Search

Aim: To study the dynamics of cystatin C in patients after procedures on retroperitoneal viscera using laparoscopic and retroperitoneal access., Material and Methods: A prospective study of serum and urine cystostatin C levels in 162 patients with renal cysts using laparoscopic (n=83) and retroperitoneal access (n=79) was carried out. Patients were divided into four groups depending on the duration of the procedure and the gas level. For determination of cystatin C level in serum and urine, flow cytometry was performed using Human Kidney Function Panel 2 Mix and Match Subpanel (for Serum/Plasma Samples)., Results: A significant increase in the serum and urine level of cystatin C in groups 3 and 4 was seen on the 1st day after laparoscopic procedures in case of pneumoperitoneum pressure above 12 mm Hg., regardless of its duration. For retroperitoneoscopic procedures, similar changes were found only in group 4 with a gas pressure above 12 mm Hg and duration of the intervention of more than 30 minutes. By day 3, cystatin C levels returned to baseline values in all groups., Conclusion: The most significant risk factor for acute kidney injury after laparoscopic and retroperitoneoscopic procedures is the gas pressure. The second most important factor is the duration of the intervention. Pneumoperitoneum has a greater effect on cystatin C levels compared to retropneumoperitoneum.

Introduction: The search for affordable and accurate predictors of the outcome of COVID-19 is extremely important, as it provides the possibility to effectively correct the patient treatment tactics., Aim of the Study: To develop simple and accurate criteria based on the dynamics of red blood counts that predict the outcome of COVID-19., Materials and Methods: Observations were carried out in 125 patients with severe and extremely severe COVID-19, in whom indicators characterizing the state of red blood were determined in dynamics on days 1, 5, 7, 10, 14 and 21 after the hospitalization. ROC analysis was performed to calculate the threshold predictive values for survival and mortality., Results: The total number of erythrocytes and the level of hemoglobin in severe and extremely severe patients did not go beyond the acceptable limits, although showed a tendency to decrease in the group of fatal cases. On the 1st and 21st days, the number of MacroR in the deceased patients was reduced compared to those in group of survivors. It has been established that the RDW-CV test can predict the outcome of the COVID-19 with a high degree of probability at a relatively early stage of disease. RDW-SD test can be an additional predictive criterion of COVID-19 outcome., Conclusion: The RDW-CV test can be used as an effective predictor of disease outcome in patients with severe COVID-19.

The aim of the work was a comparative study of Tocilizumab and Thymalin effects on the morphological composition and indicators of the blood clotting system in COVID-19 of middle aged and elderly patients. Severe COVID-19 patients were divided into 3 groups: 1st - control (basic therapy), 2nd - basic therapy +Tocilizumab, 3rd - basic therapy +Thymalin. Hospital mortality in COVID-19 patients after standard therapy, Tocilizumab and Thymalin application was 40,9; 28,4 and 20,6% accordingly. The number of platelets increased by 1,5 times, the concentration of fibrinogen in blood decreased by 78% and activated partial thromboplastin time decreased by 9,3% in patients taking Tocilizumab. Under the influence of Tocilizumab, the platelet/white blood cell and platelet/lymphocyte ratios increased by 1,6 and 1,4 times, which may be a predictor of an unfavorable outcome of COVID-19. Thymalin increased the number of lymphocytes and monocytes by 2 times, the number of leukocytes - by 1,3 times, the number of platelets in the blood - by 1,5 times. Thymain decreased the platelet/lymphocyte and neutrophil/lymphocyte ratios by 1,4 times and 2 times. The use of Thymalin decreased the level of fibrinogen, lactate dehydrogenase and D-dimer in the blood by 1,2; 1,8 and 1,7 times, respectively. Thymalin, compared with Tocilizumab, meets the principles of pathogenic therapy for severe COVID-19 of middle aged and elderly patients to a greater extent, having a normalizing effect on the morphological composition and indicators of the blood clotting system.

The authors report successful surgical treatment of apostematous pyelonephritis complicated by sepsis in an 18-year-old patient with severe COVID-19 pneumonia (CT-2) and diabetes mellitus type 1. Active surgical approach with retroperitoneal drainage and decapsulation of the right kidney ensured positive dynamics in the treatment of destructive pyelonephritis, course of diabetes mellitus and elimination of sepsis. These aspects determined favorable outcome of disease.

Objective: To report our experience in surgical treatment of patients with COVID-19., Material and Methods: There were 7815 patients with COVID-19 for the period from April 1, 2020 to December 31, 2020. During this period, 172 operations were performed in this group., Results: The most common procedures were tracheostomy ( n =86, 50.0%), pleural puncture and drainage ( n =20, 11.6%), caesarean section ( n =22, 12.7%). There were 24 (14.0%) abdominal surgeries including 11 laparoscopies, 5 appendectomies, 3 bowel resections and others. Six lower limb amputations were carried out. We should emphasize common soft tissue hematomas and effusions. This complication is associated with anticoagulation recommended for patients with COVID-19., Conclusion: Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.

