Over the past decades, there has been an active introduction of minimally invasive surgical technologies in the treatment of various diseases, including gastric cancer. In Asian countries and Europe, laparoscopic gastrectomy is an alternative to open gastrectomy for early gastric cancer, with a tendency to displace the latter. In the Russian Federation, laparoscopic gastrectomy is performed in a few specialized centers. From 2013 to 2022, the surgeons of our Center treated 141 patients diagnosed with gastric cancer at different stages (64 men, 39 women, mean age of 60.5±10 years). Of these, 52 patients (50.5%) underwent open surgeries (group I), 51 (49.5%) — laparoscopic surgeries (group II). The study included patients diagnosed with gastric cancer complicated by bleeding or gastric outlet/cardioesophageal junction obstruction, over 18 years of age, who signed consent for the processing of personal data and inclusion of their clinical data in the research and underwent surgical treatment. We analyzed such parameters as the duration of surgical intervention and the duration of hospital stay, the rates of hospital/relapse-free 2-year survival, and uncomplicated postoperative period. Laparoscopic-assisted surgeries lasted longer; however, due to more precise technique and better visualization of anatomical structures, there was a smaller volume of intraoperative blood loss. During laparoscopic-assisted radical gastrectomy, it is possible to perform more precise lymph node dissection, increase the number of harvested lymph nodes and, thus, increase the probability of detecting lymph nodes with metastases; which, in turn, has a direct impact on increasing the 2-year relapse-free and 2-year overall survival of patients. There was no significant difference in the incidence or severity of postoperative complications and mortality. These data are an important indicator of the effectiveness of the minimally invasive surgical method of treatment, which indicates greater safety of the laparoscopic method compared to intervention from laparotomy access.

RELEVANCE. One of the problems complicating the early postoperative period in patients with supratentorial meningiomas is epileptic seizures, which in 9-16% of cases first develop within the first 7 days after tumor removal (acute symptomatic epileptic seizures).

AIM OF THE STUDY. To identify risk factors for the occurrence of acute symptomatic epileptic seizures in the early postoperative period in patients with supratentorial meningiomas and to evaluate the effectiveness of prophylactic antiepileptic therapy.

MATERIAL AND METHODS. A prospective, single-blind, randomized, placebo-controlled study was conducted using the sequential, alternate-arm randomization method. The treatment of 102 patients with supratentorial meningiomas was analyzed, in whom the tumor was removed between 01.01.2021 and 30.09.2023 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. To identify risk factors for the development of acute symptomatic epileptic seizures in patients, we assessed the data of the anamnesis, examination of the patient, electroencephalography before surgery, neuroimaging before and after tumor resection, as well as the characteristics of the intraoperative period, duration and outcomes of hospitalization. To evaluate the effectiveness of the prophylactic use of antiepileptic drugs, patients were divided into two groups. The first group consisted of 49 patients who took an antiepileptic drug as a prophylaxis of early epileptic seizures. The second group consisted of 53 patients who took a placebo drug. Both groups were divided into two subgroups each depending on the development of an epileptic seizure or its absence after surgery. In the first group, patients with epileptic seizures were considered the main subgroup, the patients without seizures were considered the control. We assessed the placebo group similarly.

RESULTS. In the placebo group, a risk factor for the development of acute symptomatic epileptic seizures was the transection of one or more veins, which was necessary to achieve sufficient surgical access, leading to a change in cerebral venous blood flow (p=0.013, odds ratio (OR)=11.43; 95% CI [1.75–74.73]). In both the antiepileptic drug group and the placebo group, risk factors included an increase in the volume of cerebral edema according to postoperative CT scan data compared with preoperative (p=0.05, OR=18.8; 95% CI [2.0–182.7] and p=0.01, OR=12.6; 95% CI [2.36–68.0], respectively), as well as hemorrhagic transformation of the perifocal edema zone (p=0.03, OR=8.75; 95% CI [1.36–56.4] and p=0.02, OR=9.7; 95% CI [2.1–44.6], respectively). The efficacy of prophylactic use of antiepileptic drugs in reducing the incidence of acute symptomatic epileptic seizures in the first 7 days after surgery was not established (p=0.295, OR=0.533; 95% CI [0.181–1.572]).

