Aim of study. Analysis of the results of a new method of emergency glomus-sparing carotid endarterectomy (CEE) according to A.N. Kazantsev in the acute period of ischemic stroke.

Material and methods. This cohort comparative prospective open-label study from January 2017 to April 2020 included 517 patients operated on for occlusive stenotic lesions of the internal carotid arteries (ICA) in the acute period of ischemic stroke (within 24 hours after the development of ischemic stroke). Depending on the implemented revascularization strategy, all patients were divided into three groups: group 1 — 214 patients (41.4%) — glomus-sparing CEE according to A.N. Kazantsev; 2nd group — 145 (28%) — classical CEE with plasty of the reconstruction zone with a patch; 3rd group — 158 (30.6%) — eversion CEE. The observation period was 35.2±9.6 months. Glomus-saving СE according to A.N. Kazantsev was carried out as follows. Arteriotomy with transition to the common carotid artery (CCA) was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2–3 cm above the ostium, depending on the spread of atherosclerotic plaque, the ICA was cut off at the site formed by the sections of the wall of the ECA and CCA. Then endarterectomy from the ICA was performed using the eversion technique. The next step was open endarterectomy from ECA and CCA. Then the ICA was implanted in the same position on the saved site.

Results. In the hospital follow-up period, there were no significant intergroup differences in the number of complications. However, it should be noted that in the CEE group according to A.N. Kazantsev had no adverse cardiovascular events. In the long-term follow-up period, the smallest number of cardiovascular accidents was detected after CEE according to A.N. Kazantsev. However, intergroup differences were found only in the combined endpoint and the incidence of thrombosis, which were the highest in the 2nd and 3rd groups (p = 0.01). When analyzing the survival curves, it was revealed that the greatest number of cardiovascular accidents in the group of classical and eversion CEE occurred either during the hospital observation period or during the first months after surgery, and after CEE according to A.N. Kazantsev - in a year or more. When analyzing the graph of the dynamics of systolic blood pressure (BP), it was revealed that after glomus-sparing CEE according to A.N. Kazantsev, stable numbers are maintained while receiving preoperative antihypertensive therapy and do not rise above 140 mm Hg. In turn, after classical and eversion CEE, critical hypertension persists in the first three days, which is difficult to treat. In the future, blood pressure figures are unstable and fluctuate in the range from 140 to 160 mm Hg. All cases of myocardial infarction and ischemic stroke were recorded against the background of critical numbers of systolic blood pressure, reaching 180-200 mm Hg.

Conclusion. The presented glomus-sparing carotid endarterectomy according to A.N. Kazantsev meets the modern standards of carotid surgery, combined with the minimum permissible risks of developing adverse cardiovascular events, both in hospital and in the long-term follow-up. The confident effect of the developed revascularization is based on the precise removal of plaque from the common, external and internal carotid arteries, as well as maintaining the stability of hemodynamic parameters.

Introduction. Acute cerebrovascular event (ACVE) is the leading cause of persistent disability and death in the world. Due to the high medical and social significance, much attention is paid to the problem of out-of-hospital stroke, and the issues of diagnostics and treatment of in-hospital stroke are practically not studied.

Relevance. In-hospital stroke is defined as stroke that develops in a patient hospitalized for other reasons. It is known that the incidence of in-hospital stroke ranges from 2 to 19% of all acute cerebrovascular accidents recorded in the hospital, 0.04–0.06% of all hospital admissions. It was found that patients with inhospital stroke have significant restrictions on thrombolytic therapy, mortality can reach 60%, and the diagnosis is often made with long delays and deviations in examination protocols. The most common pathogenetic subtype of in-hospital ischemic stroke is the cardioembolic subtype. The explanation for this is that in most cases, in-hospital ischemic strokes develop in patients after open cardiac surgery with prosthetics of one or more valves, bypass surgery in conditions of artificial circulation, carotid endarterectomy. In the overwhelming majority of patients, the first symptoms of in-hospital stroke are observed not by doctors, but by nurses, patients or their relatives. Mortality in in-hospital stroke is significantly higher than in non-hospital stroke, which is due to the high incidence of extracerebral complications in this cohort of patients, as well as initially more severe stroke.

Aim of study. To analyze the incidence of in-hospital stroke and the tactics of its treatment in a multidisciplinary hospital.

Material and methods. The study included 975 patients with ACVE hospitalized at the N.V. Sklifosovsky Research Institute for Emergency Medicine from January 1, 2018 to January 1, 2019. The inclusion criterion was any case of CVE - out-of-hospital or in-hospital. The study did not include patients with subarachnoid hemorrhage (SAH) where secondary cerebral ischemia developed against the background of vasospasm. Also, we did not include patients with stroke, transferred from other hospitals for neurosurgical treatment.

