Combined cardiological and ophthalmological pathology has a high prevalence in older age groups of the population and common pathogenetic mechanisms, among which, of course, is a violation of the cytokine profile. However, the cytokine profile of the blood was practically not analyzed in elderly patients with combined ischemic heart disease with glaucoma. The aim of the study was to study the cytokine profile in patients with combined cardio- and ophthalmopathology. The study was performed at the S.N. Fedorov National Medical Research Center “MNTK Eye Microsurgery”, in two groups: patients with combined coronary heart disease with glaucoma (n = 58 people), and patients with coronary heart disease (n = 49 people), who in both cases have the same age of 60-74 years. The diagnosis of glaucoma was carried out in accordance with the criteria of the “National Glaucoma Guidelines”. Electrocardiographic, echocardiographic, radiographic, and enzyme studies were performed to diagnose coronary heart disease. The determination of cytokines in blood plasma was carried out on the device “Becton Dickinson FACS Canto 2 (USA)” using a special set of CBA (BD Biosciences, USA). Among the patients of the compared groups of the same age, significant differences in most cytokines were revealed, namely, a predominant increase in patients with combined cardio- and ophthalmopathology relative to the group with coronary heart disease. The content of IL-5, IL-12, IFNγ, TNFα in the blood plasma of patients with coronary heart disease combined with glaucoma increased with a significant difference compared to patients with coronary heart disease. However, the highest increase among the cytokines under consideration is characteristic of IL-6 and IL-17, which amounted to 23.8±1.1 pg/mL and 20.2±1.7 pg/mL in patients with combined cardio- and ophthalmopathology versus 6.3±0.3 pg/mL and 7.9±0.5 pg/mL, respectively, in patients with coronary heart disease. At the same time, the level of IL-4 and IL-10 decreased significantly to 2.2±0.2 pg/mL and 6.4±0.4 pg/mL versus 4.8±0.3 pg/mL and 11.9±0.6 pg/mL. The use of logistic regression made it possible to determine the relative risk values of the studied blood cytokines and to develop uncorrected and adjusted models, according to which the closest association with the risk of developing combined coronary heart disease with glaucoma was established for IL-6 and IL-17, with the relative risk values in the uncorrected model of 2.87 and 2.71, respectively (p < 0.001). However, in the adjusted model, the association of IL-6 with combined coronary heart disease with glaucoma increased to 2.92 (CI 2.80-3.27, p = 0.004), and IL-17 decreased to 2.64 (CI 2.51-2.85, p = 0.003). There was also a significant association of IL-4, IL-5, IL-12, IFNγ and TNFα with combined coronary heart disease with glaucoma. The study demonstrated new associations of systemic cytokines with the risk of developing combined coronary heart disease associated with glaucoma.

