Background. Postoperative delirium is one of the most severe and common complications of thoracic surgery in elderly patients.

Objective. To establish a simple and accurate method for predicting the development of postoperative delirium in patients after thoracic surgery.

Material and Methods. We performed an observational cohort study of 303 patients who underwent lobectomy for oncological diseases. The nature of anesthesia and surgical intervention, features of the volume status and hemodynamic changes during the perioperative period were analyzed, laboratory indicators of this period were evaluated.

Results. Of 303 patients, 43 (14.2%) developed postoperative delirium. Non-modifiable factors for the development of postoperative delirium included age, history of cerebrovascular accident, alcohol misuse disorder, chronic heart failure, more severe physical status according to the ASA (American Society of Anesthesiologists) Physical Status Classification System. Modifiable factors are the following: the duration of one-lung ventilation, episodes of perioperative hypotension and hypoxemia, the use of opioids, the intensity of the pain syndrome in the postoperative period, and reduced oxygen transport function of the blood. A number of laboratory parameters (blood albumin, blood glucose, leukocytosis), reflecting the degree of surgical stress, may also be useful in postoperative delirium predicting.

Conclusion. A prognostic coefficient was compiled with a concordance of 99.9 and Somers' D 0.998. It is equal to the sum of the products: (–3.5367) multiplied by pain intensity on a 10 cm Visual Analogue Scale an hour after surgery; 2.2037 multiplied by the blood albumin level the morning after surgery;    (–4.8151) multiplied by the blood glucose level the morning after surgery. 

Objective. To increase efficiency of cavitary pulmonary tuberculosis treatment by developing modern indications and technology of extrapleural pneumolysis with filling material.

Material and Methods. We reviewed 25 patients with cavitary pulmonary tuberculosis and bacterial excretion who had undergone extrapleural pneumolysis with different types of filling material in 2004–2015. In 16 cases, we performed surgery in patients with one lung.

Results. 56% of operated patients demonstrated extensively drug-resistant TB, 40% had multidrug-resistant TB. Cavities were closed and bacterial excretion ceased in 92% of patients at discharge. Long-term results with observation period from 1 to 12 years were analyzed in 24 patients, 17 (71%) of them had complete clinical efficacy.

Conclusion. Extrapleural pneumolysis is a mini-invasive surgical treatment that can prove positive effect in patients with non-fibrotic changes in a cavity wall and pathological process in upper parts of the lungs. 

Objective. To define possibilities of clinical application of the new original method for estimating failure (death) probability in patients on a liver transplant waiting list.

Material and Methods. The study included 350 patients who had been on a liver transplant waiting list for 5 years. Using the comparison of Mann-Whitney test results and evaluation of sensitivity and specificity (ROC curves) it was established that values of age, MELD-Na score, leukocyte level, nature of liver failure and presence of portal vein thrombosis had statistically significant differences between the dead and survived patients (p < 0.05). By means of binary logistic regression, the model assessing the risk of death taking into consideration indicators mentioned above has been obtained. The new index of death probability of a patient on a liver transplant waiting list within one year has been created.

Results. Quality evaluation of the created model and the index derived from it showed that the new index had a stronger ability to estimate somatic status severity in a patient with cirrhosis and allowed to make more precise prognosis of adverse outcome risk for not less than 12 months as compared to the standard MELD-Na score. The predicted risk of death coincided with actual mortality of patients in 83% of cases. The EPV criterion was 17.4 what exceeded the minimum admissible threshold of the criterion (10) for small samples and allowed to use the obtained index.

Conclusion. The original method allows increasing the accuracy of assessment of failure (death) development in a patient with cirrhosis for one year at any time of its application in the non-invasive way, using the data of the examination standard. In addition, the method helps setting priority in liver transplantation. 

Objective. To justify the possibility of using botulotoxin type A for the prevention of pain syndrome after aesthetic endoprosthesis of the mammary glands.

Material and Methods. The study included 72 women aged between 21 and 45 to whom were scheduled to perform breast endoprosthesis with silicone implants. All patients were divided into two groups: the first group included 38, the second group – 34 people. Two weeks before the expected date of surgery, botulotoxin type A in an amount of 100 U was injected into the patients of the first group to reduce pain syndrome in the pectoralis major muscle. Patients of the second (control) group were injected with a 0.9% NaCl solution (placebo effect) into the pectoralis major muscle. All patients underwent electroneuromyography (ENMG) to assess the denervation of the pectoralis major muscle before drug administration and two weeks after.

