Pathologia

Eechinococcosis of the soft tissues of the thigh

Tue, 23 Dec 2025 00:00:00 +0200

Aim: to analyse a clinical case of echinococcosis of rare localisation – in the soft tissues of the thigh, taking into account the diagnostic tactics used and an individualised approach to antiparasitic treatment.

Materials and methods. The medical records of patient S., 38 years old, who underwent hospital treatment and subsequent long-term outpatient observation for echinococcosis during 2022–2024 at the Medical Educational and Scientific Center “University Clinic” of Zaporizhzhia State Medical and Pharmaceutical University were analysed.

Results. The study demonstrates the clinical observation of an extremely rare variant of Echinococcus granulosus cyst localisation in the subcutaneous tissue of the thigh. An integrated approach to the diagnosis of echinococcosis using serological, pathomorphological, and various imaging methods made it possible to identify the presence of a combined lesion. Taking into account the multiple localisation of echinococcal cysts, the patient’s treatment approach included surgical removal of the cyst from the subcutaneous tissue of the right thigh and long-term conservative drug treatment with albendazole, considering the small size of the echinococcal cyst in the right lung. Based on the results of seronegativity and calcification of the cyst in the lung, albendazole therapy was discontinued.

Conclusions. This clinical example confirms the need for a comprehensive diagnostic approach to the verification of rare and multiple locations of Echinococcus granulosus cysts and individualised treatment.

Echocardiographic findings in complete interatrial electrical dissociation in a patient after radiofrequency ablation

V. V. Syvolap, A. O. Bohun — Tue, 23 Dec 2025 00:00:00 +0200

Atrial fibrillation (AF) is one of the most common arrhythmias which increase the risk of thromboembolism and stroke. Catheter radiofrequency ablation (RFA) is an effective rhythm control method in patients with AF; however, in rare cases, interatrial electrical dissociation may develop.

Aim. To describe a clinical case of complete interatrial electrical dissociation in a patient after radiofrequency ablation for AF, diagnosed during echocardiographic examination.

Materials and methods. A single clinical case of a patient examined and treated at the “Uniclinic” (Zaporizhzhia, Ukraine) is presented. Clinical examination, ECG, and extended echocardiography with speckle-tracking analysis of atrial and ventricular function were performed.

Results. In a 63-year-old patient, one and a half years after RFA, echocardiographic signs of complete interatrial electrical dissociation were detected: Doppler assessment of the mitral inflow revealed the absence of the late diastolic A-wave, and left atrial strain analysis showed the absence of the contractile phase, whereas at the tricuspid valve Doppler imaging demonstrated preserved E and A peaks. Right atrial strain analysis showed preserved reservoir, conduit, and contractile phases. These findings were interpreted as evidence of complete interatrial electrical dissociation.

Conclusions. Complete interatrial electrical dissociation is a rare complication after RFA. Extended echocardiography with speckle-tracking analysis enables diagnosis of this condition. The presence of this complication requires continuation of anticoagulant therapy even in the absence of AF recurrence on ECG.

Key risk factors for in-hospital mortality following valve surgery in patients with prior COVID-19 infection

D. M. Kosovan, O. A. Krykunov, V. V. Lazoryshynets, K. V. Rudenko — Tue, 23 Dec 2025 00:00:00 +0200

Aim of the study. To identify the clinical, laboratory, hemodynamic, and anamnestic factors associated with in-hospital mortality in patients with a history of COVID-19 undergoing surgical correction of valvular heart disease, considering infection severity, timing of infection (pre- or postoperative), renal dysfunction, protein status, tissue injury biomarkers, and respiratory failure.

Materials and methods. This retrospective, single-center study included 100 patients who experienced COVID-19 either before or after surgical correction of valvular heart disease at the National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine (Kyiv, Ukraine), between 2021 and 2024. Patients were stratified by in-hospital outcome (survival vs. death). Comparative analyses was performed across clinical, laboratory, hemodynamic, and operative parameters, with particular attention to the timing (pre- or postoperative) and severity of COVID-19 infection. Statistical analysis was carried out Student’s t-test and chi-square tests; significance was set at p < 0.05.

