Relevance. Intestinal obstruction can occur in all age groups, but most often it occurs at the age of 40–70 years and one of the causes of colonic obstruction may be volvulus of the sigmoid or cecum. Volvulus of the sigmoid colon is most common and reaches 15% of all types of strangulation intestinal obstruction. The mortality rate in sigmoid colon volvulus reaches 14–16%. In cases of necrosis of the sigmoid colon, the mortality can reach 70–78%.

Aim of study. To evaluate the results of diagnosis and treatment of patients with sigmoid volvulus.

Material and methods. In 2015–2020 at the N.V. Sklifosovsky Research Institute for Emergency Medicine we treated 28 patients with volvulus of the sigmoid colon. Of these, there were 13 women (46.4%) and 15 men (53.6%). The average age of the patients was 69 years. Upon admission to the hospital, patients underwent a clinical examination, basic laboratory and instrumental methods of examination. If volvulus of the sigmoid colon was suspected, colonoscopy, irrigoscopy, computed tomography of the abdominal organs with contrast enhancement, and diagnostic laparoscopy were additionally performed. In the department, patients underwent fluid maintenance, antispasmodic and symptomatic therapy, cleansing enemas. According to the indications, an operative benefit was provided by open and laparoscopic accesses.

Results. The sensitivity of the x-ray method was 88%, but the sensitivity of the plain x-ray examination, supplemented with a barium enema (irrigoscopy), was 100%. The sensitivity of the ultrasound method was 57%, however, when supplemented with a Doppler study, the sensitivity increases to 72%. The sensitivity of CT was 100%. The sensitivity of colonoscopy among those studied is 96%. Operations performed in patients with volvulus of the sigmoid colon: endoscopic detorsion in 15 patients (64.3%), video-laparoscopic elimination of volvulus of the sigmoid colon in 3 (10.7%) patients. Midline laparotomy in 17 patients (60.7%). Among patients after endoscopic bowel detorsion, no complications were observed in the early period. After laparotomy and elimination of volvulus of the sigmoid colon, postoperative complications were observed in 3 (17.7%) patients. There were 3 deaths (10.7%).

Conclusion. High mortality does not allow us to call the results of treatment satisfactory, and a small number of observations does not allow us to obtain statistically significant results, which requires further case recruitment and data analysis.

Introduction. Direct oral anticoagulants (DOAC) rivaroxaban and apixaban have significantly reduced the risk of developing venous thromboembolic complications (VTEC). However, the use of DOAC may be associated with a higher risk of bleeding, especially actual in patients after total hip arthroplasty (THA).

Material and methods. We enrolled 38 patients with moderate osteoarthritis of the hip joints undergoing THA. The mean age of patients was 58 (33; 85) years. All the patients received rivaroxaban or apixaban in the doses specified by Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC). Retrospectively, in the postoperative period, the patients were divided into two groups: Group 1 — 31 patients (20 women and 11 men), who had no hemorrhagic complications after hip replacement; and Group 2 — 7 patients (4 women and 3 men) who experienced hemorrhagic events in the form of hematomas in the wound area. Laboratory tests were performed for all patient baseline (1st day of hospitalization), after surgery (1st day after THA), and on the 7th day after THA. Analyses included the determination of hemostasis parameters (INR, aPPT, fibrinogen, D-dimer), hematological (HGB, PLT, RBC) and biochemical parameters (calcium, ionized calcium, serum iron, hs-CRP).

Results. The analysis of biochemical parameters in patients with hemorrhagic complications revealed a significant increase of fibrinogen (p=0,023) compared with uncomplicated cases. Serum iron concentration in men with hemorrhagic complications in the postoperative period was significantly lower than in patients without complications. In patients with hemorrhagic complications, the ionized calcium was lower (p=0,032) than in patients without complications, but within the reference values. The hs-CRP concentration in the group with hemorrhagic complications was twice higher than in the group without complication and eight times above the reference values.

Conclusion. The concentration of iron in the blood serum in men below 11 mmol/l and a slight hyperfibrinogenemia of 4.65 g/l in all the patients are the risks of developing hematomas in the area of surgery. These parameters should be used to predict the risk of hemorrhagic complications in patients before THA and recommended for control before the surgery and on the 1st day after THA (hs-CRP).

