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Background: The standard approach to an occlusive vascular injury is open arterial reconstruction, although endovascular stenting is becoming more common, despite limited evidence. The aim of this study is to examine the performance of bare-metal stents in an ovine model of occlusive arterial trauma. Methods: Through a groin incision, a 2 cm segment of the left superficial femoral artery (SFA) was bluntly injured using a hemostat and injection of air to achieve thrombosis. Animals then underwent a stent deployment (Stent group, n=5) or no-treatment (Control group, n=5). In the Stent group, recanalization of the thrombotic lesion, thromboaspiration and bare-metal stent deployment were performed. Enoxaparin 1.5 mg/kg was given to all animals. The stent group animals were fed Clopidogrel 75 mg and Aspirin 125 mg daily. Angiography and doppler ultrasound were used to evaluate arterial patency during the 7-day observation period. Results: A thrombosis was obtained in all cases. After the fall in the systolic velocity (SV, cm/sec) in both the Control (43 (36–56) to 6 (0–16); p<0.001) and Stent Groups (45 (32–53) to 8 (0–12); p<0.001), stent implantation resulted in a significant permanent increase of the SV. Day 7 angiography confirmed SFA patency in all (5/5) stented animals, with persisting occlusions in the Control group (p=0.008). There was no evidence of distal emboli in the run-off arteries. Conclusions: Bare-metal stent implantation restores arterial patency of a traumatic occlusive lesion in a standardized ovine model with a short follow-up period.

Aim. To evaluate the results of surgical intervention planning using three-dimensional models based on magnetic resonance imaging in patients with postinfarction left ventricular aneurysms.Material and Methods. Two groups of patients with postinfarction left ventricular aneurysm (PLVA) were included in the study, totaling 41 patients. The first (experimental) group included 17 patients diagnosed with PLVA by magnetic resonance imaging (MRI), and surgical intervention planning was performed using a 3D model of the heart. The control group comprised 24 patients in whom PLVA was diagnosed by echocardiography (TTE) or ventriculography, and surgical intervention planning was performed using traditional two-dimensional slice images.Results. Comparison of full perfusion under cardiopulmonary bypass (CPB) showed statistically significant differences between the groups: this parameter was 60 [56; 68] min in group 1 vs. 71 [61; 84] min in group 2, which was significantly higher (p = 0.043). There were no significant differences in total operation time (280 [265; 320] min in group 1 vs. 263 [248; 283] min in group 2, p = 0.055), overall CPB time (93 [86; 109] min in group 1 vs. 104 [83; 109] min in group 2, p = 0.653), and partial CPB time (31 [26; 39] min in group 1 vs. 27 [21; 32] min in group 2, p = 0.127).Conclusion. The use of 3D models to support surgeons for PLVA correction makes it possible to determine the type of reconstructive surgery, practice the main stages of the upcoming intervention, and reduce the time of full perfusion under CPB during its implementation.

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Surgical treatment remains the only way to primary prevention of intracranial hemorrhage in patients with cerebral aneurysms. The implementation of such interventions is associated with the risk of the development of secondary cerebral circulation disorders. The effect of ischemic damage to cerebral structures on the state of mental functions and the quality of life of patients is currently not well understood. The interrelation of the formation of foci of cerebral infarction according to magnetic resonance imaging and the dynamics of the state of cognitive functions of patients undergoing surgery for unruptured cerebral aneurysms is considered. It has been established that «fresh» foci of ischemic damage are formed in a third of patients. Among patients operated on with intravascular access, brain infarction zones are formed in half of the patients. Endovascular interventions under balloon assistance are associated with a high risk of asymptomatic ischemic complications. When comparing the results of neuropsychological examination in patients with diagnosed foci of cerebral infarction and the group where the ischemic complications were absent, no significant differences were found. According to the neuropsychological examination, the results before and after the operation did not differ significantly in patients with infarction foci. Thus, after surgery for unruptured aneurysms, local foci of cerebral infarction are often detected. In most cases, these changes are not associated with the deterioration of the higher mental functions of patients and are asymptomatic.

