Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko最新文献

{"title":"Nomogram M validity assessment for predicting multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass","authors":"L. Berikashvili, A. V. Smirnova, E. A. Laricheva, Nadezhda D. Gracheva, Kristina K. Kadanceva, Mihail Ya. Yadgarov, A. Grechko","doi":"10.53652/2782-1730-2022-3-3-30-37","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-3-30-37","url":null,"abstract":"Purpose. To evaluate the predictive value of nomogram M for multiple organ failure (MOF) and acute kidney injury (AKI) after elective cardiac surgery with cardiopulmonary bypass. Materials and methods. This was a retrospective cohort study. The predictive value of nomogram M for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass was evaluated using ROC-analysis. Results. The sample size was 158 patients. The incidence of AKI was 5.7% (9 of 158 patients). The incidence of MOF was 3.8% (6 of 158 patients). AUC nomogram M for AKI was 0.714 [95% CI: 0.555–0.874] (p=0.031); the cut-off value was 12,5 points; the sensitivity was 66.67% and specificity was 82.55%; the odds ratio was 9.46 (95% CI: 2.22–40.30) (p<0.001). AUC nomogram M for MOF was 0.770 [95% CI: 0.594–0.946] (p=0.025); the cut-off value was 12,5 points; the sensitivity was 83.33% and specificity was 82.24%; the odds ratio was 23.15 (95% CI: 2.60–206.20) (p<0.001). Conclusion. Nomogram M has an acceptable predictive value for multiple organ failure and acute kidney injury after elective cardiac surgery with cardiopulmonary bypass based on the results of the ROC-analysis.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"165 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133318694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of non-small cell lung cancer using radiation therapy","authors":"A. R. Gevorkian, Aleksej V. Smolin","doi":"10.53652/2782-1730-2022-3-2-18-24","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-2-18-24","url":null,"abstract":"The article is devoted to the use of a combination of systemic and radiation therapy in patients with locally advanced non-small cell lung cancer (NSCLC). The high risk of latent metastasis in this category of patients sets the prerequisites for active research of the combination of radiation therapy and systemic treatment worldwide. The article presents the results of clinical studies aimed to find the most optimal ratio of efficacy and safety of the chemotherapeutic component of chemoradiotherapy (CRT). According to the results of the research, the authors prefer the use of schemes based on platinum doublets. The article discusses the evaluation of the effectiveness of chemoradiotherapy with escalation of the radiation dose to the tumor within the framework of the concept of a personalized approach to therapy of patients with NSCLC. The article also pays attention to the description of new possibilities for RT intensification and the introduction of new RT methods, the use of which became possible with the introduction of innovative linear accelerators. The results of comparing the effectiveness of combined chemoradiotherapy with immunotherapy and chemo radiotherapy alone in patients with lung NSCLC are presented.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128563190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of calculated glomerular filtration rate before and after endovascular correction of renal artery stenosis against the background of resistant vasorenal arterial hypertension","authors":"A. Fursov, Nikolaj P. Potekhin, Elena G. Zakharova, T. G. Makeeva, A. V. Gaydukov, Konstanin Yu. Gorodnichev","doi":"10.53652/2782-1730-2023-4-1-7-11","DOIUrl":"https://doi.org/10.53652/2782-1730-2023-4-1-7-11","url":null,"abstract":"Atherosclerotic stenosis of the renal arteries is the most common cause of renovascular hypertension (RVHT) among middle-aged and elderly people. In this survey a comparative analysis of the calculated glomerular filtration rate (cGFR) in a patient with resistant renovascular hypertension (RVHT) before and after endovascular correction of atherosclerotic renal artery stenosis is given. The medical records (medical history) of 44 patients (34 men, 10 women) with RVHT were analyzed. The criterion for inclusion in the study was renal artery stenosis of more than 75% of the vessel diameter. The mean age of the patients was 50.7±7.2 years. All patients had unilateral lesion of the renal arteries. Patients were divided into three groups according to the initial level of cGFR. The patients were divided into three groups according to initial cGFR value: Group 1 included 12 patients with cGFR over 90 ml/min/1.73 m2, Group 2 — 19 patients with cGFR from 89 to 60 ml/min/1.73 m2, Group 3 — 13 patients with cGFR from 59 to 45 ml/min/1.73 m2. It was revealed that the level of blood pressure after endovascular correction of stenosis decreased significantly among all patients. At the same time, among the patients with initially preserved cGFR (from 90 ml/min/1.73 m2 and more), there was an improvement in the functional state of the kidneys, a decrease in the number of antihypertensive drugs from 3–5 to a 3-component regimen. Among the patients with initially minimally reduced cGFR (less than 90 ml/min/1.73 m2), the functional state of the kidneys did not change, and among the patients with cGFR less than 60 ml/min/1.73 m2, this state continued to worsen progressively; antihypertensive therapy did not change. During the 2-year follow-up period, restenosis of the renal arteries according to duplex scanning was not observed. When deciding whether to perform endovascular interventions for atherosclerotic stenosis of the renal arteries, it is advisable to take into account the calculated GFR data.