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№3, 4-2023
№2 2023
№1 2023
№4 2022
№3 2022
№2 2022
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№4 2021
№3 2021
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№1 2020
№3, 4-2023

MORBIDITY AND RESULTS OF TREATMENT OF PERFORATED GASTRIC

AND DUODENAL ULCERS IN SOME REGIONS OF THE RUSSIAN

FEDERATION, SVERDLOVSK REGION AND YEKATERINBURG IN 2017–2022

© V.A. KOZLOV1, E.Yu. LEVCHIK1,2, A.V. STOLIN1, V.Yu. EREMKIN1

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

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

ABSTRACT

A comparative analysis of the incidence, hospital and postoperative mortality in perforated gastric and duodenal ulcers in some regions of the Russian Federation in 2017–2021, the Sverdlovsk region and the city of Yekaterinburg in 2017–2022, and the relationship of these indicators is presented. It has been proven that a gradual decrease in the incidence, both in the Russian Federation and in the regions selected for analysis, the Sverdlovsk region and the city of Yekaterinburg, was combined with an increase in hospital postoperative mortality. A strong direct relationship was shown between the average rates of morbidity and postoperative mortality in selected regions of the Russian Federation in 2019–2021. Differences in morbidity, in-hospital and postoperative mortality rates were found between the regions of the Russian Federation selected for analysis, as well as the Sverdlovsk Region and the city of Yekaterinburg. It is concluded that it is expedient to develop, on the basis of the Russian next revision, regional and city clinical recommendations “Perforated ulcer”, considering the immediate and long-term results of treatment, the characteristics of socio-economic and demographic conditions, personnel and technological capabilities of local healthcare.

KEYWORDS: perforated gastric and duodenal ulcer, morbidity, surgical treatment, results.

TO CITE THIS ARTICLE. V.A. Kozlov, E.Yu. Levchik, A.V. Stolin, V.Yu. Eremkin Morbidity and results of treatment of perforated gastric and duodenal ulcers in some regions of the Russian Federation, Sverdlovsk region and Yekaterinburg in 2017–2022 // The Journal of Emergency Surgery named after I.I. Dzhanelidze.

2023. N 3. P. 6–14.

 

 

 

RETROSPECTIVE ANALYSIS OF ACUTE ABDOMINAL SURGICAL DISEASES

DURING THE COVID-19 PANDEMIC

© D.G. BURIBAYEV2, D.B. TULYAGANOV1, KH.E. ANVAROV1, A.O. KURBANOV2,

R.K. DJAMALDINOVA1

1 Republican Research Center of Emergency Medicine, Tashkent, Uzbekistan

2 Tashkent regional branch of the Republican Ambulance Service, Tashkent, Uzbekistan

ABSTRACT THE AIM of the study was to improve the treatment results of acute abdominal surgical diseases during the COVID-19 pandemic. MATERIAL AND METHODS: The object of the study was 200 patients who were randomized into 2 groups. The present study was retrospective, based on the analysis of the medical histories of patients hos-pitalized with clinical manifestations of acute abdominal pathology developed against the background of COVID-19.

The present study was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology developed against the background of COVID-19.

RESULTS: Cardiovascular and endocrinological background conditions were significantly less frequently recorded in the main group of patients. Perhaps the reason for this was that at the height of the pandemic, due to theexcessive burden on the healthcare system, doctors did not pay enough attention to the presence of background conditions whuch could complicate the course of the main pathology. Patients in the comparison group were recruited in the post-pandemic period, when the functioning of the health system was normalized.

CONCLUSION: The new SARS-CoV-2 virus

will eventually line up with existing viruses and will periodically lead to COVID-19 outbreaks. A thorough analysis of acute abdominal surgical diseases during the COVID-19 pandemic leads to the correct tactics of surgical treatment with background and concomitant pathology. In this regard, the optimal planning of preventive and therapeutic measures requires the establishment of accurate diagnostics.

KEYWORDS: COVID-19, new coronavirus infection, diagnostics of COVID-19, surgery, SARS-CoV-2.

TO CITE THIS ARTICLE. Buribayev D.G., Tulyaganov D.B., Anvarov Kh.E., Kurbanov A.O., Djamald-

inova R.K. // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3. P. 15–21.

 

 

 

ANESTHESIA IN THE ACUTE PERIOD OF SEVERE BURN INJURY

© O.V. ORLOVA, V.S. AFONCHIKOV, V.N. LAPSHIN

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

ABSTRACT.

INTRODUCTION. Burn injury is one of the most painful types of traumatic injuries, and little attention is paid to the issues of anesthesia of patients in the period of burn shock.

PURPOSE OF THE WORK: to assess the severity of pain syndrome and the level of anxiety in severely burned patients in the acute period of shockogenic burn injury and to determine the best options for their correction.

MATERIALS AND METHODS. We examined 48 patients with shock burn injury aged 18 to 65 years, with a total area of more than 30% of the body surface. All patients underwent a standard examination and intensive care, as well as an assessment of the visual analogue pain scale and the short scale of anxiety, depression and post-traumatic stress disorder (B.B. Hart, 1996). Threshold values requiring anesthesia according to VAS were taken as 5 or more points. The use of

anxiolytics was considered necessary at an anxiety level of more than 4 points. The results of analgesia and sedation were evaluated 30 minutes, 2 and 6 hours after administration.

RESULTS. Pain syndrome assessment at admission showed high values of background pain — at the level of 5–6 points and a high level of anxiety - more than 4 points, which was an indication for pain relief and the use of anxiolytics. Given the relationship between anxiety and pain syndrome, patients were first anesthetized, and then reassessed the level of pain and anxiety and determined indications for anxiolytic therapy. 30 minutes after anesthesia, the level of background pain syndrome was in the range of 2–3 points, the level of anxiety was in the range of 1–2 points, which in most cases excluded the introduction of anxiolytic agents. The introduction of midazolam was required once in

5 patients with psychomotor agitation (+3 points on the Richmond scale). Low levels of background pain and anxiety persisted 2 and 6 hours after anesthesia. During the first day, background pain was recorded at the level of 3–4 points, and the level of anxiety was less than 4 points. To eliminate procedural pain in the acute period of shock burn injury, general non-inhalation or combined anesthesia was performed according to the generally accepted method. Postoperative analgesia was also carried out by intravenous administration of ibuprofen at a dosage of 800 mg after assessing the level of pain according to the VAS.

CONCLUSIONS. 1. In patients with severe burn injury, the severity of pain syndrome should be assessed regularly, from the moment of admission,

with appropriate correction depending on the severity. 2. The optimal drugs for pain relief are non-selectivenon-steroidal anti-inflammatory drugs with a high safety profile.

KEYWORDS: pain syndrome, burns, non-steroidal anti-inflammatory drugs

TO CITE THIS ARTICLE: Orlova O.V., Afonchikov V.S., Lapshin V.N. Pain Management in the Acute Period of a Shock Burn Injury // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3.

P. 22–27.

 

 

 

HYSTERECTOMY FOR PELVIC ORGAN PROLAPSE: A NECESSITY

OR A RELIC OF THE PAST?

© N.N. RUKHLIADA, V.I. MATUKHIN

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia

ABSTACT

Hysterectomy is one of the standard surgical interventions in operative gynecology. The indication for the above operation is also complete or partial prolapse of the uterus. However, according to the indications for hysterectomy, studies have not been conducted for a long time to determine the need for surgery for genital prolapse, given the possible risks of postoperative complications. This article presents a retrospective study of surgical interventions for pelvic organ prolapse, as well as an assessment of the quality of life according to the SF-36 questionnaire after three months of surgery.

KEYWORDS: genital prolapse, hysterectomy, quality of life assessment.

TO CITE THIS ARTICLE. Rukhliada N.N., Matukhin V.I. Hysterectomy for Pelvic Organ Prolapse: A Necessity or a Relic of the Past? // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023.

N 2. P. 28–31.

CONFLICT OF INTEREST. The authors declare no conflicts of interest.

 

 

 

ANKLE ARTHRODESIS AS A RESULT OF HIGH-ENERGY OPEN FRACTURE

OF THE DISTAL TIBIA: A CASE REPORT

© B.A. MAYOROV1,2,3, I.G. BELEN’KIY 1,2, G.D. SERGEEV1,2, M.A. SERGEEVA2

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

2 St. Petersburg State University, St. Petersburg, Russia

3 First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia

33

ABSTRACT.

INTRODUCTION. Fractures of the distal tibia are the leading cause of severe osteoarthritis of the ankle joint. An alternative to arthroplasty is ankle arthrodesis. The variety of described techniques of this surgery allows to choose the optimal option for a particular clinical case.

AIM OF THE STUDY: to demonstrate the efficacy of ankle arthrodesis with the use of cancellous screws in the treatment of the consequences of complex intra-articular pilon fracture with outcome in clinically significant osteoarthritis.

CASE REPORT. A 54-year-old patient was admitted to the hospital with a diagnosis of an isolated open fracture of the distal metaepiphysis of the tibia and a transverse fracture of the fibula in the lower third, type 43 C3 according to the AO/ASIF classification with impression of the anterior and central part of the articular surface. Two-staged osteosynthesis

tactics was applied. Internal fixation was performed 15 days after the injury. At the examination 8 months later, revision surgery was performed due to persisting pain syndrome and signs of tibial fracture nonunion in X-rays. Two months after the revision surgery, the patient complained of pain in the ankle joint despite the radiologic fracture consolidation. Control X-rays also showed signs of degenerative changes in the ankle joint. Six months after the revision surgery, due to progressive signs of posttraumatic osteoarthritis and persistent pain syndrome,

a decision was made to perform ankle arthrodesis. All hardware was removed from the distal tibia, and ankle arthrodesis with three 7.3 mm partially threaded cancellous cannulated screws was performed. Ankylosis of the ankle joint was diagnosed at the follow-up examination after 5 months. The patient walks with full weight bearing on the limb without any pain syndrome.

CONCLUSION. The described technique of ankle arthrodesis gives a good functional result and can be successfully used as an option for surgical treatment of complex high energy fracture of the distal tibia and fibula complicated by the development of posttraumatic osteoarthritis.

KEYWORDS: pilon fracture, fracture of the tibia, high-energy fracture, post-traumatic osteoarthritis, ankle arthrodesis.

TO CITE THIS ARTICLE. Mayorov B.A., Belen’kiy I.G., Sergeev G.D., Sergeeva M.A. Ankle arthrodesis as a result of high-energy open fracture of the distal tibia: a case report // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3. P. 32–44

 

 

 

THE 12-YEAR RESULT OF SURGICAL TREATMENT OF A BILATERAL

COMMINUTED FRACTURE OF THE TALUS BONES. CASE REPORT

© K.S. EGOROV, A.K. ARKHIPOVA

St. Petersburg State Budgetary Healthcare Institution “City Hospital of St. George the Great Martyr”, Saint-Petersburg, Russia

ABSTRACT

The talus bone is an extremely important element that ensures the normal functioning of the ankle joint. Improper treatment of talus fractures leads to extremely serious consequences. We present an example of the treatment of bilateral intra-articular impression comminuted damage to the talus bones (on the right, type II according to Sneppen, on the left, type V according to Sneppen) in a physically active woman of 23 years old. Surgical treatment was performed, open reposition of fragments with bone autoplasty, fixation with screws. The result of treatment was tracked in 4, 6.5 and 12 years. The functional result was evaluated according to the AOFAS and FFI scales. Despite the regular development of post-traumatic arthrosis, excellent functional scores were obtained for the right ankle joint and good ones for the left one throughout the observation, without a clear tendency to deterioration over the time. The clinical observation presented by us is an example of the fact that with all the complexity of this pathology, even with a multi-fractured fracture, successful treatment with a good long-term result is possible.

KEYWORDS: talus bone, ankle joint, fracture of the talus bone.

TO CITE THIS ARTICLE. Egorov K.S., Arkhipova A.K. The 12-year result of surgical treatment of a bilateral comminuted fracture of the Talus Bones. Case report // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3. P. 45–53.

 

 

 

A NEW LOOK AT THE PROCESSES OF FORMATION OF TISSUE EDEMA

OF THE RECIPIENT WOUND BED AND THE POSSIBILITY OF ITS

ASSESSMENT USING MODERN INSTRUMENTAL DIAGNOSTIC METHODS

IN EXPERIMENT AND CLINICAL PRACTICE (LITERATURE REVIEW)

© I.V. PAVLENKO, M.S. BALEEV, V.N. GOSTEV

ABSTRACT.

The complete closure of extensive wound defects is a serious problem of modern surgery. In a significant part of clinical cases, practicing surgeons have difficulties in the surgical treatment of extensive soft tissue wounds, especially those that have existed for a long time and have no tendency to heal. Split-skin grafting is the operation of choice when closing chronic wounds, as it has a number of advantages over other options for skin plastic surgery. At the same time, the percentage of split-skin graft engraftment depends on the state of the recipient bed in most cases, the degree of which is determined by such mutually influencing processes as inosculation, angio- and vasculogenesis occurring simultaneously in the graft itself and the receiving wound bed. The review presents studies by domestic and foreign authors concerning new possibilities of instrumental assessment of the condition of the recipient bed of the wound, namely the degree of its edema. The results of scientific papers describing the relationship between the degree of swelling of the wound and the result of its plastic closure are shown. The features of modern methods of optical bioimaging are revealed when they are used in determining the amount of fluid in soft tissue wounds both in experiment and clinical practice.

KEYWORDS: split-skin grafting, chronic wound, recipient bed, swelling of the wound bed, amount of fluid in the tissue, instrumental diagnostics.

TO CITE THIS ARTICLE: Pavlenko I.V., Baleev M.S., Gostev V.N. A new look at the processes of formation of tissue edema of the recipient wound bed and the Possibility of its assessment using modern instrumental diagnostic methods in experiment and clinical practice (literature review) // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3. P. 54–67

 

 

 

SURGICAL TREATMENT OF PATIENTS WITH DEGENERATIVE STENOSIS

OF THE LUMBAR AND SACRAL SPINE

(REVIEW ARTICLE)

© T.I. TAMAEV1, S.V. VISSARIONOV3, V.A. MANUKOVSKIJ1,2, V.V. SERIKOV1, I.S. AFANAS’EVA1

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

ABSTRACT.

INTRODUCTION. Spinal stenosis is a limited or diffuse pathological process of narrowing of the lumen of the spinal canal and intervertebral foramina due to degenerative changes in the bone, ligamentous and synovial elements of the lumbar spine, which over time leads to compression of the dural sac, spinal cord or nerve roots of the cauda equina, vascular elements and the development of neurological deficit.

PURPOSE OF ARTICLE. To highlight the modern vision of the problem of degenerative stenosis by analyzing the available literature data.

LITERATURE REVIEW. Literary sources on the main issues of epidemiology, pathogenesis, diagnosis and surgical treatment of degenerative stenosis are analyzed.

CONCLUSIONS. If the main issues of pathogenesis and diagnosis do not cause widespread debate in the world, then issues of surgical treatment continue to cause heated discussions and there are no generally accepted “gold standards”.

KEYWORDS: spine, degenerative stenosis, spondyloarthrosis, posterior spinal fusion, anterior spinal fusion, decompression, stabilization, TLIF, DLIF, ALIF, OLLIF, PLIF.

TO CITE THIS ARTICLE. Tamaev T.I., Vissarionov S.V., Manukovskij V.A., Serikov V.V., Afanas’eva I.S. Surgical treatment of patients with degenerative stenosis of the lumbar and sacral spine (review article) // The

Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3. P. 68–83

 

 

 

MINIMAL GASTROSTOMY THROUGH MINILAPAROTOMY IN A PALLIATIVE

PATIENT. A CLINICAL EXAMPLE OF IMPORT SUBSTITUTION

© M.V. GAVSHCHUK1,2, G.O. BAGATURIYA1, M.A. PROTCHENKOV1,2, A.A. PETROSYAN2,

F.M. SHERMATOV2

1 St. Petersburg State Pediatric Medical University, St. Petersburg, Russia

2 City hospital №26, Saint-Petersburg, Russia

ABSTRACT.

The organization of adequate nutrition is a vital component of palliative care, especially relevant in

patients with dysphagia 3-4 art. Puncture gastrostomy is considered to be the operation of choice for providing enteral nutrition for prolonged dysphagia, the availability of which is limited due to the need for imported disposable kits for installation. The article presents a clinical example of the successful application of import substituting gastrostomy technologies and demonstrates the long-term results of minimal gastrostomy through minilaparotomy, which can be considered as an alternative to puncture gastrostomy if it is impossible.

KEYWORDS: gastrostomy, minilaparotomy, import substitution, palliative care.

TO CITE THIS ARTICLE. Gavshchuk M.V., Bagaturiya G.O., Protchenkov M.A., Petrosyan A.A., Shermatov F.M. Minimal gastrostomy through minilaparotomy in a palliative patient. A clinical example of import substitution // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3. P. 84–89.

 

 

 

CASE OF TREATMENT OF A PATIENT WITH 1A TYPE CHOLEDOCH CYST IN

COMBINATION WITH A COMPLICATED CHOLEDOCHOLITHIASIS

© V.YE. SAVELLO 1,2, A.E. DEMKO 1,3, I.M. BATYRSHIN 1,3, T.A. SHUMAKOVA 1,2,

A.N. KOSTENIKOV1, A.V. MARCHENKO 1, D.A. NIKITIN 1, A.A. SOKOLOV 1.

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

2 Academician I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia

3 St. Petersburg, Russia Military Medical Academy n. a. S.M. Kirov, St. Petersburg, Russia

ABSTRACT

Choledoch cyst is a congenital dilatation of the extrahepatic bile ducts due to underdevelopment of the muscle layer. Delayed detection leads to appearance of difficulty and an increased risk of malignancy. The purpose of the work is to demonstrate the difficulty in MRI diagnosis of type 1A choledochal cyst in a patient with complicated choledocholithiasis. Presented a clinical case of a choledoch cyst with contradictory results of radiation diagnosis and surgical intervention is presented. This pathology according to MRI was not reliably detected due to the presence of another pathology of the biliary tract, which complicates the diagnosis — choledocholithiasis and a choledochoectasia.

KEYWORDS: MRI, choledoch cyst, endoscopic retrograde cholangiopancreatography,

papillosphincterotomy, lithotripsy.

TO CITE THIS ARTICLE Savello V.Ye., Demko A.E., Batyrshin I.M., Shumakova T.A., Kostenikov A.N., Marchenko A.V., Nikitin D.A., Sokolov A.A. Case of treatment of a patient with 1A type choledoch cyst in combitation with a complicated choledocholithiasis // The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023. N 3. P. 90–96.

 

 

 

RISK FACTORS FOR NON-UNION OF FEMORAL AND TIBIAL DIAPHYSEAL

FRACTURES IN MINIMALLY INVASIVE OSTEOSYNTHESIS

© A.V. BONDARENKO, R.G. GUSEJNOV, I.A. PLOTNIKOV, N.I. ZAVSEGOLOV

Regional State Budgetary Healthcare Institution “Regional Clinical Hospital of Emergency Medical Care”, Barnaul, Russia

ABSTRACT

Introduction. The most common causes of failure in the treatment of diaphyseal fractures are delayed consolidation and nonunion. The most significant factors are believed to be mechanical instability, impaired vascularization, and infection at the fracture site. Objective: to clarify the frequency, type, nature, risk factors for the development of diaphyseal nonunions of the long bones of the lower extremities when using minimally invasive osteosynthesis, to identify the most significant among them, to outline preventive measures. Material and methods: a retrospective analysis of medical records of 1411 patients with 1623 diaphyseal fractures of the femur and tibia was performed under conditions of minimally invasive osteosynthesis. Patients were evaluated

for adhesion 8 months after injury. When analyzing the results, the frequency, type and nature of nonunions in groups of patients were taken into account depending on the impact of various factors. Results. A total of 883 diaphyseal fractures of the femur and 740 of the tibia were noted in patients. After 8 months, the union of fractures did not occur in 162 (9.9 %). The frequency of nonunions in patients with isolated fractures and polytrauma, polysegmental, open and closed, simple and comminuted fractures, infections, and the degree of osteogenic activity of the regenerate were assessed. Conclusion. The main risk factors for nonunions in patients with minimally invasive osteosynthesis were the consequences of high-energy injuries with impaired fragment vascularization: polysegmental, open, comminuted fractures, infection. If there are risk factors, it is necessary to control the process of consolidation at the outpatient stage in order to correct the treatment process early.

KEYWORDS: nonunion of fractures, delayed consolidation, mechanical instability.

TO CITE THIS ARTICLE. Bondarenko AV, Gusejnov RG, Plotnikov IA, Zavsegolov NI. Risk factors, predictors of nonunion of femoral and tibial shaft fractures in minimally invasive osteosynthesis. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):99–104. (In Russ.). DOI: 10.54866/27129632_2023_4_99

 

 

 

RENAL REPLACEMENT THERAPY IN PATIENTS WITH POLYORGAN

DYSFUNCTION AND SEPSIS OF DIFFERENT GENESIS

© N.P. SHEN 1,2, N.S. NAZAROV 2, V.V. SHAPOVALOV 2, A.S. MININ 1,2

1 Tyumen State Medical University, Tyumen, Russia

2 Regional Clinical Hospital No. 1, Tyumen, Russia

ABSTRACT

The results of treatment of 88 patients with sepsis of different localization and etiology, in whom the triggers for starting renal replacement therapy were evaluated, are presented. A total of 119 procedures were performed. By analyzing a number of inflammatory and blood biochemistry parameters, it was found that the most significant triggers for initiating the procedure were indicators of inflammatory response (procalcitonin, C-reactive protein, and lactate) and renal function (glomerular filtration rate, urea, and creatinine), which correlated with and increased the likelihood of mortality. Only in 6,7 % of cases this technique was performed for so-called

“extrarenal” indications.

KEYWORDS: renal replacement therapy, sepsis, multiple organ failure, triggers, indications.

TO CITE THIS ARTICLE. Shen N.P., Nazarov N.S., Shapovalov V.V., Minin A.S. Renal replacement therapy in patients with multiple organ dysfunction and sepsis of various origins. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):105-113. (In Russ.). DOI: 10.54866/27129632_2023_4_105

 

 

 

PREVENTION AND TREATMENT OF MOTOR EVACUATION DYSFUNCTION

OF THE GASTROINTESTINAL TRACT IN SEVERELY BURNED PATIENTS

© A.D. FAYAZOV 1, A.I. AKHMEDOV 2

1 Republican Scientific Center of Emergency Medical Care, Tashkent, Uzbekistan

2 Samarkand State Medical University, Samarkand, Uzbekistan

ABSTRACT

Objective: to study disorders of the motor-evacuation function of the gastrointestinal tract in severely burned patients. Material and methods. In the burn department of the Samarkand City Medical Association in the period from 2020 to 2022 102 severely burned patients were observed and had impaired motor-evacuation function of the gastrointestinal tract. Results and discussion. Severe burns contributed to the development of disorders of the motor-evacuation function of the gastrointestinal tract in the form of gastroesophageal reflux, duodeno-gastric reflux and gastrostasis. Timely implementation of antisecretory preventive therapy enhances protective factors and prevents the development of impaired motor-evacuation function of the gastrointestinal tract in severely burned patients. From the point of view of pathogenesis, the faster the motor and evacuation

functions of the gastrointestinal tract are restored, the better blood circulation is in the mucous membranes and the less often gastroduodenal complications occur.

KEYWORDS: burn injury, burn disease, gastrointestinal complications, antisecretory therapy.

TO CITE THIS ARTICLE. Fayazov AD, Akhmedov AI. Prevention and treatment of motor evacuation dysfunction of the gastrointestinal tract in severely burned. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):114-118. (In Russ.). DOI: 10.54866/27129632_2023_4_114

 

 

 

THE ROLE OF MODERN WOUND COVERINGS IN LOCAL TREATMENT

OF SEVERELY BURNED PATIENTS

© A.D. FAYAZOV, D.A. RUZIMURATOV, U.R. KAMILOV, S.I. SHUKUROV

Republic Research Centre of Emergency Medicine, Tashkent, Republic of Uzbekistan

ABSTRACT

The article presents the data of recent literature devoted to the problem of local treatment of burn wounds. The authors consider the issues of modern tactics of local treatment of burn wounds with the use of various drugs and temporary wound coverings. They analyze patients with superficial and deep burns, in the treatment of which synthetic temporary wound coatings “ParaPran” and “Voskopran” with different variants were used. Application of temporary wound coatings allows to reduce the terms of the recovery process, achieving the main goal, early formation of granulation tissue, reduction of secondary inflammatory processes. The effectiveness of local treatment of burn wounds depends on the timely and correct choice of drugs depending on the phase of the wound process.

KEYWORDS: burns, wound dressings, necrectomy, osteonecrectomy, autodermoplasty.

TO CITE THIS ARTICLE. Fayazov AD, Ruzimuratov DA, Kamilov UR, Shukurov SI. The role of modern wound coverings in local treatment of severely burned. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):119-126. (In Russ.). DOI: 10.54866/27129632_2023_4_119

 

 

 

DYNAMICS OF INCIDENCE AND RESULTS OF TREATMENT

OF PERFORATED ULCERS OF THE STOMACH AND DUODEN IN ADULTS

IN EKATERINBURG IN 1986–2022

© V.A. KOZLOV 1, E.YU. LEVCHIK 1,2, A.V. STOLIN 1

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

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

RESUME

The dynamics of morbidity and postoperative mortality of patients operated on for perforated ulcers of the stomach and duodenum in Yekaterinburg in 1986–2022 were analyzed. In 1991-2000 in Yekaterinburg there was an increase in the incidence of perforated ulcers from 13,3 to 39.5 cases (per 100 thousand adult population); since 2001, the incidence has gradually decreased to 14,5 cases in 2022. At the same time, postoperative mortality of patients with perforated gastric and duodenal ulcers in Yekaterinburg increased from 4 % in 1996–2000, to 10–14,5 % in 2011–2022, which coincided with a change in the structure of types of surgical operations for perforated gastric and duodenal ulcers, with an absolute (more than 9/10) predominance of suturing/tamponade of perforated ulcers.

KEYWORDS: perforated ulcer of the stomach and duodenum, morbidity, surgical treatment, postoperative mortality.

TO CITE THIS ARTICLE. Kozlov VA, Levchik EYu, Stolin AV. Dynamics of Incidence and Re-

sults of Treatment of Perforated Ulcers of the Stomach and Duoden in adults in Ekaterinburg in 1986–2022. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):127-132. (In Russ.). DOI:

10.54866/27129632_2023_4_127

 

 

 

EXPERIENCE OF USING ULTRASONIC NAVIGATION IN ADULTS WHEN

PERFORMING MINIMALLY INVASIVE EMERGENCY NEUROSURGICAL

INTERVENTIONS ON THE BRAIN

© M.R. REZBAEV 1, V.A. MANUKOVSKIY 1, V.E. PARFENOV 1, K.N. BABICHEV 2,1

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

2 Kirov Military medical academy, St. Petersburg, Russia

ABSTRACT

The article presents the experience of using ultrasound through a post-trephination defect of the skull when performing emergency neurosurgical interventions. Examples of the use of real-time ultrasound navigation in emergency neurosurgical practice are given. The work reflects the accessibility and effectiveness of the method used by the authors.

KEYWORDS: u ltrasound navigation, craniotomy, traumatic brain injury, hydrocephalus, intracerebral abscess.

TO CITE THIS ARTICLE. Rezbaev M.R., Manukovskiy V.A., Parfenov V.E., Babichev K.N. Experience Of Using Ultrasonic Navigation In Adults When Performing Minimally Invasive Emergency Neurosurgical Interventions On The Brain. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):133-137.

(In Russ.). DOI: 10.54866/27129632_2023_4_133

 

 

 

SURGICAL TREATMENT OF GUNSHOT WOUND OF THE CERVICAL SPINE

USING MONOPORTAL ENDOSCOPIC TECHNIQUE

© M.I. SIDOR, M.N. KRAVTSOV, V.A. MANUKOVSKY, V.E. PARFENOV

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

ABSTRACT

Objective: to highlight the possibilities of endoscopic surgery in the treatment of gunshot wounds of the cervical spine. Material and methods. A clinical case of a gunshot penetrating blind wound of the cervical spine with an intravertebral foreign body in the spinal canal at the level of the CII vertebra is described. A minimally invasive endoscopic technique was used for sanation of the gunshot wound, foreign body extraction and revision of the epidural space. Results. A patient with a gunshot wound of the spine underwent removal of an injuring projectile from the epidural space at the level of the CII vertebra, revision of the epidural space using a monoportal endoscopic technique in a liquid medium through the entrance hole of the gunshot wound. The postoperative period was without complications. The patient was activated on the second day.

KEYWORDS: full-endoscopic spine surgery, gunshot wound of the spine, cervical spine, minimally invasive surgery.

TO CITE THIS ARTICLE. Sidor MI, Kravtsov MN, Manukovsky VA, Parfenov VE. Surgical Treatment of Gunshot Wound of the Cervical Spine Using Monoportal Endoscopic Technique. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):138-144. (In Russ.). DOI: 10.54866/27129632_2023_4_138

 

 

 

BIORESORBABLE PINS FOR INTRAMEDULLARY RIB OSTEOSYNTHESIS

IN A PATIENT WITH CLOSED CHEST TRAUMA WITH RIB CAGE

DISRUPTION: A CASE REPORT

© M.V. ISAEV 1, B.A. MAYOROV 2,3,4, I.G. BELENKIY 2,3, G.D. SERGEEV 2,3, A.N. TULUPOV 2

1 Interdistrict clinical hospital of Gatchina, Gatchina, Leningrad region, Russia

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

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

Rationale. In modern publications, researchers describe in detail the advantages of surgical treatment of multiple rib fractures with flail chest over conservative treatment. Surgeons use plates and intramedullary fixators for rib osteosynthesis. The use of bioresorbable intramedullary implants can be a promising direction of development of the surgery of rib cage injuries.

