[Postoperative applications of the fast track technology in patients with herniated intervertebral discs of the lumbosacral spine]. / Primenenie tekhnologii bystrogo vosstanovleniya posle khirurgicheskikh vmeshatel'stv u patsientov s gryzhami mezhpozvonkovykh diskov poyasnichno-kresttsovogo otdela pozvonochnika.

TOPICALITY: The fast track technology means a complex of targeted measures involving rational preoperative preparation, minimally invasive surgery, regional anesthesia and short-acting anesthetics, and early postoperative rehabilitation. Elucidating the possibility of applying the fast track technology in neurosurgery, in particular in spinal surgery, is extremely topical. This is associated with the epidemiological data and the fact that minimally invasive techniques used in neurosurgery are highly expensive. AIM: The study objective was implementation of the fast track technology and subsequent analysis of its use after surgery in patients with herniated intervertebral discs of the lumbosacral spine. MATERIAL AND METHODS: The fast track technology following spinal surgery was implemented at the Clinical Hospital of the Presidential Administration of the Russian Federation and the Neurosurgical Department of the Clinical Hospital № 1 of the Presidential Administration of the Russian Federation using an algorithm of technology application. The study included 48 patients who underwent surgical treatment for herniated intervertebral discs of the lumbosacral spine between January and July 2015. RESULTS: An analysis of pain severity using the Visual Analog Scale demonstrated a slight decrease (10%) in a group of patients who were subjected to the fast track technology, at discharge and at 1 month after surgery; there was no difference in longer follow-up. An analysis of the functional status using the Oswestry index and Roland-Morris scale demonstrated that patients of the study group had faster and more efficient recovery and an improvement of the functional activity by 20% (p<0.05) compared to those in the control group. An analysis of patient-reported assessment of treatment quality revealed that indicators, such as awareness and pain control, in the study group were highest and amounted to 95% and higher. An analysis of the hospital stay duration showed a decrease in the number of bed-days in an integrated group by 39%, which saved 34 bed-days. CONCLUSION: The fast track technology reduces the degree of surgical aggression, increases surgery safety, and decreases the number of intraoperative complications and hospital stay duration.

[How to manage patients with atrial fibrillation in a general hospital]. / Problemy organizatsii vedeniia bol'nykh s fibriliatsiei predserdii v usloviiakh mnogoprofil'nogo statsionara.

AIM: To evaluate efficacy of use of technological charts (TC) in upgrading management and treatment safety in patients with atrial fibrillation (AF). MATERIAL AND METHODS: Two groups of AF patients were compared: 196 patients treated before introduction of TC (group 1) and 431 patients managed according to TC technology (group 2). RESULTS: In group 2 treatment duration reduced from 26.1 to 18.5 days, rehospitalizations occurred by 6% less frequently, number of unexpected side effects fell 2.5-fold, the rate of varfarin prescription for prevention of thromboembolic complications rose from 18 to 64%, the patients were satisfied with the treatment in 97% vs past 79%. CONCLUSION: TC was a tool of treatment improvement and introduction of the latest clinical recommendations into clinical practice with reference to facilities and staff qualification of an individual hospital without additional financial input.

[Risk and prevention of atrial fibrillation of non-valvular origin]. / Risk i profilaktika fibrilliatsii predserdii neklapannoi étiologii.

Atrial fibrillation (AF) is an independent risk factor for ischemic stroke. In patients with AF, cardioembolias present about 10% of ischemic strokes. Transesophageal echocardiography is an ideal instrument for diagnostics of intracardiac thrombi. An aim of the study was to find the high risk markers for stroke in patients with AF of non-valvular origin. The patients have been divided into 2 groups with and without stroke in anamnesis. To search for stroke dependence of clinical and echocardiographic high risk markers, the data were analyzed using Poly Analyst Power statistical package. In the group of the patients with stroke in the anamnesis, echocardiographic markers for high risk of thromboembolia occurred significantly more frequently. Thrombi in the left atrial or its appendage were registered in 12.5% patients without stroke in anamnesis and in 31% of those, who survived stroke. The independent risk factors for stroke were age, AF duration, left ventricular ejection fraction, diabetes mellitus and arterial hypertension.

[Results of surgical treatment of ventricular tachycardia]. / Rezul'taty khirurgicheskogo lecheniia zheludochkovykh takhikardii.

Surgical treatment is the method of choice in patients with ventricular tachycardia refractive to drug therapy. Fifty-six patients with ventricular tachycardia of various genesis were examined and separated into two groups according to the main heart disease. Group 1 was formed of patients with ischemic heart disease. In 16 of the 17 patients of this group disorders of left-ventricular contractility were revealed, the ejection fraction varied from 18 to 56% (average 32 +/- 13.8%). The attacks of ventricular tachycardia in patients of group 1 were characterized by an extremely severe course and cardioversion had to be resorted to repeatedly in order to relieve them. Endo- and epicardial mapping revealed localization of the arrhythmogenic focus on the boundary of the myocardial area involved in fibrosis. Surgical treatment was successful in 72% of cases in this group. Group 2 included patients with ventricular tachycardia of noncoronary genesis. In electrophysiological examination tachycardia could not be induced in 6 patients of this group. In 12 of 39 patients attacks of tachycardia were not attended by hemodynamic disorders. Contractility of the left-ventricular myocardium was disturbed only in 14 (36%) patient. The arrhythmogenic focus was in the right ventricle in 22 patients and in the left ventricle in 11 patients. Operation was performed on 29 patients of this group. The arrhythmogenic focus was successfully removed in 79% of cases. Surgical treatment of ventricular tachycardias of various genesis was successful in 76% of cases in follow-up periods of 2 months to 6 years.