Quite a lot of manuals have been published recently, both in paper and electronic form, on the relatively new technique of puncturedilated tracheostomy. However, it is almost impossible to find information about the features of this technique in elderly and old patients. And they are there and attract attention. For the first time in the article, we drew attention to the peculiarity of the anatomical structure of the neck and adjacent structures in elderly and old patients. A comparative table of mortality of patients with various techniques of tracheostomy is presented, which allows us to visually determine the most beneficial in elderly and old patients. The protocol of puncture-dilated tracheostomy in relation to elderly and old patients is presented. 

Aim. Identify the features of the ultramicroscopic structure of thyrocytes in rats under conditions after 60 days of tartrazine administration and simulated traumatic bone defect, as well as to establish the effectiveness of sodium selenite.

Material and methods. White mature male rats were divided into 3 groups. In Group 1, a through defect in the tibiae was applied to rats after the previous 60-day intragastric administration of saline solution. In Group 2, rats were subjected to 60-day exposure with tartrazine at a dosage of 750 mg/kg instead of saline solution under similar experimental conditions and in Group 3 – additionally intramuscularly injected sodium selenite at a dose of 40 µg/kg. On days 3, 10, 15, 24 and 45, the animals were removed from the experiment, samples of thyroid gland were processed for electron microscopic examination according to the standard method.

Results. In Group 2, inactive chromatin prevailed in the nucleus, expanded cisterns of the rough endoplasmic reticulum, single mitochondria with matrix destruction sites were observed in the cytoplasm from 3rd to 15th days of experiment. There were cells in a state of apoptosis. By the day 24, the ultramicroscopic picture was almost restored to the control values.In Group 3, an increase in the area of active euchromatin in the nucleus, restoration of the lumen of the cisterns of the rough endoplasmic reticulum, an increase in the number of lysosomes in the cytoplasm, a decrease in the number of mitochondria with signs of destruction of crysts and cells with signs of apoptosis were revealed.

Conclusion. The bone defect applied after the previous 60-day administration of tartrazine causes an aggravation of ultramicroscopic changes in thyrocytes, compared with the group without the introduction of a food additive. Use of sodium selenite allows, to a certain extent, to neutralize the changes caused by tartrazine in these cells by the time of traumatic injury. 

Objective: to analyze the results of a morphological study of the lung tissue and small airways in the surgical material of patients with a combination of tuberculoma and nontuberculous mycobacteriosis of the lungs caused by different types of pathogen.

Materials and methods. A comparative retrospective histological study of the surgical material of 34 patients with a combination of LT and NM with established microbiological different types of non-tuberculous mycobacteria (NTMB) and 36 patients with LT without concomitant pathology was carried out.

Results. Diagnostically significant differences in the morphological picture of TL and NM, which manifests its morphological features in areas free from foci of tuberculosis, were revealed. The features of changes in the lung tissue and small airways in patients with slow- and fast-growing types of NTMB are shown.

Conclusion. The results obtained are aimed at resolving the issue of possible correction of chemotherapy in the postoperative period. 

Currently, there is a steady increase in morbidity and mortality from acute cerebrovascular conditions, which are based on vascular ischemic manifestations, which are systemic in nature. At the heart of the root cause of any ischemic process – heart attack, stroke, hypertension – is atherosclerosis and dyslipoproteinemia. One of the biomarkers of this pathological process is oxidative stress.

The purpose of the study: to analyze the dynamics of the activity of glutathione peroxidase and glutathione reductase in the blood and liver of rats of different ages under oxidative stress caused by modeling dyslipoproteinemia followed by mechanical injury to the skeletal muscle.

