Background There is still no information on the dynamics of pro- and anti-inflammatory cytokines and mark-ers of the septic process before the clinical manifestation of sepsis. The aim of the study was to analyze the dynamics of inflammation and sepsis markers concentration in early periods in patients with urgent pathology, depending on the subsequently developed sepsis. Materials and methods. The concentration of procalcitonin, C-reactive protein, LBP, IL-6, IL-10, IL-2R in 61 patients with a high risk of sepsis was investigated starting from the first day after admission to the hospital and then with intervals of 3–5 days. The Group 1 included 29 patients with verified sepsis. All patients of this group survived. The Group 2 included 8 patients who died. The Group 3 included 24 patients who had no clinical signs of sepsis. All the patients in this group recovered. Results. We revealed significant differences in concentrations of systemic inflammatory response markers and its dynamics in the period preceding clinical manifestations of sepsis. It was found that it was possible to predict the development of sepsis and its unfavorable outcome with a high statistical probability in the study of paired samples of blood serum of patients received on day 1–3 and 4–6 from the onset of the disease or severe trauma. The predictors were multidirectional changes of IL-6, IL-10, LBP concentrations and more than three-fold IL-2R increase on the background of high concentrations of procalcitonin and C-reactive protein. Conclusion. The highest concentrations of procalcitonin, C-reactive protein, IL-10 and IL-2R were revealed within the first three days in patients who died of sepsis. High concentrations of IL-6 and IL-10 within first three days and different directions of their concentrations during the next 4–6 days indicate the development of sepsis with an unfavorable outcome. Reduction of IL-2R and IL-6 and an increase in IL-10 within the first week after the onset of the disease or trau-ma are predictors of lethal outcome.

Background The advantages of thrombolytic therapy over anticoagulant therapy in the treatment of acute pulmonary embolism are uncertain. Aim of study To compare primary outcomes and incidence of complications in patients with PE of high and intermediate risk in the course of TLT or ACT and to assess efficacy and safety of TLT and ACT. Study Design Prospective non-randomized study. Intervention was administration of a thrombolytic, the control group consisted of patients who had an anticoagulant introduced. Characteristics of a sample 503 patients with a high and intermediate risk of early death at the age of 16 to 93 years (mean age 61±16, Ме 63 (51; 74) admitted to the resuscitation department in 2011–2016. Thrombolytics were administered to 222 patients, heparin — 281. Results The mortality rate was 10.8% (24/222) when treated with thrombolytic vs. 17.8% (50/281) with anticoagulant treatment; odds ratio was 0.56, 95% confidence interval 0.32; 0.97; p=0.031; P=0.60. The mortality rate in the subgroup with unstable hemodynamics was 30.2% (19/63) with thrombolytics vs. 47.1% (32/68) with anticoagulant treatment; OR 0.49 (0.22; 1.06); p=0.051; P=0.51. The mortality rate in the subgroup of intermediate risk was 3.2% (5/158) vs. 8.4% (18/214); OR 0.36 (0.11; 1.05); p=0.049; P=0.54. The use of thrombolytic was associated with a decrease in mortality: in the age group< 75 (mortality rate 5.5% (10/181) vs. 16.2% (33/204), OR 0.30 (0.14; 0.67); p=0.001, P=0.92); in the subgroup with acute cardiac arrhythmias (mortality rate 4.5% (1/122) vs. 44.0% (11/25); OR 0.061 (0.003; 0.557); p=0.002; P=0.91); in the subgroup with no hospital recurrence of embolism (mortality rate 1.6% (3/188) vs. 12.9% (32/248); OR 0.14 (0.03; 0.46), p< 0.001; P=1.0). With thrombolysis, infarction pneumonia developed less often: in 19.8% (44/222) vs. 28.8% (81/281); OR 0.61 (0.39; 0.95); p=0.022; P=0.64. There were no differences in the incidence of hemorrhagic complications in the treatment of thrombolytics in comparison with anticoagulant therapy: 7.7% (17/222) vs. 10.3% (29/281); OR 0.72 (0.37; 1.40); p=0.35; P=0.17. Severe hemorrhages (including intracranial): 2.7% (6/22) vs. 3.2% (9/281); OR 0.84 (0.26; 2.62); p=0.80; P=0.06. Minor hemorrhages: 5.0% (11/ 222) vs. 7.1% (20/281); OR 0.72 (0.31; 1.63); p=0.36; P=0.16. Intracranial hemorrhages: 0.90% (2/222) vs. 0.71% (2/281); OR 1.27 (0.13; 12.67); p=0.81; P=0.13). There was no difference in the re-occurrence of embolisms: 15.3% (34/222) and 11.7% (33/281); OR 1.36 (0.79; 2.35); p=0.29; P=0.22. Conclusion Thrombolytic therapy appeared to be more effective for survival compared to anticoagulant therapy with no differences in the incidence of complications.

