From the Chief Editor.

The relevance of the study is associated with the exceptional medical and social significance of the issues of toxicological assistance. In order to improve toxicological assistance to the population, we analyzed the dynamics of patient admission to major toxicological centers in St. Petersburg, Novosibirsk and Kazan in 2011–2017, which revealed a significant increase in the number of patients with a toxicological pathology and unidirectional changes in the structure of acute poisoning. We used statistical and analytical research methods. According to the results of the study, in all three centers the proportion of poisoning by narcotic substances increased, and the qualitative characteristics of poisoning changed (compared to 2011). Poisonings with opioid alkaloids and heroin haven’t been substantially found recently; the main proportion of poisonings was associated with the use of synthetic drugs (phencyclidines, piperazines, synthetic cathinones, synthetic cannabinoids, amphetamines, γ-butyrolactone and 1,4-butanediol, etc.). The proportion of patients with ethanol poisoning increased significantly: the number grew by 2.5 times in St. Petersburg, 3.0 times in Novosibirsk and 30% in Kazan. At the same time, the number of drug poisoning decreased in all three centers by an average of 20–30%. The number of carbon monoxide poisoning has also decreased in St. Petersburg and Novosibirsk. Data were obtained on some regional features of poisoning. The prevalence of poisoning by cauterizing agents in Novosibirsk and by plant poisons in Kazan. Despite a decline of mortality, the absolute number of deaths by acute poisoning during the study period increased. The study resulted in an attempt to identify the main problems and tasks of the toxicological service at present and to develop mechanisms for its improvement, taking into account modern changes in the volumes and structure of acute poisonings.

Authors declare lack of the conflicts of interests.

Significant decrease in death rates from out-of-hospital cardiac arrest (OHCA) can be achieved by developing and implementing an integrated program of administrative interventions focused on improvements in the provision of the first aid and emergency medical care. However, both identification of the foreground and reasonable components of the program, and evaluation of its efficiency are impossible in the absence of reliable tools for collecting and analyzing data on epidemiology of OHCA and performance of the prehospital care system. This paper discusses the development of unified form for collecting data on cases of OHCA with attempted cardiopulmonary resuscitation (CPR), addresses the promising data form “The protocol of CPR” that is recommended by the Specialized Board on Emergency Medical Care of the Ministry of Health of Russia, and offers a set of proposals for optimizing the form with consideration for the international guidelines for uniform reporting of data from OHCA.

Author declare lack of the conflicts of interests.

At the present stage of development of medicine, the delivery of psychological assistance is an important component of a systemic biopsychosocial approach. Patients and persons accompanying them undoubtedly experience anxiety during hospitalization due to the fact that the very appeal to the hospital and the preceding events are stressful. In turn, many previous studies show that stress can have both mobilizing (eustress) and negative effects (distress) on the emotional state and adaptive processes of a person.

The objective of this study is to study the level of stress and anxiety in patients (n=83) at the time of hospitalization and hospital stay. The study was conducted using three self-reporting scales (the Distress Thermometer, A. Beck Anxiety Inventory, and Hospital Anxiety and Depression Scale (HADS). The results of the study showed that most patients (58%) experienced an increased level of distress. Distress was most often accompanied by the following emotional reactions: anxiety (51%), fear (25%), sadness (21%), and loneliness (21%). The study of emotional state showed that 22% of respondents had a high level of anxiety (according to HADS), and 5% had clinically significant symptoms of anxiety (according to Beck Inventory). Symptoms of depression are less common. In the group of patients with a significant level of distress, a greater number of patients noted high rates of hospital anxiety and depression. In addition, the authors investigated the emotional state of patients after psychological assistance received in the hospital. The results show that the level of distress was almost twice reduced.

A pilot study of a group of patients being treated in the clinical departments of an emergency hospital allows us to draw a preliminary conclusion about the positive effect of the course of psychocorrective classes on the patient’s emotional state and the level of distress experienced, i.e. helps the patient resolve certain internal conflicts associated with a sudden change in life, calm down and positively set oneself up for treatment.

Authors declare lack of the conflicts of interests.

RELEVANCE. Telemedicine solves the problem of the availability of highly qualified personnel at the decision-making stage in the management of patients with intracerebral hemorrhage. AIM OF STuDY We set out to evaluate the effect of teleconsultation on outcomes in patients with intracerebral hemorrhage 30 days after the event.

MATERIAL AND METHODS. A prospective, open, nonrandomized clinical trial in two parallel groups. The first group included adult patients up to 80 years of age with a hemorrhagic stroke from 4 to 36 points according to NIHSS due to unilateral supratentorial intracerebral hematoma of non-aneurysmal genesis, who were examined by a neurosurgeon and resuscitator of the Regional Vascular Center in a ward. The second group included similar patients, but they received telemedicine consultation of the above specialists. The primary endpoint of the study was mortality 30 days after the onset of the stroke. The hypothesis of non-superiority was tested where the 95% confidence interval (CI) for the difference in mortality between the groups should not go over 15 percentage points.

RESULTS. A total of 140 patients (70 in each group) with intracerebral hematomas were studied. Mortality in the bedside group was 14.3% (CI 7.1%; 24.7%), and in the remote group it was 25.7% (16.0%; 37.6%), p=0.091. However, there was no evidence of superiority, since the difference between the groups in mortality was 11.4 with CI from –0.07 to 24.5 percentage points, which was beyond the predefined limit.

CONCLUSIONS. At the current level of development of medicine and information technology, telemedicine cannot fully replace the traditional (bedside) consultation of an expert level of neurosurgeon and neuroresuscitator in patients with intracerebral hematomas.

Authors declare lack of the conflicts of interests.

For the treatment of patients with severe multysistem pelvic trauma accompanied by pelvic bleeding, many algorithms have been proposed that have different procedures for the use of various methods of surgical hemostasis, but none of them may guarantee the complete arrest of pelvic bleeding. The purpose of this study was to estimate clinical efficacy and developed algorithm, aimed at timely diagnosis of intrapelvic bleeding and its complete arrest with the help of different methods of surgical hemostasis in patients with severe concomitant injury of the pelvis. The article analyzes the results of treatment of 168 patients with unstable pelvic ring injuries and signs of intrapelvic bleeding, who were treated in two trauma centers of the first level in St. Petersburg: I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine and Military Surgery Clinic of S.M. Kirov Military Medical Academy in 2010-2018. The victims were divided into two statistically homogeneous groups. In the comparison group (75 people), the pelvic ring was mechanically stabilized with the Ganz C-clamp or the anterior part of the pelvis was fixed with an external fixation device (EFD), and the arrest of the ongoing pelvic bleeding was expected due to occur due to the effect of biological tamponade. In the main group (93 people), after mechanical stabilization of the pelvic ring, various methods of surgical hemostasis were used: balloon occlusion of the aorta, pelvic tamponade, angiography with embolization. The choice of method for surgical haemostasis after trauma depended on the severity of the affected condition of hemodynamic parameters, availability of life-threatening consequences of damage to other areas of the body and the efficacy of previously applied method for intrapelvic bleeding arrest. The introduction of modern diagnostic and treatment algorithm, aimed at complete hemostasis in patients with ongoing intrapelvic bleeding reduced the overall mortality rate by 1.7 times, mortality within 24 hours of admission by 2.3 times, as well as the duration and the volume of blood transfusion therapy by 3 and 1.8 times.

Authors declare lack of the conflicts of interests.

THE AIM OF THE STUDY. was an index creation for both single and multiple acute traumatic intracranial hematomas (ATIH) for objectification of the surgical treatment indications and using multispiral computed tomography (MSCT) and based on up-to-date clinical recommendations.

MATERIAL AND METHODS. We performed a retrospective study of 3 groups of patients with ATIH. Group 1 included 19 patients who were treated conservatively and discharged from the hospital without complications (group of conservative treatment). Group 2 included 9 patients who were observed after hospitalization and were treated in a delayed manner surgically due to growth of the intracranial hematoma volume or the patient condition deterioration (group of observation). Group 3 included 18 patients who were operated due urgent indications (group of surgical treatment). For each patient, the acute traumatic hematoma index (ATHI) was calculated by our original formula. It took the ATIH location, volume in milliliters according to the first MSCT, and risk factors significant for poor outcomes into account. After a preliminary assessment of the significance of differences between the studied characters of groups, a discriminant analysis was carried out with determination of the ATHI values in each group.

RESULTS AND CONCLUSIONS. The suggested ATHI index has been shown to be effective in assessing single and multiple ATIHs of any location in accordance with current recommendations. The index is an objective (digital) and easy-to-use for determining ATIH surgical treatment indications and statistical treatment. If ATHI is less than 3 points, there are no indications for surgery and the repeated MSCT of the brain is indicated at least 12 hours after the first checkup or if the suspicious clinical sings appear; if ATHI is 3–4, the indications for surgery are relative and the repeated MSCT of the brain is required 6 hours later even if the patient condition is unaltered; the surgery is indicated if ATHI is more than 4 points.

Authors declare lack of the conflicts of interests.

BACKGROUND. Ultrasound study significantly expanded the possibilities of bedside diagnosis in patients with respiratory failure. Using ultrasound, it is possible to determine the volume of lung damage in the form of collapsed alveoli and infiltration areas with preserved airness of the lung tissue. AIM OF STuDY To study the possibility of assessing the recruitment maneuver of the alveoli based on changes in the ultrasound signs of lung tissue damage.

MATERIAL AND METHODS. A prospective study was performed in the Clinic of Anesthesiology and Resuscitation of S.M. Kirov Military Medical Academy. The study included 36 patients who were treated in the period from 2010 to 2017 with a duration of respiratory support of at least 48 hours and oxygenation index less than 300 mmHg. For 36 patients, 48 alveoli recruitment maneuvers were performed according to a step-by-step method under the control of dynamic compliance and average tidal volume. Ultrasound determined the type and extent of destruction of lung tissue by signs of infiltration and consolidation.

RESULTS. In the studied patients, after carrying out a maneuver of recruitment of the alveoli, arterial blood oxygenation indices increased statistically significantly, PaCO2 level decreased, pulmonary tissue compliance improved, respiratory volume grew. All this confirmed the mobilization of the alveoli and improved lung ventilation. Ultrasonographic evaluation of lung tissue showed a significant decrease in the severity of the ultrasound sign of infiltration after recruitment maneuver from 46.5 (38; 57.5) to 37.5 (30.5; 49.5). However, recruitment had practically no effect on the volume of the consolidated area of lung tissue: the general consolidation index before (4 (3; 5)) and after (4 (3; 5)) the maneuver had no statistically significant differences.

CONCLUSIONS. The pneumonia-affected consolidated lung tissue has a low recruitment potential and the volume of consolidation does not change with the growth of PEEP. After the recruitment maneuver, the number of B-lines decreases, indicating a decrease in infiltration and an increase in lung airness.

Authors declare lack of the conflicts of interests.

BACKGROUND. Traumatic brain injury (TBI) is one of the most important contemporary health issues. According to the World Health Organization, TBI is one of three leading causes of death in the world. Despite the development and widespread use of neuroimaging tools and instrumental research methods, clinical diagnosis of TBI is preferred. It is especially relevant at the prehospital stage when it is impossible to use instrumental diagnostic methods.

THE AIM OF THE STUDY. To determine the clinical course features and prognosis of treatment outcomes in patients with various types of traumatic brain damage.

MATERIAL AND METHODS. We studied the results of examination and treatment of 100 victims with a severe head injury hospitalized during the first days after receiving an injury and undergoing treatment at the N.V. Sklifosovsky Research Institute in 2008–2017. Depending on the type of brain injury patients were divided into 3 groups: Group 1 — isolated hematoma (n=20), Group 2 — hematomas and injuries of the brain (n=40), Group 3 — injuries of the brain (n=40). All patients underwent neurological examination, CT scan of the brain upon admission and over time within 12 days after trauma. In 30 victims, intracranial pressure (ICP) was monitored.

RESULTS. We revealed features of the dynamics of individual neurological symptoms in patients with different types of brain damage. In patients with isolated hematomas, neurological status was represented mainly with clinic dislocation syndrome and contralateral hematoma hemiparesis, and clinical pattern significantly depended on intracranial hemorrhage. In patients with combination of hematomas and contusions, the neurological status and its dynamics were less dependent on the volume of the hematoma and were mainly determined by contusions of the midline structures of the brain. In patients with brain injuries, neurological status reliably correlated with injuries of midline structures.

CONCLUSION. We revealed significant differences in neurological status, its changes over time and correlation with CT findings in patients with different types of traumatic brain injury.

Authors declare lack of the conflicts of interests.

ABSTRACT. When penetrating into the cell, local anesthetics affect some structures and processes, in addition to blocking sodium channels, leading to the development of cell damage. The aim of the article was to study the damaging effect of bupivacaine on the sciatic nerve and biceps femoris in rats.

AIM OF STUDY. Analysis of the first results of a randomized clinical trial (RCT) for the use of Hemoblock in patients with large incisional hernias and postoperative ultrasound (US) monitoring.

OBJECTIVES. Improving the results of surgical treatment of patients with large incisional hernias.

MATERIAL AND METHODS. Design of a simple blind randomized controlled trial with a 90 percent study power, α-error equal to 0.05 and β-error equal to 0.10. For this purpose, the total number of subjects is planned to be 66. Currently, there are 18 patients in the study, 10 in the comparison group (B), and 8 in the main group (A). Surgery is plastic prosthetic mesh implant in the sublay retromuscular position. We applied Hemoblock 15 ml retromuscularly and 15 ml subcutaneousely in group B. Wounds were drained by vacuum suction drains. Postoperatively — monitoring of a wounds by ultrasound examination on day 3, 7, 10, 12, 15, 18, and 21 after the removal of drains. The average age was 58.5±6.3 in group B and 55.6±11.7 years in group A (U=36.5, p>0.05), BMI 33.6±3.44 and 32.2±5.19 kg/m² respectively (U=35, p>0.05), the width of the hernia defect was 11±1.7 cm and 11.1±1.0 (U=33, р>0.05), length 13.6±2.7 cm and 12.5±3.3 cm (U=29.5, p>0.05), the area was 118±22.7 cm²  and 108.1±24.1 cm²  respectively (U=28.5, p>0.05). The average ASA was 2.2 in group B and 2.0 in group A.

RESULTS AND DISCUSSION. Median of follow-up for all patients was 30 days. Significant differences obtained in the duration of postoperative wound drainage — 4.2±0.9 days in group B versus 2.5±0.5 days in group A (U=4, p<0.01). In patients of group A, the amount of discharge by drainage and the level of CRP and albumin were lower. On ultrasound examination of the postoperative wound, starting from the 10th day, a significantly smaller volume of fluid accumulations was revealed in patients of this group, and from the 15th day fluid accumulations were not detected. In group B, one patient had seroma IIIc (according to MoralesCondo, 2012), 8 patients had IVa seroma, and one patient had IVb seroma spontaneously opened through the postoperative wound, which required debridement of the cavity on an outpatient for 21 days. In group A, only 3 patients had IVa seroma. The number of punctures was 23 in group B, and 3 in group A (χ² =8.654, p=0.04, Fisher’s exact two-sided test (F) =0.00654, p<0.05). Hospital stay was 8.9±0.6 days in group B and 8.0±0.5 days in group A (U=11.5, p<0.05).

CONCLUSION. According to preliminary data using local haemostatic agent Hemoblock allows: 1) to reduce the duration of postoperative wound drainage, 2) to reveal the period of inflammatory exudative processes in the postoperative wound, 3) to reduce the number of puncture interventions after incisional hernia repair, 4) to reduce the severity of pain and the need for analgesics, 5) to reduce the hospital stay time.

Authors declare lack of the conflicts of interests.

The purpose of this review is to evaluate the results endovascular treatment of popliteal artery aneurysms. Endovascular treatment using stent grafts is a safe and effective alternative to open surgical repair, has a lower wound complication rate and shorter length of hospital stay, satisfactory technical and clinical results even at long-term follow-up. In patients requiring long segment coverage or numerous stents, the poor state of distal blood flow may increase the risk of failure. Careful patient selection, proper operative technique and adequate sizes of stent grafts are required for good outcomes.

Author declare lack of the conflicts of interests.

The analysis of domestic and foreign literature sources showed that the problem of diagnosing and treating electrical injuries remained relevant as in the early 20th century. Over the past century, the mechanisms of the effects of electric current on organs and tissues have been well studied. However, the search for methods for diagnosing the volume of tissue damage has not been completed, and such methods are necessary, since they are designed to help determine the volume of surgical intervention. Many patients still require repeated surgical interventions to completely excise necrotic tissue. In most patients with severe electrical trauma, reconstructive surgery takes place in several stages. Today, most clinical data and practical recommendations are based on the opinions of individual experts and limited clinical studies.

Authors declare lack of the conflicts of interests.

AIM OF STUDY. To show the implementation of routing, results and methods of surgical treatment of patients with infectious complications of acute pancreatitis in specialized department of septic surgery of a regional hospital.

MATERIAL AND METHODS. After managing pancreatogenic shock and stabilization of the patient’s condition, the emergency medical teams or the territorial center of disaster medicine transferred the patients to the regional septic center (Department of Purulent and Septic Surgery of Sverdlovsk Regional Clinical Hospital No. 1). Over the past 5 years, 422 patients with acute pancreatitis of severe and moderate severity were transferred: 62 patients with peripancreatic infiltrates and signs of infection, but without a liquid component; 76 patients with pancreatogenic abscesses, 284 patients with non-localized variants of septic sequestration.

RESULTS. Infected peripancreatic infiltrates complicated by sepsis without a liquid component. An attempt of surgical separation and drainage was made in 19 patients out of 62. Nine patients (47.4%) died. Subsequently, the remaining 43 patients were treated conservatively and 11 (25.5%) patients died. Pancreatogenic abscesses (delimited septic sequestration). All 76 patients were operated with the use of minimally invasive technologies (navigation punctures, navigation puncture drainage, drainage and sequestration from the mini-access). There were no deaths. Non-localized pancreatogenic septic sequestration (pancreatogenic phlegmon). Suppuration areas within one quadrant (S1 or D1) occurred in 120 patients. All of them were simultaneously drained from 1–2 incisions of 3–5 cm, 16 patients died (13.3 %), another 164 patients had more common variants of lesions (2–5 quadrants), including central localization (C), 64 patients of them were operated simultaneously, 18 patients died (28.1%). Another 100 patients were operated using stage-by-stage drainage tactics, and 21 patients died (21%).

CONCLUSION. 1. The modern treatment of patients with purulent-septic forms of pacreatogenic lesions of retroperitoneal cellular spaces requires effective resuscitation support, verification of the form of the inflammatory process, high-precision visualization of foci of suppuration and the use of a wide range of modern minimally invasive surgical technologies.

2. The development and implementation of regional programs for routing patients with infectious complications of acute pancreatitis and providing them with staged medical care can improve the results of surgical treatment and reduce mortality from 28.1% to 19.3%.

Authors declare lack of the conflicts of interests.

The presented clinical case demonstrates the hybrid imaging SPECT/CT-angiography solutions in the diagnosis of post-traumatic femoral artery pseudoaneurysm combined with arteriovenous fistula. The presented case shows the effective use of CT and radionuclide medicine which allowed detailed of blood flow and tissue perfusion of lower extremities as well as an outcome of surgical treatment to be evaluated.

Authors declare lack of the conflicts of interests.

We report a rare clinical case of spontaneous rupture of the aneurysm left gastroepiploic artery with life-threatening intra-abdominal haemorrhage.

Authors declare lack of the conflicts of interests.

The biography of Olga Ivanovna Glazova, doctor of medical sciences, honored doctor of the RSFSR, member of the Scientific Council of the N.V. Sklifosovsky Research Institute, is an example of an exceptionally successful diversification of scientific activity, both in the field of cardiology and clinical toxicology, which is the new direction of Russian medicine.

There are suggestions in the works of O.I. Glazova similar to modern ideas of acute poisonings (AP), as confirmed by later publications in this field. The pathogenetic approach to the study of AP was considered by O.I. Glazova from the perspective of the teachings of I.P. Pavlov about the body as a single entity, and the action of the poison hypothetically dependent on its concentration in the blood. She emphasized the need for the early removal of poison from the body to prevent the adverse course of poisoning. The role of antidote therapy as an example of a detoxification approach to the treatment of AP was noted, while antidotes for parenteral administration were recommended in order to increase the effectiveness of detoxification.

Some thoughts were expressed about the dependence of the toxic effects of poisons on physical and chemical properties, as well as similar ideas about the quantitative measure of poisoning, selective and situational toxicity, the presence of concentration, space and temporal factors in the pathogenesis of poisoning. The systematization of the AP was presented.

Thus, O.I. Glazova made a significant contribution to the study of AP thanks to her enthusiasm, constant creative eagerness and high professional competence, which contributed to a significant growth the role of representatives of the emergency medical clinic in AP treatment, and in turn positively affected the regularity and quality of further research in this area.

Authors declare lack of the conflicts of interests.

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