Annotations journal "Polytrauma" 4/2020
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Secondary care organization
POSSIBILITIES OF INTER-TERRITORIAL MEDICAL ASSISTANCE IN EMERGENCY RECOVERY Bogdanov S.B., Porkhanov V.A., Baryshev A.G., Mukhanov M.L., Blazhenko A.N., Enikeev M.A., Khuzhina M.V., Bogdanova Yu.A., Shevchenko A.V.
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Bogdanov S.B., Porkhanov V.A., Baryshev A.G., Mukhanov M.L., Blazhenko A.N., Enikeev M.A., Khuzhina M.V., Bogdanova Yu.A., Shevchenko A.V. Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital No. 1, Kuban State Medical University, Krasnodar, Russia, Pirogov Kerch Hospital No. 1, Kerch, Russia
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The provision of medical assistance in the elimination of the consequences of emergency situations is relevant. Objective − to analyze the possibility of providing inter-territorial medical care in the elimination of the consequences of a terrorist act. Materials and methods. An analysis of the provision of medical assistance in emergency situations in the city of Kerch on October 17, 2018 is presented. Results. Exercises in emergency response medical exercises help improve the preparedness of medical personnel. Upon receiving an emergency signal in the city of Kerch, 3 hours later, a comprehensive medical team from Krasnodar arrived for help at the 1st city hospital in Kerch and began to provide high-tech medical care. During the medical evacuation on 18.10.18, 12 patients of moderate severity were sent to Krasnodar by road transport and two seriously injured by helicopter. With the joint assistance of doctors from Kerch, Krasnodar, Moscow, St. Petersburg, the mortality rate was 0 %. Conclusion. Inter-territorial interaction in the provision of medical care in the event of an emergency contributes to better quality care and thereby reduces mortality. Key words: emergency situation; mine-blast wound; medical evacuation.
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Information about authors:
Bogdanov S.B., MD, PhD, chief of burn center, Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital No. 1; professor at department of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia. Porkhanov V.A., MD, PhD, academician of RAS, chief physician, Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital No. 1; chief of department of oncology with thoracic surgery course, Kuban State Medical University, Krasnodar, Russia. Baryshev A.G., MD, PhD, deputy chief physician of surgery, Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital No. 1; chief of surgery department No. 1 of advanced training and professional retraining faculty, Kuban State Medical University, Krasnodar, Russia. Mukhanov M.L., candidate of medical sciences, assistant of department of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia. Blazhenko A.N., MD, PhD, professor at department of orthopedics, traumatology and military field surgery, Kuban State Medical University, Krasnodar, Russia. Enikeev M.A., candidate of medical sciences, chief physician, Pirogov Kerch Hospital No. 1, Kerch, Russia. Khuzhina M.V., deputy chief physician of medical issues, Pirogov Kerch Hospital No. 1, Kerch, Russia. Bogdanova Yu.A., candidate of medical sciences, docent at pathologic physiology department, Kuban State Medical University, Krasnodar, Russia. Shevchenko A.V., chief of traumatology unit, Scientific Research Institution – S.V. Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.
Address for correspondence: Bogdanov S.B., Matrosova St., 88, Krasnodar, Russia, 350007 Tel: +7 (918) 650-28-57 E-mail: bogdanovsb@mail.ru
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REFERENCES: 1. Agadzhanyan VV. Organization of medical care for multiple and concomitant trauma (polytrauma), clinical guidelines (treatment protocol) (draft). Polytrauma. 2015; (4): 6-18. Russian 2. Zavrazhnov AA, Samokhvalov IM, Bosko OYu. Peaceful and wartime trauma systems: past, present and future. In: Injury - 2017: multi-disciplinary approach: collection of abstracts of the International conference, Moscow, November 3-4, 2017. P. 135-136. Russian 3. Fisun AYa, Samokhvalov IM, Boykov AA, Parfyonov VE, Badalov VI, Kipor GV. Elimination of the medical and sanitary consequences of a terrorist act: the chronology of the event and the clinic of defeats. Disaster Medicine. 2018; 2 (102): 22-24. Russian 4. Pelakh VI, Rozinov VM. Step-by-step surgical care for children injured in the terrorist act in Beslan. Medicine: theory and practice. 2019; 5(4): 424-425. Russian 5. Bagnenko SF, Minnullin IP, Miroshnichenko AG, Teplov VM, Razumny NV. Directions for improving the organization of emergency, including emergency specialized, medical care, specialized medical care in emergency and urgent forms of medical evacuation in the subject of the Russian Federation. Bulletin of Roszdravnadzor. 2019; (3): 70-74. Russian 6. Trukhan AP, Samokhvalov IM, Skakunova TYu, Ryadnov AA. The structure of injuries in victims with an explosive trauma in peacetime: the terrorist attack in the St. Petersburg metro on April 3, 2017. Emergency Medicine. 2020; (2): 29-31. Russian 7. Baranova NN, Goncharov SF. Medical evacuation during emergency response: routing, quality criteria. Emergency medical care. 2019; 4(20): 4-13. Russian (Áàðàíîâà Í. Í., Ãîí÷àðîâ Ñ. Ô. Ìåäèöèíñêàÿ ýâàêóàöèÿ ïðè ëèêâèäàöèè ïîñëåäñòâèé ÷ðåçâû÷àéíûõ ñèòóàöèé: ìàðøðóòèçàöèÿ, êðèòåðèè êà÷åñòâà // Ñêîðàÿ ìåäèöèíñêàÿ ïîìîùü. 2019. Ò.20, ¹4. Ñ. 4-13). 8. Âogdanov SB, Babichev RG, Marchenko DN, Polyakov AV, Ivashchenko YuV. Plastic surgery for layered skin autografts of wounds of various etiology. Innovative Medicine of Kuban. 2016; (1): 30-37. Russian 9. Method for taking skin autograft: patent No. RU 2618166 C1 / No. 2016103838 / GBOU VPO KubGMU of the Ministry of Health of Russia, Bogdanov SB, Babichev RG; declared 02.05.2016; publ. 05.02.2017, Bul. No. 13. Russian 10. Method for plastics of limb skin after early necrectomy: patent No. RU 2248757 C2 / No. 2003115315/14 / Bogdanov SB, Kurinny NA; declared 05.22.2003; publ. 27.03.2005, Bul. No. 9 Russian 11. Method of skin plasty after early necrectomy: patent No. RU 2295924C1 / 2005123211/14 / Bogdanov SB, Kurinny NA, Polyakov AV, Afaunova ON; declared 21.07.2005; publ. 27.03.2007, Bul. No. 9. Russian 12. Budkevich LI, Rozinov VM. Tragedy in Bashkiria - the origins of the formation of modern pediatric combustiology in the service of disaster medicine // Russian Bulletin of Pediatric Surgery, Anesthesiology and Reanimatology. 2015; 1(5): 28-32. Russian 13. Shatalin AV, Agadzhanyan VV, Kravtsov SA, Skopintsev DA. Assessment of transportability in patients with polytrauma during inter-hospital transportation. Emergency medical care. 2016; 4: 20. Russian 14. Porkhanov VA, Polyakov IS, Bogdanov SB, Afaunov AA, Blazhenko AN, Mukhanov ML, et al. Modern aspects of providing medical care in emergency situations: a textbook for doctors, edited by Porkhanov VA, Fistal EYa. Krasnodar; LLC "Prosveshchenie-Yug", 2020. 315 p. Russian 15. Goncharov SF, Bystrov MV, Kudryavtsev BP, Savvin YuN. The problem of multiple and concomitant trauma (polytrauma), solutions, the role of the disaster medicine service. Polytrauma. 2016; (2): 6-10. Russian
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OPTIMIZATION OF EMERGENCY MEDICAL CARE FOR VICTIMS OF ROAD TRAFFIC ACCIDENTS Baranov A.V., Grjibovski A.M., Mordovsky E.A.
