Introduction

Invasive procedures used in the former Soviet Union (SU) are delineated in this review. More details and references are in the book and the article in Russian [1, 2]. Clinical recommendations are generally avoided here. The placebo effect might have had a hand in some cases. However, placebo treatments must be devoid of risks. Foreign literature is available on the Internet today, many guidelines being adjusted to international standards, so there is an improvement dendency. Some human factors have remained from the Soviet time. In conditions of paternalism, misinformation, persuasion of patients and compulsory treatments are deemed permissible [3]. For example, appendices histologically indistinguishable from the norm or surgery-related artefacts have been habitually described by pathologists as compatible with appendicitis, surgeons receiving no proper feedback. Various invasive methods have been applied without indications in people diagnosed with alcohol-related disorders [4]. Furthermore, cauterization of endocervical ectopies (called pseudo-erosions) without epithelial dysplasia have been applied routinely [5]. This procedure does not protect from cervical cancer and disagrees with the international practice. In particular, the recommended treatment of large ectropions by diathermoconization was noticed to be associated with complications. As before, the treatment of cervical ectopy is claimed to prevent cervical cancer [5]. Further examples from surgery, endoscopy and pediatrics are in the book [1]. The overuse of renal biopsy and overdiagnosis of glomerulonephritis in comparison with Rostock (Germany) has been discussed previously [6].

Breast cancer

According to a review, the incidence of breast cancer (BC) in the Russian Federation (RF) is considerably lower than in the rest of Europe, North and South America, while mortality thereof is approximately on the same level. This is indicative of comparatively low reliability of registration and efficiency of diagnostics in RF [7]. The average size of malignant tumors in surgical specimens was larger in Moscow clinics than in West European hospitals, according to the author’s estimation following repeated practice of pathology in other countries (1990 to 2008). The different level of tumor size (stage) indicates a higher efficiency of cancer diagnosis in Europe. Another distinction is that virtually all mastectomies abroad lacked muscle. Leading specialists recognized that Russian senology had not followed the global trend toward a more sparing BC management for decades [8]. The Halsted operation, which involved removing both pectotal muscles, was a common modality in the 1980s and, to a lesser extent, in the 1990s, references are in [1]. In several 21st-century papers, textbooks, and monographs, the aforenamed procedure was designated as the foremost or single surgical treatment for operable BC [9–12]. In a handbook re-edited 2018, the Halsted operation is defined as the “most typical and commonly used radical mastectomy” [13]. In the oncology textbook published 2020, the Halsted procedure is defined as the “standard radical mastectomy” without further commentary [14]. Articles dated 2011 and later designated Halsted procedure as one of the main operations for BC [9,15,16]. This disfiguring method has been used and recommended also as a palliative procedure in disseminated cancer [9,15,16], which is hard to comprehend physiologically.

Even more extensive methods were applied e. g. the Kholdin operation, where a part of the sternum is removed en bloc with the breast, pectoral and parts of intercostal muscles, fragments of ribs, axillary and subscapular fat [17,18]. Operations with the muscle removal were applied also in aged patients [19]. Over the years, adverse effects of the Halsted procedure had become evident. Therefore, certain leading surgeons recommended the Patey operation with excision of only the M. pectoralis minor for early (stage 1–2) cancers in lateral quadrants [20]. Others advocated the Halsted procedure [21,22]. The latter experts changed their attitude in favor of the Patey operation because supposedly “insufficient radicality can be compensated by radiotherapy” [23]. The radiotherapy has sometimes been overused in RF, being recommended after a radical mastectomy with no evidence of nodal disease [24], which is generally at variance with the international practice. Today the recommendations tend to be adjusted to international guidelines thanks to free Internet resources.

The Patey operation has been broadly applied in RF. Tumor infiltration of the smaller pectoral muscle has never been seen; its extraction from under the M. pectoralis major requires time, while blood loss may be comparable with that at the Halsted procedure [20]. In numerous recent publications, referenced in [1], the Patey operation has been discussed as a usual routine; but the preservation of both pectoral muscles has finally become predominant. At least hundreds of thousands patients of different ages have needlessly lost their Pectoralis muscles. Allegorically this was named a payback by Hugo Pectoralis, a foreign professional harassed in a Russian town, described in a well-known novel [25]. This novel illustrates what can happen to a foreign expert in Russia if he or she is not officially authorized. The obstinate belief that “we have our own ways” is an obstacle on the thorny way of Russia towards European and global civilization, medical and common ethics. Dmitry Trenin generalized about the “national character”: deification of the state authority, low value of human life and personality, insufficient respect for laws, private property and education [26]. This is a fake image of ethnic Russians, who are not very different to other Europeans, but a herd mentality.

Guidelines are now modified in accordance with global trends. Another extreme has come to the fore: mastectomy without the removal of pectoral muscles is referred to as “mutilation” while the breast-preserving and reconstructive surgery is propagated [27]. One of the incentives is that patients pay for plastic surgery. Accordingly, some patients get biased advice. Patients should be objectively informed about potential risks associated with breast-conservation and reconstructive surgery.

