Sklifosovsky Journal "Emergency Medical Care" / Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь»
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КОМПЕНСАТОРНЫЕ ВОЗМОЖНОСТИ ТОНКОЙ КИШКИ ПОСЛЕ ОБШИРНОЙ ДИСТАЛЬНОЙ И ПРОКСИМАЛЬНОЙ ЕЕ РЕЗЕКЦИИ (ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ)
Get PDFResection of certain parts of the small intestine is common in clinical practice for various diseases and traumatic injuries. The significant decrease in bowel functioning leads to the development of a specific “short bowel syndrome” (SBS). There is an opinion that the remaining parts of the intestine after resection perform a compensatory function as a result of the development of morphological changes in the intestinal wall. Histological examination of the intestinal wall with evolved compensatory changes is of undoubted interest from the scientific and clinical point of view.Material and Methods. To create the experimental model of SBS, 107 laboratory Wistar male rats were used, weighing 500–600 g, which underwent resection with removal of 1/2 or 2/3 of the small intestine length in proximal or distal parts. The observation period for the animals was 1, 2, 4 and 6 months. Upon expiration of indicated dates, samples of the small intestine and liver were taken from rats for autopsy to be used for histological examination. At the indicated terms, the animals had signs of SBS (diarrhea, weight loss), as well as morphological changes in the intestinal mucosa.Results and Conclusion. According to the results of the study, we concluded that the loss of 1/2 the length of the small intestine is overcome without consequences, and the loss of 2/3 of its length, especially of its proximal part, is accompanied by a longer period of adaptation and more significant morphological alteration of the mucosa, which has to perform not only digestion, but also absorption.
МОДИФИЦИРОВАННАЯ МЕТОДИКА КОРРЕКЦИИ ДИСКРЕТНЫХ И ДИФФУЗНЫХ СУБАОРТАЛЬНЫХ СТЕНОЗОВ
Get PDFWe report a new original method of management for subaortic stenosis. When performing myectomy from the transaortic access of Morrow, the significant problem is poor visualization of the interventricular septum. The key to the successful implementation of the septal myectomy is achieving sufficient length, width and depth of resection of the hypertrophied interventricular septum. The authors introduced a new modification called “fixed needle technique” in order to visualize the entire region of septal hypertrophy and achieve safe extended myectomy of ventricular hypertrophy. Three needles of 21 gauge (0.8 mm) are introduced into the interventricular septum immidiately under the fibrous ring of the aortic valve, and reache the distal part of the hypertrophic portion. The right and left needles limit the width of resection and its depth is limited with the central needle. Each needle is a marker for the width, length and depth of resection. Needles allow to fix the interventricular septum and improve exposure of septal hypertrophy. The described technique allows to perform the required myectomy of the same thickness. The technique provides high-quality visualization of the interventricular septum and adequately removes hypertrophied part of myocardium in challenging patients with discrete subaortic stenosis and idiopathic hypertrophic cardiomyopathy
К 60-ЛЕТИЮ ВЛАДИМИРА ВИКТОРОВИЧА КРЫЛОВА
Get PDF.В этом году свое 60-летие отмечает выдающийся нейрохирург и ученый, академик РАН Владимир Викторович Крылов
ПРОШЛОЕ И НАСТОЯЩЕЕ САНКТ-ПЕТЕРБУРГСКОГО НАУЧНО- ИССЛЕДОВАТЕЛЬСКОГО ИНСТИТУТА СКОРОЙ ПОМОЩИ ИМЕНИ И.И. ДЖАНЕЛИДЗЕ (К 85-ЛЕТИЮ ОСНОВАНИЯ)
Get PDFThe article gives materials on the development of the St. Petersburg Research Institute of Emergency Medicine named after I.I Dzhanelidze. This modern multidisciplinary center of emergency and urgent medicine takes leading positions on many directions of medical science development.В статье представлены материалы по истории развития Санкт-Петербургского научно-исследовательского института скорой помощи имени И.И. Джанелидзе, современного многопрофильного центра экстренной и неотложной медицины, занимающего лидирующие позиции по многим направлениям развития медицинской науки
АЛЕКСЕЙ ПЕТРОВИЧ ГОЛИКОВ (17.07.1921 — 24.01.2017)
Get PDF.24 января 2017 г. ушел из жизни Алексей Петрович Голиков, ветеран Великой Отечественной войны, выдающийся ученый-клиницист, признанный авторитет в области неотложной терапии, академик РАН, заслуженный деятель науки РФ, действительный член Международной научной академии, почетный член Американского общества интернистов, лауреат Премии Правительства РФ, мэра Москвы, премий им. А.Л. Мясникова и А.Н. Косыгина, кавалер Золотой медали им. И.П. Павлова. Кембриджским центром А.П. Голиков занесен в книгу выдающихся ученых мира и награжден почетной медалью «Человек года 1995–1996»