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Baranov A.V., Grjibovski A.M., Mordovsky E.A. Northern State Medical University, Arkhangelsk, Russia, Cherepovets State University, Cherepovets, Russia, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan, M.K. Ammosov North-Eastern Federal University, Yakutsk, Russia
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Objective − to characterize the practice of providing emergency medical care to victims of road traffic accidents at the present stage and to identify possible ways to improve it. Materials and methods. We carried out the analysis of the results of research studies, and legal acts on the organization of emergency medical care for victims of road traffic accidents (RTA). Scientific papers were selected in specialized databases (eLibrary, PubMed, Scopus) by the following keywords: "emergency medical care", "pre-hospital stage", "road traffic injuries", "road traffic accidents". All papers were published between 1990 and 2020. Papers with outdated or unreliable information were excluded from further analysis; some scientific papers were found by references in the articles selected for initial analysis. Results. We identified the factors that determine the occurrence of RTA with medical consequences, as well as factors associated with the risk of untimely provision of emergency medical care to victims at the pre-hospital stage of medical evacuation. Expediency to create a system of interaction between the emergency service and disaster medical service was shown, as well as the organization of unhindered passage for ambulance car with special signals to the place of RTA. It is necessary to introduce the regular training of medical personnel on the specifics of providing medical care to victims with polytrauma, transportation of injured people to trauma centers in professional development cycles. The necessity to implement the register of health consequences of road traffic injuries in the Russian Federation was shown. Conclusion. The results of the review can be used in the development of federal and regional programs for the prevention of RTA, and for programs to improve the provision of emergency medical care. Key words: road accidents; road traffic injuries; polytrauma; emergency medical care; pre-hospital stage; register of health consequences of road traffic injuries.
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Information about authors:
Baranov A.V., candidate of medical sciences, traumatologist-orthopedist, researcher, Northern State Medical University, Arkhangelsk, Russia; leading researcher, Cherepovets State University, Cherepovets, Russia. Mordovsky E.A., MD, PhD, docent, chief at department of public health, healthcare and social work, Northern State Medical University, Arkhangelsk, Russia. Grjibovski A.M., MPhil, MD, Hard of central research laboratory, Northern State Medical University, Arkhangelsk, Russia; professor at department of public health, healthcare, general hygiene and bioethics, Ammosov Northern-Eastern Federal University, Yakutsk, Russia; consultant, Marat Ospanov Western Kazakhstan Medical University, Aktobe, Kazakhstan.
Address for correspondence: Baranov A.V., Gogolya St., 38-63, Cherepovets, Russia, 163612 Tel: +7 (960) 000-52-27 E-mail: Baranov.av1985@mail.ru
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REFERENCES: 1. Agadzhanyan VV. Organization of medical care for multiple and combined trauma (polytrauma). Clinical recommendations (treatment protocol). Polytrauma. 2015; (4): 6–19. Russian 2. Akin'shin AB, Borisenko LV, Ivashina LI. Criteria for expert assessment of the quality of medical care for victims of traffic accidents. Disaster Medicine. 2008; (4): 24–27. Russian 3. Aleksanin SS, Gudz' YuV. The concept (principles, model, directions) of the organization of emergency trauma care for victims of emergency. Biomedical and socio-psychological safety problems in emergency situations. 2016; (4). 21-32. Russian 4. Anisimov AYu, Isaeva IV, Bobiy BV. Improving the results of the treatment of victims with combined mechanical injuries in traffic accidents using the example of the Republic of Tatarstan. Emergency. 2018; (1): 40-47. Russian 5. Artemov AN, Vorob'yov II, Balabaev GA. Analysis of the organization of the elimination of the health consequences of a traffic accident-emergency on the federal highway at the border of two regions. Disaster Medicine. 2017; (1): 18-20. Russian 6. Astankin SV, Zolotaryova VI, Dvorskiy AG, Prokhas'ko LV. The organization of emergency medical assistance to victims of traffic accidents in the Republic of Crimea. Disaster Medicine. 2017; (4): 11-13. Russian 7. Baranov AV, Klyuchevskiy VV, Men'shikova LI, Barachevskiy YuE, Petchin IV. Assessment of the provision of medical care at the prehospital stage in patients with polytrauma in road traffic accidents in the Arctic zone of the Russian Federation. Polytrauma. 2018; (2).: 11-16. Russian 8. Baranov AV, Vilova TV, Barachevskiy YuE, Baushev VO. Analysis of the provision of medical care at the prehospital stage to victims of traffic accidents in the Arctic zone of the Russian Federation. Emergency. 2016; (3): 11–14. Russian 9. Baranov AV, Klyuchevskiy VV, Barachevskiy YuE. Organization of medical assistance to victims of traffic accidents at the prehospital stage of medical evacuation. Polytrauma. 2016; (1): 12-17. Russian 10. Baranov AV, Matveev RP, Barachevskiy YuE, Gudkov AB. Analysis of the provision of medical care to victims of pelvic injuries at the prehospital stage. Emergency. 2012; (2): 22-25. Russian 11. Blazhenko AN, Dubrov VE., Kurinnyy SN. Problems of providing medical care to victims with polytrauma and open fractures of long bones of the lower extremities. Polytrauma. 2018; (4): 22-30. Russian 12. Boyko IV, Zaft VB, Lazarenko GO. Organization of emergency medical care for victims of polytrauma at the stages of medical evacuation. Emergency Medicine. 2013; (2):77–84. Russian 13. Ershov AL, Yakirevich IA, Popov AS. Organizational aspects of the work of the medical team during the evacuation of victims of emergency situations on an IL-76 airplane. Emergency. 2011; (4): 7–30. Russian 14. Isaeva IV. Regional aviation in the Russian Federation. Disaster Medicine. 2019; (2): 52-55. Russian 15. Isaeva IV, Chalaya LL. The system of emergency advisory medical care and medical evacuation (ambulance) in the Republic of Tatarstan and its development prospects. Disaster Medicine. 2016; (3): 31-38. Russian 16. Ivanchenko AN, Sergeev VV, Siglaeva TM. The role of the dispatching service of the ambulance station in providing emergency medical care to victims of traffic accidents and other accidents. Disaster Medicine. 2008; (1): 47–49. Russian 17. Girsh AO, Stukanov MM, Maksimishin SV. The ability to improve emergency medical care for patients with traumatic shock. Polytrauma. 2017; (2): 23-32. Russian 18. Goncharov SF. Organization of emergency consultative medical care and medical evacuation. Moscow: Zashchita; 2015. 229 p. Russian 19. Goncharov SF, Chernyak SI, Bobiy BV. Fundamentals of the development of a pilot project for the organization of medical care for people affected by traffic accidents in the subject of the Russian Federation. Moscow: Zashchita, 2008. 39 p. Russian 20. Goncharov SF, Bystrov MV, Kudryavtsev BP, Savvin YuN. The problem of multiple and combined trauma (polytrauma), solutions, the role of the disaster medicine service. Polytrauma. 2016; (2): 6-10. Russian 21. Govorov MV, Mamontov VV, Govorov VV. Analysis of typical injuries in various groups of victims with severe combined trauma. Emergency. 2017; (3): 15-21. Russian 22. Grachev SYu, Novikova NP, Sukovatykh AL. Analysis of the volume and quality of care for patients with combined trauma at the prehospital and hospital stages. Emergency. 2016; (4): 33-39. Russian 23. Gubaydullin MI, Tyukov YuA, Zarkov SI, Safin RYa. Expert assessment of the causes of adverse outcomes of road traffic injuries. Herald of the South Ural State University. Series: Education, Health Care, Physical Culture. 2011; (2): 240–242. Russian 24. Gubaydullin MI, Safin RYa, Zarkov SI. Defects in the provision of medical care to victims of traffic accidents at the hospital stage (review of domestic and foreign literature). Herald of the South Ural State University. Series: Education, Health Care, Physical Culture. 2010; (19): 84–88. Russian 25. Kirsanova AA. Improving the organization of first aid and medical care for victims of traffic accidents in the North-West Federal District for January-June, 2017. Pacific Medical Journal. 2017; (4): 93–94. Russian 26. Kurnyavka PA, Sukhanov AV, Katik AA. The role of air ambulance in providing emergency medical care and medical evacuation in the Khabarovsk Territory. Disaster Medicine. 2017; (2): 58-62. Russian 27. Makhnovskiy AI, Yergashev ON, Miroshnichenko AG, Kasimov RR. Experience in using an improved method for recording multiple and associated injuries. Emergency. 2019; (1): 40-45. Russian 28. Matveev RP, Gudkov SA, Bragina SV. Organizational aspects of providing medical care to victims of road traffic polytrauma: literature review. Disaster Medicine. 2015; (4): 45-48. Russian 29. Mikhaylovich VA. A guide for emergency doctors. Saint Peterburg: Nevskiy Dialekt, 2005. 703 p. Russian 30. Shlyafer SI. Analysis of the performance of emergency medical care in Russia. Emergency. 2019; (2):4-13. Russian 31. Miroshnichenko AG, Stozharov VV, Alimov RR, Moskvin VA. Criteria for assessing the quality of emergency and specialized medical care in emergency form in stationary conditions (realities and prospects). Emergency. 2019; (1) 8-17. Russian 32. Parfenov VE, Tulupov AN, Barsukova IM, Bumay AO. Efficiency of emergency medical assistance to victims of road traffic accidents at the pre-hospital and hospital stages. Emergency. 2015; (2): 4-9. Russian 33. Peden M. World report on road traffic injury prevention. Geneva : WHO. 2004. 217 p. 34. Petchin IV, Barachevskiy YuE, Men'shikova LI, Baranov AV. The system of emergency medical care at the prehospital stage in the Arctic zone of the Russian Federation. Ekologiya cheloveka (Human Ecology). 2018; (12): 12-19. Russian 35.