Results. In total, in 2018 at the N.V. Sklifosovsky Institute ACVE were diagnosed in 975 patients, of which in-hospital and out-of-hospital strokes were diagnosed in 109 (11.2%) and 866 patients (88.8%), respectively. The proportion of in-hospital stroke was 0.03% of the total number of patients treated at the institute in 2018. Systemic thrombolytic therapy (sTLT) is the main method of treating patients with IS. However, patients with in-hospital stroke may have a large number of contraindications to this type of therapy. Systemic TLT was performed in 1 patient (1%) with in-hospital stroke, while in out-of-hospital stroke, thrombolysis was performed in 36 patients (4.7%). After analyzing the reasons for refusing to perform sLT in patients with in-hospital and out-of-hospital IS. The leading reason for the impossibility of sTLT in patients with in-hospital stroke was the unspecified time of disease development - 44 (43.2%). In 35 patients (34.3%) with in-hospital stroke, refusal to perform sLTT was associated with late IS diagnosis, despite the fact that the stroke developed in the hospital.

Conclusion. Thus, an in-hospital stroke aggravates the course of the underlying disease and, as a consequence, the outcome of the disease, leads to an increase in social and medical and economic costs. In this regard, there is a need to study the prevalence, risk factors, clinical features of in-hospital stroke, as well as the development of diagnostic and therapeutic algorithms in order to improve the efficiency of care for patients with in-hospital stroke.

Abstract. Recently, quantitative analysis of the level of the N-terminal prohormone of the brain naturetic peptide (NT-proBNP) has been widely used to diagnose heart failure (HF). A statistically significant correlation was found between the serum NT-proBNP concentration and HF stage. It was found that in patients with high cardiovascular risk, NT-proBNP has the highest predictive value in relation to mortality. In young and middle-aged patients with diabetes mellitus (DM) with myocardial infarction (MI) and stents of an infarct-associated artery, the frequency of unfavorable remodeling (UR) of the left ventricle (LV) in the long-term prognosis was studied. The frequency of atherosclerotic lesions of the coronary arteries (CA) in patients with diabetes in acute coronary syndrome (ACS) was determined, the results of echocardiographic parameters were presented in the follow-up dynamics, the value of serum NT-proBNP in predicting LV UR 12 months after myocardial infarction (MI) was determined.

Aim of study. To assess the diagnostic capabilities of NT-proBNP in the long-term prediction of the development of LV infarction in patients with MI with diabetes in young and middle age after percutaneous coronary intervention (PCI).

Design. Prospective controlled non-randomized trial. The patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months after AMI. The study included 191 patients with ACS with / without ST-segment elevation, who were divided into two groups. The main group included 76 patients with ACS with diabetes mellitus, the comparison group included 115 patients with ACS without diabetes mellitus. Patients in both groups were comparable in age, gender, comorbidity, and complications of AMI. The duration of diabetes was, on average, 6 years (from one to 12 years).

Material and methods. All patients underwent electrocardiography, echocardiography, tests for the content of troponin I, NT-proBNP, glycosylated hemoglobin, lipids, determined the level of creatinine in the blood and the glomerular filtration rate according to the Modification of diet in renal disease (MDRD). All patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months later.

Results. In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months.

Conclusion. The NT-proBNP level of more than 776 pg/ml on the first day after PCI is an indicator of an unfavorable long-term prognosis in patients with young and middle-aged diabetes in terms of the development of LV systolic dysfunction.

Relevance. The present time can be called a period of accumulation of experience of national health systems in different countries of the world in the application of transport extracorporeal membrane oxygenation (ECMO) technology at the pre- and inter-hospital stages of evacuation of patients to specialized ECMO-therapy centers. The role of such centers is to provide timely advice and, if necessary, perform inter-hospital evacuation.

Material and methods. The study summarized and analyzed with the help of the national register “RosECMO” the own experience of 13 hospitals in the Russian Federation, who performed 68 inter-hospital evacuations under ECMO conditions by different modes of transport in patients of different age groups with symptoms of circulatory and respiratory failure. The following parameters were evaluated: characteristics of transport ECMO, clinical manifestations of potentially negative effects of transport, hospital survival, as well as the effect of experience (less and more than 10 cases of transport ECMO) of the presented clinics on the difference in the results obtained.

Results. Connecting patients to the ECMO device reduces the likelihood of death on the SOFA and APACHE IV scales by 1.2 times (p <0.0001) and 1.4 times (p<0.0001), respectively. Despite the absence of deaths during inter-hospital transportation of patients under ECMO conditions, 14.93% of patients died within 3 days from the moment of their execution, without a significant difference in clinics with different practical experience. The overall hospital survival rate of ECMO transport scenarios in all 13 clinics of the Russian Federation was comparable to the data of the international register 48.52% versus 48.81%, at the same time it was significantly lower (1.3 times) in the group of clinics with less clinical experience 40% versus 52.08% (p<0.0001).

Conclusion. The results of the first stage of the study we obtained indicate the prospects of using the method of extracorporeal membrane oxygenation at the stage of inter-hospital evacuation, due to the effective stabilization of the patient’s condition and a significant reduction in the risks of the likelihood of death. Clinics with less clinical experience showed significantly worse results of hospital survival of patients who underwent inter-hospital transportation under conditions of extracorporeal membrane oxygenation compared to clinics with more clinical experience, which can be a significant argument in adopting a model for the development of specialized regional centers for extracorporeal membrane oxygenation. The experience accumulated over the past six years and the analysis of new data from the register of transport cases of extracorporeal membrane oxygenation of the national healthcare system will make it possible to formulate the correct trajectory for the development of the method of extracorporeal membrane oxygenation and its application, including at the stage of pre- and inter-hospital evacuations of patients.

