Background. Children with HL are forced to undergo repetitive studies accompanied by radiation, which increases radiation doses. High radiation during studies in children is a huge problem, since the risk of developing complications for patients of this age is much higher than for adults.

Purpose. To optimize the computed tomography protocol in pediatric Hodgkin's lymphoma for radiation dose reduction by reducing the scanning phases.

Material and methods. CT scan analysis of 75 children with newly diagnosed, verified Hodgkin’s lymphoma was performed at the primary staging and after treatment. All studies were performed with contrast enhancement, scanning on a 16-slice computed tomography in the precontrast, arterial, venous and delayed phases. The radiation dose and the diagnostic value of each phase were assessed.

Results. Using the reduced CT protocol for primary patients allows significantly reduce the cumulative ED by 3.8 times and by 3.6 times for dynamic scanning. Using the abbreviated protocol does not reduce the diagnostic value of CT.

Conclusion. The proposed low-dose CT protocol with the reduction of contrast enhancement phases allows to obtain CT images with good diagnostic quality and reliably reduces the radiation dose to the child. 

Introduction. Arterial hypotension is the reasonable cause for intravenous injections of crystalloid solutions. However, as far as this statement is fair in the patients that underwent extensive scheduled thoracic operations at that moment is not defined.

Aim. To reduce the number of complications in patients following thoracic operations by definition of optimum strategy for correction of postoperative hypotension.

Methods. The retrospective analysis of 154 patients who were divided into 2 groups was conducted. In 58 patients, for correction of arterial blood pressure we used noradrenaline, in other cases (96 patients) noradrenaline in combination with infusion therapy was administered. The comparative analysis of the perioperative volemic status, levels of hemoglobin, urea, creatinine, a lactate, glucose, paO2 , paCO2 , ScvO2 , SaO2 , pvCO2 -paCO2 , duration of noradrenaline application and also a range of the postoperative complications was carried out.

Results and conclusions. It is revealed that correction of hypotension with crystalloid solutions in thoracic patients results at and conclusions increased risk of pneumonia development. At the same time, infusion therapy in the early postoperative period in thoracic patients did not reduce the risk of intense kidney failure development. Severity of postoperative complications according to Clavien-Dindo classification was higher in patients who had infusion therapy. At the same time, duration of vasopressor support showed no change. 

Aim. Atrial fibrillation (AF) is connected with the increased risk of stroke, mortality rate and costs for health care around the world. Earlier the predictive role of a dyslipidemia was not estimated in available literature.

Material and methods. This retrospective study included 13,244 patients who consistently referred to Scientific Research Institute – Regional Clinical Hospital no. 1, Krasnodar, with acute coronary syndrome from November 20, 2015 to November 20, 2017. Primary final points were defined both as mortality from all reasons and from the cardiovascular events. Secondary final points were defined as repeated myocardial infarction. Follow up period was 12 months.

Results. In the studied group ACS + AF we included 201 patients. This group of patients was divided into 3 subgroups: patients with originally developed AF episode accompanied with acute coronary syndrome, included 52 patients (Group 1), patients with constant AF form, included 96 patients (Group 2) and patients with paroxysmal or persistent atrial fibrillation registered before ACS episode, included 53 patients (Group 3). In Group 1 the level of the general cholesterol and low-density lipoproteins (LDL) was authentically higher. Among the survived and discharged patients after ACS episode there were 45 patients in Group 1, in Group 2 and 3 there were 81 and 47 patients, respectively. In 12 months the general mortality rate was comparable, however, the frequency of lethal and non-lethal myocardial infarction development was authentically higher in Group 1.

Conclusions. Higher initial levels of the general cholesterol and LDL are connected with development repeated MI that does not affect the general mortality rate. However, these data are obtained in a small selection of patients and demand a further investigation. 

Introduction. The analysis of clinical experience for using biodegradable wound coating based on «HitoPran» chitosan in treatment of patients with burn trauma is presented.

Background. Our work included an analysis of clinical experience for using a biodegradable wound coating based on «HitoPran» chitosan for surgical treatment in patients with local and common thermal burns.

