From the editor.

Current issues of pathologic anatomy in case of emergency at the present stage of medicine development.

Conference Report “Emergency care for patients with acute cerebrovascular accident”.

BACKGROUND. Hemocarboperfusion, previously widely used in our country, can universally pass out of use due to the lack of industrial production of disposable mass exchange devices.

MATERIAl AND METHODS. Physicochemical properties of materials and design features of the body samples elements of various sizes have been studied.

RESULTS. The elements and materials properties of the hemosorption mass exchanger cylinder have been studied. Hydrodynamic parameters of manipulation using the developed cylinders at different perfusion rates have been studied in bench experiments.

CONCLUSION. The original cylinder of the disposable mass exchange device for hemosorption, which meets the current clinical needs, has been developed. 

ABSTRACT. Fractures of the pelvis may be accompanied by a vascular injury with subsequent bleeding, hemodynamic instability and high mortality. The following endovascular techniques are used: temporal aortic occlusion with a balloon, stents in case of damage of the great arteries, and most commonly — embolization.Embolization is often used in a complex of therapeutic measures. despite the high effectiveness of the methods, there are various approaches and algorithms, complications are possible andthe need for repeated interventions may occur. The review is related to diagnosis, treatment strategy, results of the use of endovascular techniques in pelvic trauma, combined with the damage to blood vessels. 

RElEVANCE. Hypotension caused by intrapleural bleeding or wound of the heart is an indication for thoracotomy in chest wound. drainage of the pleural space is performed in normotensive patients in the absence of immediate threat to life and other indications for thoracotomy. Thoracoscopy allows diagnosing and fixingintrapleural damage in patientswhen thoracotomy is not indicated. The main condition for the procedure is stable hemodynamics.

MATERIAl AND METHODS. Medical histories of 591 patients operated on between 2002 and 2012 with the use of traditional methods and videothoracoscopy have been studied. Four expert groups were formed (drainage of pleural space, atypical thoracotomy, videothoracoscopy and typical thoracotomy), consisting of 375 patients, to determine the value of shock index and the pace of intrapleural bleeding, enough for a safe thoracoscopy. We used binary logistic regression (ROc analysis), studying the findings.

THE RESULTS. It was found that the safe performance of thoracoscopic surgery for a chest injury is reasonable when the value of shock index is less than 0.97 and the pace of intrapleural bleeding is less than 250 ml/hour.

CONCLUSION. The retrospective study determined the safety parameters to perform thoracoscopyin patients with chest wound. 

 INTRODUCTION. High risk of venous thrombosis in patients with multisystem trauma is associated with a number of precipitating factors, such as direct damage to vessels, prolonged immobilization, major changes in the hemostatic system, as well as possible surgical intervention.

THE PURPOSE OF THE STUDY. Analysis of the incidence, echosemiotics, and evolutionof venous thrombosis in the course of various prophylactic drug therapies in patients with polytrauma.

METHODS. The results of leg veins ultrasonography in 610 patients with various prophylactic drugtherapies have been analyzed over time. Antiplatelet agentswere received by 314 patients of the first group, low molecular weight heparins — 186 patients of the second group, oral anticoagulants — 110 patients of the third group. THE RESulTS Evolved thromboses varied in frequency (52.5% in the first group, 15.6% in the 2nd group and 10% in the 3rd group), prevalence, nature of the proximal border, with an increase in the proportion of nonocclusive lesions in the 2nd and 3rd groups, as well as in start time and degree of recanalization.

CONCLUSION. Low molecular weight heparins and oral anticoagulants reduce the risk of venous thrombosis by 3.3 and 5 times respectively, compared to the group of patients who did not receive anticoagulants in the early posttraumatic period; recanalization begins 1−2 weeks earlier with more effective restoration of the lumen. As the number of thromboses in the course of modern anticoagulants decreases, the proportion of non-occlusive thromboses including the floating onesgrows, requiring ultrasoundobservation. 

ABSTRACT. According to most researchers, spontaneous rupture of the esophagus (SRE) occurs relatively rarely, ranging from 1.7% to 17.5% of all cases of damage to the esophagus. Today, there is no one categorical opinion on the effectiveness of various treatments for SRE among surgeons, there are no uniform algorithms for diagnosis and evaluation of the treatment. SRE is a real threat to the life of a patient: SRE mortality rate is up to 75% in the prehospital period and up to 25%-85% in the postoperative period, and depends on the time interval between the rupture of the esophageal wall and the surgery, as well as complications. 

ABSTRACT. Patients with major thermal injury require anticoagulant therapy during almost the whole period of the burn disease, forcing the physician to balance constantly between the risk of possible bleeding associated with surgical treatment and the risk of thrombosis development in patients demonstrating a number of factors predisposing to the development of VTС. We report a clinical case of appropriate anticoagulant therapy using the new oral anticoagulants in a patient with a high risk of VTС development and recurrent bleeding from the tumor of the ascending colon. 

The 75th birth anniversary of Aleksandr G. Chuchalin.

The 65th birth anniversary of Aleksandr V. Gavrylenko.

The 60th birth anniversary of Andrey A. Alekseyev.

Источник: Mauri L., Kereiakes D.J., Yeh R.W., et al. Twelve or 30 Months of dual Antiplatelet Therapy after drug Eluting Stents // N. Engl. J. Med. – 2014. – Vol. 371: Р. 2155–2166.

Источник: McMurray J.J., Packer M., Desai A.S., et al. Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure. N. Engl. J. Med. – 2014. – Vol. 371. – P. 993–1004.

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