[Consequences of the COVID-19 pandemic for surgical service]. / Posledstviya pandemii COVID-19 dlya khirurgicheskoi sluzhby.

The COVID-19 pandemic has a serious impact on surgical service, emergency and especially elective surgical care. Many hospitals were re-designated as COVID hospitals due to resource constraints and large number of COVID-19 patients requiring hospitalization. This led to cancellation or postponement of scheduled surgeries. In addition, restrictions in elective surgery were associated with the risk of infection in surgical patients. Various protocols and guidelines recommended non-surgical or outpatient treatment if possible. During the pandemic, postoperative morbidity and mortality in emergency surgery increased significantly. The same is true for elective surgeries in 7-8 weeks after previous coronavirus infection. The authors analyze the issues of organization, priorities for restoration of elective surgery and criteria for patient selection.

[Decellularized cadaveric human artery for substitution of connective tissue and smooth muscle defects on the example of tunica albuginea of penis (experimental work)]. / Ispol'zovanie detselliuliarizirovannoi trupnoi arterii cheloveka dlia zameshcheniia defektov soedinitel'notkannykh i gladkomyshechnykh struktur na primere belochnoi obolochki polovogo chlena (éksperimental'naia rabota).

AIM: To analyze experimentally the outcomes of xenotransplantation (cadaveric artery, decellularized cadaveric artery) for tunica albuginea defects repair. MATERIAL AND METHODS: The study included 60 chinchilla rabbits. Rabbits underwent local replacement of tunica albuginea. Animals were divided into 2 groups (group 1 - human cadaveric artery, group 2 - decellularized cadaveric artery). The result was considered after 7, 14 and 30 days postoperatively. RESULTS: Tendency to stasis, sludge-phenomenon and ultimately development of fibrosis of transplantation area were histologically observed in group 1 after 30 days. In group 2 luminal surface of decellularized artery was smoothed, fibrin and blood elements were absent. In group 1 mean level of C-reactive protein was 3.86±0.43, 1.17±0.2 and 0.73±0.16 mg/L after 7, 14 and 30 days respectively. In group 2 the same values were 0.33±0.03, 0.23±0.03 and 0.11±0.02 mg/L. Differences were significant (t =-46.28, t = -25.95, t = -14.84; p<0.0001).

[Buccal mucosa substitution urethroplasty in a patient with an extensive urethral stricture].

Urethral strictures are one of the most common reasons to see a urologist and are considered a socially significant disease. Management of urethral strictures is one of the challenging issues in urology. The article presents a case of a patient with extensive iatrogenic stricture of the penile urethra. The patient underwent penile augmentation urethroplasty using buccal mucosa resulting in the restoration of the whole length of the urethral lumen and non-obstructive urination according to uroflowmetry findings.

[Topical respiratory strategies in neurocritical care]. / Aktual'nye respiratornye strategii v neiroreanimatologii.

Management of the respiratory tract and maintenance of adequate gas exchange are the basic goals of critical care. Injury to the nervous system is often accompanied by development of respiratory disorders. On the other hand, changes in the gas composition of arterial blood can cause brain damage. In addition, approaches to the patient with respiratory failure, which are used in general critical care and neurocritical care, may differ. The presented literature review is devoted to modern respiratory strategies used in neurocritical care.

[Penile revascularization using laparoscopic mobilization of the inferior epigastric artery].

The article presents a case of successful penile revascularization using laparoscopic mobilization of the inferior epigastric artery in a 35 y. o. patient with penile arteriovenous insufficiency.

[Surgery for intractable epilepsy in a patient with encephalocele of the temporal lobe: a case report]. / Khirurgicheskoe lechenie farmakorezistentnoi épilepsii u patsientki s éntsefalotsele visochnoi doli (klinicheskoe nabliudenie i obzor literatury).

We describe a case of surgical treatment of intractable temporal epilepsy in a female patient with congenital middle cranial fossa encephalocele. We present clinical-anamnestic and neuroimaging data as well as the microscopic and macroscopic pictures of encephalocele. We analyze outcomes of surgery for this pathology, which have been reported in the literature. To date, there have been a few articles on this subject in the domestic literature. The development of neuroimaging techniques and a growing number of verified encephalocele cases promote the widespread use of surgery for treatment of intractable epilepsy. Congenital encephalocele should be considered in the differential diagnosis of intractable temporal epilepsy, and, if verified, surgical treatment is the method of choice in most cases.

[HYPOTHERMIA INFLUENCES ON OXYGEN TENSION IN THE BRAIN PARENCHYMA IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE].

Aneurysmal subarachnoid hemorrhage is a serious medical and social problem. The main physiological mechanisms that determine secondary brain damage in this patients are intracranial hypertension, cerebral vasospasm, dysfunction of autoregulation mechanisms, violation of liquorodynamics and delayed cerebral ischemia. The multimodal neuromonitoring for prevention and timely correction ofsecondary brain injury factors has become routine practice in neuroICU. Measurement of oxygen tension in the brain parenchyma is one of neuromonitoring options. During the years of intensive use of this method in clinical practice the reasons for reducing the oxygen tension in the brain parenchyma were revealed, as well as developed and clinically validated algorithms for correction of such conditions. However, there are clinical situations that are difficult to interpret and even more difficult to make the right tactical and therapeutic solutions. We present the clinical observation of the patient with aneurysmal subarachnoid hemorrhage, who had dramatically reduced brain intraparenchymal oxygen pressure although prolonged hypothermia were used. Despite this, the outcome was favorable. The analysis allowed to assume that the reason for this decrease in oxygen tension in the brain parenchyma could be hypothermia itself

[AUTONOMIC NERVOUS SYSTEM AND ITS IMBALANCE IN NEURO INTENSIVE CARE UNIT].

