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Emergency Medicine (Medicina neotložnyh sostoânij)
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This is an Open Access Journal

Open Access journal
ISSN (Print) 2307-1230 - ISSN (Online) 2224-0586
Published by Publishing House Zaslavsky

[9 journals]

Appeal of editor-in-chief
- Authors: No authors
  Pages: 225 - 225
  Abstract: No abstract
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1705
  Issue No: Vol. 20, No. 4 (2024)
Problematic issues of diagnosis and treatment of Boerhaave’s
syndrome
- Authors: V.S. Zhukovskiy, I.R. Trutyak, Ya.M. Pidhirnyi, Zh.V. Filip, M.V. Pankiv, V.S. Kozopas
  Pages: 226 - 232
  Abstract: Boerhaave’s syndrome is a rare disease with an incidence of 3.1/1,000,000 per year, has a high mortality rate due to late diagnosis and difficulty in treatment. The purpose of the message is to draw the attention of doctors to the variety of clinical manifestations of Boerhaave’s syndrome, which complicates early diagnosis and decision making. Clinical observation of two patients with Boerhaave’s syndrome is presented. One patient was hospitalized 7 hours after the onset of pain in the upper left side, nausea, vomiting. Clinical examination, ultrasound and chest X-ray revealed no pathology. However, after 3 hours, the patient’s condition deteriorated sharply, emphysema of the neck and chest appeared. X-ray revealed left-sided pneumohemothorax. Thoracotomy revealed a 3.5-cm long rupture in the lower third of the esophagus on its left lateral wall, which was sutured. The chest cavity and mediastinum are debrided and drained using tubes. A gastrostomy was formed. The postoperative period was complicated by multiple organ failure and sepsis. Patient was in the intensive care unit for 29 days. The esophageal wound healed on the 46th day and the patient was discharged for outpatient observation. Another patient was hospitalized three hours after onset of illness with a left-sided pneumohemothorax and acute abdomen symptoms. Chest tube on the left was placed and a dark brown liquid released under pressure. The peritonitis clinical symptoms prompted surgeons to perform urgent laparotomy during which no pathology of the abdominal organs was detected. Only after computed tomography, a rupture of the esophagus was diagnosed. As a result of delayed surgery, infection complications and sepsis developed, which led to the patient’s death.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1706
  Issue No: Vol. 20, No. 4 (2024)
Investigation of metal non-opaque foreign bodies of firearm origin by
radiation methods
- Authors: E.M. Khoroshun, V.V. Makarov, V.V. Nehoduiko, I.F. Mykhaylov, A.I. Mykhaylov, I.V. Veryovkin
  Pages: 233 - 236
  Abstract: Background. The purpose is to investigate metal non-opaque foreign bodies of firearm origin. Materials and methods. Five cases of removing soft tissue foreign bodies of gunshot origin were investigated, when radiography of the limb soft tissues didn’t detect foreign bodies, but they were removed during the primary surgical wound debridement. X-ray of soft tissue gunshot wounds found no foreign bodies. To study radiographic density, foreign bodies were placed in a foam model with subsequent multislice computed tomography. For spectral analysis of metal foreign bodies, we used wavelengths unconventional for X-ray, which allowed to conduct X-ray fluorescence and X-ray structural studies. Results. Radiographic density of metal foreign bodies ranged from 989 to 2123 HU. Given the different thickness of foreign bodies, from 0.4 to 3.2 mm, the average was 1700 ± 189 HU. The foam had radiographic density of –969 HU with model dimensions of 200 × 100 × 50 mm. When examining samples of foreign bodies, it was found that they are deformed, have different thicknesses. One of the samples is light and smooth on one side, and dark and rough on the other. X-ray fluorescence results: composition on the light side (% by mass): Al — base, Mn — 0.8, Fe — 0.3, Zn — 0.1, Cr — 0.05, Ti — 0.2, corresponding to Al-Mn alloy. The dark side is an oxidized Al-Mn alloy. In the spectrum of the dark side of the sample, the Br-Kα line was detected, which indicates the participation of bromine compounds in the oxidation process. From the smooth side of the sample, the spectrum of this line is not determined. Conclusions. Non-opaque metal foreign bodies of gunshot origin are a rare phenomenon. Metal foreign bodies with low radiographic density are non-ferromagnetic, the use of modern magnetic surgical instruments will not be effective. Visualization of metal foreign bodies, which are not determined by radiography, is possible with the help of multislice computed tomography. The use of the wavelength of primary radiation, which is unconventional for X-ray spectral analysis, and original X-ray optical schemes allows for quantitative determination of the composition and structure of any metal foreign bodies.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1707
  Issue No: Vol. 20, No. 4 (2024)
