From the Editor.

Prevention and treatment of pain syndromes is an important trend in modern medicine.

PURPOSE OF THE STUDY. To compare efficacy and safety of nefopam and paracetamol as components of the preventive multimodal anesthesia (PMA) in patients operated on for a hernia of an intervertebral disc (hID).

MATERIAL AND METHODS. In 2013, 35 patients were operated on for hID. Group 1 (21) received PMA including wound infiltration by bupivacaine, ketoprofen and paracetamol. Group 2 (15) received nefopam instead of paracetamol. Intensity of postoperative pain, side effects and satisfaction of patients with anesthesia were assessed, and in 6 months later — existence and intensity of chronic pain.

RESULTS. Intensity of postoperative pain, satisfaction with anesthesia, and also frequency and intensity of chronic pain didn’t differ in group 1 and 2. Occurrence of undesirable reactions was higher in group 2.

CONCLUSION. In patients receiving nefopam and paracetamol as components of PMA, intensity of postoperative pain and also occurence and intensity of chronic pain don’t differ, but the patients receiving to nefopam, experience the undesirable reactions more often which do not affect satisfaction with anesthesia. 

PURPOSE OF THE STUDY. Improvement of perioperative multimodal analgesia at long­termed traumatizing abdominal interventions with estimation of its effectiveness.

MATERIALS AND METHODS. Eighty six patients have been examined and divided into 3 groups depending on anesthesia and postoperative pain relief methods.

RESULTS. The effectiveness of perioperative multi­modal analgesia using methods affecting the whole pathogenesis of pain has been revealed. Minimal stress of central and peripheral hemodynamics parameters, less evident pain syndrome in the post­operative period, economic effect shown up by the decrease of the use of narcotic analgesics both in intra­ and post­operative period have been observed.

CONCLUSION. Algorithm of perioperative multi­modal analgesia at long­termed and traumatizing abdominal operative interventions has been developed. 

ABSTRACT. The pilon fractures are one of the most technically difficult injuries to treat. Recently, the frequency of distal tibia intra­articular fractures has increased rapidly, but controversial discussion of optimal surgical technique and optimal timing of surgery is ongoing. The goal of this article is to review different options available for treatment of pilon fractures and evolving of views on the treatment of such fractures. 

ABSTRACT. Changes in the structure of the main causative agents of nosocomial infections and significant spread of multidrug­resistant strains of bacteria are a natural biological response for antibiotics that selectively inhibit pathogens and contribute to selection, survival and growth of drug resistant strains of bacteria. In this literature review we present the change of structure of the major causative microorganisms of nosocomial septic infections and theirs resistance to antibiotics for the last 70 years. 

BACKGROUND. Сraniocerebral injury is the most common type of trauma in Russian Federation especially among working age persons. These patients require unification of surgical tactics, intensive care and continuity of treatment in order to increase of effectiveness of treatment. Purpose of the study is evaluation of emergency neurosurgical aid efficiency in Voronezh region in terms of introduction of threelevel health care system.

MATERIAL AND METHODS. Neurosurgical service functioning of Voronezh Clinical Center for Disaster Medicine has been evaluated. It included treatment and transportation of patients with a brain injury during 2012–2014.

CONCLUSION. Admittance of patients with severe craniocerebral injury at the hospital with neurovisualization and telecommunication equipment improves neurosurgical aid efficiency of the Center for Disaster Medicine. It is possible due to effective patient’s data transmission and shortening of time before surgical intervention. The decrease of number of groundless neurosurgical team’s rides has been registered. 

SUMMARY. Authors operated on 24 children with tumors of the heart and mediastinum. Analysis of the results showed that a third of patients with tumors of the thymus has had a rapid malignancy. This fact allows to conclude about the necessity of the surgery soon after the detection of tumors, despite the absence of clinical signs of the chest organs lesion. 

ABSTRACT. In the N.V. Sklifosovsky Research Institute for Emergency Medicine minimally invasive technique is used for treatment of acute appendicitis, gastric and duodenal ulcer perforations, abdominal hernias, bowel obstruction and abdominal trauma. More than 5,000 emergency laparoscopy operations have been performed in our institute since 2000. Diagnostic and treatment algorithm for acute abdominal diseases and abdominal trauma has already been developed by now. 

ABSTRACT. This paper presents a comparative analysis of the existing systems of health insurance in number of advanced countries as well as suggests some possible directions of optimization and modernization of social health insurance. 

