AIM OF THE STUDY. To establish the incidence of acute thrombosis of the veins of the lower extremities and the activity of the most significant trigger agents that led to this complication in patients with a new coronavirus infection.

   MATERIAL AND METHODS. The clinical section of the work is presented by observations of 123 patients with acute surgical pathology and thrombosis of the veins of the lower extremities. The first group (comparison) (n = 48) included patients with thrombosis of the veins of the lower extremities, the second (studied) group (n = 87) included patients with a similar problem that arose against the background of coronavirus infection. All patients underwent surgical interventions: thrombectomy and plication. Before surgery, on the 1st, 4th and 7th days after surgery, disorders of the hemostasis system, the severity of endogenous intoxication syndrome, and lipid metabolism were assessed.

   RESULTS. Damage to the veins of the lower extremities in patients with acute surgical pathology and new coronavirus infection occurs much more often, in 8.04 % of cases, than in such patients without COVID-19, in 0.76% (χ² = 252.5, p < 0.001). Of the 87 patients with acute venous thrombosis of the inferior vena cava system and COVID-19, 63 patients (72.41 %) were operated on. In the early postoperative period, venous rethmbosis occurred in 11 (17.5 %) patients. The mortality rate was 6.3 %. According to thromboelastography, in the main group the values of such parameters as reactive time, the growth rate of the fibrin network and its structure formation and the maximum strength of the clot were statistically significantly higher than in the control group, which indicates the predominance of hypercoagulation in these patients. Patients in this group showed more significant phenomena of endotoxemia, oxidative stress and activation of phospholipases.

   CONCLUSION. With a new coronavirus infection, surgical patients have a high probability of developing threatening thrombohemorrhagic complications. The most important trigger for their occurrence is significant disturbances in the hemostatic system, which are generally characterized by an increased ability of the blood to form thrombosis against the background of a decrease in its fibrinolytic activity. Disturbances in the hemostatic system occurred against the background of oxidative stress, activation of phospholipases and endotoxemia. The obtained material is proof of the significance of the new coronavirus COVID-19 infection worsens coagulopathy, which plays an important role in the pathogenesis of the disease in general and the development of complications.

   RELEVANCE. The novel coronavirus (SARS-CoV2) infection (COVID-19) was first identified in China and quickly spread throughout the world, becoming a public health emergency. Acute kidney injury (AKI) occurs in 8–60% of patients with COVID-19 and is associated with significant mortality, especially in patients requiring renal replacement therapy (RRT). Identification of risk factors for the development of AKI, analysis of the course of this life-threatening condition, study of the use of RRT and extracorporeal hemocorrection (ECHC) in patients with COVID-19 after cardiac surgery is of significant interest.
   AIM OF THE STUDY. To identify risk factors for the development of AKI, assess the incidence of complications and treatment outcomes in patients with COVID-19 after cardiac surgery. To study the experience of using RRT and ECHC methods.

   MATERIAL AND METHODS. We examined 23 patients with a confirmed diagnosis of COVID-19 who were treated in the Infectious Diseases Department of the N. V. Sklifosovsky Research Institute for Emergency Medicine in 2021. Of these, 19 were men (82.6%), and 4 — women (17.4%). The mean age of the patients was 42 years. All the patients required emergency cardiac surgery. Depending on the development of AKI, which required the use of RRT and ECHC methods, patients were divided into two groups: in 10 patients with the development of AKI and multiple organ dysfunction, the use of RRT and ECHC methods was required (group 1); in 13 patients without AKI, standard therapy was used (group 2). Twenty-two patients underwent surgery using cardiopulmonary bypass (CPB), and 1 — without CPB. Indications for the use of RRT and ECHC methods in the patients were the development of AKI, including against the background of chronic kidney disease, in accordance with the KDIGO-2012 criteria, as well as sepsis, septic shock, acute respiratory distress syndrome, water-electrolyte imbalance, acid-base imbalance, systemic inflammation and “cytokine storm”.

