ORIGINAL ARTICLES

UDC 616-001.17 : 615.849.19

DOI: 10.54866/27129632_2025_3_08

POSSIBILITIES OF INCREASING ADHESION AND FIXATION OF AUTODERM GRAFT AFTER TREATMENT WITH LOW‑TEMPERATURE ARGON PLASMA

© E.V. ZINOVIEV ^1,2,3, V.A. ILYINA ¹, V.V. SOLOSHCHENKO ¹, D.V. KOSTYAKOV ^1,4, D.O. WAGNER ^1,5, O.S. PANKRATYEVA ¹, S.N. PYATAKOVA ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State Pediatric Medical University” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

³ Kirov Military Medical Academy, St. Petersburg, Russia

⁴ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

⁵ North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

ABSTRACT

Rationale. In the process of studying the effect of low-temperature argon plasma on skin graft for the purpose of fixation on the wound, a number of questions arose regarding the definition of safe parameters for the method of treating a burn wound and skin graft with low-temperature argon plasma.

objective: to study morphological changes in a split skin graft and burn wound during the treatment of skin graft on the wound surface with low-temperature argon plasma to improve their adhesion and fixation.

Materials and methods. The work is based on clinical and morphological data of the results of treating 41 patients with deep burns that required skin grafting with split skin grafts. The effect on the wound with low-temperature plasma was carried out using the plasma-arc surgical unit “Plasmoran” (Russia, Moscow).

Results. All the examined burn wound biopsies with a fixed skin graft area revealed viable tissue without signs of thermal damage or secondary necrosis. The most important characteristics of the device: the distance from the plasmatron nozzle to the skin graft was 8 cm, the exposure of the plasma flow to the graft was 2 seconds. According to the results of morphological studies, it was proven that the selected low-temperature burn plasma treatment mode does not damage cellular structures. A multiple increase in the treatment exposure damages the skin graft.

Conclusion. The selected low-temperature argon plasma treatment mode ensures the creation of a temperature in the range from 55 to 66 °C, resulting in reliable fixation of the graft to the wound surface in the absence of a damaging effect on the skin graft tissue.

KEYWORDS: skin burn, skin graft, fixation, low-temperature argon plasma, wound treatment.

TO CITE THIS ARTICLE. Zinoviev E.V., Ilyina V.A., Soloshchenko V.V., Kostyakov D.V., Wagner D.O., Pankratyeva O.S., Pyatakova S.N. Possibilities of Increasing Adhesion and Fixation of Autoderm Graft after Treatment with Low Temperature Argon Plasma. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):8–14.

UDC 616.711 : 616-073.75 : 613.648.4

DOI: 10.54866/27129632_2025_3_15

TRANSPEDICULAR SPINAL FIXATION UNDER X‑RAY GUIDANCE AND INTRAOPERATIVE CT NAVIGATION: ASSESSMENT OF RADIATION DOSES

© M.V. KUBASOV ¹, M.N. KRAVTSOV ^1,3,4, I.S. ZHELEZNYAK ¹, S.S. SARYCHEVA ², E.N. SHLEENKOVA ², D.V. SVISTOV ¹

¹ Kirov Military Medical Academy, St. Petersburg, Russia

² Federal budgetary institution of science “St. Petersburg Research Institute of Radiation Hygiene named after professor P.V. Ramzaev”. Federal Service for Supervision of Consumer Rights Protection and Human Well-being, St. Petersburg, Russia

³ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

⁴ North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

Abstract

Modern spinal surgery is inseparable from radiation guidance methods, and therefore from the effects of X‑rays on both the operating team and patients. The aim of the study was to compare the radiation doses of patients and the operating team during transpedicular spine fixation using CT navigation and traditional fluoroscopy.

Research design: retrospective, clinical and experimental, description of a series of cases.

Materials and methods. The selection comprised 164 patients after transpedicular spinal fixation performed using closed or open techniques. In the O‑arm group (n = 109), cone beam CT combined with optical navigation was used; in the C‑arm group, fluoroscopy (n = 55) was used. The effective dose and the maximum absorbed dose in the skin were evaluated. After verifying the “zero” dose burden on surgeons when working with CT navigation, the sample of the clinical and experimental part of the study consisted of 11 cases of percutaneous transpedicular fixation. We evaluated the effective dose of the operating team, the equivalent radiation doses of the lenses of the eyes and the skin of the hands of spinal surgeons.

Results. Patients: effective dose in the O‑arm group was: Ме 9.1 muSv, [IQR: 7.1–11.6], in the C‑arm group: Ме 1.8 muSv [IQR: 1.8–5.6], p < 0.0001. The maximum absorbed dose in the skin in the O‑arm group was: Ме 49.3 mGy [IQR: 27.0–96.9], in the C‑arm group: Ме 36.1 mGy [IQR: 16.6–111.5], p = 0.424. Medical staff: surgeon's effective dose 0.07 muSv; eye lens effective dose 1.2 muSv; hand skin 11.96 muSv.

Conclusion. The values of the patients' maximum absorbed dose in the skin indicate that the use of CT navigation and fluoroscopy in spinal transpedicular fixation is not associated with the risk of developing deterministic effects. The lens of the eye and the skin of the operator's hands are exposed to the greatest radiation during the operation. Calculations show that the safe annual dose limit for the lens will be reached after about 50 percutaneous transpedicular fixations, and for the skin of the hands — after about 115 similar interventions, which requires the mandatory use of specialized protective equipment.

Keywords: transpedicular fixation, radiography, fluoroscopy, CT navigation, radiation safety, effective radiation doses, equivalent radiation doses.

to cite this article. Kubasov M.V., Kravtsov M.N., Zheleznyak I.S., Sarycheva S.S., Shleenkova E.N., Svistov D.V. Transpedicular Spinal Fixation Under X-Ray Guidance and Intraoperative CT Navigation: Assessment of Radiation Doses. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3): 15–24.

UDC 616-092.4 : 616-001.513

DOI: 10.54866/27129632_2025_3_25

REVISITING THE ISSUE OF FIXATION STABILITY IN MULTICOLUMN OSTEOSYNTHESIS OF COMPLEX TIBIAL PLATEAU FRACTURE: A BIOMECHANICAL EXPERIMENT AND CLINICAL CASE

© B.A. MAYOROV ^1,2,3, I.G. BELEN'KIY ^1,2, G.D. SERGEEV ^1,2, A.V. BENIN ⁴

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

⁴ Emperor Alexander I St. Petersburg State Transport University, St. Petersburg, Russia

Abstract

Background. In complex tibial plateau fractures, it is necessary to fix the lateral, medial, and posterior columns. In the case of a comminuted posterior fragment, multiple buttress plates should be used during osteosynthesis. However, the stability of such implant configurations has not been sufficiently studied.

Objective: To compare the biomechanical stability of different variants of plate osteosynthesis for complex tibial plateau fractures, considering the three-column fixation considering both concept and without it.

Materials and methods. Condylar fractures (type 41C3) were simulated on the models of the right tibia. In the first fixation variant, plates were placed along the lateral and posteromedial surfaces. In the second variant, following the three-column concept, implants were positioned along the lateral, medial, posteromedial, and posterior surfaces. In both models, a pre-contoured lateral L-shaped condylar buttress plate was placed on the lateral surface, and a 1/3 tubular plate was placed on the posteromedial surface. In the second model variant, two additional 1/3 tubular plates were placed: one on the medial surface and one on the posterior surface in an oblique direction. To study deformations under vertical loading, the samples were placed in a testing machine, and a load of 300 N was applied at a rate of 1 mm/min from top to bottom. To study deformations under lateral loading, the samples were placed cantilevered in a horizontal position in the testing machine. A load of 50 N at a rate of 1 mm/min was applied to the sample in four positions: from outside to inside, from inside to outside, from front to back, and from back to front.

Results. In the bilateral fixation model, under vertical loading, the metaphyseal fracture gap deformed more significantly compared to the three-column osteosynthesis model (p = 0.021). The most pronounced difference in displacement magnitude was observed in the anteromedial fragment area (0.872 mm and 0.163 mm, respectively). The bilateral fixation model was also statistically significantly less stable (p = 0.035) under lateral loading compared to the three-column osteosynthesis model.

Conclusion. The three-column fixation model for a complex tibial plateau fracture demonstrated greater resistance to deformation under both vertical and lateral loads compared to the model fixed with two plates.

Keywords: biomechanical experiment, plateau fracture, multi-column fixation, buttress plate, osteosynthesis stability.

To cite this article. Mayorov B.A., Belen'kiy I.G., Sergeev G.D., Benin A.V. Revisiting the Issue of Fixation Stability in Multicolumn Osteosynthesis of Complex Tibial Plateau Fracture: a Biomechanical Experiment and Clinical Case. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3): 25–38.

UDC 616-001.513 : 616.718.56/.66 : 616-089.8

DOI: 10.54866/27129632_2025_3_39

DOES THE QUALITY OF PRIMARY REDUCTION IN EXTERNAL FIXATOR AFFECT THE FINAL TREATMENT OUTCOME IN COMPLETE INTRA-ARTICULAR TIBIAL PLATEAU FRACTURES?

© B.A. MAIOROV ^1,2,3, I.G. BELEN’KIY ^1,2, G.D. SERGEEV ^1,2, M.A. SERGEEVA ^1,3

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

The two-stage osteosynthesis of tibial plateau fractures involves initial fracture fixation using an external fixator that spans the injured joint. However, little attention is paid to the techniques of external fixation and the quality of initial fracture reduction.

The aim of the study was to determine whether the functional outcomes in patients with complete intra-articular tibial plateau fractures were associated with the quality of initial reduction achieved in the external fixator.

Material and Methods. The study included 40 patients who underwent surgery for complete intra-articular tibial plateau fractures. External fixation with moderate distraction was used for initial fracture stabilization. Based on CT data, patients were divided into two groups (23 and 17 patients) according to the quality of initial reduction in the external fixator. After definitive internal fixation, reduction quality was assessed using X-rays and CT scans. Evaluation criteria included: the presence and size of intra-articular step, widening of the articular surface compared to the femoral condylar width, residual angular deformity relative to the contralateral limb, and the angle between the anatomical axes of the femur and tibia. Functional outcomes were assessed using the Lysholm and KSS scores at 6, 12, and 24 months.

Results. Anatomical final reduction was more frequent in the group with satisfactory initial alignment in the external fixator: 15 (65 %) patients versus 5 (29 %) in the comparison group (p = 0.025). Complications were more common in the comparison group: 9 (53 %) cases versus 3 (13 %) (p = 0.009). No statistically significant differences were found in hospital stay duration, preoperative bed-days, or functional outcomes.

Conclusion. The quality of initial fracture reduction in external fixator influenced the quality of final reduction during definitive osteosynthesis. Satisfactory positioning of tibial plateau fragments at the initial stage was associated with a lower rate of complications after final fixation. Achieving the most accurate reduction should be pursued by surgeons at every stage of osteosynthesis, as it may affect overall treatment outcome.

Keywords: tibial plateau fracture, two-stage protocol, temporary fixation, external fixation, definitive osteosynthesis, intra-articular fracture reduction.

TO CITE this article. Maiorov B.A., Belen’kiy I.G., Sergeev G.D., Sergeeva M.A. Does the Quality of Primary Reduction in External Fixator Affect the Final Treatment Outcome in Complete Intra-Articular Tibial Plateau Fractures? The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3): 39–50.

UDC 617.583 : 617.581

DOI: 10.54866/27129632_2025_3_51

EVALUATION OF THE EFFECTIVENESS OF MINIMALLY INVASIVE APPROACH IN TOTAL KNEE REPLACEMENT

© E.E. MALYSHEV, S.E. SOKOLOVSKII, O.V. VOROBIEVA, A.M. TRIFONOV, M.H. ELKASEER

Privolzhsky Research Medical University, Nizhny Novgorod, Russia

Abstract

Rationale. Total knee arthroplasty (TKA) is an orthopaedic surgery used to treat patients with end-stage gonarthrosis. Minimally invasive approaches are an excellent alternative to traditional techniques, which have many disadvantages. The high effectiveness of minimally invasive approaches was the reason for conducting this study.

The aim of the study was to evaluate the effectiveness of the developed minimally invasive epivastus approach in TKA.

Materials and methods. A prospective, single-centre, comparative, randomised study included two groups of patients who underwent a comparative analysis based on the results of a questionnaire and an assessment of gait biomechanics in 2D mode before and after TKA using medial parapatellar approach (n = 62) and minimally invasive approach epivastus (n = 65).

Results. Data from 2D gait analysis after 2 months showed better gait speed and movement in the knee joint during walking in the epivastus group (p < 0.05). Six months after surgery, gait speed and movement in the knee joint remained better in the epivastus group (p < 0.05). Twelve months after surgery, the epivastus group showed improvements in gait speed, swing phase, double-step period, and movement in the knee and ankle joints (p < 0.05). Similarly, after surgery, there was a significant difference in all KOOS scale indicators, with the best result in the epivastus group compared to the medial parapatellar approach group (0.0001). The knee flexion angle was 115.86 (±13.5) in the epivastus group and 106 (±9.42) in the medial parapatellar approach group.

Conclusion. Our results showed the advantages of a minimally traumatic technique without compromising the final treatment outcome. The use of the epivastus minimally invasive approach in TKA demonstrates advantages in the postoperative period, accelerating rehabilitation and improving functional outcome.

Keywords: total knee arthroplasty, minimally invasive approach, epivastus, medial mediapatellar approach, 2D gait analysis, KOOS.

to cite this article. Malyshev E.E., Sokolovskii S.E., Vorobieva O.V., Trifonov A.M., Elkaseer M.H. Evaluation of the effectiveness of minimally invasive approach in total knee arthroplasty. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):51–58.

UDC 616.8-089

DOI: 10.54866/27129632_2025_3_59

RESULTS OF REPLACING EXTENSIVE NERVE DEFECTS WITH SYNTHETIC CONDUITS BASED ON POLYLACTIDE in an experiment

© V.P. ORLOV ¹, A.YU. NISHT ¹, I.YU. SAPURINA ², B.L. GAVRILYUK ¹, P.G. TOLKACH ¹, M.E. STRELTSOV ¹

¹ Kirov Military Medical Academy, St. Petersburg, Russia

² Institute of Macromolecular Compounds of the Russian Academy of Sciences, St. Petersburg, Russia

Abstract

Background. The relevance of the study is caused by the ever-increasing need to improve approaches to surgical restoration of damaged nerves in connection with the increase in the number of high-energy injuries to large nerves of the extremities.

The objective is to evaluate the effectiveness of restoring tissue innervation lost due to trauma after replacing extensive nerve defects with synthetic conduits based on polylactide in an experiment on laboratory animals.

Materials and methods. In the experimental conditions on 10 laboratory animals (rats) the modeling of the extensive defect of the sciatic nerve was performed with its subsequent replacement using a synthetic conduit based on polylactide. In the postoperative period the nature of changes in the functional state of nerves restored using experimental implants was assessed by experimental-clinical, electro-physiological and morphological methods.

Results. According to the results of stimulation electroneuromyography, the animals of the experimental group showed a persistent loss of nerve conductivity throughout the observation period, which was manifested by sensory, motor and trophic disorders. Morphologically, signs of the formation of the proximal segment terminal neuroma of the nerve located inside the conduit were noted. Myelinated nerve fibers were not determined in the distal segment.

Conclusion. Connection of the nerve ends damaged in the experiment with a polylactide conduit prevented retraction of the proximal and distal ends of the nerve sutured into the conduit and also prevented their involvement in the postoperative scar. Regenerating nerve fibers from the proximal end of the nerve sutured into the conduit filled the internal lumen of the implant and formed a neuroma. Thus, connection of the ends of the damaged nerve with a polylactide conduit helps to maintain relatively favorable conditions for subsequent reconstructive operations on the nerves.

Keywords: limb nerves, nerve injury, extensive nerve defect, reconstructive surgery, synthetic nerve conduits.

To cite this article. Orlov V.P., Nisht A.Yu., Sapurina I.Yu., Gavrilyuk B.L., Tolkach P.G., Streltsov M.E. Results of Replacing Extensive Nerve Defects with Synthetic Conduits Based on Polylactide in an Experiment. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):59–65.

UDC 617-089.5.15/.16

DOI: 10.54866/27129632_2025_3_66

GENERAL COMBINED ANESTHESIA STRESS-PROTECTIVE EFFECT WITH THE USE OF HALOGEN-CONTAINING ANESTHETICS FOR HIGHLY TRAUMATIC SURGICAL INTERVENTIONS

© I.A. SOKORNOV, L.P. PIVOVAROVA, V.N. LAPSHIN, M.E. MALYSHEV, I.V. OSIPOVA, O.B. ARISKINA, N.K. RAZUMOVA

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

abstract

The article presents the results of a study of stress markers during high-grade trauma operations in patients who underwent combined general anesthesia using artificial lung ventilation.

The aim of the study was to assess the adequacy of combined general anesthesia in patients with high surgical and anesthetic risk by examining the content of stress–implementing hormones and T-lymphocytes in venous blood before, during and after surgery.

A comparative analysis of the levels of CD3, CD4 lymphocytes, ACTH, TSH, thyroxine, and cortisol during the perioperative period was carried out.

Keywords: high-risk surgical interventions, anesthesiological care, stress markers, perioperative period.

to cite this article. Sokornov I.A., Pivovarova L.P., Lapshin V.N., Malyshev M.E., Osipova I.V., Ariskina O.B., Razumova N.K. General Combined Anesthesia Stress-Protective Effect with the Use of Halogen-Containing Anesthetics for Highly Traumatic Surgical Interventions. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):66–71.

UDC 617-089 : 519.711.2

DOI: 10.54866/27129632_2025_3_72

A NEW METHOD FOR PREDICTING THE RISK OF COMPLICATIONS IN SURGERY

© A.A. SOLOMAKHA ^1,2, D.V. ULYBINA ²

¹ Penza Regional Clinical Hospital named after N.N. Burdenko, Penza, Russia

² Federal State Budgetary Educational Institution of Higher Education “Medical Institute of Penza State University”, Penza, Russia

abstract

The high prevalence of postoperative complications in surgery poses the challenge for the medical community to develop accurate and reliable methods for their prediction. Existing approaches often have insufficient predictive ability, especially in complex clinical cases.

Aim: to carry out the theoretical substantiation and practical implementation of the method of predicting complications in surgery based on a combined approach.

Material and methods. A combined method for predicting postoperative complications in surgery is proposed, combining the method of group consideration of arguments and neural network algorithms. The multi-row self-organization approach of discriminant functions is used, including cross-validation, iterative optimization, and model selection based on the minimum error criterion.

Results. Based on the analysis of 13 clinical cases with 19 indicators, including laboratory and clinical data, key three-factor combinations of indicators were identified to ensure the accuracy of the forecast.

Conclusion. The developed method has shown high efficiency in predicting purulent-septic complications and can be implemented in clinical practice to reduce risks.

Keywords: forecasting, postoperative complications, method of group consideration of arguments, neural network algorithms, clinical analytics.

To cite this article. Solomakha A.A., Ulybina D.V. A New Method for Predicting the Risk of Complications in Surgery. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):72–79.

UDC 616.361-003

DOI: 10.54866/27129632_2025_3_80

DESTRUCTIVE FORMS OF CHOLECYSTITIS AS A COMPLICATION OF ENDOSCOPIC TRANSPAPILLARY INTERVENTIONS

© D.B. TULYAGANOV, SH.К. ATADJANOV, B.A. ALIEV, SH.A. MAGDIEV

Republican Research Centre of Emergency Medicine, Tashkent, Uzbekistan

ABSTRACT

Background. Despite their minimally invasive nature, endoscopic transpapillary interventions are surgical procedures that may be accompanied by complications. The pathogenesis of destructive forms of cholecystitis following such interventions remains a subject of debate. Some authors attribute their development to infection of the biliary tract, while others suggest that accelerated bile passage and displacement of gallstones into the gallbladder neck with subsequent occlusion play a key role. There are also opinions regarding the adverse chemical effects of contrast agents. This study aims to elucidate the specific pathogenetic mechanisms of this complication.

Objective is to identify factors contributing to the development of destructive forms of cholecystitis after endoscopic transpapillary interventions.

Materials and Methods. The study is based on an analysis of treatment outcomes in 328 patients with complicated gallstone disease. The analysis included the incidence of complicated forms of cholelithiasis, the structure of complications, clinical and laboratory parameters, and instrumental examination findings. According to the interval between endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy, patients were divided into two groups. Group 1 comprised 217 patients (66.2 %) who underwent cholecystectomy more than 24 hours to several days after ERCP. Group 2 included 111 patients (33.8 %) who underwent cholecystectomy within 24 hours after ERCP.

Results. The more frequent occurrence of acute biliary pancreatitis in cases of delayed cholecystectomy was associated with insufficient decompression of the biliary tract after endoscopic transpapillary interventions, as evidenced by incomplete evacuation of bile and contrast material in 22.8 % of patients. Changes in blood biochemical parameters and the results of microbiological studies indicate the need for early cholecystectomy following endoscopic transpapillary procedures, while emphasizing the necessity of an individualized approach to each patient.

Conclusion. The degree of alteration in blood biochemical parameters reflects the severity of disturbances within the biliary tract. Microbiological findings underscore the role of infection in the pathogenesis of gallstone disease complications. Stagnant bile with altered properties and the viscosity of contrast agents are factors that provoke exacerbation of inflammatory processes in the gallbladder. Therefore, cholecystectomy should be performed as early as possible.

KEYWORDS: endoscopic transpapillary interventions, destructive forms of cholecystitis, complications, obstructive jaundice, cholangitis, cholecystectomy.

TO CITE THIS ARTICLE. Tulyaganov D.B., Atadjanov Sh.К., Aliev B.A., Magdiev Sh.A. Destructive Forms of Cholecystitis as a Complication of Endoscopic Transpapillary Interventions. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):80–88.

UDC 616.25-003.219

DOI: 10.54866/27129632_2025_3_89

ANALYSIS OF RISK FACTORS FOR THE DEVELOPMENT OF CHRONIC PAIN SYNDROME IN PATIENTS AFTER SURGICAL TREATMENT OF SPONTANEOUS PNEUMOTHORAX

© B.N. SHAKH ¹, N.A. SKRIPKIN ¹^,², V.A. VOLCHKOV ¹, V.N. LAPSHIN ³, O.V. NOVIKOVA ¹

¹ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

² Leningrad Emergency Medical Service Station, Vsevolozhsk, Leningrad Region, Russia

^3. St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

Rationale. Spontaneous pneumothorax often requires surgical treatment; however, the development of chronic pain syndrome after intervention remains a widespread and underestimated problem. Despite existing treatment and prevention methods, the issues of predicting and early identification of chronic pain syndrome risk remain insufficiently studied. Since spontaneous pneumothorax is common among young, working-age individuals, addressing this challenge has not only medical but also socio-economic significance.

Objective: To determine the key risk factors for the development of chronic pain syndrome in patients who underwent VATS pleurectomy for spontaneous pneumothorax.

Materials and Methods. The study included 136 patients. A single-center, cohort, non-randomized study consisting of two parts was conducted.

Results. Among patients who underwent VATS intervention, the frequency of chronic pain syndrome at the time of examination was 40 %, whereas in the pleural cavity drainage group it was 30.8 %; however, the difference was not statistically significant (p = 0.386). However, the intensity and severity of pain syndrome measured by the painDETECT scale were higher in the VATS surgery group. In 6.6 % of patients after VATS surgery, painDETECT scores were above 12, indicating a high likelihood of a neuropathic pain component. This was not observed in the pleural drainage group. Differences were also identified in several other parameters: duration of drainage, length of hospitalization, and the need for analgesics after discharge. The developed prognostic model helped identify the following risk factors: the fact of surgical intervention, persistence of pain after discharge, need for analgesics after discharge, and reduced physical endurance.

Conclusion. The obtained data point to the need for developing individualized prevention and treatment strategies for chronic pain syndrome, especially in patients who underwent surgical treatment for spontaneous pneumothorax.

KEYWORDS: spontaneous pneumothorax, subtotal pleurectomy, video-assisted thoracoscopy, chronic pain syndrome in thoracic surgery, postoperative pain syndrome.

TO CITE this article. Shakh B.N., Skripkin N.A., Volchkov.V.A., Lapshin V.N., Novikova O.V. Analysis of Risk Factors for the Development of Chronic Pain Syndrome in Patients After Surgical Treatment of Spontaneous Pneumothorax. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):89–96.

CLINICAL CASES AND REVIEW ARTICLES

UDC 616.72-002

DOI: 10.54866/27129632_2025_3_97

EXPERIENCE OF PRACTICAL APPLICATION OF TOMOSYNTHESIS IN DETECTION OF STRUCTURAL CHANGES OF SACROILIAC JOINTS IN PATIENTS WITH SPONDYLOARTHRITIS

© A.S. GAYDUK ¹, I.S. ZHELEZNYAK ¹, D.S. AGANOV ¹, D.YU. ANOKHIN ¹, A.A. EMELYANTSEV ¹, A.S. KOLODIN ²

¹ Kirov Military Medical Academy, St. Petersburg, Russia

² Federal State Public Institution “1469 Naval Clinical Hospital” of the Ministry of Defense of Russia, Severomorsk, Russia

ABSTRACT

rationale. Spondyloarthritis is one of the leading rheumatic diseases. Its late diagnosis leads to untimely administration of effective therapy and, as a consequence, rapid progression of structural changes in the musculoskeletal system, decreased functional activity and social adaptation of patients. The main manifestation of spondyloarthritis is inflammatory damage to the sacroiliac joints — sacroiliitis.

Objective. The work demonstrated the capabilities of tomosynthesis in patients with spondyloarthritis, which allowed us to suggest the advisability of its use as a method of choice in identifying structural changes in the sacroiliac joints, including its use for more specific diagnosis of the stage of ankylosing spondylitis at the stage of X-ray diagnostics.

Material and methods. The presented article describes clinical observations of patients with suspected sacroiliitis, who, in addition to traditional radiography, underwent tomosynthesis of the sacroiliac joints.

Results. Tomosynthesis has increased the likelihood of visualizing manifestations of sacroiliitis such as erosions and changes in the joint space (its expansion, narrowing and ankylosis), which were not determined by traditional radiography.

Conclusion. The clinical cases described in this article indicate that tomosynthesis can be used as a method of choice in radiological diagnostics to identify signs of sacroiliac joint damage in spondyloarthritis.

KEYWORDS: sacroiliac joints, tomosynthesis, sacroiliitis, spondyloarthritis, ankylosing spondylitis, clinical case.

TO CITE THIS ARTICLE. Gayduk A.S., Zheleznyak I.S., Aganov D.S., Anokhin D.Yu., Emelyantsev A.A., Kolodin A.S. Experience of practical application of tomosynthesis in detection of structural changes of sacroiliac joints in patients with spondyloarthritis. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):97–108.

UDC 616-073.756.8 : 616-001.3

DOI: 10.54866/27129632_2025_3_109

RADIOLOGY DIAGNOSTICS OF TRAUMATIC DAMAGE TO THE SPLEEN: CLINICAL CASE

© A.S. KAZANKIN ¹, V.E. SAVELLO ^1,2, A.N. KOSTENIKOV ¹, YA.V. GAVRISHCHUK ¹, A.V. MARCHENKO ¹, M.A. KISELYOV ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

Traumatic injury to the spleen remains one of the most pressing problems of emergency surgery, being the leading cause of death in isolated abdominal injuries. Ruptures of the parenchyma with the formation of a false aneurysm of the splenic artery branch are particularly dangerous, as they can lead to delayed bleeding even after the patient's condition has stabilized. This clinical observation presents a detailed analysis of a case of traumatic injury to the spleen complicated by the formation of a false aneurysm. The main attention is paid to a comprehensive assessment of the diagnostic capabilities of multispiral computed tomography (MSCT) with multiphase contrast enhancement. The high diagnostic capabilities of the method in detecting vascular complications of spleen injury are demonstrated, and CT semiotics is described in detail. Attention is paid to the comparative characteristics of various phases of contrast (arterial, parenchymal, delayed) and their diagnostic value in different types of spleen injuries. The presented case demonstrates the effectiveness of a modern integrated approach combining accurate MSCT diagnostics and minimally invasive treatment methods, which allows us to adhere to the strategy of non-surgical treatment of traumatic injuries of the abdominal cavity.

KEYWORDS: spleen injury, false aneurysm, CT scan.

TO CITE THIS ARTICLE. Kazankin A.S., Savello V.E., Kostenikov A.N., Gavrishchuk Ya.V., Marchenko A.V., Kiselyov M.A. Radiology Diagnostics of Traumatic Damage to the Spleen: Clinical Case. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):109–114.

UDC 616.149-089-073 : 616-07

DOI: 10.54866/27129632_2025_3_115

THE ROLE OF SONOGRAPHY IN THE DIAGNOSIS OF PNEUMOPORTALIZATION IN PATIENTS WITH A SURGICAL PROFILE

© A.YA. LATYSHEVA ¹, A.B. VALCHINSKAYA ²

¹ Kirov Military Medical Academy, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

Rationale. Portal venous gas of liver (PVGL) is a sign indicating serious problems in the gastrointestinal tract and is often associated with acute mesenteric ischemia. The basis for the PVGL sign can be any type of damage to the intestinal mucosa, both with of obvious damage and  intestinal hypertension without ulcerative defects. Among the etiological factors leading to the appearance of gas in the portal vein are damage to the intestinal wall, distension of the intestine due to mechanical obstruction, blunt abdominal trauma, the development of infection, portal vein embolism, and iatrogenic causes. Early and accurate diagnosis of this condition can lead to a change in surgical treatment tactics to eliminate its causes, adjust the ongoing drug therapy and prevent the systemic consequences of gas entering the portal vein. The sonography is informative in detecting portal gas in the liver, therefore it is necessary to present the peculiarities of its sonographic pattern.

Objective. The aim of this work is to summarize theoretical information about portal gas of the liver and present the possibilities of sonograohy in its detection using the example of our own observation.

Material and methods. We used the results of previously conducted original research, clinical cases, and meta-analyses presented in the Elibrary — scientific electronic library, the PubMed search engine, and the ResearchGate scientific and information social network. A personal emergency clinical observation of a patient with portal gas in the liver accompanying perforation of the sigmoid diverticulum is also presented.

