Objectives. In severe cardiac and pulmonary insufficiency extracorporeal membrane oxygenation (ECMO) is increasingly used in gynecological, pregnant and postpartum patients, although the management of such patients and clinical results remain underestimated. This study presents the experience of ECMO in gynecological and obstetric patients in the peripartal period.

Methods. This study included all obstetric, pregnant or postpartum patients who received ECMO support in the Department of anesthesiology and intensive care unit between 1 November 2009 and 1 September 2019. The data were analyzed retrospectively. The preliminary task was to describe the circumstances and clinical characteristics of patients receiving ECMO, describe the management of such patients during pregnancy, childbirth and the postpartum period, evaluate the results of treatment of mothers and fetuses and report bleeding and thrombotic complications.

Results. During the study period, seven obstetric and gynecological patients were treated with ECMO. Including two pregnant, 4 postpartum and 1 gynecological. The mean age was 27.0 years and the average gestational age of pregnant women was 27.5 weeks. Five patients (71.4%) were discharged from the hospital with full recovery. The fetal survival rate in the group of pregnant and postpartum 85 was 5 (80.8%). One patient was successfully delivered to ECMO. Hemorrhagic complications developed in 3 patients (42.8%) and were associated with disseminated intravascular coagulation. There were no complications in the fetus associated with ECMO.

Summary. In the work of a multidisciplinary team of experienced specialists ECMO can be used in gynecology, in pregnant women and in the postpartum period, outweighing the risks of bleeding or thrombosis, with favorable results for the mother and fetus. 

Background. It is reported that radiodensity measured in Hounsfield units becomes more and more popular in bone property assessment, however also mismatch with DXA results is observed.

Purpose. The aim of this study is to evaluate the relationships between the results of DXA and CT with a focus on explanations for observed discrepancies.

Material and Methods. This is a cross-sectional study; forty patients were enrolled, all patients underwent DXA and CT. A bone mineral density BMD (g/cm²) was calculated for each vertebra of a lumbar spine (L1-L4 inclusive), neck, upper neck, shaft, Wards triangle and trochanter of hip. Bone radiodensity in HU was taken from each vertebral body in the sagittal, axial and coronal planes. A total vertebra body radiodensity including cortical bone and radiodensity of only cancellous bone were calculated. To assess a potential impact on DXA and CT data agreement a mean radiodensity and square of the right and left vertebral pedicles and facet joints were measured for each vertebra.

Results. A strong correlation between BMD measured using DXA and CT data was estimated with a multiply r accounting for 0.84169, p < 0.0001, however the most contributing parameters were those calculated for facet joints. It has been detected that both radiodensity of only a cancellous bone and total have a weak correlation with matching BMD measurements of a proximal femur.

Conclusion. The results of DXA could be strongly influenced by hypertrophic changes of facet joints. Both CT and DXA measurements taken from a lumbar spine may have a mismatch with figures taken from hip. 

Aim. CEAE is an effective method of ischemic stroke prevention. However, as any invasive treatment method, CEAE is associated with a risk of complications in the early and late postoperative periods. One of the possible complications is intraoperative injury of cranial nerves.

Material and Methods. From 2008 to 2014 in the department of vascular surgery in Pletnev City Hospital in Moscow, 172 patients with hemodynamically significant ICA stenosis who suffered ischemic stroke or TIA underwent surgery.

Results. In the early postoperative period, 7 episodes of cranial nerve injury (4.0%) were detected. The following cranial nerves were most often damaged during surgery: the terminal branches of the facial nerve (VII), the hypoglossus nerve (XII), the glossopharyngeal nerve (IX), and the vagus nerve (X). Injuries were associated with coagulation damage or compression of nerves. In one case, the intersection of the hypoglossus nerve was recorded. In all cases except this one, nerve damage was reversible.

Conclusion. It is impossible to avoid cranial nerves injury during carotid endarterectomy. However, the number of such complications can be reduced by the measures described in this article. 

Aim. Evaluation of the biliary tract decompression methods and their use results, in patients with obstructive jaundice of various etiologies on the basis of our own clinical material.

Material and Methods. A retrospective analysis of the biliary tract drain results in 6935 patients with obstructive jaundice with benign and tumor etiology. In 87% cases there was B Class of obstructive jaundice. In 93% we observed mild (A Class) obstructive jaundice. For the biliary tract drainage we used laparoscopic or open surgical access. The retrograde drain we used in sixty-seven percent cases with obstructive jaundice B Class. In sixty-six percent cases of obstructive jaundice C Class, we used antegrade drain.