   CONCLUSIONS. 1. In patients with COVID-19 who require cardiac surgery, the development of acute kidney injury worsens the prognosis of the disease and is accompanied by a statistically significant increase in the duration of mechanical ventilation, the median was 3.2 days compared to 1.0 day in group 2, and the period of stay in the intensive care unit was 16.5 days and 9 days, respectively. 2. Mortality was 30 % in group 1, and 15 % in group 2, p = 0.475; in patients with acute kidney injury, there was a tendency towards a more frequent development of postoperative complications — thus, acute cerebrovascular accident occurred in 20 % and 7.7 % of cases, anemia — in 80 % and 53.3 %, respectively, while mediastinal hematoma developed in 20 % of patients in group 1 only. 3. Risk factors for the development of acute kidney injury in the postoperative period were elevated urea levels and a history of chronic kidney disease. In patients of group 1, the level of intraoperative blood loss was 41.7 % higher than in group 2, but the differences were not statistically significant.

   AIM OF STUDY. To analyze results of surgical treatment of infective endocarditis in the context of the COVID-19 pandemic at the N. V. Sklifosovsky Research Institute for Emergency Medicine.

   MATERIAL AND METHODS. From January, 2021 to April, 2022 at N.V. Sklifosovsky Research Institute for Emergency Medicine we performed 59 surgical interventions on patients diagnosed with infective endocarditis, of which 20 patients (33.9%) had a competing diagnosis “new coronavirus infection”.

   RESULTS. The overall mortality was for the specified period was 18.6 %, 11 patients. In the first group, 5 patients died (25 %). Hospital mortality in the second group was 6 patients (15.4 %).

   CONCLUSION. Preoperative preparation, as well as the surgical intervention itself, did not differ significantly between patients in the two groups. Hospital mortality in the group of patients with new coronavirus infection was higher than in patients without the virus, despite the fact that the risk of surgical intervention according to EuroSCORE II was higher in the second group. From which we can conclude that the EuroSCORE risk scale II does not fully reflect the initial severity of the condition of patients with COVID-19. Such risk factors as decreased immunity due to immunosuppressive therapy and respiratory failure and coagulopathy influenced the results of surgical treatment of infective endocarditis in this cohort of patients, but not so significantly as to refuse surgical intervention. The significant difference in the postoperative period was the increase in bed days in intensive care and therapeutic departments among patients with COVID-19. This factor is associated with the initial severity and specifics of management of these patients in the postoperative period, which required greater vigilance and attention from cardiac surgeons, resuscitators and infectious disease doctors in the “red” zones.

   BACKGROUND. Critical condition (CC) is defined as any life-threatening condition that requires support of the functions of vital organs and systems to prevent imminent death. From the point of view of the course of CC and the survival of the patient, adequate functioning of the hypothalamic-pituitary-adrenal axis (HPA) is fundamentally important.

   AIM OF STUDY. To improve treatment outcomes for critically ill patients requiring temperature management through early diagnosis and timely correction of adrenal dysfunction.

   MATERIAL AND METHODS. Of the 59 patients, 45 (76.3 %) patients were diagnosed with adrenal dysfunction upon body temperature management (BTM) caused by critical illness: group I with vascular failure (VF+); in 14 (23.7 %) patients of group II adrenal disfunction wasn’t revealed (VF-).

   RESULTS. In group I (VF+) there was a high SOFA score, the highest number of days from the moment of illness to admission to the intensive care unit and
initiation of BTM, the presence of liver dysfunction, and a high level of C-reactive protein. Vascular failure in patients in group I developed earlier than other organ dysfunctions and sepsis. The high level of cortisol in the blood plasma in group II (VF-) was associated with the development of corticoresistance.

   CONCLUSIONS. 1. At body temperature management initiation, patients with adrenal dysfunction had a statistically significant high sofa score compared to patients without adrenal dysfunction (8 (5–9); 7 (6–8), respectively, p < 0,05). 2. The number of days from the disease onset to admission to the icu and initiation of body temperature management was statistically significantly high in the group with adrenal dysfunction compared to the group without adrenal dysfunction (20 of 45 patients (44.4 %); 4 of 14 (28.6 %) respectively, p < 0.05). 3. In the development of septic shock in patients with adrenal dysfunction, the criterion for the efficacy of the therapy was stabilization of the patient’s condition: positive hemodynamic response to the introduction of hydrocortisone with reduced doses of noradrenaline and its subsequent cancellation. 4. Despite the fact that the rate of organ dysfunction, sepsis and septic shock were statistically significantly higher (p < 0.05) in the group with adrenal dysfunction and the presence of vascular insufficiency, the performed treatment (hydrocortisone administration) allowed outcomes comparable to these in patients without adrenal dysfunction to be achieved (p > 0.05).

