No abstract

<b><i>Introduction:</i></b> From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. <b><i>Methods:</i></b> The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. “Overlooked” urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11–36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6–1.5%). <b><i>Results:</i></b> Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. <b><i>Discussion/Conclusion:</i></b> Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.

The use of cytoflavin promoted the early post anesthesia adaptation and more rapid recovery of initial cognitive status of the patients.

У новорожденных с тяжелой интранатальной асфиксией отмечается нарушение адаптации системы ге мостаза, в связи с этим они имеют высокий риск кровотечений в течение первых суток жизни.Цель исследования -оценить влияние перенесенной тяжелой асфиксии в родах и метаболического ацидоза на состояние системы гемостаза у новорожденных.Материалы и методы. Провели ретроспективный анализ историй болезни 40 новорожденных, рож денных в тяжелой асфиксии (1 я группа), и 20 «здоровых» новорожденных (2 я группа). Исследование проводили в течение первого часа жизни новорожденных на основе использования метода тромбоэлас тографии (ТЭГ).Результаты. У новорожденных 1 ой группы выявили сниженную активность тромбоцитов и энзимати ческой части коагуляции. Энзиматическая часть коагуляционного гемостаза (р<0,001) и кинетика увеличе ния прочности сгустка (р<0,01) значительно снижены у 1 й группы новорожденных в сравнении со 2 й группой. Скорость роста фибриновой сети и ее структурообразование (р<0,05) у новорожденных 1 й груп пы ниже, чем у новорожденных 2 й группы. Активность тромбоцитов у новорожденных 1 й группы, сниже на по сравнению со 2 й группой (р<0,05). Фибринолиз на 30 й минуте исследования у новорожденных не отличается. Корреляционный анализ показал, что снижение рН, Bе и гиперлактатацидоз имеют корреляци онную связь с изменением тромбоцитарного и коагуляционного гемостаза в сторону гипокоагуляции.Выводы. Тромбоэластографическое исследование нативной крови показало сдвиг системы гемостаза в сторону гипокоагуляции, как тромбоцитарной так и энзиматической части гемостаза, без изменений про цессов лизиса сгустков у новорожденных, рожденных в тяжелой асфиксии. Ключевые слова: гипоксически ишемическая энцефалопатия; тяжелая асфиксия в родах; метаболичес кий ацидоз; тромбоэластография; новорожденные; гемостазIn newborns with severe intranatal asphyxia, the hemostasis system adaptation is impaired, thus increasing the risk of bleeding during the first day of life.The purpose of the work was to evaluate the effect of severe birth asphyxia and metabolic acidosis on the new borns' hemostasis system, based on the thromboelastography (TEG) findings.Materials and methods. A retrospective analysis of medical records of 40 severely asphyxiated newborns (group 1) and 20 healthy newborns (group 2) was performed. The study was carried out during the first hour of life of the newborns.Results. Infants in group 1 demonstrated a reduced activity of platelets and enzymatic components of the coagulation. The enzymatic phase of the coagulation hemostasis (P<0.001) and the kinetics of clot strength growth significantly decreased in group 1 newborns, as compared to the second group (P<0.001 and P<0.01, respective ly). The fibrin network growth rate and its structurization in group 1 newborns was lower than that in group 2 newborns (P<0.05). The platelet activity in group 1 infants was reduced as compared to group 2 (P< 0.05). Fibrinolysis in newborns did not differ at the 30th minute of the study. The correlation analysis demonstrated that Влияние тяжело...

A case of successful treatment of a patient with a periprosthetic fracture of the femur is described. The fracture occurred one day after total hip replacement as a result of a fall, possibly associated with postoperative conduction analgesia. Lower limb large joints total replacement may become the most frequently performed type of elective surgery already in the current decade. The increasing prevalence of osteoporosis, osteoarthritis, rheumatic diseases and hip fractures is an objective prerequisite for it. Despite of all efforts, the problem of postoperative pain control during these surgical interventions currently remains unresolved. There is currently no “gold standard” for pain relief after total hip and knee replacement surgeries. An excellent ratio of effectiveness and safety is demonstrated by multimodal pain relief programs based on peripheral nerve blocks. However, while having undeniable advantages, conduction anesthesia/analgesia has a critically important drawback. The cornerstone of postoperative rehabilitation for patients undergoing total hip or knee replacement is their early activation. All methods of conduction anesthesia are associated with motor blockade. In particular, femoral nerve block causes weakness of quadriceps muscle of thigh, inducing patients’ inadvertent falling when attempting to stand or walk. The situation with the choice of the method of anesthesia after total replacement of the lower limb large joints can be described as “a long way to go”.