The active development of minimally invasive procedures on retroperitoneal organs using endoscopic technology raises the question of the most rational approach. The studies dedicated to the comparison of transperitoneal and retroperitoneoscopic approach are analyzed in the article. The advantages and the most common complications, as well as the factors limiting the widespread use of retroperitoneoscopic approach, are reviewed.

We undertook prospective and retrospective analysis of 120 cases of A/HINI (2009) influenza complicated by pneumonia in pregnant women with the purpose of comprehensive assessment of these conditions taking into account relevant risk factors and preventive measures. Control groups were comprised of 100 pregnant women with uncomplicated influenza and 100 ones who did not fall ill during flu pandemic. The risk of severe disease and probability of its fatal outcome in pregnant women were 2.5 and 2.4 times those in the general population. Most women developed pneumonia in the 3d trimester Risk factors offlu complications included smoking, obesity, underlying respiratory and cardiovascular diseases, sexually transmitted infections. Combined prophylaxis reduced probability of pandemic influenza in pregnant women by 5.6-7 times. Severe forms of the disease were due to manifest symptoms of intoxication and concomitant pneumonia. The clinical picture of lethal cases was characterized by severe pneumonia with subtotal lung involvement, rapid progress of acute respiratory distress syndrome, and development of polyorgan insufficiency.

Aim: To study features of immune status and causative agents of severe pneumonia in patients with influenza A/H1N1., Materials and Methods: Fifty-seven isolates from 43 patients with pneumonia, which complicated pandemic influenza A/ H1N1 and treated in Chita city clinical hospital No.1 as well as 32 immunograms were retrospectively studied. Comparison of immunologic and epidemiologic status of patients with influenza A/ H1N1 complicated by pneumonia was performed. Data on dynamics of epidemic process and outcomes are presented., Results: It was established that severe course of influenza A/H1N1 complicated by pneumonia characterized by relative lymphopenia, 2-fold decrease of CD3+ cells, 2.9-fold decrease of CD4+ cells, and 1.7-fold decrease of CD8+ lymphocytes. Degree of changes in parameters of cellular immunity corresponded to severity of pneumonia. Bacteriologic tests showed that there was contamination of respiratory tract of patients with influenza A/H1N1 by opportunistic microflora, predominantly by Streptococcus mitis., Conclusion: In patients with severe form of influenza A/H1N1, which complicated by development of pneumonia, depression of T-cell immunity with contamination of respiratory tract by opportunistic microflora and prolonged course of pathologic process was observed.

In the article was quoted data about the thrombocyte aggregation and collagenbinding activity of Willebrand factor in the blood of 50 patients with local frostbite of third and forth degree. Thrombocyte aggregation was studied with the help of photometry. Collagenbinding activity of Willebrand factor was determined with the help of enzyme-linked immunosorbent assay. It was established that decrease of intensity, potential and rate of induced thrombocyte aggregation took place in patients. Collagenbinding activity of Willebrand factor in blood plasma increase in 1, 7-2, 6 times.

The paper describes the experience of the Department of Anesthesiology and Resuscitation, Chita Medical Academy, in upgrading the quality of teaching at the pre- and postgraduate stages of education and the prestigiousness of the specialty for students. The forms of collaboration of the department's collective body with the Academy's governing body and the territory's health care structures are described. These undertakings have doubled the hours of teaching the subjects that are a sphere of anesthesiology and resuscitation at the pregraduate stage. The authors' experience suggests that 2-year clinical residency is the minimum training period under the present conditions. The innovation approach to solving the organizational and professional problems, which is proposed and tested by the authors, resulted in the provision of the health care facilities of the Transbaikal Territory with educated anesthetists-resuscitators (by 98.8%). The use of innovation educational technologies, including internet bases and internet libraries, and audiovisual and telecommunication technologies for distance education and counseling, makes an educational process interesting to young specialists and, overall, serves to increase the prestigiousness of the specialty.

We studied the role of lymphocyte-platelet adhesion, IL-1beta, TNFalpha and endothelial dysfunction in pathogenesis of damage in local frostbites. Examination of 60 patients aged 17-50 years with frostbites of the second-forth degree has demonstrated that in patients with local frostbites the number of lymphocyte-platelet adhesions, circulating desquamated endothelial cells increases as well as the level of proinflammatory cytokines, while nitrites concentration decreases.

