The Bulletin of Emergency Medicine

Blast injuries – the role of anesthesia and intensive care in improving outcomes

Yu.S. Polushin — Mon, 03 Feb 2025 00:00:00 +0000

В статье рассмотрены некоторые аспекты анестезиолого-реаниматологической помощи
пациентам с взрывными поражениями, которые влияют на исход. Учет специфики не
только анатомических разрушений, но и неизбежно развивающихся в ответ на них пато
физиологических сдвигов способствует выбору правильной тактики на всех этапах ле
чения таких пострадавших. В остром посттравматическом периоде целенаправленные и
персонализированные действия по восстановлению микрокровотока, а также снижению
напряжения ноцицептивной системы могут предотвратить расширение зоны вторично
го некроза и повлиять на частоту развития раневых осложнений. Сделан акцент на том,
что анестезиолог-реаниматолог должен дифференцировать свои действия: не использо
вать либеральную тактику инфузионно-трансфузионной терапии при неостановленном
кровотечении, но и не применять или по возможности максимально быстро отказывать
ся от рестриктивного подхода с вазопрессорами, если оно остановлено. Адекватность
анестезиологической защиты во время любых хирургических манипуляций у этого кон
тингента должна быть безупречной. Нестабильность гемодинамики не является основа
нием для уменьшения анальгетического компонента. Повреждения, наносимые совре
менными высокоскоростными снарядами, требуют длительного лечения. В отдаленном
периоде после травмы пострадавшие подвергаются многочисленным хирургическим
вмешательствам. В эти сроки высока вероятность рецидивирования инфекционных ос
ложнений с развитием сепсиса и септического шока, переход острого критического со
стояния в хроническое, возникновение стойкого острого или хронического болевого
синдрома. Для правильной тактики болеутоления важно дифференцировать характер
боли (ноцицептивная, нейропатическая) и подбирать специальные схемы ее устранения.

Comparative analysis of the results of interventional and surgical treatment for stenotic atherosclerosis of the carotid arteries

Mon, 03 Feb 2025 00:00:00 +0000

Aim. Improving the short- and long-term outcomes of carotid artery stenting (CAS) and ca
rotid endarterectomy (CEA) in patients with significant carotid stenosis by optimizing diag
nostic methods to select the most appropriate treatment modality.
Material and methods. This prospective, non-randomized, observational clinical trial
included 100 patients with severe carotid artery stenosis (stenosis ≥70%) confirmed by
Doppler ultrasonography and CT angiography. Patients were allocated to either carotid
stenting (CAS) (n=50) or carotid endarterectomy (CEA) (n=50) using a decision-making
algorithm proposed by the authors based on diagnostic ultrasonography and CT angiog
raphy data.
Results. At 1-year follow-up, CAS and CEA demonstrated comparable rates of restenosis,
stroke freedom, and reintervention. This supports the idea that both CAS and CEA are effec
tive treatment options for preventing cerebrovascular events in patients with carotid artery
stenosis

Interventional procedures in patients with acute forms of coronary artery disease after surgical revascularization

Mon, 03 Feb 2025 00:00:00 +0000

Aim. To evaluate the efficacy of percutaneous coronary interventions (PCI) performed for
unstable forms of coronary artery disease (CAD) in patients with a history of coronary artery
bypass grafting (CABG).
Materials and Methods: The outcomes of PCI were analyzed in 52 patients admitted with
acute coronary syndrome (ACS) after a history of CABG. The average age of patients was
51.2±6.4 years. A total of 75 drug-eluting stents (Resolute Integrity, n=50; Ultimaster, n=25)
were implanted. Stenting of aortocoronary grafts was performed in 22 cases (42.3%), while
native coronary arteries were treated in 30 cases (57.7%).
Results: PCI resulted in positive clinical and angiographic outcomes in all patients. Signs of
myocardial ischemia were reduced or completely resolved. The left ventricular ejection fra
ction (LVEF) increased from 48.5±3.2% to 53.1±5.5% on average. Hypokinetic zones were
reduced in 6 patients (11.5%), myocardial contractility was fully restored in 20 patients
(38.5%), and previously akinetic zones regained kinetics in 3 cases (5.8%). The left ventricu
lar end-diastolic volume (LVEDV) decreased from 192.6±10.5 mL to 178.2±13.5 mL

The effect of postinfarction cardiosclerosis placement on diastolic functionality and concentration of natriuretic peptides

