RELEVANCE The problem of choosing the optimal treatment method for patients with uncomplicated fractures of the thoracic and lumbar spine remains open.

AIM To present an analysis of the immediate outcomes of various surgical treatment methods: transpedicular fixation (open and percutaneous), spinal canal decompression, anterior and combined spinal fusion.

MATERIALS AND METHODS The study is based on a retrospective analysis of the data of 377 patients operated on in 2009-2022. The average age was 40.5. Radiological parameters (Cobb angle, vertebral height, degree of spinal canal stenosis), complications, duration of hospitalization, and clinical outcomes were evaluated.

RESEARCH RESULTS The results showed that transpedicular fixation (percutaneous or open) demonstrated minimal invasiveness, and reduced the duration of operations and hospitalization. Decompression of the spinal canal increased the degree of restoration of its lumen, but increased intraoperative blood loss and the duration of the intervention. Anterior access was effective for correcting kyphotic deformity; and combined operations were more often used for severe types of injuries. The overall complication rate was 15.5% including somatic and surgical complications. Serious complications were more often observed in complex interventions; and percutaneous fixation tended to decrease them. Improvement was achieved in 93.1% of patients at the time of discharge.

CONCLUSIONS The conclusions of the work indicate the need for an individual approach to the choice of surgical tactics based on the X-ray characteristics of the injury and the patient’s condition.

BACKGROUND Venous thromboembolic complications (VTEC) are an urgent problem of modern military medicine and require constant improvement of methods for their prediction, prevention, diagnosis and treatment.

AIM to study the incidence of VTEC in casualties with combat burn injury and evaluate the possibility of predicting their development.

MATERIAL AND METHODS An analysis of treatment outcomes of 47 casualties with combat burn injury in the period from 2022 to September 2024 was carried out. All the patients were men, average age 27.3±3.1 years. The average severity of injuries on the Injury Severity Score (ISS) scale was 12.4±1.7 points.

Depending on the severity of the injuries received, the casualties were divided into 2 groups. Group I included 21 (44.7%) wounded with ISS ≤6; group II included 26 (55.3%) with ISS>6.

For casualties of group I, pharmacoprophylaxis of VTEC was carried out only in 2 cases; mechanical types of prophylaxis were not used. All casualties of group II were prescribed anticoagulant therapy in preventive and therapeutic dosages, mechanoprophylaxis — in the absence of contraindications.

To identify significant prognostic signs of VTEC development, multiple regression analysis was used, and ROC analysis was used to assess the ability of independent prognostic factors.

RESULTS Combined thermomechanical injuries were diagnosed in 25 (53.2%) wounded, isolated burn injury — in 22 (46.8%). Deep burns were detected in 19 (40.4%), of which 5 (26.3%) were in group I, 14 (73.7%) were in group II (p<0.001); thermal inhalation injury — in 10 (38.5%) patients of group II. With ISS≤6 (group I), venous thrombosis did not develop; with ISS≤6 (group II), a significant increase in VTEC was noted to 42.3% (χ²=9.4; p<0.002). Pulmonary embolism (PE) was present in 1 (2.1%) wounded person of group II.

Multiple regression analysis showed that of all the studied signs, only the severity of injuries on the ISS scale turned out to be a reliable prognostic indicator of the development of VTEC (p=0.000085). The area under the ROC curve was 0.829.

CONCLUSION 1. The incidence of VTEC in casualties with combat burn injury is 23.4%, PE — 2.1%.

1. The number of points on the Injury Severity Score is a reliable predictor of the development of VTEC (p=0.000085) and, according to the results of ROC analysis, has a good predictive ability for assessing the likelihood of developing VTEC in combat burn injury.

ABSTRACT Preeclampsia with onset between 20 and 34 weeks is conditioned by the development of endothelial dysfunction caused by increased secretion of antiangiogenic factors, activation of the immune system, and the synthesis of inflammatory mediators. This complication is responsible for the progression of multiple organ failure in the mother, and more than 60,000 maternal deaths annually worldwide. The only method of therapy at present is early delivery. Such tactics lead to high neonatal morbidity and mortality.

AIM OF STUDY To evaluate the possibilities of safely prolonging pregnancy using therapeutic apheresis methods in the development of early-onset preeclampsia.

MATERIAL AND METHODS A prospective randomized study was conducted involving 58 patients diagnosed with early-onset severe preeclampsia. The patients were divided into three groups. The patients of the first group underwent 2 sessions of cascade plasma filtration with a total processed plasma volume of 4810 (3250; 5680) ml. In the second group, hemoperfusion was performed with a perfusion volume of 18,460 (16.890; 21.350) ml in two sessions. At the stages of the study, the dynamics of clinical and laboratory parameters of the mother and newborn were assessed in comparison with the control group.

