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Published By Fsbei He I.P. Pavlov Spbsmu Moh Russia

2072-6716

2021 ◽  
Vol 22 (3) ◽  
pp. 38-47
Author(s):  
A. N. Kazantsev ◽  
K. P. Chernykh ◽  
S. V. Artyukhov ◽  
L. V. Roshkovskaya ◽  
M. O. Janelidze ◽  
...  

Purpose. Analysis of the immediate results of emergency glomus-sparing auto-transplantation of the internal carotid artery (ICA) in the acute period of ischemic stroke, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg.Material and methods. In this prospective, single-center study from January 2017 to August 2020. 49 patients were included in the acute period of ischemic stroke with hemodynamically significant extended atherosclerotic lesions of the ICA. All patients underwent glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg (Kazantsev A. N., Zarkua N. E., Chernykh K. P. et al. Аrteries with extended atherosclerotic lesions of the internal carotid artery. Patent application No. 202.013.4151/14 (062595), filing date 10/16/2020). Glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg, was performed as follows. On the inner edge of the external carotid artery (ECA), adjacent to the carotid sinus, 2–3 cm above the orifice, depending on the spread of atherosclerotic plaque (ASB), arteriotomy was performed with the transition to the common carotid artery (CCA) (also 2–3 see below the mouth of the NSA). The ICA was cut off at the site formed by the sections of the wall of the NSA and the CCA. Then the ICA was cut off as distally as possible in front of the hypoglossal nerve, so that the artery was completely resected. In view of the presence of an intact carotid glomus on the resected area of the ICA, which connects it to the wound, endarterectomy from the ICA was performed inside the operating field by its complete eversion. Then, open endarterectomy from ECA and CCA was performed. At the next stage, the ICA was implanted in its previous place with the creation of proximal and distal end-to-end anastomoses, so that the continuing ASB above the endarterectomy zone was fixed with a circular vascular suture.Results. There were no complications in the postoperative period. No cases of restenosis / thrombosis of the reconstruction zone were identified in all the sample according to the color duplex scanning data. On the 7th day after the operation, all patients were diagnosed with regression of neurological symptoms according to the National Institute of Health Stroke Scale: on admission, the mean score was 10.5±3.5; at the moment of the control point — 6.5±1.5; p=0.001. This reflects the effectiveness of the chosen treatment strategy. According to the data on the dynamics of systolic blood pressure, stable systolic parameters were observed in the postoperative period against the background of antihypertensive therapy taken before the operation.Conclusion. Carotid endarterectomy in the acute period of ischemic stroke is safe in the presence of mild neurological deficits (up to 25 points on the National Institute of Health Stroke Scale) and the diameter of the ischemic focus in the brain not exceeding 2.5 cm according to the computer data. tomography. Glomussparing ICA autotransplantation, developed on the basis of the Aleksandrovskaya Hospital, St. Petersburg, does not require the use of a patch and is not characterized by the risk of developing ICA thrombosis as a result of intimal detachment behind the endarterectomy zone. Preservation of the carotid glomus during reconstructive intervention on the ICA prevents the development of labile arterial hypertension and hemorrhagic transformation in the postoperative period.


2021 ◽  
Vol 22 (3) ◽  
pp. 61-64
Author(s):  
R. A. Narziculov ◽  
A. A. Denisova ◽  
E. D. Ozerova

Paracetamol is non-narcotic analgesic and antipyretic of the central action from group of anilides, widely used in clinical practice. This drug has pronounced hepatotoxic effect which amplifies with alcohol. Paracetamol intoxication most frequently happens as a result of deliberate peroral intake of excessive doses of drug with a suicidal purpose. Undeliberate medicine poisoning is possible as a result of self-treatment.


2021 ◽  
Vol 22 (3) ◽  
pp. 12-18
Author(s):  
V. V. Masljakov ◽  
O. N. Pavlova ◽  
A. V. Pimenov ◽  
A. G. Proshin ◽  
A. V. Poljako ◽  
...  

The purpose of the study. Study the organizational aspects of providing primary health care for victims with the facial department of the skeleton as a result of traffic accidents. Materials and methods. To achieve this goal, a retrospective study was conducted. The work included victims of road accidents with damage to the facial part of the skull between the ages of 18 and 70 years. In total, 150 victims were included in the study between 2000 and 2019. Results of the study and their analysis. The study shows that injuries to the facial skeleton as a result of traffic accidents are relevant. As a result of the study, it was found that as a result of an accident, there is approximately the same number of closed and open injuries. At the same time, open injuries, which could be regarded as medium and severe, were identified in 45 (30%) cases. In addition, data analysis showed that in 30,7% of observations, first aid was provided by random witnesses and/ or relatives of victims who did not have the skills and necessary knowledge to provide such assistance. In addition, an additional 19,3 per cent of first aid was provided by staff of various services who have some knowledge and skills in first aid. This is due to the fact that in the first group, first aid was provided faster than in the second group. The lack of the necessary skills to provide first aid to victims with such an injury can be explained by the rather high percentage of errors, which in the first group amounted to 18,7%, while employees of various services showed good results in providing such assistance and errors were not noted. Key words: primary health care, damage to the facial skeleton, traffic accident.


