[Diagnostic difficulties in a patient with a combined gunshot injury involving non-penetrating abdominal wound and injury of superficial femoral artery]. / Sochetannaya ognestrel'naya travma bedrennoi arterii i nepronikayushchego raneniya zhivota.

Non-penetrating gunshot abdominal wounds are rare in peacetime and mainly caused by firearm traumatic weapons. The main therapeutic measure in this case is primary surgical debridement with adequate drainage. At the same time, such injuries may be accompanied by damage to internal organs. Timely diagnosis of these lesions may be difficult, and surgical treatment may be necessary. We report a patient with combined gunshot injury, damage to superficial femoral artery and non-penetrating abdominal wound followed by contusion and necrosis of small bowel. When providing medical care in patients with non-penetrating gunshot abdominal wounds, one should remember possible damage to internal organs due to high kinetic energy of the wounding projectile resulting contusion-induced necrosis.

[Advantages of laparoscopic technologies for blunt abdominal trauma: a systematic review and meta-analysis]. / Preimushchestva laparoskopicheskikh tekhnologii pri zakrytoi travme zhivota (sistematicheskii obzor i metaanaliz).

OBJECTIVE: To analyze the effectiveness of laparotomy and laparoscopy in the treatment of patients with blunt abdominal trauma. MATERIAL AND METHODS: Literature searching was conducted in accordance with the recommendations «Preferred Reporting Items for Systematic Reviews and Meta-Analyses¼ between January 2015 and August 2021. We used the electronic databases PubMed, Cochrane Library, Scopus, eLibrary. RESULTS: Laparoscopy reduces hospital-stay, postoperative morbidity and mortality in hemodynamically stable patients with blunt abdominal trauma compared to laparotomy. CONCLUSION: Further systematic reviews and meta-analyses of randomized controlled trials are required to obtain high quality data.

[Reality and prospects of sepsis epidemiology research]. / Real'nost' i perspektivy izucheniia épidemiologii sepsisa.

Current foreign and Russian literature for sepsis epidemiology is reviewed. There is advanced incidence of sepsis in developing countries among young people as a rule. Absent high-quality epidemiological studies lead to overdiagnosis of sepsis and increased morbidity. National and territorial screening and diagnostic programs for sepsis became possible with introduction of new recommendations 'Sepsis-3'. Thus, there is a possibility to systematize regular epidemiological studies devoted to sepsis.

[Law and educational components of patient's safety in surgery]. / Pravovye i obrazovatel'nye komponenty bezopasnosti patsientov v khirurgii.

AIM: To evaluate law and educational components of patient's safety (PS) in surgery. MATERIAL AND METHODS: In order to analyze complex causes of adverse outcomes in surgery we performed an interviewing of 110 surgeons, 42 emergency physicians and 25 health care managers. The main keynote consisted in assessing law and educational components of PS. RESULTS: The study revealed significant professional shortcomings in law PS level and low educational and motivational activity of physicians of all specialties. CONCLUSION: Multi-faceted nature of PS problem requires multidisciplinary training of modern surgeons not only in the knowledge of key risk factors for adverse outcomes, but also in satisfaction of non-medical expectations of patients. Due to numerous objective reasons Russian surgical school should have the opportunity not to blindly copy the experience of our foreign colleagues, but to scientifically substantiate the development of own national security system both for surgical patients and medical workers themselves.

[The definition of sepsis. 25-year experience of concept development]. / Chto takoe sepsis: 25-letnii opyt razvitiia kontseptsii.

The review, presented in chronological order the stages of formation of the modern definition of sepsis syndrome, since the recommendations of the conciliation conference ACCP/SCCM (1991), the experience of the practical use of which has been extensively critically assessed in future studies. As a result, it formed a strong opinion that the global challenge of early diagnosis of sepsis, under the previously proposed definitive categories have not been solved, moreover, in the scientific community formed a firm belief in the need to make fundamental changes in the definition of the term 'sepsis'. As a result, in 2016 the scientific community were presented the recommendations of the working group 'Sepsis-3', in which sepsis is defined as life-threatening organ dysfunction due to dysregulated response to infection, and fundamentally distinguish them from the former, is a laconic definitions and availability of diagnostic criteria. National expert community to analyze, discuss and define the field of clinical testing 'Sepsis-3' in the Russian Federation.

[A structured look at the problem of patients' safety in surgery]. / Strukturirovannyi vzglyad na problemu bezopasnosti patsientov v khirurgii.

