Background. Unstable fractures of the posterior pelvic ring represent a pressing concern in trauma surgery. Minimally invasive osteosynthesis techniques have gained widespread acceptance in contemporary practice. Accurate radiographic visualization is a critical component for the precise and successful placement of iliosacral and transsacral screws. Obtaining and accurately interpreting X-ray images can pose challenges in specific clinical situations, particularly those involving age-related skeletal changes. The aim of the study is to assess the influence of the patient’s age on the measures of pelvic radiographic inlet and outlet views angles for performing a sacral fracture fixation using cannulated screws. Methods. A retrospective analysis of CT data was conducted on 106 patients with posterior pelvic ring injuries requiring cannulated screw fixation. Preoperative CT scans were reconstructed into sagittal projections. We performed construction and measurement of the true inlet angle, super-inlet angle, pelvic outlet angle, sacral concavity angle, promontory angle, S1 and S2 outlet view angles. Statistical correlation between sacral tilt angle and the patient’s age was assessed. Results. A two-step cluster analysis divided the patient cohort into two groups with significant differences in pelvic outlet angles and age (N1 = 64, N2 = 42). Statistically significant differences were found between the two clusters in all the studied parameters: median values of true pelvic inlet angles were 27.2° [23.2-32.2] and 18.2° [11.4-26.6] respectively (p0.001); super-inlet angles were 42.5° [39.3-47.8] and 36.2° [28.7-42.8] respectively (p0.001); promontory angles were 128.1° [123.3-133.2] and 122.1° [115.6-129.3] respectively (p = 0.003); pelvic outlet angles were 62.6° [58.4-69.6] and 50.3° [45.9-53.5] respectively (p0.001); S1 outlet angles were 51.8° [48.9-56.5] and 46.8° [43.1-50.2] respectively (p0.001); S2 outlet angles were 40.8° [37.3-44.6] and 35.7° [30.9-38.6] respectively (p0.001); the mean of the sacral concavity angles was 174.8°±10.5 and 152.1°±38.2 respectively (p0.001); and the main age was 41.6±18.7 and 69.2±16.1 years respectively (p0.001). A statistically significant inverse correlation between age and pelvic tilt angle (ρ = 0.534; p0.001) was found. A novel diagnostic method for identifying sacral dysmorphism using angle measurement within the S1 bone corridor is presented. The sacrum was considered dysmorphic if the angle was equal to or less than 5°. Conclusions. As the patient’s age increases by one year, pelvic outlet angle decreases by 26°. If pelvic inlet angles are equal to or less than 14.45°, the difficulties in visualizing S1 and S2 outlet views during surgery are to be expected. The median of angles difference before and after anterior sacral tilt correction using a coccyx pad was 9.4° with interquartile range from 7.8° to 11°. Significant anatomical variations in posterior pelvic ring structure were observed among the study cohort. Preoperative CT sagittal reconstructions allow appropriate planning of intraoperative visualization considering expected intraoperative radiographic inlet and outlet views.

OBJECTIVE:To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations.MATERIAL AND METHODS:The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions.RESULTS:Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery.CONCLUSION:EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.

Introduction. The number of victims with abdominal trauma over the past 20 years has not tended to decrease due to an increase in the number of road accidents, falls from heights, man-made disasters and natural disasters. Diagnosis of damage to hollow organs should be fast and accurate, since the time factor in providing medical care to such patients is crucial. The delay of surgery for intestinal injury for 24 hours or more is associated with an increase in the mortality rate of up to 30%. In such cases, computed tomography is the method of choice for hemodynamically stable patients with closed abdominal trauma.The aim is to demonstrate the possibilities of computed tomography in the early detection of damage to the small intestine and mesentery using the example of a clinical case of closed combined abdominal trauma with damage to a hollow organ and multiple injuries of the musculoskeletal system.Materials and methods. A clinical case of combined trauma of a patient in a traffic accident is described.Conclusion. In this clinical case, the victim with a combined injury was shown the modern possibilities of computed tomography in early detection of damage to the walls of the small intestine and mesentery, which made it possible to make a timely decision on emergency surgery, avoid serious complications, restore the patient's ability to work and quality of life.

