Introduction. Non-traumatic subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysms remains one of the most severe forms of acute cerebrovascular disease with a high risk of delayed cerebral ischemia. One of the key pathogenetic mechanisms in this pathology is severe impairment of endogenous regulation of vascular tone and the development of oxidative stress. Inhaled nitric oxide therapy is considered a potential method for modulating vascular tone and reducing the risk of vasospasm.

The aim of the study. Was to evaluate the effect of inhaled nitric oxide therapy on the severity of oxidative stress and endogenous factors involved in regulation of vascular tone in patients with acute non-traumatic SAH due to ruptured cerebral aneurysms.

Materials and methods. The study included 57 patients with acute SAH hospitalized at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 2020 and 2025. The study group consisted of 25 patients receiving inhaled nitric oxide therapy (50–80 ppm, 3–24 hours per day, 4–7 days postoperatively); the comparison group consisted of 32 patients without this therapy. Inclusion criteria: massive basal hemorrhage, aneurysm clipping within the first 72 hours, and Hunt-Hess stage II–IV. Levels of malondialdehyde (MDA), total antioxidant activity, stable nitric oxide (NOx) metabolites, angiotensin-converting enzyme (ACE), glucose, and lactate dehydrogenase (LDH) were assessed in serum and cerebrospinal fluid. Statistical analysis was performed using the Mann-Whitney U test, with a significance level of p<0.05.

Results. In patients receiving therapy, serum NOx levels increased statistically significantly at all observation periods (p<0.05). The NOx/ACE ratio was higher than in the untreated group and approached the control group’s values, indicating restoration of the balance between vasodilatory and vasoconstrictive mechanisms. MDA levels and the oxidative stress index were elevated in both groups, but no significant differences were found. Serum and cerebrospinal fluid LDH and glucose levels increased in both groups, with statistically insignificant differences.

Conclusions. Inhaled nitric oxide therapy helps restore the balance of endogenous factors involved in regulation of vascular tone without increasing oxidative stress and ischemic damage. This method can be considered as an additional component of complex therapy, but requires further study.

RelevancE Instrumental tracheal ruptures (ITRs) are a rare but dangerous complication of invasive medical procedures. The lack of uniform diagnostic algorithms and treatment strategies, especially in patients requiring mechanical ventilation (MV), underscores the relevance of this study.

The aim of our study was to improve treatment outcomes for patients with instrumental tracheal injuries (ITIs).

Material and methods A retrospective and prospective analysis of 80 patients with ITI treated between 2003 and 2024 was conducted. The mean patient age was 52.2±11.4 years, and the majority of patients (87.5%) were women. Computed tomography (CT, n=60), tracheoscopy (n=55), and esophageal radiocontrast imaging/esophagoscopy (n=77) were used to diagnose instrumental tracheal ruptures. The sensitivity and specificity of the methods were assessed. Treatment included conservative and minimally invasive approaches (n=72), and surgical closure of the tracheal defect (n=8).

Results The  sensitivity  of  CT  for  diagnosing  tracheal  rupture  was  100%. All  spontaneously  breathing  patients  (n=53)  received  conservative  treatment; 14 patients requiring long-term mechanical ventilation were treated by positioning the endotracheal tube (ETT) cuff below the defect. Among patients on mechanical ventilation in whom the ETT cuff was placed below the rupture, healing occurred in 85.7% (12/14) of cases. For distal tracheal membranous wall ruptures, tracheal stenting with a bifurcation stent, and placement of the ETT cuff within the stent lumen was considered (n=4). In one case of distal tracheal rupture, the patient was transferred to spontaneous breathing with support from venovenous extracorporeal membrane oxygenation. Surgical treatment was used in 8 cases. The mortality rate in the conservative and minimally invasive treatment group was 8.3% (6/72), while in the surgical treatment group it was 50% (4/8). Overall mortality was 12.5% (10/80).

Conclusion 1. Computed tomography for tracheal ruptures is 100% sensitive, eliminating the need for routine tracheoscopy to confirm the diagnosis. Tracheoscopy is used to assess the parameters of rupture and reposition the endotracheal tube. 3. Conservative treatment is highly effective and is the treatment of choice. 4. Prioritizing conservative and endoscopic techniques over surgical ones significantly improved outcomes in patients on mechanical ventilation

Objective To develop a predictive model for diagnosing acute appendicitis in pediatric patients.