Results. Seventeen clinical and biochemical indicators demonstrated significant differences between survivors and non-survivors. The key predictors included older age (65.05 ± 2.11 vs 54.71 ± 1.62 years; p = 0.001), longer hospitalization (29.7 ± 4.46 vs 18.73 ± 1.31 days; p < 0.001), reduced glomerular filtration rate (pre- and postoperatively; p < 0.05), hypoproteinemia (p < 0.01), elevated tissue injury markers (LDH, CK-MB, AST; p < 0.05), and markers of respiratory and metabolic failure. In addition, the severity of COVID-19 significantly influenced mortality: 85 % in the severe group, 6.38 % in the mild group, and 0 % in the moderate group (χ² = 66.51; p < 0.01). The timing of infection was also critical: mortality was highest (59.3 %) among patients who contracted COVID-19 postoperatively, compared to only 4.35 % among those infected preoperatively (χ² = 36.64; p < 0.01).

Conclusions. The primary determinants of in-hospital mortality after valve surgery in post-COVID-19 patients include advanced age, renal dysfunction, reduced protein reserves, tissue damage biomarkers, respiratory failure, as well as the timing and severity of COVID-19 infection. These factors should guide perioperative risk stratification and support the rationale for delaying surgery in high-risk post-COVID-19 cases.

Coronavirus disease 2019 (COVID-19) in pregnancy: pathomorphological ultrastructural changes of the placenta

Tue, 23 Dec 2025 00:00:00 +0200

Aim. To investigate ultrastructural changes in the placenta of pregnant women with COVID-19 during the second and third trimesters of gestation.

Materials and methods. A total of 128 placentas from pregnant women with a confirmed positive PCR test for SARS-CoV-2 RNA were examined. Group I – placentas after live births (n = 94; gestational age 40 ± 2 weeks). Group II – placentas after antenatal fetal death (n = 34; gestational age 33 ± 4 weeks). Based on the post-COVID interval (the time between maternal COVID-19 diagnosis and delivery), the following subgroups were formed: in I.1 (n = 54) and II.1 (n = 12), the post-COVID interval was 5–16 weeks; and in I.2 (n = 40) and II.2 (n = 22), it was 1–4 weeks. For comparison, placentas from physiological deliveries before the COVID-19 pandemic were analyzed (n = 50; gestational age 39 ± 1 week). Macroscopic, microscopic, electron microscopic, morphometric, and statistical analyses were performed.

Results. Results. In 100 % of cases, placentitis, endothelial dysfunction, and microcirculatory damage were observed. During the acute phase of COVID-19, cytoplasmic edema of endothelial cells, disruption of cell membranes, and nuclear apoptosis were detected, along with stromal edema of chorionic villi, narrowing of vascular lumina, and destructive changes in telocytes (TCs). With a longer post-COVID interval, Group I showed a decrease in placentitis and stromal edema, as well as restoration of endothelial function and vascular lumina. In Group II, however, arteriolosclerosis, stromal fibrosis, and impaired villous maturation were identified.

Conclusions. The effect of SARS-CoV-2 in all groups caused edema and irreversible changes in the endothelial cells of chorionic villous vessels during the acute phase of the disease. The morphogenesis of SARS-CoV-2-induced placental dysfunction involved endothelial dysfunction, impaired microcirculation, inflammatory infiltration, stromal edema of terminal villi followed by fibrosis, narrowing of vascular lumina, and a reduction in the proportion of free intervillous space. Microcirculatory disturbances and stromal villous edema in COVID-19 led to destructive changes in TCs, thereby limiting adequate angiogenesis and regulation of vascular tone in immature intermediate villi. Irreversible alterations of TCs, their fibroblastic differentiation, and subsequent stromal fibrosis of stem and intermediate villi resulted in a reduced number of terminal villi and a dissociated disordered villous maturation.