Iatrogenic injuries of the esophagus and trachea are rare. However, these are life-threatening events due to severe complications. The authors report iatrogenic perforation of cervical esophagus with a long false passage in posterior mediastinum in an 83-year-old patient undergoing endoscopic retrograde cholangiopancreatography for choledocholithiasis. Post-intubation rupture of thoracic trachea was diagnosed early after suturing the defect of esophagus and drainage of mediastinum. Treatment strategy was analyzed and conservative management of tracheal injury was substantiated.

The purpose of the study. To study the possibilities of computed tomography (CT) in the diagnosis of spontaneous hematoma of the esophagus, including in the process of dynamic observation. Materials and methods. A retrospective analysis of CT results in 11 patients with spontaneous esophageal hematoma treated at the N.V. Sklifosovsky Research Institute of SP in the period 2005–2020 is presented. All patients underwent a comprehensive laboratory and instrumental examination, including CT. CT studies were performed with oral and intravenous bolus contrast, primarily at admission and in dynamics. Results. In all cases, according to CT data, acute pathology of the aorta, rupture of the esophagus were excluded and signs of spontaneous hematoma of the esophagus were revealed. CT semiotics of esophageal hematoma was analyzed with quantitative treatment of changes in density, linear dimensions and volume. CT semiotics analysis also revealed the volumetric effect of hematoma on surrounding organs and structures, accumulation of blood in the pleural cavities, and verified signs of infection of hematoma with inflammatory changes in the surrounding paraesophageal tissue. CT data served as the basis for determining the optimal treatment tactics for spontaneous esophageal hematoma. Conservative therapy was the main method of her treatment. CT examination in dynamics allowed timely detection of complications of spontaneous hematoma of the esophagus (hemothorax, perforation of the esophagus, infection of the hematoma) requiring surgical intervention. Conclusion. CT is the method of choice in the diagnosis of spontaneous hematoma of the esophagus, which allows for a clear differential diagnosis with urgent life-threatening conditions. CT data make it possible to justify treatment tactics and assess the dynamics of the pathological process.

The purpose of the study. To clarify the possibilities of using radiation research methods in the framework of complex diagnostics of local peritonitis for timely recognition and treatment of intra-abdominal abscesses and infiltrates.Materials and methods. The analysis of the results of a complex radiation examination in 61 patients with local peritonitis of various etiologies who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine was carried out. The complex of radiation diagnostics included ultrasound and X-ray examinations, computed tomography (CT). The studies were performed both initially at admission and in dynamics.Results. The diagnostic algorithm for local peritonitis is analyzed, three stages are identified with the determination of the method of choice on each of them. Ultrasound and X-ray examination methods are mainly used at the stage of primary diagnostics and for dynamic control. CT allows you to clarify the type, localization and volume of inflammatory changes, their relationship with the surrounding organs and structures. When analyzing the results of radiation diagnostics, it was determined the need to identify and evaluate the main signs of local peritonitis, both direct: the presence of voluminous formation of inflammatory genesis (infiltrate and/or abscess); and indirect: changes in the source organ of peritonitis; changes in structures adjacent to the infiltrate /abscess; the presence of reactive effusion into the thoracic and abdominal cavities.Conclusion. Comprehensive radiation diagnostics for local peritonitis makes it possible to obtain complete information about the nature of both inflammatory changes in local peritonitis and the causes of them. The obtained data of complex diagnostics help the surgeon to choose a rational treatment strategy for these patients, including minimally invasive. Diagnostic monitoring allows you to evaluate the effectiveness of treatment and carry out timely correction of tactics.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка эффективности эндоскопической вакуумной терапии (ЭВТ) в комплексном лечении пациентов с механическими повреждениями пищевода. МАТЕРИАЛ И МЕТОДЫ Проведен анализ результатов лечения 15 пациентов с механическими повреждениями пищевода за период 2019—2021 гг. Комплексное лечение пациентов включало применение минимально инвазивных технологий, в том числе чрескожной эндоскопической гастростомии, ЭВТ и видеоторакоскопической санации. Оценку эффективности лечения проводили с учетом данных мультиспиральной компьютерной томографии, эндоскопии и лабораторных исследований. Учитывали длительность стационарного лечения и продолжительность ЭВТ, количество замен системы, осложнения и летальность. РЕЗУЛЬТАТЫ ЭВТ у пациентов с механическими повреждениями пищевода позволила добиться эпителизации дефекта в пищеводе у 12 (85,5%) пациентов в виде формирования тонкого линейного рубца на месте перфорации либо псевдодивертикула. Осложнения отмечены у 4 (27%) пациентов, в том числе кровотечение (у 2 пациентов) и стеноз пищевода в зоне перфорации (у 2 пациентов). Умер 1 (7%) больной. ЗАКЛЮЧЕНИЕ Эндоскопическая вакуумная терапия в комплексном лечении пациентов с механическими повреждениями пищевода и их осложнениями является эффективным минимально инвазивным методом, позволяющим снизить количество осложнений и летальных исходов.