Results. The biliary decompression was effective in 98%. Regarding the rate and timing of bilirubin reduction, all the applied methods showed a similar result, however, the greatest number of complications and fatalities we recorded in patients after antegrade percutaneous drain of the biliary tract and transabdominal access. In 36% the performed interventions became the final treatment option, and the sixty-one percent of patients underwent two-stage treatment. The overall mortality rate was 3%.

Conclusion. The use of percutaneous drainage is justified for obstructive jaundice with tumor origin, and possible radical surgical treatment. Transabdominal access drainage for benign etiology of obstructive jaundice in compensated patients can be safely used. Transduodenal endoscopic drain is an alternative to other methods biliary tract drain in severe and medium obstructive jaundice of benign etiology. The same drain method can be used for drainage of biliary tract in patients with tumors of the hepatopancreatobiliary zone organs, as a palliative treatment. 

Background. Despite the progress and development of scientific directions in various fields of medicine, the problem of tuberculosis and its morphological manifestations remains relevant and is not fully disclosed due to complex pathogenesis, the presence of various clinical forms, therapeutic pathomorphosis, torpid to therapy, the presence of relapses. It is known that a surfactant system occupies a special place in the system of local lung protection.

Aim. To study the condition of surfactant-assotiated protein A in the foci of specific destruction and in the surrounding intact lung tissue to assess its functional status, degree of respiratory failure and possible dissemination of tuberculous inflammation.

Material and Metods. An analysis of 163 lung fragments of the dead or operated on for cavernous pulmonary tuberculosis with active bacterial excretion of 89 fragments and with clinical abacilation – 74 was carried out.

Results. A morphological study revealed stereotypical dynamic depression of surfactant-associated protein A in all the samples studied, both in the areas of cavernous destruction and pericavernouse zone, and in intact lung tissue. The maximum intensivity of the immunohistochemical expression of this surfactant protein was recorded in the alveolar macrophages, which indicated intensive recycling and utilization of the components of the surfactant.

Conclusion. Minimizing the production of surfactant components and its active utilization in intact lung tissue leads to a collapse of the alveoli with subsequent progression of respiratory failure. 

Relevance. Today LUTS cause a lot of complexity and misunderstanding among doctors and patients. Among the symptoms, nocturia is the most difficult to interpret. Nocturia affects a significant part of the population, especially in older age groups. Currently, there are no data on the ratio of nocturia in various diseases of neurological etiology which are manifested by nocturia. Nocturia can be classified only according to urination diaries: diurnal polyuria, nocturnal polyuria, decreased bladder capacity, sleep disorders, and circadian rhythm disorders. Nocturia is also classified by degree of severity: mild severity from 1 to 3 episodes of nocturnal urination and severe when the number of nocturnal awakenings for urination is more than 3.

Objective. To prove the effectiveness of the analysis of additional data on the daily diary of urination, together with the determination of the specific gravity of urine in the daytime and at night in patients with nocturia.

Material and Methods. Two hundred eleven male patients were examined, with nocturia from 1 to 6 times and with a diagnosis of benign prostatic hyperplasia (BPH). The average age of the patients was 71 ± 4.7 years, the age interval of patients ranged from 50 to 84 years. the presence of symptoms of the lower urinary tract (LUTS), the total score on the I-PSS scale >21, an indicator of the quality of life index QOL >3, the maximum flow rate of urine (Q_max) >10 ml/s, residual urine volume (OOM) <150 ml.

Discussion. The lack of improvement in urination disorders and the inability to determine the type of nocturia led to an in-depth analysis of urination diaries taking into account the duration of night sleep, determination of night and day diuresis, and also, features of deviation of the urine specific gravity at night. Together with one of the days of urination diary filling, it was recommended to perform a urinalysis according to Zimnitsky. In 4 (1.8%) patients, daily polyuria with diuresis of more than 40 ml/kg per day was determined. One hundred thirty-nine (65.8%) people had nocturnal polyuria with a predominance of nocturnal diuresis of 1.8 ± 0.8 ml/min over daytime 1.32 ± 0.3 ml/min. A decrease in bladder capacity was detected in 56 (26.5%) male patients. Twelve (5.6%) patients had various sleep disorders, which was the reason for their awakening.