Relevance. Currently, the use of ultraviolet (UV) radiation for the disinfection of objects and the treatment for infectious diseases is considered as a promising alternative to chemical biocides and antibiotics. Shortwave — UV-C and UV-B -light emitting diodes (LED) are a relatively new type of UV radiation sources and potentially able to meet the requirements of current medical technologies. However, their possibilities for the treatment of wounds and infectious diseases have not been practically researched to date, which determines the relevance of experiments aimed at studying the biocidal and therapeutic properties of shortwavelength UV LEDs.

Purpose. OF STUDY To evaluate the bactericidal efficacy of 272 nm LED radiation against hospital strains of Klebsiella pneumoniae bacteria characterized by multidrug resistance.

Materials and Methods. The studies were carried out with an experimental sample of the LED apparatus for UV irradiation. In the irradiator of the device, 5 LEDs are installed with a maximum radiation at a wavelength of 272 nm and a total electrical power of 10 watts. The UV radiation dose achieved in one irradiation session (12 seconds) at a distance of 10 cm from the irradiator was 8 mJ/cm2 . In the experiments, a hospital strain of the bacterium Klebsiella pneumoniae, isolated from the patient’s blood, was used. The strain was characterized by multidrug resistance. A daily culture suspension of K. pneumoniae with a concentration of 108 CFU/ml in a volume of 100 µl was transferred into a Petri dish with a diameter of 9 cm with meat-peptone agar and evenly distributed over a surface with a diameter of 8 cm. Petri dishes were irradiated from a distance of 10 cm from the irradiator. The change in the dose of UV irradiation from 4 to 80 mJ/cm2 was carried out by varying the exposure time. Studies were carried out in 4 repetitions at each dose. After irradiation, the experimental and control (without irradiation) Petri dishes were placed in a thermostat at 37ºC for 24 hours, then the grown colonies were counted. A total of 60 experiments were carried out.

Results. As a result of the research, it was shown that the LED device based on five 272 nm diodes provides deep and prompt disinfection of the surface from hospital strains of K. pneumoniae bacteria characterized by multidrug resistance. A dose of UV radiation of 8 mJ/cm2 reduces surface contamination with K. pneumoniae bacteria by more than a million times (decontamination efficiency over 99.9999%). At doses less than 10 mJ/cm2 , the efficiency of the 272 nm LED device in terms of inactivation of K. pneumoniae bacteria is 3–4 times higher than the bactericidal efficiency of mercury lamps.

Conclusion.The prospects of using UV devices based on LEDs with a maximum radiation at a wavelength of 272 nm in systems for the operational disinfection of massively contaminated surfaces, potentially including wound surfaces, have been shown.

Aim of study. The development of a program for predicting thrombosis with subsequent amputation of a limb in the long-term period after femoral-popliteal bypass (FPB).

Material and methods. This is a retrospective open comparative study performed from January 10, 2016 to December 25, 2019 at Research Institute – Professor S.V. Ochapovsky Regional Clinical Hospital No. 1 of the Ministry of Health of the Krasnodar Territory, Krasnodar, which included 473 patients who underwent FPB. Depending on the type of bypass, five groups were formed: Group 1 (n=266), reversed vein (great saphenous vein (GSV); Group 2 (n=59), autovenous vein (GSV), prepared in situ; Group 3 (n=66), autovenous vein (GSV), prepared ex situ; Group 4 (n=9) synthetic graft (Jotec, Germany); Group 5 (n=73), veins of the upper limb (forearm and shoulder). In all cases of observation, multislice computed tomography with angiography revealed an extensive (25 cm or more) atherosclerotic occlusive lesion of the superficial femoral artery, corresponding to type D according to the transatlantic consensus (TASC II). The long-term followup period was 16.6±10.3 months.

