[Laparoscopic totally extraperitoneal repair of strangulated groin hernia]. / Laparoskopicheski assistirovannaya total'naya ekstraperitoneal'naya plastika (laparoscopic assistant total extraperitoneal plastic ­ latep) v lechenii ushchemlennykh gryzh pakhovoi oblasti.

OBJECTIVE: To study the possibility of totally extraperitoneal repair combined with diagnostic laparoscopy in the treatment of strangulated groin hernias (Laparoscopy-Assisted Totally Extraperitoneal Plasty, LATEP). MATERIAL AND METHODS: We analyzed the results of laparoscopic totally extraperitoneal hernia repair. The trocar placement technique was modified. There were 38 patients with strangulated groin hernia. The sample included 26 patients with strangulated inguinal hernia, 9 ones with strangulated femoral hernia and 3 patients with recurrent strangulated inguinal hernia. RESULTS: LATEP was attempted in 38 patients and successful in 37 (97.3%) cases. In 1 (2.6%) patient, correction of small bowel strangulation was failed and conversion to open surgery was required. In 29 patients (76.3%), correction of strangulation was performed after laparoscopy-assisted external manipulations and careful traction from abdominal cavity. In 8 (21%) cases, strangulation spontaneously regressed before laparoscopy. Laparoscopy confirmed viability of strangulated organs in 36 patients. One (2.6%) patient required bowel resection due to small intestine wall necrosis. Later, all patients underwent totally extraperitoneal repair. We were able to prevent the contact of hernia sac fluid with the implant in all cases. At the stage of preperitoneal repair, local damage to peritoneum occurred in 9 patients. Nevertheless, sealing was not required since hernia fluid was previously removed from abdominal cavity. There were no signs of implant infection and hernia recurrence within 6-14 months. CONCLUSION: Totally extraperitoneal repair combined with diagnostic laparoscopy is possible for strangulated groin hernias.

[Risk Factors for diarrhea associated with Clostridium difficile in patients at a clinical hospital].

AIM: to identify risk factors for Clostridium difficile infection in patients of a therapeutic clinic in a multidisciplinary hospital. MATERIALS AND METHODS: A retrospective analysis of 110 case histories of patients who were hospitalized in therapeutic departments in the Municipal Autonomous Institution "City Clinical Hospital No. 40" in Yekaterinburg (MAU City Clinical Hospital No. 40) in 2014-2015 was conducted, in which antibiotic therapy has developed diarrhea. According to the results of the study of coprofiltrate on Clostridium difficile (CD), patients were divided into 2 groups: 60 patients with a positive result and 50 patients with a negative result. RESULTS: The proportion of patients with CD infection in the structure of patients of the therapeutic profile of the MAU GKB No.40 for 2014-2015 amounted to 0.42%. Predictors of the risk of developing diarrhea associated with CD infection in patients are: age over 65 years (OS 4.33, 95% CI 1.15-16.20, p=0.028), Charlson comorbidity index more than 2 points (OS 3.05, 95% CI 1.29-7.23, p=0.016), the presence of anemia (OR 2.32, 95% CI 1.07-5.02, p=0.048), chronic dialysis in patients with chronic renal insufficiency (CRF) (OR 8.64, 95% CI 1.05-70.81, p=0.020), patients staying in hospital for more than 5 days (OR 3.50, 95% CI 1.57-7.75, p=0.003) and hospitalization of patients in the intensive care unit (ICU) lasting more than 1 day (OS 9.80, 95% CI 1.20-79.47, p=0.011), the use of proton pump inhibitors (PPIs) (OR 2.82, 95% CI 1.12-7.11, p=0.041), antibiotic therapy more than 10 days (OS 39.62, 95% CI 10.85-144.71, p.

[qSOFA score for prediction of outcome in surgical patients in intensive care units. Post hoc analysis of the Russian multi-center trial Rises]. / Ispol'zovanie shkaly qSOFA v prognoze iskhoda lecheniya u khirurgicheskikh patsientov v orit. Subpopulyatsionnyi analiz materialov issledovaniya RISES.

OBJECTIVE: To define the informative value of qSOFA score in the prediction of outcomes in surgical patients admitted to the Intensive Care Units. STUDY DESIGN: Post hoc analysis of multicenter prospective observational study RISES. The following patient information was analyzed: gender, age, diagnosis, presence of infection, SIRS criteria, qSOFA and SOFA scores, outcomes. RESULTS: The study included data of 331 patients with surgical diseases. Infection was not observed in 174 (52.6%) cases, 157 (47.4%) patients had infection. In the group of patients without infection, area under ROC-curve for SIRS criteria was 0.519 (95% CI 0.429-0.610) and similar to that qSOFA (p=0.535). Area under ROC-curve for SOFA scale was 0.619 (95% CI 0.511-0.726) and did not significantly differ from this value for QSOFA (p=0.241). In the group of surgical patients with infection, area under ROC-curve for SIRS was 0.490 (95% CI 0.419-0.561), that was significantly lower than area under ROC-curve for qSOFA (p=0.016). Area under ROC-curve for SOFA scale was 0.803 (95% CI 0.681-0.924), that significantly exceeded area under ROC-curve for qSOFA (p=0.017). CONCLUSION: qSOFA scale is important in surgical patients with infection admitted to ICUs. Increased qSOFA score is associated with augmentation of mortality rate. qSOFA scale significantly exceeds the SIRS criteria, but is inferior to the SOFA in the prognosis of mortality in these patients.

