2022 г. № 4 (10)

Experience in the treatment of gunshot wounds of extremities using modern methods

Davydov D.V., Kerimov A.A., Besedin V.D., Naida D.A., Ivanov G.G.

Abstract. Currently, despite the wide possibilities in the treatment of wounds, patients with gunshot wounds of the extremities present a complex surgical task.

The study included 60 patients with gunshot wounds of the extremities who underwent inpatient examination and treatment at the Center of Traumatology and Orthopedics of the Federal State Budgetary Institution «GVKG named after ak. N.N.Burdenko» of the Ministry of Defense of the Russian Federation. The patients were divided into groups. In group I, physical methods of treatment were used, such as vacuum therapy (35 people), of which 19 patients combined vacuum therapy with laser irradiation of the wound (group IA), 16 patients used vacuum therapy in combination with high-intensity pulsed optical irradiation (group IB). Group II included patients who used orthobiological techniques in the complex treatment of wounds (25 people), of which fibrin glue enriched with platelets in 13 patients (group IIA) and the implantable gel «Sphero®GEL» LONG in 12 patients (group IIB).

Results. When comparing the results of the treatment, a significant improvement in the reparative process was revealed according to the histological method in the IA group of patients, the maturation of mature granulation tissue was noted on day 9 after the application of local exposure methods. Patients in group IIA had a positive adhesive and wound healing effect. According to the «AnaliRan» program, a significant reduction in the time of wound healing was revealed.

During the study, all methods showed positive dynamics of wound healing, reduction of the inflammatory process.

Keywords: wound, laser, ultraviolet irradiation, fibrin glue enriched with platelets.

Organization of eye care in modern armed conflict: state and prospects

Kulikov A.N., Churashov S.V., Gaiduk K.Yu., Pavlov V.A., Sukhinin M.V., Kurnosov V.E.

Abstract. The main feature of modern armed conflicts is the use of new weapons and, as a result, changes in the nature and structure of eye injuries. This feature, on the one hand, as well as the rapid progress of medical science, on the other hand, require a quick response to a changing environment, using the resources of modern ophthalmology in order to provide care to the wounded and injured efficiently and rationally.

There are some contradictions in the approaches to providing pre-medical self-help and mutual assistance to the wounded with eye injuries directly on the battlefield in different schools of military medical training and tactical medicine. Some use a binocular bandage, others use a rigid eye shield.

The complexity and variety of damage to the eyes requires good practical skills and experience in order to qualitatively perform surgical treatment of perforated corneal and scleral wounds in open eye injury. This determines the need for high-quality training of specialists with the development of practical skills.

Of particular importance is the issue of medical supply of units providing specialized care at the stages of medical evacuation, which include a military ophthalmologist. Obviously, the problem of a reasonable and rational renewal of ophthalmic equipment at the stages of medical evacuation is ripe.

The issue of using effective means of eye protecting during combat operations remains relevant, which, without limiting visual functions, could prevent combat damage to the eyes, most often caused by small fragments and secondary injuring projectiles.

Keywords: combat eye injury, ophthalmic care, military ophthalmology, open globe injury.

Significance of microvascular reconstruction in treatment of gunshot wounds of the face

Tereshchuk S.V., Sukharev V.А., Vasil’yev E.А.


Keywords: Experience in the treatment of a blind combined shrapnel wound with damage to the liver, left lung, heart with thrombosis of the left ventricle and material embolism of the left common femoral artery

Fedorov A.J., Zamskiy K.S., Vinogradov D.L., Kranin D.L.

Abstract. The experience of staged treatment of a wounded man with a shrapnel wound of the abdominal and chest cavities is shown. Of interest are atypical thrombosis of the left ventricle and material embolism by a fragment of the left common femoral artery.

Keywords: cardiovascular surgery, thrombosis, foreign body, material embolism.

Abstract. Treatment of patients with gunshot bone and soft tissue defects of the extremities requires non-standard approaches and the participation of doctors of various specialties. Applying of additive and microsurgical technologies makes it possible to restore bone defects once and perform the functions of soft tissue formations.

Objective: To present the possibilities of modern reconstructive plastic surgery in combination with additive 3D technologies in the treatment of patients with severe gunshot wounds of the extremities.

Clinical case: a patient with a combined wound of the chest and upper limb with a primary defect of the humerus and radial nerve. Treatment was based on damage control surgery (DCS) and damage control orthopedic (DCO) tactics. X-ray, computed tomography, and angiography were used for diagnostics and preoperative planning. Based on the CT data, a 3D model of the autograft, resection templates, and a metal structure for osteosynthesis were made. After stabilization of the general condition of the wounded man and elimination of the risk of infectious complications, simultaneous replacement of the defect of the radial nerve at the level of the middle third of the shoulder with an autograft from the gastrocnemius nerve, replacement of the defect of the humerus in the upper and middle thirds with a free peroneal fibular autograft, osteosynthesis of a 3D individual plate with bacteriostatic spraying of hydroxyapatite in combination with zinc.

А positive anatomical and functional outcome was achieved in the treatment of a patient with a gunshot defect of the humerus and radial nerve.

An individual integrated approach in combination with innovative technologies allows achieving good anatomical and functional results in the treatment of patients with primary gunshot combined limb defects.

Keywords: gunshot wounds, bone defect, nerve defect, 3D technologies, defect replacement.

70 years of the neurosurgical clinic of the N.N. Burdenko Hospital. Experience in the treatment of gunshot wounds of the central and peripheral nervous systems

Gizatullin Sh.Kh., Isengaliev I.N., Ovchinnikova M.B.

Abstract. The article highlights the historical aspects of the origin of neurosurgery as a specialty within the walls of the Main Military Clinical Hospital named after Academician N.N. Burdenko. Based on the clinical experience of the neurosurgical center, the principles of diagnosis and surgical treatment of gunshot wounds of the central and peripheral nervous systems are described.

Keywords: neurosurgical care, gunshot wounds, academician N.N. Burdenko, the first neurosurgical department of the Soviet Army. 

Modern trends in intensive care of cranial gunshot wounds

Gizatullin Sh.Kh., Onnitsev I.Ye., Stets V.V., Kolobaeva E.G., Antokhov V.P.

Abstract. Taking into account the modern development of military field (может быть tactical) medicine, air medical evacuation, the levels of medical care are undergoing changes. As for the neurosurgical combat injury, the provision of medical care to this contingent requires greater specialization, closer to the front line and reduction of stages. The article summarizes the results of the experience of treating cranial gunshot wounds. The severity of the condition of those wounded in the skull and brain upon admission was assessed on the Injury Severity Score. In 67% of the admitted wounded, the condition was regarded as severe, the mortality rate was 0.8%, the duration of stay in the intensive care unit was 12 days. 33% of the wounded were in extremely serious condition, the mortality rate in this group was 2.2%, and the duration of stay in the ICU was 31 days. When assessing the level of consciousness at our stage on the Glasgow Coma Scale, most of the wounded had 6-8 points, which corresponds to a deep coma. Direct evacuation of the wounded to a specialized stage of care, computed tomography, the presence of a qualified neurosurgeon, the earliest possible performance of decompressive craniotomy are the components of success in the fight against intracranial hypertension, the development of subsequent neurological deficits, reduced mortality. Nutritional support and antibiotic therapy are important components of intensive care in neuro-intensive care.

Keywords: cranial gunshot wounds, air medicale evacuation, intensive care, intracranial hypertension, nutritional support, decompressive craniotomy, meningoencephalitis, antibiotic therapy (не уверена в антибиотикотерапии).

