ABSTRACT Acute lower limb ischemia (ALLI) is a limb threatening condition with high risk of adverse outcomes. The timely and proper diagnosis of the severity of limb ischemia is crucial in selecting the optimal treatment method.

AIM OF STUDY To evaluate the advantages of hybrid imaging in diagnosis of ALLI, patient selection and its severity in order to choose an optimal revascularization method.

MATERIAL AND METHODS we examined 163 patients with grade 1–3A ALLI based on I.I. Zatevakhin et al. classification (2002) on a Discovery 670 NM/CT hybrid device, using X-ray (computed tomographic angiography) and radionuclide method (three-phase scintigraphy/single photon emission computed tomography with osteotropic or perfused radiopharmaceutical).

RESULTS CT angiography accurately showed level of acute occlusion as well as distal arterial blood flow in all ALLI cases, thus allowing optimal choice of possible revascularization. CT angiography findings alone did not allow optimal staging of ALLI, which is essential for choosing an optimal revascularization method and were considered as supplementary. Three-phase scintigraphy allowed to differentiate the degrees of ALLI based on the visual picture and calculated data, while studies with osteotropic radiopharmaceutical 99mТс-PYP provided information on viability of affected tissues showing the areas of muscle necrosis, compared to perfused radiopharmaceutical.

CONCLUSION 1. CT angiography makes it possible to assess in detail the level and severity of occlusive lesions of the arterial system and study the vascular anatomy of the lower limb to resolve the issue of the possibility of revascularization, and also indirectly characterizes the presence of ischemic changes in soft tissues. 2. The radionuclide method (three-phase scintigraphy with an osteotropic radiopharmaceutical/single photon emission computed tomography), performed in addition to computed tomographic angiography, allows not only to detect the presence of ischemic changes in soft tissues, but also to differentiate the degree of acute ischemia of the lower. 3. The hybrid method (three-phase scintigraphy in combination with computed tomographic angiography) contributes to an objective assessment of the state of blood flow in the lower extremities in acute ischemia, both at the main and at the microcirculatory

ABSTRACTS  Ischemic stroke occupies a leading position among the causes of mortality and disability. Long-lasting motor and cognitive impairments, a decrease in the level of consciousness over time aggravate the course of the disease, leading to immobilization syndrome and comorbidity load, which contributes to the development of life-threatening conditions in this category of patients. In this regard, the search for new neuroprotective strategies used at an early stage and capable of minimizing the severe consequences of stroke for the patient in particular and society as a whole seems extremely relevant. The paper presents the effect of inhaled xenon for sedation in patients with severe ischemic stroke on the level of consciousness and severity of neurological disorders, and also shows its effect on S100B protein, a marker for blood brain barrier damage.

AIM OF STUDY To evaluate the effect of inhaled xenon for sedation in comparison with propofol intravenous sedation on the dynamics of the level of consciousness, the severity of neurological dysfunction and changes in the concentration of astroglial-derived S100B protein in severe ischemic stroke.

MATERIAL AND METHODS The research was conducted on two groups of patients comparable in age, gender, comorbid background, as well as the severity of the underlying disease. In both groups, the condition of patients required the start of mechanical ventilation immediately after admission to the intensive care unit. Group I (control, n=12). After intubation and the start of ventilation, patients were sedated with propofol at a dose of 1-2 mg/ kg / hour for 24–72 hours. Group II (xenon, n=12). After intubation and the start of ventilation, patients underwent xenon inhalation at a concentration of 40 vol. % for the first 6 hours. If it was necessary to continue sedation after the end of xenon inhalation, propofol was used in doses similar to Group I. Neurological status was assessed on days 1, 3 and 8 using the Glasgow Coma Scale (GCS), the Full Outline of UnResponsivness (FOUR) score and the National Institutes of Health Stroke Scale (NIHSS). The critical analysis of the value of S100B as a marker of brain damage was carried out before the start of sedation, on the 3rd and 8th days.

RESULTS Xenon inhalation (40 vol. %) in comparison with propofol intravenous sedation significantly increases the level of consciousness in patients with severe ischemic stroke (p=0,026), reduces neurological disorders assessed using NIHSS (p=0,007) on day 7, and also reduces serum S100B levels on day 3 (p<0,05) after ischemic stroke.

