[Endovascular embolization for prevention of recurrent bleeding from the upper gastrointestinal tract]. / Opyt primeneniya endovaskulyarnoi embolizatsii dlya profilaktiki retsidiva krovotecheniya iz verkhnikh otdelov zheludochno-kishechnogo trakta.

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%.

[Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19].

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 (55.8 % vs. 74.3 %; 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 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/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.

[CT angiography and endovascular treatment in acute mesenteric ischemia]. / KT-angiografiya i endovaskulyarnye vmeshatel'stva pri ostroi mezenterial'noi ishemii ­ pervye rezul'taty.

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.

[Hybrid interventions for tandem occlusions in acute phase of ischemic stroke]. / Gibridnye vmeshatel'stva pri lechenii tandemnykh okklyuzii v ostreishei faze ishemicheskogo insul'ta.

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.

[Retrospective analysis of clinical outcomes of patients with COVID-19 depending on receiving antihypertensive, lipid-lowering and antihypertensive therapy].

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.

[Surgical help organization during wartime].

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.

[Infectious complications of combined injuries in large-scale catastrophes].

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.

[Delivery of the surgical services to the wounded with injuries of major vessels].

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.

[About perfection of the complex system of the treatment of the wounded with the gunshot fractures of the limb's long bones].

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.

[Changes of dynamics of the lymph production after the cannulation of the thoracic duct].

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.

[Organization of surgical aid for gunshot wounds of the large bowel in the armed conflicts on Northern Caucasus].

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.

[Extraperitoneal complications in gun-shot penetrating wounds of the stomach].

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.

Harmful alcohol use among acutely ill hospitalized medical patients in Oslo and Moscow: A cross-sectional study.

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 24 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.

[Optimal treatment of benign prostatic hyperplasia (BPH) with comorbid chronic prostatitis (category IIIA)].

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.

[Prevention of incompetence of sigmoid-rectal anastomosis after frontal resection of rectum in the treatment of cancer]. / Profilaktika nesostoiatelnosti sigmorektalnykh anastomozov posle perednei rezektsii priamoi kishki pri rake.

Planned anterior resection of the rectum for carcinoma was conducted in 111 patients, 38 of them underwent low resection. The formation of relieving transversostomy is suggested as a method for the prevention of early postoperative complications resulting from incompetence of the anastomosis. It was formed in 51.3% of cases. Besides, for preventing incompetence of sigmoidorectal anastomoses, connecting antimicrobial elements with kanmycin, dioxydin, and cephamezin were applied in 27 patients (26.2%). Incompetence of the anastomosis was not encountered in such cases. Complications occurred in the immediate postoperative period in 45 patients (40.5%), 14 of them (12.6%) had incompetence of the anastomosis suture. There were no fatal outcomes. The authors believe relieving transversostomy to be expedient mainly in low resection of the rectum and in patients with partial obstruction of the large intestine.

[Therapeutic policy in rectal cancer]. / Lechebnaia taktika pri rake priamoi kishki.

The results of clinical examination and treatment of 751 patients with rectal cancer are presented. A total of 684 (91.0%) patients underwent radical surgery. In 439 (64.2%) from them sphincter saving operations were carried out. The rate of sphincter saving procedures for the last 5 years has increased up to 73.8%, most often of them transbdominal resection was used--284 (64.7%) patients. Sygmoidorectal anastomosis in 158 (55.6%) patients was carried out by the hand sutures, and in 126 (44.4%)--suturing apparatuses were used. The operation was finished by the suture of the pelvic peritoneum by two layers of sutures and the drainage of the area of the anastomosis from the perineum site by two tubes for prevention of the development of peritonitis even in case of insufficiency of the anastomosis was made. All the operated patients underwent preoperative radiotherapy with a total dose 20-25 Gy. The basic stage of the operation was on demand followed by chemohyperthermic perfusion of the abdominal cavity. It was carried out in 30 patients, including 12 patients with rectal cancer. In cancer of the rectum of the II B and III stages the usage of chemotherapy is obligatory. New operations for metastases of cancer of the colon into the liver were made in 4 patients (left and extended right hemihepatectomy). Complications developed in 33.5% of patients, lethality made up 3.8%, including 1.8% for the last 5 years.

[Prevention of incompetence of sigmoidorectal anastomosis after anterior resection of the rectum in cancer]. / Profilaktika nesostoiatel'nosti sigmorektal'nykh anastomozov posle perednei rezektsii priamoi kishki po povodu raka.

The results of surgery in 11 patients with rectal cancer are analysed. The anterior rectal resection was performed in all cases, in 38 cases-the lower resection was performed. The use of decompressive colostomy as a method to prevent complications, caused by anastomotic incompetence is recommended. The colostomy was used in 51.3% cases. Besides colostomy, in 27 (26.2%) patients the antiseptic connection elements impregnated with kanamycin, dioxidine and cephamezine were used to prevent sigmoido-rectal anastomotic incompetence. The rate of anastomotic incompetence was 12.6% (14 patients). There were no mortality. The use of decompressive colostomy in operations on transverse colon especially in cases of lower rectal resection and in patients with partial colon ileus is advocated. The use of antiseptic connective elements is an efficient method to prevent anastomotic incompetence.