From the editor.

I Russian congress with foreign participants “Emergency endoscopy”. Materials of conference. Part 3.

Scientific and practical conference with international participation «Current issues of trauma care for victims of traffic accidents».

About clinical work in Sklifosovsky Research Institute for Emergency Medicine.

ABSTRACT. The paper describes the first experience of successful small bowel transplantation in the Sklifosovsky Research Institute for Emergency Medicine. It contains a brief review of literature on essential aspects of small bowel transplantation, presents the donor’s case history, specific features of anesthesia, surgical procedure, and postoperative course, including the immunosuppression scheme, diagnosis and treatment of evolved complications. The paper provides in-detail results of morphological control over rejection development, presents the data of ultrasonographic observation of the changes in the transplanted intestine in the course of its adaptation to new requirements, covers the tactics of parenteral and enteral nutrition.

PURPOSE. Сomprehensive study of morphological features in patients with adenomyosis.

MATERIAL AND METHODS. Comprehensive clinical and morphological study was performed in 40 adenomyosis patients who had been operated (the average age 44,1±3,47 years) with histologically verified diagnosis. A comprehensive morphological study using survey, histochemical and morphometric methods was carried out.

RESULTS. Growth of heterotopic lesions was accompanied by a marked plethora microvasculature of the myometrium, lymphostasis, oedema of the tissues of the myometrium, number of tissue basophils increase around the endometriosis, alcian-positive glycosaminoglycans high content in the intercellular substance. Local changes taking place in the uterus play important role in adenomyosis occurrence. The research results allow to consider the onset and progression of adenomyosis from the position of the concept of the local failure of the uterus connective tissue. Knowledge of the morphological basis of adenomyosis allows to diagnose the pathology better and to interpret the results obtained by the application of additional methods of examination . 

ABSTRACT. The article presents the results of experiments and clinical research of the last decades in the sphere of study of the anemia development pathogenesis in burn patients. Burn anemia was proven to have multifactor genesis and combine both manifestations of acute anemia, hemolysis (primary, seconary), mechanical blood loss, hemorrhagic syndrome and symptoms of chronic autoimmune anemia. It has been shown how the principles of transfusion therapy in burn patients have been changing during the last 30 to 40 years, and what kind of contradictions exist at the present stage in defining strategies for treatment of patients with burn anemia. The article presents the results of our own observations, materials of foreign multi-center studies, analysis of the most promising and up-todate recommendations to prevent or ameliorate the adverse effects of anemia on the condition of a burn patient.

ABSTRACT. Traumatic injury of spine vertebra in children is an actual problem of modern traumatology which is actively being discussed in literature. Recently, the frequency of such registered traumas has increased considerably. Primary diagnostics of uncomplicated traumas in spinal vertebra in children has considerable difficulties which are determined by objective reasons, and is characterized by a high percentage of mistakes. The clinical presentation, diagnostics and treatment of stable injuries of spinal vertebra in children need further studies. 

PURPOSE. The problem of sudden cardiac death (SCD) is the most relevant in the modern cardiology , and if organic heart diseases exist, treatment strategy and prevention of SCD is developed , this problem is not solved in the patients without organic changes. Currently, a group of diseases, clinical and electrocardiographic syndromes, has emerged, that are closely associated with the formation of fatal arrhythmias. Special hazard of the course of these pathological conditions is due to the high risk of SCD, especially in young people. These diseases are not accompanied by structural changes in the myocardium and manifest themselves mainly by electrophysiological abnormalities in cardiomyocytes. Mutations in genes encoding ion channel proteins expressed in the myocardium, and their modulators, is the basis of these diseases. This fact is accounted for the unification of these diseases in the group of «channelopathies». The article presents the current diagnostic criteria for these diseases and treatments. In 2011 Guidelines of the European Society of Cardiology for genetic research in channelopathies and cardiomyopathies that have defined the indications for genetic research in this pathology, were issued. 