OBJECTIVE: to describe the application of bioresorbable pins made of polylactic and polyglycolic acids for intramedullary osteosynthesis of ribs in closed chest trauma with rib cage disruption.

CASE REPORT: a 55-year-old patient was admitted to the hospital due to severe combined trauma to the chest and abdomen, fractures of II-IX ribs on the right side with flail chest, and contusion of the right kidney. Osteosynthesis of four ribs was performed to stabilize the patient’s condition and prevent respiratory complications. Bioresorbable intramedullary pins were used for fixation of three (III, V, VII) ribs, and wire suture was used for one (II) rib. Postoperative period was uneventful. Drainage of the pleural cavity was being conducted for 8 days after the surgery. The patient was discharged for outpatient treatment 13 days after the admission. Discussion. Several studies demonstrate within mathematical models the insufficient stiffness of intramedullary pins to provide stable fixation of rib fractures. Nevertheless, in the presented clinical case, a good early and mid-term results were obtained after performing rib osteosynthesis using the studied technique. Its application provided fast restoration of the rib cage, short terms of the patient’s stay on ventilation and oxygen support, short length of hospital stay, and allowed to avoid postoperative complications. The properties of bioresorbable pins determine a number of their advantages over metal implants in fixation of simple rib fractures. This suggests that further study of the described technique is promising. Conclusion. Bioresorbable intramedullary pins can be used in patients with multiple rib fractures and flail chest. This minimally invasive method of fixation of rib cage injuries provides sufficient stability, does not require implant removal, and can be performed in level 2 trauma centers.

KEYWORDS: rib fracture, rib osteosynthesis, flail chest, polytrauma, bioresorbable implants.

TO CITE THIS ARTICLE. Isaev MV, Mayorov BA, Belenkiy IG, Sergeev GD, Tulupov AN. Bioresorbable Pins for Intramedullary Rib Osteosynthesis in a Patient with Closed Chest Trauma with Rib Cage Disruption: a CASE REPORT. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):145-153. (In Russ.).

 

 

 

RADIOLOGY DIAGNOSTICS OF REPHARYNGEAL AND PERITONZILLAR

ABSCESSES CASES AND THEIR COMPLICATIONS

© A.N. KOSTENIKOV1, V.E. SAVELLO1, E.S. KONSTANTINOVA2, T.A. SHUMAKOVA1,

I.S. AFANASEVA1, A.S. KAZANKIN1, V.V. SERIKOV1

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

2 Saint-Petersburg City Hospital of the Holy Great Martyr George, 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

Retropharyngeal and peritonsillar abscesses have a similar clinical picture, but different ways of spreading the purulent process. In a multidisciplinary hospital, concomitant pathology and the general severity of the condition may mask the main purulent focus in the deep spaces of the neck, and clinically complications of the underlying disease come to the fore. The purpose of the work is to demonstrate cases of complications of retropharyngeal and peritonsillar abscesses, and the effectiveness of computed tomography (CT) in their detection. Two clinical observations of patients with different directions of spread and manifestation of this pathology are presented, CT signs of the disease and treatment tactics are considered. According to the authors, computed tomography demonstrates high effectiveness in identifying peritonsillar and retropharyngeal abscesses and their complications. Clinical specialists of various profiles should be aware of the possible complications of this pathology and promptly prescribe a computed tomography scan of the neck.

KEYWORDS: retropharyngeal abscess, peritonsillar abscess, deep neck infections, spread of peritonsillar and retropharyngeal abscesse

TO CITE THIS ARTICLE. Kostenikov AN, Savello VE, Konstantinova ES, Sumakova TA, Afanaseva IS, Kazankin AS, Serikov VV. Radiology Diagnostics of Repharyngeal and Peritonzillar Abscesses Cases and Their Complications. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2023;(4):154-163. (In Russ.).

 

 

 

CACE REPORT OF A PATIENT WITH AN ETHMOIDAL ARTERIOVENOUS

FISTULA COMPLICATED BY INTRACEREBRAL HEMORRHAGE. FEATURES

OF DIAGNOSIS AND TREATMENT

© A.A. TSIBIROV 1, K.N. BABICHEV 2,1, D.V. KANDYBА3, I.SH. KARABAEV1, A.A. PALIKOVSKY 1,

D.V. SAVITSKII1

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

2 Kirov Military Medical Academy, St. Petersburg, Russia

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

ABSTRACT

Ethmoidal dural arteriovenous fistula is special case among other dural arteriovenous malformations (up to 5 % of the total number of all dural arteriovenous fistulas), which due to venous drainage and severe venous hypertension, usually determine an unfavorable disease scenario. A complete diagnosis of DAVF is only possible using angiography with separate catheterization of the external and internal carotid arteries. Indications for surgical treatment are symptomatic cases and drainage into the system of cortical veins. The treatment issue of ethmoidal DAVFs is usially decided individually. Endovascular treatment is minimally invasive, but not always 100 % effective; open surgical treatment considered as more effective. Preoperative assessment and careful management of the frontal sinus is important when open surgery is performed.

KEYWORDS: arteriovenous malformation, ethmoidal arteriovenous fistula, hemorrhagic stroke, intrace rebral hemorrhage.

TO CITE THIS ARTICLE. Tsibirov AA, Babichev KN, Kandybа DV, Karabaev ISh, Palikovsky AA, Savitskii DV. Cace report of a patient with an ethmoidal arteriovenous fistula complicated by intracerebral hemorrhage. Features of diagnosis and treatment. The Journal of Emergency Surgery named after I.I. Dzhanelidze.

2023;(4):164-174. (In Russ.). DOI: 10.54866/27129632_2023_4_164

 

 

 

MODERN APPROACHES TO OBTURATION OF UNFORMED FISTULAS

OF THE SMALL INTESTINE (CLINICAL LECTURE)

© E.YU. LEVCHIK 1,4, K.V. ATAMANOV 2, A.E. DEMKO 3

1 Ural State Medical University, Yekaterinburg, Russia

2 Novosibirsk State Medical University, Novosibirsk, Russia

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

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

RESUME

The clinical lecture, based on own many years of experience in the staged treatment of external fistulas of the small intestine, describes modern ideas about the possibilities and limitations of obturation of unformed small intestinal fistulas, including those opening into eventration wounds of the abdominal wall. The main points of the lecture are illustrated with examples from the authors’ own clinical observations.

KEYWORDS: small intestine, external intestinal fistulas, staged treatment, obturation.

TO CITE THIS ARTICLE. Levchik EYu, Atamanov KV, Demko AE. Modern Approaches to Obturation of Unformed Fistulas of the Small Intestine (Clinical Lecture). The Journal of Emergency Surgery named

after I.I. Dzhanelidze. 2023;(4):175-189. (In Russ.). DOI: 10.54866/27129632_2023_4_175

№2 2023

RESULTS OF TREATMENT FOR A PERFORMED ULCER OF THE STOMACH AND DUODENAL IN EKATERINBURG IN 2019 AND SOME FACTORS THAT INFLUENCED THEM

Authors

V.A. KOZLOV 1, E.Yu. LEVCHIK1,2, A.V. STOLIN1

1 Ural State Medical University of the Ministry of Health of Russia, Ekaterinburg, Russia

2 Sverdlovsk Regional Clinical Psychoneurological Hospital for War Veterans of the Ministry of Health of the Sverdlovsk Region, Yekaterinburg, Russia

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SUMMARY:The results of treatment of 204 patients admitted to medical organizations in Yekaterinburg with perforated ulcers of the stomach (43) and duodenum (161) in 2019 are presented. 36 (17.6%) died, 8 with gastric ulcers, 28 duodenal ulcers. In total, 201 (98.5%) of 204 patients were operated on, 34 (16.9%) died, 8 with perforated gastric ulcers, 26 with duodenal ulcers. When analyzing the factors that influenced hospital mortality of patients, it was revealed that its increase was more significantly influenced by late admission than the age of patients over 70 years. In 93.5% of patients, suturing/tamponade of perforated ulcers of the stomach and duodenum was performed, which determined postoperative mortality in the group. When analyzing the dynamics of postoperative mortality of patients for 1996–2019. noted its strong direct connection with an increase in the proportion of suturing/tamponade of perforated ulcers of the stomach and duodenum.

KEYWORDS:perforated ulcer of the stomach and duodenum, surgical treatment, results.

HOW TO QUOTE:Kozlov V.A., Levchik E.Yu., Stolin A.V. Results of treatment of perforated gastric and duodenal ulcers in Yekaterinburg in 2019 and some factors that influenced them // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 5–9


 

WAYS TO REDUCE THE FREQUENCY OF PURULENT-SEPTIC COMPLICATIONS OF BURN DISEASE

Authors

D.B. TULYAGANOV, A.D. FAYAZOV, U.R. KAMILOV, D.A. RUZIMURATOV

Republican Scientific Center for Emergency Medical Care, Tashkent, Republic of Uzbekistan

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SUMMARY:A retrospective analysis of the results of treatment of severely burned patients with extensive and deep burns was carried out, who underwent early surgical interventions using temporary wound coverings and traditional treatment in the postoperative period, salicylic acid ointment with chemical necrectomy. When using active surgical tactics, closing postoperative wound defects with temporary wound coverings, there is a tendency to reduce the frequency of purulent-septic complications of burn disease, the time required to prepare deep burns for autodermoplasty and the complete restoration of the integrity of the skin is reduced.

KEYWORDS:burns, temporary wound coverings, surgical treatment, necrectomy, autodermoplasty.

HOW TO QUOTE:Tulyaganov D.B., Fayazov A.D., Kamilov U.R., Ruzimuratov D.A. Ways to reduce the frequency of purulent-septic complications of burn disease // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 10–15


 

OPTIMIZATION OF TREATMENT OF SEVERE COMBINED TRAUMA

Authors

A.V. NIKITIN, V.A. MANUKOVSKY, A.N. TULUPOV, L.P. PIVOVAROVA, M.I. GROMOV, A.E. DEMKO, Y.V. GAVRISCHUK, A.A. ESENOKOV

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

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SUMMARY:The article describes a developed, tested and patented method for treating polytrauma by intramuscular injection of 75 mg of sodium deoxyribonucleate (Derinat) from days 1 to 10. It has been established that this contributes to an earlier restoration of the level of total protein and hemoglobin in the blood, activation of the entry into the blood of stem cells and neutrophil granulocytes armed with antimicrobial peptides. The method made it possible to reduce the number of complications by 1.8 times and the duration of treatment for victims by 6.8 days.

KEYWORDS:combined trauma, polytrauma, traumatic shock, anemia, hypoproteinemia, immunodeficiency, erythropoiesis, sodium deoxyribonucleate, immunomodulators.

HOW TO QUOTE:Nikitin A.V., Manukovsky V.A., Tulupov A.N., Pivovarova L.P., Gromov M.I., Demko A.E., Gavrishchuk Ya.V., Yesenokov A.A. Optimization of treatment of severe combined trauma // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 16–23


 

DIFFICULTIES IN DIAGNOSIS OF NECROTIZING SOFT TISSUE INFECTIONS IN A MULTIDISCIPLINARY HOSPITAL

Authors

D.S. SKLIZKOV1, S.A. SHLYAPNIKOV1, I.M. BATYRSHIN1, N.R. NASER1,2, Y.S. OSTROUMOVA1, D.V. FOMIN1, A.A SHUMEYKO1

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

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

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SUMMARY:Necrotizing soft tissue infection is a nonspecific infection of bacterial etiology that can affect all layers of soft tissue. It manifests itself as rapidly progressive necrosis, characterized by severe intoxication and high mortality. Early diagnosis of NSTI is difficult, since the initial skin changes are indistinguishable from those of simple superficial infections, and may also be similar to a number of pathologies of non-infectious origin. Delayed diagnosis leads to increased mortality in patients with this pathology.

KEYWORDS:necrotizing soft tissue infection, timely diagnosis, high mortality.

HOW TO QUOTE:Sklizkov D.S., Shlyapnikov S.A., Batyrshin I.M., Nasser N.R., Ostroumova Yu.S., Fomin D.V. Shumeiko A.A. Difficulties in diagnosing necrotizing soft tissue infections in a multidisciplinary hospital // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 24–30


 

A NEW METHOD FOR DETERMINING THE VOLUME OF OPERATIVE BLOOD LOSS IN PATIENTS WITH DEEP BURNS

Authors

E.V. ZINOVIEV1,2, D.O. WAGNER1,3, A.E. CHUKHAREV1,3

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

2 St. Petersburg State Pediatric Medical University of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

3 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

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Rationale:Most manuals on combustiology indicate that when excision of a burn eschar over an area of ​​1 cm2 with simultaneous skin grafting, the blood loss, taking into account donor wounds, is about 1 ml. This amount of estimated blood loss plays a significant role in planning surgical treatment of burned patients. To date, given the volume of blood lost, calculated using existing methods for determining intraoperative blood loss, it is not recommended to excise necrotic tissue over an area of ​​more than 15% of the body area.

Purpose of the study:development of a new method for determining intraoperative blood loss during surgical treatment of burn victims.

Material and methods:During the study, we developed and proposed our own, original method for determining the volume of intraoperative blood loss, based on taking into account hemoglobin and hematocrit indicators, as well as a differentiated calculation of the volume of circulating blood. This technique was tested on 109 victims with deep burns of II–III degree. (ICD-10), admitted to the department of thermal injuries in the period from January 2022 to December 2022. The data obtained were processed using Microsoft Office Excel 2007, as well as generally accepted methods of nonparametric statistics. Results. Having obtained the results using the new formula, we determined that 1 cm2 of excised tissue accounts for 0.52 ml of blood loss, which is 2 times less than predicted by traditional methods.

Conclusion:Based on the data obtained, the expected intraoperative blood loss may not be 1 ml/1cm2, as currently prescribed in clinical recommendations, but 0.5 ml/1cm2 of excised tissue. The data obtained allow us to think about the possible expansion of burn eschar removal before the development of infectious complications.

KEYWORDS:burns, burn disease, bleeding, volume of blood loss, necrectomy, calculation of blood loss.

HOW TO QUOTE:Zinoviev E.V., Vagner D.O., Chukharev A.E. A new method for determining the volume of surgical blood loss in victims with deep burns // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 31–35


 

PAIN RELIEF FOR SHOKOGENIC TRAUMA AND ACUTE BLOOD LOSS

Authors

V.N. LAPSHIN1,2, A.F. KOTLYARSKY1, V.S. AFONCHIKOV1,3, V.Yu. TINCHURIN1, T.V. SOKOLOVA1, N.A. RYMALIS1, N.A. SUKHOTINA1, H. BEJAOUI1, I.V. STRAKHOV1, I.YU. PETROV1, N.K. RAZUMOVA1

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

2 First St. Petersburg State Medical University named after. acad. I.P. Pavlova Ministry of Health of Russia, St. Petersburg, Russia

3 St. Petersburg State University, St. Petersburg, Russia

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SUMMARY: In addition to the main pathological processes (acute blood loss, dysfunction of damaged organs, fat embolism and traumatic toxicosis), which determine the functional response of the body to mechanical damage, pain syndrome is considered as a factor that mobilizes and depletes adaptation reactions, which are realized through the hypothalamic-pituitary-adrenal and sympathoadrenal systems. An effective component of anti-shock measures is surgery, which in most cases is performed under anesthesia for emergency indications in the acute period of a traumatic illness in conditions of circulatory and hemic hypoxia. Adequate pain relief, along with artificial ventilation and thoughtful infusion and drug provision, is an essential part of the pathogenetic therapy of traumatic shock and its consequences. Over a fairly long period of studying traumatic shock and treating victims with mechanical injuries at the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze managed to significantly reduce hospital mortality, including through optimizing the approach to providing anti-shock care, a component of which is resuscitation and anesthesia.

KEYWORDS:hospital stage, shockogenic injury, traumatic disease, anesthesia.

HOW TO QUOTE:Lapshin V.N., Kotlyarsky A.F., Afonchikov V.S., Tinchurin V.Yu., Sokolova T.V., Rymalis N.A., Sukhotina N.A., Bezhaoui H., Strakhov I.V. ., Petrov I.Yu., Razumova N.K. Anesthesia for shockogenic trauma and acute blood loss // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 36–42


 

COMPARATIVE ANALYSIS OF THE IMMEDIATE AND LONG-TERM RESULTS OF SURGICAL AND DRUG METHODS FOR SECONDARY PREVENTION OF ISCHEMIC STROKE IN SYMPTOMIC OCCLUSION OF THE INTERNAL CAROTID ARTERY

Authors

M.R. REZBAEV1, V.A. MANUKOVSKY1, V.E. PARFENOV1, A.S. BELYASNIK1,
A.N. KOSTENNIKOV1, K.N. TYULIKOV1, K.N. BABICHEV2,1

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

2 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

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Purpose of the study:comparison of immediate and long-term results of surgical and medical methods of secondary prevention of ischemic stroke in symptomatic ICA occlusion.

Materials and methods:A retrospective analysis of the results of treatment of patients with acute stroke who were treated at the Research Institute of Emergency Medicine named after. I.I. Janelidze since 2011. Patients were divided into two groups: surgical treatment (n = 56) and conservative therapy (n = 96). The criteria for surgical intervention were: occlusion of one ICA with a proven significant decrease in cerebral perfusion based on CT perfusion data; initial functional status according to mRs 1–2 points and the presence of a superficial temporal artery of suitable diameter (more than 1 mm) on the side of the intended anastomosis.

Results:Both groups were comparable to each other in terms of patient age, initial neurological deficit and the nature of concomitant pathology. The performed surgical intervention made it possible to prevent recurrent ischemic manifestations in the most critical 30 days after the primary event and reduce the likelihood of stroke after 12 months in comparison with the group of patients receiving drug therapy.

Conclusions:The effectiveness of surgical prevention of recurrent ischemic stroke by forming a vascular microanastomosis between the branch of the superficial temporal artery and the branch of the middle cerebral artery (MCA) in patients with symptomatic occlusion of the internal carotid artery in the first 3 weeks after the onset of acute cerebrovascular accident (ACVA) has been demonstrated, with strict adherence to the selection criteria .

KEYWORDS:EICMA, ICA occlusion, ischemic stroke.

HOW TO QUOTE:Rezbaev M.R., Manukovsky V.A., Pafenov V.E., Belyasnik A.S., Kostennikov A.N., Tyulikov K.N., Babichev K.N. Comparative analysis of the immediate and long-term results of surgical and medical methods of secondary prevention of ischemic stroke in symptomatic occlusion of the internal carotid artery // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 43–48


 

RESULT OF SURGICAL TREATMENT OF A PATIENT WITH A COMPLANT INTRA-ARTICULAR TIBIAL PLATEAU FRACTURE

Authors

B.A. MAYOROV1,2,3, I.G. BELENKY1,2, G.D. SERGEEV1,2

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

2 St. Petersburg State University, St. Petersburg, Russia

3 Vsevolozhsk Clinical Interdistrict Hospital, Vsevolozhsk, Leningrad Region, Russia

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SUMMARY:Treatment of high-energy tibial plateau fractures is one of the most challenging tasks in modern traumatology. When osteosynthesising such fractures, it is often quite difficult to perform anatomical reduction and stable fixation of articular fragments. The desire to achieve them leads to excessive trauma to soft tissues and serious complications. Purpose of the study: to show the method of preoperative planning and performance of osteosynthesis surgery for a complete intra-articular comminuted fracture of the tibial plateau. A clinical example of the treatment of a patient with a comminuted fracture of the right tibial plateau 41C3.3 according to the AO classification is presented. The final osteosynthesis is performed through two surgical approaches: reverse L-shaped posteromedial and anterolateral, slightly extended posteriorly. Restoration of the anatomy of the articular surface has been achieved. 2 years after the injury, the functional result was considered good and amounted to 94 points on the Lysholm scale and 95 points on the KSS scale. Control radiographs did not reveal secondary displacement of fragments, loss of reduction or migration of implants.

Conclusion:High-quality surgical treatment of complex tibial plateau fractures is impossible without careful preoperative planning, good knowledge of the surgical anatomy of the damaged area and surgical approaches.

KEYWORDS:tibial fracture, plateau fracture, comminuted fracture, bone osteosynthesis, surgical approaches.

HOW TO QUOTE:Mayorov B.A., Belenkiy I.G., Sergeev G.D. The result of surgical treatment of a patient with a comminuted intra-articular fracture of the tibial plateau // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 49–55


 

EXTRAANATOMIC SURGICAL TREATMENT OF INFECTION OF BIFURCATION AORTIC VASCULAR PROSthesis USING CAPID ARTERIES

Authors

I.A KHOMCHUK, A.B. KURILOV, S.A. PLATONOV, S.V. ORDYNETS, O.N. REZNIK, K.N. FOMIN, A.I. TOMCHENKO, R.L. SHAHNAZARYAN, V.S. DAINEKO

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

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SUMMARY:Approaches to the treatment of infection of vascular prostheses and modern types of surgical operations are described, depending on the degree of infection. Options for using allografts to replace an infected artificial prosthesis are considered.

KEY WORDS: artificial prosthesis, synthetic prosthesis infection, allograft, cadaveric aorta.

HOW TO QUOTE:Khomchuk I.A., Kurilov A.B., Platonov S.A., Ordynets S.V., Reznik O.N., Fomin K.N., Tomchenko A.I., Shakhnazaryan R.L., Daineko V. WITH. Extra-anatomical surgical treatment of infection of the bifurcation aortic vascular prosthesis using cadaveric arteries // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 56–61


 

NON-ANEURYSMATIC RUPTURE OF THE ABDOMINAL AORTA IN PATIENTS WITH PENETRATING ULCERS

Authors

K.A. ANDREYCHUK1,2,3, N.N. ANDREYCHUK1,2, V.E. SAVELLO1,2, G.Yu. SOKURENKO2,3

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

2 First St. Petersburg State Medical University named after. acad. I.P. Pavlova Ministry of Health of Russia, St. Petersburg, Russia

3 All-Russian Center for Emergency and Radiation Medicine named after. A.M. Nikiforova EMERCOM of Russia, St. Petersburg, Russia

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SUMMARY:Nonaneurysmal aortic rupture is a violation of the integrity of the vessel wall that does not have signs of aneurysmal dilatation, and in most cases is associated with the progression of a penetrating aortic ulcer. Reports regarding the diagnosis and treatment of this disease in patients with abdominal aortic lesions are few. Timely identification of signs of destructive damage to the aortic wall based on the results of the use of radiological diagnostic methods and the correct interpretation of these results are a key aspect that determines effective treatment tactics. The purpose of the work is to demonstrate the effectiveness of radiological diagnostic methods in identifying non-aneurysmal aortic ruptures in patients with penetrating ulcers. Two clinical observations of patients with different clinical and radiation manifestations of this pathology are presented, radiological and ultrasound signs of the disease and treatment tactics are considered. According to the authors, radiation diagnostic methods demonstrate high efficiency in detecting rupture of the vessel wall. However, correct interpretation of the results requires an understanding of the nature of the identified pathological process, the stages of its development and the features of the natural course of the disease.

KEYWORDS:penetrating aortic ulcer, abdominal aorta, emergency diagnosis.

HOW TO QUOTE: Andreychuk K.A., Andreychuk N.N., Savello V.E., Sokurenko G.Yu. Non-aneurysmal rupture of the abdominal aorta in patients with a penetrating ulcer // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 62–67


 

PROFESSIONAL DEFORMATIONS AND DESTRUCTION OF PERSONALITY OF MEDICAL STAFF: INEVITABILITY AND OVERCOMING

Authors

E.S. REGENTOVA, A.V. Konyukyuv, A.L. SMIRNOVA

Center for Postgraduate Education of Medical Specialists, St. Petersburg, Russia

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SUMMARY:This article is devoted to an important aspect of psychological and correctional work: providing psychological assistance to employees of medical institutions with pronounced signs of professional deformations (destructions). The article covers an analysis of the nature, essence, content and specificity of professional deformations and professional destruction; Features of diagnosis and assistance to medical specialists with severe symptoms of professional destruction.

KEYWORDS:professional deformations, professional destruction, activities of medical specialists, prevention, overcoming.

HOW TO QUOTE:Regentova E.S., Konyukov A.V., Smirnova A.L. Professional deformations and personality destruction of medical personnel: inevitability and overcoming // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2023. No. 2 (11). pp. 68–75

№1 2023


 

DISEASES OF THE WORMIC APPEAL. EXPERIENCE OF A CITY MULTI-SPECIALIZED HOSPITAL IN THE PRE-COVID PERIOD

Authors

O.V. LISOVSKY1, M.A. PROTCHENKOV1,2, A.A. PETROSYAN2, R.F. ASANBEKOV2, A.S. SHUKAN1, T.A. NIKOLSKAYA1

1 St. Petersburg State Pediatric Medical University, St. Petersburg, Russia

2 City Hospital No. 26, St. Petersburg, Russia

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Introduction:Analysis of cases of medical care for diseases of the appendix allows us to evaluate the effectiveness of the emergency surgical service of the hospital.

Purpose of the study: To analyze the interventions performed for diseases of the appendix, the results of a morphological study of removed vermiform appendices and the timing of hospital treatment of patients.

Materials and methods: Cases of medical care provided to patients with appendix diseases in St. Petersburg City Hospital No. 26 for 2019 are analyzed. Electronic medical records of patients discharged in 2019 who underwent appendectomy were selected from the hospital information system.

Results:614 appendectomies were performed in patients aged from 18 to 93 years, average age - 35.7±14.86 years. The duration of inpatient treatment ranged from 1 to 44 days, with an average of 5.4±3.87 bed days. Morphological examination verified gangrenous appendicitis in 53 (8.6%) cases, phlegmonous appendicitis in 466 (75.9%) cases, and catarrhal appendicitis in 52 (8.5%) cases. The majority (85.8%) of patients underwent laparoscopic appendectomy. Morphological changes in the appendix did not have an independent effect on the duration of hospitalization. In the absence of peritonitis, septic complications and other things being equal, the duration of hospital treatment correlated with the traumatic nature of the operation. Minimally invasive laparoscopic operations were associated with the shortest duration of hospital treatment (p < 0.05), on average 4.3 ± 1.80 bed days.

Conclusions:1. The predominance of phlegmonous and catarrhal forms of inflammation of the appendix and the effectiveness of laparoscopic approaches confirm the feasibility of this method as the operation of choice in patients with clinical signs of appendicitis. 2. Conversion of laparoscopic access to laparotomy during surgical intervention increases the duration of hospitalization and reduces the cost-effectiveness of treatment of patients with acute appendicitis.

KEYWORDS: appendicitis, appendectomy, duration of hospitalization.

HOW TO QUOTE:Lisovsky O.V., Protchenkov M.A., Petrosyan A.A., Asanbekov R.F., Shukan A.S., Nikolskaya T.A. Diseases of the appendix. Experience of a city multidisciplinary hospital in the pre-Covid period. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1. P. 19-23


 

PAIN RELIEF FOR SHOKOGENIC TRAUMA AND ACUTE BLOOD LOSS

Authors

V.N. LAPSHIN1,2, A.F. KOTLYARSKY1, V.S. AFONCHIKOV1,3, T.V. SOKOLOVA1, N.A. SUKHOTINA1,
H. BEJAOUI1, V.Yu. TINCHURIN1, D.V. SHALAMOV1, I.V. STRAKHOV1, I.Yu. PETROV1, N.K. RAZUMOVA1

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

2 First St. Petersburg State Medical University named after. acad. I.P. Pavlova Ministry of Health of Russia, St. Petersburg, Russia

3 St. Petersburg State University, St. Petersburg, Russia

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SUMMARY:In addition to the main pathological processes (acute blood loss, dysfunction of damaged organs, fat embolism and traumatic toxicosis), which determine the functional response of the body to mechanical damage, pain syndrome is considered as a factor that mobilizes and depletes adaptation reactions, which are realized through the hypothalamic-pituitary-adrenal and sympatho-adrenal systems An effective component of anti-shock measures is surgery, which in most cases is performed under anesthesia for emergency indications in the acute period of a traumatic illness in conditions of circulatory and hemic hypoxia. Adequate pain relief, along with artificial ventilation and thoughtful infusion and drug provision, is an essential part of the pathogenetic therapy of traumatic shock and its consequences. Over a fairly long period of studying traumatic shock and treating victims with mechanical injuries at the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze managed to significantly reduce hospital mortality, including through optimizing the approach to providing anti-shock care, a component of which is resuscitation and anesthesia.

KEYWORDS: hospital stage, shockogenic injury, traumatic disease, anesthesia.

HOW TO QUOTE: Lapshin V.N., Kotlyarsky A.F., Afonchikov V.S., Sokolova T.V., Sukhotina N.A., Bezhaoui H., Tinchurin V.Yu., Shalamov D.V., Strakhov I. V., Petrov I.Yu., Razumova N.K. Pain relief for shockogenic trauma and acute blood loss. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1. P. 24-30.