Material and methods The study was conducted at the Surgical Department of Ulyanovsk Regional Children’s Clinical Hospital from September 1, 2023, to June 1, 2024. The analysis included patients admitted with suspected acute appendicitis. A total of 400 patients were included in the study, of which 300 were diagnosed with acute appendicitis, and 100 had functional bowel disorders. Patient characteristics were assessed using a standardized protocol.

Results Univariate statistical analysis showed that the differential diagnosis of these conditions is most frequently required in children aged 6–12 years. Logistic regression analysis indicated that nausea (OR 11.586; 95% CI 3.347–40.125), white blood cell count (OR 1.52; 95% CI 1.343–1.721), lymphocyte count (OR 0.59; 95% CI 0.371–0.939), age (OR 1.207; 95% CI 1.079–1.350), appendix diameter of >6 mm (OR 32.691; 95% CI 12.846–83.179), and vomiting (OR 0.121; 95% CI 0.03–0.487) were independent risk factors for acute appendicitis in children during differential diagnosis. The identified variables were included in a nomogram using logistic regression analysis. The validation results showed that the area under the ROC curve was 0.967±0.008, with a 95% CI of 0.951–0.983. The developed model was statistically significant (p<0.001).

Conclusion A nomogram and an interactive prognostic calculator were developed for predicting the presence of acute appendicitis in children, which can be used for differential diagnosis with functional bowel disorders.

Introduction. Extracellular DNA (exDNA) is a well-known but poorly understood mediator of sepsis. The aim was to investigate the role of exDNA as an independent predictor of mortality and as a marker of unfavorable clinical phenotype for patients with septic shock.

Material and methods. The patients over the age of 18 with septic shock (Sepsis-3 criteria) who were admitted to the intensive care unit of the S.S. Yudin City Clinical Hospital between August 2023 and May 2024 were included in a prospective observational study.

Results. Total of fifty-two patients (64% men, 36% women) aged 52.1 ± 17.3 years, with severity of the condition on the SOFA score 10±4 and APACHE II score — 22±7 were included. The exDNA concentration was 3041 (876–7815.0) ng/ml. For exDNA, a significant (p=0,031) association with 28-day mortality was determined (AUC 0.69, 95% CI (0.54–0.84)), and a cut-off point >1893 ng/ml was identified, at which the OR of the hospital death corresponded to 4.3 (95% CI 1.3–15.1, p=0.03). The dependence of the risk of death on the concentration of exDNA (<1893 or >1893 ng/ml), estimated using the Mantel-Cox log-rank test, was statistically significant (p=0.028). The median survival time in the exDNA group >1893 ng/ml was 7 days, and for exDNA levels <1893 ng/ml — 11 days. Independent predictors of exDNA concentrations >1893 ng/ml in patients with septic shock were the level of mixed venous blood lactate (OR 2.0; 95% CI [1.02, 3.92], p=0.044) and SOFA score (OR 1.23; 95% CI [1.02, 1.47], p=0.029).

Conclusion. The exDNA level is an independent predictor of mortality in septic shock. Its cut-off point of 1893 ng/ml could be considered as an indication for extracorporeal elimination of exDNA. Point of care laboratory markers of a significant increase in the blood concentration of exDNA were also identified and could be considered as a guide to an intensive care.

Introduction. The skin graft is the “gold standard” of wound dressing, but if it is unavailable, a special type of wound dressing — wound covering (WC) — can serve as an alternative. Promising materials for WC are natural components. One of the main requirements for WC is protection from secondary contamination of the wound and the ability to suppress the growth of pathogenic microflora. Traditional methods for assessing the antimicrobial properties of drugs are not always applicable to them.

Aim of study. To develop a method for assessing WC by antimicrobial properties, and to use it to conduct a comparative analysis of the antimicrobial properties of a skin graft (SG) and two types of WC.

Material and methods. In the study, we used a split SG and two types of WC: histoequivalent bioplastic material (HBM) based on hyaluronic acid and atraumatic WC (AC) Voskopran®. Antimicrobial properties were assessed against a hospital-acquired mecitillin-resistant strain of S. aureus and a fluoroquinoloneresistant strain of P. aeruginosa. Two series of 8 experiments were conducted on blood agar (BA) plates with the dilution of the bacterial densities by a factor of 10, resulting in final concentrations of 102, 104,106, and 108 CFU/ml.