Material and Methods. A treatment analysis was conducted in 46 male and female patients, aged from 1 to 63 years with thermal burns on an area of 5 to 56% of the body surface. All injured were given surgical treatment in the complex with the use of low-temperature air plasma of arc discharge with atmospheric pressure in the conditions of our burn center in 2017–2018. Depending on the area and depth of the lesion, the patients were divided into two clinical groups: with local burns of II degree and area to 5% of the body surface and common burns of II and III degree and body surface 10% and more. In the course of early surgical treatment in patients with local border burns, the use of the wound coating «HitoPran» allows to achieve spontaneous epithelialization of wounds in dry environment after dermabrasion or escharotomy within the surface layers of dermis due to chitosan adhesion to the wound bottom, to reduce the number of dressings in the postoperative period. Covering skin grafts with perforation index 1:4 and 1:6 with wound «ChitoPran» coating in case of autodermoplasty in deep burn wounds provides satisfactory cellular epithelialization, reduces risk of regression of grafts, reduces consumption of wound coating and dressing material.

Conclusion. Application of Russian modern biodegradable coatings based on «HitoPran» chitosan in complex treatment in patients with local and common burns with different depth allows to optimize local treatment of burn injuries, as well as to reduce the cost of used dressing material in comparison with foreign alternatives. 

Objective. To evaluate the effect of A-PRP-therapy on reparative bone regeneration in acute limb bone fractures. 

Material and Methods. The study consisted of two parts – in the first part we studied the effect of A-PRP-therapy on the model of a comminuted fracture created in the operating room, an experimental study conducted on 40 Mature rabbits of the Flander breed, all animals were divided according to the principle of analogues into 2 groups (20 animals): in the study group – on the 5th day after osteotomy, platelet-rich plasma was injected into the fracture area, in the comparison group – the fusion occurred without the influence of any drugs. The second part presents the results of clinical testing of A-PRP-therapy, analyzed the results of treatment of 16 women with low-energy fractures of the distal radius metaepiphysis. The study group consisted of 6 patients whose surgical treatment was supplemented by A-PRP-therapy on 7, 14 days after surgery. The control group consisted of 10 patients who underwent surgical treatment without A-PRP-therapy.

Results. The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5 ± 1.1%.

Conclusion. Platelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective alternative to the methods considered. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the use of PRP-therapy to stimulate the maturation of bone calluses. 

Objective. Improvement of treatment outcomes in patients with the cholelithiasis complicated by mechanical jaundice when it is impossible to apply retrograde techniques for biliary tract decompression.

Material and Methods. From 2014 to 2017 in our hospital 1158 patients with cholelithiasis complicated by mechanical jaundice have been treated. The group consisted of 59 (5.1%) patients with initially predicted difficulties for endoscopic lithoextraction. In 12 of that group antegrade decompression was the only surgical method for completing treatment. In 2 cases the ‘rendezvous’ technique was used, and in 23 patients the antegrade decompression it was complemented with laparotomy and choledocholithotomy. In 22 patients for verification the nature of the bile-excreting ducts and the cholelithic occlusion revealed at the same time the first stage included an antegrade decompression that allowed to finish surgical treatment by an endoscopic transpapillary lithoextraction.

Results. In the main group of clinical observations for 59 patients the surgical treatment complemented with an antegrade decompression was without fatal outcomes. All patients were cured of cholelithic occlusion and recovered. In the study group with 1099 patients that were treated with only an endoscopic lithoextraction 8 patients died that showed 0.7 ± 0.2% of operational mortality. Complications, in the form of operational wounds in the main group of observations were found in 7 patients and it was 11.8 ± 4.2%. Other postoperative complications in the main group were not observed. In the control group similar wound complications were seen in 13 patients (1.2%). In the control group with 57 patients we observed intraabdominal complications which resulted in mortality (5.2 ± 0.7%). Of those postoperative reversible pancreatitis was found in 34 patients, 3 patients had fulminant pancreonecrosis, in 4 cases there was profuse bleeding from a papillosphincterotomy area, in 3 cases we observed insertion of Dormia basket at lithoextraction, septic cholangitis was in 11 and duodenum perforation with retroperitoneal phlegmon was in 3 cases.