 

ANALYSIS OF THE FEATURES OF THE COURSE OF BURN INJURY TAKEN INTO ACCOUNT THE VALUE OF THE INDEX OF SEVERITY OF LESIONS

Authors

E.V. ZINOVIEV1,2, V.A. MANUKOVSKY1 ., O.O. ZAVOROTNIY1,3,D. V. KOSTYAKOV1

1 State budgetary institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze"

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

3 Federal State Budgetary Educational Institution of Higher Education "St. Petersburg State University"

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Relevance: In the Russian Federation, specialists at burn centers use a number of prognostic scales to determine the prognosis of the course and outcomes of burn disease. The most common scales are the Baux rule, the Frank index, and the modified lesion severity index. Despite the prevalence and widespread use of these prediction methods, these scales are of questionable effectiveness, since the survival prognosis is based directly on the indicators of age, depth and area of ​​the burn, excluding the pathophysiological features of the burn disease.

Purpose of the study:To analyze the features of the course of burn injury, taking into account the value of the lesion severity index.

Materials and methods:A retrospective analysis of the dynamics of 48 laboratory parameters and 19 results of instrumental research methods was carried out on the first day of admission to the department of thermal injuries of the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze 330 burned people from 18 to 91 years old with an area of ​​superficial burns from 20% b.t. and deep burns from 10% of the body weight, divided into three groups taking into account the value of the lesion severity index and delay in providing medical care.

Results:The data obtained in groups of patients, taking into account the value of the injury severity index and delay in providing medical care, do not allow us to compose a general set of factors that fully reflect the clinical picture of a burn disease, since each degree of severity of burn shock and delay is characterized by a certain set of anamnestic data, laboratory and instrumental parameters diagnostics In this connection, it is advisable to search for a new method of forecasting, taking into account the dynamics of laboratory and instrumental parameters.

KEYWORDS:lesion severity index, prognosis, skin burn, burn disease, death

HOW TO QUOTE:Zinoviev E.V., Manukovsky V.A., Zavorotniy O.O., Kostyakov D.V. Analysis of the characteristics of the course of burn injury, taking into account the value of the lesion severity index. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1 (10). pp. 32–39.


 

POSSIBILITIES OF COMPUTER AND MAGNETIC RESONANCE TOMOGRAPHY IN THE DIAGNOSTICS OF NON-SPECIFIC PURENTIC-INFLAMMATORY DISEASES OF THE SPINE IN THE DEPARTMENT OF EMERGENCY MEDICAL CARE

Authors

I.S. Afanasieva, V.E. SAVELLO, T.A. SHUMAKOVA, V.V. SERIKOV, A.S. KAZANKIN, T.I. TAMAEV, Yu.V. BELYAKOV

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

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SUMMARY:The article presents the results of radiation and clinical laboratory examination of 150 patients admitted to the emergency department of the St. Petersburg Research Institute of Emergency Medicine named after. I.I. Janelidze in the period from 2014 to 2022. with nonspecific purulent-inflammatory diseases of the spine (NPISD). The issues of diagnostic significance and priority of using radiological diagnostic methods depending on the localization of the pathological process in the spine at the stage of emergency medical care are analyzed.

KEYWORDS:computed tomography, magnetic resonance imaging, spondylodiscitis, nonspecific purulent-inflammatory diseases of the spine.

HOW TO QUOTE:Afanasyeva I.S., Savello V.E., Shumakova T.A., Serikov V.V., Kazankin A.S., Tamaev T.I., Belyakov Yu.V. Possibilities of computed tomography and magnetic resonance imaging in the diagnosis of nonspecific purulent-inflammatory diseases of the spine in the emergency department. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1. P. 40-47


 

ENDOSCOPIC SURGICAL TREATMENT OF GUNSHOT BLIND NON-PENETRATING WOUND OF THE LUMBAR SPINE

Authors

V.A. MANUKOVSKY, M.N. KRAVTSOV, M.I. SIDOR, K.V. TYULIKOV, T.I. TAMAEV, V.E. PARFENOV

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

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TARGET:To demonstrate the capabilities and effectiveness of endoscopic surgery in the treatment of gunshot wounds of the lumbar spine.

METHODS:A clinical case of a gunshot blind non-penetrating wound of the lumbar spine is described. A minimally invasive endoscopic technique was used to sanitize the gunshot wound and remove the bullet.

RESULTS:A victim with a gunshot wound to the spine underwent removal of a foreign body (bullet) from the iliopsoas muscle using a single-portal fully endoscopic technique through the entrance hole of the gunshot wound. The postoperative period was without complications. The patient was activated on the second day. KEY WORDS: fully endoscopic surgery, gunshot wounds of the spine, lumbar spine, minimally invasive surgery.

HOW TO QUOTE:Manukovsky V.A., Kravtsov M.N., Sidor M.I., Tyulikov K.V., Tamaev T.I., Parfenov V.E. Endoscopic surgical treatment of a gunshot blind non-penetrating wound of the lumbar spine. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1. P.48-52

KEYWORDS:fully endoscopic surgery, gunshot wounds of the spine, lumbar spine, minimally invasive surgery.


 

A CASE OF SUCCESSFUL USE OF ENDOSCOPIC VACUUM THERAPY IN THE TREATMENT OF ESOPHAGUS WALL SUTURE FAILURE AFTER SURGICAL TREATMENT OF BOERHAAVE SYNDROME

Authors

A.A. ZAVRAZHNOV1,2,3, I.A. SOLOVIEV1,2,3, A.A. OGLOBLIN 2,3, O.Yu. BOSCO3, D.V. LUCHININA 3, M.V. ANTIPOVA 2,3, D.S. RUSANOV2,3, Sh.D. MAMEDOV.2,3

1 Federal State Budgetary Military Educational Institution of Higher Education Military Medical Academy named after S.M. Kirov.

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

3 State budgetary healthcare institution “City Mariinsky Hospital”, St. Petersburg, Russia.

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SUMMARY:The so-called Dieulafoy's ulcer (UD) is actually a malformation located in the submucosa of the stomach and has the appearance of an abnormally developed tortuous artery of unusual caliber, the spontaneous rupture of which is accompanied by life-threatening bleeding. An essentially incorrect name, but well-established in the domestic literature, and insufficient familiarity of doctors with the essence of this pathology can cause inadequate medical tactics, which in fact should be different than for ordinary acute ulcers. A clinical observation of poisoning in a 73-year-old woman, which ended in death, is presented, as well as an analysis of the literature regarding the tactics used in such cases. According to the author, endoscopic hemostasis should be considered only as the initial stage of emergency care for ulcerative urinary tract, since it eliminates the rupture, but not the malformation itself, and endoscopic treatment in combination with atypical gastrectomy, including laparoscopic, or vessel embolization should be considered optimal.

KEYWORDS:esophagus, Boerhaave's syndrome, endoscopic vacuum therapy.

HOW TO QUOTE:Zavrazhnov A.A., Solovyov I.A., Ogloblin A.A., Bosco O.Yu., Luchinina D.V., Antipova M.V., Rusanov D.S., Mamedov Sh.D. A case of successful use of endoscopic vacuum therapy in the treatment of incompetent sutures of the esophageal wall after surgical treatment of Boerhaave's syndrome. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1 (10). pp. 53-57.


 

THE FIRST EXPERIENCE OF INVASIVE THERMOREGULATION IN A PATIENT WITH DIENCEPHAL DYSFUNCTION SYNDROME

Authors

E.V. CHARTORIZHSKY, A.V. SHCHEGOLEV, A.A. Emelyanov, R.E. LAKHIN, V.V. SHUSTROV

Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

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SUMMARY:Body temperature management is an urgent task in resuscitation. Hyperthermia in neurocritical care patients is a factor of secondary brain damage, it increases the length of hospitalization in the intensive care unit, and is a negative prognostic factor in the treatment of patients with neurosurgical pathology. A clinical case of invasive intravascular thermoregulation in a patient with a gunshot blind penetrating wound of the right temporal region is presented. The applied technique with the introduction of a heat exchange catheter into the vascular bed made it possible to effectively control the patient’s body temperature, which made it possible to control intracranial hypertension, reduce the oxygen demand of brain tissue and, probably, reduce the area of ​​secondary damage. On the 13th day after connecting the device, it was possible to stop central hyperthermia, and on the 15th day the patient emerged from the coma. Intravascular temperature monitoring allowed the patient's body temperature to be accurately controlled without exceeding target values, which likely allowed the patient to survive the acute period of traumatic brain injury.

KEYWORDS:traumatic brain injury, cooling, neurological outcome, targeted temperature control

HOW TO QUOTE:Chartorizhsky E.V., Shchegolev A.V., Emelyanov A.A., Lakhin R.E., Shustrov V.V. First experience of invasive thermoregulation in a patient with diencephalic dysfunction syndrome. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 2. P.58-65


 

EXPERIMENTAL STUDY OF THE EFFECTIVENESS OF A LOCAL HEMOSTATIC AGENT BASED ON CHITOSAN AND EXTERNAL ABDOMINAL COMPRESSION FOR TEMPORARILY STOPING INTRA-ABDOMINAL BLEEDING

Authors

THEM. SAMOKHVALOV1,2, K.P. GOLOVKO1,3, M.S. GRISHIN1, A.M. NOSOV1, D.D. LYABAH1, A.Ya. KOVALEVSKY1

1 Military Medical Academy named after S.M. Kirov, St. Petersburg, Russia

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

3 St. Petersburg State University, St. Petersburg, Russia

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SUMMARY:The results of an experimental study of the effectiveness of a local hemostatic agent (LHA) based on chitosan in combination with the method of external compression of the abdominal area in a model of intense intra-abdominal bleeding in a large biological object (pig, n=12) are presented. The results obtained allow us to identify two promising samples of MGS, the study of which is planned in full preclinical trials.

KEYWORDS: abdominal trauma, intra-abdominal bleeding, hemostasis, chitosan, abdominal compression, pre-hospital stage.

HOW TO QUOTE:Samokhvalov I.M., Golovko K.P., Grishin M.S., Nosov A.M., Lyabakh D.D., Kovalevsky A.Ya. Experimental study of the effectiveness of a local hemostatic agent based on chitosan and external compression of the abdomen to temporarily stop intra-abdominal bleeding. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1. P. 66-72


 

CLINICAL EVALUATION OF HYDROGEL WOUND COVERING WITH A COMPLEX OF NATURAL ANTIMICROBIAL PEPTIDES FLIP7 IN THE TREATMENT OF DERMAL BURNS

Authors

E.V. ZINOVIEV, D.V. KOSTYAKOV, A.V. SEMIGLAZOV, P.K. KRYLOV

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

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SUMMARY:To date, a large number of methods and techniques for the treatment of borderline burn wounds have been developed, including a wide range of both medications and physiotherapeutic procedures. However, most of them do not have the ability to completely suppress the activity of modern microorganisms growing in burn wounds. Today, a burn wound is a combination of both gram-positive and gram-negative strains that are resistant to most modern antibacterial drugs used in all medical institutions of the country. This problem is justified by the evolutionary mechanisms of adaptation of microorganisms, allowing them to develop various defense systems in the form of the formation of polymicrobial associates and biological films, in which traditional methods of exposure become ineffective. The use of a gel of rarely cross-linked acrylic polymers with a complex of natural antimicrobial peptides FLIP-7 may become one of the promising ways to solve microbial resistance. Its application to the wound surface ensures active elimination of this pathogenic microflora from the area of ​​damage and creates optimal conditions for reparative regeneration. The introduction of hydrogels with FLIP7 into the system of care for victims with borderline skin burns will improve the results of treatment for this category of patients.

KEYWORDS:skin burn, dermal lesions, humid environment, natural antimicrobial peptides, FLIP7

HOW TO QUOTE:Zinoviev E.V., Kostyakov D.V., Semiglazov A.V., Krylov P.K. Clinical evaluation of hydrogel wound covering with a complex of natural antimicrobial peptides FLIP7 in the treatment of dermal burns. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1 (10). pp. 73-76


 

EXPERIENCE OF PARTICIPATION OF A NON-GOVERNMENTAL ORGANIZATION IN TRAINING FIRST AID VOLUNTEERS

Authors

E.A. LAVROVA1, O.A. PANTELEEVA 2

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

2 Medical College No. 1, St. Petersburg, Russia

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SUMMARY:The article discusses the experience of participation of a public organization in training volunteers to provide first aid. The authors highlight the relevance of the implementation of this project, the stages of preparation for its joint implementation and the conditions for those wishing to undergo training. At the end of the article, data is provided on the readiness of those trained for volunteer work in the Northern Military District zones.

KEYWORDS:public organization, first aid, volunteers, training, health care.

HOW TO QUOTE:Lavrova E.A., Panteleeva O.A., Experience of participation of a public organization in training volunteers in first aid. Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2023. No. 1. P.77-80

№4 2022

TALENTED SCIENTIST, TEACHER, TEACHER: IN MEMORY OF PROFESSOR L.P. ZUEVOY

Authors

B.I. ASLANOV, K.D. VASILIEV

Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

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SUMMARY:The article briefly describes the life path, activities and creative heritage of Doctor of Medical Sciences, Professor, Honored Scientist of the Russian Federation Lyudmila Pavlovna Zueva (1939–2021). An outstanding scientist-epidemiologist, organizer, teacher and pedagogue, for 30 years she headed the Department of Epidemiology, Parasitology and Disinfectology of North-Western State Medical University named after. I.I. Mechnikov.

KEYWORDS:L.P. Zueva, epidemiology of infectious and non-infectious diseases.

HOW TO QUOTE:Aslanov B.I., Vasiliev K.D. Talented scientist, teacher, pedagogue: in memory of Professor L.P. Zueva // Journal “Emergency Surgery named after. I.I. Dzhanelidze". 2022. No. 4 (9). pp. 5–7.


 

RESTORATIVE SURGERY IN PATIENTS WITH EXTERNAL FISTULAS OF THE SMALL INTESTINE IN THE BACKGROUND OF COMMON PERITONEAL ADHESIONS

Authors

E.Yu. LEVCHIK, S.A. VOROBYOV

Sverdlovsk Regional Clinical Psychoneurological Hospital for War Veterans, Ekaterinburg, Russia

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SUMMARY:The results of restorative treatment of 293 patients with small intestinal fistulas, divided into 3 groups (60, 70 and 163 patients) depending on the prevalence of peritoneal adhesions, the timing of surgical interventions and the volume of adhesiolysis are presented.

Result:It was revealed that the highest postoperative mortality and incidence of intra-abdominal complications were characterized by reconstructive operations performed within 30 days after the occurrence of fistulas, against the background of widespread peritoneal adhesions. For periods of more than 30 days in patients with small intestinal fistulas against the background of widespread peritoneal adhesions, more favorable postoperative outcomes were observed after complete distal, from the level of the internal opening of the fistula, or total adhesiolysis. The lowest mortality rate of patients, 1 (0.9%) out of 110, after restorative treatment of small intestinal fistulas against the background of widespread peritoneal adhesions was observed within 3 months of their occurrence, after complete distal or total adhesiolysis.

KEYWORDS:external fistulas of the small intestine, peritoneal adhesions, surgical treatment

HOW TO QUOTE:Levchik E.Yu., Vorobiev S.A. Reconstructive operations in patients with external fistulas of the small intestine against the background of widespread peritoneal adhesions // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 8–13


 

MODERN OPPORTUNITIES FOR TREATING POST-TRAUMATIC BILIARY STRICTURES AND EXTERNAL BILIOUS FISTULAS

Authors

M.Yu. KABANOV1,2, D.M. YAKOVLEVA1,3, K.V. SEMENTSOV1,2, D.A. SUROV3, D.B. DEGTEREV1, M.Ya. BELIKOVA1, S.O. ZDASYUK1

1 Hospital for war veterans, St. Petersburg, Russia

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

3 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

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SUMMARY: The article is devoted to the consideration of modern possibilities of minimally invasive surgery aimed at correcting such serious complications in the early and late postoperative periods as strictures of the extrahepatic bile ducts and external bile fistulas. Several clinical observations are presented, such as: clipping of the common hepatic duct, failure of the biliodigestive anastomosis (severity grade C), treatment of ischemic stricture of the right lobar duct of the liver, as well as suprastenotic choledocholithiasis against the background of a stricture of the hepaticojejunostomy. The capabilities of modern minimally invasive technologies, ante- and retrograde, in the treatment of these complications have been demonstrated. It has been shown that in choosing treatment tactics for a patient with obstructive jaundice it is necessary to use a personalized approach. Timely provision of medical care was demonstrated in multidisciplinary medical centers with extensive experience and modern equipment, capable of performing equally both ante- and retrograde interventions on the biliary tree.

KEYWORDS:minimally invasive interventions, percutaneous transhepatic cholangiost arthroplasty of the bile ducts.

HOW TO QUOTE:Kabanov M.Yu., Yakovleva D.M., Sementsov K.V., Surov D.A., Degterev D.B., Belikova M.Ya., Zdasyuk S.O. Modern possibilities for the treatment of post-traumatic biliary strictures and external biliary fistulas // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 14–21.


 

COMPARATIVE EVALUATION OF THE USE OF POLYMERS AND TRADITIONAL APPROACHES FOR LOCAL TREATMENT OF BURN WOUNDS IN EXPERIMENTAL

Authors

U.R. KAMILOV1, A.D. FAYAZOV1,3, V.U. UBAIDULLAEVA1, H.E. YUNUSOV2, M.M. MIRKHAYDAROV1, A.A. NABIEV3

1Republican Scientific Center for Emergency Medical Care of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan

2 Institute of Chemistry and Physics of Polymers of ANRUz, Tashkent, Republic of Uzbekistan

3 Center for the Development of Professional Qualifications of Medical Workers, Tashkent, Republic of Uzbekistan

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SUMMARY:The clinical and morphological picture of the course of the wound process in simulated thermal burns of II–IIIAB degrees in rats with various approaches to local treatment is described. The course of the wound process was assessed both clinically and through morphological studies. It has been shown that the morphological picture of the course of the wound process, the timing of complete epithelization of burn wounds, and clinical and biochemical blood parameters indicate a fairly pronounced effectiveness of using a polymer film with silver nanoparticles.

KEYWORDS:burn, wound process, local treatment, polymers, silver, experiment.

HOW TO QUOTE:Kamilov U.R., Fayazov A.D., Ubaydullaeva V.U., Yunusov Kh.E., Mirkhaidarov M.M., Nabiev A.A. Comparative assessment of the use of polymers and traditional approaches to local treatment of burn wounds in an experiment // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 22–30.


 

RISK-BASED APPROACH TO PREVENTION OF BLOODSTREAM INFECTIONS IN ICU AND INTENSIVE CARE UNITS

Authors

A.S. ZAKHVATOVA1, B.I. ASLANOV2, M.G. DARINA1,2, Y.S. SVETLICHNAYA1,2, O.V. SHIRAI1,2

1 Medical Information and Analytical Center of the Health Committee of St. Petersburg, St. Petersburg, Russia

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

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Relevance:Sepsis, as a generalized bloodstream infection, is a consequence of the worsening clinical course of various common infections, including healthcare-associated infections. The World Health Organization report on the burden of sepsis (2017) notes that 49% of patients diagnosed with septicemia acquired the infection in a medical facility.

Goal of the work: Improving epidemiological surveillance and risk-based technologies for preventing the development of bloodstream infections in intensive care units based on a predictive model for the development of septic reactions.

Materials and methods:On the basis of a large multidisciplinary hospital in St. Petersburg, data on 559 patients in intensive care units was collected for 36 months from March 14, 2019 to March 14, 2022. The “case” group consisted of 179 patients, the “control” group380, to interpret the results of the case-control study, the odds ratio was calculated. Binary logistic regression was used to build a prognostic risk-based model for the development of bloodstream infections.

Results:According to the obtained mathematical model, patients with respiratory failure (OR 7.2 (2.1–15.1)), an established source of infection (OR 15.4 (9.7–25.1)), long-term use of a ventilator ( more than 7 days) (OR 6.8 (3.6–13.1)), long-term use of a central venous catheter (more than 7 days) (OR 11.5 (4.8–21.1)) have a potential risk of developing infection blood flow equal to 98%.

Conclusions:The resulting mathematical predictive risk-oriented model shows the fundamental possibility of predicting septic conditions with proper entry of data into the electronic medical record and justifies the introduction of a risk-based approach for the early detection of epidemiological problems in relation to bloodstream infections in intensive care units.

KEYWORDS:bloodstream infections, risk-based approach, sepsis, epidemiological surveillance, prognostic model, electronic medical record.

HOW TO QUOTE:Zakhvatova A.S., Aslanov B.I., Daryina M.G., Svetlichnaya Yu.S., Shirai O.V. Risk-based approach to the prevention of bloodstream infections in intensive care units // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. No. 4 (9). R. 31–37. KEY WORDS: bloodstream infections, risk-based approach, sepsis, epidemiological surveillance, predictive model, electronic medical record.


 

MODERN MINIMALLY INVASIVE METHODS FOR THE TREATMENT OF CHOLEDOCHOLITHIASIS IN PATIENTS IN OLDER AGE GROUPS

Authors

M.Yu. KABANOV1,2, K.V. SEMENTSOV1,2, A.A. FOKINA2, D.K. SAVCHENKOV1,2, V.V. ALEXEEV1,2

1 Hospital for war veterans, St. Petersburg, Russia

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

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SUMMARY:The work carried out a comparative analysis of the effectiveness of treatment of cholelithiasis complicated by choledocholithiasis in patients of older age groups using standard endoscopic techniques and modern endoscopic methods. A conclusion is drawn about their effectiveness.

KEYWORDS:“Complicated” choledocholithiasis, direct cholangioscopy, laser, electrohydraulic lithotripsy, SpyGlass.

HOW TO QUOTE:Kabanov M.Yu., Sementsov K.V., Fokina A.A., Savchenkov D.K., Alekseev V.V. Modern minimally invasive methods of treating choledocholithiasis in patients of older age groups // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 38–41.


 

THE SO-CALLED “DIELAFOY'S ULCER” IS NOT AN ULCER

Authors

S.A. POVZUN

Bureau of Forensic Medicine, St. Petersburg, Russia

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SUMMARY:The so-called Dieulafoy's ulcer (UD) is actually a malformation located in the submucosa of the stomach and has the appearance of an abnormally developed tortuous artery of unusual caliber, the spontaneous rupture of which is accompanied by life-threatening bleeding. An essentially incorrect name, but well-established in the domestic literature, and insufficient familiarity of doctors with the essence of this pathology can cause inadequate medical tactics, which in fact should be different than for ordinary acute ulcers. A clinical observation of poisoning in a 73-year-old woman, which ended in death, is presented, as well as an analysis of the literature regarding the tactics used in such cases. According to the author, endoscopic hemostasis should be considered only as the initial stage of emergency care for ulcerative urinary tract, since it eliminates the rupture, but not the malformation itself, and endoscopic treatment in combination with atypical gastrectomy, including laparoscopic, or vessel embolization should be considered optimal.

KEYWORDS: Dieulafoy's ulcer, gastric arterial malformation, death, optimal medical tactics.

HOW TO QUOTE:Povzun S.A. The so-called “Dieulafoy's ulcer” is not an ulcer // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 42–46.


 

A CASE OF SIMULTANEOUS OPERATION IN CONNECTION WITH “COMPLEX” CHOLEDOCHOLITHIASIS IN AN 86-YEAR-OLD PATIENT

Authors

K.V. SEMENTSOV1,2, D.B. DEGTEREV1, A.A. FOKINA2, D.K. SAVCHENKOV1,2

1 Hospital for war veterans, St. Petersburg, Russia

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

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SUMMARY: A case of treatment of choledocholithiasis complicated by obstructive jaundice in an 86-year-old patient with significant comorbidity is presented. A simultaneous operation was performed, which included laparoscopic cholecystectomy and oral digital choledochoscopy with contact lithotripsy. The postoperative period proceeded without complications, obstructive jaundice regressed. In our opinion, the high efficiency and safety of the technique used serve as a serious argument in favor of its use in significantly comorbid patients with “complex” choledocholithiasis during a one-stage endoscopic operation.

KEYWORDS:endoscopic retrograde cholangiopancreatography, elderly patient, comorbidity, “complex” choledocholithiasis, lithotripsy, oral cholangioscopy.

HOW TO QUOTE:Sementsov K.V., Degterev D.B., Fokina A.A., Savchenkov D.K. // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 47–50.


 

ORGAN-PRESERVING TACTICS FOR STABLE WOUND OF THE SPLEN

Authors

A.A. ZAVRAZHNOV1,2,3., I.A. SOLOVIEV1,2,3, Sh. D. MAMEDOV1,2, R. G. AVANESYAN 1,2, L.E. FEDOTOV1,2, A.L. OGLOBLIN1,2, K.P. KILADZE1

1 City Mariinsky Hospital, St. Petersburg, Russia

2 St. Petersburg State Pediatric Medical University of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

3 Military Medical Academy named after S. M. Kirov, St. Petersburg, Russia

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SUMMARY:A clinical case of a stab wound of the spleen, grade 2 according to AAST, is presented, in which non-invasive organ-preserving tactics were chosen in a multidisciplinary hospital.

KEYWORDS:spleen, spleen injury, spleen preservation.

HOW TO QUOTE:Zavrazhnov A.A., Soloviev I.A., Mamedov Sh. D., Fedotov L.E., Ogloblin A.L., Kiladze K.P. Organ-preserving tactics for stab wounds of the spleen // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 51–54.


 

LONG-TERM RESULT OF DUODENAL EXCLUSION ACCORDING TO A.G. ZEMLYANYA WITH COMPLICATED PARAPHATERIAL DIVERTICULUS

Authors

V.I. KULAGIN1,2, E.V. BATIG1, M.I. ANDREEV1, E.S. MOLLAEV3

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

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

3 City Clinic No. 109, St. Petersburg, Russia

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SUMMARY:The long-term (7 years) result of the use of duodenal exclusion surgery for complicated parafaterial diverticulum is presented.

KEYWORDS:exclusion of the duodenum, parafaterial diverticulum, long-term result.

HOW TO QUOTE:Kulagin V.I., Batig E.V., Andreev M.I., Mollaev E.S. Long-term result of switching off the duodenum according to A.G. Zemlyanoy with a complicated course of parafaterial diverticulum // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 55–59.


 

PROJECT MANAGEMENT OF A MEDICAL COLLEGE IN THE CONTEXT OF IMPLEMENTING NEW EDUCATIONAL STANDARDS FOR TRAINING NURSING MEDICAL PERSONNEL

Authors

I.V. Bublikova, V.S. ERMOLENKO

Medical College No. 1, St. Petersburg, Russia

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SUMMARY:The article discusses the prerequisites for modernizing the management system of a medical educational organization. Project management technology stands out as a promising and effective tool for managing the development of a medical college in the situation of introducing new educational standards for training paramedical personnel. The authors highlight the stages of implementation of project management in an educational organization implementing training programs for paramedical personnel. The conditions for the use of design technology in the context of transformations in the secondary medical education system are clarified. The positive effects of management through the implementation of development projects are indicated.

KEYWORDS:management system, project management, medical college, secondary medical education, professional development, nursing staff.

HOW TO QUOTE: Bublikova I.V., Ermolenko V.S. Project management of a medical college in the context of introducing new educational standards for the training of nursing staff // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 60–63.


 

NEED FOR NURSING CARE IN PATIENTS WITH CORONARY HEART DISEASE

Authors

I.I. POLONSKAYA, D.YU. BATRAKOV, E.L. SHEVCHENKO

Obstetric College, St. Petersburg, Russia

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Introduction:The main cause of mortality and disability remains diseases of the circulatory system, and most of them are due to morbidity from coronary heart disease (CHD). Patients with coronary artery disease often have comorbid diseases. The presence of comorbid diseases increases the need of patients for nursing care, which increases the role of the nurse in the diagnostic, treatment and rehabilitation process, as well as in the primary and secondary prevention of these diseases.

Goal of the work:Assess functional impairments and problems in patients with coronary artery disease, limitations of their life activities and characterize the main areas of nursing care.

Materials and methods:The study included 221 patients with coronary artery disease, recognized as group 3 disabled. Results. Functional dysfunctions of the cardiovascular system were detected in 100%, respiratory organs in 79.2%, musculoskeletal system 43.4%, endocrine system 23.1%, digestive system 61.9%, sensory dysfunction in 1.36% of those examined .

Conclusions:The main activity of the nurse (brother) is to identify the patient's problems with the subsequent drawing up of a care plan and its implementation at all levels of medical care.

KEYWORDS:coronary heart disease, comorbidity, nursing care, nurse.

HOW TO QUOTE:Polonskaya I.I., Batrakov D.Yu., Shevchenko E.L. The need for nursing care in patients with coronary heart disease // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 64–68.


 

PREVENTION OF THE RISKS OF INFECTIOUS COMPLICATIONS IN THE OPERATING BLOCK OF A CARDIAC SURGICAL HOSPITAL

Authors

O.M. BRYZGALOVA, O.V. IVANOVA, S.V. GLADKOV

Federal Center for Cardiovascular Surgery named after. S.G. Sukhanova, Perm, Russia

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Goal of the work:To study the main factors, approaches and directions of the causes and prevention of surgical site infections in a surgical hospital in patients with a high risk of complications.

Materials and methods:In the period from 2019 to 2021 at the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov" of the Ministry of Health of the Russian Federation (Perm) (hereinafter - FCSS) performed 15,632 operations in the field of cardiovascular surgery, 504 operations were performed for emergency indications. The subjects of the study were 118 patients who underwent open heart surgery (59 of whom received medical care for emergency reasons, 59 patients - routinely), identical in gender and age.

