RELEVANCE Thrombosis of a popliteal artery aneurysm is an intractable problem. For decades, the number of amputations in this disease has remained at the level of 20% and does not have a significant downward trend due to the fact that during thrombosis of an aneurysm, the infragenicular arteries, the only “outflow paths” for bypass surgery, are also thrombosed. Currently, in order to increase the capacity of the peripheral bloodstream, thrombolytic therapy has been proposed.

AIM To evaluate the effectiveness of preoperative and intraoperative thrombolytic therapy in the surgical treatment of thrombosed popliteal aneurysms.

MATERIAL AND METHODS In the period from 1997 to 2020, 94 patients with acute ischemia of the lower extremities caused by thrombosed popliteal aneurysms underwent 98 reconstructive surgeries at the N.V. Sklifosovsky Research Institute for Emergency Medicine. The age of the patients was 62.5±10.1 years. Group I (n=66/98 patients, 67.3%) consisted of patients after primary reconstructive surgery; Group II (n=32/98, 32.7%) consisted of patients who, in order to improve the patency of the infragenicular arteries, underwent thrombolytic therapy in addition to surgery (12 preoperative catheter-directed, 20 intraoperative). A retrospective analysis was carried out.

RESULTS Limb preservation was achieved in 86.7% of patients. In Group I, early postoperative thrombosis occurred in 22.7% of cases (n=13/98), in Group II — in 6.3% (n=2/32), p<0.05; amputations were performed in Group I in 18.1% of patients (n=12/66), in Group II — in 3.1% of patients (n=1/32), p<0.04.

INTRODUCTION An increase in the survival rate of patients with severe brain injuries of various origins determines the relevance of the search for approaches to assessing the prognosis of changes in the state of patients with chronic disorders of consciousness (CDC). Concomitant diseases are predictors of the recovery of consciousness and functional independence of patients with CDC. To assess the impact of the level of comorbidity on the prognosis of the patient state, the Comorbidities Coma Scale (CoCoS) is used abroad. However, the lack of a Russian-language version of this scale limits the practical and scientific areas of work with this category of patients.

THE AIM of the study was to evaluate the psychometric properties of the developed Russian version of the Comorbidities Coma Scale (CoCoS).

MATERIALS AND METHODS As part of the validation study, an assessment of psychometric properties (reliability, validity, sensitivity) was performed on a group of 52 adult patients with traumatic (18/52) and non-traumatic (34/52) brain damage.

RESULTS High levels of validity and reliability were obtained (the Spearman’s Rank Correlation Coefficient r=0.98 (p<0.0001), Cronbach’s alpha α=0.73 (p<0.001), Cohen’s kappa κ=0.72 (p<0.0001)). However, when evaluating the CoCoS sensitivity, there were no statistically significant changes in the parameters (p=0.316).

CONCLUSION In the present study, a sufficient level of psychometric properties of the Russian-language version of the CoCoS was obtained, which opens up the possibility of a quantitative assessment of comorbidities in unresponsive patients both in scientific research and clinical practice. The scale is available for download on the website of the Group for Validation of International Scales and Questionnaires of the Research Center of Neurology.

The intestine plays an important role in the processes of systemic inflammation, sepsis and multiple organ dysfunction, in the course of hemorrhagic shock, trauma, burns, pancreatitis, extensive abdominal surgery and in seriously ill patients in intensive care units (ICUs). One of the leading causes affecting the outcomes of treatment of surgical patients after interventions on the abdominal organs continues to be the syndrome of intestinal insufficiency developing in the early postoperative period, which important pathogenetic aspect is impairment of the propulsive function of the intestine.

AIM OF THE STUDY Improving treatment outcomes in patients with severe acute pancreatitis by restoring propulsive bowel function.

MATERIAL AND METHODS The study included 94 patients with severe acute pancreatitis (67 (71.3%) men and 27 (28.7%) women) admitted to the ICU in the first 24–72 hours from the onset of the disease (abdominal pain syndrome). The mean age was 48.2 ± 12.5 years, the patients were divided into two study groups: patients of the comparison group (n=40) received standard therapy in the ICU, patients of the study group (n=54) described treatment was supplemented with the use of saline enteral solution and early start of enteral nutrition in order to restore the functional activity of the intestine.