On the example of a clinical case, the possibilities of radiation diagnosis of a rare type of injury received from a construction and installation gun are shown. The modern possibilities of radiation diagnostics in the detection of injuries and complications in a gunshot wound of the chest are shown. Ultrasound data on the presence of intrapleural contents allowed us to determine the penetrating nature of the wound. The data obtained by polypositional chest radiography gave an idea of the localization and size of the foreign body. During chest CT, an accurate anatomical characteristic of the wound canal was given, the exact localization of the foreign body was indicated, an intrapulmonary hematoma, a lung contusion were identified, the exact nature and volume of the intrapleural contents were determined. In the postoperative period, CT revealed PE and infarct pneumonia, and scintigraphy assessed the total deficit of lung perfusion, which affected the treatment tactics. In the diagnosis of complications of breast injury such as intrapulmonary hematoma, infarction pneumonia, inflammatory changes in the soft tissues of the chest wall, ultrasound diagnostic data are comparable with CT results.

The study objective is to evaluate the effectiveness of intracranial pressure (ICP) monitoring in patients with severe head injury in a multispecialty hospital. Materials and methods . A retrospective study included 2343 patients who underwent surgical treatment at the N. V. Sklifosovsky Research Institute of Emergency Medicine between 2012 and 2018. Patients admitted in atonic coma, who died in the space of 48 hours after hospitalization, with intracranial hematoma volume >200 cm3, and older than 65 years were excluded. Additionally, results of conservative therapy in 69 patients with severe cerebral contusion were included. ICP monitoring was performed in 249 patients (22.5 % of all patients who underwent surgery with indications for monitoring and no counterindications). A binary logistic regression model included age, sex, type of intracranial injury, depression of consciousness severity at admittance as variables. For treatment outcomes, odds ratio (OR) with 95 % confidence interval and p <0.05 were calculated. Results . Postoperative mortality among patients without ICP monitoring was 64.6 %, among patients with ICP monitoring — 51.2 %. Probability of death in the patient group without ICP was somewhat higher than among patients who underwent ICP (odds ratio (OR) 1.74; 95 % confidence interval (CI) 1.31—2.34). No significant differences were observed in outcomes between patients with or without ICP monitoring for level of consciousness of 4—6 points per the Glasgow Coma Scale (OR 1.01; 95 % CI 0.43—2.37). Among patients with 7—8 points per the Glasgow Coma Scale, outcomes were significantly better among patients who underwent ICP monitoring (OR 1.65; 95 % CI 1.23—2.20). In patients with acute epidural hematomas (AEH), time to death was significantly different: in patients with 7—8points per the Glasgow Scale it was 15 days, with ICP monitoring 52 days; for patients with 4—6points it was 7 and 39 days, respectively. Among patients with multiple hematomas who underwent surgery in moderate coma, outcomes of surgical treatment were a little better with ICP monitoring (OR 1.82; 95 % CI 1.09—3.41). Time to death was significantly different: in patients without ICP monitoring it was 16 days, in patients with ICP monitoring it was 29 days. In patients with microfocal cerebral contusions, probability of death with ICP monitoring was 40 % lower than among patients without ICP monitoring (OR 1.43; 95 % CI 1.01—3.12). Per our data, invasive ICP monitoring is an independent predictor of infectious complications in the postoperative period (OR 1.39; 95 % CI 1.17—3.19). On day 1 after intracranial hemorrhage, hyperosmotic solutions were used in 35 % of patients who underwent ICP monitoring, and in 19 % of patients without ICP measurement (p < 0.05). Conclusion . ICP monitoring does not decrease postoperative mortality and does not improve outcomes in patients with epidural and subdural hematomas. In these patients, ICP control significantly increases time to death. ICP monitoring significantly decreases postoperative mortality in patients with intracranial hematomas and cerebral contusions. ICP monitoring is effective in patients with consciousness levels of moderate coma and above. ICP control allows to accurately diagnose intracranial hypertension and perform targeted therapy. In the absence of ICP monitoring, hyperosmotic solutions are used empirically or for increased negative neurological symptoms.