   RELEVANCE. Among the deadly complications of severe poisoning, pneumonia occupies a leading position, and therefore the search for new solutions aimed at prevention and treatment of this complication is relevant.

   AIM OF THE STUDY. To study the role of intestinal translocation in the pathogenesis of pneumonia in acute poisoning and to evaluate the contribution of intestinal lavage to its prevention and resolution.

   MATERIAL AND METHODS. Here at the N.V. Sklifosovsky Research Institute for Emergency Medicine, we analyzed the outcomes of treatment of 1124 patients with severe oral poisoning: by psycho-pharmacological drugs (PPD) — 172 and corrosive substances (CS) — 325 people; with intravenous administration of methadone (M) — 575, as well as 50 patients with alcoholic delirium (AlD) as a complication of PPD and CS poisoning. In cases of PPD and M poisoning, the patients’ Glasgow Coma Scale (GCS) scores ranged from 3 to 5, with respiratory disorders requiring mechanical ventilation. The severity of CS poisoning was due to the 2^nd-3^rd degree chemical burn of the mucous membrane of the mouth, pharynx, esophagus and stomach. The condition of patients with AlD was severe and corresponded to 29.0 (27.0; 30.0) points on the DELIRIUM RATING SCALE – R – 98. In cases of PPD and CS poisoning, the state of the intestinal microbiocenosis, the permeability of the intestinal barrier, the endotoxin content of gram-negative bacteria in the blood and integral indicators of intoxication were studied. Intestinal lavage (IL) was used in the observed groups (655). Patients in the comparison groups (469) received standard therapy.

   RESULTS. Initially detected: intestinal dysbiosis of II–III degree, increased permeability of the intestinal barrier — 3.8–4.9 times higher than normal, a tenfold increase in the content of endotoxin in the blood and a 6-fold increase in the leukocyte index of intoxication. It was established that intestinal lavage effectively cleanses the entire gastrointestinal tract, eliminates intestinal dysbiosis, reduces excessive permeability of the intestinal wall, and is accompanied by a 2-fold decrease in the endotoxin content in the blood and the leukocyte index of intoxication. As a result, pneumonia was registered in cases of PPD poisoning 2.1; M —1.9; CS — 2.4, and AlD — 9.8 times less often than in the comparison groups. Mortality among the patients with PPD poisoning decreased by 7 times, and with M and CS poisoning, as well as with AlD, there were no deaths, while in the respective comparison groups, the mortality rate for pneumonia was 5.1, 7.4, and 17.4 %, respectively. The differences were statistically significant.

   CONCLUSION. A pattern in the form of intestinal dysbiosis, excessive permeability of the intestinal barrier, and increased levels of endotoxin in the blood may indicate that the source of the infectious-inflammatory process in the lungs during acute poisoning is the intestine; and the cause-and-effect relationship between the sanitation of the gastrointestinal tract by intestinal lavage and a reduction in the incidence of pneumonia and mortality confirms this hypothesis.

   INTRODUCTION. Despite the widespread use of methods for thermoobliteration of varicose veins, there are no standards for prescribing solutions for tumescent anesthesia when performing these operations. Existing prescriptions can be difficult, both in terms of finding the necessary components in a certain concentration, and in terms of correct dilution of the components in saline.

   AIM OF STUDY. To determine the reasonability of using complex medicinal prescription solutions for tumescent anesthesia when performing endovenous laser obliteration of varicose veins of the lower extremities.

   MATERIAL AND METHODS. The prospective study included 64 patients who underwent endovenous laser obliteration of the great or small saphenous vein. The operations were performed in accordance with the standard protocol on a device with a wavelength of 1,940 nm and radiation power from 5.0 to 6.0 W. Tumescent anesthesia was created using an automatic infiltration pump using 21 G needles with a length of 120 mm. Group I included patients (n = 34) who were anesthetized with a 0.1 % lidocaine solution at room temperature. Group II included patients (n = 30), for whom the anesthesia solution was prepared according to Klein’s standard prescription for tumescent anesthesia. The distribution of patients into groups was carried out using random sampling. Evaluation criteria: the presence or absence of complaints of pain during surgery and the level of pain assessed using a visual analogue scale.