RESULTS Extended therapy with the inclusion of saline enteral solution made it possible to correct the manifestations of intestinal failure syndrome 2.4 times faster, to start enteral nutrition on day 2.1±0.8 of dynamic observation in the ICU in patients of the study group, which contributed to leveling the manifestations of intestinal failure syndrome, prevention and treatment of nutritional deficiencies. At the same time, effective intestinal peristalsis, confirmed by ultrasound, was determined in 57.4% of patients on day 2.1±1.6, in 35.1% on day 3.6±2.0, in 7.4% of patients on day 4.8±1.7 of stay in the ICU. While in the comparison group, peristalsis was determined in 37.5% of patients in 4.4±2.3 days, in 30% of patients in 6.2±1.1 days, in 27.5% in 8.1±3.6 days, in 5% of patients in 10.4±2.2 days and in 6.7% of patients it was not possible to restore effective peristalsis.

CONCLUSION Enteral solution in the treatment regimen for patients with a diagnosis of “Acute severe pancreatitis” contributed to a more rapid recovery of the effective motor-evacuation function of the intestine and made it possible to reduce the number of purulent-septic complications 1.4-fold, cases of multiple organ failure 1.7-fold, and mortality 1.6-fold.

BACKGROUND The market of hypnotic and sedative drugs is being updated due to the high toxicity of barbiturates and the limitations of their use. Currently, safer drugs such as Z-drugs, Doxylamine, and some benzodiazepine derivatives are often prescribed for the treatment of anxiety and insomnia, but they can cause acute poisoning if overdosed or in case of nonmedical use.

AIM To establish an affordable express thin-layer chromatography (TLC) technique for preliminary screening detection of Doxylamine, Phenazepam and Zaleplon in order to diagnose acute poisoning.

MATERIAL AND METHODS Thin-layer chromatography (TLC) and gas chromatography with mass selective detection (GC-MS) methods were used. Urine samples from patients with symptoms of acute Doxylamine, Zaleplon, Phenazepam poisoning, and model urine samples were prepared by liquid-liquid extraction at pH 9.0 with chloroform for TLC analysis, with ethyl acetate-diethyl ether mixture (1:1) for GC-MS.

RESULTS We developed the TLC method of Doxylamine, Zaleplon and Phenazepam detection which helps reveal their presence in the patient’s urine, as well as distinguish one from another in case of similar toxic symptoms. The GC-MS method was used for confirmatory analysis. Compared to confirmatory methods, the developed technique of TLC screening is expressive, does not require expensive high-tech equipment, while allowing to differentiate Doxylamine, Zaleplon and Phenazepam from each other and from other toxicologically significant psychoactive substances detected in general screening.

SUMMARY The index used in Russia to predict mortality in patients with burns, the Frank index, needs to be revised because it has a low prognostic value.

TARGET Modify the Frank index to increase its predictive value for mortality.

MATERIAL AND METHODS A retrospective study included 307 patients with skin burns. We added the age of the patient to the Frank index (FI) formula and changed the score for inhalation trauma (IT). We compared the discriminatory power and predictive value of FI and the Revised Frank Index (RFI) using statistical analysis methods.

RESULTS Adding the absolute number of years of the patient and 30 points for IT to the FI formula improved the discriminatory power and predictive value of RFI, which is calculated by the formula ∑ = S_{surface burns} (% b.s. ) + 3*S_{surface burns} (% b.s. ) + age (full years) + 30 (points for IT).

CONCLUSION The predictive power of the revised Frank index is higher than the Frank index currently used. The threshold value of the revised Frank index, dividing the forecast into favorable and unfavorable, is score 130.

RELEVANCE A special place in the development of enteral insufficiency is given to dysproteinemia, which is one of the leading causes of the development of decubital ulcers in patients with spinal cord injury. Early enteral nutrition partially solved this problem, but the incidence of bedsores still remains high and reaches 68%. The risk of metabolic disorders in the acute period of spinal injury is largely determined by non-occlusive intestinal ischemia against the background of spinal shock, neurohumoral dysregulation; intra-intestinal and intra-abdominal hypertension; change in intestinal microflora. Pathological changes in the intestinal wall occur during the first 20 days after injury and further exacerbate chronic maldigestion, malabsorption, intestinal dyskinesia in patients with traumatic spinal cord disease. New knowledge about the features of early enteral nutrition in patients in the acute period of traumatic spinal cord disease will reduce the risk of decubitus ulcerative defects.