The purpose of the study. To analyze possibilities of computed tomography (CT) for esophageal injuries and their complications as part of a differentiated approach to the choice of a minimally invasive treatment method.Materials and methods. The results of CT scans were analyzed in 25 patients with esophageal injuries of various etiologies who were treated at the N.V. Sklifosovsky Research Institute of SP in the period 2019–2020. CT was performed with oral and intravenous bolus contrast, primarily at admission and in dynamics, a total of 77 studies.Results. In all cases, direct and indirect CT signs of esophageal damage were detected, and the degree of involvement of surrounding organs and tissues in the pathological process was assessed. Based on the data obtained, the following variants of esophageal damage and its complications were identified: intramural esophageal hematoma (2); rupture of the thoracic esophagus without the development of purulent complications (2); rupture of the thoracic esophagus complicated by the development of mediastinitis (4); rupture of the thoracic esophagus with the development of mediastinitis and pleural empyema (13); rupture of the cervical calving of the esophagus, complicated by phlegmon of the neck and descending mediastinitis (4). Different patient management tactics were used for each variant. Thus, the selection and sequence of minimally invasive interventions, such as thoracoscopic sanitation mediastinal and pleural cavity, esophageal stenting, percutaneous endoscopic gastrostomy (CEG) and endoscopic vacuum aspiration system (E-VAS), were carried out taking into account CT data, including observations in dynamics.Conclusion. CT scan for esophageal injuries allows you to get complete information about both the nature of esophageal damage and its complications, to determine their type, localization and volume. CT data allow us to justify a minimally invasive approach in the treatment of esophageal injuries, to determine the order of interventions. CT studies performed in dynamics allow us to evaluate the effectiveness of treatment and to carry out timely correction of tactics.

Relevance. The variety of options for combining injuries and disorders occurring in the body with a combined injury, the need for rapid decision-making on treatment require rapid diagnosis of the entire volume of injuries and determining the severity of the injury, but there is still no single protocol for examining such victims.The aim of the work was to present a modern CT study protocol for patients with concomitant trauma. Materials and methods. The results of computed tomography of 30 patients with severe concomitant trauma were analyzed. All the victims were admitted in the first hours after the injury. Men were 30 (67 %), women – 10 (33 %), the average age was 41.3 ± 7.6 (22–79) years. Traditional multiphase full-body MSCT was performed in 20 patients, in 10 patients a special protocol was used for the study of the "whole body" by the method of divided bolus. The results of the study. Craniocerebral injuries were detected in 15 (50 %), spinal injuries – in 7 (23.3 %). Simultaneous injuries to the chest and abdomen were detected in 19 (63.3 %) of the victims. When subjectively evaluated, the quality of the images obtained using the full-body MSCT protocol with bolus separation and the standard multiphase protocol for the diagnosis of traumatic injuries was equivalent. The average radiation load per patient with traditional multiphase full-body MSCT is 66 % higher than with the split-bolus protocol. Conclusions. Full-body MSCT using a split bolus is a modern technique that fully meets the diagnostic conditions for severe combined trauma and, with a decrease in the radiation dose, allows you to determine all possible injuries in the victim in a single study.