Assessment of lipid metabolism parameters in patients with ischemic chronic heart failure and concomitant metabolic pathology depending on nesfatinemia levels

Tue, 23 Dec 2025 00:00:00 +0200

The aim: to evaluate serum nesfatin-1 levels and their correlation with lipid profile parameters in patients with ischemic heart failure (HF) with and without concomitant metabolic comorbidities such as type 2 diabetes mellitus (T2DM) and obesity.

Materials and methods. The study included 225 patients with HF due to ischemic heart disease, divided into four groups: Group 1 (n = 75) – with T2DM and obesity; Group 2 (n = 50) – with T2DM; Group 3 (n = 50) – with obesity; Group 4 (n = 50) – without metabolic disturbances. Serum nesfatin-1 levels were determined using an enzyme-linked immunosorbent assay (ELISA). Biochemical analysis included measurements of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C), as well as calculation of the atherogenic coefficient (AC). Correlation analysis was performed using Spearman’s rank correlation test.

Results. In patient groups with concomitant metabolic comorbidities (Groups 1, 2, and 3), statistically significant inverse correlations were observed between serum nesfatin-1 levels and pro-atherogenic lipids (TC, TG, LDL-C, VLDL-C), along with a significant direct correlation with the anti-atherogenic fraction (HDL-C). In these groups, higher nesfatin-1 levels were associated with a significant decrease in TC (17.6–24.6 %), TG (11.3–49.6 %), LDL-C (29.1–65.0 %), and AC (49.7–59.6 %), alongside an increase in HDL-C (23.1–44.7 %). In contrast, in Group 4 (patients without metabolic disturbances), the effect of nesfatin-1 on the lipid profile was less pronounced. While TG levels decreased significantly (by 28.6 %), other parameters (TC, HDL-C, LDL-C, AC) showed no statistically significant changes or only minimal variations. These findings suggest a context-dependent role of nesfatin-1 in lipid metabolism, with more pronounced effects in the presence of metabolic comorbidities.

Conclusions. Elevated serum nesfatin-1 levels are associated with an improved lipid profile in patients with ischemic HF complicated by type 2 diabetes mellitus and/or obesity, suggesting a potential protective role of this peptide in the presence of metabolic comorbidities. In contrast, in patients without metabolic disturbances, this effect is markedly attenuated or absent. These findings underscore the need for further investigation into the underlying mechanisms of nesfatin-1 action across different clinical populations.

Comparative assessment of video capsule endoscopy and computed tomography in the diagnosis of small bowel tumors in patients with gastrointestinal bleeding

Tue, 23 Dec 2025 00:00:00 +0200

Aim: this study aimed to comprehensively compare the diagnostic capabilities of modern video capsule endoscopy (VCE) and standard computed tomography (CT) in detecting small bowel tumors in patients presenting with gastrointestinal bleeding.

Materials and methods. We performed a retrospective analysis of diagnostic data from 128 patients exhibiting clinical manifestations of small bowel bleeding. The patients were divided into two clinically comparable groups based on their chosen diagnostic approach. Group I comprised 65 patients who underwent VCE, while Group II included 63 patients whose diagnosis was facilitated by contrast-enhanced CT. A crucial inclusion criterion for all patients in both groups was prior gastroscopy and colonoscopy that failed to identify the source of bleeding.

Results. The study’s findings demonstrated a substantial difference in the diagnostic efficacy of the methods. In the VCE group, tumors as a cause of bleeding were identified in 11 (16.9 %) patients, whereas in the CT group, an analogous diagnosis was established in only 6 (9.5 %) patients. A pivotal observation was that among Group II patients with negative CT results, subsequent application of VCE led to the detection of an additional 7 small bowel tumors, none exceeding 10 mm in size. This clearly indicates the superior diagnostic value of VCE for identifying small bowel neoplasms, particularly those of diminutive size, compared to CT.

Conclusions. This research substantiates that VCE exhibits significantly higher diagnostic effectiveness compared to CT for detecting small bowel tumors up to 10 mm. The detection rate was 16.9 % for VCE versus 9.5 % for CT (p < 0.05), thereby justifying its application for the early and precise diagnosis of this pathology.