CONCLUSION Our open randomized clinical trial of xenon inhalation versus propofol intravenous sedation revealed the neuroprotective properties of xenon anesthesia in patients with severe ischemic stroke. Based on the obtained clinical and laboratory data, it can be concluded about the effective implementation of the neuroprotective effects of xenon in the administration scheme used in the research.

BACKGROUND Numerous studies have shown that coronary reperfusion with primary percutaneous coronary intervention (PCI) improves outcomes in patients with ST-segment elevated myocardial infarction (STEMI). However, the question of the effect on the myocardium as a whole of an isolated intervention on an infarct-related artery in multivessel coronary disease remains incompletely studied.

AIM OF STUDY To study the features of perfusion redistribution and myocardial function using perfusion single photon emission computed tomography (SPECT) in patients with STEMI and multivessel coronary disease after isolated PCI on an infarct-related artery.

MATERIAL AND METHODS SPECT-ECG (electrocardiography) was performed in 32 patients (27 men and 5 women) with STEMI. According to the ECG results, the location of focal myocardial changes was regarded as “lower” MI in 19 (59%) patients, “anterior” in 13 patients (41%). Coronary angiography revealed a multivessel lesion of the coronary vessels in all of them. The patients were divided into groups according to the location of the infarction and the area of the lesion: group 1 — lower MI (stenting of the right coronary artery (RCA) and its branches) — 19 patients (mean age — 57.7±2.5; median — 55 [51.5; 63.5]), of which 8 with small-focal (1a) and 11 with large-focal infarction (1b); group 2 — anterior MI (stenting of the left coronary artery (LCA) and its branches) — 13 patients (mean age — 55.4±3.5; median — 54 [48.5; 62.5]), of which 5 with small-focal (2a) and 8 with large-focal infarction (2b). SPECT-ECG was performed 3 times: 1st — on days 2–3 after PCI of the infarct-related artery, 2nd — 6 days after PCI, and 3rd — 6 months after PCI.

RESULTS After RCA stenting in patients with lower MI and multivessel coronary disease, SPECT-ECG revealed a statistically significant decrease in local contractility of individual segments of the anterior septal and lateral walls (with sufficient revascularization of the RCA system) and worsening of perfusion and right ventricular (RV) volumes. After stenting of the LCA branches in patients with anterior MI and multivessel coronary disease, a statistically significant decrease in local contractility in the basal segment of the diaphragmatic wall was observed, as well as impaired perfusion and an increase in the volume of the RV (with successful revascularization of the anterior interventricular branch). All these findings could be the result of partial steal of the blood supply to neighboring areas and myocardial remodeling after PCI in patients with multivessel coronary artery disease.

CONCLUSION 1. According to the data of single-photon emulsion computed tomography synchronized with electrocardiography in the early and late period of myocardial infarction after percutaneous coronary intervention in patients with multivessel coronary disease, there is a significant improvement in perfusion and function of the infarct-associated artery system. 1. Recanalization of only the left coronary artery with remaining stenoses in the right coronary artery in the long-term period can lead to an increase in the size of the cavity of the right ventricle of the heart and uneven distribution of perfusion in its The revealed statistically significant disturbances in perfusion and local contractility of neighboring areas after percutaneous coronary intervention of an infarct-related artery may be the result of steal of the blood supply and early myocardial remodeling in multivessel disease. 3. Disturbances in perfusion and local contractility in neighboring myocardial blood supply pools after percutaneous coronary intervention of an infarct-related artery dictates the need to repeated single-photon emulsion computed tomography synchronized with electrocardiography as early as possible in patients with multivessel coronary disease in order to assess the redistribution of perfusion and myocardial remodeling for timely complete revascularization, preventing recurrent coronary

The effective care for patients with self-poisoning with antihypertensive and antiarrhythmic drugs is associated with taking into account both clinical and adverse social, psychological and environmental stress factors. To identify their specifics, a retrospective analysis of 120 medical records and a clinical and psychological examination of 20 patients with antihypertensive and antiarrhythmic drugs self-poisoning and a comparison group of 34 patients with selfpoisoning with psychotropic drugs were carried out. It has been shown that the risk group for re-suicide in self-poisoning with antihypertensive and antiarrhythmic drugs is about 30% of patients. Risk factors are depressive symptoms that persist before discharge from the hospital, as well as dysfunctional personality traits (perfectionism in the form of increased preoccupation with the assessments of other people and frequent unfavorable comparisons with them, experiencing loneliness and isolation, increased impulsivity and a feeling of hostility from others) and unproductive ways of coping with stress (ruminative thinking or repetitive unpleasant and unproductive thoughts about anergy, lack of strength and loneliness). The results of the study and the developed psychodiagnostic complex can be used to identify targets for urgent psychological assistance and screening for the risk of re-suicide.