Surgical tactics in cases with large wounds of soft tissue of limbs and pelvis

Badalov V.I., Samokhvalov I.M., Koskin V.S., Petrov A.N., Rud’ A.A., Borisov M.B.

Abstract. In modern war conflicts, the frequency of occurrence of multiple and combined injuries of the limbs with extensive wound defects is increasing.

This pathology is accompanied by long periods of treatment, a high incidence of wound infection (up to 35–80%), the impossibility of early internal osteosynthesis and early rehabilitation, and a fairly high incidence of disability. The closure of large defects in combination with the algorithm for managing the wound process in the early post-traumatic period reduces blood and plasma loss, the development of endotoxicosis and wound infection and significantly improves the results of treatment, both increasing the effectiveness of wound healing and reducing the duration of patient treatment.

Keywords: war surgery, trauma surgery, large wounds, wound infection, damage control

2022 г. № 3 (9)

Features of clinical manifestations of coronary heart disease in patients with amiodarone-associated hypothyroidism

Chernavsky S.V., Dorokhina A.V., Artyushkevich O.V., Stremoukhov A.A., Kudentsova L.A.

Abstract. Coronary heart disease (CHD) is one of the urgent problems of modern medicine. First of all, this is due to the high prevalence of the disease among the able-bodied population, as well as significant mortality and disability of patients. Amiodarone (Am) is the drug of choice in the treatment of cardiac arrhythmias (NSD) ― one of the most frequent and formidable manifestations of coronary heart disease. Prolonged use of the drug can lead to the development of primary hypothyroidism, which significantly aggravates the course of cardiovascular diseases.

Objective. Assessment of the state of the cardiovascular system of patients with coronary heart disease with the development of amiodarone-associated hypothyroidism (AmGT).

Material and methods of research. The analysis of the case histories of 810 patients with coronary heart disease and various NSD who took Am to control sinus rhythm was carried out. The case histories were studied and a retrospective analysis of the clinical course of coronary heart disease was carried out in 28 AmGT patients before and after the development of thyroopathy. To assess the state of the cardiovascular system in patients were evaluated, objective examination data, ECG and echocardiography (Echo-KG) were performed.

Results. With prolonged use of Am by patients with coronary heart disease, primary hypothyroidism develops in 3.4% of cases. The formation of thyroopathy significantly affects the course of the disease. Patients have an increase of 19.6% in the volume parameters of the myocardium and a decrease in its contractility by 22.7%. At the same time, there is an increase in the mass of the myocardium of the left ventricle by 30.2%.

Conclusion. Amiodarone-associated hypothyroidism is one of the important complications that develops in patients with prolonged use of the drug. The formation of thyroopathy in patients with coronary heart disease significantly aggravates the course of the underlying disease, which must be taken into account when prescribing treatment and dynamic monitoring.

Keywords: amiodarone, coronary heart disease, hypothyroidism.

Surgical mini-Scarf osteotomy in hallux valgus with biodegradable headless screws fixation

Davydov D.V., Kerimov A.A., Khominets I.V., Grechukhin D.A.

Abstract. The use of biodegradable implants is becoming increasingly popular, especially in operations on small bones of the skeleton, including operations on the anterior part of the foot. 23 surgical interventions were performed to correct the first metatarsal using the mini-Scarf technique and fixation of fragments with a biodegradable implant. All the operated patients did not have a severe radiological stage of osteoarthritis of the first metatarsophalangeal joint and stiffness. The results of treatment were evaluated using AOFAS and Groulier questionnaires. According to the questionnaires, it was possible to track and obtain data from 23 patients in 18 (78.3%) cases (16 had grade III deformity (88.9%)). 6 months after surgical treatment 77.8% (14) patients according to the AOFAS questionnaire and 83.3% (15) patients according to the Groulier questionnaire had good and exellent results. The achieved results allow us to make a favorable prognosis for the widespread use of magnesium oxide implants. However, further studies and comparison of the results of treatment of patients with hallux valgus who were operated using titanium standard screws are needed.

Keywords: Hallux valgus, Magnesium, Biodegradable implant, Bioabsorbable implant, mini-Scarf osteotomy.

Аpplication of regression analysis for differential diagnosis of essential arterial hypertension and neurocirculatory asthenia by hypertensive type

Datsko A.V., Orlov F.A., Petrova O.N., Dorokhin S.I.

Abstract. In the practice of a military doctor, it is often necessary to make a differential diagnosis between neurocirculatory asthenia (NCA) of the hypertensive type and hypertension of the first stage among young and middle-aged military personnel. The studied patients with both NCA of the hypertensive type and hypertension of the first stage had various degrees of severity of vegetative disorders. In patients with NCA of the hypertensive type, the frequency and severity of the latter was higher. It is often not possible to make an accurate differential diagnosis of two diseases based on data from a standard clinical examination and basic laboratory and instrumental research methods. When constructing prediction equations for a specific patient with a probability of more than 96.1%, it is possible to calculate the admissibility of attributing it to a particular diagnosis.

Keywords: arterial hypertension, neurocirculatory asthenia, autonomic nervous system, prognosis of diagnosis.

Nomogram M validity assessment for predicting multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass

Berikashvili L.B., Smirnova A.V., Laricheva E.A., Gracheva N.D., Kadantseva K.K., Yadgarov M.Y.

Abstract. To evaluate the predictive value of nomogram M for multiple organ failure (MOF) and acute kidney injury (AKI) after elective cardiac surgery with cardiopulmonary bypass.

Materials and methods. This was a retrospective cohort study. The predictive value of nomogram M for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass was evaluated using ROC-analysis.

Results. The sample size was 158 patients. The incidence of AKI was 5.7% (9 of 158 patients). The incidence of MOF was 3.8% (6 of 158 patients). AUC nomogram M for AKI was 0.714 [95% CI: 0.555–0.874] (p = 0.031); the cut-off value was 12,5 points; the sensitivity was 66.67% and specificity was 82.55%; the odds ratio was 9.46 (95% CI: 2.22–40.30) (p < 0.001). AUC nomogram M for MOF was 0.770 [95% CI: 0.594–0.946] (p = 0.025); the cut-off value was 12,5 points; the sensitivity was 83.33% and specificity was 82.24%; the odds ratio was 23.15 (95% CI: 2.60–206.20) (p < 0.001).

Conclusion. Nomogram M has an acceptable predictive value for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass based on the results of the ROC-analysis.

Keywords: cardiac surgery, cardiopulmonary bypass, acute kidney injury, multiple organ failure, postoperative complications, prognostic scale.

Correlations of CT signs of COVID-19 viral pneumonia with phases of diffuse alveolar damage

Parshin V.V., Lezhnev D.A., Berezhnaya E.E., Mishina A.V.

Abstract. A computed tomography (CT) is the leading diagnostic technique in identifying detailed and specific signs of viral infection. The objective of the work is to correlate between the typical set of signs that occur during viral infection and the phases of diffuse alveolar damage (DAD). The volume of lung damage in 78 patients was retrospectively estimated. All the patients had lung CT from 1 to 3 day before death. 14 patients had a targeted comparison of 3 signs ― «ground-glass, crazy paving pattern and consolidates» with the phases of DAD. It was found that the «ground glass» feature is most characterized by the exudative phase (lasting up to 8 days), the «crazy paving pattern» ― by the exudative-proliferative phase (up to 10 days), the consolidation ― by the proliferative phase (lasting from 8 to 20 days). According to these scientific data, CT-lung can be a prognostic factor of histological phases of DAD and their duration, which in turn may be one of the predictors of a negative prognosis and the onset of death in pneumonia caused by SARS-CoV-2 (COVID-19).