The use of cascade plasma filtration statistically significantly reduced the sFlt-1/PIGF ratio (p=0.017), pregnancy was prolonged by 32.5 (5.5; 42.5) days, the gestational age at delivery was 34.1 (29.6; 36.0) weeks. When using hemoperfusion, the level of neutrophil extracellular traps decreased statistically significantly. Pregnancy was prolonged by 26.5 (8; 52) days, the patients gave birth at a gestational age of 34.3 (33.5; 36.8) weeks. In the control group, the duration of pregnancy prolongation was 5.5 (2;7) days, p<0.017 compared with other groups. In this group, progression of laboratory signs of multiple organ failure and deterioration of fetal blood flow were noted. Newborns from the control group showed a statistically significantly greater need for surfactant: OR 7.3 95%CI [1.81; 29.6], p=0.005. Resuscitation bed-day and treatment in the department of premature infants for newborns from the control group were 12.5 (8.5; 16.8) and 15 (7; 22) days, respectively, p<0.017 compared with other groups.

CONCLUSION The use of therapeutic apheresis techniques in patients with early-onset preeclampsia may allow for safe prolongation of pregnancy in the interests of the fetus, which requires further study.

BACKGROUND Endothelial dysfunction (ED), formed under the influence of risk factors (RF), is the leading link in the pathogenesis of cardiovascular diseases (CVD), sudden cardiac death (SCD). The study of SCD as a consistently progressive ED reveals the mechanisms of SCD formation, its prognosis and prevention.

AIM OF STUDY To determine the dynamics of ED progression under the influence of each predictor in the chain of events of the continuum of SCD using the example of a group of initially healthy 7,959 male workers of locomotive crews of the Transbaikal Railway aged 18–66 years.

MATERIAL AND METHODS Based on the data of a 6-year observation of a natural group of 7,959 men, predictors of microalbuminuria (MAU), creatininemia (CR), reduced glomerular filtration rate (rGFR), retinopathy (RP), and SCD were determined for 22 positions. A 2×2 table, survival analysis, and multivariate analysis were used, and the relative risk (RR) of RF was estimated, which made it possible to construct a chronic kidney disease (CKD) continuum from the prepared symptomatic blocks: MAU, RP, CR, rGFR using the synthesis method, to which the rGFR block was added according to this principle. In the Cox proportional hazard model, the hierarchical significance of predictors of SCD, CKD, and the increase in risk when adding predictors to the SCD continuum were determined. The Kaplan–Meier (K–M) curves determined the time of SCD, stages of ED, and the effect of damage to RF.

RESULTS The formation of SCD can occur from RFs from any point of the SCD continuum and depends on their set, proximity of the RF to the outcome, its impact and (or) interaction with other predictors. The most dangerous RF of SCD is excessive alcohol consumption (EAC), causing damage to the heart and (or) kidneys, forming a dysfunctional circle of re-entry SCD, forming cardiorenal syndrome (CRS) with the magnitude of damage to tissues of target organs in a sequential chain of SCD events: EAC→2,63%MAU15,24%↔100%RP58,12%↔27,10%CR100%↔100%rGFR27,36%↔3,31%SCD47,64%←EAC. All other risk factors for SCD and CKD also worsen the condition and bring the SCD closer.

CONCLUSION Further study of the continuum of sudden cardiac death is needed to determine whether cardiac or renal involvement is primary.

RELEVANCE Despite a sufficiently large number of works, spleen ruptures at closed abdominal traumas are among the most frequent pathology that a surgeon has to face in emergency surgery.

THE AIM OF STUDY To analyze the frequency of diagnostic errors in trauma centers of different levels and to outline the ways of their reduction.

MATERIAL AND METHODS The study presents the analysis of treatment of 360 victims with closed abdominal injuries accompanied by spleen rupture, who were treated in medical institutions of the Saratov region in the period from 2003 to 2023. The average age of the injured was 34 [28; 40] years. Medical care of the injured was provided in level I–III trauma centers. All patients were divided into two groups: A — assistance at the prehospital stage was provided by ambulance brigades and B — assistance was provided by non-medical workers.