Results. The analysis indicates sonography to be highly informative in detecting portal gas of the liver and makes it possible to identify it with high information content and differentiate it from aerocholia within the context of urgent diagnosis of urgent surgical pathology of assessing the impact of pharmaceutical and non-pharmaceutical (including psychotherapeutic) treatment. The main echographic signs of gas in the portal venous system of the liver are the following: B‑mode visualization of gas microbubbles, which manifest themselves as highly echogenic particles, rapidly moving along the segmental and subsegmental branches of the portal vein in the direction of blood flow inside the portal vein lumen with reverberation effect.

Conclusion. The sonography makes it possible to carry out urgent primary and differential diagnosis of PVGL with high information content, which makes it possible for surgical specialists to suspect the conditions that cause its occurrence and undertake the necessary diagnostic search during the further provision of emergency surgical care.

KEYWORDS: portal venous gas of the liver, radiation diagnostics, sonography, computed tomography, emergency surgery, portal vein, diverticular perforation, peritonitis.

TO CITE THIS ARTICLE. Latysheva A.Ya., Valchinskaya A.B. The role of sonography in the diagnosis of pneumoportalization in patients with a surgical profile. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3): 115–125.

UDC 578.834.1 : 616-002.4

DOI: 10.54866/27129632_2025_3_126

SARS-COV-2 AND NECROTIZING SOFT TISSUE INFECTION — AN EXAMPLE OF NEGATIVE SYNERGISM (LITERATURE REVIEW)

© O.B. CHERNYSHEV ¹, T.S. KALININA ², M.A. SHATIL ¹, I.V. AVDOSHIN ^1,3, N.A. BUBNOVA ^1,3

¹ St. Petersburg State Budgetary Institution “St. George the Great Martyr City Hospital”, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

Abstract

Rationale. The novel coronavirus infection has been mentioned to be a frequent reason for secondary infections, mostly bacterial. During the COVID‑19 pandemic a series of clinical cases of necrotizing fasciitis have been described. Necrotizing soft tissue infection is a severe bacterial infection, known for high mortality level and demanding emergency surgical treatment. Clinical cases of necrotizing fasciitis during the COVID‑19 pandemic require precise analysis in order to derive common pathogenic features of SARS-CoV-2 and soft tissues necrotizing infection and find out if the new coronavirus infection and necrotizing fasciitis could be an example of negative synergism.

Objective. The objective of the present literature review is to evaluate the influence of the novel coronavirus infection on the course of necrotizing fasciitis.

Methods. The following literature review is based on Russian as well as foreign publications. A precise analysis of mutual pathogenic features of SARS-CoV-2 and necrotizing fasciitis has been made.

Results. Based on analysis of 70 publications, certain conclusions on specific features of SARS-CoV-2, causing secondary infections, have been made. Organization factor of the COVID‑19 pandemic influence on the course of necrotizing fasciitis have also been evaluated.

Conclusions. The following literature highlights the influence of the novel coronavirus infection on the course of necrotizing fasciitis, a severe bacterial infection, known for high mortality level and demanding emergency surgical treatment. Some pathogenic features of SARS-CoV-2, including its influence on blood vessels as well as severe immunosuppression, lead to secondary infections. Organizational and social restrictions of the pandemic period resulted in late presentations and late treatment. Necrotizing fasciitis and COVID‑19 infection should be considered an example of negative synergism.

KEYWORDS: pandemic, COVID‑19, necrotizing infection, immunosuppression, pathogenesis, SARS-CoV-2.

To cite this article. Chernyshev O.B., Kalinina T.S., Shatil M.A., Avdoshin I.V., Bubnova N.A. SARS-CoV-2 and Necrotizing Soft Tissue Infection — an Example of Negative Synergism (Literature Review). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):126–135.

UDC 616-089.5 : 616-001

DOI: 10.54866/27129632_2025_3_136

ANESTHESIOLOGIST CARE OF SURGICAL INTERVENTIONS IN THE ACUTE PERIOD OF INJURY

© A.V. SHCHOGOLEV, V.S. AFONCHIKOV, A.N. GRITSAY, O.V. ORLOVA

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

Abstract

The article presents the basic principles of providing anesthetic care in the acute period of injury. The specifics of infusion therapy for ongoing bleeding are reflected, the mechanisms of development, clinical and laboratory signs of ventilation and parenchymal respiratory failure, the goals and indications for tracheal intubation and artificial ventilation are presented. The most common signs are described, which make it possible to perform an express diagnosis of difficult airways and predict difficult intubation. The main measures for the prevention of nausea and vomiting are presented. The essence of the technique of rapid sequential induction and algorithms of actions in case of unexpectedly difficult ventilation and intubation of the trachea are revealed. A brief description of the most widely used intravenous and inhalation anesthetics and muscle relaxants is given. Their effect on hemodynamics and cerebral blood flow in the acute period of injury during induction and maintenance of anesthesia is described. The advantages and disadvantages of the most widely used methods of anesthesia and the features of respiratory support during anesthesia in the acute period of injury are reflected.

The presented data allow us to draw the following conclusions:

•  timely identification and elimination of additional causes of hemodynamic and gas exchange disorders increases the effectiveness of therapeutic measures for acute blood loss;

•  the strategy of acceptable hypotension reduces the amount of blood loss and the risk of dilution coagulopathy;

•  all injured need to take measures to prevent aspiration and protect VDP in preparation for emergency surgery.;

•  preoxygenation is an extremely important component of preparation for performing rapid sequential induction;

•  the correct positioning of the patient ensures the creation of optimal conditions for successful tracheal intubation.;

•  apneistic oxygenation with unexpectedly difficult intubation and ventilation allows delaying the onset of hypercapnic hypoxia and circulatory arrest;

•  anesthesia with ketamine in combination with fentanyl and benzodiazepines is one of the simplest and most effective ways to provide anesthesia in traumatic shock;

•  it is advisable to carry out a dynamic assessment of the P_aCO₂–P_etCO₂ difference in concomitant head injuries and wounds, since an unrecognized pathological change in P_aCO₂ is one of the causes that increase mortality in intracranial hypertension;

•  avoidance of hyperoxia and protective ventilation can reduce additional damage to lung tissue.

KEYWORDS: trauma, shock, blood loss, anesthesiologist care, systolic blood pressure, infusion therapy, oxygenation, upper respiratory tract patency, difficult airways, rapid sequential induction.

TO CITE THIS ARTICLE. Shchogolev A.V., Afonchikov V.S., Gritsay A.N., Orlova O.V. Anesthesiologist care of surgical intervention in the acute period of injury. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3): 136–148.

NURSING AND PUBLIC HEALTH, AN ORGANIZATION AND SOCIOLOGY OF HEALTHCARE, MEDICAL AND SOCIAL EXPERTISE

UDC 614.2

DOI: 10.54866/27129632_2025_3_149

SIZE AND COMPOSITION OF THE POPULATION SERVED BY EMERGENCY MEDICAL CARE TEAMS IN THE RUSSIAN FEDERATION

© I.M. BARSUKOVA ^1,2, O.A. CHEKULAEVA ³, A.O. BUMAY ^1,4

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

³ Moscow Regional Emergency Medical Service Station, Krasnogorsk, Moscow Region, Russia

⁴ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

ABSTRACT

RATIONALE. The demographic challenges of modern Russia are a significant problem for the state and society. Emergency medical care is the first contact service with the patient, capable of preserving their life and health.

OBJECTIVE is to study the size and composition of the population of the Russian Federation receiving services from emergency medical care organizations.

MATERIALS AND METHODS. The data of industry statistical observation such as form No. 40 (2010–2013) and federal statistical observation form No. 30 (2014–2024) for the Russian Federation were used; statistical and analytical research methods, electronic tables “MS Office Excel 2016” were applied.

RESULTS. Over the 15-year observation period, the population assigned for medical care purposes was 146.3 ± 3.0 million people with multidirectional dynamics in different years and an overall growth dynamic of 9.6 million people (0.7 %) to 151.5 million people in 2024. A quarter of the country's population (25.4 ± 1.6 %) is the rural population with special medical care features (infrastructure, resources, organizational) with a downward trend in number (by 2.5 %) and share (by 6.7 %) to 30.7 million people (20.2 %) in 2024. The most significant in solving social and demographic problems is the dynamics of the country's child population (0–17 years): 29.3 ± 2.8 million citizens, every fifth resident of the country (20.0 ± 1.6 %) with positive growth dynamics in their number (by 4.3 %) and share (by 6.2 %) to 37.2 million people (24.6 %) in 2024.

CONCLUSIONS. Actual volumes of medical care may differ significantly from those planned, calculated according to the attached population, and may be determined by seasonal factors, fluctuations in morbidity, and the dynamics of external and internal migration of the population. These issues are especially relevant for emergency medical care, since it is the one that provides medical care to the unattached population. The available forces and resources must ensure unplanned volumes of medical care, its availability and quality throughout the country.

KEYWORDS: emergency medical care, demography, population size, emergency medical care teams, emergency medical care resources.

TO CITE this article. Barsukova I.M., Chekulaeva O.A., Bumay A.O. Size and Composition of the Population Served By Emergency Medical Care Teams in the Russian Federation. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):149–154.

UDC 617-089

DOI: 10.54866/27129632_2025_3_155

DYNAMICS OF OPERATIVE ACTIVITY INDICATORS IN ACUTE SURGICAL PATHOLOGY OF ABDOMINAL ORGANS IN ST. PETERSBURG: 20 YEARS OF OBSERVATION

© V.E. PARFENOV ¹, I.M. BARSUKOVA ^1,2, P.A. DUBYKAITIS ¹, A.O. BUMAY ^1,3

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

ABSTRACT

RATIONALE. Acute abdominal surgery is a key link in surgical science and practice. Despite obvious successes, there are many problems. One of the significant performance indicators is operational activity, which characterizes the organizational features of the use of specialized hospital beds, the efficiency of the surgical service as a whole.

OBJECTIVE is to study the dynamics of indicators of surgical activity in acute surgical pathology of abdominal organs in medical organizations of St. Petersburg during 2005–2024.

MATERIALS AND METHODS. The data of monitoring the state of acute surgical pathology of abdominal organs were used in accordance with the Order of the Health Committee of St. Petersburg of 31.07.2009 No. 477-r “On the control of emergency hospitalization in state health care institutions of St. Petersburg”, conducted by the St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, 2005–2024.

RESULTS. 20 years data of observation indicate an increase by one third (by 29.04 %) in the overall indicators of surgical activity in patients with acute surgical pathology of the abdominal organs in St. Petersburg. Stably high indicators (90.0–100.0 %) of surgical activity were noted in patients with acute appendicitis, acute intestinal obstruction, strangulated hernia and perforated ulcer due to the high risk of developing life-threatening conditions that often do not allow the use of conservative treatment methods. Nosological forms with changed surgical activity were identified: an increase in the indicator was noted in patients with a bleeding ulcer (by 19.57 %), acute cholecystitis (by 15.32 %) and acute pancreatitis (by 26.06 %).

CONCLUSIONS. The obtained data indicate both the improvement of treatment and diagnostic tactics in patients with acute surgical pathology of the abdominal organs, and a change in the contingent of patients hospitalized in surgical beds, an increase in the justification and specialization of the use of beds in surgical departments.

KEYWORDS: acute abdomen, acute surgical pathology of abdominal organs, St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, surgical activity.

TO CITE this article. Parfenov V.E., Barsukova I.M., Dubykaitis P.A., Bumay A.O. Dynamics of Operative Activity Indicators in Acute Surgical Pathology of Abdominal Organs in St. Petersburg: 20 Years of Observation. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(3):155–160.

ORIGINAL ARTICLES

UDC 617.3 : 617.547

DOI: 10.54866/27129632_2025_2_08

COMPARATIVE ANALYSIS OF CLINICAL EFFICACY OF LASER DENERVATION IN RAILWAY WORKERS WITH ISOLATED LUMBAR FACET SYNDROME

© V.A. BYVALTSEV ^1,2,3, A.A. KALININ ^1,2, A.V. EGOROV ², YU.YA. PESTRYAKOV ¹, D.V. HOZEEV ¹, S.I. BRYANSKIY ², G.YU. ANPALOVA ², E.E. SATARDINOVA ³

¹ Irkutsk State Medical University, Irkutsk, Russia

² Clinical Hospital “Russian Railways-Medicine” of Irkutsk, Irkutsk, Russia

³ Irkutsk State Medical Academy of Postgraduate Education. Branch of FSBEI FPE RMACPE MOH Russia, Irkutsk, Russia

ABSTRACT

Rationale. The long-term efficacy of percutaneous surgical treatment of isolated facet syndrome remains controversial and requires additional research.

Objective. Conducting a comparative analysis of the clinical effectiveness of the treatment of isolated lumbar facet syndrome in railway workers using the author's original method of laser denervation of the medial branch of the lumbar spinal nerve and traditional surgical technology.

Material and methods. The prospective non-randomized study included 90 railway workers with isolated lumbar facet syndrome, operated on at the Neurosurgery center of the Clinical Hospital “Russian Railways-Medicine” of Irkutsk in 2020–2021. Depending on the method of laser denervation of the medial branch of the lumbar spinal nerve, 2 groups were identified: those operated on using the original method (group 1, n = 45) and using the generally accepted method (group 2, n = 45). For comparative assessment, the level of pain in the lumbar region according to VAS, functional state according to ODI, patient satisfaction according to the Macnab scale, and the presence of complications were analyzed. The minimum observation period was 24 months after surgery.

Results. When assessing the pain level using VAS and the functional state using ODI, comparable improvements were found in both groups at discharge, 3 and 6 months after surgery. After 12 months and in the long-term period, the group of patients operated on using the original method showed lesser severity of pain symptoms compared to the traditional technology of laser denervation of the medial branch of the lumbar spinal nerve — p = 0.03 and p = 0.01, respectively. After 12 months and in the long-term period, the group of patients operated on using the original method showed a better functional status according to ODI compared to the traditional surgical technology of laser denervation of the medial branch of the lumbar spinal nerve — p = 0.04 and p = 0.01, respectively. Greater satisfaction with the operation was verified in Group I compared to Group II (p = 0.002). A statistically significantly lower number of postoperative complications was established in Group I compared to Group II (p = 0.03).

Conclusion. The developed method of laser denervation of the medial branch of the lumbar spinal nerve, compared with the generally accepted surgical technology, has better clinical outcomes in the late postoperative period in terms of pain in the lumbar spine and functional status according to ODI, as well as subjective satisfaction according to the Macnab scale with a lower number of postoperative surgical complications.

KEYWORDS: lumbar spondyloarthrosis, facet syndrome, laser destruction.

TO CITE THIS ARTICLE. Byvaltsev V.A., Kalinin A.A., Egorov A.V., Pestryakov Yu.Ya., Hozeev D.V., Bryanskiy S.I., Anpalova G.Yu., Satardinova E.E. Comparative analysis of the clinical effectiveness of laser denervation in railway workers with isolated lumbar facet syndrome. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):8–16.

UDC: 617-089.844

DOI: 10.54866/27129632_2025_2_17

THE USE OF PLATELET-ACTIVATED PLASMA IN THE TREATMENT
OF DEEP BURNS IN PATIENTS WITH CONCOMITANT DIABETES MELLITUS

© D.S. VEGERA ¹, E.V. ZINOVIEV ¹, P.K. KRYLOV ¹, A.G. BAINDURASHVILI ²

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery, St. Petersburg, Russia

ABSTRACT

Rationale. Treatment of patients with deep skin burns against the background of diabetes mellitus is one of the complex tasks of surgery. This is due to the high frequency of purulent-inflammatory complications and the low efficiency of skin grafting. One of the possible ways to solve this problem is the use of platelet-rich plasma, the action of biologically active components of which helps to reduce the negative impact on the regeneration processes of the organic consequences of diabetes mellitus.

Objective: to improve the immediate results of treating patients with deep burns on the background of diabetes mellitus through the use of platelet-rich plasma.

Materials and methods. The study is based on the results of treatment of 72 injured with deep skin burns, who had diabetes mellitus type II as a background disease, diagnosed at least 1 year before the date of injury. All patients were divided into 2 groups taking into account the method of wound preparation for skin grafting: the main (application of platelet-rich plasma) and comparison (ointments based on silver sulfadiazine). The analysis of the obtained data was carried out using clinical, laboratory, instrumental methods.

Results. It was found that the average period of wound preparation for grafting in patients of the analyzed contingent exceeded the average in both groups. However, the implementation of the effects of growth factors contained in platelets made it possible to reduce the studied interval to 23.9 days compared to 28.8 days in the control group (p < 0.05). A period not exceeding 25 days was sufficient for 59 % of victims in the main group. A similar indicator in the comparison group was 43 %. Application of platelet-rich plasma allowed achieving complete epithelialization of perforation cells of autodermal grafts by 20.6 % (p < 0.05) faster compared to the comparison group. During the generalized assessment of the results of surgical closure of wound defects, no reliable significant differences were registered. At the same time, a significant difference was recorded in the analysis of the duration of inpatient treatment in the variant of reducing the indicator in patients in the main group by 16.9 % (p < 0.05) days compared to the victims of the comparison group.

Conclusion. The study confirms the effectiveness of using platelet-rich plasma in patients with deep burns against the background of type 2 diabetes mellitus and indicates the advisability of including a course of applications of this drug in the scheme of wound preparation for plastic surgery.

KEYWORDS: deep skin burns, diabetes mellitus, free autodermoplasty, platelet activated plasma.

TO CITE THIS ARTICLE. Vegera D.S., Zinoviev E.V., Krylov P.K., Baindurashvili A.G. Use of platelet-activated plasma in the treatment of deep burns in patients with concomitant diabetes mellitus. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):17–25.

UDC 616.34-007.253 : 617-089.844

DOI: 10.54866/27129632_2025_2_26

INTRAOPERATIVE DESEROSIS OF THE INTESTINAL WALL: PROGNOSTIC FACTORS, IMPACT ON POSTOPERATIVE OUTCOMES
AND COMPLICATION RATE OF RECONSTRUCTIVE OPERATIONS
IN PATIENTS WITH SMALL BOWEL FISTULAS

© E.YU. LEVCHIK ^1,2

¹ Ural State Medical University, Yekaterinburg, Russia

² Sverdlovsk Regional Clinical Psychoneurological Hospital for War Veterans, Yekaterinburg, Russia

Abstract

In a group of 234 patients operated on for small intestinal fistulas, the outcomes of interventions complicated by intestinal wall deserosis (104) and without it (130) were studied. Modifiable (optimal terms of restorative treatment, after the inflammatory changes in the abdominal cavity and abdominal wall subside) and (conditionally) non-modifiable (multiple fistulas, high prevalence and planar nature of the adhesive process in the abdominal cavity) prognostic factors of intraoperative deserosis were revealed. Deserosis of the intestinal wall was associated with an increase in the proportion of deaths (OR = 1.7), the frequency of postoperative small intestinal perforations (OR = 8.8), common forms of peritonitis (O = 3.3), neoplasm of intestinal fistulas (OR = 2.7), and other complications, compared with the group of patients without deserosis.

Keywords: small intestine, small intestinal fistulas, surgical treatment, postoperative complications, deserosis, prognostic factors.

To cite this article. Levchik E.Yu. Intraoperative deserosis of the intestinal wall: prognostic factors, impact on postoperative outcomes and complication rate of reconstructive operations in patients with small bowel fistulas. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):26–33.

UDC 616-089.5

DOI: 10.54866/27129632_2025_2_34

ANESTHETIC CARE AT THE STAGE OF THE TRIAGE SITE
FOR THE WOUNDED DURING A SPECIAL MILITARY OPERATION

© A.V. RUMYANTSEV ¹, V.A. VOLCHKOV ^1,2, S.A. BUNIN ¹, M.V. VASILCHENKO ¹, A.A. YEROFEYEV ¹, V.L. RYCHKOV ¹, G.V. VOLCHKOV ³

¹ St. Petersburg State Budgetary Institution “City Multidisciplinary Hospital No. 2”, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

Abstract

Rationale. As a result of the development of methods of warfare based on new technologies, including high-precision long-range weapons (UAVs), the nature of the separation of forces and assets, including those of the medical service, has changed. The concept of “evacuation shoulder” has changed dramatically due to exceeding the established time limits, which sometimes leads to the need to delay the evacuation of the wounded. The way out of this situation was the creation of mobile medical groups that ensure the proximity of qualified surgical care with intensive care components to the line of combat contact, which had a direct impact on the structure of anesthesiological and resuscitation care.

Objective: To analyze the structure of anesthetic care in the context of modern armed conflict at the stage of the sorting site. The objectives of the study included determining the nature and characteristics of combat injuries among the wounded who arrived at the triage site, as well as the content of measures to provide anesthetic care, depending on the type and severity of the lesion.

Materials and methods. A retrospective analysis of the results of providing anesthetic care at the stage of triage of the wounded was carried out. The study group included 523 men of various age groups (20–52 years old). The authors are direct participants in the ongoing therapeutic measures.

results. By the nature of the damage, mine-explosive (61 %) and fragmentation (31 %) wounds prevail, which in turn are divided into multiple (60 %) and combined (37 %). The share of general anesthesia (non-inhalation) in some cases caused by the conditions of the sorting site was 64 %; combined anesthesia 60 %; regional anesthesia 36 %.

Conclusion. At the stage of sorting the wounded, it is difficult to perform inhalation anesthesia, which is explained by the peculiarities and conditions of medical sorting due to the lack of conditions for the full use of medical gases. The methods of local anesthesia, as well as the comprehensive use of anesthetic aid methods, are gaining priority.

Keywords: military field surgery, special military operation, combat trauma, structure of combat trauma, traumatism, gunshot wound, sorting area, combat surgical pathology, combat trauma.

To cite this article. Rumyantsev A.V., Volchkov V.A., Bunin S.A., Vasilchenko M.V., Yerofeyev A.A., Rychkov V.L., Volchkov G.V. Anesthetic care at the stage of the triage site for the wounded during a special military operation. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2): 34–41.

UDC 616.711.1

DOI: 10.54866/27129632_2025_2_42

PARTICULAR FACTORS OF BIOMECHANICAL EFFECTIVENESS
OF VENTRAL SUBAXIAL FUSION IN TRAUMA

© D.A. TRAVKOV ¹, A.V. VERESHCHAKO ^2,3, V.A. MANUKOVSKY ^2,3, M.N. KRAVTSOV ^2,3,4, K.V. TYULIKOV ^2,3

¹ Lipetsk Regional Clinical Hospital, Lipetsk, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

³ North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

⁴ Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

Objective. Based on quantitative indicators, to analyze the accuracy and symmetry of the installation of structures for ventral subaxial cervicospondylodesis, depending on the type of device and the special tools used for implantation. To evaluate the immediate results of surgical treatment depending on the quality of the endofixator position.

MATERIALS AND METHODS. The study covers 32 patients who underwent surgery for lower cervical spine injury using various endo-fixing devices and installation tools. The symmetry and accuracy of the installation and the possibility of linking this factor with the nearest clinical results were determined.

RESULTS. With generally satisfactory implantation, the best results were achieved with the use of special devices (7 out of 8 cases, or 87.5 %) compared with cases with ordinary instruments (7 out of 28, or 25 %). The effect of these features on the immediate clinical results has not been established.

CONCLUSION. The endofixators used ensure reliable spinal fusion. The use of special tools and platforms contributes to a more accurate arrangement of the construction and fasteners. The location of the endofixator does not affect the clinical outcome in the short term. The medium- and long-term impact remains to be determined. A unified approach and terminology is needed to evaluate the results of implantation. The lack of a thesaurus complicates research on this issue.

KEYWORDS: ventral subaxial fusion, injury of the lower cervical spine

TO CITE THIS ARTICLE. Travkov D.A., Vereshchako A.V., Manukovsky V.A., Kravtsov M.N., Tyulikov K.V. Particular factors of biomechanical effectiveness of ventral subaxial fusion in trauma. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):42–48.

UDC 617.541-001-08

DOI: 10.54866/27129632_2025_2_49

TOPICAL ISSUES OF DIAGNOSIS AND TREATMENT
OF SEVERE chest INJURY

© A.N. TULUPOV ^1,2, V.A. MANUKOVSKY ^1,3, A.YE. DEMKO ^1,2, G.M. BESAEV ¹, V.E. SAVELLO ¹, I.V. KAZHANOV ^1,2, M.I. SAFOEV ¹, M.A. KISELEV ¹, A.V. NIKITIN ¹, YA.V. GAVRISHCHUK ¹, A.V. LAPITSKY ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Kirov Military Medical Academy, St. Petersburg, Russia

³ North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

ABSTRACT

 The aim of the study was to develop and evaluate the clinical effectiveness of new methods for the diagnosis and treatment of severe isolated and combined chest injuries due to the high frequency of injuries and mortality. It is based on the results of examination and treatment of more than 1000 victims with the pathology over the past 10 years. A complex of modern laboratory, radiation (ultrasound, MSCT, including intravenous contrast), X-ray endovascular and instrumental (fibrobronchoscopy, videothoracoscopy) research methods was used. High efficiency of the method of external fixation of the costal valve developed by the authors, endobronchial clipping of ruptures of large bronchi, early enteral infusions, immunostimulation with sodium deoxyribonucleate preparation is shown. Thanks to the use of a complex of modern medical and diagnostic methods, mortality in severe combined breast injury was reduced from 44 % to 19 %, and the frequency of emergency thoracotomies — up to 4 %.

KEYWORDS: chest injury, polytrauma, costal valve, aortic tears, bronchial tears, enteral infusions, sodium deoxyribonucleate, videothoracoscopy.

To cite this article. Tulupov A.N., Manukovsky V.A., Demko A.Ye., Besaev G.M., Savello V.E., Kazhanov I.V., Safoev M.I., Kiselev M.A., Nikitin A.V., Gavrishchuk Ya.V., Lapitsky A.V. Topical issues of diagnosis and treatment of severe chest injury. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):49–57.

UDC 616.8-089

DOI: 10.54866/27129632_2025_2_58

PERIOPERATIVE DIAGNOSTICS OF BRAIN LESIONS USING
FLAT-DETECTOR COMPUTED TOMOGRAPHY

© A.A. TSIBIROV ¹, D.V. KANDYBA ², B.V.MARTYNOV ³, D.V.SVISTOV ³

¹ Federal State Public Enterprise Nikiforov’s All-Russian Center for Emergency and Radiation Medicine of the Emergencies Ministry of Russia, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

³ Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

RATIONALE. Modern computed tomography is method of choice for rapid and reliable assessment of the skull bones and brain structures in acute neurosurgery. Most modern angiographic complexes allow emulation of computed tomography.

OBJECTIVE: to evaluate the effectiveness of flat detector computed tomography in comparison with traditional spiral computed tomography in perioperative diagnostics of neurosurgical interventions, early complications diagnosis of interventional prosedures.

MATERIALS AND METHODS. The examination results of 67 patients performed sequentially on a spiral computed tomography scanner and a flat detector computed tomography scanner were assessed. A comparison of the resolution in non-traumatic hemorrhages, tumor lesions of the brain and traumatic brain injury was made.

RESULTS. The results indicate that flat detector computed tomography is sensitive enough to detect brain lesions in emergency interventional neuroradiology. The correlation in all groups is determined to be very high, and statistically significant.

CONCLUSION. The resolution of flat detector computed tomography is sufficient to detect brain structures changes that arise as a result of complications of interventional procedures.

Keywords: flat-detector computed tomography (FD-CT), computed tomography (CT), non-traumatic cerebral hemorrhage, brain tumors, traumatic brain injury.

To cite This article. Tsibirov A.A., Kandyba D.V., Martynov B.V., Svistov D.V. Perioperative diagnostics of brain lesions using flat-detector computed tomography. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):58–66.

CLINICAL CASES AND REVIEW ARTICLES

UDC 616.132-007.64: 616-079.4

DOI: 10.54866/27129632_2025_2_67

RADIOLOGY IMAGING IN ACUTE ABDOMINAL
AORTIC SYNDROME

© K.A. ANDREICHUK ^1,2,3

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Public Enterprise Nikiforov’s All-Russian Center for Emergency and Radiation Medicine of the Emergencies Ministry of Russia, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

OBJECTIVE. Acute aortic syndrome is defined as a group of emergency life-threatening conditions with similar clinical characteristics and high risk of severe complications.  The majority of actual studies deal with manifestations of the syndrome in the thoracic aorta only.  Nevertheless, the same lesions can be revealed in abdominal aorta too as a manifestation of acute abdominal aortic syndrome. The aim of the paper is summary and analysis of the experience of acute aortic syndrome in the abdominal aorta radiology imaging.

MATERIAL AND METHODS. Two hundred and twenty-three patients with acute abdominal aortic syndrome were revealed. The results of radiologic examinations (CTA and DUS) were analyzed and compared with the surgical and morphological data, as well as with results of long-term follow-up for as long as 192 months.

RESULTS. Radiologic and ultrasound signs of different form of acute abdominal aortic syndrome were identified and described. Differences in their morbidity were established. The most typical form for the abdominal aorta is penetrating aortic ulcers (71.6 %). Intramural hematoma and local dissection took place more rarely: 20.3 % and 8.1 % respectively.  

CONCLUSION. The radiologic signs for manifestations of acute aortic syndrome are similar both in thoracic and abdominal aorta. The differences concern mainly the frequency of separate form of syndrome.

KEYWORDS: acute abdominal aortic syndrome, abdominal aorta, penetrating aortic ulcer, aortic rupture, emergency diagnosis.

TO CITE THIS ARTICLE. Andreichuk K.A. Radiology imaging in acute abdominal aortic syndrome. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):67–79.

UDC 616.132-002/.132-007.64

DOI: 10.54866/27129632_2025_2_80

SALMONELLA AORTOARTERITIS
AS A CAUSE OF NON-ANEURYSMAL RUPTURE OF AORTA

© K.A. ANDREICHUK ^1,2,3, D.I. NAYDENOV ¹, E.P. GOLOVAN ¹, E.V. KULESHOVA ¹, D.N. DOYNIKOV ¹, V.I. KORNEV ¹, G.YU. SOKURENKO ¹, A.V. KOCHETKOV ¹, V.E. SAVELLO ^2,3, N.N. ANDREICHUK ^2,3

¹ Federal State Public Enterprise Nikiforov’s All-Russian Center for Emergency and Radiation Medicine of the Emergencies Ministry of Russia, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

The purpose of this report is to demonstrate a rare case of Salmonella aortoarteritis, which caused a non-aneurysmal rupture of the abdominal aorta bifurcation in a middle-aged patient. Clinical manifestations of the disease were represented by pain syndrome, systemic inflammatory and bacteremia. The aortic wall defect was detected during
computed tomography angiography, and its infectious genesis was confirmed by positron emission tomography/computed tomography. The patient underwent reconstructive aortofemoral bypass surgery. The patient has fully recovered. Four-months follow-up did not reveal any signs of the repeated infection. The discussion considers problematic issues of diagnostics, management strategy and treatment tactics of the disease.

