study included 80 participants aged 20–30 years: 40 newly diagnosed obsessive–compulsive disorder patients and 40 age- and sex-matched healthy controls. Heart rate variability was assessed using a 5-minute resting electrocardiography recording under standardized conditions.

Results: Patients with obsessive–compulsive disorder demonstrated a significant reduction in heart rate variability compared with healthy controls. Time-domain heart rate variability parameters were significantly lower in the obsessive–compulsive disorder group, indicating reduced parasympathetic cardiac modulation. In the frequency domain, total power and high-frequency normalized units were significantly decreased in obsessive–compulsive disorder patients, whereas low-frequency power, very-low-frequency power, and the Low Frequency/High Frequency ratio did not show statistically significant differences between the two groups. Nonlinear heart rate variability analysis revealed a significant reduction in Standard Deviation 2, reflecting impaired long-term heart rate variability dynamics, while the Standard Deviation 1/ Standard Deviation 2  ratio remained preserved.

Conclusion. Patients with obsessive–compulsive disorder demonstrates significant autonomic imbalance characterized by parasympathetic withdrawal, reduced overall heart rate variability, and diminished autonomic flexibility. These findings support impaired cardiovascular autonomic regulation as a consistent physiological feature of obsessive–compulsive disorder and highlight the potential role of heart rate variability assessment in early cardiovascular risk stratification and integrative psychiatric evaluation.

Introduction. The presence of daughter aneurysms is a factor of increased risk of rupture of the parent aneurysm sac. Increased wall shear stress of the aneurysm, caused by the impact of the blood flow against the aneurysm wall, leads to local damage of the latter and, consequently, to the formation of a daughter sac. A literature search in various scientific databases showed a limited number of studies investigating the above scientific hypothesis.

Aim. To study the hemodynamics and growth of daughter cerebral aneurysms using an individual mathematical model.

Materials and methods. Thirty-eight aneurysms with 50 daughter sacs were studied. The selected aneurysms varied in size and location. The mathematical model is based on the assumption that when an aneurysm reaches a state of imminent rupture, the weakest area of the aneurysm wall passively responds to a surge of intra-aneurysmal pressure by forming a daughter aneurysm that will be the site of the eventual rupture. The daughter and parent aneurysms were assumed to be spherical. Using mathematical modeling, the growth of the daughter aneurysm was observed. To determine the change in tensile stress in the daughter aneurysm wall under conditions of constant pressure and changing geometry, the Law of Laplace was applied to the parent and daughter aneurysms.

Results. Aneurysm rupture occurs at specific combinations of the coefficients λ and μ. The higher the λ (3.2–4.5), the lower the critical μ (0.02–0.05), and vice versa. The highest risk of rupture is characteristic of aneurysms of the middle cerebral artery (p=0.008) and the anterior communicating artery (p=0.014). Aneurysms of the posterior communicating artery and the ophthalmic segment of the internal carotid artery have a significantly lower risk of rupture (p<0.001). During dynamic follow-up, significant aneurysm growth due to the daughter sac occurred only in cases with high λ values (3.4–4.1) and specifically in aneurysms of the middle cerebral and anterior communicating arteries.

Conclusion. The critical values of the aneurysm's orifice coefficient (μ) and aspect ratio (λ) can serve as determining risk factors for rupture and act as crucial guidelines when deciding on the suitability of surgical treatment.

Background: The coronavirus pandemic has significantly impacted the structure of endocrine pathology in the pediatric population. The COVID-19 pandemic. It is hypothesized that the coronavirus exhibits tropism for pancreatic β-cells, potentially acting as a trigger for the development of type 1 diabetes mellitus.

Aim. To analyze the dynamics of hospitalizations of children with newly diagnosed type 1 diabetes mellitus in the intensive care unit and to evaluate the potential correlation between disease manifestation and a history of coronavirus infection.