AIM OF THE STUDY To study the dynamics of metabolic processes in the tissues of the small intestine in the acute period of spinal injury.

MATERIAL AND METHODS Wistar rats (n=22). Spinal injury was simulated by acute complete transection of the spinal cord at the level of Th5–Th6 vertebrae. The assessment of metabolic changes in the cells of the serous membrane of the intestine was performed immediately, 3 and 24 hours after injury. The metabolism was assessed in vivo using fluorescence time-resolved macroimaging technology FLIM by autofluorescence in the spectral channel of the metabolic cofactor nicotinamide adenine dinucleotide (phosphate).

RESULTS The acute period of spinal cord injury is accompanied by a change in the endogenous autofluorescence of the serous membrane of the small intestine: a statistically significant decrease in the mean fluorescence lifetime (τm), the lifetime of the long component (τ2), and the relative contribution of the long component (а2) in 24 h after injury was recorded. The changes observed using FLIM confirm the catabolic type of metabolism in the tissues of the small intestine after spinal cord injury.

CONCLUSION For the first time in the experiment in vivo it has been shown that the acute period of spinal injury is accompanied by a violation of metabolic processes in the tissues of the small intestine. This fact requires a more balanced approach in calculating the calorie content of nutrients used for early enteral nutrition in patients with spinal cord injury.

RELEVANCE In patients with colorectal cancer (CRC), the normal small intestine, located outside the pathological focus, undergoes changes that may be the cause of digestive dysfunction after radical surgery to remove the tumor.

The assessment of metabolic and microstructural changes in the ileum mucosa in patients with colorectal cancer is necessary to correct the algorithms of postoperative therapy and enteral nutrition. Modern means of optical bioimaging are potentially capable of solving this complex diagnostic problem.

AIM OF STUDY To study the features of metabolism and morphological structure of the wall of a conditionally normal small intestine in the mucosa in patients with stage 1–3 CRC using macro- FLIM and optical coherence tomography (OCT).

MATERIAL AND METHODS The object of the study was the wall of the ileum (66 samples) from the mucosal side of patients with histologically confirmed CRC stages 1–3 with tumor location in the right sections of the colon. Eight samples were obtained from patients with stage 1 CRC, 38 samples were obtained from patients with stage 2 and 20 samples were obtained from patients with stage 3 tumor. The volume of surgical intervention is right-sided hemicolectomy with total mesocolonectomy, CME (D2 lymph node dissection). Fresh tissue samples were examined using fluorescent lifetime macroimaging (macro-FLIM ) and OCT, followed by histological analysis of the material.

RESULTS According to a histological study in the small intestine of patients with stage 1 CRC, the mucosa is covered with a normal single-layer prismatic border epithelium. In the intestine samples of patients with stage 2 CRC, mucus hypersecretion with areas of fibrosis and vascular congestion was observed. At the 3rd stage of CRC, the mucous membrane of the small intestine was loose, with local thickenings, areas of fibrosis with severe leukostasis, and foci of atrophy. None of the samples showed histological signs of a malignant tumor.

According to OCT data, in the mucous membrane of the small intestine in patients with the 1st and 2nd stages of CRC, the contours of the villi and, partially, the crypts were well visualized. The structure of the villi was smooth, not coarse, and the shape was regular. In patients with stage 3 CRC, the contours of the crypts and villi were indistinct. There were no differences in the OCT picture between histologic preparations in the 1st and 2nd stages of CRC: the structure of the villi of the small intestine was clear, the shape was unchanged. According to FLIM data, statistically significant differences were revealed in the mean fluorescence lifetime values of reduced nicotinamide dinucleotide (phosphate) NAD(P)H (τm) between 2nd and 3rd (p=0.031), 1st and 3rd (p=0.018) by CRC stages. At the 1st stage of CRC τm was 1.61 [1.30; 2.02] ns, at the 2nd stage 1.50 [1.36; 1.73] ns, at the 3rd stage 1.37 [1.22; 1.51] ns. The FLIM results suggest an increase in the role of glycolysis in enterocyte energy metabolism along with progression of the CRC stage.