Results:The likelihood of surgical site infections increases with the presence of risk factors, which are numerous, especially in patients requiring emergency cardiac surgery. After analyzing the factors, we found out that the main role is played by the nature of the underlying disease, concomitant diseases or conditions, microflora of the skin, which reduce resistance to infections and/or interfere with the wound healing process, as well as smoking. It should be noted that exogenous factors of infection also play an important role in the transmission of infection, which include the personnel of the operating unit, the clothing of the operating team, the air in the operating room, surrounding surfaces, instruments, as well as a set of perioperative aseptic measures, surgical equipment, surgical coverings, suture material .

Conclusions:The risk of emergency surgery is much higher than planned surgery due to the severity of the initial condition, concomitant pathology, insufficient history, lack of laboratory tests and endogenous microflora of the skin. As a result, the length of stay of patients in hospital increases by an average of 30%. In the perioperative period, it is important to prevent infectious complications, mandatory compliance with a full range of measures aimed at reducing the microbial load, which must be observed at all stages of patient management.

KEYWORDS:risk factors, complications in cardiovascular surgery, prevention of surgical site infections.

HOW TO QUOTE:Bryzgalova O.M., Ivanova O.V., Gladkov S.V. Prevention of the risks of infectious complications in the operating unit of a cardiac surgery hospital // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. No. 4 (9). pp. 69–72.


 

FIRST AID IN EDUCATIONAL ORGANIZATIONS: REGULATORY AND LEGAL ASPECTS

Authors

A.I. MAKHNOVSKY1,2, I.M. BARSUKOVA 1.3, L.I. DUTY 4, Z.A. ZARIPOVA3, L.G. BUYNOV5, A.Yu. ZAKURDAEVA4, O.N. ERGASHEV2,3

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

2 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

3 First St. Petersburg State Medical University named after. I.P. Pavlova, St. Petersburg, Russia

4 Central Research Institute for Organization and Informatization of Health Care, Ministry of Health, Moscow, Russia

5 Russian State Pedagogical University named after. A.I. Herzen, St. Petersburg, Russia

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SUMMARY:The problem of providing first aid to students in educational organizations continues to be relevant. Every year, more than 200 children die in physical education classes in the Russian Federation. The article provides an overview of federal laws and regulatory legal documents regulating the provision of first aid in educational organizations, and substantiates the feasibility and main directions for their improvement.

KEYWORDS:first aid, educational organization.

HOW TO QUOTE:Makhnovsky A.I., Barsukova I.M., Dezhurny L.I., Zaripova Z.A., Buynov L.G., Zakurdaeva A.Yu., Ergashev O.N. First aid in educational organizations: regulatory and legal aspects. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022. No. 4 (9). R. 73–77.


 

TYPES OF MEDICAL CARE IN THE MILITARY MEDICAL DOCTRINE AND THE FEDERAL LAW ON THE BASICS OF CITIZENS’ HEALTH IN THE RUSSIAN FEDERATION

Authors

A.I. MAKHNOVSKY1,2, O.N. ERGASHEV2,3, I.M. BARSUKOVA1,3

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

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

3 First St. Petersburg State Medical University named after. acad. I.P. Pavlova Ministry of Health of Russia, St. Petersburg, Russia

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Purpose of the study: define the types of medical care in the Military Medical Doctrine in accordance with the basic concepts used in the federal law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation.” Comparative and analytical research methods were used.

KEYWORDS:military medical doctrine, types of medical care

HOW TO QUOTE: Makhnovsky A.I., Ergashev O.N., Barsukova I.M. Types of medical care in the Military Medical Doctrine and the Federal Law On the Fundamentals of Protecting the Health of Citizens in the Russian Federation. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022. No. 4 (9). pp. 78–80

№3 2022

PROFESSOR ANATOLY ALEXEEVICH KURYGIN (1932-2011) (TO THE 90TH ANNIVERSARY OF THE BIRTH OF A.A. KURYGIN)

Authors

V.A. MANUKOVSKY1,3, V.E. PARFENOV1, A.E. DEMKO1,2, V.G. VERBITSKY1,2

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I. I. Dzhanelidze”, St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education "Military Medical Academy named after. S. M. Kirov" Russian Ministry of Defense, St. Petersburg, Russia

3 Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov", St. Petersburg, Russia

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SUMMARY:On September 10, 2022, the surgical community of St. Petersburg and Russia celebrated the 90th anniversary of the birth of the prominent surgeon, prominent scientist, talented teacher and wonderful poet Anatoly Alekseevich Kurygin. Professor Kurygin has created an entire scientific school of surgeons, which develops the ideas of the teacher.

KEYWORDS:Military Medical Academy, Department of Faculty Surgery named after. S.P. Fedorova, Department of Surgery No. 2 (for advanced training of doctors), A.A. Kurygin

HOW TO QUOTE:V.A. Manukovsky, V.E. Parfenov, A.E. Demko, V.G. Verbitsky Professor Anatoly Alekseevich Kurygin (1932-2011) (on the 90th anniversary of the birth of A.A. Kurygin) // Journal “Emergency Surgery named after. I.I. Dzhanelidze". 2022;2(8):8-12.


 

CLINICAL CASE OF TREATMENT OF SEVERE FORM OF CROHN'S DISEASE AND AUTOIMMUNE HEPATITIS

Authors

S.S. GAIDUK1,2, M.I. GROMOV1, A.V. KOSACHEV1,2, L.P. PIVOVAROVA1

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education "Military Medical Academy named after. CM. Kirov", St. Petersburg, Russian Ministry of Defense

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SUMMARY:A clinical case of a severe form of Crohn's disease that developed in a patient at the age of 13 and was complicated by autoimmune hepatitis with signs of cirrhosis is presented.

KEYWORDS:Crohn's disease, TNF-α, monoclonal antibodies, native DNA, sodium deoxyribonucleate.

HOW TO QUOTE:S.S. Gaiduk, M.I. Gromov, A.V. Kosachev, L.P. Pivovarova Clinical case of treatment of severe Crohn's disease and autoimmune hepatitis // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. 3(8): 13-17.


 

ALGORITHMS FOR THE SAFE IMPLEMENTATION OF HOSPITAL-SUBSTITUTE ENDOVIDEOSCOPIC SURGICAL TECHNOLOGIES INTO THE PRACTICE OF A POLYCLINIC SURGEON

Authors

N.N. LEBEDEV1, A.N. SHIKHMETOV1, A.M. ZADIKYAN1

1 Medical private institution Industry Clinical Diagnostic Center PJSC Gazprom, Moscow

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Purpose of the study:To create algorithms for the introduction of endovideoscopic surgical interventions in the work of a polyclinic surgeon based on an analysis of more than ten years of experience in endovideoscopic surgical operations in inpatient conditions in patients with cholelithiasis, gastroesophageal reflux disease, hernias, adhesive disease of the peritoneum and simultaneously with various benign diseases of the uterus, appendages and tubo-peritoneal infertility at OKDC PJSC Gazprom.

Materials and methods:Determination of absolute and relative contraindications to planned endovideoscopic operations in a surgical day hospital, selection of an adequate surgical aid, optimization of preoperative support, intraoperative and postoperative management based on a multimodal individualized approach, early activation of the operated patient. The results of treatment using endovideoscopic technology were studied using the example of treatment of patients with inguinal hernias and simultaneous pathology of the abdominal and pelvic organs.

Results:If the algorithm for introducing endovideosurgical interventions in a surgical day hospital is followed, such operations do not lead to an increase in the number of intra- and postoperative complications compared to a multidisciplinary hospital.

KEYWORDS:endovideosurgical interventions, laparoscopic surgery, hospital-replacing technologies.

HOW TO QUOTE:N.N. Lebedev, A.N. Shikhmetov A.N., A.M. Zadikyan Algorithms for the safe implementation of hospital-replacing endovideoscopic surgical technologies in the practice of a polyclinic surgeon // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. 3(8):18-24


 

POSTOPERATIVE INFECTIOUS COMPLICATIONS OF GENERAL PERITONITIS

Authors

S.I. PEREGUDOV1,2, A.N. TULUPOV2,1, S.V. SMIRENIN3, R.V. TITOV1

1 Military Medical Academy named after. CM. Kirov

2 St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze

3 St. Petersburg Hospital for War Veterans

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Purpose: to determine the most rational and accessible methods of drug prevention and treatment of infectious complications of widespread peritonitis, 243 patients with this pathology were examined and treated.

KEYWORDS:widespread peritonitis, infectious complications of peritonitis, empirical antibacterial therapy.

HOW TO QUOTE:S.I. Peregudov, A.N. Tulupov, S.V. Smirenin, R.V. Titov Postoperative infectious complications of widespread peritonitis // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. 3(8):25-30


 

ENDOVASCULAR HEMOSTASIS IN THE TREATMENT OF BLEEDING FROM GASTROINTESTINAL TRACT TUMORS

Authors

G.I. SINECHENKO, A.E. DEMKO, V.G. VERBITSKY, A.N. SEKEEV, M.A. KISELEV.

St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze

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SUMMARY:The article presents the results of treatment of 40 patients with bleeding from tumors of the gastrointestinal tract, who were treated at the 2nd Clinic (Advanced Surgery) of the Military Medical Academy named after. CM. Kirov on the basis of the Research Institute of Emergency Medicine named after. I.I. Janelidze in 2019-2021.

Result:The data obtained indicate the high efficiency of X-ray surgical techniques in the diagnosis and treatment of bleeding, which makes it possible to abandon open palliative interventions.

KEYWORDS:endovascular hemostasis, gastrointestinal bleeding, recurrent bleeding, angiography, embolization.

HOW TO QUOTE:G. I. Sinenchenko, A. E. Demko, V. G. Verbitsky, A. N. Sekeev, M. A. Kiselev Endovascular hemostasis in the treatment of bleeding from tumors of the gastrointestinal tract. // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. 3(8):31-35


 

COMBINED COMPLICATIONS OF PYLORODUODENAL ULCERS AND THEIR SURGICAL TREATMENT IN THE CONDITIONS OF THE RESEARCH INSTITUTE OF SP. I.I. DZHANELIDZE

Authors

A.O. PARFYONOV1,2, A.E. DEMKO1,2, V.G. VERBITSKY1,2

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

2 Military Medical Academy named after. S. M. Kirova, St. Petersburg, Russia

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SUMMARY:According to the department of emergency care organization of the Research Institute of Emergency Medicine named after. I.I. Janelidze mortality rate for ulcerative gastroduodenal bleeding in St. Petersburg in 2021 was 4.27%, and postoperative mortality was 6.71%. Mortality rates for perforated ulcers are 10.27%, postoperative mortality rates are 14.86%. The combination of duodenal perforation with ulcerative bleeding is considered a particularly complex pathology in abdominal surgery and occurs in 3–10% of cases among patients with duodenal ulcer.

Goal of the work: to analyze the results of surgical treatment of combined complications of pyloroduodenal ulcers for the period from 2010 to 2020. to improve the results of treatment of this category of patients in an emergency hospital. The results of treatment of 134 patients with combined complications of peptic ulcer of the pyloroduodenal region, who were treated at the Research Institute of Emergency Medicine named after. I.I. Dzhanelidze.

Result of the study: it was found that the most common (up to 50%) combination of complications of peptic ulcer disease is perforation and bleeding. The most common operation was pyloroplasty with vagotomy. Rational surgical tactics in patients with combined complications of a pyloroduodenal ulcer should be based on a comprehensive diagnosis to quickly determine indications for surgical intervention. An individual approach to the choice of surgical intervention should be based on the general condition of the patient. At the same time, in our opinion, preference should be given to radical organ-preserving surgical interventions in the form of truncal vagotomy with Finney pyloroplasty, as they most fully meet the principles of emergency surgery.

KEYWORDS:peptic ulcer, gastric ulcer, duodenal ulcer, combined complications of pyloroduodenal ulcers, bleeding, perforation, stenosis.

HOW TO QUOTE:Lapshin V.N., Manukovsky V.A., Tulupov A.N., Gavrishchuk Ya.V., Demko A.E., Afonchikov V.S., Barsukova I.M., Razumova N.K. Mechanical shockogenic injury, dynamics of mortality in a first-level trauma center. // Journal “Emergency Surgery named after. I.I. Dzhanelidze". 2022;3(8):36-40


 

STAGED SURGICAL TREATMENT WITH VACUUM-ASSISTED LAPAROSTOMY IN PATIENTS WITH SECONDARY PERITONITIS AND SEVERE ABDOMINAL SEPSIS

Authors

A.E. DEMKO1,2, S.A. SHLYAPNIKOV1,2, I.M. BATYRSHIN1,2, Y.S. OSTROUMOVA2, D.S. SKLIZKOV2, D.V. FOMIN2

1 Federal State Budgetary Educational Institution of Higher Professional Education "Military Medical Academy named after. CM. Kirov" Ministry of Defense of the Russian Federation, St. Petersburg, 194044, St. Petersburg, Academician Lebedev street, 6

2 GBU St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze, 192242, St. Petersburg, Budapestskaya street, 3

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Target:determine indications for staged surgical treatment in patients with secondary peritonitis and severe sepsis. We analyzed 92 medical records of patients treated in surgical departments and intensive care units of the St. Petersburg Research Institute of Emergency Medicine named after. I. I. Dzhanelidze in the period from 2015 to 2018.

Analysis result:It was revealed that when determining the volume of primary surgical intervention in patients with secondary peritonitis complicated by severe sepsis, it is necessary to take into account the following combination of factors: age, Charlson comorbidity index, severity of organ dysfunction assessed using the SOFA scale, Mannheim Peritonitis Index (MPI), duration of preoperative period and duration of the operation itself. The indication for staged surgical treatment in patients with secondary peritonitis and severe sepsis is the sum of the indicators of the developed prognostic score scale equal to 6 or more. In other cases, in such patients it is possible to perform surgical treatment in full.

KEYWORDS:peritonitis, staged surgical treatment, severe sepsis.

HOW TO QUOTE:Demko A.E., Shlyapnikov S.A., Batyrshin I.M., Ostroumova Yu.S., Sklizkov D.S., Fomin D.V. Staged surgical treatment with vacuum-assisted laparostomy in patients with secondary peritonitis and severe abdominal sepsis. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;3(8):43-50


 

ABDOMINOPERINEAL EXTIRPATION OR EXTREMELY LOW RECTAL RESECTION: CHOICE OF DOCTOR OR PATIENT?

Authors

A.M. KARACHUN1,2, D.V. SAMSONOV1,3

1 Federal State Budgetary Institution National Medical Research Center for Oncology named after N.N. Petrov" of the Ministry of Health of Russia, St. Petersburg;

2 Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after I.I. Mechnikov" of the Ministry of Health of Russia, St. Petersburg;

3 FGBVOUVO "Military Medical Academy named after. CM. Kirov" Ministry of Defense of the Russian Federation, St. Petersburg.

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SUMMARY:Currently, significant attention is being paid to studying the effect of surgical treatment of rectal cancer on the quality of life of patients. Many medical professionals consider the presence of a permanent stoma to be the factor that has the most adverse impact on quality of life after surgery. However, a significant number of modern studies do not agree with this point of view, demonstrating the absence of a significant difference in the quality of life in patients with a permanent stoma and a low colorectal anastomosis.

KEYWORDS:rectal cancer; surgery; the quality of life; post ostomy; low anterior resection syndrome.

HOW TO QUOTE:A.M. Karachun, D.V. Samsonov Abdominoperineal extirpation or extremely low rectal resection: choice of doctor or patient? // Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. 3(8):51-55


 

MININIVASIVE EXTERNAL AND INTERNAL DRAINAGE IN SURGICAL TREATMENT OF PANCREAS CYSTS.

Authors

S.Ya. IVANUSA1, A.E.DEMKO 2, M.V.LAZUTKIN 1,2, E.V. BATIG 2, V.I. KULAGIN 2, A.A. POPOV 1

1 FGBVOUVO "Military Medical Academy named after. CM. Kirov" Ministry of Defense of the Russian Federation, St. Petersburg.

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

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Goal of the work:comparative assessment of the effectiveness of modern minimally invasive drainage operations for pancreatic cysts.

Materials and methods:Between 2012 and 2022. Clinic of General Surgery of the Military Medical Academy named after. S.M. Kirov and Research Institute of SP named after. I.I.Dzhanelidze performed minimally invasive drainage of pancreatic cysts on 286 patients.

Results:Percutaneous puncture drainage of pancreatic cysts was performed in 234 patients. After percutaneous drainage of cysts, positive results were observed in 195 (83.3%) patients. Recurrences of cystic formations were noted in 39 (16.7%) patients. Endoscopic transmural drainage of pancreatic cysts was performed in 52 patients. Long-term results were monitored in 21 patients. In 14 patients, plastic stents were removed after 1 year, in 7 cases - 2 years after installation. In these observations, instrumental studies did not visualize cysts.

Conclusions:Percutaneous external drainage of pancreatic cysts is an effective intervention in more than 80% of patients. Relapses of the disease (16.7%) are due to the fact that in some cases it is not possible to identify the connection of the cyst cavity with the pancreatic ductal system using available methods, which does not allow achieving complete obliteration of the cyst cavity with long-term external drainage. Endoscopic installation of a stent between the cyst cavity and the lumen of the stomach allows one to create conditions for the constant outflow of cyst contents into the stomach and eliminate pancreatic hypertension. The effectiveness of internal drainage is determined by the duration of the stent’s operation, as well as the possibility of forming an internal cystogastric fistula in the area where the stent is placed.

KEYWORDS:pancreatic cyst, minimally invasive drainage intervention.

HOW TO QUOTE:S.Ya. Ivanusa, A.E. Demko, M.V. Lazutkin, E.V. Batig, V.I. Kulagin, A.A. Popov Minimally invasive external and internal drainage in the surgical treatment of pancreatic cysts // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. 3(8):56-60


 

PREDICTIVE POTENTIAL OF BIOMARKERS OF SYSTEMIC INFLAMMATION IN ACUTE CHOLANGITIS.

Authors

A.V. OSIPOV1,2, A.E. DEMKO1,2, A.V. SVYATNENKO1,2, D.N. PERUNOVA1, I.Yu. TREGUBOV3, A.A. KALASHNIKOVA3

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

2 Military Medical Academy named after. S. M. Kirova, St. Petersburg, Russia

3 FSBI VTsERM im. A.M. Nikiforova, St. Petersburg, Russia

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SUMMARY:For earlier identification of patients with a poor prognosis, a study was designed and conducted to study the value of determining various biomarkers of the systemic inflammatory response and sepsis in the diagnosis of acute cholangitis. Currently, the level of procalcitonin is widely used as a prognostic factor and the possible division of patients with acute cholangitis into groups according to severity.

Result:It was revealed that the level of procalcitonin reliably indicates the presence of cholangitis in patients in combination with the clinical picture at a level above 2.2 ng/ml and the presence of severe cholangitis (severe biliary sepsis) at values ​​of 4.2 ng/ml. The value of presepsin in the diagnosis and determination of the severity of acute cholangitis seems to be the most optimal. However, the use of PSP as a predictor of progression of severity of acute cholangitis turned out to be insufficiently informative. IL-6 and CRP in acute cholangitis were assessed as markers reflecting the severity of the inflammatory response to a greater extent than indicators of the generalization of bacterial infection and predictors of unfavorable outcome.

KEYWORDS:biomarkers of inflammation, presepsin, procalcitonin, interleukin-6.

HOW TO QUOTE:Osipov A.V., Demko A.E., Svyatnenko A.V., Perunova D.N., Tregubov I.Yu., Kalashnikova A.A. Prognostic potential of biomarkers of systemic inflammation in acute cholangitis // Journal of Emergency Surgery named after. I.I. Dzhanelidze". 2022;3(8):61-68


 

POSSIBILITIES OF THE CONCEPT OF EARLY RECOVERY AFTER OPERATION IN EMERGENCY SURGERY FOR ELDERLY AND SENILE PATIENTS WITH DECOMMENDED COLON OBSTRUCTION OF TUMOR GENESIS

Authors

ON THE. SIZONENKO1, A.I. YAKIMOVICH 1, A.M. Grinev1, A.E. DEMKO1,2, O.V. BABKOV 2, V.A. LOGINOV1, D.A. SUROV1, A.V. OSIPOV1,2

1 Federal State Budgetary Educational Institution of Higher Education "Military Medical Academy named after S.M. Kirov" RF Ministry of Defense

2 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze"

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Relevance:In recent years, there has been growing interest in the application of the concept of enhanced recovery after surgery in emergency abdominal surgery in gerontological patients.

Purpose of the study:to conduct a comparative analysis of the results of using the accelerated recovery program in the surgical treatment of elderly and senile patients with colorectal cancer complicated by acute decompensated colonic obstruction.

Material and research methods:The study involved 73 patients with acute obstructive colonic obstruction of tumor origin, included in the main and control groups (37 and 36 people, respectively). In the treatment of patients in the main group, an adapted program of early recovery after surgery was used. The following criteria for comparative assessment were studied: the intensity of pain, restoration of motor and evacuation functions of the gastrointestinal tract (timing of appearance of intestinal peristalsis sounds, passage of gases and stool), the number and structure of postoperative complications, the duration of the postoperative period, the number and causes of deaths.

Results:It has been established that the proposed original program for rapid rehabilitation of this category of patients is a safe and effective way to improve the immediate results of surgical treatment.

KEYWORDS:colorectal cancer, acute obstructive colonic obstruction, accelerated recovery after surgery

HOW TO QUOTE:Sizonenko N.A., Yakimovich A.I., Grinev A.M., Demko A.E., Babkov O.V., Loginov V.A., Surov D.A., Osipov A.V. Possibilities of the concept of early recovery after surgery in emergency surgery of elderly and senile patients with decompensated colonic obstruction of tumor genesis // Journal of Emergency Surgery named after. I.I. Dzhanelidze". 2022;3(8):69-78

№2 2022

PROS AND DISADVANTAGES OF OSTEOSYNTHESIS IN EMERGENCY

Authors
I.G. BELENKY1,3, V.A. MANUKOVSKY1,2, A.N. TULUPOV1,2, A.E. DEMKO1,2, D.V. KANDYBA1, G.D. SERGEEV1,3, B.A. MAYOROV1,3,4,5, I.M. BARSUKOVA1,5, B.O. AJIMURADOV1, V.V. GLADNEVA1

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

2 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

3 St. Petersburg State University, St. Petersburg, Russia

4 Vsevolozhsk Clinical Interdistrict Hospital, Vsevolozhsk, Leningrad Region, Russia

5 First St. Petersburg State Medical University named after. acad. I.P. Pavlova Ministry of Health of Russia, St. Petersburg, Russia

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Rationale:There are three fundamental approaches to performing osteosynthesis operations: urgently, plannedly, and a third option, in which some of the operations are performed urgently, and some in a planned manner.

Target:The study was to evaluate the feasibility of a strategy for performing emergency osteosynthesis operations in a level 1 trauma center.

KEYWORDS: osteosynthesis, tactics of osteosynthesis, efficiency of osteosynthesis

HOW TO QUOTE:Belenky I.G., Manukovsky V.A., Tulupov A.N., Demko A.E., Kandyba D.V., Sergeev G.D., Mayorov B.A., Barsukova I.M., Adzhimuradov B. .O., Gladneva V.V. Pros and cons of emergency osteosynthesis. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;2(7):5-11


 

TREATMENT TACTICS OF SEVERE COMBINED INJURY (POLYTRAUMA) BASED ON AN INDIVIDUAL PREDICTION OF THE DURATION AND OUTCOME OF TRAUMATIC SHOCK (+/-T-PROGNOSIS). LECTURE

Authors

V.A. MANUKOVSKY1,2, A.N. TULUPOV1,2, M.I. GROMOV1, I.G. BELENKY1,3, A.E. DEMKO1,2, G.M. BESAEV1, S.I. PEREGUDOV 2, A.A. ESENOKOV1, N.V. RUTOVICH1

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

2 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

3 St. Petersburg State University, St. Petersburg, Russia

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SUMMARYThe tactics of treating victims with severe injuries remains an urgent problem. The desire of surgeons to do everything at once often ends in death, so an important task is to divide surgical treatment into stages depending on the severity of the injury and the response to it (damade control).

KEYWORDS:severe combined injury, polytrauma, severity of injury, traumatic shock, treatment of polytrauma, damade control, +/- T-prognosis.

HOW TO QUOTE.Manukovsky V.A., Tulupov A.N., Gromov M.I., Belenkiy I.G., Demko A.E., Besaev G.M., Peregudov S.I., Yesenokov A.A., Rutovich N. .IN. Treatment tactics for severe combined trauma (polytrauma) based on individual prognosis of the duration and outcome of traumatic shock (+/- T-prognosis) // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. 2 (7): 12-23


 


 

OSTEOSYNTHESIS OF COMPLEX INTRA-ARTICULAR FRACTURES OF THE DISTAL RADIUS WITH A DORAL DISTRACTION PLATE (literature review)

Authors

G.D. SERGEEV1,2, I.G. BELENKY1,2, B.A. MAYOROV1,2,3,4, M.A. SERGEEVA4, K.N. FOMIN1, V.V. GLADNEVA1

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

2 St. Petersburg State University, St. Petersburg, Russia

3Vsevolozhsk Clinical Interdistrict Hospital, Vsevolozhsk, Leningrad Region, Russia

4First St. Petersburg State Medical University named after. acad. I.P. Pavlova Ministry of Health of Russia, St. Petersburg, Russia

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SUMMARY:Fracture of the distal radius is one of the most common skeletal injuries. However, there is still no “gold standard” for the treatment of such injuries, especially in the case of complex intra-articular fractures. One of the options for osteosynthesis is bridge-like fixation with a dorsal distraction plate, but it is little used by domestic surgeons.

Purpose of the study:to present systematic modern data on the indications for use and clinical effectiveness of the use of a dorsal distal distraction plate in osteosynthesis of complex fractures of the distal radius. The paper describes the surgical technique for installing a distraction plate, and also presents data from foreign authors regarding the incidence of complications, functional and anatomical results of treatment using the technique under study. Also identified are issues relevant for further study aimed at comparative analysis with alternative treatment methods, as well as assessment of long-term functional results.

KEYWORDS:fracture of the distal radius, distal metaepiphysis, external osteosynthesis, distraction plate, intra-articular fracture.

HOW TO QUOTE:Sergeev G.D., Belenkiy I.G., Mayorov B.A., Sergeeva M.A., Fomin K.N., Gladneva V.V. Osteosynthesis of complex intra-articular fractures of the distal radius with a dorsal distraction plate (literature review) // Journal of Emergency Surgery named after. I.I. Dzhanelidze. 2022. 2(7):24-30.


 

FRACTURES OF THE BONES OF THE DISTAL FOREARM. HISTORY AND CURRENT STATE OF THE ISSUE (literature review)

Authors

A.V. POLIKARPOV, Yu.B. KASHANSKY

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

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SUMMARY:The article provides an excursion into the history of the formation and development of approaches to providing care for fractures of the distal forearm. Various aspects of the issue under consideration are covered in many ways. The process of diagnostics evolution is revealed as new technical capabilities, as well as the means of its implementation, improve and emerge. Particular attention is paid to the treatment of this type of damage. A critical assessment of modern approaches and methods of treating fractures of the distal forearm is given. The issues of their current epidemiology and classification are considered. Emphasis is placed on assessing the results of treatment and optimizing their criteria for an objective comparison of the outcomes of medical care.

KEYWORDS:distal forearm, fracture, epidemiology.

HOW TO QUOTE:Polikarpov A.V., Kashansky Yu.B. Fractures of the bones of the distal forearm. History and current state of the issue (literature review) Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. 2(7):31-40


 

FEATURES OF TREATMENT OF PATIENTS WITH PERIPROSTHETIC FRACTURES AFTER HIP ENDOPROSTHETICS

Authors

V.V. KHOMINETS, P.A. METLENKO, A.L. KUDYASHEV, A.L. DRESVYANNIKOV, V.V. CHERNYSHEV, D.R. FAKHRUTDINOV

Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

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SUMMARY:The study assessed the immediate results of treatment of patients with periprosthetic fractures after hip replacement depending on the type of fracture, the stability of the femoral component and the quality of the bone tissue.

KEYWORDS:periprosthetic fracture, endoprosthetics, hip joint, femoral component.

HOW TO QUOTE:Khominets V.V., Metlenko P.A., Kudyashev A.L., Dresvyannikov A.L., Chernyshev V.V., Fakhrutdinov D.R. Features of treatment of patients with periprosthetic fractures after hip replacement. Journal "Emergency Surgery" named after. I.I. Dzhanelidze. 2022. 2(7):40-47


 

MECHANICAL SHOCKOGENIC INJURY, DYNAMICS OF MORTALITY IN A FIRST LEVEL TRAUMA CENTER

Authors

V.N. LAPSHIN1,3, V.A. MANUKOVSKY1,2, A.N. TULUPOV1,3, Y.V. GAVRISCHUK1, A.E. DEMKO1,4, V.S. AFONCHIKOV1,4,5, I.M. BARSUKOVA1,3, N.K. RAZUMOVA1

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

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

3 First St. Petersburg State Medical University named after. acad. I.P. Pavlova, St. Petersburg, Russia

4 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

5 St. Petersburg State University, St. Petersburg, Russia

Annotations

SUMMARY:The article presents information on mortality in victims with shockogenic trauma, in-hospital, and during various periods of the disease. To determine the severity of injury, we used publicly available criteria and a prognostic algorithm developed at the St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze.