Postoev VA, Grjibovski
AM, Odland YO. Population-based medical birth registries as tools for birth
defects surveillance and 36. Rebikov IV, Levin AM, Gushchin AA, Purusov SV. Track medical station or mobile medical team? Analysis of the effectiveness of the specialized team to provide medical assistance to victims of traffic accidents in the Chelyabinsk region. Disaster Medicine .2016; (1): 48-50. Russian 37. Sebelev AI, Yarmolich VA, Poroyskiy SV. Providing emergency medical assistance to victims of traffic accidents in the Volgograd region. Disaster Medicine. 2019; (3): 12-16. Russian 38. Shatalin AV, Kravtsov SA, Agadzhanyan VV. The main factors affecting mortality in patients with polytrauma, transported to a specialized trauma center. Polytrauma. 2012; (3): 17–21. Russian 39. Skoroglyadov AV, Lyadova MV, Tuchik E.S. Medical and expert characteristics of errors and complications in providing emergency inpatient care to victims of injuries of the musculoskeletal system. Disaster Medicine. 2015; (3): 25-28. Russian 40. Skopintsev DA, Kravtsov SA, Shatalin AV. New approaches to the use of the anti-shock suit “Kashtan” during inter-hospital transportation of victims with polytrauma. Polytrauma. 2014; (2): 21–25. Russian 41. Sokolov VA. Road traffic injuries. Moscow: GEOTAR Media, 2009. 176 p. Russian (Ñîêîëîâ Â. À. Äîðîæíî-òðàíñïîðòíûå òðàâìû. Ìîñêâà: ÃÝÎÒÀÐ Ìåäèà, 2009. 176 ñ.) 42. Starodubov VI, Kalininskaya AA, Son IM. Primary health care: improvement mechanisms: monograph. Moscow, 2017. 117 p. Russian 43. Surin MV. The organization of the sanitary-aviation evacuation in the Komi Republic. Disaster Medicine. 2018; (4):45-47. Russian 44. Tolkachev DA., Ruzanov NN, Popova EV. Emergency response teams of the Center for Disaster Medicine of the Saratov Region and their role in providing medical assistance to victims of road accidents. Disaster Medicine. 2009; (1): 38–39. Russian 45. Ul'yanov AA, Gromut AA, Fed'ko RV. Organization of medical assistance to victims of traffic accidents outside settlements in the Khanty-Mansiysk Autonomous Okrug - Ugra. Disaster Medicine. 2017; (4): 19-21. Russian 46. Unguryanu TN, Kudryavtsev AV, Anfimov VG, Yutterstad B, Grjibovski AM. The first population-based injury register in Russia: establishment, logistics and role in the municipal Iijury prevention programme. Ekologiya cheloveka (Human Ecology). 2017; (3): 56-64. Russian 47. Valkov MYu, Karpunov AA, Coleman MP, Allemani C, Pankratieva AYu, Potekhina EF, et al. The Population-Based Cancer Registry as a Resource for Research and Practical Healthcare. Ekologiya cheloveka (Human Ecology). 2017; (5): 54-62. Russian 48. Zaritskaya LP, Svirskiy AA., Panov BV. Prehospital emergency care in terminal conditions for victims of transport. Urgent problems of transport medicine. 2012; (1): 110–116. Russian
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Clinical aspects of surgery
Wounds of magistral vessels in combat thermomechanical injuries Dubrov V.E., Gereykhanov F.G., Koltovich A.P.
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Dubrov V.E., Gereykhanov F.G., Koltovich A.P. Main Clinical Hospital of Ministry of Internal Affairs of Russian Federation, Moscow, Russia
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Gunshot wounds combined with burns are diagnosed in 8-10 % of the wounded. Vascular damages range from 1-2 % to 17.6 %. The frequency of limb amputations is 27-31.5 %, disability − 45 % or more, mortality − 12%. Objective − to assess the effect of burn injury on the results of surgical treatment of injured persons with damages to the main vessels of the limbs. Material and methods. 166 patients with vessel injuries to the limbs were included: 9 (5.4 %) patients (group 1) had burns, 157 (94.6 %) had no burn injuries (group 2). In the group 1, 18 vascular injuries were diagnosed: 10 arteries, 8 veins. Burns in the area of vascular injury were detected in 5 (55.6 %) wounded persons. Combined bone-vascular damage was diagnosed in the group 1 in 4 (44.4 %), in the group 2 − in 32 (20.4 %) (p ≤ 0.05). Vascular reconstructions were distributed as follows: temporary vascular shunts (2 (22.2 %) and 18 (11.5 %) people), ligation (5 (55.6 %) and 109 (69.4 %)), marginal suture (3 (33.3 %) and 22 (14.1 %)), autovenous graft (2 (22.2 %) and 2 (1.2 %)), circular suture in 9 (5.7 %) in the group 2, amputation (2 (22.2 %) and 12 (7.6 %)). Access to vascular injuries in 5 wounded persons was through a burn. Results. Complications associated with vascular damage were diagnosed in all wounded in the 1st group and in 127 (80.9 %) in the group 2. 22 (13.3 %) patients died: 2 (22.2 %) in the 1st group and 20 (12.7 %) in the 2nd group (p ≥ 0.05). Conclusion. For combined thermomechanical injuries, a burn injury with Frank index of up to 35 does not lead to a significant increase in the number of complications in the early period of trauma. Temporary bypass surgery is an operation of choice. Access to the vessel and introduction of Schantz screws into the bone fragments through the burn wound does not affect outcome deterioration. Key words: wound; burn; trauma; vascular damage.
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Information about authors:
Dubrov V.E., MD, PhD, professor, head of department of general and specialized surgery of faculty of fundamental medicine, Lomonosov Moscow State University, Medical Research and Educational Center of Lomonosov Moscow State University, Moscow, Russia. Gereykhanov F.G., senior thoracic surgeon of medical intensification department of special medical detachment, Main Military Clinical Hospital of National Guard Troops of the Russian Federation, Balashikha, Russia. Koltovich A.P., MD, PhD, chief surgeon, Main Clinical Hospital of Ministry of Internal Affairs of Russian Federation; professor of damage surgery department of Medical Institute of Continuing Education of Moscow State University of Food Production, Moscow, Russia.
