Vol 340, No 5 (2019)

The history of the establishment of the cardiac surgery service in the P.V.Mandryka Central Clinical Hospital. A twelve-year journey from a cardiac surgery department with one operating room and several resuscitation beds to a cardiovascular surgery center with separate unit specializing in open heart surgery, arrhythmology, X-ray endovascular surgery, its own resuscitation unit and an operating unit. Considered the birth, development, results and achievements.

Presented the experience of traditional cardiac surgery for aortic defect in 191 patients. In 49.2% of cases, the clinic of aortic stenosis prevailed, with the obstructive function of the valve preserved. Surgeries to patients were performed under conditions of cardiopulmonary by sternotomy access. To replace the defective aortic valve, modern, both mechanical and biological prostheses were used. A significant reduction in the temporal parameters of the operation (up to 64%) was achieved when using the frameless Perseval-S bioprosthesis. Evaluation of the immediate results of the operation was carried out 2-3 months after the patients underwent a rehabilitation course. Subsequently, operated patients (n=180) were examined after 6, 12, 24 months. The classical method of surgical treatment of aortic defect remains a priority and relatively safe. If there is evidence, delay in surgical treatment increases the risk of intervention, and in some cases leads to failure.

The results of extended pelvic lymphadenectomy for radical prostatectomy performed in 157 patients with localized and locally advanced prostate cancer from 2012 to 2017 are analyzed. In addition to the treatment-and-prophylactic effect, lymphadenectomy and prostate cancer determine the need for adjuvant treatment. The frequency of metastases and their localization were assessed, the risk of complications when performing advanced pelvic lymphadenectomy was analyzed. Lymph node metastases were diagnosed in 22 (14%) patients, a total of 42 affected nodes were removed. According to N + localization, 14 (33.3%) were detected along the external iliac vessels, 19 (45.3%) in the internal iliac vessels, and 9 (21.4%) in the locking fossa of the lymph nodes. Thus, metastasis of prostate cancer was most often (45.3%) diagnosed in the internal ileal lymph nodes.

The goal of antihypertensive treatment of glaucoma is to achieve a «target pressure» level. The reason for the gradual decrease in the effectiveness of the action of drugs is directly related to the need for lifelong treatment of patients with glaucoma and is due to a change in tolerance. The results of a prospective study of 22 patients (35 eyes) with different stages of primary open-angle glaucoma, aged 74 (71; 77) years, with an average illness duration of 11 (6; 14) years, receiving combined antihypertensive therapy for 11 (6; 12) month Against the background of the compensated level of intraocular pressure and the planned replacement of one of the previously prescribed drugs, including the recommended washout period, an additional significant decrease in the level of intraocular pressure was achieved.

In connection with the peculiarities of military service in recent years, an understanding has emerged of the need for early and comprehensive treatment of pain syndrome in military personnel in specialized pain centers using safe and effective minimally invasive techniques. In the established office of diagnostics and treatment of pain, a positive clinical result was achieved in 95% of cases, which confirms the effectiveness of the treatment of pain syndrome, improvement of the functional status and ensures the continuation of active military service.

Modern approaches to the diagnosis of neuroendocrine tumors, proposed by practitioners, based on the results of international multicenter studies, as well as on the recommendations of scientific societies, are considered.

A clinical case of a chest gunshot wound in a private conscript is described. On admission, a gunshot (bullet) blind penetrating wound of the left half of the chest, a closed injury of the abdomen was diagnosed. Based on radiography and computed tomography data, combined damage to the chest and abdomen was established; bullet blind penetrating wound of the left half of the chest with a foreign body S9 lung; closed injury of the abdomen with damage to the spleen 2 degrees. According to the conclusion of the consultation, the patient was shown a planned simultaneous operation in the volume of laparotomy, splenectomy, revision of the left dome of the diaphragm, thoracoscopic resection of the S9 left lung with a foreign body (bullet). At the first stage of the operation, median laparotomy was performed, revision of the abdominal organs and the left diaphragm dome. Adhesiolysis, evacuation of the subphrenic hematoma, typical splenectomy, drainage of the left subdiaphragmatic space were performed. At the second stage, after a thoracoscopic revision of the organs of the left hemithorax, an atypical resection of the IX segment of the lung with a foreign body was performed using an endoscopic stapler. The postoperative period was uneventful. This clinical case shows the possibility of performing a planned simultaneous operation («laparotomy-thoracoscopy») in the early periods after a gunshot wound to the lung.

The historical data on the creation, formation and development of the «1st Therapeutic Hospital of the Red Cross of the Field Staff of the Revolutionary Military Council» - later the P.V.Mandryka Central Military Clinical Hospital. The presented 100-year period encompasses the Civil War, the pre-war and war period of 1937-1945, the construction of new hospital complexes in Krasnogorsk and Sokolniki. The stages of the creation of the sanatorium department in the village of Bolshevo and the system of dispensary monitoring of officers and generals of the command staff of the Armed Forces are reflected. The basic data on the hospital management and the name change of the institution over 100 years are presented.