Keywords: COVID-19, computed tomography of the lungs, prognostic factor, diffuse alveolar damage, histological phases.

Visualization and analysis of cells with automatic counting in real time using a high-tech microscope

Bagrov V.V., Dikov A.V., Krylov V.I.

Abstract. An overview of the monitoring system is given, which provides fast high–quality visualization with minimal preparation, allowing real–time monitoring of the state of molecular–cellular and genetic diagnostics.

Keywords: microscope, cells, seeding, video monitoring, fluorescence, ultraviolet radiation.

Biocompatible calcium-phosphate-collagen composite

Budoragin E.S., Gorshenev V.N., Petcherskaya M.S., Bambura M.V.,

Dragun M.A., Akopyan V.B.

Abstract. Biocompatible calcium-phosphate-collagen porous composite material useful for creation bone implants production was accelerated synthesized in the field of the hydroacoustic irradiator. Received substance separated and conditioned in an ultrasonic self-cleaning filter, was homogenized, the body with the specified dimensions and shapes was formed from the resulting homogenate and subjected to fries-drying to form the implants. Samples of received implants were sewed under the skin of white mice and were not stimulate appearance of negative effects in nearest around tissues.

Keywords: biocomposite, biocompatibility, synthesis, ultrasound.

Modern principles of endoscopic transnasal reconstruction of skull base defects. Literature review

Chernov I.V., Chernov V.E.

Abstract. CSF leak is an urgent problem of modern neurosurgery. In elective surgery, this condition is most often found when removing skull base. The reconstruction stage is the final stage in the course of such operations and directly affects the postoperative period of the patient. Thanks to the development of technologies, a number of techniques have now been developed that allow hermetically closing the intracranial space. The most significant was the introduction of vascularized flaps, which reduced the frequency of liquorrhea at times. This paper presents the current trends in this section of neurosurgery.

Keywords: CSF leak, skull base reconstruction.

2022 г. № 2 (8)

Fibromuscular dysplasia: a review of the literature and case report

Fursov A.N., Potekhin N.P., Lyapkova N.B., Gorodnichev K.Y.

Аbstract. The data on the prevalence of fibromuscular dysplasia, its role in the development of arterial hypertension are presented, their classification is given, approaches to diagnosis and treatment are summarized. Cases of different localization of fibromuscular dysplasias and individual (personified) management tactics in this category of patients are described.

Keywords: fibromuscular dysplasia, arterial hypertension, vasorenal hypertension, treatment of fibromuscular dysplasia.

Сomparison of efficiency of methylene blue preparations for visualization of lymph drainage pathways ways in the experiment

Kovalenko V.V., Barinov O.V., Fufaev E.E., Dmitrochenko I.V., Kurakevich I.V.

Abstract. Objective ― compare and evaluate the effectiveness of using methylene blue solutions to visualize lymphatic outflow pathways in laboratory animals (outbred rat).

Materials and methods. In the experiment were used 16 female outbred rats aged about 40 days with an initial body weight of 180–220 g contained in standard vivarium conditions. For anesthesia was used «Zolazepam» (Zoletil®100). Animals were randomized into 2 groups ― 8 in each. The first group was injected subcutaneously in the left thigh with a 1% aqueous solution of methylene blue, the second group ― solution of methylene blue with human serum albumin. Depending on the time of exposure, animals were divided randomly into 4 subgroups ― 15, 30, 45 and 60 minutes. There was evaluated the effectiveness of marking the pathways of lymph outflow from the injection site.

Results. As a result of the study, it was demonstrated that the use of a 1% methylene blue solution allows visualizing of the lymphatic outflow paths during drug exposure for 30 minutes. Staining of the lymph nodes of the next order occurs with an increase in exposure time. A solution of methylene blue in combination with human serum albumin stains the first node in the lymph drainage path 30 minutes after administration. The drug is characterized by slow migration from the first order lymph nodes (>60 minutes).

Conclusion. The use of methylene blue solution in combination with serum albumin characterized by slow migration from the first order lymph nodes, which makes its use preferable in surgical interventions.

Keywords: signal lymph node, non-small cell lung cancer, micrometastasis, N-staging, sentinel lymph node, methylene blue, human serum albumin.

Treatment of non-small cell lung cancer using radiation therapy

Gevorkian A.R., Smolin A.V.

Abstract. The article is devoted to the use of a combination of systemic and radiation therapy in patients with locally advanced NSCLC. The high risk of latent metastasis in this category of patients creates the prerequisites for active study in the world literature of the combination of radiation therapy and systemic treatment.

The article presents the results of clinical studies aimed at finding the most optimal ratio of efficacy and safety of the chemotherapeutic component of CRT. According to the results of the study, the authors prefer the use of schemes based on platinum doublets.

The article discusses the evaluation of the effectiveness of chemoradiotherapy with escalation of the radiation dose to the tumor within the framework of the concept of a personalized approach to the treatment of patients with NSCLC.

The article also pays attention to the description of new opportunities for RT intensification and the introduction of new RT methods, the use of which became possible with the advent of innovative linear accelerators. The results of comparing the effectiveness of combined chemoradiotherapy with immunotherapy and chemoradiotherapy alone in patients with lung NSCLC are presented.

Keywords: lung cancer, radiation therapy, chemoradiotherapy, chemotherapy, immunotherapy.

Application of activated conditioned plasma in patients with macular rupture

Pavlov V.A., Kurnosov V.E., Zinovyev S.A., Kapatsina A.A., Utkina E.E.

Abstract. Objective. To evaluate and systematize the results, as well as to conduct a comparative analysis of the treatment of patients with macular rupture using autoplasm, using a Rotofix 32A Centrifuge and Arthrex ACP systems to obtain autologous conditioned plasma (АСР) with previously used methods.

Material and methods. The study conducted a comparative analysis of the data of patients with macular rupture, with a corrected visual acuity of more than 0.08 (according to the Golovin–Sivtsev table). Group 1 (prospective analysis) included the results of treatment using peeling of the inner boundary membrane with a gas-air tamponade in combination with the application of AСР (4 eyes, 4 patients). In the 2nd group (retrospective analysis of the medical history), surgical treatment was limited to peeling the inner boundary membrane with a gas-air tamponade (8 eyes, 8 patients). The parameters were analyzed after 3.0±0.5 and 6.0±0.5 months with an assessment of the maximum corrected visual acuity (MCI), OCT, and color photography. The closure of the macular rupture when comparing the groups was evaluated during 6 months of follow-up.

Results. During the observed period in both groups, no complications were detected in any case. According to visometry and OCT, the best functional results were obtained in group 1. The average visual acuity after 6 months was 0.4±0.1.

Conclusion. According to the results of the study, it was found that the use of techniques using the technique of preserving the internal boundary membrane in the papillomacular bundle area and the use of platelet mass increase the likelihood of closing the gap.

Keywords: autologous plasma, macular rupture, platelets, cystic retinal edema, surgical treatment.

Hemodynamic monitoring in liver transplantation

Zhuravel S.V., Kuznetsova N.K., Statsura V.E., Gavrilov P.V., Goncharova I.I.

Abstract. Hemodynamic monitoring is an important part of the anesthetic management in liver transplantation. There is no single algorithm protocol for studying the parameters of the cardiovascular system. The article describes the criteria for the presence or absence of the need to use methods of routine or additional invasive monitoring.