INTRODUCTION. Currently there are a lot of articles of lung ultrasound (LUS) in COVID-19 both in the diagnosis and in the prognosis of the disease. OBJECTIVE. Evaluation of the relationship between the ultrasound-guided lung lesion index (UIL) with the volume of lung involvement determined by computed tomography (CT) and disease outcomes in patients with COVID-19. MATERIALS AND METHODS. A prospective observational cohort clinical study included 388 patients aged 18-75 years; diagnosed with pneumonia with COVID-19 or suspected COVID-19. Lung ultrasound was performed according to the 16-zone “Russian Protocol” within 24 hours after CT scan of the chest organs. RESULTS. The median lung lesion volume on CT was 55 (35-74) % and UIL was 46 (28-60) points. UIL had a strong direct correlation of 0.873 (95 % CI 0.842-0.897, p < 0.01) with the change in the volume of lung involvement determined by CT and the inverse with the SpO2/FiO2 index - 0.850 (95 % CI 0.827-0.871, p < 0.01). Mortality was 56 patients (14.4 %) (p = 0.018). The optimal cut-off point for ROC analysis in predicting mortality was 55 points and had a sensitivity of 97.6 % and a specificity of 73.9 % with an area under the curve of 0.896 (95 % CI 0.861-0.931). Kaplan- Meier analysis on the entire data set (n = 388) demonstrated a survival rate of 97.6 % in the group with a UIL score less than 55 points and 62 % in the group with a UIL score more than 55 points. Differences between groups were statistically significant (Log Rank test p < 0.001; Breslow test p < 0.001). As a result, multivariate Cox regression analysis, using the stepwise exclusion method, only UIL remained a significant predictor of adverse outcome (p < 0.01). CONCLUSIONS. UIL determined by 16-zone “Russian protocol” correlated with severity of respiratory failure and volume of lung injury and was a predictor of adverse prognosis of disease outcome.

The presented article is devoted to the issue of diagnosis of rupture of ovarian cyst complicated by hemoperitoneum. Ovarian apoplexy ranks third in the structure of urgent diseases in gynecology and second among the causes of intra-abdominal bleeding. It is a sudden hemorrhage into the ovarian tissue, accompanied by a violation of the integrity of its tissue and in some cases bleeding into the abdominal cavity, may be asymptomatic or accompanied by the sudden appearance of unilateral pain in the lower abdomen. In the conditions of emergency rest during emergency diagnostics, the main advantage of ultrasound is the ability to perform in any conditions and in any condition of the patient, therefore, this method is considered in the scientific literature as the main one for the initial examination of such patients, nevertheless, in the scientific literature there is information about the differential diagnosis of emergency gynecological conditions accompanied by hemoperitoneum by X-ray computed tomography. The article presents the signs detected during ultrasound diagnostics and computed tomography in case of rupture of an ovarian cyst, systematized on the basis of literature data and our clinical experience. The main ultrasound and CT symptoms are intraperitoneal effusion with the presence of a sentinel thrombus in the injured ovary and cystic formation in the ovary. The combined analysis of these signs will help the practitioner in an urgent situation not only to determine the blood in the abdominal cavity, but also to determine the source of bleeding, as well as to differentiate the rupture of the ovarian cyst from other conditions accompanied by acute abdominal pain syndrome.

Introduction. In the literature, the insufficient attention is paid to preoperative planning of access to adrenal masses using modern computed tomographic navigation capabilities. The purpose. To demonstrate the possibilities of designing a safe access for adrenalectomy with the appliation of three-dimensional printed models based on the integral assessment of preoperative computed tomographic data. Materials and methods. The possibilities of preoperative design of access for adrenalectomy were studied in 362 patients with adrenal tumors, for whom computed tomography was performed on an Aquillion 64 (Toshiba, Japan). Results. Reliable anthropometric (BMI, body shape) and CT criteria for designing surgical access to the right and left NP were determined. Three patients with a borderline number of risk criteria for the development of vascular complications associated with technical difficulties of adrenalectomy (for the right AP, ≥4, for the left AP, ≥3) underwent CT-segmentation of images followed by the creation of three-dimensional plates — a model of the AP tumor with adjacent organs and vessels. Conclusion. Preoperative computed tomographic access design, taking into account the criteria of the risk of complications and the application of three-dimensional printed models, make it possible to reasonably use endoscopic and open adrenalectomy options, significantly improving the immediate results of patient treatment.