6 апреля исполнилось 180 лет со дня рождения русского хирурга, ученого и педагога Николая Васильевича Склифосовского. Его имя часто ставится в один ряд с самыми выдающимися врачами прошлых веков. По словам В.И. Разумовского, «если Н.И. Пирогов был в России первым крупным представителем научной медицины и первым врачом-общественником, а С.П. Боткин — его преемником, то Николай Васильевич Склифосовский был достойным и наиболее крупным продолжателем их дела».

21–22 апреля 2016 г. в г. Суздале Владимирской области Арт-отель «Николаевский посад» принимал гостей научно-практической конференции «Новые технологии в скорой и неотложной медицинской помощи». Мероприятие было инициировано межрегиональной общественной организацией «Научно-практическое общество врачей неотложной медицины», нашло большую поддержку администрации Владимирской области, в частности, ее губернатора Светланы Юрьевны Орловой, Общественной врачебной палаты, директора Департамента здравоохранения Владимирской области Алексея Викторовича Кирюхина, и стало важным событием в медицинской жизни России.

Представляем Вашему вниманию интервью с главным сердечно-сосудистым хирургом Департамента здравоохранения г. Москвы, заведующим научным отделением неотложной кардиохирургии, вспомогательного кровообращения и трансплантации сердца НИИ СП им. Н.В. Склифосовского ДЗ г. Москвы доктором медицинских наук, профессором Виктором Викторовичем Соколовым.

Understanding the leading role of the endogenous proteolysis activation in a number of serious diseases has existed for a long time, the large group of antifermental drugs has been created and widely used. The hemosorbent, capable of selectively removing from the blood the most significant class of serine proteases in purulent septic pathology, was developed and tested in the clinic. The nature of the hemosorbents` therapeutic effect and the status of the proteins metabolism certain parts in connection with the application for haemosorption with biospecific antiproteinase hemosorbents has been studied in patients with diffuse purulent peritonitis of appendicular origin.

Background. Rearfoot injuries occur 2.5 times more often in a multisystem trauma than in patients with an isolated injury. The foot trauma is often misdiagnosed at the stage of intensive care treatment. Up to 22% of victims with foot injuries become disabled.

Aim of the study. The aim of the study is to determine distinctive characteristics of rearfoot injuries in patients with multisystem trauma.

Material and methods. We peformed a retrospective study of 89 cases of rearfoot injuries in patients admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2011–2013.

Results. There were 128 calcaneus and talus fractures. Middle-aged male patients (39±14.5 years) prevailed.

Conclusion. We found several peculiarities: the common mechanism of an injury was the fall from a height (64%). Up to 40% of patients with multisystem trauma had injuries of two and more anatomic areas. The multisystem spinal (lower thoracic and lumbar) injury was detected in 29% of patients. In 38% of cases we revealed polysegmental fractures of lower limbs. In patients with polytrauma, multiple foot injuries were diagnosed in 31 cases (35%), most common were bilateral calcaneus fractures. We also diagnosed 60% of Gustilo and Anderson open fractures of III type.

Background. Due to the significant infectious complications mortality, the search for prognostic biochemical markers of sepsis development in critically ill patients is relevant.

Material and methods. The study involved 57 patients; in 40 cases sepsis developed. The control group included 17 patients where sepsis did not develop. The study was performed on day 1–2, 5–7 and 10–12 after admission. The intensity of oxidative stress was assessed by the level of malondialdehyde (MDA) and total antioxidant activity of blood serum (TAA). The endogenous intoxication was assessed by the concentration of medium molecular weight peptides (MMWPs), total and effective albumin concentration (TAC, EAC) in serum. The disturbance of endogenous vascular regulation was assessed by the level of stable metabolites of nitric oxide (NOx) in serum and the concentration of angiotensin converting enzyme (ACE).