In addition to high mortality, craniocerebral injuries have another danger, a long rehabilitation period and a high percentage of disability with the development of cognitive impairment. This is primarily associated with the processes of neuroinflammation, which development, according to recent data, leads to a long-term impairment of consciousness. The anti-inflammatory effects of xenon inhalation anesthetic, which have been repeatedly shown in previous studies, have the potential to beneficially affect the level of consciousness in these patients by targeting key links of neuroinflammation.

AIM OF STUDY To evaluate the effect of oxygen-xenon mixture inhalation on the level of consciousness recovery and the severity of spastic activity in patients after traumatic brain injury.

MATERIAL AND METHODS A prospective randomized clinical trial of the effect of inhaled xenon sedation on the level of consciousness and spastic activity in patients with post-coma long-term impairment of consciousness was conducted. Patients were randomized into two equal groups. In group I (comparisons, n=15) (in addition to the standard treatment after a traumatic brain injury), each patient included in the study underwent 7 sessions of inhalation of an air-oxygen mixture with an oxygen content of at least 30 vol% for 30 minutes. In group II (study, n=15) (in addition to standard treatment), each patient included in the study inhaled an oxygen-xenon gas mixture (xenon content 30 vol%) for 7 days 1 time per day. Before and after the course of treatment (on the 7th day), patients were assessed using the CRS-R scale and the modified Ashworth scale.

RESULTS The final evaluation included 12 patients from the comparison group and 12 patients from the study group. Three patients were excluded from each group as a result of critical incidents not related to the type of the therapy. In the comparison group on the 7th day, the level of consciousness was score 9 [7; 11] and did not differ statistically significantly from the baseline (p>0.05), which was score 8 [6; 10]. Spastic activity also did not change statistically significantly. In group II, the initial level of consciousness was 9 [7; 10], and on the 7th day — score 15 [12; 17], which was statistically significantly higher both in relation to the level of consciousness by the 1st day (p=0.021) within the group, and in relation to it on the 7th day in group I (p=0.038). When comparing spastic activity on the 1st and 7th days, we did not obtain a statistically significant difference in any of the groups.

CONCLUSION Our method of xenon inhalation made it possible to have a beneficial effect on the level of consciousness of patients after traumatic brain injury, but this did not affect the final level of spastic activity in any way.

The article presents a study of palliative surgical treatment of patients with pathological fractures of the long bones and chronic trochanteric fractures. Those patients are not indicated for special oncological treatment. Therefore, the article does not provide staging of malignant neoplasms. The surgical treatment was aimed at improving the quality of life of palliative patients, and accompanying therapy in the form of the Altaicae extract adaptogen and the neutral anolyte led in our study to an increase in the effectiveness of surgical treatment of such a severe contingent of patients.

INTRODUCTION According to domestic and foreign literature, the number of oncological diseases in young and old people is growing. There is a trend to neglecting the disease and late visits to doctors. Almost all types of cancer of various localization and other malignant tumors metastasize to the bones. An increase in the number of pathological (metastatic) fractures of the trochanteric region and the long bones was also noted. Surgical treatment of patients with such a severe type of fractures leads to an aggravation of the already existing immunodeficiency and, as a rule, creates the prerequisites for the occurrence of infectious complications in the postoperative period. The choice of a conservative method of treatment often does not justify itself as well, it leads to diagnostic and therapeutic errors, and in the future — to chronic pathological fractures.

AIM To improve the effectiveness of surgical treatment and the quality of life of palliative patients with pathological (metastatic) fractures of the long bones and chronic trochanteric fractures using original authors’ accompanying therapy.

MATERIAL AND METHODS 177 patients were examined and divided into two groups the main and the control groups. 72 patients were included in the main group, and 105 patients in the control group. There were 110 men and 67 women. The patient age ranged from 35 to 90 years. The main group received surgical treatment with the use of new accompanying therapy along with the basic one, and the control group received only surgical treatment and basic therapy.