The objective of the study: to compare the degree of lung damage according to chest CT data to the clinical state of COVID-19 patient, to analyze the semiotics and changes in CT data. Subjects and methods. 317 CT scans were retrospectively analyzed; those scans belonged to 98 patients with COVID-19 treated at N.V. Sklifosovsky Research Institute for Emergency Medicine. Patients were divided into 4 groups, depending on the degree of the lungs damage detected by CT during the primary examination, their clinical state was assessed at each subsequent CT scan. To determine the relationship between the degree of pulmonary changes and the clinical status of patients, a correlation analysis was performed using the rank correlation method, significance was assessed using the Student's coefficient. Results. It was found that CT allowed to identify changes in the lungs typical of COVID-19 and assess their degree, as well as to analyze progression or regression lung changes, including comparison with clinical data. A significant correlation was revealed (rs = 0.577) between the growing degree of lung damage, as determined by CT and deterioration of the clinical status of patients.

Poster: ECR 2020 / C-11060 / Intraabdominal abscesses (non-visceral). Would MRI be helpful? by: D. Kalimullina , E. Egorova, F. Sharifullin, T. Barmina, P. Yartsev; Moscow/RU

Background The use of neuroimaging methods is an integral part of the process of assisting patients with acute cerebrovascular events (ACVE), and computed tomography (CT) is the «gold standard» for examining this category of patients. The capabilities of the analysis of CT images may be significantly expanded with modern methods of machine learning including the application of the principles of radiomics. However, since the use of these methods requires large arrays of DICOM (Digital Imaging and Communications in Medicine)-images, their implementation into clinical practice is limited by the lack of representative sample sets. Inaddition, at present, collections (datasets) of CT images of stroke patients, that are suitable for machine learning, are practically not available in the public domain.Aim of study Regarding the aforesaid, the aim of this work was to create a DICOM images dataset of native CT and CT-angiography of patients with different types of stroke. Material and meth ods The collection was based on the medical cases of patients hospitalized in the Regional Vascular Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine. We used a previously developed specialized platform to enter clinical data on the stroke cases, to attach CT DICOMimages to each case, to contour 3D areas of interest, and to tag (label) them. A dictionary was developed for tagging, where elements describe the type of lesion, location, and vascular territory.Results A dataset of clinical cases and images was formed in the course of the work. It included anonymous information about 220 patients, 130 of them with ischemic stroke, 40 with hemorrhagic stroke, and 50 patients without cerebrovascular disorders. Clinical data included information about type of stroke, presence of concomitant diseases and complications, length of hospital stay, methods of treatment, and outcome. The results of 370 studies of native CT and 102 studies of CT-angiography were entered for all patients. The areas of interest corresponding to direct and indirect signs of stroke were contoured and tagged by radiologists on each series of images.Conclusion The resulting collection of images will enable the use of various methods of data analysis and machine learning in solving the most important practical problems including diagnosis of the stroke type, assessment of lesion volume, and prediction of the degree of neurological deficit.

ЗНАЧЕНИЕ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ В ОЦЕНКЕ ДИНАМИКИ ДЕСТРУКТИВНОГО ПАНКРЕАТИТАБармина Т.Г. 1 , Шарифуллин Ф

The basis of this work is the retrospective analysis of results of application of spiral computer and magnetic resonance tomography for 102 patients undergone to transplantation of abdominal and retroperitoneal organs in N.V. Sklifosovsky Institute. Possibility of early exposure of complications with the purpose of their timely correction is demonstrated.

ЗНАЧЕНИЕ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ В ДИАГНОСТИКЕ ПОВРЕЖДЕНИЙ ПОЧЕКБармина Т.Г. 1 , Шарифуллин Ф.А. 1,2, Абакумов М

The basis of this work is the retrospective analysis of results of application of spiral computer and magnetic resonance tomography for 102 patients undergone to transplantation of abdominal and retroperitoneal organs in N.V. Sklifosovsky Institute. Possibility of early exposure of complications with the purpose of their timely correction is demonstrated.

This article presents the rare clinical case of abscess of sella turcica (AST) after transnasal endoscopic removal of pituitary adenoma. This female patient underwent the transnasal endoscopic removal of abscess with the following conservative treatment with achievement of good clinical outcome. The features of clinical sings of AST and variants of treatment strategy are analyzed in this article.