Results. During the hospital postoperative period, all complications developed in groups 1, 2, 3 and 5. However, no significant intergroup statistical differences were found. In the long-term follow-up period, according to the mortality rate (group 1: 4.6%; group 2: 1.7%; group 3: 4.6%; group 4: 0%; group 5: 2.8%; p=0.78), myocardial infarction (group 1: 1.9%; group 2: 0%; group 3: 1.5%; group 4: 0%; group 5: 0%; p=0.62), ischemic stroke (group 1: 0.8%; group 2: 1.7%; group 3: 1.5%; group 4: 0%; group 5: 0%; p=0.8) and bybass thrombosis (group 1: 14.5%; group 2: 19.3%; group 3: 18.5%; group 4: 44.4%; group 5: 19.7%; p=0.16), no significant intergroup differences were identified. However, the largest number of limb amputations (group 1: 4.2%; group 2: 5.3%; group 3: 9.2%; group 4: 22.2%; group 5: 1.4%; p=0.03) and the maximum composite endpoint (sum of all complications) (group 1: 26.0%; group 2: 28.1%; group 3: 35.4%; group 4: 66.7%; group 5: 23 .9%; p=0.05) were observed after the use of a synthetic graft. Using “random forest” analysis, a model and computer program was created that allows, the risk (low, medium, high) of developing bypass thrombosis to be assessed interactively, based on clinical, anamnestic, demographic and perioperative data, with subsequent amputation after FPB in the long-term follow-up period.

Conclusions. Revascularization strategy for patients with extended atherosclerotic lesions of the femoropopliteal segment should be determined individually and only by a multidisciplinary council. The conduit of choice for femoral-popliteal bypass surgery is an autovenous graft. Synthetic prostheses can only be used in the absence of the latter. To identify a group of patients with a high risk of thrombosis of the femoral-popliteal bypass and limb amputation in the long-term follow-up period, the created risk stratification program for the development of these complications can be used. Precision supervision of these patients in the postoperative period will make it possible to prevent these adverse events in time.

Relevance. Suicide is one of the leading causes of death worldwide. Suicidal behavior is a complex phenomenon that includes suicidal thoughts, intentions and actions; and those actions do not always lead to death, but often turn into chronic suicidal behavior. The study of the factors in chronification of suicidal behavior is necessary for the development of evidence-based programs for the prevention of repeated suicide attempts.

Aim of study. is to compare cognitive and behavioral strategies for coping with stress in patients with single suicide attempts and chronic suicidal behavior.

The hypothesis of the study is that in patients with repeated suicide attempts, destructive cognitive and behavioral strategies for coping with stress are more pronounced.

Materials and methods. The study included 119 patients treated at the somatopsychiatric and toxicology departments, 60 patients after the primary suicide attempt, 59 – after repeated ones. Patients were asked to complete the following procedures: Beck Depression Inventory (Beck, 1961; N.V. Tarabrina, 2001), Beck Anxiety Inventory (Beck, 1961; Tarabrina, 2001), Rumination Scale (Treynor W. et al., 2003; adaptation by O.D. Pugovkina et al., 2021), Alexithymia Scale (Toronto Alexithymia Scale G.J. Taylor et al., 1985; adaptation by Starostina E.G. et al. 2009), COPE Inventory (Ch.S. Carver et al., 1989; adaptation by P.A. Ivanov and N.G. Garanyan, 2013).

Results. Patients after repeated suicide attempts, compared with patients who made the first attempt, are more likely to be diagnosed with borderline personality disorder, have more pronounced symptoms of depression and suicidal readiness, higher rates of ruminative thinking and alexithymia — reflecting a deceptive cognitive style, — as well as indicators of the use of destructive behavioral strategies for coping with stress in the form of various types of avoidance behavior.

Relevance. Due to the pandemic of the new coronavirus infection, changes have occurred in the work of most surgical hospitals aimed at optimizing and improving the provision of medical care. Performing acute and emergency surgical interventions in patients with confirmed COVID-19 infection dictates the need to review surgical tactics.

Aim of study. To assess the quality of publications in the scientific press from the standpoint of systematic analysis on the provision of emergency surgical care in remodeled hospitals and to identify the main changes in surgical tactics in patients with abdominal emergency and COVID-19.

Material and Methods. The analysis of data from publications dated from December 2019 to July 10, 2021 from electronic databases PubMed, Cochrane Library, Scopus, eLibrary. An analysis of numerous studies, recommendations of national and international surgical, urological, oncological, gynecological, endoscopic and anesthesiological communities and associations, the World Health Organization, temporary guidelines of the Ministry of Health of the Russian Federation on the prevention, diagnosis and treatment of new coronavirus infection was performed. The quality of the selected publications was assessed in accordance with the recommendations.