Conclusion. Mortality in the group with antegrade treatment application for choledocholithiasis was not found. On the contrary, rather higher rate of complications in the control group testifies in advantage of the antegrade techniques for choledocholithiasis treatment in the shown cases. 

Clinical observation of the patient with legionella pneumonia which developed in the setting of hairy-cell leukosis, required use of extracorporeal membrane oxygenation for controlling life-threatening hypoxia is presented. Active diagnostic approach for identification of the etiologic agent (Legionella pneumophila, Acinetobacter baumannii) that caused pneumonia, allowed to choose an optimum set of antibacterial agents and medicines for specific therapy of hemoblastosis (BRAFV600E mutation and use of Zelboraf). After correction of respiratory insufficiency and discontinue the patient from ECMO, we could reach hematologic remission and transfer the patient to the Institute of Hematology for further treatment.

This report presents a clinical case of endovascular treatment of a rare complication – a spurious aneurysm from a linear aorto-femoral shunt. We performed implantation of a self-expandable stent graft directly into the vascular prosthesis in the projection of the defect of its wall. We tried to foresee possible procedural complications, and in this regard to justify the choice of tactics of treatment and selection of the applied tools. Given the lack of available literature data on the methods and techniques of interventions in this pathology, we believe that our experience will be interesting and useful for professionals involved in the treatment of patients with vascular diseases.

Steady growth of patients with diffuse coronary atherosclerosis is a challenge for cardiac surgeons and intervention cardiologists for achieving a full revascularization of myocardium. Considering results of an endarterectomy, more and more surgeons perform reconstructive procedures on coronary arteries without removal the atheromatous plaques. In the literature review various versions of the surgical equipment, perioperative techniques and results of extended segmental plastic surgeries are discussed regarding the patients with diffuse coronary atherosclerosis. The purpose of the present work consists in highlighting changes in reconstructive procedures technique.

Since of the invention lipofilling, there was a significant change in ideas of the role used autologous fat tissue (Auto Fat) from natural filler of defects to the product for stimulating regeneration. There was a considerable evolution in technology of liposuction and Auto Fat processing, material and methodical providing of the procedure was improved. Opening and studying role of the stromal-vascular fraction (SVF) of the adipose tissue, in particular mesenchymal stem cells of the adipose tissue (MSC FT), promoted considerable extension of indications while using this method in aesthetic medicine. During experience accumulation of lipofilling application new concepts of application of Auto Fat in combination with MSC FT, platelet-enriched plasma (PRP) and growth factors were developed for scar correction. Understanding of a key role recipient area in succesful engrafting Auto Fat on scars resulted in development of transcutaneous aponeurotomy in a combination with a lipofilling (riggotomy). The procedure of a nanolipofilling which can be considered an attempt of the isolated use of lipofilling for regeneration stimulation and remodeling of cicatricial tissue was developed. However, despite the achieved success, carrying out further researches which would allow to confirm this method efficacy from the point of view evidence-based medicine and develop clear clinical guidelines about its application for treatment of dermal scars would be necessary.

Those who are working in the conditions accompanied with industrial noise exceeding normal rates and who receive irreversible decrease in hearing of sensorineural nature, proceeding from the existing legislation, have to be exposed to expert assessment of the audiologist-otorhinolaryngologist, for the purpose of examination of professional suitability. Medical experts should face such phenomena as aggravation and simulation of hearing loss which exposure and also definition of a true threshold for sound perception, nature of the available violations, is their paramount task.

The tests serving for simulation identification are carried out with application of subjective audiometry, i.e. with active participation of the examined person or by means of the objective audiometry excluding participation of the patient. Observation of the patient behavior, analysis of the anamnestic data, carrying out the acumetry and tuning testing, subjective and objective audiometry and also comparison of the obtained data allows to make expert assessment of a clinical case. The objective audiometry (OET, KSVP, ECOG, acoustic impedancemetry) is crucial in case of the doubts arising after carrying out a subjective audiometric research.