Materials and methods. The study was conducted on outbred healthy male rats, divided into two groups according to age: the first group (c) – 24-month-old (old) rats, weighing 230–250 grams in the amount of 120 pieces and the second group (m) – 6-month-old (young) rats, weighing 190–210 grams in the amount of 120 pieces, kept under standard vivarium conditions. All rats were divided into four subgroups within their group, 30 animals each. Animals of the first subgroup in each group (1s, 1m) are intact (old and young) animals, to which no effects were applied. Animals of the second subgroup (2c, 2m) (regeneration control, old and young) had a mechanical dissection in the region of the middle third of the gastrocnemius muscle of the hind limb. Animals of the first and second subgroups were on a standard vivarium diet and had free access to water and food. Animals of the third (3s, 3m) and fourth (4s, 4m) subgroups of each group were subjected to dyslipoproteinemia modeling for 63 days and received a high-carbohydrate and high-fat diet with an increased fat content of up to 30% by weight of dry matter and replacement of drinking water with a 20% fructose solution. After the specified time, the animals of the fourth subgroups of both groups were injured in the middle third of the gastrocnemius muscle of the hind limb.

Conclusions. Against the background of dyslipoproteinemia, oxidative stress occurs in the tissues of young and old rats, which is reflected by a decrease in the activity of enzymes of the glutathione system. Mechanical injury of the calf muscle in combination with dyslipoproteinemia aggravates oxidative processes against the background of inflammation and leads to an even more intense decrease in the activity of glutathione peroxidase and glutathione reductase in the liver and blood tissues of rats, and in old animals these processes are more pronounced than in young ones. 

Introduction. Currently, despite the introduction of modern diagnostic algorithms in 20-40 % of patients with ischemic stroke, it is not possible to establish its cause. Potential causes of acute cerebral ischemia in patients with cryptogenic ischemic stroke include paroxysmal atrial fibrillation, patent foramen ovale, atrial cardiomyopathy, carotid network, aortic arch atheroma, and cancer-associated thrombophilia.

Target: to systematize data on methods for diagnosing and preventing aortic arch atheroma.

Material and methods. The literature search was carried out in electronic search systems Scopus, eLibrary, PubMed using the key words: ischemic stroke, cryptogenic stroke, aortic arch atheroma, pathogenesis of ischemic stroke.

Results. At present, despite such a detailed study of therapeutic strategies for the prevention of recurrent thrombotic events in patients with aortic arch atheroma, none of the drugs has proven its advantage. Although the NAVIGATE ESUS and RESPECT ESUS trials did not show the superiority of oral anticoagulants over antiplatelet agents in preventing recurrent ischemic strokes in patients with cryptogenic stroke, it was found that cryptogenic ischemic stroke is heterogeneous, which requires a differentiated approach to secondary prevention.

Conclusion. Аortic atheroma can be the cause of embolic syndrome and cryptogenic stroke. The main methods for diagnosing aortic atheroma are transesophageal echocardiography and computed tomographic angiography. The therapeutic strategy for the treatment of aortic atheroma is lipid-lowering, antithrombotic therapy in combination with blockers of the renin-angiotensin-aldosterone system. 

This article presents a review of current modern research on the use of botulinum toxin therapy for the prevention and treatment of patients with chronic migraine, as well as briefly outlines current views on the pathogenesis of migraine, its impact on quality of life and patients' ability to work. Botulinum toxin A is currently the drug of first choice for the treatment of chronic migraine. Numerous studies confirm the effectiveness and safety of its use in clinical practice. 

In lymphedema, various types of congenital and acquired anomalies of opened vessels and opened nodes are observed. They often lead to cardiac hypertension, valvular insufficiency, and lymphedema. Today, secondary lymphostasis ranks first among the pathologies of the cardiac system of the extremities. The etiology of this situation, which results in a mechanical disease of the current of the lymphatic system, is very different. However, the most common cause of secondary lymphostasis of the extremities is the blockade of inflammatory nodes and vessels after the inflammatory process in them [1]. 