Results. The intensity of pain syndrome was evaluated on the 1st-2nd day after surgery using a special questionnaire. In women of the first group, who were injected with botulinum toxin type A two weeks prior the intended surgery, a decrease in the intensity of the pain syndrome was observed, which in most cases allowed not to take analgesics at all. In women of the second group who were injected with a 0.9% NaCl solution, the severity of the pain syndrome reached its maximum values (according to the questionnaire), which required the prescription of analgesics, including narcotic ones, to reduce the severity of the pain syndrome. According to ENMG, when using botulotoxin type A by injecting into the pectoralis major muscle, denervation indices reached 55% compared to the initial ones, while using the saline solution, the ENMG indices did not change.

Conclusion. Clinical use of botulotoxin type A injections into the pectoralis major muscle will improve the results of pain syndrome treatment after endoprosthetics of the mammary glands with implants in aesthetic surgery. 

Background. Static deformation of the forefoot is one of the common orthopedic pathologies, most often found in women. X-ray index of the first metatarsocuneiform joint (M1C1) is important during preoperative planning to determine the surgeon volume for surgical treatment of static forefoot deformity.

Objective. To determine the radiometric prerequisites for the development of transverse platypodia depending on the structure of the first metatarsopharyngeal joint to improve the results of surgical treatment of patients.

Material and Methods. From 2015 to 2017, a retrospective study of X-rays of 236 feet (118 patients) performed in a standard dorsoplant projection at rest and with a functional load was carried out.

Results. The analysis of the obtained X-ray patterns revealed a direct dependence between the inclination of the articular surface of the medial sphenoid bone and angles of inclination of the articular surface of the base of the first phalanx of the first finger, the head of the first metatarsal bone (PASA), the intertarsal angle (M1M2) and the deflection angle of the first finger (M1P1).

Conclusion. Further study of the dependence of the degree of transverse platypodia to the angle of inclination of the articular surface of the medial sphenoid bone and the use of the angle P1C1 as a prognostic indicator, in our opinion, will improve the quality of preoperative planning of surgical treatment of patients with transverse platypodia to reduce the risk of relapse. 

Background. The paper presents the clinical results of treating patients using full-thickness skin autografts for granulating wounds.

Objective. To study the surgical aspects of full-thickness skin autograft engraftment on a granulating wound.

Material and Methods. In traumatology and burn research, to achieve the best cosmetic results, transplantation methods of free full-thickness skin autografts are used. In the Regional Clinical Hospital no. 1, a method of skin grafting with a full-thickness autograft was developed, which allows to close the defect in the conditions of a purulent wound: granulations are excised before skin transplantation, and a vacuum is applied after grafting.

Results. Annually, the specialists of the Burn Center of the Scientific Research Institute – Regional Clinical Hospital no. 1 assist more than 1300 patients. Of these, from 20 to 25 cases are face burns. 132 patients with burns of the face have been admitted to the hospital over the past 10 years. 37 patients underwent plastic surgery with a full-thickness skin autograft. The authors presented the technology for the surgical treatment of deep burns on the face. After cleansing the wound from areas of necrosis and granulations, usually 20 days after the injury, the upper layers of granulation tissue are removed with a dermatome parallel to the skin surface, to a depth of 1–2 mm. Then, plastic surgery with the free full-thickness skin autograft is carried out on the skin of the face with the formation of cuts for the nose, mouth, eyes. The wound is tightly bandaged with 5–7 rounds of a medical bandage or a vacuum-assisted closure is applied.

Conclusion. In case of traumatic skin detachment, plastic surgery according to Krasovitov should be performed in the first hours from the moment of injury. Our study allows transplantation of a full-thickness skin graft to granulating wounds as well. After 5 days, the condition of skin autografts is assessed at the first dressing. Their engraftment is observed on the 7th day. In the postoperative period, scar tissue does not form. 

Objective. To evaluate the diagnostic utility of trophoblastic blood flow Doppler parameters in predicting an adverse pregnancy outcome.

Material and Methods. This was a retrospective study of 218 pregnancies of women between 8 and 11 weeks’ gestation. Depending on the pregnancy outcome, patients were divided into 4 clinical groups. All women underwent an ultrasound examination using Voluson S8, Voluson E8 with high-quality grey scale, color flow mapping and pulsed-wave Doppler modes. We used a program for obstetric research with the following instrument settings: 100 MHz Doppler frequency, thermal index (TI) was <1, mechanical index (MI) was 1. The examination time did not exceed 20 minutes. There was no radiation exposure. Transvaginal and transabdominal sonographies were performed.

