ong-term consequences of COVID-19 remain the subject of active research interest. In this article the Post-COVID-19 syndrome (PCS) main features and symptoms are considered, its incidence and link with comorbidity is presented and the possible mechanisms are discussed. Due to the damage COVID-19 has on lungs, heart, brain and other systems, patients with PCS require multidisciplinary management. 

Relevance. The pathogenesis of COVID-19 remains one of the most pressing. The literature discusses the role of iron as a factor supporting inflammatory processes, hypercoagulability and microcirculation crisis in severe COVID-19.

The aim of study. was to identify changes in iron metabolism in patients with severe COVID-19 and hyperferritinemia.

Material and methods. In this study, we used a content analysis of available scientific publications and our own observations of the peculiarities of the clinical picture and laboratory parameters in patients with a severe course of COVID-19 who had hyperferretinemia at the height of the disease. The main group consisted of 30 patients hospitalized in the Department of Anesthesiology, Resuscitation and Intensive Care of N.A. Semashko City clinical Hospital No. 38 with the diagnosis COVID-19, bilateral polysegmental pneumonia, severe course and hyperferritinemia. The diagnosis of a new coronavirus infection was confirmed by visualization of bilateral viral lung lesions with chest CT-scan, positive PCR test for SARS-CoV-2 and the presence of immunoglobulins to SARS-CoV-2. The control group consisted of 20 healthy volunteers. The study evaluated the biochemical parameters of iron metabolism, fibrinolysis and markers of inflammation. Changes associated with impaired iron metabolism were assessed by the level of serum iron, transferrin, daily and induced iron excretion in the urine. Statistical processing was carried out using nonparametric methods.

Results. All patients with severe COVID-19 and hyperferritinemia showed signs of impaired iron metabolism, inflammation and fibrinolysis — a decrease in the level of transferrin (p<0.001), serum iron (p><0.005), albumin (p><0.001), lymphocytes (p><0.001) and an increase in leukocytes (p><0.001), neutrophils (p><0.001), CRP (p><0.005), IL-6 (p><0.001), D-dimer (p><0.005), daily urinary iron excretion (p><0.005) and induced urinary iron excretion (p><0.001). Conclusions The study showed that in the pathogenesis of the severe course of COVID-19, there is a violation of iron metabolism and the presence of a free iron fraction. The appearance of free iron can be caused by damage to cells with the “release” of iron from cytochromes, myoglobin, hemoglobin, or violation of the binding of iron to transferrin, which may be the result of a change in the protein structure or violation of the oxidation of iron to the trivalent state. When assessing the degree of viral effect on the body, one should take into account the effect of various regulators of iron metabolism, as well as an assessment of the level of free iron not associated with transferrin. Keywords: new coronavirus infection, COVID-19, SARS-CoV-2, iron metabolism, free iron, ferritin, transferrin, NTBI, nontransferrin bound iron>˂0.001), serum iron (p˂0.005), albumin (p˂0.001), lymphocytes (p˂0.001) and an increase in leukocytes (p˂0.001), neutrophils (p˂0.001), CRP (p˂0.005), IL-6 (p˂0.001), D-dimer (p˂0.005), daily urinary iron excretion (p˂0.005) and induced urinary iron excretion (p˂0.001).

Conclusions. The study showed that in the pathogenesis of the severe course of COVID-19, there is a violation of iron metabolism and the presence of a free iron fraction. The appearance of free iron can be caused by damage to cells with the “release” of iron from cytochromes, myoglobin, hemoglobin, or violation of the binding of iron to transferrin, which may be the result of a change in the protein structure or violation of the oxidation of iron to the trivalent state. When assessing the degree of viral effect on the body, one should take into account the effect of various regulators of iron metabolism, as well as an assessment of the level of free iron not associated with transferrin. 

Relevance. The article investigates the choice of anesthesia technique during a caesarean section, which would minimally affect such components of cognitive functions as memory and alertness.

The aim of the study is to increase the safety of anesthetic care in women of reproductive age by choosing the method of anesthesia.

Material and methods. Two groups of maternity patients were examined: with a normal pregnancy and preeclampsia. They were tested according to a specially designed examination, which included: MoCA test, Benton’s test, Wechsler’s test, self-assessment questionnaire, hospital scale of anxiety and depression before and after surgical delivery.

