Urgent Surgical Pathology Research Articles

Emergency surgical pathology in pregnant women and women in labor: analysis of the structure of morbidity and routing paths in St. Petersburg

Relevance. Today, despite the development of medical technologies and the improvement of the logistical aspects of healthcare, the problem of unified treatment, diagnostic and routing algorithms for pregnant women and women in labor with urgent surgical pathology remains unresolved. The first step towards its solution is a detailed analysis of the current structure of incidence and routing paths.The objective was to analyze the incidence of urgent extragenital surgical pathology and routing paths in pregnant women and women in labor in St. Petersburg.Methods and materials. Based on the database of invoices issued by insurance organizations in St. Petersburg for completed cases of treatment, we performed a retrospective analysis of the data of pregnant patients with extragenital surgical pathology, hospitalized on an emergency basis in the period from 2019 to 2021. We assessed the structure of morbidity, terms of delivery to the hospital, indications and range of surgical interventions, treatment outcomes.Conclusions. In the structure of urgent and emergency hospitalizations in pregnant women, extragenital surgical pathology is 1 %. The total proportion of surgical interventions in patients with extragenital pathology is 35.1 %. Routing of a pregnant woman with suspected surgical pathology through the primary visit to the maternity hospital significantly increases (p<0.05) the average time to admission to the surgical hospital. > <0.05 ) the average time to admission to the surgical hospital.

THE SPECTRUM OF IMMUNORESISTANCE DISORDERS AND INFLUENCE OF CYTOTOXICITY AND PATHOGENICITY OF DAMP FRACTIONS ON THE POST-COVID-19 SYNDROME FORMATION AND THE MAIN DОISEASE COMPLICATION IN PATIENTS WITH URGENT SURGICAL PATHOLOGY

Summary. The infectious nature of COVID-19 leads to complications in the immune system. It is relevant to determine the long-term consequences of COVID-19, which can be triggers for the urgent surgical pathology’s development of the thoracic and abdominal organs in patients with certain risk factors associated with characteristic disorders of immunometabolic reactions.
 The aim. To determine the spectrum of immune resistance disorders and to find out the effect of cytotoxicity and pathogenicity of DAMP fractions on the post-COVID-19 syndrome formation and complications of the main disease in patients with urgent surgical pathology.
 Materials and methods. Patients (n = 143) with urgent cardiovascular and abdominal surgical pathology that arose against the background of post-COVID-19 syndrome were examined. We used: spectrophotometry (content of DAMP fractions), immunoturbimetry (concentration of C3 and C4 complement components); luminescent microscopy (phagocytic activity of neutrophils); light microscopy (spontaneous activity of NADPH-oxidase systems of neutrophils); flow cytometry (expression of T lymphocyte activation markers); immunofluorescence (determination of antinuclear antibodies).
 Results. It was found that the predominance of certain DAMP fractions is the cause of the immunopathological patterns formation in the development of post-COVID-19 syndrome. In patients with urgent surgical pathology and the predominance of the DAMP260 oligonucleotide fraction, significant changes in the hemogram, failure of endocytosis and incomplete phagocytosis of neutrophils, increased expression of the T lymphocytes late activation marker (CD3+HLA-DR+) were found. In all examined patients, a high frequency of autoantibodies to nuclear structures (ANA) was found, which depended on the content of DAMP fractions. The maximum repertoire of antibodies was found in patients with the oligonucleotide fraction (DAMP260) predominance.
 Conclusions. In patients with urgent surgical pathology, during the formation of post-COVID-19 syndrome, the chronic immunoinflammatory reaction formation occurs against the background of the activation cascades development of innate and adaptive immunity factors.