   RESULTS. The groups did not differ statistically significantly in terms of main clinical and demographic indicators (p < 0.05). Complaints of pain or burning during surgery were made by 2 patients (5.9 %) in group I and 5 patients (16.7 %) in group II (p = 0.0023). The average pain value according to the visual analogue scale in group I was 0.75 cm [0.30; 1.44], in group II – 1.85 cm [0.85; 2.72], p = 0.0017, while in group I the maximum number of patients — 24 (70.6%) were distributed in the range of 0–1 cm, in group II the maximum number of patients, 17 (56.7 %) were distributed in the range of 1.5–3 cm according to a visual analogue scale.

   CONCLUSIONS. When using a simple 0.1 % lidocaine solution for tumescent anesthesia, a significantly lower average pain value according to VAS was obtained in comparison with the group of patients who used the standard D. Klein solution (0.75 cm and 1.85 cm, respectively, p = 0. 0017). Also, for the study group, a significantly lower frequency of perioperative complaints and complaints of severe pain was obtained (p < 0.01). The use of complex prescriptions of solutions for tumescent anesthesia when performing endovenous laser obliteration of varicose veins is impractical. The use of a simple 0.1 % lidocaine solution at room temperature, while following the surgical protocol, provides comfortable anesthesia.

   AIM OF STUDY. To evaluate the effectiveness of prolonged blockade of the transverse abdominal space compared with analgesia based on ketoprofen and tramadol after operations for closing intestinal stomas from local access.

   MATERIAL AND METHODS. The prospective single-center randomized study included 74 patients aged from 23 to 83 years (Me = 61; Q1 = 49–Q3 = 67) during the period January–December 2021. Patients were randomly divided into two groups depending on the method of postoperative pain relief. Randomization was carried out using the envelope method. The main group consisted of 41 patients who, for pain relief after surgery, had a catheter installed for prolonged blockade of the transverse abdominal space. In case of ineffectiveness, ketoprofen and tramadol were prescribed according to the regimen. The comparison group consisted of 33 patients who received postoperative analgesia based on ketoprofen as the main drug and tramadol as a rescue drug. The groups were statistically comparable in terms of basic characteristics. Over the course of 4 days, we assessed the daily dosage of tramadol and ketoprofen, the level of dynamic and static pain on a digital rating scale, the time and degree of activity, the frequency of urinary retention, the occurrence of nausea and vomiting, the timing of return to good nutrition and restoration of bowel function, and the duration of postoperative treatment.

   RESULTS. The study included 74 patients. In the main group, on the first day, the frequency of additional use of tramadol (17 % versus 57.6 %, p  = 0.0007) and the frequency of use of submaximal daily dosage (0 % versus 24.2 %, p = 0.003) were statistically significantly lower than in the comparison group. In the comparison group, the frequency of ketoprofen use was higher on days 2 (54 % vs. 94 %, p = 0.0004), days 3 (36.6 % vs. 76 %, p = 0.0018) and days 4 (19 % versus 52 %, p = 0.0081) due to the administration of the maximum daily dosage (all comparisons given are statistically significant). There were no statistically significant differences between the groups in terms of the level of pain at rest and movement, as well as the level of activity of the patients. The period of activity in patients of the main group during the day was statistically significantly longer on the 2^nd (on average 30 minutes versus 15 minutes, p = 0.0187) and 3^rd day (on average 60 minutes versus 45 minutes, p = 0.043).

   CONCLUSIONS. Extended blockade of the transverse abdominal space is an effective method of pain relief after operations to close an intestinal stoma from local access, significantly reducing the need for non-steroidal anti-inflammatory drugs and opioid analgesics.

   BACKGROUND. The development of new samples of local hemostatic agents is an intensively developing area of the modern industrial biotechnology due to a high need of clinical bases for such products. In addition to constant search for optimal substances used as a basis (collagen, cellulose and its derivatives, gelatin, etc.) for local hemostatic agents, methods for their comprehensive testing are also being developed.

   AIM OF THE STUDY. To evaluate the hemostatic activity of multicomponent polymer sponge implants using the coagulometer method developed by the authors in an in vitro experiment.

   MATERIAL AND METHODS. As research materials, new samples of multicomponent polymer sponge implants developed within the Laboratory of Experimental Surgery and Oncology of the Kursk State Medical University were used. The samples were based on marine collagen made from deep-sea squid in different ratios by weight with carboxymethylcellulose sodium salt (15/85, 25/75, 50/50). The hemostatic activity of these products was evaluated in the in vitro experiment using our method based on coagulometric measurement of blood clotting time of volunteer donors. Statistical processing of the data was carried out using methods of descriptive and variation statistics (Me [25; 75]). The validity of the difference was determined using the Mann–Whitney test (p ≤ 0,05).