Address for correspondence: Koltovich A.P., Narodnogo Opolcheniya St., 35, Moscow, Russia, 123060 Tel: +7 (965) 359-36-55 E-mail: akoltovich@mail.ru
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REFERENCES: 1. Kauvar DS, Propper BW, Arthurs ZM, Causey MW, Walters TJ. Impact of staged vascular management on limb outcomes in wartime femoropopliteal arterial injury. Annals of Vascular Surgery. 2020; 62(1): 119-127. 2. Rasmussen ÒÅ, Stockinger Z, Antevil J, Fernandez N, White JM, White P. Vascular injury. Clinical practice guideline. Joint Trauma System. 2016; 61: 8-15. 3. Bradley M, Nealeigh M, Oh JS, Rothberg P, Elster EA, Rich NM. Combat casualty care and lessons learned from the past 100 years of war. Current Problems in Surgery. 2017; 54: 315–351. 4. Samokhvalov IM. Injuries to the main blood vessels. Experience of medical support of troops in Afghanistan 1979-1989. Vol. 3: Providing surgical care for wounds of various localization / Eryukhin IA, Khrupkin VI, editors. Ch. 11. Moscow: N.N. Burdenko Main Military Clinical Hospital, 2003. 422-444. Russian 5. Steinle AV. Analysis of the results of treatment of wounded with injuries of the main arteries of the extremities during counter-terrorist operations in the North Caucasus. Siberian Medical Journal. 2010; 25(1): 31-36. Russian 6. Sharrock AE, Remick KN, Midwinter MJ, Rickard RF. Combat vascular injury: influence of mechanism of injury on outcome. Injury. 2019; 50: 125-130. 7. Paltyshev IA. Programmable multistage surgical treatment of wounded with combined thermomechanical injuries in a local armed conflict: dissertation abstract by candidate of medical sciences. Moscow, 2014. 22 p. Russian 8. Turner CA, Stockinger ZT, Gurney JM, Vascular surgery during U.S. combat operations from 2002 to 2016: analysis of vascular procedures performed to inform military training. Journal of Trauma. 2018; 85(1 (Suppl. 2): S145-S153. 9. Grigorian A, Wilson SE, Nii-KabuKabutey, Fujitani RM, Virgilio C, Schub SD, et al. Decreased national rate of below the knee amputation in patients with popliteal artery injury. Annals of Vascular Surgery. 2018; 51: 276. 10. Clouse WD, Rasmussen TE, Peck MA, Eliason JL, Cox MW, Bowser AN, et al. In-theater management of vascular injury: 2 years of the Balad Vascular Registry. Journal of American College Surgery. 2007; 204(4): 625-632. 11. Sohn VY, Arthurs ZM, Herbert GS, Beekley AC, Sebesta JA. Demographics, treatment, and early outcomes in penetrating vascular combat trauma. Archive of Surgery. 2008; 143(8): 783-877. 12. Leininger BE, Rasmussen TE, Smith DL, Jenkins DH, Coppola C. Experience with wound VAC© and delayed primary closure of contaminated soft tissue injuries in Iraq. Journal of Trauma. 2006; 61:1207-1211. 13. Stannard A, Brown K, Benson C, Clasper J, Midwinter M, Tai NR. Outcome after vascular trauma in a deployed military trauma system. British Journal of Surgery. 2011; 98(2): 228–234. 14. Kragh Jr JF, Dubick MA. Bleeding control with limb tourniquet use in the wilderness setting: review of science. Wilderness & Environmental Medicine. 2017; 28(2 suppl.): 25-32. 15. Mavrogenis AF, Panagopoulos GN, Kokkalis ZT. Vascular Injury in Orthopedic Trauma. Orthopedics. 2016; 39(4): 249–259.
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Clinical aspects of neuro-surgery
TREATMENT OF ARACHNOID CYSTS COMPLICATED BY HEMORRHAGE DUE TO TRAUMATIC BRAIN INJURY Larkin V.I., Larkin I.I., Dolzhenko D.A., Novokshonov A.V.
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Larkin V.I., Larkin I.I., Dolzhenko D.A., Novokshonov A.V. Omsk State Medical University, Omsk, Russia Regional Clinical Hospital, Barnaul, Russia, Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia, Tsyvyan Novosibirsk Research Center of Traumatology and Orthopedics, Novosibirsk, Russia
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Objective − to study the clinical course and principles of treatment of patients with traumatic ruptures of arachnoid cysts. Materials and methods. Two clinical cases of rupture of arachnoid cysts due to injuries are analyzed. The study is exempt from the need for evaluation by the ethics committee. Clinical manifestations were evaluated taking into account the phase of the pathological process. Paraclinical and radiological diagnostic methods were used. Results. In the first described case, the arachnoid cyst was not recognized before the operation. The patient was admitted in the phase of moderate clinical decompensation. taking into account the volume of the pathological focus (including the hematoma and cyst contents), decompressive trepanation was performed, which led to recovery. In the second case, an arachnoid cyst was diagnosed at admission. The patient was also in a phase of moderate clinical decompensation, and emptying the cyst through the trefinal opening would have been logical. However, the patient refused from the operation, conservative therapy was effective, and the patient's condition improved. Discussion. The literature provides rather contradictory information about the clinical manifestations and methods of treatment of traumatic ruptures of arachnoid cysts. In some cases, conservative treatment is allowed. Surgical treatment is often reduced to emptying the cyst through the trephination hole. Also, the issues of expediency of excision of the cyst wall during surgical treatment, as well as the assessment of the degree of traumatic brain injury, are not fully resolved. Conclusion. Currently, there is no generally accepted treatment strategy for traumatic ruptures or hemorrhages in the AC. Each case requires an individual approach to treatment. There is difficulty in establishing the severity of head injury in such cases (determination of mild TBI in the presence of dislocation syndrome, in the absence of gross neurological disorders). Key words: intracranial cysts; traumatic brain injury.
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Information about authors:
Larkin V.I., MD, PhD, chief of neurology and neurosurgery department, Omsk State Medical University, Omsk, Russia. Larkin I.I., MD, PhD, professor at neurology and neurosurgery department, Omsk State Medical University, Omsk, Russia. Dolzhenko D.A., MD, PhD, chief of neurosurgery unit, Regional Clinical Hospital, Barnaul, Russia. Novokshonov A.V., MD, PhD, chief of neurosurgery unit No. 2, Kuzbass Clinical Center of Miners' Health Protection, Leninsk-Kuznetsky, Russia; leading researcher of polytrauma department, Tsyvyan Novosibirsk Research Center of Traumatology and Orthopedics, Novosibirsk, Russia.