2021 ◽  
Vol 22 (3) ◽  
pp. 71-78
Author(s):  
A. V. Shchegolev ◽  
A. N. Gricaj ◽  
A. G. Klimov ◽  
V. N. Lapshin ◽  
V. S. Afonchikov ◽  
...  

The article covers the principles of holding the infusion therapy at the prehospital stage with the ongoing uncontrolled bleeding. The scientific work shows the effectiveness of isoosmolar crystalloid solutions in conditions of low capillary pressure, which is typical for blood loss. The article shows that the concept of an acceptable hypotension is the most optimal approach to the infusion therapy if the ongoing bleeding is suspected in peacetime as well as in combat conditions. Recommendations are given for ensuring and maintaining venous access during short, long and delayed evacuation of victims with the suspected ongoing bleeding.


2021 ◽  
Vol 22 (3) ◽  
pp. 65-70
Author(s):  
D. V. Oblavatckii ◽  
S. A. Boldueva ◽  
S. V. Alekseeva ◽  
A. A. Sushkova ◽  
R. R. Mikhailov ◽  
...  

As known, a new coronavirus infection that causes acute respiratory distress syndrome can proceed in severe forms and lead to various complications, including acute cardiovascular events. This article describes a clinical case of the occurrence of acute myocardial infarction in a patient with a confirmed diagnosis of coronavirus infection. A peculiarity of this observation is the pathogenesis of the development of myocardial infarction, which is not directly related to atherothrombosis and differs from the classic type 1 myocardial infarction.


2021 ◽  
Vol 22 (3) ◽  
pp. 4-11
Author(s):  
V. V. Ruksin ◽  
O. V. Grishin ◽  
A. G. Miroshnichenko

The results of the study showed that during 3 years (2012–2014), the number of cases of uncontrolled arterial hypertension in two adjacent (control and main) emergency departments increased by 15.7% and 19.3%, respectively, and amounted to 95.2 and 95.4% of cases, respectively. It was proved that the increase in calls for emergency medical care in connection with uncontrolled arterial hypertension was due to an increase in multiple calls (23.5% and 26.4%, respectively) to the same patients, mainly of elderly senile age with comorbid pathology (78.4% and 84.2%, respectively). In the final comparative 3-year (2015–2017) study in two adjacent (control and main) emergency departments, it was shown that individually selected self-help with two-component combinations of antihypertensive agents was associated with a decrease in emergency medical care by 18.2%, due to uncontrolled arterial hypertension. The main indications, contraindications and methods of prescribing personalized self-help are proposed.


2021 ◽  
Vol 22 (3) ◽  
pp. 19-23
Author(s):  
E. G. Skorodumova ◽  
V. A. Kostenko ◽  
E. A. Skorodumova ◽  
I. N. Gayvoronskiy ◽  
A. V. Siverina ◽  
...  

The aim of the study was to evaluate the systolic-diastolic ratio in patients with acute decompensation of heart failure against the background of the intermediate function of the left ventricle. This article is based on data from 585 electrocardiograms of 195 patients (98 males and 97 females), the average age was 64.6±14.8 years. By the level of the ejection fraction of left ventricle (LVEF), all patients were divided into three groups: with a reduced LVEF an intermediate LVEF and a preserved LVEF. As a result it was shown that in the groups of intermediate and low EF, when the systole of ventricles dominate over the diastole, but under the treatment ratio changed to the prevalence of diastole. In the preserved LVEF sample diastole dominates at all stages of the observation. Analysis of the ratio described may be useful for assessment of treatment effectiveness and coronary flow in patients with different types of LV function under acute heart failure decompensation.


2021 ◽  
Vol 22 (3) ◽  
pp. 32-37
Author(s):  
A. A. Abdullaev ◽  
R. M. Gafurova ◽  
U. A. Islamova ◽  
R. G. Khabchabov ◽  
E. R. Makhmudova ◽  
...  