   RESULTS. The blood clotting time in experimental group No. 2 turned out to be 2.12 s less than in the control group (the tested samples of hemostatic agents were not added). Statistically significant differences were found when comparing the values of coagulation time in experimental groups No. 3 (2.98 s less) and No. 4 (2.37 s less) with the values of the control group (No. 1). A decrease in the blood clotting time indirectly proves the effectiveness of the products used, due to the formation of the blood clot in a shorter period of time. This suggests that when the hemostatic agents are used in bleeding conditions, the products will reduce the time and volume of bleeding due to their hemostatic activity.

   CONCLUSION. Within the framework of the completed study, it was established that our method for assessing the hemostatic activity of local hemostatic agents, based on the evaluation of blood clotting time using electrocoagulometry, after grinding the tested samples, is easy to perform, accessible to most laboratories, and allows researchers to investigate the effectiveness of various forms of multicomponent polymer sponge implants. The development of multicomponent polymer sponge implants based on carboxymethylcellulose sodium salt and collagen seems to be a promising direction, since these products accelerate blood clotting time in the in vitro experiment.

   RELEVANCE. Despite the development of modern diagnostic methods, osteosynthesis instruments and rehabilitation, surgical management of distal tibia fractures remains a great problem due to the high complication rate leading to permanent disability, such as problems with soft tissue healing, infectious complications, post-traumatic arthrosis of the ankle joint. These complications are associated with the high incidence of high-energy injuries, soft-tissue envelope features, and the wide range of movements in the ankle joint. At the same time, in the treatment for comminuted intra-articular pilon fractures, there is no clearly defined operation algorithm: choice of access, reduction and fixation techniques. Recently, when planning osteosynthesis, additive technologies have become increasingly widespread, in particular, 3D printing of full-size fracture prototypes.

   AIM OF STUDY. To analyze preoperative planning methods of osteosynthesis in pilon fractures and evaluate 3D-printing for the improvement of surgical treatment of pilon fractures.

   MATERIAL AND METHODS. The literature search was carried out in the databases of medical publications: PubMed, eLibrary, Cyberleninka. The search was performed using the following terms: pilon fractures, osteosynthesis, preoperative planning, 3D-printing, 3D-model, and the corresponding terms in Russian.

   RESULTS. According to various authors, the use of 3D printing in preoperative planning improves the parameters of operative duration, reduction quality, functional outcome, intraoperative blood loss, and reduces the number of complications.

   CONCLUSIONS. Evaluation of the long-term results of using 3D printing in preoperative planning for osteosynthesis in pilon fractures is ongoing. But even now we can draw conclusions about the prospects of the method and recommend it for widespread use in the routine practice of the orthopedic traumatologist.

   In recent years, the number of infectious diseases caused by fungi has been progressively increasing, which is a serious clinical problem. The literature review is devoted to Candida auris — a new causative agent of nosocomial fungal infections with multidrug resistance. This pathogen was first described in 2009. As of the beginning of 2021, the documented isolation of Candida auris was noted in 47 countries around the world. This pathogen can persist for a long time on various surfaces in hospitals, is resistant to antifungal drugs and traditional disinfectants, and causes invasive infections accompanied by high mortality. The study of Candida auris is important both for the development of approaches to the diagnosis and treatment of diseases caused by this pathogen, and for predicting the emergence of new pathogens in the future.

   AIM OF THE STUDY. To investigate the clinical and functional outcomes of autosplenotransplantation in cases of spleen injuries, and to establish its effectiveness in clinical practice.

   MATERIAL AND METHODS. Using the databases “e-library” and “PubMed”, a thorough review of national and international literature on autosplenotransplantation in patients with traumatic splenic injury was performed.

   RESULTS. This study analyzes literature sources to describe the technical aspects of autosplenotransplantation. The immediate outcomes of this operation show a low incidence of postoperative complications and good graft survival. In addition, this study presents the indications and contraindications of autosplenotransplantation. Comparing autosplenotransplantation to splenectomy, functional results indicate the best indices of humoral and cellular immunity and hemocoagulation. In the published literature, the functional activity indices of the transplant were comparable to those of healthy individuals with the functioning spleen. However, the studies yielding these results were conducted on small patient samples, limiting the reliability of the conclusions drawn.

