From the Editor.

The Scientific-Practical Conference The pain. Problems and Solutions 20 October, 2015.

The meeting of the Board and the Coordination Council of Interregional Civil Society Organization Scientific and Practical Society of Emergency Medicine Doctors.

New molecular imaging technologies. The Annual Congress of the European Association of Nuclear Medicine.

The success of the emergency medical services in Moscow is a shared achievement.

BACKGROUND. Endogenous intoxication (EI), following acute poisoning, aggravates the disease course, increases the risk of complications and death, as well as the scope and duration of therapeutic measures. That is why, prevention and correction of EI in acute poisoning with psychopharmacological drugs (PPD) as well is relevant.

MATERIAL AND METHODS. In 115 patients with PPD poisoning, intestinal lavage (IL) was performed, 50 patients were control group. EI was evaluated by the level of medium molecular weight peptides (MMWP) and lipopolysaccharides (LS) in serum, albumin tests, leukocyte index of intoxication (LII) and shear index of neutrophils (SIN). The level of MMWP in blood and intestinal lavage fluid (intestinate) in 23 patients and 22 healthy donors was measured.

RESULTS. Initial level of WWMP in the blood of patients exceeded the norm by 32%, LS — by 10 times, LII — by 6.3 times and SIN — by 2.4 times. At the beginning of the gastrointestinal lavage, the intestinate’s MMWP in patients and donors exceed their values in the blood. At the end of the IL it fell by 3– 6 times. This was accompanied by a fall of MMWP in blood of patients by 18.2%, LS — 50%, and LII and SIN by 52% and 70% respectively. In the comparison group LII and SIN continued to grow during the 1st day.

CONCLUSION. In patients with uncomplicated poisoning with PPD the source of endotoxemia was the intestines. The IL promotes the elimination of endogenous toxins and the reduction of EI. 

ABSTRACT. The key component of the sepsis pathogenesis is the gram-negative bacteria endotoxin. It is a lipopolysaccharide of the bacterial wall, which circulation in the bloodstream results in unlimited activation of some biological systems, causing serious complications. Nowadays, there are developed and practiced sorption methods, based on the selective removal of the lipopolysaccharide from the blood during perfusion through the sorption column with covalently immobilized polymyxin on a bioinert matrix, which can bind and inactivate it. The therapeutic effect of hemosorption using the biospecific antilipopolysaccharide hemosorbent has been studied in patients with septic shock, associated with peritonitis and septic complications of destructive pancreatitis. 

ABSTRACT. The paper presents the results of hemorheological parameters and coagulation study in 67 volunteers of three age groups, including young, middle-aged and elderly people. Studies have shown that values of the vast number of blood rheological parameters increase with advancing age, which is mostly significant after 60 years. Based on the findings, it is concluded that the presented results of hemorheological parameters studies in patients older than 60 years should be used as a comparison group in evaluation of the disease severity and the effectiveness of treatment for geriatric patients. 

ABSTRACT. Traumatic radial nerve palsy is a frequent complication of humerus fractures. Significant amount of unacceptable results of treatment for this impairment motivates the physicians for ongoing investigation on optimization of diagnostic and therapeutic procedures. In this article we discuss various ideas of diagnosis and treatment of traumatic neuropathies, methods and terms of treatment for fractures of the humerus, complicated by radial nerve palsy. 

ABSTRACT. In critically ill patients, cases of non-transportable condition, multiple trauma, skeletal immobilization, intolerance for contrast agents, kidney failure, severe overweight and pregnancy, implantation of inferior vena cava filters in the angiography operating room after the contrast cavography is a challenge. The purpose of the review is to highlight the possibility of installing inferior vena cava filters using alternative imaging techniques during transabdominal duplex scanning and intravascular ultrasound. 

BACKGROUND. The rate of the multisystem chest trauma and mortality in patients with catatrauma remains high.

OBJECTIVE. To study the diagnosis and treatment of the multisystem chest trauma in patients associated with the fall from a height.

MATERIAL AND METHODS. 243 patients (208 multisystem injuries and 35 isolated injuries) with a chest trauma associated with the fall from a height were examined in the surgical department of Republic research centre of emergency medicine. We performed X-ray, CT and endosurgical examinations.