A Clinical Case of an Extrapulmonary form of Generalized Sarcoidosis 
 in the Practice of a Surgeon

The aim of the study is to present a clinical case of generalized sarcoidosis with no involvement of the lungs and intrathoracic lymph nodes.Materials of the study. The literature and data of clinical observation, surgical treatment and results of autopsy of a patient with generalized sarcoidosis were analyzed.Results. In this article the authors would like to draw attention to the case of generalized sarcoidosis with no lesions of the lungs and intrathoracic lymph nodes, which is 5% in the structure of morbidity, and present the clinical case of patient A., who was hospitalized in the surgical department of the Emergency Hospital. The patient was admitted with suspicion of urgent surgical pathology with extrapulmonary manifestations of the disease (polyserositis) and granulomatous lesions of the parietal and visceral peritoneum, extrapulmonary pleura, characteristic of sarcoidosis, and peritonitis, progression and development of a rare clinical form of this disease, neurosarcoidosis, which also amounts to no more than 10 % of all cases of this disease.Conclusions. This clinical case could draw the attention of specialists to this multisystem disease and the need for a multidisciplinary approach to treatment and diagnosis, which may be difficult due to the absence of typical manifestations of this pathology, as in the presented clinical case. The team of authors hopes that our experience will be interesting and will allow residents to avoid diagnostic and tactical errors in the management of such patients, since we have encountered a truly unusual and rare manifestation and complication of sarcoidosis in a patient, who ended up not in a specialized therapeutic or pulmonological department, but in surgical department of a multidisciplinary hospital.

A Clinical Case of an Extrapulmonary Form of Generalized Sarcoidosis 
 in the Surgical Practice

The aim of the study was to present a clinical case of generalized sarcoidosis without involvement of the lungs and intrathoracic lymph nodes.Materials and methods. The literature and data of clinical observation, surgical treatment and results of autopsy of a patient with generalized sarcoidosis were analyzed.Results. In this study, the authors draw attention to the case of generalized sarcoidosis without lesions of the lungs and intrathoracic lymph nodes, accounting for 5% in the structure of morbidity. A clinical case of patient A., who was hospitalized in the surgical department of the Emergency Hospital, is presented. The patient was admitted with suspicion of urgent surgical pathology with extrapulmonary manifestations of the disease (polyserositis) and granulomatous lesions of the parietal and visceral peritoneum, extrapulmonary pleura typical of sarcoidosis, and peritonitis, progression and development of a rare clinical form of the disease, neurosarcoidosis, which amounts to as much as 10 % of all cases of this disease.Conclusions. The clinical case demonstrates specificity of this multisystemic disease and the need for a multidisciplinary approach to treatment and diagnosis, which may be challenging due to the absence of typical manifestations of this pathology, as in the presented clinical case. The authors share their experience to help medical professionals avoid diagnostic and tactical errors in the management of such patients, since they encountered a truly untypical and rare manifestation and complication of sarcoidosis in a patient, who was admitted not in a specialized therapeutic or pulmonological department, but in surgical department of a multidisciplinary hospital.

EVALUATION OF THE RESULTS OF SURGICAL TREATMENT OF ACUTE DESTRUCTIVE PANCREATITIS

Acute destructive pancreatitis during several years still ranks second, and in some regions the first place in the structure of the urgent surgical pathology, ahead of acute appendicitis and acute cholecystitis. The most common cause of the disease is excessive alcohol usage and gallstone disease, but in 10-30% of patients, the etiology of acute pancreatitis remains uncertain. The study was based on the assessment and treatment of 300 patients with acute destructive pancreatitis. To assess the condition of patients the severity and progression of the disease, dynamic monitoring of the patients' state we were used such integral methods as APACHE II and III, Balthazar, SOFA, Ranson, Glasgow-Imrie, CTSI, SARS. Differentiated approach to surgical treatment in patients with destructive pancreatitis depending on the scale of the initial lesion of the pancreas has allowed an average reduction in the number of purulent complications per patient in 4 times (from 9.7% to 2.3%), lower lethality of purulent complications 3 times (from 16.3% to 5.7%), and consequently reduce the overall mortality in 2.7 times (from 26.0% to 9.9%). During the first 7 days from the onset of the disease, the number of platelets decreased, later, as the symptoms of pancreonecrosis subsided the number of platelets increased. Acute respiratory distress syndrome was characterized by shortness of breath, dry cough, and pain behind the sternum, inadequate condition of the patient, cyanosis, and rough crepitations.