Gastric and duodenal ulcers

Reportedly, there are 3 million patients diagnosed with gastric or duodenal ulcer in RF, of which every tenth has been operated. Over 100,000 operations are performed annually for peptic ulcers, including about 60,000 gastric resections (gastrectomies) [28]. The management of gastro-duodenal ulcers in the former SU deviated from the approach common in other countries. Gastrectomy has become the predominant method of surgical treatment of gastric and duodenal ulcers since the 24th Congress of Soviet Surgeons (1938); it prevailed in the ulcer surgery for decades, being virtually the single available modality for gastric ulcers. Gasrectomy predominated also in aged ulcer patients. It was recommended to widen indications for surgical treatment of gastric and duodenal ulcers also in the elderly. Resections prevailed among second surgeries after unsuccessful vagotomy or suturing of perforated ulcers; references are in [1]. The 8th All-Russian Congress of Surgeons (1995) promoted the 2/3 distal gastrectomy both for elective and emergency gastric and duodenal ulcer surgery. The well-known surgeon Sergei Yudin was a protagonist of the hyper-radicalism. Yudin was one of the top specialists in the Soviet Army. His methods involved broad muscle and bone excisions in lieu of wound drainage [29]. “Unhesitatingly excise muscular tissue to access fractured bone” [30] was his motto. The former health minister Boris Petrovsky noticed that Yudin’s hyper-radicalism, followed by other military surgeons, caused hemorrhages, permanent defects of bone and soft tissues [31, 32].

Apparently, Yudin’s reports on consequences of gastrectomy for ulcers were biased: ostensibly 92–94 % of complete cure, no complaints related to the surgery, “transient and benign” post-surgery diarrhea in 5–8 % of cases [33]. It is known that many patients after gastrectomy have significant symptoms including dumping syndrome often including diarrhea. Yudin concluded that near-total gastrectomy is indicated to a majority of patients with peptic ulcers. His writings have been republished with favorable editorial commentaries [33]. References to Yudin’s publications continued until recently, quoting among others that he had performed gastrectomy in 75 % of perforated ulcers. In the 1990s, a pylorus-preserving gastrectomy was propagated [34]; more references are in [1].

The concept of primary gastrectomy for perforated ulcers has been supported by many Russian surgeons. This generally disagreed with the international practice. The currently remaining indication to gastric resection for peptic ulcer is a defined risk of cancer in an unhealed ulceration, and seldom a recurrent therapy-resistant peripyloric ulcer. Gastrectomy for perforated peptic ulcer is generally not recommended. As mentioned above, clinical recommendations are avoided here. According to the author’s observations, resections were comparatively rarely performed abroad for peptic ulcers; their volume was smaller, often corresponding to antrectomy. For perforated ulcers, a local excision was usually performed, while a ring-shaped specimen of the ulcer was sent to the pathologist. Laparoscopic repair is used increasingly these days. A recent decrease in elective gastrectomies confirms the fact of the overtreatment in the recent past. Like in many topics discussed here, recommendations are currently adjusted to international patterns thanks to the PubMed, other gratis resources, as well as the Food and Drug Administration (FDA), regarded as a stronghold of evidence-based medicine.

The attitude delineated above is reappearing. In recent publications, gastrectomy (resection) has been designated as the most frequent, main or single surgical treatment of gastric ulcers [35–37], an universal operation applicable for all ulcer locations [28]. As before, appeals to radicalism in ulcer surgery can be heard. Gastric ulcers are listed in the first place among indications for gastrectomy, accompanied by duodenal ulcers with “humoral or mixed secretion type”. Now as before, gastrectomy is generally recommended for gastric ulcers; as well as for peripyloric ones except for small ulcers without humoral hyperacidity and motoric derangements, when selective proximal vagotomy can be considered. Antr- or gastrectomy is proposed as a choice also for duodenal ulcers. As per some papers cited above, advantages of early surgery for uncomplicated ulcers is emphasized [28] under the motto “surgery must come before complications” [35]. Pre-operative “psychological preparation” includes sedation but not discussion of treatment choices. For perforated gastric ulcers, 2/3 (or more) distal gastrectomy is advocated [28]. The ulcer excision, frequently used in other countries, is not mentioned in [28, 36, 37].

Thyroid tumors

Neither research on atomic bomb survivors nor experience with radioiodine could have predicted the early rise in the registered incidence of thyroid cancer (TC) after the Chernobyl accident; references are in [1]. Before the accident, the former SU had a much lower detection rate of pediatric TC than other developed nations, most likely due to the lack of attention to the thyroid and lower diagnostic quality. Regardless of size, all thyroid nodules were considered as potentially malignant at that time. Experts doubted reliability of histo- and cytological diagnostics [38]. Intensive screening in the contaminated areas found advanced neglected malignancies, interpreted as rapidly growing radiogenic cancers. In 1990, the year that regulations on Chernobyl social protection were issued, there was a rapid increase in the diagnosis of diseases under this category. International observers noticed that many claims of that kind had been unproven [39]. Some patients were brought from outside and registered as radiation-exposed on the basis of wrong information.

Prior to the accident, TC had been infrequently diagnosed in pediatric patients of the former SU: in Belarus between 1981 and 1985, there had been only three cases under the age of 15, the annual rate per million being 0.3; in Ukraine, the corresponding figures were 25 vs. 0.5 for the whole country and 1.0 vs. 0.1 for the partly contaminated northern provinces [40]. Analogous data were reported by the IARC [41]. As per the Surveillance, Epidemiology, and End Results (SEER) Program, the TC incidence is approximately 8.5 per million per year, 1.8 — in subjects ≤20 years of age [42]. According to the American Thyroid Association (ATA), thyroid cancer is more common in older children with incidence rates of ≤1 cases/million/year in those ≤10 years old; 3.5 in 10–14 years old; and 15.4 cases/million/year in adolescents 15–19 years old [43].