Results. According to the test results, it was found that memory and alertness in pregnant women were initially reduced (compared to the norm), especially with concomitant preeclampsia. When comparing the test results before and after abdominal delivery, it was found that the deterioration of memory and alertness parameters occurs less after the use of neuraxial methods (spinal and epidural anesthesia) compared to patients who underwent general combined anesthesia. 

Relevance. To provide emergency specialized neurosurgical care to patients living in rural areas, medical evacuation to a neurosurgical hospital is required. Despite the fact that medical evacuation is a necessary stage of medical care, there are not enough studies on the impact of transportation of patients with a ruptured cerebral aneurysm over long distances. There is little information about the time intervals for transportation, the timing of the start of treatment and the outcomes of the disease in patients who are at a considerable distance from the neurosurgical hospital.

Aim of the study. To analyze the impact on the extensive results of surgical treatment of patients with cerebral aneurysm rupture.

Material and methods. A retrospective analysis of the results of surgical treatment of 145 patients with cerebral aneurysm rupture in the acute period of hemorrhage, hospitalized in the regional vascular center of the State Budgetary Institution of the Sakha Republic (Yakutia) “Republican Hospital No. 2 — Center for Emergency Medical Aid” in the period from 01.01.2017 to 31.12.2018. Patients were divided into two groups: Group I — patients from remote areas of the Republic of Sakha (Yakutia) who underwent medical evacuation by the Disaster Medicine Service of the Sakha Republic (Yakutia); Group II — hospitalized from the territory of the city of Yakutsk and its nearest suburbs.

Results. 145 patients were hospitalized at the regional vascular center in Yakutsk. Sanaviation (Sanitary Aviation) delivered 91 patients from the districts of the republic to the regional vascular center (62.8% of the total number of patients) (Group I), 54 patients (37.2%) were hospitalized from the territory of the urban district of Yakutsk (Group II). The distance of transportation by ambulance aircraft in Group I ranged from 45 to 1330 kilometers. Deterioration from admission to the local medical organization to admission to the regional vascular center was noted in 8 patients (8.8%), improvement in the condition in 25 (27.5%) patients, there were no dynamics of changes in the state of 58 (63.7%) patients. The total number of deaths in two groups of patients was 11 (12.1%) patients. Postoperative mortality had no statistically significant differences between the two study groups: in Group I — 7.7% (7 patients), in Group II — 7.4% (4 observations) (p=1,000).

Conclusions. With an established system of medical evacuation, transportation over a considerable distance does not worsen the course of the disease and the results of surgical treatment of patients with cerebral aneurysm ruptures in the acute period of hemorrhage. 

Background. In acute poisoning, accompanied by a violation of microbiocenosis, the problem of its correction has not been studied enough.

Aim of study. Evaluate the possibility of correcting violations of microbiocenosis using intestinal lavage in cases of poisoning with psychopharmacological preparations and cauterizing substances.

Material and methods. 50 male (76.4%) and female (23.6%) patients aged 42 (36; 52) years with psychopharmacological drugs and cauterizing substances poisoning were examined, the composition of the fecal microflora was studied. A total of 100 studies of up to 10 species of microorganisms were conducted. In order to correct violations of the species composition of microbiocenosis, 30 patients underwent intestinal lavage. The comparison group included 20 patients who did not use intestinal lavage.

Results. In patients with these poisonings, violations of the specific microbial composition of feces were detected. Intestinal lavage, in contrast to standard therapy, had a corrective effect on fecal microbiocenosis.

Conclusion. With the help of intestinal lavage, it is possible to correct violations of microbiocenosis in acute poisoning in a short time. 

Aim of study. Development in an anatomical experiment of a technique for operative access to the splenic and left renal veins during distal splenorenal bypass surgery with justification of the possibility of its successful application in clinical conditions.

Material and methods. In the conditions of an anatomical experiment on 40 unfixed corpses of adults of both genders, objective volumetric and spatial indicators in surgical wounds were studied in two variants of exposure of retroperitoneal space vessels, as the first stage of distal splenorenal anastomosis. In clinical conditions in 40 patients with portal hypertension of various genesis, during the operation of distal splenorenal anastomosis, the wide exposure of the anterior surface of the pancreas, spleen, left renal veins and most of their branches was performed using the original method of partial left — sided medial visceral rotation, followed by an objective assessment of the volume-spatial parameters of access. Measurements were performed using a medical goniometer in relation to the mobilized areas of the left renal and splenic veins. Statistical processing of the study results was carried out using the method of variation statistics. To identify statistically significant differences, the Student’s t-test was used for disjoint samples.

