Objective: Improvement of the results of treatment of vertebral tumors with neural compression by means of analyzing the authors’ experience.

Material and methods: The study included 151 patients with primary and metastatic vertebral tumors, operated in the neurosurgical departments of three large medical institutions from 01.01.2014 to 31.12.2020.

Results: Most of the patients underwent palliative interventions. Radical surgery (marginal or wide resection of the tumor) was performed in 8 (5%) patients. Surgical treatment as the only method of treatment was used in 75 (50%) cases, combined treatment was used in 42 (28%) people, complex treatment – in 34 (22%). The immediate results of treatment of 91% of patients were characterized by the absence of negative dynamics in the neurological status and in 50% of cases by positive dynamics in the functional state. Among patients with malignant tumors and a traced catamnesis, the one-year survival rate was 66%, three-year – 52%, five-year – 47%. The median overall survival rate was 12.8 months, the median event-free survival rate was 12.55 months.

Conclusion: The use of non-radical interventions in the surgery of vertebral tumors with neural compression expands the possibilities of minimizing surgical trauma, while maintaining the neurological and improving the functional status of the patient.

Background: Regarding burn injury there are many approaches to assessing the possibility of death in severely burned patients. Despite the ease of use and the maximum prevalence of existing models, the assessment of the outcome in each of them is questionable, since the emphasis in different indices is on different indicators, avoiding the overall clinical picture of the disease.

Objective: Comparative analysis of the effectiveness of methods for predicting a lethal outcome in patients with extensive skin burns.

Material and мethods: Calculated characteristics of known in the literature and widely used Baux rules, Frank index, probit analysis and a new method of logistic regression were obtained and applied to evaluate the results of treatment of 282 adult patients with extensive skin burns, hospitalized in the Department of Anesthesiology and Intensive Care of the Thermal Injuries Unit, Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine in the period 2015–2021.

Results: During the study a descriptive characteristic of methods for predicting a lethal outcome was obtained. Based on the data obtained, four-field contingency tables were compiled and a comparative analysis of the effectiveness of the models was carried out.

Conclusion: Despite the high frequency of use of such forecasting methods as the Baux score, the Frank index and probit analysis in the combustiology practice, the results of the calculation indicate that these methods have low efficiency: the Baux score method accuracy of a lethal outcome prediction is 49.7%, the Frank index method – 41.5%, probit analysis method – 60%. The logistic regression model developed by us showed high efficiency compared to those presented earlier (the accuracy of predicting a lethal outcome was 93%), which gives grounds for recommending it for practical application.  

Objective: To assess the frequency of ruptures of very small cerebral aneurysms, features of the perioperative period and outcomes, in comparison with the rupture of ordinarily sized aneurysms.

Material and methods: A comparative analysis of the group of patients with ruptured cerebral miliary aneurysms (n = 18) and the group of patients with ruptured cerebral aneurysms of regular size (n = 308) was carried out. All patients underwent open surgery in the first 3 days after the rupture (osteoplastic craniotomy, microsurgical aneurysm clipping). We compared gender, age of patients, severity of the patient’s condition at the moment of admission, severity of subarachnoid hemorrhage, location of aneurysms, aspect ratio, duration of the operation, frequency of intraoperative ruptures, postoperative mortality.

Results: It was found that miliary aneurysm rupture occurs in 5.5% of all patients with cerebral aneurysm rupture. The most common cases of rupture of very small aneurysms were in women (77.7%), with a mean age of 50.8 years. Aneurysms of the anterior communicating artery (66.6%) with a narrow neck (average aspect ratio – 2.1) were the most common. Patients with rupture of very small aneurysms were 7.9% more likely to be admitted in a state of subcompensation or decompensation (Hunt-Hess IV–V), they had massive subarachnoid hemorrhage (Fisher III) 19.6% more often than with ruptured aneurysms of regular size. On average, operations in cases of very small aneurysms lasted 30 minutes less than clipping of ordinary aneurysms, but were complicated by intraoperative rupture twice as often (38.8% and 16.5%, respectively). Postoperative mortality in the group of patients with ruptured miliary aneurysms was 5.7% higher than in patients with ruptured aneurysms of regular size.