Moving to Medical Treatment for COVID-19 Influence on Pediatric Appendicitis: A Meta-Analysis.

Acuteappendicitis (AA) is cited as the leading cause of surgical acute abdomen in pediatrics and the most frequent urgent surgical pathology worldwide. For a long time, surgical appendectomy has been effectively used as the first-line treatment for AA.Other conservative management practices, such as the use of antibiotics, have been applied in the treatment of appendicitis. COVID-19 has had a significant impact on the surgical treatment strategies of AA in pediatrics, with many pediatric surgeons having to shift from upfront surgical appendectomy to conservative management involving the use of antibiotics as a treatment strategy. This meta-analysis compares the outcomes between appendectomy and conservative therapy in the management of AA during COVID-19 in pediatrics. Twenty-one articles fully met the inclusion criteria. Articles that were published more than five years ago were excluded from the analysis. Also, articles that included studies on the adult population were excluded. Results from various retrospective studies, prospective clinical controlled trials, correlational studies, and randomized clinical trials were analyzed. This study reveals that the use of antibiotics has been demonstrated to be safe and effective in the treatment of uncomplicated appendicitis. However, antibiotics have been shown to have somecomplications. Despite this being the case, the studies identified the potential of using antibiotics as a definitive treatment of uncomplicated AA in pediatrics. Further studies are required to evaluate the cost-effectiveness and recurrence of AA of this alternative treatment method.

Intestinal alkaline phosphatase — a biomarker of the degree of acute enteralinsufficiency in urgent surgery

The diagnostic significance for levels of alkaline phosphatase (ALP) and intestinal alkaline phosphatase (IAP) and their ratio in blood serum and intestinal contents were compared to assess the degree of acute enteral insufficiency in urgent surgical pathology complicated by peritonitis. The results of examination of 112 patients with acute surgical pathology complicated by peritonitis were retrospectively analyzed. Biochemical data were compared with clinical and instrumental data obtained by ultrasonography and Doppler flowmetry. The main statistical indicator was Spearman's rank correlation coefficient, which showed a moderate direct correlation in patients with stage I and II enteral insufficiency (r=0.63 at p≤0.05), and in the group with st. III it showed a direct correlation with a high closeness of association (r=0.71 at p≤0.05). The IAP/ALP ratio makes it possible to objectively assess the severity of acute intestinal failure in urgent surgery

Biomarker assessment in urgent surgical pathology of the small bowel: case-control analysis of a retrospective database

Background: Small bowel obstruction, mesenteric thrombosis, and strangulated ventral hernia area a challenge in emergency abdominal surgery. This study aimed to evaluate biomarkers of damage to the digestive tract in patients with urgent pathology. Materials and methods: The study involved 71 patients aged 18 to 80 years who were hospitalized in the intensive care unit in the immediate postoperative period. Results: All 71 underwent emergency surgery, 27 with small bowel necrosis. Lactate level area under curve (AUC = 0.964), C-reactive protein (AUC = 0.805) and systolic blood pressure (area under curve, AUC = 0.803) on the context of Sequential Organ Failure Assessment (SOFA) score (AUC = 0.880) showed stratification of patients with complications before surgery. Small bowel necrosis patients revealed an increase in primary thiobarbituric acid (TBA) reactive products (AUC = 0.813) lipid peroxidation products, and a decrease in superoxide dismutase activity (AUC = 0.818) and catalase (AUC = 0.804). Wide variability of intestinal fatty-acid binding protein (I-FABP) from 199.8 to 2189.6 pg/mL were observed in all patients studied, with an AUC = 0.814 in small intestinal necrosis. Conclusion: Surgical pathology of the small intestine due to obstruction of various origina, mesenteric thrombosis, and strangulated ventral hernia pronounced revealed disorders of the antioxidant-prooxidant balance. This was expressed by an increase in lipid peroxidation products, and the level of TBA-reactive products, and the activities of superoxide dismutase (SOD), and catalase. Viewed against the background of an increase in I-FABP above 577 pg/mL, these variables were the most significant indicators of small intestinal necrosis.