Aim of study. The study is devoted to the effect of L-lysine aescinat on the nervous tissue of the CA1 and CA3 fields of the hippocampus of the brain of white rats in the acute period after severe traumatic brain injury (TBI).

Material and methods. TBI was simulated by applying a blow to the parieto-occipital region with a freely falling weight weighing 200-250 grams from a height of 50 cm using a special rail rack. The objectives of the study were: 1) comparative morphometric assessment of the degree of hydration, cyto- and glioarchitectonics of different layers of CA1 and CA3 fields after ischemia without treatment; 2) the effect of L-lysine aescinat on these indicators. We used histological (staining of sections with hematoxylin-eosin and Nissl), immunohistochemical (for NSE, MAP-2 and GFAP) and morphometric methods. On thin (4 μm) serial frontal sections of the hippocampus, neurons, astrocytes, microvessels and neuropiles were studied in control (intact animals, n=5) and 1 and 3 days after injury without treatment (n=10, comparison group) and with treatment ( n = 10, main group). The number density of neurons was determined using the Nissl staining of cells and by the reaction to NSE. The cytoskeleton of neurons was studied by detecting MAP-2, and astroglia by GFAP. On color raster images (staining with hematoxylin and eosin, x100) using the Find Maxima plug-in filter, the zones of maximum brightness were determined, which were then analyzed using Analyze Particles from the ImageJ 1.52s program. Zones of maximum brightness corresponded to areas of the hippocampus with a high degree of hydration of the nervous tissue - edema-swelling. The nature of the distribution, statistical hypotheses, and plotting were checked using Statistica 8.0 software and R environment.

Results. In control animals, normochromic neurons without signs of changes in the cytoskeleton prevailed in all layers of fields CA1 and CA3, and a low degree of hydration of the nervous tissue was noted (the relative proportion of zones of maximum brightness was 5–8%). One and 3 days after TBI, there was a statistically significant increase in the focal content of dystrophic and necrobiotically altered neurons (95% confidence interval: 52–78%), manifestations of reactive gliosis were noted, and the proportion of zones of maximum brightness increased to 16%. Statistically significant layer-by-layer differences were revealed between the CA1 and CA3 fields of the hippocampus. The use of L-lysine aescinat had a statistically significant effect on the morphometric parameters of the nervous tissue of the hippocampus.

Conclusion. In the early post-traumatic period after TBI, the degree of hydration of the nervous tissue of the hippocampus increased. Heteromorphicity of dystrophic and necrobiotic changes in different layers of CA1 and CA3 fields was noted. L-lysine aescinate had a statistically significant positive effect on these changes. To a greater extent, this is typical for the CA3 field. The revealed changes are considered not only as patho-, but also as sanogenetic structural mechanisms of protection and reorganization of the hippocampus in the acute post-traumatic period.

1. In the acute period (1−3 days) after severe traumatic brain injury, the degree of hydration of all components of the hippocampal nervous tissue increased. In the group without treatment, 3 days after injury, the relative volume of edema-swelling zones varied from 10 to 13% in CA1 (control 3-7%) and from 8 to 16% in CA3 (control 5–10%).

2. The heteromorphism of hydropic changes in the molecular layer, the layer of pyramidal neurons and the polymorphic layer was established. The maximum increase in the volume of free water (more than twofold) was characteristic of the molecular and polymorphic layer CA1, as well as the polymorphic layer CA3.

3. The use of L-lysine aescinat in the acute period significantly changed the manifestations of hydropic dystrophy. One day after injury, the volume of free water increased in comparison with animals without treatment, and then, after 3 days, decreased, but remained higher than in the comparison group. The maximum effect of the drug was noted in field CA3.

Summary. The use of endoscopic transsphenoidal access is an effective and safe method for the surgical treatment of pituitary adenomas (PA). In endoscopic transsphenoidal surgeries, there is a need to control intracranial pressure (ICP) for reposition and expansion of the tumor capsule. Currently, the main method for reducing ICP in transsphenoidal surgery is installation of an external lumbar drainage, which is associated with a number of complications.

Aim of study. To improve the results of surgical treatment of patients with arterial hypertension using hypertonic saline solution.

Material and methods. A clinical and anatomical analysis of material from 27 deceased patients who were treated in the cardiac surgery department of the Institute was carried out. Valve replacement was performed in 11 patients, aortic replacement - 2, valves and aorta - 7, combined operations - 7. The patient’s records, autopsy protocols, results of histological examination of surgical and autopsy material were studied. Already on the next day after surgery, an increase in serum creatinine by more than 25% was noted under the conditions of CBR. Morphological examination of the kidneys revealed acute pathological processes - necrosis of nephrocytes of the convoluted tubules in 59.3% of cases and dystrophic changes in 40.7% of cases against the background of chronic pathology (nephrosclerosis, vascular atherosclerosis, glomerulosclerosis, pyelonephritis, secondary contracted kidney). After coronary angiography with a radiopaque contrast agent (RCA), signs of excretory nephrosis were noted, often with fixation of the RCA in the loop of Henle, with tubulorexis and the formation of cell casts.