RESULTS. Instrumental examination revealed pneumothorax and hydrothorax in 24.4% and 22.6% of victims respectively. The rib injuries were observed in 181 patients, sternum fractures in 8 victims and thoracic vertebrae fractures in 84 patients. The puncture and thoracocentesis of the pleural cavities were performed in 85 cases. The thoracoscopy was performed in 21 patients, the thoracotomy – in 15 patients, suturing of the lung – in 22 patients, coagulation – in 15 patients, external plate fixation of multiple injured ribs – in 10 patients. The mortality rate was 21.4%.

CONCLuSION. The specifics of the multisystem chest trauma associated with the fall from a height is the development of hemothorax and pneumothorax. Thoracocentesis and videothoracoscopy allow to diagnose and stop the hemorrhage properly, to restore the lung rupture and perform the thoracotomy in severe cases, as well as reduce of complications frequency and mortality rate. 

SUMMARY. On the basis of single photon emission computed tomography of the myocardium (SPECT) with Technetril 99mTc performed in 81 patients with myocardial infarction (MI), we confirmed the proportion of myocardial segments of the left ventricle (LV) with varying degrees of RP inclusion and, therefore, with varying degrees of perfusion impairment. In 75% of patients, reduction of hypoperfusion area in the remote period after myocardial infarction has been revealed compared to the acute period. The relation between slow ECG evolution with the severe impairment of left ventricular myocardial perfusion has been showed. The relation between the degree of impairment of LV myocardial perfusion (by SPECT) and its contraction (according to the two-dimensional echocardiogram) has been revealed. It is shown that one of the leading factors in the restoration of myocardial perfusion is the time of intracoronary intervention. 

ABSTRACT. The possibilities of ultrasonography in the diagnosis of intussusception in children and disinvagination by hydroechocolonoscopy have been studied. The study was conducted in 2014–2015 at the Children’s Regional hospital of Tver. The age of children varied from 3 months up to 12 years. The disease duration before admission was 3–63 hours. The X-ray study confirmed the intussusception in all patients. In all cases, mesenteric lymphadenitis was revealed. Of 28 children, disinvagination was sucsessfuly performed with an aid of hydroechocolonoscopy in 26 (92.8%) patients. In 2 cases (7.2%), we failed to eliminate intussusception and children underwent the surgery. Three patients had recurrence; re-elimination of intussusception with hydroechocolonoscopy was performed. No complications were observed after disinvagination. Conclusion: The use of ultrasound in the diagnosis and treatment of intussusception eliminates radiation exposure, and allows the cause of intussusceptions to be determined as well. Disinvagination with hydroechocolonoscopy is technically simple, highly effective and safe. 

ABSTRACT. The article reports the clinical observation of the successful surgical treatment of a patient with a penetrating gunshot injury of the abdomen and the peforating wound of the mesentery of the ileum, the cecum and the external iliac vein with intense bleeding. The foreign body (bullet) entered the system of the inferior vena cava through the external iliac vein defect and migrated into the cavity of the right atrium, and then into the inferior vena cava. This article focuses on diagnostics (Х-ray, ultrasound and computer methods) and discusses the tactics of treatment. 

ABSTRACT. Intracardiac cyst is an extremely rare disease in adults. The article describes the clinical observation of the true cyst of the mitral valve, which led to obstruction of the left ventricular outflow tract. A young woman underwent transthoracic echocardiography due to complaints for shortness of breath, which revealed a floating rounded formation with the echo negative content on the anterior flap of the mitral valve. Transesophageal echocardiography and magnetic resonance imaging confirmed the presence of intracardiac formation. The patient was successfully operated on. The histological test verified the true (congenital) cyst of the mitral valve. 

ABSTRACT. The digital subtraction aortic arteriography with the transaxillar venous approach was successfully performed in a patient with multifocal atherosclerosis and inability to underwent any transarterial procedures. Fine-quality angiographic images of the thoracic and abdominal aorta and the arteries of lower extremities were obtained. The total volume of the injected non-ionic contrast medium Ultravist-370 was 210 ml. 

The birth anniversary of Veronika I. Skvortsova.

The 85th birth anniversary of Anatoly V. Pokrovsky.

The 60th birth anniversary of Leonid S. Kokov.

Cung T.T., Morel O., Cayla G., et al. Cyclosporine before PCI in Patients with Acute Myocardial Infarction // N. Engl. J. Med. – 2015. – Vol. 373. – P. 1021–1031.

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Scientific and practical events in the first quarter of 2016.