RESULTS In the main group patients with chronic pathological fractures of the trochanteric region, who underwent endoprosthetic replacement, osteosynthesis, a new method of surgical treatment of metastatic fractures of the long bones and the authors’ accompanying therapy, the effectiveness of surgical treatment increased significantly compared to the comparison group. As a result, most of the unwanted symptoms disappeared, time spent in hospital decreased, the psychoemotional status and immunity improved, the functional state of the body was optimized, and the quality of life improved.

CONCLUSION The use of new accompanying therapy, the authors’ method of surgical treatment of patients with pathological (metastatic) fractures of the long bones, chronic fractures of the trochanteric region allows us to successfully and effectively operate on such severe patients and perform a fast track surgery program in the early postoperative period.

BACKGROUND Our study provides a unique opportunity to compare the course of the disease with a new coronavirus infection in seriously ill patients in the groups of vaccinated and unvaccinated patients hospitalized in the infectious intensive care units of N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department since the start of the vaccination campaign.

AIM OF STUDY  The  study of  the  composition  of  hospitalized  patients  with  COVID-19  in  the  N.V. Sklifosovsky Research  Institute  for  Emergency Medicine of the Moscow Health Department in serious condition, requiring resuscitation, in groups of vaccinated and unvaccinated patients in terms of their age and gender characteristics, the severity of the condition and duration of treatment, the presence of concomitant (chronic) diseases, as well as the outcome of hospitalization.

MATERIAL AND METHODS The initial analyzed material was data from the Unified Medical Information and Analytical System (EMIAS) of the Institute and statistical cards of patients who left the hospital. The formation of the main group of vaccinated patients was carried out in accordance with the instructions of the Moscow Department of Health and in pursuance of the letter of the Office of Rospotrebnadzor for the city of Moscow No. I-17-17/1 dated January 26, 2021 “On monitoring COVID-19 cases in those vaccinated against a new coronavirus infection “. The Institute has created a registry of hospitalized patients diagnosed with Coronavirus infection caused by the COVID-19 virus, who have a certificate of vaccination with registration in EMIAS. Also, to determine vaccinated patients, we used information from the Headquarters for measures to prevent the importation and spread of infection caused by the 2019-nCoV coronavirus in the city of Moscow. The comparison group included patients with coronavirus infection caused by the SARS-CoV-2 virus, hospitalized in the infectious diseases intensive care units of the Institute and not having information about the certificate in EMIAS. The analyzed period was counted from the moment the register was created and amounted to 6 months: from May 1 to October 31, 2021. Discrete numerical accounting characteristics of each unit of observation (hospitalized patient) were age, duration of stay in the hospital (including in intensive care). Categorical data were gender, diagnosis, source of admission, severity, presence of pneumonia upon admission, history of chronic diseases, outcomes of hospitalization. After the anonymization of the personal data of patients and the distribution of patients into comparison groups, the obtained information was processed by standard means of mathematical statistics using the R-free software computing environment. The calculation of additional absolute and relative values, average errors of indicators was made. Statistical significance of differences in numerical values was determined using the Student’s t-test, categorical values were calculated using the ӽ2 test. In both cases, the p-value was chosen to be less than 0.05.

RESULTS When comparing the course of coronavirus infection, concomitant diseases, the duration and nature of inpatient treatment, the frequency of external and internal transfers between different departments, as well as disease outcomes in vaccinated and unvaccinated patients hospitalized at N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department revealed:

• the average duration of stay both in clinical units and in intensive care units in vaccinated patients is significantly less than in unvaccinated patients;
• all patients were admitted to the hospital in a serious or extremely serious condition caused by severe clinical manifestations of coronavirus infection in unvaccinated patients and comorbid diseases in most of the vaccinated patients;
• the mortality among vaccinated patients is significantly lower, and the immediate cause of death was almost always complications of a severe course of competing (non-infectious)

CONCLUSION The study showed that in vaccinated patients with intense post-vaccination immunity, the risk of developing a severe course of coronavirus infection (requiring resuscitation) is much lower. Along with this, the duration of treatment is also significantly reduced, especially in intensive care units, and the likelihood of an unfavorable outcome of the disease is reduced to a minimum.

Standardization is one of the most important tools for ensuring the quality of medical care. The paper presents analysis results of a number of existing federal and regional standards that regulate the processes of providing medical care, which confirm the need and expediency of developing internal standards for diagnostic and treatment processes (DTP) in a medical institution. The authors also formulate requirements for their minimum content. The importance of the effective implementation of the developed internal DTP standards necessitates the development of a methodological approach to standard execution support and analysis.