Conclusion: Rupture of cerebral miliary aneurysms is relatively rare. Women of 50–60 years old with very small aneurysms of the anterior communicating artery with a narrow neck constitute the main group of such patients. Massive subarachnoid hemorrhage and severe condition of patients on admission are more common with miliary aneurysms than with ordinarily sized aneurysms. The small size of the aneurysm and the work near the rupture determine the more frequent contact intraoperative rupture when the neck is exposed as compared to operations on larger aneurysms, which negatively affects the treatment outcomes in this group of patients.

Objective: To study the features of the coronavirus infection course in cardiosurgical and thoracic patients to determine the factors potentially affecting the possibility of lethal outcome. To identify the predictors of fatal outcome based on the analyses of the features of the coronavirus infection course in this category of patients.

Material and methods: During the analyzed period 80 patients from the departments of thoracic surgery and cardiac surgery were transferred to the infectious diseases department: 20 patients from the cardiac surgery department (CSD) – group 1; 60 patients from the thoracic surgery departments (TSD) – group 2. A control group number 3 consisting of 59 non-thoracic and non-cardiosurgical patients was also formed. According to the disease outcome the patients were divided into two groups: group 1 – fatal outcome, group 2 – recovery.

Results: Out of 80 patients, lethal outcome was recorded in 25 cases: 22 patients of the thoracic profile (36% of the total number of transferred from this department) and 3 patients of the cardiosurgical profile (15% of the total number of those transferred from the cardiac surgery department). 20 out of 20 cardiac patients had been operated on the day before, 49 out of 60 thoracic patients also underwent surgery. 3 people from the group of non-operated patients transferred from departments of thoracic surgery died. Moreover, after pneumonectomy, fatal outcome was recorded in 7 out of 8 cases (87.5%).

Conclusion: During the analyses of indicators it was revealed that the number of fatal outcomes in patients of the thoracic profile with COVID-19 infection is higher than of the cardiosurgical profile and in the infectious diseases department. Presumably, this is due to the fact that coronavirus infection affects the lungs to a greater extent, and in patients with a thoracic profile (in particular, those who have undergone resection interventions), the volume of the lung parenchyma is initially reduced. This is confirmed particularly by the highest percentage of fatal outcomes after pneumonectomy. Cardiosurgical patients after surgical interventions do not have a reduction in the functioning lung parenchyma, which creates an additional “reserve” for recovery. Moreover, men predominate among patients of the thoracic profile, with the survival rate lower in all groups compared to women. Patients transferred from thoracic departments showed higher rates of systemic inflammation, which indicates a more severe course of the viral infection and the possible development of complications.

When analyzing the predictors of lethal outcome, the following factors were identified: male gender and, in general, a more severe course of a viral infection (low saturation, a high percentage of lung lesions on CT, more pronounced changes in laboratory screening). The studied factors are associated with a large number of fatal outcomes in thoracic and cardiac surgery patients. Among the factors that do not affect the prognosis are diabetes mellitus, stroke and myocardial infarction in history.

Thus, patients diagnosed with coronavirus infection that developed after thoracic surgery had the most unfavorable prognosis. The revealed patterns are of interest for optimizing the routing of this category of patients in order to prevent coronavirus infection.

Objective: To determine the optimal technological modes for the preparation of platelet-rich plasma (PRP) using standard laboratory equipment.

Material and methods: Blood for the research was taken from 25 healthy volunteers. Its centrifugation was performed on a standard CM-6M laboratory centrifuge using various modes and two types of vacuum tubes with lithium heparin containing separation gel and without it. The number of platelets and leukocytes was calculated in the upper, lower and middle layers of the obtained plasma sample.