Based on the method developed by the authors for quantifying the severity of patients with acute pancreatitis, a method for calculating the duration of therapeutic fasting in a particular patient has been created. We studied the medical histories of 500 patients with acute pancreatitis who were in two medical hospitals from 2010 to 2021. They underwent complex therapy of acute pancreatitis. Based on the dependence found using multivariate regression analysis using the universal statistical software package StatSoft Statistica for OC Windows, the authors previously developed and published a method for calculating the severity of a patient's condition with acute pancreatitis in the enzymatic toxemia phase. This method in the process of practical application was significantly improved by the authors and called the IDAP scale (ACUTE PANCREATITIS HAZARD INDEX). The advantages of this method: the calculation of the severity of the patient's condition can be made at any time of interest, the indicators are included in the Medical and Economic standards of the Russian Federation for acute pancreatitis, it is enough to use the standard office program MS Excel, which is available to any practicing physician. When comparing the results of assessing the severity of patients on the IDAP and APACH II scales, no discrepancies of more than 15% were found in 640 measurements in 50 patients, which allowed us to use the IDAP system in our study on a par with the generally accepted APACH II. At the second stage of the study, as a result of the analysis of 86 clinical observations using the technique of multidimensional regression analysis, a relationship was found between the clinical severity of the patient upon admission to the hospital for treatment, the severity at a given time and the required duration of therapeutic fasting (in days). At the second stage of the study, as a result of the analysis of 86 clinical observations using the technique of multidimensional regression analysis, a relationship was found between the clinical severity of the patient upon admission to the hospital for treatment, the severity at a given time and the required duration of therapeutic fasting (in days). When using this method of calculating the duration of fasting, only 7 (8%) patients had an exacerbation of the process after the start of feeding them through the mouth. Thus, taking into account the coefficient of severity of the patient's condition with acute pancreatitis, it is possible to reliably determine the timing of therapeutic fasting in this disease. 

Carpal tunnel syndrome is one of the most common neuropathies of the upper extremities. The disease is manifested by pain in the hand, accompanied by numbness, paresthesia, muscle weakness, a significant decrease in grip strength and a marked deterioration in the functional state of the hand as a whole, which causes disability of patients. Surgical treatment of pathology is considered the most effective. In order to assess the long-term results of surgical treatment with the use of transverse carpal ligament reconstruction, depending on the age and severity of the disease, a clinical examination of 48 patients was conducted in the periods before surgery and 6 months after surgery. The patients were divided into four groups by age categories: from 18 to 44 years old, from 45 to 60 years old, from 61 to 75 years old, over 75 years old, and into three groups according to the severity of the disease according to the classification of R. Szabo. The examination included a clinical examination with specialized provocative tests and questionnaires, dynamometry and electoroneuromyography. It was determined that patients with grade II severity of SPC of categories from 18 to 44 years and from 44 to 60 years had the best indicators. 

Imaging of bone lesions has an important role in diagnosis of multiple myeloma (MM) and evaluating the response to treatment. Computed tomography scan (CT) allows to detect osteolysis, plasmacytoma and the risk of fractures with high sensitivity. In the National Research Center For Hematologysince 2014 all patients with MM are diagnosed with the whole-body low-dose CT.

The aim of the study was to demonstrate the sensitivity of the whole-body low-dose CT and to characterize localization, number and size of bone lesions in primary MM patients.

Materials and methods. 50 patients with newly diagnosed MM were enrolled in the study. The diagnosis was established in accordance with international diagnostic criteria. All patients received the whole-body low-dose CT. According to the Durie-Salmon and ISS staging systems 62% and 66% of patients had stage III, respectively.

Results. 96% of MM patients had bone lesions. In 30% of patients, bone involvement was the only criterion for CRAB. Pelvic bone lesions was most often diagnosed (92%). The destruction of the long bones of the arms and legs were most rarely detected (42% of patients) and mostly small. The presence of intraosseous plasmocytoma was noted in 40% of cases.

Conclusion. The whole-body low dose CT was found to be the most sensitive modality for detection osteolytic bone lesions. Low-dose CT is available in MM case with bone disease only, for establish symptomatic stage. This patients require immedate antimyeloma treatment. 

