Purpose of the study - to assess the level of cognitive disorders in gerontological patients of the urological profile, depending on the use of sedation in the intraoperative period. A prospective cohort study was performed on 60 gerontological patients diagnosed with BPH II-III stages. Two groups were formed: conscious patients and patients using sedation. Operation - bipolar transurethral enucleation of the prostate (BTUEP). Determination of the depth of sedation with propofol was carried out according to the Ramsey sedation scale in the BIS-monitoring mode. Registration of cognitive status was carried out on the basis of the Montreal Cognitive Function Scale and the Hamilton Depression Scale. The level of cognitive functions of patients in both study groups before surgical treatment indicated the presence of mild impairments according to the Montreal Cognitive Function Scale and the Hamilton Depression Scale. In the group using sedation in patients, a statistically significant decrease (p<0,005) in the score for three items of the Hamilton depression scale was determined in comparison with the group with preserved consciousness in patients: average insomnia (χ2=5,07), working capacity and activity (χ2=4,17), mental anxiety (χ2=4,43). Anesthesia, including spinal anesthesia and sedation controlled by BIS-monitoring, in gerontological patients during BTUEP provides a positive effect on the cognitive functions of patients and reduces the manifestations of depressive symptoms according to the results of clinical interviews using the Montreal Cognitive Assessment Scale and the Hamilton Depression Scale.

Цель исследования - оценка эффективности использования транексамовой кислоты в профилактике интраоперационных геморрагических осложнений у пациентов геронтологического профиля с биполярной трансуретральной резекцией простаты (БТУРП). Пациенты методом конвертов были разделены на две группы. Пациентам 1-й группы (контрольная, n =42) не проводили инфузию транексамовой кислоты. Пациентам 2-й группы (основная, n =42) прединтраоперационно проводили инфузию транексамовой кислоты в дозе 2 мг/кг. Всем пациентам была выполнена БТУРП на эндоскопическом оборудовании по стандартной методике под спинальной анестезией. Сравнение групп проводили по следующим критериям: объём интраоперационной кровопотери, уровень эритроцитов, тромбоцитов и гемоглобина, показатели гемостаза, тромбоэластография до и после операции. Установлено, что периоперационное применение транексамовой кислоты позволило достоверно уменьшить объем кровопотери при БТУРП. Метод тромбоэластографии за счет количественно-качественных характеристик способен выявить, почему достигается эффективность применения ингибитора фибринолиза. The aim of the study was to evaluate the effectiveness of the use of tranexamic acid in the prevention of intraoperative hemorrhagic complications in geriatric patients with bioply transurethral resection of the prostate (BTURP). The patients were divided into 2 groups by the envelope method. Patients of the first group (control group, n =42) did not receive tranexamic acid infusion. Patients of the second group (main group, n =42) received pre-intraoperative infusion of tranexamic acid at a dose of 2 mg/kg. All patients underwent BTURP on endoscopic equipment according to the standard technique under spinal anesthesia. The groups were compared according to the following criteria: the volume of intraoperative blood loss, the level of erythrocytes, platelets and hemoglobin, indicators of hemostasis, thromboelastography before and after surgery. It was established that the perioperative use of tranexamic acid allowed to significantly reduce the volume of blood loss in BTURP. The method of thromboelastography, due to quantitative and qualitative characteristics, is able to assess how the effectiveness of the use of a fibrinolysis inhibitor is achieved.

We presented a clinical case of the successful treatment of a severe course of polysegmental pneumonia caused by the novel coronavirus infection, that developed in the postoperative period after bariatric surgery in the patient with morbid obesity, comorbid type 2 diabetes mellitus, ischemic heart disease, arterial hypertension, pulmonary embolism (in past medical history), and stage 3 chronic obstructive pulmonary disease. The given clinical case demonstrates the possibility of successful treatment of coronavirus infection in the polymorbid patient at an extremely high risk of an unfavorable outcome, given timely diagnosis, combination therapy using drugs that block cytokine storm, and strict adherence to clinical recommendations.

Aim. To evaluate the results of a three-year follow-up of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and quality of life (QOL) dynamics after pulmonary thromboendarterectomy (PTE).Material and methods. The study included 125 patients with CTEPH aged 49,7± 11,9 years. Three-year follow-up included the recording of adverse cardiovascular events, surgeries, death during the period from the end of hospitalization and up to three years. The SF-36 questionnaire was used to assess physical and mental wellbeing before and three years after PTE. Multivariate linear regression was used to assess the factors affecting QOL in the long-term postoperative period.Results. During a three-year follow-up, adverse cardiovascular events was recorded in 1,9% of patients. One patient underwent coronary artery bypass graft surgery and one patient — cholecystectomy. Reoperative PTE was not carried out. The overall three-year survival rate was 90,4%.At baseline, patients with CTEPH had a low level of physical and mental well-being (<40 points). Three years after the operation, these parameters significantly increased (p<0,05), but did not exceed 50 points. Multivariate linear regression revealed an unfavorable effect of early postoperative residual pulmonary hypertension on the physical health three years after PTE. Other factors (age, sex, body weight, comorbidity, hospital acquired complications) did not affect the physical and emotional aspects of QOL.Conclusion. Three-year survival rate in patients with CTEPH after PTE was 90,4%. During the follow-up period, no recurrent thromboembolic events were recorded. Adverse cardiovascular events were recorded in 1,9% of patients. Three years after surgery, the physical and mental health increased in comparison with preoperative values, but did not exceed 50 points on the SF-36 questionnaire. The physical aspect of QOL after surgery is affected by early postoperative residual pulmonary hypertension.

