Efficiency of an algorithm for the prevention of sternal infection after cardiac surgery in children under 1 year of age: A single-center retrospective study.

Background: Sternal infection is one of the most challenging complications to manage after heart surgery. The aim of our study is to evaluate the effectiveness of a developed algorithm for preventing sternal infection in pediatric patients after surgery for congenital heart disease (CHD). Methods: We conducted a single-center study examining the treatment of 478 children with CHD. Patients were divided into 2 groups, taking into account the application of a developed management algorithm. A multivariate logistic regression analysis was used to identify the factors influencing the development of sternal infection following heart surgery using median sternotomy. Results: A developed algorithm was applied in 308 children. In total, there were 16 cases of sternal infection (3.34 %) across both groups. Deep wound infection developed in 6 patients (1.26 %). Sternal infection developed in 2 children (0.65 %) in the first group (in which the algorithm was applied) and 14 children (8.2 %) in the second group. Deep sternal infection developed in 1 patient in the first group (0.33 %) and in 5 patients in the second group (2.94 %). As a result, perioperative risk factors as postoperative resternotomy (OR 23.315; p < 0.001), delayed sternal closure (OR 9.087; p = 0.003), development of acute renal failure (OR 5.322; p = 0.018) were associated with increased risk of infection and application of the developed algorithm resulted in a significant reduction in risk (OR 0.032; p < 0.001). Conclusion: The suggested method for the prevention of sternal infection has significantly reduced the incidence of sternal infection after cardiac surgery in children less than 1 year of age. In patients with moderate to high risk for surgical site infection, surgeons can enhance wound healing and prevent wound infections with simple, inexpensive, and readily available tools and techniques. Surgical aspects, topical use of antibiotics, prevention of peripheral vasoconstriction, maintenance of normal oxygen delivery rates, and an individual approach to intensive care are essential.

A rare case of diagnosed absent aortic valve and severely hypoplastic pulmonary valve with double outlet right ventricle: A case report.

Agenesis of the aortic and pulmonary valves is a very rare congenital malformation of the semilunar valves. The literature describes no more than thirty cases of such anomaly in combination with congenital heart disease. Most descriptions include aplasia of either the aortic or pulmonic valve. The combination of such defect in both valves has been described in a much smaller number of scientific papers. In this article, we present a clinical case of the treatment of a patient with agenesis of aortic valve and severely hypoplastic pulmonary valve. As a result circulatory arrest occurred immediately after birth, which required the implementation of cardiopulmonary resuscitation. The child was resuscitated and transferred to the intensive care unit for further examination and treatment.

[The Input of Medical Societies and Zemstvo Physicians into Development of Sanitary Business in the Saratov Gubernia in the Second Half of XIX - Beginning of XX Centuries].

The article presents review of becoming of sanitary business in the Saratov Gubernia, the role of medical community, Zemstvo sanitary bureau in struggling epidemics in XIX - early XX centuries.

[Geometric and morphological features of the aortic root in norm and aortic regurgitation]. / Geometricheskie i morfologicheskie kharakteristiki kornia aorty v norme i pri nedostatochnosti aortal'nogo klapana.

AIM: To assess linear and geometric parameters of the aortic valve and to determine the changes which are associated with impaired leaflets coaptation and aortic root enlargement. MATERIAL AND METHODS: Surgical anatomy of the aortic root and its spatial relationships with surrounding heart structures were studied with plastination by using of combined silicon technologies. 123 specimens of the aortic root with preserved original geometry were created with silicone plastination technique and perfusion embalming. Analysis included 15 heart specimens with the signs of aortic root dilatation and 108 specimens without evidence of dilatation. Multiple logistic regression was used for statistical analysis. RESULTS: Anatomical and clinical analysis showed that deviation angle of the intercusp triangle is the factor contributing impaired aortic root geometry and aortic regurgitation (OR 1.3, 95% CI 1.114-1.350, p<0.0001). CONCLUSION: 1) Increased deviation angle of intercusp triangles is associated with impaired coaptation of aortic valve leaflets. 2) Restoration of intercusp triangle deviation angle within 1.7±1.2° degrees is geometrically necessary to achieve normal function of the aortic valve.

[SUCCESSFUL TREATMENT OF ACUTE PULMONARY ABSCESS IN AN ELDERLY PATIENT].