A.Ya. Latipov, A.L. Alyavi, S.R. Kenjayev — Mon, 03 Feb 2025 00:00:00 +0000

Aim. The aim of this study is to assess the impact of post-infarction cardiosclerosis locali
zation on left ventricular diastolic function and natriuretic peptide levels in patients after
myocardial infarction.
Patients. The study included 150 patients (mean age 51±8 years) who had suffered an acute
myocardial infarction no more than 3 months ago and had confirmed post-infarction car
diosclerosis diagnosed based on echocardiography. Patients were divided into two groups depending on the location of cardiosclerotic changes:1) patients with anterior localization of
the post-infarction scar (n=78);2) patients with posterior localization of the post-infarction
scar (n=72); The study included patients with preserved systolic function of the LV (LVEF
was more than 50%).
Results. The study yielded the following results demonstrating the relationship between
the localization of post-infarction cardiosclerosis, diastolic function, and natriuretic peptide
levels. Echocardiographic data analysis showed that patients with left ventricular anterior
wall cardiosclerosis had significantly worse diastolic function compared to other groups. The
mean E/A ratios were 0,83±0.2 and 0,78±0.32 for the anterior and posterior wall groups,
respectively. Tissue Doppler velocity (e’) values were also lower in the anterior wall group.
Enzyme immunoassay revealed statistically significant elevated N-terminal pro b-type nat
riuretic peptide BNP (NT-proBNP) levels in patients with anterior wall cardiosclerosis. The
mean NT-proBNP levels were 580 pg/ml for the anterior wall and 456 pg/ml for the poste
rior wall.
Conclusion. The study showed a significant effect of the localization of postinfarction cardi
osclerosis on the diastolic function of the left ventricle and the levels of natriuretic peptides
in patients after acute myocardial infarction. Particularly significant changes were found in
patients with cardiosclerosis of the anterior wall of the left ventricle, who demonstrated wor
se diastolic function and increased levels of natriuretic peptides compared to other groups.

Results of surgical treatment of thoracic aortic aneurysm

A.A. Abdurakhmanov, M.A. Obaid, O.S. Sultanov, S.A. Tursunov — Mon, 03 Feb 2025 00:00:00 +0000

Purpose. To analyze of the work was to study the immediate results of surgical treatment of
aneurysms of the ascending section and the arch of the thoracic aorta.
Material and methods. An assessment of 30 operations for this pathology was carried out from
2017 to 2023. All operated patients were operated on for complicated forms of aneurysms
and performed urgently. The main clinical and diagnostic criteria of indications for surgical
treatment are presented, on the basis of which various types of aortic prosthetics were per
formed both with the preservation of the aortic valve and with simultaneous correction of
valvular pathology.
Results. The most common operations were performed using valve-containing conduits. The
hospital mortality rate was 26%. The main proportion of deaths is associated with the de
velopment of bleeding and multiple organ failure in the early postoperative period due to
malperfusion syndrome.
Conclusion. Thus, based on the conducted research, the problem of surgical treatment of
aneurysms of the ascending section and the arch of the thoracic aorta remains very relevant.
The statistics of our center (survival rate at 74%), as a hospital providing emergency surgical
care to patients with acute aortic dissection. The option we have developed to strengthen the
anastomosis line with a double winding seam using synthetic materials is worthy of attention
and has proven its effectiveness in practice

Diagnosis and treatment of deep vein thromboses below the inguinal fold

Sh.M. Muminov, D.D. Alimukhamedov, B.P. Khamidov, D.L. Kim, Sh.Sh. Komiljonov — Mon, 03 Feb 2025 00:00:00 +0000

The article is devoted to a review of the literature and modern aspects of the management
of patients with deep vein thrombosis of the lower extremities below the inguinal fold. A
brief analysis of modern ideas about the clinical picture, complications, methods of diagnosis
and treatment of patients with this pathology were carried out, and methods of surgical tre
atment and the prevention of thromboembolism of the branches of the pulmonary arteries
were also considered

Medical therapy of congitive disorders in comorbid patients with metabolic syndrome and atherosclerotic congitive disorders

M.Z. Zakhidova, M.U. Zakhidova — Wed, 05 Feb 2025 00:00:00 +0000

The pathogenesis of metabolic syndrome (MS) is complex and multifactorial. All pathological
changes in MS are based on an increase in visceral fat mass, a decrease in the sensitivity of
peripheral tissues to insulin, which leads to the development of disorders of carbohydrate,
lipid metabolism, arterial hypertension (AH), an increase in blood viscosity and a state of ch
ronic inflammation. In recent studies, MS has been considered as an independent risk factor
for cognitive impairment (CI), while other studies have not found a significant association
between MS and CI. This article discusses the development of CI against the background of
MS, AH, insulin resistance, dyslipidemia, hyperglycemia, obesity, and cardiovascular compli
cations of atherosclerotic genesis.