Диабетическая ретинопатия (ДР) может вызвать зрительный дефицит, с которым у пациентов снижается качество жизни, уход за собой, увеличивает риск смертности. Также при ДР изменяются лабораторно-инструментальные показатели: параметры антиоксидантной системы, содержание белка, печёночных ферментов, витаминов. Однако изучение зрительного дефицита и лабораторно-инструментальных изменений у пациентов старческого возраста анализируется редко, поэтому изучение данных показателей остаётся актуальным. Цель исследования – изучение зрительного дефицита и лабораторно-инструментальных изменений у пациентов старческого возраста с диабетической ретинопатией. При проведении настоящего исследования выполнено офтальмологическое и лабораторно-инструментальное обследование 284 пациентов с ДР. Выявление ДР включало применение: оптической когерентной томографии с функцией ангиографии, исследование глазного дна, определение остроты зрения без коррекции, периметрию, определение максимальной корригированной остроты зрения, определение полей зрения. Всем пациентам проводилось также определение лабораторных показателей антиоксидантного статуса, содержание белка, печёночных ферментов, витаминов. Среди параметров, характеризующих зрительный дефицит у пациентов старческого возраста с наличием ДР, при комплексном офтальмологическом обследовании диагностировано репрезентативное снижение всех изученных показателей центрального зрения. При оценке зрительного дефицита на основе параметров периферического зрения пациентов старческого возраста с ДР и без нее установлено статистически достоверное снижение суммы полей зрения по изученным восьми меридианам в клинических группах. При сравнении показателей местной артериальной гемодинамики в рассмотренных выше артериях у пациентов старческого возраста выявлены статистически значимые различия в величинах максимальной систолической и конечной диастолической скорости во всех исследованных сосудах. Уровень общего белка в крови больных 75-89 лет с ДР статистически значимо снизился в сравнении с возрастным контролем также как и удельный вес альбуминов. Полученные результаты свидетельствуют о влиянии ДР на зрительную функцию обследованных пациентов, изменяя различные параметры остроты зрения и способствуют формированию существенного зрительного дефицита, обуславливая снижение функциональной активности вследствие изменения тяжести дефицитарного состояния Diabetic retinopathy can complicate visual deficits, with which patients' quality of life decreases, self-care increases the risk of mortality. Also, in diabetic retinopathy, laboratory and instrumental parameters change: parameters of the antioxidant system, protein content, liver enzymes, vitamins. However, the study of visual deficits and laboratory-instrumental changes in elderly patients is rarely analyzed, so the study of these indicators remains relevant. The aim of the study was to study visual deficits and laboratory and instrumental changes in elderly patients with diabetic retinopathy. During the present study, ophthalmological and laboratory-instrumental examination of 284 patients with DR was performed. The identification of DR included the use of: optical coherence tomography with angiography function, fundus examination, determination of visual acuity without correction, perimetry, determination of maximum corrected visual acuity, determination of visual fields. All patients were also assessed for laboratory indicators of antioxidant status, protein content, liver enzymes, vitamins. Among the parameters characterizing the visual deficit in elderly patients with the presence of DR, a representative decrease in all the studied indicators of central vision was diagnosed during a comprehensive ophthalmological examination. When assessing visual deficits based on the parameters of peripheral vision of elderly patients with and without DR, a statistically significant decrease in the sum of the fields of vision for the studied eight meridians in clinical groups was found. When comparing the indicators of local arterial hemodynamics in the arteries considered above in elderly patients, statistically significant differences in the values of the maximum systolic and final diastolic velocity in all the vessels studied were revealed. The level of total protein in the blood of patients aged 75-89 with DR decreased statistically significantly in comparison with the age control, as well as the specific weight of albumins. The results obtained indicate the influence of DR on the visual function of the examined patients, changing various parameters of visual acuity and contribute to the formation of a significant visual deficit, causing a decrease in functional activity due to changes in the severity of the deficit condition

Aim. To analyze Barthel Index of Activities of Daily Living (ADL) in elderly patients with hypertension (HTN) and frailty 6 months after non-ST segment elevation myocardial infarction non-STEMI).Material and methods. ADL was studied in 114 elderly patients (60-74 years old) with non-STEMI, HN and frailty and 80 patients of the same age with non-STEMI and HTN, but without frailty. ADL was determined 6 months after suffering non-STEMI.Results. ADL in patients with frailty was reduced to a greater extent (55,8 [52,4-57,9]) than in non-frail patients (72,9 [70,3-78,6]) (p<0,01). According to factor analysis, ADL reduction in frail patients compared with non-frail patients was mainly due to bed-chair transfer — 6,4 [6,2- 6,8] vs 9,8 [8,1-11,5] (p<0,001), walking test — 8,1 [8,0-8,5] vs 10,6 [9,4-12,7] (p<0,001), stair climbing — 5,3 [5,1-5,7] vs 7,4 [6,8-8,9] (p<0,001). ADL in patients with frailty and blood pressure (BP) <160/100 mm Hg was 62,1 [60,3-69,9], which is significantly higher than in frail patients with BP ≥160/100 mm Hg (48,0 [36,3-53,2]) (p<0,01).Conclusion. In frail patients aged 60-74 years, compared with non- frail patients, 6 months after non-STEMI, ADL was significantly lower in such components as stair climbing, walking, and bed-chair transfer. In patients with frailty and BP <160/100 mm Hg, ADL is significantly higher than in patients with higher blood pressure.