KEYWORDS: salmonella aortoarteritis, aortic rupture, emergency diagnosis.

TO CITE THIS ARTICLE. Andreichuk K.A., Naydenov D.I., Golovan E.P., Kuleshova E.V., Doynikov D.N., Kornev V.I., Sokurenko G.Yu., Kochetkov A.V., Savello V.E., Andreichuk N.N. Salmonella aortoarteritis as a cause of non-aneurysmal rupture of aorta. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):80–89.

UDC 617.3

DOI: 10.54866/27129632_2025_2_90

TREATMENT ALGORITHM OF A PATHOLOGICAL COMPLEX (TRAUMATIC OSTEOMYELITIS WITH EXTENSIVE DEFECT OF THE TIBIA)
IN A PATIENT WITH MULTIPLE TRAUMA: A CASE REPORT

© G.M. BESAEV ^1,3, A.N. TULUPOV ^1,2, V.G. BAGDASARIANTS ^1,3, A.A. ESENOKOV ¹, Y.V. GAVRISHCHUK ^1,3, M.A. ANDREEVA ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Kirov Military Medical Academy, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State Pediatric Medical University” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

ABSTRACT

Treatment of patients with open fractures of long bones with severe multiple trauma remains a problem in trauma surgery. Despite careful surgical treatment of wounds and early stabilization of fractures with external fixators, the level of infectious complications stays significant.

According to various authors, more than 30 % cases of severe open fractures of long bones are complicated by post-traumatic osteomyelitis, and repeated surgical treatment of the lesion (necrosequestrectomy, resection of non-viable bone sections) often leads to bone defects. This report illustrates the successful treatment of post-traumatic osteomyelitis with the resulting extensive circular defect of the tibia in a patient with severe multiple trauma with the help of Ilizarov method.

KEYWORDS: multiple injury, open fracture, posttraumatic osteomyelitis, Ilizarov method, distraction, compression.

TO CITE THIS ARTICLE. Besaev G.M., Tulupov A.N., Bagdasariants V.G., Esenokov A.A., Gavrishchuk Y.V., M.A. Andreeva M.A. Treatment algorithm of a pathological complex (traumatic osteomyelitis with an extensive defect of the tibia) in a patient with multiple trauma: a case report. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):90–100.

UDC 616.342

DOI: 10.54866/27129632_2025_2_101

POSTBULBAR DUODENUM ULCER COMPLICATED BY RECURRENT BLEEDING: A CASE REPORT

© SH.T. LYONG ¹, A.E. DEMKO ^1,2, R.V. TITOV ¹, S.I. PEREGUDOV ^1,2, A.O. PARFENOV ^1,2, I.N. ESYUTIN ², A.V. SVYATNENKO ²

¹ Kirov Military Medical Academy, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

Rationale. Complicated postbulbar duodenal ulcers represent a significant challenge in emergency surgery due to diagnostic and surgical difficulties associated with the anatomical peculiarities of this region. Most modern clinical guidelines address postbulbar ulcers within the broader context of peptic ulcer disease without detailed specification. The article presents the clinical case of successful management of the patient on a postbulbar ulcer complicated by recurrent bleeding, which are among the most severe complications of this pathology. The discussion focuses on timely diagnosis and the selection of surgical strategies for such complications.

Objective. The goal was to demonstrate the successful treatment of a female patient on a postbulbar duodenal ulcer complicated by severe recurrent bleeding.

Material and methods. The analysis of the patient’s examination data, the management strategy analysis have been performed, and the review of medical literature on complicated postbulbar duodenal ulcers was made.  

Results. A 43-year-old female patient was admitted to the hospital on the recurrent ulcer bleeding after discharge. The following interventions were performed: The endoscopic hemostasis, 2 surgeries for suture ligation of the bleeding ulcer under conditions of hemorrhagic shock, then followed by the gastric resection after stabilization. The postoperative course was complicated by pulmonary edema, hospital-acquired pneumonia, acute protein deficiency, intestinal eventration and duodenal stump suture dehiscence with duodenal fistula formation. A percutaneous transhepatic cholecystostomy was created to reduce the bile output. Before discharge, cholecystography confirmed contrast medium passage from the cholecystostomy into the duodenum without extravasation beyond the stump. The patient was discharged for outpatient follow-up, with planned cholecystostomy removal in one month.

Conclusion. The problem of timely diagnosis and optimal treatment strategies on complicated postbulbar duodenal ulcers remains unresolved. Endoscopic verification may be inaccurate, while hemostatic methods on bleeding ulcers in this location often fail to achieve durable hemostasis and lead to recurrence. Surgical interventions are technically demanding and carry a high risk of severe postoperative complications, thus necessitating an individualized approach to patient’s management.

KEYWORDS: gastrointestinal bleeding; postbulbar ulcers; pyloroplasty; gastric resection; difficult duodenal stump.

TO CITE THIS ARTICLE. Lyong Sh.T., Demko A.E., Titov R.V., Peregudov S.I., Parfenov A.O., Esyutin I.N., Svyatnenko A.V.  Postbulbar duodenum ulcer complicated by recurrent bleeding: a case report. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):101–108.

UDC 615.099.07: 616-037

DOI: 10.54866/27129632_2025_2_109

ACUTE SEVERE POISONING WITH AN INDIRECT-ACTING ANTICOAGULANT COMPLICATED BY THE DEVELOPMENT OF TOXIC COAGULOPATHY (CLINICAL CASE)

© R.A. NARZIKULOV ^1,2,3, A.N. LODYAGIN ^2,3, N.P. SIDOROVA ¹, A.A. BASSANETZ ^1,4, M.A. KOLEBOSHINA ^1,4

¹ State Budgetary Institution of Healthcare of the Leningrad Region “Vsevolozhsk Interdistrict Hospital”, Vsevolozhsk, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

⁴ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State Pediatric Medical University” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

Abstract

RELEVANCE. At present, cardiovascular diseases occupy one of the first places in the structure of morbidity and mortality throughout the world, despite the conducted treatment and preventive measures. In recent years, new oral anticoagulants have become widespread. Nevertheles, there are still a number of clinical situations when the only possible anticoagulant is warfarin. Acute poisoning with warfarin is accompanied by the development of severe complications, which causes high mortality in this group of diseases. The search for intensive care methods aimed at preventing hemostasis system disorders is a relevant area in clinical practice.

OBJECTIVE: to evaluate the use of phytomenadione as a first-line therapy drug in the intensive care of acute severe poisoning with an indirect anticoagulant (warfarin), complicated by the development of toxic coagulopathy.

MATERIALS AND METHODS. The material of the work included an acute indirect anticoagulant severe poisoning clinical case, complicated by the development of toxic coagulopathy and bleeding. The features of the clinical picture in dynamics, changes in clinical and biochemical parameters, an indicative study of the hemostasis system, blood gas composition and acid-base balance were studied.

RESULTS. It was established that poisoning with an indirect anticoagulant complicated by the development of toxic coagulopathy was characterized by nasal discharge and a violation of the hemostasis system parameters (international normalized ratio (INR) 24.65). In addition to maintaining life support systems and correcting metabolic disorders, the complex of intensive care measures included phytomenadione as a first-line therapy drug and transfusion of human blood plasma. This approach made it possible to significantly reduce the severity of the clinical course and prevent the development of massive bleeding.

CONCLUSION. Uncontrolled use of indirect anticoagulant may cause serious and life-threatening complications. Therefore, patients undergoing warfarin therapy should be informed of possible complications and require regular monitoring of INR. In acute severe poisoning with indirect anticoagulant complicated by the development of toxic coagulopathy, the earliest possible use of vitamin K1 — phytomenadione is recommended as part of the complex of measures of syndromic general resuscitation therapy for rapid neutralization of the indirect anticoagulant and transfusion of human blood plasma.

KEYWORDS: poisoning, warfarin, toxic coagulopathy, phytomenadione.

TO CITE this article. Narzikulov R.A., Lodyagin A.N., Sidorova N.P., Bassanetz A.A., Koleboshina M.A. Acute severe poisoning with an indirect-acting anticoagulant complicated by the development of toxic coagulopathy (clinical case). Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):109–115.

UDC 616.33-005.1

DOI: 10.54866/27129632_2025_2_116

CROHN’S DISEASE WITH AN INAPPARANT COURSE
(CLINICAL case)

© A.O. PARFENOV ^1,2, A.E. DEMKO ^1,2, V.G. VERBITSKY ^1,2, D.V. NAGORNOV ¹, A.V. KOSACHEV ^1,2, N.YU. NOVITSKAYA ²

¹ Kirov Military Medical Academy, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

Resume

The article presents a clinical case of successful treatment of a patient with a complicated course of Crohn's disease, the development of intestinal fistula and intestinal abscess. A 23-year-old patient was admitted to the I.I. Dzhanelidze Research Institute of Joint Venture with complaints of pain in the right iliac region. Diagnostic laparoscopy revealed an effusion with fibrin in all parts of the abdominal cavity and an infiltrate 30 cm from the ileocecal angle, consisting of loops of the small intestine and omentum. The patient underwent access conversion and small intestine resection. According to the macroscopic picture of the macropreparation and morphological examination, the diagnosis was Crohn's disease.

Keywords: Crohn's disease, peritonitis, small intestine resection.

To cite this article. Parfenov A.O., Demko A.E., Verbitsky V.G., Nagornov D.V., Kosachev A.V., Novitskaya N.Yu. Crohn's disease with an inapparant course (clinical case). Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):116–119.

UDC 616-089.5

DOI: 10.54866/27129632_2025_2_120

COMPARATIVE ANALYSIS OF PALLIATIVE METHODS OF BILIARY TRACT
DECOMPRESSION IN PATIENTS WITH INOPERABLE
PERIAMPULLARY TUMORS

© K.V. SEMENTSOV ^1,2, D.YU. BOYARINOV ^1,2, M.N. MYANZELIN ¹, E.E. FOMENKO ³, V.E. BURANOV ³, M.A. LAUSHKIN ^2,3

¹ Leningrad Regional Clinical Hospital, St. Petersburg, Russia

² North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

³ St. Petersburg State Budgetary Institution “State Hospital for War Veterans”, St. Petersburg, Russia

Abstract

Rationale. Recently, due to the accumulation of long-term results for various types of surgical interventions in the pancreatoduodenal region, a dilemma has arisen in the medical community regarding the correct management of patients with primarily unresectable tumors of the periampullary zone. Such patients require palliative treatment consisting of decompression of the bile ducts. Although endobiliary stenting is traditionally considered the method of choice, the increase in median patient survival thanks to new polychemotherapy regimens has revealed significant limitations of this approach. Numerous studies in recent years have demonstrated that, during long-term follow-up, endoscopic methods are associated with a high frequency of obstruction recurrence, stent migration, and the need for repeat interventions, which calls into question their unconditional advantage.

Objective. Comparative analysis of the effectiveness of surgical bypass and endobiliary stenting based on a systematic review of publications by various authors in recent years.

Materials and Methods. The comparative analysis of the effectiveness of different methods of biliary tract decompression in patients with inoperable periampullary tumors was performed. Publications (meta-analyses, RCTs, cohort studies) for the last 10 years on the treatment of cancer of the mentioned area on PubMed, elibrary, National Library of Medicine, Google academy were selected for the study.

Results. Most authors come to similar conclusions: surgical shunting demonstrates high technical success of the operation, a long-term palliative effect, and is not accompanied by a high frequency of complications or prolonged hospitalization. At the same time, palliative endoscopic treatment is a well-established procedure and is considered an acceptable alternative to surgical intervention. It is less invasive, requires a shorter hospital stay, and has a low mortality rate, but is associated with a high frequency of disease recurrence, stent obstruction and migration, and the development of other late postoperative complications.

Conclusion. Endoscopic stenting is preferable for patients with a poor prognosis in terms of life expectancy. In other cases, with satisfactory somatic status, primary surgical bypass is recommended as a method that provides a longer palliative effect.

KEYWORDS: periampullary tumors; cancer of the pancreas; cancer of the terminal choledochus; cancer of the great duodenal papilla; shunt operations; methods of biliary decompression.

TO CITE THIS ARTICLE. Sementsov K.V., Boyarinov D.Yu., Myanzelin M.N., Fomenko E.E., Buranov V.E., Laushkin M.A. Comparative analysis of palliative methods of biliary tract decompression in patients with inoperable periampullary tumors. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):120–131.

UDC 616.7 : 616-71

DOI: 10.54866/27129632_2025_2_132

THE USE OF RADIATION RESEARCH METHODS IN MODERN
COMBAT LIMB INJURY (LITERATURE REVIEW)

© A.G. FRUMEN ¹, G.E. TRUFANOV ²

¹ Main Military Clinical Hospital of the National Guard Troops of the Russian Federation, Balashikha, Moscow Region, Russia

² Federal State Budgetary Institution “Almazov National Medical Research Center” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

ABSTRACT

Rationale. There is a large number of works in the domestic and foreign literature devoted to the radiation diagnosis of acute gunshot injury, but there is not enough work on the consequences of combat injury to limbs. Limb injuries occupy the first place in the structure of modern combat injuries and are one of the main reasons for the decrease in fitness for military service and disability.

Objective. The article summarizes the information available in the literature on the use of radiation research methods (digital radiography, computed tomography and ultrasound) in the diagnosis of limb injuries in modern combat trauma.

Materials and methods. A search was conducted for literary sources in the MedLine/PubMed and eLibrary databases published between 2011 and 2025.

The indications for use, the features of the methods of conducting, the advantages and disadvantages of modern methods of radiation imaging in modern combat limb injury are considered.

Results. 442 articles were analyzed, 40 of which were used to compile the review. Search results — blocks of articles were created, within which publications were analyzed to study radiation research methods in the diagnosis of limb injuries in modern combat trauma.

Conclusion. The tactics of targeted radiation diagnostics of combat limb injury involves performing various radiation examinations (X-ray, computed tomography and ultrasound) in order to detect damage to bones, blood vessels and nerves. The issue of timely and adequate diagnosis of limb injuries in modern combat trauma, including with the use of radiation research methods, is still not fully resolved.

KEYWORDS: combat injury, limb injuries, mine and explosive damage, radiation diagnostics.

To cite this article. Frumen A.G., Trufanov G.E. The use of radiation research methods in modern combat limb injury (literature review). Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):132–141.

NURSING AND PUBLIC HEALTH, AN ORGANIZATION AND SOCIOLOGY OF HEALTHCARE, MEDICAL AND SOCIAL EXPERTISE

UDC 614.2

DOI: 10.54866/27129632_2025_2_142

STRUCTURE OF ACUTE SURGICAL PATHOLOGY OF ABDOMINAL ORGANS
IN ST. PETERSBURG OVER 20 YEARS OF OBSERVATION

© V.E. PARFENOV ¹, I.M. BARSUKOVA ^1,2, P.A. DUBYKAITIS ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

RATIONALE. The problem of diagnostics and treatment of patients with acute surgical diseases of abdominal organs remained relevant at all stages of the development of surgery. Today, monitoring the state of acute surgical pathology of abdominal organs stays relevant; it has been carried out for many years by the St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine.

OBJECTIVE: to study the volume and structure of acute surgical pathology of abdominal organs in St. Petersburg over the past 20 years (2005–2024).

MATERIALS AND METHODS. The data of monitoring the state of acute surgical pathology of abdominal organs were used in accordance with the Order of the Health Committee of St. Petersburg “On the control of emergency hospitalization in state health care institutions of St. Petersburg” dated 31.07.2009 No. 477-r and conducted by the St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, 2005–2024.

RESULTS. Over 20 years of observation, the average annual number of patients with acute surgical pathology of abdominal organs in St. Petersburg was identified (17.2 thousand people) with a tendency to decrease by 31.3 % for 2005–2024. The main group were patients with acute appendicitis (29.1 ± 5.2 %), acute pancreatitis (27.1 ± 5.5 %), acute cholecystitis (20.3 ± 1.9 %). Together they make up 76.5 % of the number of patients with acute surgical pathology of the abdominal organs. An increase in the proportion of patients with acute appendicitis by 16.3 % and a decrease in the proportion of patients with acute pancreatitis by 24.0 % were noted during the observation period.

CONCLUSIONS. Long-term monitoring conducted in St. Petersburg characterizes an entire era in the development of the surgical direction in the city. It has great scientific and practical significance, demonstrates modern successes and achievements of surgical science and practice. The accumulated experience has been and remains a school for surgical specialists and health care organizers.

KEYWORDS: acute abdomen, acute surgical pathology of the abdominal organs, St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine.

to cite this article. Parfenov V.E., Barsukova I.M., Dubykaitis P.A. Structure of acute surgical pathology of abdominal organs in St. Petersburg over 20 years of observation. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):142–146.

UDC 614.2

DOI: 10.54866/27129632_2025_2_147

AUTOMATION ISSUES OF EMERGENCY MEDICAL CARE
IN THE RUSSIAN FEDERATION

© I.M. BARSUKOVA ^1,2, O.A. CHEKULAEVA ³,  M.V. POLYUKOVA ^1,2

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

³ Moscow Regional Emergency Medical Service Station, Krasnogorsk, Moscow Region, Russia

ABSTRACT

RATIONALE. Digital technologies have come to the emergency medical care system. The construction of a unified regional emergency medical care dispatching system in a constituent entity of the Russian Federation is an important condition for organizing accessible and high-quality care for emergency medical care patients.

OBJECTIVE: to examine the number of emergency medical care stations (departments) equipped with an automated control system for receiving and processing emergency medical care calls in the Russian Federation in dynamics from 2010 to 2023.

MATERIALS AND METHODS. The data of industry statistical monitoring were used — form No. 40 “Report of the station (department) of the emergency medical care hospital” for 2010–2013 and the data of federal statistical monitoring — form No. 30 for the Russian Federation for the period 2014–2023. Statistical and analytical research methods were applied. MS Office Excel 2016 spreadsheets were used for data processing.

RESULTS. Analysis of the dynamics of the number of emergency medical care stations (departments) equipped with an automated call reception and processing management system for the period 2010–2023 shows an increase in the number of the latter by 4.2 times: from 377 units in 2010 to 1572 units in 2023.

CONCLUSIONS. Informatization and automation of emergency medical care is a most important component in the formation of the Unified Dispatch Centers system of the Russian Federation constituent entities aimed at monitoring the activities of emergency medical care organizations at all stages of its provision, improving the efficiency and quality of emergency medical care.

KEYWORDS: emergency medical care, emergency medical care informatization, emergency medical care automation, emergency medical dispatching.

To cite this article. Barsukova I.M., Chekulaeva O.A.,  Polyukova M.V. Automation issues of emergency medical care in the Russian Federation. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(2):147–151.

ORIGINAL ARTICLES

UDC 616.34-007.272 : 616.34-089

PREVENTION OF ENTERO-COLONIC ANASTOMOSIS LEAKAGE IN ACUTE INTESTINAL OBSTRUCTION (EXPERIMENTAL RESEARCH)

© T.S. BELYAKOVA ¹, K.V. ATAMANOV ², Y.S. VAYNER ^2,3, V.V. BELYAKOV ⁴, A.P. MICHURINA ⁵, V.N. SILKOV ²

¹ Medical Institution Joint-stock Company “Admiralty Shipyards”, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Novosibirsk State Medical University”, Novosibirsk, Russia

³ Novosibirsk State Budgetary Institution “City Hospital No. 1”, Novosibirsk, Russia

⁴ Kirov Military Medical Academy, St. Petersburg, Russia

⁵ St. Petersburg State Budgetary Institution “City Hospital No. 26”, St. Petersburg, Russia

ABSTRACT

RATIONALE. Acute intestinal obstruction (AIO) is an actual problem in emergency surgery. Creation of ileo-transverse anastomosis in AIO is associated with a high risk of anastomotic leakage (AL), which leads to septic complications and death. It is necessary to search for effective methods of AL prevention.

OBJECTIVE. The aim of research is to create a method of ileo-transverse anastomosis in conditions of AIO to reduce the risk of AL, compare the parameters of blood supply, inflammation and healing in the anastomosis zone with the control group.

MATERIALs AND METHODS. The objects of the study were Wistar rats, divided randomly in 2 groups: the experimental group — 36 animals and the control group — 48 individuals. AIO model was made in both groups, and right-sided hemicolectomy with ileo-transverse anastomosis was performed 24 hours later. In the experimental group, an end-to-end anastomosis was formed with the intersection of the small intestine at an angle of 45° in such a way that the mesenteric edge was longer than the anti-mesenteric one. In the control group, classic side-to-side ileo-transverse anastomosis was performed. On day 7, the animals were removed from the experiment, a histological examination of the anastomoses zones was performed. The number of immune cells (neutrophilic leukocytes, macrophages, lymphocytes), fibroblastic cells and the area of blood vessels were counted for the submucosal and muscular layers.

RESULTS. The number of vessels near anastomosis is statistically more in wall of small intestine intersected at an angle of 45° than in side-to-side anastomosis. The reason is the blood supply of the anastomosis, which is provided by some intramural arteries. In the study group, the number of immune cells is significantly less and collagen-producing cells are significantly more than in the control group.

CONCLUSION. The use of the proposed method of ileo-transverse anastomosis in AIO improves reparation in anastomosis zone by enhancement of neoangiogenesis in the intestinal wall in comparison with side-to-side anastomosis, inflammation regresses faster, collagen production occurs faster. The result is decreased rate of mortality, AL and intraabdominal abscesses incidence.

KEYWORDS: acute intestinal obstruction, intestinal anastomosis, ileo-transverse anastomosis, anastomotic leakage, prevention of anastomotic leakage.

TO CITE THIS ARTICLE. Belyakova T.S., Atamanov K.V., Vayner Y.S., Belyakov V.V. Michurina A.P. Prevention of entero-colonic anastomosis leakage in acute intestinal obstruction (experimental research). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):8–15.

UDC 355.123.1 + 616-001.45 : 616.831-001.45

ANALYSIS OF THE STRUCTURE OF COMBAT INJURIES SUSTAINED DURING SPECIAL MILITARY OPERATION (based ON the experience of providing qualified and specialized surgical care in a multidisciplinary hospital)

© M.V. VASILCHENKO ¹, V.A. VOLCHKOV ^1,2, S.A. BUNIN ¹, V.L. RYCHKOV ¹, A.V. RUMYANTSEV ¹, G.V. VOLCHKOV ³

¹ St. Petersburg State Budgetary Institution “City Hospital No. 26”, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

abstract

Relevance. The development of means of fire destruction, the use of weapons with the indiscriminate action of striking elements with high kinetic energy, completely new principles of warfare based on accurate intelligence, change the magnitude and structure of combat trauma received during Special Military Operation (SMO). The relevance of the study reflects the need for timely planning of measures to provide qualified and specialized surgical care in an urban multidisciplinary hospital in a modern armed conflict with a massive influx of wounded and injured from various means of fire damage.

purpose: to analyze and evaluate the structure of a combat surgical injury resulting from the use of fire damage during SMO.

objectives: to conduct a comparative analysis of the structure of surgical trauma received in the conditions of SMO with similar indicators of previous wars and armed conflicts.

Materials and methods. The study group comprised an incoming stream of wounded and affected, consisting of 321 male patients aged 20 to 56 years who were being treated in the same multidisciplinary medical hospital in the conflict zone. The study is based on data from the experience of treating the wounded and injured and the results of the analysis of medical histories conducted by the authors who were directly involved in the treatment process.

Results. The results of the study show that more than 97.0 % of combat injuries are gunshot wounds, of which 60.0 % of all injuries are mine-explosive, 29.0 % are shrapnel and 11.0 % are bullet wounds. Limb injuries remain the most common localization of injuries — 47.6 %, while cranial brain injuries account for 7.3 %. In 25.5 % of the wounded, the lesions are of a combined nature.

Conclusion. In modern military conflicts, gunshot bullet wounds, which previously occupied a leading place in the structure of wartime injuries, have been replaced mainly by mine-explosive and fragmentation wounds, which are the most crippling for the wounded and difficult to treat for physicians.

Keywords: traumatism; military field surgery; combat injury; structure of combat injury.

To cite this article. Vasilchenko M.V., Volchkov V.A., Bunin S.A., Rychkov V.L., Rumyantsev A.V., Volchkov G.V. Analysis of the structure of combat injuries sustained during Special Military Operation (based on the experience of providing qualified and specialized surgical care in a multidisciplinary hospital). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):16–22.

UDC 616.367-007.64-007.271-089

MORPHOLOGICAL FEATURES AND TREATMENT OF BENIGN STRICTURES OF THE LARGE DUODENAL PAPILLA AND DISTAL CHOLEDOCHUS IN PARAFATERIAL DIVERTICULA

© H.O. GOGOKHIA, V.E. NAZAROV

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

abstract

RATIONALE. Duodenal diverticula (duodenum) occupy the second place in terms of frequency of detection in the gastrointestinal tract, second only to the colon. Often, duodenal parafaterial diverticulum is the cause of the large duodenal papilla stricture development and, more rarely, of the distal choledochus. The reason for the formation of the large duodenal papilla stricture is partly the anatomical structure of the diverticulum itself.

OBJECTIVE: to enhance the efficacy of treatment modalities employed in managing patients afflicted with strictures of the greater duodenal papilla and distal choledochus accompanied by parapharyngeal diverticulum. This endeavor was undertaken through the implementation of percutaneous endoscopic and hybrid techniques.

MATERIAL AND METHODS. The object of the study was 78 patients with obstructive jaundice caused by stricture of the distal part of the choledochus and the great duodenal papilla with parapharyngeal diverticulum.

RESULTS. An analysis of morphologic features of strictures in parapharyngeal diverticula showed that 70 (89.7 %) patients had strictures of the large duodenal papilla, and strictures of the distal choledochus were diagnosed much less frequently, in only 8 (10.3 %) patients. The large duodenal papilla was most often located directly in the lumen of the diverticulum (type I localization) in 43 (55.1 %) patients. Type II localization of the large duodenal papilla was detected in 21 (26.9 %) patients, and type III was diagnosed in 14 (18.0 %) patients, with the large duodenal papilla located 5–10 mm from the edge of the diverticulum neck. The median distribution of strictures in parapharyngeal diverticula by severity corresponded to the 1D degree, the 25th percentile was the 1B degree, and the 75th percentile was the 2B degree. Of the 10 patients with severe strictures (2D–3D degrees) of the distal choledochus and the greater duodenal papilla, 6 had the papilla located at the edge of the diverticulum neck (type II), and 4 had it in its lumen (type I).

We managed to perform endoscopic retrograde cholangiopancreatography with endoscopic papillosphincterotomy only in 68 (87.2 %) patients. There were no statistically significant differences in the frequency of successful cannulation and performance of endoscopic retrograde cholangiopancreatography with endoscopic papillosphincterotomy between different types of the location of the large duodenal papilla in the diverticulum (p > 0.05). Other 2 (2.6 %) patients underwent supapillary cholangiodiverticulostomy under EUS control. Postoperative complications were noted in 6 (7.7 %) patients. The other 8 patients underwent traditional interventions: choledochoduoduodenoanastomosis according to Rowland-Mirizzi, of which 6 patients were treated with disconnection of the duodenum according to A.G. Zemlyanoy. Of them 1 (1.3 %) patient developed failure of the subpyloric duodenojejunoanastomosis, which was the cause of death.

CONCLUSION. Endoscopic techniques and hybrid technologies for  treatment of strictures of  distal parts of  the bile ducts distal parts stricture treatment which developed as a result of the inflammatory process caused by diverticulum in parafaterial diverticulum, proved effective in 70 (89.7 %) of 78 patients. The use of hybrid technologies in the form of a combination of endoscopy and EUS creates new opportunities for effective treatment of pathology.

KEYWORDS: parafaterial diverticulum, benign strictures, large duodenal papilla, distal choledochus, morphological features, treatment.

to cite this article. Gogokhia H.O., Nazarov V.E. Morphological features and treatment of benign strictures of the large duodenal papilla and distal part of the cholecondus in parafaterial diverticula. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):23–29.

UDC 340.66 + 616.72-089.843

ASSESSMENT OF ADVERSE OUTCOMES CASES AFTER KNEE REPLACEMENT

© K.A. EGHIAZARYAN ¹, M.V. LYADOVA ^1,2, D.S. ERSHOV ¹, D.A. BADRIEV ¹

¹ Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation, Moscow, Russia

² State Institution of Health, Moscow region, “Bureau of Forensic Medical Examination”, Moscow, Russia

ABSTRACT

Rationale: Federal Law No. 323 “On the Basics of Public Health protection in the Russian Federation” regulates the rights of patients in providing them with medical care. The patient is entitled to compensation for damage caused to their health during the provision of medical care. There is a steady increase in the number of complex forensic medical examinations related to the legal assessment of the quality of medical care in “Traumatology and orthopedics” sphere.

Objective: according to the analysis of complex forensic medical examinations in patients after knee replacement, to identify the main defects in the provision of medical care and their relationship with the surgical intervention, following the study of normative legal documents on the assessment of the medical care quality, to objectify medical expert criteria for the quality of medical care.

Material and methods. The analysis of 90 expert opinions of complex forensic medical examinations in “Traumatology and Orthopedics” sphere on the quality of medical care performed at the Bureau of Forensic Medical Examinations of Moscow, the Moscow region, the Russian Center of Forensic Medical Expertise of the Ministry of Health of the Russia and a number of autonomous non-profit organizations during the period 2019–2023 was carried out. All cases are associated with endoprosthetics of large joints. The database of regulatory documents on the treatment of gonarthrosis has been studied. General scientific and special research methods were used: content analysis, retrospective analysis.

Results. Of the 90 expert cases reviewed (100.0 %) in patients with orthopedic diseases, 22 (24.4 %) were associated with knee replacement. Adverse outcomes were revealed: long-term persistence of pain syndrome — 4 cases; development of periprosthetic infection — 8; impaired limb function after surgery — 5; neurological complications — 2; amputation of a limb — 2; death of a patient in the early postoperative period — 1 case. The analyzed regulatory documents on the treatment of gonarthrosis contain a number of contradictions that may cause legal conflicts in assessing the quality of medical care.