CONCLUSION In patients with cancer of the right colon, lesions of the microstructure of the mucous membrane were revealed in the ileum not affected by the malignancy. At the same time, the severity of microstructural disorders in the wall of the small intestine is associated with the stage of tumor development in the colon. Bioimaging technologies, namely, methods of optical coherence tomography and fluorescence lifetime macroimaging, made it possible to objectively display microstructural and metabolic disorders in the ileum wall. The data of optical colorectal tomography demonstrated differences in the structural picture of the intestinal villi in patients with stages 1–2 and 3 of colorectal cancer. Results of fluorescence lifetime macroimaging of the metabolic cofactor nicotinamide dinucleotide (phosphate) confirmed an increase in the role of glycolysis in the energy metabolism of enterocytes along with an increase in the stage of colorectal cancer. The identified disorders in the state of the small intestine develop in patients with colorectal cancer before surgery and are highly likely to be an important pathogenetic link of malabsorption in the postoperative period. If the hypothesis is confirmed, the developed algorithm for the complex diagnosis of microstructural and metabolic disorders in tissues will expand the possibilities for the rehabilitation of patients with cancer of the right colon.

The leading role of neuroinflammation as the culprit of a long-term impairment of consciousness in patients after injuries to the central nervous system forces us to look for new effective strategies for resolving this pathological process. Xenon reducing the intensity of the inflammatory response due to the impact on several links is potentially able to have a beneficial effect on this category of patients. Using laboratory equipment, we evaluated the effect of half-hour daily inhalations of a 30% air mixture with 30% xenon for 7 days on the level of markers of neuronal damage and regeneration of nervous tissue.

AIM To study the effect of inhalation of an air-xenon mixture on the dynamics of markers of neuroinflammation and restoration of nervous tissue in patients after traumatic brain injury (TBI).

MATERIAL AND METHODS We conducted a prospective randomized clinical trial evaluating the effect of inhaled xenon for sedation on the level of consciousness and spasticity in patients with prolonged post-coma impairment of consciousness. Patients were randomized into 2 equal groups. In Group I (Comparison, n=15) in addition to the standard treatment for TBI, each patient included in the study underwent 7 sessions of inhalation of an air mixture with an oxygen content of at least 30 vol.% for 30 minutes. In Group II (Xenon, n=15) in addition to the standard treatment, each patient included in the study underwent a half-hour inhalation with an air-xenon gas mixture (with a xenon content of 30 vol.% and oxygen — 30 vol.%) for 7 days, 1 time per day. The levels of interleukin-6, α-1 acid glycoprotein (AGP), S100 b protein and brain-derived neurotrophic factor were assessed before the first treatment and then once a day for 6 days.

RESULTS The final evaluation included 12 patients from the Comparison Group and 12 patients from the Xenon Group. The greatest difference in the concentration of interleukin-6 between the Comparison and Xenon Groups was noted on the 5th day - 12.31 (10.21; 15.43) pg/ml vs. 7.93 (3.61; 9.27) pg/ml, respectively; however, the findings only tended to be statistically significant (p=0.07). When assessing the AGP level, the maximum difference was noted on the 4th day. In the Comparison Group, the AGP level was 0.81 (0.74; 0.92) pg/ml versus 0.614 (0.4; 0.79) pg/ml in the Xenon Group. And again, the data showed only a trend towards statistical significance (p=0.09). The highest level of brain-derived neurotrophic factor in the Xenon Group was observed on the 3th day — 0.1271 (0.046; 0.2695) pg/ml, which was statistically significantly higher than the one in the Comparison Group — 0.062 (0.036; 0.121) pg/ml (p=0.04). The concentration of S100 b protein during the entire observation period in both groups did not exceed 0.005 pg/ml.

CONCLUSION Xenon inhalation according to the method proposed by the authors had a beneficial effect on the processes of neural tissue regeneration, however, with regard to neuroinflammation, its effects were not so pronounced.

Psychological support of the family whose child is in rehabilitation after severe injury is one of the important areas of medical psychologist activities. The psychologist is to involve parents into the rehabilitation process as active participants. Thus, at the initial stage of support, the psychologist’s task is to identify unproductive parental patterns and correct them in a timely manner.