Keywords: hemodynamic monitoring, liver transplantation, invasive monitoring.

Extracorporeal detoxification in intensive care of metabolic acidosis in cancer patients

Gromova E.G.

Abstract. Metabolic acidosis is a companion and consequence of a number of damaging factors, belongs to the category of critical pathological conditions, is associated with high mortality and requires competent intensive therapy. In cancer patients, the risk of decompensated homeostasis disorders is significantly higher compared to the general population of patients, which reduces the possibility of antitumor treatment and worsens the prognosis. Timely application of extracorporeal detoxification allows avoiding fatal complications and continuing the antitumor treatment.

Keywords: metabolic acidosis, extracorporeal detoxification, cancer.

Non transfusion dependent thalassaemia: conventional and novel therapy

Asadov Ch.D.

Abstract. This literature review attempts to describe modern approaches to the diagnosis and therapy of non transfusion dependent thalassaemia (NTDT). NTDT has a wide clinical spectrum. Clinical polymorphism of the disease is due to genetic heterogeneity. Three major factors are responsible for the clinical manifestations of NTDT: ineffective erythropoiesis, chronic anemia, and iron overload.

Untreated NTDT is the cause of various complications: splenomegaly, gallstones, extramedullary erythropoiesis, kidney stones, leg ulcers, thrombophilia, pulmonary hypertension, endocrine complications, iron overload, bone abnormalities, osteoporosis.

Traditional therapy for NTDT include splenectomy, transfusion therapy, modulation of fetal hemoglobin (HbF), synthesis, and bone marrow transplantation.

However, due to the limitations and challenges associated with available conventional therapies, novel therapy for this disease are currently being developed. These include: JAK2 inhibition, hepcidin modulation, TMPRSS6 inhibition, apo-transferrin, HIF2α inhibition, Activin receptor-II trap ligands, ferroportin inhibitors.

Keywords: non transfusion dependent thalassaemia, genetic heterogeneity, clinical polymorphism, transfusion therapy, chelating therapy, modulation of fetal hemoglobin, bone marrow transplantation, gene therapy, novel therapy.

Differential diagnosis of essential arterial hypertension and neurocirculatory asthenia of the hypertensive type

Datsko A.V., Orlov F.A., Petrova O.N., Emanova I.A.

Abstract. Neurocirculatory asthenia (NCA) by hypertensive type (synonyms: vegetative-vascular dystonia by hypertensive type, neurocirculatory dystonia (NCD) or hypertensive type of vegetative-vascular dysfunction) is one of the three main forms of NCA. This type includes vegetative-vascular disorders of the sympathetic part of the autonomic nervous system (ANS). First of all, it is characterized by an increase in systolic blood pressure (BP). NCA is characterized by a syndrome of vegetative-vascular disorders with an inadequate response of blood pressure to any stimuli.

Hypertension is a chronic disease, the main manifestation of which is the syndrome of high blood pressure, which is not associated with the presence of pathological processes in which the increase in blood pressure is due to known causes (symptomatic arterial hypertension.

When making an expert decision, it is necessary to use methods of non-invasive assessment of the state of the ANS: the Kerdo index, the cold test, the ocular reflex (Dagnini–Aschner), the solar reflex (Toma–Ru), and the Vane–Solovyova tables.

Keywords: arterial hypertension, neurocirculatory asthenia, autonomic nervous system.

2022 г. № 1 (7)

Integration of virtual reality into the program of non-drug treatment of pain and early rehabilitation

Veremeenko N.A., Saukina A.V., Perepelitsa S.A.

Abstract. The article deals with the issues of non-drug treatment of pain from the standpoint of a biopsychosocial approach using virtual reality (VR), as well as the possibility of integrating this method into an early rehabilitation program for neurological patients. The historical aspects of the discovery of the integration of VR into medicine and the results of using the method to reduce the intensity of pain in patients with burn disease, the possibility of using VR technology in anesthesiology and resuscitation as an alternative to narcotic analgesics for certain types of intervention are presented. The use of VR is promising in the motor and cognitive rehabilitation of patients with various pathologies of the central nervous system and can be used at any stage of rehabilitation, at low financial costs, with minimal involvement of medical personnel in the hospital and outpatient settings.

Keywords: virtual reality, pain, theories of pain, biopsychosocial approach, stroke, rehabilitation.

Polymer biodegradable fixators in treatment of near- and intra-articular fractures

Fajn A.M., Vaza A.Yu., Mamatov E.A., Zhirkova E.A., Gnetetskiy S.F., Titov R.S., Skuratovskaya K.I.

Abstract. The number of victims with intra-articular fractures, as well as the severity of such fractures, has recently increased. Traditionally, for osteosynthesis of intra-articular fractures with small bone and cartilage fragments, metal implants are used, such as wires, capless screws, Herbert screws. But the metal implants used have their drawbacks. An alternative to metal implants can be biodegradable fixatives (BDF) made from a copolymer of polylactic and polyglycolic acids (PLGA).

Two groups of 132 people with intra-articular fractures of different localization were formed, biodegradable implants were used in the main group, metal implants were used in the comparative group. The groups were correlated by sex, age and nature of fractures. We compared the time spent in the operating room for similar operations, the number of operations to remove the fixators in both groups, and the number of complications. Compared functional outcomes. We assessed the possibility of interpreting MSCT and MRI data in the isolated use of BDF.

In the group with the use of biodegradable implants, fewer removal operations were required (44%) than in the group without the use of biodegradable implants (58%), which is statistically significant. Complications developed in the main group amounted to 3% (4 cases), than in the group with metal implants — 10% (13 cases).

We have found that the use of biodegradable implants has satisfactory clinical results, a low percentage of implant removal operations, and a low complication rate.

Keywords: biodegradable implants, intraarticular fractures, surgical treatment, polylactic acid, polyglycolic acid.

Results of autologous peripheral hematopoietic stem cell transplantation in multiple myeloma in Kyrgyzstan

Raimzhanov А.R., Аtabayev B.S., Zhusupova Sh.K.

Abstract. The article is devoted to performing a series of autologous transplantation of peripheral hematopoietic stem cells in multiple myeloma (MM). For the first time in Central Asia, in particular, in the Kyrgyz Scientific Center of Hematology of the Ministry of Health of the Kyrgyz Republic, autologous hematopoietic stem cells were used in the treatment of 26 patients with MM. Comprehensive laboratory and functional research methods were carried out to diagnose MM, autologous stem cells were collected at the «Com Tek» blood cell separator (Fresenius). Conditioning mode, algorithm of therapeutic approaches of patients before autotransplantation and post-transplantation monitoring are used.

Keywords: autologous transplantation of hematopoietic stem cells, multiple myeloma, melphalan-autologous, blood cell separator «Com-Tek», conditioning, monitoring.

Endoscopic treatment of degenerative spinal canal stenosis

Abukov D.N., Cherebillo V.Yu., Dulaev A.K., Goranchuk D.V., Alikov Z.Yu., Aslanov R.A.

Abstract. Microsurgical decompression technique has been regarded as the standard surgical method up to date in degenerative spinal diseases. The conventional method may lead to instability and provoke chronic lower back pain by injuring facet joints, posterior ligamentous complex as well as paraspinal muscles. In order to avoid these complications, the new biportal endoscopic technique has been introduced in our clinical practice. Since 2019, we have been widely using this technique and for the first time in Russia we have accumulated unique experience that allowed us to complete this article.