CONCLUSION. We have identified the following risk factors for the development of acute symptomatic epileptic seizures: an increase in the volume of cerebral edema compared to the preoperative level according to postoperative computed tomography, the development of hemorrhagic transformation of cerebral edema in both groups, and the intersection of one or more veins during surgery (in the placebo group). Confirmation of the efficacy of routine use of antiepileptic drugs for the prevention of acute symptomatic epileptic seizures not received.

AIM OF STUDY. The study was aimed to evaluate the effectiveness of treating acute pancreatitis by early enteral nutrition and selective introduction of nutritional mixtures directly into the initial sections of the jejunum, bypassing the duodenum.

MATERIAL AND METHODS. A comprehensive treatment method for acute pancreatitis was developed based on the use of a pancreatoduodenal catheter. The method focuses on preventing intestinal failure syndrome by isolating the duodenum and preventing any liquid from entering it while ensuring the selective introduction of glucose-saline solutions and/or enteral nutritional mixtures directly into the initial sections of the jejunum. Several Russian clinics are currently conducting the research approved by local ethics committees. This article presents preliminary results from the data analysis. The study included moderate to severe forms (according to the 2012 Atlanta classification) of acute biliary pancreatitis without indications for endoscopic retrograde cholangiopancreatography, as well as alimentary-alcoholic pancreatitis. The first group of patients received standard therapy according to the 2020 clinical guidelines of the Russian Society of Surgeons. The second group received standard therapy combined with the new selective enteral nutrition method. The observation period lasted until the end of the hospital treatment, including five mandatory visits and a final visit to the physician. A follow-up survey was conducted three months or more after discharge to identify delayed episodes of acute pancreatitis complications, focusing on the incidence of infectious complications and surgical interventions.

RESULTS. A total of 148 patients were treated. Patients were evenly distributed by etiology, gender, age, and body mass index. The analysis revealed that the number of patients with infectious complications decreased from 19.3% in the comparison group to 6.67% in the study group (p=0.041). The number of patients requiring surgical interventions was 5.0% in the study group compared to 19.3% in the comparison group (p=0.017).

CONCLUSIONS. The study demonstrated that the use of the new method in the comprehensive treatment of acute pancreatitis, including early enteral feeding at the onset of the disease, may improve the course of the disease by reducing the incidence of infectious complications and the number of necessary surgical interventions.

ABSTRACT. Determination of rehabilitation potential (RP) is necessary for optimal rehabilitation strategy and the best rehabilitation measures. Navigational transcranial magnetic stimulation (nTMS) has been proposed as a method for PR determination in after-stroke patients.

THE AIM. was to study the importance of navigational diagnostic transcranial magnetic stimulation as a neurofunctional predictor of motor function recovery after ischemic stroke.

MATERIAL AND METHODS. The study included 28 after-stroke patients, 19 men and 9 women, the mean age was 60.07±5.67 years, who underwent a course of inpatient medical rehabilitation at the Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky in 2022–2023. Clinical examination and assessment were conducted before and after the rehabilitation course using validated scales and questionnaires — the Medical Research Committee (MRCs) scale, the Box and Block Test (BBT), the modified Rankin scale (mRS); the rehabilitation routing scale (RRS). The patients were also examined using nTMS at the N.V. Sklifosovsky Research Institute for Emergency Medicine with the determination of motor evoked potential (MEP) parameters from the muscles of the upper and lower extremities.

RESULTS. In patients with preserved MEP, there was a significant increase in the strength of the paretic limb on the MRCs scale from 4.00 (2.94–4.06) to 4.22 (3.83–4.89) points (p <0.001) for the upper limb and from 4.00 (3.67–4.00) to 4.44 (3.83–4.61) (p<0.001) for the lower limb. Improvements were revealed according to the mRS scale — the number of patients with an mRS score of 2 points in the group of patients with defined MEP increased by 26.1%, reached values of 1 point — 13.0% of patients, and the number of patients with an assessment of disability and self-care ability of 4 points decreased by 8.7%.

CONCLUSION. Navigational transcranial magnetic stimulation is one of the methods for assessing the rehabilitation potential in patients with ischemic stroke. But TMS should not be used as the only method of evaluating rehabilitation potential. The assessment of RP should be comprehensive and based on the complex data obtained.