KEYWORDS:hospital stage, shockogenic injury, traumatic illness, periods of traumatic illness, mortality.

HOW TO QUOTE:Lapshin V.N., Manukovsky V.A., Tulupov A.N., Gavrishchuk Ya.V., Demko A.E., Afonchikov V.S., Barsukova I.M., Razumova N.K. Mechanical shockogenic injury, dynamics of mortality in a first-level trauma center. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;2(7):48-53 CONFLICT OF INTEREST: The authors declared no conflict of interest


 

TECHNOLOGIES OF THREE-DIMENSIONAL PLANNING AND PRINTING IN TRAUMATOLOGY AND ORTHOPEDICS

Authors

A.A. AKULAEV1, A.A. POVALIY1, I.G. BELENKY1,2

1 St. Petersburg State University, St. Petersburg, Russia

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

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SUMMARY:Advances in MRI and CT data processing are opening up the possibility of widespread clinical use of 3D printing technology, which provides the surgeon with a realistic physical model of the anatomy of the intervention site, helping to create a surgical plan and perform the operation.

Purpose of the study:based on data from modern scientific publications, study the possibilities of three-dimensional printing in traumatology and orthopedics.

KEYWORDS:three-dimensional printing, additive technologies, modeling in traumatology and orthopedics, individual modeling

HOW TO QUOTE:Akulaev A.A., Povaliy A.A., Belenkiy I.G. Technologies of three-dimensional planning and printing in traumatology and orthopedics. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;2(7):54-61


 

FEATURES OF USE OF PERSONAL PROTECTION EQUIPMENT FOR LOWER LIMBS DURING HUMANITARIAN DEmining

Authors

V.V. KHOMINETS, G.A. LYAKHOVETS, D.A. SHAKUN, A.V. DENISOV

Military Medical Academy named after S. M. Kirov, St. Petersburg, Russia

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SUMMARY:Based on a study of the impact of explosion factors of high-explosive anti-personnel mines of various power on the lower limb, the minimum permissible parameters of the sole (platform) for the mine-resistant footwear being developed were determined. An analysis of the tactical and technical characteristics of high-explosive anti-personnel mines and their design features that influence the damaging effect of the lower extremities was carried out. The characteristics of commercially available models of mine-resistant boots are analyzed from the point of view of reducing the impact of the explosion of high-explosive anti-personnel mines or explosive charges of various powers.

KEYWORDS:explosion, sapper, mine, land mine, protection, demining, injury, mine-resistant shoes, personal protective equipment for sappers, humanitarian demining.

HOW TO QUOTE:Khominetz V.V., Lyakhovets G.A., Shakun D.A., Denisov A.V. Features of the use of personal protective equipment for lower extremities during humanitarian demining. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 2(7):62-68


 

OUR EXPERIENCE IN SURGICAL STABILIZATION OF THE RIPAL FRAME IN MULTIPLE FRACTURES OF THE RIBS AND ROBAL VALVE

Authors

M.V. ISAEV1, B.A. MAYOROV2,3,4,5, S.S. SMIRNOV4, G.D. SERGEEV 3.5

1 Gatchina Clinical Interdistrict Hospital, Gatchina, Leningrad Region, Russia

2 Vsevolozhsk Clinical Interdistrict Hospital, Vsevolozhsk, Leningrad Region, Russia

3 St. Petersburg State University, St. Petersburg, Russia

4 First St. Petersburg State Medical University named after. Academician I.P. Pavlova, St. Petersburg, Russia

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

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SUMMARY: The relevance of the problem of treating patients with severe thoracic injuries is beyond doubt. Promising for these injuries are surgical interventions to restore the frame of the chest.

Purpose of the study: to evaluate the early results of surgical stabilization of the rib frame in patients with multiple rib fractures and rib valve. This article presents short-term results of treatment of patients of this profile, laying the foundation for further research.

KEYWORDS: rib fracture, multiple rib fractures, floating chest, osteosynthesis, rib osteosynthesis

HOW TO QUOTE: Isaev M.V., Mayorov B.A., Smirnov S.S., Sergeev G.D. Our experience in surgical stabilization of the rib frame for multiple rib fractures and rib valve. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 2(7):69-74


 

SURGICAL TREATMENT OF A PATIENT WITH UNSUCCESSFULLY OPERATED SPINE SYNDROME (clinical observation)

Authors

V.V KHOMINETS, E.B. NAGORNY, K.A NADULICH, A.V. TEREMSHONOK, A.L. KUDYASHEV, A.A. SHOOTING

Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

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SUMMARY: The article presents a clinical case of surgical treatment of a patient for a degenerative disease of the lumbosacral spine. The article discusses in detail the data of clinical and instrumental research methods and the results of surgical treatment in chronological order.

Target: focusing the attention of specialists on the problem of treating patients with syndrome of unsuccessfully operated spine, which occurs despite the use of modern decompressive and stabilizing high-tech techniques.

KEYWORDS: intervertebral disc herniation; spinal instability; spinal imbalance; spinal fusion, back pain

HOW TO QUOTE: Khominets V.V., Nagorny E.B., Nadulich K.A., Teremshonok A.V., Kudyashev A.L., Strelba A.A. Surgical treatment of a patient with syndrome of unsuccessfully operated spine (clinical observation). Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 2(7); 75-80.

№1 2022

MILITARY SURGEON AND anatomist PROFESSOR V.A. PAVLENKO (TO THE 90TH ANNIVERSARY OF THE DEPARTMENT OF MILITARY SURGERY)

Authors
THEM. SAMOKHVALOV1,2, V.I. BADALOV1, S.A. SHLYAPNIKOV1,2, N.A. TYNYANKIN1, N.F. FOMIN1, P.P. LYASHEDKO1

1 Federal State Budgetary Educational Institution of Higher Education Military Medical Academy named after. S. M. Kirova≫Russian Ministry of Defense, St. Petersburg, Russia

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

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In connection with the anniversary date - the 90th anniversary of the creation of the world's first department of military field surgery of the Military Medical Academy - materials are presented about one of its creators, Professor V.A. Pavlenko. Student of Academician V.N. Shevkunenko, V.A. Pavlenko initially held the position of deputy head of the newly created department of military field surgery, then headed this department for five years and made a great contribution to its formation.

KEYWORDS: Military Medical Academy, Department of Military Field Surgery, V.A. Oppel, V.A. Pavlenko

HOW TO QUOTE: Samokhvalov I.M., Badalov V.I., Shlyapnikov S.A., Tynyankin N.A., Fomin N.F., Lyashedko P.P. Military surgeon and anatomist Professor V.A. Pavlenko (to the 90th anniversary of the Department of Military Surgery). Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;1(6):5–11.


 


 


 

EIGHT YEARS OF EXPERIENCE IN THE USE OF MINIMALLY INVASIVE TRANSFORAMINAL SPONDILODESIS WITH UNILATERAL TRANSPEDICULAR FIXATION IN DEGENERATIVE DISEASES OF THE LUMBAR SPINE

Authors

K.A. POYARKOV, I.SH. KARABAEV, V.V. KHLEBOV, A.A. PALIKOVSKY, A.ZH. TILOV

FSBI All-Russian Center for Emergency and Radiation Medicine named after. A.M. Nikiforova" EMERCOM of Russia, St. Petersburg, Russia

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Goal of the work:to evaluate 8 years of experience in the use of minimally invasive transforaminal spinal fusion with unilateral transpedicular fixation for degenerative diseases of the lumbar spine in the neurosurgical department of the All-Russian Center for Reconstructive Medicine. A.M. Nikiforova.

Materials and methods:From 2014 to 2021 155 surgical interventions were performed using the MISTLIF method with unilateral fixation for degenerative pathology of the spine.

Result:after surgery there was a significant improvement in clinical results according to the Macnab, ODI, VAS scales.

Conclusion:in our study, surgical interventions with unilateral fixation showed good clinical and radiological results.

KEYWORDS:minimally invasive transforaminal spinal fusion, unilateral transpedicular fixation.

HOW TO QUOTE:Poyarkov K.A., Karabaev I.Sh., Khlebov V.V., Palikovsky A.A., Tilov A.Zh. 8 years of experience in the use of minimally invasive transforaminal spinal fusion with unilateral transpedicular fixation for degenerative diseases of the lumbar spine. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;1(6); 12–16.


 

INFLUENCE OF CHANGES IN CERVICAL SUBAXIAL LORDOSIS ON PAIN SYNDROME AFTER ONE-TWO-LEVEL ACDF IN DEGENERATIVE-DYSTROPHIC DISEASES OF THE SPINE

Authors

A.Zh. TILOV, I.SH. KARABAEV, K.A. POYARKOV, V.V. KHLEBOV, A.A. PALIKOVSKY

FSBI All-Russian Center for Emergency and Radiation Medicine named after A.M. Nikiforova" EMERCOM of Russia, St. Petersburg, Russia

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Goal of the work.To determine the relationship between sagittal parameters of the cervical spine and axial pain syndrome in the neck in patients after one- or two-level ACDF.

Materials and methods: The work is based on data from the medical records of 83 patients operated on between 2020 and 2022. in the neurosurgical department of the Federal State Budgetary Institution “All-Russian Center for Emergency and Radiation Medicine named after A.M. Nikiforova" EMERCOM of Russia

Result: Our results show a statistically significant increase in subaxial cervical lordosis, from 6.74 (preoperative) to 10.13 (postoperative) (p < 0.05).

Conclusion:An increase in cervical lordosis during ACDF is accompanied by a decrease in axial pain in the cervical region.

KEYWORDS:sagittal balance of the cervical spine, anterior cervical decompression and fusion, subaxial cervical lordosis

HOW TO QUOTE:Tilov A.Zh., Karabaev I.Sh., Poyarkov K.A., Khlebov V.V., Palikovsky A.A. The influence of changes in cervical subaxial lordosis on pain after one- or two-level acdf in degenerative diseases of the spine. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 1 (6): 17–21.


 

PREDICTORS OF THE DEVELOPMENT OF ADVERSE OUTCOMES OF SURGICAL TREATMENT OF DEGENERATIVE-DYSTROPHIC DISEASE OF THE LUMBAR SPINE

Authors

V.V. KHLEBOV1, I.V. VOLKOV1,2, I.SH. KARABAEV1, K.A. POYARKOV1, A.ZH. TILOV1, A.A. PALIKOVSKY1, V.N. SOLNTSEV3

1 Federal State Budgetary Institution “All-Russian Center for Emergency and Radiation Medicine named after. A.M. Nikiforova" EMERCOM of Russia, St. Petersburg, Russia, St. Petersburg, Russia

2 CHUZ "Clinical Hospital "RZD-Medicine" St. Petersburg", St. Petersburg, Russia

3 Federal State Budgetary Institution “National Medical Research Center named after V.A. Almazov" Ministry of Health of Russia, St. Petersburg, Russia

SUMMARYDecompression and stabilization surgery on the lumbar spine is one of the most common interventions for degenerative pathologies, where the formation of spinal fusion plays a key role.

Result:Excellent and good outcome was present in 168 (71.2%) and 29 (12.3%) patients, respectively, satisfactory - in 9 (3.8%), unsatisfactory - in 30 (12.7%).

KEYWORDS:degenerative-dystrophic disease of the spine, interbody fusion, risk factors.

HOW TO QUOTE:Khlebov V.V., Karabaev I.Sh., Volkov I.V., Poyarkov K.A., Tilov A.Zh., Palikovsky A.A., Solntsev V.N. Predictors of the development of unfavorable outcomes of surgical treatment of degenerative-dystrophic diseases of the lumbar spine. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;1 (6):22–28


 

TREATMENT OF DEEP PERI-IMPLANT ABSCESS OF THE UPPER CERVICAL SPINE USING NEGATIVE WOUND PRESSURE (NPWT) SYSTEM (CLINICAL OBSERVATIONS)

Authors

V.A. MANUKOVSKY1,2, T.I. TAMAEV1, I.M. BATYRSHIN1, K.V. TYULIKOV, V.V. SERIKOV1, I.S. AFANASYEVA1, Yu.V. BIRKO1, M.Sh. MUSTAFA1, M.I. SIDOR1, S.V. DUKHNOV1

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze"

2 Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov" Ministry of Health of Russia, St. Petersburg, Russia

Annotation:

Summary:The issue of treatment of peri-implant infections.

Target:To present successful experience using negative pressure therapy (NPWT) to preserve spinal stabilizing systems in patients with deep peri-implant infection.

Material and methods: Two clinical cases of the use of wound treatment with negative pressure systems in patients with deep peri-implantation infection are described.

Results:In the shortest possible time from the start of NPWT therapy, it was possible to stabilize the infectious process in the wound, close the previously installed structure with soft tissue, and obtain a healthy skin scar. The absence of relapses was confirmed by follow-up.

Conclusion:NPWT can be used as the treatment of choice in patients with deep peri-implant infection in clinical situations where removal or subsequent reimplantation is not possible.

KEYWORDS:spine, discitis, spondylitis, paravertebral abscess, vacuum bandage, NPWT, cervical spinal fusion.

HOW TO QUOTE:Manukovsky V.A., Tamaev T.I., Batyrshin I.M., Tyulikov K.V., Serikov V.V., Afanasyeva I.S., Birko Yu.V., Mustafa M.Sh., Sidor M. .I., Dukhnov S.V. Treatment of deep peri-implant abscess of the upper cervical spine using a negative wound pressure (NPWT) system (clinical observations). Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022;1(6):29–37


 

ROLE OF REAL-TIME PCR IN EARLY DETECTION OF CARBAPENEMASES PRODUCTION BY ENTEROBACTERIA IN ICU

Authors:

N.R. NASER 1,2, L.N. POPENKO 1, S.A.SHLYAPNIKOV 1.3

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Institution of Higher Professional Education “North-Western State Medical University named after. I.I. Mechnikov", St. Petersburg, Russia

3 Federal State Budgetary Educational Institution of Higher Education "Military Medical Academy named after S.M. Kirov" Ministry of Defense of the Russian Federation, St. Petersburg, Russia

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Abstract: Treatment of infections caused by antibiotic-resistant pathogens is a problem for modern medicine. The results of treatment of patients with severe sepsis directly depend on timely and adequate antimicrobial therapy. The increasing number of infections caused by carbapenem-resistant Enterobacteriaceae, including Kl.pneumoniae, complicates the choice of an adequate empiric antibiotic therapy regimen. Early detection of the ability of Kl.pneumoniae to produce carbapenemases is a real possibility of timely administration of an antimicrobial therapy regimen close to the etiotropic one. Assessment of risk factors for the presence of carbapenem-resistant strains of Enterobacteriaceae allows us to identify a group of patients at risk of carrying such strains of Enterobacteriaceae. Performing real-time PCR in this category of patients can ensure early detection of carbapenem resistance genes and the use of appropriate antibiotics effective against a specific carbapenemase as initial empirical therapy.

KEYWORDS:severe sepsis, antibacterial therapy, antibiotic-resistant pathogens, carbapenem resistance Kl.pneumoniae, early diagnosis of carbapenemase gene production, real-time PCR

HOW TO QUOTE.Nasser N.R., Popenko L.N., Shlyapnikov S.A. The role of real-time PCR in the early detection of carbapenemase production by enterobacteria in the ICU. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;4(5):38–42.


 

CURRENT PROBLEMS OF CONSERVATIVE TREATMENT OF ADULT PATIENTS WITH SHORT BOWL SYNDROME AND CHRONIC INTESTINAL FAILURE (SBS-CI)

Authors

V.M. LUFT 1, A.E. DEMKO1, I.N. Leiderman 2, A.V. LAPITSKY1, I.M. BATYRSHIN 1, A.M. SERGEEVA 1

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Institution “National Medical Research Center named after V.A. Almazov" Russian Ministry of Health, St. Petersburg, Russia

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SUMMARYThe article discusses the clinical manifestations and problematic issues of treatment and rehabilitation of patients with short bowel syndrome. A functional classification of intestinal failure present in this condition is provided. The pathogenesis of the development of possible immediate and long-term postoperative complications is outlined, as well as the features of pharmacotherapy for this category of patients, aimed at correcting impaired digestion, taking into account the changing pharmacokinetics of drugs taken per os. The issues of diet therapy, indications and features of infusion therapy, as well as various options for nutritional support, including supportive parenteral nutrition for these patients in outpatient settings are considered. We present our own experience in organizing parenteral nutrition for such patients at home.

KEYWORDS: short bowel syndrome, chronic intestinal failure, nutritional support.

HOW TO QUOTE. Luft V.M., Demko A.E., Lapitsky A.V., Batyrshin I.M., Sergeeva A.M. Current problems and prospects for treating patients with short bowel syndrome. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 1(6):43–52


 

COMBINED TRAUMA IN A LARGE CITY IN PEACETIME. EPIDEMIOLOGICAL ASPECTS

Authors

N.I. ZAVSEGOLOV1, A.V. BONDARENKO2, V.V. LUKYANOV3, O.A. GERASIMOVA2

1 Federal State Budgetary Educational Institution of Higher Education "Altai State Medical University" of the Ministry of Health of the Russian Federation, Department of Traumatology and Orthopedics, Barnaul, Russia

2Regional state budgetary healthcare institution “Regional Clinical Hospital of Emergency Medical Care”, trauma department No. 2, Barnaul, Russia

3 Regional state budgetary healthcare institution “City Clinical Hospital No. 11”, trauma center, Barnaul, Russia

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Introduction.Combined injuries are injuries resulting from exposure to various traumatic factors. They are characterized by the particular severity of clinical manifestations, the difficulty of diagnosis, the complexity of treatment, high mortality and disability of victims

Purpose of the study.To determine the frequency, prevalence, structure, severity of combined injuries, mortality characteristics and duration of hospital treatment in Barnaul (a large city).

Materials and methods.An analysis of the treatment of 134 victims over 15 years was carried out. All victims were divided into 3 groups: the 1st group included patients whose main component of the combined injury, in addition to mechanical injuries, was chemical burns, the 2nd group included cold trauma, and the 3rd group included thermal burns. The 3rd group was divided into 2 subgroups: the 1st group included victims with burns of a location other than the fracture, the 2nd group included victims with burns of a location identical to the fracture.

Results and discussion.The greatest severity of CombT was observed in patients of the 1st group with chemical burns and in the 3rd group with thermal exposure (in its 2nd subgroup), the least - with cold injury.

Conclusion.In a large city, combined injuries are a rare pathology in peacetime.

KEYWORDS:combined injury, thermomechanical injury, thermal burns.

HOW TO QUOTE.Zavsegolov N.I., Bondarenko A.V., Lukyanov V.V., Gerasimova O.A. Combined trauma in a large city in peacetime. Epidemiological aspects. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 1(6):53–59.


 

COMBINED TRAUMA IN A LARGE CITY IN PEACETIME. EPIDEMIOLOGICAL ASPECTS

Authors

N.I. ZAVSEGOLOV1, A.V. BONDARENKO2, V.V. LUKYANOV3, O.A. GERASIMOVA2

1 Federal State Budgetary Educational Institution of Higher Education "Altai State Medical University" of the Ministry of Health of the Russian Federation, Department of Traumatology and Orthopedics, Barnaul, Russia

2Regional state budgetary healthcare institution “Regional Clinical Hospital of Emergency Medical Care”, trauma department No. 2, Barnaul, Russia

3 Regional state budgetary healthcare institution “City Clinical Hospital No. 11”, trauma center, Barnaul, Russia

annotation

Introduction. Combined injuries are injuries resulting from exposure to various traumatic factors. They are characterized by the particular severity of clinical manifestations, the difficulty of diagnosis, the complexity of treatment, high mortality and disability of victims.

Purpose of the study. To determine the frequency, prevalence, structure, severity of combined injuries, mortality characteristics and duration of hospital treatment in Barnaul (a large city).

Materials and methods. An analysis of the treatment of 134 victims over 15 years was carried out. All victims were divided into 3 groups: the 1st group included patients whose main component of the combined injury, in addition to mechanical injuries, was chemical burns, the 2nd group included cold trauma, and the 3rd group included thermal burns. The 3rd group was divided into 2 subgroups: the 1st group included victims with burns of a location other than the fracture, the 2nd group included victims with burns of a location identical to the fracture.

Results and discussion.The greatest severity of CombT was observed in patients of the 1st group with chemical burns and in the 3rd group with thermal exposure (in its 2nd subgroup), the least - with cold injury.

Conclusion. In a large city, combined injuries are a rare pathology in peacetime.

KEYWORDS:combined injury, thermomechanical injury, thermal burns.

HOW TO QUOTE. Zavsegolov N.I., Bondarenko A.V., Lukyanov V.V., Gerasimova O.A. Combined trauma in a large city in peacetime. Epidemiological aspects. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 1(6):53–59.


 

THEORETICAL BASES OF TECHNOLOGY FOR PERFUSION PRESERVATION OF DONOR ORGANS

Authors

HE. REZNIK 1,2, V.A. MANUKOVSKY 1,2, V.S. DAINEKO 1

1 State Budgetary Institution “St. Petersburg Scientific Research Institute named after I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov" Ministry of Health of Russia, St. Petersburg, Russia

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SUMMARYThe article analyzes the reasons for the shortage of donor organs and determines the prospects for expanding the donor pool through modification of donor organs (at the tissue, cellular and molecular level) using perfusion technologies. The adopted strategies for reducing the consequences of ischemia-reperfusion injury of donor organs, current trends in addressing issues of preservation and modification of donor organs are described, and literature data on the role of perfusion methods in modern organ transplantation is provided.

KEYWORDS: organ donation, ischemia-reperfusion, machine perfusion of donor organs, organ transplantation.

HOW TO QUOTE. Reznik O.N., Manukovsky V.A., Daineko V.S. Theoretical foundations of the technology of perfusion preservation of donor organs. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 1(6); 60–64.


 


 

SUCCESSFUL MULTISTAGE TREATMENT OF POST-RADIATION COMPLICATIONS OF CERVICAL CANCER. CLINICAL OBSERVATION

Authors

A.E. DEMKO1, S.A. SHLYAPNIKOV1, Yu.S. OSTROUMOVA1, N.R. NASER1,2, D.S. SKLIZKOV1, S.A. PLATONOV1

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze"

2 Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after. I.I. Mechnikov" of the Ministry of Health of Russia, St. Petersburg

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SUMMARYA clinical case of successful treatment of a patient with multiple complications after a course of radiation therapy for cervical cancer is presented.

KEYWORDS:cervical cancer, intestinal-vesical fistula, post-radiation complications.

HOW TO QUOTE. Demko A.E., Shlyapnikov S.A., Ostroumova Yu.S., Nasser N.R., Sklizkov D.S., Platonov S.A. Successful multi-stage treatment of post-radiation complications of cervical cancer. Clinical observation. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 1(6); 65–69.


 

PROSPECTS FOR THE USE OF STEM CELLS IN THE TREATMENT OF BURNED PATIENTS (LITERATURE REVIEW)

Authors

HELL. FAYAZOV 1, O.S. CHARYSHNIKOVA 2, M.D. URAZMETOVA 1, U.R. KAMILOV 1, N.A. TSIFEROVA 2, A.A. STOPNITSKY 1

1 Republican Scientific Center for Emergency Medical Care of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan

2 Center for Advanced Technologies under the Ministry of Innovative Development of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan

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SUMMARYThe article provides a review of modern literature on the problem of using cellular technologies in the treatment of burn victims. An analysis of the proposed carriers for transplantation of stem cells onto the wound surface was carried out.

KEYWORDS:burn wound, fibroblasts, keratinocytes, mesenchymal stem cells, allo- and autodermoplasty.

HOW TO QUOTE.Fayazov A.D., Charyshnikova O.S., Urazmetova M.D., Kamilov U.R., Tsiferova N.A., Stopnitsky A.A. Prospects for the use of stem cells in the treatment of burn patients (literature review). Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2022; 1(6); 70–78.

№4 2021

DIAGNOSIS AND ENDOVASCULAR TREATMENT OF PATIENTS WITH ACUTE BLEEDING

Authors

M.A. KISELEV1, S.A. Platonov1, A.A. POLIKARPOV2, V.E. SAVELLO1, A.E. DEMKO1, D.V. KANDYBA1

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

2 Russian Scientific Center of Radiology and Surgical Technologies named after. acad. A.M. Granova, St. Petersburg, Russia

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Introduction:Bleeding is a dangerous life-threatening complication of any disease. Despite the active development of open and minimally invasive techniques for stopping bleeding, the mortality rate from this pathology, unfortunately, remains at a high level. Endovascular methods for performing hemostasis for bleeding of various etiologies have been successfully used almost since the middle of the last century. Currently, interventional radiology plays an important role in the treatment of patients with traumatic and non-traumatic bleeding. This article presents the experience of using endovascular methods to stop bleeding at the Department of X-ray surgical methods of diagnosis and treatment of the St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze.

Conclusions:The analysis indicates the high effectiveness of endovascular interventions in patients with bleeding. This technique allows you to determine the source of bleeding, assess the state of hemostasis, stop hemorrhage, stabilize the patient’s hemodynamics with the prospect of radical open intervention.

KEYWORDS:endvascular embolization, acute bleeding, computed tomography with intravenous bolus contrast, angiography, St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

HOW TO QUOTE:Kiselev M.A., Platonov S.A., Polikarpov A.A., Savello V.E., Demko A.E., Kandyba D.V. Diagnosis and endovascular treatment of patients with acute bleeding. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;4(5); 6-10.


 

THE NEED FOR FURTHER EXAMINATION OF PATIENTS WITH CORONARY ARTERY ATHEROSCLEROSIS FOR THE PREVENTION OF ISCHEMIC STROKE

Authors

M.S. BERDIKHOJAEV, G.Z. TANBAEVA, M.A. SARSHAYEV, N.A. SULEIMANKULOV, D.K. AUESKHANOVA

Neurosurgical Center, JSC "Central Clinical Hospital", Almaty, Republic of Kazakhstan

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Introduction:When treating patients for coronary heart disease or acute coronary syndrome, additional diagnostics should be carried out to prevent the risk of acute ischemic cerebrovascular accident. This should significantly reduce the likelihood of an unfavorable outcome, increase access to treatment, reduce the number of hospital days and have a positive impact on future quality of life.

Materials and methods:This article uses medical histories from the medical database of the neurosurgical center of JSC "Central Clinical Hospital" in Almaty, treated between January 2016 and July 2021. according to the main diagnosis: stenosis of the brachiocephalic arteries against the background of atherosclerotic lesions. All data are presented and calculated using descriptive statistics using Microsoft Excel 2020, Microsoft Word 2020, Apple Pages 11.1.

KEYWORDS:coronary heart disease (CHD), arterial hypertension, acute coronary syndrome (ACS), acute cerebrovascular accident (ACVA), arteriography of cerebral arteries

HOW TO QUOTE:Berdikhodzhaev M.S., Tanbaeva G.Z., Sarshaev M.A., Suleymankulov N.A., Aueskhanova D.K. The need for additional examination of patients with atherosclerosis of the coronary arteries for the prevention of ischemic stroke. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;4(5):11-15


 

EMBOLIZATION OF THE MIDDLE TECHNOLOGICAL ARTERY IN THE TREATMENT OF SMALL EPIDURAL HEMATOMA

Authors

BABICHEV K.N.1,2, SVISTOV D.V.1, KANDYBA D.V.1, 2, SAVELLO A.V.1, MARTYNOV R.S.1, LANDIK S.A.1

1 Federal State Budgetary Educational Institution of Higher Education ≪Military Medical Academy named after. S. M. Kirova≫ Russian Ministry of Defense, St. Petersburg, Russia

2 GBU ≪St. Petersburg Research Institute of Emergency Medicine named after. I. I. Dzhanelidze≫, St. Petersburg, Russia

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Goal of the work:To evaluate the effectiveness of middle meningeal artery embolization in patients with small epidural hematomas.

Materials and methods:In total, from 2014 to 2021. In 6 patients with small epidural hematomas, embolization of the middle meningeal artery was performed as an independent treatment method. At the time of surgery, all patients were clearly conscious without neurological symptoms caused by the epidural hematoma.

Results:Superselective angiography of the middle meningeal artery in all patients revealed signs of its damage in the form of the formation of traumatic pseudoaneurysms (n=6) and AV fistulas between the arteries and diploic vein (n=4), ongoing bleeding/extravasation (n=1). In all cases, embolization of the middle meningeal artery was performed with an adhesive adhesive composition. No perioperative complications were noted.

Conclusion:A control CT scan of the brain, performed on average 7 days after surgery, showed a decrease in the volume of hematomas in all cases. None of the cases required open surgery for epidural hematoma. Patient treatment outcomes were good, corresponding to 0-1 points on the mRs scale.

Conclusion:Middle meningeal artery embolization is an effective and safe treatment for small epidural hematomas.

KEYWORDS:microsurgical training, stereomicroscope, anastomosis

HOW TO QUOTE:Babichev K.N., Svistov D.V., Kandyba D.V., Savello A.V., Martynov R.S., Landik S.A. Embolization of the middle meningeal artery in the treatment of small epidural hematomas. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;4(5):16-20


 

ANALYSIS OF FATAL OUTCOMES AFTER CEREBRAL THROMBOEXTRACTION: OWN EXPERIENCE

Authors

S.V. SHENDEROV, V.A. GOSTIMSKY, M.V. Tugbaev, D.A. SVEKLOV, E.A. KURNIKOVA, A.A. SERKIN, A.N. SMIRNOV, E.G. KARMAZANASHVILI, E.L. BELYAEV

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

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Relevance:Acute cerebrovascular accident (ACVA) is in second place in the world among all causes of death in adults, and among people under the age of 44 it is one of the 10 leading causes of death. Intravascular methods of treating acute ischemic cerebrovascular accidents are currently the standard of care for patients with acute occlusion of large arteries of the brain. According to the results of various studies and registries, three-month mortality after ischemic stroke is 21-35%.