Results. An original method of operative access to the splenic and left renal veins was developed during the operation of distal splenorenal bypass by lifting the internal organs of the left flank of the abdominal cavity from the posterior abdominal wall and diverting them to the right. In the anatomical experiment in the original method of partial left-sided medial visceral rotation, all indicators were better (depth of the wound is less and the angles of operative activity and the inclination of the axis of operative activity — larger) than with a classic approach of intraoperative intraperitoneal access via transverse incision in the mesentery of the transverse colon. Despite the various variants of vascular architectonics and various anthropometric indicators of patients, there were no any forced refusal of distal splenorenal bypass surgery or unintentional damage to both the vessels themselves and the pancreas, specific complications associated with the implementation of the proposed operative approach to the vessels of the left retroperitoneal space, including damage to the spleen and ischemia of the descending colon, in any of 40 clinical cases.

Conclusion. The suggested option of operative access to the splenic, left renal veins and their branches at the first stage of performing distal splenorenal anastomosis in patients with portal hypertension of various genesis provides convenient spatial relations in the operating wound; creates comfortable conditions for performing the main surgical technique — applying vascular anastomosis; has a minimal risk of developing specific complications associated with the approach to the vessels of the left retroperitoneal space. 

Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.

Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.

Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.

Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.

Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice. 

Background. Severe fractures of the shin bones are often accompanied by the formation of defects in the tibia, suppuration and soft tissue necrosis. In the case of surgical treatment of fractures, infectious complications reach 3.6-9.1%. One of the methods of treatment of infected defects is resection of the ends of the tibia with shortening. This operation has proven to be effective in the treatment of fresh fractures. The relevance of the work is due to the prospects of using this technique in the treatment of the consequences of fractures with the formation of infected defects of the tibia.

Aim of the study. Improving the results of treatment of patients with post-traumatic defects of the tibia complicated by osteomyelitis by performing a shortening resection with simultaneous or sequential correction of the segment length.

Material and methods. The results of treatment of 65 patients with diaphyseal post-traumatic tibial defects complicated by osteomyelitis were analysed. They were divided into 2 groups. Group 1 was formed by 31 (47.7%) patients, they underwent shortening resection of the ends of bone fragments in the defect zone with simultaneous lengthening at another level. Group 2 included 34 (52.3%) patients who underwent a shortening resection of the tibia without lengthening. In all cases, the Ilizarov apparatus was used as a fixator.

Results. The technique for assessing the size of the true defect of the tibia was optimized taking into account the initial shortening of the segment and the distance between the proximal and distal fragments after resection of their ends. A treatment regimen was developed depending on the level of localization of the tibial defect, and the results of treatment of patients in the compared groups were assessed.

Conclusion. Shortening resection is an effective treatment for patients with post-traumatic tibial defects complicated by osteomyelitis. Depending on the level of localization of the defect, it is advisable to carry out treatment according to one of two possible options. When the defect is localized in the upper and middle third of the tibia, shortening resection in an isolated form is shown. If the defect is localized in the lower third of the tibia, it is possible to supplement the shortening resection with an osteotomy in the upper third with Ilizarov lengthening. 

Aim of the study. An actual problem of the modern approach to the management of patients in the post-traumatic period with the aim of predicting, preventing and treating complications of post-traumatic pneumonia is the assessment of the dynamics of the cytokine profile in this period.

Material and methods. Investigations were carried out at the time of hospitalization prior medical interventions. During the research the following methods were used: clinical, physical, instrumental, follow-up, radiation (MRI, CT, X-Ray), endoscopic, laboratory. Blood was taken from the peripheral vein on the first, third, fifth, seventh and ninth day of hospitalization to determine the interlikin profile. The definition of Proinflammatory cytokines: IL-1, IL-6 and IL-10 in the blood serum performed by ELISA on the immunofermental analyzer Abbott AXSYM using standard kits ProCon (“Protein contour”, St. Petersburg, Russia). Data were processed statistically using Student’s t-test.