The approach presented in the article is methodically based on the use of modified operogrammes, which allow taking into account the DTP specifics and resource equipment of a particular medical institution. The authors propose key areas for standard execution support and possible forms of implementation in information systems, as well as basic directions for standard execution analysis with integral indicators for assessment of those standards.

Approbation of the developed methodological approach was carried out on the example of the N.V. Sklifosovsky Research Institute for Emergency Medicine in terms of DTP standard execution support and analysis in relation to ordering laboratory, instrumental tests and consultations at various stages of the patient treatment process. The results of the approbation confirmed that the introduction of the methodological approach increases the effectiveness of the implementation of the developed DTP standards in the activities of a medical institution, and also ensures the achievement of a number of important systemic management effects.

Postpartum hemorrhage is a serious obstetric complication due to the threat to the life and health of a woman. One of the common causes of bleeding in the postpartum period is uterine hypotension. If conservative methods of treating hypotonic bleeding are ineffective, hemostatic compression sutures are applied to the body of the uterus, ligation/clipping of the main vessels of the uterus and (or) ligation of the internal iliac arteries. If available, endovascular uterine artery embolization (UAE) is performed. The review is devoted to the efficacy and safety of UAE in pregnant women with postpartum hypotonic bleeding, as well as to the long-term results of follow-up.

BACKGROUND The literature review is devoted to an urgent problem of the diagnosis of pneumonia in the practice of an anesthesiologist-resuscitator using ultrasound. The literature review describes the methodological foundations of this method, its advantages and disadvantages, sensitivity and specificity for the diagnosis of severe community-acquired pneumonia in the practice of an anesthesiologist-resuscitator.

AIM OF STUDY The analysis of the most modern domestic and foreign evidence base based on the information content of lung ultrasound in CAP in the practice of an anesthesiologist-resuscitator.

MATERIAL AND METHODS Russian publications were searched in the elibrary.ru database, foreign publications were searched in the PubMed database. Publications (literature reviews, observational studies, double-blind randomized trials) were searched for the period 2010–2020. A total of 1379 publications were initially selected, identified through database searches. After removing duplicates, the number of publications was reduced to 695. Of this number, 503 publications were excluded. The remaining 192 full-text articles were evaluated for text acceptability. Due to inconsistency with the main sections of the review, 77 articles were deleted from them. The remaining 115 ones were included in the qualitative synthesis and 67 ones were selected in the quantitative synthesis.

RESULTS The ultrasound is a promising and worthy alternative to other imaging modalities. According to the results chest X-ray was inferior to lung ultrasound in diagnosing the presence of fluid in the pleural cavities. The sensitivity of ultrasound in assessing pleural effusion reaches 100%, the specificity is 99.7%. Pulmonary ultrasonography plays an important role in the diagnosis of pneumonia and is a promising alternative to chest X-ray and chest CT.

DISCUSSION Since POCUS is performed at the patient’s bedside, the results are available to the doctor in real time, which helps in diagnosis and treatment. Sequential examinations can be performed to monitor disease progression and response to treatment. However, many facilities do not have the ability to store ultrasound images, so other healthcare professionals cannot see them.

FINDINGS The ultrasound examination of the lungs is unlikely to replace computed tomography of the chest, as it does not have 100% specificity, however, it is indispensable in bedside examination and is the doctor’s sonographic “stethoscope”, which significantly expands diagnostic capabilities.

RELEVANCE The overall incidence of Achilles tendon rupture has been increasing in recent decades due to population aging, the growing prevalence of obesity and increased participation in sports. Achilles tendon ruptures are common injuries of the musculoskeletal system, and according to various authors, they account for 47% of all ruptures of human tendons and muscles, about 18 cases per 100 thousand people per year. Despite the abundance of various options of tendon suture in surgery, a wide choice of suture material and the use of precision techniques in tendon reconstruction, the proposed methods of macroscopic reconstruction of the tendon apparatus do not solve the problem of tendon suture failure.

CONCLUSION Despite the abundance of proposed accesses to the Achilles tendon, the optimal one for all types of injuries has not yet been developed. Currently, there are no clear recommendations for choosing a specific method of treating an Achilles tendon rupture.