Formation of initial changes in hemodynamics and fluid compartments in high surgical risk patients under the influence of acute abdominal pathology

Among the main factors of pathological changes that accompany acute abdominal pathology are the inflammatory process of the peritoneum and fluid deficiency due to its pathological losses. The aim of our study was to analyze the initial state of fluid compartments of the body and hemodynamics in high surgical risk patients with acute surgical abdominal pathology. There were examined 157 patients with acute abdominal pathology who underwent emergency laparotomy. The presence and severity of fluid deficiency were determined clinically by tissue hydrophilicity test by P.I. Shelestiuk, biochemically – by assessing the levels of hematocrit, hemoglobin, erythrocytes, blood electrolytes, vasopressin (ADH) and brain natriuretic propeptide (proBNP), as well as the mean erythrocyte volume and plasma osmolarity. Variables of fluid compartments of the body and central hemodynamics were studied using the non-invasive bioimpedancemetry. Based on the values of oxygen concentration in arterial and venous blood, total oxygen consumption (VO2) and delivery of oxygen (DO2), oxygen extraction ratio (O2ER) were calculated. The detected changes indicate intravascular fluid deficiency and concomitant hemoconcentration with normal electrolytes levels and plasma osmolarity. In patients with high surgical risk and moderate dehydration according to P.I. Shelestiuk, urgent surgical pathology of the abdominal cavity reduces extracellular fluid volume by 19.1% (p=0.019) of the reference by reducing the volume of the interstitium and intravascular fluid respectively by 20.7% (p=0.002) and 16.3% (p=0.001) of regional values, which forms in patients a state of "volume depletion" of moderate severity. This is accompanied by an increase in the ADH concentration by 16.7% (p=0.041) above reference and normal proBNP levels. Stroke volume decreases by 28.8% (p=0.021) against tachycardia (increase in heart rate by 39.7% (p=0.001) above normal) and vascular spasm (increase in systemic vascular resistance by 86.9% (p=0.001) above reference), which supports the normodynamic type of blood circulation (cardiac index – 3.2 (0.4) l/min/m2) with the decrease in stroke index and peripheral perfusion index by 41.3% (p=0.002) and 55.2% (p=0.002) from reference, respectively. DO2 decreases by 11.1% (p=0.011) from reference with VO2 increased by 16.3% (p=0.004) above reference, which leads to a decrease in oxygen utilization by 7.2% (p=0.041) from reference.

