RESUMEN
OBJECTIVE: To evaluate the results of preventive endovascular hemostasis in patients with high risk of recurrent bleeding from the upper gastrointestinal tract. MATERIAL AND METHODS: We analyzed treatment outcomes in 158 patients with ulcerative gastroduodenal bleeding and high risk of recurrence (≥17 scores), Forrest 1-2 A/B and mortality (SAPS II score ≥30). Endovascular embolization of the left gastric or gastroduodenal artery was performed to prevent recurrent bleeding. RESULTS: Endovascular hemostasis was technically successful in 94.4% of cases (153 patients). Embolization could not be performed due to technical reasons in 5 patients. One patient developed retroperitoneal hematoma as a complication after transcatheter angiography and embolization that required surgical intervention. Recurrent bleeding after technically successful embolization occurred in 11 (7%) patients. The PVA microemboli and spirals were used for embolization of the left gastric and gastroduodenal arteries, respectively. Additional PVA microemboli were also used in gastroduodenal artery in some cases. Twenty-six (16.5%) patients died. CONCLUSION: Endovascular hemostasis in patients with severe comorbidities (SAPS II score ≥30) and high risk of recurrent bleeding (≥17 scores) reduced the incidence of recurrent bleeding to 6.96% and mortality to 17%.
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Embolización Terapéutica , Hemostasis Endoscópica , Tracto Gastrointestinal Superior , Humanos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/prevención & control , Tracto Gastrointestinal Superior/cirugía , Hemostasis Endoscópica/efectos adversos , Hemostasis Endoscópica/métodos , Resultado del Tratamiento , Angiografía , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the effectiveness of hybrid interventions, i.e. endovascular mechanical thrombectomy from intracranial arteries combined with open thrombectomy or carotid endarterectomy from extracranial internal carotid artery. MATERIAL AND METHODS: We analyzed 16 patients who underwent mechanical thrombectomy/thrombaspiration combined with open surgery between January 2014 and March 2021. All patients had occlusion of extracranial and intracranial segments internal carotid artery or initial segments of the middle cerebral artery. Baseline data, diagnostic algorithm, timing and results of treatment were analyzed. Study endpoints were technical success of revascularization, clinically significant hemorrhagic transformation, NIHSS and modified Rankin score of neurological impairment, as well as outcome of disease within 90 days. RESULTS: We restored patency of ICA and intracranial arteries in 13 out of 16 patients. In 9 patients, we obtained a positive effect with significant regression of neurological symptoms (mRS <2). In 3 patients, severe neurological deficit persisted throughout the entire follow-up period. Four patients died. Thus, effectiveness of technique was 56.2% (t=3), mortality rate was 25% (t=2.3). There was a relationship between the timing of interventions and outcomes of disease. Indeed, all dead and most of disabled patients underwent surgery later than 6 hours from the onset of disease. CONCLUSION: Hybrid interventions for tandem occlusions of carotid arteries can significantly increase efficiency and accelerate recanalization of great extracranial vessels in patients with tandem lesions in acute phase of ischemic stroke. Moreover, hybrid interventions significantly reduce the cost of reperfusion procedure. In case of severe atherosclerotic stenosis, simultaneous open endarterectomy from common and internal carotid arteries has a significant advantage over stenting due to no need for antithrombotic therapy.
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Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/cirugía , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/cirugía , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Resultado del Tratamiento , Trombectomía/efectos adversos , Trombectomía/métodosRESUMEN
Aim To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8â% vs. 74.3â%; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0âU/l, concentration of С-reactive protein ≥40.0âmg/l, total protein <65âg/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.
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COVID-19 , Infarto del Miocardio , Infarto del Miocardio sin Elevación del ST , Infarto del Miocardio con Elevación del ST , Anciano , Arritmias Cardíacas/complicaciones , COVID-19/complicaciones , COVID-19/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Infarto del Miocardio sin Elevación del ST/complicaciones , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/epidemiología , Factores de Riesgo , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVE: To optimize the treatment strategy for acute mesenteric ischemia (AMI). MATERIAL AND METHODS: The study included 43 patients aged 76.4±10.3 years. CT angiography and endovascular repair of mesenteric vessels underlie the new treatment approach. RESULTS: CT angiography according to the established criteria was performed in 31 patients with suspected AMI throughout 1 year. Sensitivity was 90.0%, specificity - 100%, accuracy - 95%. Endovascular interventions were applied in 13 patients (successful in 8 cases and unsuccessful in 5 patients). Mortality rate was 37.5%. Fifteen patients with clinical signs of peritonitis or after previous unsuccessful interventional revascularization underwent open surgery. Mortality rate was 86.7%. CONCLUSION: CT angiography is valuable to diagnose AMI at the stage of reversible changes in bowel wall in some cases. Endovascular revascularization as the first-line treatment has certain prospects.