ПРЕДИКТОРЫ СЕПСИСА У ПАЦИЕНТОВ С НЕОТЛОЖНЫМИ СОСТОЯНИЯМИ
Get PDFBackground. Given that the imbalance in pro- and anti-inflammatory cytokines plays an important role in the pathogenesis of sepsis, estimation of its prognostic value in patients in the early stages from the disease onset or injury is of concern.Aim of study. To study changes in concentrations of biomarkers for inflammation on day 1–2 in patients with a high risk for sepsis.Materials and methods. On day 1-2 from the admission, blood tests were performed in 48 patients with a high risk of sepsis: 9 — with mediastinitis, 6 — with widespread purulent peritonitis, 24 — with severe concomitant injury, 9 — with acute destructive pancreatitis. Sepsis occurred in 28 patients of group 1. Group 2 consisted of 20 patients without sepsis. We investigated concentration of procalcitonin, C-reactive protein, interleukine-6 and -10, lipopolysaccharide-bindidng protein and soluble receptor for interleukine-2.Result. Significant differences in concentrations of groups were identified on day 1-2 in CRP (P=0.00009), IL-2R (P=0.0005) LBP (P=0.00002) and IL-6 (P=0.0192).Conclusion. Hyper LBP and CRP on the background of high IL-2R, IL-6, increase the risk of sepsis
РАСШИРЕНИЕ КОСТНЫХ ТОННЕЛЕЙ ПОСЛЕ АУТОПЛАСТИКИ ПЕРЕДНЕЙ КРЕСТООБРАЗНОЙ СВЯЗКИ ТРАНСПЛАНТАТАМИ ИЗ СУХОЖИЛИЙ ПОДКОЛЕННЫХ МЫШЦ (ОБЗОР ЛИТЕРАТУРЫ)
Get PDFABSTRACT Such a phenomenon as bone tunnel widening after anterior cruciate ligament autoplasty with hamstrings has been known for 30 years. Despite the long history of this issue, the etiology is still not fully understood. The process of expansion of the bone tunnels is influenced by many factors such as graft fixation technique, surgical technique and rehabilitation protocol, as well as various biological factors. It is believed that this phenomenon has no influence on a functional result, but may create serious problems in revision anterior cruciate ligament surgery. Given the growing interest in the use of hamstring tendon grafts for anterior cruciate ligament reconstruction, increasing number of these operations and as a result, of revision procedures, the search for methods of bone tunnel widening prevention is becoming more urgent.Такой феномен, как расширение костных тоннелей после пластики передней крестообразной связки с использованием сухожилий подколенных мышц, известен на протяжении 30 лет. Несмотря на длительную историю данной проблемы, этиология остается до конца не изученной. На процесс расширения костных тоннелей влияет множество факторов, таких как метод фиксации трансплантата, особенности хирургической техники, протокол реабилитации, а также различные биологические факторы. Считается, что на функциональные результаты лечения данный феномен не влияет, но может создать серьезные проблемы при ревизионной пластике передней крестообразной связки. Учитывая возрастающий интерес к использованию трансплантатов из сухожилий подколенных мышц для пластики передней крестообразной связки, увеличение количества данных операций и, как следствие, ревизионных вмешательств, поиск методов профилактики расширения костных тоннелей становится все более актуальным
ПЕРВИЧНОЕ ЭНДОПРОТЕЗИРОВАНИЕ ПЛЕЧЕВОГО СУСТАВА ПРИ ТЯЖЕЛЫХ ПОВРЕЖДЕНИЯХ ПРОКСИМАЛЬНОГО ОТДЕЛА ПЛЕЧЕВОЙ КОСТИ
Get PDFIntroduction. Lesions of proximal humerus occur often nowadays. Many surgical methods are performed in such situations.Material and Methods. In October 2014 — August 2016, 25 patients with severe lesions of proximal humerus underwent primary unipolar shoulder joint arthroplasty in the Trauma Department no. 2 of S. Yudin City Clinical Hospital. AO\ASIF classification was used. The results were evaluated in the period from 5 to 18 months by Swanson shoulder score. The result 20-30 points was assessed as excellent, 10–19 points — fair, less than 10 points — poor.Objectives. To evaluate immediate and midterm results of the unipolar shoulder joint arthroplasty in severe injuries of the proximal humerus.Results. Good results were received in 19 cases (76%), fair results were achieved in 6 (24%) cases and there were no poor results. There were no intraoperative or postoperative complications.Discussion. It is preferable to perform hemiarthroplasty if glenoid surface is intact. In such cases the results are similar to total arthroplasty. Standard surgical technics were used in all patients. All of them underwent rehabilitation courses after the surgery and returned to daily life and work.Conclusion: Primary shoulder joint arthroplasty may be considered as a method of choice for severe fractures and fractures with dislocation of head and surgical neck of humerus.