Conclusion. The most significant medical expert criterion in the legal field is the preoperative examination of the patient with the consultation of profile professionals with the identification of absolute and relative contraindications for endoprosthetics. Another significant criterion is the assessment of the X-ray picture after surgery with the use of telerentgenograms. These criteria should be discussed among the expert community and introduced into clinical guidelines as an objectifying sign of a properly performed intervention.

KEYWORDS: knee replacement, forensic medical examination, assessment of the quality of medical care.

TO CITE THIS ARTICLE. Eghiazaryan K.A., Lyadova M.V., Ershov D.S., Badriev D.A. Assessment of adverse outcomes cases after knee replacement. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):30–40.

UDC 616-001.17 : 616.5-089

POSSIBILITIES OF INCREASING ADHESION AND FIXATION OF AUTODERM GRAFT ON A GRANULAR WOUND BY TREATMENT WITH LOW-TEMPERATURE ARGON PLASMA

© E.V. ZINOVIEV ^1,2,3, V.V. SOLOSHENKO ¹, D.V. KOSTYAKOV ¹, D.O. VAGNER ^1,4, O.S. PANKRATEVA ¹, S.N. PYATAKOVA ¹, V.A. MANUKOVSKY ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State Pediatric Medical University” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

³ Kirov Military Medical Academy, St. Petersburg, Russia

⁴ North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

ABSTRACT

Rationale. To fix skin grafts on the wound surface, the vast majority of clinics use suture material, metal staples, and glue. In the process of studying the effect of cold argon plasma in our clinic, the effect of increased adhesion and fixation of the split skin graft on the granulating burn wound as a result of the action of plasma was revealed.

Objective. The aim is to study the effects of treating the wound surface and transplanted autodermal grafts with low-temperature argon plasma to improve their adhesion and fixation.

Materials and methods. The study is based on the analysis of the results of skin grafting in 41 patients with deep dermal burns of various etiologies who were treated in the Department of Thermal Injuries of the St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine in the period from 2023 to 2024. For the synthesis of low-temperature argon plasma, the plasma-arc surgical unit “Plasmoran” (Russia, Moscow) was used. The effect of the plasma was aimed at improving the adhesion and fixation of the non-perforated skin graft to the wound surface.

Results. The use of plasma technology statistically significantly reduced the incidence of hematomas and seromas under transplanted skin by 13.6 %. The use of low-temperature argon plasma reduces the duration of skin grafts by 35 %, compared to surgical interventions during which the grafts were fixed with interrupted sutures.

Conclusion. The method of treatment for the purpose of fixing non-perforated grafts is advisable to use for grafts of small and medium thickness in order to ensure adhesion of the graft to the bottom of the wound surface, which significantly reduces the time of the operation.

KEYWORDS: skin burn, skin graft, fixation, low-temperature argon plasma, wound treatment.

TO CITE THIS ARTICLE. Zinoviev E.V., Soloshenko V.V., Kostyakov D.V., Vagner D.O., Pankrateva O.S., Pyatakova S.N., Manukovsky V.A. Possibilities of increasing adhesion and fixation of autoderm graft on a granular wound by treatment with low-temperature argon plasma. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):41–46.

UDC 616-006.484.04

RELEVANCE OF EXTREMES: ANALYSIS OF FACTORS OF POSTOPERATIVE LIFE EXPECTANCY IN PATIENTS WITH RECURRENT GLIOBLASTOMA

© R.S. MARTYNOV, B.V. MARTYNOV, E.YU. KLIMENKOVA, D.V. SVISTOV

Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

RATIONALE. There is a view outside the medical field that information about extreme values of any measured values is rare and may be important. Of particular interest may be those groups of patients whose survival time after repeated surgeries for recurrent glioblastoma differs in extreme positions on the time scale. Knowledge of the nuances of these patients may provide a clue to the choice of treatment methods for this category of patients and to improve life expectancy and quality of treatment.

OBJECTIVE: To demonstrate the significance of extreme values of some indicators in medicine through the analysis of survival of patients with operated recurrent glioblastoma and to develop a prognostic model.

MATERIALS AND METHODS. The sample included 34 (68 %) men and 16 (32 %) women. Surgical interventions were performed in one institution between 1999 and 2017, on average 69 ± 18.9 days after diagnosis. In at least 50 % of cases, this period was 27 (Q1–Q3 = 13–48) days. Three comparison groups were formed: group I — patients with a life expectancy in the range from the minimum value to 25 % quartile (Q1); group III — patients whose life expectancy was outside the 75 % quartile (Q3). These are the groups of extreme values of the overall life expectancy indicator. Patients (50 %) with an overall life expectancy in the interquartile range were assigned to group II.

RESULTS. The median overall survival in group I was 11.9 (95 % CI = 9.96–13.84) months, in group II — 21.5 (95 % CI = 16.9–26.0) months, in group III — 49.2 (95 % CI = 37.9–60.5) months (p < 0.001; PI–II < 0.001, PI–III < 0.001, PII–III < 0.001). Of the compared variables, the three groups showed differences only in the duration of the relapse-free period (months), maximum recurrent glioblastomas size (cm) and volume (cm3). Discriminant analysis allowed us to develop a model that allows us to predict the expected (more or less than 13 months — this is the established 25 % quartile of life expectancy of patients with glioblastoma in our sample) life expectancy of patients with glioblastoma in the case of surgical intervention and to classify the patient into a category with a favorable (II and III groups) or unfavorable outcome (I group).

CONCLUSIONS. In medical research, it is necessary to consciously approach the analysis of rare objects. The analysis of extremes allows us to classify a patient with recurrent glioblastoma as “long-” or “short-lived” regardless of localization. Patients with different life expectancies differ in such indicators as the duration of the relapse-free period, the maximum size and volume of glioblastoma. Evaluation of the glioblastoma’s volume allows us to predict the expected life expectancy (more/less than 13 months). The developed calculator allows us to estimate the interval of the expected total life expectancy of a patient with recurrent glioblastoma.

KEYWORDS: recurrence glioblastoma, life expectancy, extreme values.

TO CITE THIS ARTICLE. Martynov R.S., Martynov B.V., Klimenkova E.Yu. Relevance of extremes: analysis of factors of postoperative life expectancy in patients with recurrent glioblastoma. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):47–57.

UDC 616-01

IATROGENESIS AND ASSOCIATED RISK IN SURGICAL PRACTICE

© S.A. POVZUN

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

The legislative changes that occurred in the Russian Federation in the 1990s had a significant impact on healthcare, particularly in terms of enhancing the accountability of medical professionals and expanding the rights of patients. As the legal competence of the population grows, the number of forensic medical examinations based on materials from criminal and civil cases against medical personnel is increasing year after year. In excess of 85 % of examinations have revealed defects in the standard of medical care provided, including instances where such defects have been subsequently considered by the courts to constitute iatrogenic crimes.

This article examines the justified risk of surgeons as circumstances that exclude the criminal nature of the act, as well as the legal criteria for determining the criminal nature of possible iatrogenic damage. It is important to note that in order to prevent the possibility of a physician being accused of causing adverse effects to a patient in an unfounded claim, the preoperative medical report must contain an assessment of the degree of risk taken during treatment in comparison with the risk of refusing the proposed treatment or using alternative methods of treatment. In order to prevent a possible accusation of a doctor in a iatrogenic crime, it is necessary to justify the risks taken when choosing the treatment method and to follow the relevant clinical recommendations. This should be indicated in the medical card when justifying the choice of treatment method. In case of deviation from these recommendations, the decisions taken ex consilio should be formalized, as these serve as legal confirmation of the legality and appropriateness of the actions taken.

KEYWORDS: surgery, justified risk, risk assessment in the preoperative medical report, legal criterions of criminal character of the iatrogenic damage.

TO CITE THIS ARTICLE. Povzun S.A. Iatrogenesis and associated risk in surgical practice. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4):58–63.

UDC 616-06

CHOLEDOCHOLITHIASIS COMPLICATED BY A STONE INPACTION into THE MAJOR DUODENAL PAPILLA

© M.I. SAFOEV, A.E. DEMKO, Y.N. ULYANOV, A.E. BABAYTSEVA

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

Rationale. Over the last decades the number of patients with cholelithiasis has been steadily increasing by 10-20 %. Among them choledocholithiasis occurs in 5–28 % of patients coming with complicated forms of cholelithiasis. The most severe form of complicated course of cholelithiasis is stone inpaction into the ampulla of major duodenal papilla characterized by rapidly increasing intraductal biliary and pancreatic hypertension, development of fermentative cholecystopancreatitis, accession of destructive and infectious processes. Taking into account the fulminant nature of the course, the time from the onset of the disease to diagnosis and surgical intervention should be minimal. Endoscopic papillosphincterotomy, endoscopic lithoextraction and restoration of bile and pancreatic juice outflow in the duodenum are the methods of choice for surgical intervention in case of stone inpaction into the ampulla of the major duodenal papilla.

Objective: to evaluate the efficacy of clinical and laboratory, radiation and endoscopic methods of diagnostics of stone inpaction into the ampulla of the major duodenal papilla, as well as the timing and technical features of restoration of bile and pancreatic juice outflow into the duodenum.

Material and methods. In St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine we analyzed the experience of endobiliary interventions in patients with complicated forms of cholelithiasis over 11 years. In the period from 2013 to 2023, 1352 patients with the diagnosis “cholelithiasis, mechanical jaundice” were treated, among which 118 patients (8.7%) were diagnosed with stone inpaction into the ampulla of the major duodenal papilla. Among them women were 65 (56 %), men — 53 (44 %). The age of the patients was 23-86 years, the average age was 61 years.

All patients were examined in the reception or surgical department of the institute. The diagnosis of “cholelithiasis, choledocholithiasis complicated by stone inpaction in the ampulla of the major duodenal papilla” was made on the basis of complaints, anamnesis, results of clinical and laboratory minimum (clinical, biochemical blood analysis), instrumental examination of patients (ultrasound of abdominal cavity organs, esophagogastroduodenoscopy with targeted examination of the area of the major duodenal papilla, magnetic resonance cholangiopancreatography.

Results. All patients (1352 patients) at admission to the hospital underwent clinical and biochemical blood analysis, ultrasound of abdominal cavity organs. The obtained data were not sufficient for making a diagnosis. Video-gastroscopy was performed to detect the stone inpaction into the ampulla of the major duodenal papilla.

Endoscopic papillosphincterotomy was performed in all patients with the diagnosis “cholelithiasis, choledocholithiasis complicated by stone inpaction into the ampulla of the major duodenal papilla”.

In 3 patients (2.5 %), the wedging was complicated by simultaneous development of purulent cholangitis and severe biliary pancreatitis.

In 86 patients (72.8 %) operative intervention was performed within the first 6 hours from the moment of diagnostics of the inpacted stone. In the remaining 32 patients endoscopic intervention was performed before 24 hours from the moment of admission. In this group of patients the development of severe biliary pancreatitis, purulent cholangitis, increased duration of postoperative pain syndrome, general severity of the patient's condition, increased duration of treatment of patients were noted.

The average duration of treatment of patients who underwent endoscopic intervention in a timely manner amounted to 17.5 ± 2.42 days, whereas the delay of surgery resulted in the increase of the postoperative period up to 24.4 ± 3.93 days.

We did not observe any complications of surgical intervention in the form of bleeding, perforation of the duodenal wall or bile duct wall. There were no lethal outcomes among the patients with stone inpaction into the major duodenal papilla.

CONCLUSIONS:

1.    Clinical and laboratory methods of diagnostics are important, but not decisive in diagnostics of stone inpaction into the major duodenal papilla.

2.    Instrumental and endoscopic methods of research are of leading importance in diagnostics of stone inpaction into the major duodenal papilla.

3.    The time interval from the moment of diagnosis to surgery should be minimal and should not exceed 6 hours.

4. The optimal therapeutic aid in this complication is endoscopic papillosphincterotomy with endoscopic lithoextraction. In doubtful cases it is necessary to perform stenting of common bile and (or) pancreatic duct, external bile drainage (percutaneous transhepatic cholangiostomy, cholecystostomy).

KEYWORDS: choledocholithiasis, stone inpaction into the ampulla of the major duodenal papilla, biliary pancreatitis, cholangitis, atypical papillosphincterotom.

TO CITE THIS ARTICLE. Safoev M.I., Demko A.E., Ulyanov Y.N., Babaytseva A.E.. Сholedocholithiasis complicated by a stone inpaction into the major duodenal papilla. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):64–70.

UDC 616-073.584 : 616-073.75 : 615.099

POTENTIAL ABILITIES OF MULTIVOXEL HMR-SPECTROSCOPY OF THE BRAIN IN PATIENTS WITH ACUTE METHADONE AND GHB PRECUSSOR POISONING

© A.A. SOKOLOV ¹, V.E. SAVELLO ^1,2, T.A. SHUMAKOVA ^1,2, A.G. SINENCHENKO ¹, A.A. BOGDAN ³, D.A. NIKITIN ¹, A.V. MARCHENKO ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

³ St. Petersburg Electrotechnical University LETI, St. Petersburg, Russia

ABSTRACT

Rationale: in our study, we measured the relative concentration of neurometabolites in comparison with poisoning with a synthetic opioid (methadone) and a precursor of GHB (1,4-butanediol) in the intact (according to structural magnetic resonance imaging) cingulate cortex, parenchyma of the periventricular substance of the cerebral hemispheres.

Objective: to conduct a semi-quantitative assessment of the spectral parameters of neurometabolites (Chо/Cr, NAA/Cr, Cho/Naa) in patients with acute poisoning with methadone and the precursor of GHB (1,4-butanediol) and compare their changes in various structures of the brain.

Materials and methods. In the period from 2023 to 2024, 30 patients (28 men and 2 women) with acute drug poisoning were examined at the Acute Poisoning Treatment Center of St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. For comparative statistical analysis, the patients were divided into 2 groups: Group 1 (main) included patients with acute methadone poisoning (n = 15). The median age was 29 [27;34] years; Group 2 (comparison) included patients with acute poisoning with the precursor GHB (1,4-butanediol) (n = 15). The median age was 27.5 [27;33.7] years. Statistically the groups did not significantly differ in age. The median age was 30 [27; 35] years. All patients underwent multivoxel proton ¹НMR spectroscopy according to the developed protocol to study brain neurometabolites (Cho/Cr, NAA/Cr, Cho/NAA). Cho/Cr was chosen as the main differential diagnostic biomarker.

Results. In somatically healthy volunteers, heterogeneity in the distribution of the Cho/Cr index in the studied areas of the brain was observed. During the intergroup comparative analysis, a statistically significant increase in the index of this ratio of neuromethabolites in the white matter and the cortex of the frontal lobes of the brain was established in patients with acute poisoning with methadone and the precursor GHB.

Conclusion. The Cho/Cr index can potentially be used as a marker for assessing damage to the cellular membranes of the cortex and white matter of the frontal lobes. The effect of methadone on the metabolism of the brain structures under study appears to be more pronounced than the effect of the GHB precursor (1,4-butanediol). During the course of the work, it was proven that the middle sections of the white matter of the frontal lobes are among the most sensitive areas of the brain to changes in acute poisoning with synthetic narcotic substances.

KEYWORDS: multivoxel proton MR spectroscopy, methadone, GHB, 1,4-butanediol, poisoning.

TO CITE THIS ARTICLE. Sokolov A.A., Savello V.E., Shumakova T.A., Sinenchenko A.G., Bogdan A.A., Nikitin D.A., Marchenko A.V. Potential abilities of multivoxel HMR-spectroscopy of the brain in patients with acute methadone and GHB precussor poisoning. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):71–80.

UDC 616-001.17

POSSIBILITIES OF PLANNING THE TIMING OF SURGICAL INTERVENTION IN BURNED PATIENTS CONSIDERING THE FEATURES OF THE NEUROHUMORAL RESPONSE

© A.R. KHASANOV ¹, E.K. DERII ², N.K. SOKOLOV ¹, A.V. KOSTYAKOVA ², A.V. YUSUPOV ¹, E.V. ZINOVIEV ^1,2, E.Y. FISTAL ³

¹ Kirov Military Medical Academy, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

³ V.K. Gusak Institute of Urgent and Recovery Surgery, Donetsk, Russia

ABSTRACT

RATIONALE. To date, early necrectomy remains the primary treatment method for patients with extensive thermal injury. However, it is not feasible to restore the skin of patients with an extensive area of deep skin damage during a single surgical intervention. To determine the optimal time between surgical interventions in patients diagnosed with burn disease, it is advisable to analyze prognostically significant indicators of the neurohumoral response. Scientific research on this issue, the features of the pathophysiology of the neurohumoral response of the body, in particular burn injured, in terms of choosing the optimal timing of surgical interventions remain a subject of debate.

OBJECTIVE: to determine prognostically significant markers reflecting the characteristics of the neurohumoral response to burn disease in order to select the optimal timing of staged surgical interventions.

MATERIAL AND METHODS. A comprehensive analysis of treatment outcomes was conducted on a cohort of 31 patients with extensive burn injuries who were admitted to the burn department of the St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine from 2018 to 2020. To assess the effectiveness and predict the neurohumoral response when planning multiple staged surgical interventions in order to select the optimal timing, the results of clinical and biochemical blood tests taken from patients diagnosed with burn disease before and after each operation are used. These include creatinine level, glucose level, protein level, Na+ level, leukocyte level, hematocrit level, Er level, platelet level, hemoglobin level.

Conclusion. The neurohumoral response markers taken as the basis of the study are not direct indicators of determining the stress impact on the body, but rather a consequence of cascade reactions. However, these laboratory indicators are the most accessible to almost every medical institution. To determine the optimal timing of surgical interventions, it is necessary to monitor the level of the aforementioned neurohumoral response markers to determine prognostically favorable time frames for the patient with multiple surgical interventions. A stable and smooth path for the patient between surgical interventions, taking into account the neurohumoral response markers of burn disease, will allow the most significant success in compensating for the body's condition and restoring the patient in the optimal terms of inpatient treatment.

KEYWORDS: burn disease, surgical treatment, neurohumoral response.

TO CITE THIS ARTICLE. Khasanov A.R., Kostyakov D.V., Derii E.K., Sokolov N.K., Kostyakova A.V., Yusupov A.V., Zinoviev E.V. Possibilities of planning the timing of surgical intervention in burned patients considering the features of the neurohumoral response. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):81–90.

CLINICAL CASES AND REVIEW ARTICLES

UDC 616.711-002 : 616-072.1

TREATMENT OF NONSPECIFIC SPONDYLODISCITIS USING PERCUTANEOUS ENDOSCOPIC SANITATION AND REGIONAL ANTIBACTERIAL THERAPY

© M.I. SIDOR ¹, M.N. KRAVTSOV ^1,2,3, T.I. TAMAYEV ¹, V.A. MANUKOVSKY ^1,2, V.E. PARFENOV ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

³ Kirov Military Medical Academy, St. Petersburg, Russia

Abstract

OBJECTIVE: to demonstrate the possibilities and evaluate the results of percutaneous endoscopic sanation of spondylodiscitis in combination with combined (systemic and regional) antibiotic administration.

MATERIALS AND METHODS. A clinical case of a 66-year-old man with pyogenic spondylodiscitis at the LII–LIII vertebral level is presented. For sanitation and drainage, a percutaneous full endoscopic discectomy was performed via a posterolateral transforaminal approach, along with simultaneous selective intravertebral antibacterial therapy. The treatment outcomes were analyzed according to the dynamics of pain syndrome (VAS), laboratory blood parameters, CT, MRI and were compared with the data from contemporary literature.

RESULTS. Percutaneous full endoscopic decompression of neural structures and sanitation of the inflammatory focus, combined with regional antibacterial therapy, proved effective in the treatment of nonspecific spondylodiscitis with localized epiduritis at the lumbar level.

CONCLUSION. The described technique can be considered as an alternative treatment method for nonspecific spondylodiscitis in the absence of significant deformity and instability of the spine, as well as severe neurological symptoms.

Keywords: spondylodiscitis, spondylitis, epiduritis, minimally invasive spine surgery, percutaneous fully endoscopic surgery, regional antibiotic therapy, intraosseous antibiotic therapy.

To cite this article. Sidor M.I., Kravtsov M.N., Tamayev T.I., Manukovsky V.A., Parfenov V.E. Treatment of nonspecific spondylodiscitis using percutaneous endoscopic sanitation and regional antibacterial therapy. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):91–103.

UDC 616.717.46-001.5 : 616-001.5 : 616-089

LOW-TRAUMATIC OSTEOSYNTHESIS METHOD OF THE HUMERUS DISTAL METAPHYSIS FRACTURES IN CHILDREN: A CLINICAL CASE

© O.N. AMAIRI ^1,2, I.F. AKHTYAMOV ², I.V. TSOY ¹, P.S. ANDREEV ³, A.P. SKVORTSOV ⁴

¹ The State Autonomous Healthcare Institution “Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan”, Kazan, Russia

² Kazan State Medical University, Kazan, Russia

³ Kazan State Medical Academy — Branch of Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation, Kazan, Russia

⁴ State Autonomous Healthcare Institution Republican Clinical Hospital of the Republic of Tatarstan Ministry of Health, Kazan, Russia

ABSTRACT

Rationale. Distal humerus fractures are quite common among upper limb injuries in children. Treatment of this trauma in childhood remains a difficult task, requiring reliable, low-traumatic fixation with the lowest risk of neurovascular complications. Methods of internal fixation, external osteosynthesis are relatively traumatic, which predetermines the development and improvement of minimally invasive interventions.

Material and methods. A clinical case of treatment of a child with displaced right humeral supracondylar fracture is presented. Clinical and functional assessments of the patient during treatment and observation period are carried out.

Results. In the treatment of displaced pediatric humeral supracondylar fracture by using the authors’ method a positive functional result was achieved.

Conclusion. Displacement humerus metaphyseal fractures in children are an indication for minimally invasive surgical treatment. The proposed pinning osteosynthesis option reduces the invasiveness of intervention, in this particular case it ensured the effect of patient treatment, but requires further study on bigger clinical material.

KEYWORDS: distal metaphysis humerus fractures in children, osteosynthesis, clinical case

TO CITE THIS ARTICLE. Amairi O.N., Akhtyamov I.F., Tsoy I.V., Andreev P.S., Ckvortsov A.P. Low-traumatic osteosynthesis method of the humerus distal metaphysis fractures in children: a clinical case. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):104–111.

UDC 616-001.17 + 616.34-073.75 : 616.34-089 :  616.34-008.7

A CASE REPORT OF THE DIAGNOSTIC COMPLEXITY OF PORTAL PNEUMATOSIS IN INTESTINAL NECROSIS IN A PATIENT WITH BURN INJURY TO THE BODY

© V.E. SAVELLO ^1,2, A.E. DEMKO ^1,3, T.A. SHUMAKOVA ^1,2, A.N. KOSTENIKOV ¹, D.A. NIKITIN ¹, A.V. MARCHENKO ¹, A.M. AKHMADISHINA ¹, E.A. NIKOLAEVA ¹, A.E. RODIN ¹

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

³ Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

Portal pneumatosis (gas in the portal vein system, gas embolism of the portal vein) is a radiological diagnostic sign characterized by the accumulation of gas in the portal vein, its branches and mesenteric veins. The radiological picture of portal pneumatosis can occur in various abdominal pathologies or be observed in the early postoperative period, but it is most often identified in cases of ischemia and intestinal necrosis. Differential diagnosis is made with pneumobilia (aerobilia), which accounts for a significant proportion of cases in which gas is visualized in the porto-biliary area. Early detection and correct interpretation of the imaging findings can critically influence the management strategy for the patient and reduce the risk of a fatal outcome.

The objective of this study is to illustrate the intricacy of the clinical and radiological diagnosis of portal pneumatosis in a patient with thermal burns.

KEYWORDS: CT, MRI, portal pneumatosis, portal vein gas embolism, portal vein gas, aerobilia, intestinal ischemia and necrosis, acute mesenteric thrombosis.

TO CITE THIS ARTICLE. Savello V.Е., Demko A.E., Shumakova T.A., Kostenikov A.N., Nikitin D.A., Marchenko A.V., Akhmadishina A.M., Nikolaeva E.A., Rodin A.Е. A case report of the diagnostic complexity of portal pneumatosis in intestinal necrosis in a patient with burn injury to the body. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):112–119.

UDC 616.61-008.64

CAUSES OF ACUTE KIDNEY INJURY AFTER ORTHOTOPIC LIVER TRANSPLANTATION (LITERATURE REVIEW)

© S.V. ZHURAVEL ¹, P.YU. FALEVKO ², V.A. MANUKOVSKY ², M.E. MALYSHEV ², A.N. ANANYEV ²

¹ Sklifosovsky Research Institute For Emergency Medicine, Moscow, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

abstract

rationale. Liver transplantation is currently the most effective method for treating diseases with end-stage liver failure. Acute kidney injury is one of the most common complications in the early postoperative period. The pathogenetic cascade of ischemic and reperfusion injury of the liver graft has a multifactorial nature, which initiates the development of acute kidney injury.

OBjective. The aim is to summarize current data on the mechanisms of acute kidney injury development in liver transplantation.

MATERIALS AND METHODS. The analysis of data from foreign and domestic experimental and clinical studies dealing with the pathogenesis of acute kidney injury in liver transplantation was performed. The literature search was conducted in international databases (PubMed/MedLine, ResearchGate), as well as in the scientific electronic library of Russia (Elibrary.ru) for the period of 2003–2024.

RESULTS. The analyzed publications note that the high incidence of acute kidney injury continues to this day and the results of treatment of this syndrome cannot be considered satisfactory. There are no clear criteria for prognostication, classification of this syndrome.

Various factors playing a role in the development of a formidable complication, acting before, during and after transplantation require the attention of a multidisciplinary team throughout the perioperative period.

CONCLUSION. The literature review shows the problems of diagnosis and treatment of acute kidney injury after orthotopic liver transplantation. The article considers the etiology, risk factors, diagnostics, and principles of patient management in the early perioperative period.

KEYWORDS: liver transplantation, acute kidney injury, risk factors, biomarkers, renal replacement therapy.

TO CITE THIS ARTICLE. Zhuravel S.V., Manukovsky V.A., Falevko P.Yu., Malyshev M.E., Ananyev A.N. Causes of acute kidney injury after orthotopic liver transplantation (literature review). Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):120–129.

UDC 618.2-055.25 : 618.3-06 : 616.12-008.46

CLINICAL CASE OF SUCCESSFUL MANAGEMENT OF A PATIENT WITH PERIPARTUM CARDIOMYOPATHY AT 38 WEEKS OF PREGNANCY

© S.YU. FALEVKO ¹, A.R. BIGASHEV ¹, L.SH. TSECHOYEVA ^1,2, K.A. DUDOVA ^1,2

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State Pediatric Medical University” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

ABSTRACT

Peripartal cardiomyopathy is one of the causes of heart failure at the end of pregnancy or in the first 5–6 months after childbirth. In all diagnostic cases, peripartal cardiomyopathy is a diagnosis of exclusion of other causes of heart failure.

Description of the case. A 29-year-old patient at the 38^th week of her first pregnancy for the first time had a feeling of lack of air, pronounced general weakness, shortness of breath with minimal physical exertion. The pregnant woman was in a forced sitting position. According to echocardiography, eccentric hypertrophy of the left ventricle with dilation of the cavity was revealed, relative mitral insufficiency 3^rd degree, tricuspid insufficiency 2^nd degree, diffuse hypokinesis, the dissynchronous movement of the interventricular septum at ejection fraction is 22 %, an increase in the design pressure in the pulmonary artery, bilateral hydrothorax. After further examination and stabilization of the pregnant woman's condition, thoracocentesis was performed, in which 250 ml of the serous nature of the liquid was evacuated. Next, a laparotomy was performed using Joel-Cohen access, and a live full-term fetus was extracted. Further treatment of the patient was carried out under the dynamic supervision of an obstetrician-gynecologist, a cardiac surgeon, an endocrinologist, a septologist, a clinical pharmacologist, a nutritionist with the supervision of laboratory and instrumental studies. The patient was discharged on the 13th day in a satisfactory condition.

Conclusion. Peripartal cardiomyopathy is a rare pathology in Russia, but for timely diagnosis and treatment it is necessary to have an understanding of this disease.

KEYWORDS: peripartum cardiomyopathy, peripartum disease, postpartum cardiomyopathy, dilated cardiomyopathy of pregnancy, Meadows cardiomyopathy, pregnancy, childbirth, heart failure.

TO CITE THIS ARTICLE. Falevko S.Yu., Bigashev A.R., Tsechoyeva L.Sh., Dudova K.A. Clinical case of successful management of a patient with peripartum cardiomyopathy at 38 weeks of pregnancy. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):130–136.

NURSING AND PUBLIC HEALTH, AN ORGANIZATION AND SOCIOLOGY OF HEALTHCARE, MEDICAL AND SOCIAL EXPERTISE

UDC 614.2

RECRUITMENT (STAFFING) ISSUES OF MID-LEVEL MEDICAL PERSONNEL FOR EMERGENCY MEDICAL CARE

© M.V. POLYUKOVA ^1,2, I.M. BARSUKOVA ^1,2

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

Rationale: Currently, the problem of staffing in healthcare still remains acute. This applies to both the healthcare of the Russian Federation and the entire professional world community. The lack of personnel affects the speed of implementation of innovations, the quality and safety of the medical care provided. The programs and strategies being implemented to eliminate the personnel shortage do not yet have a clear positive trend. Thus, studying the need for personnel is relevant.

The objective of the study was to analyze the staffing of emergency medical services (EMS) by paramedical personnel. Materials: scientific electronic library resource, annual statistical accounting forms (form 30) for 2019–2023. RF.

Methods: content analysis, statistical and analytical.

Results: an analysis of the staffing level of emergency medical services with mid-level medical staff was carried out.

Keywords: staffing, personnel structure, mid-level medical staff, emergency medical care.

To cite this article. Polyukova M.V., Barsukova I.M. Recruitment (staffing) issues of mid-level medical personnel for emergency medical care. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):137–142.

UDC 614.2

PROFESSIONAL PERSONnEL RECRUITMENT OF FUNCTIONAL DIAGNOSTICS DEPARTMENTS OF ST. PETERSBURG

© N.N. LUKOGORSKAYA ¹, I.M. BARSUKOVA ^1,2, N.I. VISHNYAKOV ^1,2

¹ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

abstract

rationale. Functional diagnostics is an integral part of the main areas of clinical medicine, including surgical profile. Personnel is the most valuable resource of the healthcare system, determining the efficiency of its work.

OBJECTIVE: to analysis the personnel composition of functional diagnostics units in St. Petersburg in dynamics during 2018–2023.