Address for correspondence: Larkin V.I., 50 Let Profsoyuzov St., 114-91, Omsk-53, Russia, 644053 Tel: +7 (913) 152-34-36 E-mail: larkin_valery@mail.ru
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REFERENCES: 1. Cress M, Kestle JR, Holubkov R, Riva-Cambrin J. Risk factors for pediatric arachnoid cyst rupture/hemorrhage. Neurosurgery. 2016; 72(5). P.716-722. 2. Konovalov AN, Kornienko VN, Ozerova VI, Pronin IN. Neuroradiography at pediatric age. Moscow: Antidor, 2001. P. 60-113. Russian 3. Mirsadykov DA, Avdumazhitova MM, Kholbaev RI, Temirov FT. Subdural intraparacystic bleedings at the background of arachnoid cysts of middle cranial fossa. Neurosurgery. 2013; (1): 68-74. Russian 4. Dolzhenko DA, Bashmakov VA, Lyutikova NI, Eremeeva VI. A clinical case of cerebral vascular abnormality in a child which led to epidural hematoma. Polytrauma. 2015; (1): 59-62. Russian 5. Larkin VI, Larkin DV. Craniocerebral disproportion in children. Omsk: Publishing office of Omsk State Technical University, 2009. 256 p. Russian 6. Patent N 2301625 of Russian Federation, 2301625 Ñ1, À61Â8/13 (2006) A method for diagnostics of hydrocephalus No. 2006108279/14: application from 16.03. 2006: published on 27.06.2007. Larkin VI, Larkin II: applicator Omsk State Medical University.7 p.: il. text: direct. Russian 7. Chiazor O, Olusegun A, O. Adebyo A. Chimezie Short report on a rare presentation of temporal arachnoid cyst and lessons learned. World Neurosurgery. 2019; 126: 310-313. 8. Balestrino A, Piatelli G, Consales A, Cama A, Rossi A, Pacetti M, et al. Spontaneous rupture of middle fossa arachnoid cysts: surgical series from a single center pediatric hospital and literature review. Childs Nerv Syst. 2020; 36(11):2789-2799. doi: 10.1007/s00381-020-04560-3. 9. Lui B, Wang B, Yan Q. Treatment of arachnoid cyst with spontaneous hemorrhage with atorvastatin. Frontiers in pharmacology. 2019;10: 1-4. 10. Hall A, Whit MA, Myles L. Spontaneous subdural hemorrhage from an arachnoid cyst: a case report and literature review. British Journal of Neurosurgery. 2017; 31(5):606-609. 11. Flamarin G, Zanini RM, Willian F. Arachnoid cyst with a non-traumatic acute subdural hematoma in an eleven-year-old patient. Brazilian Neurosurgery. 2017; 36(2): 122-124. 12. Tamburrini G, Caldarelli M, Massimi L, Santini P, Di Rocco C. Subdural hygroma: an unwanted result of Sylvian arachnoid cyst marsupialization. Childs Nerv Syst. 2003; 19(3):159-165. doi: 10.1007/s00381-003-0724-2. 13. Wu X, Li G, Zhao J, Zhu X, Zhang Y, Hou K. Arachnoid cyst-associated chronic subdural hematoma: report of 14 cases and a systematic literature review. World Neurosurg. 2018; 109:e118-e130. doi: 10.1016/j.wneu.2017.09.115. 14. Lee YJ, Barker R. An unusual cause of back pain in a child: spinal subdural haematoma secondary to intracranial arachnoid cyst haemorrage. Quant Imaging Med Surg. 2016; (6): 478-481.
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Functional, instrumental and laboratory diagnostics
SARS-CoV-2. INFLAMMATION MARKERS Ustyantseva I.M., Zinchenko M.A., Guselnikova Yu.A., Kulagina E.A., Aliev A.R., Agadzhanyan V.V.
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Ustyantseva I.M., Zinchenko M.A., Guselnikova Yu.A., Kulagina E.A., Aliev A.R., Agadzhanyan V.V. Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia, Kemerovo State Medical University, Kemerovo, Russia
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Objective – to estimate the clinical and metabolic manifestations of systemic inflammatory response in patients with new coronaviral infection COVID-19 complicated by community-acquired pneumonia in critical conditions. Materials and methods. A retrospective analysis of clinical cases of treatment of new coronaviral infection COVID-19 with community-acquired pneumonia included 49 patients (28 men, 21 women) in the intensive care unit at Kuzbass Clinical Center of Miners’ Health Protection from July 1, 2020, to November 30, 2020. The cases were recorded according to registration date of data of positive test of COVID-19. The discharge status (survival) was considered. The survivors were 39 patients. 10 patients died. The demographic data (age, gender), comorbid status, and clinical, physiological (qSOFA, GCS) and laboratory parameters were analyzed. Etiological laboratory diagnostics of COVID-19 was performed with samples from nasal and/or nasopharyngeal smears to identify RNA of SARS-CoV-2 with PCR. General blood analysis was performed with Sysmex XN-1000 (Sysmex Co., Japan). Urea, creatinine, electrolytes, glucose, AST, ALT, bilirubin, total protein, albumin, high-sensitive troponin (hÒs), ferritin, C-reactive protein (CRP) were measured with analytic platform Cobas 6000 SWA (Switzerland). Acid base metabolism parameters and whole venous blood lactate were measured with critical conditions analyzer Cobas b221 (Germany). The parameters of the coagulogram (activated partial thromboplastin time (APTT), prothrombin time (PTT), fibrinogen, D-dimer) were measured with the automatic hemostasis system STA Compact Max (France). The statistical analysis was conducted with IBM SPSS Statistics 21 (Statistical Product and Service Solutions – SPSS). The quantitative signs were presented as absolute and relative (%) values. The quantitative variables were presented as mean arithmetic (M) and standard deviation (SD), as Me (LQ-UQ), where Me – median, (LQ-UQ) – interquartile range (IQR) (LQ – 25 %, UQ – 75 % quartiles). Kolmogorov-Smirnov test was used for testing the pattern of distribution of quantitative values. Mann-Whitney’s U-test was used for identification of intergroup differences in quantitative signs. Fisher’s test and χ2-test were used for comparison of qualitative values. The critical level of significance (α) for testing statistical hypotheses was 0.05. Differences were considered as statistically significant with p < 0.05. Results. The mean age of the patients with COVID-19 with community-acquired pneumonia was Me (IQR) 65 (55-72). Most patients were men (57 %). There were some age differences. Deceased patients were 1.15 time older as compared to survivors (p < 0.05). In the group of deceased patients, the presence of 3 concurrent diseases was noted 2.5 times more often than in survivors (p < 0.001). Glasgow Coma Scale values were almost 1,7 time lower in deceased patients as compared to survivors (p = 0.06). They also showed higher qSOFA (1.9 time, p = 0.01). The most intense generalized manifestation of systemic inflammatory response in deceased patients was shown by a significant increase in blood levels of CRP (by 2.9 times, p < 0.001), hTs (by 1.2 time, p < 0.05), ferritin (by 3 times, p < 0.001), fibrinogen (by 2 times, p < 0.001), D-dimer (by 12.2 times, p < 0.001) and 1.1-fold increase in APTT as compared to survivors (p < 0.05). Development of inflammatory response in patients with lethal outcome was characterized by increasing AS-LYMP (by 35 % on average, p < 0.001) as compared to survivors. Conclusion. The results show that COVID-19 caused by SARS-Cov-2 can be considered as systemic inflammatory response, which is characterized by life-threatening hyperinflammation, hypercoagulation and disbalance in oxygen delivery and consumption, resulting in multiple organ failure. These abnormal processes are especially significant for patients with concurrent diseases, which increase the risk of severe course of COVID-19 and lethal outcome. Key words: SARS-CoV-2; COVID-19; AS-LYMP, RE-LYMP inflammation markers.
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Information about authors:
Ustyantseva I.M., doctor of biological sciences, professor, deputy chief physician of clinical laboratory diagnostics, Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia, professor at chair of medical biochemistry, Kemerovo State Medical University, Kemerovo, Russia. Zinchenko M.A., physician of clinical laboratory diagnostics, Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Guselnikova Yu.A., epidemiologist at management quality department, Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Kulagina E.A., physician of clinical laboratory diagnostics, Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Aliev A.R., physician of clinical laboratory diagnostics, Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. Agadzhanyan V.V., MD, PhD, professor, chief physician’s adviser, Kuzbass Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence: Ustyantseva I.M., Kuzbass Clinical Center of Miners’ Health Protection, 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: +7 (384-56) 2-38-88 E-mail: irmaust@mail.ru
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REFERENCES: 1. Pachetti M, Marini Â, Benedetti F, Giudici F, Mauro E, Stori-ci P, et al. Emerging SARS-CoV-2 mutation hot spots include a novel RNA-dependent-RNA polymerase variant. J. Transl. MedlQlQ. 2020; 18(1): 179. DOI: http://doi.org/10.H86/sl2967-020-02344-6 2. Bajaj A, Purohit HJ Understanding SARS-CoV-2: genetic diversity, transmission and cure in human. Indian J. Microbiol. 2020; 1 -4. DOI: http://doi.org/10.1007/s12088-020-00869-4 3.
Shen Z, Xiao Y, Kang U, Ma W, Shi L, Zhang L, et al.
Ge- 4.
Forster P, Forster L, Renfrew C, Forster M.
Phylogenetic net 5. WHO. A new strategy of control of COVID-19. ÂÎÇ. Îáíîâëåííàÿ ñòðàòåãèÿ áîðüáû ñ COVID-19. 1404.2020 URL: https://www.who.int/ru/emergencies/diseases/novel-coronavirus-2019/strategies-plans-and-operations (äàòà îáðàùåíèÿ 20.05.2020) 6.