   CONCLUSION. Autosplenotransplantation appears to be the only viable option for preserving the function of the lost spleen in patients with traumatic splenic injury who, for various reasons, cannot receive organ-preserving treatment. Large randomized studies are needed to assess functional results of the operation and, particularly, the immunological function of the transplant.

   BACKGROUND. At the beginning of the 21st century, the structure of acute exotoxicoses changed, in particular, an increase in poisoning by drugs that mainly affect the cardiovascular system, including calcium channel blockers, was noted. Currently, there is no clear treatment algorithm for this group of patients.

   AIM OF STUDY. To evaluate the effectiveness of methods for the treatment of acute calcium channel blocker (ССВ) poisoning according to the literature.

   MATERIAL AND METHODS. The search for domestic publications was carried out in the eLibrary database, foreign ones - in the MEDLINE/PubMed, Google Scholar databases for the period from 2010 to February 2022, as well as among previously published works that have no modern analogues. The terms used as a search query were according to the official MeSH terms: “calcium channel blockers” OR “Blockers, Calcium Channel” OR “Calcium Channel Antagonists” AND “poisoning”.

   RESULTS. This review contains information about the mechanism of action, clinical picture, diagnosis of calcium channel blocker poisoning, as well as the results of using various methods of treatment for this pathology.

   CONCLUSIONS. Summarizing the data obtained, it is possible to schematically present an algorithm for the treatment of patients with acute CCB poisoning. After cleansing the gastrointestinal tract and starting infusion therapy, pathogenetic treatment with the use of calcium preparations should be carried out, subsequently, in case of unstable hemodynamics, the prescription of vasopressors and inotropic drugs is indicated; and if there is no positive dynamics, insulin therapy must be added. However, it should be noted that such a scheme is indicative, reflecting the key points. In general, this problem remains open and requires further multicenter studies.

   In recent years, there has been a trend of increasing poisoning by various substances among the general population throughout the world. For the complex treatment of these patients, modern toxicology uses a combination of drug and non-drug methods that have universal mechanisms aimed at restoring body functions. Currently, antihypoxants and antioxidants are actively used in medical practice in all situations where there are oxygen deficiency and certain manifestations of the ischemic cascade in order to interrupt the mechanisms of hypoxia progression as early as possible. The widespread use of ethylmethylhydroxypyridine succinate (Mexidol®, NPK PHARMASOFT LLC, Russia) both in the form of monotherapy and in combination with various methods of non-pharmacological intervention (mesodiencephalic modulation, hyperbaric oxygenation, etc.) is becoming quite interesting for practical use in toxicological practice for the treatment and rehabilitation of conditions developing after acute poisoning by neurotropic substances (psychodysleptics, drugs, ethanol and its substitutes).

   AIM OF STUDY. To study the individual structural features of the surface of the lumbar region of the back of patients who underwent catheterization of the epidural space at the lumbar level, and, depending on these features, to determine a group of patients with the possibility of convenient and reliable fixation of the epidural catheter (EC) to the skin with fixing devices and a group of patients who require such fixation will be inconvenient and unreliable and for whom it is better to use subcutaneous tunneling for reliable fixation of the EC, and based on this, determine the absolute and relative indications for this method of fixation.

   MATERIAL AND METHODS. A study of the surface of the lumbar region of the back was carried out in 600 patients who were on the operating table in a sitting position, while performing neuraxial blockades in the intervertebral spaces L2–L3 and L3–L4. As a result, 4 forms of the back surface were identified: “V” shape, “M” shape, “^” shape and “—” flat shape of the back surface.

   RESULTS. The overwhelming majority of the studied patients had absolutely convenient (34.2 %) and relatively convenient (53.5 %) places for EC fixation in the area of epidural access. Significantly fewer patients (2 %) had a completely uncomfortable site for EC fixation to the skin using fixation devices, which can be considered an absolute indication for EC fixation by subcutaneous tunneling.