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Isquemia Mesentérica , Anciano , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada , Humanos , Intestinos/irrigación sanguínea , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/etiología , Isquemia Mesentérica/cirugía , Procedimientos Quirúrgicos VascularesRESUMEN
BACKGROUND: The main factors that increase the risk of cardiovascular accidents and mortality among patients with COVID-19 include hyperglycemia, arterial hypertension and dyslipidemia. Therefore, all patients with COVID-19 and metabolic syndrome should receive antihypertensive (AHT), hypolipidemic (GLT) and hypoglycemic therapy (GGT). Currently, there is a limited number of studies regarding the effectiveness and safety of this therapy in patients with COVID-19. AIM: Evaluate the clinical outcomes of patients with COVID-19, depending on the recipient of AHT, GLT and GGT. MATERIALS AND METHODS: A retrospective analysis of the clinical outcomes "discharged/died" of 1753 patients with COVID-19 was carried out depending on the received AHT, GLT and GGT. RESULTS: A significant reduction in the risk of mortality among patients with COVID-19 was observed during therapy with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers ACE inhibitors/ARBs (OR 0.39, 95% CI 0.210.72; p0.05) and b-adrenergic blockers b-AB (OR 0.53, 95% CI 0.281; p0.05). At the same time, against the background of therapy with ACE inhibitors/ARBs and b-ABs, the chance of mortality decreased more significantly among patients with type 2 diabetes mellitus (T2DM) compared with patients without T2DM. Diuretic therapy was associated with a 3-fold increase in the chances of death: OR 3.33, 95% CI 1.884.79; p0.05. Statin therapy did not affect clinical outcomes in COVID-19 patients. On the background of therapy with oral hypoglycemic drugs, the risk of mortality decreased 5-fold (OR 0.19, 95% CI 0.070.54; p0.05). Against the background of insulin therapy, there was an increase in mortality risk by 2.8 times (OR 2.81, 95% CI 1.55.29; p0.05). CONCLUSION: A significant reduction in mortality among patients with COVID-19 was observed during therapy with ACEI/ARB, b-AB, and oral hypoglycemic therapy. Increased risk of death was associated with insulin therapy and diuretic therapy.
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Tratamiento Farmacológico de COVID-19 , Diabetes Mellitus Tipo 2 , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Hipertensión , Insulinas , Humanos , Antihipertensivos/efectos adversos , Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Estudios Retrospectivos , Diabetes Mellitus Tipo 2/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/complicaciones , Antagonistas Adrenérgicos/uso terapéutico , Hipoglucemiantes/efectos adversos , Diuréticos , Insulinas/uso terapéutico , LípidosRESUMEN
BACKGROUND: The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). METHODS: A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24â¯h were collected. PEth and alcohol concentration were measured in whole blood. RESULTS: Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged < 61 years. CONCLUSIONS: The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.
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Alcoholismo/sangre , Alcoholismo/epidemiología , Glicerofosfolípidos/sangre , Hospitalización/tendencias , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/sangre , Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/diagnóstico , Biomarcadores/sangre , Estudios Transversales , Intervención Educativa Precoz/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Moscú/epidemiología , Noruega/epidemiología , Autoinforme , Adulto JovenRESUMEN
Immediate proximity of medical groups of special purpose from the troops led to reduction of transportation time. 64% of wounded received medical help during first 2 hours after the incident. All wounded received medical help, even those, who were lethally wounded. 0.6% of wounded finished their treatment on the stage of qualified medical help, 97.3% were evacuated on the next stages and 2.1% had died. 10.2% of patients finished treatment in hospitals of specialized medical stage, 88.2% were sent to next evacuation stages and 1.6% had died. Emergency specialized surgical help was rendered to 43% of wounded. All stages of medical evacuation should be developed in full, in view of the impossibility of further evacuation under certain conditions. At the same time, multiple staging of medical evacuation should be avoided. Evacuation by means of air-transportation should be considered the main way of transportation of the wounded. Medical groups of special purpose are considered to be the leading field medical formations during wartime.