Comparative study of the functional activity of blood mononuclear cells by cytokine production under the influence of titanium dioxide nanoparticles with different sulfur content in vitro

Tue, 23 Dec 2025 00:00:00 +0200

Aim. To investigate the effect of titanium dioxide (TiO₂) nanoparticles (anatase form) with varying sulfur content on the functional activity of peripheral blood mononuclear cells (PBMCs) from healthy donors in vitro, based on the production of cytokines IL-1β, IL-4, IL-6, and TNF-α.

Materials and methods. The objects of the study were titanium dioxide (TiO₂) nanopowders of the anatase crystalline form, with a particle size of 21-28 nm and varying sulfur content (0.04 %, 0.16 % and 0.83 %), developed at the I. M. Frantsevich Institute for Problems of Materials Science. Peripheral blood mononuclear cells (PBMCs) from healthy volunteer donors (n = 30) were incubated in vitro either without a stimulating agent, with the mitogen phytohemagglutinin (PHA), or in the presence of TiO₂ nanoparticle suspensions (10 μL) at concentrations of 0.3 mg/mL, 3 mg/mL, and 30 mg/mL. Cytokine concentrations (IL-1β, IL-6, IL-4, and TNF-α) in the PBMC supernatants were measured using enzyme-linked immunosorbent assay (ELISA). The tests were performed using a Stat Fax-303 Plus ELISA reader.

Results. In vitro studies demonstrated that the nanomaterial at concentrations starting from 0.3 µg/mL, specifically TiO₂ nanoparticles with 0.16 % and 0.83 % sulfur content, suppressed the functional activity of peripheral blood mononuclear cells, as evidenced by a statistically significant decrease in the production of cytokines IL-1β, IL-6, TNF-α, and IL-4 in donor samples (p < 0.05). This suggests a potential disruption of immune system function. In contrast, exposure to TiO₂ nanoparticles containing 0.04 % sulfur at a concentration of 30 µg/mL resulted in a statistically significant reduction only in TNF-α production (p < 0.05), while IL-6, IL-1β, and IL-4 levels did not significantly differ from spontaneous cytokine production. Moreover, the data indicate that the immunomodulatory effect of TiO₂ nanoparticles is closely related to their sulfur content: the higher the sulfur concentration, the more pronounced the suppression of key cytokine production (IL-1β, IL-6, TNF-α, IL-4). Overall, these results highlight the ability of sulfur-modified nanoparticles to exert differential effects on the immune response, ranging from neutral to potentially immunotoxic outcomes.

Conclusions. The functional activity of peripheral blood mononuclear cells, in terms of cytokine production (IL-1β, IL-6, TNF-α, IL-4), is suppressed by the tested TiO₂ nanoparticles at specific concentrations, following the order: nano-TiO₂ (0.04 % S) < nano-TiO₂ (0.83 % S) < nano-TiO₂ (0.16 % S). A sulfur content of 0.16 % or higher in TiO₂ nanoparticles is associated with increased immunotoxicity. These findings suggest that the effect of TiO₂ nanoparticles on cytokine production by peripheral blood mononuclear cells varies depending on the sulfur content, indicating a direct relationship between the chemical composition of the nanomaterial and its potential immunotoxicity.

Systemic effect of alumina-coated titanium implants: histopathological analysis in rats

Tue, 23 Dec 2025 00:00:00 +0200

The systemic biocompatibility of implant materials is crucial for ensuring their safety, since materials such as titanium (Ti), hydroxyapatite (HAp) and, in particular, alumina (Al₂O₃) can affect vital organs beyond the site of implantation. While alumina-based coatings are valued for their mechanical stability, experimental studies suggest that aluminium ion release can cause toxicity to the liver and immune system.

The aim of the study is to evaluate the organ-specific toxicity of Ti bone implants, both with and without functional-protective coatings, by conducting a histopathological analysis of the liver, kidney and spleen in an experimental model.