Results. Analysis of the results of determination of IL-1 in the serum of patients DK showed that in all stages of the disease, in addition to IV, the contents of this cytokine exceeded the control values in varying degrees of severity. While the levels of IL-1 in the serum of patients with the 1ststage of the disease was 4.0 times; stage 2–3.4 times; the third stage is 1.5 times higher than normal. And only in patients with very severe stage of pneumonia contents IL-1 did not differ from the norm. A similar picture was observed when determining the serum content of patients with a very severe stage of pneumonia, and only in contrast to the level of IL-1 in patients with a very severe stage of pneumonia, the IL-6 content remained significantly higher than normal. So, the content of IL-10 in patients with a very severe stage of pneumonia of stage I, II, III and IV of the disease averaged 330.7±24.5, respectively; 210.5±17.3; 123.4±15.3 and 98.5±12.7 pg/ml (in all cases p<0.05). CONCLUSION The results obtained in a comparative study of contents of proinflammatory cytokines (IL-1, IL-6 and TNF-a) in the blood serum showed that the determination of the spectrum of cytokines in peripheral blood, in our opinion, is the most perspective and can be a key marker for early detection of inflammation. Key words: post-traumatic pneumonii, interlikin profile, peripheral blood serum>˂0.05).

Conclusion. The results obtained in a comparative study of contents of proinflammatory cytokines (IL-1, IL-6 and TNF-a) in the blood serum showed that the determination of the spectrum of cytokines in peripheral blood, in our opinion, is the most perspective and can be a key marker for early detection of inflammation. 

The influence of the consequences of aneurysmal subarachnoid hemorrhage on the human body in the long-term period has been insufficiently studied. Most studies indicate a high risk of developing cognitive impairment. Until now, there is no unified algorithm for the management of patients with aneurysmal subarachnoid hemorrhage, who need long-term comprehensive rehabilitation and supervision of specialists in various fields.

Aim of study. To study the influence of the nature, severity, features of the clinical manifestation of aneurysmal subarachnoid hemorrhage, as well as the choice of the method of intervention in the acute period of the disease on the long-term results of treatment of aneurysms.

Material and methods. In the presented study, the observation group included 74 patients who were operated on in the emergency neurosurgery department of the N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department from 2013 to 2019 in the acute period of subarachnoid hemorrhage (during the first 14 days after the rupture of the cerebral aneurysm). The average age of patients at the time of surgery was 47 [Me=46; min=27; max=76] years old. The ruptured aneurysm was turned off from the bloodstream by one of the following methods: microsurgical intervention with the application of a clip to the aneurysm neck (50 (67,6%) patients), the simultaneous open intervention of aneurysm clipping, and the formation of an extra-intracranial micro anastomosis from the side of the aneurysm access (8 (10,8%) patients), endovascular exclusion of the cerebral aneurysm from the bloodstream (16 (21,6%) patients). On average, after 2,4 [Me=2,5; min=1; max=6] years, patients were invited for a clinical and neurological examination, which included testing according to the Modified Rankin Scale (MRS), the Bartel Index questionnaire, the Mini-Mental Status Scale (MMSS), and the Hospital Anxiety and Depression Scale (HADS). We analysed the changes in the professional activity and habitual lifestyle of patients, as well as the influence of the most common risk factors: arterial hypertension, diabetes mellitus, smoking, on long-term outcomes.