Relevance. Chronic critical ischemia of the lower extremities (CCILE) in the stage of trophic complications is the final stage of diseases of the arteries of the lower extremities, leading to disability of patients and having a poor prognosis in terms of preservation of the lower extremities and mortality.

Aim of study. Objective assessment of the efficacy of lower limb revascularization in trophic disorders.

Material and methods. The analysis of treatment of 52 patients with stage IV CCILE (according to the classification of R. Fontaine and A.V. Pokrovsky) was carried out. Of these, 42 patients underwent three-phase scintigraphy combined with X-ray computed angiography on a hybrid apparatus. After the operation, this study was conducted in 37 patients.

Results. Out of 52 patients, surgery for revascularization of the lower extremities was performed in 37 patients, 15 were not operated on. Out of 37 operated patients, improvement of blood circulation occurred in 32 (86.5%). Circulatory decompensation was observed in 5 patients (9.7%). Among non-operated patients, improvement of blood circulation occurred in 9 patients (17.3%), no effect or decompensation — in 5 (9.7%). Subjective improvement in the condition and decrease in the degree of ischemia corresponded to the improvement of microcirculation according to the data of three-phase scintigraphy.

Conclusion.

1. Revascularization of the lower extremities in patients with trophic disorders is an effective method of treating this pathology. Therefore, all patients with chronic ischemia threatening limb loss should be considered as candidates for revascularization.

2. If the leg arteries or short occlusive or stenotic lesions of the main arteries are affected, such patients should be discussed together with specialists in endovascular surgery for endovascular treatment or joint intervention.

3. Hybrid radiation method (three-phase scintigraphy and single-photon emission computed tomography, combined with X-ray computed angiography) is an objective method that reflects the state of peripheral circulation and microcirculation, and allows you to objectively assess the effectiveness of the treatment.

Background. In acute poisoning, accompanied by a violation of the parameters of homeostasis, the problem of its management by the enteral route has been insufficiently studied.

Purpose of the study. To assess the possibility of correcting electrolyte and volemic disorders of the body using an enteral solution (ER) in case of poisoning with psychopharmacological drugs.

Material and methods. The study involved 120 patients who underwent intestinal lavage (IL) with ER on the 1st day in complex therapy. In the following days, 40 of them received infusion therapy, and 80 — drank glucose enteral solution (GES), 3–4 liters per day.

Results. IL had a corrective effect on the electrolyte composition of the blood, volemic and hemorheological parameters, as well as on central and peripheral hemodynamics. The subsequent administration of GER had a stabilizing effect on these indicators, comparable to that of infusion therapy.

Conclusion. In case of poisoning with psychopharmacological drugs, the use of saline enteral solution in the form of intestinal lavage and subsequent oral administration of the same solution in a daily volume of 3–4 liters, but with the addition of glucose, provides correction of impaired homeostasis indicators and may be an alternative to infusion therapy.

Relevance. The increase in the number of severe brain injuries due to stroke and traumatic brain injury determines the need to study and develop effective strategies for neuroprotection. The article highlights new mechanisms of the neuroprotective action of the inhalation anesthetic xenon based on the data of our own experimental studies.

Aim of study. To assess the effect of anesthesia with xenon at a concentration of 0.5 MAC (minimum alveolar concentration) on the phosphorylation of glycogen synthase kinase 3β (GSK-3β) and the content of antioxidant defense enzymes in the rat brain.

Material and methods. The effect of inhalation anesthesia with xenon on the phosphorylation of the GSK-3β enzyme in comparison with lithium chloride, as well as on the content of heme oxygenase, catalase, and Mn-superoxide dismutase in rat brain homogenates was studied by immunoblotting.

Results. The use of xenon at a concentration of 0.5 MAA causes an almost twofold increase in the content of the phosphorylated form of the GSK-3β enzyme in comparison with the control (p<0.05) and significantly increases the pool of antioxidant defense enzymes: heme oxygenase by 50% (p <0.05) and Mn-superoxide dismutase by 60% (p<0.05).

Conclusion. The conducted experimental study revealed new molecular mechanisms of action of the inhalation anesthetic xenon. The effect of xenon on the pool of enzymes involved in the protection of the brain from oxidative distress was found. The data obtained indicate the prospects for using xenon and require further research in this direction. The use of xenon at a concentration of 50 vol.% (0.5 MAA) for 30 minutes does not affect the content of the glycogen synthase-3β enzyme, at the same time causing an almost twofold increase in its phosphorylated form, the glycogen synthase-3β enzyme, and is accompanied by a significant increase the content of heme oxygenase, Mn-superoxide dismutase and a slight increase in the content of catalase in rat brain homogenates. Thus, the results of the study suggest that one of the possible mechanisms of the neuroprotective effect of xenon is the phosphorylation of glycogen synthase-3β, which prevents the opening of the mitochondrial pore, inhibiting the death of mitochondria-mediated apoptosis of neurons and increasing the level of antioxidant protection in them.

Relevance. Different lengths of the lower extremities have a negative impact on the position of the pelvis and spine and lead to secondary deformities. To prevent these consequences, early surgical correction of the shortening is necessary.