Preservation of reproductive function in women with uterine myoma, after surgery for its removal, is of great social significance. One of the pathological processes in the body of a woman who develops in this category of patients before and after surgery is anemia, which arises from pathological hemorrhage from a diseased organ. Therapy of anemia in this category of patients, in practice, is a difficult task, because against a background of recurrent menometrorrhagia, a vicious circle is formed, because of the severity of the patient's condition there are no conditions for conservative myomectomy, and the treatment of anemia, for a short period before the next bleeding - Ineffective. Within the framework of this work, the efficacy of iron carboxymethyltosate and tranexamic acid has been evaluated in organ-saving operations in gynecological practice. It has been established that the therapy of iron deficiency anemia in the preoperative period with iron carbomethyltosate in combination with intraoperative administration of fibrinolysis inhibitors allows avoiding transfusions of homologous donor blood.

Aim: to study lung diffusion capacity and efficiency of pulmonary ventilation in patients with chronic thromboembolic pulmonary hypertension (CTEPH) depending on the severity of pulmonary hypertension. Materials and Methods. The study included 139 patients with CTEPH. The parameters of body plethysmography, lung diffusion capacity, efficiency of pulmonary ventilation and their interrelation with results of angiopulmonography were assessed. Results. Patients were divided according to systolic pulmonary artery pressure (SPAP): group 1 - < 50, group 2 - 50-80, group 3 - > 80 mm Hg. The lung diffusion capacity and the efficiency of pulmonary ventilation in patients with CTEPH were reduced against the background of normal spirometric parameters, most pronouncedly in group 3. Regression analysis revealed an inverse relationship between severity of pulmonary hypertension and lung diffusion capacity (regression coefficient -13.7 [-19.1; -8.3], p<0.001), pulmonary ventilation efficiency (regression coefficient -1.4 [-3.5; -0.1], p=0.046), and arterial oxygenation (regression coefficient -1.3 [-2.0; -0.7], p=0.001). Conclusion. In patients with CTEPH against a background of normal basic spirometric parameters, the lung diffusion capacity and efficiency of pulmonary ventilation were significantly decreased, most pronouncedly at SPAP > 80 mm Hg. The results of the study demonstrate the close relationship between pulmonary hypertension and respiratory ventilation-diffusion disorders in patients with CTEPH.

Aim. To estimate immunobiochemical markers of the stress response during uterine artery embolization (UAE), and to assess the connection of the endocrine and immune response with pain severity Materials and мethods: 62 patients (ages 31 to 56) with a diagnosis of multiple symptomatic uterine body fibroids were made EMA, and analgesia was achieved by intravenous injection of narcotic and non-narcotic analgesics. Immunobiochemical profile of the stress reaction was investigated (IL-1, IL-6, TNFα, IL-4, IL-10, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH), cortisol, blood glucose) at four (I ONLY SEE 3-SMT) time points (baseline at 2 hours after occlusion of the uterine arteries, and 24 and 48 hours after surgery). Pain syndrome was assessed using a visual analogue scale (VAS) by means of hemodynamic profile.Results. The occlusion of the uterine arteries and ischemia myoma nodes lead to the development of the stress response, as anincrease in the serum concentration of pro-inflammatory (IL-1, IL-6, TNFα) and anti-inflammatory (IL-4, IL-10) cytokines, CRP, stress hormones (ACTH, cortisol) levels of glucose was observed. Pain of various intensity was recorded in all cases, and 18% of patients experienced marked pain (7 to 10 points on the VAS).Conclusion. The maximum increase in immunobiochemical stress markers coincides with the highest manifestations of pain. The necessity of optimization methods of analgesia when performing EMA with the use of immunobiochemical stress markers as a control reaction taking into account hemodynamic profile and VAS data was observed.

This literature review dedicated to the importance of an integrated assessment of external respiratory function in cardiovascular diseases (CVDs), including an analysis of up-to-date techniques, such as spirometry, body plethysmography, examination of the diffusing capacity of the lung, determination of O2 consumption with evaluation of the effectiveness of pulmonary ventilation. It considers the pathogenetic components of impairments in pulmonary ventilation and gas exchange, which develop in different CVDs, as well as during and after cardiac surgery. The authors analyze the results of international investigations and their own experience, which emphasize the prognostic value of lung function tests and suggest that there is a need for a comprehensive functional assessment of the respiratory system in cardiac surgical patients for their effective preoperative preparation, assessment and reduction of operational risks, and improvement of the prognosis of surgical treatment.