Results. It has been found that MDA may be a prognostic index of poor outcome on day 5–7 after admission (relative risk (RR)=1.141, confidence interval (CI) 95% (1.033; 1.259), р=0.09); NOx level may be a predictor of a poor outcome on day 1–2 (RR=1.026, CI 95% (0.999; 1.055), р=0.064), as well as on day 10–12 (RR=1.012, CI 95% (1.000; 1.023), р=0.098) together with ACE concentration (RR=1.034, CI 95% (1.007; 1.062), р=0.015); MMWP254 level (RR=11.195, CI 95% (1.571; 79.771), р=0.016) and MMWP280 level (RR=17.370, CI 95% (1.568; 192.455), р=0.02) are significant predictors of a poor outcome on day 1–2 and 5–7 as well (MMWP254 — RR=4626.791, CI 95% (7.903; 27808.629), р=0.009 and MMWP280 — RR=1331.590, CI 95% (5.006; 354179.342), р=0.012).

Conclusion. We identified prognostically significant signs of unfavorable outcomes of septic process: decrease in NOx; growth of ACE concentration; increase in MDA and decrease in TAA; increase in MMWPs; decrease in TAC and EAC.

Abstract. Increased intracranial pressure results in cerebral blood flow decrease and cerebral edema formation. Correction of intracranial hypertension is one of the most important goals of intensive care in patients with severe traumatic brain injury. Objectives To determine the effects of L-lysine aescinat on ICP in patients with severe TBI.

Material and methods. Twenty patients with TBI and Glasgow coma scale below 9 enrolled in the study. All patients were operated: 6 patients underwent craniotomy and intracranial hematoma removing; 11 — decompressive craniotomy and intracranial hematoma removing. In 3 patients only ICP-sensor was implanted. ICP-monitoring was used in all patients. Ten patients were randomized to L-lysine aescinat treatment (daily dose of 20 ml for 7 days after surgery) (study group), 10 — to standard therapy (control group). We perfomed a comparative analysis of the mean ICP and the incidence of ICH within 7 days after surgery in the study and control groups.

Results. The length of ICP monitoring was 6.4±3.7 days: in the control group — 7.6±4.9 days, in the study group — 5.2±1.4 days. Mean intracranial pressure was less in the study group as compared to patients in the control group. The number of intracranial hypertension episodes was higher in the control group compared with patients who received L-lysine aescinat.

Conclusion. L-lysine aescinat treatment in patients with severe traumatic brain injury is accompanied by reduction of mean intracranial pressure and the number of intracranial hypertension episodes.

An acute disorder of mesenteric circulation is a serious disease with high mortality. It occurs much more often due to the arterial flow impairment, and less often due to the venous blood flow disturbance. Etiology: thrombosis, embolism, compression of the lumen under dissection. To restore the mesenteric blood flow endovascular techniques are performed: mechanical recanalization, balloon angioplasty, stent installation, thrombolysis, tromboaspiration and their various combinations. If recanalization of the superior mesenteric artery is unable to be performed, hybrid operations are carried out anterogradely: retrograde stent installation during laparotomy. The review shows that endovascular methods is a promising direction of treatment for acute mesenteric ischemia.

In the article, we report the incidence and etiology of pulmonary hemorrhage, and modern classifications according to the literature data. Methods of endoscopic diagnosis and treatment of pulmonary hemorrhage are analyzed.

The article presents the literature data on the regulation of endometrial cells apoptosis in health and proliferative diseases of the uterus. It is noted that throughout the menstrual cycle the cells apoptosis and regeneration take place in strictly controlled sequence and depend on the phase of the cycle and hormonal changes. The expression of Bcl-2 (inhibitor of apoptosis) in cells also varies cyclically in endometrial glandular cells, peaking in the late proliferative phase, and then decreasing to a minimum at the end of the secretory phase and within the menstruation phase. In endometriosis, the apoptosis index in endometrial functional layer is significantly lower than in healthy women. The weakened apoptosis is associated with the disturbance of its regulation. The expression of Bcl-2 increased with the progress of the disease in the endometrial tissue, while the expression of bax (apoptosis activator) corresponded to figures in healthy women. The increase in the expression of Bcl-2 was observed in the cells of myomatous fibroids. Thus, in patients with uterine myoma the ratio Bcl-2/Bax is more important. It is noted that the weakened apoptosis of endometrial cells and disorders of apoptosis regulation are leading pathogenic mechanisms for the development of proliferative diseases of the uterus. This is the basis of a new search for the effective diagnosis, prognosis and treatment of this widespread disease.