RESULTS The conducted study shows that the number of diagnostic errors in closed spleen injuries depends on the level of the trauma center. The lowest number of diagnostic errors was observed in level I trauma centers, 5.8% of cases, whereas in level II trauma centers, 32.8% (r=0.86, p<0.05), and in level III trauma centers, 35.7% (r=0.88, p<0.05), i.e., the highest number of diagnostic errors. The reasons that led to the delay in surgical intervention for such injuries can be emphasized as follows: diagnostic errors — in 5.8% of observations in level I trauma centers, in 11.8% of cases in level II trauma centers (r=0.76, p<0.05) and in 35.7% of observations in level III trauma centers (r=0.84, p<0.05); medical errors were absent in level I trauma centers, in 7.8% of cases in level II trauma centers (r=0.67, p<0.05), and in 28.5% of observations in level III trauma centers (r=0.87, p<0.05); concealment of injury or difficulty in diagnosis due to alcohol intoxication — in level I trauma centers — in 2.7% of cases, in level II trauma centers — in 13.1% of observations (r=0.87, p<0.05), in level III trauma centers — none.

CONCLUSION The conducted study has shown that the prevalence of diagnostic errors in level III trauma centers might be the result of organizational problems and the lack of diagnostic equipment and/or the absence of a profile specialist who can perform additional diagnostic tests, especially at night.

INTRODUCTION The rapid development of endovascular surgery, vascular surgery, as well as the improvement of visualization methods leads to an increase in the incidence and number of operations on different parts of the aorta, in particular the aortic arch.

THE AIM of our study was to compare the results of different types of debrunching.

MATERIAL AND METHODS In the period from 2015 to 2023, 96 patients with aortic arch lesion were operated on using the endovascular method in several medical organizations. A multicenter retrospective comparative study was conducted among patients with endovascular (n=76) and open (n=20) debranching during thoracic aortic endoprosthetics (TAE). The average follow-up time for patients was 32±22 months. Carotid-subclavian bypass and fenestrated on-table and in-situ stent grafts were used for debranching. The following patient characteristics were used in the comparative analysis in the groups: mean age, body mass index, gender, comorbidity. Also, operational parameters: surgery time, blood loss volume, contrast, surgery urgency, number of endoleaks. Subsequently, the results of the operations were analyzed: the number of hospital days, complications, repeated interventions, mortality rates (in-hospital, long-term).

RESULTS Technical success in both groups was 100%. The operation time was statistically significantly shorter in the endovascular debranching group 173.3±83.8 minutes (p=0.0002), the volume of blood loss was statistically significantly lower in the endovascular debranching group 87.4±48.7 ml (p=0.0001), the consumption of contrast agent was statistically significantly higher in the endovascular debranching group 233.1±93.38 ml (p<0.0001), the endovascular debranching group had significantly more planned surgeries (p=0.0005), the number of endoleaks without statistically significant difference (p=0.67). Endovascular debranching statistically significantly reduces the time of hospitalization by 4.5 days p=< 0.0001. There was no statistically significant difference in the rates of complications and re-interventions (p=0.3294, p=0.1618, respectively). There was no statistically significant difference in the analysis of hospital and long-term mortality (p=0.11, p=0.65).

CONCLUSION Endovascular debranching reduces the time of surgery, the volume of blood loss, and the number of days spent in hospital. There are no statistically significant differences between the groups when analyzing endoleaks, repeated interventions, and complications. No statistically significant difference was found when analyzing mortality (in-hospital, long-term).

RELEVANCE The greatest technical difficulties in the surgical removal of foreign bodies after gunshot shrapnel wounds (GSW) of soft tissues arise when fragments are deeply located near large vessels, nerve trunks, and in the area of the tendon-ligamentous apparatus of the extremities. At the moment, there is practically no information about the possibilities of removing soft tissue fragments localized in areas with complex surgical anatomy using intraoperative ultrasound navigation (IUN).

AIM OF THE STUDY To evaluate the effectiveness of the use of IUN in the removal of soft tissue foreign bodies localized in areas with complex surgical anatomy after GSW.

MATERIAL AND METHODS A comparative analysis of the outcomes of surgical treatment of 74 patients with GSW of soft tissues, in whom foreign bodies were localized in hard-to-reach anatomical zones near large vessels, nerve trunks, as well as in the thickness of the tendon-ligamentous apparatus of the extremities, was carried out. In 26 patients (group 1), foreign bodies were removed by a conventional surgical method. In 5 patients, a C-Arm X-ray machine was additionally used during the conventional procedure. In 48 patients (group 2), foreign bodies were removed using IUN.