The aim of the study is to develop psychological criteria for assessing the parental position in the situation of rehabilitation of children with severe trauma.

MATERIAL AND METHODS The trial setting was the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia. 40 parents of children with severe trauma were included in the study. Research instruments were as follows: overt observation of parent-child interaction based on selected evaluation criteria, clinical interviews as well as analysis of homework assignments with the child. To assess parental position in the rehabilitation process, a number of criteria were formed: involvement in the rehabilitation process, attitude towards their child and child’s trauma, attitude towards their child’s independence, attitude towards their parental role as well as the attitude towards the outcome of rehabilitation.

RESULTS Types of parental position in the process of the child’s rehabilitation were clarified and updated; its subtypes were defined and characterized. So, according to the criterion “Involvement in the rehabilitation process”, the following distribution by sample was observed: passive (10% of parents), formal (20% of parents), controlling (25% of parents) and productive (45% of parents). According to the criterion “Attitude towards their child” — rejecting (7% of parents), condoning (18% of parents), dominant (35% of parents), accepting (40% of parents). According to the criterion “Attitude towards their child’s trauma” — superficial (10% of parents), defective-directed (32% of parents), positively-directed (18% of parents), adequate (40% of parents). According to the criterion “Attitude towards their child’s independence” — directive (22% of parents), hyper-protective (25% of parents), permissive (18% of parents), democratic (35% of parents). According to the criterion “Attitude towards their parental role” — unformed (17% of parents), dependent (25% of parents), rigid (30% of parents), reflexive (28% of parents). According to the criterion “Attitude towards the outcome of rehabilitation” — amorphous (15% of parents), anxious (15% of parents), categorical (35% of parents), and flexible (35% of parents).

CONCLUSIONS The performed psychological assessment of parental position in the process of their child’ rehabilitation after severe injury has revealed important intra-group differences, indicating that a significant part of parents need psychological help, since they cannot independently come to productive forms of interaction with their child in the process of his rehabilitation.

INTRODUCTION Development of effective biological products, based on human platelets, is very actual in regenerative medicine. The initial material for biological products’ obtaining is platelet-rich plasma (PRP), but the method of PRP isolation has not yet been standardized.

AIM To assess the quality of platelets in PRP, harvested by different centrifugation modes.

MATERIAL AND METHODS For platelet study, venous blood was harvested from volunteer donors. We used 3 methods for PRP-preparation, each methods included 2-stage centrifugation: 5 min 300g and 17 min 700g (Group 1); 10 min 300g and 10 min 700g (Group 2); 15 min 300g and 5 min 700g (Group 3). Platelets were examined using morphofunctional method based on vital cell staining.

RESULTS In Group 1 and Group 2, the overall safety of biologically high-grade platelets in PRP was similar and estimated 55-60% of their total content in the blood. In Group 3 the safety of biologically high-grade platelets was only 30% (p<0,05).

CONCLUSION The centrifugation modes «5 min 300 g / 700 g 17 min» and «10 min 300 g / 10 min 700 g» allowed researchers to obtain equal quality PRP, while «10 min 300 g / 10 min 700 g» mode has a number of instrumental benefits.

AIM OF STUDY The study of the results of delivery of pregnant women with placenta ingrowth in the uterine scar depending on the clinical status and the methods of blood saving.

MATERIAL AND METHODS The design of a selective retrospective study included 54 pregnant women with central placenta previa and uterine scar after caesarean section (CS), with histologically confirmed results of placenta accreta. Among blood-saving methods we used: ligation of three pairs of main vessels of the uterus, ligation of the internal iliac arteries, complex compression hemostasis according to R.G. Shmakov, temporary clamping of the common iliac arteries.

RESULTS CS with fundal incision was performed in 47 women (87.0%) out of 54. Hysterectomy was performed in 17 women (31.5%) out of 54. In the remaining 37 cases (68.5%), metroplasty and organ preservation were performed. There was no relaparotomy; there was no maternal mortality; perinatal mortality was 4 (7.4%); forced opening, bladder resection were performed in 7 (13.0%) cases; opening of the bladder without wall resection — in 2 (3.7%); 2 near miss cases; there were no complications associated with temporary clamping of the common iliac arteries; endometritis (recovery after conservative treatment) was revealed in 2 women (3.7%). Histologic examination results: 15 (27.8%) of placenta accreta, 30 (55.6%) of placenta increta, 8 (14.8%) of placenta percreta. In 8 cases, there was a combination of placenta increta into the uterine scar region of different depths, and in 2 (3.7%) cases, a combined deeply invasive lesion of the posterior wall of the lower segment and the body of the uterus.