Aim of study. Study of the features of post-traumatic shortening of the lower extremities, mechanisms of adaptation to this condition and, on the basis of this, optimization of surgical technique when performing reconstructive and restorative operations.

Material and methods. A total of 276 patients with posttraumatic shortening of the lower extremities were examined, 102 of whom were operated on. Comparative radiography of both legs was used to diagnose different lengths. The Ilizarov method was used as the main method of surgical correction.

Results. We studied the mechanisms of adaptation of patients to post-traumatic shortening of the hip and lower leg and optimized surgical technique. A method was developed for determining the optimal elongation value.

Conclusion. The most effective and least traumatic method is external osteosynthesis according to Ilizarov. Distraction in the apparatus allows the formation of a regenerate of the required shape and length and the elongation of exactly the amount that is optimal for a given patient.

Relevance. One of the key points in plasty of the anterior cruciate ligament (ACL) is the isometric position of the graft, in which its tension remains the same during flexion and extension of the knee joint. However, no method has been described today for the intraoperative determination of the isometricity of the location of the femoral and tibial tunnels (for placing the graft) before their formation.

Purpose of the study. To develop a method for intraoperative determination of the isometricity of the location of the femoral and tibial tunnels before their formation during ACL plasty and to study its effectiveness.

Material and methods. The study included 30 patients who underwent ACL repair. For a preliminary intraoperative assessment of the isometric areas of graft fixation on the femur and tibia, the proposed original method with the use of two knot pushers and a thread passing through them. Isometry was assessed by the degree of displacement of this thread. After determining the isometric areas of fixation, the femoral and tibial tunnels were formed, and the isometric position of the graft before its fixation in the tibia was checked by the degree of displacement of the threads with which the graft was sutured relative to the aperture of the tibial tunnel.

Results. The average displacement of the thread relative to the pusher of the knot in the preliminary determination of the isometric areas of fixation according to the proposed method corresponded to the displacement of the threads with which the distal end of the graft was sewn relative to the outer aperture of the tibial tunnel (this value did not exceed 2 mm on average) until the final fixation of the graft in the tibial tunnel.

Conclusion. The developed method makes it possible to determine the isometric location of the femoral and tibial tunnels during arthroscopic plasty of the anterior cruciate ligament before their formation. If the location of the fixation points on the femur and tibia is determined non-isometric, it is possible to correct their position.

Relevance. The supraglottic airways (SA) are now more and more often used as devices of the first choice for providing ventilation during surgical interventions of low trauma and duration, during laparoscopic operations as well. Nevertheless, some concerns remain about the possibility of using these devices in operations accompanied by a significant increase in intra-abdominal pressure, for example, when performing laparoscopy, especially in the Trendelenburg position.

Aim of study. Comparison of the efficiency and safety of ventilation, the incidence of postoperative complications when using two different types of SA during laparoscopic surgical interventions performed in the Trendelenburg position.

Material and methods. Eighty-three gynecological patients who were scheduled to undergo laparoscopic surgery in the Trendelenburg position were randomly assigned to two groups. In the 1st group, a laryngeal tube was installed for general anesthesia, in the 2nd group patients had a laryngeal mask. The adequacy of ventilation, gas exchange rates, oropharyngeal leakage pressure, rate of successful placement, mean and peak airway pressure at various stages of surgery, as well as the frequency of intra- and postoperative complications were assessed.

Results. In all observations, there were normal indicators of gas exchange and capnography, no leakage of the breathing mixture from the circuit. The level of oropharyngeal leakage pressure was statistically different in the groups and was 32 (28; 35) in the 1st group and 28.5 (27; 31.8) cm of water column in the 2nd group. (p=0.007). The time to the onset of ventilation was 19s (18; 21) in the laryngeal tube group, 21s (19; 22.5) in the laryngeal mask group; statistically significant differences were not obtained by this criterion (p=0.059). The first installation attempt was successful in 40 cases (93%) in the 1st group and in 38 cases (95%) in the 2nd group; there was no significant difference in this indicator (p=0.94). The peak and mean airway pressure at the stages of surgery also did not differ. The study did not reveal such intraoperative complications as dislocation of the airway and aspiration of gastric contents. When analyzing postoperative complications, statistical differences were obtained in terms of the level of sore throat 3 hours after removal of SA. In terms of sore throat after 5 minutes, 6, 12, 24 hours, the frequency of hoarseness, no differences were found.

Conclusion. 1. The use of different types of 2nd generation supraglottic airways with inflatable cuff (s) provides reliable protection of the upper airway during anesthesia and effective ventilation during laparoscopic surgery in the Trendelenburg position. 2. The laryngeal mask and laryngeal tube did not differ significantly in the frequency of successful insertion, ventilation efficiency, airway pressure levels at various stages of surgery, and the incidence of intra- and postoperative complications. 3. The use of a laryngeal tube provided a higher level of oropharyngeal leakage pressure, while the differences with the laryngeal mask for this indicator were statistically significant.

Aim of study. Determination of the diagnostic significance of laboratory biomarkers of renal tissue damage in remote nephrolithotripsy in patients with urolithiasis.

