[New possibilities in antibacterial treatment of intra-abdominal infections caused by multiresistant microflora]. / Novye vozmozhnosti antibakterial'noi terapii intraabdominal'nykh infektsii, vyzvannykh polirezistentnoi mikrobnoi floroi.

AIM: To determine the place of new drugs with activity against multidrug resistant strains of microorganisms in the treatment of complicated intraabdominal infections. MATERIAL AND METHODS: The incidence and distribution of pathogens isolated from intra-abdominal specimens in patients with intra-abdominal infections are analyzed. RESULTS: The current situation on the growth of resistant strains among pathogens causing intra-abdominal infections is rewied. New combined drugs for the treatment of multidrug resistant infections - ceftolozane/tazobactam and ceftazidim/avibactam plus metronidazole, has been suggested. Their potential role in empiric and targeted antibacterial treatment of complicated intraabdominal infections is defined. CONCLUSION: Taking into consideration local monitoring data and risk factors of multi resistant strains Ceftolozane/tazobactam in combination with metronidazole can be used in empiric regime of treatment. Due to the high activity on carbapenem resistant strains of Klebsiella pneumonia and the lack of alternatives, it is advisable to use Ceftazidim/avibactam for the targeted therapy.

[Compression anastomoses with nikelid-titanium rings in peritonitis]. / Kompressionnye anastomozy nikelid-titanovymi kol'tsami pri peritonite.

AIM: To introduce into clinical practice compression anastomosis with nikelid-titanium rings (NTR) with shape memory in advanced peritonitis patients who need for intestinal resections. MATERIAL AND METHODS: Seventy-six procedures of interintestinal anastomoses with NTR (Günter-Ziganshin implant) have been analyzed for the period 2011-2017. Interventions were carried out for widespread peritonitis. In all cases a unified technique of anastomosis was used by applying an implant in the form of a 'clerical clip'. There were following procedures: gastroenterostomy resection for its failure - 5; small intestine resection followed by interntestinal anastomosis - 36; ileotransverso- or colocolostomy - 35. RESULTS: Mean time of enteroenterostomy was 2.6±0.98 min. If elective re-laparomy was supposed, laparostomy was formed followed by sanation within 48 hours. In 55% of patients 3-5-fold elective sanations were performed. Adequacy of compression anastomoses was assessed clinically according to the nature of drainage output and visually during redo surgery. There were 11 (14.5%) deaths: 9 (12%) patients had APACHE-II score over 20. Macro- and microscopic analysis of intestinal specimens and interintestinal anastomoses with nikelid-titanium rings showed complete impermeability and no visual defects. Microscopically neutrophilic leukocyte infiltration and increased number of fibroblasts were observed as the evidence of regenerative processes activation. Implant rejection time was 7.8±1.4 days. CONCLUSION: The use of compression anastomoses in case of advanced peritonitis reduces the risk of anastomosis failure to 3% and decreases time of surgery that reduces intraoperative aggression and improves outcomes in patients with prognostically unfavorable outcomes.

[Role of correction of the syndrome of intestinal failure and abdominal hypertension in the prevention of infection of pancreatic necrosis]. / Rol' korrektsii sindromov kishechnoi nedostatochnosti i vnutribryushnoi gipertenzii v profilaktike infitsirovaniya pankreonekroza.

UNLABELLED: The number of patients with acute pancreatitis and pancreatic necrosis has been steadily increasing. Mortality in infected pancreatic necrosis remains high. AIM: To develop measures to prevent infection of pancreatic necrosis by timely correction of intra-abdominal hypertension and the syndrome of intestinal failure. MATERIAL AND METHODS: Developed a package of measures, consisting of early intestinal lavage and enterosorption, intravenous highdoses of octreotide, epidural blockade, adequate detox and the start of effective antimicrobial therapy. Comparative evaluation of clinical, laboratory and instrumental data in the primary (n=50) and control (n=50) groups. RESULTS: In the main group pancreatogenic sepsis occurred in 10%, control 18%. Mortality, respectively, was 8 and 16%.

[Topical issues of organisation and implementation of forensic medical expertise]. / Nekotorye aktual'nye voprosy organizatsii i proizvodstva sudebno-meditsinskikh ékspertiz.

The shaped-up experience of management and implementation of expertise as applicable to civil and criminal cases and with respect to the requirements of new legislative acts was analyzed. Issues connected with composing a commission of experts, with the range of competence of forensic medical expert and of clinical practitioner, as well as with the content and form of the expert conclusions are under discussion.

[Difficulties in forensic medical evaluation of some forms of craniocerebral injury]. / Trudnosti v sudebno-meditsinskoi otsenke nekotorykh form cherepno-mozgovoi travmy.

Conclusions of 41 repeated expert evaluations of craniocerebral injuries within the framework of criminal and civil cases investigation are analyzed. Some aspects of clinical and forensic medical diagnosis of lethal and nonlethal injuries to the head, evaluation of the quality of medical care, and qualification of the severity of harm to health are discussed. Causes of typical expert errors and approaches to their prevention are shown.

[Effects of the hormonal activity of the thyroid gland and insulin system on the glucose level in man in the North]. / Vliianie gormonal'noi aktivnosti shchitovidnoi zhelezy i insuliarnogo apparata na uroven' glukozy u cheloveka na severe.

Correlation analysis of the findings suggests that in March an increase of the glucose level is induced by the thyroid hormones in humans living on Spitsbergen Archipelago. A liability of functional interactions among thyroid hormones, insulin, and glucose seems to be caused bias alterations in the air temperature as contrast to photoperiodicity.

[Plasticity of blood vessels of the heart and lungs in collateral circulation under conditions of high altitude]. / Plastichnost' krovenosnykh sosudov serdtsa i legkikh pri okol'nom krovotoke v usloviiakh vysokogor'ia

The combination of the collateral blood flow in the heart and lungs with effects of Alpine hypoxia and pronounced additional loads was found to allow the detecting of plastical capacities of these organs in a sufficiently full volume. The experiments were performed in 273 dogs by microscopic, macro-microscopic, macroscopic and partly functional methods. The collateral coronary blood flow (after ligation of the anterior interventricular artery) under Alpine conditions (3200 m over the sea level) combined with compensatory hyperfunction of the heart (due to stenosing of the aorta arc), gets worse as compared with the conditions of the valley. In these experiments in mountains the extra- and intraorganic anastomoses are more pronounced, the capacity of the coronary artery branches being less pronounced than in the valley. The muscle fibres grow thicker, the heart weight enlarges, the diffusion distances of capillaries increase and the ratio of the arterial bed capacity and the heart weight decreases. Under Alphine conditions (as compared with the valley) the collateral blood flow of lungs deteriorates (after ligation of two lobar branches of the pulmonary artery or of the lobar vein) against the background of additional loads (stenosing of the aorta arc or pulmonectomy). Deterioration of the collateral bloodflow is related with the combination of conditions of the alphine hypoxia with additional loads resulting in a weakening or even block of compensatory reactions of pulmonary or bronchial arteries and veins.