2021, volume 17

Massive pulmonary embolism (PE) with damage to the trunk and main branches of the pulmonary artery is one of the most common causes of death in hospitalized patients, both surgical and therapeutic. At present, there are no clearly formulated recommendations on the duration of anticoagulant therapy for pulmonary embolism. In addition, there are no clear indications and timing of CT angiography in the clinical guidelines to monitor the presence of pulmonary artery thrombosis. The given clinical case clinical case demonstrates the lysis of a thrombus-"rider" spreading into the pulmonary arteries on both sides and further into the lobar, segmental and subsegmental branches after taking Warfarin for two weeks during hospital stay, followed by CT angiopulmonography before discharge.

Violation of hemocoagulation is an important factor that complicates the course of a new coronavirus infection (SARS-CoV-2) and largely determines the prognosis and outcome of the disease. Correction of rheological and hemo-static disorders in SARS-CoV-2 is one of the key aspects of pathogenetic therapy, which is necessary in the practice of patient management. Purpose: analyzed the data of the current literature on various aspects of thrombotic complications in SARS-CoV-2: the frequency of their development, the features of pathogenesis, clinical manifestations and approaches to the treatment of COVID-19-associated. 42 literary sources were analyzed using databases and information resources with open access: PubMed, Google Scholar, UpToDate, eLibrary; the depth of search for literary sources was 5 years. A significant increase in the concentration of D-dimer in patients with SARS-CoV-2 was established, which can serve as a predictor of death. A distinctive feature of COVID-19-associated coagulopathy is the so-called "thromboinflammation", which underlies the damage to organs and systems in a new coronavirus infection. The most significant markers of COVID-19-associated coagulopathy are the levels of D-dimer, prothrombin time, and blood fibrinogen. Prevention of thromboembolic complications is indicated in all hospitalized patients with SARS-CoV-2. For the correction of hemocoagulation disorders, the drugs of choice are low-molecular-weight heparins. The tactics of primary prevention of thromboembolic complications in hospitalized and outpatient patients require further study.

The goal is to present a clinical observation of a patient with pulmonary alveolar proteinosis, a rare interstitial disease from the accumulation disease group. The clinical case demonstrates the difficulties in diagnosing this disease due to the absence of pathognomonic clinical and computed tomographic symptoms, the need for differential diagnosis with pneumonia. Variants of treatment tactics are considered. Raising the awareness of doctors about this nosology will contribute to its timely diagnosis and treatment.

Purpose: of the review is to demonstrate the capabilities of telemedicine technologies in one nosology — urolithia-sis. The article discusses both promising and currently available technologies for remote dynamic monitoring of patients with diagnosed urolithiasis based on the data of general urine analysis based on materials from foreign (PubMed — 21 publications) and domestic (eLibrary— 11 publications) literature, published between 2007 and 2021. The search was carried out according to the phrases «urolithiasis», «remote monitoring», «urinary analyzer», «test strips», «urine pH», «pH-selfie-control». Today, there are no standardized methods that could be offered to the patient as a single standard for home monitoring of urolithiasis. The available analyzers, pH meters, diagnostic strips, test strips, collector devices for determining the acidity and density of urine in patients with ICD are characterized by a certain level of error. However, in most cases they provide good performance combined with ease of use. Devices of this type have yet to truly take their place in the market. The introduction of remote technologies into medical practice is already a fait accompli, which, in our opinion, will continue to develop in the coming years.

Purpose: to analyze the information available in the literature on the effectiveness of the use of artificial intelligence (Al) in the diagnosis and treatment of urological diseases. To write the review, databases were studied: PubMed, MEDLINE, Cohrane Library, eLibrary using keywords: neural network modeling, artificial neural networks, artificial intelligence, machine learning, deep learning, urology, oncourology, urolithiasis, prostate cancer, benign prostate hyperplasia, bladder cancer. Search depth: from 1994 to 2021. The number of analyzed sources is 32. The presented review demonstrates the effective use of Al in many areas of urology and oncourology, however, the use of Al in the treatment of benign prostate hyperplasia is currently extremely limited. The study of these meta-analyses and randomized trials indicates the need to useAl to treat patients with benign prostate hyperplasia to improve the results of surgical interventions by forming a personalized approach.

Purpose: to demonstrate successful experience in the treatment of spondylodiscitis caused by Burkholderia cenocepacia in a patient who underwent COVID-19, to show minimalism of surgical trauma and low risk of postoperative complications. When analyzing the modern literature, there was not a single described case of spinal column spondylodiscitis, the causative agent of which was Burkholderia cenocepacia. Surgical treatment in the volume of percutaneous biopsy of Th5-Th6 vertebrae with microflora in combination with competently selected antibacterial therapy allowed to achieve early activation of the patient, reduce the time of medical and social rehabilitation, prevent the development of gross compression of neural structures.

Purpose: to evaluate the frequency of discordance of receptor status and HER2 status in primary and metastatic brain tumor in patients with breast cancer. Material and methods. The study included 18 patients whose brain metas-tases from breast cancer were treated surgically. An immunohistochemical assay of tumoral samples was performed to assess the expression of ER, PR, HER2. The results obtained were compared in pairs with samples from primary tumors. Results. The receptor status of the primary tumor and brain metastasis was constant in 50% of patients, while discordance in HR status was detected in 44% of cases. The rarest receptor conversions were the acquisition of HER 2+ status at 6% (n=1) and the loss of HER 2+ status at 11 % (n=2). 67% of patients with HR+ primary breast tumors, receiving adjuvant anti-estrogen therapy lost expression of the target receptor in brain metastases. Conclusion. In half of the tumor pairs under study we detected discordance in at least one of the indicators (ER, PR, HER2) of tumor biological heterogeneity. Loss of HR+ status in metastatic tumor was observed more often than other morphological transformations.

A clinical case of the development of acute intestinal obstruction as a result of the formation of an appendicular infiltrate and a periappendicular abscess in gangrenous-perforative appendicitis is presented. This observation illustrates the features of preoperative diagnosis of acute intestinal obstruction as a rare life-threatening complication of acute appendicitis.

The aim was to evaluate the effectiveness of the use of bioplastic materials based on chitosan "ChitoPran" in the treatment of deep dermal burn wounds in comparison with atraumatic mesh dressings. 22 patients with deep dermal thermal burns were included in the study. Material and methods. In 2-3 days after injury surgical necrectomy of the affected areas to viable tissues was performed under general anesthesia. After surgical cleansing and local haemostasis using 1 % adrenaline solution, the wounds were covered with different materials: bioplastic material "ChitoPran" (main group, 12 patients) and atraumatic wound dressing "ParaPran" with chlorhexidine (comparison group, 10 people). Results. "ChitoPran" proved to be effective bioplastic wound dressing for the local treatment of burn wounds after necrectomy: it protects the newly formed epidermis, resorbs in 5.5±1.6 days and optimizes reparative processes, which allows in most cases to achieve epithelialization of deep dermal burns in 20.9±1.6 days without performing autologous skin transplantation. Conclusion. Epithelialization of deep dermal burns using "ChitoPran" is 3-4 days faster compared to the use of atraumatic mesh dressings.

This research had the reporting of the successful surgical management of posttraumatic thumb carpometacarpal osteoarthrosis by means of total arthroplasty with a ceramic-ceramic implant as its objective. This case focuses on the relevance of medical decision-making in favour of total joint replacement for the management of Bennett fracture consequences as a viable alternative of trapeziectomy, arthrodesis, or other surgeries.