We performed the clinical and morphological analysis of 84 elderly and senile patients, died of poisonings with psychoactive drugs in 2013–2015. There were two main drug agents: benzodiazepines and barbiturates. During the first 5 days intoxication was a cause of death in 15.5%, pneumonia — in 44%. The peak of mortality due to pneumonia was registered on week 3 and later in the presence of hypostasis. Morphological analysis showed various pathological findings in different lungs areas. Сirculation disorders, thrombosis, alternation of dystelectasis and emphysema, edema, atelectasis, bronchoconstriction, bronchiolitis and aerocele were detected out of pneumonic focuses. The most frequent abdominal pathological findings were liver and pancreatic steatosis. Prolonged toxic phase, crucial role of hypostasis in pneumonia incidence and the disease course on the background of acute and chronicle diseases were special aspects in this category of patients.

Severe multisystem craniocerebral injury (smcci) is characterized by long-term disability and high lethal rates. Objective: analysis of smcci, features of its clinical course and lethality, including the main causes and terms of death. Materials and methods. An analysis of 170 case histories of the deceased with smcci was carried out: 130 men (76.5%) and 40 women (23.5%). The average age is 43.3±17.5 years. Victims were divided into groups, depending on the combination of head trauma with injuries to other anatomical areas of the body. The analysis of lethality, including the main causes and terms of lethal outcomes, was conducted. Depending on the main causes of death, all the deceased were divided into five groups: massive blood loss and shock, edema and dislocation of the brain, infectious pulmonary complications, purulent intoxication and others. Depending on the terms of death, the victims were divided into four subgroups: i — up to 24 hours, ii — from 1 to 3 days, iii — from 3 to 10 days, and iv — more than 10 days. The severity of the damage was assessed according to the injury severity score (iss), the level of consciousness was assessed according to the glasgow coma scale (gcs). The frequency of development of infectious complications and its relation to the terms of death was analyzed as well. Results. In the distribution of the victims, depending on the main causes of death, it was found that: in 41.2% (70) cases, the main cause of death was edema and dislocation of the brain; 25.3% (43) — massive blood loss and shock; 15.9% (27) had purulent intoxication, 12.9% (22) had infectious pulmonary complications and 4.7% (8) died due to other causes. The number of patients who died on the first day was 62 (36.5%), while 35 victims (56.5%) died within the first 3 hours after admission. On the third day, 24 patients (14.1%) died, 37 patients (21.8%) died 3-10 days after admission, and 47 patients (27.6%) died later than 10 days after admission. There was a significant correlation between the severity of the trauma and the terms of death: spearman’s rank correlation coefficient = -0.637 (-0.718; -0.538), p<0.0001. A significant connection between the iss and the timing of death was indicated by the chi-square=99.495, degrees of freedom=9, p<0.0001 for the contingency table 4x4. A significant correlation between the development of the ipc and the terms of death was indicated by the analysis of the contingency table (2x4): chi-square=143.136 with degrees of freedom=3 and p<0.0001. Conclusion. In the general structure of smcci, victims with a combination of head and musculoskeletal injuries prevailed, the combination with a chest trauma was second, the combination with a trauma to the abdomen was third and the combination with a spinal injury was fourth. The main causes of death were edema and dislocation of the brain, massive hemorrhage and shock, infectious pulmonary complications, septic complications and others. The statistically significant relation was found between the trauma severity, the development of infectious complications, “main causes” on the one hand, and the terms of death on the other.

The article presents the results of a morphological study in 35 operated patients with uterine leiomyoma (lm) of various sizes and localizations, admitted with uterine bleeding. We studied morphological changes which occured in tumors and uterine tissues of patients with lm after therapy with agents and devices for embolization of uterine arteries (eua). The analysis of structural changes in the uterine arteries and body in patients with lm anduterine bleeding made it possible to clarify the mechanism of hemostasis. The obtained morphological data confirmed the validity of eua with a haemostatic purpose for patients with lm and uterine bleeding in the delivery of emergency medical care.

Background Vertigo is the most common complaints addressed to a neurologist. There is few information about a role of physiotherapy in the treatment of vertigo.

Objective: To assess an efficacy of stimulation current physiotherapy in the treatment of acutely developed vertigo.