Using the orthostatic test, we examined peripheral perfusion by means of laser Doppler flowmetry (LDF) and transcutaneous oximetry in a total of 104 patients presenting with coronary artery disease and functional class II-IV chronic heart failure (CHF) prior to coronary artery bypass grafting (CABG) and in the remote terms thereafter. Volumetric velocity of the microcirculatory blood flow (MCB) of the lower limbs was measured by means of LDF in perfusion units; partial oxygen pressure (TcPO2, mmHg) was registered by means of transcutaneous oximetry. The patients with CAD were subdivided into two groups as follows: Group One comprised patients with FC II CHF and Group Two included those with FC III-IV CHF. Prior to CABG according to the findings of LDF, the lowest level of MCB of the lower limbs was revealed in Group Two, being by 57.9% (42.5-61.3) less as compared with Group One (p=0.008). In Group Two patients as compared with Group One there was a larger proportion of patients with impaired reactivity of the peripheral microcirculatory bed during the orthostatic test in the form of: 1) a paradoxical reaction of the MCB both before CABG (60.6 versus 13.9%, p=0.00001) and in the remote terms after the operation (64.3 versus 16.2%, p=0.00001); 2) lack of the reaction of the MCB prior to the operation (19.7 versus 4.7%, p=0.02) and in the remote period after CABG (16.7 versus 2.7%, p=0.04). Group Two patients both before and after CABG were found to have a decrease (compared with the norm) in the TcPO2 parameters at rest, as well as lower reactivity of tissue metabolism of peripheral tissues during the orthostatic test. An initial decrease in the left ventricular output fraction of < 42% increases the chances of preserving the post-CABG decreased values of TcPO2 of less than 24 mm Hg (OR=3.1; 95% CI 1.1-6.8; p=0.003). Lack of the reaction of the MCB during the orthostatic test prior to CABG increases the chances for the development of surgically significant atherosclerotic lesions of lower-limb arteries after myocardial revascularization (OR=4.2; 95% CI 1.3-2.3; p=0.01). Hence, the most pronounced impairments of the mechanisms of adaptation of the MCB in the orthostatic test prior to and in the remote terms after CABG were detected in CAD patients with FC III-IV CHF. A decrease in the microvascular tonicity during the test and, consequently, inhibition of the nutritive component in this cohort of patients were accompanied by low metabolic reactivity of peripheral tissues.

The definition of operational risk is key to determining the tactics of surgical treatment, anesthesia and preventive measures, as well as to prove the real severity of the patients' condition.

We studied the phenotype and cytokine production in peripheral blood mononuclear cells mobilized from the bone marrow after administration of granulocyte colony-stimulating factor (G-CSF) and the relationship of these parameters with clinical efficacy of autologous intramyocardial injection of donor cells in patients with chronic heart failure. We found that mononuclear cells contain endothelial progenitor cells and are capable of producing pleiotropic cytokines exhibiting angiogenic and cardioprotective properties. High concentration of cells with of CD34+ and CD34+/CD133+ phenotype in the cell transplant and enhanced production of IL-10, TNF-α, and granulocyte-macrophage-CSF by blood mononuclear cells mobilized from the bone marrow can contribute to improvement of myocardial perfusion and increase in left ventricular ejection fraction after intramyocardial transplantation and can serve as predictors of high efficiency of cell therapy. Peripheral blood is an available source of progenitor cells, while mononuclear cells after administration of granulocyte-CSF can produce a reparative effect on ischemic myocardium.

The aim of the study was to examine the effectiveness of renal replacement therapy (RRT) in the treatment of sepsis as an example of severe destructive forms of pancreatitis. During the course of treatment was a significant positive trend of laboratory parameters and course of the main pathological process in the group of patients who were conducted RRT together with basic therapy sessions. Ultrahemodiafiltration inclusion in complex intensive sepsis and septic shock therapy helps to stabilize hemodynamics faster and renounce the use of agonists as well as greatly reduces the laboratory hypoxia and endotoxemia presentations.

Цель исследования: выявить позитивное влияние подкожных субмастоидальных лимфотропных лимфостимулирующих инъекций (ПСЛЛИ) на результаты лечения при ЧМТ тяжелой степени. Все пациенты были разделены на 2 группы. Группа сравнения ‒ 26 пациентов ‒ получала стандартную консервативную терапию. Пациентам, вошедшим в основную группу, ‒ 23 человека, дополнительно проводились ПСЛЛИ. Основные параметры сравнения: оценка по Шкале Ком Глазго (ШКГ) на первые, пятые сутки ЧМТ и при переводе из отделения реанимации в профильное, оценка по шкале Карновского, летальность, длительность нахождения в палате реанимации. Полученные результаты: летальность меньше в основной группе на 34,6 %; на 30,1 % больше пациентов контрольной группы, которые имели менее 60 % по шкале Карновского.