Laparoscopic cholecystectomy with or without drainage: a systematic review
and meta-analysis
- Authors: S.S. Chuklin, S.M. Chooklin
  Pages: 237 - 250
  Abstract: Background. The abdominal drainage with a prophylactic purpose was used by surgeons for decades because of the possibility to detect early signs of postoperative complications. However, the real value of routine drainage after abdominal surgery is still debated. There are discrepancies between studies supporting the drain placement only in patients with intraoperative complications and works showing a beneficial effect of prophylactic abdominal drainage on postoperative pain, nausea, and vomiting. However, there is still a lack of evidence on the use of routine abdominal drainage following laparoscopic cholecystectomy and its clinical value. Current guidelines do not mention the role of drainage after laparoscopic cholecystectomy. Objective: to evaluate whether conventional postoperative drainage is more effective than no drainage in patients with non-complicated benign gallbladder disease after laparoscopic cholecystectomy. Materials and methods. A search in the electronic databases MEDLINE, Scopus, Cochrane Library was conducted for randomized controlled trials reporting outcomes of laparoscopic cholecystectomy with and without an abdominal drainage until January 2024. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis — using fixed and random effects models. Odds ratio (OR) with confidence interval (CI) for qualitative variables and mean difference (MD) with CI for continuous variables were calculated using IBM SPSS Statistics 29.0.2.0. Results. Forty-four randomized controlled trials involving 5,185 patients (2,592 with drains vs 2,593 without them) were included in the meta-analysis. There were no statistically significant differences in the incidence of intra-abdominal fluid accumulation (OR = 0.87; 95% CI: 0.64–1.19; p = 0.39) between two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (OR = 1.51; 95% CI: 0.85–2.70; p = 0 .16) or shoulder pain (OR = 0.90; 95% CI: 0.58–1.41; p = 0.65). The abdominal drain group reported significantly higher pain scores (MD = 0.67; 95% CI: 0.37–0.98; p < 0.001) than patients without drains. Abdominal drainage increased operative time (MD = 3.82; 95% CI: 1.93–5.70; p < 0.001) but not the length of hospital stay after surgery (MD = 0.42; 95% CI: –0.02–0.85; p = 0.06). Wound infection (OR = 3.26; 95% CI: 2.35–4.51; p < 0.001), fever (OR = 4.40; 95% CI: 2.57–7.8554; p < 0.001) and pneumonia (OR = 4.74; 95% CI: 2.25–9.97; p < 0.001) were found to be associated with the use of abdominal drains. Conclusions. Currently, there is no evidence to support the use of routine drainage after laparoscopic cholecystectomy in non-complicated benign gallbladder disease. No drainage after laparoscopic cholecystectomy is safe and associated with fewer complications. Postoperative recovery is improved if drain is not used. Further well-designed randomized clinical trials are required to confirm this finding.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1708
  Issue No: Vol. 20, No. 4 (2024)
Adherence to the treatment in patients with hypertension during the war in
Ukraine
- Authors: V.I. Tseluyko, L.М. Yakovleva
  Pages: 251 - 258
  Abstract: Background. The aim of the study: to investigate additional factors that affect the adherence to antihypertensive therapy in patients with hypertension in conditions of war in Ukraine. Materials and methods. The study included 1,299 hypertensive patients with an average age of 65.4 ± 14.8 years, who are residents of different regions of Ukraine. The observation period lasted 3 months, from October 1 to December 12, 2023. All patients were divided into four groups: I — a fixed three-component combination of olmesartan medoxomil/amlodipine/hydrochlorothiazide, II — a fixed two-component combination of olmesartan/hydrochlorothiazide, III — a fixed two-component therapy with olmesartan/amlodipine, IV — any other non-fixed two- or three-component antihypertensive therapy. Adherence to therapy was assessed after 1, 2, and 3 months and statistical analysis of the obtained data was performed. Results. During the first month of observation, 50 (3.8 %) patients stopped or did not even start taking antihypertensive therapy, during the second — 71 (5.5 %), during the third — 127 (9.8 %). Adherence to antihypertensive therapy is higher in younger people (up to 55 years) compared to patients aged over 65, in people with higher education, in patients taking fixed combinations, especially olmesartan/amlodipine, or olmesartan/amlodi-pine/hydrochlorothiazide, while gender had no effect on adherence. Additional factors related to adherence to antihypertensive therapy during the war were as follows: the level of danger in the region of residence, the internally displaced status of the patient or doctor. The lowest adherence to antihypertensive therapy after 3 months was registered in the internally displaced persons who suffered morally or physically and is only 34.5 % compared to patients who stayed in the place of permanent residence — 82.6 % (р = 0.0001), or to those who moved preventively — 74.3 % (р = 0.0001). Adherence to therapy also depends on the status of the doctor. Among doctors with the status of an internally displaced person, patients’ adherence to therapy is lower: 68.3 against 82 % (р = 0.0008). Conclusions. Adherence to antihypertensive therapy in Ukraine during the war depends on known factors influencing the completeness of the doctor’s recommendations, including age, educational level, concomitant diseases, the number of tablets, and specific factors caused by the war, such as activity of hostilities in the region, as well as the status of an internally displaced person, both in patients and doctors.