Results. When analyzing the selected publications, it was revealed that most of them are retrospective, uncontrolled one-time studies and descriptions of clinical cases (level 4 evidence, level C recommendation). We found 1 combined (prospective-retrospective) multicenter and 1 retrospective comparative study on the treatment tactics of acute cholecystitis, 1 retrospective multicenter cohort study on acute pancreatitis, 1 retrospective study on acute intestinal obstruction and 2 studies on acute appendicitis, 1 case-control study on gastrointestinal tract and intestinal bleeding (level 3 evidence, level B recommendation).

Conclusion. Currently, there are no high-level evidence or recommendations to change surgical tactics in patients with COVID-19 and abdominal emergency.

Traumatic brain injuries are a global problem, with more than 50 million people suffering from brain injuries every year. A frequent consequence of severe traumatic brain injury is intracranial hematoma (ICH), causing mortality, disability, post-traumatic epilepsy. ICH has different clinical manifestations and physical characteristics. Standard treatment for ICH includes conservative monitoring for small volume hematomas or surgical evacuation of the hematoma. Craniotomy is often used to remove hematomas, because acute and subacute hematomas contain clots, and drainage of the hematoma cavity alone is not enough. In chronic hematomas, drainage through a hole is usually used, but this is effective only if the hematoma is represented by one cavity and its contents are completely liquid, which is not always the case. Thus, widely used techniques do not always meet modern requirements for effectiveness and low invasiveness of surgical treatment.

The review considers endoscopic methods of surgical treatment for all variants of traumatic ICH; 31 publications have been found on this topic, mentioning 602 interventions. Differences in patient selection criteria make it difficult to compare the methods and outcomes. From the technical point of view, the procedures were also very diverse. The article analyzes the main features of different authors’ methods.

None of the authors comes to the conclusion about outcome worsening after endoscopic intervention. With regard to acute and subacute hematomas, there are currently no reliable statistical data, but the results obtained can generally be assessed as positive.

In acute and subacute hematomas, endoscopic intervention is perceived by the authors not as providing more opportunities, but only as a less invasive replacement for conventional craniotomy. In chronic hematomas, endoscopic intervention is considered to have more opportunities and advantages over the standard treatment.

At present, the widespread use of endoscopic minimally invasive methods of surgical treatment for traumatic hematomas is hampered mainly by the lack of clear criteria for selecting patients and well-established methods of intervention. More high-quality research is needed to determine the role of these methods in general clinical practice.

Cicatricial tracheal stenosis is a fairly common complication that occurs after tracheal intubation or tracheostomy. However, critical tracheal stenosis is a rare case, sometimes not associated with trauma, and is probably due to the peculiarities of the patient’s immune response during the development of stenosis. In this regard, the study of the immune mechanisms of the development of inflammation in the upper respiratory tract is a very relevant and promising direction. This review is devoted to the analysis of the immunological mechanisms of tracheal stricture formation, and presents modern data on the immunopathogenesis of the disease.

Clarification of some pathogenetic mechanisms of the immune response during the formation of tracheal strictures of various origins can help in identifying laboratory markers as risk factors for tracheal stricture and timely prevention of such complications.

Posterolateral rotational instability (PLRI) of the elbow joint can occur acutely as a result of dislocation of the bones of the forearm, and also be chronic, for example, after inadequate healing of a previous rupture of the lateral ligamentous complex, in particular the lateral ulnar collateral ligament (LUCL). It is necessary to take into account that, as a result of repeated microtraumas, persistent pain syndrome and recurrence of dislocation develop, which can lead to disability. We conducted a systematic review of the literature according to the protocol outlined in the PRISMA guidelines. From 1,903 publications, 11 studies were selected that met our criteria and assessed the results of treatment of 181 patients. The main reason for the development of PLRI was simple traumatic dislocation of the forearm bones (37.5%). Of the studies that assessed the elbow joint using the MEPS, 86.5% of patients had excellent or good results, with a mean MEBS score of 91 points. Before surgery, pain syndrome was present in 131 patients (87.3%) out of 150, and in the postoperative period it was observed in 55 (36.6%) out of 150 (p=0.01). The incidence of recurrent instability after surgery was observed in 6.6% of patients. A review of the literature on the problem of the elbow joint shows that this problem has not been fully studied, treatment strategies differ and should be performed based on the surgeon’s experience and available data, however, it has been proven that the key to the stability of the elbow joint is the LUCL, which requires its restoration through its refixation or plastic surgery.