   CONCLUSION. 1. The absolute indication for fixing an epidural catheter using the subcutaneous tunneling method is the presence of an absolutely uncomfortable fixation site in the area of epidural access in the patient in the form of a combination of a recess greater than 7 mm and a distance from the points of maximum elevation in the specified zone to the right and left of the midline less than the size of the dense adhesive plate of the fixing device (for the Epi-Fix device this is 55 mm). 2. A relative indication for fixing an epidural catheter using the subcutaneous tunneling method is the presence of a relatively inconvenient fixation site in the epidural access area for the patient, regardless of the size of the depression or elevation of the surface shape at the epidural access site and the distance from the points of maximum elevation to the right and left of the larger midline than the size of the dense adhesive plate of the fixing device.

   Telemedicine technologies for transmitting digital information about the patient are presented and characterized in the practice of application at the prehospital stage for clarifying the diagnosis, correcting the measures taken, efficient logistics and routing. High diagnostic accuracy and the possibility of round-the-clock diagnostics anywhere significantly improves the quality of medical care provided.

   We report a case of severe retrosternal pain in 28-year-old patient with no cardiovascular diseases in history, developed after intravenous administration of 0.5 atropine sulfate 0.1 % solution for the purpose of premedication before the planned operation for endometrioid ovarian cysts and managed with nitrates spray. Taking into account the clinical picture, transient ischemic changes in the electrocardiogram and the association with the administration of atropine, it can be assumed that the patient had a spasm of the coronary arteries caused by the administration of atropine. There are only a very small number of descriptions of similar observations in the literature, which are also discussed in the article.

   The article describes a clinical case of recanalization of the superior mesenteric artery during acute mesenteric ischemia in an 81-year-old patient who was admitted to the emergency hospital in Ryazan with a clinic for “acute” abdomen. As a result of a diagnostic study, collection of anamnestic data and clinical picture, a diagnosis was made: “Embolism of mesenteric vessels.” Taking into account the early diagnosis (less than 4 hours from the onset of the disease), as well as the extremely complicated somatic status, selective angiography with mesentericography was performed, which revealed the patency of the main trunk of the superior mesenteric artery and complete occlusion of the distal segment of the intestine. Revascularization was performed ischemic area of the superior mesenteric artery. In the postoperative period, positive dynamics was observed, with complete relief of the clinical manifestations of mesenteric ischemia. On the 12^th day, the patient was discharged for outpatient treatment under the supervision of a surgeon at her place of residence in satisfactory condition.

   RELEVANCE. In conditions of increased sensitivity of damaged brain tissue to disruption of homeostasis, it is important to achieve stabilization of the vital functions of the body as soon as possible. Given the excess afferent impulse, adequate sedation and analgesia are an integral component of intensive care for patients with traumatic brain injury. The use of halogenated anesthetics is associated with a lower risk of complications associated with long-term sedation with intravenous drugs. In the example of two patients with severe traumatic brain injury, the effectiveness and safety of sevoflurane for prolonged inhalation sedation was noted. This study was approved at a meeting of the Local Ethics Committee of the Federal Scientific and Clinical Center for Resuscitation and Rehabilitation, an extract from protocol No. 5/21/1 dated December 23, 2021, as well as at a meeting of the LEC of the N. V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department, meeting No. 1-2022 dated January 11, 2022.

   AIM OF STUDY. To demonstrate the safety of inhalation sedation in patients with traumatic brain injury using clinical observations as an example.

   MATERIAL AND METHODS. An analysis of two clinical observations of patients with severe traumatic brain injury was carried out. The effectiveness and safety of prolonged inhalation sedation was assessed by indicators: intracranial pressure, dynamics of mean arterial pressure and blood saturation in the jugular vein bulb, as well as the total duration of artificial ventilation and stay in the intensive care unit. Clinical observation No. 1. Patient B., 41 years old, was admitted with cerebral insufficiency (GCS 8) with damage to the soft tissues of the head. As a result of the examination, the patient was
diagnosed with “Closed craniocerebral injury.” Fracture of the bones of the vault and base of the skull. Severe brain contusion. Traumatic subarachnoid hemorrhage, acute subdural hematoma in the left frontotemporal region 3 cm³”. Considering the size of the trauma (65 cm³) and the life-threatening dislocation syndrome, the patient underwent surgical intervention: “Decompressive craniotomy, removal of contusion areas. Installation of a ventricular intracranial pressure sensor.” The early course of the postoperative period was complicated by the development of infectious complications, which led to the need for prolonged sedation in the intensive care unit. On the 3^rd day, a lower tracheostomy was performed. The total time of sedation was 3 days, and the duration of artificial ventilation was 10 days. On the 21^st day, the patient was decannulated and transferred to a specialized department. Clinical observation No. 2. Patient K, 42 years old, was admitted to the hospital with a depressed level of consciousness (GCS 6). Based on the results of the examination, a diagnosis was made: “Penetrating traumatic brain injury with severe brain contusion, a focus of crush contusion in the right temporal lobe, acute subdural hematoma of the right frontal-temporo-parietal region 100 cm³ and a fracture of the bones of the vault and base of the skull, facial skeleton, micropneumocephaly”. Considering the size and location of the hematoma, the patient underwent surgery including decompressive craniotomy, removal of an acute subdural hematoma, and a Spiegelberg intracranial pressure sensor was installed. In the early postoperative period, severe hemodynamic instability associated with vascular insufficiency of central origin was noted. The use of inhalational sedation sevoflurane did not lead to the development of intracranial hypertension and escalation of vasopressor therapy. The total time of use of sevoflurane was 36 hours. Spontaneous breathing was restored by the 18^th day. The patient’s stay in the ICU was 31 bed days.