RELEVANCE In Russia, insufficient motivation and low readiness of laypeople to provide first aid (FA) stipulate low rates of bystander cardiopulmonary resuscitation (CPR) and, as consequence, high mortality from cardiac arrest (CA). News reports on real cases of CA, in addition to describing circumstances of the event, may carry important information promoting FA provision among a wide audience. However, existing practice of presenting such content in Russian media sphere is unknown.

AIM To investigate contemporary trends for presentation of information on the problem of CA and provision of help in CA in reports of online news media on the example of a news sample about cases of pediatric CA in kindergartens and schools of Russia.

MATERIAL AND METHODS In August 2021, Google and Yandex were searched for Russian-language news reports describing cases of CA that happened in children in Russian schools and kindergartens in 2020, and structured content analysis of the news was carried out.

RESULTS The study sample consisted of 207 news reports describing 21 unique case of CA. In 76.2% cases (n=16) CA occurred in children at school, in 23.8% cases (5) — at kindergarten. At least in 28.6% of cases (6) Emergency Medical Services providers did not attempt CPR at arrival on scene. FA provision by bystanders was described in two cases (9.5%), provision of help by medical employees of educational organizations — in six cases (28.6%). Only in one case (4.8%) the child was transferred to a hospital after successful resuscitation. In the rest of cases (n=20; 95.2%) biological death was verified on scene. Information on the value of FA for saving life in CA was present in one out of 207 news reports (0.5%); and there were no reports mentioning legal aspects of FA provision, describing procedure of FA in CA, or highlighting the importance of mass public resuscitation education.

CONCLUSIONS News reports that describe cases of CA confirm high relevance of the problem, but do not carry important information related to popularization of FA knowledge. Inclusion of information on significance, principles and procedures of providing FA to CA victims into the content of the news reports is necessary for establishing positive public opinion and increasing motivation of the general population of Russia towards training in FA and FA provision. This in turn indicates the necessity for enhancing awareness of the professional journalistic community on the problem of FA provision in CA.

The deep femoral vessels are the main branches/donor vessels of the femoral vessels. Their branches penetrate the entire array of muscles of the posteromedial group and descend almost to the popliteal region, so they are able to both largely compensate for blood flow disorders in obliterating atherosclerosis of the arteries of the lower extremities, and in the presence of an anastomosis with the popliteal vein, influence the course of acute and chronic vein diseases. The modern standard for studying the vascular system of the lower extremities is duplex scan, but it allows deep femoral vessels to be examined only in the ostium segment up to 5–6 cm.

AIM OF STUDY To determine the patency and state of blood flow in the deep femoral vessels throughout the entire length using ultrasound duplex angioscanning.

MATERIAL AND METHODS The analysis of the results of 30 computed tomograms and 100 ultrasound scans of patients (aged 20 to 85 years) who underwent routine examination of the vascular system of the lower extremities in a polyclinic setting was carried out. The study was performed according to the original method (Patent for invention No. 2751819).

RESULTS In the upper third of the thigh, the deep femoral vessels are located most superficially, 2.3±0.15 cm from the skin surface and 0.5±0.08 cm from the posterior wall of the femoral artery. In the middle third of the thigh, the depth of the deep femoral vessels is 3.5±0.9 cm from the skin surface and 4.3±0.24 cm from the posterior wall of the femoral artery. The deep femoral vessels are located between the vastus medialis and adductor longus muscles closer to the femur. In the lower third of the thigh, deep femoral vessels are located at a distance of 4.3±0.4 cm from the skin surface and 1.8±0.5 cm from the posterior wall of the femoral artery. Therefore, for ultrasound examination, a linear probe is first used, which is placed along the projection line of the femoral vessels in the upper third of the thigh, and then the orifice of the deep femoral vessels is visualized. Next, a convex probe is used, and in the middle and lower third of the thigh, it is drawn along a line located 2 cm medially to the projection line of the femoral vessels, while the probe itself deviates posteriorly by ~ 15°.

CONCLUSION The research algorithm helps increase the length of the areas of the deep femoral artery and vein available for research and help the physician choose the optimal method of treating the patient.

Clinical case. A patient after mitral valve replacement surgery for infective endocarditis was hospitalized with a new coronavirus infection. The examination revealed a left ventricular-right atrial communication. The complex treatment with a good clinical effect was performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine. Conclusions In the context of a pandemic of a new coronavirus infection, patients with a new coronavirus infection who have undergone a history of heart surgery are subject to greater clinical vigilance regarding the development of postoperative complications, including rare ones.