Results. In the long-term period of surgical treatment of cerebral aneurysms, on average after 2,4 [Me=2,5; min=1; max=6] years after subarachnoid hemorrhage, 30 (40,5%) patients scored 0 points on the Modified Rankin Scale, 27 (36,5%) patients — 1 point, 6 (8,1%) patients — 2 points, in 6 (8,1%) patients — 3 points, in 4 (5,4%) patients — 4 points and in 1 (1,4%) patient — 5 points. A significant dependence of the degree of disability according to the modified Rankin scale in the long-term period of subarachnoid hemorrhage on the severity of the patient’s condition at discharge from the hospital was revealed according to the Glasgow Outcome Scale (p<0,001). The patient’s age at the time of rupture of the aneurysm independently influenced cognitive functions and the ability to self-care in the long-term period. With an increase in age by 1 year, the score on the short scale of mental status and on the Bartel questionnaire decreased by 0,08 (p=0,03) and by 0,3 (p=0,04), respectively. With the simultaneous presence of intracerebral hemorrhage and the severity of subarachnoid hemorrhage corresponding to grade III according to the Fisher classification, the likelihood of developing anxiety and depressive mental disorders according to the hospital scale of anxiety and depression increased significantly (p><0,01). The development of intracerebral hematoma with aneurysmal hemorrhage contributed to the appearance of hypertension (p><0,05). Conclusion The revealed disorders that persist for several years after the intervention indicate the need for long-term follow-up of patients who underwent intervention for subarachnoid hemorrhage, the development of individual programs for physical and psychological rehabilitation, and clinical examination of persons at high risk. Keywords: subarachnoid hemorrhage, aneurysm, follow-up, low-flow bypass, endovascular intervention>˂ 0,001). The patient’s age at the time of rupture of the aneurysm independently influenced cognitive functions and the ability to self-care in the long-term period. With an increase in age by 1 year, the score on the short scale of mental status and on the Bartel questionnaire decreased by 0,08 (p=0,03) and by 0,3 (p=0,04), respectively. With the simultaneous presence of intracerebral hemorrhage and the severity of subarachnoid hemorrhage corresponding to grade III according to the Fisher classification, the likelihood of developing anxiety and depressive mental disorders according to the hospital scale of anxiety and depression increased significantly (p˂ 0,01). The development of intracerebral hematoma with aneurysmal hemorrhage contributed to the appearance of hypertension (p<0,05). Conclusion The revealed disorders that persist for several years after the intervention indicate the need for long-term follow-up of patients who underwent intervention for subarachnoid hemorrhage, the development of individual programs for physical and psychological rehabilitation, and clinical examination of persons at high risk. Keywords: subarachnoid hemorrhage, aneurysm, follow-up, low-flow bypass, endovascular intervention>˂ 0,01). The development of intracerebral hematoma with aneurysmal hemorrhage contributed to the appearance of hypertension (p˂ 0,05).

Conclusion. The revealed disorders that persist for several years after the intervention indicate the need for long-term follow-up of patients who underwent intervention for subarachnoid hemorrhage, the development of individual programs for physical and psychological rehabilitation, and clinical examination of persons at high risk. 

At present, in emergency surgery, great importance is attached to reliable intraoperative hemostasis, for the achievement of which local hemostatic agents are used. The use of these funds tends to increase. The hemostatic agents are divided on 3 main groups. In turn, each group has its own physical and chemical characteristics and different ways of application. The surgeon have task of choosing and correctly using a specific hemostatic agent in a specific clinical situation, especially an emergency one. 

Background. The high frequency of injuries of the spleen, as well as its important immunocompetent role in the body, dictate the need to develop a standardized approach to the diagnosis and treatment of this category of patients.

Aim. Standardization of the treatment and diagnostic approach for combined blunt splenic injury to improve treatment results.

Material and methods. The analysis of literary sources of Russian and foreign authors on this issue.

Results. The therapeutic and diagnostic algorithm was developed for combined blunt splenic injury based on the severity of the patient, and a detailed description of non-operative and damage control surgical treatment was given.

Conclusion. The use of endovascular interventions in the treatment of splenic injuries, as well as their gradual treatment in conditions of severe polytrauma, helps to reduce mortality. 

Out-of-hospital cardiac arrest (OHCA) is a serious social and economic problem, and control over it is highly dependent from the overall performance of the system of public first aid and resuscitation training. Coverage of the population with theoretical and practical training in basic cardiopulmonary resuscitation (CPR) is significantly limited in the Russian Federation, and the quality of training is generally low. Based on the analysis of international scientific literature and current international guidelines, this review is delineating modern organizational approaches and technologies of resuscitation training that help to enhance the efficiency and increase the accessibility of CPR training for lay people. In particular, the paper discusses methods of resuscitation training utilizing distant learning technologies, technical means for CPR skills training using feedback and virtual reality technologies, target audience and retraining intervals. Guided by the results of analysis of the cumulative experience, the directions for optimization of the resuscitation training system in Russia are proposed, that offer a perspective to improve coverage of the population with basic CPR training, increase the rates of bystander resuscitation and decrease mortality from OHCA. 