AIM: To study surgeons' awareness about safety of patients in surgery and to determine necessary educational measures in this area. MATERIAL AND METHODS: 110 surgeons were interviewed. Mean length of work was 16.1±0.97 years. 88.2% of surgeons worked at hospitals. 47.3% of surgeons were engaged elective surgery. RESULTS AND DISCUSSION: Previously 55.5% of respondents were involved into conflict with patients. A half of respondents are familiar with WHO program «About patient' safety¼ and key issues of patient' safety during prevention of postoperative thromboembolic and infectious complications. 76% of respondents have the possibility to use videoendoscopic technologies, but only 36% of them realize these techniques. Up to 33% of respondents consider to be studied at certification cycles only. Many surgeons use the Internet as the main source of information. CONCLUSION: Current tendencies of surgical development require to focus on perioperative safety and the need for intensive research of the technologies of surgical patients' safety.

[Optimization of prophylaxis of hypercoagulation complications in oncological surgery].

The authors investigate the results of prophylaxis of venous thromboembolic complications (VTC) during 24 years in onco- logical surgery. The multicentric study shows that common frequency of occurrence of such VTC was reduced due to period of routine prophylaxis of VTC to 3.4%. The strategy of active revision and escalation of preventive measures in the third period of study in comparison with the second period resulted in the decrease of VTC. Patients with moderate risk degree had the results from 3.2% to 1%, patients with high risk degree moved from 4.1% to 13%. The fatal thromboembolism of the lung artery was 0.1%.

[Endovascular treatment of a large aneurysm of the splenic artery using the Gianturco spirals].

A splenic artery aneurysm is a rarely encountered disease typically proceeding symptom-free and associated with a relatively high lethality rate, should a rupture occur. Currently, various types of endovascular treatment for this nosological entity are used widely. The article deals with a case of successful embolization of a large aneurysm of the splenic artery by means of the Gianturco spirals. The minimally invasive nature and high efficacy of this method make it possible to regard it as one of the therapeutic modalities for treating splenic-artery aneurysms.

[Pharmacological neuroprotection against brain damage in ischemiai/reperfusion experiment].

Experiment carried out on laboratory animals (rats) were aimed at comparative evaluation of the effect of several neuroprotective drugs under the conditions of model brain ischemia-reperfusion. The experimental methods included staining of brain tissue sections by hematoxiline-eosine, Nissl staining, and expression of NOS1, NOS3, TRAIL by imunnohistological means. The intensity of damage in various parts of brain and the nature of apoptosis without neuroprotection and with popular neuroprotectors (cytoflavin, actovegin, mexidol) and a test drug at the stage ofpreclinical trial (AKF-90-7) were evaluated. Characteristic cytotoxic (coagulative pycnomorphic and colliquative necrosis of neurons) and vascular (hemostasia, erythropedesis) changes were revealed. The neuroprotective effectof drugs decreases in the following order: AKF-90-7 > cytoflavin > actovegin > mexidol.

[One-row continuous suture in abdominal surgery]. / Odnoriadnyi nepreryvnyi shov v abdominal'noi khirurgii.

One-row continuous suture (OCS) was used in 3605 patients while placing anastomoses in different parts of the digestive tract, extrahepatic bile ducts and pancreas as well as suturing after gastrostomy and choledochotomy. Two techniques of OCS were used. In 526 patients OCS was used for biliary tract surgery with complications rate 1.3%. In surgery of the stomach and small intestine OCS was used in 2606 patients; the insufficiency rate of stomach and small intestine anastomoses was equal (0.04%). In surgery of colon and rectum OCS was used in 405 patients; insufficiency rate was 1.5%. In surgery of the pancreas this suture was used in 70 patients without complications after surgery. Analysis of the data shows high reliability of OCS for anastomoses in abdominal surgery and allows to recommend its wider use in clinical practice.

[Comparative aspects of the diagnosis of diseases of organs of the hepato-pancreatico-duodenal zone]. / Sravnitel'nye aspekty diagnostiki zabolevanii organov gepatopankretoduodenal'noi zony.

The results of investigations the hepato-pancreatico-duodenal organs are analysed. High diagnostic effectiveness of the ultrasound examination in acute cholecystitis (95.5%) is demonstrated. In chronic calculous cholecystitis and in choledocholithiasis the ultrasound examination appeared to be accurate in 97.0% and 84.2% of cases respectively. Retrograde cholangiopancreatography was the most informative method for detection of the concrements in choledochus (effective in 94.4% of the cases). The diagnostic effectiveness of the ultrasound examination and laparoscopy in detection of mechanical jaundice and acute pancreatitis are considered to be equal. Ultrasound examination, retrograde cholangiopancreatography, laparoscopy appeared to be the most accurate and informative methods in diagnosis of the diseases of the organs of hepato-pancreatico-duodenal zone. The role of the X-ray examination decreased. At the same time the significance and reliability of intraoperative cholangiography has been stressed.