Traumatic testicular dislocation can be easily missed, especially against the background of obvious severe injuries in a patient with multiple and concomitant trauma. Despite the fact that traumatic testicular dislocation is a rare condition and does not pose an immediate threat to patient safety, it can cause serious consequences leading to male infertility. To prevent complications, this pathology should be diagnosed and treated as soon as possible. For this purpose, it is necessary to exercise diagnostic vigilance and conduct an appropriate examination in patients with polytrauma, especially those received while riding a motorcycle. The diagnosis of the trauma can be made if, on physical examination, there is a dense elastic formation corresponding to a displaced testicle with simultaneous desolation of half of the scrotum. This will help speed up the diagnosis and initiation of treatment, as well as facilitate preoperative planning of interventions on the bones of the anterior pelvic ring. Therefore, diagnostic instrumental and physical examination with palpation of both testicles upon admission is highly recommended.

Neonatal necrotic enterocolitis (NEC) is a nonspecific inflammatory disease of unknown etiology with multifactorial pathogenesis, which development is explained as a result of hypoperfusion of the immature intestinal mucosa of a newborn who has undergone perinatal hypoxia and, as a result, a change in blood flow in the mesenteral vascular system. This disease more often affects the intestinal wall of premature babies. In typical cases, mucosal necrosis develops in the terminal iliac and right parts of the colon, and when the process progresses, it can spread to the entire thickness of the intestinal wall, causing its perforation, so peritonitis is a frequent complication of NEC. But in addition, distant complications of NEC are distinguished, which include the development of intestinal obstruction in view of a decrease in the contractility of the intestinal wall section due to its fibrosis and, as a result, narrowing of the lumen.

We report the clinical case of surgical treatment of the twisting of stenosed portion of the ileum in a child who underwent NEC in the early neonatal period. A mother sought assistance with a child of 3 months at the Reginal Children’s Hospital (born at 28 weeks of gestation). After birth, there was a violation of the absorption of enteral nutrition (periodic posseting, bloating), blood in the stool was determined. On the 14th day of life a pediatric surgeon examined the baby: necrotizing enterocolitis II A. After stabilizing the condition (2 months), the child was transferred from the perinatal center to a pediatric hospital with a diagnosis of bronchopulmonary dysplasia, a new form, a severe course, and a period of exacerbation. At the age of 2.5 months, he was discharged in a satisfactory condition to the outpatient stage. On the 15th day from the moment of discharge (3 months of life), the mother noted the expressed anxiety of the baby, bloating, stool retention. On the 16th day from the moment of discharge during feeding, the child began to suck sluggishly, did not absorb the age norm. He was examined by a pediatrician, the consultation of a pediatric surgeon was recommended. Due to the severity of the condition, the baby was hospitalized.

In the initial examination, no data for intestinal obstruction were detected. The patient received parenteral nutrition, antibacterial therapy. Ultrasound and radiography of abdominal organs were performed daily. On the third day of observation, deterioration is noted (abdomen bloated mainly in the upper parts, soft upon with palpation, the baby was anxious, peristalsis was reduced), with ultrasound: between the loops of the enlarged intestine, an echogenic band of up to 18 mm (adhesion?) was determined, there was the liquid component between the loops. A laparotomy was performed, during the revision there was a displacement of the large intestine into the left parts of the abdominal cavity. Ten cm from the ileocecal angle, a section of the ileum with a length of up to 15 cm was found, which was like a “double trunk” wrapped at the base around its axis around a cord-like adhesive stretching to the posterior abdominal wall. Visually, the loop was dark bard in color, its walls were swollen, infiltrated, and their cartilaginous density was determined upon palpation in the contact area of the walls of the intestine. The resection of this loop was performed, end-to-end anastomosis was formed according to the method of J. Louw. After the operation, the baby received treatment in the intensive care unit, enteral feeding on day 5, on day 9, after expanding the volume of feeding, he was transferred to the department of pediatric surgery. Discharged in satisfactory condition on the 12th day after surgery.

On the example of a clinical observation, we demonstrate the possibilities of dynamic multimodality imaging techniques and clinical and laboratory data, taking into account the severity of the concomitant trauma, which allow us to reflect objectively the dynamics of post-traumatic changes in the organs and tissues and predict the course of multiple organ failure (MOF). Consistency and adequate choice of treatment tactics with early use of active detoxification methods contribute to a favorable outcome.

