We studied apoptosis of peripheral blood cells in 47 patients older than 60 years with varying course and outcome of acute poisoning with psychopharmacological drugs. It is shown that a control group of volunteers of the same age should be formed for an objective assessment of these disturbances. We revealed deviation of apoptotic parameters from the control group values. However, we failed to specify its information value for the prognosis and disease outcome

BACKGROUND. Pulmonary embolism (PE) is a pathological condition complicating the course of many diseases, which often remains unrecognized. An important role for its diagnosis is given to D-dimer concentration in blood. This marker has a low specificity and a high predictive value of a negative result. The normal level of D-dimer with low clinical probability of pulmonary embolism allows to exclude this diagnosis with an accuracy of 97%. According to the European Society of Cardiologists, the specificity of D-dimer may be improved by the correction of the upper reference values in patients of different age groups. The aim of the study was to calculate the correction coefficient of the normal D-dimer upper limit depending on age in order to improve the diagnosis of pulmonary embolism in patients with chronic heart failure (CHF).

MATERIAL AND METHOD. We surveyed 160 patients over 50 years with suspected pulmonary embolism on the background of CHF of III-IV functional class according to NYHA classification. All patients underwent clinical and biochemical blood tests, d-dimer, echocardiography, Doppler ultrasound, angiography of pulmonary arteries. Based on the results of examination, the diagnosis of pulmonary embolism was set in 102 patients with heart failure of III-IV functional class according to NYHA classification. The level of the proximal occlusion was distributed as follows: main pulmonary artery — 41%, lobar artery — 31%, segmental artery — 28% of patients. All patients had not a high risk of death from pulmonary embolism. In 58 patients with CHF of III–IV functional class and D-dimer above reference values, PE was excluded.

RESULTS AND CONCLUSION. In patients with CHF of III–IV functional class (NYHA) over 50 years, the correction of upper limit of D-dimer reference with a coefficient of 0.012 allows to increase the specificity of this marker in the diagnosis of pulmonary embolism by 40%.

Obliterating atherosclerosis of internal carotid arteries is one of the main causes of ischemic stroke and discirculatory encephalopathy. It causes up to 40% of ischemic disorders of cerebral circulation. Currently, the strategy for stroke prevention is determined by the intensive development of surgical methods of treatment, primarily methods for managing lesions of brachiocephalic arteries. Based on the results of a number of international multicenter randomized studies, indications for reconstructive operations for BCA, tactics for managing patients in the postoperative period were formulated. A number of patients with atherosclerotic lesions of brachiocephalic arteries have reduced cognitive functions. The aim of the study is to compare cognitive functions (CF) in patients who underwent different surgical approaches in the treatment of obliterating atherosclerotic lesion of internal carotid arteries (ICA).

MATERIAL AND METHODS. We studied higher mental functions (HMFs) in 116 patients with obliterating unilateral or bilateral lesion of ICA. The study of cognitive functions (MF) was performed prior to carotid endarterectomy (CE, group 1, n=73) and transluminal balloon angioplasty of ICAs (TBA of ICA, group 2, n=43), and on days 5–7 and 30–31 after cerebral revascularization (CR). To assess the overall severity of cognitive impairment, the summary indicators of main screening neuropsychological tests were used: MMSE; MoCA; Frontal Assessment Battery (FAB); Beck Depression Inventory and Hamilton Depression Rating Scale.

RESULTS. Results Neuropsychologic disorders were reavealed in 98% of patients prior to surgery. An initially comparable condition of HMF in groups with CE and TBA of ICA was revealed. MMSE2 revealed a significant improvement in the results in group 1 both in comparison with the initial data (p<0.05) and in comparison with the results of the second test of group 2. The results of MMSE1 and MMSE2 in group 2 did not show significant differences (p>0.05). MMSE3 showed a significant improvement in the test results in each group compared to MMSE1 and MMSE2. MMSE3 results were significantly better (p<0.01) in group 1 than in group 2. MoCA revealed most significant differences in group 1 results with a significant decrease in cognitive dysfunction both in MoCA1, MoCA2, MoCA3 either within the group (p><0.05) or compared to MoCA3 data between CE group and TBA group (p><0.01). FAB showed that the FAB2 test amounted to 16.2 points in the group with CE and 14.6 points in the group with TBA of ICAs (p><0.05). A significant improvement in the performance of mnestic functions was noted when examining patients in the dynamics of FAB3: 17.3 and 15.6 points (p><0.05), respectively. According to Hamilton Depresion Rating Scale and Beck Depression Inventory, both groups of patients showed a moderate level of anxiety and depression (12.4 and 15.8 according to Hamilton Depression Rating Scale (p><0.05), 12.3 and 14.4 according to Beck Depression Inventory (p>0.05)). During the second test, the depressive mood of patients was reduced (on the Hamilton scale 8.4 and 13.8 points.

