The paper presents a comparative analysis of the state and principles of managing the emergency medicine in Western Europe and the United States, and reviews a number of actual problems, facing the medical community in these countries.

BACKGROUND. Extra-articular fractures of the proximal femur are severe lower extremity trauma, most patients are of elderly and senile age, what makes the problem of surgical management actual.

MATERIALS AND METHODS.We made a retrospective analysis of surgical treatment in 91 patients treated in 2010–2013. Entry criteria were: age over 65 years, application of a standard proximal femoral fixator (PFF) and PFF with modified neck screw, postoperative monitoring period up to 36 months. The overall performance was assessed depending on the fracture type in accordance with AO/ASIF classification (A1, A2, and A3). To assess the effectiveness of the proposed PFF with modified neck screw we formed the study group (n=28) and the comparison group (n=63). The PFF with modified neck screw was applied in the study group. The standard PFF was applied (“Osteosynthesis”, Rybinsk) in the control group. The x-ray, clinical and statistical methods of research were used. To assess the functional status and quality of life, harris hip score was applied.

RESULTS. In overall performance, excellent results occurred in 35.3% 12 months postoperatively, good — 29.7%, satisfactory — 26%, unsatisfactory — 8.8%. In patients with A1 type fractures, excellent and good results (77.7%) were higher in total than the corresponding figures in patients with A2 (51.3%) and A3 (75.0%) type fractures. Unsatisfactory results more frequently occurred in patients with A2 type fractures (p=0.038). Twelve months after the surgery excellent and good results in the study group (75.0%) exceeded the similar data in the comparison group (46.0%) by 1.63 times (p=0.039). Unsatisfactory results were observed 3.08 times more often in patients of the comparison group (3.6% and 11.1%, respectively), p=0.041.

CONCLUSION. Application of PFF with modified neck screw, allowed 75.0% excellent and good results to be achieved in the study group, compared to 46.0% in the comparison group.

We assessed the lack of blood supply to the femoral head in the fracture area in 52 elderly and senile patients with fractures of the femoral neck on the basis of radionuclide studies of the hip joints with osteotropic specimen 99mTc-Pyrphotech. It allowed us to define groups of patients with favorable and unfavorable reparative outcome in order to justify the selection of adequate surgical tactics.

Colon dysbacteriosis was revealed in 40 patients with acute poisoning caused by psychopharmacological agents at the stage of rehabilitation which waы confirmed by clinical symptoms and bacteriological tests in 21 cases (10 — control group, and 11 — study group) as well. We demonstrated an adequacy of Pectovit prebiotic for management of colon microbiocenosis violations.

The article analyzes the currently existing data concerning incidence and timing of venous thrombosis development in burn patients. There is no consensus not only on the incidence of this disease amongst burn patients, but also on methods of diagnosis and prevention. For the first time, we raised an issue of the need for formation of risk groups using the scale of prof. Joseph Caprini (USA) applied to patients with thermal injury.

Oxidative stress, developing in many diseases, is an imbalance between pro-oxidants and antioxidant defense mechanisms of the body. Antioxidant enzymes such as superoxide dismutase (SOD) play a key role in reduction of oxidative stress in vivo. Thus, a decrease in formation of reactive oxygen species (ROS), as well as activation of lipid peroxidation (LPO) due to exogenous SOD intake could be an effective method of prevention and treatment of some diseases. In this paper, we provide an overview of the results of experimental and clinical studies on the use of intravenous drugs and dietary supplements, containing SOD, in the treatment of inflammatory, infectious, cardiovascular and neurodegenerative diseases. As a result of SOD administration, the majority of authors observed an increase in the content of endogenous antioxidant enzymes (SOD, catalase, glutathione peroxidase), i.e., stimulation of endogenous antioxidant defence and consequent reduction of oxidative stress, which may explain mechanisms of positive effects observed.

Today, in connection with the development of surgical techniques, one of the main tasks is minimization of surgical trauma, reduction of postoperative complications and mortality, as well as the timing of hospital treatment of patients with maintained quality of surgical care. The widespread adoption of endoscopic surgery techniques into daily practice may help achieve the goal.

Annually, we perform more than 450 laparoscopic surgeries for acute surgical diseases at the Institute, and we have performed more than 6,000 interventions since 2000. however, the laparoscopic method of surgery is not a priority, there are strict indications and contraindications, which we followed and thus avoided the development of iatrogenic complications associated with the use of this method for urgent diseases. Today, the laparoscopic technique is used in acute appendicitis, perforated gastric ulcer and duodenal ulcer, acute cholecystitis, strangulated hernia of the anterior abdominal wall, intestinal obstruction, as well as in patients with abdominal trauma. The use of the laparoscopic method in emergency abdominal surgery improves the quality of diagnosis and treatment, reduces the number of postoperative complications and mortality, as well as the time of treatment.