Materials and methods. Cylindrical Ti pins, either uncoated, alumina-coated (Al), or HAp-coated, were produced and characterized previously. Ninety-five female Wistar rats were divided into four groups (Ti-, Al-, HAp-groups, and sham control). Implants were inserted into the right femur following by postsurgical treatment and observation. Liver, kidney, and spleen tissues were collected at 1, 2, 4, and 8 weeks and processed for blinded histopathological evaluation using a semi-quantitative scale (based on ISO 10993-11:2017). Statistical analysis utilized Kruskal–Wallis tests, with p < 0.05 denoting significance.

Results. In the first week after implantation, all groups showed hepatocellular swelling, sinusoidal congestion and moderate portal mononuclear infiltration in the liver. They also showed tubular epithelial swelling and focal lymphocytic infiltration in the kidneys and follicular hyperplasia in the spleen. By the second week, these inflammatory alterations persisted but generally decreased, showing no significant difference from the sham-operated control group. By the fourth week, hepatocyte swelling and periportal infiltration were evident primarily in the Ti-group, while the Al₂O₃- and HAp-coated groups showed only mild reactions. Renal infiltration remained more pronounced in the Ti-group. By the eighth week, liver morphology was almost normal in all groups, with only minimal residual periportal infiltration. The kidneys showed only slight tubular swelling. While most splenic changes had resolved, some Ti-group specimens retained follicular hyperplasia, indicating a prolonged systemic response.

Conclusions. This study confirms that all tested Ti-based biomaterials are acceptable in terms of systemic biocompatibility. No necrosis or irreversible organ damage was observed, indicating an absence of toxicity induced by the materials. The initial, transient histological changes were nonspecific responses to surgical stress. Systemic responses indirectly correlated with the implant surface. HAp coatings demonstrated the most favourable systemic profile due to their robust osseointegration, whereas uncoated Ti resulted in prolonged immune activation. This highlights the importance of coatings that promote rapid and complete osseointegration in minimizing long-term systemic effects.

Molecular mechanisms of regulation and damage of β-cells in the development of experimental dexamethasone-induced diabetes

T. V. Ivanenko, A. V. Vynokurova — Tue, 23 Dec 2025 00:00:00 +0200

According to the World Health Organization (WHO), diabetes mellitus remains one of the most prevalent and rapidly increasing non-communicable chronic diseases worldwide. Over the past few decades, there has been a consistent trend towards an increase in the number of patients in developed, as well as low- and middle-income countries. This trend is driven by a complex set of factors, including urbanization, sedentary lifestyles, poor nutrition, overweight and obesity, population aging, as well as comorbid pathology.

The aim of this study was to identify and analyse the expression of genes involved in the morphological and secretory regulation of β-cells and their alterations in response to damage under conditions of the development of experimental dexamethasone-induced diabetes.

Materials and methods. The analysis of gene expression involved in the morphological and secretory regulation of β-cells, as well as changes associated with their damage, was performed using real-time reverse transcription polymerase chain reaction on a CFX-96 Touch™ amplifier (Bio-Rad, USA) with the RT²Profiler™ PCR Array Rat Diabetes kit (QIAGEN, Germany).

Results. Based on the PCR analysis, the activity of the investigated genes involved in the morphological and secretory regulation of β-cells can be categorized as follows: Parp1 – a gene exhibiting increased expression compared to the control group of animals; Enpp1, Ide, Trib3, Ucp2, Ccl5, Cd28, Icam1, Il12b, Tgfb1, Tnfrsf1a – genes demonstrating decreased expression compared to the control group of animals; Ceacam1, Dusp4, Retn, Ctla4, Ifng, Ikbkb, Il10, Il4r, Il6, Igfbp5, Tnf – genes in which no significant changes were detected in the samples relative to the control group of animals; Adra1a, Agt, Foxc2, Slc2a4, Srebf1, Tnfrsf1b – genes whose expression was not detected.