CONCLUSION When comparing HMFs in patients who underwent a different surgical approach (CE vs TBA of ICAs) in the treatment of obliterating atherosclerotic lesions of ICAs, we found that: 1) the maximum improvement in HMFs appears by the 30th day of the postoperative period in comparison with preoperative parameters; 2) the most significant improvement HMFs test parameters by the 30th day of the postoperative period is noted in the group where CE was used as the method of surgical revascularization of the brain.

Objectives Critical analysis of the own first clinical results of the treatment in patients with pancreatogenic sepsis by inclusion of alternating negative pressure in

OBJECTIVES. Critical analysis of the own first clinical results of the treatment in patients with pancreatogenic sepsis by inclusion of alternating negative pressure into the complex therapy with assessing the possibility of using NPWT as an alternative to traditional omentobursostomy.

METHODS. We report the literature data and own first clinical experience in treating patients with pancreatogenic sepsis by negative variable pressure.

RESULTS. The advantages of the negative variable pressure method are earlier arrest of systemic inflammatory response syndrome, continuous evacuation of exudate, effective cleansing of the wound cavity, stimulation of granulation tissue proliferation, reducing the risk of compartment syndrome, shortening of hospital stay in patients with a favorable outcome and improved quality of life in patients during their stay in hospital. The disadvantages of NPWT should include development of petechial and arrosive bleeding in 12.5%, the occurrence of intestinal fistulas in 12.5% of clinical observations.

CONCLUSION. Today, it is not clear what place will NPWT take in the treatment of pancreatogenic sepsis. The data obtained in the course of literature search and analysis of our own clinical experience using the method of negative pressure therapy, indicate the need to confirm the initial clinical results in further comparative randomized controlled trials.

to the complex therapy with assessing the possibility of using NPWT as an alternative to traditional omentobursostomy. Methods We report the literature data and own first clinical experience in treating patients with pancreatogenic sepsis by negative variable pressure. Results The advantages of the negative variable pressure method are earlier arrest of systemic inflammatory response syndrome, continuous evacuation of exudate, effective cleansing of the wound cavity, stimulation of granulation tissue proliferation, reducing the risk of compartment syndrome, shortening of hospital stay in patients with a favorable outcome and improved quality of life in patients during their stay in hospital. The disadvantages of NPWT should include development of petechial and arrosive bleeding in 12.5%, the occurrence of intestinal fistulas in 12.5% of clinical observations. Conclusion Today, it is not clear what place will NPWT take in the treatment of pancreatogenic sepsis. The data obtained in the course of literature search and analysis of our own clinical experience using the method of negative pressure therapy, indicate the need to confirm the initial clinical results in further comparative randomized controlled trials.

ABSTRACT Such a phenomenon as bone tunnel widening after anterior cruciate ligament autoplasty with hamstrings has been known for 30 years. Despite the long history of this issue, the etiology is still not fully understood. The process of expansion of the bone tunnels is influenced by many factors such as graft fixation technique, surgical technique and rehabilitation protocol, as well as various biological factors. It is believed that this phenomenon has no influence on a functional result, but may create serious problems in revision anterior cruciate ligament surgery. Given the growing interest in the use of hamstring tendon grafts for anterior cruciate ligament reconstruction, increasing number of these operations and as a result, of revision procedures, the search for methods of bone tunnel widening prevention is becoming more urgent.

The review presents the results of experimental and clinical studies of the effect of early osteosynthesis in the femoral fracture on the development of systemic complications and the outcome of polytrauma with chest injuries. We explored the role of combination of thoracic injuries with a fracture of the femur, as well as its intramedullary osteosynthesis in the mechanisms of local and systemic inflammatory reaction formation, coagulopathy, fatty embolism and pulmonary embolism, respiratory failure. The concepts of “immediate total care” and “orthopedic damage control” are described with reference to fractures of the femur, combined with a chest trauma. The criteria for the relative safety of osteosynthesis of the femur in polytrauma with thoracic injuries are given.

N.V. Sklifosovsky Research Institute for Emergency Medicine is the main clinical base for medical elimination of mass disasters consequences, and about 20% of victims arrive here in emergency situations in Moscow. The current clinical structure of N.V. Sklifosovsky Research Institute for Emergency Medicine provides for the provision of skilled medical care to a large number of patients in massive admissions. Resuscitation departments of various specialties are organized at the Institute. In elimination of medical consequences of mass disasters, 11 clinical departments with 544 beds and 9 resuscitation departments are used. The capacity of resuscitation units (101 beds) allows to admit a large number of severely affected patients simultaneousely, including patients with combined and multisystem trauma, as well as to re-admit after surgery, taking into account the type of injury.