This paper describes successful application of nebulizer inhalation therapy with the antibacterial drug tobramycin in the combined treatment of acute pulmonary abscess caused by Pseudomonas aeruginosa in an elderly woman. Possibilities of modern antibiotic therapy of pulmonary abscess are discussed along with prospects for its further development.

[PULMONARY THROMBOEMBOLISM IN WOMEN USING ORAL HORMONAL CONTRACEPTIVES].

Pulmonay thromboembolism is a common difficult-to-diagnose pathology not infrequently with a lethal outcome. There are many factors leading to hypercoagulation. One of them is intake of hormonal contraceptives to which doctors sometimes do not pay due attention. This paper reports two cases of acute coagulopathy with massive pulmonary thromboembolism in young women using these agents during a long period.

[ASSESSMENT OF EFFICACY OF TEMPORARY EPICARDIAL BIVENTRICULAR RESYNCHRONIZATION PACING AFTER CARDIAC SURGERY].

The temporary pacing is provided as a key principle of maintenance and correction of hemodynamics after weaning the patient from cardiopulmonary bypass. There are conventional algorithms of temporary pacing, but the substantiation of electrode fixation areas is variable. The authors experimentally investigated the efficacy of temporary epicardial pacing in DDD and DDDBV using 18 laboratory animals after cardiac surgery with application of cardiopulmonary bypass. The hemodynamic parameters were compared in given groups. It was noted that in case of temporary epicardial pacing in DDDBV conditions was the best hemodynamic effect. The authors recommended more optimal areas for electrode fixation in temporary pacing: bachmans bunble (closest to the artrial septum), proximal part of the crista terminalis for the right atrium electrodes; the front-side free wall of the right ventricle at the distance of 3-4 cm from the apex of the heart, diaphragmatic surface of the right ventricle proximal to artioventricular groove for the right ventricle electrodes; obtuse margin (side wall of the left ventricle), diaphragmatic surface of the left ventricle proximal to artioventricular groove for the left ventricle electrodes.

[RESULTS OF APPLICATION OF THE METHOD OF STERNAL INFECTION ELIMINATION IN CARDIOSURGICAL PATIENTS].

A retrospective analysis of cases of sternal infection development was made in 388 cardiovascular patients from 2006 to 2012. The standard preventive measures of wound infection development were applied in the first period from 2006 to 2009. The method of "elimination of sternal infection" was used in the second period from 2009 to 2012. The application of the method of "elimination of sternal infection" allowed reducing the rate of sternal infection from 7.7 to 0.5% (odds ratio 0.099, 95% CI: 0.013-0.747; p = 0.025). According to results of statistical analysis the most significant factors were: body mass index (p = 0.002), resternotomy in early postoperative period (p < 0.001), risk according EuroSCORE Logistics (p < 0.001) and usage of the method of "elimination of sternal infection" (p = 0.006). The prevention of postoperative infectious complications shorthens the terms of hospital stay no less than 3 weeks, improves the quality of life for the patients and decreases treatment costs on 2.5 times.

[Focused ultrasound survey in surgery for abdominal trauma: methods and the capabilities in clinical use].

In severe abdominal trauma ultrasound provides fast and accurate diagnostics of damages and detect the source of internal bleeding. In the absence of trained professionals (in injury care centre of 2-3rd levels, In emergency situations) it is possible to use by the method of research in the reduced volume. The article presents a comparative analysis of the use of traditional methods and reduced ultrasound diagnostics of abdominal injuries on 56 victims. Concluded that reduced ultrasound is affordable, mobile, fast and accurate method of diagnosis, allowing to use it repeatedly.

[Treatment of extracranial gunshot wounds caused by non-lethal weapon].

The deaths happened as a result of wounds caused by non-lethal weapon (NLW) are mainly associated with severe and extremely severe damage of brain. However, vast number of specific problems occurs in cases of extracranial gunshot wounds caused by NLW. Taking into account little physicians' experience, and absence of standard approaches to treatment of these wounds till now. This paper embraces peculiarities of clinical signs, diagnosis and surgical treatment of cervical, truncal, and extremities wounds caused by NLW. Our investigation allowed to draw a conclusion that gunshot wounds caused by NLW have similar characteristics. These ones are the same with signs of wounds caused by small arms. Surgical treatment of wounds caused by NLW is based on the standard approaches to treatment of low-velocity missile wounds.

[Clinical features of chronic obstructive pulmonary disease course in persons who underwent radiation impact].