PROLONGED IMMUNE-INFLAMMATORY REACTIONS IN PATIENTS WITH COVID-19- ASSOCIATED SURGICAL PATHOLOGY IN THE POSTCOVID PERIOD

Summary. Introduction. The combination of pathogenetic factors of the main surgical pathology, multiple organ dysfunction, acute respiratory distress syndrome and cytokine storm against the background of SARS-Cov-2 infection justifies the relevance of this study.
 Materials and methods. We examined 13 patients with acute COVID-19 and 29 patients with SARS-Cov-2-associated urgent surgical pathology. Investigated the concentration of C-reactive protein (CRP) by latex agglutination, C3 and C4 components of the complement by immunoturbidimetry, the content of interleukins IL-6 and IL-18 by ELISA, determination of autoantibodies by luminescence microscopy.
 Results. In patients with SARS-Cov-2-associated urgent surgical pathology, certain patterns of changes in the markers under study were revealed: in all examined groups of patients, an increased concentration of C-reactive protein was observed, which indicated a systemic inflammatory response both in the acute and in the postcovid period. In the postcovid period of viral infection, the most significant are the high frequency of the maximum increase in the concentration of CRP, C3- and C4-complement components, and a significant or moderate increase in the content of interleukins IL-6 and IL-18, more pronounced than in the acute period of infection. The maximum increase in pro-inflammatory cytokines was found in patients with abdominal surgical pathology against the background of COVID-19 (postcoid period), while in the acute period of COVID-19, an increase in the concentration of IL-6 had no diagnostic value. A cytokine storm was detected in 20.5% of the examined patients with COVID-19-associated urgent surgical pathology.
 Conclusions. For COVID-19-associated surgical pathology, the formation of autoimmune conditions is characteristic, which is expressed in the presence of a wide range of autoantibodies to nuclear structures. Thus, for the prevention and complex treatment of COVID-19-associated urgent surgical pathology, it is advisable to use personified step-by-step immunotropic therapy.

FEATURES OF DIFFERENTIAL DIAGNOSIS OF URGENT SURGICAL ABDOMINAL PATHOLOGY DURING A PANDEMIC OF CORONAVIRUS INFECTION

Summary. Aim. To analyze the features of differential diagnosis of urgent surgical pathology during a coronavirus infection pandemic.
 Materials and methods. The work is based on the analysis of the results of additional examination of 28 patients at the admission department, who sought medical help in an urgent manner.
 Results. The advantages and disadvantages of using instrumental methods for detecting atypical forms of coronavirus infection and acute abdominal pathology are analyzed. Based on this, a diagnostic algorithm was developed using express tests for the determination of COVID-19 and urgent ultrasound protocols, which made it possible to identify lung lesions without clinical symptoms in 8 (28.6 %) patients, and to confirm acute surgical pathology in 5 (17.9 %) patients.
 Conclusion. Еxamining patients with suspected acute abdominal pathology for the purpose of differential diagnosis with the gastrointestinal form of COVID-19, it is necessary to use rapid tests for detecting antibodies to coronavirus infection and sonographic examination of the abdominal organs (FAST protocol), chest organs (BLUE protocol).

FEATURES OF THE FUNCTIONAL STATE OF MUSCLE TISSUE IN ELDERLY PATIENTS WITH URGENT SURGICAL PATHOLOGY

Sarcopenia is an important factor in the occurrence of complications in elderly patients with urgent surgical pathology. Decreased muscle strength and function is an important criterion for impaired early activation of such patients, which increases the number of complications and length of stay in the clinic. Identification of functional disorders of muscle tissue, as well as other metabolic disorders, such as type 2 diabetes, disorders of lipid metabolism, is important for the appointment of an adequate complex of intensive care. Prescribing levocarnitine and D-fructose-1,6-diphosphate sodium salt of hydrate is an important part of the treatment program in such patients.

Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics

IntroductionAcute appendicitis (AA) is the most frequent urgent surgical pathology in paediatrics. The COVID-19 pandemic has led to a decrease in emergency department (ED) visits, which can lead to a delay in health care and an increase in the severity of the pathologies. The objective is to analyze the rate of complicated AA during the pandemic, compared to the same period of the previous year. Materials and methodsRetrospective unicenter observational cohort study that included patients under 14 years of age seen in the ED with a diagnosis of AA during the months of March to May 2019 (non-pandemic) and 2020 (pandemic). Results90 patients were included (41 in non-pandemic and 49 in pandemic). No difference was found between the two periods in the time from the clinic onset until the visit to the ED (37h vs. 38h, P=.881), but there was a difference in the time from arrival at the ED until the surgery (7:00h vs. 10:30h, P=.004). The difference was accentuated when comparing the month of March with April–May 2020 (6h vs. 12h; P=.001). No significant differences were observed in the rate of complicated AA in intraoperative diagnosis (35% vs. 33%; P=.870) or anatomopathology (35% vs. 48%; P=.222), nor in the number of postoperative complications, length of hospitalization and readmissions. An increase in the anatomopathological diagnosis of AA with periapendicitis was observed (47% vs. 81%; P=.001). ConclusionDuring the pandemic, a delay from arrival at the ED until the surgery was observed in children diagnosed with AA. This delay resulted in an increase in the diagnosis of histologically evolved AA, but without an increase in the clinical complications of the disease.