RESULTS In 19.2% of group 1 patients, during the conventional surgical intervention, it was not possible to visualize and remove the foreign body. When removing soft tissue foreign bodies under conditions of additional use of X–ray scanning, we noted damage to large nerve trunks in 3 cases, and the intersection of tendons in various limb segments in 1 case. In 38.5% of patients, the operation was performed under anesthesia. The average length of the incision to remove the fragment was 18 cm (14; 21). The average duration of surgery was 150 minutes (90; 210). In group 1, 5 (19.2%) patients developed postoperative wound infectious complications. The average length of hospital stay was 10 days (7; 18). In patients of group 2, the use of IUN made it possible to clearly visualize the foreign body in soft tissues and nearby anatomically important structures, which ensured the safe performance of closed surgical manipulations in the wound during fragment extraction. In those patients, the operation was performed under local anesthesia. A positive result of the intervention (removal of the foreign body) was achieved in all the cases. The average length of the surgical incision was 1.5 cm (0.9; 2.1). The average duration of the intervention is 18 minutes (11; 24). In the 2-nd group of patients, there were no wound infectious complications in the postoperative period. The average length of hospital stay was 4 days (3; 5).

CONCLUSION The use of IUN in the removal of soft tissue foreign bodies localized in hard-to-reach and “dangerous” anatomical areas can significantly increase the effectiveness of surgical treatment of patients with GSW due to clear visualization of all stages of fragment extraction, optimization of surgical access and surgical technique, which significantly reduces the degree of surgical trauma and shortens the duration of surgery.

INTRODUCTION Acute poisoning (AP) of chemical etiology is one of the leading problems, including among the elderly and senile population. Traditional approaches to the treatment of AP, including the use of antidotes, infusion therapy and extracorporeal detoxification methods, may not always be effective in elderly patients due to the characteristics of their body. In this regard, the search for safe and effective treatment methods adapted to the characteristics of the body of elderly people is becoming a priority.

AIM OF STUDY To evaluate the effectiveness of the enteral correction program (ECP) in elderly and senile individuals with AP with psychopharmacological drugs (PPD) and corrosive substances (CS).

MATERIAL AND METHODS A prospective clinical study with a retrospective comparison group, which included 74 elderly and senile patients who were treated in the Department of Occupational Health and Somatopsychiatric Disorders at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2022–2023. Patients in the study group received ECP as part of the complex treatment, while in the comparison group they received standard treatment. The endpoints were: incidence of complications, incidence of death, length of stay in intensive care, and length of hospital treatment.

RESULTS The use of ECP contributed to a 1.6-fold reduction in the duration of treatment in the intensive care unit and hospital for acute poisoning with PPD (p=0.043, statistically significant) and for acute poisoning with CS (p=0.028, statistically significant). When using intestinal lavage as part of ECP, a 10% reduction in the incidence of pneumonia was found for AP PPD and 11.8% reduction for CS poisoning. The use of ECP in complex treatment resulted in a 2.1-fold reduction in mortality for PPD poisoning and a 1.7-fold reduction for CS poisoning.

CONCLUSION Inclusion of the enteral correction program to treatment of acute poisoning with psychopharmacological drugs and corrosive substances in people over 60 years of age leads to improvement of treatment efficacy criteria. However, further studies are required to confirm the findings and determine optimal treatment protocols for this category of patients.

RELEVANCE One of the urgent issues in the complex treatment of patients with traumatic spinal cord disease is the treatment of pressure wounds. Despite the large number of suggested and applied methods, the results of surgical closure of pressure wounds remain unsatisfactory. The risks of developing purulent-septic wound complications and local circulatory disorders after surgery are high. The correct choice of the method of plastic surgery of bedsores can be made on the basis of a thorough analysis of the advantages and disadvantages of the main surgical methods.

AIM OF THE STUDY To study the spectrum of complications after the use of various types of pressure ulcer plastic surgery in patients with traumatic spinal cord disease and to determine, based on the data obtained, the indications for their implementation.

MATERIAL AND METHODS An analysis of surgical treatment of 151 patients was conducted, who underwent 215 planned surgeries for bedsores of various localizations. The surgical treatment included: plastic surgery using local skin-fat, skin-fascial and skin-muscle flaps. The frequency and spectrum of complications characteristic of each type of plastic surgery were analyzed.

RESULTS Among all operated patients, the most frequent complications in the postoperative period were: partial or complete suture failure, wound infection, flap ischemia, lymphorrhea. In total, wound process complications were recorded in 39 cases (18%) out of 215 reconstructive plastic surgeries performed.

The frequency of ischemic and infectious complications leading to complete or partial loss of flaps after the use of cutaneous-fascial flaps was 4.1%. In patients operated using skin-fat and skin-muscle flaps, relapses did not develop.