Results. To form a risk group for an adverse fetal outcome due to fetoplacental insufficiency, it is necessary to identify ultrasound markers of inadequate placental perfusion by means of a Doppler study of fetoplacental blood flow. For this purpose, we examined 218 pregnancies of women between 8 and 11 weeks’ gestation to determine the diagnostic utility of various parameters: resistivity index, pulsatility index, systolic/diastolic ratio and chorionic vascularization index (k, %). We received results proving high sensitivity (76.9%) and specificity (89.7%) of the chorionic vascularization index (k, %), as well as low specificity (54.7%) and high sensitivity (81.5%) of trophoblastic blood flow resistivity index.

Conclusion. Thus, the chorionic vascularization index (k, %) is of high diagnostic utility for predicting an adverse fetal outcome. 

Background. The need to find the most effective ways to restore liver function after performing its resection.

Objective. To evaluate the effectiveness of the use of stem cell technology in liver resection in an experiment.

Material and Methods. 210 C57 black mice were included in the experiment. All individuals were divided into 4 groups, 60 individuals in groups 1–3 and 30 individuals in group 4. Individuals of groups 1–3 underwent liver resections in the amount of 60–65% of the total liver mass. To the individuals of group 1, stem cells were administered intraoperatively intravenously, group 2 – intraoperatively intraportally. No stem cells were introduced to individuals of group 3. Individuals of group 4 (n = 30) were removed from the experiment to determine the average liver mass and obtain stem cells.

Results. On the 10th day after the operation, the liver mass of mice in group 2 corresponded to normal indicators, in group 1 it was 79% of the norm, in group 3 – 62.6% of the norm. The level of total protein and albumin on day 10 after surgery in group 2 was within normal limits, in group 1 – 75% and 87% of the norm, in group 3 – 51.7% and 64.5% of the norm respectively. On the 10th day after the operation, the AST level in group 2 was 4% higher than the baseline, in group 1 – 26%, in group 3 – 58% higher than the baseline. The level of AST and alkaline phosphatase on day 10 after surgery in group 1 was 51% and 189% higher than the initial level, in group 2 – 5.9% and 49%, in group 3 – 90% and 266% higher respectively.

Conclusion. The use of stem cell technology in liver resection contributes to a faster restoration of liver function in the postoperative period. 

We report the rare case of 65-year-old male patient with supratentorial hemangioblastoma and gigantic cyst of the left hemisphere of the brain without von Hippel-Lindau disease. Hemangioblastoma is a rare benign tumor classified as grade I by the WHO of the central nervous system of uncertain histogenesis. This neoplasm’s stroma consists of dense networks of thin-walled blood vessels of various calibers. About 140 cases of supratentorial localization of this type of tumor are presented in the world literature. We have given a fairly complete clinical, neuroradiological and histological picture that allows one to differentiate hemangioblastoma from other histological structures. Promising modalities in the treatment of patients with this pathology when it is impossible to perform total tumor resection are considered.

This report presents a clinical case of treatment of Salmonella coxitis, developed as a result of bacteremia, which is a fairly rare complication. We performed head resection of both femurs and, after long-term antibiotic therapy, total hip replacement within six months from the onset of the disease. Given the lack of publications on the tactics of treating patients with this pathology in the accessible medical literature, we believe that our experience will be useful to specialists engaged in the treatment of patients with diseases of large joints.

Acute respiratory disease COVID-19 caused by the SARS-CoV-2 coronavirus demonstrate weak clinical manifestation in most patients. However, pneumonia and acute respiratory distress syndrome in some cases may cause serious problems due to the lack of effective etiotropic and pathogenetic therapy. Presumably, SARS-CoV-2 leads to the delayed type I interferon activation and loss of control over virus replication in the early stages of infection, which is why the adaptive CD8+T-cell response must be controlled to avoid the development of pulmonary pathology. These data should be taken into account when developing strategies for COVID-19 therapy. Mesenchymal stem cells therapy serves as possible treatment opportunity for severe forms of the disease due to their homing, pronounced anti-inflammatory and antifibrotic properties. It was found that in viral infections, including COVID-19, mesenchymal stem cells can synthesize antiviral defense mediators under the influence of interferon causing resistance to viruses. Thus, mesenchymal stem cells are able to provide comprehensive anti-inflammatory protection, which leads to clinical improvement in patients with COVID-19.