[Prospects of qualitative and quantitative assessment of bowel perfusion by fluorescent angiography with indocyanine green in colorectal surgery. First experience]. / Perspektivy kachestvennoi i kolichestvennoi otsenki perfuzii kishki metodom flyuorestsentnoi angiografii s indotsianinom zelenym v kolorektal'noi khirurgii. Pervyi opyt.

OBJECTIVE: To assess the possibilities of fluorescent detection system in qualitative and quantitative assessment of bowel perfusion in colorectal resections. MATERIAL AND METHODS: From May to August 2023, a single-center pilot cross-sectional unblinded study with inclusion of 18 patients with colon cancer (of left-sided - 12, of right-sided - 6, mean age - 72.9 years, m/w - 61/39%) was conducted. All patients underwent laparoscopic colorectal resections with extracorporeal stage of bowel transection. The evaluation of the bowel's ICG perfusion was conducted to assist in decision making about the level of its resection. Qualitative (visual) assessment was carried out in all 18 patients, in one patient twice, quantitative assessment of perfusion was conducted in 8 patients (left-sided resections - 6, right-sided hemicolectomy - 2). The qualitative evaluation was performed in real time on the analysis of the color gradient. The time parameters and fluorescence intensity at different level proximally and distally from the resection line were quantitatively estimated: Tstart - time of occurrence of minimal fluorescence in the areas of interest after the ICG injection (sec); Tmax - time to achieve maximum fluorescence intensity after the ICG injection (sec); Tmax-start - time interval between Tstart and Tmax, Imax - level of maximum fluorescence intensity (I). RESULTS: Visual qualitative analysis of fluorescence revealed unsatisfactory perfusion characteristics (black, dark-gray color) in the area planned by the surgeon to anastomose the bowel in 3 of 18 patients (16.6%). When analyzing the quantitative data of this group of patients, there was a 2-6-fold decrease in Imax level, and one patient had an increase in Tmax-start at the level of intended resection compared to the bowel's sections in the favorable zone. In all cases, the final bowel transection was conducted in the area of good perfusion. There was no clinical evidence of anastomotic dehiscence in the study group. CONCLUSION: Intraoperative evaluation of bowel perfusion is an important component of safe anastomosis formation in colorectal surgery. The use of ICG-FA allows to conduct qualitative and quantitative assessment of tissue perfusion of the bowel in order to assist in making intraoperative decisions. Quantitative evaluation of fluorescence provides more objective information about perfusion parameters. Imax and Tmax-start are the most promising quantitative indicators of local bowel's perfusion. Nevertheless, the precise interpretation of the quantitative indicators of ICG perfusion needs to be clarified.

[Surgical strategy for combined gun-shot wounds of extremities with injuries of main arteries].

An investigation of materials of treatment of 130 wounded with combined wounds (CW) of extremity blood vessels during war in Afghanistan and in counter-terrorist operations in the Northern Caucasus has shown that the specific feature of surgical treatment of wounds of the extremity arteries associated with severe wounds of other localizations consists in limited possibilities to save the extremities. The scale MESS of a severity of extremity wounds was improved. It allowed a reliable prognosis for wounded with gunshot injuries of the arteries concerning necessary amputation (97%) or a possibility to save the extremity (100%). A strategy of surgical treatment of CW of the extremity arteries is proposed on the basis of an estimation of the general severity of the trauma, the V.A. Kornilov classification of the severity of acute ischemia and a FS-MESS scale of extremity injuries.

[Surgical strategy for wound to the neck under conditions of medical institutions in peace time].

The work is based on a clinical-statistical analysis of results of treatment of 316 wounded with injuries to the neck got in different situations in St. Petersburg and admitted to the clinic of field surgery and other medical institutions of the city. It was found that unfavorable outcomes of treatment of neck wounds of peace time depend on the character of the neck wound, adequacy of medical aid at the pre-hospital period, the decision on the medico-diagnostic strategy. The decision on the medico-diagnostic strategy for wounded to the neck must depend on the diagnostic resources of the medical institution and the succession and volume of the medico-diagnostic measures must be chosen depending on the general state, life-threatening consequences of the neck wound and severe associated injuries of other anatomical areas.

[Diagnosis and surgical strategy in injuries of the heart and pericardium]. / Diagnostika i khirurgicheskaia taktika pri raneniiakh serdtsa i perikarda.

Results of the emergency diagnosis and surgical treatment of wounds of the heart and pericardium were summed up in 207 wounded during twenty years of work. It was found that injuries of the heart and pericardium were diagnosed in 42% of cases according to clinical symptoms, while emergency thoracotomy during the first minutes after admission to the surgical hospital was performed in 55-60% of wounded to the heart. About half wounded at the moment of admission to the hospital were at the state of relative stabilization of hemodynamic indices and had no clinical symptoms of wounds to the heart. In this group of patients injuries of the heart and pericardium were diagnosed on the basis of additional investigations, extrapleural pericardiotomy (fenestration of the pericardium) being most reliable. The results of treatment of wounded to the heart can be improved at the expense of acute surgical strategy which is determined by the stable state of the wounded, character of the myocardium injury and associated wounds.

[Rendering surgical care to wounded with neck wounds in an armed conflict]. / Okazanie khirurgicheskoi pomoshchi ranennym v sheiu v vooruzhennom konflikte.

The results of rendering of the medical care (the first aid, qualified and specialized) obtained in 172 servicemen with neck injuries who stayed in Republic of Chechnya during the period from 09.08.1999 to 28.07.2000 were analyzed. Basing on the results of analysis and experience of casualties' treatment the authors discuss the problems of sequence and volume of surgical care in this group of casualties with reference to available medical evacuation system, surgical tactics at the stage of specialized care. They also consider the peculiarities of operative treatment of the casualties with neck injuries.