World Health Organization. Coronavirus disease 2019
(COVID-19) 7. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-733. doi: 10.1056/NEJMoa2001017 8.
World Health Organization. Modes of transmission of
virus causing 9. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020; 395(10223):514-523. doi: 10.1016/S0140-6736(20)30154-9 10. Su S, Wong G, Shi W, Liu J, Lai ACK, Zhou J, Liu W, et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends microbiol. 2016; 24(6):490-502. doi: 10.1016/j.tim.2016.03. 11.
How Coronavirus Spreads. U.S. Department of Health
and Human Services, Centers for Disease 12. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020; 104(3):246-251. doi: 10.1016/j.jhin.2020.01.022. 13. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and Is blocked by a clinically proven protease inhibitor. Cell. 2020; 181(2):271-280.e8. doi: 10.1016/j.cell.2020.02.052. 14. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020; 172(9):577-582. doi: 10.7326/M20-0504. 15. Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020; 25(10):2000180. doi: 10.2807/1560-7917.ES.2020.25.10.2000180. 16.
Symptoms of Coronavirus. U.S. Department of Health
and Human Services, Centers for Disease 17. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. doi: 10.1001/jama.2020.1585. 18. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. 19. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020; 323(16):1612-1614. doi: 10.1001/jama.2020.4326. 20. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. doi: 10.1001/jama.2020.2648. 21. American college of chest physicians/Society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20(6): 864-874. 22. Orlov YuP, Dolgikh VT, Vereshchagin EI, Lukach VN, Govorova NV, Kokhno VN, Shmakov AN, Patyukov YaN. Is there a relationship between iron metabolism and COVID-19 course. Herald of Anesthesiology and Critical Care Medicine. 2020; 17(4): 6-13. Russian 23. Ustyantseva IM, Khokhlova OI, Goloshumov NP, Agadzhanyan VV. Innovative laboratory techniques in sepsis diagnosis. Polytrauma. 2018; (1): 52-59. Russian 24. Ustyantseva IM, Kulagina EA, Aliev AR, Agadzhanyan VV. A relationship of extended inflammation parameters of hematological analysis (NEUT-RI, NEUT-GI, RE-LYMP, AS-LYMP) with risk of infection in polytrauma. Polytrauma. 2019. (3): 6-15. Russian
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Case history
FEATURES OF TREATMENT OF A PATIENT WITH THE CONSEQUENCES OF A COMBINED INJURY IN THE TYPE OF NON-HEALING FRACTURE OF DISTAL FEMUR Khominets V.V., Gubochkin N.G., Metlenko P.A., Shakun D.A., Ivanov V.S., Kazemirskiy A.V., Lukicheva N.P.
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Khominets V.V., Gubochkin N.G., Metlenko P.A., Shakun D.A., Ivanov V.S., Kazemirskiy A.V., Lukicheva N.P. Kirov Military Medical Academy, Russian Vreden Scientific Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia
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The report presents the experience with treating a patient with the consequences of a combined injury and avascular non-fusion of the femur, in which an individual multi-stage surgical treatment strategy was applied. Objective − to demonstrate the modern possibilities of surgical treatment of a patient with the consequences of a combined trauma in the form of an atrophic non-union of the distal third of the femur against a background of systemic osteoporosis and an allergic reaction. Materials and methods. Laboratory and instrumental examination methods were used in the process of surgical treatment and evaluation of results, (radiography, computed tomography (CT), magnetic resonance imaging (MRI)). Functional treatment outcomes were evaluated using the SF-36 quality of life scale. Surgical treatment of the patient was carried in the clinic of Kirov Military Medical Academy in several stages. At the 1st stage of treatment, metal removal, decortication of the ends of the pseudoarthrosis and sclerosis zones at the sites of the removed screws were performed. The 2nd stage of surgical treatment included: arthrolysis of the knee joint, myolysis and tenolysis of the quadriceps femoris, osteosynthesis with a retrograde femoral nail to correct valgus deformity. At the 3rd stage, removal of the intramedullary nail was performed, primary complex of the right knee joint was performed with semi-connected LCCK prosthesis with long intramedullary legs and femoral augments. Results. As a result of the comprehensive multi-stage treatment, it was possible to prepare the right lower limb by correcting the hallux valgus deformity, improving the quality of bone tissue and fusion of the atrophic pseudoarthrosis to the knee arthroplasty. Satisfactory functional, acceptable anatomical results and a significant improvement in quality of life indicators were achieved. Conclusion. It is important to plan treatment with the ability to clearly predict the outcome at all stages − from the initial intervention to the final reconstructive surgery and rehabilitation in the process of multi-stage surgical treatment of a patient with a complication of a severe femoral injury. Key words: diaphyseal fractures; condyle fractures; internal osteosynthesis; endoprosthetics; osteoporosis.
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Information about authors:
Khominets V.V., MD, PhD, professor, head of military traumatology and orthopedics department (clinic), Military Medical Academy, chief traumatologist, Ministry of Defence of the Russian Federation, Saint Petersburg, Russia. Gubochkin N.G., MD, PhD, docent at military traumatology and orthopedics department, Kirov Military Medical Academy, Saint Petersburg, Russia. Metlenko P.A., candidate of medical sciences, head of unit of clinic of military traumatology and orthopedics, Kirov Military Medical Academy, Saint Petersburg, Russia. Shakun D.A., candidate of medical sciences, senior lecturer, military traumatology and orthopedics department, Kirov Military Medical Academy, Saint Petersburg, Russia. Ivanov V.S., assistant of chief of clinic of military traumatology and orthopedics, Kirov Military Medical Academy, Saint Petersburg, Russia. Kazemirskiy A.V., candidate of medical sciences, senior researcher, department of knee joint pathology, Russian Vreden Scientific Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia. Lukicheva N.P., student of residency in the specialty "traumatology and orthopedics", Kirov Military Medical Academy, Saint Petersburg, Russia.
Address for correspondence: Ivanov V.S., Botkinskaya St., 13, Saint Petersburg, Russia, 195009 Tel: +7 (921) 404-06-66 E-mail: ivanovka78@gmail.com
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REFERENCES: 1. Alekseeva LI, Baranova IA, Belova KYu, Ershova OB, Zazerskaya IE, Zotkin EG, et al. Clinical recommendations for prevention and management of patients with osteoporosis. Russian Association of Osteoporosis. Yaroslavl: Litera, 2012. 24 p. Russian 2. Belenkiy IG, Sergeev GD. The modern state of the problem of treatment of patients with distal femur fractures. Modern Problems of Science and Education. 2014; 4: 330. Russian 3. Barabash AP, Shpinyak SP, Barabash YuA. Comparative assessment of osteosynthesis techniques for patients with fragmented fractures of femoral diaphysis. Traumatology and Orthopedics of Russia. 2013; 2: 116-124. Russian 4. Gilev YaKh, Milyukov AYu, Koltanyuk DG. Intramedullary osteosynthesis with locked nails for patients with polytrauma. Xth anniversary convention of traumatologist-orthopedists of Russia: collection of abstracts of the conference. Moscow, September 16-19, 2014. Moscow, 2014. 94 p. Russian 5. Gayko GV, Kozak RA. Risk factors of development of false joints of femoral bone. Polytrauma. 2012; (4): 14-18. Russian 6. Metsemakers WJ, Roels N, Belmans A, Reynders P, Nijs S. Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: êemaining controversies. Injury. 2015; 46(8): 1601-1607. 7. Zuev PP, Barabash AP, Barabash YuA. Locked intramedullary osteosynthesis for treatment of consequences of femoral fractures. Modern Problems of Science and Education. 2017. No. 5. URL: http://www.science-education.ru/ru/article/view?id=26736 (addressing date: 23.11.2019) Russian 8. Gaydukov VM. False joints of bones. Aetiopathogenesis, diagnosing, treatment: manual for physicians. Saint Petersburg: Nauka, 1998. 16 p. Russian 9. Copuroglu C, Calori GM, Giannoudis PV. Fracture non-union: who is at risk? Injury. 2013; 44:1379–1382. 10. Gaston MS, Simpson AH. Inhibition of fracture healing. J Bone Joint Surg Br. 2007; 89:1553–1560. 11. Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury. 2014; 45:554–559. 12. Calori GM, Phillips M, Jeetle S, Tagliabue L, Giannoudis PV. Classification of non-union: need for a new scoring system? 2008; Injury. 39(Suppl.): S59–S63. 13. Calori GM, Albisetti W, Agus A, Iori S, Tagliabue L. Risk factors contributing to fracture non-unions. Injury. 2007; 38(Suppl. 2): S11–8.