Purpose of the study:To conduct a retrospective analysis of in-hospital mortality in patients with acute occlusion of one or more large cerebral arteries who underwent endovascular thromboextraction between January 2019 and November 2021.

Materials and methods:During the observation period, 462 patients were admitted to St. Petersburg State Budgetary Healthcare Institution “City Hospital No. 26” with IS with occlusion of a large artery. All patients were examined by a neurologist upon admission, neurological deficit was determined according to NIHSS, and sequential computed tomography of the brain, CT angiography of the cerebral arteries, and, if necessary, CT perfusion of the brain were performed. Cerebral angiography was performed in the X-ray operating room, followed by thromboextraction. A control study (CT) of the brain was performed 24 hours after surgery.

Results:The average age of all patients was 71.04±12.77 years (32-92 years), men – 70.57±12.77 years (36-92 years), women – 71.21±12.67 years (32- 92 years old). The average time from the onset of the clinical picture of IS to the patient’s admission to the hospital was 217.45±227.98 minutes (38–963 minutes). Hemorrhagic changes during control computed tomography 24 hours after surgery were detected in 54 (43.9%) patients. In-hospital mortality was 26.7% (123 patients).

Conclusion:Despite the rather high mortality rate (26.7% according to our own data and 31.8% according to the results of the Moscow Stroke Registry for 2019), cerebral thromboextraction remains the priority choice of care for patients with ischemic stroke.

KEYWORDS:acute cerebrovascular accident, ischemic stroke, cerebral angiography, cerebral thromboextraction

HOW TO QUOTE:Shenderov S.V., Gostimsky V.A., Tugbaev M.V., Sveklov D.A., Kurnikova E.A., Serkin A.A., Smirnov A.N., Karmazanashvili E.G., Belyaeva E. .L. Analysis of lethal outcomes after cerebral thromboextraction: personal experience. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 4(5):19-26


 

RESULTS OF ENDOVASCULAR TREATMENT OF PATIENTS WITH INTRACRANIAL ATHEROSCLEROTIC STENOSIS IN THE VERTEBROBASILAR BASIS

Authors

E.D. ANISIMOV 2, V.S. KISELEV 1, A.O. SOSNOV 1, A.M. PERFILIEV 1,2, R.R. GAFUROV 1

1 Federal State Budgetary Institution “Federal Center for Neurosurgery” of the Ministry of Health of Russia, Novosibirsk, Russia

2 Federal State Autonomous Educational Institution of Higher Education "Novosibirsk National Research State University", Novosibirsk, Russia

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Relevance:intracranial atherosclerosis (IA) is one of the most common causes of ischemic stroke (IS) in the world. The incidence of IS in the vertebrobasilar region (VBB) is about 25% of all strokes of the ischemic type. Considering the fairly high percentage of recurrent IA during conservative therapy, patients with IA in the VBD need to search for more effective treatment tactics.

Purpose of the study:to evaluate the results of endovascular treatment in patients with intracranial stenosis in the VSB.

Materials and methods:From October 2017 to October 2021, 12 patients with IA stenosis were operated on in the Department of Vascular Neurosurgery of the Federal Center for Neurosurgery in Novosibirsk: 7 (58.3%) with lesions of the basilar arteries, 5 (41.7%) with lesions of the vertebral arteries. All patients were hospitalized as planned. The average degree of artery narrowing was 86.5±6.5%. The average duration of the last ischemic event was 11 months (range 1 to 55 months). Treatment results were assessed both in the immediate (immediately after surgery) and long-term periods.

Results:According to the results of control angiograms at the end of the operation, all patients achieved an excellent angiographic result with complete restoration of blood flow through the main vessel. In the early postoperative period, deterioration of neurological symptoms in the form of the appearance of severe cerebellar ataxia occurred in 1 (8.3%) patient. There were no deaths. In the long-term period (maximum follow-up 22 months), not a single case of recurrent IS was registered. At the same time, two (16.6%) patients showed an improvement in indicators on the mRs scale. Control cerebral angiograms did not reveal restenosis in the area of ​​the implanted stent in any case.

Conclusion:Endovascular angioplasty and stenting have proven to be effective and safe treatment methods for patients with IA stenoses in the VBB. Our data obtained in the long-term period allow us to speak not only about the stability of the angiographic result, but also about the possibility of improving the clinical condition of patients.

KEYWORDS:VBB stenosis, basilar artery stenting, VBB stroke

HOW TO QUOTE: Anisimov E.D., Kiselev V.S., Sosnov A.O., Perfilyev A.M., Gafurov R.R. Results of endovascular treatment of patients with intracranial atherosclerotic stenosis in the vertebrobasilar region. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 4(5):27-33


 

THE FIRST EXPERIENCE OF USING THE PORTICO TRANSCATHETER BIOLOGICAL PROSTHETIC AORTAL VALVE IN ST. PETERSBURG. COMPARATIVE EVALUATION WITH COREVALVE AORTIC VALVE

Authors

V.V.ZELENIN, K.D. KOTENKOV, O.I. KUDRYAVTSEV, A.Z. MAKHEGOV, I.A. YATSENKO, N.V.YARYGINA, A.A. ZAVRAZHNOV

St. Petersburg State Budgetary Healthcare Institution "City Mariinsky Hospital", St. Petersburg, Russia

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Purpose of the study:To compare the technical features and clinical results of implantation of transcatheter biological aortic valve prostheses Portico and CoreValve based on the experience of a city hospital.

Materials and methods:The results of treatment of 48 elderly patients with high surgical risk with severe aortic stenosis and extensive concomitant pathology were retrospectively analyzed. Two groups were identified, comparable according to the main clinical indications: the 1st group was implanted with a transcatheter biological prosthesis CoreValve, the 2nd group was implanted with a transcatheter biological prosthesis Portico.

Results:Transcatheter implantation of valves of both modifications demonstrated their effectiveness in the form of a decrease in the average gradient of less than 10 mm Hg in both groups, a decrease in the maximum blood flow velocity at the aortic valve of less than 2 m/s. The delta reduction in the average gradient on the aortic valve was greater in the second group and amounted to 38.4 mm Hg with Portico implantation, versus 32.4 mm Hg. Art. when implanting CoreValve. Also in the second group, the control Echo-CS revealed a greater decrease in the end-systolic volume of the left ventricle. When analyzing paravalvular regurgitation in the immediate postoperative period, grade 3 regurgitation was not detected in any patient. Grade 2 regurgitation was more often observed in the second group of patients: 26.6% versus 10.5% with implantation of Evolute R valves (p>0.05).

Conclusion:Transcatheter implantation of biological aortic valve prostheses of both modifications has demonstrated high safety and effectiveness. However, there are some differences and features during implantation that must be taken into account when planning endovascular surgery.

KEYWORDS: aortic stenosis, TAVI, transcatheter aortic valve implantation

HOW TO QUOTE:Zelenin V.V., Kotenkov K.D., Kudryavtsev O.I., Mamkhegov A.Z., Yatsenko I.A., Yarygina N.V., Zavrazhnov A.A. The first experience of using the transcatheter biological prosthetic aortic valve Portico in St. Petersburg. Comparative evaluation with the CoreValve aortic valve. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;4 (5):34-39


 

COMBINED ENDOVASCULAR AND PUNCTURE TRANSOVAL EMBOLIZATION OF MENINGIOMA OF THE SPHENOPETROCLIVAL AREA: A CASE FROM PRACTICE

Authors

M.S. BERDIKHOJAEV, MAKHANBETKHAN S.SH., SARSHAEV M.A., MUSABEKOV M.G., M.M. MIRZAKHMETOV

Neurosurgical Center, JSC "Central Clinical Hospital", Almaty, Republic of Kazakhstan

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Introduction:Meningiomas are the most common primary brain tumors in adults, accounting for approximately one third of all intracranial neoplasms, ranking second only to gliomas. Surgical treatment remains the method of choice, but to achieve good prognostic results and reduce intraoperative complications, presurgical embolization of meningioma is recommended. In this article, we demonstrate an accessible and safe technique for puncture transoval embolization of sphenopetroclival meningioma using a liquid adhesive that diffusely penetrated the entire tumor parenchyma without migrating out of the tumor.

KEYWORDS:benign formation, petroclival meningioma, sphenopetroclival meningioma, transoval embolization, endovascular embolization

HOW TO QUOTE:Berdikhodzhaev M.S., Makhanbekhan Sh.Sh., Sarshaev M.A., Musabekov M.G., Mirzakhmetov M.M. Combined endovascular and puncture transoval embolization of meningioma of the sphenopetroclival area: a case report. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;4(5):40-47


 

ENDOVASCULAR INTERVENTIONS ON THE INTERNAL ILIAC ARTERY IN CHRONIC LIMB-THREATING ISCHEMIA: A RETROSPECTIVE CHORT STUDY

Authors

P.S. KURYANOV1, E.P. ZAICHENKO1, D.V. ZHUKOV1, A.A. GUSEV1, A.V. YAKIMOVA1, M.A. SHATIL1, O.N. DOBRYDIN1, V.V. STRIZHELETSKY1, A.N. LIPIN2, Yu.V. PLAMENEVA1, O.B. CHERNYSHEV1

1 St. Petersburg State Budgetary Healthcare Institution City Hospital named after. St. Great Martyr George, St. Petersburg, Russia

2 St. Petersburg State Budgetary Healthcare Institution City Hospital No. 14, St. Petersburg, Russia

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Relevance of the problem: in complex, extended lesions of the aortoiliac segment, revascularization of the IPA is sometimes used as a way to save a limb or relieve stump ischemia after major amputation. The existing literature data on this issue is limited to single reports; the advantages and disadvantages of various approaches to ICA revascularization have not been studied. This retrospective study analyzed the experience of intravascular revascularization of the IPA in several patients with chronic limb-threatening ischemia (CLTI), as well as in patients with critical ischemia of the limb stump after major amputation.

Materials and methods:The study included patients with occlusive lesions of the arteries of the lower extremities who underwent reconstructive interventions on the IPA for CIU or critical ischemia of the femoral stump between October 2019 and March 2020. Clinical and demographic characteristics of patients, early (mortality, rate of high amputations) and long-term (overall survival, rate of limb salvage, freedom from repeated revascularization) outcomes were assessed.

results: Endovascular interventions were performed in 5 patients, median age 60 years (45-73). Clinical manifestations of CIUC in 3 out of 5 patients were represented by rest pain and the presence of trophic defects of the foot, in another 2 – rest pain in the femoral stump after amputation in combination with necrosis of the amputation wound. Angiography revealed total occlusion of the common and external iliac arteries in 80%, and occlusion of the internal iliac artery in 20% with patent PPA and IPA. Only in 40% of patients was the lumen of the deep femoral artery visualized from the collaterals. In 80% of cases, balloon angioplasty of the PCA and ICA was performed with implantation of a self-expanding stent in the PCA, less often in the ICA trunk. One patient (20%) had isolated angioplasty and ICA stenting. The incidence of major perioperative complications and mortality was 0%. Within 1 year after surgery, survival rate was 80%, freedom from limb amputation was 75%, freedom from repeated revascularization was 100%.

Conclusions:Revascularization of the IPA basin using the endovasal method for complex lesions of the aortoiliac segment turned out to be an effective method for preserving the limb and relieving ischemia of the femoral stump in the patients with CIUC we studied.

KEYWORDS:chronic ischemia threatening the limb; ischemia of the femoral stump; internal iliac artery; endovascular interventions

HOW TO QUOTE:Kuryanov P.S., Zaichenko E.P., Zhukov D.V., Gusev A.A., Yakimova A.V., Shatil M.A., Dobrydin O.N., Strizheletsky V.V., Lipin A. N., Plameneva Yu.V., Chernyshev O.B. Endovascular interventions on the internal iliac artery for chronic limb-threatening ischemia: a retrospective cohort study. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 4(5):48-54

 

A CASE OF STAGE TREATMENT OF A PATIENT WITH ACUTE DEBAKEY TYPE I AORTIC DISSOLUTION

Authors

I.R. UZHAKHOV, E.A. SHLOYDO, A.B. Shlyakhova, K.P. KRAVCHENKO

GBUZ "City Multidisciplinary Hospital No. 2", St. Petersburg, Russia

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Introduction:Surgical treatment of patients with DeBakey type I dissecting aneurysm remains a serious challenge for surgeons and still presents an unresolved problem in terms of choosing the ideal tactics. A multidisciplinary approach using a staged or hybrid method gives the best results in the treatment of this pathology. A case of successful use of a staged method of treatment of acute dissecting type I aneurysm according to DeBakey is presented.

Material and methods:A 39-year-old patient was admitted urgently with a diagnosis of acute coronary syndrome. Complained of new acute pain behind the 56 sternum, radiating to the left half of the chest and interscapular region, accompanied by a feeling of lack of air, shortness of breath, palpitations

Conclusions:This clinical case provides an example of the successful use of a staged approach to the treatment of DeBakey type I dissecting aneurysm. The progress made in recent years in the treatment of such a complex pathology has reduced operative mortality and improved long-term results.

KEYWORDS:aortic dissection, aneurysm, computed tomography, stent graft

HOW TO QUOTE:Uzhakhov I.R., Shloido E.A., Shlyakhovoy A.B., Kravchenko K.P. A case of staged treatment of a patient with acute aortic dissection type I according to DeBakey. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 4(5):55-59


 

MECHANICAL THROMBECTOMY USING RETROGRADE DISTAL ACCESS IN A PATIENT WITH IN-STENT OCCLUSION OF THE FEMOROPPLITHEAL SEGMENT

Authors

V.N. ZHIGALO 1, S.A. PLATONOV 1, I.D. MAGAMEDOV 1, K.SH. ISAEV 1, A.I. AVRAMENKO 1, M.A. KISELEV 1, D.V. KANDYBA 1, V.E. SAVELLO 1, N.N. ZHERDEV 2

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

2 St. Petersburg State Budgetary Healthcare Institution "City Pokrovskaya Hospital", St. Petersburg, Russia

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Introduction:We present a case of successful endovascular mechanical thrombectomy performed using a primary retrograde distal approach in a patient with intra-stent subacute thrombosis of the femoropopliteal segment. The choice of tactics is justified and the features of endovascular revascularization are described.

Conclusions:In a patient with in-stent thrombosis of the femoropopliteal arterial segment, MT with the Rotarex device, performed through retrograde access through the anterior tibial artery, turned out to be safe and effective.

KEYWORDS:primary retrograde distal access, critical ischemia of the limbs, mechanical thrombectomy, St. Petersburg Research Institute of Emergency Medicine named after I.I. Janeli

HOW TO QUOTE:Zhigalo V.N., Platonov S.A., Magamedov I.D., Isaev K.Sh., Avramenko A.I., Kiselev M.A., Kandyba D.V., Savello V.E., Zherdev N. .N. Mechanical thrombectomy using retrograde distal access in a patient with in-stent occlusion of the femoropopliteal segment. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 4 (5): 60-63


 

OSTEOSYNTHESIS OF THE CHEST BONES IN TRAUMATIC INJURIES

Authors

A.A. MENSHIKOV1,2, A.V. BONDARENKO1,2, E.A. TSEYMAKH1,2

1 Federal State Budgetary Educational Institution of Higher Education "Altai State Medical University" of the Ministry of Health of Russia, Barnaul, Russia

2 Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia

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Relevance:Chest trauma is one of the most severe forms of injury to the chest organs, which leads to death and complications. Traditional management in the presence of floating areas of the chest consists of artificial ventilation of the lungs. For sternum fractures, bed rest for up to three weeks. The result of such management of victims cannot be called satisfactory due to the high degree of complications, prolonged stay in the intensive care unit and non-union of bone fragments of the ribs and sternum.

Target:Increasing the effectiveness of complex treatment of patients with traumatic injuries of the chest bones by restoring the frame with plates with angular stability.

Materials and methods:The results of treatment of 96 patients with varying degrees of damage to the chest bones were analyzed. The groups included: patients with multiple, fragmented fractures of the ribs and sternum requiring artificial ventilation; and patients with fractures of the ribs and/or sternum with displacement of fragments that do not require artificial ventilation.

Results:In all patients requiring artificial ventilation, after osteosynthesis, the signs of “paradoxical breathing” of the costal cusp were stopped. The duration of mechanical ventilation in the postoperative period averaged 2.5 days. The number of pulmonary pleural complications decreased by 2.6 times. In patients who do not require artificial ventilation, the pain syndrome has significantly decreased, and the bed/day has decreased by 3 times.

Conclusions:Early restoration of the chest wall frame using osteosynthesis with plates with angular stability can reduce the duration of artificial ventilation, reduce the number of intrapleural complications and improve the outcomes of traumatic disease.

KEYWORDS:polytrauma, multiple rib fractures, sternum fracture, rib osteosynthesis, sternum osteosynthesis, chest flotation, severe chest injury.

HOW TO QUOTE:Menshikov A.A., Bondarenko A.V., Tseymakh E.A. Osteosynthesis of chest bones in traumatic injuries. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 4(5); 64-71


 

OSTEOSYNTHESIS OF FRACTURES OF THE POSTERIOR WALL OF THE ACETABULAR FOR SIMPLE AND COMBINED TYPES OF DAMAGE

Authors

I.V. KRUGLYKHIN, A.V. BONDARENKO, M.I. TALASHKEVICH, I.A. PLOTNIKOV

Federal State Budgetary Educational Institution of Higher Education "Altai State Medical University" of the Ministry of Health of Russia, Barnaul, Russia

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Introduction:Fractures of the acetabulum are not life-threatening, but they cause severe pathology of the hip joint. They are often accompanied by injuries, the treatment of which is a priority for emergency indications. Often, because of this, surgical reconstruction of the acetabulum is delayed, which reduces the chances of a favorable outcome, but in most cases it is impossible to do without surgery.

Purpose of the study:to find out the frequency and nature of damage to the posterior wall of the acetabulum, and features of the use of modern methods of osteosynthesis.

Material and methods:Over 15 years, 386 patients with fractures of the acetabulum were treated, isolated fractures were observed in 85, with polytrauma - in 301, elementary types of fractures - in 220, combined - in 166. Fractures of the posterior wall were noted in 137 of them. 59 patients were treated conservatively, 78 were treated surgically. Results. Somatic complications were observed in 50 patients; vascular disorders, bronchopulmonary complications and bedsores were more common, local – in 8. Long-term anatomical and functional results were monitored in 88 patients. In most cases, good and satisfactory results prevailed (86.4%).

Conclusion:Fractures of the acetabulum are a consequence of high-energy impacts. Of these, posterior wall fractures are the most common. Most local and all somatic complications were observed in polytrauma. The use of internal osteosynthesis contributed to a reduction in somatic complications and the incidence of degenerative arthrosis.

KEYWORDS: acetabulum, osteosynthesis, pelvis.

HOW TO QUOTE: Kruglykhin I.V., Bondarenko A.V., Talashkevich M.I., Plotnikov I.A. Osteosynthesis of fractures of the posterior wall of the acetabulum in simple and combined types of injuries. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 4(5); 72-80

№3 2021

ABOUT THE HISTORY OF MONITORING ACUTE SURGICAL PATHOLOGY OF THE ABDOMINAL ORGANS IN ST. PETERSBURG

Authors

V.E. PARFENOV, I.M. BARSUKOVA

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

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Introduction:The article presents materials on the role of the St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze in monitoring acute surgical pathology of the abdominal organs in St. Petersburg. This monitoring has been carried out since the first days of the institute’s founding and continues all these years. It includes an analysis of generalized morbidity rates among the adult population of St. Petersburg for acute appendicitis, acute cholecystitis, acute pancreatitis, perforated gastric and duodenal ulcers, gastrointestinal bleeding, strangulated hernias and acute intestinal obstruction, and reflects the results of the work of the city’s medical organizations in providing emergency surgical care. and emergency form, taking into account the time factor from the onset of the disease, seeking medical help, length of hospitalization, and surgical treatment.

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

HOW TO QUOTE:Parfenov V.E., Barsukova I.M. On the history of monitoring acute surgical pathology of the abdominal organs in St. Petersburg Journal “Emergency Surgery named after. I.I. Dzhanelidze". 2021;3(4):6-12


 

THE DEPARTMENT OF MILITARY FIELD SURGERY OF THE MILITARY MEDICAL ACADEMY IS 90 YEARS OLD

Authors

THEM. SAMOKHVALOV1,2, V.A. MANUKOVSKY1,2,3, V.I. BADALOV1

1 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

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

3 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia

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Introduction:The 90-year history of the department and clinic of military field surgery, founded in 1931 by the outstanding surgeon, creator of the system of staged treatment of the wounded, V.A., is described. Oppel. Such outstanding military surgeons as M.N. worked at the department. Akhutin, N.N. Elansky, S.I. Banaitis, V.I. Popov, A.N. Berkutov, I.I. Deryabin, I.A. Eryukhin. The purpose of the article is to show the importance of the Department of Military Field Surgery of the Military Medical Academy in the training of surgical personnel, the formation of military medical doctrine, and the development of methods for providing surgical care to the wounded. The Military Field Surgery Clinic is a level 1 trauma center that provides multidisciplinary emergency care for the most severe and complex wounds and injuries, which allows its specialists to be recognized as experts in all areas of trauma surgery.

Keywords:surgical care in war, training of military surgeons

HOW TO QUOTE:Samokhvalov I.M., Manukovsky V.A., Badalov V.I. The Department of Military Field Surgery of the Military Medical Academy is 90 years old. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3(4); 13-20.


 

MODERN CRITERIA FOR SELECTION OF SURGICAL TREATMENT FOR PERFORATIVE DUODENAL ULCERS AS COMPONENTS OF FAST TRACK SURGERY

Authors

A.I. KHRIPUN1, A.N. ALIMOV1,2, I.V. SAZHIN1,2, A.A. CHURKIN2

1 Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after. N.I. Pirogov" of the Ministry of Health of Russia, Moscow, Russia

2 GBUZ “City Clinical Hospital named after. V.M. Buyanova DZM", Moscow, Russia

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Introduction:Perforated ulcers of the stomach and duodenum occur in 2–10% of patients with peptic ulcer disease and are one of the main causes of high mortality.

Purpose of the study:optimization of the choice of surgical intervention and improvement of treatment results for patients operated on for perforated duodenal ulcer (PDU) using an accelerated rehabilitation program.

Materials and methods:The results of surgical treatment of 179 patients with PJD in the period 2015–2019 were analyzed. The choice of the method of surgical intervention was carried out using prognostic scales, DEP classification and classification of PDJ, developed at the Research Institute of Emergency Medicine named after N.V. Sklifosovsky. All patients with PJD are divided into 4 groups: main, control 1 (CG1), 2 (CG2) and 3 (CG3). The main group (Fast-Track group) included 51 patients who underwent laparoscopic suturing of the PJ and used an accelerated rehabilitation program (ARP). Group 1 consisted of 44 patients who underwent open suturing of the PJ and received traditional treatment in the perioperative period. CG2 included 43 patients who underwent laparoscopic suturing of the PDJ; the Fast-Track protocol was not performed; traditional treatment was carried out in the perioperative period. The fourth group (CG3) was formed from 41 patients who, according to the exclusion criteria, were not included in the main group, CG1 and CG2.

Results:Combined use of a modified protocol for accelerated rehabilitation for PJD using prognostic scales, DEP classification and classification of PJD developed at the N.V. Sklifosovsky allowed to improve the immediate results of surgical treatment of patients with PJD.

KEYWORDS:duodenal ulcer, perforated ulcer class, prognostic scales, classification

HOW TO QUOTE:Khripun A.I., Alimov A.N., Sazhin I.V., Churkin A.A. Modern criteria for choosing a method of surgical treatment for perforated duodenal ulcer as components of FAST TRACK SURGERY Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3 (4): 21-26


 

CURRENT TRENDS IN SOLVING THE PROBLEM OF DIAGNOSIS AND TREATMENT OF DAMAGE TO ABDOMINAL ORGANS

Authors

A.N. TULUPOV, V.A. MANUKOVSKY, A.E. DEMKO, D.V. KANDYBA, V.E. SAVELLO, G.M. BESAEV, YU V. GUDZ, A.V OSIPOV, S.A. PLATONOV, Y.V. GAVRISCHUK, M.I. SAFOEV, M.R. BONDAREV, A.V. NIKITIN

State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze", St. Petersburg, Russia

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Introduction:Progress in the field of diagnosis and treatment of severe mechanical injuries of the abdominal organs in recent years is associated with the development and introduction into clinical practice of modern high-tech, including minimally invasive methods: radiation (ultrasound, MSCT with intravenous contrast), endoscopic (endoscopic clipping of wounds), endovideosurgical (endosurgical hemostasis, sanitation and drainage of the abdominal cavity), x-ray endovascular (aniography with selective embolization of bleeding vessels and false aneurysms), general surgical (installation of VAC systems and dermotension devices), resuscitation (early enteral infusions, immunocorrection with the drug "Derinat") and etc.

Purpose of the study:assessment of the main modern trends in the diagnosis and treatment of abdominal organ injuries.

Research results:Based on an analysis of literature data and the results of our own long-term research (2000-2021), we have established that such trends include the provision of modern radiation diagnostics, as well as conservative and minimally invasive organ-preserving treatment of injuries to the abdominal organs:

1. use of modern methods of radiation diagnostics of damage;

2. application of modern methods of interventional radiology;

3. use of therapeutic and diagnostic endoscopic and endovideosurgical technologies;

4. treatment using suction drainage and dermotension devices;

5. improvement of anesthesiology and resuscitation. Modern diagnosis of abdominal organ injuries is unthinkable without ultrasound sonography

Keywords:abdominal trauma, MSCT with intravenous contrast, selective embolization, endoscopic clipping

HOW TO QUOTE:Tulupov A.N., Manukovsky V.A., Demko A.E., Kandyba D.V., Savello V.E., Besaev G.M., Gudz Yu.V., Osipov A.V., Platonov S. .A., Gavrishchuk Ya.V., Safoev M.I., Bondarev M.R., Nikitin A.V. Current trends in solving the problem of diagnosis and treatment of injuries to the abdominal organs. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;3 (4):27-36


 

TECHNIQUE FOR PERFORMING ENDOSCOPIC SANITATION OF THE BILY DUCTS IN DIFFICULT CANNULATION OF THE BDSM

Authors

M.I.SAFOEV1,2, A.E.DEMKO1, Y.N.ULYANOV1, A.V.OSIPOV1, Kh.O.GOGOKHIYA2, M.Z.YARMAGOMEDOV1, I.A.SVETLICHNY1

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Institution of Higher Professional Education “North-Western State Medical University named after. I.I. Mechnikov", St. Petersburg, Russia

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Introduction:Currently, the technical capabilities and effectiveness of transpapillary interventions in the diagnosis and treatment of biliary obstruction have increased significantly. In this regard, they have found widespread use as preliminary or definitive methods of treating patients with choledocholithiasis and its complications, as well as benign and malignant obstructions of the biliary tract. At the same time, these methods are often accompanied by severe complications and deaths.

Purpose of the study:identifying the causes of difficulties that arise and ways to overcome them during endoscopic sanitation of the biliary tract in patients with obstructive jaundice.

Material and methods:The article is based on an analysis of the work of the endoscopic department of the St. Petersburg Research Institute of Emergency Medicine named after. I. I. Dzhanelidze in the period 2012-2018. During this period, transpapillary interventions for complicated forms of cholelithiasis and cancer of the biliary tract were performed in 830 patients. Atypical EPST was performed in 234 (28.2%) patients, whose ages ranged from 21 to 95 years, with an average age of 64 years. There were 78 men (33.3%), twice as many women - 156 (66.6%). Results and discussion: for 7 years at the Research Institute of SP named after. I. I. Dzhanelidze performed endoscopic correction of bile outflow in complicated forms of cholelithiasis and oncological diseases of the biliary tract in 830 patients. In every fourth of them (234 - 28.2%), it was assessed as atypical.

Conclusion:The developed algorithm for performing EPST is a universal method of sanitation of the biliary tract and allows to reduce the number of intra- and post-manipulation complications (3.4%) and mortality (0.8%). The technology of “two or more instruments in one channel” is the method of choice for “difficult” cannulations.

KEYWORDS:biliary obstruction, transpapillary interventions, endoscopic retrograde cholangiopancreatography, atypical papillosphincterotomy, post-manipulation pancreatitis

HOW TO QUOTE:Safoev M.I., Demko A.E., Ulyanov Yu.N., Osipov A.V., Gogokhiya Kh.O., Yarmagomedov M.Z., Svetlichny I.A. technique for performing endoscopic sanitation of the bile ducts with difficult cannulation BDS. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;3(4):37-44


 

ENTERAL SUPPORT AS AN MANDATORY COMPONENT OF INTENSIVE TREATMENT OF PATIENTS (VICTIMS) IN THE POST-GRESSIVE PERIOD

Authors

V.M.LUFT, A.V. LAPITSKY, A.M. SERGEEVA

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

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Introduction:The article discusses pathophysiological reactions and structural and functional disorders of the gastrointestinal tract (GIT) under aggressive influence on the human body, as well as often developing acute intestinal failure (AIF). The necessity of mandatory inclusion of early enteral support (therapy) in the intensive treatment of seriously ill (injured) patients is substantiated, its purpose, main objectives and content are outlined.