MATERIALS AND METHODS. The data of Federal Statistical Reporting for St. Petersburg during the period 2018–2023 were used, comparative analysis, statistical and analytical methods were applied.

CONCLUSIONS. Analysis of functional diagnostics departments and offices staffing indicates the presence of problems caused by the shortage of personnel— doctors and nurses of departments (offices). The staffing level of functional diagnostics physicians in outpatient and inpatient medical organizations differs insignificantly and amounts to 78.8 ± 3.6 % and 80.4 ± 1.3 % for occupied positions, and 51.8 ± 2.9 % and 61.8 ± 0.7 % for individuals, respectively, without significant dynamics over the observation period. As a result, a significant level of combining positions (1.4 ± 0.1) and a high level of workload on personnel remain, which may have a negative impact on ensuring the availability and quality of functional studies.

KEYWORDS: functional diagnostics, functional diagnostics units, functional diagnostics personnel, functional diagnostics physician.

To cite this article. Lukogorskaya N.N., Barsukova I.M., Vishnyakov N.I. Professional personnel recruitment for functional diagnostics departments of St. Petersburg. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):143–147.

HISTORY. EVENTS. PEOPLE

UDC 614.2

THE LENINGRAD INSTITUTE OF EMERGENCY CARE during the war (ON THE 80TH ANNIVERSARY OF THE GREAT VICTORY)

© V.A. MANUKOVSKY, V.E. PARFENOV, I.M. BARSUKOVA, N.K. RAZUMOVA

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

Abstract

Rationale. The Leningrad Siege (09/08/1941–01/27/1944) is one of the unforgettable pages in the history of the city and the Leningrad Institute of Emergency Care.

Objective: in connection with the anniversary date — the 80th anniversary of the Victory in the Great Patriotic War (1941–1945), to present the historical pages of heroism and courage of the personnel of the Leningrad Institute of Emergency Care, who lived and fought, doing their duty, during the difficult war years of the siege (09/08/1941–01/27/1944).

MATERIALS AND METHODS. The archives of the St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, the memoirs of the Institute employees radiologist E.A. Pchelina and doctor M.G. Kamenchik were used. Historical and analytical methods of research were emploid.

CONCLUSIONS. During the war, the population of Leningrad and its defenders at the front demonstrated mass heroism. The city stood firm and won. Together with everyone else, the Leningrad Institute of Emergency Care fought for the victory, continuing to work as a close-knit team in the most difficult conditions, returning the wounded to duty and saving the lives of inhabitants of the besieged city.

KEYWORDS: Leningrad Institute of Emergency Care, Leningrad blockade, Great Patriotic War, E.A. Pchelina, M.G. Kamenchik.

To cite this article. Manukovsky V.A., Parfenov V.E., Barsukova I.M., Razumova N.K. The Leningrad Institute of Emergency Care during the Great Patriotic War (on the 80th anniversary of the victory). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2025;(1):148–152.

ORIGINAL ARTICLES

Perspectives of multimodal approach for monitoring local tumor metabolism in assessing the therapeutic pathomorphosis of breast cancer after neoadjuvant therapy

© M.I. ARABACHYAN ^1,2, V.V. SHUPLETSOV ³, M.YU. KIRILLIN ⁴, A.V. DUNAEV ³, E.V. POTAPOVA ³

¹ Smolensk State Medical University, Ministry of Health of the Russian Federation, Smolensk, Russia

² Smolensk Regional Oncology Clinical Dispensary, Smolensk, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Orel State University named after I.S. Turgenev”, Orel, Russia

⁴ Federal Research Center A.V. Gaponov-Grekhov Institute of Applied Physics of the Russian Academy of Sciences (IAP RAS), Nizhny Novgorod, Russia

Abstract

Rationale. Breast cancer (BC) is the most prevalent malignant disease affecting women on a global scale. Along with the gradual rise in incidence, a decline in mortality rates from breast cancer is currently evident, which is linked to enhanced diagnostic techniques and improved treatment strategies for this disease. The advent of neoadjuvant therapy for breast cancer has enabled a greater proportion of organ-sparing surgical procedures to be performed, thereby improving the survival rate of patients with aggressive forms of the disease. Nevertheless, in certain instances, it is not feasible to accurately ascertain the efficacy of treatment through the use of existing diagnostic techniques. One promising avenue for evaluating the metabolic characteristics of breast tumors following neoadjuvant treatment is the multimodal use of fluorescence spectroscopy and diffuse reflectance spectroscopy.

The objective of this study is to evaluate the potential for a multimodal approach to assess the local metabolism of breast tumors using spectroscopic methods to evaluate the therapeutic pathomorphosis of breast cancer after neoadjuvant therapy.

Materials and Methods. This article presents the results of an ex vivo examination of macroscopic samples of 10 removed mammary glands from patients with morphologically verified breast cancer. This research study included a postoperative assessment of local tumor metabolism with fluorescence spectroscopy and diffuse reflectance spectroscopy using a specially designed device with a fine-needle fiber optic probe. This was followed by an analysis of the characteristics of tumor metabolism in patients with or without previous neoadjuvant therapy.

Results. The results demonstrated that in the cohort of patients who received neoadjuvant therapy, the dynamics of change in maximum fluorescence intensity exhibited a same trend, namely an initial increase during the first 45 minutes, followed by a subsequent decline. In patients who had not undergone neoadjuvant therapy, this trend was not observed, and the fluorescence signals exhibited different dynamics. Backscatter spectroscopy revealed the presence of developed blood hypoxia in the measurement volume in samples from both groups of patients.

Conclusion. The proposed approach for assessing the local metabolism of breast tumors has the potential to evaluate the therapeutic pathomorphosis of breast cancer. However, to estimate further perspectives of this approach, it is necessary to continue the study with a larger set of patient cohorts to obtain statistically reliable data.

KEYWORDS: breast cancer, optical diagnostics, therapeutic pathomorphosis, neoadjuvant therapy, fluorescence spectroscopy, diffuse reflectance spectroscopy.

To cite this article. Arabachyan M.I., Shupletsov V.V., Kirillin M.Yu., Dunaev A.V., Potapova E.V. Perspectives of multimodal approach for monitoring local tumor metabolism in assessing the therapeutic pathomorphosis of breast cancer after neoadjuvant therapy. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4):08-15.

A critical examination of the outcomes of arthroscopic intervention in the management of osteochondral injuries of the talus bone

© D.O. BARULIN, R.O. GORBATOV, A.YU. KOPYLOV, E.E. MALYSHEV

Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Healthcare of Russian Federation, Nizhny Novgorod, Russia

Abstract

Rationale. Osteochondral lesions of the talus (OCLT) are a pathological condition of the ankle joint that is characterized by degenerative changes and aseptic necrosis of the talar dome. This condition is typically post-traumatic, often underdiagnosed, and affects young individuals in their working years. Currently, there are various arthroscopic treatment methods for OCLT, and it remains relevant to analyze the long-term postoperative outcomes in patients who underwent therapeutic and diagnostic ankle arthroscopy.

Objective: to analyze the long-term postoperative outcomes of arthroscopic treatment for osteochondral lesions of the talus.

Materials and Methods. A total of 32 patients were selected for inclusion in this study, in accordance with the established criteria (age above 18 years, presence of OCLT, and voluntary consent to participate), and underwent surgical intervention at the Institute of Traumatology and Orthopedics of the University Clinic of PRMU, Ministry of Health of Russia, between 2015 and 2022. The diagnosis was corroborated through the utilisation of X-ray imaging of the ankle in two projections, in conjunction with magnetic resonance imaging (MRI). The size of the osteochondral defects of the talus was determined based on the results of the examination. All patients underwent ankle arthroscopy, which included debridement, removal of osteophytes and chondromic bodies, edge-modulating resection of the talar dome and anterior distal epiphysis of the tibia, and abrasive chondroplasty. Questionnaires were administered to the subjects prior to the surgical procedure and at 2, 6, 12, and 24 months postoperatively. The questionnaires included the VAS, AOFAS, EQ-5D-5L, and FAAM (ADL).

Results. The study demonstrated a statistically significant (p < 0.05) reduction in pain intensity at the 24-month postoperative follow-up. Complete pain relief was achieved in 41 % of patients. Furthermore, a statistically significant improvement (p < 0.05) in ankle function was observed. An “excellent” result was observed in 40 % of patients, while a “good” result was observed in 34 %. The postoperative FAAM (ADL) score demonstrated a statistically significant improvement, increasing from 55 [53;57] to 79 [75;82], while the EQ-5D-5L score exhibited a notable enhancement, rising from 20 [19;22] to 23 [20;24.5].

Conclusions. Arthroscopic treatment of osteochondral lesions of the talus has been demonstrated to result in a reduction in pain, improved functional outcomes of the ankle joint, and an enhanced quality of life for patients.

KEYWORDS: osteochondral lesions of the talus, ankle arthroscopy.

TO CITE THIS ARTICLE. Barulin D.O., Gorbatov R.O., Kopylov A.Yu., Malyshev E.E. A critical examination of the outcomes of arthroscopic intervention in the management of osteochondral injuries of the talus bone. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 16-25.

Micromorphology of the vascular bed of the colon wall in the formation of different types of anastomoses in conditions of ileus

© YU.S. VAJNER

Federal State Budgetary Educational Institution of Higher Education “Novosibirsk state medical University” of the Ministry of health of Russia, Novosibirsk, Russia

ABSTRACT

Rationale. With the rise in the prevalence of colorectal cancer, the incidence of its complex manifestations also increases, with intestinal obstruction representing a significant challenge. In cases where the tumor is located on the right side, an anastomosis is typically formed following the resection stage. However, this procedure has a failure rate of 2 to 15%.

objective. The objective is to provide a morphological substantiation of the improvement of arterial and venous blood flow in the tissues of the zone of small-colonic anastomosis during the formation of its "end to side" with excision of a fragment of the colon in conditions of acute intestinal obstruction.

Materials and Methods. An anatomical study was conducted, wherein fragments of the colon were obtained from the surgical material of 20 patients who had undergone surgery for acute intestinal obstruction. The intestinal wall was dissected in a linear fashion (comparison group) and a fragment of the wall was excised along the mesenteric margin (main group). The preparations were stained with hematoxylin and eosin. Additionally, the preparations were treated with antibodies to the CD34 antigen. Histological and immunohistochemical studies were conducted at magnifications of x400 and x630. The number and total area of arterial and venous vessels in the muscular and submucosal layers per 1 mm² of the intestinal incision area were calculated. The results of the study were statistically processed.

Results. A significantly greater number of arterial and venous vessels were observed in the muscular and submucosal layers of the colon wall during excision of the fragment along the mesenteric margin than during a linear incision. This is due to the fact that the mesenteric edge is the most distant from the vascular lines.

Conclusion. Excising an oval fragment along the mesenteric edge in the wall of the colon when forming an ileocolonic anastomosis "end to side" is an advisable procedure. This improves blood supply to the suture line and may be accompanied by a decrease in the likelihood of anastomosis failure.

KEYWORDS: colon, acute intestinal obstruction, anastomosis, blood supply.

TO CITE THIS ARTICLE. Vajner Yu.S. Micromorphology of the vascular bed of the colon wall in the formation of different types of anastomoses in conditions of ileus. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 26-31.

Chemiluminescence of blood during an infectious process and the possibility of its use to assess endotoxin activity in sepsis

© M.I. GROMOV, L.P. PIVOVAROVA, O.B. ARISKINA, I.V. OSIPOVA

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

Abstract

RATIONALE. Specific granules of neutrophil granulocytes and the cytoplasm of monocytes contain enzymes that lead to the rapid and massive formation of oxygen metabolites (“oxygen explosion”). These enzymes are the main factor in the microbicidal activity of phagocytes. With the development of infectious diseases, the number and activity of enzymes that increase the production of oxygen metabolites may increase significantly.

OBJECTIVE: To determine the presence of a reserve of microbicidal activity of phagocytes in patients with intracellular infections and sepsis by measuring chemiluminescence (CL) of whole blood.

MATERIALS AND METHODS. We studied groups of healthy subjects (40 subjects), gynecological/urological patients treated for a long time for chronic intracellular — viral, mycoplasma, ureaplasma, chlamydial infections (157 subjects), and patients with sepsis (33 subjects). Luminol-dependent CL in whole blood was measured 7 times at 10-minute intervals using a Luminometer-1251 apparatus, Bio-Orbit (Finland). The resulting sum of 7 CL measurements was considered as an indicator of oxygen-dependent metabolic and microbicidal activity of blood phagocytes. The reserve of phagocyte metabolic activity was assessed by determining the CL reserve as a percentage of antigen (zymosan)-induced CL and spontaneous CL in whole blood (induced/spontaneous x 100 %).

RESULTS. 95 % of the healthy subjects showed a CL reserve, i.e. an increase of the CL level by an average of 33 % when blood phagocytes were exposed to an excessive amount of antigen in vitro. In 1/3 of patients with intracellular infections and sepsis, there was a lack of phagocyte CL reserve or its depletion in the form of a decrease in CL levels when blood phagocytes were exposed to an excess amount of antigen in vitro.

Conclusions. The indicator of CL metabolic reserve is universal in nature — it is calculated in the form of a coefficient and does not depend on the characteristics of the luminometer used and the units of measurement. The lack of metabolic reserve in a significant number of patients with sepsis and septic shock calls into question the possibility of using the blood CL method to indirectly determine endotoxin activity in the diagnostic endotoxin activity assessment (EAA) test.

Keywords: blood chemiluminescence, chemiluminescence reserve, intracellular infections, sepsis, assessment of endotoxin activity.

To cite this article. Gromov M.I., Pivovarova L.P., Ariskina O.B., Osipova I.V. Chemiluminescence of blood during an infectious process and the possibility of its use to assess endotoxin activity in sepsis. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 32-39.

DEVELOPMENT OF AN ORIGINAL METHODS FOR MECHANICAL ISOLATION OF STROMAL-VASCULAR CELL FRACTION

© E.V. ZINOVIEV, V.A. MANUKOVSKY, A.E. DEMKO, E.K. DERII, D.V. KOSTYAKOV

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

Rationale. The stromal vascular cell fraction (SVF) is a heterogeneous population of regenerative cells, the main representatives of which are mesenchymal stem cells, endothelial cells, macrophages, and monocytes. From our perspective, the most optimal approach is the mechanical method of isolating SVF, as it is highly effective, safe, straightforward to learn, and can be readily integrated into routine clinical practice. In light of this, it is imperative to identify a single, standardized method of mechanical isolation of SVF.

Objective: to develop the method of mechanical isolation of the stromal-vascular cell fraction with the most optimal parameters of centrifugation speed and time in order to achieve the greatest number of regenerative cells in the final product.

Materials and methods. The study population consisted of 30 patients, with an age range of 18 to 59 years. Lipoaspirate was obtained from the anterior abdominal wall. The cellular composition was analyzed using flow cytometry.

Results. The study demonstrated that the optimal centrifugation speed is 3000 rpm, and the optimal time period is 2 minutes. This ratio of parameters resulted in the highest number of regenerative cells in the final SVF. It can thus be concluded that the content of mesenchymal stem cells in the SVF was increased by 200 % (p < 0.05), while the number of nucleated hematopoietic cells increased by 7.1 % (p < 0.05). The content of macrophages and monocytes increased by 126.1 % (p < 0.05), while the content of endothelial cells increased by 40.7 % (p < 0.05) in comparison with the existing methodology described in the literature.

Conclusion. The use of SVF is a promising method for treating pathologies in various fields of medicine. The mechanical method of isolating SVF is a fast, easy-to-learn, and effective technique.

KEYWORDS: stromal-vascular cell fraction, regeneration, mesenchymal stem cells, isolation method.

TO CITE THIS ARTICLE. Zinoviev E.V., Manukovsky V.A., Demko A.E., Derii E.K., Kostyakov D.V. Development of an original methods for mechanical isolation of stromal-vascular cell fraction. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 40-47.

APPLICATION OF THE ERAS CONCEPT IN PATIENTS AFTER VTS LUNG RESECTIONS

© O.V. NOVIKOVA ^1,2, V.A. VOLCHKOV ^1,2, A.S. PETROV ^1,2, B.N. SHAH ^1,2, A.A. BOYARKIN ^1,2, M.A. ATYKOV ²

¹ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

² Saint Petersburg State Budgetary Institution of Healthcare “City multi-field hospital № 2”, Saint-Petersburg, Russia

Abstract

The objective of this study is to identify an optimal ERAS-compliant analgesic regimen for patients undergoing video-assisted thoracoscopic (VATS) lobectomies.

MATERIALS AND METHODS. A prospective randomized study was conducted including 85 patients with peripheral lung lesions, classified as class I–IV according to the American Society of Anesthesiologists (ASA) classification, who underwent VATS anatomic lung resections. Patients were randomly assigned to one of three groups based on the method of anesthesia utilized: 28 patients received prolonged paravertebral block (PVB), 30 patients received intraoperative intercostal block (ICB), and 27 patients were administered systemic analgesics without regional techniques. The primary outcome measure was the dosage of narcotic analgesics (trimeperidine) administered in each group. The intensity of acute postoperative pain was repeatedly measured at rest and during coughing over the first 72 hours after surgery using the Numeric Rating Scale (NAS). The gas composition of arterial blood and complications in the postoperative period were registered and analysed.

The results demonstrated that patients with PVB exhibited the lowest requirement for trimeperidine (22.4 ± 4.3 mg per patient) in comparison to the ICB group (33.5 ± 4.2 mg) and the group without regional analgesia (RA) with systemic administration of drugs (33.5 ± 4.2 mg), p = 0.017. The lowest NAS values were observed in the PVB group in comparison with the ICB group and the group without RA (p = 0.002). The oxygenation index was higher in the PVB group than in the ICB group and the group without regional analgesic methods (p = 0.018). Additionally, the PaCO₂ was highest in the group without RA and lowest in the group with PVB (p = 0.047). In the PVB group, 67 % of patients exhibited no complications, compared to 57 % in the ICB group and 45 % in the group without regional techniques (p = 0.048).

CONCLUSION. The implementation of PVB in the postoperative management of patients following VATS lobectomies facilitates the fulfillment of the ERAS strategy. This is due to the fact that patients who undergo PVB require the lowest dosage of trimeperidine, report the lowest intensity of pain throughout the entire follow-up period, and experience the lowest number of postoperative complications when compared to both the ICB group and the group that did not undergo RA.

Keywords: paravertebral block, intercostal block, video-assisted thoracoscopic lobectomy, ERAS.

To cite this article. Novikova O.V., Volchkov V.A., Petrov A.S., Shah B.N., Boyarkin A.A., Atykov M.A. Application of the ERAS concept in patients after VTS lung resections. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 49-56.

Possibilities of vacuum fine-needle aspiration biopsy in the context of sclerotherapy for colloid thyroid nodules

© A.O. TAGIL, A.V. BORSUKOV

Smolensk State Medical University. Fundamental research laboratory «Diagnostic researches and minimally invasive technologies», the Ministry of Health of the Russian Federation, Smolensk, Russia

ABSTRACT

RATIONALE. The prevalence of thyroid nodules is 3–7 % in patients undergoing palpation and 50 % in the general population during ultrasound examination. The majority of nodules are benign and do not result in any clinically apparent manifestations. Minimally invasive treatment methods, such as ethanol sclerotherapy and radiofrequency ablation, are frequently proposed as alternatives to surgical treatment. While ethanol ablation has proven effective in treating simple cysts and predominantly cystic nodules of the thyroid gland (comprising more than 50% cystic content), challenges may emerge when addressing nodules with densely densely colloid content.

The objective of this study is to determine the effectiveness of vacuum fine-needle aspiration biopsy during sclerotherapy in patients with dense colloid content in cystic nodules of the thyroid gland.

MATERIALS AND METHODS. At the Diagnostic and Minimally Invasive Research Laboratory of the Smolensk State Medical University, a device for performing vacuum fine-needle aspiration biopsy was developed (Russian Federation Patent 2757525). Initially, ethanol sclerotherapy was attempted using a single-use LUER-type syringe with a volume of 10 ml, equipped with a 21G needle. However, the procedure was terminated due to the inability to aspirate the cystic content.

Results. A complete evacuation of the cystic material was accomplished in all patients. Subsequently, patients were monitored dynamically with control ultrasound imaging at the three-month mark. The recurrence of the formation was identified in 17 (81.0 %) patients, who were subsequently assigned to the subsequent stage of treatment. All patients underwent ethanol sclerotherapy of cystic nodules using 95 % alcohol in a volume of 50 % of the obtained cystic content, with an exposure time of the sclerosing agent in the cavity of four minutes. During subsequent questioning, all patients reported a resolution of the symptoms associated with compression syndrome. In patients with cosmetic indications, the cystic protrusion on the anterior surface of the neck was observed to have disappeared.

CONCLUSIONS: Ethanol sclerotherapy of cystic thyroid nodules represents an effective alternative treatment method. The application of vacuum fine-needle aspiration biopsy facilitates the collection of dense colloid content, which influences the efficacy of ethanol sclerotherapy.

KEYWORDS: thyroid gland, sclerotherapy, colloid nodules, minimally invasive treatment, vacuum biopsy.

TO CITE THIS ARTICLE. Tagil A.O., Borsukov A.V. Possibilities of vacuum fine-needle aspiration biopsy in the context of sclerotherapy for colloid thyroid nodules. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 57-64.

REVIEWS AND CLINICAL CASES

KNIFE PENETRATING BRAIN INJURY: DESCRIPTION OF A CLINICAL CASE

© N.A. SEREBRENNIKOV ¹, K.N. BABICHEV ^1,3, M.N. KRAVTSOV ^1,2,3, K.V. TYULIKOV ^1,2, V.E. PARFENOV ¹, V.A. MANUKOVSKY ^1,2

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

³ Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

Rationale. Penetrating traumatic brain injuries caused by sharp metallic objects are uncommon occurrences in neurosurgical clinical practice. The infrequency of such cases results in a paucity of established guidelines for management strategies. In the present article, the authors present a clinical case of an isolated penetrating traumatic brain injury in the left temporal lobe. The article addresses several key issues, including the pathogenesis, instrumental diagnosis, and surgical strategy for this type of lesion.

objective: to present a clinical case of a patient who was successfully treated for a penetrating brain injury caused by a sharp metallic object (a knife).

MATERIAL AND METHODS. An analysis of the clinical data obtained during the evaluation of the patient was conducted, along with an examination and discussion of the relevant literature.

RESULTS. The patient, aged 25 years, sustained a penetrating brain injury caused by a knife. Subsequent to the examination, surgical intervention was undertaken for the purpose of removing the foreign body from the cranial cavity. Following the patient's rehabilitation, an early cranioplasty was performed. The patient was discharged from the hospital with an improvement in his neurological status.

CONCLUSION. Penetrating traumatic brain injuries caused by sharp metallic objects are uncommon in neurosurgical clinical practice and pose a significant risk to patient health. The severity of injury and the resulting outcome are contingent upon the location of the lesion and the presence of vascular injury in the adjacent region. In such cases, computed tomography serves as the primary evaluation method. The presence of specific “red flags” determines the necessity for selective cerebral angiography in these patients. Medical assessment and treatment prior to hospitalization, in conjunction with the expeditious transportation of the patient to a specialized medical facility and the initial surgical treatment of the injury, play a pivotal role in achieving a favorable outcome in this patient population.

KEYWORDS: knife injury, penetrating brain injury, cranioplasty, clinical case.

To cite this article. Serebrennikov N.A., Babichev K.N., Kravtsov M.N., Tyulikov K.V., Parfenov V.E., Manukovsky V.A. Knife penetrating brain injury: description of a clinical case. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 65-70.

Cubital canal syndrome: surgical treatment methods

© E.A. PETRENKO, A.I. GAYVORONSKIY, L.I. CHURIKOV, D.E. ALEKSEEV, M.A. LEGZDAYN, G.G. BULYSHCHENKO, D.V. SVISTOV

Kirov Military Medical Academy, St. Petersburg, Russia

abstract

OBJECTIVE. To study different methods of treatment of cubital canal syndrome, to determine the directions that are the most effective and priority in this area.

Materials and Methods. A review of the scientific literature of the last 20 years was carried out and Internet sources were used for the above keywords. Articles were selected that provided relevant and current information on the treatment of ulnar nerve compression.

Results. Cubital canal syndrome is a tunnel neuropathy characterized by impaired sensory and motor activity of the hand in the area of innervation of the ulnar nerve, which is compressed in the cubital canal at the level of the elbow joint. In most of the sources studied, the authors identify 2 priority areas in the treatment of the tunnel neuropathy under consideration: simple decompression and decompression with subcutaneous displacement as the least traumatic techniques. However, there are no less opinions of the scientific community about the effectiveness of restoring lost functions with other surgical treatment methods.

Conclusion. The treatment of cubital canal syndrome does not have a single, well-defined algorithm described in the modern literature. None of the surgical options in this review demonstrated universal superiority over the others. However, all types of interventions demonstrate their efficacy in the presence of appropriate indications and features of the clinical course of the disease.

Keywords: cubital canal syndrome, ulnar nerve neuropathy, ulnar nerve compression, compression-ischemic neuropathy, surgical decompression, surgery for cubital canal syndrome.

TO CITE THIS ARTICLE. Petrenko E.A., Gayvoronskiy A.I., Churikov L.I., Alekseev D.E., Legzdayn M.A., Bulyshchenko G.G., Svistov D.V. Cubital canal syndrome: methods of surgical treatment. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 71-86.

FEATURES OF METABOLIC DYSFUNCTION IN PATIENTS WITH HEPATIC ENCEPHALOPATHY AND MODERN APPROACHES TO ITS NUTRITIONAL CORRECTION

© V.M. LUFT, A.M. SERGEEVA, A.V. LAPITSKY, B.R. KELBETOVA, M.V. NANIEVA

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

Rationale. Hepatic encephalopathy remains one of the most serious manifestations of liver failure, often occurring in critically ill patients. One of the most important components of intensive care for such patients is nutritional-metabolic therapy (NMT), which aims to correct the developing systemic metabolic dysfunction.

Objective: To present literature data and own experience on optimal implementation of NMT in patients with hepatic encephalopathy.

Materials and Methods. Previously published studies in the field of intensive therapy of patients with hepatic encephalopathy were analysed and modern possibilities of their intensive treatment were outlined, taking into account our own experience.

Results. The article presents modern approaches and possibilities of nutritional correction of hepatic encephalopathy, including nutritional approaches and rational choice of optimal substrate provision for such patients.

Conclusion. The use of NMT approaches described in the article in patients with hepatic encephalopathy will expand the professional knowledge of doctors in the field of modern possibilities of their intensive care.

KEYWORDS: hepatic encephalopathy, nutritional metabolic therapy.

TO CITE THIS ARTICLE. Luft V.M., Sergeeva A.M., Lapitsky A.V., Kelbetova B.R., Nanieva M.V. Features of metabolic dysfunction in patients with hepatic encephalopathy and modern approaches to its nutritional correction. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 87-98.

MEDICAl REHABILITATION OF PATIENTS

WITH CHEST INJURIES (lecture)

© A.N. TULUPOV ^1,2, A.YE. DEMKO ^1,2, I.G. BELENKY ^1,3

¹ St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

² Kirov Military Medical Academy, St. Petersburg, Russia

³ Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

Abstract        

The modern, effective surgical treatment of closed chest injury is unthinkable without medical rehabilitation, which must be carried out at all stages of patient management. This includes a set of medications, physiotherapeutic, psychotherapeutic, and general health measures, physiotherapy exercises, nutritional therapy, climatotherapy, and so forth. Rehabilitation is organized into three stages: hospital, outpatient clinic, and sanatorium-resort. Well-organized rehabilitation significantly contributes to the speedy and more complete restoration of the work and combat capability of the victims.

Keywords: closed chest injury, rehabilitation of victims.

TO CITE THIS ARTICLE. Tulupov A.N., Demko A.Ye., Belenky I.G. Medical rehabilitation of patients with chest injuries (lecture). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 99-108.

NURSING AND PUBLIC HEALTH, AN ORGANIZATION AND SOCIOLOGY OF HEALTHCARE, MEDICAL AND SOCIAL EXPERTISE

RUSSIAN MEDICAL STAFF

© N.I. VISHNYAKOV ^1,2, M.V. OKULOV ¹, I.M. BARSUKOVA ^1,2

¹ Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

² St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

The human resources policy is a crucial aspect in the advancement of domestic healthcare sector.

Objective: to study the quantitative characteristics of the medical personnel of medical organizations in the Russian Federation, with a focus on the main types and conditions of medical care.

Materials and methods. Statistical data from ROSSTAT (Federal Statistical Observation form No. 30, 2018–2023), domestic and foreign literature (2019–2024) sourced from the eLibrary.ru database, and legislative and regulatory documents. The research employed a content analysis, analytical and statistical methods.

Results. Given the considerable overall deficit in the medical personnel workforce, the situation was particularly acute in hospitals, where the staffing level for individuals was 58.7 ± 2.8 %, and the proportion of individuals combining positions was 1.5 ± 0.04. The situation is similarly dire in emergency medical care units, where there is a shortage of 50.6 % of doctors (staffing by individuals is 49.6 ± 1.4 %). The analysis of staffing dynamics from 2018 to 2023 revealed a decrease in the indicator during the period of the SARS-CoV-2 pandemic, due to the implementation of anti-epidemic measures. However, there was a subsequent trend towards an increase in values in subsequent years.

Conclusion. The key to solving personnel problems in healthcare is the implementation of a well-thought-out, planned personnel policy for the medium and long term, including the provision of career guidance for schoolchildren and the targeted training of specialists.

KEYWORDS: personnel, medical personnel, medical personnel, staffing, personnel shortage.

TO CITE THIS ARTICLE. Vishnyakov N.I., Okulov M.V., Barsukova I.M. Russian medical staff. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(4): 109-113.

HISTORY. EVENTS. PEOPLE

Dear readers of the journal "Emergency Surgery". We bring to your attention a new category: "The story. Events. People", in which we will introduce you to prominent figures of medicine of the past and present, interesting events and facts. And we will begin our column, of course, with a story about the founder of the St. Petersburg Scientific Research Institute of Emergency Medicine, Justin Ivlianovich Dzhanelidze.

