[Carotid endarterectomy in patients with internal carotid artery thrombosis in the acutest period of ischemic stroke with COVID-19]. / Karotidnaya endarterektomiya u patsientov s trombozom vnutrennei sonnoi arterii v ostreishem periode ishemicheskogo insul'ta na fone COVID-19.

OBJECTIVE: Analysis of the results of emergency carotid endarterectomy (CEE) in internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVI) in patients with COVID-19. MATERIAL AND METHODS: During the COVID-19 pandemic (April 1, 2020 - May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019 - March 1.2020). RESULTS: In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n=1; group 2: 1.1%, n=1; p=0.81; OR=2.09; 95% CI=0.12-34.3) myocardial infarction (group 1: 2.3%, n=1; group 2: 0%; p=0.7; OR=6.3; 95% CI=0.25-158.5), CVA (group 1: 2.3%, n=1; group 2: 2.2%, n=2; p=0.55; OR=1.03; 95% CI=0.09-11.,7). ICA thrombosis and hemorrhagic transformations were not recorded. However, in view of severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n=5; group 2: 1.1%, n=1; p=0.02; OR=11.5; 95% CI=1.3-102.5). CONCLUSION: Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.

[Transposition of internal carotid artery over hypoglossal nerve in eversion carotid endarterectomy]. / Eversionnaya karotidnaya endarterektomiya: transpozitsiya vnutrennei sonnoi arterii nad pod"yazychnym nervom.

OBJECTIVE: To analyze in-hospital and long-term results of eversion carotid endarterectomy (CEE) with transposition of internal carotid artery (ICA) over hypoglossal nerve. MATERIAL AND METHODS: A cohort prospective open-label study included 919 patients with severe ICA stenosis for the period from January 2017 to April 2020. The 1st group (n=172) included patients who underwent eversion CEE with ICA transposition over hypoglossal nerve; the 2nd group (n=747) - who underwent conventional eversion CEE. ICA transposition technique included standard mobilization of the carotid arteries, cross-clamping, arterial wall incision, removal of atherosclerotic plaque and ICA translocation above the hypoglossal nerve for subsequent anastomosis. All patients were examined every 6 months. Mean follow-up period was 17.5±6.9 months. RESULTS: There were no significant between-group differences in cardiovascular morbidity. However, all complications occurred in the 2nd group (traditional eversion CEE). Nevertheless, incidence of adverse events was minimal and combined endpoint did not exceed 0.6% (n=5). Both groups were also comparable by overall incidence of cardiovascular events in long-term period. All ICA restenoses (over 70%) were symptomatic with similar incidence (4 (2.3%) vs. 18 (2.4%), respectively, p=0.83; OR 0.96; 95% CI 0.32-2.88). Mean restenosis-free period was 7.2±2.6 months. In case of significant restenosis, redo CEE with patch repair was performed. There were no cardiovascular complications. All cases of hypoglossal nerve injury occurred in the 2nd group (0 vs. 18 (100%), respectively; p=0.0001; OR 0.003; 95% CI=5.21-0.17) without ICA transposition over the hypoglossal nerve. CONCLUSION: Eversion CEE with ICA transposition over the hypoglossal nerve ensures optimal conditions for successful redo CEE in case of restenosis. This technique facilitates ICA mobilization without hypoglossal nerve injury. This aspect is valuable for successful postoperative outcome and adequate quality of life. ICA transposition is not difficult and does not require additional experience. Transposition per se is not a risk factor of ICA restenosis. Thus, ICA transposition may be routinely recommended in patients eligible for eversion CEE.

[Catheter-directed thrombolysis in iliofemoral thrombosis and aplasia of the inferior vena cava]. / Kateter-napravlennyi trombolizis pri iliofemoral'nom tromboze i aplazii nizhnei poloi veny.

Demonstrated in the article are the results of catheter-directed thrombolysis in a male patient presenting with bilateral acute iliofemoral venous thrombosis on the background of aplasia of the inferior vena cava. The incidence rate of this pathology is specified, with an emphasis on no recommendations on choosing optimal therapeutic strategy in this cohort of patients. The main causes and complications of the disease are described. The realized policy of revascularization demonstrated its safety and efficacy. The chosen method of correction resulted in a successful outcome of treatment, preventing phlegmasia cerulea dolens. This policy can be recommended as most preferred for patients with acute iliofemoral venous thrombosis on the background of aplasia of the inferior venal cava.

[Management of medical care for the victims of road accidents in traumatology centers of Saint-Petersburg].

The number of road accidents, fatal outcomes and victims exceeded in 1.5 times in Saint-Petersburg in comparison with Moscow. At the average, 600 victims were treated in each of 6 first-level traumatology centers every year. The quantity of patients, who were admitted to 3 second-level traumatology centers, numbered 10 times less. About 300 people entered to others hospitals. The lethality consisted of 15%, 20% and 37%, respectively. There are a lot of matters, that should be discussed, such as an importance of better treatment financing of multitrauma by using compulsory medical insurance system, an optimization of pre-admission treatment and a necessity of patient delivery by mobile medical team using the anaesthesiology and resuscitation.

[Application of intramedullary blocked osteosynthesis for treatment of patients with open fractures of the shin and femur in combined injuries].

Actual problems of using intramedullary blocked osteosynthesis for open fractures of the shinbones and femoral bones in patients with combined injuries are considered. The most optimal terms of operative treatment were established depending on the severity of the injuries by ISS scale and on classification of injuries of the soft tissues by Gastillo-Andersen. The schemes of antibacterial prophylactics of infectious complications are proposed both during operation and at the postoperative period. Under consideration are the questions of intraoperative boring of the bone marrow canal of the shinbones and femoral bones in severe combined injuries.

[Principles of organization of emergency care to victims of traffic accidents at the stages of evacuation under conditions of a megapolis].

The article describes organizational grounds of the system of organization of emergency care to victims of traffic accidents (TA) under conditions of a megapolis at the stages of evacuation. The principles of rendering emergency medical care in TA are considered in detail. The succession of actions at each stage is stressed. Organization of trauma centers is recommended which will be able to render specialized medical care to the victims. Special attention should be paid to the conception of trauma disease. Correct organization of rendering specialized medical care to TA victims substantially reduces lethality.