The aim of this study is to demonstrate a new biportal endoscopic spinal surgical technique’s possibility in treatment of degenerative lumbar spine diseases and to report the results of using this technique in our clinic.

Study design: retrospective study.

One hundred two patients who were suffering from neurologic symptoms by degenerative lumbar spine diseases were included in study. All patients divided into 3 groups according to the clinical situation: 1group ― patients with degenerative central spinal stenosis who underwent biportal endoscopic bilateral decompression using a unilateral approach, 2 group ― patients with foraminal spinal stenosis who underwent biportal endoscopic foraminotomy using a extraforaminal approach, 3 group-patients with degenerative monosegmental instability, degenerative or isthmic spondylolisthesis who underwent biportal endoscopic lumbar interbody fusion. Clinical outcomes were analyzed in view of modified-Macnab criteria, Oswestry Disability Index (ODI), Numeral rating scale (NRS), and postoperative complications were analyzed.

There was a significant improvement in the dynamics of pain syndrome, ODI scale in all 3 groups. According to the McNab scale, no unsatisfactory results were observed in any group. There were 4 cases of durotomy. In all cases, the durotomy did not exceed 3 mm. and did not require further treatment. No cases of infectious complications were identified.

Biportal endoscopic surgery can be considered as an alternative to the traditional microsurgical technique of spinal decompression and spinal fusion in the lumbar spine. The use of this technology can significantly reduce muscle trauma, achieve sufficient decompression, and reduce the frequency of infectious complications.

Keywords: biportal, endoscopic, stenosis, lumbar.

Application of cellular technologies in the treatment of chronic pain of the lumbar spine

Kudryakov S.A., Naida D.A., Kozlov G.N.

Abstract. The paper presents the results of clinical testing of autologous cells of the stromal vascular fraction (SVF) mesenchymal stromal cells in patients with deforming spondyloarthrosis of the lumbar spine. The study selected 20 patients aged 45 to 85 years with symptoms of degenerative spondyloarthrosis of the lumbar spine confirmed by radiological methods (CT, MRI, X-ray), 5 men, 15 women, average age 64.7 years with a disease duration of 5 years. Autologous SVF cells were injected into the affected facet joints under the control of an electron optical converter. The introduction of SVF cells did not cause the development of inflammatory allergic and toxic reactions. Patient survey conducted 1 month after the introduction of SVF cells revealed a decrease in the severity of pain syndrome, assessed on a visual analog scale (VAS) and a specialized SF-36 scale (p<0.05 on both scales). Patients noted an improvement in functional activity and quality of life associated with the affected facet joints. Positive clinical dynamic was maintained during follow-up up to 6 months. The control magnetic resonance imaging after 6 months revealed no significant differences from the initial examination. Our study showed the safety and good tolerability of the introduction of autologous SVF cells into the area the zygapophysial (facet) of facet joints. Our study showed the safety and good tolerability of the introduction of autologous SVF cells into the area of the Lumbar Facet Joint Injections in patients with severe manifestations of deforming spondyloarthrosis. The obtained results also indicate a significant anti-inflammatory effect of autologous SVF cells of adipose tissue at the early stages of cell therapy.

Keywords: chronic low back pain, regenerative therapy, medicinal signaling or mesenchymal stem cells, platelet-rich plasma, disc injection, lumbar facet joint injections.

Selection criteria for patients with hepatocellular carcinoma for liver transplantation

Pitkevich M.Yu., Breder V.V., Kosirev V.Yu., Dzhanyan I.A.

Abstract. The article is devoted to the selection criteria for liver transplantation for patients with hepatocellular carcinoma. Liver resection is an effective method of radical treatment of the early stages HCC. However, severe liver cirrhosis makes this method of therapy impossible. For these patients, liver transplantation is a good alternative. The article discusses the problem of correct selection of patients for liver transplantation. The world experience in assessing various criteria for liver transplantation described. Statistical data are provided. There are also examples of science works that analyze additional factors used as extended criteria for liver transplantation: AFP, PIVKA, the effectiveness of locoregional therapy. The article focuses on neoadjuvant therapy, presents the results of world research on neoadjuvant therapy, emphasizes their importance.

Keywords: liver transplantation, neoadjuvant therapy, inclusion criteria, hepatocellular carcinoma, TACE, systemic therapy.

Effectiveness of endoscopic operations in modern vertebrology. Literature review

Kolesov S.V., Gorbatyuk D.S., Kazmin A.I., Morozova N.S., Bagirov S.B.

Abstract. In this literature review, an attempt to describe the main possibilities and limitations of arthroscopic spine surgery. The description is made according to topographic principle, for each re gion of the spine (cervical, thoracic, lumbar).

Arthroscopic interventions in vertebrology is a group of methods that are promising and gaining popularity. At present, their main scope of their application (and indication for treatment as well) is degenerative diseases of the spine that are associated with nerve structures’ compression. Arthroscopic methods allow, according to present data, to achieve better functional results than conventional ‘open’ surgical methods, including lower pain level at the postoperative  period.

The main issues for development of the methods are as follows: minimizing the working parts of the endoscope to be used for interventions at the cervical spine; avoidance of anatomic restrictions for operations on the thoracic spine; expanding the possibilities and indications for the method.

Keywords: spine surgery, endoscopy, mini-invasive surgery, literature review.

Biportal endoscopic surgery for degenerative disease of the lumbar spine

Pereverzev V.S., Shvets V.V., Chernova N.A.

Abstract. Biportal endoscopic spine surgery is a minimally invasive innovative method of treatment, where two ports are used, one for visualization, the other for surgical instruments. In this article we describe the biportal endoscopic technique for laminectomy and discectomy, as well as discuss the features of these interventions in degenerative diseases of the spine.

Keywords: endoscopy, fusion,; lumbar degenerative disease, minimally invasive surgery.

 2021 г. № 4(6)

A variant of anesthesia for total arthroplasty of the lower extremity joint

Ermokhina L.V., Ermokhina N.V., Zavarzin A.Yu., Stets V.V.

Abstract. Optimizing analgesia in total joint arthroplasty of the lower extremities and reducing the risk of arterial hypotension in patients with various degrees of obesity contributed to the development of a new technique of spinal anesthesia with the epidural volume extension provides the possibility of using small doses of local anesthetic for administration into the subarachnoid space and saving the level of sensory block. The aim of our study was to study the effect of the technique of spinal anesthesia with the epidural volume extension on the level of the sensory block and hemodynamics in patients with various degrees of obesity during operations of total arthroplasty of the joints of the lower extremitiesfor osteoarthritis 3 stage. A prospective single-center study included 103 patients (79 men (76.7%), mean age 59±11 years, range from 33 to 74 years) who were treated in the Department of Traumatology and Orthopedics from September 2019 to May 2020. We analyzed anthropometric parameters, levels of sensory and motor blocks, level of pain syndrome, sympathetic block, duration of surgery and anesthesia. To assess the impact of all factors on the outcome, methods of one-dimensional analysis with the calculation of relative risk (RR) were used. The average upper level of the sensor block (Th-segment) at 15 minutes afterspinal anesthesia did not significantly differ in the groups (p=0.95). Differences in the frequency of hypotension in the groups were not statistically significant (p˃0.05). RR: 1.17 [95% CI: 0.794; 1.726].

Reducing the dose of a local anesthetic by 25% to provide adequate spinal anesthesia with the epidural volume extension in patients with a high body mass index achieves the same result when assessing sensory, motor and sympathetic blockages when compared with the traditional method of anesthesia.