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1710
  Issue No: Vol. 20, No. 4 (2024)
Safety of performing distal block in diabetic foot syndrome
- Authors: Y.V. Lysak, D.V. Dmytriiev
  Pages: 259 - 264
  Abstract: Regional methods of anesthesia are widely used in surgical interventions on the lower limb, in particular on the foot. But to date, the risks associated with performing distal blocks in patients with diabetes are insufficiently studied. We analyzed the 30-day consequences of tibiocalcaneal nerve block in 88 patients who underwent surgery for diabetic foot syndrome. The obtained results indicate the absence of an increased risk of infectious and trophic complications in the block area in the group of patients who underwent tibiocalcaneal nerve block compared to those with popliteal nerve block and the group of spinal anesthesia. The frequency of repeated operations was not significantly different in all 3 groups.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1711
  Issue No: Vol. 20, No. 4 (2024)
The role of the pressure in the endotracheal tube cuff in the development
of iatrogenic tracheal injuries
- Authors: V.Yu. Sadovyi, Yu.L. Kuchyn, K.Yu. Bielka, D.S. Sazhyn
  Pages: 265 - 269
  Abstract: Background. The endotracheal tube insertion, which is a veritable patient care procedure, carries risks and possible adverse effects. Such complications vary in severity and range from mild symptoms such as sore throat or cough, which are often considered normal post-intubation events, to severe damage, including damage to the vocal cords, trachea, malacia, and fistula formation. A critical factor influencing the manifestation of these complications is the pressure exerted by the endotracheal tube cuff on the trachea. The purpose was to study the influence of high pressure of the intubation tube cuff on the incidence and severity of complications in an in vivo model. Materials and methods. A total of 12 rabbits were studied and divided into three groups according to target cuff pressure: 30, 50, and 100 cm H2O. Sevoflurane was used to maintain anesthesia, monitoring of vital functions included heart rate, pulse oximetry, capnography, and electrocardiography. Intubation was performed after induction with ketamine and administration of relaxants, and cuff pressure was measured with a mechanical manometer. The duration of pressure exposure was 20 minutes for each group, then the degree of tracheal damage was assessed by autopsy. Results. Increasing pressure generally leads to an increased risk of injury. In the third group (pressure of 100 cm H2O), all subjects had damage to the trachea, in 75 % of cases, it was a complete tracheal rupture. However, the dependence on pressure is not unambiguous for all types of injuries: the frequency of pneumothorax does not correlate directionally with the incidence of iatrogenic injuries and does not increase proportionally to pressure. So, for example, subcutaneous emphysema developed only in a third of cases of tracheal rupture. This emphasizes possible difficulties in timely diagnosis of this type of complications. Conclusions. The work highlights the risks associated with endotracheal intubation and emphasizes the need to maintain recommended practices and individual approach to each case. The most severe damage was observed at a pressure of 100 cm H2O, while at a pressure of 30 cm H2O, a smaller proportion of rabbits showed signs of damage.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1712
  Issue No: Vol. 20, No. 4 (2024)
Venous thrombosis and embolism in surgical hospital patients in the
conditions of the COVID-19 pandemic
- Authors: B.O. Matviychuk, N.R. Fedchyshyn, R.L. Bokhonko
  Pages: 270 - 273