Sepsis is the leading cause of mortality in patients with severe acute pancreatitis (SAP). High mortality rate in patients with SAP is mainly associated with purulent and inflammatory process in parapancreatic fat. Early laboratory diagnosis of infection is vitally important for timely indications for surgery and successful therapy. Aim of study The comparison of prognostic and diagnostic values of presepsin and acute phase proteins (CRP, PCT) in the development of septic complications in patients with SAP at the early stage. Material and methods We examined 37 patients with SAP. Depending on the course and outcome of the disease, patients were divided into two groups: Group 1 (n=10) — deceased patients, Group 2 (n=27) — patients with a favorable outcome. Each of these groups was divided into two subgroups: 1A (n=8) — patients who died of sepsis, 1B (n=2) — patients who died of other causes, 2A (n=7) — patients with a favorable outcome of sepsis and 2B (n=20) — patients without septic complications. The PSEP level was measured with PATHFAST enzyme immunoassay analyzer (LSI Medience Corporation, Japan). Descriptive statistics of quantitative characteristics were represented by medians and quartiles (Me (LQ; UQ)), values of area under the ROC curve (AUC) and 95% confidence interval. To compare the groups, the Mann–Whitney U test was used. Results The concentration of PSEP 785 pg/ml and higher on day 2–5 from the onset of the disease indicated a significant risk of purulent complications in intensive care patients with a sensitivity of 91.2% (95% CI, 77.93–97.89) and a specificity of 77.3% (95% CI, 51.59–97.91). The area under the curve for PSEP was 0.859 (AUC). PCT — 0.804 (AUC), sensitivity — 85%, specificity — 57%. CRP — 0.718 (AUC), sensitivity — 75% and specificity — 50%. Conclusion Based on the data obtained, it can be concluded that PSEP has the most informative value and diagnostic sensitivity compared to other markers of inflammation for an early diagnosis of sepsis in patients with SAP.

Background Due to the non-decreasing incidence of such injuries, prolonged treatment and high incidence of complications, treatment of posttraumatic soft tissue defects of extremities is an actual problem within traumatology and plastic and reconstructive surgery. Aim of study Development of tactics for the treatment of posttraumatic soft tissue defects of extremities with the use of vascularized tissues (flaps) and evaluation of its results. Materials and methods: 118 patients with posttraumatic soft tissue defects of extremities were included into the study. Patients were divided into 2 groups. In the comparison group (49 patients), the traditional management for posttraumatic defects was performed: local treatment of the wound followed by autodermoplasty. In the second group (study group), the developed procedure of cover tissues restoration using vascularized tissue complexes (69 patients) was applied. Results The developed treatment reduced the incidence of deep wound infection by 13.6%, necrosis of naked functional structures by 36.3%, chronic osteomyelitis by 17% and contraction of adjacent joints by 18.2%. At the same time, we noted a decrease in the duration of inpatient treatment by 14.7 days in patients with posttraumatic soft tissue defects of extremities. Conclusion The developed tactics of cover tissues restoration using vascularized tissue complexes reduced the incidence of complications and improved the functional results of treatment in patients with posttraumatic soft tissue defects of extremities.

The article shows the world experience of metabolic therapy use in the treatment of ischemic stroke. The issue still remains prominent. The reasonability of prescribing metabolic drugs is not completely clear, its effectiveness has not been fully proved, despite numerous studies which show only trends. The article presents an overview of the most popular drugs of different pharmacological groups with a metabolic effect which affect different parts of the ischemic cascade. Ethylmethylhydroxypyridine succinate and cytoflavin have predominantly antihypoxic effect, improve functional outcome and neurological functions, and normalize overall well-being and adaptation. Cerebrolysin is a complex of low molecular weight biologically active peptides derived from the pig’s brain. It has a multimodal effect on the brain, helps to reduce the volume of cerebral infarction, restores neurologic functions and improves the functional outcome. Cortexin is a mixture of cattle brain polypeptides, also has a complex action that provides the most complete reversion of neurological deficit, improves cognitive functions and the functional outcome, reduces the level of paroxysmal convulsive readiness and improves bioelectric activity of the brain. Citicoline is a precursor of cell membrane key ultrastructures, contributes to significant reduction in the volume of cortical brain damage, improves cholinergic transmission, which results in better clinical outcome, even despite the questionable impact on the neurological status. Choline Alfoscerate is a precursor of choline, and the use of the drug significantly limits the growth of the cerebral infarction area starting from the first day of therapy, leads to reversion of neurological symptoms and achievement of rehabilitation goals. Actovegin is deproteinized derivative of calf blood, activates metabolism in tissues, improves trophism and stimulates regeneration. In a large study, it was shown that Actovegin improved cognitive function in patients who had experienced a stroke,. The drug does not significantly improve the neurological status of patients after a stroke, but it reduces the risk of the stroke development in the next 10 years. Thus, we analyzed mechanisms of medical substances action and data of experimental and clinical studies, including ones after thrombolytic therapy and with inclusion of drugs for primary and secondary prevention of ischemic stroke. The reasonability and effectiveness of prescribing a combination of drugs of different pharmacological groups affecting brain metabolism remains controversial, since the excessive drug treatment may have complications. The safety of metabolic therapy is in doubt, and some of authors views presented confirm the need for additional large independent studies.

Abstract The purpose of this review is to evaluate the results of superior vena cava filters placement in order to prevent pulmonary embolism associated with upper extremities deep vein thrombosis. The central venous catheter, malignancy and lower extremities deep venous thrombosis are main risk factors of upper extremities deep venous thrombosis. The placement of the superior vena cava filter is a safe and effective method for preventing pulmonary embolism in patients with acute upper extremities deep vein thrombosis where therapeutic anticoagulation is contraindicated or appeared to be ineffective.

Background Chemical burns are 2.5 % to 5.1% of all burn injuries. Burns caused with household chemicals occur even more rarely. Because of its relative rarity there is no common surgical tactics for such patients. This type of burn trauma still remains under discussion. Aim of study Optimization of surgical treatment tactics in patients with severe chemical burns caused by household chemicals. Material and methods Medical histories of patients with life-threatening burns, caused by household chemicals. Results In order to remove the damaging agent, multiple incisions were performed as early as possible after admission. After stabilization, necrotized tissue was removed gradually to the superficial fascia. Single-stage autografting was considered unreasonable due to the lack of objective factors of the lesion depth. Hydrocolloid dressings were used for temporal closure of wounds. As tissues became clean we covered granulating wound by split-skin grafts. Conclusion Early fascial excision and delayed autoplasty is the priority method of surgical treatment of patients with life-threatening burns caused by household chemicals.

The article gives a situational task with detailed solving on providing emergency medical service at traffic accident with several victims. This type of educational technology is applicable for training classes and monitoring of medical personnel training level.

Abstract The given clinical example demonstrates the possibility of diagnosis and surgical treatment of Dieulafoy’s lesion with rare location (cecum in this case) when endoscopic hemostasis cannot be adequately performed. The manifestation of the disease is caused by the use of dual antiplatelet therapy after installation of stents into coronary arteries for unstable angina.

We report the clinical observation of acute myocardial infarction development associated with the compression of the left coronary artery trunk and discuss etiological role of primary and secondary cardiac tumors in the development of acute coronary syndrome.

The author report a clinical case of a one-year-old-child treatment with a foreign body (diode lamp) in the larynx. Despite the large size of the aspirated object and its location at the level of the glottis, the child was breathing independently. The foreign body was removed through natural airways with direct laryngoscopy, avoiding complications. This case emphasizes necessity of properly performed objective examination in children of younger age in order to reveal foreign bodies of respiratory ways.