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Hemopericardium with cardiac tamponade in the long-term period after CONCOMITANT INJURY Batekha V.I., Podkamennyy V.A., Novak D.G., Grigoryev E.G.
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Batekha V.I., Podkamennyy V.A., Novak D.G., Grigoryev E.G. Irkutsk State Medical University, Irkutsk State Medical Academy for Postgraduate Education, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
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Objective − to discuss the features of surgical tactics in patients with hemopericardium and cardiac tamponade in the long-term period after a blunt trauma of the chest. Materials and methods. We report the results of treatment of a patient with cardiac tamponade which manifested in the remote posttraumatic period. Results. The patient was presented 10 weeks following the blunt trauma in a severe condition (hypotension, tachycardia, jugular vein pulsation). In view of multiple rib fractures in the history, we supposed a hemopericardium with cardiac tamponade. Emergency drainage of the pericardium was performed. The hemodynamic parameters improved, but the proceeding bleeding resulted in the open heart revision. The postoperative period was uneventful and the patient was discharged on the 8th day. Conclusion. Late posttraumatic manifestation of hemopericardium with cardiac tamponade is not a common case. Delayed cardiac tamponade after non-penetrating chest trauma is a matter of some diagnostic difficulties, especially for general practitioners, and may result in late patient's admission to a specialized hospital, which results in a high mortality rate. Key words: polytrauma; multiple rib fractures; femoral bone fracture; lung contusion; hemopericardium; cardiac tamponade; delayed tamponade.
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Information about authors:
Batekha V.I., assistant at department of hospital surgery, Irkutsk State Medical University, cardiovascular surgeon, Irkutsk Regional Clinical Hospital of Honour Badge, Irkutsk, Russia. Podkamennyy V.A., MD, PhD, professor at department of cardiovascular surgery and angiology, Irkutsk State Medical Academy for Postgraduate Education, Irkutsk, Russia. Novak D.G., trauma surgeon, Irkutsk Regional Clinical Hospital of Honour Badge, Irkutsk, Russia. Grigoryev E.G., MD, PhD, professor, corresponding member of Russian Academy of Sciences, scientific supervisor, Irkutsk Scientific Center of Surgery and Traumatology, head of hospital surgery department, Irkutsk State Medical University, Irkutsk, Russia.
Address for correspondence: Batekha V.I., Irkutsk Regional Hospital, Yubileyniy district,100, Irkutsk, Russia, 664049 Tel.: +7 902-57-67-231 e-mail: bateha_vi@mail.ru
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REFERENCES: 1. Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM, Cowley R. Blunt traumatic cardiac rupture. A 5-year experience. Ann Surg. 1990; 212(6): 701-704. https://doi.org/10.1097/00000658-199012000-00008 2. Yun JH, Byun JH, Kim SH, Moon SH, Park HO, Hwang SW, et al. Blunt traumatic cardiac rupture: single-institution experiences over 14 years. Korean J Thorac Cardiovasc Surg. 2016; 49(6): 435-442. https://doi.org/10.5090/kjtcs.2016.49.6.435 3. Teixeira PG, Inaba K, Oncel D, DuBose J, Chan L, Rhee P, et al. Blunt cardiac rupture: a 5-year NTDB analysis. J Trauma. 2009; 67(4): 788-791. http://dx.doi.org/10.1097/TA.0b013e3181825bd8 4. Schiavone W. Cardiac Tamponade: 12 pearls in diagnosis and management. Cleveland Clinic journal of medicine. 2013; 80(2): 109-116. https://doi.org/10.3949/ccjm.80a.12052
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A rare case of complicated surgical treatment of inborn occlusive hydrocephalus in a child Yakushin O.A., Novokshonov A.V.
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Yakushin O.A., Novokshonov A.V. Kuzbass Clinical Center of Miners' Health Protection, Leninsk-Kuznetsky, Russia, Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia
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Objective – to present a case of rare complication (valvular pump insufficiency) after ventriculo-peritoneal shunting in a child with inborn occlusive hydrocephalus. Materials and methods. The article presents the clinical case of early complication of surgical treatment in the child (age of 11 months) with progressing course of inborn internal occlusive hydrocephalus of degree 3 and dysfunction of previously installed liquor-shunting system. The cause of dysfunction of ventriculo-peritoneal shunting was a fracture of the connector of the valve pump. The child received revision replacement of the ventricular drain and the valve pump. At the background of the conducted treatment, we could observe improvement in general condition of the child and regression of common cerebral symptoms. Results. The main method of shunting interventions is ventriculo-peritoneal shunting, which consists of 97.7 % of all implantations. There is a significant amount of various complications in 50-80 % of cases within the first 3-5 years after surgery. One of the causes of shunt dysfunction is its mechanical disconnection, resulting in increasing hypertension syndrome and, as result, worsening of general condition of the child. There are not any publications, in which the mechanic disconnection of the shunt by means of a fracture of the valvular pump connector is the cause of dysfunction of shunting system. Conclusion. In the presented clinical follow-up of the child with occlusive hydrocephalus, we dealt with the quite rare case of dysfunction of ventriculo-peritoneal shunting system determined by a fracture of the valve pump connector, resulting in recurrent surgery and revision replacement of the ventricular drain and the valve pump. Key words: hydrocephalus; ventriculo-peritoneal shunting; fracture of valve pump connector.
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Information about authors:
Yakushin O.A., candidate of medical science, traumatologist-orthopedist, neurosurgery unit No. 2, Kuzbass Clinical Center of Miners' Health Protection, Leninsk-Kuznetsky, Russia; leading researcher of polytrauma department, Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia. Novokshonov A.V., MD, PhD, chief of neurosurgery unit No. 2, Kuzbass Clinical Center of Miners' Health Protection; chief researcher of polytrauma department, Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.
Address for correspondence: Yakushin O.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509 Tel: +7 (38456) 9-53-58; +7 (905) 075-5373 E-mail: Yakushin-GNKC@rambler.ru
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REFERENCES: 1. Sysoeva AA, Letyagin GV, Kim SA, Danilin VV, Rzaev DA. Life quality in children after surgical management of hydrocephalus. Literature review. Neurosurgery and Neurology of Pediatric Age. 2014; 2: 45-51. Russian 2. Khachatryan VA, Orlov YuA, Kim AV. Complications of valvular liquor-shunting operations. St. Petersburg. Russian Polenov Neurosurgery Institute. 2013; 440 p. Russian 3. Kalenchik SI, Kubarko NP, Talabaev MV, Kubarko YuA. Neuro-ophthalmological manifestations of occlusive hydrocephalus in children. Neurosurgery and Neurology of Pediatric Age. 2009; 3-4: 13-17. Russian 4. Orlov YuA, Malovichko IA, Marushchenko LL. Critical hydrocephalus in children (condition of the problem and perspectives). Ukrainian Neurosurgery Journal. 2012; 1: 4-11. Russian 5. Dudarev VA, Ryzhov VD. Diagnosis of early and late complications in patients with communicating hydrocephalus. Academician Journal of Western Siberia. 2014; 10(2(51): 93-95. Russian 6. Ganin SA, Khil DV, Knyazkov LV, Britikova EA, Lipatova ES. Methodology of surgical correction of occlusive hydrocephalus in children. Tolyatti Medical Concilium. 2014; 3-4: 31-36. Russian 7. Kobozoev VV, Orlov KYu, Ashurkov AV, Murtazin VI, Kiselev RS. Placement of ventriculoatrial shunt for a patient with occlusive hydrocephalus at the background of concurrent abdominal pathology and anatomical features of internal jugular vein. Pathology of Blood Circulation and Cardiosurgery. 2015; 19(2): 134-137. Russian 8. Sufiamov AA, Rustamov RR, Yakimov YuA, Sufianov R.A., Alzerkhani AA, Borba LA, et al. Endoscopy for achievement of shunt-independent state in treatment of slit ventricle syndrome. Avicenna Bulletin. 2020; 22(1): 45-55. Russian 9. Popov VE. Management of patients with ventricular peritoneal shunt at the background of criptogenic peritonitis. Neurosurgery and Neurology of Pediatric Age. 2018; 4: 65-72. Russian 10. Abdykerimov SA, Kochkunov DS. Shunting of inborn hydrocephalus in children. Bulletin of Science and Practice. 2019; 2(5): 103-108. Russian 11. Shchedrov DN, Shelkoshveev DK, Pisareva MV, Morozov EV. Acute scrotal complications of ventricular peritoneal shunting in pediatric practice: review of the problem and clinical manifestations. Herald of Urology. 2019; 7(3): 66-71. Russian
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Rehabilitation
CLINICAL AND STABILOMETRIC CHARACTERISTICS OF VERTICAL POSTURE OF PATIENTS WIHT BRAIN PATHOLOGY OF DIVERSE GENESIS Lyakhovetskaya V.V., Konovalova N.G., Sharapova I.N., Artemyev A.A.