   CONCLUSION. Based on the data obtained, we may conclude that the use of inhalation sedation in this category of patients is safe, as well as the absence of a significant effect of sevoflurane on the level of intracranial pressure and central hemodynamic parameters. However, secondary complications that developed in patients do not allow us to draw an unambiguous conclusion about the effect of this method of sedation on the duration of artificial ventilation and stay in the intensive care unit. Only the accumulation of a sufficient volume of clinical material will reveal all the advantages and disadvantages of this method.

   Cecal volvulus (CV) is one of the rare forms of strangulated intestinal obstruction, which accounts for 20–40 % of all colonic volvuluses and 1.0–1.5 % of all cases of intestinal obstruction in adult patients, mainly females aged from 40 to 62 years old (female to male gender ratio 4:1). One of the complications of cecal volvulus is a violation of the blood supply to the intestinal wall (23.8–44.2 %), which leads to necrosis in 36.7 % of cases, to perforation of the intestinal wall 23 % of cases, and to the development of peritonitis in 41.6–43 % of cases. If there is doubt about the viability of the ischemic intestine, the choice of the extent of surgical intervention was always determined in favor of its resection. The emergence of laparoscopic technologies in the arsenal of modern surgery makes it possible to assess the viability of the organ in the dynamics of its conduction, to choose the optimal tactics for treating the patient in the delayed period, which in some cases helps refrain from unnecessary resection operations, to preserve the organ and achieve a favorable outcome in patients diagnosed with cecal volvulus.

   AIM OF STUDY. To describe a rare clinical case of surgical treatment of chronic recurrent dislocation of the forearm bones using the method of circular plastic surgery of the elbow joint ligaments.

   MATERIAL AND METHODS. In the conditions of the Department of Traumatology and Orthopedics on the basis of the Department of Traumatology and Orthopedics of the Federal State Autonomous Educational Institution of Higher Education “Russian Peoples’ Friendship University” in the V. M. Buyanov City Clinical Hospital of the Moscow Health Department, a comprehensive diagnosis and treatment of a 38-year-old patient with recurrent dislocation of the forearm bones was carried out. Clinical and radiological examinations including computed tomography and magnetic resonance imaging of the elbow joint were performed to verify the diagnosis. After a diagnosis of chronic posterior instability of the elbow joint was established, simultaneous plastic surgery of the medial and lateral ulnar collateral ligaments was performed using a single-loop circular autograft from the peroneus longus tendon.

   RESULTS. At a follow-up period of 12 months, a successful clinical result of surgical treatment with restoration of stability and function of the elbow joint was observed. Pain syndrome on the VAS scale decreased to 1 cm (before surgery 0 cm) with physical activity. The amplitude of active movements in the elbow joint after surgery was: flexion 140° (before surgery 135°), extension 5° (before surgery 5°), pronation-supination 150° (before surgery 160°). After surgery: QuickDASH score 26 (before surgery 44 points), OES score 72 (before surgery 45), MEPS score 85 (before surgery 55). MEPS was score 55, OES was score 45, QuickDASH was 44 points, QuickDASH (work section) was score 75.

   CONCLUSION. The method of tendon circular plasty of the elbow joint is an effective method of surgical treatment of multidirectional recurrent instability of the elbow joint, helps restore stability and function of the joint and does not lead to limitation of movements.