Results. The SG at a concentration of S. aureus of less than 106 CFU/ml is able to significantly slow down the growth of the microbial culture, and at concentrations of 104 CFU/ml and below, it completely suppresses and protects the BA surface from infection. AC, which does not include antiseptic agents, has virtually no inhibitory effect on the growth of pathogenic S. aureus and does not protect BA from the ingress of microorganisms. HBM occupies an intermediate position between the SG and AC. In relation to P.aeruginosa in all concentration, no suppression or growth retardation was observed in any of the WC samples.

Conclusion. The developed method of antimicrobial properties rating has proven its effectiveness. The skin graft is capable of significantly slowing the growth of gram-positive microbial culture at concentrations of 104 CFU/ml and below. If P. aeruginosa is detected, the use of any type of WC and skin grafting are ineffective.

Aim of study. To evaluate the effectiveness of the proposed method for preventing surgical site infections (SSI) and reducing postoperative pain.

Material and methods. A randomized clinical study was conducted, including 58 patients from the medium and high-risk groups for developing SSI, who underwent midline laparotomy from January 1, 2024, to May 15, 2024, at two institutions: Ulyanovsk Regional Clinical Hospital and Ulyanovsk Regional Oncological Dispensary.

Results. Univariate statistical analysis revealed that patient clinical data—gender, age, type of surgical intervention, and comorbidities — were not statistically significant. Analysis of laboratory parameters — including the leukocyte intoxication index according to V.K. Ostrovsky, neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR), C-reactive protein (CRP) level, and cortisol level — were significantly lower on the 5th day in the experimental group, which was statistically significant. Additionally, the incidence of surgical site infections was significantly lower in the experimental group (3/29, 10.3%) compared to the control group (7/29, 24.1%), p=0.03. No differences were found between the groups in the structure of infectious complications at the surgical site. During statistical analysis, it was determined that in the study group, the Visual Analogue Scale (VAS) score on the third postoperative day was significantly lower than in the control group (p=0.048).

Conclusion. The use of the proposed method in clinical practice during midline laparotomy may be an effective and safe technique for preventing surgical site infections and reducing postoperative pain.

Relevance. Acute kidney injury caused by massive postpartum hemorrhage is accompanied by secondary impairment of liver function. Clinical and laboratory parameters (transaminases, bilirubin, prothrombin index, protein metabolism) reflect the severity of hypoxic and toxic liver injury. A direct correlation has been established between the degree of renal dysfunction and changes in hepatic functional status, emphasizing the need for comprehensive monitoring in the postpartum period.

The aim of the study was to assess the incidence, nature, and severity of combined liver damage in postpartum women with acute kidney injury (AKI) of obstetric origin, and to develop approaches for predicting this complication and for differentiated therapy aimed at reducing mortality from acute liver injury (ALI).

Material. and methods. This retrospective study included 22 patients with ALI resulting from obstetric pathology who were treated in the intensive care unit between 2020 and 2024. The mean age of the patients was 28.0±1.8 years. Liver function was assessed using biochemical tests (ALT, AST, LDH and its isoenzymes, bilirubin, prothrombin index), the Bromsulphalein test, as well as evaluation of fractional hepatic blood flow (FHF) by imaging techniques.

Results. Despite satisfactory standard biochemical parameters in most patients, in-depth examination revealed impaired liver function. Analysis of the LDH isoenzyme spectrum showed increased activity of LDH-4 and LDH-5 fractions, indicating hepatocyte cytolysis. The Bromsulphalein test demonstrated impaired detoxification and uptake–excretory function of the liver in 4 out of 5 examined patients. In 2 out of 4 patients, a moderate decrease in fractional hepatic blood flow (FHF) was recorded.

Conclusion. The obtained data indicate that patients with ALI following obstetric hemorrhage often develop combined liver injury, which may not be detected by routine biochemical tests. For early diagnosis and assessment of the severity of liver damage in this category of patients, it is advisable to use methods such as LDH isoenzyme determination and the Bromsulphalein test.

Relevance. Epidural hematomas occur in 8.2% of all patients with traumatic brain injury, more than half of whom require surgical treatment. Most patients with this condition have a favorable outcome with an uncomplicated clinical course. However, the clinical course of epidural hematomas depends mainly on the presence of additional intracranial injuries. There are few studies that compare in detail the results of treatment of isolated (without additional intracranial injuries) and combined (with additional intracranial injuries) variants of epidural hematomas.