The figures presented above indicate that there had been considerable number of undiagnosed pediatric TCs in the former SU before the Chernobyl catastrophe. Evidently, the vast scale screening resulted in finding thousands of “occult” cancers and some overdiagnosis as TCs of lesions with uncertain malignant potential, hyperplastic papillary nodules etc. Besides, the contaminated territories overlap with endemic iodine deficient zones. The frequency of TC tends to be elevated in iodine-deficient areas i. e. independently of radiocontamination [44].

Considering the above, the claim that “in children born a year after the Chernobyl disaster, the age-specific incidence rates were comparable to those expected based on the incidence trend of 1978–1986” [45] is unfounded. The pre-accident TC frequency was low, and no growth tendency was noticed. It has been claimed without references by the same and other researchers that TC incidence in Belarus had been at the same level as in other countries [46], that is, much higher than the statistics quoted above [40, 41]. Despite the normal radiation background long since, detection rates of TC in Belarus have remained elevated probably as a result of awareness among medics and the population. Enhanced incidence of TC during the whole study period (until 2020) is shown on the graph in [45]. On the contrary to earlier post-Chernobyl TC, the highest incidence after 2003 has been in the age group ≥45 years at presentation probably due to the discontinued screening in younger people but higher attention to own health and coverage by medical services of older individuals [45].

Mechanisms of false-positivity have been delineated elsewhere [1]. One of them is as follows. Patients were referred for surgery if the fine-needle cytology was suspicious. The surgical specimen was forwarded to a department of pathology, where cancer diagnosis was sometimes formulated after a radical surgery also in case of some doubt. A histological verification confirmed cancer in ~78 % of surgical specimens [47]. The true percentage was probably higher because of the tendency to cover up false-positivity. Instable quality of histological specimens contributed to the overdiagnosis. Back in the 1990s, cyto- and histopathological criteria of certain thyroid carcinoma varieties were known insufficiently. Some cases were overdiagnosed as cancer by reference to cellular atypism, which can occur in benign thyroid nodules. Adenomas, papillary hyperplastic and other nodules were diagnosed as cancers. Illustrations from Russian-language handbooks, potentially conductive to false-positivity, have been reproduced and commented in the book [1]. Foreign handbooks of cytology and histopathology were rarely used at that time.

Marked invasiveness and early metastasizing of Chernobyl-related TCs have been reported [48, 49]; more references are in [50]. The authors of the latter article found no unusual invasiveness of TCs that developed after radiation therapy [50]. Misinterpretation of undiagnosed advanced carcinoma as rapidly growing radiogenic cancer resulted in an unfounded concept that TCs in radiation-exposed patients are outstandingly aggressive [45, 49, 51]. This had consequences for the practice. Thyroid surgery in some institutions has become more extensive. A “maximally radical approach”, i.e. total thyroidectomy with neck dissection plus radiotherapy, was recommended [51–56]. Previously operated children underwent completion thyroidectomy [54]. This approach is different from the more conservative one in other countries, also following the Fukushima Daiichi accident.

The overdiagnosis and “excessive activity of thyroid surgery”, the overtreatment and avoidable post-surgery complications, were pointed out by the Health Minister of RF in 1998 [57]; but the overtreatmment continued, especially in Ukraine and Belarus [51–55]. A monograph published in 2009 compared percentages of thyroidectomies, where some functioning thyroid parenchyma had been left in children and adolescents (some of them coming from contaminated areas of Chernobyl or the Urals). For medical institutions of Chelyabinsk, St. Petersburg, Minsk, Moscow and Kiev these percentages were respectively 87.2, 64.3, 35.0, 14.2, 13.9 % [58]. After the Fukushima accident this figure was 92 % [59]. Japanese pediatric papillary TCs have been different from those in contaminated areas of the former SU, being on average better differentiated [60,61], which indicates earlier tumor detection in Japan. Apparently, international comparisons of average cancer grade are informative in regard to the diagnostic quality and coverage of the population by checkups. The Health Minister of RF ordered a revision of surgical TC specimens from patients born after 1968, residing in the partly contaminated Bryansk province [57]. The verification confirmed the diagnosis of malignancy in ~78.5 % of the cases [47]. True percentages of false-positivity were probably higher due to the known tendency to cover up false-positivity. Insufficient quality and quantity of specimens restricted reliability of verifications.

In a later study, radical thyroidectomy was performed in 87.1 % of papillary microcarcinomas. Recurrences were detected in 1.3 % of the patients (average observation 5.2 years) [62]. As per recent research, decennial follow-up of “Non-invasive Follicular Thyroid Neoplasms with Papillary-like Nuclear Features” (NIFTP), overlapping with microcarcinoma, demonstrated a very low risk of spreading or causing other adverse effects. The level of mortality risk in patients with persistent or recurrent NIFTP was less than 1 %. Papillary microcarcinoma, frequently diagnosed after the accident, had a cancer-specific mortality rate 0–4 % [63]. Obviously, total thyroidectomy is an overtreatment for many cases of NIFTP and/or microcarcinoma diagnosed pre-operatively. In a large-scale study, no survival advantage has been found to be associated with total thyroidectomy over lobectomy for patients with papillary TCs up to 4 cm in size [64]. Of note, the frequency of regret about chosen treatment in microcarcinoma patients after thyroidectomy was 24.2 % compared to 3.4 % among those under active surveillance [65].