CONCLUSION The method of choice for treating patients with extensive bedsores is reconstructive plastic surgery, which is based on the formation of skin-fat, rotational skin-fascial flaps with the provision of principles of tension-free plastics. At the same time, the issue of complications such as suture failure, wound infection, flap ischemia and lymphorrhea remains unresolved, which requires further scientific and practical research.

AIM OF THE STUDY Evaluation of the results of prophylactic transarterial embolization after primary endoscopic hemostasis among patients with a high risk of rebleeding.

MATERIAL AND METHODS This is a prospective study. In the period from 2019 to 2023, a total of 118 patients with acute gastroduodenal bleeding (AGDB), classified as Forrest type IA , IB and IIA on the Rockall scale of at least 5, sought medical assistance. Among them 87 (73.7%) were men and 31 (26.3%), were women (p<0.01). The age of the patients ranged from 21 to 81 years, while the average age was 49.8±18.5 years.

RESULTS Of the 118 patients with AGDB, 45 (38.1%) had a high risk of rebleeding after endoscopic hemostasis. Of this group, 28 patients (23.7%) underwent preventive transarterial embolization and 90 patients (76.3%) underwent endoscopic hemostasis. A significantly lower rebleeding rate was observed in the preventive transarterial group embolization (3.6% versus 13.3%) — in the endoscopic hemostasis group (p=0.005). The need for surgical intervention reached 3.6% versus 4.4% in the preventive transarterial embolization and endoscopic hemostasis, respectively (p=0.068). Patients who underwent preventive transarterial embolization, required less fresh frozen plasma, 1.3 units versus 2.6 units with endoscopic hemostasis (p=0.001). The mortality rate was similar in the groups with a tendency to decrease in the preventive transarterial embolization: 3.6% versus 4.4% endoscopic hemostasis (p=0.418).

CONCLUSION Prophylactic transarterial embolization is a feasible and safe procedure that may help reduce the incidence of rebleeding and the need for surgical intervention in patients with acute gastroduodenal bleeding when the risk of rebleeding remains high after primary endoscopic hemostasis.

INTRODUCTION In patients with cranial vault defects autologous cranioplasty with the bone flap is often accompanied by flap lysis. Bio-conductive factors, including additional biological structures and drugs, can be used to stimulate osteogenesis and integration of the bone flap.

THE AIM OF THE STUDY To evaluate the safety of using a modified autologous cranial graft combined with bone-plastic material (BPM) and autologous platelets´ preparations, as well as the dynamics of cranial vault reconstruction in patients with delayed cranioplasty.

MATERIAL AND METHODS 7 patients, aged from 32 to 69 years, with diagnoses involving delayed cranioplasty were examined and treated. To increase the bioconductive properties, the bone flap was perforated, saturated with 0,8% allogeneic solution of human type 1 collagen, lyophilized, sterilized with ionizing radiation and stored at 20–22°C. The diastasis region was filled with allogeneic BPM, consisted of 0,8% human type 1 collagen and bone chips. Autologous platelet lysate was used to stimulate the revitalization of the cranial graft. The assessment of reparative processes was performed by multispiral computed tomography (CT) and three-phase osteoscintigraphy after 6, 12 and 18–24 months.

RESULTS In all the patients, the postoperative period was uneventful. Edges of the bone flap maintained their stability during all time of observation. In 6 of 7 patients the appearance of bone bridges was observed after 6 months, which led to formation of consolidation sites within 12–24 months. The X-ray density of the bone flap decreased slightly after 12 months without pronounced signs of flap lysis. In the postoperative period, steady decrease in the size of diastasis was noted from 2,0 (2,0; 3,1) mm to 0,9 (0,8; 1,5) mm after 18–24 months. Three-phase scintigraphy showed intensification of blood flow in the bone flap after 6–12 months, which was normalized by 12–24 months. Thus, active repair and regeneration of bone tissue in the area of diastasis began after 6–12 months and lasted for 18–24 months, followed by stabilization of the bone flap.

CONCLUSION The use of autologous cranial graft in combination with allogeneic bone-plastic material and platelet preparations was safe for delayed cranioplasty. Within 24 months after surgery, high preservation of the bone flap is observed, followed by gradual regeneration and consolidation of the bone in the diastasis area, which could be observed by CT and three-phase scintigraphy.

AIM OF STUDY Evaluation of the use of the nutritional mixture Nutriset D in the nutritional support program for patients with acute respiratory distress syndrome according to the results of monitoring indicators of nutritional status, gas exchange, organ disorders, carbohydrate metabolism and criteria for tolerance of the enteral nutrition.