The autonomic nervous system (ANS) provides homeostasis due to the innervation of the secretory glands, smooth muscle and cardiac muscle. Higher centers of the ANS (primarily the hypothalamus, some centers of the brain stem and limbic system) form a integrative network, which plays a key role in coordinating the functioning of the endocrine, immune system and other parts of the central nervous system. Intracranial centers of the ANS are responsible for the consciousness, behavioral, emotional, and other components of the higher nervous activity. Thus, the significance of the ANS can't be overestimated. At the same time today in neurointensive care there are no clear criteria for ANS dysfunction, we don't have universally recognized monitoring facilities for ANS and approaches to targeted therapy of its disorders. This paradox is even more important as in the pathogenesis of some critical conditions such as neurogenic pulmonary edema, stunned myocardium, cardiomyopathy Takotsubo lies precisely ANS imbalance. This review devoted to the ANS and some problems associated with its imbalance.

[Comparative effectiveness of Marmar technique and laparoscopic clipping of testicular vein in surgical treatment of varicocele in athletes].

INTRODUCTION: Varicocele is one of the most common diseases among men and a proven cause of male infertility, which is directly proportional to its clinical prominence. The aim To evaluate the immediate and long-term outcomes of different surgical methods to treat varicocele in athletes. MATERIALS AND METHODS: A total of 165 athletes were treated for varicocele. Of them, 82 patients (group 1) underwent varicocele surgery using Marmar technique and 83 patients (group 2) were treated by laparoscopic clipping of testicular vein (endoscopic analogue of Ivanissevitch open surgery). RESULTS: The incidence of postoperative complications and relapse at 6 months after surgery in groups 1 and 2 was 1.2% and 8.4%, and 4.9 and 14.5%, respectively. The study findings showed a statistically significant (p<0.05) improvement in the spermogram parameters in both groups compared with preoperative values. CONCLUSIONS: The length of hospital stay and postoperative rehabilitation period were shorter in patients after Marmars varicocelectomy than in patients of group 2. Besides, Marmar technique for varicocele was cost-effective and justified.

[Minimal invasive treatment of bleeding of esophagus and stomach varices in patients with portal hypertension].

The results of examination and treatment of 57 patients with liver cirrhosis and portal hypertension with bleeding from the varices of the esophagus and stomach, admitted in the Clinical Hospital No 29 named after N.E. Bauman in Moscow. The Studies show that the efficiency of the radio-endovascular embolization for bleeding varices of the esophagus and the stomach is 89,5% of patients.The use of prolonged infusions of vasoconstrictors in combination with venous embolization helps further reduce portal hypertension and has a hemostatic effect in 10.5% of patients. The study shows the therapeutic tactic in bleeding varices of the esophagus and the stomach should be individualized and based on clinical-endoscopic prediction of rebleeding according to the severity of blood loss and patient's condition.

[Pathomorphological alterations in the liver and small intestine in experimental modelling of abdominal compartment syndrome].

Review of experimental study of pathomorphological alterations of hepar and small intestine of rats under modeling of intra-abdominal hypertension of up to 20 mm. Hg within 6, 12, and 24 hours. Dissection of liver pulp shows the signs of venous stasis, dystrophic alterations of liver pulp, focal bleedings; visceral edema is observed on the intestine wall, plethora and bleedings. At that pathomorphological alterations augmented towards the end of experiment.

[Syndrome of intraabdominal hypertension among ill persons with peritonitis].

The article presents results of measuring and dynamics of intraabdominal tension (IAT) by 108 patients with peritonitis. Was proved that in conditions of peritonitis IAT increases more then 10 mm Hg in 77.8% cases, also syndrome of hypertension was marked in 8.3% cases. Was found a fixed statically important correlation connection between sign of IST and frequency of inflammatory process of stomach and after stomach space (p < 0.05), and also between level of IAT and gravity of condition on scale APACHE II, SOFA (p < 0.05). Using of method of laparostomya in combination with intubation of bowel is the most effective method, directed on prophylaxis and treatment of intraabdominal hypertension among ill persons with peritonitis.

[Syndrome of intraabdominal hypertension in patients with destructive forms of pancreatitis].

Results of intraabdominal pressure examination in 129 patients with acute destructive pancreatitis are presented. It is demonstrated that pancreonecrosis was associated with intraabdominal pressure rise in 78% cases, and intraabdominal hypertension syndrome developed in 9.3% patients. Prolonged intraabdominal hypertension in patients with advanced pancreonecrosis requires laparotomy. Correlation between intraabdominal hypertension and diffusion of pancreatogenic intra- and retroabdominal inflammation, and also between intraabdominal hypertension and condition severity according to APACHE II scale is demonstrated.

[Can the intra-abdominal hypertension be the cause of poly-organic insufficiency during the destructive pancreatitis?].

The results of measurement and dynamics of intra-abdominal pressure obtained in 129 patients with acute destructive pancreatitis are presented. It was revealed that in 78% cases the pancreatonecrosis is accompanied by increase in intra-abdominal pressure (IAP); the intra-abdominal hypertension have developed in 9,3% patients. The prolonged intra-abdominal hypertension in the patients with progressive pancreatonecrosis requires the performance of laparotomy, which contributes to decrease in intra-abdominal pressure. The dependence between IAP value and dissemination of pancreatogenic inflammatory process in abdominal cavity and retroperitoneal space as well as between IAP level and condition gravity according to APACHE II scale was revealed.