CONCLUSION Complex compression hemostasis according to R.G. Shmakov is the most rational and promising method of blood saving, acceptable among the majority of patients with placenta accreta spectrum. Temporary clamping of the common iliac arteries is advisable in case of damage to the posterior wall of the bladder. Preservation of the uterus: in case of a deeply invasive lesion, including cases of combined damage to the posterior wall of the lower segment of the uterus or the body of the uterus, significant blood loss before the woman enters the hospital, it is not an imperative of surgical tactics.

INTRODUCTION Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after shoulder joint trauma. It can also occur as a complication after orthopaedic surgeries, for example, after Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: large trauma of soft tissue, severe bleeding, high rate of complications, poor cosmetic effect. Endoscopic surgical technique of decompression is an effective, less traumatic alternative to open procedures.

AIM To improve the outcomes of treatment of patients with axillary nerve neuropathy.

MATERIAL AND METHODS We present the outcomes of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of the patients was 44.4±14.9. An original surgical technique of decompression, which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position, was developed and applied to all the patients. Statistical analysis was performed using the MannWhitney U test.

RESULTS According to VAS-scale, the severity of pain syndrome before the surgery was 6±4.6 points, 6 months after surgery it decreased to 1.4±0.5 points (p<0.05). According to DASH scale, the function of the of shoulder joint before surgery was 77,6±6,9 points, 6 months after surgery it increased to 12±5,2 points (p<0.05). According to BMRC scale (M0–M5), strength of the deltoid muscle before surgery was 2±0,4 points, after surgery it increased to 4,4±0,5 points (p<0.05). Range of motion in the shoulder joint before surgery was as follows: flexion 107±45,6°, extension 102±49°, external rotation 22±13,6°; 6 months after surgery: flexion 154±25,6°, extension 156±22,4°, external rotation 50±8° (p<0,05). The thickness of the middle portion of the deltoid muscle according to ultrasound examination before the surgery was 7.2±1.04 mm, after surgery 11.8±1.44 mm (p<0.05). All the patients (100%) during long follow-up noticed complete relief of pain and regression of neurological symptoms.

CONCLUSION The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients.

The treatment of traumatic soft tissue detachments is an urgent problem for a first-level trauma hospital. This paper provides an analysis of the literature sources of the PubMed database, which are devoted to the classification, diagnosis and treatment of traumatic skin detachments. It was revealed that most of the works are publications of 1–2 clinical cases, only a few works are retrospective studies of patient groups. Currently, there is no generally accepted classification of traumatic detachment of soft tissues, due to the complexity and mosaic nature of pathoanatomical signs. According to the tactics of treatment, there is a difference in approaches for low-energy trauma (sports injury) and high-energy impact (traffic accidents, falls from a height). In the first case, the treatment methods are compression therapy, physiotherapy, and in rare cases, puncture. In the second case, puncture and drainage are the main method of treatment, and in persistent recurrent cases, chemical ablation or open surgery to excise the capsule in combination with vacuum drainage are the methods of treatment. Methods of endoscopic treatment of the walls of the detachment, ligation of the lymphatic vessels around the detachment, and the use of blockable sutures for obliteration of the detachment cavity are currently new methods of treatment, which effectiveness requires further study.

Foreign body airway obstruction (FBAO) is one of the most common causes of accidental death in adults and children. Probability of saving a life in severe FBAO depends on the ability of the bystander to quickly recognize the problem and correctly provide first aid (FA) to the victim. However, due to the lack of knowledge and skills of the FA, bystanders rarely attempt to give necessary help. Along with mass FA training, provision of instructions on the FA to untrained bystanders over the telephone by emergency medical services (EMS) dispatchers can facilitate active involvement of the population in the process of providing FA. In this study, a detailed analysis of the modern principles and approaches to the provision of the FA in FBAO was carried out and a draft of a universal Russian-language algorithm for remote dispatch support of the FA was developed. The developed algorithm can become a component of the domestic program for remotely instructing the population on provision of FA in life-threatening conditions and is proposed for further testing and implementation in the practice of EMS dispatchers.