ORIGINAL ARTICLES

Multi-stage treatment of a patient with multiple small intestinal fistulas

© V.V. ATAMANOV¹, K.V. ATAMANOV¹,², YU.S. VAINER¹,², E.YU. LEVCHIK3

¹ Novosibirsk State Medical University, Novosibirsk, Russia

² State budgetary health care institution of the Novosibirsk region “Novosibirsk City Clinical Hospital № 1”, Novosibirsk, Russia

³ Sverdlovsk Regional Clinical Psychoneurological Hospital for War Veterans, Yekaterinburg, Russia

ABSTRACT

Currently, the leading strategy is the staged treatment of immature small intestinal fistulas, which ensures higher patient survival. One of the methods that creates the possibility of long-term staged treatment of patients is obturation of small intestinal fistulas. The purpose of the work was to show the effectiveness of using the technology of intraintestinal obturation according to V.V. Atamanov in the multi-stage treatment of a patient with multiple unformed fistulas of the small intestine on eventrated loops, against the background of hard peritoneal adhesive process. It was shown that obturation, together with the surgical complete shutdown of the loop with one of the fistulas by intestinal anastomosis, ensured the implementation of restorative intervention in the optimal time frame, with good immediate and long-term treatment results.

KEYWORDS: external fistulas of the small intestine, staged treatment, obturation of fistulas.

TO CITE THIS ARTICLE. Atamanov V.V., Atamanov K.V., Vainer Yu.S., Levchik E.Yu. Multi-stage treatment of a patient with multiple small intestinal fistulas. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):08-15.

Assessment of the renal cortical layer according to the multiparametric complex of contrast-enhanced ultrasound and elastography (2D-SWE) in patients with type 2 diabetes of various clinical course

© O.A. GORBATENKO, A.V. BORSUKOV

Smolensk State Medical University, Smolensk, Russia

Abstract

Objective. To assess the stiffness of the renal parenchyma according to ultrasound elatography in patients with type 2 diabetes mellitus of various clinical courses.

Relevance. To evaluate changes in the renal cortex according to a multiparametric complex of contrast-enhanced ultrasound and shear wave elastography (2D-SWE) in patients with type 2 diabetes of various clinical courses.

Materials and methods. From 2022 to 2024 84 patients were studied: 28 women (33,3 %), 56 men (66,7 %), average age 61 ± 6,1. The control group consisted of (n = 48). All patients were studied using a single examination design: medical history, physical examination, laboratory examination, multiparametric examination, including 2D-SWE and CEUS.

Results. 1. The use of a combination of a multiparametric complex of contrast-enhanced ultrasound and shear wave elastography (2D-SWE) in assessing the angioarchitecture of the renal cortex in patients with type 2 diabetes can be an addition to the study block with CEUS of the kidneys.

2. The combination of CEUS + 2D-SWE showed the highest sensitivity, accuracy and specificity compared with these studies performed separately in assessing the renal cortex in patients with type 2 diabetes.

Keywords: diabetes mellitus, chronic kidney disease, elastography of the kidneys.

TO CITE THIS ARTICLE. Gorbatenko OA, Borsukov AV. Assessment of the renal cortical layer according to the multiparametric complex of contrast-enhanced ultrasound and elastography (2D-SWE) in patients with type 2 diabetes of various clinical course. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):16–25.

USING BIOSURGICAL NECRECTOMY IN PATIENTS WITH SOFT TISSUE DEFECTS

© A.V. KOSTYAKOVA1, E.V. ZINOVIEV1, A.V. SEMIGLAZOV1, D.V. KOSTYAKOV1,2, P.K. KRYLOV1

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

ABSTRACT

Providing medical care to victims with critical and supercritical burns is the most difficult task of surgery. The mortality rate for lesions covering more than 50 % of the body surface is 52.83 %, i.e. every second patient dies. At the same time, early necrectomy in order to reduce the risk of developing toxemia in such victims is impossible due to the severity of their condition. At the same time, conservative treatment tactics are accompanied by severe autointoxication, secondary addition of pathogenic multidrug-resistant nosocomial microflora, and a septic course of burn disease, requiring long-term administration of multicomponent regimens of systemic antibacterial therapy. One of the possible ways to solve this problem is biosurgery, which has been actively used in Europe and the United States of America since the end of the twentieth century. The application of live Lucilia Sericata larvae allows you to selectively remove areas of necrotic tissue, improve blood supply through micromassage, and also effectively eliminate pathogenic microorganisms, incl. multiresistant strains. The main disadvantage of this method is the need for direct contact of the patient with insect larvae. Despite the fact that the claimed treatment method demonstrates high efficiency in providing medical care to victims with soft tissue defects, it was unreasonably abandoned. Also, at present there are no clinical recommendations and algorithms for the use of a “biological scalpel” in such areas of surgery as combustiology. The purpose of this work is to demonstrate the effectiveness of larval therapy and justify the possibility of its implementation in the practice of surgical hospitals. We analyzed the available literature on the use of Lucilia sericata insect larvae in the treatment of soft tissue lesions of various etiologies. The following electronic bibliographic databases were used: PubMed, Web of Science, Embase, Wanfang (Chinese) and China National Knowledge Infrastructure (CNKI), Google Academy, eLIBRARY. The literature search was conducted from 2000 to 2023.

KEYWORDS: burns, biosurgery, necrectomy, larvae, Lucilia sericata.

TO CITE THIS ARTICLE. Kostyakova AV, Zinoviev EV, Semiglazov AV, Kostyakov DV, Krylov PK. Using biosurgical necrectomy in patients with soft tissue defects The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):26-33.

Preoperative planning of surgical interventions in the treatment of patients with lower thoracic and lumbar spinal cord injury

© V.A. MANUKOVSKY 1, A.A. AFAUNOV 2, I.V. BASANKIN 2,3, N.S. CHAIKIN 4, A.A. GYULZATYAN 3

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 State Budgetary educational institution of higher professional education Kuban State Medical University of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia

3 State Public Health Budget Institution Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry, Krasnodar, Russia

4 Stavropol Regional Clinical Hospital, Stavropol, Russia

Resume

Objective: to propose an algorithm for choosing tactics for surgical treatment of patients with in the lower thoracic and lumbar spinal cord injury

Materials and methods: 240 patients with lower thoracic and lumbar spinal cord injury, were operated urgently. Depending on the tactics of surgical treatment, the patients were divided into 3 groups: Group 1 — two-stage surgical treatment from combined approaches: the first stage is transpedicular fixation (TPF), supplemented by dorsal decompression options; the second stage is fusion from ventral approaches (n = 129); Group 2 — transpedicular fixation (TPF) and decompression from posterior approaches (n = 36); Group 3 — one-stage surgical treatment: TPF, decompression and fusion from extended posterior approaches (n = 75).

Were analyzed complications after surgery, including respiratory complications, intraoperative damage to the dural sac, surgical site infection, iatrogenic neurological complications, metal construct instability and predictors of their development were identified. Comparison of groups by quantitative indicators was performed using the method of one-way variance analysis; the Kruskal-Wallis test. Comparison of percentages in the analysis of multifield contingency tables was performed using the Pearson chi-square test.

Results. It has been established that in order to reduce the likelihood of surgical complications during surgical treatment of patients with spinal cord injury in the lower thoracic or lumbar spine, at the planning stage it is first necessary to determine the parameters whose indicators can be predictors of complications. It is the surgical risk of death according to the modified SOFA scale, the initial neurological deficit according to the ASIA scale, the level of spinal injury and the length of fusion. Taking these parameters into account allows for a step-by-step selection of one of three surgical intervention options, which is formulated and presented graphically as an algorithm for choosing a tactical and technical option for performing decompressive and stabilizing operations.

Conclusions. 1. At the stage of preoperative planning of surgery in patients with spinal cord injury in the lower thoracic or lumbar spine, the following parameters should be taken into account to reduce the likelihood of postoperative complications: the degree of surgical risk of death according to the modified SOFA scale, the severity of the initial neurological deficit according to the ASIA scale, the level of spinal injury and the length of the required fusion. Certain values ​​of these parameters, depending on the chosen surgical technique, can be predictors of complications.

2. The proposed algorithm for step-by-step selection of one of three tactical and technical options for surgical intervention in patients with spinal cord injury in the lower thoracic and lumbar spine allows eliminating the negative impact of predictors of complications.

Keywords: thoracic and lumbar spine; trauma; surgical treatment; complications, predictors, algorithm.

TO CITE THIS ARTICLE. Manukovsky VA, Afaunov AA, Basankin IV, Chaikin NS, Gyulzatyan AA. Preoperative planning of surgical interventions in the treatment of patients with lower thoracic and lumbar spinal cord injury. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):34–55.

METHOD OF APPLICATION OF DEVICE FOR REHABILITATION OF WOUNDED AFTER GUNSHOOT AND MINE-EXPLOSIVE WOUNDS OF THE SPINE AND SPINAL CORD

© V.P. ORLOV, S.D. MIRZAMETOV, O.V. MALYSHEVA, D.V. SVISTOV

Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

AIM of the study. Creation and practical application of a device for the rehabilitation of the wounded with various degrees of spinal cord injury in the early and intermediate periods of traumatic disease of the spinal cord after gunshot wounds of the spine

Materials and methods. We have carried out rehabilitation of the wounded after surgery on the spine and spinal cord after removal of metal foreign bodies from the spinal canal and decompression of the spinal cord and cauda equina roots using the device we developed.

Results. With the help of the device used, it was possible to achieve the maximum possible restoration of the motor function of the trunk and limbs; performing self-care for the wounded; improving the quality of life of the patient by adapting to living conditions; improve psychological and physical adaptation to their limited prevent the growth of neurological disorders, as well as prepare the wounded for further rehabilitation in a specialized center.

Conclusion. The device presented in the work can be recommended for use in level 4 and 5 hospitals for the rehabilitation of those injured in the spine with spinal cord injury.

Keywords: system for rehabilitation, frame for installation of blocks, restoration of neurological deficit, exoskeleton.

TO CITE THIS ARTICLE. Orlov VP, Mirzametov SD, Malysheva OV, Svistov DV. Method of application of device for rehabilitation of wounded after gunshoot and mine-explosive wounds of the spine and spinal cord. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):56-65.

COMPARATIVE POSSIBILITIES OF MRI AND MSCT IN THE EMERGENCY DIAGNOSTICS OF DIFFUSE AXONAL INJURY IN TRAUMATIC BRAIN INJURY BASED ON CLINICAL CASES

© V.YE. SAVELLO 1,2, T.A. SHUMAKOVA 1,2, A.N. KOSTENIKOV 1, A.V. MARCHENKO 1, D.A. NIKITIN 1, A.A. SOKOLOV 1, A.S. KAZANKIN 1

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

Diffuse axonal injury (DAI) is a severe form of traumatic brain injury (TBI) and is a leading cause of death and disability in young individuals. Delayed diagnosis significantly worsens the prognosis and poses a threat to the patient's life. Diagnosing DAI is difficult because there are often no significant macroscopic morphological signs of brain injury. Causes of DAI include traffic accidents, falls from great heights, and barotrauma. While MSCT reliably identifies hemorrhagic changes in the brain, it is less sensitive to non-hemorrhagic injuries according to the literature. Therefore, we decided to compare the capabilities of MSCT and MRI in visualizing diffuse axonal injury.

OBJECTIVE. To demonstrate the comparative capabilities of MRI and MSCT in the emergency diagnostics of diffuse axonal brain injury in traumatic brain injury.

MATERIALS AND METHODS. We examined 27 patients aged 19 to 71 years who were admitted to the I.I. Dzhanelidze Research Institute of Emergency Medicine from 2019 to 2024. All patients underwent brain and bone structure imaging with standard protocols: MSCT upon admission and MRI within 1–4 days. MRI was performed under artificial lung ventilation for 18 (66.7 %) patients due to the severity of their condition.

RESULTS. MSCT of the brain upon a patient's admission to a hospital with TBI is the method of choice due to its high scanning speed, which allows for the rapid diagnosis of acute surgical pathology; availability; and lack of most contraindications characteristic of MRI. MSCT enables detection of brain contusion foci (types I–IV), subarachnoid hemorrhages, subdural and epidural hematomas, intracerebral hematomas, intraventricular hemorrhage, facial and cranial fractures, and diffuse axonal injury. However, diffuse axonal injury detection with MSCT was observed in 3 out of 27 cases (11.1 %) due to several reasons: type of diffuse axonal injury (hemorrhagic or non-hemorrhagic injuries), lesion size, time elapsed since injury, and susceptibility to artifacts from the bony structures of the posterior cranial fossa. In contrast, MRI identified this pathology in 23 individuals (85.1 %).

DISCUSSION. In our work, we had similar information to other authors, who explored diffuse axonal injury in patients with traumatic brain injury (TBI). MSCT is the first and most important radiology diagnostics upon a patient's admission to the hospital, it helps to detect numerous traumatic pathologies of the brain substance and skull in the shortest time. However, this diagnostic method has low sensitivity to small, non-hemorrhagic lesions of the brain. MRI has more sensitivity in detecting brain injuries, especially in the deep regions of the brain, which determines of the patient's condition.

CONCLUSIONS. The complex use of MSCT and MRI of the brain in traumatic brain injury (TBI) allows for the timely detection and detailed characterization of injuries. MSCT is the method of a choice in the diagnostics of TBI. However, when clinical presentation does not match MSCT findings, MRI should be performed to search for potential diffuse axonal injury. MRI can determine the cause of the patient's severe condition, identify both hemorrhagic and non-hemorrhagic foci, and determine the stage of diffuse axonal injury, which influences the choice of an adequate treatment strategy.

KEYWORDS: MRI, MSCT, diffuse axonal injury, traumatic brain injury.

TO CITE THIS ARTICLE. Savello VYe, Shumakova TA, Kostenikov AN, Marchenko AV, Nikitin DA, Sokolov AA, Kazankin AS. Comparative possibilities of MRI and MSCT in the emergency diagnostics of diffuse axonal injury in traumatic brain injury based on clinical cases. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):66-75.

STRESS–PROTECTIVE EFFECT OF GENERAL COMBINED ANESTHESIA IN HIGHLY TRAUMATIC SURGICAL INTERVENTIONS

© I.A. SOKORNOV, L.P. PIVOVAROVA, V.N. LAPSHIN, M.E. MALYSHEV, I.V. OSIPOVA, O.B. ARISKINA, N.K. RAZUMOVA

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

Abstract

The article presents the results of a study of stress markers during high-grade trauma operations in patients who underwent combined general anesthesia using artificial lung ventilation (ALV).

The aim of the study was to assess the adequacy of combined general anesthesia in patients with high surgical and anesthetic risk by examining the content of stress–implementing hormones and T-lymphocytes in venous blood before, during and after surgery.

A comparative analysis of the levels of CD3, CD4 lymphocytes, ACTH, TSH, thyroxine, and cortisol during the perioperative period was carried out.

Keywords: high-risk surgical interventions, anesthesiological aid, stress markers, perioperative period.

TO CITE THIS ARTICLE. Sokornov IA, Pivovarova LP, Lapshin VN, Malyshev ME, Osipova IV, Ariskina OB, Razumova NK. Stress-protective effect of general combined anesthesia in highly traumatic surgical interventions. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):76–81.

Epidemiology of surgical sepsis in St. Petersburg. Experience of the “City Center for the Treatment of Severe Sepsis” of the ST. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

© O.N. ERGASHEV 4, V.A. MANUKOVSKY 1,3, S.A. SHLYAPNIKOV 1, N.R. NASER 1,2, DARYINA M.G. 2,3, V.E. PARFENOV 1

1 Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Medical Center for Information and Analysis, Saint Petersburg, Russia

3 North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

4 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

Abstract

The article discusses the epidemiology of sepsis in St. Petersburg based on the analysis of data from the Territorial Compulsory Medical Insurance Fund and the Medical Information and Analytical Center of the Health Committee, as well as the experience of the «City Center for the Treatment of Severe Sepsis» of the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine for 2022. For the first time, data on the prevalence of this complication is presented — 130 per 100 000. Mortality rate was 34.03 %. The existing differences in the mortality rate in various hospitals in the city are shown. The article analyzes the main causative agents of sepsis, especially those associated with deaths. Attention is focused on the high antibiotic resistance of problematic sepsis pathogens. The presented study results can be used to improve diagnostic and treatment strategies for sepsis in patients with surgical pathology.

Keywords: epidemiology, sepsis, mortality, sepsis causes, antibiotic resistance.

TO CITE THIS ARTICLE. Ergashev ON, Manukovsky VA, Shlyapnikov SA, Naser NR, Daryina MG, Parfenov VE. Epidemiology of surgical sepsis in St. Petersburg. Experience of the “City Center for the Treatment of Severe Sepsis” of the St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):82–89.

REVIEWS AND CLINICAL CASES

Nonfatal gunshot wounds of the brainstem: review of the literature and analysis of case series

© N.K. VASILEVA, S.D. MIRZAMETOV, E.YU. KLIMENKOVA, V.K. KUULAR, K.A. CHEMODAKOVA, D.V. SVISTOV

Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

Brainstem injury is considered to be both a clinical and CT risk factor for poor outcome in traumatic brain injury. Due to the high risk of developing dysfunction of life support systems, wounded with damage to the brain stem require urgent, long-term and expensive treatment aimed at prosthetics of vital functions, treatment of intracranial hypertension syndrome and infectious complications. In most cases this type of injury causes severe neurological deficits which determines the need for subsequent rehabilitation. We conducted a retrospective analysis of the treatment of five patients with gunshot fragment wounds of the brain stem who were treated at the Department of Neurosurgery of the Military Medical Academy named after S.M. Kirov. In three out of five patients, wounding projectiles were removed at the stage of providing qualified care. No negative dynamics in the neurological status were noted in all patients after surgery. All patients were transferred to the stage of rehabilitation treatment: three in consciousness; two are in minimally conscious state (MCS). Despite the small number of patients, a clear trend was noted: the best outcomes were observed in patients with injuries to the caudal parts of the brainstem (pons), even with perforating injuries. At the same time, the result obtained in practice allows us to consider the possibility of conservative treatment of patients with foreign bodies in the brain stem which is confirmed by the observed partial regression of neurological deficit in two out of five patients. Surgical intervention aimed at sanitation of the wound channel and removal of the wounding projectile does not lead to a deterioration in the neurological status.

Keywords: wartime brain stem injury, combat trauma.

TO CITE THIS ARTICLE. Vasileva NK, Mirzametov SD, Klimenkova EYu, Kuular VK, Chemodakova KA, Svistov DV. Nonfatal gunshot wounds of the brainstem: review of the literature and analysis of case series. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):90-100.

PSEUDOMEMBRANOUS COLITIS AFTER SURGICAL TREATMENT OF A PATIENT WITH MULTIPLE RIB FRACTURES WITH A FLAIL CHEST

© M.V. ISAEV 1, G.A. PICHUGINA 1, I.G. BELEN’KIY 1,2, B.A. MAIOROV 1,2, A.E. DEMKO 1, V.S. AFONCHIKOV 1, I.M. BATYRSHIN 1

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

ABSTRACT

Most of recently published studies and reviews suggest surgical stabilization of the flail chest in multiple fractures of the ribs and rib valve significantly reduces the mortality rate, as well as the duration of ventilation, stay in the intensive care unit, the incidence of ventilator-associated pneumonia and the duration of hospital stay. These patients need to be prescribed antibiotics in order to prevent the development of infectious pulmonary complications, which can be accompanied by various complications from other organs and systems. However, we have not found studies evaluating the incidence of systemic complications of antibiotic use that are not directly related to the bronchopulmonary system or infection of the surgical area, especially in elderly patients.

A clinical case of treatment of an elderly patient with severe chest injury complicated by the development of pseudomembranous colitis and sepsis is described. The developed complication required the transfer of the patient to a specialized hospital and a change in treatment tactics. As a result, pseudomembranous colitis was stopped and the patient was recovered.

Discussion: the incidence of Clostridioides difficile — associated infection in patients hospitalized for various reasons, according to Russian and foreign studies, has been increasing in recent decades. The patient's age over 65 years is a proven risk factor for the development of such a complication. Rational antibiotic therapy can reduce the incidence of this complication, and alertness about the risk of development and the correct tactics of diagnosis and therapy can improve the results of treatment, the duration of the hospital stay. Thus, in the treatment of severe chest injury, as well as in other surgical pathology requiring the use of systemic antibacterial therapy, it is necessary to take into account the likelihood of developing pseudomembranous colitis. Adequate diagnosis and treatment of this complication lead to a positive result, as was shown by the presented clinical example.

KEYWORDS: chest trauma, rib fracture, flail chest, rib osteosynthesis, antibiotic-associated diarrhea, pseudomembranous colitis.

TO CITE THIS ARTICLE. Isaev MV, Pichugina GA, Belen’kiy IG, Maiorov BA, Demko AE, Afonchikov VS, Batyrshin IM. Pseudomembranous colitis after surgical treatment of a patient with multiple rib fractures with a flail chest. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):101-109.

INTENSIVE CARE FOR SEVERE HYPOTHERMIA (LITERATURE REVIEW)

© R.E. LAKHIN

Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

RATIONALE: primary hypothermia is a dangerous condition with a high risk of death, the approaches to therapy of which have undergone significant changes in the last two decades.

OBJECTIVE: analyze approaches to intensive care for severe hypothermia.

RESULTS. Patients with hypothermic cardiac arrest, who often did not survive using traditional methods of warming (external warming dialysis, pleural lavage, peritoneal lavage), were able to increase their chances of survival with the introduction of extracorporeal circulation techniques into intensive therapy for severe hypothermia. Patients with a high risk of developing circulatory arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), as well as those who have already experienced circulatory arrest, should be transported directly to medical institutions where there is equipment for extracorporeal life support. Patients with circulatory arrest on the background of severe hypothermia have features that need to be taken into account during cardiopulmonary resuscitation.

CONCLUSION. Based on new data and additional clinical experience, clearer recommendations for intensive hypothermia therapy have been formulated. Extracorporeal oxygenation has significantly improved survival and is the method of choice in patients with unstable hemodynamics or circulatory arrest.

KEYWORDS: hypothermia, ECMO, warming, intensive care, intensive care, extracorporeal life saving.

TO CITE THIS ARTICLE. Lakhin R.E. Intensive care for severe hypothermia (literature review). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):110-125.

MAIN BRONCHIAL LIPOMA AS A RARE CLINICAL OBSERVATION

© A.N. TULUPOV1,2, M.I. SAFOEV1, A.E. DEMKO1,2, A.A. ESENOKOV1

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Kirov Military Medical Academy, St. Petersburg, Russia

Abstract

The purpose of the article is to demonstrate the successful treatment of a patient with lipoma of the right main bronchus, which caused the presence of clinical and radiological signs of chronic pneumonia with predominant damage to the lower lobe of the right lung. The lipoma was successfully removed by fibrobronchoscopy under topical lidocaine analgesia. In the remote postoperative period, the signs of chronic pneumonia in the convalescent completely disappeared.

Keywords: lipoma of the main bronchus, endoscopic removal of a benign tumor.

TO CITE THIS ARTICLE. Tulupov AN, Safoev MI, Demko AE, Esenokov AA. Main bronchial lipoma as a rare clinical observation. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):126-134.

SPECIAL EDITION. TOPICAL ISSUES OF TRAUMATOLOGY AND ORTHOPEDICS

THE ROLE OF COMPUTER TECHNOLOGIES IN DECISION-MAKING IN TRAUMATOLOGY (LITERATURE REVIEW)

© A.A. POVALIY 1, I.G. BELENKY 1,2

1 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, Saint-Petersburg, Russia

2 Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

АBSTRACT

Clinical guidelines are a fundamental part of practice, but represent only one type of evidence influencing clinical decisions. Decision-making is a multifactorial phenomenon that requires detailed and comprehensive study.

OBJECTIVE. Based on the study of specialized literature, to determine the ways to improve the decision-making process in traumatology and orthopedics using computer technologies. Even though decision-making is one of the most complex and important tasks performed by surgeons, there is a relative dearth of research examining surgical decision-making and strategies to improve it. This is most clearly manifested in emergency trauma practice.

MATERIAL AND METHODS. A systematic search was carried out for publications in the Russian Science Citation Index, PubMed, Scopus, Web of Science databases, published mainly in the last ten years on decision-making in surgery, traumatology on the example of a fracture of the proximal humerus, artificial intelligence in medicine, not by keywords and combinations: decision-making in surgery, decision-making in traumatology, decision-making in proximal humerus fracture, Artificial Intelligence in Medicine, Machine Learning. In particular, the capabilities of database architecture and the creation of automated analysis systems. The field of traumatology and orthopedics has its own specifics and requires detailed study.

RESULTS. Using proximal humerus fractures as an example, we can say that making decisions in a routine way without detailed analysis leads to errors, but the other side of the problem is that these errors are difficult to describe. Modern computer technologies and principles of data analysis open up new opportunities in the study of the problem.

CONCLUSIONS. Decision-making research is required on specific fractures and localization, detailing the data and follow-up actions taken on them.

KEYWORDS: decision-making, surgery, traumatology and orthopedics, computer technologies, artificial intelligence.

TO CITE THIS ARTICLE. Povaliy AA, Belenky IG. The role of computer technologies in decision-making in traumatology (literature review). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):134-146. (In Russ.).

Bone regeneration and principles of bone defects substitution. Literature review

© D.YU. REFITSKAYA1, I.G. BELEN’KIY1,2, D.A. MALANIN3, B.A. MAYOROV1,2,4, M.V. DEMESHCHENKO3

1 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

2 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

3 Federal State Budgetary Educational Institution of Higher Education “Volgograd State Medical University”, St. Petersburg, Russia

4 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

Abstract

Bone is a highly dynamic tissue that is constantly being remodeled to achieve and maintain optimal bone integrity, mass, and strength. Normal bone remodeling is regulated by maintaining a balance between osteoclast activity in relation to bone resorption and osteoblast activity in relation to bone formation. In reparative osteogenesis, unlike physiological osteogenesis, achieving balance is not enough. The recovery processes in the area of bone tissue damage in a certain period should exceed the processes of its loss. This is extremely important in patients with fractures and their consequences, especially when injuries are accompanied by bone defects. Understanding these processes will facilitate the appropriate use of various bone substitutes and osteogenesis stimulators depending on the clinical situation.

Objective: to determine the main properties of available plastic materials for stimulation of osteogenesis and substitution of bone defects and to clarify the indications for their use depending on the clinical situation.

Materials and methods: a systematic search and analysis was performed for publications in the databases of RSCI, PubMed, Scopus, Web of Science.

No doubt that for a normally functioning bone tissue, it is necessary to have a balance of the processes of osteoconduction, osteoinduction and osteogenesis. In case of fracture, adequate stabilization of bone fragments and their vascularization are also required. Failure to comply with these conditions leads to various types of nonunion.

To optimize bone union and substitution of bone defects, both traditional methods (autobone, allobone and xenobone, synthetic bone substitutes, biological stimulators of osteogenesis) and new methods based on 3D modeling and genetic engineering are proposed.

For the treatment of patients with various types of nonunion, it is necessary to understand what properties are necessary to ensure fracture union and which materials possess them. Thus, the osteoconductive effect can be achieved by using of various scaffolds (hydroxyapatite, calcium phosphate, tricalcium phosphate, calcium carbonate, etc.). Stimulation of osteogenesis can be obtained by implanting substances that contain live stimulant proteins (bone morphogenetic proteins, platelet derivative growth factor, vascular endothelial growth factor, basic fibroblast growth factor, demineralized bone matrix, and others). To obtain an osteogenic effect, it is necessary to have alive progenitor cells or mature bone cells contained in an autograft. If we are talking about the use of composite materials, then their properties are determined by the properties of their constituent components. Understanding of these processes will greatly contribute to the adequate use of various bone substitutes and osteogenesis stimulants, depending on the clinical situation.

Keywords: bone regeneration, bone substitutes, nonunion, hypertrophic nonunion, normotrophic nonunion, hypotrophic nonunion, osteoconduction, osteoinduction, osteogenesis.

TO CITE THIS ARTICLE. Refitskaya DYu, Belen’kiy IG, Malanin DA, Mayorov BA, Demeshchenko MV. Bone regeneration and principles of bone defects substitution. literature review. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):147-158.

TREATMENT OF POST-TRAUMATIC RECURRENT INSTABILITY OF THE ELBOW JOINT

© K.A. EGIAZARYAN 1, A.P. RATYEV 1,2, G.D. LAZISHVILI 1,2, M.A. DANILOV 1,2, N.S. ERSHOV 1,2, D.A. BADRIEV 1

1 Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation, Moscow, Russia

2 Pirogov City Clinical Hospital № 1, Moscow, Russia

ABSTRACT

INTRODUCTION. Chronic post-traumatic instability of the elbow joint is one of the topical problems in modern traumatology due to the fact that the treatment of patients with this pathology is associated with many difficulties faced by a trauma surgeon. This situation usually occurs with late or unsuccessful attempts to reduction of elbow dislocation; the treatment of such patients requires the choice between several methods of fairly extensive surgical interventions. The development of persistent post-traumatic instability is one of the possible complications of treatment.

AIM OF THE STUDY: to analyze the sequential surgical treatment of recurrent chronic instability of the elbow joint in one patient using various types of plastic ligaments of the elbow joint and show the possibility of using the method of temporary arthrorisis of the elbow joint with a plate in the treatment of severe persistent post-traumatic instability of the elbow joint with a satisfactory outcome.

CASE REPORT. Patient L, 59 years old, hypersthenic build, was admitted for routine treatment with recurrent elbow dislocation. Patient history: injury occur 6 weeks before hospitalization; on the day of the injury was diagnosed posterior elbow dislocation; attempts were made to closed reduction of dislocation, followed by plaster immobilization of the right upper limb; three weeks later, the plaster immobilization was removed and the patient was diagnosed with recurrent elbow dislocation. The patient was recommended for open reduction of the elbow dislocation as a scheduled operation. The patient underwent open reduction of the elbow dislocation, transosseous suture of the lateral and medial collateral ligaments. Instability of the elbow joint was noted 4 weeks after open reduction of the dislocation and suture of the ligaments; the patient underwent loop autoplasty of the collateral ligaments of the elbow joint. Relapse of instability was detected after 9 months, the elbow joint was stabilized by circumferential plasty of the lateral and medial collateral ligaments with a synthetic ligament in combination with temporary internal bridge fixation with a plate with limited contact, the plate was removed after 8 weeks. The patient demonstrates satisfactory elbow joint function 2 years after the last operation, with a flexion-extension range of motion of 95 degrees and a deficit of supination movements of 20 degrees. Moderate instability in the elbow joint and ulnar nerve neuropathy are observed. Assessment of right upper limb function using questionnaires: QuikDASH = 47.73; Mayo elbow performance score (MEPS) = 75 (good), Oxford elbow score (OES) = 54.17. Control X-ray reveal posterior subluxation of the head of the radial bone and signs of elbow arthrosis.