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124933743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential external osteosynthesis of gunshot fractures of limb bones at the stages of medical evacuation","authors":"Aleksandr A. Artemev, A. A. Kerimov, Sergej N. Perehodov, Maksim A. Grigoriev, Maksim N. Nelin, S. V. Torshina","doi":"10.53652/2782-1730-2023-4-1-22-31","DOIUrl":"https://doi.org/10.53652/2782-1730-2023-4-1-22-31","url":null,"abstract":"Staged treatment of the patients with gunshot fractures of long bones implies a differentiated approach to the choice of different methods and means of extremity immobilization taking into account their peculiarities and functional capabilities. The frequency of different types of osteosynthesis in specialized care of 212 wounded patients with 276 gunshot fractures of long bones who were immobilized with external fixation devices (EFD) at the stage of advanced care was analyzed. It was revealed that when performing sequential osteosynthesis, preference for internal constructions was given — 122 (44.2%) observations. External osteosynthesis with Ilizarov apparatus (IA) was second most frequently used — 87 (31.5%). EFD was used as the definitive method of treatment in 67 (24.3%) cases. We studied and compared the constructive and functional capabilities of EFD and IA. The main advantage of the Ilizarov apparatus is the ability to control the position of the fragments and influence the process of regeneration by creating compression and distraction forces. The advantage of the EFD is the simplicity of use and, accordingly, the possibility of rapid fixation of the limb in resource-poor conditions with the simultaneous admission of a considerable number of wounded patients. Application of IA implies complex reconstructive interventions with prolonged subsequent treatment and rehabilitation. It should be taken into account when organizing staged treatment and use the type of osteosynthesis that corresponds to a particular stage. When providing qualified care, the use of EFD is absolutely indicated; when performing complex reconstructive operations of specialized trauma care, it is advisable to use the capabilities of the Ilizarov method.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114484029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of a combined gunshot wound with a defect of the humerus and radial nerve (clinical observation)","authors":"V. Sukharev, I.V. Khominets, E.A. Kukushko, Denis I. Vaskul","doi":"10.53652/2782-1730-2022-3-4-57-64","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-57-64","url":null,"abstract":"Treatment of patients with gunshot bone and soft tissue defects of the extremities requires non-standard approaches and the participation of doctors of various specialties. The application of additive and microsurgical technologies allows one-stage restoration of bone defects and functionally important soft tissue formations. Objective: To demonstrate the possibilities of modern reconstructive-plastic surgery in combination with additive 3D-technology in the treatment of patients with severe gunshot wounds of the extremities. Clinical case: a patient with a combined wound of the chest and upper limb with a primary defect of the humerus and radial nerve. Treatment was based on damage control surgery (DCS) and damage control orthopedic (DCO) tactics. X-ray, computed tomography, and angiography were used for diagnostics and preoperative planning. Based on the CT data, a 3D model of the autograft, resection templates, and a metal structure for osteosynthesis were made. After stabilization of the general condition of the wounded man and elimination of the risk of infectious complications, a one-stage replacement of the radial nerve defect at the level of the middle third of the shoulder with a gastrocnemius nerve autograft was performed; the upper and middle third humeral bone defect was replaced with a free blood-supplied fibula autograft with osteosynthesis using an individual 3D plate with bacteriostatic hydroxyapatite spraying in combination with zinc. А positive anatomical and functional outcome was achieved in the treatment of a patient with a gunshot defect of the humerus and radial nerve. An individual complex approach combined with innovative technologies makes it possible to achieve good anatomical and functional results in the treatment of patients with primary combined limb gunshot defects.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124176528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of activated conditioned plasma in patients with macular rupture","authors":"V. A. Pavlov, V. E. Kurnosov, Sergey A. Zinovyev, Aleksandr A. Kapatsina, E. Utkina","doi":"10.53652/2782-1730-2022-3-2-26-34","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-2-26-34","url":null,"abstract":"Objective. To evaluate and summarize the results, as well as to conduct a comparative analysis of the treatment of patients with macular rupture with autoplasm, using a Rotofix 32A Centrifuge and Arthrex ACP systems to obtain autologous conditioned plasma (АСР) with previously used surgical methods. Material and methods. The study conducted a comparative analysis of the results of treatment of patients with macular rupture, with a corrected visual acuity of more than 0.08 (according to the Golovin–Sivtsev table). Group 1 (prospective analysis) included the results of treatment using peeling of the inner boundary membrane with a gas/air tamponade in combination with the application of AСР (4 eyes, 4 patients). In the 2nd group (retrospective analysis of the medical history), surgical treatment was limited to the peeling of the inner boundary membrane with a gas/air tamponade (8 eyes, 8 patients). The parameters were analyzed after 3.0±0.5 and 6.0±0.5 months with assessment of maximum corrected visual acuity (MCOZ), optical coherence tomography (OCT), color photography. Closure of the macular gap was assessed at 6 months of follow-up when comparing the groups. Results. No complications were detected in both groups during the observation period. According to visometry and OCT data, the best functional results were obtained in group 1. The average visual acuity after 6 months was 0.4±0.1. Conclusion. The study found that the use of the peeling of the inner boundary membrane with gas/air tamponade and the use of platelet-derived mass increased the probability of rupture closure.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129904862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of gunshot wounds of extremities using physical and orthobiological methods","authors":"D. Davydov, A. A. Kerimov, V.D. Besedin, Dar'ya A. Naida, Georgij G. Ivanov, M. A. Shchedrina","doi":"10.53652/2782-1730-2022-3-4-5-15","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-5-15","url":null,"abstract":"Currently, despite the wide possibilities in the treatment of wounds, patients with gunshot wounds of the extremities present a complex surgical task. The study included 60 patients with gunshot wounds of the extremities who underwent inpatient examination and treatment at the Center of Traumatology and Orthopedics of the Main Military Clinical Hospital named after academician N.N. Burdenko of Ministry of Defence of the Russian Federation. The patients were divided into groups. In group I, physical methods of treatment were used, such as vacuum therapy (35 people), of which 19 patients underwent combined vacuum therapy with laser irradiation of the wound (group IA), 16 patients underwent vacuum therapy in combination with high-intensity pulsed optical irradiation (group IB). Group II included patients in whom orthobiological techniques were used in the complex treatment of wounds (25 patients), including platelet-enriched fibrin glue — in 13 patients (group IIA) and a composition of heterogeneous implantable gel SpheroGEL® in the LONG version (hereinafter SpheroGEL®) — in 12 patients (group IIB). Results. Comparison of the results of the treatment revealed a significant improvement in the regenerative process according to the histological method in group IA: the maturation of mature granulation tissue was observed on the 9th day after the application of local treatment methods. Positive adhesive and wound healing effects were observed in group IIA. According to the \"AnalyRan\" program, there was a significant reduction in the time of wound healing in all groups under study. According to the results of the study, all techniques showed positive dynamics of wound healing and reduction of the inflammatory process.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"11 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124616143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical tactics in cases with large wounds of soft tissue of limbs and pelvis","authors":"V. Badalov, I.M. Samohvalov, Valerij S. Koskin, Aleksandr N. Petrov, Aleksandr A. Rud’, M. Borisov","doi":"10.53652/2782-1730-2022-3-4-16-23","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-16-23","url":null,"abstract":"In modern armed conflicts the incidence of multiple and combined limb wounds with extensive wound defects of the limbs and pelvis remains high and tends to increase [1]. Such wounds are accompanied by prolonged treatment period, high frequency of wound infection development (up to 35–80%), impossibility of early internal osteosynthesis and early rehabilitation, and rather high incidence of disability [2–4]. The closure of extensive defects in combination with the wound management algorithm in the early posttraumatic period reduces blood and plasma loss, the development of endotoxicosis and wound infection, significantly improves the results and outcomes of treatment, increasing the efficiency of wound healing and reducing the duration of patient treatment.