Results: Plasma samples obtained during centrifugation modes from 415 to 1660 g for 10 minutes using test tubes that do not contain separation gel are optimal in terms of the number of platelets. Plasma intake from the lower layer of the obtained sample after centrifugation is always accompanied by the inclusion of leukocytes in its composition, which can lead to undesirable tissue reactions when it is used.

Conclusion: To obtain PRP, it is possible to use standard laboratory equipment in the centrifugation mode from 415 to 1660 g for 10 minutes using test tubes that do not contain separation gel. Plasma sampling for clinical use should be carried out from the middle layer of the obtained sample.

Background: The pandemic of COVID-19 caused an overload of national health care systems worldwide. The analyses of the ways the pandemic changed the availability of the medical care provided in emergency situations has been carried out based on cases of craniocerebral trauma treatment.

Material and methods: Data for the period of 2019–2020 on each of 85 territorial subjects of the Russian Federation which are contained in forms of the state statistical observation and also data of Federal State Statistics Service on number of the deceased from head injuries (bone fractures of skull and face) in the period of 2019–2020 have been analyzed. For the measurement of medical care availability level we used the ratio of number of hospitalizations to the total number of deaths due to head injury in territorial subjects of the Russian Federation before COVID-19 pandemic (in 2019) and during the pandemic in 2020. The higher the ratio of admissions in the round-the-clock hospitals to total number of lethal cases due to head trauma, the higher the availability of the specialized emergency medical care. At the same time, we recognize that if the person with a severe head injury is brought to the hospital alive the chances to save his life increase.

Results: In 2019 approximately half of the patients with cases of head injuries were admitted in the round-the-clock hospital (the ratio is 274.6 thousand cases of hospitalization to 566.6 thousand cases of the head injury – 48.5% of the total number of head injury cases). In 2020 the share of such cases decreased to 43.1% – 207.5 thousand cases of hospitalization to 481.3 thousand cases of head injury in a year total. On an average in territorial subjects of the Russian Federation the ratio coefficient of hospitalizations number to the total number of lethal outcomes due to head injury in 2019 was 11.6 ± 4.3, in 2020 – 8.8 ± 3.3. Feature variation coefficient is 37.5% and 37.6% in 2019 and 2020 respectively which demonstrates its high variability in territorial subjects of the Russian Federation. A share of the lethal outcomes due to a head injury increased from 3.8% in 2019 to 4.5% in 2020 of total number of patients that received this type of trauma, or by 1.2 times.

Conclusion: Due to the decrease of the emergency specialized medical care availability because of the pandemic the excess mortality from severe head injuries in 2020 was not less than 3 thousand people or 15% of the total number of cases of death. Hospital repurposing, redistribution of temporary and physical healthcare resources during the pandemic shouldn’t be followed by the decrease of medical care in emergency cases. The relation indicator of the number of admissions in the round-the-clock hospitals of patients with severe injuries or diseases to total number of lethal outcomes due to the same reasons is the indicator showing the availability level of medical care that can’t be delayed.

In most cases, patients with multifocal atherosclerotic lesions, including brachiocephalic arteries, are denied surgical treatment due to the high risks of intra- and postoperative complications. Despite the severe stenotic lesion of the carotid arteries, which can lead to such a major complication as ischemic stroke, in most cases surgeons refuse to perform the operation. Endovascular surgery is often the only option for these patients. After analyzing the world experience in the treatment of hemodynamically significant lesions of the arteries of the brachiocephalic basin and applying in practice various methods of endovascular interventions in patients with complex stenotic lesions of the internal carotid arteries, we were convinced that endovascular correction of such lesions is often the main method of treatment for patients with multifocal atherosclerosis, and can also be used as a primary method of treatment, as it demonstrates high effectiveness, low risk of complications and good long-term results.

The presented literature review shows up-to-date information about the possibilities and new methods of magnetic resonance angiography in patients with cerebral aneurysms who have undergone surgical treatment. The articles for analyses have been taken from the PubMed database. The most important aspects of the implementation and the possibilities of improving magnetic resonance angiography protocols for visualization and postoperative control of treated cerebral aneurysm have been considered.