INTRODUCTION. In case of polytrauma, an imbalance occurs between substances produced by the endothelium, the rheological properties of the blood are disrupted, the content of procoagulants increases, the permeability of the vascular wall increases, which contributes to thrombus formation and increased tissue hypoxia, and subsequently to the development of multiple organ failure, and, of course, affects the course of traumatic disease, the development of complications and mortality. However, specific markers of endothelial dysfunction and their levels, by which it is possible to reliably predict the course of traumatic disease in severe combined closed abdominal trauma for the appropriate pathogenetic treatment have not yet been determined.

AIM OF THE STUDY. To determine the significance of some markers of endothelial dysfunction (C-reactive protein, von Willebrand factor, the number of desquamated endothelial cells in the blood) in combined blunt abdominal trauma to predict the likelihood of complications and adverse outcomes.

MATERIAL AND METHODS. The main group consisted of 31 patients with severe combined blunt abdominal trauma, the comparison group consisted of 5 patients operated on for large ventral hernias. All patients underwent blood tests for C-reactive protein, von Willebrand factor, the number of desquamated endothelial cells.

RESULTS. The level of all three considered markers of endothelial dysfunction in severe abdominal trauma significantly differs from that in operated non-traumatized patients, which allows differential diagnostics to be made between abdominal wall contusion and damage to internal organs; extremely high values suggest an unfavorable course of traumatic disease and a high probability of a fatal outcome.

CONCLUSION. Taking into account that the development of traumatic disease is based on damage to the vascular endothelium, it is necessary to consider as prognostic indicators changes in the level of activity of C-reactive protein, von Willebrand factor, desquamated endothelial cells in patients with severe combined blunt abdominal trauma.

RELEVANCE. The problem of treating thoracic endometriosis complicated by recurrent spontaneous catamenial pneumothorax is associated with the widespread prevalence of endometriosis, the complexity of its treatment and unsatisfactory long-term outcomes. The diagnosis of catamenial pneumothorax can only be established with a carefully collected history and confirmation of its recurrent nature. Favorable results are achieved with complex therapy carried out by the thoracic surgeon and gynecologist, consisting of an adequate volume of surgical intervention and hormonal therapy with gonadotropin releasing hormone agonists.

AIM OF STUDY. To improve the diagnosis of thoracic endometriosis and recurrent catamenial and endometriosis-related spontaneous pneumothorax. To optimize the currently available treatment tactics by reducing the incidence of early relapses of catamenial pneumothorax and creating favorable conditions for the formation of reliable pleurodesis.

MATERIAL AND METHODS. We studied the immediate outcomes of complex treatment of 30 patients (14.7%) with right-sided recurrent catamenial (28) and endometriosis-related spontaneous pneumothorax (2), with a median age of 41 (37;44) years, for the period from 2011 to the first half of 2023. Surgical treatment via video-assisted thoracoscopic access was performed in 26 patients (86.7%). After surgery, all the patients were recommended a six-month course of hormonal therapy with gonadotropin releasing hormone agonists.

RESULTS. Various types of mechanical pleurodesis were performed in 25 patients (96.1%), resection of the diaphragm — in 17 (65.4%), alloplastic reconstruction with a synthetic mesh implant — in 12 patients (46.1%), pulmonary resection — in 9 (34.6%). In 12 of 26 patients (46.1%) in the early postoperative period, 6 (3; 6.75) days after surgery, a recurrence of catamenial pneumothorax developed, which subsequently required repeated interventions. In 5 patients, the relapse clearly coincided with the menstrual cycle. Early recurrence of pneumothorax required repeated drainage of the pleural cavity in all the patients, chemical pleurodesis in 2, and prolonged drainage of the pleural cavity in 1.

CONCLUSION. Surgeries involving resection and reconstruction of the diaphragm with a mesh implant, pleurectomy, lung resection do not ensure the removal of all endometrioid heterotopias of the diaphragm and lung, therefore, during the first mensis after surgery, in the early postoperative period, 46.1% of the patients had a recurrence of catamenial pneumothorax, with no formed pleurodesis, which contributes to the possibility of further recurrences of pneumothorax. Improving the immediate outcomes of complex treatment of catamenial pneumothorax is possible with the preventive administration of hormonal therapy 1.5–2 months before the planned surgical intervention, which requires a multidisciplinary approach of the thoracic surgeon and gynecologist.