Experience of 10-years observation of 164 patients who underwent radiation impact, 38 (23%) afterwards had chronic obstructive pulmonary disease (COPD), is analyzed in the article. It is demonstrated, that timely COPD diagnostics must be based on thorough gathering of anamnestic data, analysis of clinical manifestations and results of annual examination of pulmonary ventilation function. Changes in time of COPD clinical symptoms among COPD patients who underwent radiation influence are considered. It was established, that in patients who underwent radiation influence, COPD began in younger age, coursed more severe, with more frequent aggravations, requiring inpatient treatment. Therapy of this category of persons required all drugs used at COPD treatment.

[Significance of endovideosurgery in treatment of surgical infections].

Results of treatment of 186 patients treated in the clinic in the period from 2000 through 2005 for infectious complications after severe combined injuries who underwent 264 operations have been studied. It was established that the endovideosurgical method of sanitation of the infection focus was used in 50% of cases at an average. The investigation of surgical treatment of infectious complications in patients with severe surgical pathology has shown high efficiency of endovideosurgical method for treatment of such complications in the third period of wound dystrophy. The proposed endovideosurgical methods of sanitation of the infection focus have a number of advantages over open ones--low traumatism, less number of postoperative infectious complications, less duration of the postoperative period.

[Errors in performing artificial ventilation of the lungs in the wounded and casualties]. / Oshibki pri provedenii iskusstvennoi ventiliatsii legkikh u ranenykh i postradavshikh.

Under investigation in the clinics of the Military-Medical Academy there was a group of the wounded and casualties whose lungs were artificially ventilated. The systemic hemodynamics, indices of gas exchange and the acid-base condition were controlled. The invasive and non-invasive methods were used. The most typical errors during performing lung ventilation were revealed and the causes of them were analyzed.

[The severe combined cerebro-cranial trauma. Pathobiochemical characterization]. / Tiazhelaia sochetannaia cherepno-mozgovaia travma. Patobiokhimicheskaia kharakteristika.

The indices of the endocrine system, systemic transport and consumption of oxygen, metabolism, hemostasis in the femoral artery, central and internal jugular veins were investigated in 144 patients with severe combined cerebro-cranial traumas (CCT) during the first 7 days after trauma. In 15 of them liquor was investigated. The results of the investigation have shown that in not severe CCT (FS-II: 0.50+/-0.25 scores) the ACTH level in blood was 1.9 times higher and cortisol 5.6 times higher than normal. In the cerebral tissue aerobic oxygenation of glucose prevailed (aerobic index: 90+/-2%): metabolic disorders were caused by extracranial injuries--the content of lactate, malon dialdehyde (MDA), middle molecular peptides (MCM238-302) was higher in the central vein than in the jugular vein. In patients with the superior truncal form of severe contusion of the brain (Field Surgery-II: 11.8+/-0.2 scores) in the cerebral tissue there was prevalence of anaerobic glycolysis (aerobic index: 60.1+/-3.5%), lactate oxygen index grew to 0.160+/-0.018. The inferior truncal form of brain contusion (FS-II: 18.8+/-0.2 scores) had sharply decreased both aerobic and anaerobic oxidation of glucose in the cerebral tissue. In cases of severe and extremely severe CCT there was a suppression of central regulatory mechanisms--in response to the trauma the elevation of the level of ACTH and cortisol in blood was insignificant. Thrombinemia and prevailing endotoxemia were noted in the jugular vein. Great concentrations of lactate, MDA, MCM were determined in the liquor. So, liquor sorption is thought to be expedient. Lower index of oxygenation (1.9+/-0.3), higher respiratory index (1.5+/-0.1) and alveolar dead space (37.7+/-7.2%) evidenced secondary injury of the lungs in cases of severe and extremely severe combined CCT.

[Restrictions on use of prolonged and long-term artificial ventilation of the lungs in the wounded and casualties]. / Ogranichenie pokazanii k prodlennoi i dlitel'noi iskusstvennoi ventiliatsii legkikh u ranennykh i postradavshikh.

On the basis of an analysis of results of treatment of two groups of the wounded and casualties the authors render concrete indications and contraindications for prolonged and long-lasting artificial ventilation of the lungs.

Main results and experience obtained on Mir space station and experiment program for Russian segment of ISS.

This article presents main scientific and practical results obtained in course of scientific and applied research and experiments on Mir space station. Based on Mir experience, processes of research program formation for the Russian Segment of the ISS are briefly described. The major trends of activities planned in the frames of these programs as well as preliminary results of increment research programs implementation in the ISS' first missions are also presented.