Aim. Оf the study Analysis of treatment outcomes in patients with isolated and combined types of epidural hematomas.

Material and methods. We conducted a retrospective, single-center, cohort study at the Mariinsky City Hospital from April 2015 to December 2019. We included 129 patients in the study. 68 (52.7%) patients had the isolated version of epidural hematoma, 61 (47.3%) patients had the combined version of epidural hematoma. 81 (62.8%) patients were men, and 48 (37.2%) were women. The average patient age was significantly higher in the group with the combined version of epidural hematoma (48.3 years versus 32.7 years, p=0.001). The average follow-up time was more than 5 years.

Results. With increasing age, the combined variant of epidural hematoma had a higher incidence rate than the isolated variant of epidural hematoma. The in-hospital mortality rate in patients in the sample was 3.1%, in the group with the isolated variant of epidural hematoma 1.5% (1 patient), and 4.9% (3 patients) in the group with combined epidural hematoma. A good favorable outcome was achieved in 84 patients (65.1%), in the group with the isolated variant of epidural hematoma this figure was 88.2% (60 patients), in the group with the combined variant of epidural hematoma 41.4% (24 patients). Analysis of various additional intracranial injuries in patients with the combined variant of epidural hematomas did not reveal a significant difference in the results. Patients with isolated epidural hematoma had a statistically significantly lower risk of mortality (relative risk: 0.31; 95% CI: 0.11–0.41), and a statistically significantly lower risk of poor outcome according to the Glasgow Outcome Scale (GOS) (relative risk: 0.19; 95% CI: 0.11–0.29) than patients with combined epidural hematomas.

Conclusion. In general, patients with surgically treated isolated epidural hematomas have a positive favorable outcome. In addition, favorable outcomes can be achieved in 50% of cases in patients with combined epidural hematomas or isolated epidural hematomas with a low Glasgow Coma Scale (GCS) score. Therefore, every possible effort should be made to treat and achieve a favorable outcome in this potentially fatal injury.

Relevance. The importance of damage control resuscitation (DCR) in patients with multiple trauma and massive bleeding is increasing, representing one of the major challenges facing modern healthcare in the Russian Federation. Over the past three years, there has been a rise in the number of injuries and their consequences, requiring a comprehensive approach to patient management in resuscitation practice.

The aim of the study was to assess the structure of the current literature on the topic of damage control resuscitation and to conduct a qualitative analysis of publications within its areas.

Material and methods. We presented a scoping review of 5 years of studies devoted to the use of damage control resuscitation in polytrauma patients. The review was performed in accordance with the principles of PRISMA-ScR. The search was conducted in electronic databases: Pubmed, Cochrane, Google scholar, eLIBRARY, UpToDate and cyberleninka.

Results. We found 309 articles, 82 of which met the inclusion criteria. Of these, 30 publications contained all the data required for extraction, and 52 studied only 1 component of DCR. More than half of the sources were literature reviews (n=29) and retrospective studies (n=20). The most studied DCR issues were trauma-induced coagulopathy (n=15), massive blood transfusion (n=13), and prehospital treatment (n=13).

Conclusion. Damage control resuscitation is a promising concept in intensive care for traumatic shock, combining massive blood transfusion, low-volume infusion therapy, correction of hypothermia and hypocalcemia, as well as a specific prehospital phase including respiratory support, early administration of tranexamic acid, and blood components. When combined with modern approaches, such as viscoelastic testing methods and endovascular techniques for bleeding control, along with the presence of qualified specialists, the care for patients with polytrauma has become more effective. However, several specific issues still require further research.

Introduction. The development of minimally invasive technologies in medicine is fast, but their role and place in surgery of blunt abdominal trauma have not yet been definitively determined.

Aim of the study to compare the effectiveness of various treatment options (non-operative with percutaneous or transluminal methods, laparoscopic, robotic and laparotomic) in patients with blunt abdominal trauma.

Material and methods. A systematic literature search was conducted in accordance with the recommendations of PRISMA (2020) and AMSTAR (2017). The analysis of non-randomized studies from January 1, 2016, and randomized ones — without time limits, to September 10, 2024 from the electronic databases eLibrary, PubMed, Cochrane library was carried out.