  Abstract: Background. Venous thrombosis and embolism are one of the main and most threatening complications in emergency abdominal surgery in the conditions of global pandemic caused by the SARS-CoV-2, which is constantly worsening the morbidity and mortality rates. Despite the accumulation of sufficient knowledge on the problem of venous thromboembolism in general, understanding the unique prothrombotic pathophysiology of the virus and its potentiation of the coagulation system in patients with COVID-19 remains at a suboptimal level. The purpose of the study is to assess the extent of venous thrombosis in patients undergoing emergency surgery for abdominal pathology with concomitant coronavirus disease and to determine the main measures to improve the effectiveness of prevention and treatment. Materials and methods. The results of the treatment of 3,476 patients in the Surgical center 1 of the CNPE of the Lviv Territorial Medical Union “Multidisciplinary Clinical Hospital of Intensive Treatment Methods and Emergency Medical Care” from April 2021 to March 2022 were analyzed, 89.3 % of them were hospitalized urgently. One hundred and fifty-nine (4.6 %) patients died, mainly from purulent-septic complications, multi-organ (primarily severe respiratory) failure and venous thrombosis and embolism. Results. Non-specific prevention of venous thrombosis and embolism was carried out in all patients. It consisted in elastic compression of the legs before transporting the patient to the operating room and early ambulation after surgery. Adequate analgesia and assistance from medical staff were considered an important component of motor activity recovery. Specific prevention of venous thrombosis was carried out by subcutaneous injection of low-molecular-weight heparins once or twice a day. With the beginning of the pandemic and a sharp rise of thromboembolic complications, a longer prophylaxis with increased dose and frequency of anticoagulant administration began to be used in clinical practice. Conclusions. Unresolved issues that stood in the way of optimizing the prevention of venous thrombosis and embolism in the clinic are the new challenges associated with the COVID-19 pandemic, insufficient alertness of doctors to the problem of thromboembolic complications, difficulties in objective assessment of the risk of deep vein thrombosis in the presence of many factors, absence of scales for evaluating the risk of venous thrombosis adapted to today’s conditions.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1713
  Issue No: Vol. 20, No. 4 (2024)
Spontaneous bacterial peritonitis in patients with portal hypertension
- Authors: M.I. Tutchenko, M.S. Besedinskyi, D.V. Rudyk, S.L. Chub, I.V. Klyuzko, G.G. Roshchin
  Pages: 274 - 280
  Abstract: Background. Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in patients with portal hypertension (PH) and ascites. Its prevention and treatment are vital to improve the prognosis in decompensated PH. Alterations in gut microbiota, gut permeability, and systemic immune dysfunction are cornerstones in the development of SBP in patients with PH. This contributes to the translocation of bacteria from the intestinal lumen to the mesenteric lymph nodes, and then to the portal and systemic circulation from where the ascitic fluid can be colonized with the subsequent development of peritonitis. The purpose was to monitor the course of the disease and determine the possibility of correcting pathological factors of SBP such as bacterial contamination and volume of ascitic fluid, nature of bacterial contamination, increased intra-abdominal pressure, hypoalbuminemia, and to evaluate the role of antibacterial therapy, paracentesis in the treatment of patients with SBP in decompensated PG. Materials and methods. Examination and treatment of 242 patients with ascites who were admitted for emergency medical care were carried out. Diagnostic paracentesis was performed to examine ascitic fluid, which allowed to detect neutrophilia > 250 cells in 1 mm3 in 194 (80.2 %) patients and indicated the presence of SBP. These patients made up the first group of observation. In the second group, there were 48 (19.8 %) patients with no clinical and laboratory signs of SBP at the time of hospitalization. Methodology of analysis of actual research material: to find a statistical difference between the distribution of nominal data of patients in this study, we used Pearson’s χ2 test. To establish the strength of the relationship between variables, we determined the polychoric correlation coefficient. When a statistically significant difference was detec-ted, a stratification analysis was performed with determination of the 95% confidence interval of the odds ratio (Clopper-Pearson method) and the risk ratio for the development of complications in PH. Results. Empiric antibacterial therapy, which was carried out from the moment of receiving information about SBP and began with the use of broad-spectrum antibiotics, was successful in 41 % of cases that was confirmed by repeated examination of ascitic fluid. In antibiotic resistance, determining the sensitivity of ascitic microflora led to a delay in an effective anti-inflammatory treatment and affected the results. In the first group, 39 (20.1 %) patients died, in the second group, 22 (50 %), total mortality was 25.2 %. Conclusions. Diagnostic paracentesis combined with the assessment of bacterial contamination of ascitic fluid, evaluation of intra-abdominal pressure, state of osmoregulation based on albumin concentration is a safe and informative method of diagnosing the severity of pathological process in patients with complicated PH. Treatment of SBP requires urgent care, both in terms of elimination of the infectious factor, and normalization of the disturbed mechanisms of reabsorption regulation by peritoneal and hepatorenal processes. High mortality in patients with SBP is due to the development of inflammation in the abdominal cavity against the background of progressive hepatorenal insufficiency and the inability to correct decompensated PH.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1714
