Objective. To estimate the efficacy of surgical treatment of internal carotid artery (ICA) thrombosis in patients suffered from acute ischemic stroke (AIS).

Material and methods. Author operated 25 patients suffered from AIS and ICA thrombosis from 01 Feb, 2014 till 31 Aug, 2016 in Neurosurgical Department of N.V. Sklifosovsky Research Institute for Emergency Medicine. Among them, 15 patients had total thrombosis of ICA and were operated on, 10 patients had partial mural thrombosis or floating thrombus (6 patients were operated on). There were 7 thrombectomies with the removal of intima, 13 superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses, 1 ICA stent installation.

Results. The excellent outcomes were seen in 7 (33.4%) patients, good outcomes — in 11 (52.3%) and satisfactory outcomes were observed in 3 (14.3%) patients. The improvement of functional deficit in the early post-operative period was 4.85 scores according to NIHSS, 1.2 scores according to Rankin scale and 2.3 scores according to Rivermead mobility index. The regress of neurological deficit was more significant among patients with severe focal disturbances; better outcomes were among patients operated on within first 3 days from an onset of the disease. There was no significant improvement among non-operated patients at the moment of discharge from hospital. Thrombectomy with the removal of intima performed in 2 (40%) patients with partial mural thrombosis was complicated by repeated thrombosis of ICA. The improvement of cerebral blood supply was verified in 16 (76.2%) operated patients according to the data of cerebral perfusion examination.

Conclusions. The early surgical treatment is indicated for patients with acute total thrombosis of ICA. It is possible to perform STA-MCA bypass in case of inability to perform endovascular thrombextraction or open thrombectomy with the removal of intima. The conservative treatment is indicated for patients with partial mural thrombosis while urgent operation is necessary among patient with floating thrombus to decrease the risk of cerebral embolism. 

Aim. To determine the influence of the time gap between acute myocardial infarction with ST-segment elevation and intracoronary intervention performed later than 2.5 hours on myocardium, we studied indicators of perfusion over time with an aid of SPECT, including intraventricular asynchrony (2–4 days and 6–8 months after stent installation).

Materials and method. We observed 22 patients with multivessel coronary lesion. The Russian program with the analysis of perfusion, function and the phase images was used in SPECT synchronized with ECG.

Results. Showed that the time gap prior to coronary intervention in the acute phase of myocardial infarction may be directly connected with the increase in impaired perfusion during the end-systole and the severity of pathological intraventricular asynchrony without ECG signs. All patients had significantly decreased wall mobility and intraventricular asynchrony together with increased R-R interval in the late period (after 6–8 months) independently from the coronary intervention time. In patients of group 1 (coronary intervention within 6 hours), focal transmural lesions of myocardium significantly decreased.

Conclusion. Late revascularization help decrease intraventricular asynchrony reducing the risk of heart failure in future. 

Resection of certain parts of the small intestine is common in clinical practice for various diseases and traumatic injuries. The significant decrease in bowel functioning leads to the development of a specific “short bowel syndrome” (SBS). There is an opinion that the remaining parts of the intestine after resection perform a compensatory function as a result of the development of morphological changes in the intestinal wall. Histological examination of the intestinal wall with evolved compensatory changes is of undoubted interest from the scientific and clinical point of view.

Material and Methods. To create the experimental model of SBS, 107 laboratory Wistar male rats were used, weighing 500–600 g, which underwent resection with removal of 1/2 or 2/3 of the small intestine length in proximal or distal parts. The observation period for the animals was 1, 2, 4 and 6 months. Upon expiration of indicated dates, samples of the small intestine and liver were taken from rats for autopsy to be used for histological examination. At the indicated terms, the animals had signs of SBS (diarrhea, weight loss), as well as morphological changes in the intestinal mucosa.

Results and Conclusion. According to the results of the study, we concluded that the loss of 1/2 the length of the small intestine is overcome without consequences, and the loss of 2/3 of its length, especially of its proximal part, is accompanied by a longer period of adaptation and more significant morphological alteration of the mucosa, which has to perform not only digestion, but also absorption. 

The study of acute coronary syndrome (ACS) in patients with chronic kidney disease (CKD) is one of the areas of modern cardiology. The prevalence, course, prognosis and tactics of treatment of myocardial infarction in CKD are not well understood. The analysis of literature sources allows us to state that CKD in ACS doubles the risk of immediate and long-term death and adverse cardiovascular events. It is necessary to determine the CKD stage to predict the hospital and long-term mortality of the infarct patient. It is difficult to diagnose ACS at advanced stages of CKD. CKD should be considered an independent risk of death after percutaneous coronary intervention and coronary bypass surgery.

Introduction. Despite great diagnostic and therapeutic advances, the amount of complications and mortality rate in patients with retroperitoneal hemorrhage associated with pelvic trauma remains high. The primary aim of treatment in such patients is early recognition and arrest of bleeding source and intensive therapy. Thus, the development of diagnostic and treatment algorithm is important for improvement the results of treatment of patients with pelvic trauma complicated by retroperitoneal hemorrhage.

The aim of the study is to evaluate the effectiveness of the developed algorithm for diagnosis and treatment of patients with pelvic trauma complicated with retroperitoneal hemorrhage.

Material and Methods. Retrospective comparative analysis was performed in 374 patients with pelvic fractures complicated with retroperitoneal hemorrhage who were admitted to our hospital from 2007 to 2015. The study group consisted of 164 patients who were treated according to the new algorithm for diagnosis and treatment. The control group consisted of 210 patients who were not treated with the developed algorithm.