ABSTRACT. We analyzed long-term results of coronary artery bypass grafting in patients with acute coronary syndrome. In 2002–2014, 489 patients with acute coronary syndrome underwent surgical myocardial revascularization. Information for analysis was obtained by questionnaire via telephone, as well as upon outpatient and inpatient examination of a patient. Twelve-year survival rate was 98%. The repeated surgeries were not performed. CONCLUSION. Obtained long-term results of surgical treatment of patients with acute coronary syndrome were regarded as favorable.

ABSTRACT. Early initiation of artificial nutrition is one of the important components of intensive care for those affected with SMCT. The priority is given to enteral nutrition (EN). Parenteral nutrition (PN) is indicated in order to cover estimated needs in various substrates when EN cannot be performed or is inadequate. However, it must be taken into account that in addition to positive effects, PN may be followed by a number of complications: hyperglycemia, hypertriglyceridemia, impaired pulmonary function, increased thrombogenesis..

PURPOSE OF THE STUDY. To assess the safety of PN, used as a component of mixed artificial nutrition in victims with SMCT.

MATERIAL AND METHODS. Twenty patients with SMCT, conscious state up to GCS 6-13 and severity of the condition ISS 30-55 upon admission were examined. The age of victims was 40.2±13.1 years, the ratio of men/women was 17/3. All the victims had the diagnosis of brain contusion. In 9 patients, acute subdural hematomas were revealed. They underwent decompressive craniotomy and hematoma removal. The energy consumption was calculated using the Harris-Benedict equation with correction coefficients and indirect calorimetry (IC) method. IC was performed 24 hours a day also calculating respiratory coefficient. Nitrogen balance was studied to assess the severity of hypercatabolism. Enteral nutrition was initiated in all victims starting from day 2 after the injury. In connection with the impossibility of complete compensation of protein-energy requirements by EN, on day 8.8±1.3, PN was added. A three-component mixture of Nutriflex Lipid 70/180 (B. Braun, Germany), 625 ml was used. The concentration of triglycerides (TG) and glucose in venous blood plasma was assessed daily, as well as the ratio of oxygen tension in the arterial blood to the oxygen fraction in the inhaled mixture (PaO2 /FiO2 ).

RESULTS. All patients had hypercatabolism prior to initiation of mixed artificial nutrition, and its severity lowered when mixed artificial nutrition was initiated (on day 3 of artificial nutrition in 11 patients, on day 5 in 3 patients and by day 7 in 6 patients). The introduction of PN “three in one” mixture was accompanied by a slight increase in the concentration of TG 2 hours after the start of the infusion and did not affect the dynamics of pulmonary gas exchange. The introduction of PN was accompanied by the development of hyperglycemia. The increase of glucose in venous blood serum was noted 2 and 12 hours after the onset of PN.

CONCLUSION. Mixed artificial nutrition in patients with severe multisystem craniocerebral trauma does not lead to the development of hypertriglyceridemia and violation of pulmonary gas exchange and allows to achieve nutritional therapy goals.

Surgical treatment of cervicothoracic injuries has a special place in emergency surgery. Trauma of two anatomic regions adds some difficulties to exploration of wound and detection of all injuries. Unrevealed injuries lead to various complications, including fistulas of hollow organs.

We report the clinical case of successful conservative treatment in a patient with poisoning and thermomechanical trauma, complicated by acute renal failure and spontaneous rupture of both kidneys with retroperitoneal hemorrhage

The scientific school of the academician of the Russian Academy of Science E.A. Luzhnikov is the largest and most authoritative school in clinical toxicology in Russia, uniting about 150 scientists whose research continues and develops ideas, views and methodological approaches suggested by the teacher. Scientific achievements of E.A. Luzhnikov school have a high degree of relevance and novelty. Some studies of the school are of a fundamental nature. The feature of the scientific school of E.A. Luzhnikov is its great scientific and organizational activity, such as establishment and development of toxicological services in the country, which significantly improved the results of treatment for acute poisonings in Russia.

The article is dedicated to doctor of medicine, professor V.A. Sokolov. In 2017 he celebrates his eightieth birthday. Professor V.A. .Sokolov is one of the founders of polytrauma treatment in USSR and Russia. For a long time he had been heading polytrauma department at the N.V. Sklifosovsky Research Institute for Emergency Medicine. Due to his work, algorithms of life sustaining and recovery of serious patients were developed. Professor V.A. Sokolov is the author of 6 monographies and about 300 periodical papers. Besides, he is the holder of 32 patents. Some of his inventions were popularized and manufactured. He had been leading active scientific work, which resulted in 6 doctoral dissertations and 15 candidate theses. The staff of N.V. Sklifosovsky Research Institute for Emergency Medicine congratulates on the anniversary.