Some experts from the former SU recommended radioiodine therapy for patients with thyroid microcarcinoma [66] or TC in general [54], which is at variance with the international approach. Considering potential adverse effects of radioiodine, the 2009 ATA Guidelines supported the selective rather than universal administration of ¹³¹ I, especially for younger patients having intrathyroidal papillary carcinoma with no or limited lymph node disease [67]. Selective use of radioiodine therapy is generally advocated for papillary carcinoma with intermediate risk [68]. High-dose (40 Gy) external radiotherapy of Chernobyl-related TC, combined with radical surgery, was recommended as well [56]. As mentioned above, radiotherapy has sometimes been overused in the former SU especially after radical surgery for well-differentiated cancer with no evidence of metastasizing.

Another study encompassed the period 1990–2005 and 936 TC patients from Belarus (600 females and 336 males, mean age at the time of surgery 14.4 years). During the observation period, 17 patients died (average follow-up 12.4 years). The causes of death included 7 suicides and 5 trauma/accident cases; only two patients died of advancing cancer (pulmonary metastases) [69]. Especially for young females, the esthetic aspect would be of importance. The postoperative scar/deformity, stigma as a cancer patient, hypothyroidism as well as anxiety over effects of radiation may contribute to depression. Both intentional and unintentional underreporting of suicides may occur; reported suicide rates being 2–3 times lower than actual figures. Policymakers, authorities, medics and families may cover up suicides [70].

The overdiagnosis and overtreatment of thyroid lesions should be seen within the scope of the broader problem: overestimation of Chernobyl consequences to strangulate nuclear energy production worldwide and to maintain high prices for fossil fuels. To prevent accidents, an international executive centered in developed countries must oversee the global usage of nuclear energy. Of note, one of the causes of Chernobyl accident was negligence and disregard of written instructions [71–73].

Selected respiratory and urological conditions

The surgical treatment of asthma was officially recommended by the Health Ministry [74]. The “skeletonization” of large bronchi (denervation with cutting of peribronchial nerve trunks) was recommended both for steroid-dependent and infectious-allergic asthma [74, 75]. Along with the denervation, or as a separate procedure, instructions included lung resections (lobectomies) without sufficient indications. The claimed purpose of the surgery was elimination of focal infection. Lung resections in asthma were applied also without denervation, even in the cases where drug and inhalation therapy were effective. Sokolov and co-workers reported that ≤10 % of their asthma patients had been operated on [76]. Efficiency of pneumonectomy was stressed, also in pediatric cases of bilateral chronic pneumonia [77]. More references are in the book [1].

Lobectomies were applied by surgeons based on histopathological reports by Irina Esipova, a well-known expert in pulmonary pathology. Esipova regularly found malformations in lobectomy specimens: in ~66 % of resected pulmonary tissues from pediatric patients undergoing surgery for inflammatory bronchopulmonary conditions [78]. Histopathological descriptions contained non-specific terms such as inflammation, fibrosis and degeneration, small cystic cavities, local pigmentation, microscopically atypical bronchial branching, lack of a bronchus narrowing from the center to periphery, “nudity” of bronchi, thin-walled dilated bronchi, lacking cilia, and so forth [78,79]. Some histological phenomena described as malformations are common in postnatal lungs normally or in consequence of inflammatory conditions [80, 81]. Reportedly, the percentage of inadequate diagnostic conclusions was as high as 65–75 % [82]. Nevertheless, the patients undervent surgery under the pretext of prevention of suppuration [82]. Some experts generalized that lung malformations in children “make necessary a surgical treatment at an age ≤ 6 years” [83]. Undoubtedly, in some cases the surgery was necessary and life-saving; but the overuse of surgery and bronchoscopy was known to occur [1]. The overuse of surgery in tuberculosis has been discussed previously [1, 4].

Unfounded descriptions of dysplasia or atypia in renal [84, 85] and bladder [86,87] specimens (the latter including carcinoma in situ and microinvasion) has been reported previously [6,88]. Surgeons might overuse nephrectomy instead of kidney-preseving procedures if they read that renal-cell carcinoma from radiocontaminated territories is on average more aggressive, while surrounding parenchyma contains “proliferative atypical nephropathy with tubular epithelial nuclear atypia and carcinoma in situ” [85]. The same experts found in patients with benign prostatic disease and/or cystitis from contaminated territories severe dysplasia or carcinoma in situ in urinary bladders of 56–73 % random or consecutive cases of benign prostatic hyperplasia and chronic cystitis in females [86,87]. We have no information on cyst- and nephrectomies, but cystoscopy and repeated biopsies without sufficient indications have occurred [6, 88].