Currently, the issues of improving the quality of medical care and the effectiveness of management are in the focus of attention of heads of medical organizations. Obviously, for the successful management of any complex object, it is necessary to understand the principles of its operation and have a formalized description (model).

This article presents the experience of systemic implementation of the organizational and methodological approach developed by the authors to the description and standardization of the treatment and diagnostic processes of a multidisciplinary hospital.

When writing the work, the methods of system analysis and synthesis were used. Analyzed and systematized the successful experience of the N.V. Sklifosovsky Research Institute for Emergency Medicine on the introduction of the developed organizational and methodological approach into the current activities of a medical institution, as well as the results of its approbation in more than 270 complex medical and diagnostic processes, surgical interventions, active methods of treatment, instrumental and laboratory diagnostics.

The article defines the most important principles for the formation of small groups, the basic values underlying their work, the main motivational factors for the participation of doctors, as well as critical factors for the success of the implementation of the organizational and methodological approach. The experience of its phased implementation is considered: from the processes of the admission department to the processes of medical and intensive care departments; as well as implementation features in the description of diagnostic profile processes.

Based on the results of the implementation of the organizational and methodological approach at the N.V. Sklifosovsky Research Institute for Emergency Medicine, a conclusion was made about its universality and applicability for any medical institution.

In the conclusion of the article, recommendations are formulated for the systemic organization of implementation in a medical institution of the organizational and methodological approach developed by the authors to the description and standardization of treatment and diagnostic processes. 

Aim of study. Comprehensive assessment of clinical and hemodynamic results of surgical treatment of high- and intermediate-high risk of pulmonary embolism in a group of patients who underwent spinal surgery.

Materials and methods. The analysis of the results of open surgical treatment of pulmonary embolism in high- and intermediate-high-risk patients after neurosurgical operations on the spine in the period from 2013 through 2019. The study group included 5 patients. The average age of patients was 59.74±3.42 years. The Wells index was 9.2±2.4. The Pesi index of the studied patients was in the range of 100–126, which allowed them to be classified as a high-risk group of 30-day mortality (class IV). Clinical manifestations of pulmonary embolism developed on average by 5.8±1.08 days after the initial neurosurgical intervention. The calculated pressure in the pulmonary artery was 56.6±8.22 mm Hg. In all cases, surgical intervention was performed for emergency indications, in conditions of artificial blood circulation, without aortic compression during the main stage of the operation.

Results. The 30-day survival rate of patients was 100%. Among non-lethal postoperative complications, acute cardiovascular failure and hepatic-renal failure prevailed, which were levelled by the time the patients were transferred to a cardiac hospital. In 1 patient, the early postoperative period was complicated by the development of exudative pericarditis with cardiac tamponade, which required a finger revision of the anterior mediastinum, its drainage for 2 days. In all cases, there was an improvement in the condition of patients, in the form of increased tolerance to physical activity. The estimated pressure in the pulmonary artery at the time of discharge was 24.69±8.03 mm Hg.

Conclusions. Surgical treatment of acute pulmonary embolism of high- and intermediate-high risk of early death in a group of patients with a neurosurgical profile is a highly effective and reliable method with great prospects for application. 

Introduction. Primary cardiac tumors are rare, and the autopsy detection rate does not exceed 0.003%. Approximately 80% of primary heart tumors are benign, 50% of them are myxomas. Diagnosis of cardiac tumors at present in the presence of transesophageal echocardiography is not difficult in most cases. Surgical treatment of mixomas became possible after the introduction of open-heart surgery under cardiopulmonary bypass into clinical practice. After verification of the tumor, its surgical removal is indicated. In the practice of large cardiac surgery clinics, the experience of radical treatment of heart neoplasms is relatively small; therefore, the analysis of tactical approaches and results of operations in this pathology is of absolute interest.

Aim of study. To present an analysis of 10 years’ experience in surgical treatment of cardiac mixomas. Material and methods The results of treatment of 58 patients with myxomas who underwent surgical removal of the neoplasm of the heart are presented.

Results. Hospital mortality after surgical removal of myxoma was 1.7%, 1 patient died. All patients, we have the long-term period data about, noted a significant improvement in well-being, a decrease or disappearance of dyspnea at rest and/or during exertion, and no recurrence of myxoma was noted. Conclusion. The data obtained indicate, on the whole, good immediate results and high quality of life of patients in the long-term period operated on for heart mixomas. 