INTRODUCTION. Multidrug-resistant (MDR) organisms are increasingly becoming a major surgical site infection (SSI); however, the clinical outcomes and risk factors associated with resistant pathogens in general surgery remain poorly understood.

THE AIM of the present research is to study the risk factors and consequences of infections in patients with SSI caused by antibiotic resistant pathogens with MDR.

MATERIAL AND METHODS. A single-center, retrospective case-control study was carried out. The results of the examination and treatment of 50 patients with SSI + MDR, who made up the main group, and two control groups — non-MDR SSI and no SSI, 50 patients each, were analyzed. A total of 38 risk factors were used: pre- and surgical criteria, clinical, biochemical, instrumental data, postoperative complications and treatment features. The microbial landscape was studied in SSI+MDR. Single- and multivariate analysis was carried out, binary and multinomial logistic regression was performed. P-values <0.05 were considered significant at 95% CI.

RESULTS. Significant risk factors were as follows: previous hospitalization, previous antibiotic therapy, terms of preoperative stay of the patient in the department, emergency surgery, class of surgery, decrease in the ratio of ALP/ ALPI, MEI and EMFC (p<0.01); elevated ASA score, obesity, low levels of plasma proteins and albumin, (p<0.05). Among the pathogens, there were more gram-negative enterobacteria (61%) than gram-positive ones (30.5%). Escherichia coli (36.3%) was the most commonly found bacterium, followed by Enterococcus faecium (9.09%), Morganella morganii (7.58%), Staphylococcus aureus (6%), and Pseudomonas aeruginosa (6%). In SSSI, Staphylococcus spp. prevailed. (>80%); in DSSI — Echerichia, Acinetobacter (>70%); and in OSSSI — Enterobacter spp., Acinetobacter and Citrobacter (>90%). SSI+MDR were characterized by serious surgical complications (Clavien Dindo Classification grade 3–5), wound dehiscences and OSSSI, reoperations (p<0.05).

CONCLUSION. 1. The primary risk factors for multiple antibiotic resistance were as follows: previous hospitalization, previous antibiotic therapy, the duration of the patient’s preoperative stay in the department, emergency surgery, surgery class, reduced ALP/ALPI ratio, MEI and EMFC. In addition to the above, the following were also of great importance: increased ASA score, obesity, low plasma proteins, albumin.

2. When identifying risk factors for multiple antibiotic resistance in surgical patients, the development of severe postoperative complications, sepsis and multiple organ failure can be predicted.

3. Perioperative medical and preventive measures require a multidisciplinary approach involving the microbiologist, pharmacologist, immunologist, nutrition specialist, and other expert consultants.

RELEVANCE. Venous thromboembolic complications (VTEC) occur in patients hospitalized with various pathologies, complicate treatment and increase mortality. This problem has not received enough attention in toxicology.

AIM OF THE STUDY. Conduct an analysis of VTEC in patients with acute chemical poisoning (AP).

MATERIAL AND METHODS. The hospital patient records and pathological examination reports of 670 patients of the N.V. Sklifosovsky Research Institute for Emergency Medicine who died from VTEC in the period 2016–2022 were retrospectively analyzed. VTEC were confirmed by Doppler ultrasound during life or during pathological examination. Statistical analysis of the data was performed using the IBM computer program SPSS Statistics 26.0.

RESULTS. VTEC were diagnosed in 245 patients. The proportion of VTEC increased from 20.2 to 46.7% over the years, and in cases of VTEC caused by psychopharmacological drugs, they were registered in 48.8% of cases. VTEC occurred twice more often in people over 60 years of age and 1.3-fold more often in women. Deep vein thrombosis of the right lower limb was predominant in all types of poisoning, and the prevalence of the lesion was mainly local. Concomitant cardiovascular diseases, oncological diseases, diabetes mellitus, and the development of pneumonia increased the risk of VTEC. Pulmonary embolism was observed in more than a third of cases of VTEC in patients with VTEC caused by psychopharmacological drugs, corrosive substances, and hypotensive and antiarrhythmic drugs.