MATERIAL AND METHODS The study involved 10 patients with acute respiratory distress syndrome. Energy consumption, plasma albumin, glucose and absolute lymphocyte counts, and the severity of multiple organ failure were determined. Statistical analysis was performed.

RESULTS Positive dynamics of energy consumption, oxygenation index, plasma albumin content, absolute lymphocyte count, glucose, as well as a decrease in multiple organ failure were revealed.

CONCLUSION 1. The use of Nutriset D mixture in patients with acute respiratory distress syndrome contributed to a decrease in energy consumption, an increase in the blood albumin and the absolute number of lymphocytes. 2. The use of Nutriset D mixture in patients with acute respiratory distress syndrome contributed to a decrease in the severity of organ failure and gas exchange disorders. 3. Administration of Nutriset D mixture to patients with acute respiratory distress syndrome did not cause bloating or discharge of the administered mixture through the tube, which indicated its complementary tolerance, absorption and digestibility.

BACKGROUND Compliance with medical recommendations and adherence to cardiac rehabilitation remains one of the pressing problems in helping patients who have suffered a myocardial infarction (MI). Additional difficulties include insufficient research in this area and limited tools. One possible solution may be a qualitative method such as a semi-structured McGill Illness Narrative Interview to describe the disease.

AIM OF THE STUDY to identify factors influencing adherence to cardiac rehabilitation.

MATERIAL AND METHODS The study was conducted at the Federal State Budgetary Institution E.I. Chazov National Medical Research Center of Cardiology from April to August 2023. The sample included 17 people (14 men, 3 women) aged 36 to 62 years, the average age was 51 years. Of these, 7 people were admitted directly by ambulance to the cardiology center at the time of myocardial infarction (3–7 days ago), 10 people underwent treatment for the cardiovascular system in various departments of the cardiology center and had myocardial infarction in the past (from 2 months to 3 years ago). Each respondent was interviewed once, in an individual format, mainly in the cardiac rehabilitation department, in the office of a medical psychologist.

RESULTS AND CONCLUSIONS Insufficient awareness of the signs and possibilities of first aid for myocardial infarction was found among the target group. It is advisable to allocate additional consultations to increase awareness of cardiac rehabilitation, strengthen motivation and draw up a plan for independent patient actions. Involvement of people close to the patient in the cardiac rehabilitation process can have a positive impact on achieving the desired changes.

CONCLUSION The use of qualitative research methods allowed additional factors that influence poor adherence to cardiac rehabilitation to be identified. The data obtained can be used by cardiologists, medical psychologists, and other members of the medical team to improve the quality of interaction and motivate patients to change.

Dilated cardiomyopathy (DCM) is the second most common cause of chronic heart failure, and a leading indication for heart transplantation. In the early stages of the disease, many patients are asymptomatic, but they have a high risk of developing life-threatening ventricular arrhythmias (VA) and sudden cardiac death (SCD). Modern methods of DCM diagnosis, such as MRI of the heart, speckle tracking and 3D echocardiography, have convincingly proved the development of structural and functional changes of the right heart (RH) in patients with DCM, their prognostic and therapeutic significance. By MRI of the heart, myocardial fibrosis (MF) is diagnosed, which occurs in the early stages of DCM. Progressive fibrosis is observed in one fifth of patients and is associated with a more than a 3-fold increase in the risk of death and complications of chronic heart failure (CHF). With adequate pharmacological and hardware treatment, reverse heart remodeling occurs in some patients. However, optimal and long-term drug therapy does not lead to MF regression even in individuals with improved left ventricular (LV) function. Remodeling of the RH, regardless of LV ejection fraction (EF), is a predictor of SCD, indicates the progression of the disease, foreshadowing an unfavorable outcome. The prevalence of RH remodeling has not been reliably determined; however, systolic dysfunction of the right ventricle was registered in 34-65% of patients with DCM. The annual and subsequent mortality of patients with DCM remains high.MRI of the heart with contrast enhancement has become the gold standard for the diagnosis of DCM and crucial for the stratification of risk and prognosis of the disease. The treatment of patients with DCM is a complex process. Adequate drug and instrumental therapy in 40% of cases leads to reverse remodeling of the heart, which may be unstable.

Cardioplegia is an integral and important method of myocardial protection in patients of all ages requiring cardiac surgery in which cardiac arrest is necessary. Numerous solutions and delivery methods have been developed. Del Nido solution has been used for 30 years at Boston Children’s Hospital. It is a unique solution consisting of four parts crystalloid and one part whole blood that is typically used in a single dose. Although the drug was originally developed for use in pediatrics and infants, its use in adult cardiac surgery has recently been expanding.