Results. Clinical use of the developed algorithm led to reduction in mortality from 12.2 to 9.7%. The number of common complications decreased from 41.3 to 25.0%, and local complications decreased from 28.6 to 18.9%. The time of patients’ activation after the definitive fixation of pelvis reduced from 17.5 to 7.6 days. The average hospital stay decreased from 46.1 to 35.2 days.

Conclusion. The developed diagnostic and treatment algorithm helped reduce mortality rate, the number of general and local complications in patients with pelvic trauma complicated by retroperitoneal hemorrhage as well as the duration of bed rest and hospital stay.

We performed a retrospective analysis of treatment in 4,197 patients with acute cholecystitis. Destructive complicated cholecystitis was diagnosed in 658 (25.3%) patients . There were 431 (65.5%) patients of elderly and senile age. All patients had comorbidities. Cardiovascular insufficiency — 73.9%, respiratory diseases — 29.2%, diabetes — 26%. For urgent indications, 12 (2.8%) patients were operated, 2 (16.6%) of them died. In 419 (97.2%) patients, mini-invasive treatment was performed. Endoscopically, jaundice wasn’t managed in 86 (20.5%) cases. In 62 (14.8%) cases, percutaneous transhepatic microcholangiography was performed under ultrasound guidance. Laparoscopic cholecystectomy was performed in 183 (43.6 %) cases, traditional cholecystectomy was performed in 149 (35.6%) cases, and in 38 of them (23.9%) it was combined with Kerr’s drainage of choledoch. Mini-invasive cholecystectomy was performed in 87 (20.7%) cases. Postoperative complications were revealed in 21 (5.0%) patients, in 7 (2.9%) of elderly age and 14 (7.9%) of senile age. Postoperative mortality rate was 2.0%. The use of minimally invasive interventions in the complex treatment of this group of patients was the main goal and it was reasoned by the severity of the initial condition of elderly and senile patients.

Gastric lavage in patients with acute poisoning is an important component of the complex of detoxification activities at the pre-hospital stage of medical care. Non-compliance with the rules of gastric lavage may result in iatrogenic complications, among which 4.9% are gastric injuries by the probe. The analysis of treatment of 8,926 patients poisoned with non-cauterizing substances was performed. In 44 of them (0.5%), there were signs of gastroduodenal bleeding, caused by trauma of the gastric mucosa and in 12 patients (0.13%), there was perforation of a gastric wall by a probe. The main method of endoscopic hemostasis in patients with bleeding was infiltration hemostasis with epinephrine solution, with the exception of 5 patients with bleeding of type F1a and F2a, where the combined hemostasis with argon-plasma coagulation was performed. All 12 patients with gastric perforation were urgently operated. Prevention of gastric trauma during lavage at the prehospital stage is the strict implementation of the procedure developed by the staff of the Center for Treatment of Acute Poisoning at the N.V. Sklifosovsky Research Institute for Emergency Medicine.

Introduction. Lesions of proximal humerus occur often nowadays. Many surgical methods are performed in such situations.

Material and Methods. In October 2014 — August 2016, 25 patients with severe lesions of proximal humerus underwent primary unipolar shoulder joint arthroplasty in the Trauma Department no. 2 of S. Yudin City Clinical Hospital. AO\ASIF classification was used. The results were evaluated in the period from 5 to 18 months by Swanson shoulder score. The result 20-30 points was assessed as excellent, 10–19 points — fair, less than 10 points — poor.

Objectives. To evaluate immediate and midterm results of the unipolar shoulder joint arthroplasty in severe injuries of the proximal humerus.

Results. Good results were received in 19 cases (76%), fair results were achieved in 6 (24%) cases and there were no poor results. There were no intraoperative or postoperative complications.

Discussion. It is preferable to perform hemiarthroplasty if glenoid surface is intact. In such cases the results are similar to total arthroplasty. Standard surgical technics were used in all patients. All of them underwent rehabilitation courses after the surgery and returned to daily life and work.

Conclusion: Primary shoulder joint arthroplasty may be considered as a method of choice for severe fractures and fractures with dislocation of head and surgical neck of humerus. 

This article describes a clinical case of a patient with acute cerebrovascular accident, acute respiratory failure and acute coronary syndrome. The ischemic lesion was associated with sodium nitrate, poisoning and its metabolite nitrite which resulted in increased methemoglobin concentration in blood and manifested as reversible discirculatory encephalopathy, respiratory disorder and myocardial damage. The article shows figures, reflecting changes in the biochemical composition of blood and changes in the electrocardiogram. The purpose of this study is to demonstrate clinical features of acute poisoning with sodium nitrate.

Treatment of patients with complicated course of post-traumatic retroperitoneal cysts is a difficult task due to the relative rarity of this disease. The absence of a single treatment and diagnostic algorithm for this group of patients contributes to the high mortality rate. This clinical case demonstrates the complexities of diagnosis and surgical treatment of patients with multilocular post-traumatic retroperitoneal cyst complicated by recurrent bleeding into the cavity of the cyst and violation of the blood supply to the right side of the colon.

The case demonstrates an opportunity of safe and successful colonic stenting to treat bowel obstruction with following laparoscopic radical intervention for right-sided colon cancer localization. The colonic stent as a “bridge to the surgery” improves immediate results and surviving rate in elderly patients with complicated right-sided colon cancer and severe concomitant disease.

We report a case of successful treatment of a patient with multiple aneurysms of internal carotid artery, abdominal aorta, iliac and common femoral arteries. The first stage was reconstruction of the carotid artery, and then, the second stage was resection of the abdominal aorta aneurysm and aorto-femoral bifurcation replacement.