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Cirugía General/organización & administración , Hospitales Militares/organización & administración , Personal Militar , Guerra , Heridas y Lesiones/cirugía , Humanos , Federación de RusiaRESUMEN
The article deals with clinical study of treatment results of 106 wounded. The study was carried out with the help of different methods of correction of blood flow in the place of shotgun fracture of long bones in terms of application period. Developed system of incipient complex correction post shotgun circulatory injuries improves the results of treatment by 87.3 +/- 1.8% (p < 0.05), decreases the number of wounded with laps of blood flow in tissues by 34.1 +/- 1.1%, that is lower than 20% from normal level, and in 38.2 +/- 1.5% cases helps to avert the development of necrosis and wound abscess.
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Fracturas Óseas/terapia , Extremidad Inferior/lesiones , Flujo Sanguíneo Regional , Extremidad Superior/lesiones , Heridas por Arma de Fuego/terapia , Fracturas Óseas/patología , Fracturas Óseas/fisiopatología , Humanos , Extremidad Inferior/irrigación sanguínea , Masculino , Extremidad Superior/irrigación sanguínea , Heridas por Arma de Fuego/patología , Heridas por Arma de Fuego/fisiopatologíaRESUMEN
An adequate cannulation of the thoracic duct is always accompanied with appropriate dynamics of the lymph production. As a result, the daily output of lymph increases from 2.0 to 2.2 times during 4-5 days. To find out the reasons of the lymph production changes were examined 57 patients with acute purulent inflammatory diseases of abdominal and thoracic organs. It was determined that the lymph production change is conditioned by 2 factors: the first is the stopping of the flow into venous vessels via lympho-venous anastomosies of the thoracic duct, lymphatic trunks and large lymphatic vessels. It leads to a mobilization of the greater part of lymph in lymphatic vessels. The second is the speeding-up of lymph production.
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Cateterismo/métodos , Linfa , Proteínas/metabolismo , Conducto Torácico/fisiología , Animales , Enfermedades Autoinmunes/metabolismo , Enfermedades Autoinmunes/fisiopatología , Enfermedades Autoinmunes/terapia , Proteínas Sanguíneas/metabolismo , Perros , Femenino , Humanos , Hiperlipidemias/metabolismo , Hiperlipidemias/fisiopatología , Hiperlipidemias/terapia , Infecciones/metabolismo , Infecciones/fisiopatología , Infecciones/terapia , Cinética , Linfa/química , Linfa/metabolismo , Linfa/fisiología , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
According to consolidated data the frequency of injuries of blood vessels during the Great Patriotic war 1941-1945 was 2.3-4.9%. In the first and the second period of the war the temporary hemostasia on the battlefield was delivered via surgical tubing, tamponade or compressing bandage; the final--via deligation of the arteries in the wound or overlap of hemostatic clamp or the amputation was performed. In the process of delivering of the knowledgeable medical assistance garrot was removed, traumatonesis was performed and the final hemostasia was performed via vasoligation in the wound or along it, than transfused. In some hospitals were organized special units for patients with injuries of vessels. In the third period of the war the main method of primary and secondary hemostasia was vasoligation in the wound or along it. The vessel suture was performed rarer than in the first and the second period. The methods of treatment and prophylaxis of complication of vessel's injury were examined.
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Vasos Sanguíneos/lesiones , Atención a la Salud/historia , Personal Militar , Procedimientos Quirúrgicos Vasculares/historia , Segunda Guerra Mundial , Atención a la Salud/organización & administración , Historia del Siglo XX , Humanos , Personal Militar/historia , U.R.S.S. , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Main forms of infectious complications and their causes in large-scale catastrophes and baseline conditions were studied based on examination of 1463 casualties with combined injuries. The following parameters were analysed: mean injury severity (ISS and APACHE-II systems), shock severity, and blood volume deficit. The frequency of infectious complication of combined injuries was estimated with reference to severity of the major trauma and the number of affected body regions. Infectious complications were diagnosed in 46.6 and 30% of the casualties of natural cataclisms and car accidents respectively. They included wound suppuration (23.8%), osteomyelitis (17%), acute abscess (12.9%), sepsis (7.7%), and progressive peritonitis (6.7%). The incidence of complications directly correlated with the severity of injuries and shock, general conditions of the casualties, the character of the major injury, and the number of affected body regions.