For decades, imaging of the lymphatic system was limited to lymphoscintigraphy and transvascular lymphangiography with X-ray. These methods do not provide information on the state of the central large lymphatic collectors and vessels. Obtaining images of the central link of the lymphatic pathways using radiographic examination has become possible due to the introduction of a contrast agent through a lymphatic vessel in the foot. The pronounced variant anatomy of the distal lymphatic bed and the technical difficulties in isolating such a vessel in a surgical wound make it difficult to perform these methods.

Intranodal contrast injection combined with magnetic resonance imaging (MRI) has led to the development of dynamic contrast-enhanced MR lymphangiography, which provides exceptional imaging capabilities for the central lymphatic system.

Due to the physical properties, primarily the viscosity of the oil-based contrast agent, visualization of the central lymphatic system may be inadequate without MRI. The issue of developing a reliable method for delivering the drug to the lymphatic system also remains relevant, which requires a surgical approach to the task. The role of lymphangiography as a diagnostic and therapeutic method has not yet been determined. A large number of patients with chylothorax and chyloperitoneum (up to 4% in thoracic interventions) of both iatrogenic and idiopathic etiology (up to 14%) make lymphangiography a promising method in treatment and diagnosis for the purpose of planning access and volume of surgery when conservative treatment is ineffective.

BACKGROUND The key link in saving the life of the victim is the provision of first aid at the scene of the incident by random bystander. In order to plan measures aimed at increasing the effectiveness of first aid and reducing the mortality of victims, a clear understanding of the degree of readiness of the population to provide first aid and the factors that determine it is required.

AIM OF THE STUDY To determine the level of willingness of the population to provide first aid, the factors that determine it and ways to increase the population’s readiness to provide it.

MATERIAL AND METHODS In January–June 2023, a survey of workers in the fuel and energy complex of the Republic of Belarus was conducted using the developed questionnaire “Willingness to Provide First Aid”. Respondents’ participation in the survey was anonymous and voluntary. The questionnaire contained two blocks of questions: the first was thematic, the second was socio-demographic, with characteristics of the respondents. Statistical analysis was performed using the program IBM SPSS Statistics 26.0 (IBM Corporation , USA) using nonparametric statistics methods. To quantitatively describe the results of the regression analysis, odds ratio (OR) and 95% confidence interval (95% CI) were used.

RESULTS The study involved 894 respondents without medical education. 24.9% were trained in first aid skills, 9.1% studied independently. 4.2% participated in providing first aid (carrying out cardiopulmonary resuscitation, CPR) to the victim in real conditions. 16.6% of respondents showed a high degree of readiness to provide first aid, 50.7% — average, 32.7% — low. Statistically significant predictors of high readiness to provide first aid to a victim in critical condition are: male gender (OR: 2.9; 95% CI: [1.1–7.4]; p=0.025), previous experience (OR: 2.2; 95% CI: [1.4–3.4]; p=0.000) or independent training (OR: 2.1; 95% CI: [1.1–3.9]; p=0.024) and participation in providing first aid (performing CPR) to a victim in real conditions (OR: 5.5; 95% CI: [2.6–11.6]; p=0.000). The main barriers to providing first aid to a victim in critical condition are: fear of causing irreparable harm to the victim and lack of knowledge and skills in providing first aid.

CONCLUSION The study proved that the respondents’ readiness to provide first aid directly depends on its psychological and practical components. Promising areas for optimizing the existing training system may include: increasing the motivation of the population, unifying training, and creating a national electronic database for posting information materials.

RELEVANCE At present, despite the dynamic progress in urgent abdominal surgery, based on the introduction of advances in medical technology and, as a consequence, the development of non-invasive and minimally invasive diagnostic and treatment technologies, the problem of diagnosis and treatment of the catarrhal form of acute appendicitis (acutis appendicitis forma catarrhalis) remains relevant.

THE AIM was to improve the outcomes of endovideolaparoscopic appendectomy by optimizing the differentiation of pathomorphological forms of acute appendicitis based on the results of non-invasive and minimally invasive diagnostic and treatment methods.

MATERIAL AND METHODS In the surgical department of the Al-Mozn Medical Complex (Arab Republic of Libya), 182 patients underwent appendectomy using endovideolaparoscopic technology from 2019 to 2024. This work is based on the analysis of 128 patients who underwent appendectomy using endovideolaparoscopic technology; in 54 (29.7%) patients out of 182, the surgical technique had distinctive features that were the subject of further research.