Analysing 166 cases of patients operated on in 2007 – 2013, we revealed adverse factors of postoperative period, leading to serious complications and death. The developed comprehensive approach allows to improve treatment outcomes in patients with a ruptured aneurysm of the abdominal aorta.

The article summarizes changes in the structure of the N.V. Sklifosovsky Research Institute for Emergency Medicine. The analysis of major indicators of therapeutic practice showed the effectiveness of measures for the foundation of new departments and reorganization of existing ones, which greatly improved treatment outcomes and resulted in more efficient use of hospital beds.

We report 9 clinicopathologic cases of Lyell’s syndrome, known as toxic epidermal necrolysis (TEN). Five deceased patients had dermal exposure to cow parsnip, grey mercury ointment or whitening agents. In 4 cases, TEN developed in the course of drug treatment as a part of polytherapy, and in one of them it was accompanied with the infection. All of TEN patients suffered from acute or chronic diseases, endogenous or exogenous intoxication, immunodeficiency.

We report a favorable outcome of late diagnosed and operated (delayed for several days) perforated duodenal ulcer from the practice of medical support for the modern oil-tanker fleet. Main features of medical care for shipboard personnel are discussed as well.

The case of timely diagnosis and surgical treatment of a rare strangulated hernia through the foramen of Winslow is reported.

The authors report 4 clinical cases from own practice of unusual foreign bodies in the lower respiratory tract in children. The diagnosing procedure and aspects of surgical treatment have been analyzed. The modern endoscopic equipment was used to remove foreign bodies.

2 апреля свое 70-летие отметил выдающийся советский и российский кардиохирург академик РАН Ренат Сулейманович Акчурин.

В этом году свое 50-летие празднует известный ученый, врач-стоматолог, доктор медицинских наук, профессор Олег Олегович Янушевич.

В начале апреля 2016 г. в Чикаго, США, проходили очередные научные сессии Американской коллегии кардиологов. Во время сессий были доложены результаты нескольких крупных исследований, включая такие исследования, как: 1) HOPE-3 (Heart Outcomes Prevention Evaluation 3) по оценке эффективности снижения артериального давления и холестерина в крови у лиц без сердечно-сосудистых заболеваний; 2) исследования GAUSS-3 (Goal Achievement After Utilizing an Anti-PCSK9 Antibody in Statin Intolerant Subjects 3) по оценке эффектов ингибитора пропротеинконвертазы субтилизин/кексин 9-го типа эволокумаба у больных с гиперхолестеринемией, которые не переносят прием статинов, и результаты еще нескольких исследований. В том числе и исследований, в ходе выполнения которых оценивали эффективность определенной тактики лекарственной терапии у больных с острым инфарктом миокарда, в частности исследования Early-BAMI по оценке эффективности внутривенного введения метопролола в ранние сроки после развития инфаркта миокарда с подъемом сегмента ST до выполнения первичного чрескожного вмешательства на коронарных артериях.

В данном материале, наряду с результатами двух других исследований, которые могут представлять интерес для врачей, занимающихся оказанием неотложной медицинской помощи, будут достаточно подробно представлены результаты исследования EarlyBAMI.

Научная медицинская библиотека НИИ СП им. Н.В. Склифосовского знакомит читателей журнала с изданиями, вышедшими в последние годы на русском языке, в которых отражены вопросы оказания скорой и неотложной специализированной помощи населению и проблемы, актуальные для современной медицинской науки в целом.

Scientific and practical events in the third quarter of 2016