The paper presents three case reports to discuss the criteria of myocardial reinfarction. The cases are of interest because of a short-term interval (from 1 to 14 days) between the infarctions occurred in different coronary arteries. In two cases resulting in a fatal outcome after ineffective PCI, the total affected area of the left ventricle reached 90 %; in one more case, early re-canalizations of two infarct-related arteries at an interval of one day, made it possible to prevent a fatal outcome and preserve the contractile function of the heart. The currently used classification defines such infarctions as primary recurrent infarctions due to the persisting occlusion in one and the same infarct-related artery. In our cases, the infarctions were the results of occlusions in different coronary arteries, and therefore, the total affected area, in case of no effective PCI, covered almost the entire left ventricle, which resulted in a fatal outcome. Such infarctions, despite their early development, should reasonably be defined as reinfarctions rather than as recurrent myocardial infarctions.

In this work we represented the results of the dynamics of blood pressure of 62 patients with coronary artery disease combined with hypertension according to blood pressure monitoring. It was found that 40.0 % of them with a high variability and 52.5 % have insufficient night decrease in arterial pressure (non-dipper). Most of the article is devoted to the analysis of the main indicators of BPM depending on the age and sex of the patients.

The article considers the question of the appropriateness of the use of the drug based on succinic acid in the surgical treatment of atherosclerotic occlusion of the carotid artery, for the prevention of neurological complications in the postoperative period. A comparative characteristic of the obtained data of oxidative, antioxidant statuses, as well as markers of neuronal damage in two groups was carried out. The results suggest that the use of cytoflavin during the stages of surgical treatment reduces the number of neurological disorders.

The aim of the work was to assess the structural and functional parameters of the superficial veins of the lower extremities in men with arterial hypertension. A comparative analysis of the results of the angioscanning of the superficial veins of the lower extremities between 60 men with arterial hypertension and 27 men with normal blood pressure at the age of 30–50 years was performed. In hypertension, an increased rate of venous blood flow and signs of chronic vein diseases are recorded — an increased diameter and area of the lumen of the veins; abnormal venous reflux marked in 10 % of men; in 3 % — varicose veins and thrombotic masses, signs of postrombotic lesion of the superficial veins.

Conclusion. For men with hypertension aged 30–50 years, there is an increased rate of venous blood flow and signs of chronic venous disease of the lower extremities: chronic venous insufficiency, varicose and postrombotic venous disease, which must be considered when stratifying cardiovascular risks and treating hypertension.

Objectives. To compare the influence of different priming techniques on cerebral oximetry results during CPB in adult patients.

Methods. This study is a single-center retrospective review of data collected from adult patients who underwent isolated CABG with CPB between January and December, 2016. The patients were divided into two standardized groups with the sole difference between them being the method of priming CPB circuit: the first one was the group where we used our modified retrograde method of priming (n = 45) and the second one was the group with standard priming (n = 45). Hematocrit, hemoglobin, cerebral oxygenation were evaluated at the following points: beginning of the operation, start of CPB, cross clamping, 15, 30, 45 minutes and the end of CPB and the end of operation.

Results. In the first group indices of cerebral oximetry were higher comparing to the second group at list of the 45 minutes of CPB (р < 0,001). For the first 15 minutes of CPB hematocrit was also higher in the first group. Priming volume and the need for blood transfusion or ultrafiltration were also smaller in the first group.

Conclusion. Modified priming technique allows to maintain higher indices of cerebral oximetry, decreases volume overload and the need for blood transfusion comparing to standard technique.

Acute respiratory failure has been and remains one of the main problems of modern medicine. Among the large number of high-tech methods of treating acute respiratory failure, adequate moisture and warming of the upper respiratory tract of the patient at all stages of the respiratory therapy are important. It should be noted that ensuring optimal moistening and warming of the inhaled gas mixture allows to avoid the development of many pulmonary complications. On the other hand, even with the use of the most modern treatment methods, inadequate microclimate in the upper respiratory tract can significantly reduce the effectiveness of their use. Thus, maintaining an adequate microclimate in the upper airways is normal, with various bronchopulmonary diseases and in conditions of respiratory support will improve the functional state of the lungs, prevent the development of many complications, reduce material costs and duration of treatment, reduce the mortality of this patient population. Despite the existence of the large database, the question of choosing the most effective technology to ensure homeostasis and protection of the upper respiratory tract in different clinical situations with different methods of respiratory support is still relevant. This dictates the necessity of continuing the research in this direction. This review is devoted to the current state of the problem of moistening, warming and filtering the breathing mix under conditions of prosthetic respiratory function.

Purpose of Research: to determine whether we can use free hemoglobin concentration as early prognostic marker and a predictor of mortality in sepsis.

Materials and Methods. In a retrospective study in 60 patients aged 47.6 ± 7.2 years with sepsis (30.4 ± 2.1 points on the Mannheim’s scale for evaluation of the severity of peritonitis) modern methods of statistics (ROC-analysis) hypothesis was tested, whether level of free hemoglobin in the first 24 hours from the moment of admission can be used as a biomarker for diagnosis and prognosis for severe sepsis. Informative criterion was compared with the information of the procalcitonin test.

Results. The present study had shown that the above average free hemoglobin concentration, measured on the first day of the heavy flow of sepsis, is directly connected with increased 30-days mortality, and the level of free hemoglobin in a first day of the disease has high sensitivity, specificity, and can determine the outcome of sepsis with accuracy up to 96.7 %.

Conclusion. Free hemoglobin concentration above medium size identified on the first day of the currents of severe sepsis, is directly related to increased 30-day mortality, and researched level of free hemoglobin in day 1 of the disease has a high proportion of sensitivity and specificity. Level of free hemoglobin is predictor outcome of sepsis in the first 24 hours after the start of therapy, but the results did not rule out the need to use the necessary test from septic patients, but rather the feasibility of combining the two dictates the criteria to assess the outcome of severe septic process that requires further research.

The article is devoted to the study of the effect of own endogenous bacteriophages on the course and outcomes of severe concominant injury. The microflora isolated from the blood of resuscitation patients was analyzed. The mortality rate and the presence or absence of endogenous bacteriophages were compared. Less lethal outcomes were found in patients with endogenous bacteriophages, regardless of whether they are virulent or moderate. In the absence of endogenous bacteriophages, K. pneumonia and staphylococci were isolated from the blood of patients with further lethal outcome more often than other species.

In critically ill patients the adequacy of starting empirical antimicrobial therapy is a determining factor of the survival of patients with sepsis This article describes the main aspects of the empirical prescription of antibiotics in patients with sepsis who are on renal replacement therapy. Changes in the pharmacokinetic and pharmacodynamic mechanisms that lead to the selection of specific dosing regimens for antibiotics are described. Information on dosing changes for current groups of antibacterial drugs is presented. The purpose of this article is to rationalize antibiotic therapy in a selected group of patients.

The protocol of empirical antimicrobial therapy (AMT) in the National Medical & Surgical Center n. a. N. I. Pirogov is a part of antimicrobial stewardship program, implemented in 2013. The protocol is based on local antimicrobial resistance data, takes into account features of the hospital and contains the decision-making process for risk stratification of antibiotic-resistant microorganisms, for start, choice, removal of AMT and its results assessment, as well as differentiated algorithms of empirical antibiotic therapy for respiratory tract infections, skin and soft tissues infections, urinary tract infections, bloodstream infections, intra-abdominal infections, periprosthetic joint infection, central nervous system infection, infections in neutropenic patients, treatment regimens for antibiotic-associated colitis. The protocol is updated annually, the fourth edition of the protocol is presented.