Problems of treatment of combined trauma.

BACKGROUND. The relevance of such an issue as the treatment of patients with unstable pelvic ring fracture is caused by the high frequency of this pathology in the general structure of polytrauma — up to 34% and a high rate of poor functional treatment outcomes — up to 20%. Purpose of the study: the improvement of rehabilitation treatment in patients with polytrauma operated on for complex fractures of the pelvis, using mechanotherapy and electro stimulation in the complex of therapy of an early postoperative period.

MATERIAL AND METHODS. There were 81 patients with severe pelvic ring injuries treated in N.V. Sklifosovsky Research Institute for Emergency Medicine in 2010 – 2013. The main group consisted of 29 patients who were recommended a comprehensive methodology of rehabilitation, including therapeutic exercises (TE), mechanotherapy using the simulator “RECK MOTOmed letto2” and electro stimulation using the “Galatea” apparatus. The test group consisted of 52 patients who underwent rehabilitation treatment only by methods of therapeutic exercises. Overall effectiveness of the treatment was evaluated using the Majeed score.

CONCLUSION. Early use of therapeutic exercises in combination with mechanical therapy and electrical stimulation in patients operated on for unstable pelvic ring injuries, helps reduce pain syndrome, shortens the period of bed rest from 17.5 to 7.6 days and the duration of hospital stay from 46.1 to 35.2 days. At the same time, the 14.1% increase of excellent and good functional outcomes based on Majeed score is registered. 

BACKGROUND. Erosive and ulcerative gastroduodenal bleedings observed in patients with cardiac disease, are associated with a high rate of mortality and significantly complicate the course of the underlying disease. Studying the etiology of erosive and ulcerative lesions of the upper gastrointestinal tract mucosa in these patients may serve as a basis for the development of preventive measures for gastroduodenal hemorrhage. The multiple treatment of patients with erosive and ulcerative gastroduodenal bleeding complicating a cardiac disease should be carried out with the interaction of antisecretory drugs and antiplatelet drugs. 

THE PURPOSE OF THE STUDY. The purpose is an analysis of the frequency, predictors, and approaches of treatment for loss and migration of the stent during coronary interventions.

MATERIAL AND METHODS. Stent migration occurred in 4 patients (3 men and 1 woman aged 45–70 years), which accounted for 0.13% of 3081 cases of coronary intervention from January 2010 to December 2013. In 3 cases, interventions were performed in acute condition.

RESULTS. In 3 patients, there was an attempt to stent the circumflex artery and in one case – the anterior interventricular artery. In 2 patients, the undeployed stent was not retreived from the coronary bed, in 1 patient, the stent was advanced down and removed from the femoral artery during arteriotomy, and in 1 patient, visualization of the stent was lost after being advanced down to the terminal branches of aorta.

CONCLUSIONS. Predictors of loss and migration of coronary stents are: acute condition, a large divergence angle of a vessel and its tortuosity, calcification. Different methods are used to remove the stent: wrapping two guide wires around the stent; advance of a balloon catheter through the stent, its expansion and removal of the stent; extraction using various loops and forceps. When the removal of the stent is impossible, the «crush» method may be used. By moving the stent into the distal bed further complications usually does not occur. 

SUMMARY. Based on the data of 370 patients with acute myocardial infarction with ST segment elevation, problems affecting the efficiency of revascularization treatment by PCI have been analyzed. It has been considered difficult to achieve further reduction in the timing of PCI compared to the available. The acceleration dynamics of ST segment on the electrocardiogram during PCI against thrombolysis and limitations of ECG monitoring during reperfusion in assessing myocardial perfusion have been specified. The necessity and appropriateness of PCI in different periods from the onset of MI have been reasoned. The prospects of using perfusion myocardial SPECT in assessing hypoperfusion and prognosis of restoration of myocardial function have been mentioned. 

BACKGROUND. Early detection of complications of pancreatic necrosis including purulent-septic ones largely predetermines the outcome of the treatment. In this article, we evaluated the role and capabilities of X-ray computed tomography in the diagnosis of acute pancreatitis complications.

OBJECTIVE. Studying the capabilities of spiral computed tomography (SCT) in the diagnosis of acute severe pancreatitis complications.

MATERIAL AND METHODS. Spiral CT results in 56 patients with severe acute pancreatitis and suspected septic complications have been analyzed.

RESULTS. Revealed complications of the severe acute pancreatitis: circumscribed collection of fluid (32), abscesses of bursa omentalis and retroperitoneal fat (18), retroperitoneal phlegmon (6). The semiotics of revealed complications has been described, and their relation with other organs and structures has been evaluated.

CONCLUSIONS. SCT conducted with contrasting techniques, reveals septic complications of severe acute pancreatitis, ascertains their form, location and amount, as well as the relation with other organs and structures which helps identify the tactics of management, indications for surgery and assess its effectiveness.

ABSTRACT. This article describes the current trends concerning diagnostics and treatment of spinal trauma as well as tumors and diseases of vertebra column and spinal cord. The assessment of computer tomography and magnetic resonance imaging capabilities to reveal various pathologies of vertebra column and spinal cord is given. The clinical cases of usage the minimally invasive, endoscopic and transcutaneous technologies for treatment of various spinal pathologies are presented. 

ABSTRACT. Severe coughing might lead to development of a number of complications, including the diaphragmatic rupture and the ribs fractures. The report contains two similar rare clinical cases: male patients aged 48 and 74 years with transdiaphragmatic intercostal thoracic wall hernia after the rupture of the left half of the diaphragm and ribs fractures as a result of violent coughing. Both patients had a late diagnosis of injuries. Surgical therapy was performed via thoracotomy access using a mesh implant. histological study of the rib in the damaged area in one case detected fibrous osteodysplasia. The review of literature on this rare type of injury was analyzed. 

ABSTRACT. Primary B-cell lymphoma of the heart is an extremely rare disease. We report a case of successful removal of the right heart B-cell lymphoma and the tricuspid valve replacement in a hIV-infected patient. The use of modern diagnostic procedures and aggressive surgical management allow clinical effect in this category of patients to be achieved. 

ABSTRACT. The article covers the history of over a 60-year experience of dermatome skin grafting in burn patients. The study emphasizes a great contribution of Academician B.A. Petrov in the development of dermatome skin grafting methodology, its principles remaining unchanged so far. Based on his own observations, the author states that anemia complicating the severe burn course and the lack of anemia prevention caused by a number of factors make a negative impact on the outcome in operative burn treatment, leading to a gradual loss of dermatome skin grafting principles. The author makes a conclusion on the necessity of adequate blood transfusions in patients with severe burns in order to keep the red blood parameters normal. 

The 75th birth anniversary of Leo A. Bokeria.

The 65th birth anniversary of Michael A. Paltsev.

Conference “Emergency care for patients with an acute cerebrovascular accident”.

Montalescot G., van ‘t Hof A.W., Lapostolle F., et al. Prehospital ticagrelor in ST-segment elevation myocardial infarction // N. Engl. J. Med. – 2014. – Vol. 371. – P. 1016–1027.

Cappato R., Ezekowitz M.D., Klein A.L., et al. Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation // Eur. heart J. – 2014. Sep. 2. [Epub ahead of print].

ABSTRACT. The most usable formal criteria for measuring the research impact in our country have been reviewed: impact factor of a publication (IMP), citation index (CI), h-index. 

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