Results. Laparoscopic interventions in hemodynamically stable/stabilized patients with abdominal trauma are less prolonged than laparotomic, but no significant differences were obtained with blunt abdominal trauma. Laparoscopy helps to reduce the time spent in hospital in hemodynamically stable patients with both abdominal injuries in general and with blunt abdominal trauma. According to percutaneous, transluminal and robotic methods, there is insufficient data for meta-analysis.

Conclusion. Laparoscopy is a safe technique for the treatment of hemodynamically stable patients with blunt ab-dominal trauma and has a number of advantages over open interventions. To obtain data of a higher Level of Evidence and Grade of Recommendations, it is necessary to further conduct systematic reviews and meta-analyses based on randomized clinical trials.

This article reviews modern technologies for durable mechanical circulatory support (dMCS) —implantable devices that replace or support cardiac function.

The process of improving circulatory support devices has spanned several decades. We have evolved from bulky first-generation pulsatile pumps to compact and reliable non-pulsatile flow pumps. Today, these highly effective systems are used in 95% of cases. Modern devices can serve not only as a bridge to heart transplantation for patients awaiting a donor organ, but also as ongoing therapy for patients who are not eligible for a heart transplant.

At the same time, trends toward improving the quality of medical care are also impacting the refinement of existing circulatory support techniques: minimally invasive devices for full and partial cardiac support are being developed; fully magnetically levitated centrifugal-flow left ventricular assist devices are becoming dominant; solutions for right ventricular and biventricular failure, including the total artificial heart, are emerging.

Sputnik portable circulatory support devices and STREAM CARDIO systems have been developed and are being used in Russia. They are comparable in efficacy and safety to their foreign counterparts, and in some respects (for example, antithrombogenic coating) they are superior. Their main advantage is their significantly lower cost and accessibility for Russian patients, which is critically important given the shortage of donor organs and the high cost of imported systems.

DMCS has become a life-saving and life-preserving standard practice in cardiac surgery. Given current demographic conditions, the growing proportion of patients with heart failure, and the chronic shortage of donor organs, further development and cost reduction of the aforementioned technologies is a strategic necessity for this country.

The aim of the study To determine the role of regional anesthesia in carotid endarterectomy in the acute period of ischemic stroke.

Material and methods. The world literature on the comparison of regional and general anesthesia in carotid endarterectomy has been studied and analyzed. The analysis also included the main randomized clinical trials and meta-analyses on this topic over the past 16 years. However, most of the articles are retrospective and from a single center.

Results. It was found that all the researches were devoted to comparing these two methods of anesthesia for planned carotid endarterectomy. Large meta-analyses, which included randomized trials, did not reveal significant differences between these two types of anesthesia according to the main results (transient ischemic attack, stroke, myocardial infarction and mortality). We have not found randomized clinical trials comparing regional and general anesthesia for carotid endarterectomy in the acute period of ischemic stroke (28 days). In this regard, a single-center prospective randomized clinical trial “Regional or general anesthesia for carotid endarterectomy in patients in the acute stage of ischemic stroke” was planned and registered in The ClinicalTrials.gov (Unique protocol ID: NCT06175715). General anesthesia means total intravenous anesthesia. The research was approved by the local ethics committee of the Federal State Budgetary Educational Institution of the Russian National Research University named after N.I. Pirogov of the Ministry of Health of the Russian Federation (extract from the minutes of the meeting of the LEK of the Russian National Research University named after N.I. Pirogov No. 223 dated October 23, 2023). The main endpoints of the study are: repeated ipsilateral stroke, any other stroke, big hemorrhagic complications that required surgical revision of the surgical wound or transfusion of blood components, fatal outcome and a combination of major adverse cardiovascular events (stroke + myocardial infarction + fatal outcome). The preliminary deadline for completing the study is December 2026.

The aim of the work was to study the features of COVID-19 in patients with cardiovascular pathology based on the results of global research.

Material and methods. Articles were searched in the following bibliographic databases: eLIBRARY.RU, CyberLeninka, Google Scholar, PubMed, Cochrane Central Register of Controlled Trials. Randomized clinical trials involving adult patients were selected for review.

Results. As a result of the search, 146 articles were identified. After evaluating their content, 65 studies were selected for full-text analysis.