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"197 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121215531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significance of microvascular reconstruction in treatment of gunshot wounds of the face","authors":"Sergei V. Tereshchuk, Evgenij A. Vasil'yev","doi":"10.53652/2782-1730-2022-3-4-50-56","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-4-50-56","url":null,"abstract":"Efficient Combat Casualty Care System aims at saving lives of the wounded as well as regaining their quality of life at the highest possible level. This article provides the data on using revascularized grafts to repair gunshot defects, presents data on the proportion, cause, severity and nature of facial wounds. We also give here recommendations on treatment modalities in these patients. In between the 1 March and the 1 November 2022 in the Center of maxillofacial surgery and dentistry of Main Military Hospital named after N.N. Burdenko we performed 54 reconstructions, 47 of which were microvascular utilizing 49 free flaps. Despite good vasculature in the face, it lacks soft tissues for closing vast gunshot defects. Damaged with high energy projectiles the tissue of the face gives poor bedding to the alloplastic implants, resulting in their exposure. Contemporary level of microvascular technique gives the plastic surgeon an efficient instrument for closing the gunshot defects in early wound healing period. We do not recommend using regional tissues to treat gunshot defects in the first place, because they are usually insufficient to fully resolve the defect, and at the same time it leads to a violation of the anatomy and even greater deformation of the soft tissues surrounding the defect. Titanium re constructive and mesh plates are associated with high rate of exposure in the bone defects and are not to be recommended for the reconstruction either.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122987227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic treatment of degenerative spinal canal stenosis","authors":"D. N. Abukov, V. Cherebillo, A. K. Dulaev, D. V. Goranchuk, Z. Y. Alikov, Ramis A. Aslanov","doi":"10.53652/2782-1730-2022-3-1-33-42","DOIUrl":"https://doi.org/10.53652/2782-1730-2022-3-1-33-42","url":null,"abstract":"Microsurgical decompression technique has been regarded as the standard surgical method in degenerative spinal diseases to date. The conventional method may lead to instability and lead to chronic lower back pain due to injury of facet joints, posterior ligamentous complex, as well as paraspinal muscles. To avoid these complications, the new biportal endoscopic technique has been introduced in our clinical practice. Since 2019, we have been widely using this technique and for the first time in Russia we have accumulated unique experience that allowed us to complete this article. The aim of this study is to demonstrate a new biportal endoscopic spinal surgical technique’s possibility in treatment of degenerative lumbar spine diseases and to report the results of using this technique in our clinic. Study design: retrospective study. One hundred two patients who were suffering from neurologic symptoms by degenerative lumbar spine diseases were included in study. All patients were divided into 3 groups according to the clinical condition: 1st group — patients with degenerative central spinal stenosis who underwent biportal endoscopic bilateral decompression using a unilateral approach, 2nd group — patients with foraminal spinal stenosis who underwent biportal endoscopic foraminotomy using a extraforaminal approach, 3rd group — patients with degenerative monosegmental instability, degenerative or isthmic spondylolisthesis who underwent biportal endoscopic lumbar interbody fusion. Clinical outcomes were analyzed in accordance with modified-Macnab criteria, Oswestry Disability Index (ODI), Numeral rating scale (NRS), also postoperative complications were analyzed. There was a significant improvement in the dynamics of pain syndrome, ODI scale in all 3 groups. According to the McNab scale, no unsatisfactory results were observed in any group. There were 4 cases of durotomy. In all cases, the durotomy did not exceed 3 mm and did not require further treatment. No cases of infectious complications were identified. Biportal endoscopic surgery can be considered an alternative to the traditional microsurgical technique of spinal decompression and spinal fusion in the lumbar spine. The use of this technique can significantly reduce muscle trauma, achieve sufficient decompression, and reduce the frequency of infectious complications.","PeriodicalId":344630,"journal":{"name":"Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko","volume":"79 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120874451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}