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Desastres , Traumatismo Múltiple/epidemiología , Infección de Heridas/epidemiología , Humanos , Incidencia , Indonesia/epidemiología , Puntaje de Gravedad del Traumatismo , Estudios Retrospectivos , Infección de Heridas/diagnósticoRESUMEN
The article after a short literature review presents data of analyze of progression of extra-peritoneal visceral pathology by wounded persons with penetrating wound of stomach. There was described frequency of morbidity of extra-peritoneal organs in dependence on flow of peritonitis. Were marked differences in frequency of progression of peritonitis in conditions of fragment and ballistic wounds. In course of effectuated research was marked dependence between frequency of lethal outcomes and flow of peritonitis and added diseases of respiratory organs, uropoiesis, cardiovascular system. There was effectuated a comparative analysis of frequency of appearance of pathology of marked systems in dependence on localization of ballistic wound. Also there was shortly described a clinical-laboratorial presentation in conditions of appearance of diseases of extra-peritoneal organs.
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Enfermedades Cardiovasculares/etiología , Peritonitis/complicaciones , Neumonía/etiología , Estómago/lesiones , Enfermedades Urológicas/etiología , Heridas por Arma de Fuego/complicaciones , Enfermedades Cardiovasculares/epidemiología , Humanos , Personal Militar , Peritonitis/epidemiología , Neumonía/epidemiología , Federación de Rusia , Enfermedades Urológicas/epidemiología , Heridas por Arma de Fuego/epidemiologíaRESUMEN
The article presents generalization of experience of organization of surgical aid for gunshot wound of large bowel in the armed conflicts on Northern Caucasus. Were studied results of treatment of 272 wounded persons. Were detected 249 wounds of segmented intestine, 23 wounds of straight intestine. 78% of injured had multisystem injuries. All wounded persons had fire peritonitis, which is a logical result penetrating wound of stomach. On the base of results of treatment were proposed algorithms of surgical tactic in condition of wound of large bowel, also were proposed original methods of closing of major softgranulating wounds of perineum. The article presents a generalized experience of work in sphere of treatment of given category of wounds in coloproctologic center CMCH by Vishnevsky A.A.
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Intestino Grueso/cirugía , Medicina Militar/organización & administración , Guerra , Heridas por Arma de Fuego/cirugía , Hospitales Militares/organización & administración , Humanos , Intestino Grueso/lesiones , Personal MilitarAsunto(s)
Cirugía General , Hospitales Militares/organización & administración , Medicina Militar , Atención a la Salud/historia , Cirugía General/historia , Cirugía General/organización & administración , Cirugía General/tendencias , Historia del Siglo XX , Hospitales Militares/historia , Hospitales Militares/tendencias , Humanos , Medicina Militar/historia , Federación de RusiaAsunto(s)
Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas/métodos , Traumatismo Múltiple/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Cuello Femoral/diagnóstico por imagen , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Prótesis de Cadera , Humanos , Fijadores Internos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico por imagen , Radiografía , Resultado del TratamientoAsunto(s)
Disfunción Eréctil/diagnóstico , Disfunción Eréctil/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Prostatectomía , Algoritmos , Terapia Combinada , Disfunción Eréctil/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Erección Peniana/psicología , Inhibidores de Fosfodiesterasa/uso terapéutico , Complicaciones Posoperatorias/tratamiento farmacológico , Neoplasias de la Próstata/cirugía , PsicoterapiaRESUMEN
The trial of efficacy of physical factors in combined treatment of BPH stage I patients with concomitant abacterial chronic prostatitis (category IIIA) enrolled 42 patients who were divided into two groups. Group 1 received combined treatment including complex physical factors (CAP-ELM-01). The efficacy of the treatment was judged by dynamics of clinical and device indices and severity of leading CP syndromes. It is shown that physical factors contributed to noticeable improvement in the parameters of prostatic secretion, uroflowmetry, size of the prostate, hemodynamics, clinical manifestations of chronic prostatitis.