Keywords: digestive system, acute intestinal failure, enteral support

HOW TO QUOTE: Luft V.M., Lapitsky A.V., Sergeeva A.M. Enteral support as a mandatory component of intensive treatment of patients (victims) in the post-aggression period. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3(4):45-52


 

SURGICAL TACTICS FOR THE TREATMENT OF ULCERATING GASTRODUODENAL BLEEDING AT THE ST. PETERSBURG RESEARCH INSTITUTE OF EMERGENCY CARE NAMED AFTER I.I. DZHANELIDZE

Authors

V.G. VERBITSKY1,2, G.I. SINECHENKO1,2, D.V. KANDYBA1, A.E. DEMKO1,2, S.A. PLATONOV1, A.O. PARFYONOV1,2, M.A. KISELEV1, A. N. SEKEEV1

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Educational Institution “Military Medical Academy named after S.M. Kirov" Ministry of Defense of the Russian Federation, St. Petersburg, Russia

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Introduction:E According to the department of ambulance organization of St. Petersburg Research Institute of Emergency Medicine named after. I.I. Janelidze mortality rate for ulcerative gastroduodenal bleeding (UGDB) in St. Petersburg in 2016 was 5%, and postoperative mortality was 8.5%. Transcatheter arterial embolization (TAE), thanks to the development of endovascular hemostasis methods, is an alternative to palliative surgical interventions when conservative treatment of ulcer bleeding using endoscopic hemostasis methods is ineffective, especially in the group of patients with a high risk of surgery and unfavorable outcome.

Goal of the work:to develop indications for surgery and transcatheter arterial embolization (TAE) based on an analysis of the results of treatment of patients with ulcerative gastroduodenal bleeding (UGDH) for the period 2016-2018. Materials and methods. An analysis of the case histories of 260 patients with bleeding from stomach ulcers who were treated at the St. Petersburg Research Institute of Emergency Medicine named after I.I. Janelidze in 2016-2018.

Result:The study found that a reduction in mortality in the study groups can be achieved by reducing the number of palliative interventions, the wider use of angiographic embolization for the prevention and treatment of recurrent bleeding, and the expansion of indications for urgent radical operations outside of recurrent hemorrhage. Thus, the use of TAE in a group of elderly patients with severe somatic pathology and recurrent gastrointestinal tract allows one to prevent recurrent bleeding and perform hemostasis. The results obtained determine the need for further research in order to optimize the indications and techniques for performing TAE in emergency surgery of gastroduodenal bleeding.

KEYWORDS:peptic ulcer, gastric ulcer, bleeding, recurrent bleeding, transcatheter arterial embolization

HOW TO QUOTE:Verbitsky V.G., Sinenchenko G.I., Kandyba D.V., Demko A.E., Platonov S.A., Parfenov A.O., Kiselev M.A., Sekeev A.N. Surgical treatment tactics ulcerative gastroduodenal bleeding at the St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3(4):53-58


 

ENTERAL INFUSIONS IN THE TREATMENT OF SEVERE COMBINED CHEST INJURY

Authors

A.V. LAPITSKY, V.M. LUFT, A.N. TULUPOV

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

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Introduction:The protocol for intensive treatment of victims with shockogenic combined chest trauma uses the technique of early enteral infusion of glucose-saline solution. Its high efficiency, simplicity and safety have been proven. The use of early enteral infusion allows, due to the homeostasis function of the small intestine, interconnected with the volume status of the body, to significantly reduce the volume of parenteral infusion-transfusion therapy (ITT). This reduces the infusion load on damaged lungs, which helps to significantly reduce the incidence of nosocomial pneumonia, reduce the duration of treatment for surviving victims and reduce mortality.

Purpose of the study:improving the results of treatment of victims with severe combined chest trauma through the use of enteral infusions in their complex intensive treatment in the acute and early periods of a traumatic disease.

Materials and methods.:The study included victims of both sexes aged from 18 to 60 years with combined chest trauma, accompanied by traumatic shock of II - III degree, without severe dominant brain damage, who were admitted within 6 hours after the injury and successfully survived the first 48 hours of the traumatic illness.

Keywords:enteral infusions, combined chest trauma, traumatic shock.

HOW TO QUOTE:Lapitsky A.V., Luft V.M., Tulupov A.N. Enteral infusions in the treatment of severe combined chest trauma. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3(4); 59-66.


 

COMPARATIVE ANALYSIS OF MINIMALLY INVASIVE METHODS OF OSTEOSYNTHESIS OF PELVIC RING INJURIES IN PATIENTS WITH POLYTRAUMA

Authors

I.V. KRUGLYKHIN, A.V. BONDARENKO, I.A. PLOTNIKOV, M.I. TALASHKEVICH

Regional Clinical Hospital of Emergency Medical Care, Barnaul, Russia

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Introduction:In the treatment of pelvic injuries due to polytrauma, the use of the least time-consuming and minimally invasive techniques is justified. In our country, osteosynthesis with external fixation devices has become widespread; recently, internal osteosynthesis with cannulated screws has become widely used.

Purpose of the study:to identify the advantages and features of the use of minimally invasive osteosynthesis methods in the treatment of injuries to the pelvic ring in patients with polytrauma.

Material and methods:An analysis of the results of treatment of 462 patients over 10 years was performed. The patients were divided into groups: the 1st group included patients (n=165), whose final treatment method was external osteosynthesis, the 2nd group included patients (n=297), in whom the final treatment method for injuries of the posterior semi-ring of the pelvis was osteosynthesis using cannulated screws.

Results:Complications were more often observed in patients of group 1 compared to patients of group 2, the differences are statistically significant. Secondary displacements or relapses of deformity were more often observed in patients of group 1. Both methods are ineffective in treating patients with lumbosacral dissociation.

Conclusion:The use of cannulated screws in patients with polytrauma and pelvic injury is preferable to osteosynthesis with external fixation devices. Osteosynthesis with external fixation devices for injuries of the pelvic ring in patients with polytrauma can be used as a temporary measure at the resuscitation stage, as a component of combined pelvic osteosynthesis, for open injuries and purulent-septic complications.

Keywords:External fixation, pelvic injuries, polytrauma.

HOW TO QUOTE:Kruglykhin I.V., Bondarenko A.V., Plotnikov I.A., Talashkevich M.I. Comparative analysis of minimally invasive methods of osteosynthesis of pelvic ring injuries in patients with polytrauma. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3(4); 66-74.


 

EXPERIENCE OF USING THERMAL IMAGING SCREENING DIAGNOSTICS OF RHINOSINUSITIS

Authors

Yu.V. KARAMYSHEV1,2, A.I. MAKHNOVSKY1,3,4, E.A. PONIKAROVSKAYA1, S.L. SHILOV1, I.M. DOLGOV4, I.M. BARSUKOVA3,5, O.N. ERGASHEV4.5

1 442 Military Clinical Hospital of the Russian Ministry of Defense, St. Petersburg, Russia;

2 Military Medical Academy named after. CM. Kirova, St. Petersburg, Russia;

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

4 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia;

5 First St. Petersburg State Medical University named after. acad. I.P. Pavlova, St. Petersburg, Russia;

6 Federal Scientific Clinical Center for Sports Medicine and Rehabilitation, Moscow.

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Introduction:The work analyzed the experience of using thermal imaging for screening detection of rhinosinusitis in 271 patients. The sensitivity of the method was 96%, specificity – 81%, accuracy – 93%.

Purpose of the study:to justify the feasibility of using thermal imaging for screening detection of sinusitis in patients with acute upper respiratory tract infections.

Materials and methods:271 patients with mild forms of acute upper respiratory tract infections underwent screening thermal imaging diagnostics of diseases of the nose and paranasal sinuses.

Conclusions:

1. Thermal imaging is a sensitive and specific screening method for detecting rhinosinusitis.

2. Screening thermal imaging diagnostics of diseases of the nose and paranasal sinuses is advisable to use to determine the indications for radiography of the paranasal sinuses in patients with mild forms of acute upper respiratory tract infections when rhinosinusitis is suspected.

Keywords:thermal imaging, thermography, rhinosinusitis, sinusitis.

HOW TO QUOTE:Karamyshev Yu.V., Makhnovsky A.I., Shilov S.L., Ponikarovskaya E.A., Dolgov I.M., Barsukova I.M., Ergashev O.N. Experience in the use of screening thermal imaging diagnostics of rhinosinusitis. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3(4); 75-80.

№2 2021

HISTORICAL MILESTONES IN THE STUDY OF TRAUMA AT THE ST. PETERSBURG RESEARCH INSTITUTE NAMED AFTER I.I. DZHANELIDZE

Authors

V.E. PARFENOV, I.M. BARSUKOVA

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

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Introduction:The study of the medical aspects of injury, its diagnosis and treatment is one of the main topics of scientific research by the team of the St. Petersburg Research Institute of Emergency Medicine named after. I.I.Dzhanelidze for many decades.

Purpose of the study:The purpose of the study was to assess the historical aspects of the development of the problem of trauma in Russia and the role of the St. Petersburg Research Institute of Emergency Medicine named after. I.I. Janelidze in studying these issues.

Material and methods:Historical-analytical, normative legal, and statistical methods were used.

Conclusion:Today, without exaggeration, we can say that the foundations of the modern system of providing medical care in Russia for combined and multiple trauma accompanied by shock were laid and tested in our institute. The essence of this concept is to organize the provision of medical care to the wounded and victims with polytrauma in the system of trauma centers. At the same time, we worked and continue to work in close contact with the staff of the department and clinic of military field surgery of the Military Medical Academy named after. CM. Kirov.

KEYWORDS:trauma, St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

HOW TO QUOTE:Parfenov V.E., Barsukova I.M. Historical milestones in the study of trauma at the St. Petersburg Research Institute named after. I.I. Dzhanelidze. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;2(3):6-10


 

PRINCIPLES OF DIAGNOSIS AND TREATMENT OF SEVERE COMBINED TRAUMA (LECTURE)

Authors

A.N. TULUPOV1, V.A. MANUKOVSKY1,3, I.M. SAMOKHVALOV1,2, I.V. KAZHANOV1, Y.V. GAVRISCHUK1,

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

2 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

3 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

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Introduction:The basis of the modern concept of providing medical care for severe combined trauma is the need to examine and treat patients of this category in trauma centers with round-the-clock availability of modern, including high-tech treatment and diagnostic methods (radiation, instrumental, endoscopic, endovideosurgical, x-ray endovascular, traumatological). The use of the basic principles of management of patients with polytrauma in St. Petersburg, highlighted in the lecture, has made it possible over the past 7 years to reduce mortality in this pathology from 17 to 12.

Purpose of the lecture:determining the basic principles of providing medical care to victims with severe combined trauma and assessing the effectiveness of their use in the conditions of St. Petersburg.

KEYWORDS:severe combined injury, polytrauma, traumatic shock, traumatic pain

HOW TO QUOTE:Tulupov A.N., Manukovsky V.A., Samokhvalov I.M., Kazhanov I.V., Gavrishchuk Ya.V. Principles of diagnosis and treatment of severe combined injury. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 2 (3): 11-28


 

DIAGNOSTICS, CLINICAL MANIFESTATIONS, HOMEOSTASIS DISORDERS IN SHOCOGENIC DAMAGES IN THE ACUTE PERIOD OF TRAUMATIC DISEASE

Authors

V.N. LAPSHIN1,3, V.S. AFONCHIKOV1, A.F. KOTLYARSKY1, N.K. RAZUMOVA1, I.V. STRAKHOV1, A.N. GRITSAI1,2

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Military Educational Institution of Higher Education “Military Medical Academy named after S.M. Kirov" of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia

3 Federal State Budgetary Military Educational Institution of Higher Education “First St. Petersburg State Medical University named after. acad. I.P. Pavlova" of the Ministry of Health of Russia

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Introduction:Based on the domestic concept of periodization of a traumatic disease, the stages of its acute period were identified, both with a favorable outcome and with “irreversible” shock. The dynamics of the clinical course and changes in laboratory parameters reflecting the severity of homeostasis disorders in victims with a favorable and unfavorable prognosis are described. The article presents information about changes in significant parameters of homeostasis during the period of acute response to injury and identifies a group of signs, changes in which can be used to predict outcomes.

Purpose of the study:Summarize data on diagnosis, clinical manifestations, homeostasis disorders in shockogenic injuries in the acute period of a traumatic illness. Material and methods. Materials from literary sources, content analysis and analytical methods were used.

Keywords:hospital stage, shockogenic injury, traumatic disease, acute period, homeostasis disorders, outcome prediction

HOW TO QUOTE:Lapshin V.N., Afonchikov V.S., Kotlyarsky A.F., Razumova N.K., Strakhov I.V., Gritsai A.N. Diagnosis, clinical manifestations, homeostasis disorders in shockogenic injuries in the acute period of traumatic illness. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;2 (3):29-36


 

THE ROLE OF OBJECTIVE ASSESSMENT OF THE SEVERITY OF THE CONDITION OF THE VICTIMS AND “DAMAGE CONTROL” IN THE COMPLEX OF MEASURES TO REDUCE INFECTIOUS COMPLICATIONS IN POLYTRAUMA

Authors

KONDRATIEV I.P., SHLYAPNIKOV S.A., LINNIK S.A., KUCHEEV I.O.

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

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Introduction:The article presents definitions of the strategy and tactics of the treatment process in relation to patients with severe mechanical injury. Objective criteria for assessing the severity of the victim’s condition and injury are identified. The place of the concept of “Damage control” in the treatment of patients with severe mechanical trauma, based on scales for assessing the severity of injuries and the condition of the victim (JSS, RTS, TRJSS, APACHJ, etc.), is determined.

Purpose of the study:to determine possible ways to prevent the development of purulent-septic complications in severe mechanical trauma by including objective criteria for assessing the condition of victims in the process of providing assistance.

Research objectives:1. Identify objective criteria that influence the occurrence of complications. 2. To establish subjective factors leading to errors in the provision of medical care. 3. Determine the place of “Damage control” in the process of treating victims 4. Clarify the possibility of influencing the prognosis of the outcome of a traumatic illness on the prevention of septic complications.

Materials and research methods:An analysis of the treatment of patients with severe mechanical trauma for the period 2014-2018 was carried out. The positive and negative aspects of the existing algorithms for providing assistance to this category of victims are highlighted.

KEYWORDS:strategy and tactics of the treatment process, damage control, severe mechanical injury, polytrauma

HOW TO QUOTE:Kondratyev I.P., Shlyapnikov S.A., Linnik S.A., Kucheev I.O. The role of an objective assessment of the severity of the condition of victims and “damage control” in a set of measures to reduce infectious complications in polytrauma. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;2(3):37-41


 

INTERHOSPITAL MEDICAL EVACUATION OF PATIENTS WITH SEVERE INJURY: FIVE YEARS OF EXPERIENCE IN THE EMERGENCY DEPARTMENT 442 MILITARY CLINICAL HOSPITAL

Authors

S.A. KOVALENKO1, R.R. KASIMOV1, M.V. KHAUSTOV1, I.M. BARSUKOVA2,3, A.I. MAKHNOVSKY2,

1 442 Military Clinical Hospital, St. Petersburg, Russia

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

3 First St. Petersburg State Medical University named after. I.P. Pavlova, St. Petersburg, Russia

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Introduction:Up to 90% of victims with severe trauma are initially hospitalized in level II and III trauma centers and require further evacuation to level I trauma centers. To solve this problem, the first emergency medical department in the Armed Forces with an aeromedical team was created at the 442 Military Clinical Hospital. Five-year results of medical evacuations of victims with severe trauma allow us to consider the department’s work effective

Purpose of the study:summarize five years of experience in the emergency medical department of the 442 Military Clinical Hospital and justify the feasibility of creating such departments in other district and naval military clinical hospitals.

Materials and methods:Five years of experience (2016 – 2021) of the emergency medical department of the 442 Military Clinical Hospital in the organization and implementation of medical, including air ambulance, evacuation of 232 patients with severe trauma was analyzed.

Conclusion:It is advisable to use the positive five-year experience of the emergency medical department of the 442 Military Clinical Hospital, including developed prognostic criteria and an algorithm for justifying surgical and evacuation tactics in patients with polytrauma, in the work of district and naval military clinical hospitals

Keywords:severe combined trauma, polytrauma, traumatic shock, traumatic disease, medical evacuation, sanitary aviation evacuation, interhospital transportation, emergency medical care

HOW TO QUOTE:Kovalenko S.A., Kasimov R.R., Khaustov M.V., Barsukova I.M., Makhnovsky A.I. Medical evacuation of patients with severe trauma: five years of experience in the emergency department of the 442 Military Clinical Hospital. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 2(3):42-47


 

Rib VALVE IN SEVERE COMBINED CLOSED CHEST INJURY: WHEN AND HOW TO FIX

Authors

A.N. TULUPOV1, V.A. MANUKOVSKY1,2, G.M. BESAEV1, I.V. KAZHANOV1, Y.V. GAVRISCHUK1, A.V. NIKITIN1

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

2 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

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Introduction:Chest injuries during polytrauma are diagnosed in more than 60% of victims, and 28.6 of them have severe (dominant and competing) injuries. The mortality rate for this pathology reaches 50%. One of the most severe forms of closed chest injury is multiple and floating rib fractures, the incidence of which reaches 20 of all chest injuries, and the mortality rate is 10-46 [1, 2]. This indicates the great relevance of the topic of this article.

Purpose of the study:determination of indications for fixation of the rib valve and development of the optimal technique for its implementation in severe combined closed chest trauma.

Material and methods: The results of examination and treatment of 32 patients with a rib valve with severe combined closed chest injury were studied at the St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze (level I trauma center) for the period from 2000 to 2020.

Conclusion:Treatment of multiple unstable rib fractures with rib valve represents one of the central problems in breast injury surgery.

KEYWORDS: polytrauma, chest injury, multiple rib fractures, rib valve

HOW TO QUOTE: Tulupov A.N., Manukovsky V.A., Besaev G.M., Kazhanov I.V., Gavrishchuk Ya.V., Nikitin A.V. Costal valve in severe combined closed chest injury: when and how to fix it. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 2(3):48-54


 

TREATMENT OF TRAUMATIC SKIN DETACHMENT

Authors

I'M IN. GAVRISCHUK1, V.A. MANUKOVSKY1,3, S.I. MIKYTYUK1,2, A.N. TULUPOV1, A.E. DEMKO1,2, I.V. KAZHANOV1,2

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

2 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

3 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

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Introduction:A large number of diagnostic errors and the lack of a unified treatment strategy for traumatic detachment of the skin of the trunk and extremities remains an urgent problem in injury surgery.

Purpose of the study:Improving treatment outcomes for patients with polytrauma through early diagnosis and active surgical treatment of extensive traumatic skin detachment.

Material and methods:The results of treatment of 105 victims with traumatic detachment of the skin of the torso and limbs, who were treated at the St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze and the Military Field Surgery Clinic of the Military Medical Academy named after. CM. Kirov in the period from 2013 to 2020. Results. Traumatic skin detachment in the area of ​​the lower extremities occurred in 84 (80%), in combination with the pelvis – in 12 (11.4%), in the upper extremities – in 9 (8.6%) victims; limited skin detachment occurred in 58 (55.2%), extensive (more than 200 cm2) - in 47 (44.8%); circular skin detachment was detected in 43 (40.9%) victims. In 9 out of 47 victims with extensive skin detachment of the lower extremities, necrosis of the skin flap developed: in 5 cases the cause was primary surgical treatment without autodermoplasty according to Krasovitov, in 4 cases it was late diagnosis.

conclusions: Active surgical treatment of traumatic skin detachment, according to the proposed algorithm, can be recommended for use in victims with associated trauma.

KEYWORDS:combined trauma, traumatic skin detachment, extensive skin damage.

HOW TO QUOTE:Gavrishchuk Ya.V., Manukovsky V.A., Mikityuk S.I., Tulupov A.N., Demko A.E., Kazhanov I.V. Treatment of traumatic skin detachment. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 2(3); 55-60


 

MODERN VIEW ON PATHOLOGICAL PHYSIOLOGY OF THE GASTROINTESTINAL TRACT IN VICTIMS WITH SEVERE COMBINED TRAUMA (LITERATURE REVIEW)

Authors

D.Sh. S'ADULAEV, P.A. DUBIKAITIS, I.M. BARSUKOVA, A.I. MAKHNOVSKY

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

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Introduction:The article presents a literature review that reveals modern ideas about gastrointestinal disorders in patients with severe concomitant trauma.

Purpose of the study:outline modern ideas on gastrointestinal disorders in patients with severe concomitant trauma.

Materials and research methods:A content analysis of the available modern world and domestic literature on the research topic was carried out.

Conclusion:Thus, the analysis of scientific data on the pathological physiology of the gastrointestinal tract in patients with severe combined shockogenic trauma revealed the exceptional medical and social significance of the problem, showed that a search for concepts, methodologies, and directions for innovative development is currently underway, and has actualized the need to study the mechanisms of development of gastrointestinal dysfunctions. -intestinal tract in this category of patients, their consequences and methods of correction in order to save the life and health of victims.

KEYWORDS:trauma, combined trauma, traumatic shock, gastrointestinal disorders.

HOW TO QUOTE: Saadulaev D.Sh., Dubikaitis P.A., Barsukova I.M., Makhnovsky A.I. Modern view on the pathological physiology of the gastrointestinal tract in victims with severe combined trauma (literature review). Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;2(3):61-69


 

DIFFERENTIATED APPROACH TO SURGICAL TREATMENT OF COOKING-RELATED BURNS

Authors

BEFORE. WAGNER1,2, E.V. ZINOVIEV1, M.R. ARUSTAMYAN2

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “North-Western State Medical University named after I.I. Mechnikov" of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

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Introduction:One of the causes of burns at home is neglect of safety rules during cooking. In women, these injuries are most often associated with clothing igniting from a gas stove; in men, they are a consequence of safety violations when using barbecues.

Purpose of the study:substantiation of the feasibility of a differentiated approach to surgical treatment of patients with flame burns, including those received during cooking.

Materials and methods:In accordance with the circumstances of the injury, the victims were divided into two groups: ignition of clothing from a stove (n=55) and use of flammable liquids when lighting a barbecue (n=26). Data processing was performed in Microsoft Office Excel 2007 and IBM SPSS 20.0 using descriptive and nonparametric statistics. According to the study results, patients in the study groups differed significantly from each other in gender, age, area of ​​deep burn and severity of condition.

Conclusion:A unified approach to surgical treatment of such victims does not always achieve optimal results. To develop differentiated surgical tactics, it is necessary to identify groups of patients that are as homogeneous as possible in terms of a number of analyzed parameters. As a grouping factor for the formation of such patient models, one can use not only the generally accepted division by the damaging agent, but also the circumstances of the burns.

KEYWORDS: burn, burn injury, skin grafting, household injuries, patient model

HOW TO QUOTE:Vagner D.O., Zinoviev E.V., Arustamyan M.R. Differentiated approach to surgical treatment of burns associated with cooking. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;2(3):70-74


 

STRUCTURE OF DAMAGE IN PATIENTS WITH SEVERE OCCUPATIONAL INJURY

Authors

A.I. MAKHNOVSKY1, Y.V. GAVRISCHUK1, I.M. BARSUKOVA1,2, O.N. ERGASHEV2,3, P.A. DUBIKAITIS1, A.O. BOOMAY1

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

2 First St. Petersburg State Medical University named after. I.P. Pavlova, St. Petersburg, Russia

3 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

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Introduction: The problem of industrial injuries in the Russian Federation continues to remain relevant. At the same time, the scientific literature does not sufficiently cover the issues of clinical epidemiology of industrial injuries.

Purpose of the study: To study the structure of damage in patients with severe work injury.

Material and methods: Over a five-year period (2016 – 2020) in the operating room for anti-shock measures at the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze received 90 patients with severe work injuries. The structure of severe industrial injuries has been studied by causes, location and severity of injuries. The causes and localization of damage were coded in accordance with the ICD-10 classification and the classification of anatomical regions generally accepted in the Russian Federation (Sokolov V.A., 2006). The severity of injuries was determined using the AIS and ISS scales; the severity of the condition at admission was determined using the RTS scale.

conclusions: The results of the study are advisable to use in organizing the provision of first aid and emergency medical care to patients with severe work injury.

KEYWORDS: industrial accidents, severe trauma, polytrauma, shock

HOW TO QUOTE: Makhnovsky A.I., Gavrishchuk Ya.V., Barsukova I.M., Ergashev O.N., Dubikaitis P.A., Bumay A.O. Structure of damage in patients with severe work injury. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021; 3:75-78

№1 2021

BURN CENTER OF ST. PETERSBURG RESEARCH INSTITUTE OF EMERGENCY CARE NAMED AFTER I.I. DZHANELIDZE: PAST AND PRESENT

Authors

V.E. PARFENOV, K.M. KRYLOV, E.V. ZINOVIEV, I.M. BARSUKOVA

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

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Introduction:The development of combustiology in the Russian Federation is inevitably associated with the name of I.I. Dzhanelidze and the St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze, which is rightfully considered the cradle of combustiology in Russia.

Purpose of the study:The purpose of the study was to assess the historical aspects of the development of combustiology in Russia. 7

Material and methods:Historical-analytical, regulatory, and statistical methods were used.

Conclusion:Today the St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze is the largest scientific, medical and educational center in Russia. Burn Center St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze has decent potential for further development.

Keywords:burns, thermal injury, St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

HOW TO QUOTE:Parfenov V.E., Krylov K.M., Zinoviev E.V., Barsukova I.M. Burn Center of the St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze: past and present. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:6-12


 

OPTIMIZATION OF TREATMENT TACTICS FOR PATIENTS WITH BURNS AND NEW CORONAVIRUS INFECTION COVID-19

Authors

V.A. MANUKOVSKY1,2, E.V. ZINOVIEV1, D.O. WAGNER1,2, P.K. KRYLOV1, D.A. KOZULIN1, V.V. SOLOSHENKO1, A.M.O. GASANOV1, A.S. KOUROV1, N.S. KLEMESHEV1

1 State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze", St. Petersburg, Russia

2 Federal State Budgetary Educational Institution of Higher Education “Northwestern State Medical University named after I.I. Mechnikov" of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

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Introduction. In 2019, the world learned about a completely new highly contagious viral infection - Covid 19, which left its mark on the lives of ordinary people and medicine in general. This event allows us to assess the readiness and performance of the healthcare system during the epidemic.

Purpose of the study:To summarize the results of treatment of victims with thermal injury and confirmed new coronavirus infection COVID-19, and to develop recommendations for preventing the spread of infection among patients and staff of burn departments.

Material and methods:The medical histories of patients hospitalized in the department of thermal injuries of the State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze" from March 11 to December 31, 2020.

Conclusions:Infection of burnt people with the SARSCoV-2 virus is accompanied by an increase in mortality by more than 2.5 times, which is due not only to the severity of the new coronavirus infection, but also to difficulties in providing specialized medical care in hospitals repurposed for the treatment of COVID-19.

Keywords: burns, necrectomy, skin grafting, new coronavirus infection, COVID-19, SARS-CoV-2

HOW TO QUOTE:Manukovsky V.A., Zinoviev E.V., Wagner D.O., Krylov P.K., Kozulin D.A., Soloshenko V.V. and others. Optimization of treatment tactics for patients with burns and the new coronavirus infection COVID-19. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;2:13-19


 

ORGANIZATIONAL MODEL AND PRINCIPLES OF PROVIDING MEDICAL CARE TO VICTIMS OF BURN TRAUMA IN EMERGENCY SITUATIONS

Authors

S. G. SHAPOVALOV1, V, E. PARFENOV2, E.V. ZINOVIEV2, K.M. KRYLOV2, S.N. PYATAKOV3

1 All-Russian Center for Emergency and Radiation Medicine named after. A.M. Nikiforova EMERCOM of Russia, St. Petersburg, Russia

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

3 Kuban State Medical University, Krasnodar, Russia

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Rationale:Information on treatment and evacuation measures for 238 victims who received a combined thermal inhalation injury during a fire in Perm at the Lame Horse nightclub on December 4, 2009 was studied and analyzed. A model and principles for organizing the provision of medical care to victims of burn injury in emergency situations were proposed.

Purpose of the study:Based on an analysis of the organization of medical care for victims of burn injury during a large-scale fire, develop a model and determine the principles of organizing the provision of medical care in emergencies.

Conclusion:Providing specialized and high-tech medical care for the mass arrival of victims of severe burn injury is possible only in a multidisciplinary medical institution for providing emergency medical care.

Keywords:burn injury, emergency, medical care, evacuation

HOW TO QUOTE:Shapovalov S.G.., Zinoviev E.V., Krylov K.M. Organizational model and principles of providing medical care to victims of burn injury in emergency situations. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:20-29


 

EXPERIMENTAL STUDY OF THE EFFECTIVENESS OF USING PANTOLEN GEL FOR LOCAL TREATMENT OF BURNS

Authors

N.V. OSTROVSKY1, A.S. BYSTROVA2, M.V. MUSATSKOVA2

1 State healthcare institution “Regional Clinical Center for Combustiology”, Saratov, Russia

2 Limited Liability Company “Corporation “SpektrAcoustics”, Saratov, Russia

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Rationale:Studies have been conducted on the effect of drugs on the healing of burn wounds in an experiment after inflicting II–III degree burns. The speed of the healing effect of drugs applied to the affected areas of the skin was taken into account.