CONCLUSIONS. The characteristics of venous thromboembolic complications in acute chemical poisoning in general is similar to the complications indicated that arise in other pathologies, but has some features caused by the effect of specific chemicals on the body.

AIM OF THE STUDY. Comparative clinical analysis of the efficacy of terlipressin and octreotide as additional drug therapy to mechanical hemostasis with nitinol stent in patients with liver cirrhosis complicated by bleeding from esophageal varices refractory to endoscopic treatment.

MATERIAL AND METHODS. Thirty-one patients with liver cirrhosis complicated by esophageal variceal bleeding refractory to endoscopic treatment , in whose complex treatment program, as a first-line life­saving measure, hemostasis with a self-expanding hemostasis was performed nitinol stent were randomly assigned to two groups. In group A, 20 patients were treated with terlipressin as an adjuvant to mechanical hemostasis, and in group B, 11 patients were treated with octreotide. Unpaired Student’s t-test was used for statistical analysis of the results. Graphs for assessing the survival function of patients for 8 weeks after the end of treatment were constructed using the Kaplan-Meier method.

RESULTS. In the acute observation period terlipressin and octreotide were equally effective in treating refractory variceal bleeding. In the subacute observation period, the administration of octreotide was generally accompanied by a greater number of side effects (54.5%) than terlipressin (30.0%) (p=0.453). In the remote observation period, 8-week survival in the group of patients receiving terlipressin was higher than in the group of patients receiving octreotide.

CONCLUSION. Terlipressin is as effective as octreotide as an adjunct to endoscopic stenting in drug therapy for liver cirrhosis complicated by esophageal variceal bleeding refractory to endoscopic treatment. At the same time, terlipressin has a greater effect than octreotide on reducing 8-week mortality, which approaches statistical significance. In this regard, terlipressin may be the vasoactive drug of choice in acute refractory variceal bleeding.

AIM OF STUDY. To compare the results of carotid endarterectomy performed at different times (1st, 2nd and 3rd week) of the acute period of ischemic stroke.

MATERIAL AND METHODS. In the acute period of ischemic stroke (1–21 days), 92 patients with symptomatic stenosis of the internal carotid artery of 50% or more were operated on using carotid endarterectomy . There were 66 men and 26 women. The average age was 65.7±8.4 years. All patients were divided into three groups depending on the timing of the operation: Group 1, where the operation was performed on the 1st week of stroke (n=48); Group 2, where the operation was performed on the 2nd week after stroke (n=28); Group 3, where carotid endarterectomy was performed on the 3rd week after stroke (n=16). In-hospital endpoints of the study in each group were ipsilateral ischemic stroke, any other stroke (contralateral ischemic or hemorrhagic), myocardial infarction, wound hemorrhagic complications requiring repeated operation and surgical hemostasis, death, and major adverse cardiovascular events (stroke + myocardial infarction + fatal outcome).

RESULTS. There were no postoperative ipsilateral ischemic strokes, myocardial infarctions, or deaths in the study group (92 patients). In the overall group of patients (n = 92), the incidence of any postoperative stroke was 2.2% (2 patients): one hemorrhagic stroke on the side of carotid endarterectomy (group 3) and one contralateral ischemic stroke on the first postoperative day in a patient with bilateral critical stenosis of the internal carotid artery (group 1). Postoperative wound hematoma, which required revision and bleeding arrest in the early postoperative period, developed in one (1.1%) patient in Group 1. The overall incidence of major adverse cardiovascular events was 2.2% or 2 patients. In all three groups, a statistically significant and positive effect in regression of the initial neurological deficit was obtained at discharge. In patients operated in the first week after stroke, the neurological deficit at discharge according to the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale was the lowest. In general, 31.3%, 17.9% and 12.5% of patients in groups 1, 2 and 3 were discharged without neurological deficit (0 points according to the NIHSS scale), respectively.

CONCLUSIONS. Carotid endarterectomy performed in the acute period of ischemic stroke is a safe surgical intervention in the prevention of recurrent ipsilateral ischemic events. The most positive neurological dynamics and the least neurological deficit at discharge were achieved after operations performed in the first week of ischemic stroke.

AIM OF STUDY. To study the outcomes, complications and risk factors of CEA surgery in patients after thrombolytic therapy.