CONCLUSION. The delayed surgical treatment may lead to subsequent complications in the form of persistent instability of the elbow joint, as encountered in the described clinical observation. Temporary arthrorisis of the elbow joint using a plate can be considered as an option for stabilizing the elbow joint in severe clinical cases.

KEYWORDS: elbow joint, elbow dislocation, chronic elbow instability, collateral ligaments reconstruction of the elbow joint.

TO CITE THIS ARTICLE. Egiazaryan K.A., Ratyev A.P., Lazishvili G.D., Danilov M.A., Ershov N.S., Badriev D.A. Treatment of post-traumatic recurrent instability of the elbow joint. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):159-169.

Variants of surgical accesses in surgical treatment of patients with fractures and posttraumatic deformities of the lateral condyle of the tibia (Review)

© R.S. YAGFAROV, I.A. VORONKEVICH, D.V. STAFEEV

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, St. Petersburg, Russia

Abstract

Rationale. Surgical treatment of intra-articular fractures of the proximal tibia requires great skill on the part of the surgeon to restore the correct joint configuration. Incorrect restoration of the articular surface of the tibial plateau and limb axis results in compromised articular relationships and angular deformities in 19 % to 26 % of cases. The quality of articular surface restoration correlates with clinical outcomes and this correlation is further supported by the fact that intra-articular fractures of the tibial plateau require proper visualization of the lesion, anatomic repositioning and firm fixation, and therefore a large number of accesses have been developed.

The aim is to systematize the data on surgical accesses in the surgical treatment of intra-articular fractures and posttraumatic deformities of the lateral condyle of the tibial condyle.

Materials and Methods. To analyze the literature, we selected 100 foreign articles on fractures and posttraumatic deformities of the tibial plateau and methods of their treatment published from 1985 to 2023, as well as 18 domestic publications from 2007 to 2022. 59 most relevant articles were selected. The publications were searched in PubMed/MedLine and eLIBRARY databases.

Results. Recent and distant literature recognizes that despite the ease of performing the anterolateral surgical access, which is the most popular, many authors tend to perform various modifications of posterior accesses for osteosynthesis of the posterior lateral condyle of the tibia, which allow for greater visualization of the lesion and better repositioning.

Conclusion. There is limited evidence to support that any one access is superior to another for surgical interventions on the posterior aspect of the lateral condyle of the tibial condyle. Some experts believe that traditional anterolateral access allows adequate repositioning and fixation of the fragments of the discussed localization, but opponents of this approach argue that accurate repositioning and stable fixation cannot be performed from this access. Some authors suggest using two separate accesses: traditional anterolateral and additional posterior, which significantly increases the traumatic nature of the operation. In addition, in recent years, proposals have been published on the use of various posterolateral surgical accesses: both without osteotomy of the fibula head and with its osteotomy. The independent posterior access to the posterior portions of the lateral condyle of the tibia, although described in several modifications, has not yet been widely used due to its complexity.

Keywords: tibial plateau fracture, posttraumatic deformities of the posterior aspect of the lateral condyle of the tibia, osteosynthesis, surgical access.

TO CITE THIS ARTICLE. Yagfarov RS, Voronkevich IA, Stafeev DV. Variants of surgical accesses in surgical treatment of patients with fractures and posttraumatic deformities of the lateral condyle of the tibia (review). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):170-183.

THE USE OF IMMUNOMODULATORS IN THE COMPLEX TREATMENT OF PATIENTS WITH CHRONIC OSTEOMYELITIS AND INFECTED PSEUDARTHROSIS

© S.A. LINNIK, YA.B. TSOLOLO, P.P. ROMASHOV, G. KARAGEZOV, G.E. KVINIKADZE, M.B. SERGEEVA

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

Abstract

Rationale. Chronic osteomyelitis and infected pseudoarthroses are a serious problem in orthopedics and traumatology, characterized by a high recurrence rate, long course and risk of severe complications, which necessitates the search for new, more effective approaches to therapy, including the use of immunomodulators.

Objective: to study the results of treating patients with chronic osteomyelitis and infected pseudoarthroses using the immunomodulator Derinat.

Materials and methods. The results of treating 156 patients with chronic osteomyelitis and infected pseudoarthroses of long tubular bones were analyzed. The patients were divided into two statistically comparable clinical groups. All patients with osteomyelitis underwent surgical treatment of the purulent focus with plastic replacement of the bone cavity, and in the presence of pseudoarthroses, transosseous osteosynthesis was performed and, if indicated, bone grafting. In the complex treatment of the main group, Derinat was used. Taking into account the proposed treatment methods, the authors conducted a comparative analysis of clinical, hematological, immunological and radiological examination results in the postoperative and late periods.

Results. Evaluation of the treatment results showed that in the main group of patients with infected pseudoarthrosis and osteomyelitis, good and satisfactory outcomes were achieved in 97.1 % of cases, while in the control group they were statistically significantly lower — 79.7 %.

Conclusion. The proposed approaches to treating patients in the compared groups improved the clinical and functional indicators of objective function assessment according to the table of N.A. Lyuboshits and E.R. Matisse in our modification, which allows for an objective assessment of treatment results, and the quality of life according to the “International Classification of Functioning, Disability and Health” of WHO.

KEYWORDS: osteomyelitis, pseudoarthrosis, Derinat immunomodulator, bone grafting, transosseous osteosynthesis.

TO CITE THIS ARTICLE. Linnik SA, Tsololo YaB, Romashov PP, Karagezov G, Kvinikadze GE, Sergeeva MB. The use of immunomodulators in the complex treatment of patients with chronic osteomyelitis and infected pseudarthrosis The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):184-188.

DOES THE QUALITY OF PRIMARY REDUCTION IN AN EXTERNAL FIXATOR AFFECT THE OUTCOME IN THE TREATMENT OF DISTAL TIBIAL METAEPIPHYSEAL FRACTURES?

© B.A. MAIOROV 1,2, I.G. BELEN’KII 1,2, G.D. SERGEEV 1,2, K.K. GADOEV 2

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

ABSTRACT

Rationale. In the two-stage approach to osteosynthesis, when performing initial stabilization of pilon fractures using an external fixator, the quality of fragment reduction is not always given adequate attention, which can negatively affect the final outcome of surgical treatment.

Objective. To evaluate the radiological and functional outcomes in patients with all types of pilon fractures, depending on the quality of initial fragment reduction in the external fixator.

Materials and Methods. The study included 50 patients with various types of distal tibial metaepiphyseal fractures. Patients were divided into two groups based on the quality of fragment reduction in the external fixator. All patients underwent surgery according to the two-stage treatment protocol, using either ORIF or MIPO. The quality of fragment reduction after surgery was radiologically assessed, as well as short- and medium-term functional outcomes using the AOFAS scale.

Results. Anatomical reduction was achieved statistically significantly more often in Group 1 patients, while unsatisfactory reduction was statistically significantly less common than in Group 2 (p = 0.011 for both comparisons). Functional outcomes on the AOFAS scale at 6, 12, and 24 months were comparable between both groups.

Conclusion. The quality of primary reduction in the external fixator had a significant impact on the final osteosynthesis outcomes. Patients with correct fragment reduction in the external fixator showed better anatomical and functional results.

Keywords: pilon fracture, external fixation, intra-articular fracture, anatomic reduction, two-stage treatment protocol.

TO CITE THIS ARTICLE. Maiorov B.A., Belen’kii I.G., Sergeev G.D., Gadoev K.K. Does the quality of primary reduction in an external fixator affect the outcome in the treatment of distal tibial metaepiphyseal fractures? The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):189-197.

Topographic and Anatomical Rationale for the Clinical Application of Posterolateral and Posteromedial Surgical Approaches to the Posterior Part of the Distal Metaepiphysis of the Tibia

© I.G. BELEN’KIY1,2, B.A. MAIOROV1,2,3, A.YU. KOCHISH4,5, G.D. SERGEEV1,2, YU.V. REFITSKII1

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

3 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

4 Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, St. Petersburg, Russia

5 Kirov Military Medical Academy, St. Petersburg, Russia

Abstract

Introduction. Until recently, it was believed that in cases of ankle fractures associated with posterior malleolus fractures, even large fragments of the posterior edge of the tibia, including up to 1/3 of its articular surface, could remain unfixed. However, more and more trauma surgeons now advocate for the mandatory fixation of large posterior edge fragments of the tibia, considering that this better restores the anatomical relationships of the bones forming the ankle joint and increases the stability of the joint after osteosynthesis as a whole. It is also considered highly important to use a reliable method of fixation for Volkmann’s fragment, ensuring its stability after osteosynthesis, which largely depends on the proper choice of surgical approach. The technique of inserting screws from posterior to anterior allows for anatomical reduction of the large fragment of the posterior edge of the tibia and its stable fixation. Moreover, if required, osteosynthesis can be performed not only with screws but also with an anti-glide plate.

The aim of the study is to investigate the potential and risks of using posterolateral and posteromedial surgical approaches for osteosynthesis in ankle fractures involving a large fragment of the posterior edge of the distal metaepiphysis of the tibia, through an applied topographic-anatomical study on fresh anatomical material.

Materials and Methods. A topographic-anatomical study was conducted on 18 fresh cadaveric specimens of the lower leg and foot, without visible damage, scarring, or previous surgical interventions in this area (9 specimens for each of the two surgical approaches studied). Posterolateral and posteromedial approaches to the distal metaepiphysis of the tibia were performed. A pre-modeled 1/3 tubular plate was placed as medially as possible via the posterolateral approach and as laterally as possible via the posteromedial approach. X-rays in the anteroposterior view were used to measure the distances from the medial and lateral edges of the distal metaepiphysis of the tibia to the plate. In the lateral view, the accuracy of the distal screw placement in relation to the articular surface of the tibia was assessed.

Results. The posterolateral surgical approach allows for adequate placement of a vertically oriented plate with proper screw direction from posterior to anterior across approximately 40% (40.4 ± 4.4 %) of the width of the distal metaepiphysis of the tibia, starting from its lateral edge. The posteromedial approach allows for fixation across approximately 60 % (58.8 ± 5.1 %) of the width of the distal metaepiphysis, starting from the medial edge.

Conclusion. Regardless of the fracture configuration of the posterior edge of the tibia, it is possible to select a surgical approach that ensures secure fixation of the posterior edge fragment by optimally positioning an anti-glide plate with screws directed from posterior to anterior.

Keywords: ankle fracture; posterior edge tibia fracture; osteosynthesis; surgical approach.

TO CITE THIS ARTICLE. Belen’ky IG, Mayorov BA, Kochish AYu, Sergeev GD, Refitskiy YuV. Topographic and anatomical rationale for the clinical application of posterolateral and posteromedial surgical approaches to the posterior part of the distal metaepiphysis of the tibia. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):198-209.

EMOTIONAL BURNOUT SYNDROME IN SURGICAL MEDICAL PERSONNEL

© M.V. POLYUKOVA 1,2, I.M. BARSUKOVA 1,2

1 Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

In the modern world, more and more people suffer from diseases and emotional burnout syndrome (EBS), to the extent that this is typical for a profession with a high psycho-emotional load.

The purpose of the study was to study the causes of EBS in medical staffs and measures to provide it.

Material and methods. Content analysis on the Scientific Electronic Library resource and analytical methods were used.

The result of the research was the study of the influence of stress, emotional (professional) burnout and their consequences that arise in surgical teams. Preventive measures of EBS at the individual, interpersonal and organizational levels increase professional motivation, reduce work stress, optimize the psychophysiological state, and equalize the balance between physical and psycho-emotional costs, increase satisfaction from the work performed.

Keywords: burnout syndrome, surgical team, anesthesiologists, nursing staff.

TO CITE THIS ARTICLE. Polyukova MV, Barsukova IM. Emotional burnout syndrome in surgical medical personnel. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):210-215.

ON THE ISSUE OF ASSESSING WILL WHEN PERFORMING EMERGENCY MEDICAL INTERVENTION WITH PATIENTS WITH “DRUNK” INJURY
 

© E.YU. TYAVOKINA1, I.M. BARSUKOVA1,2

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

Excessive alcohol consumption is related to a higher risk of injuries and deaths by traffic accidents, suicide, marital violence. Patients with “drunk” injury create objective difficulties in the diagnostic search, disorganize the process of providing medical care, and refuse to perform emergency medical intervention due to the peculiarities of their will.

The purpose of the study was to consider certain organizational and legal issues of providing emergency specialized medical care to a trauma patient in a multidisciplinary hospital.

Materials and methods: regulatory legal documents, law enforcement and data from a multidisciplinary emergency hospital was used (St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine for 2018–2022), theoretical methods of formal and dialectical logic, private scientific methods were used.

Conclusion: during this period, in a multidisciplinary hospital 18471.0 ± 4017.6 people were admitted annually with alcohol-associated diseases and conditions, on the first day of hospitalization, 3.59 % voluntarily interrupted hospitalization without filling out a form for refusing to receive medical treatment, another 1.64 % informed the medical worker about their refusal to hospitalize. At the same time, in nosological patients with alcohol-associated diseases and conditions, the pathology of the trauma profile was 7.80 % (p < 0.05). Generally accepted standardized methods for assessing the condition of patients and legal regulations do not contain the proper set of tools for assessing violation of will. Obligate and optional criteria for violation of will are proposed. To optimize the process of providing emergency hospital care to such patients, a scale for assessing violation of will has been developed for performing a medical consultation on the subject of medical interference without the consent of the person (his legal representative).

Keywords: alcohol, multidisciplinary hospital, road traffic injuries, alcohol intoxication, informed voluntary consent.

TO CITE THIS ARTICLE. Tyavokina EYu, Barsukova IM. On the issue of assessing will when performing emergency medical intervention with patients with “drunk” injury. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(3):216-221.

ORIGINAL ARTICLES

THE RECONSTRUCTION OF SCULL BONE DEFECTS USING THE DOMESTIC PROGRAM “AUTOPLAN”

© K.N. BABICHEV (1,2), N.A. SEREBRENNIKOV (2), M.N. KRAVTSOV (1,2,4), V.A. MANUKOVSKY (2,4), S.S. CHAPLYGIN (3), N.A. DVOYASHKINA (3), V.A. DERYUGINA (3), M.V. PUHLIKOV (3)

1 Kirov Military Medical Academy, St. Petersburg, Russia

2 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

3 Federal State Budgetary Educational Institution of Higher Education «Samara State Medical University» of the Ministry of Healthcare of the Russian Federation, Samara, Russia

4 North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

ABSTRACT

The purpose of this work is to present the experience of using the domestic program “AUTOPLAN” for modeling a polymer implant for closing a defect after decompressive craniotomy.

METHODS. The study included 16 patients with skull defects of various locations and sizes, operated using domestic program “AUTOPLAN” and additive technologies. Cranioplasty was performed using polymethylmethacrylate implants made from custom 3D printed molds. Among the 16 patients: 14 with large defects of the skull bones and 2 with defects of the frontal bone and the superior wall of the orbit.

RESULTS. In 14 cases for reconstruction defects after decompressive trepanation implants were made from polymethyl methacrylate using molds printed on a 3D printer. For simultaneous reconstruction frontal bone and superior wall of orbit the titanium mesh was modeled using a custom 3D printed mold. There were no complications after cranioplasty. The use of additive cranioplasty technologies allowed us to achieve optimal cosmetic results, confirmed by a survey of the patient and his relatives, and data from a postoperative CT scan.

CONCLUSION. Using the reconstructive module of Autoplan, it is possible to reconstruct skull bone defects of various shapes, sizes and complexity. On average, it takes 2–3 days from modeling the molds to obtain a polymer implant. It makes the ability to widely introduce additive technologies, as long training in modeling of implants is not required.

KEYWORDS: additive manufacturing; cranioplasty, skull bone defects, 3D cranioplasty.

TO CITE THIS ARTICLE. Babichev KN, Serebrennikov NA, Kravtsov MN, Manukovsky VA, Chaplygin SS, Dvoyashkina NA, Deryugina VA, Puhlikov MV. The reconstruction of scull bone defects using the domestic program “Autoplan”. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):8-15.

        TREATMENT TACTICS OF ACETABULAR FRACTURES IN POLYTRAUMA

© A.V. BONDARENKO (1,2), M.N. TALASHKEVICH (2), I.A. PLOTNIKOV (2), I.V. KRUGLYKHIN (2), N.I. ZAVSEGOLOV (2), KOLUPAEV A.E. (2)

1 Altai State Medical University, Barnaul, Russia

2 Regional clinical hospital of emergency medical care, Barnaul, Russia

ABSTRACT

RATIONALE. Acetabular fractures are the most common in polytrauma. The severity of the condition, the presence of other injuries whose treatment is prioritized, and complications that have arisen lead to a delay in surgical repair of the acetabulum, reducing the likelihood of a positive outcome.

OBJECTIVE of the study is to find out the frequency and nature of acetabular fractures in patients with polytrauma and to determine the optimal treatment tactics.

MATERIAL AND METHODS. Over 10 years (2013–2022), 475 patients with acetabular fractures were treated; 105 (22.1 %) were isolated and 370 (77.9 %) were treated for polytrauma. Surgical treatment was performed in 262 (55.2 %). It was noted that in patients with polytrauma surgical repair of the acetabulum is delayed by 10 days compared to its isolated fracture, which leads to an increase in the number of complications. A special tactic of surgical treatment was proposed. To evaluate its effectiveness, three groups of patients were formed: with isolated acetabular fractures, acetabular fractures with polytrauma before the introduction of new tactics, and after their introduction.

RESULTS AND DISCUSSION. Innovative approaches included identification of the key (defining) acetabular lesion, use of gentle repositioning techniques, and minimally invasive osteosynthesis. The use of the proposed tactics allowed to statistically significantly reduce the number of intraoperative (td = 6.21; p < 0.001) and early postoperative complications (td = 3.82; p < 0.001), reduce the number of late postoperative complications, and increase the number of positive results of acetabular fracture treatment in patients with polytrauma.

CONCLUSION. The use of the proposed tactics of osteosynthesis allowed to statistically significantly reduce the number of intraoperative, early postoperative complications, reduce the number of late postoperative complications, and increase the number of positive long-term results of treatment of acetabular fractures in polytrauma.

KEYWORDS: acetabulum, osteosynthesis, polytrauma, pelvis.

TO CITE THIS ARTICLE. Bondarenko AV, Talashkevich MN, Plotnikov IA, Kruglykhin IV, Zavsegolov NI, Kolupaev AE. Tactics of treatment of acetabular fractures in polytrauma. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):16-29.

TREATMENT OF A VICTIM WITH BLUNT ABDOMINAL TRAUMA WITH MULTIPLE DAMAGE TO THE DUODENUM AND PANCREAS: CLINICAL CASE

© Y.V. GAVRISHUK (1,2), V.I. KULAGIN (1), V.A. MANUKOVSKY (1,3), A.N. TULUPOV (1), M.N.PRAVOSUD (1), A.A. YESENOKOV (1), N.A. MAMEDOV (1)

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State Pediatric Medical University” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

3 North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

ABSTRACT

RATIONALE. Injuries to the pancreatoduodenal zone in blunt abdominal trauma are incredibly rare and are among the most difficult to treat, often leading to severe complications. Duodenal injury occurs in 0.2–0.6 % of cases among all patients with injuries and from 1 to 5 % with closed abdominal injuries. Damage to large vessels with injury to the pancreatoduodenal zone occurs in 23–40 % of cases. Pancreatic injury occurs in less than 1 % of all injuries and in 3.7–11 % of blunt abdominal trauma. According to various authors, the mortality rate ranges from 6 to 50 %. Mortality in the acute period of traumatic illness is caused by bleeding or serious damage to neighboring organs. Mortality in the long-term period, as a rule, is the result of infection or multiple organ failure. The most common postoperative complications are duodenal fistula (2–16 %), intraabdominal abscess (15 %), intestinal obstruction (5–8 %) and pancreatitis (0.5 %). The most common cause of duodenal fistula is inadequate surgical intervention.

CASE DESCRIPTION. We have presented a description of the treatment of the victim after falling on the bucket of the escalator with the diagnosis: "Closed craniocerebral injury. Mild brain injury. Subarachnoid hemorrhage. Closed abdominal injury. Complete circular separation of the duodenum at the level of the ampoule and the lower horizontal part (grade V AAST-OIS) with damage to the head and detachment of the hook-shaped process of the pancreas (grade IV AAST-OIS). Damage to the tributaries of the superior mesenteric vein with continued intra-abdominal bleeding. Large hemoperitoneum (1500 ml). Damage to the right kidney (grade III AAST-OIS). Contusion of the right adrenal gland (grade I AAST-OIS). Closed stable spinal injury without impaired spinal cord conduction. Fracture of the transverse sections of the Th12-L4 vertebrae on the right. Acute blood loss of moderate severity. Traumatic shock of the II degree." Considering the injuries received, the victim underwent gastropancreatoduodenal resection. On the 14th day after the operation, the patient was discharged in a satisfactory condition without complications. Postoperative complications include duodenal fistula (2–16 %), intraabdominal abscess (15 %), intestinal obstruction (5–8 %) and pancreatitis (0.5 %). The most common cause of duodenal fistula development is inadequate surgical intervention.

CONCLUSION. Due to the rare occurrence of damage to the duodenum combined with the pancreas, there is no single treatment algorithm available for this type of combined trauma. The volume of surgical intervention in patients with pancreatoduodenal zone damage depends on the patient's condition and the nature of organ damage.

KEYWORDS: multiple duodenal injury, pancreatic injury, combined injury, closed abdominal injury.

TO CITE THIS ARTICLE. Gavrishuk YV, Kulagin VI, Manukovsky VA, Tulupov AN, Pravosud MN, Yesenokov AA, Mamedov NA. Treatment of a victim with blunt abdominal trauma with multiple damage to the duodenum and pancreas: clinical case. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):30-36.

INTRAOSSEOUS VASCULAR METHODS OF PAIN AND EMERGENCIES

© A.V. ZHIROV (1), I.P. MINNULLIN (2,3), V.L. RADUSHKEVICH (4), E.N. PEREVOZCHIKOV (5), I.R. MINNULLIN (6)

1 Belgorod Region Emergency Medical Care Station, Belgorod, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation

3 St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze, St. Petersburg, Russia

4 RADMIRS LLC, Voronezh, Russia

5 AVTOM-2 LLC, Voronezh, Russia

6 Samarkand State Medical University, Samarkand, Uzbekistan

RESUME

STUDY OBJECTIVE: to evaluate the efficacy of intraosseous vascular access in the intensive care of shockogenic trauma and emergencies.

MATERIALS: analysis of 100 cases of intraosseous vascular access (ICSD in emergency medical care by physicians and paramedics of Belgorod Region Emergency Medical Care Station.

METHODS: literary-analytical, survey, system analysis, modeling, statistical.

RESULTS AND THEIR ANALYSIS. Based on the use of intraosseous vascular access and devices for its performance by the personnel of the Belgorod Region Emergency Medical Care Station during 2022–2024 it is shown that this technology is highly effective in pre-hospital care of patients with shockogenic trauma and other emergency conditions. In the group of patients with critical disorders of vital functions intraosseous vascular access allows to achieve a positive result in treatment in 78.7 % of cases. The new medical device of domestic production “Intraosseous cannulation device UVK M” by functional and operational characteristics is not inferior to imported analogs and meets modern trends in the development of Russian healthcare. For the successful mastering of the manual skill of intraosseous vascular access, the domestic simulator CT UVK M was used.

KEYWORDS: intraosseous vascular access, emergency medical care, shockogenic trauma, intraosseous cannulation device.

TO CITE THIS ARTICLE. Zhirov AV, Minnullin IP, Radushkevich VL, Perevozchikov EN, Minnullin IR. Intraosseous vascular methods of pain and emergencies. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(1):37–41.

Differential approach to surgical treatment of patients with pancreaticoduodenal tumors complicated by obstructive jaundice

© M.YU. KABANOV ^1,2, K.V. SEMENTSOV ^1,2, M.N. MYANZELIN ¹, D.YU. BOYARINOV ^1,2, E.E. FOMENKO ¹, D.M. YAKOVLEVA ^1,3, P.V. ISAEVA ²

¹ St. Petersburg State Budgetary Institution “State Hospital for War Veterans”, St. Petersburg, Russia

² North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

³ Kirov Military Medical Academy, St. Petersburg, Russia

ABTSRACT

Rationale. One of the first manifestations of pancreaticoduodenal diseases is mechanical jaundice, which occurs in 61.8–83.4 % of cases. The choice of treatment tactics for patients with pancreaticoduodenal tumors complicated by mechanical jaundice requires an individual, differentiated approach, including, in particular, assessment of liver function status

objective: to study the role of indocyanine green elimination test in the choice of surgical treatment tactics for patients with pancreatoduodenal tumors complicated by mechanical jaundice

Materials and Methods. The study included 60 patients with pancreatoduodenal tumors complicated by mechanical jaundice of average severity according to the classification of Galperin E. I. 2012. The patients were divided into two groups. Group 1 — 30 patients who underwent pancreaticoduodenal resection (PDR) against the background of mechanical jaundice without biliary drainage. Group 2 — 30 patients pancreaticoduodenal resection was performed after preliminary biliary tract drainage. The preoperative functional status of the patient was assessed by the technique of indocyanine green elimination determination. The treatment results were evaluated according to the Clavien-Dindo classification of 2004.

Results. The baseline status of the patients was evaluated and no statistically significant differences were found. Indocionine green elimination rates also had significant differences: In group 1 POC % vol = 12.1 [10.7; 13.5], OC15 % vol = 19.8 [16.1; 23.4], in group 2 POC % vol = 8 [6.9; 9], OC15 % vol = 34.4 [31.6; 37.1], p < 0.001. According to the results of comparative analysis of the frequencies of adverse events in the groups, it was found that the two-stage surgical treatment was statistically significantly more frequent in complications of IIIb (20 %), IV a degree (13.3 %), IVb degree,(3.3 %), V degree (3.3 %) according to Clavien-Dindo, p < 0.001. In the group with one-stage PDR there were no mentioned complications. The incidence of I–IIIa degree complications did not differ in both groups.

Conclusion. The introduction of the indocyanine green elimination test in the complex evaluation of functional reserves of patients with pancreaticoduodenal tumors complicated by mechanical jaundice of medium severity allows to single out a group of patients with overcompensated liver dysfunctions. Pancreaticoduodenal resection without preliminary biliary drainage is safe for this group of patients.

Keywords: obstructive jaundice, pancreaticoduodenal resection, indocyanine green, pancreaticoduodenal tumors.

TO CITE THIS ARTICLE. Kabanov MYu, Sementsov KV, Myanzelin MN, Boyarinov D Yu, Fomenko EE, Yakovleva DM, Isaeva PV. Differential approach to surgical treatment of patients with pancreaticoduodenal tumors complicated by obstructive jaundice. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):42-50.

INFLUENCE OF LAPAROSCOPIC MYOMECTOMY ON REPRODUCTIVE OUTCOME IN PATIENTS WITH UTERINE FIBROID AND INFERTILITY

© K.Y. KRYLOV (1,2), N.N. RUKHLIADA (3), E.I. BIRYUKOVA (2), Y.K. MIROSHNIKOVA (3)

1 Clinical Hospital of St. Luke, St. Petersburg, Russia

2 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

3 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State Pediatric Medical University” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

ABSTRACT

RATIONALE. Uterine fibroids are one of the most common tumors in women worldwide. We examined reproductive outcomes in patients undergoing laparoscopic myomectomy for various types of fibroid nodules.

OBJECTIVE: to evaluate reproductive outcomes in patients with infertility and uterine fibroids after laparoscopic myomectomy.

MATERIAL AND METHODS. The study included 38 women aged 18 to 45 years with uterine fibroids and infertility. All patients underwent elective laparoscopic myomectomy. Pregnancy was confirmed by visualizing the fertilized egg in the uterine cavity. Data on the type and number of laparoscopic myomectomies and the characteristics of myoma nodes, such as their number, size and location, were collected from medical records.

RESULTS. The study found that of 38 patients with uterine fibroids and infertility, 24 women (63 %) became pregnant within 2 years after laparoscopic myomectomy. Of these, 13 (54.1 %) were delivered by cesarean section, and 11 (45.9 %) were delivered naturally. Of the 5 women with subserous fibroid nodes (FIGO type 7), 5 (100 %) became pregnant. Of the 19 patients with intramural subserous nodes (FIGO types 5 and 6), 11 (58 %) became pregnant. Of the 24 women with intramural nodes (FIGO type 4), 8 (33 %) became pregnant. In 5 (100 %) women who became pregnant after removal of the subserous node (FIGO type 7), vaginal delivery was performed. In 7 (63.6 %) patients who became pregnant after removal of an intramural-subserous node (FIGO types 5 and 6), delivery was performed by cesarean section, in 4 (36.4 %) by natural delivery. In 6 (75 %) women who became pregnant after removal of an intramural node (FIGO type 4), delivery was performed by cesarean section, in 2 (35 %) by natural delivery. Of 14 women suffering from infertility and having only 1 fibroid node, 11 became pregnant (78.5 %), of 19 patients with 2 fibroids, 11 (58 %) became pregnant, of 5 women who had 3 or more fibroid nodes became pregnant 2 (40 %).

CONCLUSIONS. Depending on the size, number and location, uterine fibroids can cause infertility. Our study demonstrates that laparoscopic myomectomy improves reproductive outcomes in women with subserosal, intramural-subserosal, and intramural myomatous nodules. After removal of nodes larger than 5 cm, the pregnancy rate was significantly higher than after removal of nodes smaller than 5 cm. In addition, the pregnancy rate in this observation period was higher in patients after removal of a single uterine fibroid, compared with women with 2 and more myomatous nodes. After removal of the subserous nodes, delivery was carried out naturally; after removal of the intramural and subserosal-intramural nodes, in most cases the tactics of delivery by cesarean section were chosen. In the groups of women who became pregnant after removal of a node from 3 to 5 cm and more than 5 cm, the rate of delivery by cesarean section and vaginally was approximately equal. After myomectomy of a node less than 3 cm, delivery was carried out naturally. In the groups of women who became pregnant after removal of 1 and 2 nodes, the rate of surgical and natural delivery was approximately the same, and in the group of patients with 3 or more nodes, a cesarean section was performed in all cases.