The purpose of the study was to analyze the long-term results of surgical treatment of patients with a patella fracture, in the treatment of which a new method of osteosynthesis was applied.

Materials and methods. The long-term results of surgical treatment of 18 patients with a closed patella fracture were analyzed, the functional state of the knee joint was assessed after 12 months from the operation using clinical and radiological methods. A clinical example of a patient with a traumatic closed fracture of the patella is given, illustrating the surgical treatment of this patient. The results of treatment are presented.

Results. The data obtained indicate the effectiveness and biomechanical validity of the patented method. The prospects for further research are outlined. 

The improved method of intraperitoneal plasty of umbilical hernia is considered in the article, the results and efficacy of its performance in the conditions of "one day" hospital department of surgery are estimated. The classical method of non-tension hernioplasty [1] is supplemented with surgical techniques - "peritoneal desquamation" and "peritoneodesis" [2] of the hernia sac. A special patented technical device was used in the course of surgical treatment. The suggested method of umbilical hernia plasty creates the conditions for traumatic interventions reduction, excludes the possibility of wound complications, reduces the operative intervention time and shows unique possibilities of using during the operations of natural, physiologically conditioned protective-adaptive systems of the body to activate restorative processes [4, 5]. 

Relevance. Surgical interventions used in cardiovascular surgery often lead to the development of many different etiology and manifestations of purulent-septic complications. The development of this pathology worsens the course of the postoperative period and increases the duration of the patient's stay in the hospital. The range of these complications varies quite widely, which is explained by the different initial state of the patient's body, as well as the peculiarities of operations, care and treatment in the postoperative period.

The purpose of this study is to study the frequency of occurrence of purulent-septic complications of mediastinal organs in surgery and to analyze the characteristics of this pathology.

Materials and methods. In the course of this work, the analysis of foreign and domestic literature on the problem of the occurrence of purulent-septic complications of mediastinal organs in surgery was carried out.

Results. The development of purulent-septic complications in cardiovascular surgery is due to a number of factors, among which it is necessary to note the presence of concomitant diseases, the peculiarities of some surgical interventions, inadequate antibacterial therapy. Due to the severity of the above factors, the development of many formidable purulent-septic diseases is possible. And unfortunately, even with timely treatment of the patient, the percentage of mortality from them remains quite high.

Conclusion. Purulent-septic complications in cardiac surgery practice are a frequent phenomenon associated with a variety of risk factors. Such complications include mediastinitis, sepsis, pneumonia, urinary tract infections, local inflammatory reactions and much more. However, thanks to the knowledge of the causes of their occurrence and the features of the clinical course, it is possible to choose appropriate methods for correcting a particular condition at various stages of the patient's treatment. 

Introduction. The article presents the results of photodynamic therapy (PDT) of extrahepatic bile ducts (EBD) and large duodenal papilla (LDP) cancer in inoperable patients. The technique of its carrying out and ways of delivery of laser light guides to various parts of biliary tract are described. Efficiency of PDT for cancer of LDP and separately for cancer of EBD was determined. The dependence of patients' life expectancy on the number of PDT sessions during a year was revealed and the comparative analysis of two groups of photosensitizers (PS) efficiency was carried out.

Research purpose: to estimate the effectiveness of photodynamic therapy (PDT) in treatment of VUC and IBD cancer; to determine the reasonability of repeated PDT courses and time intervals between them; to compare the effectiveness of photosensitizers Photodetazine and Photosens in treatment of these patients.

Materials and Methods. The study was based on a comparative analysis of life expectancy in inoperable groups of patients with VVC and IBD cancer. The main group consisted of 29 patients (including 20 patients with IBD cancer) who were treated by PDT besides biliary operations. Control group consisted of 50 patients (14 of them with BDZ cancer), only biliary drainage interventions were used in their treatment. The number of PDT courses performed was from 1 to 3 during the year. A total of 29 patients underwent 52 courses of PDT. We used two photosensitizers from different groups: Fotoditazin (chlorine derivative E6) – was used in 18 patients and Photosense (phthalocyanine derivative) – was used as PS in 11 patients. Assessment of treatment efficacy was based on determining the median survival according to the Kaplan-Meier method.