Aim of study. Analysis of literature data on the use of extracorporeal membrane oxygenation in acute chemical poisoning.

Material and methods. The search for domestic publications was carried out in the Elibrary database, foreign publications — in the MEDLINE / PubMed, Google Scholar databases for the period of 2010–2023. The terms used as a search query were according to the official MeSH terms: “Extracorporeal Membrane Oxygenation” OR “Membrane Oxygenation, Extracorporeal” OR “ECMO Treatment” AND “poisoning”.

Results. This review provides information on the outcomes of the use of veno-arterial and veno-venous extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock, cardiac arrest and severe ARDS in acute chemical poisoning.

Conclusion. Data analysis showed that in patients with acute chemical poisoning, the incidence of complications and mortality was lower when ECMO/ECMOCPR was included in the complex therapy compared with patients in whom other reasons (not related to acute poisoning) served as indications for the use of this technique. This is probably due to the fact that patients in the group with acute poisoning are younger, they have fewer concomitant diseases; and ECMO is required, as a rule, for a shorter period of time before the toxicant is eliminated from the body using the methods of their elimination and restoration of disturbed functions.

Currently, the issue of coronavirus infection COVID-19 remains extremely relevant, and the SARS-CoV-2 virus also affects the gastrointestinal tract, and in some cases, coronavirus infection can be complicated by gastrointestinal bleeding. Up to 13% of COVID-19 patients have this complication. At the same time, the issue of determining risk factors for the development of gastrointestinal bleeding in patients with COVID-19 remains unresolved in the world literature. There is no single standardized approach to the treatment of gastrointestinal bleeding in patients with COVID-19. The above reasons served as prerequisites for this literature review. The purpose of the literature review is to establish risk factors and groups for gastrointestinal bleeding in patients with a new coronavirus infection, and to determine current and effective methods of treating this disease.

For decades, the femoral artery has been the most common access for diagnostic and therapeutic endovascular operations. However, over the past 20 years, radial access has been gaining popularity as being safer and more practical with more significant benefits. Recently, the new distal radial access has proven to be equal or perhaps even safer than the vascular access for diagnostic and therapeutic coronary and non-coronary interventions. Today, this access should be in the arsenal of every interventional surgeon.

The review presents an analysis of relevant literature on the surgical treatment of varicose veins of the lower extremities. Modern methods of surgical intervention for varicose veins are considered: open operations, methods of thermal ablation of the main veins, non-thermal non-tumescent methods, vein-preserving surgery (ASVAL), methods of treating reflux in perforating veins and recurrent varicose veins. The effectiveness of each of the surgical treatment methods used was analyzed. The frequency of relapses and the likelihood of complications of the described operations are considered. All surgical treatment methods presented in the review were developed on the basis of modern ideas about the pathogenesis of varicose veins, the mechanisms of formation of chronic venous insufficiency, and have an evidence base. These techniques are reflected in the latest clinical guidelines and are widely used in medical practice.

Background. The research of infectious hospital bed use and infectious patients’ characteristics during the COVID-19 pandemic allows proposing effective management strategies for possible future epidemics.

Aim of study. The analysis of infectious bed fund use at the N.V. Sklifosovsky Research Institute for Emergency Medicine (the Institute) and the characteristics of admitted patients with COVID-19 in order to determine the factors that are important for improving the medical care provision.

Material and methods. The data of 3365 patients treated at the Institute from March 2020 to June 2021 was used. Among them 1778 males, median age 62, average length of stay 11.2, mortality rates 17.8%, non-invasive mechanical ventilation was used for 21.5% of patients, invasive one — for 16%. For comparing the patients according to various characteristics, Fisher’s exact test and Pearson’s correlation coefficient were used. Length of stay was compared to exponential distribution using Pearson’s chi-squared test. Comorbidity was measured using the Charlson Comorbidity Index. For all calculations R software environment was used. Survival curves were obtained via the Kaplan-Meier method. Statistical significance was less than 0.05.