ABSTRACT. The article is dedicated to the problem of nontraumatic intracranial hemorrhage surgery. Principal concern was given to the contemporary aspects of target and urgent diagnostics of vascular pathology of the brain, being the cause of hemorrhage, and ischemic complications detection. Modern surgical technologies applied for surgical treatment of patients with intracranial hemorrhages are described and surgical results achieved in Sklifosovsky Research Institute are represented. 

ABSTRACT. Postoperative abdominal wall hernias account for 20-26% of all external abdominal hernias and occur in 10 - 32% of the patients operated on the abdominal organs. They are characterized by a rapid increase in size, high rate of complications. There is no standard operation. Relapses occur in 14–15%. Autoplastic ways by fascial-aponeurotic plasty are not always reliable and radical. Alloplastic methods have been widely spread and used in 75–85% of operated in Europe and in the USA. These methods are not flawless- changes of the implants properties and their capsule were marked — their size, flexibility and strength are decreased, complications — adhesions, fistulas, pain and discomfort. Therefore, the search for radical ways remains relevant. The description of the clinical follow-up after successful local fascial-aponeurotic plastic surgery of the repeatedly recurrent postoperative abdominal wall hernia. Conclusion The author recommends the wider use of the described method of hernioplasty. 

The history of the formation and improvement of the surgical service of the Sklifosofsky Research Institute for Emergency Medicine since its founding in 1923 until 1951 is set out. For this goal the published works of employees of the Institute and archival documents are brought. It is shown that the structure of the surgical service during the first half of the twentieth century has steadily expanded, rebuilt and improved depending on changes in the clinical and scientific problems. 

ABSTRACT. The historical analysis of development of the doctrine of V.N. Shamov and S.S. Judin on posthumous blood is presented: formation of laboratories of cadaveric blood and tissues in the country; ways of preparation from the suddenly deceased from a myocardial infarction or a stroke (the donor of tissues); efficiency of clinical use of fibrinolysis blood and its components. Plasma of such blood shows growth-enhancement effect at healing of wounds and is a specific raw material to obtain thrombolytic agents. For the first time the way of preparation and a fractionating of blood from the system of the lower cava during operation of multiorgan fence of organs with brain death (the donor of organs) is developed and introduced in practice. The new transfusion medium containing 1,7–5,4 standard doses of erythrocytes and 0,2–0,6 standard medical doses of thrombocytes is obtained. Biological full value and functional activity of blood cells of the donor of organs is shown. Such cellular transfusion medium provides effective increase of oxygen-transport function of blood at an acute anemia, moderate indemnification of a thrombocytopenia at liver transplantation. 

ABSTRACT. Assessment of the immune status of patients with urgent types of pathology in the Institute for Emergency Medicine is performed according to three main objects of research: humoral , phagocytic and lymphocytic components of immune system . This complex allows to fully and adequately evaluate the condition of the immune system of patients at different stages of traumatic disease and after transplantation of organs and tissues , to forecast the probability of septic complications developing, adjust the therapy . During 45 years of work of immunological service formed the algorithm of the adequate immunological screening was formed, number of innovative methods of diagnosis was developed, the ideology of post-test counseling of patients by immunologists was created, mathematical methods of storage, modeling and processing of research results was introduced. Laboratory staff identified a number of medical and social factors in the spread of blood-borne viral infections (HIV, hepatitis B and C). New organizational and economic methods of management team were introduced in the laboratory. The basis of the work is equal integration of scientific and clinical staff of the laboratory. 

ABSTRACT. Catalogue of Russian State Archive of Film and Photo Documents (RGAKFD) has been studied to identify materials on the history of the Sklifosofsky Research Institute for Emergency Medicine. A source study analysis of revealed film documents has been carried out in order to assess their relevance, completeness and objectivity, a brief summary of their contents has been done. It is shown that despite the small amount of film documents and incompleteness of the information contained, they are of great interest as the source on the history of the Sklifosovsky Research Institute for Emergency Medicine and domestic emergency medicine in general. Documentary filming of outstanding Russian scientists – surgeon academician S.S. Yudin and transplantologist V.P. Demikhov, is unique. 

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