Material and methods. On the basis of the urology department of the Republican Clinical Hospital (Ufa), 35 patients with urolithiasis were examined, who underwent remote shock wave lithotripsy sessions. The laboratory parameters were determined in patients: the number of erythrocytes, leukocytes in the blood, the level of lipocalin and microalbumin in the urine, as well as alpha2-microglobulin and cystatin C in the blood serum. The control group included 14 healthy donors. To determine the diagnostic efficacy of biomarkers of renal injury, characteristic curves were plotted, and lipocalin level shifts were interpreted taking into account the data on the critical difference criterion value.

Results. When studying the urinary level of lipocalin in patients with urolithiasis, it was found that the difference in the concentration of the biomarker in them and in healthy individuals is statistically insignificant (0.68 pg/ml versus 0.4 pg/ml). After the first session of extracorporeal lithotripsy, an increase in urinary excretion of lipocalin by 5 times is noted, after the second - by an additional 1.6 times, and after the third - by another 1.7 times (the differences are statistically significant). To analyze the prognostic efficiency of markers of renal injury, characteristic curves were plotted. The area under the ROC curve for lipocalin varied from 0.77 to 0.80 depending on the number of sessions, which indicates a high diagnostic efficiency of this biomarker. The determination of the criterion of critical difference (CCD) showed that an increase in the level of lipocalin in the urine after the first session of lithotripsy more than 2.1 times is statistically significant. The concentration of the specified biomarker in urine exceeding 4.5 pg/ml, 6 pg/ml and 10 pg/ml after the first, second and third sessions of lithotripsy, respectively, can be considered as a basis for changing treatment tactics (delaying the second procedure) or performing lithotripsy in another way.

Conclusion. Urinary lipocalin, associated with neutrophil gelatinase, is an informative biomarker of renal injury in the assessment of complications associated with the lithotripsy procedure.

Relevance.Ectopic (extrauterine) pregnancy (EP) occupies a leading place in the structure of urgent gynecological morbidity. This pathology poses a threat to the health and life of a woman, being one of the leading causes of maternal mortality during pregnancy during the first trimester. Among emergency gynecological operations, surgical interventions for EP make up about 50%, and in recent years, most operations have been performed by the laparoscopic method. However, up to now, the pathomorphological changes in the fallopian tubes in patients with EP remain poorly understood.

Purpose of the study. To study the features of pathomorphological changes in the fallopian tubes in women with tubal pregnancy, operated on by the laparoscopic method, to substantiate the volume of surgery in patients with this pathology.

Material and methods. Morphological examination was performed in 100 women operated on for tubal pregnancy using the laparoscopic method. A comprehensive morphological study of the fallopian tubes removed during the operation was carried out.

Results and discussion. The implantation of the ovum in the fallopian tube led to significant changes in its macro- and microstructure, which were caused by the invasion of chorionic villi and involved all layers of the tube wall, differing only in the depth of penetration and prevalence. The anatomical features of the structure of the fallopian tubes contributed to the deep invasion of the ovum into the myosalpinx and subserous parts of the tube, creating the possibility of wall rupture in this area.

Conclusions. 1. In all cases of ectopic pregnancy, implantation of the ovum was accompanied by invasion of cytotrophoblast and syncytiotrophoblast, and it involved all layers of the tube wall, differing only in depth and prevalence. The invasive properties of the cytotrophoblast lead to the development of pronounced degenerative changes in the tube wall, which leads to functional inferiority of the tube after the onset of tubal pregnancy in it.

2. The chronic productive endomyosalpingitis diagnosed in most patients with ectopic pregnancy with deformation of the tube lumen against the background of changes in the tube wall caused by cytotrophoblastic invasion is an indication for tubectomy. Performing organ-preserving operations on an anatomically and functionally altered fallopian tube is impractical, since it is a high risk factor for recurrent tubal pregnancy in this tube.

Introduction. In our country, severe concomitant injury is one of the main causes of death among people of working age. This poses an urgent task for the national health care and education system in the form of training qualified emergency surgeons.

Purpose of the study. To improve the quality of practical training of specialists in the delivery of urgent surgical care for concomitant injury.

Material and methods. The “Cadaver course of operative surgery for severe concomitant injury” was developed. The participants of the cadaver course were senior students of the Ryazan State Medical University. At the stages of the course, theoretical training was carried out, work in a cadaver operating room with mentors and independently was performed, as well as a comparative assessment of learning outcomes with the results of similar tests of clinical residents of the 2nd year of study.

Results. Statistically significant differences were obtained in terms of indicators reflecting the level of practical training of students who completed the developed course. The level of theoretical training in the compared groups did not differ significantly.

Conclusion. New opportunities have been opened for the widespread introduction of the developed training course into the educational process. It is necessary to further improve the proposed methodology and study the results of its use.

Introduction. The choice of the ways for optimizing management of out-of-hospital cardiac arrest by emergency medical services (EMS) should be based on the evidence from existing practice of resuscitation care. The study was aimed at evaluating personal experience of cardiopulmonary resuscitation (CPR) performance, timing of last training in resuscitation and level of self-perceived knowledge and skills of CPR among the employees of the EMS of the Republic of Crimea, as well as to assess their beliefs on significance of individual CPR procedures in terms of influence on success of resuscitation and to study their perceptions on factors that may have positive or negative impact on effectiveness of resuscitation care.