Materials and methods. A retrospective study was conducted on 382 cases of children (aged 1 to 18 years) hospitalized with type 1 diabetes mellitus in the intensive care unit of the Bratsk Children's City Hospital between 2000 and 2025. Starting in 2020, patients underwent polymerase chain reaction testing and enzyme-linked immunosorbent assay tests for antibodies to the coronavirus.

​Results. A sharp increase in the proportion of type 1 diabetes mellitus patients in the in the intensive care unit was observed, rising from 1.1 % in 2001 to 19.3 % in 2025. During the pandemic period (2020–2025), the average annual number of newly diagnosed type 1 diabetes mellitus cases increased to 14.8 compared to 4.0 in the pre-pandemic period. Positive markers of coronavirus infection were identified in 62 out of 158 primary type 1 diabetes mellitus cases.

Conclusion. The statistically significant growth in type 1 diabetes mellitus incidence during the pandemic, coupled with the presence of specific antibodies, supports the role of coronavirus as a trigger for pancreatic tissue damage and subsequent type 1 diabetes mellitus manifestation in children.

Relevance. Chronic calculous cholecystitis can cause many complications. One of them is the formation of a cholecystoduodenal fistula, the migration of gallstones into the intestines, and gallstone obstruction, which is more commonly located in the ileum. Among all forms of acute intestinal obstruction, colonic obstruction accounts for 30-40%. The main cause of colonic obstruction is tumoral damage to the colon, which accounts for 93%. The mortality rate for acute intestinal obstruction varies widely (10–40 %) and depends on the type of obstruction, the speed of diagnosis, and adequate treatment. The combination of different types of intestinal obstruction occurring at different levels is an extremely rare clinical situation. Clinical observation. This article presents a rare clinical observation of a combination of two types of intestinal obstruction of different etiologies occurring at different levels of the digestive tract.

Case Description. A 69-year-old man was admitted to the surgical department of the clinic with symptoms of acute intestinal obstruction. A multispiral computed tomography scan revealed a cholecystoduodenal fistula and a foreign body in the ileum (a gallstone) with signs of obstruction and the formation of small intestinal obstruction. A laparotomy was performed, and an ileal obstruction caused by a gallstone was discovered. An obstructing tumor with exophytic growth was found in the lower third of the sigmoid colon. The colon is moderately dilated. A dense infiltrate is detected in the subhepatic space. It is decided to perform a minimum amount of intervention in the conditions of emergency care. A loop colostomy is removed in the left iliac area, fixed. The stone from the small intestine is moved to the colon and removed through the colostomy.

Based on the available modern literature, the authors have identified only one description of a combination of different types of intestinal obstruction at different levels.

Conclusion. The rare combination of two types of intestinal obstruction was diagnosed in a timely manner. The chosen treatment strategy allowed for the resolution of a severe complication of cholelithiasis and the continuation of the examination for cancer.

Background. This paper presents a clinical case of successful surgical treatment of a shrapnel wound to the left third zone of the neck in a serviceman who was wounded while performing a combat mission in a special military operation zone.

Case Description. Four hours after the injury, upon admission to a level-two military field hospital, the patient was diagnosed with a tense hematoma in the projection of the carotid bifurcation. A diagnostic algorithm, including radiography and ultrasound angioscanning, revealed a foreign body at the level of the fifth cervical vertebra and a pulsatile hematoma. Considering the risk of bleeding, the medical team decided to perform surgery. Intraoperatively, after proximal inspection of the main vessels, a rupture of the sternocleidomastoid artery was identified as the source of the bleeding, and its stumps were ligated. Subsequent exploration of the wound channel resulted in the removal of a metal fragment. The postoperative period was uneventful, and the patient returned to duty on the 30th day.

Conclusion. This observation demonstrates the effectiveness of a staged approach using modern diagnostic methods and surgical tactics aimed at preventing life-threatening complications from neck wounds.

Background. False aneurysms of peripheral arteries are a common complication of gunshot and shrapnel wounds in modern combat. However, lesions of the distal branches of the arteries of the foot, in particular the calcaneal branch of the posterior tibial artery, are extremely rare.