[Laparoscopic rendezvous surgery for cholecystocholedocholithiasis]. / Laparoéndoskopicheskie vmeshatel'stva pri kholetsistokholedokholitiaze (tekhnika Rendezvous).

OBJECTIVE: To present a modified technique of laparoscopic surgery (Rendezvous technique) for cholecystocholedocholithiasis. MATERIAL AND METHODS: There were 41 patients with cholecystocholedocholithiasis who underwent hybrid single-stage laparoscopic surgery (Rendezvous technique) as an alternative to conventional two-stage approach. RESULTS: Two (4.8%) patients had elevated serum amylase level without signs of pancreatitis in postoperative period. Other 2 patients required redo transpapillary intervention due to residual stones. Laparoscopic interventions were successful in 95.2% of cases.

[Epidemiology and risk factors of adverse outcome in nonvariceal upper gastrointestinal bleeding]. / Épidemiologiia i faktory riska neblagopriiatnogo iskhoda pri nevarikoznykh krovotecheniiakh iz verkhnikh otdelov zheludochno-kishechnogo trakta.

AIM: To identify risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding. MATERIAL AND METHODS: Epidemiological observational analytical longitudinal retrospective cohort study included 312 patients who were hospitalized in the Clinical Hospital #40 of Yekaterinburg in 2014-2016. The main inclusion criterion was nonvariceal upper gastrointestinal bleeding. RESULTS: In-hospital mortality was 31 (9.9%) of 312 patients. Multivariate analysis confirmed the following risk factors of mortality: severity of blood loss (OR 22.70, 95% CI 5.08-102.00); open surgery (OR 15.20, 95% CI 2.71-74.80); M. Charlson comorbidity index (OR 2.15, 95% CI 1.34-3.43); risk of recurrent bleeding according to T. Rockall scale (OR 1.76, 95% CI 1.18-2.64). CONCLUSION: Independent risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding are severe hemorrhagic shock, open surgery, high M. Charlson comorbidity index and risk of recurrent bleeding according to T. Rockall scale.

[SYSTEMIC INFLAMMATORY RESPONSE ON NOSOCOMIAL BACTEREMIA].

GOAL: study of special aspects in system inflammatory reaction caused by nosocomial bacteremia in dependence of the pathogen Gram-origin. The study included 85 patients with nosocomial bacteremia in ICU from 2010 till 2012. The main inclusion criteria was bacteria identification in blood, which was taken more than 48 hours from arrival to ICU within the appearance of system inflammatory response signs. Key options for clinical rating of system inflammatory response was dynamic of patients condition according APACHE II, SOFA, SAPS-III/PIRO, Pitt scales and its correlation with durations of mechanical ventilation, length of staying in ICU, total hospital period and outcome. RESULTS: Gram-negative microorganisms are definitely leading in the modern ethiological structure of nosocomial bacteremia in ICU patients (64,4%). The main origin of Gram(+) agents is central venous catheter infections. The main reason of Gram(-) infections is ventilation-associated pneumonia. Appearance or persistence of system inflammatory response is associated with the rise of scale indexes (SOFA and Pitt from 5 scores and higher and SAPS-PIRO higher than 18 scores) and high risk of possible bacteremia.

[Problems of inhalation gas mixture conditioning in high-frequency jet apparatuses for mechanical lung ventilation].

The problem of inhalation gas mixture conditioning, an important problem of technological implementation of high-frequency jet apparatuses for mechanical lung ventilation (MLV), is discussed. Methods of heating and humidification of inhaled gas mixture are considered along with conventional methods used in anesthetic MLV apparatuses.

[Ways of improvement of the accuracy of arterial pressure oscillometry].

The history of the auscultation method of arterial pressure (AP) measurement dates back to more than century ago. Nevertheless, the problem of the accuracy of measurement is still on the agenda. Standards of the accuracy of measurements and data processing are subjects of regular revision and update. The accuracy and reliability of AP monitoring in complex clinical cases are competitive advantages important for manufacturers of medical monitors. A new Triton ElectronicS module for AP measurements based on original technology and results of its testing are considered in this work. An original algorithm of the module operation provides an opportunity for more accurate and convenient monitoring, particularly in case of disordered hemodynamics.