Aim of study: to assess the effectiveness of invasive treatment strategies in patients with repeated myocardial infarction (rMI). We compared results of three treatment strategies in 453 patients with rMI admitted to the Institute from 2003 to 2011 and analyzed long-term results (up to 2016): 139 roentgen-endovascular coronary interventions (RECI) (various types), including the delayed procedures (performed 24–72 h later), 25 surgical myocardial revascularizations 8–12 weeks after the onset of rMI and 289 cases of conservative therapy. Cardiovascular mortality had been assessed in 138 patients with different treatment strategies for 5 years after the discharge.

Findings show that rMI is a predictor of high risk of death associated with high in-hospital and longterm mortality in the absence of reperfusion therapy. RECI in the early stages of rMI does not exclude its later performance. Different types of interventions, including the delayed ones, significantly reduce the incidence of complications and deaths, which occurence remains high in the absence of interventions. however, in a significant portion of patients with rMI, the severity of coronary lesions limits the possibility of RECI performance, determining indications for elective surgical myocardial revascularization. Coronary artery bypass surgery performed after myocardial scarring prevents the growth of left ventricular dysfunction, improves its contractile function, and prolongs the life of patients. Reperfusion strategies such as various types of RECI and/or delayed surgical myocardial revascularization improve the effectiveness of treatment in patients with rMI.

The article assesses the capability and adequacy of computed tomography in patients with complex intra-articular and juxta-articular fractures of the lower leg bones. The research includes modified methodology of these studies and systemized symptoms of fractures.

The conclusion has been made about the place of computed tomography in medical treatment for patients with such fractures, including the CT over time in the postoperative period.

We retrospectively analyzed the number and causes of hospitalizations in patients with mixed types of blood-borne viral infections (BBVIs) in specialized departments of a general hospital in 2010– 2014. We revealed an increase in detection of mixed BBVIs from 1.39 up to 1.50% (χ2 =1.192, df=1, p>0.05), particularly hIV/hCV and hIV/hBV/hCV. The majority of patients with co-infections had different medical and social deviations. The highest incidence of mixed infection occurred among men, mainly in the age group of 31–40 years (χ2 =5.46, df=1, p<0.05). Departments with the highest degree of the epidemic hazard for transmission of mixed BBVIs were the department of intensive care and resuscitation with a small operating room for emergency detoxification, departments of acute poisoning for the mentally ill patients, the department of resuscitation and intensive care for emergency patients and somato-psychiatric department.

The paper examines the results of transplantation of autologous graft and epidermal layer, grown outside the body of a patient, to granulating wounds after deep burns in 18 patients as well as methods which found no practical application due to poor healing abilities. It has been shown that the main cause of poor engraftment of the dermal graft is nutritional deficiency at the cellular level. This conclusion is confirmed by morphological studies of epidermal and dermal autograft. On the views of the authors, the further study of dermal autograft transplantation will put it to the worthy place among the other surgical methods restoring skin lesioned with burns.

The diagnosis and management of gastrointestinal bleeding from unknown sources is one of the most difficult problems in emergency surgery as it is associated with a high level of morbidity and mortality, which may reach 80%. Available methods of endoscopic diagnostic in 10-15% cases of these disease don’t identify the source of bleeding. We report the clinical observation of a patient with intestinal bleeding of a high severity from acute ulcers of small intestinal stump.

BACKGROUND. Paraesophageal hernias are relatively uncommon. The incidence of this disease has increased recently, and esophageal hernias now account for 5–10% of all hiatus hernias. Surgical treatment is recommended for all patients with this disease because of high risk of complications: strangulation or perforation.

CASE REPORT. A 44-year-old male patient with a giant and symptomatic paraesophageal hernia. The diagnosis was confirmed by instrumental examination. We performed laparoscopic repair using silicone-coated polypropylene bifacial mesh. The postoperative period was uneventful.

CONCLUSION. The laparoscopic approach may be successfully used as a therapeutic option in the treatment for hiatal hernias. Our clinical experience showed, that the technique appeared to be valid and safe. In cases of large hiatal hernia with a defect greater than 5 cm, it is recommended to apply the mesh in order to minimize the recurrence rate.