INTRODUCTION Transposition of the great arteries is the second most common cyanotic congenital heart defect after tetralogy of Fallot. The arterial switch procedure (А. Jatene, 1975) is the surgical treatment of choice. Neoaortic root dilatation and valve regurgitation are quite common among the patients who underwent surgery for transposition of the great arteries. However, there are a lot of conflicting data about their direct connection.

CLINICAL CASE This article describes surgical repair of neoaortic bicuspid valve regurgitation, by it successful implantation, in an  18-year-old  patient  after arterial switch operation for transposition of the great arteries in the neonatal period.

CONCLUSION Neoaortic valve insufficiency can develop primarily as well as secondary to neoaortic root dilatation, however, the questions about valve repair or aortic root replacement with or without neoaortic valve implantation remains debatable. At this stage, decision making is based only on unsystematic clinical experience, surgeon’s intuition, the basics of anatomy and pathophysiology, as well as close interaction of “pediatric” and “adult” cardiac surgeons.

In 2022, we are approaching 125 years since the birth of Dmitry Alekseevich Arapov, a prominent domestic surgeon, scientist, experimenter, organizer of the military medical services. Dmitry A. Arapov, one of the most prominent representatives of the S.S. Yudin scientific school, worked at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 1929 till 1984. He quickly proved himself not only as an excellent doctor and a skilled surgeon, but also as a researcher, and soon became one of the closest students and associates of S.S. Yudin. Dmitry A. Arapov drafted as a field surgeon during the Soviet-Finnish war of 1939-1940, from the first to the last day he went through the Great Patriotic War, being the Head of the surgical service of the Northern Fleet in Polyarny. In this position, he significantly improved the system for providing emergency surgical care on ships and in naval hospitals, based on the experience gained over the years of work at the N.V. Sklifosovsky Research Institute for Emergency Medicine. From July 1950 Dmitry A. Arapov was Chief Surgeon of the USSR Navy, from May 1953 he was Deputy Chief surgeon of the Main Military Sanitary Directorate of the USSR Ministry of Defense, and from May 1955 again Chief Surgeon of the USSR Navy, until his retirement in October, 1968. At the same time, Dmitry A. Arapov did not leave his work at the N.V. Sklifosovsky Research Institute for Emergency Medicine until the last days of his life. Dmitry A. Arapov is the author of more than 200 research papers, including 14 monographs. Scientific interests of Dmitry A. Arapov went far beyond emergency surgery, to which he naturally paid most attention. His works are devoted to various issues of military and emergency surgery of the abdominal and thoracic organs, topical issues of burn injuries, surgical site infections, reconstructive surgery, neurosurgery, treatment of endocrine disorders, and anesthesiology and resuscitation. Also Dmitry A. Arapov successfully dealt with the problems of autotransfusion, blood reinfusion from the chest and abdomen, transfusion of fibrinolytic blood. The main directions of scientific research, laid down by Dmitry A. Arapov, are currently being continued at the Scientific Department of Emergency Surgery, Endoscopy and Intensive Care of the N.V. Sklifosovsky Research Institute for Emergency Medicine. Memory of Dmitry A. Arapov has been preserved to this day. To the 100th anniversary of the birth of D.A. Arapov, a scientific conference was held at our Institute. The naval hospital in the town of Polyarny, Murmansk region, was named after Dmitry A. Arapov, and in honor of D.A. Arapov, a memorial plaque was installed on its building. In the 70s of the twentieth century, People’s Artist of the USSR L.E. Kerbel created a sculpture of Dmitry A. Arapov, which was stored in the local history museum of the town of Polyarny. His bust portrait (by artist T.S. Smagina) is exhibited at the Scientific Department of Emergency Surgery, Endoscopy and Intensive Care of the N.V. Sklifosovsky Research Institute for Emergency Medicine. In addition, the N.V. Sklifosovsky Research Institute for Emergency Medicine owns an earlier portrait of Dmitry A. Arapov by artist F.S. Bulgak. We introduce these portraits into scientific circulation for the first time. We are confident that they will be able to tell contemporaries a lot about this scientist, surgeon and man who made a great contribution to surgery and military medicine, and rightfully entered the history of Russian medicine.