KEYWORDS: uterine fibroids, myomectomy, infertility.

TO CITE THIS ARTICLE. Krylov KY, Rukhliada NN, Biryukova EI, Miroshnikova YK. Influence of laparoscopic myomectomy on reproductive outcome in patients with uterine fibroid and infertility. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):51-58.

DIAGNOSIS OF FAT GLOBULEMIA IN PATIENTS WITH MECHANICAL INJURY

© N.K. RAZUMOVA, V.N. LAPSHIN, N.V. SELEZNEVA, A.V. SHVEDKOV

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

RESUME

Fat embolism syndrome is a relatively rare complication that can occur in an injured patient, both during transportation and during surgical interventions. Some of its forms are characterized by a severe course that significantly aggravates the prognosis, not only in patients of older age groups, but also in patients of working age.

There are no pathognomonic signs of the syndrome, but its etiology is known. The purpose of this publication was to show the diagnostic capabilities of the predictor of this syndrome – fat globules, the detection of which in the patient's blood plasma will allow timely initiation of preventive and therapeutic measures.

KEYWORDS: mechanical injury, post-traumatic fat globulemia, diagnosis, fat embolism syndrome.

TO CITE THIS ARTICLE. Razumova NK, Lapshin VN, Selezneva NV, Shvedkov AV. Diagnosis of fat globulemia in patients with mechanical injury. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):59-63.

RADIOLOGICAL CHARACTERISTICS OF THE INITIAL STAGES OF OSTEOARTHRITIS IN THE EXPERIMENT

© I.L. URAZOVSKAYA (1), V.M. KHAYDAROV (1), D.SH. MANSUROV (2), A.N. TKACHENKO (1), A.A. VOROKOV (1), V.V. MAGDALINOV (1), V.D. SAVITSKIY (1), A.A. BARANOVSKIY (1)

1 North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

2 Samarkand State Medical University, Samarkand, Uzbekistan

ABSTRACT

Introduction. Idiopathic osteoarthritis is a common disease that affects millions of people worldwide. It is important to diagnose osteoarthritis (OA) early and start treatment as soon as possible to prevent further damage of the joints. This is a challenge for arthrologists, as it is difficult to detect the early stages of OA. However, researchers can use experimental models to study the disease and develop new methods for early diagnosis and treatment.

objective. A comparative assessment of radiological changes in the knee joints of rats after injection of monoiodoacetate (MIA) and the synovial fluid from a patient with stage II OA, classified by the Kellgren-Lawrence (KL), was conducted. We suggest that the radiological and pathological changes that occur during the induction of OA through the administration of MIA and patient's synovial fluid may share similar characteristics, but may differ in the rate and pattern of development of intra-articular changes.

Material and methods. The experiment was carried out on 20 Wistar rats weighing 180–250 g. 4 groups of 5 animals (groups K, S, M, MS) were formed. In the control group (group K), a sterile 0.9 % sodium chloride solution in a volume of 10 µl was injected into both knee joints. In Group S, 10 µl of synovial fluid from a patient with stage II OA of the knee joint was injected into the right knee joint. A sterile 0.9 % sodium chloride solution in a volume of 10 µl was injected into the left knee joint of rats. Animals from group M were injected into the right knee joint with 10 µl of MIA solution at a dose of 2 mg per 10 µl, and 0.9 % sodium chloride solution in a volume of 10 µl into the left knee joint. Animals from the MS group were injected with 10 µl of MIA solution into the right knee joint, and synovial fluid into the left one. X-ray examination was performed on days 10, 25, 46, respectively, on the days of euthanasia.

Results. In groups M and MS, degenerative-dystrophic changes in the knee joints were revealed: swelling and inflammation, narrowing of the articular gap, the appearance of osteophytes, and the osteoporosis, which reached a maximum by 46 days. In group K, according to X-ray data, the articular tissue remained intact. The greatest changes were found in the joints of rats injected with MIA, with a noticeable progression of inflammatory and destructive processes on the 25th and 46th days. Changes in the joints where the patient's synovial fluid was injected were insignificant.

Conclusion. Comparing the X-ray data obtained during the experiment, it was found that the maximum changes over time were observed in the knee joints of rats that received intra-articular injections of MIA. No radiological changes were detected at the early stages of the experiment in the joints of either the control group or those where synovial fluid was injected. However, by the end of four weeks, changes in the joints after the introduction of synovial fluid differed from those in the joints injected with MIA. These changes also lagged behind in terms of both time and severity when compared to those seen in the MIA-injected joints. It is likely that the development of osteoarthritis in the synovial fluid model requires longer experimental periods. Additional studies using immunohistochemical and pathomorphological techniques are needed to further understand the nature of inflammation and compare

Keywords: osteoarthritis in an experiment, X-ray examination, sodium monoiodacetate.

TO CITE THIS ARTICLE. Urazovskaya I.L., Khaydarov V.M., Mansurov D.Sh., Tkachenko A.N., Vorokov A.A., Magdalinov V.V., Savitskiy V.D., Baranovskiy A.A. Radiological characteristics of the initial stages of osteoarthritis in the experiment. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):64-71.

EFFECTIVENESS OF CELL TECHNOLOGY APPLICATION IN TREATMENT OF BURNS IN EXPERIMENT

© A.M. KHADZHIBAEV (1,3), D.B. TULYAGANOV (1,3), A.D. FAYAZOV (1,3), T.A. VERVEKINA (1), N.A. TSIFEROVA (2,4), U.R. KAMILOV (1), O.S. CHARYSHNIKOVA (2)

1 Republican research centre of emergency medicine, Tashkent, Uzbekistan

2 Center of advanced technologies at the ministry of higher education, science and innovation, Tashkent, Uzbekistan

3 Center for the development of professional qualification of medical workers, Tashkent, Uzbekistan

4 Institute of biophysics and biochemistry, Tashkent, Uzbekistan

ABSTRACT

RATIONALE. There are many urgent problems in modern combustiology, like searching for optimal methods of skin integrity restoration in the shortest possible time, solving the problem of skin donor resources deficit in patients with extensive deep burns. Conducting research in this direction opens up new prospects for solving this problem. This study is the first step in the creation of a new homegrown biomedical cellular product.

OBJECTIVE: to study the course of the wound process during injection application of allogeneic dermal fibroblasts, active and conservative surgical tactics of burn wound management in experiment.

MATERIAL AND METHODS. The study involved 20 white mongrel male rats, which were divided into 2 groups. All animals underwent burn trauma modeling under isoflurane anesthesia. Group 1 animals received active surgical treatment tactics using an injection of allogeneic dermal fibroblasts suspension into the wound defect. In Group 2, traditional surgical treatment tactics were applied using an injection of allogeneic dermal fibroblasts suspension into the wound defect. Material collection for studying the course of the wound healing process was performed on days 12, 20, and 30 after the start of the experiment under general anesthesia.

RESULTS. A significant difference in the course of the wound healing process was identified depending on the surgical treatment tactics. Active surgical tactics and the introduction of allofibroblasts at earlier stages promoted earlier wound surface epithelialization with the onset of neoepithelialization foci by day 30 after trauma. When using traditional surgical tactics, despite the application of allofibroblasts, worse results were noted — colonization of the wound surface by microorganism colonies, sluggish course of inflammatory and reparative processes.

CONCLUSION. Accelerated reparative processes are observed in dermal allofibroblasts application against the background of active surgical management. When applying traditional surgical treatment tactics, despite the introduction of dermal allofibroblasts, an increase in the duration of inflammatory and reparative processes is noted, with only the beginning of granulation tissue formation by day 30. More active epithelium formation is detected in peripheral areas of the wounds due to the growth of epithelium from the preserved skin and hair epithelium.

KEYWORDS: experiment, burns, healing process, cell technologies, allofibroblasts.

TO CITE THIS ARTICLE. Khadzhibaev AM, Tulyaganov DB, Fayazov AD, Vervekina TA, Tsiferova NA, Kamilov UR, Charyshnikova OS. Effectiveness of cell technology application in treatment of burns in experiment. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(1):72-79.

REVIEWS AND CLINICAL CASES

A CASE OF DIAGNOSIS OF PERFORATION OF THE SMALL INTESTINE WALL WITH A "LOST" STENT AFTER GASTROPANCREATODUODENAL RESECTION

© A.V. VASILEV1 , A.D. KANKASOV1 , D.S. KALIMULLIN1 , D.V. NESTEROV1,2, S.L. TROFIMOV1 , N.V. BOYCHUK1 , A.M. KARACHUN1 , O.A. KOZLOV1 , A.A. GRUSHKO1 , S.S. BAGNENKO1, 3 , I.A. BUROVIK1,4

1 Federal State Budgetary Institution "National Medical Research Center of Oncology named after N.N. Petrov" of the Ministry of Health of the Russian Federation, village Pesochny, St. Petersburg, Russia

2 Northwestern State Medical University named after I.I. Mechnikov, Ministry of Health of the Russian Federation, St. Petersburg, Russia

3 St. Petersburg State Pediatric Medical University, Ministry of Health of the Russian Federation, St. Petersburg, Russia 4 St. Petersburg State University, St. Petersburg, Russia

resume

Diagnosis of postoperative complications of pancreatoduodenal resection is a complex clinical task. Radiation imaging techniques play a leading role in determining their cause.

THE PURPOSE OF THE WORK: to present a case of a rare complication of gastropancreatoduodenal resection — perforation of the small intestine wall with a "lost" stent. The article considers the clinical observation of displacement of the internal stent from the pancreatojunoanastomosis zone, which led to perforation of the small intestine. The features of radiation imaging are discussed, in particular, the use of computed tomography as the leading method of diagnosing postoperative complications.

KEYWORDS: duodenal cancer, computed tomography, pancreatoduodenal resection, stent, intestinal perforation.

HOW TO QUOTE. Vasiliev A.V., Kankasova A.D., Kalimullina D.S., Nesterov D.V., Trofimov S.L., Boychuk N.V., Karachun A.M., Kozlov O.A., Grushko A.A., Bagnenko S.S., Burovik I.A. The case of diagnosis of perforation of the small intestine wall with a "lost" stent after gastropancreatoduodenal resection // The journal of Emergency Surgery named after I.I. Janelidze. 2024. No. 2. pp. 80-87.

ARTIFICIAL INTELLIGENCE IN TRAUMATOLOGY AND ORTHOPEDICS: PROSPECTS AND DANGERS (LITERATURE REVIEW)

© A.A. POVALIY (1), I.G. BELENKY (1,2)

1 Federal State Budgetary Educational Institution of Higher Education “Saint Petersburg State University”, St. Petersburg, Russia

2 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

Abstract

objective. Based on the study of specialized literature, to determine the current trends in the development of artificial intelligence technologies in traumatology and orthopedics

Materials and methods. A systematic search was carried out in the Russian Science Citation Index, PubMed, Scopus, Web of Science databases, published mainly over the past ten years on the issues of artificial intelligence in medicine, not by keywords and combinations: artificial intelligence OR machine learning OR neural networks OR deep learning AND traumatology and orthopedics

Results. AI can offer solutions to the growing demands for redundant and repetitive tasks that are at a lower end of the intellectual spectrum, which contribute to physician burnout and medical errors. Detailed study of calculation algorithms for each specific task is required, and statistical analysis methods do not contradict, but often complement AI technologies. However, it is worth paying attention to the problems associated with ethical implementation, regulatory regulation, and the decision-making process.

Conclusions. AI is a potentially significant technology in traumatology and orthopedics. To date, there are many unsolved problems and a fairly small number of studies in the field of traumatology and orthopedics.

Keywords: machine learning, traumatology and orthopedics, computer technology, artificial intelligence, neural networks.

TO CITE THIS ARTICLE. Povaliy AA, Belenky IG. Artificial intelligence in traumatology and orthopedics: prospects and dangers (literature review). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):88-95.

MULTILAYER PLASTIC SURGERY OF THE ANTERIOR CRANIAL FOSSA FOR NASAL LIQUORRHEA IN CONDITIONS OF PURULENT INFLAMMATION AFTER A GUNSHOT PENETRATING ANTERIOR PARABASAL WOUND (CASE REPORT AND LITERATURE REVIEW)

© V.V. SHKOLNIKOV (1), A.S. VOLKOV (1), D.V. SVISTOV (2), B.G. ADLEYBA (2)

1 1469 Naval Clinical Hospital, Severomorsk, Russia

2 Kirov Military Medical Academy, St. Petersburg, Russia

ABSTRACT

Currently, there are a sufficient number of recommendations and guidelines for the treatment of gunshot wounds to the skull and brain in peacetime and wartime conditions, however, penetrating wounds to the base of the skull remain one of the most difficult tasks in neurosurgery, the solution of which requires an individual approach with elements of reconstructive surgery already at the front stages of care. After gunshot and mine-explosive wounds, as well as peacetime injuries, bone and soft tissue defects often form, making it difficult to choose plastic material and reconstruction tactics. The article presents a clinical case of successful treatment of liquorrhea, which developed after a penetrating wound with damage to the anterior cranial fossa on the background of purulent inflammation, in which we performed multilayer plastic surgery using a wide fascia of the femur, a free flap of the bone of the cranial vault and a free flap of subcutaneous adipose tissue.

KEYWORDS: penetrating brain injury, skull base, anterior cranial fossa, skull base defect, defect reconstruction, treatment algorithm, free flap.

TO CITE THIS ARTICLE. Shkolnikov V.V, Volkov A.S., Svistov D.V., Adleyba B.G.  Multilayer plastic surgery of the anterior cranial fossa for nasal liquorrhea in conditions of purulent inflammation after a gunshot penetrating anterior parabasal wound (case report and literature review). The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):96-102.

NURSING AND PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTHCARE, MEDICAL AND SOCIAL EXPERTISE

ROAD TRAFFIC INJURIES IN THE STRUCTURE OF CALLS FOR MOVING AMBULANCE CLIPS

© I.M. BARSUKOVA (1,2), N.I. VISHNYAKOV (1,2), A.I. MAKHNOVSKY (2,3), M.V. POLYUKOVA (1,2)

1 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

2 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

3 North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia

ABSTRACT

Road traffic injuries are a serious medical and social problem. The objective was to study the volume of emergency medical care provided to victims of road accidents.

The materials for the study were official statistical data (Rosstat) for 2014–2022. Statistical and analytical methods were used.

Conclusions. Every year in the Russian Federation there are about 200 thousand visits by emergency medical services teams to road accidents, more than 250 thousand victims need medical care. About 10 thousand victims of road accidents had an unfavorable (fatal) outcome. For the period 2014–2022. there is a positive trend associated with a decrease in the number of road accidents (by 23.4 %), the number of victims in road accidents (by 28.9 %), and the number of deaths in road accidents (by 35.9 %).

Keywords: road traffic injuries, emergency medical care.

TO CITE THIS ARTICLE. Barsukova IM, Vishnyakov NI, Makhnovsky AI, Polyukova MV. Road traffic injuries in the structure of calls for moving ambulance clips. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):103-107.

EFFECTIVENESS OF PROVIDING AMBULANCE MEDICAL CARE IN ROAD ACCIDENTS

© I.M. BARSUKOVA (1,2), V.E. PARFENOV (1), G.A. RYSEV (1), N.N. LUKOGORSKAYA (2)

1 St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

Promptness in providing medical care in case of an accident is a key task for saving the patient’s life. The objective of the study was to study the efficiency of the work of emergency medical services teams when responding to road accidents.

The materials for the study were official statistical data (Rosstat) for 2010–2022. Statistical and analytical methods were used.

Conclusions. The efficiency of teams arriving at the scene of an accident is significantly higher than reaching the place of a call for another reason, which is quite natural and is associated with the significant medical and social significance of road traffic injuries and the priority dispatch of the EMS team in this regard. Significant positive dynamics were noted associated with an increase in the efficiency of reaching the scene of an accident for the period 2010–2022: in a 20-minute interval corresponding to an emergency form of medical care — from 88.9 % to 95.0 %.

Keywords: road accident, road traffic injuries, emergency medical care, efficiency of emergency medical care.

TO CITE THIS ARTICLE. Barsukova IM, Parfenov VE, Rysev GA, Lukogorskaya NN. Effectiveness of providing ambulance medical care in road accidents. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):108-112.

THE INFLUENCE OF PSYCHOLOGICAL PORTRAITS OF MEDICAL PERSONNEL ON THE SUCCESSFUL IMPLEMENTATION OF INTERPERSONAL INTERACTION WITH PATIENTS

© L.G. FIRSOVA

St. Petersburg State Budgetary Institution “City Hospital No. 26”, St. Petersburg, Russia

ABSTRACT

The results of the study in the survey of professional and personal characteristics of physicians and nurses who carry out interpersonal interaction with patients are presented. 30 people participated in the study. Of them, 15 people with higher medical education (trauma physicians), the average age was 38.4 and the average length of service was 9.7. Also 15 people with secondary medical education (nurses), average age 29 years, average length of service - 7.2 years. Psychodiagnostic procedures were selected in accordance with the objectives. The following techniques were used in the study:

1. Technique for diagnosing the distribution, stability and switching of attention;
2. Eysenck’s method;
3. Buss-Durkey Inventory;
4. Cettell’s Sixteen Personality Factor Questionnaire (16PF);
5. Methodology for diagnosing empathy.

Analysis of our own experimental research - processing was carried out with the help of Statistica 5.0 program.

Correlation analysis was carried out for the whole sample and for subgroups of subjects.

As a result of the study, the following conclusions were formulated:

1. Physicians are more oriented to a set of skills, techniques and methods of effective oral and written communication, adequate communicative behavior, the ability to communicate effectively and without conflict within the framework of professional activity.
2. The longer nurses work in the trauma department, the more precise, practical, enduring they become. Very often they do not pay attention to their own physical ailment.
3. The degree of manifestation of extravertedness is higher in nurses, thus they are more friendly, open, attentive, cheerful, energetic. Such a nurse is more trusted by patients, which increases the level of satisfaction with the care provided.
4. Nurses have readiness to show negative reactions when patients address them, but they do not show it, and in the period of irritation, despite fatigue, they are friendly, participative, ready to help.
5. Medical nurses are reliably different from physicians in the expression of conflict in communication with patients. They are more patient and persuasive in relation to patients, cause their trust, formed under the influence of authority and charm, which positively affects the patients' compliance with the hospital regime and helps in performing therapeutic procedures and taking medications.

KEYWORDS: professional and personal characteristics, interpersonal interaction with patients, stability and attention switching, personal properties, emotional stability, sociability, impulsivity and restraint, empathy.

TO CITE THIS ARTICLE. Firsova LG. The influence of psychological portraits of medical personnel on the successful implementation of interpersonal interaction with patients. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(2):113-125.

ORIGINAL ARTICLES

FACTORS ASSOCIATED WITH INCREASED MORTALITY IN PATIENTS WITH UNFORMED LATERAL DUODENAL FISTULAS

© E.Yu. LEVCHIK (1,2), E.B. GORODETSKY (3), K.V. KASHTANOVA (1)

¹ Ural State Medical University, Yekaterinburg, Russia

² Sverdlovsk Regional Clinical Psychoneurological Hospital for War Veterans, Yekaterinburg, Russia

³ State autonomous healthcare institution of the Sverdlovsk region “Sverdlovsk Regional Clinical Hospital No. 1”, Yekaterinburg, Russia

ABSTRACT

The article analyzes the factors that increase mortality in 74 patients with unformed lateral fistulas of the duodenum during organ-preserving treatment. It was revealed that the most significant factors were the presence of common infectious complications upon admission, the persistence of high irretrievable losses of chyme through fistulas during treatment, the development of malnutrition and secondary infectious complications during the treatment of patients in a specialized department.

KEYWORDS: duodenum, intestinal fistulas, surgical treatment, mortality, prognostic factors.

TO CITE THIS ARTICLE. Levchik E.Yu., Gorodetsky E.B., Kashtanova K.V. Factors associated with increased mortality in patients with unformed lateral duodenal fistulas. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(1):8-14 (In Russ.).

SECONDARY PULMONARY ALVEOLAR PROTEINOSIS IN EXOGENOUS TOXIC ALVEOLITIS

© A.A. SPERANSKAYA, O.P. BARANOVA, G.P. ORLOVA, A.V. ZINCHENKO

Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, St. Petersburg, Russia

ABSTRACT

RATIONALE. Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of surfactant proteins and lipids in the alveoli, impaired gas exchange and the progression of respiratory failure. Secondary PAP can develop in patients with exogenous toxic alveolitis (ETA). Of interest is the clinical observation of the combination of secondary PAP with the ETA as background condition, with a detailed analysis of the difficulties in interpretation of computed tomography (CT) picture, the reasons for the late diagnosis of the disease, and the errors in treatment tactics. The purpose of the article was to show the specific features of the course, diagnosis and treatment of PAP.

METHODS. Data of dynamic observation of 85 patients with PAP for the period from 1982 to 2020 are presented. General clinical examination of patients, chest CT scan, and a comprehensive functional study of external respiration were carried out. Histological verification of the diagnosis was carried out in 84 patients. In 12 patients, the diagnosis of idiopathic (autoimmune) PAP was confirmed immunologically evidenced by increased level of autoantibodies to GM-CSF in blood.

RESULTS. The authors presented the incidence of secondary PAP in ETA. The article discusses the most characteristic clinical, radiological, functional and morphological manifestations of PAP. Diagnostic CT scans, functional and morphological signs were analyzed in 4 patients with PAP that developed with ETA as a background condition. It was noted that clinical manifestations of PAP are nonspecific, which makes it difficult to diagnose secondary PAP, and the radiological manifestations of primary and secondary PAP are similar. Based on the study, in cases of combination of LAP and ETA, the feasibility of using a combination of systemic glucocorticosteroids with courses of subsegmental bronchoalveolar lavages was substantiated.

CONCLUSION. Currently, the incidence of this pathology is increasing, which may indicate the need to compare clinical, functional, morphological data and features of the CT image of lungs with a complicated occupational history.

KEYWORDS: computed tomography, secondary pulmonary alveolar proteinosis, exogenous toxic alveolitis.

TO CITE THIS ARTICLE. Speranskaya AA, Baranova OP, Orlova GP, Zinchenko AV. Secondary pulmonary alveolar proteinosis in exogenous toxic alveolitis. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(1):15-23 (In Russ.).

VIRTUAL PLANNING OF OSTEOSYNTHESIS SURGERY FOR PATIENTS WITH ANKLES FRACTURES AND THE POSTERIOR EDGE OF TIBIA, ACCORDING TO COMPUTED TOMOGRAPHIC RESULTS: A CLINICAL CASE

© V.E. SAVELLO (1,2), I.G. BELENKY (1,3), A.N. KOSTENIKOV (1), B.A. MAJOROV (1, 2, 3), Yu. V. REFITSKI (1), G. D. SERGEEV (1,4)

1 St. Petersburg Scientific Research Institute of Emergency Medicine, St.Petersburg, Russia

2 First St. Petersburg State Medical University, St Petersburg, Russia

3 St Petersburg University, StPetersburg, Russia

Introduction. Osteosynthesis operations for fractures of the ankle and the posterior edge of the tibia are performed quite often, but they are accompanied by a high proportion of complications and unsatisfactory treatment outcomes. One of the main reasons for treatment failure is the lack of anatomical repositioning of fracture fragments containing the articular surface. This proves a direct correlation between the quality of surgical treatment and its outcome. The open reposition and internal fixation of fragments of the posterior tibial edge is a complex operation that should be carefully planned. It is necessary to determine the order of fixing fracture elements and choose the surgical approach necessary for this. Inadequate preoperative planning may lead to deficiencies in surgical treatment.

The purpose of the study: using the example of a presented clinical case, to describe the technology of diagnosis, virtual planning of surgery, and evaluation of results of osteosynthesis in patients with ankle fractures and posterior edge fracture of the tibia, according to computed tomography findings.

The presented clinical example demonstrates a technique for virtual planning of osteosynthesis surgery and evaluating the results of surgery in patients with fractures of the ankles and the posterior edge of the tibia. As part of preoperative planning, computed tomography of ankle joints was performed, capturing the lower third of shins and tarsal parts of feet. On virtual volumetric reconstruction, spatial location and displacement direction of fragments were estimated, and type of fracture determined. Using mainly multiplanar reconstruction (MPR) and volumetric rendering (VR) images, planning of surgical approaches and implants sizes were performed. Technique used in clinical example is detailed and illustrated by drawings.

Discussion. The use of radiographic diagnostic methods, such as radiography and CT, allows the surgeon to obtain a complete picture of a fracture and properly plan surgery. Neglecting available examination methods and preoperative planning reduces the quality of surgery and worsens functional results.

Conclusion. Radiographic examination plays a major role in planning traumatological and orthopaedic surgery. The paper demonstrates the adequacy of planning and the ability to implement planned plans during surgery. For comprehensive planning, a CT scan should be performed before surgery. Additionally, to assess the quality of an operation, control computed tomography should be performed.

KEYWORDS: ankle fracture, posterior edge of tibia fracture, osteosynthesis, preoperative planning, CT

HOW TO QUOTE Savello V.E., Belenky I.G., Kostenikov A.N., Mayorov B.A., Refitsky Yu.V., Sergeev G.D. Virtual Planning of Osteosynthesis Surgery in Patients with Fractures of the Ankles and the Posterior Edge of the Tibia According to the Results of Computed Tomography: A Clinical Case // Journal "Emergency Surgery named after I.I. Dzhanelidze" 2024 No. 1 pp. 24-3

PECULIARITIES OF CLINIC, DIAGNOSTICS AND SURGICAL TREATMENT TEMPORAL-FRONTAL FORM OF FOCAL EPILEPSY

© V.R. KASUMOV, V.A. MANUKOVSKY, V.E. PARFENOV, M.N. KRAVTSOV, A.V. VERESHCHAKO

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

ABSTRACT

BACKGROUND. The issues of diagnostics and treatment of various forms of focal epilepsy up to the present time remain relevant, as this pathology of the central nervous system is a severe and widespread disease with a high degree of invalidization and permanent reduction in the quality of life of patients.

AIM. To study the peculiarities of clinic and diagnostics of temporal-frontal form of epilepsy in order to solve fundamental questions of optimization of strategy and tactics of surgical treatment of this complex pharmacoresistant form.

METHODS. The report is based on the retrospective analysis of the results of complex examination and surgical treatment of 55 patients (30 men, 25 women) aged 16–43 years with the diagnosis of “epilepsy” (ICD-10 code G40). All patients were examined according to the program of neurosurgical diagnostic complex taking into account modern standards of epilepsy patients management recommended by the International Antiepileptic League.

RESULTS AND DISCUSSION. The main electroclinical and neuroimaging diagnostic features of complex pharmacoresistant temporal-frontal focal epilepsy, important for the development of indications and tactics of surgical treatment, were considered. The results of the complex examination showed the legitimacy of distinguishing the considered form of focal epilepsy and the objective possibility of correct and timely diagnosis. The preoperative EEG data clearly indicating the temporal-frontal-lobe topical epileptic focus (epileptic zone) in correlation with the semiology of paroxysmal clinical symptomatology allow us to understand the pathological process formation pathways at the late stages of epileptogenesis, which should be taken into account in the surgical treatment of temporal-frontal epilepsy.

CONCLUSION. The performed retrospective analysis allowed us to evaluate the neurodynamics and the role of electroclinical criteria at late stages of temporal lobe epileptogenesis. It was shown that the semiology of paroxysmal clinical symptoms in direct correlation with EEG monitoring data indicating temporal-frontal localization of the epileptic focus (epileptic zone) clearly determine the validity of the temporal-frontal form of focal epilepsy and the objective possibility of its correct and timely diagnosis.

KEYWORDS: focal epilepsy, temporal-frontal epilepsy, surgical treatment, pharmacoresistance.

TO CITE THIS ARTICLE. Kasumov VR, Manukovsky VA, Parfenov VE, Kravtsov MN, Vereshchako AV. Peculiarities of clinic, diagnostics and surgical treatment temporal-frontal form of focal epilepsy. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(1):34-42. (In Russ.).

FEATURES OF TREATMENT OF VICTIMS WITH DAMAGE TO THE PELVIC RING AND URETHRA IN SEVERE COMBINED TRAUMA

© G. M. BESAEV (1), A. N. TULUPOV (1, 2), V. G. BAGDASARYANTS (1), I. V. KAZHANOV (1 ,2), M. A. ANDREEV (1)

1. State Budgetary Institution "St. Petersburg Scientific Research Institute of Emergency Medicine named after I. I. Dzhanelidze ", St. Petersburg, Russia

2. S. M. Kirov Military Medical Academy of the Ministry of Defense of Russia, St. Petersburg

Summary

Justification. In the mid-twentieth century, pelvic injuries accounted for 4–7% of all skeletal fractures, and by the early twenty-first century, this percentage had increased to over 20. Currently, in case of accidents, this number exceeds 30%, with no signs of decreasing. The overall mortality rate for pelvic fractures is in the range 2.8-27%, although it can rise to 38–62% in cases of hemodynamic instability. All these factors make the treatment of pelvic fractures a pressing issue.

The purpose of the article is to demonstrate successful treatment of a long-standing deformity of pelvic bones with a ruptured urethra, and the importance of strict adherence to modern clinical recommendations for this condition immediately after injury.

MATERIALS AND METHODS: Modern methods, including MSCT, ultrasound, urethrography, minimally invasive osteosynthesis using an external fixator and cannulated screws, closed repositioning of the pelvic ring under anesthesia, urethroscopy, and urethral augmentation were used to examine and treat the patient 4 months after injury at the department of combined trauma at the St. Petersburg Emergency Medicine Institute named after I.I. Janelidze.

The result. Reliable restoration of the structure and function of the pelvic ring and urethra has been achieved. A conclusion is made about the need for adequate repositioning and reliable fixation of pelvic bone fragments in the acute and early stages of traumatic illness.

Keywords: combined trauma, poly traumatic injury, unstable pelvic injuries, urethral rupture, osteosynthesis of pubic joint.

How to cite. Besaev GM, Tulupov AN, Bagdasaryants VG, Kazhanov IV, Andreeva MA. Features of treatment of patients with damage to the pelvis and urethras in severe combined injuries. Emergency Surgery named after I. I. Dzhanelidze Journal. 2024;1:43-50

EARLY APPLICATION OF NPWT IN COMPLICATED NECROTIZING SOFT TISSUE INFECTIONS

© D.S. SKLIZKOV (1), S.A. SHLYAPNIKOV (1), I.M. BATYRSHIN (1,3), N.R. NASER (1,2)

1 Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia

2 North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia