INTRODUCTION The traditional “sandwich” technology of anastomosis between the dissected aortic wall and synthetic vascular prosthesis in the surgical treatment of acute aortic dissection type A does not fully meet the idea of an urgent surgical treatment of patients with this disease. We evaluated the experience of the new “invaginated” technique of anastomoses formation.

MATERIAL AND METHODS We compared the results of surgical treatment of patients with the “sandwich” and “invaginated” technique of anastomotic formation. The parameters of bleeding, cardiopulmonary bypass time, mortality, as well as the state of the false lumen in the early and late postoperative periods have been studied.

CONCLUSION Invaginative formation of anastomosis between the aorta and vascular prosthesis provides good immediate hemostatic effect and creates the best conditions for fi lling the false lumen in the treatment of acute aortic dissection type A.

BACKGROUND The hypercatabolism syndrome may occur in critically ill patients after the intracranial hemorrhage. Mixed enteral and parenteral nutrition is used to provide nutrition support.

MATERIAL AND METHODS We observed 20 patients with intracranial hemorrhage and consciousness score up to 13 (the Glasgow Coma Scale) in the early postoperative period.

RESULTS Administration of parenteral mixture (“three-in-one”) was followed by the progressive growth of transferrin concentration and did not lead to the signifi cant increase of triglycerides concentration in the blood serum. We also noted that the parenteral nutrition lead to the increase of malonedialdehyde (MDA) in the blood serum above normal levels, but the total serum antioxidant activity was normal.

CONCLUSION The 3-component mixture that contains polyunsaturated fatty acids omega 6/omega 3 — 2.5:1 and olive oil, administered to critically ill patients after intracranial hemorrhage, improves protein metabolism indicators and sustains lipid peroxidation and antioxidant activity in the blood serum.

BACKGROUND Acute toxic hepatitis associated with acute poisoning with alcohol-containing disinfectants remains a medical and social problem.

MATERIAL AND METHODS With an aid of chemiluminescence, we performed the integrated assessment of the oxidative status in the blood serum and homogenized liver biopsy tissue of 62 patients with the diagnosis «severe acute toxic hepatitis associated with the use of alcohol-containing disinfectants».

RESULTS The research showed that at the onset of a disease, patients with acute toxic hepatitis had an expressed activation of free radical oxidation of the blood serum and biopsy tissue. This was indicated by almost double increase in the intensity of free radicals generation (Ssp). This signifi cantly increased production of peroxide (Sind-1) and hydroxyl radicals (Slum) — 2.5 and 1.86 times, respectively; also, it increased concentration of lipid hydroperoxides (h) almost three times, evidencing activation of the initial stage of lipid peroxidation There was no statistically signifi cant fall of figures indicating the liver parenchymal oxidative status 30 days after the admission. The same situation was observed 6 months after the beginning of the study.

CONCLUSION Analyzing chemiluminescence scans of blood serums up to 30 days from admission, it is possible to conclude indirectly on a condition of the oxidative status in a liver parenchyma of patients.

Basal cell carcinoma is the most frequent human skin malignant tumor. The risk of recurrence exists regardless of the treatment method. The ultrasound assisted treatment in patients with face and neck skin basalioma is analyzed in this study. It was shown that the ultrasound assisted method with usage of modern domestic equipment allowedincreasing the treatment effi cacy of recurrent basal cell skin cancer.

Functional assessment of visual system in orbital traumas is very important both for practical treatment and in further forensic medical examination of victims. The aim of our clinical studies was to reason the differentiated approach in determining the severity of harm to the health in case of orbital trauma combined with mild craniocerebral injury. Thirty-four patients with orbital trauma have been studied within a period of 3 weeks — 2.5 months after the injury. A comprehensive check of the ophthalmologic status as performed including standard and precise methods of testing the retina and the optic nerve. An overall examination allowed to exclude eye disorders in patients with orbital trauma combined with mild craniocerebral injury, which provided an objective approach in determining the severity of harm caused to the health.

In recent years, Clostridium difficile has become one of the most common and aggressive nosocomial pathogens. The toxigenic strain of C. difficile is the etiological agent of pseudomembranous colitis. This disease leads to the development of dangerous complications without proper therapy. To prevent the C. difficile infection, optimization of in-hospital antibiotics usage and strict compliance with principles of infection control are required. The review of literature presents modern approaches to diagnosis, treatment and prevention of infections, caused by C. difficile.

The study of microcirculation is one of the most growing diagnostic areas. The article summarizes the literature on microcirculation disorders in gynecological patients. Modern methods of microcirculation disorders diagnostics have been analyzed. We also described techniques of laser Doppler fl owmetry (LDF) to assess changes in local microcirculation of the pelvic organs. The results of the clinical use of this technique in patients with various gynecological diseases are reported.

BACKGROUND Penetrating chest injuries are a common cause of hospitalization for young patients.Various types of thoracotomy prevails over the other surgical approaches performed both under absolute and relative indications, depending on the location of wounds.

PURPOSE To analyze the tactics and evaluate the possibility of thoracoscopy in order to reduce the number of unreasonable thoracotomies and reduce trauma due to surgical intervention.

MATERIAL AND METHODS We studied 596 medical histories of victims who had been operated in 2002–2012. Thoracoscopy was performed in 236 patients, traditional tactics was applied in 360 victims. Wounds in the diaphragmatic area of the chest were in 210 victims, in the “heart” area — in 172 patients, in the intersection of these two zones — 44 cases, in the projection of the lung peripheral part — 49 cases and paravertebral area of the chest — in 52 patients. Typical thoracotomy (TT) was performed in 27% of cases, atypical thoracotomy (AT) — 42.5%, and drainage of the pleural space (DPS) — 30.3% of cases.

RESULT Thoracoscopy (TS) could be carried out in 42.2% of patients who had undergone TT, and in 79.4% of patients who had undergone AT. Overall performance of the TS was possible in 70% of patients with penetrating chest wounds (PCW). Absolute contraindications for TS occurred in 29.1% of the victims.

BACKGROUND Pancreatoduodenal resection (PDR) is the only radical method of treatment in patients with malignancies of the head of pancreas, terminal part of the common bile duct, duodenum, and major duodenal papilla. That is why the demand for this operation is very high.

PURPOSE OF THE STUDY To reason the possibility and necessity of PDR in a general hospital.

MATERIAL AND METHODS We studied 55 patients aged from 29 to 75 years who had undergone PDR. In 27 (49%) patients, cancer of the head of pancreas was an indication for surgery. The tumor of the terminal part of the common bile duct was diagnosed in 12 (21%) cases, major duodenal papilla — in 2 (3%) cases. Complicated chronic pancreatitis was the indication for operation in 15 (27%) cases.

RESULTS Postoperative complications were mild or average, lethal outcomes did not occur. Failure of the pancreatic-digestive anastomosis was the most common complication (8 patients). Most postoperative complications have been cured by mini invasive methods.

CONCLUSION PDR is possible, and in many cases advisable to be performed in a multidisciplinary institution, with relevant experience and technical equipment, as it provides much greater possibilities of treatment for both surgical and non-surgical complications.

The article reports the activity of the Burn Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine. We present comparative data on changes in the structure of patients with a burn injury for the past 20 years, and indicators of clinical outcomes over time.

BACKGROUND Misdiagnosis of acute appendicitis reaches 40%. Video laparoscopy allows the correct diagnosis to be establishedin 98.1%, and identify the other disease excluding the initial diagnosisin 1.6%, as well as to determine the optimal surgical approach and perform minimally invasive surgery, if possible.

MATERIAL Clinical observation of 2 cases of perforation of the small intestine.

CONCLUSION The use of laparoscopy in acute surgical disease of abdominal organs allows to establish the correct diagnosis and properly provide a therapy with a minimal surgical trauma.

The article reports a clinical case of the stroke on the background of newly diagnosed polycythemia vera. Possible mechanisms of the stroke in the course of erythremia as well ascurrent methods oftreatment for the disease are described.

We report the clinical case and data on the delayed annualmonitoring of a patient with the Brugada syndrome, complicated with the clinical death