Results. Periods of increase and decrease in hospitalization number correspond to an increase and decrease in the detection of COVID-19 cases in Moscow without lag. Intensive care for COVID-19 patients was needed in 96% of cases, readmissions to intensive care – 37%. The effective ratio of intensive care to hospital beds was determined to be higher than 2/1. The improvement in resuscitation capacity helps to avoid overload with an increase in the number of patients treated. When a patient is admitted in satisfactory condition, mortality is practically zero, while with increasing severity, mortality reaches 30–100%. The mortality rates of patients treated with the help of respiratory support is 7–40 times higher than in patients with spontaneous breathing. Higher values of the Charlson Comorbidity Index correspond to increased risks of severe course and death for patients.

Conclusion. When providing medical care during the increase in number of infectious disease daily cases, the amount of deployed intensive care units becomes of a paramount importance. To determine the size of the bed fund, it is possible to use readily available estimates of the proportion of the population at risk of an adverse outcome from an infectious disease, based on the value of the Comorbidity Index.

Relevance. In accordance with Federal Law No. 323-FZ [17], emergency medical assistance, including emergency specialized medical care, is provided in emergency form outside a medical organization, as well as on outpatient and inpatient basis. An ambulance is an emergency medical service that travels to those whose lives and health are in danger. Emergency medical assistance, including emergency specialized medical care, is provided in case of diseases, accidents, injuries, poisonings and other conditions requiring urgent medical intervention. The reasons for calling an ambulance in an emergency form are sudden acute diseases (conditions) and (or) sudden exacerbations of chronic diseases without obvious signs of a threat to life, requiring urgent medical intervention. In the training of doctors, including in postgraduate education, these factors are taken into account.

Aim of the study. Improvement of the quality of theoretical and practical training of emergency medical specialists, as well as clinical residents and practical doctors of various specialties, taking into account issues of emergency and military medicine.

Material and methods. A review of official documents of the Ministry of Healthcare of the Russian Federation and the literature on postgraduate education of doctors with subsequent primary specialized accreditation for 2018-2022 was carried out. The literature on modern approaches to the provision of emergency medical care to victims was studied, taking into account the specifics of military (tactical) medicine for 2020–2022.

Conclusion. The training of emergency medical professionals, taking into account the realities of the present, should include issues of tactical medicine and be practice-oriented using simulation equipment. It is necessary to know and be able to work with modern means of protection and medical care available in the troops; be prepared to work in medical institutions of various levels with the mass flow of injured and wounded.

Abstract. Aortic dissection is a rupture of the inner layer of the aorta with subsequent penetration of blood into the degeneratively altered middle layer with the formation of false lumen and true lumen. Pregnancy is one of the risk factors for the development of aortic dissection. The incidence of aortic dissection during pregnancy is only 0.0004% of cases.

Aim of the study. To analyze national and foreign literature, as well as share own clinical observations in the diagnosis and treatment of patients with aortic dissection in the postpartum period.

Material and methods. Two patients after successful childbirth, in the late postpartum period, were admitted with a diagnosis of aortic dissection type A according to Stanford.

CT angiography confirmed the presence of Stanford type A aortic dissection. After additional examination, surgical treatment was performed to replace the aortic valve and ascending aorta under artificial circulation, with a satisfactory clinical result.

Conclusion. The diagnosis of aortic dissection should be considered in all pregnant women with chest pain, as this condition often goes undiagnosed.

The pregnancy period is one of the risk factors for the development of aortic dissection with a high mortality rate. The likelihood of developing aortic dissection in women at risk peaks in the third trimester and the first 12 weeks after delivery.

The risk group should include women with confirmed syndromic and non-syndromic genetic diseases, bicuspid aortic valve, coarctation of the aorta, or at least one major criterion indicating the presence of aortopathy (ectopia lentis, aortic aneurysm, habitus, genetic testing).