Cystatin C level as a prognostic risk factor for postoperative complications in elderly patients

Annotation. An important criterion for assessing the course of urgent surgical pathology in elderly patients is the concomitant state of sarcopenia. Decreased blood levels of cystatin C, which correlates with decreased muscle mass and strength, is an important screening criterion for perioperative intensive care therapy in these patients. The aim of the study was to increase the effectiveness of intensive care in patients with low sarcopenic index by improving the methods of influencing perioperative risk factors. We examined 90 elderly patients (73.3±7.9 years) with surgical pathology of the abdominal cavity, who underwent emergency surgery under general anesthesia based on sodium thiopental with artificial lung ventilation. Patients were divided into 3 randomized groups by age, sex, anthropometric data, volume and duration of surgery, concomitant comorbid background and perioperative intensive care: group I (n=30) – patients undergoing standard intensive perioperative therapy, group II (n=30) – standard intensive care with the addition of levocarnitine; group III (n=30) – standard intensive care with the addition of levocarnitine and a solution of D-fructose-1,6-diphosphate sodium salt hydrate. Muscle mass was determined by bioimpedancemetry on the analyzer “MEDASS” ABC-02, muscle strength was assessed by wrist dynamometry, muscle-skeletal mass index was calculated. The serum cystatin C concentration was determined by latex-enhanced immunoturbidimetry (DIALAB GmbH, Austria). The significance of the obtained data was checked using the r-Pearson correlation coefficient. It is established that additional prescription of levocarnitine and D-fructose-1,6-diphosphate sodium hydrate salt significantly reduces the number of days of treatment in the intensive care unit, improves prognosis, and promotes early activation of patients. Metabolic changes caused by a decreased sarcopenic index require further research.

Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics

IntroducciónLa apendicitis aguda (AA) es la patología quirúrgica urgente más frecuente en pediatría. La pandemia por la COVID-19 ha generado un descenso en las consultas a urgencias, pudiendo conllevar un retraso en la atención sanitaria y un aumento en la gravedad de las patologías. El objetivo es analizar la tasa de AA complicadas durante la pandemia, en comparación con el mismo periodo del año anterior.Material y métodosEstudio retrospectivo observacional de cohortes unicéntrico que incluyó a pacientes menores de 14 años atendidos en urgencias con diagnóstico de AA durante los meses de marzo a mayo de 2019 (no pandemia) y 2020 (pandemia).ResultadosSe incluyeron 90 pacientes (41 en no pandemia y 49 en pandemia). No se encontraron diferencias en el tiempo desde el inicio de la clínica hasta la consulta en urgencias entre los dos periodos (37 h vs. 38 h, p = 0,881), pero sí en el tiempo desde la llegada a urgencias hasta la intervención quirúrgica (7:00 h vs. 10:30 h; p = 0,004). La diferencia se acentuó al comparar el mes de marzo con abril-mayo de 2020 (6 h vs. 12 h; p = 0,001). No se observaron diferencias significativas en la tasa de AA complicadas en el diagnóstico intraoperatorio (35% vs. 33%; p = 0,870) ni anatomopatológico (35% vs. 48%; p = 0,222), ni tampoco en el número de complicaciones postoperatorias, duración de ingreso y reingresos. Se objetivó un aumento del diagnóstico anatomopatológico de AA con periapendicitis (47% vs. 81%; p = 0,001).ConclusiónDurante la pandemia se observó una demora desde la llegada a urgencias hasta la intervención quirúrgica en niños diagnosticados de AA. Esta demora se tradujo en un incremento del diagnóstico de AA evolucionadas histológicamente, pero sin objetivarse un aumento de las complicaciones de la enfermedad.

