The rare thoracic complication: perforation of gastric fundus ulcer: a case report.

BACKGROUND: Gastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012,  https://doi.org/10.2169/internalmedicine.51.6823 , Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136 , Kathayanatt et al. in Lung India 37(2):174-175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17 ). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy. CASE PRESENTATION: A 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report. CONCLUSIONS: Although, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.

[Determination of calcium metabolism markers concentration in patients with calcium oxalate nephrolithiasis].

THE AIM OF THE RESEARCH: to reveal the relationship of various markers of calcium metabolism (osteopontin (OPN), parathyroid hormone-related protein (PTHrP), vitamin D, parathyroid hormone (PTH)) on the course of urolithiasis (Urolithiasis) in patients with calcium oxalate nephrolithiasis. MATERIALS AND METHODS: 100 people were examined, the following groups were included: group 1 - patients with calcium oxalate primary nephrolithiasis (n=41), group 2 - with calcium oxalate recurrent nephrolithiasis (n=39). Group 3 included conditionally healthy volunteers (n=20). The studies were carried out by the immunoenzymometric ELIZA and biochemical methods using appropriate test systems. RESULTS: in patients with recurrent nephrolithiasis, the serum PTHrP level is 54.6 (25.4-78.2) pg / ml, which is 3.7 times higher than in conventionally healthy individuals; the level of osteopontin is more than 1.5 times higher and amounts to 1.820 (0.991-2.212) pg / ml. In the group of primary nephrolithiasis, the level of PTHrP is 2-2.5 times higher than in conventionally healthy people. In patients with primary nephrolithiasis, the blood calcium level does not correlate with the level of PTHrP in the blood (r=- 0.0173, p> 0.05), as in the group with recurrent nephrolithiasis (r=0.0223, p>0.05). DISCUSSION: in patients with recurrent nephrolithiasis in the preoperative period, the serum levels of osteopontin and PTHrP in the blood serum were higher than in patients who were first diagnosed with urolithiasis, the data obtained can be used as a criterion for predicting the risk of recurrence of urolithiasis in the postoperative period. The blood calcium level does not have a statistically significant relationship with PTHrP, which allows us to assume that PTHrP has other mechanisms of influence on the development of urolithiasis, given the data obtained that the PTHrP level in patients with primary and recurrent nephrolithiasis is higher than in conditionally healthy people. CONCLUSION: Determination of the level of PTHrP and osteopontin in patients with urolithiasis allows predicting the risk of recurrence of urolithiasis at the stage of primary calcium oxalate nephrolithiasis. Determination of the level of PTHrP makes it possible to predict the risks of developing urolithiasis in conventionally healthy individuals, which can be used for targeted prevention of an unfavorable course of urolithiasis by prescribing timely adequate rational therapy and correcting the patients diet. At the same time, no correlation was found between the level of PTHrP and the level of blood calcium in patients with calcium oxalate nephrolithiasis; therefore, further studies of the role of this protein in the pathogenesis of urolithiasis are needed.

Comparative Morphological Characteristics of the Results of Implantation of Decellularized and Recellularized Porcine Skin Scaffolds.

The tissue reaction of pig skin to implantation of decellularized and recellularized dermal matrices on a formed wound defect was evaluated by histological methods on days 2, 5, 8, 16, and 20 after surgery. Differences in tissue response to different matrices were identified. In experimental wounds coated with decellularized dermal matrices, we observed the formation of a scar tissue, which required autodermoplasty on day 12 of the experiment. In wounds coated with recellularized dermal matrices, all layers of the skin completely recovered by day 20 after surgery with the formation of full dermal and epidermal layers. Our findings suggest that reparative morphological changes in the wound depend on the presence of fibroblasts in the implanted dermal matrix.

[Anticoagulant therapy in atrial fibrillation with acute coronary syndrome in real clinical practice according to the total register of acute coronary syndrome in the Krasnodar Territory].

OBJECTIVE: to analyze patients with first-time developing atrial fibrillation (AF), against acute coronary syndrome (ACS), risk factors for arrhythmia, assessment of patients' adherence to oral anticoagulant therapy 6-24 months after the ACS episode, according to the total ACS registry for the Krasnodar Territory. MATERIALS AND METHODS: A retrospective analysis of the case histories of 13,244 patients admited to the infarction departments of all setlements of the Krasnodar Territory without exception and included in the ACS registry for the Krasnodar Territory from November 20, 2015 to January 20, 2018. RESULTS: The study group of ACS with AF included 201 patients, among them 144 men (71.642%), women 57 (28.358%). The average age was 68,084 ± 9,606 years, a maximum of 85 years, a minimum of 25 years. The frequency of the following outcomes was assessed: hospital mortality, frequency of hemorrhagic, thromboembolic complications. The effectiveness of prognostic scales of development of hemorrhage CRUSADE and HAS BLED was evaluated and the expediency of prescribing extended OAT to patients with the first developed AF atack against the background of ACS after discharge from the hospital. CONCLUSIONS: Based on the obtained results, based on the data of the total ACS register for the Krasnodar Territory, we can conclude: 1. Patients with a newly developed episode of AF on the background of ACS have demographic, anamnestic data comparable with other types of AF; 2. Patients with a newly developed AF episode on the background of ACS have a more severe course of the disease, which does not affect hospital mortality, hospital complications and lethality after 6-24 months after discharge from the hospital for ACS; 3. Patients with a newly developed episode of AF on the background of ACS after discharge from the hospital do not have arrhythmia recurrences, they do not have thromboembolic complications. The decision on the duration of oral anticoagulant therapy should be carried out afer carrying out a multi-day monitoring of the ECG.

[TO THE PROTOCOL OF ANTIBIOTIC PROPHYLAXIS IN CARDIAC SURGERY.]

BACKGROUND: Guidelines recommend that duration of antibiotic prophylaxis in cardiac surgery should be no more than 48 h, but at the same time it has been suggested that a 24h or even a single dose may be sufficient. THE AIM: To define whether 24-hour antibiotic prophylaxis on the incidence of infectious complications in cardiac surgery compared to the 72-hour period. Materials andmethods. All 125 patients were operatedfrom 01.01.2014 till 01.10.2014. All preoperative, intra and postoperative data were analyzed. Group 1 (n = 56) - these patients were administered cefazolinfor 24 h antibiotic prophylaxis (3 g/day); group 2 (n = 69) -patients with cefazolin for 72 h antibiotic prophylaxis (1 g every 8 h). Pre and intraoperative characteristics were the same in both groups. RESULTS: Duration of stay in intensive care unit (ICU), postoperative hospitalization, sternomediastinitis frequency were also similar in both groups. The frequency of nosocomial pneumonia and rate ofprescription of antibiotics after antibiotic prophylaxis was significantly higher in group 1. CONCLUSION: 24-hour antibiotic prophylaxis does not increase the frequency of the surgical field's infection, but the frequency of postoperative pneumonia and change of antibiotic prophylaxis on antibiotic therapy was higher in group 1.