Reproductive coercion, child and elder abuse

The reproductive coercion (RC) is of particular importance these days. The population growth is regarded as a tool helping to the economic advance. Governmental policies aimed at the fertility elevation in Russia potentially disregard reproductive rights of women. Although RC research is focused on male control of a female’s reproductive autonomy, RC can be perpetrated by family members, institutions and the state. RC can lead not only to unwanted pregnancy but also to negative health outcomes including mental disorders in the victims. Popular TV series depict unexpected pregnancies both in and out of wedlock as natural and unavoidable while contraception is hardly ever mentioned. The risks associated with abortion and contraception are invented or exaggerated by some literature written by medical professionals e. g. [89], let alone mass media. The misinformation can be regarded as facilitation of RC. The access to objective information has been impeded: many articles in professional journals are biased; the use of medical libraries is complicated by technical difficulties. The book [1], donated to the Central Medical Library in Moscow and another author's copy sent to the National Library of Belarus, has not been entered into the catalogues and not returned despite repeated inquiries. Another book [90] has disappeared from the Belarusian catalogue https://www.nlb.by/. Moreover, people are systematically intimidated by media, TV Series, extortion e. g. by plumbers performing repairs in private flats. Russian media often exaggerate the topic of violence in penal institutions obviously with the goal of mass intimidation. For example, the showman Leonid Kanevsky, the host and main figure behind the NTV crime documentary series, repeatedly makes exaggerating and approving remarks on harassment and lynching in Russian prisons using the phrases like: “He didn't survive his jail term… Prison inmates don’t like such people”. Violence and hidden threats have been used to control and intimidate certain students and professionals to deter them from criticism of misconduct in research and practice [1, 91].

The high social status of war veterans is maintained today. Many real veterans had been factually maltreated in the period 1985–2005. The average life expectancy of men decreased to 58–59 years in the 1990s and early 2000s due to deterioration of health services and toxic alcohol surrogates legally sold in vodka bottles. It is known that many war veterans consumed alcohol. During the anti-alcohol campaign (1985–1989) they were forced to stand hours-long queues at retail outlets and/or to drink surrogates. After the failure of the campaign, the country was flooded by poor-quality beverages and surrogates sold in vodka bottles through legally operating shops and kiosks [1, 4]. Child, elder abuse and problems associated with Covid-19 have been discussed previously [1, 92, 93].

Conclusion

The authors agree with the opinion that rich traditions of cooperation between Germany and Russia must be revitalized [94]. Should the power in Europe shift to the East without such cooperation, it may come along with losses of some values. Disregard for laws and regulations, corruption, collectivism and mass intimidation will come instead. The quality of many services and products will decline: spoiled foods on sale, antibiotics in milk, falsified beer and wine, misquoting of legal codes by civil servants in their correspondence, backdating of official letters, embezzlement of registered correspondence, different types of misconduct in the healthcare [1, 91]. The autocratic management style discourages criticism. In the healthcare, attributes of this style include a paternalistic approach to patients. Under conditions of paternalism, misinformation of patients, disregard for the principle of informed consent and compulsory treatments are seen as permissible [3]. Considering shortcomings of medical ethics, research and education, governmental directives and increase in funding is unlikely to be sufficient. More nternational trust and cooperation are needed.

References:

1. Jargin SV. Selected Aspects of Healthcare in Russia. Cambridge Scholars Publishing; 2024.
2. Яргин С. В. Инвазивные процедуры без достаточных показаний: история вопроса. Молодой ученый. 2018;4(190):234–245.
3. Микиртичан Г. Л., Каурова Т. В., Пестерева Е. В., Никитина А. Е. Введение в биоэтику. СПбГПМУ; 2022.
4. Jargin SV. Selected aspects of tuberculosis treatment with special reference to alcoholism. Karnataka Med J. 2024;47:79–84.
5. Jargin SV. Cervical ectopy: selected aspects of diagnostics and therapy. Clinical Research and Reports, BioRes Scientia Publishers. 2024;3(1):1–7.
6. Jargin SV. Renal biopsy research with implications for therapy of glomerulonephritis. Current Drug Therapy. 2012;7:263–267.
7. Мерабишвили В. М. Рак молочной железы: заболеваемость, смертность, выживаемость (популяционное исследование). Вопр. окол. 2011;57(5):609–615.
8. Харченко В. П., Редди Т. Г., Кузьмин И. В. Проблемы органосохраняющего лечения рака молочной железы. Хирургия. 1997;(4):8–14.
9. Остапенко В., Остапенко A. Значение и особенности оперативного лечения местнораспространенного рака молочной железы. Вопр. окол. 2011;57(5):578–583.
10. Казаченок В. М., Барьяш В. В. Заболевания молочной железы. Минск: БГМУ; 2005.
11. Кованов В. В., Перельман М. И. Операции на грудной стенке и органах грудной полости. В кн.: Кованов В. В., ред. Оперативная хирургия и топографическая анатомия. М.: Медицина; 2001; 297–321.
12. Семиглазов В. В., Топузов Е. Е. Рак молочной железы. М.: Медпресс-информ; 2009.
13. Труфанов Г. Е. Лучевая терапия (радиотерапия). М.: ГЭОТАР-Медиа; 2018.
14. Давыдов М. И., Ганцев Ш. Х. Онкология. М.: ГЭОТАР-Медиа; 2020.
15. Портной С. М. Местнораспространенный рак молочной железы (тактика лечения). Вопр. окол. 2011;57(5):553–558.
16. Портной С. М. Сребный А. Ю. Хирургический метод лечения рака молочной железы. В кн.: Кампова-Полевая Е. Б., Портной С. М. Актуальные аспекты клинической маммологии. М.: Авторская академия; 2014; 74–109.
17. Холдин С. А., Дымарский Л. Ю. Расширенные радикальные операции при раке молочной железы. Ленинград: Медицина; 1975.
18. Летягин В. П., Высоцкая И. В. Первичный рак молочной железы. Диагностика, лечение, прогноз. М.: 1996.
19. Суспицын Ю. В., Летягин В. П., Иванов В. М., Орлова П. Н. Лечение рака молочной железы у женщин пожилого и старческого возраста в глубокой менопаузе. Советская медицина. 1990;(3):72–76.
20. Баженова А. П., Мадич К. К., Хаханашвили Г. Н., Сихарулидзе A. B. Опыт применения операции Пэйти-Дисона при раке молочной железы. Хирургия. 1987;(4):37–42.
21. Левин А. О., Мясникова М. О. К вопросу оставления малой грудной мышцы при радикальной мастэктомии. Вопр. окол. 1992;38(1):80–84.
22. Даценко B. C., Абишева А. Б. Мастэктомия по Patey при комбинированном лечении рака молочной железы. Вопр. окол. 1977;23(2):48–53.
23. Даценко В. С., Розанов И. Б., Суховеев П. Н., Виноградов Л. И. Радикальная мастэктомия по Пейти при комбинированном лечении рака молочной железы. Хирургия. 1989;(12):81–85.
24. Гладилина И. А. Роль лучевой терапии в органосохраняющей комплексной программе лечения больных с ранними стадиями рака молочной железы. В кн.: Кампова-Полевая Е. Б., Портной С. М. Актуальные аспекты клинической маммологии. М.: Авторская академия; 2014; 162–179.
25. Leskov N. Hugo Pectoralis ou une volonte de fer. Geneve: Les editions des Syrtes; 2004.
26. Тренин Д. В. Интеграция и идентичность: Россия как «новый Запад». Москва: Европа; 2006.
27. Хайленко В. А., Хайленко Д. В., Макаров Е. С. Радикальная мастэктомия и одномоментные реконструктивно-пластические операции при раке молочной железы с применением эндопротезов. В кн.: Рябчиков Д. А., Петровского А. В., ред. Рак молочной железы. М.: ГЭОТАР-Медиа; 2023; 201–210.
28. Есипов А. В., Сухоруков А. Л., Филиппов А. В. Выбор метода операционного лечения при язвенной болезни желудка и двенадцатиперстной кишки. М.: НМИЦ им. А. А. Вишневского; 2024.
29. Alexi-Meskishvili V, Konstantinov IE. Sergei S. Yudin: an untold story. Surgery. 2006;139(1):115–122.
30. Юдин С. С. Методика операций при огнестрельных переломах бедра в условиях современной войны. М.: Медгиз; 1943.
31. Петровский Б. В. Хирург и жизнь. М.: Медицина; 1989.
32. Петровский Б. В. О Сергее Сергеевиче Юдине. В кн.: Юдин С. С. Избранное. М.: Медицина, 1991; 356–375.
33. Юдин С. С. Этюды желудочной хирургии. М.: Бином; 2003. Частично опубликовано в журнале «Хирургия» 1991;(9):152–161.
34. Помелов В. С., Смагин В. А. Надпривратниковая резекция желудка у больных язвенной болезнью. Хирургия. 1999;(1):21–24.
35. Черноусов А. Ф., Хоробрых Т. В., Богопольский П. М. Хирургия язвенной болезни желудка и двенадцатиперстной кишки. М.: Практическая медицина; 2016.
36. Михин И. В., Голуб В. А. Хирургические подходы к лечению язвенной болезни желудка и двенадцатиперстной кишки. Волгоград: ВолгГМУ; 2014.
37. Красильников Д. М. Хирургическое лечение пациентов с язвенной болезнью желудка, двенадцатиперстной кишки. Казань: МеДДоК; 2023.