Conclusions. The development of dexamethasone-induced diabetes significantly increased expression (ΔΔCt < 30) of the Parp1 gene by 3.06-fold compared with the control group of animals. Under dexamethasone-induced diabetes, significantly decreased expression (ΔΔCt < 30), relative to the control group, was observed for the following genes: Enpp1 (12.55-fold), Ide (3.31-fold), Trib3 (7.74-fold), and Ucp2 (9.76-fold), which are involved in the mechanisms of insulin secretion regulation, Ccl5 (2.27-fold), Cd28 (23.98-fold), Icam1 (4.54-fold), Il12b (4.38-fold), and Tgfb1 (3.76-fold), which are associated with autoimmune destruction of β-cells; and Tnfrsf1a (130.97-fold), which is implicated in survival and apoptosis mechanisms. The expression of Adra1a, Agt, Foxc2, Slc2a4, Srebf1, and Tnfrsf1b was not detected under conditions of dexamethasone-induced diabetes.

Primary changes in the rat’s hippocampus after exposure to an air blast wave

Yu. V. Kozlova, S. V. Kozlov — Tue, 23 Dec 2025 00:00:00 +0200

To identify the primary ultrastructural changes in the CA1 region of the rat`s hippocampus after a single exposure to an air blast wave.

Materials and methods. The study was conducted on healthy 12 sexually mature male Wistar rats weighing 220-270 g, kept under standard conditions in the vivarium of Dnipro State Medical University. The animals were randomly divided into two groups: experimental (n = 6) and sham (n = 6). The rats of experimental group were exposed to an air blast wave with a pressure of 30.1 ± 2.9 kPa. One hour after exposure to the blast wave, animals in both groups were anaesthetised with halothane and euthanised, followed by craniotomy, removal of the hippocampus and conducted electron microscopic examination using standard procedures. All manipulations were carried out in accordance with the rules of current legislation on bioethical treatment of experimental animals.

Results. It was established that a single exposure to a blast wave with a pressure of 30.1 ± 2.9 kPa resulted in mild trauma, as indicated by the absence of cell membrane rupture with cytoplasm and organelles escaping into the extracellular space and the absence of complete vessel rupture with massive haemorrhages. Signs of primary neuronal injury included increased nuclear membrane permeability and nuclear chromatin rarefaction, significant perinuclear oedema, cytoplasmic vacuolisation, and extracellular oedema. Damage to the blood-brain barrier vessels was detected in the form of perivascular oedema, thickening and delamination of the vessel membrane due to its oedema, and cavitation bubbles were present in the vascular lumen. Nerve fibres were also traumatized, as indicated by myelin delamination.

Conclusions. It has been established that swelling of neurons and increased permeability of the nucleus membrane and its oedema, as well as delamination of myelin fibres (a decrease in the sphericity coefficients of axonal profiles by 11 % (p < 0.05) and dendritic profiles by 33 % (p < 0.01) in the hippocampus of experimental rats). Signs of primary injury due to the impact of the blast wave were found on the side of the blood-brain barrier in the form of perivascular oedema, thickening and delamination of the vascular membrane due to its oedema (47 % increase in the relative area of electron-transparent sections (p < 0.01) of the hippocampus of experimental rats). The presence of a cavitation bubble in the hippocampus vessel indicates the persistence of the initial damage due to its ability to cause hydraulic shocks.

Morphological changes in transplanted hair in the treatment of cicatricial post-traumatic alopecia

O. A. Hyndych, I. M. Savytska — Tue, 23 Dec 2025 00:00:00 +0200

The aim is to study the morphological changes in transplanted hair follicles to determine the effectiveness of the FUE method under conditions of ischemic and scar tissue.

Materials and methods. The study included 10 patients diagnosed with cicatricial post-traumatic alopecia or alopecia resulting from reconstructive surgical procedures. All patients underwent hair transplantation using the follicular unit extraction (FUE) technique combined with direct hair implantation (DHI). The structural characteristics of the hair follicle and hair bulb, as well as the degree of vascularization of the transplanted follicular units (grafts), were examined. The obtained results were compared with data from healthy hair follicles, serving as controls.

Results. Microscopic examination revealed that the transplanted grafts maintained their structural integrity and demonstrated successful engraftment at the recipient sites, indicating a high level of follicular adaptation within the altered (ischemic or scarred) tissues. During clinical assessment, patients reported excellent (80 %) and good (20 %) results. The degree of engraftment was on average 90 % of the transplanted number of grafts. Thus, when all the rules of the DHI hair transplant technique were followed, we did not observe an increased risk of hair follicle loss due to their damage.