If Marfan syndrome is present, surgical intervention should be considered if the maximum aortic diameter is more than 4.5 cm before pregnancy. In women with Marfan syndrome and aortic dissection in the family history, as well as in the presence of more aggressive genetic diseases (Loeys-Dietz syndrome, Ehlers-Danlos syndrome), it is possible to consider preventive surgical treatment for an aortic diameter of 4.0 cm or more.

The delivery in high-risk patients is recommended to be performed in a hospital that has a cardiac surgery service and an “aortic” team.

In minimally invasive treatment of obstructive jaundice, complications may occasionally occur: separation of a fragment of a conductor, drainage, balloon catheter, poor function of a plastic endoprosthesis. There are two possible methods for percutaneous removal of foreign bodies: extraction and pushing into the duodenum. Two observations of percutaneous removal of conductor fragments from the bile ducts are presented.

After the October Revolution of 1917, the creation of the state healthcare and medical education system in the country played a decisive role in the organization of emergency medical services (EMS) in Moscow on the basis of the former Sheremetev Hospital which later became a large multidisciplinary medical institution — N.V. Sklifosovsky Institute of Emergency Medicine (since 1943 — N.V. Sklifosovsky Research Institute for Emergency Medicine), — and the city EMS station as a part of it.

In the pre-war period, the working out of the main principles for the EMS provision was critically important for the development of the services. It became possible to solve scientific and methodological problems related to the training of specialists. The Institute grew into a large institution, research in the field of emergency medicine was carried out at the world level. This contributed to the organization of a network of EMS institutions in the country during 1926–1935.

The years of the Great Patriotic War of 1941–1945 enriched the practice of providing emergency medical care, including during mass patient admission.

In the post-war years (1946–1970s), the Institute became the leading institution on the problems of EMS in the country. Corresponding divisions were created within the Institute, and on its basis — “Emergency Medicine” scientific and practical association, research and organizational structures of the USSR Ministry of Health, the RSFSR Ministry of Health and the USSR Academy of Medical Sciences. Thanks to this, outstanding results were achieved in the EMS organization: the specialty of “emergency medicine physician” was introduced; emergency hospitals were created in a number of the country’s regions; government programs for EMS provision were successfully implemented; а large number of regulatory documents were prepared to facilitate the further EMS development.

N.V. Sklifosovsky Research Institute for Emergency Medicine was among the main initiators of the disaster medicine service, which made it possible to fundamentally solve its organizational and technical problems. Thus, a significant contribution was made to the foundation of this service in Moscow and around the country.

At the current stage (from 1992 to the present), EMS improvement has been continued, many developments turned out to be relevant for this services in the Russian Federation. In particular, the created structure of the Institute’s admission and intensive care unit remained the flagship among emergency care institutions in the country for about 20 years. The state program “Improving medical care for road accident victims” was successfully implemented. The Institute’s departments are being actively specialized, making it possible to obtain fundamentally new scientific and practical results for widespread implementation.

Since 2011, “Scientific achievements in the field of emergency medical care in the Russian Federation” - collections of research works - have been published annually. The information presented in them can be used throughout the country.

The experience in treatment for the novel coronavirus infection COVID-19 allowed the Institute to begin a new page in the history of emergency medical services.

The recent opening of an emergency inpatient complex at the Institute contributed to optimizing the work of the hospital’s resuscitation and intensive care units and expanding their treatment and diagnostic capabilities.

For more than 10 years, the public and consolidating activities of the scientific and practical society of emergency medicine specialists have been effective. Its work primarily concerns the organization and conduct of scientific and practical events, especially congresses of emergency medicine physicians, as well as the publication of Sklifosovsky Journal Emergency Medical Care, which has unifying significance for a large number of Russian specialists in the field of EMS. The decisions made at the congresses and conferences became the basis for expanding the introduction of advanced medical technologies in the Russian regions, as well as for carrying out important structural reforms in EMS institutions.

One of the main achievements of the N.V. Sklifosovsky Research Institute for Emergency Medicine is the creation of the state EMS as a separate branch of healthcare in the country. Over the 100 years of the Institute’s activity, the foundations of its theory and practice have been developed, moreover, a contribution of world significance was made to the EMS development, thereby strengthening the scientific foundation for the activities of the Institute for many years to come.