[Ultrasound in the diagnosis and treatment of abdominal abscesses]. / Ul'trazvukovoe issledovanie v diagnostike i lechenii abstsessov briushnoi polosti.

OBJECTIVE: To improve the results of surgical treatment of abdominal abscesses using ultrasound-assisted drainage. MATERIAL AND METHODS: There were 103 cases of percutaneous ultrasound-assisted drainage of intraperitoneal abscesses for the period from 2012 to 2017. Patients who underwent drainage of intraorganic and retroperitoneal abscesses associated with pancreatic necrosis were excluded from the study. RESULTS: Complete recovery was observed in 101 (98%) out of 103 patients within 10-73 days. CONCLUSION: Ultrasound-assisted drainage is an effective procedure for abscesses. This method has demonstrated high efficiency, availability and safety without need for open approach. This method may be a reliable alternative to open surgery, for example in emergency surgical hospitals.

[Effect of normobaric hyperoxia on cerebral oxygenation, metabolism and oxidative stress in patients with subarachnoid hemorrhage caused by intracranial aneurysm rupture].

The development of cerebral vasospasm in subarachnoid hemorrhage (SAH) due to cerebral aneurysms rupture results in cerebral circulation disturbances. Application of normobaric hyperoxia can be an effective way for improving of oxygen delivery to injured brain tissues. The purpose of this study was to assess of normobaric hyperoxia influence on intracranial pressure (ICP), cerebral oxygenation and metabolism, oxidative stress and endogenous factors of vascular regulation in II critically ill patients with nontraumatic SAH due to cerebral aneurysms rupture. Increase of FiO2 from 0.3 to 0.5 and 1.0 was accompanied with brain oxygen tension (PbrO2) increase and cerebral extraction ratio for oxygen (O2ER) decrease. Application of normobaric hyperoxia had no effect on ICP, cerebral perfusion pressure, arterial blood pressure and cerebral metabolism. The results obtained from patients with nontraumatic SAH showed an evident increase of oxidative stress which had a significant effect on vascular endothelial function, causing an imbalance in the endogenous regulation of vascular tone. Application of normobaric hyperoxia was not accompanied by an increase of free-radical processes in critically ill patients with nontraumatic SAH due to cerebral aneurysms rupture.

[High-flow extracranial-intracranial (EC-IC) bypass surgery in a patient with giant right cavernous ica aneurysm].

To present the clinical case of successful extracranial-intracranial (EC-IC) high-flow bypass performance. Patient, female, 51 years old, was suffered from giant cavernous aneurysm of right internal carotid artery (ICA), presented with mass effect. The EC-IC high-flow bypass using radial artery was performed between M2 segment of right middle cerebral artery and right external carotid artery. Bypass patency was confirmed by intraoperative dopplerography, postoperative digital subtraction angiography and by ultrasound examination of anasthomosis. Patient was discharged in 3 weeks after operation in satisfactory condition. The EC-IC high-flow bypass is one of effective method for cavernous aneurysm treatment, allowing excluding aneurysm from cerebral blood flow and decreasing its mass effect.

[First case of thrombolysis with non-immunogenic staphylokinase in a patient with ischemic stroke receiving dabigatran etexilate followed by thrombectomy]. / Pervyi sluchai tromboliticheskoi terapii pri pomoshchi neimmunnogennoi stafilokinazy u patsientki s ishemicheskim insul'tom, poluchayushchei dabigatrana eteksilat, s posleduyushchei trombektomiei.

Currently, five oral anticoagulants have been shown to be effective in preventing recurrent ischemic stroke and/or systemic embolism in patients with non-valvular atrial fibrillation. However, 1.1-2.2% of patients taking oral anticoagulants develop ischemic strokes. The use of oral anticoagulants limits the possibility of systemic thrombolytic therapy, as this is associated with an increased risk of symptomatic hemorrhagic transformation. The exception is cases when, with the help of a specific antagonist, it is possible to neutralize the effect of the anticoagulant in the shortest possible time and achieve normocoagulation. Currently, the Russian Federation allows two drugs for systemic thrombolytic therapy in patients with ischemic stroke in the «therapeutic window¼ up to 4.5 hours from the onset of the disease - recombinant tissue plasminogen activator and non-immunogenic staphylokinase, which showed no less efficacy and safety in the FRIDA study compared to recombinant tissue plasminogen activator. This article describes a clinical case of the first systemic thrombolytic therapy with a non-immunogenic staphylokinase after the use of idarucizumab in a patient taking dabigatran etexilate, followed by thrombectomy.