Case Description. A military serviceman was evacuated to a level 2 military field hospital seven days after a blind shrapnel wound to the right foot and initial surgical debridement with wound suturing due to bleeding. Upon admission, he complained of severe, distending pain and an inability to bear weight on his leg. Ultrasound angioscanning revealed a 2 × 3 cm false aneurysm of the calcaneal branch of the posterior tibial artery. Given the pain, risk of rupture, and infection, surgical intervention was performed: wound exploration, aneurysm excision, and ligation of the afferent and efferent ends of the arterial branch. The postoperative course was uneventful, pain was relieved, and the patient returned to duty on the 30th day.

Discussion. This article analyzes the complexities of vascular trauma diagnosis at the frontline stages, treatment strategies depending on the caliber of the injured vessel, and the location of the aneurysm. It is emphasized that when small arterial branches of the foot are damaged and the main blood flow is preserved, ligation is the surgery of choice.

Conclusion. This case demonstrates the effectiveness of timely diagnosis and surgical management of a rare pathology in a specialized military field hospital.

Background.  Bypass graft selection is one of the most debated and unresolved issues in coronary surgery. The use of the left internal mammary artery for bypass grafting the left anterior descending coronary artery is the "gold standard," but the question of second- and third-order conduits arises. Conduits from the right internal mammary artery, radial artery, right gastroepiploic artery, and, rarely, the inferior epigastric and splenic arteries are considered. Arterial bypass grafts have varying long-term patency results. The great saphenous vein is frequently used, while the umbilical and cephalic veins are less commonly used. The proven advantages of arterial bypass grafts over venous ones often cannot be realized in practice in some patients due to various circumstances.

The aim of this report is to demonstrate the long-term results of coronary artery bypass grafting using the radial artery and cephalic vein isolated in one forearm in a patient with limited conduit selection.

 Case descriptions.  In conditions of limited choice of conduit for a patient during coronary artery bypass grafting, the radial artery and cephalic vein, isolated on one forearm, were used. Satisfactory patency of the shunts was demonstrated 3.9 years after surgery.

Conclusion. The conclusion result allows us to consider this bypass method acceptable in the absence of other conduits.

Relevance. Coverage of the work of the legendary physician and mentor is necessary to maintain the continuity of generations and traditions in medicine. The article provides information about the life, medical and pedagogical work of the outstanding pediatrician, Honored Doctor of the Russian Federation Alexandra Efimovna Ambrosova - Сandidate of Medical Sciences, Associate Professor of the Department of Childhood Diseases (1961 - 1987) of the Irkutsk State Medical Institute.

Results. A.E. Ambrosova's working life is entirely connected with pediatrics - she is a district pediatrician, neonatologist, head of the children's clinic, and head of the infectious diseases department of the Irkutsk City Children's Hospital (now the Ivano-Matreninskaya Children's Hospital). She worked as a freelance pediatric infectious disease specialist in the Irkutsk region, the Buryatia, and the Zabaykalsky Krai, participating in the response to 140 infectious disease outbreaks. Alexandra Efimovna focused on breastfeeding and proper child care, disease prevention in children, and enhancing children's resistance to infections. Topic of the candidate's dissertation «Features of the clinical course and diagnosis of dysentery in young children in combination with acute respiratory viral diseases». A.E. Тhe author of over 30 published scientific and educational works on pediatrics. As an assistant in the Department of Pediatric Diseases at Irkutsk State Medical Institute, A.E. Ambrosova carried out extensive work training future pediatricians in their sub-residency and clinical residency programs. Among her students are renowned, highly professional pediatricians from Irkutsk and the Irkutsk region.

Conclusion. Alexandra Efimovna Ambrosova left a significant mark on the development of the Irkutsk pediatric school. She is one of the founders of the Faculty of Pediatrics.  She was awarded the honorary title of "Honored Doctor of the Russian Federation." She has received awards for valiant work during the Great Patriotic War and for outstanding labor.