OBJECTIVEMorphological substantiation of laparoscopic suturing of gastric ulcer with formation of a covered perforation.MATERIAL AND METHODSTo analyze morphological tissue reaction in surgical area, we used 12 Chinchilla rabbits. All animals were divided into 2 groups by 6 animals. The main group enrolled rabbits undergoing suturing of perforated gastric ulcer with formation of a covered perforation by anterior stomach wall. In the control group, gastric perforation was sutured by conventional double-row suture. For histological analysis, 2 animals in each group were withdrawn from the experiment after 7, 14 and 21 days. We excised gastric wall within the area of perforation closure. Morphological data on healing process were compared between both groups.RESULTS. STomach deformation after 7 days was more severe in the main group compared to simple suturing. However, these differences were absent after 21 days. Morphological analysis revealed postoperative transmural necrosis after 7 days. Signs of early epithelialization were more obvious in the main group. After 21 postoperative days, we observed almost completely restored differentiation of stomach wall layers in both groups of animals.

The study objective– to present a clinical case of axillary nerve neurolysis performed through arthroscopic transcapsular access.Clinical case.Patient Ch., 38 years old, received a fracture of the head of the left humerus as a result of a fall 5 months ago. Immediately after the injury, symptoms of axillary nerve damage appeared. Conservative therapy was carried out without positive dynamics. According to ultrasound and electroneuromyography, signs of compression of the axillary nerve were noted without violating its anatomical integrity. The pathological substrate was located in the neck of the humerus, in the “blind” zone of the nerve. The situation was complicated by the progression of the phenomena of arthrosis of the joint with the formation of pain. Performed acroscopic transcapsular neurolysis of the axillary nerve with sanitation of the cavity of the shoulder joint. After 2 months, a visual increase in deltoid muscle volume and range of motion in the shoulder joint was noted.Conclusion.Arthroscopic transcapsular axillary neurolysis is, from our point of view, a promising minimally invasive intervention with the ability to perform simultaneous surgery by a multidisciplinary team. It is necessary to compare the results of the operation with arthroscopic and open access.

The objective is to describe the case of successful endovascular treatment of residual chronic subdural hematoma.Clinical case. Patient A., 77 years old, was admitted to the hospital with a directional diagnosis of stroke. During further examination, left hemispheric chronic subdural hematoma with a volume of 100 cm3 was revealed. The patient was twice performed closed external drainage of hematoma. And for each subsequent control computed tomography studies, a residual hematoma with a volume effect on the brain was determined. Endovascular selective embolization of the left middle meningеal artery was performed. During the examination after 5 months, a complete reduction of hematoma, cerebral and focal neurological symptoms was noted.Conclusion. Endovascular embolization of the middle meningeal artery may be a pathogenetically substantiated, minimally invasive alternative to repeated surgical interventions for residual and recurrent chronic subdural hematoma. It will be reasonable to continue research to assess the effectiveness and safety of the methodology.

Aim. To evaluate the dynamics and prognostic significance of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with severe abdominal sepsis.Methods. We analysed survey data of 54 patients (28 men and 26 women) aged 64.5 years [56.25–78.00] with abdominal sepsis or septic shock. Disease severity scored according to the Acute Physiology and Chronic Health Evaluation II criteria was 16.3 ± 0.8 and according to the Sequential Organ Failure Assessment (SOFA) was 3 [3–6]. Statistical analysis of these data was performed using correlation analysis, logistic regression and receiver operating characteristic analysis.Results. Serum NT-proBNP level during the 1st week following admission to the intensive care unit (ICU) exceeded normal values, i.e. 2,570 [116.25–6,559.5] to 4,600 [1,680–18,200] pg/ml. At all disease stages, serum NT-proBNP level correlated with sepsis severity scores (SOFA), procalcitonin (PCT) levels, lactatemia, mean arterial pressure, heart rate and inotropic and vasoactive–inotropic scales (rho = 0.329–0.433; p < 0.02). On ICU days 3–4, serum NT-proBNP level of >5100 pg/ml was associated with increased risk of mortality [65.6%–88.2%; area under the curve (AUC) = 0.806; р < 0.0001]. Similarly, during this interval, elevated serum NT-proBNP level was associated with the use of inotropic drugs (OR = 1.0001, 95% CI = 1.000–1.0002, p < 0.0059). Notably, we found that 76.9%–79.0% of the patients with serum NT-proBNP level of >5250 pg/ml were receiving inotropic drugs including adrenaline, dopamine and dobutamine. We were unable to identify a specific association between serum NT-proBNP level and norepinephrine administration. On ICU days 7 and 8, among patients with serum NT-proBNP level of >3450 pg/ml, we observed a very close relationship between serum NT-proBNP level and PCT (sensitivity = 63.6%, specificity = 66.7%, AUC = 0.708; р = 0.0041).Conclusion. Serum NT-proBNP level is considerably elevated in patients with abdominal sepsis or septic shock. NT-proBNP level was associated with both traditional indicators of sepsis severity and indicators characterising the state of systemic circulation. Notably, serum NT-proBNP level correlates with cardiac failure and inotropic drug requirement. Although the mechanisms underlying the observed increases in serum NT-proBNP level remain unclear, the present findings indicate that this mediator is clearly a significant biomarker and predictor of adverse outcomes related to abdominal sepsis and septic shock. Received 22 January 2020. Revised 27 January 2020. Accepted 11 February 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: I.N. Tyurin, D.N. Protsenko, I.A. KozlovData collection and analysis: I.N. Tyurin, S.A. Rautbart, S.N. ShuryginStatistical analysis: I.N. Tyurin, S.A. RautbartDrafting the article: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov, S.N. ShuryginCritical revision of the article: I.N. Tyurin, I.A. KozlovFinal approval of the version to be published: I.N. Tyurin, S.A. Rautbart, D.N. Protsenko, S.N. Shurygin, I.A. Kozlov

Цель. Изучить динамику и прогностическую значимость NT-proBNP у больных с тяжелым абдоминальным сепсисом. Методы. Проанализировали данные обследования 54 больных (28 мужчин и 26 женщин) в возрасте 64,5 [56,25; 78,00] года с абдоминальным сепсисом или септическим шоком. Тяжесть состояния по APACHE II составила 16,3 ± 0,8 балла, по SOFA — 3 [3; 6] балла. Статистическую обработку данных выполнили с использованием корреляционного анализа, логистической регрессии и ROC-анализа. Результаты. NT-proBNP в течение первой недели пребывания больных в отделении реанимации и интенсивной терапии превышал нормальные значения: от 2 570 [116,25; 6 559,5] до 4 600 [1 680; 18 200] пг/мл. На этапах исследования уровень биомаркера коррелировал с показателями тяжести сепсиса — оценкой по SOFA, уровнем прокальцитонина и лактатемией, а также со средним артериальным давлением, частотой сердечных сокращений, инотропным и вазоактивно-инотропным индексами (rho = 0,329–0,433; p<0,02). На 7–8-е сут. пребывания в отделении реанимации и интенсивной терапии связь между NT-proBNP и прокальцитонином становилась тесной. На риск летальности на 3–4-е сут. пребывания в отделении реанимации и интенсивной терапии указывали NT-proBNP >3 450 пг/мл с чувствительностью и специфичностью 63,6 и 66,7% (площадь под ROC-кривой 0,708; р = 0,0041); на 7–8-е сут. >5 100 пг/мл (65,6 и 88,2%; площадь под ROC-кривой 0,806; р<0,0001). Начиная с 3–4-х сут. NT-proBNP был ассоциирован с потребностью в инотропных препаратах (отношение шансов 1,0001, 95%-й доверительный интервал 1,0000–1,0002, p<0,0059); NТ-proBNP >5 250 пг/мл (76,9 и 79,0%) выделял больных, получающих инотропы (адреналин, допамин, добутамин). Ассоциированность с показателями, учитывающими использование норадреналина, отсутствует либо выражена слабо. Заключение. У больных абдоминальным сепсисом или септическим шоком резко повышен NT-proBNP, который связан как с традиционными показателями тяжести сепсиса, так и с показателями состояния системы кровообращения. Кардиодепрессия подтверждается ассоциированностью уровня NT-proBNP с потребностью в назначении инотропных препаратов. Независимо от причин усиления инкреции, повышение NT-proBNP является предиктором неблагоприятного исхода сепсиса. Поступила в редакцию 22 января 2020 г. Исправлена 27 января 2020 г. Принята к печати 11 февраля 2020 г. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов. Финансирование. Исследование не имело спонсорской поддержки Вклад авторов Концепция и дизайн работы: И.Н. Тюрин, Д.Н. Проценко, И.А. Козлов Сбор и анализ данных: И.Н. Тюрин, С.А. Раутбарт, С.Н. Шурыгин Статистическая обработка данных: И.Н. Тюрин, С.А. Раутбарт Написание статьи: И.Н. Тюрин, Д.Н. Проценко, И.А. Козлов, С.Н. Шурыгин Исправление статьи: И.Н. Тюрин, И.А. Козлов Утверждение окончательного варианта статьи: все авторы

КЛЕТОЧНО-ТКАНЕВЫЕ КОМПЛЕКСЫ ЗОНЫ ГАСТРОСТОМЫ Ваганов А.Г. 1 , Цулая А.З. 2 , Сафонов Л.В. 3 , Шурыгин С.Н. 3 , Криштоп В.В. 4 , Никонорова В.Г. 4 1 ГБУЗ ГКБ № 29 им.Н.Э.Баумана ДЗМ, Москва; 2 ГБУЗ ГКБ им.В.М.Буянова ДЗМ, Москва; 3 ФГБУ ФНЦ ВНИИФК Минспорта России, Москва; 4 ФГБОУ ВО Ивановская государственная медицинская академия Минздрава РФ, Иваново, е-

OBJECTIVE:To evaluate the results of traditional and high-tech physical rehabilitation in cerebral palsy and in modeling of rehabilitation prognosis.MATERIAL AND METHODS:One hundred and twenty-six patients with cerebral palsy (spastic diplegia); mean age 7.0±1.3 years, the duration of inpatient treatment 28 days, were studied. Forty patients received conventional treatment, 86 - a high-tech physical rehabilitation (robotic mechanic therapy with «Lokomat», «Armeo» and electric stimulation of the brain with «Brain-port» device).RESULTS AND CONCLUSION:The advantage of more significant therapeutic effects of high-tech physical rehabilitation over traditional treatment is established. This effect consists in improving coordination and independent movement. On the basis of the regression analysis, mathematical models of the prognosis of the rehabilitation potential are constructed. High-tech physical rehabilitation has a significantly more pronounced therapeutic effect than traditional treatment.

OBJECTIVETo demonstrate the results of endovascular treatment of 15 patients with acute mesenteric ischemia.MATERIAL AND METHODSThere were 15 patients with acute mesenteric ischemia who underwent surgery (9 men and 6 women). Mean age was 77±11 years. Acute intestinal ischemia was caused by thromboembolism of superior mesenteric artery (9 patients), thrombosis of superior mesenteric artery (5 patients) and critical stenosis of the ostia of superior mesenteric artery and celiac trunk (1 patient). Mean time from clinical manifestation of disease to admission to the hospital was 13 hours (range 2-72 hours). In-hospital development of acute mesenteric ischemia was noted in 2 patients. Indications for endovascular intervention and techniques of endovascular revascularization of superior mesenteric artery are described in the article.RESULTSBlood flow restoration in superior mesenteric artery was achieved in 14 (93%) out of 15 patients. Laparotomy was required in 4 (27%) patients for extensive resection of necrotic intestine (n=1, 6.7%), local resection of small bowel (n=2, 13%). In another (6.7%) patient, intestine was recognized as viable after laparotomy. A bulk of intestine was preserved in most patients (n=14, 93%). In-hospital mortality rate was 47% (7 patients died). The main cause of nosocomial death (6 cases) was reperfusion syndrome followed by respiratory distress syndrome and multiple organ failure.CONCLUSIONNew methods of prevention and treatment of reperfusion syndrome can improve the results of treatment of acute mesenteric ischemia.

AIM To study the effectiveness of the combined use of electromyostimulation (EMS) and static exercises to correct postural balance (PB). MATERIAL AND METHODS Seven healthy adolescents performed the static exercise 'tilt to the side' together with EMS (main group), 7 age-matched adolescents (control group), performed only the exercise. EMS was performed by the device 'Bellatronic'; current 5 A, pulse frequency 20 Hz. Stimulation was carried out for a minute, alternating 2-second exposure to electric current with a 2-second pause of rest. PB was assessed using stabilometric tests on the MBN platform. RESULTS AND CONCLUSION The tested static exercise 'tilt to the side' together with EMC has a controlled and significant effect on the displacement of the projection of the General center of mass of the body (CMT) in the frontal and sagittal planes, provided an individual approach. No significant improvements to travel speed and area of statokinesigram in the short term are, probably, due to the unfamiliarity of the exercise and prolonged fixation of a static posture. The use of EMS on stretching muscle fibers can enhance the effect of relaxation, which can be used both independently and for the correction of the static exercises. The change in muscle tone caused by the tested static pose with the use of EMS controls and corrects in the short term the projection of CMT in the frontal and sagittal planes, an important indicator of PB.

Цель исследования. Изучить влияние возраста больных с сепсисом на уровень параметров центральной гемодинамики (ЦГД), регистрируемых у них при поступлении в отделение реанимации и интенсивной терапии (ОРИТ). Материалы и методы. Ретроспективно проанализировали данные обследования 54 больных с сепсисом, диагностированным в соответствии с критериями «Сепсис-3». Возраст больных составил 22–83 (49,6 ± 2,17) года; тяжесть состояния при поступлении в ОРИТ по шкале APACHE II 6–19 (12,3 ± 0,47) баллов, по шкале SOFA — 4–14 (8 [6, 10]) баллов. У больных с сепсисом ряд показателей, характеризующих насосную функцию сердца (индекс функции сердца (ИФС), глобальная фракция изгнания сердца (ГФИС), индекс мощности сердца (ИМС), сердечный индекс (СИ)), находятся в обратных корреляционных связях с возрастом, а индекс глобального конечно-диастолического объема (ИГКДО) — в прямой связи. Результаты. У больных с сепсисом ряд показателей ЦГД имел корреляционные связи с возрастом: ИФС — rho = −0,681 (р < 0,0001), ГФИС — rho = −0,488 (р = 0,0002), ИМС — rho = −0,438 (р = 0,0009), СИ – rho = −0,395 (р = 0,0031) и ИГКДО — rho = 0,427 (р = 0,0013). Возраст > 62 лет являлся предиктором ИФС < 4,5 мин-1 (отношение шансов [ОШ] 1,1817, 95%-й доверительный интервал [95% ДИ] 1,0642–1,3121; p < 0,0001) и ГФИС < 20 % (ОШ 1,0741, 95% ДИ 1,0251–1,1255; p < 0,0006). Возраст > 64 лет являлся предиктором уровня СИ < 2,5 л/мин/м2 (ОШ 1,0834, 95% ДИ 1,0200–1,1508; p < 0,0024). В возрасте около 60 лет также возрастала вероятность урежения частоты сердечных сокращений и повышения общего периферического сосудистого сопротивления. У больных старше 62 лет чаще диагностировали сопутствующую гипертоническую болезнь (78 и 12,5 %; р < 0,001), ишемическую болезнь сердца (64 и 7,5 %; р < 0,01) и постинфарктный кардиосклероз (7 и 0 %; р = 0,02). Заключение. Высокую вероятность снижения эффективности насосной функции сердца, а также коморбидность по сердечно-сосудистым заболеваниям следует учитывать при выборе оптимальных мер интенсивного лечения и мониторинга у гериатрических больных с сепсисом.