MATERIAL AND METHODS. The results of treatment of patients after carotid endarterectomy in the acute period of ischemic acute cerebrovascular accident after thrombolytic therapy were assessed. The group of patients operated on with thrombolytic therapy included 43 patients (29 women and 14 men). The average age of the operated patients was 64±8.9 years. In 24 patients, the stroke was localized in the blood supply of the left middle cerebral artery, in 19 — in the right. A group of patients (n=50) with similar clinical characteristics was selected as a comparison group.

RESULTS. Adverse events occurred in only two patients (4.6%) in the thrombolytic therapy group. One complication required active surgical tactics, the formation of a significant hematoma in the area of surgical intervention. No adverse events were noted in the control group. There were no lethal outcomes in both groups. There were no significant differences in long-term survival rates between groups (p>0.05).

DISCUSSION. Numerous researchers have come to the conclusion that by observing clear criteria for selecting patients for surgical treatment, it is possible to minimize complications associated with the use of thrombolytic drugs in the preoperative period. Our study confirms these conclusions. Patients with previously performed thrombolytic therapy for stroke are in a group of special attention and require close monitoring in the short and long term.

CONCLUSION. Carotid endarterectomy in the acute period of stroke during thrombolytic therapy is not associated with an increased risk of postoperative complications and does not compromise long-term treatment results. Further large studies are needed to clarify the results obtained.

Endovascular thrombectomy (ET) effectively and safely recanalizes the occluded artery and restores the ischemic area in patients with acute ischemic stroke (IS), improving the clinical prognosis of stroke in the anterior and posterior circulation system, expanding the time therapeutic window from no more than 6 to 24 hours, greatly increasing the chances of functional independence and survival. However, some patients develop an unfavorable postoperative outcome, complications and “ineffectiveness” of revascularization. The thrombectomy result depends not only on the patient selection criteria, timing and success of the procedure, but on many other factors as well. Despite the advances in stroke treatment, the issues of neuroimaging and patient selection for ET remain relevant; the pathophysiological mechanisms of the influence of some factors on the effectiveness of the procedure are not completely clear; the causes of “uneffective” revascularization, unfavorable outcome and mortality after ET are unclear. An analysis of global experience in treating ischemic stroke with ET showed the heterogeneity of the patient selection criteria, clinical and neuroimaging variables, prognostic factors and treatment outcomes, which makes it difficult to draw a general conclusion and requires further targeted research. The article discusses the issues of patient selection, pathophysiological mechanisms of the influence of some risk factors on the outcome of ischemic stroke and the causes of unfavorable outcome and death after ET.

This article discusses the problem of underuse, low availability of modern imaging techniques such as magnetic resonance imaging of the heart (MRI). This technique is characterized by high accuracy and uniqueness in the diagnosis of myocardial lesions of various genesis. The widespread introduction of this technique in emergency cardiology departments can improve the accuracy of diagnosis and the effectiveness of patient therapy. Despite the high costs of implementation and current use, modern diagnostic methods can save healthcare resources by reducing hospital stays and improving treatment outcomes.

Anaphylaxis is an acute allergic reaction with rapid clinical development and risk of death. This article provides an analysis of literary sources devoted to intensive care of anaphylaxis in childhood. It was revealed that the prevalence of anaphylaxis is increasing, in children and adolescents as well. The main triggers of anaphylaxis in pediatric practice include food products, insect bites and drugs. Anaphylaxis is an IgE-mediated hypersensitivity reaction of type 1, characterized by the release of chemical mediators that lead to smooth muscle contraction, increased permeability and vasodilation and vagal activation. Clinically, anaphylaxis is manifested by allergic skin rash, angioedema, obstruction of the upper respiratory tract (URT), broncho-obstructive syndrome (BOS), arterial hypotension, tachycardia. Intensive care for anaphylaxis in children begins with stabilization of the condition: stopping the entry of a possible allergen into the body, hospitalization in the anesthesiology and intensive care unit, restoring patency of the URT, conducting oxygen therapy, monitoring vital functions. The first-line drug for the treatment of anaphylaxis in children is adrenaline at a dose of 0.01 mg/kg, which stops all the main pathophysiological links of anaphylaxis. Adrenaline autoinjectors are not used in the Russian Federation. Second-line drugs for intensive care for anaphylaxis in children include glucocorticosteroids (GCS), antihistamines, bronchodilators and infusion therapy. The effectiveness of GCS in anaphylaxis in children has not been proven, antihistamines can relieve skin manifestations of an allergic reaction, but do not affect vital disorders. Bronchodilators reduce BOS and are an additional treatment, while infusion therapy eliminates hypovolemia. Knowledge and timely implementation of modern care algorithms for anaphylaxis in children and adolescents will improve the quality of emergency care and reduce the risk of fatal outcomes in this pathology.