Based on the data of scientific literature, the current state of the problem of soft tissue defects replacement in the lower extremities in conditions of chronic osteomyelitis has been analyzed. Taking into account certain requirements for the replacement of defects of this nature, the following reconstructive tasks have been indicated. First of all, for adequate restoration of the skin with simultaneous relief of the purulent-necrotic process, it is necessary to use blood-supplied tissue complexes, which, if possible, should be formed from tissues similar to those surrounding the defect. The predominant use of technically and economically beneficial interventions is of great importance. The most suitable are loco-regional flaps with axial blood supply, among which the most promising are perforant flaps. It is necessary to develop an algorithm for defects reconstruction using loco-regional perforant flaps, depending on the defect area. It is also necessary to conduct a comparative analysis of the anatomical advantages and effectiveness of using various perforant and insular flaps on the vascular pedicle. A one-stage orthoplastic approach will allow the most effective use of the achievements of reconstructive plastic surgery in orthopedics to restore limb function, which will improve the results of treatment of patients.

This article discusses the experience of using intraoperative radiation therapy in the treatment of patients with breast cancer, as well as the prospects for the development of this area in terms of benefits (improved therapy effect, reduced severity of side effects, no effect on adjacent organs) and risks (the possibility of local recurrence) for patients.

There are several directions for predicting multiple organ dysfunction syndrome (MODS), but almost all of them are poorly tested in neonatology. This review is presented to indicate the problem of the condition severity objectification of newborns and the possibility of predicting the development of MODS. Scales for assessing the severity of MODS in critically ill children have been developed and used since the end of the last century, but their validation in the newborns faces certain difficulties. Prognostic nosospecific scales: NICHD (National Institute of Child Health and Human Development) calculator, CRIB II (Clinical Risk Index for Babies), SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension II) are used in neonatology, however their comparison in this category of patients has not been carried out.

Theoretical and practical issues of the short-term and long-term prediction of the MODS onset and its outcomes in newborns is a promising area of neonatology, since it allows a doctor to be warned about an impending catastrophe and opens a “window of opportunity” for timely correction of treatment tactics and complications prevention. Obtaining different phenotypes of critical illness and predicting their outcomes in children may have good predictive potential, but such studies have not been conducted in newborns. A promising direction in predicting MODS is the identification of biomarkers of inflammation, among which endocan, cluster of differentiation 64, cluster of differentiation molecules 11b, “pancreatic stone protein” (PSP), soluble intercellular adhesionmolecule-1 (sICAM-1), progranulin, neopterin, resistin (FIZZ3, presepsin (PSP)) carry a good potential, but their effectiveness in neonatology is still to be investigated.

Thus, the prediction of MODS in children and newborns remains an unresolved problem. At the same time, several promising scientific directions are actively being developed today, which may lead to a significant breakthrough in predicting MODS in neonatology.

Introduction: Popliteal artery aneurysm is a pathology that appears regularly in daily practice of a vascular surgeon since the popliteal artery is the most common location of aneurysms (about 70%). A rare form of aneurysm of the popliteal artery is a giant aneurysm, the diameter of which is more than 7–8 cm. Giant aneurysms are of a great clinical importance due to the high risk of rupture and complications, and the fact that this pathology has its own peculiarities of surgical treatment.

Material and methods: We conducted an electronic bibliographic search Pubmed, Cochrane Library, Wiley to find reports about treatment of giant popliteal aneurysms. According to its results the main features of the clinical picture, diagnosis and treatment of giant popliteal aneurysms have been identified.

Results and discussion: Surgical treatment of giant popliteal artery aneurysms differs from the treatment of regular popliteal artery aneurysms and is associated with the choice of adequate access and the need for partial or full resection of the aneurysm. Endovascular treatment methods are used much less frequently, however, with the improvement of techniques and the emergence of new technologies, an increase in number of giant aneurysms successful treatment cases is expected.