Goal — was to assess the quality of life of patients with coronary heart disease, concomitant type II diabetes mellitus and arterial hypertension at 2 years after coronary stenting. Material and methods. The study included 103 patients aged 44 to 67 years. Clinical and laboratory results were assessed after stenting of the coronary arteries, 2 years later in an outpatient setting. The patients were divided into two groups: the 1st group included 54 patients with ischemic heart disease, angina pectoris III–IV f.c. in combination with arterial hypertension; in the 2nd group — 49 patients with ischemic heart disease, angina pectoris III–IV f.k. in combination with arterial hypertension and type II diabetes mellitus. The study was carried out in accordance with Good Clinical Practice and Declaration of Helsinki principles. The study protocol was approved by the Ethics Committees of all participating clinical centers. Written informed consent was obtained from all participants prior to enrollment.Results. In our study, 103 patients with ischemic heart disease and angina pectoris III–IV f.c. Within 2 years after coronary artery stenting, 33 cases of myocardial infarction (32.0%) were registered. The quality of life improved to stable exertional angina pectoris I–II f.k. 34 patients (33.0%). At the same time, 39.8% did not change their quality of life. Myocardial infarction in the group with angina pectoris III–IV f.k. and arterial hypertension, developed in 12 (22.2%) patients, and in the group with angina pectoris III–IV f.c. and arterial hypertension + type II diabetes mellitus were registered in 21 (42.8%) patients, which is almost twice as high as in group 1, the same for improving the quality of life. That is, despite the stenting of the coronary arteries, the high incidence of complications in the form of myocardial infarction can be explained by a combination of concomitant diseases, in the form of arterial hypertension + type II diabetes mellitus. We are confident that type II diabetes mellitus has a greater impact on the quality of life and complications in patients who have undergone coronary stenting. At the same time, the risk of complications decreases with adequate control of arterial hypertension and type II diabetes mellitus — the transition of angina pectoris III–IV to I–II f.c. characterized by a significant improvement at p-0.0034; odds ratio 0.50; the confidence interval is 0.31–0.80. Conclusion. The improvement in the quality of life in patients with coronary heart disease and arterial hypertension after stenting of the coronary arteries in the long-term period is twice as good as in patients with coronary heart disease and arterial hypertension + type II diabetes mellitus. Arterial hypertension is a serious but manageable risk factor for the development of macrovascular and microvascular complications. The study demonstrated the effectiveness of correcting only arterial hypertension in terms of preventing cardiovascular and microvascular complications than the combination of arterial hypertension and type II diabetes mellitus, which significantly worsen the prognosis of the disease in patients with coronary artery disease after coronary artery stenting. This is reflected in the recommendations for stratification of the risk of arterial hypertension and type II diabetes mellitus.


2021 ◽  
Vol 22 (3) ◽  
pp. 48-52
Author(s):  
A. A. Zheludev ◽  
Yu. A. Parhisenko

An experimental study was conducted to establish changes in blood indices and humoral immu1nity in rats in the postoperative period with the use of catholyte and anolyte. The experiments were carried out on 45 male rats weighing 290–320 g, which were distributed equally into 3 groups: group 1 — intact animals, group 2 and 3 — animals which underwent surgery in the amount of resection of the small intestine (1.5 cm) with anastomosis end to end.After surgery, rats used catholyte as a drink, instead of drinking water. The surgical wound was treated with anolyte. Blood and the wall of the small intestine in the anastomosis zone were used as a biological substrate. The material was studied on days 5 and 15. A study of the composition of blood and the walls of the small intestine was carried out on days 5 and 15 4. An analysis of the materials showed that the use of catholyte (a liquid with negative AFP-leads to positive changes in blood counts, humoral immunity and phagocytic activity, impaired after resection of the small intestine. The use of anolyte antiseptic (liquid with positive AFP) prevents bacterial contamination of the surgical wound. The studied parameters indicate that catholyte positively affects humoral immunity, and anolyte prevents bacterial insemination of the surgical wound.


2021 ◽  
Vol 22 (3) ◽  
pp. 53-60
Author(s):  
A. V. Evseev ◽  
A. O. Girsh ◽  
S. S. Stepanov ◽  
M. M. Stukanov ◽  
R. V. Eselevich ◽  
...  

The paper presents that the use of Ringer’s solution in the program of perioperative infusion therapy, compared with the use of an isotonic sterofundin solution, causes statistically significant adverse changes in the parameters of hemostasis, acid-base state and electrolyte composition, with the exception of potassium and sodium, venous blood. Also, the correlation analysis confirmed the relationship of significant adverse changes in the parameters of hemostasis, acid-base state and electrolyte composition of venous blood in patients when using Ringer’s solution in the perioperative infusion therapy program.


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