Material and methods. An anonymous survey of the EMS personnel of the Republic of Crimea was conducted in July–December 2019. The questionnaire was utilized to collect demographic data, information on experience of conducting CPR for the last year, on a current practice of CPR debriefings and timing of last CPR training. The participants assessed their knowledge and skills of CPR and their perception of influence of early implementation of individual CPR procedures on success of resuscitation on a 5-point Likert scale, and indicated factors, that may limit or enhance the effectiveness of resuscitation.

Results. A total of 251 specialist of the EMS participated in the survey, including 63 physicians, 129 feldshers and 4 nurses of ambulance teams, 45 dispatchers and 5 senior officers of the EMS stations, which corresponds to 28.8% of physicians, 13.0% of feldsher/nursing staff and 17.4% of dispatcher specialists of the republic. Percentage of male respondents was 35.5%, mean age — 41.5 years, mean duration of EMS work experience — 15.5 years. The mean declared number of cases of CPR conducted in the last 12 months was 2.2 (range: 0–20), and 23.5% specialists of the ambulance teams have not participated in any CPR attempt over the last year. About 60.2% respondents were trained in CPR within the last year. When compared to other specialists of ambulance teams, feldshers who work alone (without a coworker), were significantly less commonly performing a real-life resuscitation (p=0.008) or receiving training in CPR (p=0.020). Dispatchers were least covered with resuscitation training (only 33.3% were trained within the last year) and had the lowest level of CPR knowledge and skills. 25.9% of the specialists had an erroneous judgement that early drug administration and/or tracheal intubation have higher influence on success of resuscitation when compared to chest compressions and/or defibrillation. The level of knowledge and skills of CPR depend on the timing of last training (p<0.001).

Conclusions. The experience of participation in real-life attempts of CPR is severely limited for considerable part of the EMS employees, and many specialists have not been trained in resuscitation for a long time. The perceptions of the EMS specialists regarding the importance of individual CPR procedures are not always compliant with the statements of current international CPR guidelines. In order to enhance the effectiveness of resuscitation care in the Republic of Crimea, it is advisable to monitor the coverage of the EMS employees with resuscitation training and the rates of their participation in resuscitation attempts, as well as to perform additional targeted training in CPR, in particular, using alternative methods of education.

Introduction. The multisystem closed abdominal trauma is accompanied by a high mortality rate, and exceeding the minimum required volume of surgery in an extremely difficult patient’s condition often leads to an unfavorable outcome.

Aim of study. Standardization of staged treatment of patients with severe concomitant closed abdominal trauma.

Material and methods. This review presents the latest information obtained as a result of studying domestic and foreign literature on the issue of multistage surgical treatment of severe multisystem closed abdominal trauma. The concept of damage control, its stages are described step by step, indications for types of surgical interventions are specified. The literature data on the results of clinical application of the technique from the standpoint of evidence-based medicine are presented.

Conclusion. A clear knowledge of the required volume of surgical intervention at each stage of treatment of patients with severe concomitant closed abdominal trauma, the main points of intensive care, the criteria for patient stabilization and indications for relaparotomy improve the treatment results for this category of victims.

Relevance. Acute kidney injury (AKI) is one of the leading causes of death worldwide. However, the epidemiology of AKI is not well understood. In Russia, toxic kidney damage plays a significant role in the nosological structure of AKI — 12.2%.

Aim of study. To study the features of AKI in patients with acute chemical poisoning.

Material and methods. We analyzed 26 case histories of patients with acute chemical poisoning with AKI (according to KDIGO). The comparison group included 25 patients with acute chemical poisoning without AKI. All patients were hospitalized in a toxicological center on the basis of the emergency department of the Ryazan Region State Budgetary Institution “City Clinical Emergency Hospital” (SBI RR “CCH EMC”) in 2016–2018. The analysis of the annual reports of the chief toxicologist of the Ministry of Health of the Ryazan Region for 2016–2018 was carried out. Data processing was performed using Microsoft Office Excel 2013 and on the website medstatistic.ru (Pearson’s chi-square test and Fisher’s exact test).

Results. In most patients AKI developed during poisoning with cauterizing action substances - 38.4% (23% - vinegar essence, 15.4% - unidentified cauterizing action substance). The poisoning with alcohol substitutes (12%) took the 2nd place, with narcotic substances (8%) – the 3 rd place. Also, isolated cases of AKI (4% each) were reported in case of poisoning with pregabalin, tramadol, ketorol and ethanol. Poisoning with an unknown toxicant was noted in 29.6% of cases. Most patients (69.2%.) had stage 3 AKI. The second stage was registered in 7.7% of patients, the first — in 23.1%. Proteinuria was detected in all patients who underwent common urine test (CUT). Infusion therapy using crystalloids was performed in 100% of cases.

Conclusion. Acute renal injury most often develops in acute poisoning with cauterizing poisons. The development of acute kidney injury in acute chemical poisoning leads to an increased risk of death. Acute kidney injury is the second most common immediate cause of death in acute chemical poisoning. Infusion therapy is an integral part of the management of toxicological patients with acute kidney injury.