38. Лушников Е. Ф., Цыб А. Ф., Ямасита С. Рак щитовидной железы в России после Чернобыля. М.: Медицина; 2006.
39. Bay IA, Oughton DH. Social and economic effects. In: Smith J, Beresford NA, editors. Chernobyl — Catastrophe and Consequences. Chichester: Springer; 2005; 239–266.
40. Stsjazhko VA, Tsyb AF, Tronko ND, Souchkevitch G, Baverstock KF. Childhood thyroid cancer since accident at Chernobyl. BMJ. 1995;310:801.
41. IARC Working Group. Internalized β-particle emitting radionuclides. IARC Monographs. Radiation. 2012;100:285–303.
42. Luster M, Lassmann M, Freudenberg LS, Reiners C. Thyroid cancer in childhood: management strategy, including dosimetry and long-term results. Hormones (Athens). 2007;6:269–278.
43. Parisi MT, Eslamy H, Mankoff D Management of differentiated thyroid cancer in children: Focus on the American Thyroid Association Pediatric Guidelines. Semin Nucl Med. 2016;46:147–164.
44. Cao LZ, Peng XD, Xie JP, Yang FH, Wen HL. The relationship between iodine intake and the risk of thyroid cancer: A meta-analysis. Medicine (Baltimore). 2017;96:e6734.
45. Fridman M, Krasko O, Veyalkin I. The incidence trends of papillary thyroid carcinoma in Belarus during the post-Chernobyl epoch. Cancer Epidemiol. 2025;95:102745.
46. Фридман М. В., Красько О. В., Маньковская С. В., Савва Н. Н., Демидчик Ю. Е. Увеличение объема внеопухолевой тиреоидной ткани у детей и подростков, оперированных по поводу папиллярного рака: факторы, ассоциированные с этим феноменом. Вопр. окол. 2013;59(2):121–125.
47. Абросимов А. Ю. Рак щитовидной железы у детей и подростков России после аварии на Чернобыльской АЭС. Дисс. д.м.н. Обнинск: Мед. радиол. науч. центр РАМН; 2004.
48. Yablokov AV. Oncological diseases after the Chernobyl catastrophe. Ann N Y Acad Sci. 2009;1181:161–191.
49. Fridman M, Lam AK, Krasko O, Schmid KW, Branovan DI, Demidchik Y. Morphological and clinical presentation of papillary thyroid carcinoma in children and adolescents of Belarus: the influence of radiation exposure and the source of irradiation. Exp Mol Pathol. 2015;98(3):527–531.
50. Naing S, Collins BJ, Schneider AB. Clinical behavior of radiation-induced thyroid cancer: factors related to recurrence. Thyroid. 2009;19:479–485.
51. Демидчик Ю. Е., Шелкович С. Е. Опухоли щитовидной железы. Минск: БелМАПО; 2016.
52. Фридман М. В., Демидчик Ю. Е., Папок В. Е., Савва Н. Н., Зборовская А. А., Спивак Л. В. Криптогенный и ятрогенный папиллярный рак щитовидной железы у детей и подростков: сравнительное описание. Архив патологии. 2011;73(6):26–29.
53. Demidchik YE, Demidchik EP, Reiners C, Biko J, Mine M, et al. Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg. 2006;243:525–532.
54. Демидчик Ю. Е., Контратович В. Л. Повторные хирургические вмешательства у детей, больных раком щитовидной железы. Вопр. онкол. 2003;(3):366–369.
55. Фридман М. В. Папиллярный рак щитовидной железы у детей и подростков: диагностика, лечение. Автореферат дисс. д.м.н. Минск: Респ. научно-практический центр онкологии и мед. радиологии; 2014.
56. Мамчич В. И., Погорелов А. В. Хирургическое лечение узловых форм зоба после аварии на Чернобыльской АЭС. Клин хирургия. 1992;(12):38–40.
57. Стародубов В. И. О совершенствовании организации медицинской помощи больным с заболеваниями щитовидной железы, проживающим на радиоактивно загрязненной территории Брянской обл. Приказ МЗ РФ № 301 от 09 октября 1998 г.
58. Романчишен А. Ф., Демидчик Ю. Е., Полиаков В. Г. Хирургическое лечение детей и подростков с патогенетически разным раком щитовидной железы. В кн.: Романчишен А. Ф., ред. Хирургия щитовидной и околощитовидных желез. СПб.: Вести; 2009; 367–369.
59. Drozd V, Saenko V, Branovan DI, Brown K, Yamashita S, Reiners C. A Search for causes of rising incidence of differentiated thyroid cancer in children and adolescents after Chernobyl and Fukushima: comparison of the clinical features and their relevance for treatment and prognosis. Int J Environ Res Public Health. 2021;18:3444.
60. Suzuki S. Childhood and adolescent thyroid cancer in Fukushima after the Fukushima Daiichi Nuclear Power Plant Accident: 5 years on. Clin Oncol (R Coll Radiol). 2016;28(4):263–271.
61. Yamashita S, Suzuki S, Suzuki S, Shimura H, Saenko V. Lessons from Fukushima: Latest findings of thyroid cancer after the Fukushima Nuclear Power Plant Accident. Thyroid. 2018;28(1):11–22.
62. Bogdanova T, Chernyshov S, Zurnadzhy L, Rogounovitch TI, Mitsutake N, et al. The relationship of the clinicopathological characteristics and treatment results of post-Chornobyl papillary thyroid microcarcinomas with the latency period and radiation exposure. Front Endocrinol (Lausanne). 2022;13:1078258.
63. Janiak MK, Kamiński G Thyroid cancer in regions most contaminated after the Chernobyl disaster. J Biomed Phys Eng. 2024;14:299–308.
64. Adam MA, Pura J, Gu L, Dinan MA, Tyler DS, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann Surg. 2014;260(4):601–605.