On the question of performing full-scale reconstructive operations in emergency cases for patients with open combined injuries of the upper extremities

Wed, 05 Feb 2025 00:00:00 +0000

The article analyzes a number of publications from recent years concerning the approach
to the tactics of treating patients with open combined injuries of the upper limb, in order to
establish what is the current state of affairs, as well as to compare the opinions of leading
specialists of the world with our own, which was formed on the basis of many years of expe
rience in this field

Clinic, diagnosis and treatment of myasthenia gravis

D. A. Ismoilov, Sh. R. Muborak, U. U. Mirjalalov, X. R. Turopov — Mon, 03 Feb 2025 00:00:00 +0000

Myasthenia gravis is a chronic autoimmune disease of neuromuscular synapses with muscle
weakness as the main clinical manifestation. Myasthenia gravis affects people of all ages but it is
considered as a “disease of young women and older men.” Myasthenic weakness usually affects
extraocular, bulbar muscles or muscles of proximal extremities. Antibodies to acetylcholine
receptors and to muscle-specific tyrosinekinase play an important role in the pathogenesis of
the disease. The main treatment principles are acetylcholine inhibitors, glucocorticosteroids
and immunosuppressive drugs and such methods as plasmapheresis and thymectomy

The use of speckle-tracking stress echocardiography in the early diagnosis of unstable angina

Wed, 05 Feb 2025 00:00:00 +0000

Speckle-tracking echocardiography and stress echocardiography are effective non-invasive
methods for the early diagnosis of unstable angina. Speckle-tracking enables the detection
of myocardial dysfunction before a reduction in ejection fraction and improves prognostic
assessment, particularly in obstructive coronary artery lesions. A reduction in the global
longitudinal strain of the left ventricle helps identify myocardial dysfunction with high sensitivity
and positive prognostic value. Stress echocardiography is a diagnostic method that helps
identify predictors of adverse cardiovascular events, and negative test results are associated
with better patient survival. The optimal combination of these methods enhances the accuracy
of diagnosing and predicting cardiovascular mortality.

Choosing adequate peep by measuring transpulmonary pressure with regard to respiratory pattern in patients with ards

D.M. Sabirov, X.X. Dadayev, A.L. Rosstalnaya, A.U. Taxirov, D.R. Maxsudov — Mon, 03 Feb 2025 00:00:00 +0000

A clinical observation is presented, which demonstrates the dynamics of changes in respira
tory parameters in a patient with acute respiratory distress syndrome (ARDS). It is shown
that in patients with acute cerebral insufficiency (ACI) and acute respiratory failure at incor
rect diagnosis and management tactics, the time of stay on a respirator can be prolonged,
hospital-acquired infection can occur, and cerebral insufficiency can progress, which in turn
contributes to the increase in mortality. The article presents the advantages of timely selec
tion of PEEP by measuring transpulmonary pressure with further correction of respiratory
parameters taking into account the individual breathing pattern. Early lung opening, imp
roves neurological dynamics, increases the percentage of early weaning from the respirator
and reduces mortality.

ИСМАИЛОВ ДЖАМШИД АЗИЗОВИЧ (К 70-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ)

Thu, 06 Feb 2025 00:00:00 +0000

16 ноября 2024 года испол
нилось 70 лет со дня рождения
и 46 лет научно-практической
деятельности одного из веду
щих торакальных хирургов Узбе
кистана, действительного члена
Ассоциации хирургов имени
Н.И. Пирогова и Ассоциации вра
чей экстренной медицинской
помощи Узбекистана.

ВАЛИЕВ ЭРКИН ЮЛДАШЕВИЧ (К 60-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ)

Thu, 06 Feb 2025 00:00:00 +0000

29 августа 2024 года исполни
лось 60 лет со дня рождения и
37 лет научно-практической и пе
дагогической деятельности од
ного из ведущих травматологов-
ортопедов Узбекистана — про
фессора Эркина Юлдашевича
Ва лиева.

96 POLUSHIN YURIY SERGEEVICH (to the 70th birthday)

Thu, 06 Feb 2025 00:00:00 +0000

14 декабря 2024 года испол
нилось 70 лет со дня рождения
и 46 лет трудовой деятельности
одного из осно воположников
современной анестезиологии
и реаниматоло гии – проректо
ра по науч ной работе Первого
Санкт-Петер бургского государ
ственного медицинского уни
верситета им. акад. И.П. Павло
ва, академика РАН, профессора,
заслуженного врача Российской
Федерации Юрия Сергеевича
Полушина.