  Issue No: Vol. 20, No. 4 (2024)
Treatment of choledocholithiasis: a review of clinical trials and current
clinical guidelines
- Authors: M.I. Kravtsiv, M.O. Dudchenko, K.Yu. Parkhomenko, D.М. Ivashchenko, M.P. Shevchuk
  Pages: 281 - 287
  Abstract: The review provides an analysis of clinical studies and current clinical guidelines from the MEDLINE database on the PubMed platform regarding the treatment of choledocholithiasis. Choledocholithiasis occurs in almost 20 % of patients with gallstone disease and is characterized by frequent dangerous complications, in particular, bile duct obstruction, cholangitis, and biliary pancreatitis. Therefore, common bile duct exploration is an important component of surgical treatment for gallstone disease, but discussions about the optimal treatment for choledocholithiasis have been ongoing for many years. Currently, there is no generally accepted standard of treatment, and various methods and approaches to the staging and sequence of surgical interventions on the gallbladder and common bile duct are used. In recent years, the leading methods of choledocholithiasis treatment are minimally invasive endoscopic and/or laparoscopic interventions, which have almost completely replaced open surgeries. For common bile duct exploration and normalization of biliary excretion, endoscopic transpapillary (retrograde) access is used mostly, which is characterized by a high risk of post-procedural immediate and long-term complications. Endoscopic management of common bile duct stones requires an additional intervention — laparoscopic cholecystectomy, which is most often performed at the second stage or simultaneously with endoscopic intervention. The optimal staging and sequencing of interventions requires further research. A good alternative to endoscopic interventions on common bile duct is its laparoscopic exploration through the cystic duct or by choledochotomy (antegrade), which can be performed simultaneously with cholecystectomy. However, this technique has not yet been widely adopted, and immediate and long-term results are conflicting that require further research into the effectiveness and safety of the method. The effectiveness of surgical treatment for choledocholithiasis depends not only on the individual characteristics of a patient, including biliary anatomy, the form and severity of the disease, but also on the local experience and availability of appropriate equipment, which must be taken into account when planning treatment.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1716
  Issue No: Vol. 20, No. 4 (2024)
Damage to the visual analyzer in military personnel with concussion
(clinical cases)
- Authors: N.A. Goncharova, M.I. Kovtun, I.V. Pastukh, O.S. Pavlyuchenko, O.P. Muzhychuk
  Pages: 288 - 298
  Abstract: Background. Concussion is a damage to the body due to a sudden mechanical impact. Organs and tissues may remain undamaged. Concussion symptoms include disorientation, loss of consciousness (duration from a few minutes to several hours); memory impairment or amnesia; severe headache; nausea and vomiting; change in psycho-emotional state; hearing and vision problems. Brain concussion is the most severe, it is characterized by the development of both general disorders (fainting, impaired breathing, blood circulation, etc.) and those related to the localization of brain tissue damage. Traumatic brain injury caused by explosions or other high-intensity events requires immediate care. The purpose of the study is to identify symptoms of a damage to the visual analyzer in military personnel with concussion in order to develop better strategies for early detection, effective treatment and prevention of the consequences of injuries, which will ultimately reduce their impact and improve visual function in war victims. Materials and methods. Five male patients (10 eyes) aged 30.0 ± 8.2 years were under supervision. Both standard ophthalmic methods (visometry, perimetry, tonometry, biomicroophthalmoscopy, keratorefractometry, Schirmer’s test) and modern special additional examinations such as optical coherence tomography of the macula and optic nerve head, computed tomography of the brain were used. Results. According to the results of the exa-mination, almost all patients had a persistent decrease in visual functions and changes in peripheral vision with normal tonometry indicators in both eyes.
  PubDate: 2024-07-02
  DOI: 10.22141/2224-0586.20.4.2024.1717
  Issue No: Vol. 20, No. 4 (2024)

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