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Lyakhovetskaya V.V., Konovalova N.G., Sharapova I.N., Artemyev A.A. Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk Institute (Branch) of Kemerovo State University, Novokuznetsk State Extension Course Institute for Medical Practitioners of Russian Medical Academy of Continuing Vocational Education, Novokuznetsk, Russia
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Restoration of the vertical posture is an important stage of rehabilitation of patients with brain pathology. Knowing the nuances of postural regulation, with considering the cause of CNS damage, will make recovery treatment more targeted. Objective − to compare the regulation of vertical posture in patients with traumatic brain injury and patients after stroke in the brain arterial systems. Material and methods. Altogether, 81 patients in the late recovery period of traumatic brain injury and 119 patients after a stroke were examined using a computer stabilograph "Trust-M STABILO" produced by OOO Nevrokor. Romberg and optokinetic tests were performed. Following moments were considered: the amplitude of the maximal value of the sagittal and front components; the ratio of the length of statokinesiogram to the area; area; velocity of movement of the projection of the overall pressure center; measures of work done and stability; 60 % of the power spectrum for each of the components; deviation in the sagittal and frontal planes. Results. In patients who had suffered a brain injury, the amplitude of the maximal value and the area of the statokinesiogram were higher, and the work and velocity were greater than in patients who had suffered a stroke. The spectrum of oscillations in this category of patients was shifted towards lower frequencies. The difference in the vertical component is particularly noticeable. Closing eyes, as well as the addition of visual noise led to unidirectional, but different in size to customize stabilogram in both groups of patients: increase in the area and length of statokinesiogram; the work required to maintain posture, and velocity of overall pressure center. In the group of patients with traumatic brain injury, these changes were more expressive. Conclusion. Patients with traumatic brain injury were less stable than patients after a stroke: to maintain a vertical posture, the first required a lot of work, mainly moving the center of mass vertically. Visual input deprivation, as well as exposure to visual interference, reduce the stability of patients in both groups; in the group of individuals with brain injury, dependence on visual input is more expressive. Key words: stabilometry; Romberg's test; optokinetic test; traumatic brain injury; stroke; vertical posture.
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Information about authors:
Lyakhovetskaya V.V., chief of department of medico-social rehabilitation, physiotherapy and remedial gymnastics, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Novokuznetsk, Russia. Konovalova N.G., MD, PhD, leading researcher at department of medico-social rehabilitation, Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons; professor at faculty of physical training and sports, Novokuznetsk Institute (Branch) of Kemerovo State University, Novokuznetsk, Russia. Sharapova I.N., assistant, department of neurology, manual therapy and reflex therapy, Novokuznetsk State Extension Course Institute for Medical Practitioners of Russian Medical Academy of Continuing Vocational Education, Novokuznetsk, Russia. Artemyev A.A., candidate of pedagogic sciences, docent, chief of department of physical culture and sports, Novokuznetsk Institute (Branch) of Kemerovo State University, Novokuznetsk, Russia.
Address for correspondence: Lyakhovetskaya V.V., Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons, Malaya St., 7, Novokuznetsk, Kemerovo region, Russia, 654055 Tel: +8 (951) 579-0782 E-mail: root@reabil-nk.ru
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REFERENCES: 1. Gorelikov AE, Melnikova EA, Rassulova MA, Rud IM. Modern aspects of stabilometry and stabilotraining in correction of postural disorders. Doctor.Ru. 2017; 11 (140): 51-56. Russian 2. Romanova MV, Kubryak OV, Isakova EV, Grokhovskiy SS, Kotov SV. Objectivization of equilibrium and stability changes in patients with stroke in the early restorative period. Annals of Clinical and Experimental Neurology. 2014; 8(2): 12-15. Russian 3. Konovalova NG. Effect of eyesight and voluntary extension of spine along the axis on postural balance of sitting of healthy persons and disabled persons with lower paraplegia on stabilometric data. Polytrauma. 2006; (2): 61-64. Russian 4. Bofanova NS. Application of stabilometric method in diagnosis of motor disorders and rehabilitation of patients after craniocerebral injury. Bulletin of New Medical Technologies [Electronic publication]. 2013; (1): 118. Russian 5. Romashkina AV, Gevorkyan LM, Burdakov VV. Peculiarities of stabilometric disorders in patients with consequences of battle brain injury Orenburg Medical Bulletin. 2016; IV, 3-2(15): 87-88. Russian 6. Plishkina EA, Beyn BN. Clinical stabilometric rebuilding of stability of patients during balance therapy from the first days of ishemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. Special issue. 2016; 116 (8): 71-77. Russian
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Reviews
NEUROGENIC SHOCK IN SPINE AND SPINAL CORD INJURY Lebedeva M.N., Ivanova A.A., Palmash A.V., Boyko N.S.
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Lebedeva M.N., Ivanova A.A., Palmash A.V., Boyko N.S. Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.
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Neurogenic shock (NS) presents a destructive consequence of the spine and spinal cord injury (SSCI). The arising life-threatening insufficiency of bleeding presents both the risk factor of multiple organ dysfunction and secondary ischemic injury to the spinal cord (SC), with decreasing probability of recovery of neurologic functions. Efficient strategies of intensive care depend on understanding of physiology of acute phase of NS. Objective − to present the modern data on neurogenic shock in the spine and spinal cord injury. Materials and methods. Using PubMed and Scopus bases and available findings in various internet resources, English and Russian language publications were selected for the period of 2009-2020 using the key words. Results. The results of large multi-center studies and the data on the basis of small groups of patients and single clinical cases have been presented. Some issues of epidemiology and pathophysiology of NS, clinical criteria of NS and the data on time of manifestation, and the modern approaches to intensive care have been reviewed. Conclusion. Currently, it is known that NS has the unique mechanism of development which is characterized by various types of hemodynamic disorders which require for various approaches to their control. Moreover, there are not any generally accepted criteria of NS state at the present time. There are some unclear issues of incidence, initiation time and duration of NS. It explains evident heterogeneity of literature data, and determines the requirement for realization of a large prospective multi-center study. Key words: spinal injury; spinal cord injury; neurogenic shock; hypotension; bradycardia; intensive care.
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Information about authors:
Lebedeva M.N., MD, PhD, head of anesthesiology and intensive care research department, Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia. Ivanova A.A., candidate of medical sciences, researcher at anesthesiology and intensive care research department, Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia. Palmash A.V., anesthesiologist-intensivist, intensive care unit, Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia. Boyko N.S., anesthesiologist-intensivist, intensive care unit, Tsyvyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia.
Address for correspondence: Lebedeva M.N., Frunze,17, Novosibirsk, Russia, 630091 Tel: +7 (913) 913-13-99 E-mail: MLebedeva@niito.ru
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REFERENCES:
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