BACKGROUND. Acute poisonings with cauterant agents are accompanied by an increase in acid­forming function of the stomach in more than half of the cases. It slows reparative processes in the gastric wall and increases the risk of complications.

MATERIALS AND METHODS. The study involved 40 patients with chemical burns of the stomach grade III­IV who had underwent standard therapy. The complex therapy for 20 patients included 5 days of intravenous Rabeloc, 20 mg daily.

RESULTS. Rabeloc included into the complex of therapeutic measures in patients with chemical burns of the stomach grade III–IV helped reduce the length of stay in the ICU by 1.5 times and inpatient treatment by 1.8 times, reduce the frequency of early secondary hemorrhage and decompensated cicatricial narrowing of the stomach.

CONCLUSION. Early parenteral use of Rabeloc increases the effectiveness of complex therapy for acute poisoning with cauterant substances. 

ABSTRACT. Currently, acute cerebrovascular accident is an extremely important medical and social issue. Stroke is a major cause of disability in the population and takes a leading place among the causes of death.

Modern high­tech endovascular treatment of the ischemic stroke (IS) and acute coronary syndrome (ACS) includes effective methods of reperfusion of the brain and myocardium within first hours of the disease.

In this paper, we report two clinical examples of high­tech reperfusion endovascular treatment in the same patient at an intervals of 1 year and 6 months in the development of clinical picture of the stroke and ACS in Regional Clinical hospital № 1 n.a. Prof. S.V. Ochapovsky.

In the first case, intra­aortic TLT of two cerebral arteries (ACA and MCA) was performed simultaneously with delayed recanalization and complete regression of focal neurological symptoms. And in the second case, selective thrombolytic therapy was performed in the acute phase of stroke, which developed few hours after PTCA RCA in ACS, with a good clinical effect. 

ABSTRACT. The article deals with the use of botulinum toxin in the treatment of chronic headache. We present four clinical cases of patients who sought treatment in the “Pain Clinic” of N.V. Sklifosovsky Research Institute for Emergency Medicine with a chronic severe cephalgic syndrome of different genesis (migraine, tension headache, dystonia), which had not responded to outpatient treatment for a long time. The paper shows the change of pain in patients with various forms of headache after treatment with botulinum toxin type A, indicating the effectiveness of the method in these patients. 

BACKGROUND. Requirements for the graft used in microsurgery are simple retrieval, minimal anatomic variability, the possibility to operate on one surgical area, great length and diameter of flap vessels.

PURPOSE OF STUDY. Evaluation of the results and advantages of revascularized free anterolateral muscle flap usage in emergency surgery.

MATERIALS AND METHODS. Free muscle flap of the lateral vastus muscle on a vascular pedicle of the descending branch of the lateral femoral circumflex artery (anterolateral flap) was used to replace the defect in 2 patients. In one case, a patient had open fractures of the lower leg, complicated with primary defects of soft tissue, and in the other case a patient had incomplete traumatic amputation of the left foot. All the victims underwent soft tissue defects restoration within the first hours after the injury, next to fixation of the fracture.

RESULTS. All grafts have completely healed, total necrosis of muscle flaps hasn’t been observed. All patients had primary wound healing after the transfer. Cases of deep purulent infection after the surgery haven’t been noted.

CONCLUSION. The transfer of a free anterolateral muscle flap is the best method for emergency plastic and reconstructive surgery of the lower limbs. The advantages are simple and prompt retreival, no need to turn the patient to the lateral position, large amount of the flap, great length and caliber of vessels. 

ABSTRACT. Sharp and sharp­pointed foreign bodies in the aerodigestive tract can result in potentially fatal complications. They can be safety removed by rigid esophagoscopy thereby avoiding open surgical methods, which may be required when there is perforation or abscess formation. This case report highlights the risk of accidental ingestion of various dental instruments, which can lead to fatal complications. Successful removal of a foreign body helped prevent the development of life­threatening complications. 

The 85th birth anniversary of Armen A. Bunyatyan.

The 75th birth anniversary of Michael M. Abakumov.

The 55th birth anniversary of Andrey V. Reshetnikov.

Stub D., Smith K., Bernard S., et al. Air Versus Oxygen in ST­Segment­Elevation Myocardial Infarction // Circulation – 2015. – Vol. 131. – P. 2143–2150.

Holmes D.R. Jr, Doshi S.K., Kar S., et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient­Level Meta­Analysis // J. Am. Coll. Cardiol. – 2015. – Vol. 65. – P. 2614–2623.

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Scientific and practical events in the fourth quarter of 2015.