Results. Median survival time in the main group was 18 months [95% CI: 15.9; 20.1], in the comparison group (without PDT) – 7 months [95% CI: 5.1; 8.9]. In patients with IBD cancer, the median survival for PDT was 18 months [95% CI: 16; 20], and 12 months [95% CI: 9.25; 14.75] in the comparison group. Life expectancy for patients with BDS cancer ranged from 1 to 60 months. Median survival time was 17 months [95% CI: 12; 21] in case of Fotosens – 18 months [95% CI: 16; 19]. In the group of patients who underwent one PDT session during a year, median survival time was 12.5 months [95% CI: 10; 15], in the group of patients who underwent 2 or more sessions, median survival time was 23 months [95% CI: 18; 28].

Conclusions. Photodynamic therapy in combination with draining interventions on bile ducts is an effective method of therapy of inoperable forms of IVC and IBD carcinoma in high risk patients. Variants of delivery of laser radiation for PDT are developed. Repeated sessions of PDT at intervals of 4-6 months potentiate the effectiveness of palliative therapy and increase life expectancy of patients. The effectiveness of Fioditazine and Photosense in PDT was found to be similar. Fotoditazine showed a lower number of complications. 

A comparative assessment of the long-term results of surgical treatment of patients with hernia of the esophageal opening of the diaphragm was made. All patients were divided into two groups. The first group included patients who underwent isolated correction of a hernia of the esophageal orifice of the diaphragm. Patients of the second group, in addition to correcting a hernia of the esophageal orifice of the diaphragm, performed simultaneous operations depending on the concomitant pathology in the abdominal cavity. The results of surgical treatment were evaluated using the method of daily pH-metry. It is concluded that performing simultaneous operations in patients with hernia of the esophageal orifice of the diaphragm is justified. 

An observation from practice is given – surgical treatment of mediastinal pulmonary hernia in a patient after pneumonectomy using the method of anterior mediastinal plastic surgery with a mesh implant with demonstration of long-term results.

The patient I. 31 years old was ill with pulmonary tuberculosis for 3 years, treatment was carried out, against which the stenosis of the left main bronchus progressed. The patient underwent endoscopic operations: argonoplasmic destruction of the left main bronchus, balloon dilation of the left main bronchus, with a temporary effect. Due to recurrent stenosis of the left main bronchus, a pneumonectomy was performed on the left. After 7 months, she complained of severe shortness of breath at rest. Computed tomography revealed a displacement of the mediastinal organs to the left, an upper-anterior pulmonary mediastinal hernia of the right lung to the left midclavicular line at the level of the anterior I-IV intercostals on the left. The patient underwent plastic surgery of the anterior mediastinum on the right using a polymer mesh implant. As a result of treatment, after 3 years, radiologically stable restoration of the position of the only right lung in its hemithorax. The patient is functionally compensated, shortness of breath is not observed. The patient has completely returned to her usual lifestyle. 

At present, there is a tendency towards an increase in emotional problems everywhere, this especially affects the working-age population – relationships in a team, professional work process – all this leads to the development of production-related stress. Health care workers are at the forefront of risk of developing stress reactions and its consequences. This is most pronounced in the specialties providing emergency medical care, among employees of ambulance teams and departments of anesthesiology and resuscitation.

The aim of the study was to conduct a comparative analysis of the psychophysiological state of emergency medical staff and departments of anesthesiology and resuscitation.

Materials and methods. The study involved 67 people – employees of ambulance teams and resuscitation and intensive care units in Saratov. To obtain the necessary data, all participants filled out questionnaires – the PSM-25 psychological stress scale, the HADS hospital anxiety and depression scale, and the symptomatic questionnaire by A. Volkova and N. Vodopyanova.