Man, 61 years old. Admitted with complaints of severe weakness in the right limbs, which developed about 4 hours ago. Multispiral computed tomography with cerebral angiography: signs of ischemic stroke in the basin of the left middle cerebral artery. Angiography of the brachiocephalic arteries (BCA) was performed: angiographic signs of damage to the BCA: the left internal carotid artery (ICA) of the C2–C3 segments up to subocclusion, up to 75% in the mouth and right third. The circle of Willis is closed.

A multidisciplinary council made a decision on emergency stenting of tandem ICA stenoses using proximal protection against distal embolism “MoMa”. The course of the operation: after angiography, the sheath introducer was replaced by a guidewire sheath with a 9F introducer. A proximal protection system “MoMa” was installed along the diagnostic conductor 260 cm at the mouth of the left external carotid artery (ECA) and the middle third of the left common carotid artery (OCA). Baloons in the ECA and OCA were inflated. The Promus element 4.0x12 mm (DES) ICA was brought into the affected area of C2–C3 segments, positioned and opened at a pressure of up to 14 atm. The balloon catheter has been removed. Aspiration from the ICA. On check angiography, residual stenosis of the ICA stenting zone was 0%. On the test angiography intracranial arteries without signs of embolism. A Protege (7x10x40) mm stent was placed, positioned and deployed in the affected area of the orifice and the right third of the ICA. The delivery system has been removed. Aspiration from the ICA. On the test angiography, the residual stenosis of the ICA stenting zone was up to 0%. The distal embolism protection system has been removed. On the control angiography intracranial arteries without signs of embolism.

The postoperative period was uneventful. On the 10th day after stenting, the neurological deficit regressed completely, the patient was discharged for outpatient observation in a satisfactory condition.

CONCLUSIONS When performing brain revascularization in the most acute period of ischemic stroke, it is necessary to take into account the recommendations of multicenter studies that report such conditions for a successful outcome of the operation as: the diameter of the ischemic focus in the brain, not exceeding 2.5 cm and the absence of severe neurological deficit (more than the Rankin scale score 2). Within the framework of this clinical example, these recommendations were taken into account, which, among other things, contributed to the optimal outcome of urgent revascularization. Emergency stenting of tandem stenosis of the internal carotid artery using the device for proximal protection “MoMa” is effective in the presence of a closed structure of the circle of Willis. The technical complexity of the operation is associated with the installation of a catheter guide and its diameter of 9 Fr (catheters up to 7 Fr are usually used), which requires additional manual skills.

Endoscopic pancreatoscopy is a highly informative method for visualizing the pancreatic ducts, which allows them to be accurately diagnosed and treated in a minimally invasive way. The SpyGlass direct imaging system is currently the most widely used device. Specially designed endoscopes and smaller diameter instruments allow direct visualization of the bile and pancreatic ducts to be performed. In this article, the first clinical case of successful direct visualization with SpyGlass is reported, which was conducted in the SBHI N.V. Sklifosovsky Research Institute for Emergency Medicine in a patient with chronic calcifying pancreatitis complicated by wirsungolithiasis.

We report a clinical case of elimination of megacholedocholithiasis using complex antegrade percutaneous transhepatic and retrograde endoscopic contact electropulse lithotripsy and extraction. Since an attempt of antegrade extraction failed due to megacholedocholithiasis, the patient underwent complex contact electropulse lithotripsy followed by lithotripsy through antegrade and retrograde access, which made it possible to eliminate megacholedocholithiasis without the development of postoperative complications, restore the lumen of the bile ducts and ensure the possibility of subsequent planned surgical treatment of chronic calculous cholecystitis.

The article presents a clinical observation of an extremely rare in gynecological practice androgen insensitivity syndrome (AIS). The authors give data on the pathogenesis of the disease, modern classification and terminology of various forms of this pathology. The phenotypic manifestations of the disease, the results of clinical and instrumental studies and surgical treatment are described.