Findings. An in-depth analysis of urination diary data, including information on the duration of sleep and the determination of the circadian rhythm of the specific gravity of urine, is the key to successfully determining the cause of nocturia, especially in patients with nocturnal polyuria. 

Background. Currently, there is no uniform tactics for the differentiated use of dorsal decompressive-stabilizing techniques for multilevel degenerative diseases of the cervical spine, and the results of these technologies application are largely controversial.

Aim. Analysis of the unsatisfactory outcomes of dorsal decompressive-stabilizing interventions in the treatment of patients with multilevel degenerative diseases of the cervical spine and development of a clinical-instrumental algorithm for differentiated surgical tactics.

Material and Methods. A retrospective study included 112 patients with degenerative diseases of the cervical spine at two levels or more due to hernias of intervertebral discs, yellow ligament hypertrophy and arthrosis of facet joints, which in 2007–2014 underwent dorsal decompressive-stabilizing interventions in the volume of laminotomy with laminoplasty (LP) and laminectomy with fixation for lateral masses (LF). A correlation analysis of clinical parameters with anamnestic data, instrumental parameters, a feature of accepted surgical tactics and postoperative adverse effects.

Results. In the analysis, it was established that "satisfactory" postoperative outcomes of LP are associated with a neutral or lordotic configuration of the cervical spine, the preservation of segmental movements without clinical and instrumental signs of instability. In addition, the use of LF is possible with mobile kyphotization of the cervical spine and the presence of translational instability of the cervical segments. The "unsatisfactory" postoperative results of the LP and LF are in direct correlation with the duration of the disease, the presence of myelopathic focus and rigid kyphosis of the cervical region.

Conclusion. Differential use of dorsal decompressive-stabilizing techniques based on a comprehensive assessment of disease duration, configuration of the cervical spine, spinal cord condition and volume of segmental movements allows to reduce neurological symptoms, improve the level of pain and improve the functional status of patients, as well as significantly reduce the number of adverse outcomes associated with the progression of kyphotic deformity, deterioration of neurological symptoms and revision on-line decompressive-stabilizing interventions. 

Neurofibromatosis type 1 (NF1) is a hereditary disease with the high frequency of neuroendocrine tumors. This article represents a clinical case of the diagnosed NF1 in a 40-year old patient with the history of bilateral pheocromocytoma and malignant gastrointestinal stromal tumor of the jejunum. Clinical diagnosis NF1 was suspected on the basis of the typical skin manifestations.The timely diagnosis of NF1 has practical significance as it enables physicians persistently search for neuroendocrine lesions in a such cohort of patients.

In the described clinical case we presented features of a clinical presentation, difficulties of textiloma diagnosis which resulted in acute intestinal obstruction in several years after surgery. The high diagnostic value of an ultrasonic method in diagnostics of foreign bodies was shown.

Neuroblastoma is one of the most common extracranial solid tumors in children. One of the main causes of death from childhood cancer in children aged one to five years, and it accounts for about 15% of all deaths from cancer in children. They have characteristic features, such as an early age of onset, a high frequency of metastasis in the diagnosis of patients older than 1 year and a tendency to spontaneous regression of tumors in young children. Although several prognostic factors were identified (age, stage, histology, heredity), identifying non-invasive biomarkers for disease surveillance and monitoring therapy is indeed still a clinical necessity. In this review, we describe the latest miRNA data in neuroblastoma, with an emphasis on those involved in tumor progression, metastasis, and drug resistance. In addition, we will discuss their potential use in the treatment of this tumor.

Thrombocytopenia is the second most frequent hematological complication of pregnancy after anemia. Among all thrombocytopenia during pregnancy, the most common is gestational thrombocytopenia. Gestational thrombocytopenia is not accompanied by coagulation disorders, has a minimal risk of bleeding, for both a mother and her fetus. Nevertheless, according to modern concepts, thrombocytopenia is a contraindication for performing obstetric neuroaxial blockades only on the basis of quantitative count of platelets, without taking into account coagulation status. These contraindications are derived from the general surgery and traumatology practice due to the high risk of developing epidural hematoma, but do not take into account the features, including physiological hypercoagulation, of pregnant patients. Refusal of the patient to perform a neuroaxial blockade during delivery on the basis of only counting the number of platelets often leads to an unreasonable increase in the risk / benefit ratio for both the mother and the fetus. Analysis of the research results indicates a change in attitude towards this problem towards a more loyal approach, taking into account the assessment of the coagulative status of a particular patient.