The article concerns the problem of studying the causes of the development of hemolytic reactions after transfusion of erythrocyte-containing blood components. The ways of preventing hemolysis as a result of blood transfusions are considered. Clinical cases are described.

Introduction. Today, the spread of the Sosnovsky hogweed plant has acquired an unprecedented scale, which is accompanied by an annual increase in the number of victims due to the occurrence of photochemical dermatitis (PD).

Aim of study. To study the clinical picture of PD arising in patients as a result of contact with Sosnovsky hogweed juice, to develop measures for their prevention and treatment.

Material and methods. The study involved 139 patients with a diagnosis of photochemical dermatitis who were treated in the department of acute poisoning and somatopsychiatric disorders of the N.V. Sklifosovsky Research Institute for Emergency Medicine.

Results. All patients had skin lesions of varying prevalence, more often the upper and lower extremities, similar in depth to superficial thermal burns of I, II, IIIA degrees.

Conclusions. The complex of treatment for patients should include detoxification, antihistamine, analgesic, hormonal, antibacterial therapy, as well as local treatment carried out by combustiologists.

Relevance. An important component of the diagnostic process in combustiology is the collection of anamnesis. At the same time, verification of the very fact of a burn injury of the skin, as a rule, does not seem to be a difficult task even for a novice doctor. However, specialists from the I.I. Dzhanelidze Institute regularly encounter errors in the differential diagnosis of burn injuries at the prehospital stage on the part of both ambulance teams (EMS) and surgeons (traumatologists) of non-specialized medical institutions. Each such case attracts attention and takes up a significant part of the time resource of the entire staff of the inpatient department of the emergency medical service for the process of clarifying and verifying the correct diagnosis, as well as determining the further routing of such a patient.

Aim of study. To study the structure of diagnostic errors at the prehospital stage of the EMS to optimize patient routing by improving the existing organizational and methodological standards.

Material and methods. A retrospective analysis of the case histories of all victims who were admitted to the inpatient department of the Emergency Medical Department of the I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine during the period from January 2018 to December 2019.

Results. 4,951 patients were admitted with a leading diagnosis of the referring institution, suggesting a history of burn injury. The incidence of diagnostic errors at the prehospital stage of emergency care was 410 cases (8.3%), while burn injury was completely excluded in 178 cases (3.6%).

Conclusions. 1. The results of the analysis revealed a high incidence of diagnostic errors at the prehospital stage of emergency care (8.3%), the main reason for which is the lack of awareness of differential diagnostics within the narrow specialty (combustiology) of primary contact physicians. 2. Shown is the introduction of training practice for doctors and paramedics of emergency medical services, surgeons and traumatologists of primary care in combustiology cycles in specialized burn departments. 3.In order to ensure continuity in the process of providing medical care to patients with burns, it is necessary to create a unified database of convalescents to form a feedback channel with the outpatient clinic during the implementation of the rehabilitation complex.

Bleeding from an aneurysm of a small intestine artery is a formidable complication, the treatment remains a difficult problem. In this case, aneurysm embolization is indicated. The aim of the article is to describe the role of embolization in the treatment of bleeding in an elderly patient, to analyze the efficacy and risk. The advantage of the intervention is minimal invasiveness and low blood loss. The presented observation showed the effectiveness of endovascular embolization in the rupture of a pseudo-aneurysm.

In contrast to conventional microsurgery, stereotactic radiosurgery has an advantage in the treatment of intracranial masses, avoiding severe complications associated with open surgery. In rare cases, the use of the method is associated with the development of radiation-induced injuries, one of which is radiation necrosis (RN). This is a late complication of radiosurgery, developing mainly 6 months after radiation exposure. The neurological manifestations of this complication depend on location, and the clinical picture is very diverse. The method of magnetic resonance imaging (MRI) with intravenous contrast enhancement is quite often the first link in neuroimaging, which helps to suggest the presence of this complication based on the X-ray picture and to clarify the location of changes.

We presented the experience of radiation necrosis treatment in a 47-year-old patient who was referred to our department with a diagnosis of frontal meningioma. The patient underwent stereotactic radiosurgical treatment using the Elekta Leksell Gamma Knife Perfextion device, and 6 months later the gradual deterioration began, the patient complained of headache, nausea; central prosoparesis developed. Considering the clinical picture and control MRI data, the changes were interpreted as radionecrosis. In order to control the complication, the patient underwent standard glucocroticosteroid therapy, supplemented by hyperbaric oxygenation (HBO), which made it possible to achieve regression of the adverse clinical and radiological manifestations of the complication. Thus, on a clinical example, it was demonstrated that the combined use of glucocorticosteroids and HBOs is highly effective in the treatment of RN.

A clinical observation of an integrated approach to surgical reconstruction of multisystem trauma complications is presented. A man came to the Department of Reconstructive Surgery with the complication of a multisystem injury as a result of a fall in the subway on the way 6 months before his visit. An individual treatment plan was developed based on the characteristics of anatomical and functional disorders and pathological tissue changes. As a result of staged surgical treatment, functional rehabilitation of the patient was achieved with the restoration of the function of the upper and lower extremities and the achievement of a stable remission of osteomyelitis. The observation period was 11 years.