Material and methods. We examined 44 patients with a single or leading complaint of vertigo. Patients were randomized into two groups. Patients of the test group (22) underwent 2–6 procedures of micropolarization with the «emtc 12-01» device (russia) (4 procedures averagely), and patients of the control group (22) underwent 2–7 procedures simulating microcurrent physiotherapy (placebo) (4 procedures averagely). To assess the outcome of the treatment, all patients were tested on the eev scale (the european evaluation of vertigo) 1 hour prior to the first procedure and immediately after the last one.

Results The initial intensity of vertigo in patients of the test group was higher than in patients of the comparison group (eev 12.4±3.0 and 9.7±2.6 points, respectively (p<0.05)). After the treatment, the results according to eev scale were 4.9±4.4 points (p<0.001 when compared with baseline values) in the test group and 7.8±3.1 points (p<0.05 when compared with baseline values) in the comparison group. The average difference between the eev assessment before and after treatment was significantly higher in the test group (7.5 points (99% ci=4.9-10.1)) than in the comparison group (1.7 points (99% ci=0.2-3.6)) (p<0.01).

In both groups, subgroups of neurological and ent diseases were selected. Differences in the efficacy of treatment in patients between subgroups were not found. The mean difference between the eev assessment before and after treatment was 6.2 (95% ci=3.8-8.6) in patients with neurological diseases and 8.6 points (95% ci=5.5-11.6) in the subgroup of ent diseases; in the comparison group, the difference was 2.1 points (95% ci=-1.0-5.2) and 1.6 (95% ci=-0.5-3.7), respectively.

Conclusion Microcurrent physiotherapy is an effective method of treatment for acute vertigo, and allows to reduce its severity significantly.

The article presents the analysis of the existing literature on the use of fiberoptic facilities during challenging tracheal intubation. Awake fiberoptic intubation is the «gold standard» for difficult intubation cases in selective surgery. However, in emergency cases there is no clear rule for particular fiberoptic bronchoscope intubation method (awake, under anaesthesia with neuroomuscular relaxants or without them). Moreover, fiberoptic bronchoscope intubation technique is not described and valid enough. This is why further shared and generalized experience of fiberoptic tracheal intubation is needed, primarily for anesthetic management of emergency operations.

The rupture of the interventricular septum (ivs) remains a severe complication of acute myocardial infarction. In this article, we discuss optimal treatment tactics for patients with internal heart ruptures in acute myocardial infarction. We consider minimally invasive interventions in the optimally early periods of acute myocardial infarction as an alternative to surgical treatment using artificial circulation. It remains urgent to improve measures preventing complications in acute myocardial infarction, as well as its early diagnosis and the specifics of managing such patients.

Abstract relevance. Acute occlusion of the left coronary artery trunk is an extremely dangerous type of acute myocardial infarction (ami), which is lethal in most cases due to the high incidence of cardiogenic shock. The only possible way to save the patient’s life is emergency coronary artery revascularization. Considering an importance of the left coronary artery trunk in the occurrence of lethal complications, the special importance is given to the quality of implantable coronary stents.

Materials and methods. The article presents the results of endovascular treatment with russian-made calypso stents in 9 patients with acute myocardial infarction, caused by acute thrombosis of the left coronary artery trunk.

Results The technical and clinical success of the procedure was noted in all cases. Within 8±3.5 months after the treatment, there was no a single case of thrombosis or repeated stenosis in the stent.

Conclusions Endovascular revascularization of the acute occlusion of the left coronary artery trunk using calypso stent is an effective and safe method of treatment which improves the survival of patients.

Bladder or prostate bleeding is a frequent complication in patients with an inoperable tumor. The treatment of such patients remains a complex problem. Patients with massive hematuria are usually of elderly age and it is impossible to perform cystectomy in them. Embolization of bladder and prostate arteries is indicated for such patients. The aim of the article is to describe the role of embolization in the treatment of bleeding from the bladder and prostate where conservative therapy fails, and to analyze its effectiveness and risks. The advantage of intervention is minimal invasiveness and low blood loss.

We report a clinical case of successful surgical treatment of the victim with penetrating abdominal trauma of lumbar lymphatic cistern, complicated by chylous ascites.

The authors report own observation of a complex wound of the neck with a favorable outcome.

We report a case of acute baclofen poisoning in a 23-year-old female patient, who committed suicide, which led to the development of a deep coma. The electroencephalogram on the first day recorded the phenomenon of “burst suppression”, which was seen as a sign of a dying brain. Subsequent studies have shown positive changes of the electroencephalogram and regression of neurological symptoms. Thus, the phenomenon of “burst suppression” in the depression of consciousness to deep coma and given adequate treatment, can be reversible.