Keywords: spinal anesthesia with the epidural volume extension, hypotension.

Trigger electromyography in endoscopic transnasal surgery of the skull base tumors

Shkarubo A.N., Chernov I.V., Ogurtsova A.A., Chernov V.E.

Abstract. Introduction. Preservation of anatomical integrity and functions of cranial nerves when removing tumors of the base of the skull is one of the significant problems of endoscopic endonazal surgery. For this purpose, it is possible to use intraoperative mapping and identification of cranial nerves.

The purpose of the study. Evaluation of the effectiveness of T-EMG used to prevent intraoperatively non-heroic damage to the cranial nerves.

Material and methods. Twenty-one patients with different tumors of the skull base, mapping and identification of cranial nerves were made during tumor removal, using endoscopic endonazal access. Operations were carried out over the large chord of the base of the skull (11), the neuro of the trigeminal nerve (5) of the region of the cavernous sine, the pituitary aden (2), the mening of the skate area (2) and the cholesterol choleateatoms (1). During the operations carried out, mapping and identification of cranial nerves were carried out using electromyography in trigger mode using bipolar and monopolar electrodes. Evaluation of the functional activity of cranial nerves was carried out both before and after the operation. A comparison of the effectiveness of the technique with the control group (41 patients) was carried out.

Results. In the course of operational interventions using trigger electromyography in the main group of patients, 40 nerves were investigated. In the course of the study, III, V, VI, VII, XII cranial nerves were identified intraoperatively. In 4 patients in the main group and in 13 patients in the control group, a postoperative deficit of cranial nerves was observed. We did not receive statistically reliable data that the intraoperative identification of cranial nerves using T-EMG reduces the frequency of postoperative complications in the form of a deficiency of cranial nerves (p = 0.11), but the ratio of chances (0.26) testifies in favor of rarely occurring complications in Main group.

Conclusion. Trigger Electromigraphy allows us to estimate the functional state of the cranial nerves during endoscopic endonazal operations. The method of using T-EMG is promising and require further research.

Keywords: electromyography, intraoperative identification of cranial brain nerves, endoscopic endonazal access, surgery of base skull tumors.

Characteristics of medical implants 3D-printing

Budoragin E.S., Gorshenev V.N., Akopyan V.B., Bambura M.V., Budoragin I.E.

Abstract. Development of new materials for 3D-printing, suitable for formation of replacing and stimulating the regeneration implants of biological tissues, is an urgent problem in traumatology, neurosurgery, andrology and urology. The article proposes ways to increase the quality of 3D-printed implants by using pasty thermoplastic compositions, as well is shown the possibility of using ultrasound and a rotating magnetic field to prevent changes in viscosity in extruders for 3D-printers.

Key words: 3D-printing, implants, extruder, viscosity, thixotropy.

Tendon-muscle transposition in severe irreversible damage to the radial nerve: surgical technique and clinical practice

Isengaliev I.N., Besedin V.D., Khrapov Yu.V.

Abstract. The assessment of early results of tendon-muscle transfer in severe irreversible damage of the radial nerve was carried out. The study included 11 patients with paralysis of the extensors of the hand and fingers due to various injuries of the radial. Treatment results were assessed after 6–12 months using the classification of Moussavi А.А. et al. taking into account the range of motion of extension of the hand, fingers, abduction and extension of the thumb. The following data were obtained: excellent results were in 4 patients, good in 7 patients. There were no satisfactory or bad results. Tendon-muscular transposition in the absence of clinical and electrophysiological recovery of radial nerve is a highly effective method of orthopedic correction that helps restore hand function and return to patients’ working activity.

Keywords: radial nerve palsy, tendon-muscle transposition.

Аnalysis of the duration and intensity of the humoral immune response in medical workers after COVID-19

Kazakov S.P., Davydova N.V., Putkov S.B., Reshetnyak D.V., Aristarchova I.V.

Abstract. The article presents data on the duration and intensity of the humoral immune response in medical workers who had COVID-19 in the first wave of the pandemic, according to the production of antibodies of the immunoglobulin M and G class to SARS-CoV-2 in the blood. Using ELISA immunoassay systems manufactured by «Vector-Best» (Novosibirsk, RF) and foreign test systems based on immunofluorescence analysis by Abbott (USA), a comparative characteristic of the production of antibodies in medical workers to SARS-CoV-2 was carried out. The presented semi-quantitative and quantitative data of Ig M and Ig G class immunoglobulin antibodies to SARS-CoV-2 in dynamics for the period from May 2020 to May 2021 from medical workers who had COVID-19 to full-sized trimerized proteins of the S- and receptor-binding domain of the S-protein. The difference in the determination of these antibodies and the dynamics of their decrease depending on the type of antibodies detected are shown. Data on the frequency of occurrence of Ig M class antibodies to SARS-CoV-2 in medical workers who have been ill with COVID-19 during the observed period are presented, with the assumption of reinfection or persistence of the virus in the body of ill medical workers. Data are presented on the number of Ig G class antibodies expressed in international units (BAU/ml) and the relative number of medical workers who manage to maintain different (150/300/590 BAU/ml) protective levels of antibodies to SARS-CoV-2 over the observed period, including those with a minimum level of protection by the minimum titer of neutralizing antibodies.

Keywords: COVID-19, medical workers, immune response, humoral response, immunochemical methods, IgG, IgM, SARS-CoV-2.

Aspects of stem cell autotransplantation treatment in patients with multiple myeloma

Kostroma I.I., Sidorova Zh.Yu., Semenova N.Yu., Stepchenkova E.I., Gritsaev S.V.

Abstract. The effectiveness of multiple myeloma (MM) patients’ treatment is dependent in particular on the depth of response after autologous stem cell transplantation (AutoSCT). The importance of predictors associated with the quality of response after AutoSCT is due to the possibility to change the intensity of some stage of transplantation.

Aim. To determine the frequency of cases without the improvement of response depth after AutoSCT and to evaluate the distribution of genotype of a number of genes and status of hemopoietic niche cells as a possible predictor of AutoSCT effectiveness in MM patients.

Material and methods of research. Retrospective analyses of 84 MM patient’s data were done. Total number of transplants performed was 112 including 84 first and 28 second transplants. The response was determined according to IWG criteria. Status of hemopoietic niche cells was evaluated by histological, immunohistochemistry and morphometric methods.

Results. Improving of the response depth after the first AutoSCT was recorded in 29 (54.7%) patients. The similar events were higher in the patients with previous VGPR: 57.9% vs 18.2% in patients with PR; p=0.005. There was no difference in other clinical and hematologic parameters between the groups. After the second AutoSCT the variant of response did not change in 4 out of 6 patients. The deepening of response significantly more often occurred in the cases with more cells localized on endost; p=0.038.

Conclusion. The results of bone marrow trepanobiopsy can be considered as predictors of a possible improvement in the quality of response or lack thereof in patients with MM after performing AutoHSCT.

Keywords: multiple myeloma, autologous stem cell transplantation, response, IL-6 gene, hemopoietic niche. 

Ultrasound-guided intra-articular injection of hyaluronic acid for osteoarthritis of the carpometacarpal joint of the thumb

Grechukhin D.A., Kerimov A.A., Naida D.A.

Abstract. Osteoarthritis (OA) is the most common disease in orthopedic practice, which is characterized by chronic pain in the joints and a violation of their function. Among the hand osteoarthritis the most common is the OA of the carpometacarpal joint (CMCJ) of the thumb.