65. Li G, Li R, Zhong J, Chen W, Shuai J, et al. A multicenter cohort study of thyroidectomy-related decision regret in patients with low-risk papillary thyroid microcarcinoma. Nat Commun. 2025;16(1):2317.
66. Гамолина Л. И., Ачинович С. Л., Пышняк В. Л. Микрокарцинома щитовидной железы. Тактика лечения и диспансерного наблюдения. В кн.: Рак щитовидной железы. Современные принципы диагностики и лечения. Материалы междунар. науч. форума, СПб., 12–13 июня 2009. СПб. гос. ун-т; 2008; 40–41.
67. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid. 2015;25(7):716–759.
68. Matrone A, Campopiano MC, Nervo A, Sapuppo G, Tavarelli M, De Leo S. Differentiated thyroid cancer, from active surveillance to advanced therapy: toward a personalized medicine. Front Endocrinol (Lausanne). 2020;10:884.
69. Фридман М. В., Маньковская С. В., Красько О. В., Демидчик Ю. Е. Клинико-морфологические особенности папиллярного рака щитовидной железы у детей и подростков в республике Беларусь: анализ 936 пост-чернобыльских карцином. Вопр. окол. 2014;60(2):43–46.
70. Holinger PC, Offer D. Toward the prediction of violent deaths among the young. In: Sudak HS, Ford AB, Rushforth NB, editors. Suicide in the young. Boston: John Wright; 1984; 15–30.
71. Беляев И. А. Чернобыль. Вахта смерти. М.: ИздАТ; 2006.
72. Mould RF. Chernobyl record: The definite history of Chernobyl catastrophe. Bristol Institute of Physics; 2000.
73. Семенов А. Н. Чернобыль. Десять лет спустя. Неизбежность или случайность? М.: Энергоатомиздат; 1995.
74. Бабичев С. И. Показания и противопоказания к оперативному лечению бронхиальной астмы. Метод. рекомендации. М.: МЗ РФ; 1988.
75. Смаков Г. М. Патогенетическое обоснование денервации легкого при бронхиальной астме. Хирургия. 1999;(2):67–69.
76. Соколов С. Н., Герасин В. А., Моисеев Н. В., Леонтьев А. И. Результаты резекций легких при бронхиальной астме. Грудная хирургия. 1975;(1):105–108.
77. Гулкова Т. М., Волкова А. В. Поздние результаты оперативных вмешательств у детей с хронической пневмонией. Вопр. охраны материнства и детства. 1968;13(8):13–17.
78. Есипова И. К., Владимирцева А. Л., Бирюков В. В. Пороки ветвления и дивертикулез слизистой оболочки бронхов у детей как факторы, предрасполагающие к развитию хронических воспалительных процессов в легких. Архив патологии 1990;52(2):6–10.
79. Есипова И. К., Владимирцева А. Л. Врожденные пороки развития легких. Архив патологии 1996;58(3):49–54.
80. Перельман М. И., Платов И. И. К вопросу о классификации пороков развития легких. В кн.: Толузакова В. Л., Ширяева К. Ф. Пороки развития и генетически обусловленные формы хронических неспецифических заболеваний легких. Сб. науч. трудов. Ленинград: 1-й мед. ин-т им. И. П. Павлова; 1976.
81. Путов Н. В., Варламов В. В. Пороки развития легких. Бронхоэктатическая болезнь. СПбГМУ; 1999.
82. Ловачева О. В. Диагностика пороков развития легких в сочетании с туберкулезом. Автореферат дис. к.м.н. М.: ЦНИИ туберкулеза; 1984.
83. Бубнова Н. И. Особенности морфогенеза бронхоэктатической болезни у детей дошкольного возраста. Архив патологии. 1991;53(12):40–45.
84. Севергина Э. С. Пальцев М. А. Гипопластическая дисплазия как одна из форм нефропатии. Архив патологии. 1989;51(10):58–63.
85. Romanenko A, Morell-Quadreny L, Nepomnyaschy V, Vozianov A, Llombart-Bosch A. Radiation sclerosing proliferative atypical nephropathy of peritumoural tissue of renal-cell carcinomas after the Chernobyl accdent in Ukraine. Virchows Arch. 2001;438:146–153.
86. Romanenko A, Fukushima S. Prediction of urinary bladder cancer induction in Ukraine after the Chernobyl accident. XXIII International Congress of the International Academy of Pathology and 14th World Congress of Academic and Environmental Pathology, 15–20 October 2000, Nagoya, Japan. Pathol Int. 2000;50(Suppl):A70.
87. Romanenko A, Kakehashi A, Morimura K, Wanibuchi H, Wei M, Vozianov A, et al. Urinary bladder carcinogenesis induced by chronic exposure to persistent low-dose ionizing radiation after Chernobyl accident. Carcinogenesis. 2009;30:1821–1831.
88. Jargin SV. Urological concern after nuclear accidents. Urol Ann. 2018;10(3):240–242.
89. Фокина Е., Чуткова Л. Выбор родителей: деторождение или контрацепция? М.: Сибирская Благозвонница; 2017.
90. Jargin SV. The Overestimation of Medical Consequences of Low-Dose Exposure to Ionizing Radiation. Cambridge Scholars Publishing; 2019.
91. Jargin SV. Misconduct in medical research and practice. New York: Nova Science Publishers; 2020.
92. Jargin SV. Child abuse in Russia. J Addiction Prevention. 2023;11(1):1.
93. Bludau H-B, Jargin SV. Post-COVID-19 syndrome vs. consequences of vaccination with special reference to cardiovascular conditions. SciBase Cardiol. 2023;1(1):1002.
94. Guérot U, Ritz H. Endspiel Europa. Warum das politische Projekt Europa gescheitert ist und wie wir wieder davon träumen können. Frankfurt am Main: Westend; 2022. Russian edition: Геро У., Ритц Х. Эндшпиль Европа: почему потерпел неудачу политический проект Европа и как начать снова о нем мечтать. М.: Гнозис; Ереван: Fortis Press; 2024.