Conclusion. Patients with cardiovascular diseases may be at an increased risk of severe COVID-19, with comorbidities significantly affecting the prognosis. In turn, coronavirus infection can exacerbate chronic heart and vascular conditions, highlighting the importance of timely diagnosis and the use of optimal therapeutic approaches.

This article presents data from systemic reviews on the incidence of purulent complications leading to bronchial fistula formation, confirming the relevance of this research. The full range of diagnostic procedures for bronchial fistulas using endoscopic and radiographic techniques is presented. The results of using all possible endobronchial occluders for sealing air leaks from bronchopleural fistulas are also presented. The advantages and disadvantages of each of the presented occluders are described in detail. A vector for further development of optimal systems for bronchial occlusion in bronchopleural fistulas was identified.

Background. Cytotoxic lesions of the corpus callosum are a rare clinical neurological syndrome, most often detected at the stage of searching for the cause of observed neurological disorders of unclear etiology. This is due to the variety of neurological symptoms detected in this syndrome. It is extremely rare to find a description of this syndrome in the literature. The described cases most often had an infectious, post-vaccination, drug etiology. Most of the described cases developed against the background of SARS-CoV-2 infection. However, given the high density of the receptor field of the splenium of the corpus callosum, this syndrome can occur due to other causes, including drug poisoning. Taking into account the variety of clinical manifestations of this syndrome, the high variability of etiological factors, patients with acute symptoms of central nervous system lesions of unknown etiology need differential diagnosis, including cytotoxic lesions of the corpus callosum.

Aim: to present a clinical case description of cytotoxic lesions of the corpus callosum development due to methadone poisoning.

Material and methods. A clinical case of cytotoxic lesions of the corpus callosum in an adult patient on the background of methadone poisoning and metabolic liver disorders is presented. A review of the literature was also conducted: the main clinical and instrumental characteristics of cytotoxic lesions of the corpus callosum in adults, possible pathogenetic and cytotoxic mechanisms of its development were summarized, modern approaches to the diagnosis of this syndrome were highlighted.

Results. Based on the examination of the patient with the indicated anamnesis and prolonged positional compression syndrome, cytotoxic lesions of the corpus callosum were revealed, which were most likely a consequence of hypoxia and rhabdomyolysis. Complex infusion, detoxification, symptomatic and neurometabolic therapy led to the regression of neurological deficit and complete restoration of the structure of the splenium of the corpus callosum according to magnetic resonance imaging of the brain in a control study.

Conclusion. According to magnetic resonance imaging, the formation of a neurotomographic picture of cytotoxic lesions of the corpus callosum in a patient with a history of chronic methadone intoxication may be reversible. This suggests the need for a detailed clinical and laboratory assessment of the pathogenesis of the identified changes and the timely implementation of a comprehensive infusion, detoxification, and neurometabolic therapy.

This article presents a clinical case of successful surgical treatment of a patient with severe aortic valve regurgitation secondary to dissection of the ascending aorta, aortic arch and its branches, and descending thoracic aorta (DeBakey type I). This paper demonstrates a successful application of modern hybrid surgical strategies, including the use of a preformed neoconduit (a 30 mm POLYTHESE POLYBRANCH vascular graft and a Medtronic No. 27 mechanical graft), an E-Vita Open Plus No. 28 stent graft (Frozen Elephant Trunk), and complete grafting of the left subclavian artery with 8 mm Angiteq linear vascular grafts for the treatment of the patient with extensive aortic disease.

Relevance Bacterial infection of a prosthetic valve is a serious and common clinical problem in cardiac surgery. Cases of infection of biological prostheses after previous combined cardiac surgeries present a particular challenge. Numerous studies demonstrate the effectiveness of aortic allografts for the surgical treatment of this complication, making them a viable option. In the clinical cases presented below, we not only confirm this point of view but also examine in detail the technical aspects of performing such surgeries.

Aim To evaluate the effectiveness of emergency surgical treatment for severe prosthetic endocarditis of aortic bioprosthesis using aortic allografts in patients with functioning mammary and coronary artery bypass grafts after previous bioprosthetic aortic valve replacement and coronary artery bypass grafting, based on an analysis of clinical cases.