The purpose of the work is to evaluate the effect of ultrasound-guided intraarticular injection of hyaluronic acid (HA) for osteoarthritis of the CMCJ of the thumb (stage II–III Kellgren–Lawrence) with persistent pain syndrome for 3 months and with failure of NSAIDs therapy.

The study included 18 patients with stage II–III CMCJ OA who received intraarticular injection of HA drugs with a mass of 2400,000 kDa and a volume of 1.0 mlc twice with an interval of 10 days. Demographic characteristics, body mass index, stage of osteoarthritis (CMCJ), severity of pain syndrome according to visual analog scale (VAS) and upper limb function assessed with the DASH questionnaire (disabilities of the arm, shoulder, and hand). Data was collected at the start of the study and in 1, 3 and 6 months after the first injection. DASH and VAS scores were compared using a variance analysis of repeated measurements. The non-parametric Friedman criteria was used to check the differences in proportions. The value of p<0.05 was considered statistically significant.

There was a significant improvement in DASH values in 1, 3 and 6 months after injection. Statistically significant differences were obtained between DASH values at the start of treatment and 6 months after therapy: χ2=45.7; df 3, p<0.001. There was also a significant decrease in the average VAS score during the study in 1, 3 and 6 months after the first injection. The differences in VAS score at the start of treatment and in 6 months reached statistical significance: χ2=47.1; df 3, p<0.001. Improvement occurred after 1 month after first injection and persisted throughout the entire follow-up period for 6 months.

HA injections provide pain relief and improve upper limb function in patients who are resistant to analgesics and physiotherapy. A significant decrease in pain was observed as early as 1 month after the first intra-articular injection of GNC. The results obtained already allow to recommend the use of HA drugs for CMCJ OA.

Keywords: CMCJ, osteoarthritis, hyaluronic acid, glucocorticosteroids.

Resection of the chest wall with alloplasty polymer material Codubix for recurrent sarcoma

Vasiukevich A.G., Fedosyuk A.M., Puchkov S.N., Fokin A.V.

Abstract. A 77-year-old patient was operated on for local recurrence of pleomorphic sarcoma of the left half of the chest wall with involvement of three ribs in the tumor process. Successful extensive resection of the chest wall with plastic Codubix plastic material made it possible to preserve the skeleton with sufficient radicalism. Periodic accumulation of uninfected exudate can be considered as reactive plervritis, which required periodic evacuation of the contents of the left pleural cavity.

Keywords: surgery of the chest wall, sarcoma of the chest wall.

Asymptomatic bacteriuria

Vasechko E.S., Pavlov M.Yu.

Abstract. Understanding the «value» of bacteriuria can help clinicians choose rational antimicrobial therapy and improve disease outcomes. Interpretation combined with clinical information helps to make informed decisions. The term «significant» bacteriuria is quantified by urine microbial count (urine microbial count) and refers to the true presence and proliferation of bacteria and / or migration into the lumen from infected tissues. The diagnostic thresholds and their role in the optimal treatment tactics for urethral pain syndrome, uncomplicated, recurrent, and complicated urinary tract infections (UTIs) are described.

Keywords: urinary, asymptomatic, infections, treatment, women.

2021 г. № 3(5)

The Moscow hospital in the first half of the XVIII century: the beginning of the glorious path

Ovchinnikova M.B.

Abstract. The article highlights the Formation of the Moscow Hospital, founded by the Decree of Peter I in 1706 in Lefortovo, and its activities in the first half of the XVIII century as a clinical institution, where from the first days the treatment of patients took place together with the training of the first doctors – students of the Moscow Medical and Surgical School. The article tells about the first chief doctor and director of the Hospital School – Nikolai Bidloo – the author of the national »Instructio de chirurgia in theatro anatomico», and his followers who devoted their lives to preserving the health of the Russian army.

Keywords: Peter I, Moscow Hospital, Hospital School, Nikolai Bidloo, the instruction on surgery, clinical medicine, the Main Military Hospital of Russia.

Evaluation of the effectiveness of the use of biodegradable implants based on magnesium oxide in comparison with titanium analogues. Experimental study

Davydov D.V., Brizhan¢ L.K., Kerimov A.A., Khominets I.V., Kalinin S.Y.,

Artemiev A.A.

Abstract. The issues of improving surgical implants used in treating patients with traumatological and orthopedic profiles continue to remain relevant. The development of a material not inferior in its elastic-strength properties to metal and that does not require further removal remains a reason for studying new samples that are inert during resorption.

The purpose of this study was to experimentally explore and compare the bone tissue reaction to the introduction of titanium and magnesium oxide implants, as well as to study the state of magnesium oxide structures at different times after implantation.

The material for the study was an implant based on magnesium oxide manufactured by the «MAGNEZIX» company. We operated on 30 rabbits based on the experimental laboratory of the Main Military Clinical Hospital named after academician N.N. Burdenko Russian Defense Ministry. The main group consisted of 10 rabbits, which were injected with a biodegradable screw made of a material based on magnesium oxide. The control group included 10 rabbits, which were injected with a titanium screw. In addition, another group of rabbits was studied. It included 10 young subjects who were injected with an implant based on magnesium oxide into the growth zone. Subjects were removed from the experiment one at a time at various stages. The X-ray and histological assessment of the paraimplant zone were performed. As a result, the experiment showed that biomaterials based on magnesium oxide are bioinert, do not cause an inflammation reaction or osteolysis of the surrounding tissue, do not lead to the release of gas and the formation of a pathological cavity. During the introduction of magnesium-containing implants to young subjects, no pathological changes in bone tissue, deformities or stunting in the growth of the studied individuals were detected. Based on the obtained experimental data gathered for 6 months, it should be concluded that the material based on magnesium oxide is very promising and suitable for use in traumatology and orthopedics.

Keywords: osteosynthesis, screw, magnesium, biodegradable, implant. 

Treating diabetic foot syndrome at the General Surgery Clinic of the S.M. Kirov Military Medical Academy

Ivanusa S.Ya., Risman B.V., Yanishevsky A.V., Shayakhmetov R.E., Matveev I.S.

Abstract. We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. The tactics of surgical treatment depended on the form of the diabetic foot syndrome, as well as the severity of the patient. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb.

Purpose of the study. To improve the results of treatment of purulent-necrotic complications of diabetic foot syndromeby developing and applying a diagnostic algorithm and differentiated treatment tactics.

The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment.

The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment consisted of the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment was carried out by performing sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out on the basis of a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. The control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years.

The developed unified approaches in the diagnosis and treatment of patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28 to 2,7%, «high» amputations by 34%, and the number of re-amputations ― 10 times.

The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions.

The approach to the management of patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

Keywords: diabetes mellitus, diabetic foot syndrome, ultrasound cavitation, wound ozonation, biofilms, general surgery.

Tricuspid regurgitation prevalence in general hospital patients

Chernov M.Yu., Pestovskaya O.R., Kranin D.L., Spesivtseva O.A., Sharonova S.P., Savina L.N., Osminina A.Yu., Varochkin K.A., Mareeva E.V., Bordyugova O.V.