The condition of the microcirculatory bed in frostbitten tissues has the decisive importance in the course of the injury. The objective of the work was to investigate the dynamics of the parameters of microcirculation in patients with an endured local frostbite injury of the upper extremities. Evaluated were oscillations of the bloodstream by means of laser Doppler flowmetry. The study was carried out in a total of sixty 18-to-45-year-old patients presenting with a degree II-IV local frostbite injury of the upper extremities at various periods of the injury. In the prereactive period, when there are no significant deviations of the blood-flow oscillation parameters, using the occlusion test makes it possible to reveal alterations in the condition of the microcirculatory bed. The early and late reactive periods of a localfrostbite injury of the upper limbs are characterized by an increase in the neurogenic and myogenic components of vascular tonicity, as well as the by-pass index, thus suggesting a vascular spasm and increased by-pass blood flow. Degree II-IV frostbites of the upper extremities in the early and late reactive periods of the injury are accompanied by decreased reactivity of the vascular wall in response to occlusion, decreased potential of the active mechanisms of regulation of vascular tonicity, and maintenance of an adequate tissue blood circulation, with a 1.5-2-fold decrease in the blood flow reserve. The revealed alterations in the parameters of microcirculation and regulation of vascular tonicity explain a lingering course of the wound process in frostbites. Using the method of laser Doppler flowmetry makes it possible to determine the condition of microcirculation and vascular tonicity, to evaluate efficiency of the methods of treatment, and to predict the course of frostbite.

Using laser Doppler flowmetry comparative evaluation of microcirculatory condition and regulatory components of vascular tone in lower limbs was carried out in 40 patients with local cold injuries in late reactive period and 12 reconvalescents with trophic disturbances. Microcirculation index decreased in all patients while neurogenous and myogenous vascular tone increased. Peak oscillation amplitude decreased in the endothelial range. At the same time in reconvalescents changes in passive regulatory components of vascular tone increase and frequency of peak amplitude neurogenous variation decrease. Thus, cold impact results in stable changes of microcirculation and therefore in dysthrophic changes in affected tissues.

The impact of prolonged conduction block of the brachial plexus on the regulatory components of vascular tone, the state of vascular platelet hemostasis, and the activity of an inflammatory process was studied in patients with second-to-fourth degree local arm frostbites. The block alleviated arterial spasm, indirectly lowered myogenic tone, and decreased shunt blood flow. Nutritive circulation increased in the presence of a total increase in blood flow to the arm. There were increases in the intensity, rate, and potential of platelet aggregation. The concentration of proinflammatory cytokines reduced. This resulted in more efficient treatment.

The state of the microcirculation bed was assessed by the method of laser Doppler flowmetry in 40 patients with frostbites of lower extremities of the II-IV stages. In the proximal zone segments there was less inflow of blood to the arterial bed, increased neurogenic and myogenic components of vascular tone, decreased nutritive and, in a less degree, shunt blood flow. In aggravation of the injury severity the changes in question become more pronounced.

Based on the results of long-term statistical monitoring, the author analyzes traumatologic care rendered to sailors of the Northern fleet and outlines the basic approaches to improvement of emergency traumatologic care on board the ship. As a result of introduction of a complex of organizational and medicosocial measures, the incidence of injuries reduced two-bold.

The author conducted an epidemiological analysis of craniocerebral traumas (CCT) suffered in 13 years by sailors sailing the Northern waters. A group of high risk of injury was set apart among crew specialists who were engaged in work connected with walking on the ship's ladder, loading and unloading, and mooring. Falling from a height played the leading role in the mechanism of the traumas. Immediate evacuation from the ship for providing qualified and specialized aid determined the social and vocational rehabilitation of 87.5% of patients. The CCT level has fallen by 21% in 13 years.

The author analyzes occupational and medicosocial aspects of ocular traumatism in the Northern basin water transport over 13 years. Wounds, foreign bodies, contusions, and burns predominated in the structure of injuries. Groups at high risk for eye injuries were distinguished with consideration for the subject's occupation, age, length of service, and type of work done. The author emphasizes the role of early urgent aid in favorable outcomes of injuries to the eye.

The analysis of the results of treating 153 sufferers of the navigating personnel, who sustained injuries of different location, was carried out. In the total structure of traumatism of the water-transport workers, the wounds comprised 15.2%.

Based on the study of incidence, characteristics and peculiarities of the localization of traumatic injuries among the crew of transportation, fishing and river fleet of the Northern Region over 10 years, a complex medico-hygienic programme of preventive activities aimed at health promotion of sailors and prevention of accidents has been elaborated. News-bulletins, methodological recommendations, large-circulation newspaper articles and radio-lectures worked out on the basis of the survey are used in practical work.

The purpose of the study was to analyze accident rates on board the ships of the North Basin Fish Fleet along with the data on surgical interventions during a 10-year period. High accident rates among the members of the deck crew were caused by intensive working conditions characterized by cargo moving, monitoring operations, insufficient lighting of the deck and different mechanisms. Such kinds of work as maintenance and repair of the mechanisms in the machine room, trawling, fishing and fish processing were regarded as highly traumatic. Hand trauma is an occupational injury in sailors because of the great amount of manual labor on board the ships. It was pointed out that control of nonoccupational accidents and alcohol abuse among sailors was also of great importance.

From analysis of the results of surgical treatment of gunshot injuries of the abdomen in 55 patients the authors conclude that insufficient experience of surgeons in the treatment of such injuries is the main cause of pyogenic complications (51%). They failed, as a rule, to take into account the extent of the affection and the spread of the devitalized tissues, as a consequence of which unjustified economical and non-radical debridement was performed. Eleven patients (20%) died, seven of them, from peritonitis.