Objectives 1. To describe the clinical features and diagnostic criteria of severe prosthetic endocarditis in patients with functioning coronary artery bypass grafts. 2 To present a technique for emergency surgical intervention using aortic allograft in this patient population, and to analyze the results of this

Material and methods The study included two patients with proven aortic valve prosthesis infection following bioprosthetic aortic root replacement and coronary artery bypass grafting. Our technique involves meticulous exposure of the coronary bypass grafts and the functioning left internal mammary artery, complete removal of infected prosthetic material, antegrade crystalloid cardioplegia via the coronary artery ostia and autologous vein grafts, and total aortic root replacement using aortic allograft.

Results The time from the primary surgery to the reoperation and the time from hospital admission to the current surgery were 3 months and 19 months, 8 hours, and 16 hours, respectively. Both patients underwent total aortic root replacement with allograft. The identified pathogens were Pediococcus pentosaceus and Streptococcus viridans. The patients were at high surgical risk (EuroScore II 64.97 and 58.28%); however, the postoperative period was uneventful in both cases. The patients were discharged with normal blood counts and perfect allograft function. The follow-up periods were 12 and 19 months. Currently, the patients have not experienced recurrent infection or structural degeneration of the allograft.

Conclusions Patients with prosthetic endocarditis after combined procedures represent a particularly high-risk surgical group. Reoperations in those patients are urgent and technically challenging. To protect the myocardium, partial cardiolysis can be performed to occlude the proximal portion of the internal mammary artery, while preserving the bypass graft function and allowing for its temporary clamping. Antegrade infusion of crystalloid solution into coronary ostia and venous grafts during cardioplegia is the preferred method. Total aortic root replacement using an aortic allograft with reimplantation of bypass grafts into the allograft has demonstrated excellent initial and mid-term results, and should be considered the procedure of choice.

The aim of the study To present a developed modified double patch sandwich technique, adapted from surgical treatment of dissecting aortic aneurysms, for penetrating left ventricular wounds.

Material and methods. A clinical case of a 25-year-old patient with a penetrating left ventricular wound is described. After failure of primary U-shaped sutures, a double patch sandwich technique was successfully applied. The method consists of placing teflon patches on both internal and external surfaces of the myocardium using a special suturing technique to prevent suture cutting through the tissue.

Results. After applying the sandwich technique, reliable hemostasis was achieved, which allowed the patient to be successfully weaned from cardiopulmonary bypass. The postoperative period was uneventful. Control examinations (echocardiography, MSCT) confirmed the integrity of the left ventricular wall repair. The patient was discharged on the 10th day in satisfactory condition with normal left ventricular ejection fraction (>55%).

Conclusion. The modified double-layer teflon plasty sandwich technique showed high efficiency in the treatment of penetrating left ventricular wounds. Translation of surgical experience from dissecting aortic aneurysms treatment to heart wounds demonstrates the promise of an interdisciplinary approach in cardiac surgery.

This article describes a clinical case of an intestinal complication of Behçet disease in patient A., born in 1996, who was admitted to the Rheumatology Department of the Ryazan Regional Clinical Hospital on January 25, 2024, with complaints of a non-productive cough, painful ulcers on the oral mucosa, hemorrhagic rash on the lower and upper extremities, pain in the Achilles tendon of the left lower extremity. On January 30, 2024, the patient’s condition worsened, and he complained of nausea, abdominal pain, a single episode of vomiting, and a fever of 37.3°C. The patient was examined by the surgeon on duty. Following examination, collection of anamnesis, and analysis of the clinical picture, a diagnosis of hollow organ perforation and peritonitis was made; it was decided to perform emergency surgery. The patient underwent an emergency diagnostic laparotomy on the night of January 31, 2024, to February 1, 2024. An abdominal examination revealed multiple acute perforations of the small intestine, as well as two large, 1/2-circumferential, hard-edged perforations in the ileum 25 cm from the ileocecal junction. The section of the ileum with the above-mentioned changes was resected, and the proximal portion was brought out to the anterior abdominal wall as a single-stoma.

Foreign body aspiration is an emergency situation that requires immediate care to prevent the development of complications, including death of the patient. The literature describes cases of late detection of foreign bodies in the respiratory tract, which were masked by symptoms of other diseases of the respiratory system and were in such situations an incidental finding. In approximately 20% of cases, foreign bodies are radiolucent and are not visualized by standard radiography. Untimely diagnosis can lead to the choice of incorrect tactics of patient treatment and development of purulent and destructive processes in the lungs. The article presents a patient with chronic bronchitis and a foreign body in the left lower lobe bronchus detected 2 years after aspiration, which was removed by cryodestruction.