AIM:To analyze the outcomes of fast track rehabilitation program in patients with perforated duodenal ulcer (PDU).MATERIAL AND METHODS:For the period 2013-2016 at the Department of Surgery and Endoscopy 206 PDU patients have been treated. Inclusion criterion for the main group (n=77) was duodenal ulcers, their dimension up to 1 cm, laparoscopic suture of perforated ulcer, fast track rehabilitation program implementation. The control group consisted of 129 patients who underwent open suturing of perforated ulcer followed by conventional treatment in postoperative period.RESULTS:In the main group (n=77) laparoscopic suturing of ulcerative defect with the use of Fast Track program was performed. Postoperative complication i.e. sutures failure was observed in 1 (1.3%) case. There were no lethal outcomes in the main group. Mean length of hospital-stay was 4.8 days. In 129 patients of the control group open suturing of the perforated ulcer and conventional postoperative therapy were applied. Postoperative surgical complications were absent in the control group; mortality rate was 2.3%. Mean length of postoperative hospital-stay was 8.1 days.CONCLUSION:Laparoscopic treatment of perforated ulcers facilitates application of fast track rehabilitation program in emergency patients. Fast track rehabilitation protocol after laparoscopic suturing of the perforated ulcer creates conditions for early discharge and is followed by good clinical and economic effects. Recurrent peptic ulcers are noted if antiulcer therapy is absent.

AIM:To study the state of cerebral hemodynamics and platelet hemostasis in patients with carotid stenosis (CS).MATERIAL AND METHODS:The prospective study included 123 patients with atherosclerotic CS. The 1st group included 53 patients (mean age 52±12.5 yrs) who underwent carotid endarterectomy (CEA); the 2nd group - 70 patients who were treated conservatively (mean age 58.5±15.9 yrs). The state of blood flow through the main arteries of the head (Doppler flowmetry), platelet aggregation induced by adrenaline, the frequency of acute cardiovascular events that occurred during 12 months were evaluated.RESULTS AND CONCLUSION:The severity of neurological deficits and cognitive impairment increased with increasing of the degree of CS. CEA leads to an improvement of cerebral hemodynamics and stabilization of cognitive functions. The adverse course of the disease occurred in 23.6% of patients (stroke/heart attack during the year in 5.7%, progression of cerebral ischemia in 20%, restenosis within 5 years after CEA in 15%). Hyperaggregation of platelets induced by ADP and epinephrine and decreased aggregation of platelets induced by collagen in patients receiving ASA were identified in 53% of the operated and in 60% of non-operated patients. The use of combined antiplatelet therapy normalize the platelet hemostasis and reduce the frequency of acute cardiovascular events.

Венозная форма острого нарушения мезентериального кровообращения (ОНМзК) — разновидность острого нарушения кровоснабжения кишечника, обусловленная острой тромботической окклюзией портомезентериального венозного бассейна и приводящая к ишемии или некрозу органов брюшной полости. Впервые некроз кишечника, вызванный тромбозом брыжеечных вен, был описан J. Elliot в 1895 г. Автор осуществил резекцию некротизированной кишечной петли с формированием двуствольной энтеростомы, которая спустя 2 нед была закрыта [23, 70]. Однако наиболее подробно это заболевание было описано S. Warren и T. Eberhardt в 1935 г. [80], что в дальнейшем привело к выделению венозного мезентериального тромбоза в отдельную нозологическую единицу.

The retrospective analysis of clinical records of 25 patients with the severe combined injury for the purpose of an assessment of influence of changes of volemichesky support on development of sharp injury of lungs is made. Monitoring of haemo dynamics and the volemichesky status carried out by means of technology of the modified PiCCO plus termodilyution (Pulsion Medical Systems, Germany). During the analysis it was revealed that application of haemo dynamic monitoring with use of a transpulmonalny termodilyution and the PiCCO technology, allows to improve authentically oxygenation index indicators, to reduce duration of respiratory support and a ball assessment of weight of a condition of patients, on an integrated scale of SOFA. From this it is possible to draw a conclusion that application of volemichesky monitoring of PiCCO allows to prevent development of the sharp injury of lungs (SIL) in patients with the severe combined injury.

It is presented 5 clinical observations of acute ischemia of intestine in which different endovascular interventions including isolated superior mesenteric artery stenting, rheolytic and aspiration thrombectomy and combination of techniques were applied. Surgical success with blood flow restoration in superior mesenteric artery was achieved in 4 of 5 patients. 2 patients have required laparotomy and intestinal resection. In 1 case extent of resection was significantly reduced after previous endovascular thrombectomy. There were no deaths. It is concluded that endovascular interventions may be considered as independent method of treatment of patients with acute mesenteric ischemia.