Conclusions. Hair transplantation after extraction can be successfully used to restore the hair cover, to mask incisions on the scalp or to restore the anterior hairline. FUE hair transplantation with DHI implantation can be considered the safest and most promising method for preserving the viability of hair follicles, especially in conditions of ischemic scar tissue.

Modern approaches to the diagnosis and treatment of liver abscesses

V. H. Yareshko, Iu. O. Mikheiev, V. V. Novak, N. O. Yareshko, Y. S. M. Albaiiuk — Tue, 23 Dec 2025 00:00:00 +0200

The aim. To determine the optimal surgical approach for liver abscesses based on ultrasound semiotics and self-developed staging of purulent center formation.

Materials and methods. The study was conducted in 80 patients with liver abscesses, operated on with the help of interventional sonography (IS), laparoscopic operations (LO), laparotomy, as well as the combined use of IS and LO. According to his own research, ultrasound characteristics of the development and formation of liver abscesses were developed, with the allocation of four stages. The informativeness of ultrasound was monitored from the first signs of a local inflammatory process to the stage of pyogenic capsule formation. Therefore, the main group consisted of patients who were operated on according to their own developed ultrasound characteristics – 48 (60 %), and the comparison group consisted of 32 (40 %) who were operated on according to generally accepted diagnostic signs. Computed tomography (CT) was performed at the stage of diagnostic search and differential diagnosis in a small part of patients – 27 (33.7 %). And the method of ultrasound diagnostics and IS remained the leading one, i.e. “the method diagnoses – the method operates”. This is confirmed by the fact that in both groups, 50 (62.5 %) operations were performed using IS at various stages of abscess formation.

Results. The choice of the method of surgical treatment largely depended on the stage of destruction of the abscess center and its localization, the severity of the patient’s condition. It is important to note that almost all patients (100 %) had elevated body temperature, 85 % had fever and symptoms of purulent intoxication. In 90 % of patients, the general condition was assessed as moderate and severe. In the main group, a differentiated approach to the choice of the method of operation was used on the basis of the developed sonographic criteria for the stage of abscess formation, as well as the technological capabilities of each method. The morphological difference of the substrate, the heterogeneity of the liquid component, the degree of capsule formation, as well as the localization of the cell made it possible to choose between these methods. In the main group, there were significantly more IC operations – 37 (77.1 %), which significantly exceeded the frequency of operations in the comparison group (χ2 = 9.39; p = 0.002). The frequency of performing LO in the comparison group was 53.1%, which is probably higher than in the main group – 14.6 % of cases. We used the combined use of IS and LO in the treatment of 4 (8.3 %) patients of the main group. The operation consisted of a laparoscopy and its puncture under the control of a sonographer, followed by the operation of a laparoscopic instrument and an ultrasonic dissector (a wide access to the abscess cavity was performed with its external drainage). The methods eliminate the shortcomings of each of them separately, and generally guarantee a positive result. Laparotomy operations of the Clermont type and others in the main group of patients were not used in the treatment of abscesses. All patients at the stages of treatment underwent a microbiological study of the focus of inflammation with de-escalation and targeted antibacterial therapy. In the main group, the average postoperative bed-day was 21.3 ± 1.2 days, which is 16.5 % (р < 0.05) less than the similar indicator in the comparison group – 25.5 % ± 1.6 days. According to the results of the treatment, there were no deaths.

Conclusions. The proposed ultrasound-based classification of liver abscess formation enables a differentiated approach to surgical treatment, leading to a 9-fold reduction (p < 0.05) in the number of repeated fluid drainage procedures and a 16.5 % reduction in hospital stay duration. In the early stages of abscess formation, interventional sonography is recommended as a safer and less invasive technique, offering high diagnostic sensitivity (91.3 %), facilitating differential diagnosis, enabling microbiological analysis, and effectively preventing disease progression.