Myasthenia gravis is an autoimmune neuromuscular disease characterized by pathologically rapid fatigue of striated muscles [1]. The main symptom of myasthenia gravis is the presence of pathological muscle weakness with involvement of the ocular, bulbar and skeletal muscles in the pathological process. The provoking factors for the development of myasthenia gravis can be infectious diseases, surgery, drugs [2, 3]. The main danger is represented by myasthenic and cholinergic crises, which are characterized by a severe course and high mortality; therefore, the problems of treating myasthenia gravis are still of high medical and social significance. The prevalence of myasthenia gravis is 17.5–20.3 per 100 thousand population, and the number of patients is increasing by 5–10% annually [4, 5]. In recent years, there has been a steady increase in morbidity with an increase in age over 50 years [6, 7]. Myasthenia gravis is a serious disease with a high mortality rate of up to 30–40% [3]. There are difficulties in the early differential diagnosis of muscle weakness in patients with respiratory failure between myasthenia gravis, myasthenic syndrome and critical illness polyneuropathy. These difficulties and insufficient awareness of patients and doctors of various specialties about myasthenia gravis can lead to the choice of the wrong treatment tactics and the development of myasthenic crisis, which is manifested by respiratory failure, requiring respiratory support. The progression of respiratory failure against the background of myasthenic crisis may require the use of extracorporeal membrane oxygenation (ECMO).

It is necessary to expand the differential diagnosis of muscle weakness in a patient during the period of resolution of respiratory failure, allowing to move away from compulsory respiratory support, termination of ECMO. 

The article describes a computer modeling technique that allows predicting the development of restenosis of the internal carotid artery after carotid endarterectomy (CEE). A clinical case has been demonstrated that proves the effectiveness of the developed method. It is indicated that for the correct formation of the geometric model, data from multispiral computed tomography with angiography of the patient after CEE with a layer thickness of 0.6 mm and a current of 355 mA are required. To build a flow model, data of color duplex scanning in three sections are required: 1. In the proximal section of the common carotid artery (3 cm proximal to the bifurcation); 2. In the section of the external carotid artery, 2 cm distal to the carotid sinus; 3. In the section of the internal carotid artery, 2 cm distal to the carotid sinus. The result of computer calculations using specialized software (Sim Vascular, Python, Open Foam) is a mathematical model of blood flow in a vessel. It is an array of calculated data describing the speed and other characteristics of the flow at each point of the artery. Based on the analysis of RRT and TAWSS indicators, a computer model of bifurcation is formed, which makes it possible to predict areas of increased risk of restenosis development. Thus, the developed technique is able to identify a cohort of patients after CEE, subjected to a high probability of loss of the vessel lumen. Such an opportunity will provide a more precise supervision of these patients in the postoperative period with the aim of early diagnosis of restenosis and timely prevention of the development of adverse cardiovascular events. 

The article presents a long-term result of surgical correction of ischemic mitral valve insufficiency, left ventricle inferior wall reconstruction. 

We present a case of a closed thoracoabdominal trauma with pancreatic rupture. Closed abdominal trauma is one of the main causes for urgent hospitalization and emergency surgery. Injury of pancreatic ductal system is noted for the most severe course because of complications caused by outflow of the pancreatic juice into the retroperitoneal fat and the free abdominal cavity. One of the main factors affecting the efficacy of treatment is the time gap between a traumatic incident and hospitalization with subsequent surgical treatment. We report the results of management of a 53-year-old patient with closed thoracoabdominal injury and incomplete rupture of the pancreas, diagnosed 6 months after the “steering wheel” trauma. The injury was diagnosed with radiation techniques. Surgery included laparotomy, corporocaudal resection of the pancreas with splenectomy. The incidence of pancreatic traumatic injuries and the results of treatment are the matters for discussion. 

Intussusception of the appendix is the introduction of the appendix into the lumen of the cecum may be accompanied by the development of acute appendicitis, or proceed without it. The combination of intussusception and acute inflammation of the appendix makes the diagnosis of appendicitis difficult due to the absence of classic clinical symptoms. The article presents the case of successful treatment of a patient with an untypical clinical presentation of acute appendicitis that developed in an invaginated vermiform appendix.