Abstract. Tricuspid regurgitation (TR) is widespread valvular heart disease. Frequently life time isn’t depending on trace to mild degrees of TR. Tricuspid valve surgery is probably recommended for patients with moderate and severe TR because of their poor long-term outcomes. It is necessary to study TR in different patients. The aim of this work was to study the incidence of TR in multi-specialty hospital and to investigate moderate and severe TR frequency. We analyzed 50 647 transthoracic echocardiograms (TTE) done in Federal State Governmental Establishment «Burdenko Main Military Clinical Hospital» of Russian Federation Defense Ministry in 2004–2019. The median age of patients was 56 years (mean age 54,23±17,95 years old). We discovered 44 854 cases of TR. Moderate and severe TR was detected in 5735 (11,3%) patients (mean age 68,11±14,42, median 71 years old). In multi-specialty hospital TR can be found in 88% of patients. Patients with moderate and severe TR is older patients with progressive TR. The male with severe TR often is mature then female.

Keywords: echocardiography, tricuspid valve, tricuspid regurgitation, tricuspid valve insufficiency.

Monocytosis in rational empirical antibacterial therapy in moderate forms of COVID-19

Kovalev A.V., Shperling M.I., Polyakov A.S., Nоskov Ya.А., Vlasov А.А., Morozov А.D., Merzlyakov V.S.

Abstract. Microbiologically confirmed bacterial co-infection occurs in 1.2–7% of hospitalized patients with COVID-19. The study of rational approaches to empirical antibacterial therapy (ABT) of SARS-CoV virus-induced pneumonia continues-2. Glucocorticoid (GCS) therapy, which is the main method of pathogenetic treatment of moderate forms of CОVID-19, can lead to the development of neutrophilic leukocytosis. The criterion for the differential diagnosis of leukocytosis can be a study of the number of peripheral blood monocytes. Determining the significance of assessing the number of monocytes can serve as an additional criterion for the appointment of empirical ABT in the treatment of pneumonia caused by a new coronavirus infection. The aim of the study the nature of glucocorticoid-induced leukocytosis in patients with moderate COVID-19. The study included 86 patients with a confirmed diagnosis of COVID-19 (ICD codes: U07. 1, U07.2) of moderate severity. The patients were divided into 2 groups. The comparison group consisted of 40 patients who were prescribed ABT after the appearance of leukocytosis on the background of glucocorticoid therapy. The control group included 46 people who were not prescribed ABT after the appearance of leukocytosis on the background of glucocorticoid therapy and until the end of their stay in the hospital. We compared the parameters of the clinical blood test (the absolute number of white blood cells, neutrophils and monocytes (×109/l)) on days 3, 6 and 9 from the start of GCS therapy. As a result, on the 3rd day, both groups had neutrophilic leukocytosis (>9.0×109/l) and absolute monocytosis (>0.8×109/L). There was a statistically significant decrease in the absolute number of white blood cells, neutrophils and monocytes by days 6 and 9, compared with day 3 from the start of glucocorticosteroid therapy. When comparing blood parameters between the groups, there was no statistically significant difference in the number of cells on the 3rd, 6th and 9th day of GCS therapy (p>0.05). Glucocorticoid-induced leukocytosis is associated with absolute monocytosis. The administration of ABT in response to the occurrence of leukocytosis in this study did not affect the change in the level of white blood cells. At the same time, a likely factor in reducing these indicators was a decrease in the daily dosage of corticosteroids.

Keywords: SARS-CoV-2, COVID-19, clinical blood test, hematological examination, monocytosis, glucocorticoids, antibacterial therapy.

Selecting the surgical treatment for patients with diaphragmatic hernia

Onnicev I.E., Chuprina A.P.

Abstract. Hernias of the diaphragm (HAP) are a common pathology that negatively affects the quality of life of patients and in some cases requires high-quality surgical correction. This pathology has a progressive course, which leads to an increase in the severity of clinical manifestations with the age of the patient. At present, behavioral and conservative therapy is the first line of treatment for HAP, while surgical correction is performed only if they are ineffective. This tactic helps to reduce the likelihood of discrediting surgical treatment and increase its effectiveness. The article presents the experience of surgical treatment of HAP on the basis of general surgery clinics of the Military medical academy of S.M. Kirov.

Keywords: hernias of the diaphragm, treatment.

Early diagnosis of melanoma: current challenge for a modern clinician

Lamotkin I.A., Kapustina O.G., Mukhina E.V., Varacina S.V.

Abstract. Authors assessed the incidence of skin melanoma during outpatient consultations at the Consultation and Diagnostic Center of the Burdenko Main Military Clinical Hospital. During the period from 2019 to 2020, the authors diagnosed 68 patients with skin melanoma with stages ranging as follows: in situ ― 3 (4.4%) people, stage IA ― 11 (16.2%) people, stage IB ― 13 (19.1%) people, IIA ― 11 (16.2%), IIB ― 6 (8.8%), IIC ― 9 (13.2%), IIIA ― 3 (4.4%), IIIB ― 4 (5.9%), IIIC ― 3 (4.4%), IV ― 5 (7.4%). The necessity to apply the knowledge about the clinical and dermoscopic features of this malignant disease in order to diagnose skin melanoma as well as exceptional prognostic significance of early detection of skin melanoma were demonstrated.

Keywords: skin melanoma, outpatient appointment with a dermatologist, dermatoscopy.

Severe reactive hyperthrombocytosis secondary to coronavirus infection. Clinical cases

Ermolin V.V., Berlina N.V., Kotelnikova A.N., Bitukov A.P., Rukavitsyn O.A.

Abstract. The article presents two cases of the new coronavirus infection COVID-19 with pronounced hyperthrombocytosis, which resolved independently.

Keywords: COVID-19, hyperthrombocytosis.

Practical use of parenteral calcimimetics for severe secondary hyperparathyroidism. A case report

Khoroshilov S.E., Besedin S.V., Nikulin A.V.

Abstract. Secondary hyperparathyroidism (SHPT) leads to bone disorders and cardiovascular complications in long-term dialysis patients. Hyperphosphatemia causes progression of SHPT. Abnormalities of calcium sensing receptor (CaSR) are associated with the pathogenesis of SHPT. Clinical trials have shown that calcimimetics significantly reduced the risks of parathyroidectomy, fracture and cardiovascular hospitalization among long-term dialysis patients with SHPT. Etelcalcetide, a novel calcimimetic compound, acts as a direct CaSR agonist, restores the sensitivity of the CaSR in parathyroid cells, and decreases serum parathyroid hormone without introducing hypercalcemia or hyperphosphatemia. Etelcalcetide’s properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session improving medication adherence.

Keywords: mineral and bone disorders, chronic kidney disease, secondary hyperparathyroidism, PTH, hemodialysis, calcimimetics, etalcalcetide.

Potential predictors of the immunotherapy effectiveness

Pavlov A.V., Smolin A.V., Kazakov S.P., Solovey T.G., Kryukov E.V.

Abstract. The development of novel predictors of immunotherapy efficacy is a clinically important and rapidly developing area. The currently existing predictors of the effectiveness of immunotherapy (PD-L1, MSI tumor status) do not always guarantee a positive treatment result. In addition, the complexity, high cost, and long terms of these analyzes lead to the fact that the identification of potential new biomarkers in peripheral blood, which would be more accurate and accessible from a technical and economic point of view, is of great interest and is the object of active research. The article is a review of the currently available world literature on the topic of potential markers of the effectiveness of immunotherapy. The most interesting and promising studies with intermediate conclusions are presented. A number of clinical studies highlighted in our review, using various assays and platforms for monitoring peripheral immune status, point to the usefulness of these biomarkers as potential prognostic indicators.

Keywords: immunotherapy, predictors, immunity control points, interleukin-6 (IL-6), interleukin-18, interferon-gamma (IFNγ).