Results. When questioned using the PSM-25 scale, which assesses mental tension, it was found that more than half of the respondents have a high level of stress, while the indicator of mental tension among ambulance workers is statistically significantly higher than among employees of intensive care units and intensive care units. An analysis of the HADS ques tionnaire showed that the vast majority of respondents, both in ambulance teams and in intensive care units, have a high level of anxiety and depression. In the study using the symptomatic questionnaire A. Volkova and N. Vodopyanova noted a high predisposition to the development of pathological stress reactions in most of the respondents.

Conclusion. Doctors in the specialties we study are characterized by long-term chronic stress, which can lead to the development of anxiety, depression, and pathological stress reactions. To avoid the occurrence of the conditions described above, it is important to adjust the work schedule of employees in time, to observe occupational and rest hygiene. 

The origin of the recipient is one of the recipient-related factors that statistically significantly affects the outcomes of kidney transplantation, but this factor is not so relevant in our country. The article presents the first experience of kidney transplantation in a patient of African descent at the N.I. N.V. Sklifosovsky.

Material and methods. Allogeneic renal graft transplantation from a post-mortem donor was performed in a 60-year-old African male patient with stage 5 chronic kidney disease as a result of hypertensive nephroangiosclerosis.

Results. The early postoperative period was complicated by the development of acute cellular graft rejection grade 1a-b according to Banff. Anti-crisis therapy was performed with some positive effect, however, in the late postoperative period, a loss of renal graft function was noted, and the patient was returned to renal replacement therapy with program hemodialysis.

Conclusion. Patients of African ancestry are at increased risk of adverse outcomes due to immunological causes and require more careful immunological selection of a donor organ, an enhanced immunosuppressive regimen, and close monitoring after transplantation.

Lymphocele formation in the kidney transplant bed is the most common postoperative complication after kidney transplantation. The article presents the observation of a clinically significant lymphocele of the kidney transplant bed.

Materials and methods. Allogeneic heterotopic kidney transplantation from a post-mortem donor was performed in a 28-year-old patient with a clinical diagnosis of stage 5 chronic kidney disease as a result of a congenital anomaly of kidney development.

Results. The early postoperative period was complicated by the development of a clinically significant lymphocele of the kidney transplant bed, which caused compression of the ureter of the kidney graft with impaired passage of urine and expansion of its pelvicalyceal system, as well as compression of the external iliac vein. The treatment carried out in the amount of laparoscopic drainage of the lymphocele into the abdominal cavity by means of capillary drainage under ultrasound control contributed to the elimination of the complication and its consequences.

Conclusion. Ultrasound examination is a routine examination that allows timely diagnosis of a kidney transplant bed lymphocele and monitoring the effectiveness of the treatment. 

Introduction. Holding mass sports events of international level imposes a special responsibility on the medical services of the host city. The issues of organizing medical support for competitions are one of the foundations for the safety of all participants. By identifying different client groups, the organizers provide optimal conditions for each of them, this also applies to medical support.

Aim. To describe the features of medical support in a life-threatening condition to a representative of one of the client groups of the 2018 FIFA World Cup in Samara.

Material and methods. A clinical case of stroke that occurred during the 2018 FIFA World Cup in Samara is presented. The stages and timing of the provision of assistance, the interaction between the links of the medical service, the coordination of medical support are described, and the other factors that played a role in the outcome of the patient's disease are also reflected.

Results. The fastest possible diagnosis and medical support at the prehospital stage led to the delivery of the patient to an authorized hospital and access to specialized medical care within the time frame envisaged by clinical protocols and recommendations. The inpatient stage of treatment with the use of high-tech methods of surgery and intensive care ended in a complete recovery of the patient. Conclusion. The described clinical case illustrates the expediency of the special requirements put forward to the medical support of major sports competitions. Competent operational planning, training of medical staff and their equipment, built inter- and intradepartmental interactions ensure the availability and quality of medical care, including in life-threatening conditions.