The basis of the pathogenesis of burn disease is a systemic inflammatory response syndrome with episodes of bacteremia and the development of sepsis. An analysis of the literature showed that the existing clinical diagnostic scales for sepsis do not allow a confident diagnosis. The interest in changes in the concentration of procalcitonin in the blood serum is justified by the fact that this prohormone is one of the proinflammatory mediators, the concentration of which quickly increases during local and systemic bacterial and fungal infections. It seems important to consider the possibilities of various scales for determining the criteria for sepsis, analyze the values of procalcitonin and its monitoring for more effective diagnosis and procalcitonin-controlled antibiotic therapy in patients with burns.

CONCLUSION. The problem of clinical diagnosis of sepsis in patients with burns has not yet been solved. Procalcitonin is an effective biomarker of bacterial infection, and its monitoring reflects the dynamics of the burn disease, predicts the outcome, indicates the effectiveness of antibiotic therapy and allows for its correction.

Reversible cerebral vasoconstriction syndrome (RCVS) is a collective term used to describe pathological conditions with a similar clinical and radiological picture which is characterized by thunderclap headaches with a sudden onset and reversible segmental (multifocal) constriction of the cerebral arteries. The article is devoted to issues of terminology, genetic and clinical features of RSCV, and also discusses risk factors, differential diagnosis, complications and prognosis. Modern pathogenetic mechanisms and possible approaches to the treatment of this condition are presented.

Unmanned aerial vehicles are an important force in search and rescue operations. They help reduce the time needed to search for and provide assistance to the wounded, sick and injured who are located at a large territorial distance and in hard-to-reach places. With the help of computer “vision” and sensors such as noise sensing, binary sensing, vibration and thermal sensing, drones are able to search for living patients not only in the sea, high in the mountains and in mines, but also buried under the rubble of buildings and structures. Such devices demonstrate advantages in emergency and urgent delivery of medical resuscitation and other medical equipment, medicines, blood products and organs for transplantation to patients, especially those in remote locations. With the help of drones, it is possible to effectively sort patients in case of mass sanitary losses, carry out disinfection and remotely monitor the health status of patients with highly contagious infectious diseases and other pathological conditions, as well as reduce the time for providing other medical and humanitarian services to the population. It is obvious that the use of drones requires further study of their promising capabilities, especially in the actual conditions of emergency medical services.

RELEVANCE. We present the results of preclinical testing of an upgraded portable AR­1 gas flow analyzer produced by JSC Krasnogvardeets (Saint Petersburg) in order to create import-substituting technologies and develop practical and scientific spheres of healthcare.

THE AIM OF THE STUDY. was to substantiate the possibility of clinical use of the upgraded device, originally intended for testing ventilators and inhalation anesthesia devices, as a monitor of the external respiration apparatus function.

MATERIAL AND METHODS. The preclinical study of the upgraded gas flow analyzer was conducted at the V.A. Almazov National Medical Research Center in comparison with devices for conventional (Bellavista 950, Berner Ross Medical, Russia) and high-frequency (IPV-2C, Intrapulmonary Percussive Ventilation, Percussionaire Corporation, USA) mechanical ventilation in volume- and pressure-controlled modes using an artificial lung. The following reflected spirometry parameters were compared: tidal and minute volume under inhalation and exhalation, respiratory rate, maximum and minimum flows, peak and positive end expiratory pressure, fraction of inspired oxygen.

RESULTS. A high accuracy of parameter matching shown by the gas flow analyzer and ventilators was demonstrated.

CONCLUSION. The upgraded model of the gas flow analyzer can be used clinically as a portable spirometer at the prehospital and hospital stages.