The post-war period of the scientific work of Professor T.Ya. Arieva. Research and publication topics for the period 1946–1958

The results of the search, restoration and systematization of research topics and publications of the first head of the Department of Thermal Injuries of the Military Medical Academy named after S.M. Kirov professor Tuviy Yakovlevich Ariev in the post-war period. The presentation of the material is connected with the urgent tasks that the faculty of the Academy solved in the first years after the end of the Great Patriotic War. The objective difficulties of the work of scientists in Leningrad in the second half of the 1940s are underlined. Nevertheless, T.Ya. Aryev, like many of his colleagues, was able to summarize the clinical material accumulated in front-line medical institutions in the shortest possible time and, only 4 years after returning from the army, to defend his doctoral dissertation. The high quality of the research performed is evidenced by the fact that the materials obtained formed the basis for a separate chapter in the multivolume edition The Experience of Soviet Medicine in the Great Patriotic War 19411945. In addition, T.Ya. Ariev took part in writing several more chapters in this work, the topics of which were also related to the topic of his doctoral dissertation research. He willingly shared the knowledge gained, the experience of preparing for the defense of dissertations and the principles of scientific leadership with young scientists and their leaders. Continued service as head of the Department of Military Field Surgery at the Saratov Military Medical Faculty allowed him to accumulate invaluable experience in the formation and leadership of the scientific and clinical team. Analysis of the subject matter of publications in the 1950s. testifies to the intensive work on improving the diagnosis and treatment of urgent surgical pathology in peacetime. About the high authority among colleagues that T.Ya. Ariev for 4 years of service at the faculty is evidenced by the right to give a speech. The experience accumulated in Saratov will allow him not only to head, but also to effectively manage for many years the first department and clinic of thermal injuries in our country, created in 1960 at the S.M. Kirov.

Recomendaciones en el manejo de la patología quirúrgica menor urgente durante la pandemia por COVID-19

Recomendaciones en el manejo de la patología quirúrgica menor urgente durante la pandemia por COVID-19

The prevalence of HIV infection in patients of general hospitals as a parameter for monitoring the system of epidemiological surveillance

Aim. The aim of this study is to compare the prevalence of HIV infection in patients of large multidisciplinary hospitals in providing emergency and planned medical care and to evaluate the value of the long-term dynamics of this indicator as a quantitative characteristic of the epidemic process of HIV infection. Materials and methods. We retrospectively analyzed the results of examination for HIV infection of patients in the Sklifosovsky Research Institute for Emergency Medicine (RIEM) and Moscow Regional Research Clinical Institute (MONIKI) from 2008 to 2017. Long-term dynamics of the prevalence HIV infection were analyzed by using linear regression analysis. The intensity of trends (growth/decline) was assessed by the criteria proposed by V. D. Belyakov et al. (1981). Results. We examined for HIV infection 251 213 and 165 194 people in the research RIEM and MONIKI, respectively. For decade, the number of hospitalizations of HIV-infected patients to RIEM increased by 1.7 times, to MONIKI by 3.1 times. Prevalence of HIV infection in the patients of RIEM exceeded MONIKI ones from 3,2 to 6,0 times. At the same time, MONIKI showed a statistically significant trend towards an increase in hospitalizations of HIV-infected citizens (R2=0,8049, p=0,0004) with a pronounced average annual growth rate of 9,6% per year. Conclusion. We obtained results indicates a tendency to increase the number of recourses HIV-infected persons to general hospitals inMoscow andMoscow region. The most significant average annual increase in the prevalence over a decade period were recorded in the intensive care (+14.2%) and surgical (+9.8%) departments of MONIKI. Indicator groups of high risk of HIV infection in theMoscow region should be considered patients with urgent surgical pathology, acute exogenous poisoning of chemical etiology, as well as persons suffering from mental disorders.

