<p>Heart failure and left bundle branch block is a common disease in the modern world. Cardiac resynchronization therapy is used to correct this condition, but some patients have no positive clinical effect from its use. One of the reasons for the lack of response to therapy is not the optimal position of the left ventricular electrode. In this clinical case we presented the experience of using myocardial perfusion scintigraphy to determine the optimal position of the left ventricular electrode.<br />A 60-year-old patient, who was admitted to the center with symptoms of heart failure and signs of complete left bundle branch block, underwent an implantation of the cardiac resynchronization system. Both intraoperative data and the data of preliminary myocardial scintigraphy were used to select the site of implantation of the left ventricular electrode. A significant improvement in the patient’s condition, evaluated after 6 months after the implantation of the device, allowed us to conclude that the use of myocardial perfusion scintigraphy with standard methods of ultrasound diagnosis can increase the efficiency of implantation of cardiac resynchronization devices and a response to the therapy.</p><p>Received 2 October 2019. Revised 20 December 2019. Accepted 23 December 2019.</p><p><strong>Funding:</strong> The work is supported by a grant of the President of the Russian Federation for young scientists No. МД-2893.2018.7.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

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The aim of the investigation was to compare the results of using different techniques of combined prosthetic repair in median incisional ventral hernias, and develop the assessment criteria for the risk of postsurgical wound complications.Materials and Methods. we studied the effect of four combination prosthetic repair techniques in 152 patients with median incisional ventral hernias w2, w3 and w4: two restorative techniques -onlay (n=38) and sublay (n=17), a reconstructive Belokonev-I technique (n=49) and a reparative technique suggested by the authors (n=48). To determine risk factors of postsurgical wound complications we used a multiple correlation analysis.Results. There were no fatal cases. long-term wound exudation was found in 19 of 38 patients (50%) after onlay technique, and in 12 of 49 (24.5%) -after Belokonev-I technique. The same groups of patients were observed to develop seromas -12 (31.6%) and 2 (4.1%) cases respectively. The best life quality levels were found in patients after sublay technique (it was used in w2 hernias only), the lowest -after onlay technique. The life quality levels after Belokonev-I repair and the authors' technique had no significant differences; they were comparable to sublay technique. The developed method for risk assessment of postoperative wound complications enables a surgeon to assess adequately the risk level and deal with controllable prognostic factors, namely endoprosthesis type and alloplasty technique.Conclusion. Combination prosthetic repair by restorative techniques is inappropriate for median incisional ventral hernias w3-w4 since it causes intra-abdominal pressure increase. An adequate choice of prosthesis type and plasty technique reduces the risk of wound complications.

The authors report a clinical case of the fracture of the base of the skull with the concomitant damage to the sigmoid sinus, jugular vein, and internal carotid artery in the temporal bone pyramid. The injury was associated with massive bleeding from the external acoustic canal that resulted in the death of the patient.