AIM OF THE STUDY. Was to improve the outcomes of treatment of patients with COVID-19-related acute abdominal pathology by developing and implementing an algorithm for the diagnosis and treatment of those patients.

MATERIAL AND METHODS. The study involved 200 patients who were randomized into two groups. This research was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology that developed against the background of COVID-19. All medical histories in emergency departments and centers of the Republic of Uzbekistan were analyzed in the period from the beginning of the declaration of the pandemic (March 2020) to July 2022 inclusive.

RESULTS. In the context of an infectious disease pandemic (COVID–19 as an example), it is very important to develop an algorithm for managing patients with acute surgical pathology. This algorithm should include a diagnostic component with the purpose of timely diagnosis of acute surgical pathology and hospitalization in the surgical department. The next step is to identify patients with a high risk of perioperative complications and adverse outcomes. The final component of the algorithm is the correction of possible risk factors for adverse outcomes.

CONCLUSION. The duration of hospitalization of patients who underwent surgery for acute abdominal pathology was significantly longer during the pandemic compared to that of in the post-pandemic period (10.35±7.01 vs. 5.83±3.85 days, p<0.001), which may be due to both changes in the structure of the pathology and a larger number of complicated forms. The application of the developed algorithm will optimize the management of patients with COVID-19-related acute surgical pathology, guarantee rapid decision-making while minimizing the risk of infection, reduce the risk of complications and adverse outcomes.

Laparoscopic transabdominal, preperitoneal hernioplasty for inguinal hernia using a synthetic mesh prosthesis is the most common operation in modern surgical practice. Given the minimally invasive approach, infectious complications are rare. Despite the rarity of infectious complications, their development requires additional use of medications, long-term use of antibiotics, repeated traumatic surgical interventions, which leads to prolonged pain syndrome, hernia recurrence and is accompanied by a serious deterioration in the mental and physical condition of patients. Ultrasound and computed tomography with contrast are quite informative research methods for diagnosing abscesses associated with the implantation of a synthetic mesh prosthesis. In this article, we consider a clinical observation: a 36-year-old man with an abscess in the area of a synthetic mesh prosthesis after laparoscopic prosthetic preperitoneal hernioplasty on the right for inguinal hernia 4 months after the initial operation. The infectious process spread from the area of the infected prosthesis into the abdominal cavity, was limited by internal organs with the formation of an abscess. The resulting complication was treated by laparoscopic access. The purpose of our article is to draw the attention of surgeons to the possibility of a rare infectious complication in the area of the synthetic mesh prosthesis after right laparoscopic preperitoneal hernioplasty for inguinal hernia 4 months after the initial operation, after which the infectious process may spread from the area of the infected prosthesis into the abdominal cavity. The emphasis is placed on the difficulties of preoperative diagnosis of the complication and its surgical correction by laparoscopic access.

One of the variants of clinical manifestation of Meckel’s diverticulum in pediatric patients is intestinal intussusception. In this case, the surgical intervention option may be laparoscopic disinvagination and resection of the diverticulum (if the clinic is equipped accordingly) or video-assisted surgery.

This article presents a clinical observation of the diagnosis and simultaneous treatment of Meckel’s diverticulitis complicated by small-colonic intussusception and necrosis of the ileum, secondary appendicitis in combination with bilateral inguinal hernia in a 5-year-old girl. The described observation demonstrates the features of the intraoperative picture and surgical treatment, and describes in detail the effective treatment tactics and the course of surgical intervention.

The described variant of simultaneous treatment of surgical diseases does not affect the course of the surgical period, and also made it possible to avoid repeated intervention (hernioplasty), reduced the anesthetic load (general anesthesia) and neutralized possible surgical stress.

When performing osteosynthesis for spinal instability after traumatic injury, diagnostic difficulties arise due to the migration of metal structure components to distant “atypical” anatomical areas, which is associated with the risk of neurological deficit and life-threatening conditions. This article presents a casuistic case of migration of a metal structure component through an iatrogenic opening in the occipital bone into the posterior cranial fossa in a patient who had previously undergone instrumental correction for comminuted fractures of the cervical vertebrae. It should be noted that there are no data on “spontaneous” perforation of the occipital bone by metal osteosynthesis elements in the domestic literature.