24 patients with different abdominal surgical pathology, surgical correction of which was possible using endovideolaparoscopic access, were examined to assess the non-inflamed appendix (according to ultrasound and endovideolaparoscopy) as a comparison group.

RESULTS 22 (17.2%) patients were diagnosed with the catarrhal form (acutis appendicitis forma catarrhalis), 89 (69.5%) with the phlegmonous form (acutus appendicitis forma phlegmonous), and 17 (13.3%) with the gangrenous form (acutus appendicitis forma gangreno). A total of 128 (100%) patients.

CONCLUSIONS Inconsistency of symptoms in the group of patients with acute catarrhal appendicitis complicates primary clinical diagnosis. The results of non-invasive diagnostic methods showed that the sensitivity of ultrasound was 87.6%; however, this method of research is ineffective in identifying the catarrhal form. The degree of effectiveness of ultrasound is directly proportional to the destructive changes in the appendix. The diagnostic accuracy of endovideolaparoscopy is 96%. This diagnostic method is effective and preferable in diagnosing the catarrhal form.

The article describes rare cases of endoscopic treatment of esophageal-bronchial fistulas in patients with severe comorbid pathology. The transesophageal tunnel technique with intra-tunnel fistula disconnection and subsequent hermetic clipping of esophageal mucosal defects was used to treat patients.

Critical coronary stenosis involving the trunk of the left coronary artery (LCA) is one of the most severe factors of coronary artery disease, especially in cases of acute myocardial infarction. The lesion of the LCA trunk, often detected by coronary angiography, is the reason for the refusal of stenting due to the high risk of life-threatening complications, especially in cases of so-called “unprotected” stem lesion (in the presence of occlusion of the right coronary artery). In this case, an emergency operation of direct myocardial revascularization using the coronary artery bypass grafting is preferable. However, in the absence of the possibility of emergency coronary artery bypass grafting and/or prohibitive risks of its performance, percutaneous coronary intervention (PCI) under extracorporeal membrane oxygenation (ECMO) may become the method of choice for the treatment of acute myocardial infarction in this category of patients.

This article presents two successful clinical cases of stenting of left coronary artery trunk stenosis (one of which is unprotected) with a transition to the anterior interventricular artery (AIVA) under veno-arterial ECMO in patients with acute myocardial infarction.

We present the data of two patients: a 92-year-old patient with recurrent myocardial infarction, LCA trunk stenosis up to 75%, AIVA stenosis from the mouth to 95%, and chronic occlusion of the RCA, and a 64-year-old patient with acute myocardial infarction, stenosis in the terminal segment of the left coronary artery by 90% with transition to the mouth of the left circumflex coronary artery and the AIVA.

The early postoperative period in both patients was uneventful, and the first six months of follow-up were favorable. Stenting of critical lesions of the LCA trunk in patients with acute myocardial infarction to reduce the risk of intraand postoperative complications can be effectively and safely performed in conditions of auxiliary veno-arterial ECMO (VA ECMO).

Bleeding continues to be an urgent problem of emergency medicine, posing a threat to the patient’s life. Generally accepted methods of stopping bleeding are for the most part highly effective, but there are unusual clinical cases where these methods are ineffective. The widespread introduction of angiographic devices in multidisciplinary hospitals has created opportunities for the use of endovascular methods of temporary and final bleeding arrest. The article provides a brief literature review and description of clinical cases of endovascular bleeding arrest.

The article is devoted to a very important issue such as the development of complications in surgical procedures where various implantable materials are used. The authors provide cases from foreign literature and rather unique observations from their own practice. In the conditions of inpatient surgical and urological departments using video endoscopy, ultrasound, tomography, the authors diagnosed complications, performed various surgical manipulations for the purpose of diagnosis and treatment. The main lesson from the observations: such complications are possible, we must learn to avoid them and look for replacement implants with a lower rejection reaction.

RELEVANCE Pleural angiosarcoma is a rare type of malignant tumors. The diagnosis of primary pleural angiosarcoma is extremely difficult and is based on the results of immunohistochemical examination of tumor biopsies. The etiology and treatment methods of this disease have been poorly studied.

AIM Demonstration of a rare case of pleural angiosarcoma as a cause of bilateral spontaneous hemothorax.

CONCLUSION Primary epithelioid pleural angiosarcoma is a rare tumor with a high degree of malignancy and an unfavorable prognosis, which does not have pathognomonic symptoms. Spontaneous hemothorax may be the only primary clinical manifestation of the disease. Diagnostic thoracoscopy with pleural biopsy performed at an early stage to clarify the cause of hemothorax allows morphological verification of the tumor structure, which can affect the outcome of the disease in case of timely treatment.