Result:A direct trend was identified that healing depended on the degree of burn damage, on the structure of the applied drug and on the condition of the animal. The tested drug “Pantolen”, a gel based on an aqueous extract from antlers, showed the best healing effect (complete healing of the burn on the 15th day), compared with the “D-Panthenol” ointment, where complete healing occurred on the 32nd day. The experimental system of Pantolen gel + sea buckthorn oil did not contribute to a faster healing effect, as expected (complete healing of the burn occurred on the 20th day). At the same time, the best therapeutic effect was observed in animals with II-III degree burns.

Keywords:thermal burn, healing, dressing, Pantolen, D-Panthenol, sea buckthorn oil.

HOW TO QUOTE:Ostrovsky N.V., Bystrova A.S., Musatskova M.V. Experimental study of the effectiveness of using Pantolen gel for local treatment of burns. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:30-33


 

CONDITION OF THE HEMOSTASIS SYSTEM IN PATIENTS WITH BURN TRAUMA DEPENDING ON OUTCOMES

Authors

E.V. KLYCHNIKOVA1, E.V. TAZINA1, V.S. BORISOV1, A.S. BOGDANOVA1, T.A. VUYMO2

1State budgetary healthcare institution Scientific Research Institute of Emergency Medicine named after. N.V. Sklifosovsky Department of Health of Moscow, Moscow, Russia

2 Federal State Budgetary Institution of Science “Center for Theoretical Problems of Physicochemical Pharmacology RAS”, Moscow, Russia

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Target:assessment of changes in hemostatic system parameters in patients with severe burn injury depending on outcomes.

Materials and methods:Based on a prospective study of data from 63 patients with severe thermal injury (Frank index more than 30 units), an analysis of changes in the hemostatic system in 2 groups of patients was carried out: with a favorable prognosis (41 patients), group 2 - patients with an unfavorable outcome (22 patients). 25 practically healthy people were examined as a control group (normal). Patients were examined on days 1, 3 and 10 from the moment of injury. Standard indicators of the hemostatic system were studied using the integral test “Thrombodynamics”.

Result:A statistically significant difference in the activity of antithrombin III, protein C and D-dimer was revealed between groups during the entire observation period. A decrease in antithrombin III activity of less than 75% is a predictor of unfavorable outcome. Using the “Thrombodynamics” test, differences between both groups were assessed using a specially introduced coefficient, which is determined by the formula K = (Vst x 100)/ D. When a value of K>0.25 is obtained, an unfavorable outcome is predicted - from 4 to 10 days, with obtaining a K value of 0.1-0.2 predicts a favorable outcome in patients with severe thermal injury (RF Patent 2738303).

Keywords:burns, hemostasis, unfavorable outcome

HOW TO QUOTE:Klychnikova E.V., Tazina E.V., Borisov V.S., Bogdanova A.S., Vuymo T.A. The state of the hemostatic system in patients with burn injury depending on the outcome. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:34-41


 

DIVERSITY OF MICROBIAL COMMUNITIES OF BURN WOUNDS

Authors

K.V. MItryashov1,2, V.A. SHARKOVA1,2, V.V. USOV1,2, I.G. MAKSEMA1,2, P.A. GRIBANY1,2

1Pacific State Medical University, Department of Microbiology and Virology, Vladivostok, Russia

2FEFU, School of Biomedicine, Department of Clinical Medicine, Vladivostok, Russia

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Introduction: The inflammatory process in the burn area is one of the main causes of local and general infectious complications. The microflora of burn wounds is distinguished by species polymorphism, associative nature, and the predominance of opportunistic microorganisms (OPM). Constant changes in the bacterial ecosystem of burn hospitals maintain the relevance of bacteriological research.

Purpose of the study:investigate the microbiocenosis of a burn wound using indices of species diversity.

Material and methods:The study of wound discharge was carried out in accordance with current regulatory documents for clinical diagnostic laboratories of medical institutions (HCI) [9]. Material was collected from the wound in compliance with aseptic rules. The skin around the wound was treated with an antiseptic, necrotic masses were removed, the material was taken using a sterile swab, using circular rotational movements from the center of the wound to the periphery.

Conclusions:The microbiocenosis of a burn wound has a pronounced species diversity and is distinguished by its associative nature; microbial combinations are very diverse.

Keywords:burn, microflora, infection, ESKAPE pathogens.

HOW TO QUOTE:Mitryashov K.V., Sharkova V.A., Usov V.V., Maksema I.G., Griban P.A. Diversity of microbial communities in burn wounds. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:42-46


 

DISORDERS OF BONE MARROW HEMOPOISIS IN SEVERELY BURNED PATIENTS

Authors

O.V. ORLOVA1,2, L.P. PIVOVAROVA1, E.V. MARKELOVA1, I.V.OSIPOVA1

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

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

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Introduction:Treatment of severely burned patients and their rehabilitation remain a pressing medical problem, and therefore new diagnostic, therapeutic and preventive methods are being developed. One of the promising directions for solving this problem is the study, preservation and correction of bone marrow hematopoiesis.

Purpose of the study:improving the results of treatment of patients with severe thermal injury by studying the state of bone marrow hematopoiesis and correcting identified disorders.

Material and methods:53 patients were examined (37 men and 16 women; average age 34(18;56) years) with a total damage area of ​​43(17;63)% and an area of ​​deep burns of 17(13;27)% of the body surface. Flame burns predominated (40 cases or 75.5%). The average Frank index was 74(62;89) units. The number of blood cells and the main populations of leukocytes was determined upon admission, on days 1, 3, 5, 10 and 20 of burn disease. Bone marrow puncture was performed upon admission (1-3 days after the burn), on days 5 and 10 of burn disease. Smears were prepared from the sternal punctate for microscopic examination. The myelogram assessed the cellularity of the bone marrow as a whole and individual hematopoietic germs, and the nature of cell maturation.

Results:Disorders of bone marrow hematopoiesis and ways of their correction have been identified.

Conclusion:Early initiation of pathogenetic treatment provides support for adaptive mechanisms and makes it possible to deploy long-term adaptation mechanisms, which will prevent the depletion of the body's reserve capabilities.

Keywords:burn injury, bone marrow hematopoiesis, intensive care

HOW TO QUOTE:Orlova O.V., Pivovarova L.P., Merkulova E.V., Osipova I.V. Disorders of bone marrow hematopoiesis in severely burned patients. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:47-53


 

COMPARISON OF EXISTING METHODS FOR DETERMINING INTRAOPERATIVE BLOOD LOSS WHEN PERFORMING SURGICAL NECRECTOMY IN PATIENTS WITH DEEP BURNS

Authors

E.V. ZINOVIEV1, D.O. WAGNER1,2, A.E. CHUKHAREV1,2

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

2 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

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Introduction:The priority method of treating victims with deep burns is radical excision of dead tissue with immediate closure of the resulting wound defects with split skin grafts. The main factor limiting the use of this pathogenetically based technique is the significant amount of intraoperative blood loss. The amount of expected blood loss plays a significant role when planning surgical treatment of burned patients.

Purpose of the study:to evaluate and compare the results obtained by various methods for determining the volume of blood loss when performing early surgical necrectomy with simultaneous skin grafting with split grafts in patients with deep burns.

Material and methods:Our study included 12 victims with burns covering 20% ​​of the body surface. All patients underwent fascial surgical necrectomy with simultaneous plasty with split perforated skin grafts in the period from 2 to 5 days after the burn. When assessing the volume of intraoperative blood loss, the following methods were used: visual, empirical and calculated.

Results:We obtained the minimum values ​​of lost blood based on the results of a visual assessment. The maximum rates of blood loss in the same clinical cases were identified using calculation methods. In 6 out of 12 patients, the difference between the minimum and maximum results obtained using various methods was more than 1000%.

Conclusion:A comparison of the listed methods for determining intraoperative exfusion indicates significant variability in the results obtained, which casts doubt on their reliability. To obtain representative results, it is necessary to create formulas that will take into account not only the dynamics of laboratory parameters, but also the characteristics of the surgical intervention performed, the volume of infusion and transfusion therapy, anthropometric data and other variables that directly depend on the volume of blood lost.

Keywords:burns, burn disease, bleeding, volume of blood loss, necrectomy, skin grafting, hemodilution.

HOW TO QUOTE:Zinoviev E.V., Vagner D.O., Chukharev A.E. Comparison of existing methods for determining intraoperative blood loss when performing surgical necrectomy in patients with deep burns. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:54-6

PREDICTING THE DEVELOPMENT OF PATHOLOGICAL SCAR TISSUE AT THE STAGE OF TREATMENT OF BURN INJURY

Authors

Yu.V. YUROVA

State budgetary institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze", St. Petersburg, Russia

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Purpose of the study:to establish a connection between the perfusion indicator (M) of the burn defect zone at the stage of treatment of burn wounds and the development of the type of pathological scar tissue of various origins during the period of convalescence. A study of burn wounds and scar deformities was carried out in 25 patients with thermal injury in the postoperative period and the period of convalescence during the year. The values ​​of perfusion of burn defects were determined using laser Doppler flowmetry, which are informatively significant for predicting the outcomes of treatment of burn wounds.

Results:if the perfusion rate is below 4 PU or above 10 PU, then a high risk of developing pathological scar tissue is predicted; if the perfusion rate varies between 4 and 10 PU, then the risk of developing pathological scar tissue is minimal. The perfusion indicator is an important criterion for the selection of early preventive measures and specialized treatment of burn defects in order to reduce the likelihood of developing pathological scars and, as a result, obtain good cosmetic and functional effects. Based on the results of the study, methods have been developed to prevent the development of pathological scar tissue.

Keywords:deep burns, prediction of scar type, scars, microcirculation, laser Doppler flowmetry, burn wounds, outcome of burn treatment

HOW TO QUOTE:Yurova Yu.V. Prediction of the development of pathological scar tissue at the stage of treatment of burn injury Journal. "Emergency surgery named after. I.I. Dzhanelidze". 2021;1:62-67


 

INNOVATIVE TECHNOLOGY OF FREE SKIN TRANSPLANT WITH A SPLITTED PERFORATED GRAFT WITH AN ADDITIONAL EPITHELIZATION LINE (according to V.A. MENZUL)

Authors

V.A. MENZUL, V.I. GUBAN, A.S. KOVALEV, A.V. CHERVIAKOV, V.I. BUKHTOYAROV, V.E. FEDORCHENKO, D.R. IVCHENKO, T.V. BOLD, A.M. PARAKHIN

Main Military Clinical Hospital of the National Guard of the Russian Federation, Balashikha, Russia

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Purpose of the study:to evaluate the effectiveness of the treatment system for deep burn wounds during autodermoplasty with mesh grafts with a bridge in a rhombus using a moisture-saving dressing with vitamin B2 and new domestic, import-substituting models of skin perforators and dermatomes with disposable ultra-thin disk knives according to V. A. Menzul.

Result: Based on a comparative study that included 273 victims with deep third-degree burns, an option was developed for preparing burn wounds for free autodermoplasty, which allows for a reduction in hospitalization and improved treatment outcomes for burnt patients.

Keywords:deep burns, autodermoplasty, skin perforator, electrodermatome

HOW TO QUOTE: Menzul V.A., Guban V.I., Kovalev A.S., Chervyakov A.V., Bukhtoyarov V.I., Fedorchenko V.E. and others. Innovative technology of free skin transplantation with a perforated graft with an additional line of epithelialization (according to V.A. Menzul). Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2021;1:68-77

№1 2020
WAR PERIOD OF THE LENINGRAD INSTITUTE OF AMBULANCE AID

Authors

V.E. PARFENOV, I.M. BARSUKOVA, I.N. ERSHOVA

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

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Introduction:In connection with the anniversary date - the 75th anniversary of Victory in the Great Patriotic War of 1941-1945. We present unforgettable historical pages of heroism and courage of the inhabitants of the city of Leningrad, who lived and fought in the enemy’s ring (09/08/1941 – 01/27/1944) in conditions of bombing, artillery shelling, cold and hunger. The Leningrad Institute of Emergency Medicine worked and fought together with everyone.

Material and methods:The main materials were archival data from the State Budgetary Institution “St. Petersburg Research Institute of Emergency Medicine named after. I.I. Dzhanelidze" and the State Budgetary Healthcare Institution "City Emergency Medical Care Station", historical and analytical research methods were used.

Keywords:Leningrad Institute of Emergency Medicine, Siege of Leningrad, Great Patriotic War

HOW TO QUOTE:Parfenov V.E., Barsukova I.M., Ershova I.N. The war period of the Leningrad Institute of Emergency Medicine. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 7-11


 

SANITARY AVIATION EVACUATION: ORGANIZATIONAL AND METHODOLOGICAL ASPECTS

Authors

HE. ERGASHEV1,2, I.M. BARSUKOVA1,3, A.G. MIROSHNICHENKO2,3, A.I. MAKHNOVSKY3,5, R.R. KASIMOV4, M.V. ISAEV5

1 First St. Petersburg State Medical University named after. acad. I. P. Pavlova, St. Petersburg, Russia

2 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

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

4 442 Military Clinical Hospital", St. Petersburg, Russia

5 Gatchina Clinical Interdistrict Hospital, Gatchina, Russia

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Introduction:The active development of air ambulance in the Russian Federation helps to increase the availability and quality of emergency specialized, including high-tech, medical care for patients, regardless of their place of residence. At the same time, the organizational and methodological aspects of sanitary aviation evacuation, including the rules for its implementation, are not sufficiently covered in the domestic scientific literature.

Purpose of the study: generalization and systematization of the provisions of regulatory legal documents regulating the issues of sanitary aviation evacuation of patients and the activities of aeromedical teams.

Material and methods:The study examined regulatory legal documents and scientific publications on the issues of sanitary aviation evacuation of patients and the activities of aeromedical teams.

Results:Modern ideas about sanitary aviation evacuation of patients, the composition and equipment of aeromedical teams, medical indications and contraindications for sanitary aviation evacuation are presented. An algorithm for the actions of an aeromedical team doctor during sanitary aviation evacuation of a patient has been developed.

Conclusion:It is advisable to use the results of the study in the work of the National Air Ambulance Service and in the work of unified regional emergency medical dispatch systems.

Keywords:air ambulance, air ambulance evacuation, aeromedical team.

HOW TO QUOTE: Ergashev O.N., Barsukova I.M., Miroshnichenko A.G., Makhnovsky A.I., Kasimov R.R., Isaev M.V. Sanitary aviation evacuation: organizational and methodological aspects. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 12-20


 

CLINICAL AND MORPHOLOGICAL RATIONALE FOR MINIMALLY INVASIVE OSTEOSYNTHESIS OF BONE FRACTURES OF THE DISTAL FOREARM

Authors

A.V. POLIKARPOV, R.V. VASHETKO, Yu.B. KASHANSKY, I.P. KONDRATIEV, V.O. TsAPENKO

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

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Introduction:The problem of surgical treatment of fractures of the distal forearm continues to remain relevant, and therefore new minimally invasive methods of osteosynthesis are being developed.

Purpose of the study:improving the results of treatment of fractures of the distal forearm through the introduction of new minimally invasive methods of osteosynthesis.

Material and methods:In the period from 2015 to 2019, treatment using the developed method was carried out in 129 victims with various types of fractures of the distal forearm in the metaepiphyseal zone and duration from the moment of injury to three weeks. The functional outcome of care was assessed 3 and 12 months after surgery. Treatment results were studied using the PRWE subjective rating scale (1998). Results. The percentage of excellent and good treatment results was 89.4%.

Conclusion:The conducted anatomical and morphological study showed the safety of the proposed method of treatment when used in clinical practice.

Keywords:forearm fracture, osteosynthesis, Kirschner wires.

HOW TO QUOTE:Polikarpov A.V., Vashetko R.V., Kashansky Yu.B., Kondratiev I.P., Tsapenko V.O. Clinical and morphological rationale for minimally invasive osteosynthesis of bone fractures of the distal forearm. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 21-27.


 

SURGICAL AND EVACUATION TACTICS IN PATIENTS WITH POLYTRAUMA IN LEVEL II and III TRAUMA CENTERS

Authors

A.I. MAKHNOVSKY1,5, O.N. ERGASHEV2,3, I.M. BARSUKOVA1,2, A.G. MIROSHNICHENKO1,3, R.R. KASIMOV4, M.V. ISAEV5, S.I. KRIVONOSOV2

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

2 First St. Petersburg State Medical University named after. acad. I. P. Pavlova, St. Petersburg, Russia

3 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

4 442 Military Clinical Hospital, St. Petersburg, Russia 5 Gatchina Clinical Interdistrict Hospital, Gatchina, Russia

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Introduction: To date, prognostic criteria have not been developed to justify surgical and evacuation tactics in patients with polytrauma in level II and III trauma centers.

Purpose of the study:improving treatment outcomes for patients with polytrauma.

Material and methods: At the first stage of the study, the course of traumatic illness was studied in 207 patients with polytrauma in level II and III trauma centers. The study gave a comparative assessment of various scales as criteria for predicting the course of a traumatic illness. During the second stage of the study, based on the obtained prognostic criteria, an algorithm was developed to justify surgical and evacuation tactics in 82 patients with polytrauma in a level II trauma center. The control group consisted of 78 patients in whom the algorithm was not applied.

Results:The implementation of the developed algorithm in a level II trauma center when justifying surgical and evacuation tactics in patients with polytrauma contributed to a significant reduction in mortality by 12.0% (p < 0.05).

Conclusion:It is advisable to use the results of the study in the development of clinical recommendations and criteria for the quality of medical care for patients with polytrauma.

Keywords:polytrauma, traumatic disease, prognostic scales

HOW TO QUOTE: Makhnovsky A.I., Ergashev O.N., Barsukova I.M., Miroshnichenko A.G., Kasimov R.R., Isaev M.V., Krivonosov S.I. Surgical and evacuation tactics in patients with polytrauma in level II and III trauma centers. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 28-34.


 

OPTIMIZATION OF SKIN RESTORATION TACTICS FOR DEEP BURNS

Authors

PC. KRYLOV, E.V. ZINOVIEV., K.M. KRYLOV., O.V.ORLOVA, D.S. VEGERA

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

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Introduction: Improving the results of treatment of victims with deep burns while simultaneously reducing the time required to restore the integrity of the skin and, accordingly, the period of the patient’s stay in the hospital - an urgent socio-economic problem of modern combustiology

Purpose of the study:improving the results of treatment of victims with deep burns by conducting a comparative analysis of the effectiveness of skin grafting techniques and developing an optimal algorithm for surgical treatment. Based on an analysis of the results of an open comparative study, which included 93 patients with deep third-degree burns, a variant of preparing burn wounds for free autotransplantation was developed, which allows to achieve a reduction in hospitalization and improve immediate and long-term results of treatment of victims with deep skin burns.

Conclusions:

1. Modernization of the technical equipment of specialized burn hospitals dictates the need to correct traditional approaches to surgical algorithms.

2. The results of the study confirmed the feasibility of intensifying the formation of a demarcation line of deep lesions through the application of necrolytic compositions.

3. Ultrasonic cavitation after excision of necrotic elements ensures selective cleansing and decontamination of the wound surface before autotransplantation.

4. The implementation of these effects determines the possibility of significantly reducing the time required to prepare wounds for plastic closure with a corresponding minimization of the period of hospital treatment.

Keywords:deep skin burns, ultrasonic cavitation, necrolytic therapy, free autodermoplasty, antibacterial therapy

HOW TO QUOTE:Krylov P.K., Zinoviev E.V., Krylov K.M., Orlova O.V., Vegera D.S. Optimization of skin restoration tactics for deep burns. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 35-40.


 

POSSIBILITIES OF APPLYING BIOMEDICAL CELL PRODUCTS BASED ON MESENCHYMAL STEM CELLS IN COMBUSTIOLOGY AND PLASTIC SURGERY

Authors

E.V. ZINOVIEV1,2, D.V. KOSTYAKOV1, K.N. MOVCHAN3,4, Yu.M. MOROZOV4, K.I. RUSAKEVICH4

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

2 St. Petersburg State Pediatric Medical University, St. Petersburg, Russia

3 Northwestern State Medical University named after. I.I. Mechnikova, St. Petersburg, Russia

4 Medical Information and Analytical Center, St. Petersburg, Russia

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Introduction:Since the beginning of this century, according to world literature, more than 30 clinical trials have been conducted using biomedical cell products in the treatment of burnt patients. Based on the results of these studies, a positive effect of this type of agent on the wound process is stated, a positive reaction to the proliferative activity of fibroblasts and keratinocytes, paracrine effects are noted, a decrease in the frequency of infectious complications, and an improvement in tissue perfusion are revealed.

Purpose of the study:to evaluate the effectiveness of the use of drugs containing multipotent human mesenchymal stromal cells in the treatment of superficial and deep skin burns.

Material and methods:The studied biomedical cell product was presented in two versions: “Cell-collagen complex product” (CCCP™) in the form of a gel for external application to wounds and a suspension of “Multipotent mesenchymal stromal cells” (MMSC™), for injection in the defect area. The work was divided into three stages: the first - a clinical study involving 30 victims with II-IIIa degree skin burns; the second and third stages included an experiment on 48 rats and the results of treatment of three victims with IIIb-IV degree burns.

Results:The use of the drug KKKP™ makes it possible to achieve wound healing within 6–7 days of observation, which is 47% faster compared to cases of using levomekol ointment.

Conclusion:Local application of a gel with mesenchymal stem cells helps to optimize and improve the course of reparative regeneration processes, and also ensures a reduction in healing time and a reduction in the frequency of suppuration in superficial and deep burns. Intramuscular or subfascial administration of an MSC suspension in a deep burn area can increase the rate of skin grafting and the effectiveness of surgical skin restoration techniques, as well as reduce the frequency of graft lysis.

Keywords:burns, biomedical cell products, mesenchymal stem cells

HOW TO QUOTE:Zinoviev E.V., Kostyakov D.V., Movchan K.N., Morozov Yu.M., Rusakevich K.I. Possibility of using biomedical cell products based on mesenchymal stem cells in combustiology and plastic surgery. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 36-51.

POSSIBILITY OF PREDICTING THE OUTCOME OF SKIN PLASTY CONSIDERING IMMUNE REACTIVITY

Authors

A.V. SEMIGLAZOV, E.V. ZINOVIEV, P.K. KRYLOV, O.V. ORLOVA, P.A. SELIVANOV

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

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Introduction:One of the most significant medical and social problems is burn injury. A significant reason for the failure of skin transplantation for burn disease is the lack of objective methods for assessing the patient’s condition on the eve of free autodermoplasty surgery. Determination of indicators of the immune status of patients is not included in the algorithm for examining and monitoring the condition of burn patients.

Purpose of the study:study of cellular immunity indicators to expand the laboratory examination algorithm when preparing patients for free autodermoplasty.

Material and methods:The subpopulation composition of lymphocytes, including T-regulatory cells, was studied using flow cytometry in 50 patients with burn injury in comparison with healthy individuals.

Results:A number of indicators have been identified that influence the mortality of patients with burn injury and the outcome of free autodermoplasty surgery. The time frame for ordering an immunological examination has been clarified. Unfavorable indicators are high leukocytosis with severe absolute and relative lymphopenia, an imbalance of the main lymphocyte populations, an increase in the number of T-regulatory cells and activated T-lymphocytes expressing HLA DR.

Conclusion:Expanding the algorithm for laboratory examination of patients with burns by identifying the main subpopulations of lymphocytes, as well as T-regulatory cells and activated T-lymphocytes, will optimize the treatment of burn patients.

Keywords:burns, autodermoplasty, and flow cytometry, cellular immunity

HOW TO QUOTE:Semiglazov A.V., Zinoviev E.V., Krylov P.K., Orlova O.V., Selivanov P.A. The ability to predict the outcome of skin grafting taking into account immune reactivity. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 52-59.


 

PREVENTION OF INFECTIONS ASSOCIATED WITH CARE IN A SURGICAL HOSPITAL

Authors

S.A. SHLYAPNIKOV 1.3, N.R. NASER 1,2.

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

2 Northwestern State Medical University named after. I.I. Mechnikov, St. Petersburg, Russia 3 Military Medical Academy named after. CM. Kirov, St. Petersburg, Russia

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Introduction:Improvement of technical support, the emergence of innovative treatment and diagnostic techniques, improvement of life support systems - the emergence of expert breathing apparatus, significant advances in pharmacology, progress in oncology and chemotherapy, etc. significantly improved the quality of patient treatment and reduced mortality in many severe pathologies. But along with successes, a new problem has emerged - the problem of infections developing in a patient in a hospital. In this article, we wanted to dwell on the problem of preventing hospital infections from the perspective of a clinician. The most common and problematic are, of course, surgical site infections, hospital-acquired pneumonia, catheter-associated infections, and antibiotic-associated colitis, but this is also a large list of other types of infections that occur in a hospital and, by definition, are hospital-acquired. Progress in medicine and the emergence of new innovative diagnostic and treatment procedures entail the emergence of new problems of an infectious nature: endovascular interventions - an increase in bloodstream infections, an increase in the number of prosthetics - an increase in the number of implant-related infections. The doctor’s task in these conditions is to direct all his efforts to reduce the risk of developing an infection or to reduce the risk of developing an infection associated with problematic antibiotic-resistant hospital strains.

Keywords:Infections in surgery, infections associated with medical care, prevention of hospital infections, antibiotic prophylaxis, complications of antibacterial therapy

HOW TO QUOTE:Shlyapnikov S.A., Nasser N.R. Prevention of infections associated with the provision of care in a surgical hospital. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 60-65.


 

TACTICS OF CERVICAL PREGNANCY MANAGEMENT IN AN EMERGENCY HOSPITAL

Authors

L.Sh. TSECHOEVA, A.D. NAUMOVA, M.A. KISELEV.

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

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Introduction:Just a few years ago, conservative treatment of cervical pregnancy was not possible; the only treatment method was hysterectomy, which deprived the woman of reproductive function. However, at present, thanks to modern techniques, there is an organ-preserving treatment tactic: it consists of embolization of the branches of the uterine artery, which leads to the cessation of blood flow through the branches of the uterine arteries that supply blood to the cervix, followed by the administration of cytostatics and removal of the fertilized egg.

Purpose of the study:using the example of a clinical case to show the effectiveness of embolization of the uterine arteries with the subsequent use of cytostatics (methotrexate) during cervical pregnancy with further removal of the fertilized egg from the cervical canal.

Material and methods:The article presents a clinical observation of the examination and treatment of a patient with cervical pregnancy using modern X-ray surgery methods in combination with the administration of cytostatics.

results: The use of X-ray endovascular treatment in combination with drug therapy with cytostatics made it possible to preserve the patient’s reproductive function.

Conclusion:Organ-sparing treatment of cervical pregnancy using embolization of the uterine arteries and the administration of cytostatics in emergency gynecology in a multidisciplinary medical institution made it possible to reduce the risk of bleeding and preserve reproductive function in a young woman.

Keywords:ectopic pregnancy, cervical pregnancy, methotrexate, embolization of uterine vessels.

HOW TO QUOTE:Tsechoeva L.Sh., Naumova A.D., Kiselev M.A. Tactics for managing cervical pregnancy in an emergency hospital. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 66-71


 

RADIATION DIAGNOSIS OF COMPLICATIONS AFTER SURGICAL TREATMENT OF DISEASES AND DAMAGES OF THE SPINE

Authors

I.S. Afanasieva, V.E. SAVELLO, V.A. MANUKOVSKY, T.A. SHUMAKOVA, V.V. SERIKOV

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

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Introduction:The article highlights the role of radiation diagnostic methods (radiography, computed tomography and magnetic resonance imaging) in identifying early signs of complications of surgical treatment for diseases and injuries of the spine.

Purpose of the study:studying the capabilities of various methods of radiation diagnostics in identifying postoperative complications of diseases and injuries of the spine.

Material and methods:We analyzed data from comprehensive radiation and clinical examinations of 215 patients (of which 109 (50.7%) were men and 106 (49.3%) women, aged from 39 to 71 years), admitted to the St. Petersburg Research Institute ambulance named after I.I. Dzhanelidze" with diseases and injuries of the spine in the period from 2015 to 2020.

Conclusion:Diagnosis of complications of surgical treatment of various diseases and injuries of the spine is an urgent problem in radiation diagnostics and neurosurgery. High-quality and timely radiation diagnostics is the basis for choosing an adequate treatment method, and, therefore, helps reduce the percentage of complications, adverse outcomes, disability and mortality.

Conclusions:An integrated approach to radiation examination of patients with complications of treatment for diseases and injuries of the spine (radiography, MSCT, MRI) is optimal and most adapted for a detailed assessment of the pathological process in the vertebrae, spinal cord, spinal canal, paravertebral tissues, and distantly located organs.

Keywords:computed tomography, magnetic resonance imaging, vertebral fracture, spondylodiscitis, nonspecific purulent-inflammatory diseases of the spine, thromboembolism.

HOW TO QUOTE:Afanasyeva I.S., Savello V.E., Manukovsky V.A., Shumakova T.A., Serikov V.V. Radiation diagnostics of complications after surgical treatment of diseases and injuries of the spine. Journal "Emergency Surgery named after. I.I. Dzhanelidze". 2020; 1; 72-78.

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