From the editor.

RELEVANCE. Patients with encephalopathy due to acute chemical agents poisoning have some brain functioning changes and a cognitive impairment during the rehabilitation program. These changes require correction of appropriate diagnostic protocol and treatment.

AIM. The aim of this study was to estimate changes of electroencephalography (EEG) and the P3 component of the event related potential (P300 ERP) that are observed in patients with encephalopathy due to acute chemical agents poisoning during stage of rehabilitation.

MATERIAL AND METHODS. The study was included 25 patients (age 37 (32; 51)) poisoned different kind of neurotoxic substances (drugs, ethanol) and complicated by toxic and hypoxic encephalopathy. They have got the treatment of encephalopathy by mexidol intravenously, mesodiencephalic modulation (MDM) and hyperbaric oxygen therapy (HBOT). All patients were recoded EEG (electroencephalograph of “MBN” company, Russia) and P300 ERP (“Neuron-Spectrum-5/EP” of “Neurosoft”, Russia) according to the international recommendations of clinical neurophysiologists. Neuropsychological testing was used for the assessment of cognitive functions.

RESULTS. There were some disturbances in primary electroencephalograms of all subjects. The follow-up EEG recording showed the main group of patients who had got the treatment (mexidol, MDM, HBOT) had more often (11 patients) the EEG improvements compared to the controls (1 patient). The main group had more rarely the EEG impairments compared to the control group. 6 patients of main group and 3 patients of controls did not have EEG changes during the follow-up EEG recordings. All controls and 17 patients of the main group patients had different cognitive disturbances. After the treatment 15 patients of the main group had improved on neuropsychological tests (MMSE, Munsterberg test, Schulte table, Number Connecting Test). They also had a decrease in the N200, P300 peak latency and an increase in the N200, P300 peak amplitude. Only 3 patients of controls had improved on neuropsychological tests.

CONCLUSION. The results of this study show that mexidol, MDM, HBOT using in the treatment of patients with acute chemical agents poisoning leads to the improvement of brain state and cognitive function compared to the controls. The findings of study have allowed making a preliminary conclusion that using in the treatment this kind of patients the combination HBOT+mexidol or MDM+HBOT+mexidol improves the results of neuropsychological examination. 

ABSTRACT. The treatment of bleeding peptic ulcers remains one of the pressing challenges in urgent surgery. Currently available endoscopic hemostasis modalities only partially meet the requirements of safety, efficiency and reliability, and therefore total and postoperative mortality rates are still high, both in our country, and around the world. The aim of the study was to identify the benefits and shortcomings of endoscopic radiofrequency energy exposure compared to standard hemostatic techniques used in the world practice to treat bleeding peptic ulcers. 

ABSTRACT. The paper reviews the treatment outcomes of 176 patients with biliary pancreatonecrosis. The history of pancreatonecrosis was identified in 82% of patients; in the remaining 18%, pancreatonecrosis was diagnosed after acute pancreatitis manifestations. Cholecystolithiasis was revealed in 82% of patients, cholecysto-choledocholithiasis was in 16%, and choledocholithiasis in 2%. A piecemeal pancreatonecrosis was found in 58% of patients, a large-focal one in 22%, subtotal or total in 20%. The combination of minimally invasive procedures on the biliary tract in the pancreatico-duodenal zone with the efficient detoxification and hepatoprotective therapies allowed mortality reduction from 28% to 18%. 

RELEVANCE. Sepsis is always accompanied by endogenous intoxication (EI). It is very important to study EI in the patients with severe sepsis and septic shock.

MATERIAL AND METHODS. Twenty seven patients with severe sepsis and thirteen with septic shock in the postoperative period were enrolled into the study. EI was assessed using the measurements of total and effective albumin concentrations (EAC), middle-molecular-weight proteins (MMWP) and EI index (Kei=MMWP/ EAC)x1000.

RESULTS. The use of the EI index in patients with severe sepsis and septic shock leads to improvement of diagnostic and therapy monitoring.

RELEVANCE. The increasing frequency of the disease in the population, the young age of the vast majority of patients, the traumatic traditional surgery, followed by removal of the organ, the high rate of postoperative complications.

PURPOSE OF THE STUDY. The introduction of transvaginal minimally invasive treatments (under the control of ultrasound scan), the formation of the protocols for patients in accordance with specific models of the pathology.

MATERIAL AND METHODS. The women in the number of 224 with the tube-ovarian purulent formations of the uterus. General clinical examination included standard techniques and pelvic ultrasound. The methods of the treatment include: the conservative methods – the combined antibiotic therapy, the minimally invasive methods – the transvaginal puncture-aspiration therapy under ultrasound, the laparoscopy and the traditional laparotomy.

Results And Conclusions. The management protocols based on the structural and topographic characteristics of the tubeovarian pus formation of the uterus are offered. The achieving the cold phase of the disease by the transvaginal puncture-aspiration therapy is an important step for addressing the need for, and nature of a post-operative treatment. 

RESUME. The aim of our study is to develop and introduce the algorithm of the early soft tissue reconstruction for the patients with severe open tibia fractures. We analyzed the treatment results retrospectively and prospectively 84 patients with severe open tibia fractures, complicated by soft tissue defects. In the comparison group (56 patients) we apply late soft tissue reconstruction. In the study group (28 patients) we applied the algorithm of early soft tissue reconstruction by plastic surgery methods. Surgery tactic depends on the patient’s condition, trauma mechanism, soft tissue defects size and localization. The algorithm of early soft tissue reconstruction was used for patients with severe open tibia fractures decreases duration of hospital treatment, rate of deep wound infection and partial necrosis of tibia bone. 

ABSTRACT. The article addresses current approaches to the management of cardiogenic shock developed in patients with acute myocardial infarction. The authors present the data on the pathogenesis, clinical manifestations of this complication, and also a detailed review of current approaches to the treatment of patients with cardiogenic shock. The authors discuss causes of poor outcomes in cardiogenic shock and possible ways of the improvement. 

ABSTRACT. An extensive traumatic wound in the patient who suffered in a road traffic accident was treated with water solutions containing pectins or silver nanoparticles. An accelerated wound clearance of purulent discharge was observed. Wound flora was represented by few germ cultures, mainly Acinetobacter spp.; many samples were free from germs. The wound was prepared for autoskin grafting that was successfully performed. The skin graft adherence and survival were uncomplicated. The patient was discharged home in a relatively satisfactory condition. 

ABSTRACT. The author presents the clinical case — the foreign body in the larynx as the chicken bone in the child of three years. Peculiarity of the presented clinical case is the uncommon foreign body in the larynx as the large chicken bone in the three year old child. Despite large size and location of the foreign body the child was breathing through natural airways. The foreign body was removed through the natural way by the direct laryngoscopy, while avoiding complications. 

Источник: Cerisano G., Buonamici P., Valenti R., et al. Early short-term doxycycline therapy in patients with acute myocardial infarction and left ventricular dysfunction to prevent the ominous progression to adverse remodelling: the TIPTOP trial // Eur Heart J. – 2014. Vol. 35, N. 3. – P. 184–191.

Источник: Than M., Aldous S., Lord S.J., et al. A 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial // JAMA Intern Med. – 2014. – Vol. 174, N. 1. – P. 51—58.

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Viktor Sergeevich Savelyev (02.24.1928 - 12.25.2013).