[Intracranial pressure, cerebral perfusion and metabolism in acute period of intracranial hemorrhage].

Estimation of the volume of cerebral lesion, reversibility of ischemia and prognosis of the disease determinate management tactics in patients with severe head injuries and non-traumatic intracranial hemorrhages. Data of multimodal neuromonitoring in patients with intracranial hemorrhage in the earlier stages of comatose period were analyzed in this paper. They included incracranial pressure, cerebral perfusion pressure, bulb oxymetry, brain oxygen tension, tissue microdialysis. Typical parameters for different types of neurological outcomes were defined.

[Role of multicomponent neuromonitoring in the determination of intensive care tactics in a female patient with subarachnoidal hemorrhage due to cerebral arterial aneurysmal rupture].

The paper describes a case of aneurysmal subarachnoidal hemorrhage in a female patient during intensive care involving the whole set of the latest neuromonitoring parameters: intracranial and cerebral perfusion pressure, brain tissue oxygen tension and temperature, as well as a set of biochemical parameters studied by the tissue microdialysis technique. The high diagnostic value of the parameters that cannot be changed by any other neuromonitoring modalities is shown.

[Prognostic significance of leukocyte count in the venous blood in the acute stage of cerebral aneurism rupture]. / Prognosticheskaia znachimost' kontsentratsii leikotsitov v venoznoi krovi v ostrom periode razryva tserebral'nykh anevrizm.

AIM: To determine a prognostic role of leukocyte count in the venous blood in the acute stage of cerebral aneurysm (CA) rupture. MATERIAL AND METHODS: Fifty-one patients with CA rupture, aged from 20 to 65 years, hospitalized in the first 72 h over the period from 01.10.12 to 01.02.16 were examined. The severity of disease and anatomical form of hemorrhage was corresponded to III-IV degree on the W. Hunt - R. Hess scale and Fisher scale. All patients underwent surgery. Outcomes after open and endovascular surgeries were similar. RESULTS: Normal leukocyte number in the venous blood at admission was identified in 12 (24%) of patients (on average 7.3±1.4·109/L), leukocytosis in 39 (76%) (14.3±3.1·109/L) (p<0.0001). Leukocyte number in the acute stage of CA rupture was correlated with the frequency and severity of the vessel spasm. In 28 (55%) of patients with ischemic lesions of the brain matter, mean leukocyte number in the first 72 h after hemorrhage was higher by 2-24% (3±4.8·109/L) compared to patients without ischemia (11.9±2.5·109/L) (p=0.06). The level of leukocytes in survivors was lower by 3 - 28% (122±3.4·109/L) compared to patients with fatal outcome and patients with severe neurological deficit after the surgery (14.5±3.9·109/L) (p>0.05). CONCLUSION: The increase in leukocyte number in the venous blood in the first 72 h after CA rupture ≥10,1·109/L is a reliable risk factor of marked vessel spasm. The level of leukocytes in patients with cerebral ischemia and poor prognosis in the first 72h after aneurysmal hemorrhage was higher by 2-28% compared to survivors without neurological impairment or mild neurological deficit.

[Dilated cardiomyopathy as a cause of ischemic stroke]. / Dilatatsionnaya kardiomiopatiya kak prichina ishemicheskogo insul'ta.

Dilated cardiomyopathy (DCMP) is a disease of the myocardium characterized by the dilatation of heart cavities with the development of systolic dysfunction but without a decrease in the thickness of the myocardium. DCMP is a frequent cause of cardioembolic syndrome, in particular cardioembolic ischemic stroke (CES). A case of a patient with DCMP after CES is presented.