Aspects of the importance of postoperative hepatoprotector therapy in urgent surgery

The purpose of this study was to determine the effect on the effectiveness of the correction of enteric insufficiency syndrome in patients with urgent surgical pathology included in the scheme of complex therapy Remaxol. The results of complex therapy of 227 patients (98 people with common peritonitis and 129 patients with acute intestinal obstruction) were analyzed. 128 patients of the main group in the postoperative period were included in the therapy scheme Remaxol: intravenously drip in a daily dose of 400 ml at a rate of 40 drops per minute, a course of -5 days. Patients of the control group (99 people) received standard treatment. The study is devoted to the role of postoperative hepatoprotective therapy in the treatment of patients with urgent surgical pathology. The main attention is paid to the hepatoenteric link of the pathogenesis of polyorganism insufficiency. This approach gives hope for a reduction in the risk of abdominal sepsis and a reduction in mortality among patients with acute abdominal pathology. The study found that in patients with acute abdominal pathology, an increase in the severity of enteric insufficiency syndrome due to toxic aggression and bacterial translocation can lead to hepatic dysfunction. Consequently, the implementation of hepatoprotective therapy is a pathogenetic link in the complex treatment of urgent surgical patients. The obtained results allowed to draw a number of conclusions. In particular, it has been established that the use of hepatoprotective therapy in the complex medical treatment of patients with acute abdominal pathology makes it possible to stop hepatorenal syndrome by the 5th day, and the syndrome of enteric insufficiency by the 7th day. Earlier relief of hepatic dysfunction and enteral insufficiency syndrome due to hepatoprotective therapy allowed to reduce the incidence of infectious complications to 9.7%, to reduce the lethality to 9.4% and to shorten hospitalization from 17.29 to 1.734 to 12.14±1.385 bed/day.

Гострі тромбоемболічні ускладнення у пацієнтів з хірургічною патологією органів черевної порожнини

Частота виникнення гострих тромбоемболічних ускладнень (ГТЕУ) щорічно збільшується та складає понад 100 випадків на 100 000 населення. В останні роки ГТЕУ стали займати провідне місце серед післяопераційних за рахунок впровадження нових хірургічних технологій, удосконалення техніки операційних втручань, високого рівня сучасної анестезіології та інтенсивної терапії, які привели до зниження операційної летальності та зменшення виникнення специфічних післяопераційних ускладнень. Незважаючи на різноманіття запропонованих схем щодо призначення антикоагулянтів із метою профілактики виникнення ГТЕУ, кількість виникнення останніх викликає необхідність більш детального вивчення факторів ризику ГТЕУ та удосконалення існуючих схем профілактики й лікування цієї патології. Проведено статистичний ретроспективний аналіз результатів лікування пацієнтів із гострою хірургічною патологією органів черевної порожнини, які перебували на стаціонарному лікуванні в КЗ “ШМКЛ” ДОР” у 2013–2015 рр. За результатами аналізу медичної документації: загальна кількість пацієнтів із ГТЕУ (ТЕЛА) – 72 (0,43 %), кількість пацієнтів, яким діагноз було встановлено під час лікування, – 34 (47,2 %), під час патологоанатомічної експертизи – 38 (52,8 %); у 51 пацієнта ТЕЛА виявилась безпосередньою причиною смерті, 21 пацієнта вилікувано консервативними методами у відділенні інтенсивної терапії. У пацієнтів із невідкладною хірургічною патологією, особливо з онкологічною патологією, необхідно визначати фактори ризику розвитку ГТЕУ, призначати профілактику або лікування останніх відповідно до затверджених стандартів (протоколів) надання медичної допомоги.