The results of the study show the possibility of clinical diagnosis of AIS and timely surgical treatment of patients with this pathology, due to the high risk of gonadal malignancy.

Acute cerebrovascular accident is one of the major causes of death and disability of patients around the world. In 30-40% of cases, the cause of ischemic stroke is an extracranial lesion of the brachiocephalic vessels. Carotid endarterectomy is the main technique for preventing cerebrovascular accident in carotid artery stenosis. General anesthesia with endotracheal intubation has been the method of choice since the widespread introduction of this type of surgical intervention into clinical practice and in most centers remains so to this day. At the same time, many authors report, that the use of general anesthesia with endotracheal intubation has limitations in a number of patients, namely, in the presence of an embologenic plaque in the operated internal carotid artery, severe coronary artery disease, decompensated aortic and / or mitral stenosis, low ejection fraction, heart rhythm and conduction disorders, severe chronic diseases of the respiratory system, as well as patient refusal for general anesthesia.

THE AIM of the study was to show the possibilities of using regional anesthesia for carotid endarterectomy in a high-risk patient.

RESULTS The use of regional anesthesia allows surgeons to avoid instability or abrupt changes in hemodynamics in the intraoperative period. Indications for its use are also cases of critical contralateral stenosis of the internal carotid artery when it is necessary to carefully consider the advisability of installing an internal stent.

CONCLUSION The use of regional anesthesia made it possible to successfully perform carotid endarterectomy without cardiovascular events, neurological deficit and postoperative complications in a patient with relative contraindications to general anesthesia.

BACKGROUND The activities of the Hospice House established by Count N.P. Sheremetev and opened on June 28, 1810, pursued a noble goal to help the suffering, sick and low-income people. However, this intention alone was not enough, and N.P. Sheremetev took care to really ensure the stable work of the Hospice House, providing for both its publicity and reliable state protection.

MATERIAL AND RESEARCH METHODS Annual financial statements of the Hospice Board of Trustees for 1862–1866, 1868, 1871, 1872 and 1902 were introduced into scientific circulation for the first time. To prepare the article, archival material was used, including 6 sources, as well as rare publications dated 1859–1927. Research methods: historical-genetic, comparative-historical, problem-chronological and systemic.

RESULTS The analysis of the activities of the Sheremetev hospital for 1810–1909 showed that funds were enlarged regularly with increasing amounts from its budget for the treatment of patients, which number was maximum in 1865 (1,798 people), and the lowest in 1814 (127 people).

The personnel of the Sheremetev Hospital took an active part in all major military operations with the participation of Russia (the creation of sanitary detachments to provide assistance to the wounded and sick in combat areas, as well as additional beds located on the territory of the hospital itself).

The Sheremetev Hospital played an important role in higher medical education in Russia, becoming the clinical base of the Moscow Medical and Surgical Academy, and later of the Faculty of Medicine of Moscow University; many of its employees were teachers of these educational institutions. The high level of teaching was also ensured by equipping the hospital with modern medical devices and the active introduction of the latest medical achievements into its work.

On the initiative of chief doctor A.T. Tarasenkov, a department for incoming patients was organized as an independent structure for the first time in Russia. It provided assistance to 175–200 patients per day. The department became the prototype of a comprehensive outpatient network that was subsequently created in our country.

The high prestige of the hospital was brought by the activities of its main doctors and operators, tirelessly working to improve the organizational and medical aspects of the provision of qualified medical care.

The final period of the hospital’s activity (1910–1923) until the October Revolution was characterized by the greatest volume of medical work, which subsequently decreased dramatically due to financial difficulties. Since 1919, the hospital functioned as a state institution, and also became the base for the revival of the ambulance service in Moscow.

CONCLUSION A review of the activities of the Sheremetev Hospital indicates that the organization of emergency medical care for the population of Moscow, pedagogic work, participation in the treatment of the wounded patients, high surgical activity and versatility were the foundation on which its work was widely developed. It is no coincidence that this particular hospital was reorganized in 1923 into the N.V. Sklifosovsky Institute of Acute Care (since 1944 — N.V. Sklifosovsky Research Institute for Emergency Medicine).

Economic difficulties and political storms could not destroy what was created at the Sheremetev hospital and was the moral and material basis for the further 100 years of successful activity of the institute.